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Sample records for tibial diaphyseal fractures

  1. Dynamic osteosynthesis by modified Kuntscher nail for the treatment of tibial diaphyseal fractures.

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    Gadegone, Wasudeo M; Salphale, Yogesh S

    2009-04-01

    We evaluated a series of diaphyseal fractures of the tibia using low-cost, Indian-made modified Kuntscher nail (Daga nail) with the provision of distal locking screw for the management of the tibial diaphyseal fractures. One hundred and fifty one consecutive patients with diaphyseal fractures of tibia with 151 fractures who were treated by Daga nail were enrolled. One of the patients who had died because of cancer, and the two patients who were lost to follow-up at 3 months were excluded from the study.Therefore data of 148 patients with one hundred and fortyeight fractures is described. One hundred twenty closed fractures, 20 open Grade I fractures, and eight open Grade II fractures as per Gustilo and Anderson classification were included in this study. One hundred fourteen men and 34 women, with a mean age of 38.4 years, were studied. The result were analysed for Surgical time, duration of hospitalisation, union time, union rate, complication rate, functional recovery and crutch walking time. The fractures were followed at least until the time of solid union. The follow-up period averaged 15 months (range, 6-26 months). Union occurred in 140 cases (94.6%). The mean time to union was 13 weeks for closed fractures,17.8 weeks for Grade I open fractures, and 21.6 weeks for Grade II open fractures. Compartment syndrome occurred in two patients. Superficial infection occurred in five cases of Grade I and II compound fractures. Three closed fractures and one case of Grade I compound fracture required bone grafting for delayed union. Two cases of Grade II compound fracture with nonunion required revision surgery and bone grafting. Twelve cases resulted in acceptable malalignment due to operative technical error. In four cases, the distal screw breakage was seen, but none of these complications interfered with fracture healing. Recovery of joint motion was essentially normal in those patients without knee or ankle injury. Unreamed distally locked dynamic tibial nailing

  2. Dynamic osteosynthesis by modified Kuntscher nail for the treatment of tibial diaphyseal fractures

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    Gadegone Wasudeo

    2009-01-01

    Full Text Available Background: We evaluated a series of diaphyseal fractures of the tibia using low-cost, Indian-made modified Kuntscher nail (Daga nail with the provision of distal locking screw for the management of the tibial diaphyseal fractures. Materials and Methods: One hundred and fifty one consecutive patients with diaphyseal fractures of tibia with 151 fractures who were treated by Daga nail were enrolled. One of the patients who had died because of cancer, and the two patients who were lost to follow-up at 3 months were excluded from the study.Therefore data of 148 patients with one hundred and fortyeight fractures is described. One hundred twenty closed fractures, 20 open Grade I fractures, and eight open Grade II fractures as per Gustilo and Anderson classification were included in this study. One hundred fourteen men and 34 women, with a mean age of 38.4 years, were studied. The result were analysed for Surgical time, duration of hospitalisation, union time, union rate, complication rate, functional recovery and crutch walking time. The fractures were followed at least until the time of solid union. Results: The follow-up period averaged 15 months (range, 6-26 months. Union occurred in 140 cases (94.6%. The mean time to union was 13 weeks for closed fractures,17.8 weeks for Grade I open fractures, and 21.6 weeks for Grade II open fractures. Compartment syndrome occurred in two patients. Superficial infection occurred in five cases of Grade I and II compound fractures. Three closed fractures and one case of Grade I compound fracture required bone grafting for delayed union. Two cases of Grade II compound fracture with nonunion required revision surgery and bone grafting. Twelve cases resulted in acceptable malalignment due to operative technical error. In four cases, the distal screw breakage was seen, but none of these complications interfered with fracture healing. Recovery of joint motion was essentially normal in those patients without knee or

  3. Defining the Lower Limit of a "Critical Bone Defect" in Open Diaphyseal Tibial Fractures.

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    Haines, Nikkole M; Lack, William D; Seymour, Rachel B; Bosse, Michael J

