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Proximal Tibial Metaphyseal Fracture
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Contents
Other Names
- Proximal Tibial Metaphyseal Fracture
Background
- This page refers to fractures of the proximal tibial metaphysis seen in pediatric patients
History
Epidemiology
- Seen in 3-6 year old patients[1]
- Only type of proximal tibia injury which is more common in females[1]
Introduction

Lateral x-ray of several different patients revealing the typical linear metaphyseal fracture that extends to the region of the tibial tubercle[2]
General
- Injury to the proximal tibial metaphysis
- Diagnosis is made with radiographs
- Management is based on degree of displacement
- Notable for increased risk of Cozens Phenomenon, a late valgus deformity
Mechanism of injury
- Typically a low energy mechanism
- Occur due to indirect injury landing on the knee in hyperextension with a varus or valgus force
- Commonly there is a valgus deformity at the fracture site
- Specific examples
- Trampoline jumping is a commonly cited mechanism of injury
- Child going down slide in the lap of an adult with leg extended
Associated Conditions
Risk Factors
- Sports
- Jumping on trampoline
Differential Diagnosis
Differential Diagnosis Knee Pain
- Fractures
- Dislocations & Subluxations
- Patellar Dislocation (and subluxation)
- Knee Dislocation
- Proximal Tibiofibular Joint Dislocation
- Muscle and Tendon Injuries
- Ligament Pathology
- Arthropathies
- Bursopathies
- Patellofemoral Pain Syndrome (PFPS)/ Anterior Knee Pain)
- Neuropathies
- Other
- Bakers Cyst (Popliteal Cyst)
- Patellar Contusion
- Pediatric Considerations
- Patellar Apophysitis (Sinding-Larsen-Johnansson Disease)
- Patellar Pole Avulsion Fracture
- Tibial Tubercle Avulsion Fracture
- Tibial Tuberosity Apophysitis (Osgood Schalatters Disease)
- Proximal Tibial Metaphyseal Fracture
- Proximal Tibial Physeal Injury
Clinical Features
History
- Immediate inability to bear weight following injury
- Parents will endorse swelling
Physical Exam: Physical Exam Knee
- Swelling, joint effusion
- Deformity over the proximal tibia may be present
- Tenderness over the fracture site
- Evaluate compartments carefully
Evaluation

fracture of the proximal tibia1 metaphysis with fibular greenstick fracture and valgus deformity. On the left: anteroposterior projection. Centre: lateral projection. On the right: after reduction and plaster cast immobilization. No adequate compact bone contact between fracture ends on the medial side after reduction[3]
Radiographs
- Standard Radiograph Knee
- Plain radiographs of the knee are sufficient to make the diagnosis
- Findings
- Incomplete vs complete fracture
- Presence of angulation, typically valgus
- Presence of proximal fibula fracture suggests more instability
Classification
- No widely accepted classification exists
- Important descriptive parameters
- Complete/Incomplete
- Displaced/Nondisplaced
- Association of fibula fracture
Management
Nonoperative
- Indications
- Nondisplaced fractures
- Greenstick deformity
- May be present, requires reduction prior to casting
- Long Leg Cast in extension with varus mold
- Duration 4-6 weeks
- Serial radiographs
- May begin weight bearing after 2-3 weeks
Operative
- Indications
- Displaced fractures
- Inability to adequately reduce a displaced fracture
- Soft tissue interposition
- Technique
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/ Work
- Needs to be updated
Prognosis and Complications
Prognosis
- Valgus deformity
- Typically resolves spontaneously
Complications
- Cozens Phenomenon
- Minimally displaced greenstick fracture that goes on to develop increased valgus deformity
- Occurs approximately 6-12 months after injury, typically resolves within 3 years
- Acute Compartment Syndrome
- Leg Length Discrepancy
- Affected tibia is often longer
See Also
Internal
- Knee Pain (Main)
- Knee Anatomy (Main)
- Physical Exam Knee
- Pediatric Fractures (Main)
- Apophyseal And Epiphyseal Injuries (Main)
External
- Sports Medicine Review Knee Pain: https://www.sportsmedreview.com/by-joint/knee/
References
- ↑ 1.0 1.1 Mubarak, Scott J., et al. "Classification of proximal tibial fractures in children." Journal of children's orthopaedics 3.3 (2009): 191-197.
- ↑ Kakel, R. "Trampoline fracture of the proximal tibial metaphysis in children may not progress into valgus: a report of seven cases and a brief review." Orthopaedics & Traumatology: Surgery & Research 98.4 (2012): 446-449.
- ↑ Visser, Jan D., and Albert G. Veldhuizen. "Valgus deformity after fracture of the proximal tibial metaphysis in childhood." Acta Orthopaedica Scandinavica 53.4 (1982): 663-667.
Created by:
John Kiel on 22 March 2023 15:00:54
Authors:
Last edited:
22 March 2023 15:25:46
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