Principles of modern surgical treatment for fractures of the proximal tibial epimetaphysis

Background. Proximal tibial epimetaphysis fractures account for 8.9–11 % of all tibial fractures and up to 87 % of fractures in the knee joint. In the latter group, lateral condyle fractures occur in 52 to 80 % of cases, medial condyle fractures — in up to 7 %, and comminuted fractures — in 41 % of patients. The main mechanism of injury is varus or valgus loading with or without axial overload. Purpose: to analyze modern methods of surgical treatment for proximal tibial epimetaphysis fractures, to identify problematic issues and promising ways to solve them. Material and methods. Literature sources were analyzed in the following databases: Pubmed, UpToDate, Scopus, Web of Science, MEDLINE, The Cochrane Library, Embase, Global Health using the search terms: “proximal tibial epimetaphysis fractures”, “surgical treatment”. Results. The AO/ASIF classification is considered to be the generally accepted classification of the proximal tibial epimetaphysis fractures. However, when determining the type of fracture, classification of J. Schatzker, R. McBroom, D. Bruce is more commonly used. Given the modern three-column concept, J. Schatzker and co-authors have finalized their classification. Current treatment principles are represented by the ORIF and MIPPO concepts. To stabilize the fragments, one can use screws, plates with various design characteristics, intramedullary nails and external fixation devices. Conclusions. Despite the development of thorough syste-matized approaches to the treatment of the proximal tibial epimetaphy-sis fractures, represented by the ORIF and MIPPO concepts, some crucial issues remain unresolved. Controversial issues include indications for surgical and conservative treatment; preoperative planning; use of fixation types and structures that will be minimally invasive and stable, which necessitates further research.