ABSTRACT
Extra-articular fractures involving the proximal tibia can be either simple metaphyseal or complex and multifragmentary. In the geriatric population, challenges in the treatment of these fractures include difficulties regarding fixation in osteoporotic bone, the patient’s functional level, and comorbidities. Treatment often requires surgical reduction and internal fixation that allow early mobilization with weight-bearing. The two most common implants used for treatment are intramedullary nails and plates. After analyzing three case examples using these fixation methods, we strongly suggest the use of dual plating in comminuted fractures with a short proximal segment. For simple fractures with a short metaphyseal fragment and an intact medial column, a lateral locked plate may suffice, and simple fractures that are located more distally can be successfully treated with intramedullary nailing, All treatment options require a careful analysis of the location and comminution, and stability should always be assessed intraoperatively. When in doubt in an osteoporotic extra-articular fracture of the proximal tibia, the use of dual plating is recommended.
