Vol. 7, Issue 2, Part C (2025)

Background: Proximal tibial fractures, although relatively uncommon, pose substantial therapeutic challenges due to their intra-articular nature, complex biomechanics, and vulnerability of the surrounding soft-tissue envelope. While staged fixation is widely used for high-energy fractures, the safety and efficacy of immediate internal fixation in selected closed injuries remain areas of ongoing debate. This study evaluates functional and radiological outcomes of immediate open reduction and internal fixation (ORIF) performed within 48 hours for isolated closed proximal tibial fractures.

Methods: A prospective observational study was conducted on 50 adults with Tscherne grade 0–1 isolated closed upper-end tibial fractures managed with immediate ORIF. All patients underwent standardised perioperative evaluation, fracture classification using the Schatzker system, and fixation via anterolateral or posteromedial approaches. Outcomes were assessed using the Rasmussen Functional and Radiological Scores across a one-year follow-up. Complication rates, union times, and correlations between clinical and radiographic parameters were analysed.

Results: The mean patient age was 42 years, with road-traffic accidents accounting for 92% of injuries. ORIF was performed within 12 hours in 64% of cases. Mean union time was 11.4 weeks. Functional outcomes were excellent or good in 92% of patients, while radiological outcomes were excellent or good in all cases. Only two complications (4%) occurred: one superficial infection and one compartment syndrome, both resolved without long-term sequelae. Age demonstrated a significant negative correlation with functional outcomes, and fracture type correlated significantly with functional results.

Conclusion: Immediate ORIF in carefully selected isolated closed proximal tibial fractures is a safe and effective strategy, providing stable fixation, facilitating early mobilisation, and yielding excellent functional and radiological outcomes. When performed with meticulous attention to soft-tissue status and surgical technique, early fixation can minimise complications and optimise recovery without the need for staged protocols.