Treatment options and research progress of proximal tibial extra-articular fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHANG Yuelei ¹ , ZHANG Qi ¹ , LIN Yuan ¹ , FAN Yuandong ²

1. Department of Orthopedics, First Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230000, P. R. China;
2. Shuangdun Central Health Center in Changfeng County, Hefei Anhui, 231100, P. R. China;

Corresponding author：

ZHANG Yuelei, Email: orthozhang5233@163.com

Keywords：

Proximal tibial fracture; extra-articular fracture; plate; intramedullary nail; external fixation frame

DOI：

10.7507/1002-1892.202506099

Video：

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Objective To review the main fixation methods for proximal tibial extra-articular fractures based on clinical and biomechanical results, and to provide evidence for clinical application. Methods Extensive literature search at home and abroad was conducted in recent years, and external fixation systems such as external fixation braces and external locking plates, as well as internal fixation systems such as plates and intramedullary nails, were systematically reviewed regarding their application indications, clinical efficacy, and biomechanical results in proximal tibial extra-articular fractures. Results External fixation systems have advantages in fractures with open or severe soft tissue injury, facilitating wound management and maintaining stability of the fracture site to some extent. However, in proximal tibial extra-articular fractures with good soft tissue conditions, internal fixation systems such as plates and intramedullary nails are still the first choice. Some studies have found that intramedullary nails allow patients to bear weight early, with shorter fracture healing time and higher rate of malunion, while other studies have found that both intramedullary nails and plates have similar clinical efficacy and can achieve satisfactory treatment results. Conclusion The choice of fixation method for proximal tibial extra-articular fractures depends not only on the type of fracture, but also on the surgeon’s habits and operational skills. Larger-scale studies are still needed to clarify the advantages and disadvantages of intramedullary nails and locking plates in the treatment of proximal tibial extra-articular fractures.

1.	Ren C, Li M, Sun L, et al. Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis. J Orthop Surg (Hong Kong), 2021, 29(2): 23094990211024395. doi: 10.1177/23094990211024395.
2.	Monahan KT, Zavras AG, Angelides GW, et al. Extra-articular proximal tibia fracture fixation with locked plating versus intramedullary nailing: A meta-analysis. Injury, 2024, 55(10): 111718. doi: 10.1016/j.injury.2024.111718.
3.	Lu Y, Zhao J, Huang Q, et al. Combined medial plate and intramedullary nailing for the fixation of extra-articular proximal tibial fractures: a biomechanics study. Front Bioeng Biotechnol, 2022, 10: 859512. doi: 10.3389/fbioe.2022.859512.
4.	Morello V, Gamulin A. Clinical and radiological risk factors associated with the occurrence of acute compartment syndrome in tibial fractures: a systematic review of the literature. EFORT Open Rev, 2023, 8(12): 926-935.
5.	Sanders E, Policicchio AL, Phillips L. High incidence of soft tissue injury in pediatric proximal tibia fractures: A systematic review. Arthrosc Sports Med Rehabil, 2023, 5(5): 100771. doi: 10.1016/j.asmr.2023.100771.
6.	Widanage KND, De Silva MJ, Dulantha Lalitharatne T, et al. Developments in circular external fixators: A review. Injury, 2023, 54(12): 111157. doi: 10.1016/j.injury.2023.111157.
7.	Ang BFH, Chen JY, Yew AKS, et al. Externalised locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness. Bone Joint Res, 2017, 6(4): 216-223.
8.	Daf A, Gachake AA, Satone PR, et al. Early-stage physical therapy for a patient with proximal tibial fracture with acute compartment syndrome and neurovascular deficits managed with external fixation complicated by chronic osteomyelitis: A case report. Cureus, 2022, 14(11): e31333. doi: 10.7759/cureus.31333.
9.	Charla JN, Sharkey MS. Acute correction of multiplanar proximal tibial deformity utilizing fixator-assisted intramedullary nailing. JBJS Essent Surg Tech, 2022, 12(3): e21.00045. doi: 10.2106/JBJS.ST.21.00045.
