There are a few different methods that a surgeon may use to obtain alignment of the broken bone fragments and keep them in place while they heal.
During this type of procedure, the bone fragments are first repositioned (reduced) into their normal position. They are held together with special devices, such as an intramedullary rod or plates and screws.
In cases in which the upper one fourth of the tibia is broken, but the joint is not injured, a rod or plate may be used to stabilize the fracture. A rod is placed in the hollow medullary cavity in the center of the bone. A plate is placed on the outside surface of the bone.
Plates and screws are commonly used for fractures that enter the joint. If the fracture enters the joint and pushes the bone down, lifting the bone fragments may be required to restore joint function.
Lifting these fragments, however, creates a hole in the cancellous bone of the region. This hole must be filled with material to keep the bone from collapsing. This material can be a bone graft from the patient or from a bone bank. Synthetic or naturally occurring products which stimulate bone healing can also be used.
Fractures that extend into the knee joint frequently require plate fixation. The plate is applied to the surface of the bone.
Fractures that are sunken must be elevated back up to restore the joint. This reduces the risk of arthritis and instability.
In some cases, the condition of the soft tissue is so poor that the use of a plate or rod might threaten it further. An external fixator (described under Emergency Care above) may be considered as final treatment. The external fixator is removed when the injury has healed.