Summary Proximal third tibia fractures are relatively common fractures of the proximal tibial shaft that are associated with high rates of soft tissue compromise and malunion (valgus and procurvatum). Diagnosis is made with orthogonal radiographs of the tibia with CT scan often required to assess for intra-articular extension. Treatment generally consists of surgical open reduction and internal fixation (ORIF) versus intramedullary nail fixation. Epidemiology Incidence common login to view 1 more bullet Etiology Pathophysiology mechanism login to view 5 more bullets Associated conditions compartment syndrome soft tissue injury login to view 2 more bullets Anatomy Osteology proximal tibia login to view 3 more bullets Muscles deforming forces login to view 10 more bullets Classification AO Classification - 42 Type A Simple fracture pattern Type B Wedge fracture pattern Type C Comminuted fracture pattern Presentation Symptoms pain, inability to bear weight Physical exam inspection login to view 7 more bullets neurovascular login to view 7 more bullets Imaging Radiographs recommended views login to view 3 more bullets findings login to view 5 more bullets CT indications login to view 1 more bullet Differential Tibial shaft fx Knee dislocation Tibial plateau fx Diagnosis Radiographic diagnosis confirmed by clinical presentation and radiographs Treatment Nonoperative closed reduction / cast immobilization login to view 11 more bullets Operative external fixation login to view 5 more bullets intramedullary nailing login to view 7 more bullets percutaneous locking plate login to view 9 more bullets Techniques Closed reduction / cast immobilizxation technique login to view 2 more bullets External fixation technique login to view 3 more bullets Intramedullary nailing approach login to view 6 more bullets technique login to view 30 more bullets complications login to view 2 more bullets Pecutaneous locking plate approach login to view 2 more bullets technique login to view 2 more bullets complications login to view 2 more bullets Complications Anterior knee pain incidence login to view 2 more bullets Nonunion infection must be ruled out dynamization if axially stable Malunion Most common is valgus and apex anterior (procurvatum) increases long-term risk of arthrosis incidence login to view 1 more bullet prevention login to view 9 more bullets treatment login to view 2 more bullets Prognosis High rate of malunion following intramedullary nailing