10.	Oleo-Taltavull R, Corró S, Tomàs-Hernández J, et al. Staged treatment of bicondylar tibial plateau fractures: influence of frame configuration and quality of reduction on outcomes. Eur J Trauma Emerg Surg, 2024, 50(3): 1033-1041.
11.	Shi B, Zhang Z, Ji G, et al. Bone transport for large segmental tibial defects using Taylor spatial frame versus the Ilizarov circular fixator. Orthop Surg, 2024, 16(9): 2157-2166.
12.	Craig A, Barron E, Sharma H, et al. Do patients achieve “full weight-bearing” immediately following application of circular frame fixation of the lower limb? Strategies Trauma Limb Reconstr, 2024, 19(1): 40-44.
13.	王刚, 章乐成, 严超, 等. Ilizarov技术结合载万古霉素骨水泥治疗胫骨创伤后骨感染合并骨与软组织缺损的疗效. 中华创伤杂志, 2021, 37(3): 210-215.
14.	Bove F, Sala F, Capitani P, et al. Treatment of fractures of the tibial plateau (Schatzker Ⅵ) with external fixators versus plate osteosynthesis. Injury, 2018, 49 Suppl 3: S12-S18.
15.	Zhao Z, Shu H, Jia P, et al. Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study. BMC Surg, 2024, 24(1): 44. doi: 10.1186/s12893-024-02327-0.
16.	Oztürkmen Y, Karamehmetoğlu M, Karadeniz H, et al. Acute treatment of segmental tibial fractures with the Ilizarov method. Injury, 2009, 40(3): 321-326.
17.	Naude JJ, Manjra MA, Birkholtz F, et al. Functional outcomes and quality of life following complex tibial fractures treated with circular external fixation: A comparison between proximal, midshaft, and distal tibial fractures. Strategies Trauma Limb Reconstr, 2021, 16(1): 32-40.
18.	Berto L, Palma GHB, Silva ACD, et al. Treatment of tibial plateau fractures with a circular external fixator: A comparative analysis of two assembly methods. Rev Bras Ortop (Sao Paulo), 2024, 59(2): e206-e212.
19.	Kumar V, Balasubramanian S, Kasirajan S. Hybrid external fixation as a comprehensive, safe, and effective solution for periarticular tibial fracture with soft tissue compromise. J Orthop Case Rep, 2025, 15(3): 250-256.
20.	Saini R, Sharma A, Sidhu SS, et al. Bridge plating versus hybrid external fixation in the management of proximal tibia metaphyseal fractures. Cureus, 2023, 15(3): e36331. doi: 10.7759/cureus.36331.
21.	Ma CH, Wu CH, Jiang JR, et al. Metaphyseal locking plate as an external fixator for open tibial fracture: Clinical outcomes and biomechanical assessment. Injury, 2017, 48(2): 501-505.
22.	Makelov B, Mischler D, Varga P, et al. Single-stage externalized locked plating for treatment of unstable meta-diaphyseal tibial fractures. J Clin Med, 2023, 12(4): 1600. doi: 10.3390/jcm12041600.
23.	Hidayat L, Triangga AFR, Cein CR, et al. Low profile external fixation using locking compression plate as treatment option for management of soft tissue problem in open tibia fracture grade ⅢA: A case series. Int J Surg Case Rep, 2022, 93: 106882. doi: 10.1016/j.ijscr.2022.106882.
24.	Zhang J, Ebraheim N, Li M, et al. External fixation using femoral less invasive stabilization system plate in tibial proximal metaphyseal fracture. Clin Orthop Surg, 2015, 7(1): 8-14.
25.	Blažević D, Kodvanj J, Adamović P, et al. Comparison between external locking plate fixation and conventional external fixation for extraarticular proximal tibial fractures: a finite element analysis. J Orthop Surg Res, 2022, 17(1): 16. doi: 10.1186/s13018-021-02907-3.
