Causes: Proximal third tibia fractures can be caused by high-impact trauma, such as motor vehicle collisions, downhill skiing injuries, and cycling accidents, or by low-impact trauma, such as ground level falls.

This fracture may also be caused by overuse, such as distance running, endurance activities, and repetitive impact activities – typically, these would be stress fractures in the proximal tibial location.

Proximal tibia fractures can also be associated with pathologic fractures secondary to cancer, infection, or metabolic deficiency.

Typical injury mechanisms: Proximal tibial fractures can occur with low- or high-impact injuries.

Low energy –

• Torque along with indirect impact to the bone can cause a spiral fracture with minimal soft tissue injury.

High energy –

• Direct impact leads to wedge / small oblique fractures along with significant comminution of the proximal tibia.
• Associated injuries: Soft tissue injury, compartment syndrome, bone loss, and ipsilateral-skeletal injury can occur as a result of this type of high-energy injury.

Classic history and presentation: Proximal third tibia fractures present similarly to other tibial fractures: inability to bear weight on the injured extremity along with pain around the fracture. Injury to the knee joint (either intraarticular extension or ligamentous injury) may also occur and present as tenderness around the joint line along with possible knee effusion.

Prevalence: In general, high-energy injuries are more likely to occur in younger male patients, while low-energy injuries resulting in a proximal tibia fracture tend to occur in older female patients.

Risk factors:

• Cancer
• Infection
• Osteoporosis
• High-energy injury mechanisms

Pathophysiology:

• High-energy trauma leading to wedge / small oblique fractures with significant comminution of the proximal tibia.
• Low-energy trauma with an indirect impact to the bone resulting in a spiral fracture with minimal soft tissue injury.

Classifications: Because of the subcutaneous nature of the tibial bone, these injuries can be associated with soft tissue injuries and open fractures. Soft tissue injuries are classified by the Oestern and Tscherne classification. Open fractures are classified by the Gustilo-Anderson classification.