    2016-05-01

    To determine healing outcomes of open diaphyseal tibial shaft fractures treated with reamed intramedullary nailing (IMN) with a bone gap of 10-50 mm on ≥50% of the cortical circumference and to better define a "critical bone defect" based on healing outcome. Retrospective cohort study. Forty patients, age 18-65, with open diaphyseal tibial fractures with a bone gap of 10-50 mm on ≥50% of the circumference as measured on standard anteroposterior and lateral postoperative radiographs treated with IMN. IMN of an open diaphyseal tibial fracture with a bone gap. Level-1 trauma center. Healing outcomes, union or nonunion. Forty patients were analyzed. Twenty-one (52.5%) went on to nonunion and nineteen (47.5%) achieved union. Radiographic apparent bone gap (RABG) and infection were the only 2 covariates predicting nonunion outcome (P = 0.046 for infection). The RABG was determined by measuring the bone gap on each cortex and averaging over 4 cortices. Fractures achieving union had a RABG of 12 ± 1 mm versus 20 ± 2 mm in those going on to nonunion (P gaps have a higher probability of nonunion. Research investigating interventions for RABGs should use a predictive threshold for defining a critical bone defect that is associated with greater than 50% risk of nonunion without supplementary treatment. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  4. Outcome of intramedullary interlocking SIGN nail in tibial diaphyseal fracture

    International Nuclear Information System (INIS)

    Khan, I.; Javed, S.; Khan, G.N.; Aziz, A.

    2013-01-01

    Objective: To determine the outcome of intramedullary interlocking surgical implant generation network (SIGN) nail in diaphyseal tibial fractures in terms of union and failure of implant (breakage of nail or interlocking screws). Study Design: Case series. Place and Duration of Study: Orthopaedics and Spinal Surgery, Ghurki Trust Teaching Hospital, Lahore Medical and Dental College, Lahore, from September 2008 to August 2009. Methodology: Fifty patients aged 14 - 60 years, of either gender were included, who had closed and Gustilo type I and II open fractures reported in 2 weeks, whose closed reduction was not possible or was unsatisfactory and fracture was located 7 cm below knee joint to 7 cm above ankle joint. Fractures previously treated with external fixator, infected fractures and unfit patients were excluded. All fractures were fixed with intramedullary interlocking SIGN nail and were followed clinically and radiographically for union and for any implant failure. Results: Forty one (88%) patients had united fracture within 6 months, 5 (10%) patients had delayed union while 4 (8%) patients had non-union. Mean duration for achieving union was 163 + 30.6 days. Interlocking screws were broken in 2 patients while no nail was broken in any patient. Conclusion: Intramedullary interlocking nailing is an effective measure in treating closed and grade I and II open tibial fractures. It provides a high rate of union less complications and early return to function. (author)

  5. Outcome of intramedullary interlocking SIGN nail in tibial diaphyseal fracture.

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    Khan, Irfanullah; Javed, Shahzad; Khan, Gauhar Nawaz; Aziz, Amer

    2013-03-01

    To determine the outcome of intramedullary interlocking surgical implant generation network (SIGN) nail in diaphyseal tibial fractures in terms of union and failure of implant (breakage of nail or interlocking screws). Case series. Orthopaedics and Spinal Surgery, Ghurki Trust Teaching Hospital, Lahore Medical and Dental College, Lahore, from September 2008 to August 2009. Fifty patients aged 14 - 60 years, of either gender were included, who had closed and Gustilo type I and II open fractures reported in 2 weeks, whose closed reduction was not possible or was unsatisfactory and fracture was located 7 cm below knee joint to 7 cm above ankle joint. Fractures previously treated with external fixator, infected fractures and unfit patients were excluded. All fractures were fixed with intramedullary interlocking SIGN nail and were followed clinically and radiographically for union and for any implant failure. Forty one (88%) patients had united fracture within 6 months, 5 (10%) patients had delayed union while 4 (8%) patients had non-union. Mean duration for achieving union was 163 + 30.6 days. Interlocking screws were broken in 2 patients while no nail was broken in any patient. Intramedullary interlocking nailing is an effective measure in treating closed and grade I and II open tibial fractures. It provides a high rate of union less complications and early return to function.

  6. Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures.