26.	Berninger MT, Eggeling L, Krause M, et al. Osteosynthesis of extra-articular proximal tibial fractures. Unfallchirurgie (Heidelb), 2023, 126(1): 55-66.
27.	Zhang X, Liu B, Wang Q, et al. Minimally invasive percutaneous plate osteosynthesis technique combined with locking compression plates guided by C-Arm X-ray machine in treatment of tibial metaphyseal fractures: Curative effect and postoperative complications. Pak J Med Sci, 2022, 38(3Part-Ⅰ): 505-510.
28.	Oh JK, Oh CW, Jeon IH, et al. Percutaneous plate stabilization of proximal tibial fractures. J Trauma, 2005, 59(2): 431-437.
29.	Naik MA, Arora G, Tripathy SK, et al. Clinical and radiological outcome of percutaneous plating in extra-articular proximal tibia fractures: a prospective study. Injury, 2013, 44(8): 1081-1086.
30.	胡鹏, 敖庆芳, 魏志勇, 等. 单纯外侧锁定板与联合内侧板内固定治疗胫骨近端关节外骨折的疗效比较. 中国骨与关节损伤杂志, 2019, 34(8): 860-862.
31.	Lee SM, Oh CW, Oh JK, et al. Biomechanical analysis of operative methods in the treatment of extra-articular fracture of the proximal tibia. Clin Orthop Surg, 2014, 6(3): 312-317.
32.	Peindl RD, Zura RD, Vincent A, et al. Unstable proximal extraarticular tibia fractures: a biomechanical evaluation of four methods of fixation. J Orthop Trauma, 2004, 18(8): 540-545.
33.	Pulley BR, Gardner MJ. Bridge plating of proximal tibial metaphyseal fracture by limited open technique. J Orthop Trauma, 2019, 33 Suppl 1: S34-S35.
34.	Telgheder ZL, Hill B, Huang K, et al. Immediate weight bearing as tolerated is safe following intramedullary fixation of extra-articular metaphyseal proximal tibia fractures (OTA/AO 41-A). J Orthop Trauma, 2023, 37(1): 38-43.
35.	Force A, Tarpada S, Follett L, et al. Fixation of proximal tibial fractures with intramedullary nail and immediate weightbearing: A beneficial alternative. Injury, 2024, 55(6): 111530. doi: 10.1016/j.injury.2024.111530.
36.	Byun SE, Maher MH, Mauffrey C, et al. The standard sagittal starting point and entry angle for tibia intramedullary nails results in malreduction of proximal tibial fractures. Eur J Orthop Surg Traumatol, 2020, 30(6): 1057-1060.
37.	Padubidri A, Sorkin AT, Gudeman A, et al. Intramedullary nail fixation of intra-articular and extra-articular proximal tibia fractures. J Surg Orthop Adv, 2021, 30(1): 55-60.
38.	Jindal K, Neradi D, Sodavarapu P, et al. Intramedullary nailing versus plating for proximal tibia fractures: A systematic review and meta-analysis. Indian J Orthop, 2020, 55(3): 582-594.
39.	王刚, 章乐成, 严超, 等. 半伸膝位髌旁关节外入路髓内钉内固定治疗胫骨干骨折. 中国修复重建外科杂志, 2020, 34(12): 1574-1578.
40.	Rayes J, Willms S, Buckley R. Proximal to midshaft closed tibial fracture-Infra or supra-patellar nailing? Injury, 2022, 53(10): 3067-3069.
41.	Ciminero M, Elsevier H, Solarczyk J, et al. Suprapatellar tibial nailing: Future or fad? J Clin Med, 2023, 12(5): 1796. doi: 10.3390/jcm12051796.
42.	Kulkarni MS, Tummala M, Aroor MN, et al. Suprapatellar nailing in proximal third tibial fractures-Clinicoradiological outcome. Injury, 2020, 51(8): 1879-1886.
