A Multicenter Randomized Trial Comparing IM Nails and Plate Fixation in Proximal Tibial Fractures

Inclusion Criteria: * Skeletally mature, * Extra-articular fracture of the proximal tibia extending into the metaphyseal with or without intra-articular extension not requiring open reduction with complete anteroposterior (AP) and lateral radiographs, * Major fracture line not closer than 4cm from the proximal tibial articular surface * Fracture requiring operative treatment amenable to either IM nail or plate * Surgeon agreed to randomize patient * Informed consent obtained * Patient is English speaking Exclusion Criteria: * Tibial shaft fractures not amenable to intramedullary nailing (i.e.fracture is less than 4 cm from joint surface), * Fracture of the proximal tibia with intraarticular extension requiring open reduction, * Known metabolic bone disease * Separate displaced tibial tubercle fragment, * Soft tissue injuries compromising treatment method with nail,plate or both. * Fractures with vascular injury (Gustillo Type IIIC injury) requiring repair, * Compartment syndrome of the leg diagnosed preoperatively, * Pathological fractures, * Retained hardware or existing deformity in the affected limb that would complicate IM nailing,plating or both, * Symptomatic knee arthritis. * Surgical delay greater than 3 weeks for closed fractures or 24 hours for open fractures, * Immunocompromised, * Unable to comply with postoperative rehabilitation protocols or instructions (i.e. head injured or mentally impaired), * Current or impending incarceration, * Unlikely to follow-up in…