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    Houben, I B; Raaben, M; Van Basten Batenburg, M; Blokhuis, T J

    2018-04-09

    The relation between timing of weight bearing after a fracture and the healing outcome is yet to be established, thereby limiting the implementation of a possibly beneficial effect for our patients. The current study was undertaken to determine the effect of timing of weight bearing after a surgically treated tibial shaft fracture. Surgically treated diaphyseal tibial fractures were retrospectively studied between 2007 and 2015. The timing of initial weight bearing (IWB) was analysed as a predictor for impaired healing in a multivariate regression. Totally, 166 diaphyseal tibial fractures were included, 86 cases with impaired healing and 80 with normal healing. The mean age was 38.7 years (range 16-89). The mean time until IWB was significantly shorter in the normal fracture healing group (2.6 vs 7.4 weeks, p bearing is independently associated with impaired fracture healing in surgically treated tibial shaft fractures. Unlike other factors such as fracture type or soft tissue condition, early resumption of weight bearing can be influenced by the treating physician and this factor therefore has a direct clinical relevance. This study indicates that early resumption of weight bearing should be the treatment goal in fracture fixation. 3b.

  7. Outcome of limb reconstruction system in open tibial diaphyseal fractures

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    Anand Ajmera

    2015-01-01

    Full Text Available Background: Management of open tibial diaphyseal fractures with bone loss is a matter of debate. The treatment options range from external fixators, nailing, ring fixators or grafting with or without plastic reconstruction. All the procedures have their own set of complications, like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, mal union, nonunion and higher patient dissatisfaction. We evaluated the outcome of the limb reconstruction system (LRS in the treatment of open fractures of tibial diaphysis with bone loss as a definative mode of treatment to achieve union, as well as limb lengthening, simultaneously. Materials and Methods: Thirty open fractures of tibial diaphysis with bone loss of at least 4 cm or more with a mean age 32.5 years were treated by using the LRS after debridement. Distraction osteogenesis at rate of 1 mm/day was done away from the fracture site to maintain the limb length. On the approximation of fracture ends, the dynamized LRS was left for further 15-20 weeks and patient was mobilized with weight bearing to achieve union. Functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI criteria. Results: Mean followup period was 15 months. The mean bone loss was 5.5 cm (range 4-9 cm. The mean duration of bone transport was 13 weeks (range 8-30 weeks with a mean time for LRS in place was 44 weeks (range 24-51 weeks. The mean implant index was 56.4 days/cm. Mean union time was 52 weeks (range 31-60 weeks with mean union index of 74.5 days/cm. Bony results as per the ASAMI scoring were excellent in 76% (19/25, good in 12% (3/25 and fair in 4% (1/25 with union in all except 2 patients, which showed poor results (8% with only 2 patients having leg length discrepancy more than 2.5 cm. Functional results were excellent in 84% (21/25, good in 8% (2/25, fair in 8% (2/25. Pin

  8. Outcome of limb reconstruction system in open tibial diaphyseal fractures.

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    Ajmera, Anand; Verma, Ankit; Agrawal, Mukul; Jain, Saurabh; Mukherjee, Arunangshu

    2015-01-01

    Management of open tibial diaphyseal fractures with bone loss is a matter of debate. The treatment options range from external fixators, nailing, ring fixators or grafting with or without plastic reconstruction. All the procedures have their own set of complications, like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, mal union, nonunion and higher patient dissatisfaction. We evaluated the outcome of the limb reconstruction system (LRS) in the treatment of open fractures of tibial diaphysis with bone loss as a definative mode of treatment to achieve union, as well as limb lengthening, simultaneously. Thirty open fractures of tibial diaphysis with bone loss of at least 4 cm or more with a mean age 32.5 years were treated by using the LRS after debridement. Distraction osteogenesis at rate of 1 mm/day was done away from the fracture site to maintain the limb length. On the approximation of fracture ends, the dynamized LRS was left for further 15-20 weeks and patient was mobilized with weight bearing to achieve union. Functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI) criteria. Mean followup period was 15 months. The mean bone loss was 5.5 cm (range 4-9 cm). The mean duration of bone transport was 13 weeks (range 8-30 weeks) with a mean time for LRS in place was 44 weeks (range 24-51 weeks). The mean implant index was 56.4 days/cm. Mean union time was 52 weeks (range 31-60 weeks) with mean union index of 74.5 days/cm. Bony results as per the ASAMI scoring were excellent in 76% (19/25), good in 12% (3/25) and fair in 4% (1/25) with union in all except 2 patients, which showed poor results (8%) with only 2 patients having leg length discrepancy more than 2.5 cm. Functional results were excellent in 84% (21/25), good in 8% (2/25), fair in 8% (2/25). Pin tract infection was seen in 5 cases, out of which 4