43.	Teixidor-Serra J, Andrés-Peiró JV, García-Sanchez Y, et al. Outcomes and their predictors in suprapatellar nailing for tibia fractures. Multivariable analysis of 293 consecutive cases. Eur J Trauma Emerg Surg, 2024, 50(4): 1577-1584.
44.	Gkouvas G, Agathangelidis F, Nakas C, et al. Biomechanical comparison of six intramedullary nails, for the treatment of ex-tra-articular, proximal tibial fractures. Hippokratia, 2019, 23(2): 58-63.
45.	Bradshaw F, Wakefield E, Zhang J, et al. Poller screws and post-operative pain relief in tibial fractures. Cureus, 2024, 16(2): e54811. doi: 10.7759/cureus.54811.
46.	Stenquist DS, McCaskey M, Diaz M, et al. Do long-segment blocking screws increase the stability of intramedullary nail fixation in proximal tibia fractures, eliminating the “Bell-Clapper effect?”. J Orthop Trauma, 2024, 38(1): e4-e8.
47.	Gouveia K, Hache P, Johal H. Plating as a reduction aid prior to intramedullary nailing of tibia fractures: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol, 2024, 34(3): 1259-1267.
48.	Toksoy S, Demirtaş I, Güngörürler M, et al. Finite element analysis of intramedullary nailing and nail-plate combinations for treating unstable proximal tibial metaphyseal fractures. Ulus Travma Acil Cerrahi Derg, 2024, 30(12): 861-867.
49.	Prabhat V, Topno R, Kundu S, et al. A randomized trial comparing outcome of expert tibial nail versus proximal tibial plate in the management of fractures of proximal tibia in adults. Ann Afr Med, 2025, 24(2): 361-369.
50.	Teimouri M, Mirghaderi P, Parry JA, et al. Intramedullary nail versus minimally invasive plate osteosynthesis for displaced extraarticular proximal tibia fractures: a prospective comparative cohort study. Eur J Orthop Surg Traumatol, 2023, 33(7): 3067-3079.
51.	Xu H, Chen P, Zhang Y, et al. Intramedullary nailing versus minimally invasive plate osteosynthesis (MIPO) for proximal tibial fracture: a systematic review and meta-analysis. J Orthop Surg Res, 2025, 20(1): 663. doi: 10.1186/s13018-025-06094-3.
52.	Lim S, Song HK, Kim TH, et al. Comparison of suprapatellar intramedullary nailing versus minimal invasive locked plating for proximal tibia fractures. Arch Orthop Trauma Surg, 2023, 143(12): 7009-7017.
53.	Dunbar RP, Egol KA, Jones CB, et al. Locked plating versus nailing for proximal tibia fractures: A multicenter RCT. J Orthop Trauma, 2023, 37(4): 155-160.
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56.	Laflamme GY, Heimlich D, Stephen D, et al. Proximal tibial fracture stability with intramedullary nail fixation using oblique interlocking screws. J Orthop Trauma, 2003, 17(7): 496-502.
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58.	Gao W, Zhao K, Guo Y, et al. Biomechanical comparison of intramedullary nail and plate osteosynthesis for extra-articular proximal tibial fractures with segmental bone defect. Front Bioeng Biotechnol, 2023, 11: 1099241. doi: 10.3389/fbioe.2023.1099241.
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1. Ren C, Li M, Sun L, et al. Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis. J Orthop Surg (Hong Kong), 2021, 29(2): 23094990211024395. doi: 10.1177/23094990211024395.
2. Monahan KT, Zavras AG, Angelides GW, et al. Extra-articular proximal tibia fracture fixation with locked plating versus intramedullary nailing: A meta-analysis. Injury, 2024, 55(10): 111718. doi: 10.1016/j.injury.2024.111718.
3. Lu Y, Zhao J, Huang Q, et al. Combined medial plate and intramedullary nailing for the fixation of extra-articular proximal tibial fractures: a biomechanics study. Front Bioeng Biotechnol, 2022, 10: 859512. doi: 10.3389/fbioe.2022.859512.
