High-energy proximal tibial fractures, particularly Schatzker Type VI, pose significant treatment challenges due to their complexity and associated soft-tissue compromise. Early surgical intervention in the presence of severe swelling and blistering increases the risk of complications. Staged or delayed management remains the preferred approach in such scenarios. We report the case of an elderly male patient who sustained a comminuted right proximal tibial fracture following a crush injury caused by the toppling of a sugarcane-laden truck. On presentation, he had gross swelling, multiple skin blisters, and extensive soft-tissue trauma. In view of the critical soft-tissue condition, initial management was conservative and included limb elevation, anti-inflammatory medications, analgesia, sterile dressings, and active toe mobilization. Once the soft-tissue status improved – indicated by subsidence of swelling and appearance of skin wrinkles – definitive internal fixation was performed. An anterolateral locking plate was used for the lateral tibial plateau, and the medial condylar fragment was stabilized with partially threaded cancellous screws. Postoperative recovery was uneventful, and physiotherapy was initiated early. The patient achieved full weight-bearing mobility with excellent joint function at follow-up. This case highlights the efficacy of a soft-tissue-guided, staged approach in the management of complex tibial plateau fractures. Conservative initial management, followed by timely fixation using limited surgical exposure, can minimize complications and ensure excellent functional outcomes.
Munde et al. (Tue,) studied this question.