  9. Management of tibial fractures using a circular external fixator in two calves.

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    Aithal, Hari Prasad; Kinjavdekar, Prakash; Amarpal; Pawde, Abhijit Motiram; Singh, Gaj Raj; Setia, Harish Chandra

    2010-07-01

    To report the repair of tibial diaphyseal fractures in 2 calves using a circular external skeletal fixator (CEF). Clinical report. Crossbred calves (n=2; age: 6 months; weight: 55 and 60 kg). Mid-diaphyseal tibial fractures were repaired by the use of a 4-ring CEF (made of aluminum rings with 2 mm K-wires) alone in 1 calf and in combination with hemicerclage wiring in 1 calf. Both calves had good weight bearing with moderate lameness postoperatively. Fracture healing occurred by day 60 in 1 calf and by day 30 in calf 2. The CEF was well maintained and tolerated by both calves through fracture healing. Joint mobility and limb usage improved gradually after CEF removal. CEF provided a stable fixation of tibial fractures and healing within 60 days and functional recovery within 90 days. CEF can be safely and successfully used for the management of selected tibial fractures in calves.

  10. Tibial shaft fractures in football players

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    Daisley Susan

    2007-06-01

    Full Text Available Abstract Background Football is officially the most popular sport in the world. In the UK, 10% of the adult population play football at least once a year. Despite this, there are few papers in the literature on tibial diaphyseal fractures in this sporting group. In addition, conflicting views on the nature of this injury exist. The purpose of this paper is to compare our experience of tibial shaft football fractures with the little available literature and identify any similarities and differences. Methods and Results A retrospective study of all tibial football fractures that presented to a teaching hospital was undertaken over a 5 year period from 1997 to 2001. There were 244 tibial fractures treated. 24 (9.8% of these were football related. All patients were male with a mean age of 23 years (range 15 to 29 and shin guards were worn in 95.8% of cases. 11/24 (45.8% were treated conservatively, 11/24 (45.8% by Grosse Kemp intramedullary nail and 2/24 (8.3% with plating. A difference in union times was noted, conservative 19 weeks compared to operative group 23.9 weeks (p Conclusion Our series compared similarly with the few reports available in the literature. However, a striking finding noted by the authors was a drop in the incidence of tibial shaft football fractures. It is likely that this is a reflection of recent compulsory FIFA regulations on shinguards as well as improvements in the design over the past decade since its introduction.

  11. The Changed Route of Anterior Tibial Artery due to Healed Fracture

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    Kemal Gökkuş

    2016-01-01

    Full Text Available We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia.

  12. Management of open tibial fractures – a regional experience

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    Townley, WA; Nguyen, DQA; Rooker, JC; Dickson, JK; Goroszeniuk, DZ; Khan, MS; Camp, D