4. Morello V, Gamulin A. Clinical and radiological risk factors associated with the occurrence of acute compartment syndrome in tibial fractures: a systematic review of the literature. EFORT Open Rev, 2023, 8(12): 926-935.
5. Sanders E, Policicchio AL, Phillips L. High incidence of soft tissue injury in pediatric proximal tibia fractures: A systematic review. Arthrosc Sports Med Rehabil, 2023, 5(5): 100771. doi: 10.1016/j.asmr.2023.100771.
6. Widanage KND, De Silva MJ, Dulantha Lalitharatne T, et al. Developments in circular external fixators: A review. Injury, 2023, 54(12): 111157. doi: 10.1016/j.injury.2023.111157.
7. Ang BFH, Chen JY, Yew AKS, et al. Externalised locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness. Bone Joint Res, 2017, 6(4): 216-223.
8. Daf A, Gachake AA, Satone PR, et al. Early-stage physical therapy for a patient with proximal tibial fracture with acute compartment syndrome and neurovascular deficits managed with external fixation complicated by chronic osteomyelitis: A case report. Cureus, 2022, 14(11): e31333. doi: 10.7759/cureus.31333.
9. Charla JN, Sharkey MS. Acute correction of multiplanar proximal tibial deformity utilizing fixator-assisted intramedullary nailing. JBJS Essent Surg Tech, 2022, 12(3): e21.00045. doi: 10.2106/JBJS.ST.21.00045.
10. Oleo-Taltavull R, Corró S, Tomàs-Hernández J, et al. Staged treatment of bicondylar tibial plateau fractures: influence of frame configuration and quality of reduction on outcomes. Eur J Trauma Emerg Surg, 2024, 50(3): 1033-1041.
11. Shi B, Zhang Z, Ji G, et al. Bone transport for large segmental tibial defects using Taylor spatial frame versus the Ilizarov circular fixator. Orthop Surg, 2024, 16(9): 2157-2166.
12. Craig A, Barron E, Sharma H, et al. Do patients achieve “full weight-bearing” immediately following application of circular frame fixation of the lower limb? Strategies Trauma Limb Reconstr, 2024, 19(1): 40-44.
13. 王刚, 章乐成, 严超, 等. Ilizarov技术结合载万古霉素骨水泥治疗胫骨创伤后骨感染合并骨与软组织缺损的疗效. 中华创伤杂志, 2021, 37(3): 210-215.
14. Bove F, Sala F, Capitani P, et al. Treatment of fractures of the tibial plateau (Schatzker Ⅵ) with external fixators versus plate osteosynthesis. Injury, 2018, 49 Suppl 3: S12-S18.
15. Zhao Z, Shu H, Jia P, et al. Hexaxial external fixator versus intramedullary nail in treating segmental tibial fractures: a retrospective study. BMC Surg, 2024, 24(1): 44. doi: 10.1186/s12893-024-02327-0.
16. Oztürkmen Y, Karamehmetoğlu M, Karadeniz H, et al. Acute treatment of segmental tibial fractures with the Ilizarov method. Injury, 2009, 40(3): 321-326.
17. Naude JJ, Manjra MA, Birkholtz F, et al. Functional outcomes and quality of life following complex tibial fractures treated with circular external fixation: A comparison between proximal, midshaft, and distal tibial fractures. Strategies Trauma Limb Reconstr, 2021, 16(1): 32-40.
18. Berto L, Palma GHB, Silva ACD, et al. Treatment of tibial plateau fractures with a circular external fixator: A comparative analysis of two assembly methods. Rev Bras Ortop (Sao Paulo), 2024, 59(2): e206-e212.
19. Kumar V, Balasubramanian S, Kasirajan S. Hybrid external fixation as a comprehensive, safe, and effective solution for periarticular tibial fracture with soft tissue compromise. J Orthop Case Rep, 2025, 15(3): 250-256.
20. Saini R, Sharma A, Sidhu SS, et al. Bridge plating versus hybrid external fixation in the management of proximal tibia metaphyseal fractures. Cureus, 2023, 15(3): e36331. doi: 10.7759/cureus.36331.
