Medial Tibial Fracture: When Is Surgery Required?

Medial tibial fractures (tibial shaft, plateau, or plafond) require surgery based on fracture personality and patient factors.

Non-Operative Candidates

• Non-displaced, stable fractures (<5° angulation, <10 mm shortening, <50% translation).
• Low-demand patients with high surgical risk.
• Treatment: long-leg cast or functional brace × 6–12 weeks; weekly X-rays for displacement.

Surgical Indications

• Displacement/angulation exceeding acceptable limits.
• Open fracture (Gustilo I–III): urgent irrigation/debridement + fixation.
• Compartment syndrome: Emergent fasciotomy + fixation.
• Intra-articular extension: Plateau/plafond fractures with step-off >2 mm → ORIF.
• Segmental/comminuted: Intramedullary nail (gold standard for shaft).
• Failed conservative: Secondary displacement in cast.
• Polytrauma: Early total care (ETC) or damage control orthopedics (DCO).

Fixation Options

• IM nail (reamed/unreamed) — most shaft fractures.
• Plates/screws — periarticular, non-nailable.
• External fixator — temporary (DCO) or definitive (severe soft tissue).

Decision by orthopedic surgeon after full imaging (XR, CT) and patient assessment.