Treatment of Nondisplaced Proximal Tibial Fractures

Conservative Management Protocol

Immobilize in a long leg cast or splint initially, as this provides the most effective pain relief and prevents displacement, according to the Anaesthesia guideline society 1

Initiate scheduled paracetamol (acetaminophen) as first-line analgesia unless contraindicated, as recommended by the Anaesthesia guideline society 1, 2
Add opioids cautiously, particularly if renal function is unknown, as approximately 40% of fracture patients present with at least moderate renal dysfunction, according to the Anaesthesia guideline society 1, 2
Avoid NSAIDs if renal dysfunction is suspected or confirmed, as these are relatively contraindicated in patients with impaired kidney function, as stated by the Anaesthesia guideline society 1, 2
Consider regional nerve blocks (femoral or fascia iliaca) for additional pain control, which can be administered by appropriately trained emergency department or orthopedic staff, according to the Anaesthesia guideline society 1, 2

Begin early physical training and muscle strengthening once immobilization is discontinued, followed by long-term balance training to prevent future falls and maintain function, as recommended by the Annals of the Rheumatic Diseases guideline society 3