    2010-01-01

    INTRODUCTION The treatment of soft-tissue injuries associated with tibial diaphyseal fractures presents a clinical challenge that is best managed by a combined plastic and orthopaedic surgery approach. The current study was undertaken to assess early treatment outcomes and burden of service provision across five regional plastic surgery units in the South-West of England. SUBJECTS AND METHODS We conducted a prospective 6-month audit of open tibial diaphyseal fracture management in five plastic surgery units (Bristol, Exeter, Plymouth, Salisbury, Swansea) with a collective catchment of 9.2 million people. Detailed data were collected on patient demographics, injury pattern, surgical management and outcome followed to discharge. RESULTS The study group consisted of 55 patients (40 male, 15 female). Twenty-two patients presented directly to the emergency department at the specialist hospital (primary group), 33 patients were initially managed at a local hospital (tertiary group). The mean time from injury to soft tissue cover was significantly less (P < 0.001) in the primary group (3.6 ± 0.8 days) than the tertiary group (10.8 ± 2.2 days), principally due to a delay in referral in the latter group (5.4 ±1.7 days). Cover was achieved with 39 flaps (19 free, 20 local), eight split skin grafts. Nine wounds closed directly or by secondary intention. There were 11 early complications (20%) including one flap failure and four infections. The overall mean length of stay was 17.5 ± 2.8 days. CONCLUSIONS Multidisciplinary management of severe open tibial diaphyseal may not be feasible at presentation of injury depending on local hospital specialist services available. Our results highlight the need for robust assessment, triage and senior orthopaedic review in the early post-injury phase. However, broader improvements in the management of lower limb trauma will additionally require further development of combined specialist trauma centres. PMID:21047449

  13. Exchange nailing for nonunion of diaphyseal fractures of the tibia: our results and an analysis of the risk factors for failure.

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    Tsang, S T J; Mills, L A; Frantzias, J; Baren, J P; Keating, J F; Simpson, A H R W

    2016-04-01

    The aim of this study was to identify risk factors for the failure of exchange nailing in nonunion of tibial diaphyseal fractures. A cohort of 102 tibial diaphyseal nonunions in 101 patients with a mean age of 36.9 years (15 to 74) were treated between January 1992 and December 2012 by exchange nailing. Of which 33 (32%) were initially open injuries. The median time from primary fixation to exchange nailing was 6.5 months (interquartile range (IQR) 4.3 to 9.8 months). The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to union. Univariate analysis and multiple regression were used to identify risk factors for failure to achieve union. Multiple causes for the primary nonunion were found for 28 (27%) tibiae, with infection present in 32 (31%). Six patients were lost to follow-up. Further surgical procedures were required in 35 (36%) nonunions. Other fixation modalities were required in five fractures. A single nail exchange procedure achieved union in 60/96 (63%) of all nonunions. Only 11 out of 31 infected nonunions (35.4%) healed after one exchange nail procedure. Up to five repeated exchange nailings, with or without bone grafting, ultimately achieved union in 89 (93%) fractures. The median time to union after exchange nailing was 8.7 months (IQR 5.7 to 14.0 months). Univariate analysis confirmed that an oligotrophic/atrophic pattern of nonunion (p = 0.002), a bone gap of 5 mm or more (p = 0.04) and infection (p exchange nailing Multiple regression analysis found that infection was the strongest predictor of failure (p Exchange nailing is an effective treatment for aseptic tibial diaphyseal nonunion. However, in the presence of severe infection with a highly resistant organism, or extensive sclerosis of the bone, other fixation modalities, such as Ilizarov treatment, should be considered. Exchange nailing is an effective treatment for aseptic tibial diaphyseal nonunion. ©2016 The British Editorial

  14. Closed Tibial shaft fractures treated with the Ilizarov method: A ten year case series.

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    May, Jonathan David; Paavana, Thumri; McGregor-Riley, Jonathan; Royston, Simon

    2017-07-01

    To review the outcomes of patients treated with the Ilizarov method for an isolated, closed, simple diaphyseal, Tibial fracture at our institution over the last decade. The Ilizarov frame database was used to identify 76 skeletally mature patients who sustained an isolated, closed, extra-articular, simple, diaphyseal Tibial fracture; the injury also known as a "nail-able Tibial fracture." The average age of the patient was 38 (17-70). All 76 patients progressed to union. The average time until union was 148 (55-398) days. The coronal and sagittal alignment was 3° (0-17°) and 4° (0-14°) respectively. No patient suffered from compartment syndrome. No patient developed septic arthritis. No patient had documented anterior knee pain or secondary knee specialist input post frame removal. On average, there were 9(4-29) follow up appointments and 10(5-26) radiographs post frame application. There is a 59% chance of a patient having a difficulty post frame application. The malunion rate was 5%. Persisting pinsite infection post frame removal occurred in 5 patients (6.5%). Drilling of the pinsite sequestrum resolved the infection in four of these patients, giving a deep infection rate of 1.3%. The Ilizarov method has a role to play in the treatment of simple closed Tibial shaft fractures in patients who need to kneel. Patient education is a priority however; the patient must be made aware of the difficulty rate associated with the Ilizarov method when compared to the complication profile of alternative treatments. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  15. Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia

    OpenAIRE

    Mustafa Seyhan; Olcay Guler; Mahir Mahirogullari; Ferdi Donmez; Arel Gereli; Serhat Mutlu

    2018-01-01

    Objectives: Intramedullary nailing is the treatment of choice for fractures of the tibial shaft, which might necessitate the nail removal due to complications in the long-term. Although considered as a low-risk procedure, intramedullary nail removal is also associated with certain complications. Here, we compared the most commonly used stainless steel and titanium nails with respect to the complications during removal and clinical outcome for intramedullary nailing of diaphyseal fractures of ...

  16. Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia

    OpenAIRE

    Seyhan, Mustafa; Guler, Olcay; Mahirogullari, Mahir; Donmez, Ferdi; Gereli, Arel; Mutlu, Serhat

    2018-01-01

    Objectives Intramedullary nailing is the treatment of choice for fractures of the tibial shaft, which might necessitate the nail removal due to complications in the long-term. Although considered as a low-risk procedure, intramedullary nail removal is also associated with certain complications. Here, we compared the most commonly used stainless steel and titanium nails with respect to the complications during removal and clinical outcome for intramedullary nailing of diaphyseal fractures of t...

  17. Ingenious method of external fixator use to maintain alignment for nailing a proximal tibial shaft fracture.

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    Behera, Prateek; Aggarwal, Sameer; Kumar, Vishal; Kumar Meena, Umesh; Saibaba, Balaji

    2015-09-01

    Fractures of the tibia are one of the most commonly seen orthopedic injuries. Most of them result from a high velocity trauma. While intramedullary nailing of tibial diaphyseal fractures is considered as the golden standard form of treatment for such cases, many metaphyseal and metaphyseal-diaphyseal junction fractures can also be managed by nailing. Maintenance of alignment of such fractures during surgical procedure is often challenging as the pull of patellar tendon tends to extend the proximal fragment as soon as one flexes the knee for the surgical procedure. Numerous technical modifications have been described in the literature for successfully nailing such fractures including semi extended nailing, use of medial plates and external fixators among others. In this study, it was aimed to report two cases in which we used our ingenious method of applying external fixator for maintaining alignment of the fracture and aiding in the entire process of closed intramedullary nailing of metaphyseal tibial fractures by the conventional method. We were able to get good alignment during and after the closed surgery as observed on post-operative radiographs and believe that further evaluation of this technique may be of help to surgeons who want to avoid other techniques.

  18. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level...... with only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...... fixator, both during treatment and at 19 months following injury. In general, the thesis demonstrates that the treatment of tibial plateau fractures are challenging and that some disabilities following these fractures must be expected. Moreover, the need for further research in the area, both with regard...

  19. A PROSPECTIVE STUDY OF DISTAL TIBIAL FRACTURES BY MIPO (LCP

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    Chandra Sekharam Naidu

    2015-05-01

    contact . 9 MIPO promoted by AO group emphasis on indirect reduction, axial alignment and s table fixation without disturbing the fracture environment and thus preserving most of the vascularization and fracture haematoma, containing all necessary growth factors for bony healing. Technique of closed reduction and MIPPO with LCP has emerged as an alternative treatment option for distal dia - metaphyseal tibia fracture. When applied subcutaneously, LCP does not endanger periosteal blood supply, respect fracture heamtoma and also provides biomechanically stable construct. Several clinical studies have established MIPO with LCP as a biologically friendly and technically sound method of fixation for distal meta - diaphyseal tibial fracture.