21. Ma CH, Wu CH, Jiang JR, et al. Metaphyseal locking plate as an external fixator for open tibial fracture: Clinical outcomes and biomechanical assessment. Injury, 2017, 48(2): 501-505.
22. Makelov B, Mischler D, Varga P, et al. Single-stage externalized locked plating for treatment of unstable meta-diaphyseal tibial fractures. J Clin Med, 2023, 12(4): 1600. doi: 10.3390/jcm12041600.
23. Hidayat L, Triangga AFR, Cein CR, et al. Low profile external fixation using locking compression plate as treatment option for management of soft tissue problem in open tibia fracture grade ⅢA: A case series. Int J Surg Case Rep, 2022, 93: 106882. doi: 10.1016/j.ijscr.2022.106882.
24. Zhang J, Ebraheim N, Li M, et al. External fixation using femoral less invasive stabilization system plate in tibial proximal metaphyseal fracture. Clin Orthop Surg, 2015, 7(1): 8-14.
25. Blažević D, Kodvanj J, Adamović P, et al. Comparison between external locking plate fixation and conventional external fixation for extraarticular proximal tibial fractures: a finite element analysis. J Orthop Surg Res, 2022, 17(1): 16. doi: 10.1186/s13018-021-02907-3.
26. Berninger MT, Eggeling L, Krause M, et al. Osteosynthesis of extra-articular proximal tibial fractures. Unfallchirurgie (Heidelb), 2023, 126(1): 55-66.
27. Zhang X, Liu B, Wang Q, et al. Minimally invasive percutaneous plate osteosynthesis technique combined with locking compression plates guided by C-Arm X-ray machine in treatment of tibial metaphyseal fractures: Curative effect and postoperative complications. Pak J Med Sci, 2022, 38(3Part-Ⅰ): 505-510.
28. Oh JK, Oh CW, Jeon IH, et al. Percutaneous plate stabilization of proximal tibial fractures. J Trauma, 2005, 59(2): 431-437.
29. Naik MA, Arora G, Tripathy SK, et al. Clinical and radiological outcome of percutaneous plating in extra-articular proximal tibia fractures: a prospective study. Injury, 2013, 44(8): 1081-1086.
30. 胡鹏, 敖庆芳, 魏志勇, 等. 单纯外侧锁定板与联合内侧板内固定治疗胫骨近端关节外骨折的疗效比较. 中国骨与关节损伤杂志, 2019, 34(8): 860-862.
31. Lee SM, Oh CW, Oh JK, et al. Biomechanical analysis of operative methods in the treatment of extra-articular fracture of the proximal tibia. Clin Orthop Surg, 2014, 6(3): 312-317.
32. Peindl RD, Zura RD, Vincent A, et al. Unstable proximal extraarticular tibia fractures: a biomechanical evaluation of four methods of fixation. J Orthop Trauma, 2004, 18(8): 540-545.
33. Pulley BR, Gardner MJ. Bridge plating of proximal tibial metaphyseal fracture by limited open technique. J Orthop Trauma, 2019, 33 Suppl 1: S34-S35.
34. Telgheder ZL, Hill B, Huang K, et al. Immediate weight bearing as tolerated is safe following intramedullary fixation of extra-articular metaphyseal proximal tibia fractures (OTA/AO 41-A). J Orthop Trauma, 2023, 37(1): 38-43.
35. Force A, Tarpada S, Follett L, et al. Fixation of proximal tibial fractures with intramedullary nail and immediate weightbearing: A beneficial alternative. Injury, 2024, 55(6): 111530. doi: 10.1016/j.injury.2024.111530.
36. Byun SE, Maher MH, Mauffrey C, et al. The standard sagittal starting point and entry angle for tibia intramedullary nails results in malreduction of proximal tibial fractures. Eur J Orthop Surg Traumatol, 2020, 30(6): 1057-1060.
