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Proximal Tibial Metaphyseal Fracture

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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

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

See Also

Internal

External

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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
Categories:
Knee | Lower Extremity | Trauma | Pediatrics | Fractures | Acute

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