  20. Collagen turnover after tibial fractures

    DEFF Research Database (Denmark)

    Joerring, S; Krogsgaard, M; Wilbek, H

    1994-01-01

    Collagen turnover after tibial fractures was examined in 16 patients with fracture of the tibial diaphysis and in 8 patients with fracture in the tibial condyle area by measuring sequential changes in serological markers of turnover of types I and III collagen for up to 26 weeks after fracture....... The markers were the carboxy-terminal extension peptide of type I procollagen (PICP), the amino-terminal extension peptide of type III procollagen (PIIINP), and the pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (ICTP). The latter is a new serum marker of degradation of type I...... collagen. A group comparison showed characteristic sequential changes in the turnover of types I and III collagen in fractures of the tibial diaphysis and tibial condyles. The turnover of type III collagen reached a maximum after 2 weeks in both groups. The synthesis of type I collagen reached a maximum...

  1. Forearm diaphyseal fractures in the adolescent population: treatment and management.

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    Truntzer, Jeremy; Vopat, Matthew L; Kane, Patrick M; Christino, Melissa A; Katarincic, Julia; Vopat, Bryan G

    2015-02-01

    Pediatric both-bone diaphyseal forearm fractures are commonly treated in a variety of clinical settings. Most often, closed reduction followed by immobilization leads to satisfactory results. However, in the adolescent population (10-16 years of age), forearm fractures are more challenging due to less remodeling potential. The purpose of this review was to provide an overview of the anatomy, biomechanics, and treatment options relevant to adolescent patients. A systematic review of peer-reviewed publications and abstracts related to the treatment for pediatric both-bone diaphyseal forearm fractures in adolescents was carried out. Forearm fractures in the pediatric population are most common following indirect blows to the forearm. When treating these fractures using closed reduction, it is important to recognize the muscular attachments of the forearm. In roughly 70-90% of cases, closed reduction leads to adequate alignment. In all cases, return to function is the primary goal; however, exact alignment parameters remain controversial. In the adolescent population, surgical treatment has risen substantially in the last few decades. Intramedullary nailing and open reduction using plate fixation are the two most common operative techniques. Unfortunately, recent results have shown that nonunion, malunion, and overall complication rates are higher in older pediatric patients. Moreover, no consensus exists regarding one technique over another. Both-bone diaphyseal fractures in the adolescent population present unique challenges regarding optimal treatment, especially when considering surgical intervention. Further research is necessary to better understand indications for specific surgical treatment.

  2. Incidence of infection after early intramedullary nailing of open tibial shaft fractures stabilized with pinless external fixators

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    Kulshrestha Vikas

    2008-01-01

    Full Text Available Background: A major drawback of conventional fixator system is the penetration of fixator pins into the medullary canal. The pins create a direct link between the medullary cavity and outer environment, leading to higher infection rates on conversion to intramedullary nailing. This disadvantage is overcome by the AO pinless fixator, in which the trocar points are clamped onto the outer cortex without penetrating it. This study was designed to evaluate the role of AO pinless fixators in primary stabilization of open diaphyseal tibial fractures that received staged treatment because of delayed presentation or poor general condition. We also analyzed the rate of infection on early conversion to intramedullary nail. Materials and Methods: This study is a retrospective review of 30 open diaphyseal fractures of tibia, which were managed with primary stabilization with pinless fixator and early exchange nailing. Outcome was evaluated in terms of fracture union and rate of residual infection. The data were compared with that available in the literature. Results: All the cases were followed up for a period of 2 years. The study includes Gustilo type 1 (n=10, 14 Gustilo type 2 (n=14, and type3 (n=6 cases. 6 cases (20% had clamp site infection, 2 cases (6.7% had deep infection, and in 28 cases (93% the fracture healed and consolidated well. Conclusion: This study has highlighted the valuable role of pinless external fixator in the management of open tibial fractures in terms of safety and ease of application as well as the advantage of early conversion to intramedullary implant without the risk of deep infection.

