Maggie's Farm

How do you have a tibial fracture that is proximal to the tibial plateau if the tibial plateau is at the proximal end of the tibia?
As to ORIF vs EF, let's just assume the treating doc felt he could achieve a stable reduction with EF and reduce the chances of infection, etc, with ORIF.

No problem. I figured you might have meant the tibial plafond and not the tibial plateau.

As Dr. B notes regarding the ortho opting for EF, the treating doc has access to info we don't have, e.g. the swelling (another reason simple casting would almost certainly yield a poor result) and the lateral x-ray view (a single AP view cannot be relied upon to tell the story).

I'm sorry to say, but doctors tend to retrospectively second guess other doctors too much. On Monday morning, it's often becomes "obvious" that the nondescript belly pain the ER doc saw on Sunday night was appendicitis. My philosophy has been that when I see a patient at some time after the initial presentation, I'm seeing something different than the initial doc saw and a diagnosis is easier to make because the disease has progressed to a more obvious state rather than assuming that I'm a better diagnostician.

Time is the diagnostic "test" that many of us forget. It always strikes me as foolish that hospital consultant types focus so much on ER turnaround time when, for many patients (esp belly pain), seeing how the disease process evolves over a few hours is often a vital clue regarding a surgical abdomen.