الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Proximal tibial fractures involving the articular surface are serious, complex injuries difficult to treat as they entail problems like articular depression, condylar displacement, and dissociation of comminuted metaphysis from diaphysis and open wounds or extensive degloving injuries
Commonest age range for this fracture in men and women 40–60 years. More women had this fracture if all age groups considered but there were more men in the age group >50 years. Commonest fracture types – AO 41-B3 (35%) and 41-C3 (17%) as per the AO/OTA classification. The Commonest cause of injury in men was the motorcycle and other motorised injuries as well as fall from heights. In women, the main causes were bicycling, indoor walking as well as fall from heights.
Varied classifications system has been devised to classify proximal tibial fractures such as Hohl’s, Moore’s, Schatzker and the AO/OTA classification.
Clinical assessment of proximal tibia fractures requires, first, a consideration of the condition of the skin and surrounding soft tissue, as this is a key factor in deciding the optimum approach to treatment.
Simple two-plane radiography provides an approximate view of the morphology of the fracture. However, for an accurate diagnosis, a CT scan must be performed to determine the three dimensions of the lesion, to classify them accurately and to plan the treatment.
Conservative management is ineffective in reducing and maintaining the joint surface congruency as well as axial alignment and is not recommended for severe soft tissue injuries.
Open reduction and internal fixation with plates though having the advantages of greater visualization of articular surface for restoration of joint congruency has been associated with major wound infections, residual osteomyelitis, late arthritis and even amputation.
Proximal tibial fracture, which can be associated with severe soft tissue injuries, requires external fixation. Joint bridging external fixators are usually applied for proximal tibial fractures because it is technically demanding to place a conventional external fixator without bridging the knee.
A prospective study. conducted on patients with proximal tibia fractures managed in the study hospitals and are eligible for fixation by biplanar external fixator. The study was carried out on 20 patients attending to Orthopedic Surgery Department, Faculty of Medicine, and Beni-Suef University after approved by local committee and an informed consent.
The study includes 20 patients, there 6 patients (30%) were female and 14 patients (70%) were males, 55% of patients their fixation were in right side. The Mean of age were 33.9 with range from 19 to 60 years. In the study there 1 patient only (5%) were having diabetes mellitus.
In the study showed that there 5 patients (25%) their type of fracture was (41-A1 & 41-A2) and 15 patients (75%) their type of fracture were (41-A3). One patient only (5%) were having associated Fractures and 4 patients (20%) were Associated ligamentous injury.
There weren’t any Intraoperative Complications among studied patients. 10 patients (50%) were having loss of reduction, 16 patients (80%) were having delayed or non-union, 12 patients (60%) were having pain during movement, 15 patients (75%) were having other implant use after fixator removal and 4 patients (20%) were having infection.
Proximal Tibial fractures are difficult to treat both due to bony as well as soft tissue injury. Biplanar external fixator has not shown good treatment option for proximal tibial fractures. In addition, nonunion and angular deformity would occur in severe metaphyseal comminution and soft tissue injury. Accurate fracture reduction and careful soft tissue management is prerequisite and should be considered.