Extra-Articular Proximal Tibial Fracture When Closed Reduction and Casting Fails to Achieve Alignment and Union

In a completely extra-articular proximal tibial fracture, the fracture lies entirely outside the joint (type A). When initial conservative management does not succeed in restoring and maintaining fracture alignment and stability, an operative approach is the indicated next step.

Previous Treatment — Failure Condition

The initial line — closed reduction and long leg casting, transitioning to a hinged knee orthosis — aimed to achieve fracture union with anatomical alignment of angulation in the coronal and sagittal planes and correct rotation.

When those goals are not reached, this operative protocol applies.

Clinical Scenario

A completely extra-articular proximal tibial fracture (type A) in which conservative casting has failed to restore or maintain acceptable fracture alignment and stability, necessitating operative intervention to achieve anatomical reduction and secure fixation.

Treatment Approach (Partial Overview)

Operative fixation is the cornerstone of management at this stage, with the goal of achieving stable, anatomically aligned fracture union. Multiple distinct operative fixation strategies are available — the selection, indications, and recommended approach for this fracture pattern are detailed in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/s0020-1383(03)00252-3

If the fracture is completely extra-articular, it is a type A.

Strategies to provide for alignment and stability of the extra-articular fracture include closed treatment, external fixation, intramedullary nailing, and plate fixation.

Optimal function requires anatomical alignment of angulation in the coronal and sagittal planes and correct rotation.

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