Proximal tibial fractures
Proximal tibial fractures include three clinically important patterns: tibial plateau (intra‑articular) fractures, tibial spine (intercondylar eminence) avulsions and tibial tuberosity avulsions. Each has distinct mechanisms, typical patient groups and ED implications for imaging, acute management and disposition.
Recognise injuries that can be occult on plain radiographs, identify limb‑threatening features, and arrange timely orthopaedic, vascular or orthoplastic review when indicated (NICE NG38, NG37).
Immediate ED priorities
- Primary survey (ABCs) and prompt, titrated analgesia.
- Immobilise the limb (knee backslab), elevate and keep limb non‑weight‑bearing.
- Complete and document neurovascular and compartment observations (pulses, perfusion, motor and sensory); repeat serially.
- For open wounds: cover with a sterile dressing, check tetanus status and give IV antibiotics; urgent orthopaedic/trauma referral (NG37).
- Aim for definitive radiology reporting (hot reporting) before discharge; if not possible, provide explicit safety‑netting and rapid orthopaedic follow‑up (NG38).
- Consider PoCUS as an adjunct (effusion detection/aspiration) if trained (RCEM PoCUS guidance).
Tibial plateau fractures
What and why
Tibial plateau fractures involve the articular surface and subchondral bone of the proximal tibia and commonly affect cartilage and meniscal attachments. Mechanisms range from low‑energy varus/valgus forces (older osteoporotic bone) to high‑energy axial loading (younger patients).
Because they are intra‑articular they risk joint incongruity, post‑traumatic osteoarthritis, instability and compartment syndrome. High‑energy patterns (medial, bicondylar or metaphyseal-diaphyseal dissociation) carry increased soft‑tissue and vascular risk (popliteal...