Table 4.

A representation of a Proximal Screw Technique (PST) for fixating type 4 modified Watson–Jones fractures in the literature.

Refs.	mWJ4 Cases (n)	Relevant Findings and Conclusions
Pace et al. [9]	24	The authors’ perception was that longer bi-cortical screws were necessary to stabilize the posterior fracture fragment. Accordingly, they stated that a screw purchase in this fragment should be achieved whenever possible. In their series, 4 patients required a supplemental plate fixation.
Haber et al. [12]	26	In all, 79% of the mWJ4/5 fractures were treated operatively. The authors did not separate types 4 and 5 in their analysis. Although they did not elaborate on the technique in the text, the image provided by the authors presented a PST as their surgical method.
Arkader et al. [10]	13	A total of 12 cases were operated with uni-cortical fixation, while only 1 case was treated with a mixed uni- and bi-cortical fixation. The authors concluded that a uni-cortical fixation might be suitable in mWJ4 fractures.
Park et al. [14]	10	All fractures were fixated by a PST construct utilizing 2 (in a few cases) or 3 (in most cases) screws, most commonly 6.5 mm cancellous. The entry points were medial and lateral to the tibial tuberosity without violating the tibial apophysis.
Formicini et al. [11]	5	The authors used 4.5 mm cannulated screws and pointed out that while mWJ 1–3 could be treated with uni-cortical screws, mWJ4 fractures required greater stability, especially for the posterior component. For this reason, they used bi-cortical screws that engaged this component to form a construct regarded by them to be more effective.
Rodriguez et al. [7]	review	The authors presented a review of tibial tuberosity fractures. In their review, they did not discuss the specifications of the screw trajectory but did provide an image that represented their concept of a proper screw position for fixating mWJ4 fractures. In that image, the posterior component was captured with a PST, with two fully threaded screws that were inserted through the tibial tuberosity midline.