37. Padubidri A, Sorkin AT, Gudeman A, et al. Intramedullary nail fixation of intra-articular and extra-articular proximal tibia fractures. J Surg Orthop Adv, 2021, 30(1): 55-60.
38. Jindal K, Neradi D, Sodavarapu P, et al. Intramedullary nailing versus plating for proximal tibia fractures: A systematic review and meta-analysis. Indian J Orthop, 2020, 55(3): 582-594.
39. 王刚, 章乐成, 严超, 等. 半伸膝位髌旁关节外入路髓内钉内固定治疗胫骨干骨折. 中国修复重建外科杂志, 2020, 34(12): 1574-1578.
40. Rayes J, Willms S, Buckley R. Proximal to midshaft closed tibial fracture-Infra or supra-patellar nailing? Injury, 2022, 53(10): 3067-3069.
41. Ciminero M, Elsevier H, Solarczyk J, et al. Suprapatellar tibial nailing: Future or fad? J Clin Med, 2023, 12(5): 1796. doi: 10.3390/jcm12051796.
42. Kulkarni MS, Tummala M, Aroor MN, et al. Suprapatellar nailing in proximal third tibial fractures-Clinicoradiological outcome. Injury, 2020, 51(8): 1879-1886.
43. Teixidor-Serra J, Andrés-Peiró JV, García-Sanchez Y, et al. Outcomes and their predictors in suprapatellar nailing for tibia fractures. Multivariable analysis of 293 consecutive cases. Eur J Trauma Emerg Surg, 2024, 50(4): 1577-1584.
44. Gkouvas G, Agathangelidis F, Nakas C, et al. Biomechanical comparison of six intramedullary nails, for the treatment of ex-tra-articular, proximal tibial fractures. Hippokratia, 2019, 23(2): 58-63.
45. Bradshaw F, Wakefield E, Zhang J, et al. Poller screws and post-operative pain relief in tibial fractures. Cureus, 2024, 16(2): e54811. doi: 10.7759/cureus.54811.
46. Stenquist DS, McCaskey M, Diaz M, et al. Do long-segment blocking screws increase the stability of intramedullary nail fixation in proximal tibia fractures, eliminating the “Bell-Clapper effect?”. J Orthop Trauma, 2024, 38(1): e4-e8.
47. Gouveia K, Hache P, Johal H. Plating as a reduction aid prior to intramedullary nailing of tibia fractures: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol, 2024, 34(3): 1259-1267.
48. Toksoy S, Demirtaş I, Güngörürler M, et al. Finite element analysis of intramedullary nailing and nail-plate combinations for treating unstable proximal tibial metaphyseal fractures. Ulus Travma Acil Cerrahi Derg, 2024, 30(12): 861-867.
49. Prabhat V, Topno R, Kundu S, et al. A randomized trial comparing outcome of expert tibial nail versus proximal tibial plate in the management of fractures of proximal tibia in adults. Ann Afr Med, 2025, 24(2): 361-369.
50. Teimouri M, Mirghaderi P, Parry JA, et al. Intramedullary nail versus minimally invasive plate osteosynthesis for displaced extraarticular proximal tibia fractures: a prospective comparative cohort study. Eur J Orthop Surg Traumatol, 2023, 33(7): 3067-3079.
51. Xu H, Chen P, Zhang Y, et al. Intramedullary nailing versus minimally invasive plate osteosynthesis (MIPO) for proximal tibial fracture: a systematic review and meta-analysis. J Orthop Surg Res, 2025, 20(1): 663. doi: 10.1186/s13018-025-06094-3.
52. Lim S, Song HK, Kim TH, et al. Comparison of suprapatellar intramedullary nailing versus minimal invasive locked plating for proximal tibia fractures. Arch Orthop Trauma Surg, 2023, 143(12): 7009-7017.
53. Dunbar RP, Egol KA, Jones CB, et al. Locked plating versus nailing for proximal tibia fractures: A multicenter RCT. J Orthop Trauma, 2023, 37(4): 155-160.
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