  3. Return to sports after stress fractures of the tibial diaphysis: a systematic review.

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    Robertson, G A J; Wood, A M

    2015-06-01

    This review aims to provide information on the time taken to resume sport following tibial diaphyseal stress fractures (TDSFs). A systematic search of Medline, EMBASE, CINHAL, Cochrane, Web of Science, PEDro, Sports Discus, Scopus and Google Scholar was performed using the keywords 'tibial', 'tibia', 'stress', 'fractures', 'athletes', 'sports', 'non-operative', 'conservative', 'operative' and 'return to sport'. Twenty-seven studies were included: 16 reported specifically on anterior TDSFs and 5 on posterior TDSFs. The general principles were to primarily attempt non-operative management for all TDSFs and to consider operative intervention for anterior TDSFs that remained symptomatic after 3-6 months. Anterior TDSFs showed a prolonged return to sport. The best time to return to sport and the optimal management modalities for TDSFs remain undefined. Management of TDSFs should include a full assessment of training methods, equipment and diet to modify pre-disposing factors. Future prospective studies should aim to establish the optimal treatment modalities for TDSFs. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Incidence and epidemiology of tibial shaft fractures.

    Science.gov (United States)

    Larsen, Peter; Elsoe, Rasmus; Hansen, Sandra Hope; Graven-Nielsen, Thomas; Laessoe, Uffe; Rasmussen, Sten

    2015-04-01

    The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large and complete population and report the distribution of fracture classification, trauma mechanism and patient baseline demographics. Retrospective reviews of clinical and radiological records. A total of 196 patients were treated for 198 tibial shaft fractures in the years 2009 and 2010. The mean age at time of fracture was 38.5 (21.2SD) years. The incidence of tibial shaft fracture was 16.9/100,000/year. Males have the highest incidence of 21.5/100,000/year and present with the highest frequency between the age of 10 and 20, whereas women have a frequency of 12.3/100,000/year and have the highest frequency between the age of 30 and 40. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. The majority of tibial shaft fractures occur during walking, indoor activity and sports. The distribution among genders shows that males present a higher frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type, representing 34% of all tibial shaft fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. TIBIAL PERIPROSTHETIC FRACTURE COMBINED WITH TIBIAL STEM STRESS FRACTURE FROM TOTAL KNEE ARTHROPLASTY

    OpenAIRE

    Fonseca, Fernando; Rebelo, Edgar; Completo, Antonio

    2011-01-01

    Total knee arthroplasty complications related to the prosthetic material are very rare, except for polyethylene wear. We report the case of a 58-year-old woman who came to the emergency service of our hospital with a periprosthetic tibial fracture (Mayo Clinic type I). Careful examination showed that this fracture was concomitantly associated with a tibial stem fatigue fracture. The prosthesis and the stem were sent to an independent biomechanics laboratory for evaluation. A finite-element CA...

  6. Paediatric diaphyseal femur fracture treated with intramedullary titanium elastic nail system

    Directory of Open Access Journals (Sweden)

    Shrawan Kumar Thapa

    2015-11-01

    Full Text Available noBackground & Objectives: Over the few years there has been a marked increase in the use of intramedullary fixation in the management of fracture of shaft of femur in children. The goals should be to stabilize the fracture, to control length and alignment, to promote bone healing and to minimize the morbidity and complications for the child. In this prospective study we intend to evaluate the functional and radiological outcome of diaphyseal fracture of shaft of femur treated with elastic intramedullary nail.Materials & Methods: All 56 patients with diaphyseal fracture shaft of femur were treated with titanium elastic nail and followed for period of 32 weeks.Results: The In this study, outcome was assessed by using Flynn’s criteria of titanium flexible nail outcome score and we found excellent result in 49 cases, satisfactory in six cases and poor in one case. We faced one major complication in form of implant failure and six minor complications inform of superficial wound infection.Conclusion: Elastic intramedullary nail used in treatment of diaphyseal fracture shaft of femur yield excellent functional and radiological outcome. It is easy and simple procedure has low rate of complication. It is physeal-protective, cost effective, does not involve heavy instrumentation and can be performed in small set up. It has minimal risk of infection and no risk of injury to the neurovascular structure.JCMS Nepal. 2015; 11(2:20-22

  7. Diaphyseal long bone nonunions - types, aetiology, economics, and treatment recommendations.

    Science.gov (United States)

    Rupp, Markus; Biehl, Christoph; Budak, Matthäus; Thormann, Ulrich; Heiss, Christian; Alt, Volker

    2018-02-01

    The intention of the current article is to review the epidemiology with related socioeconomic costs, pathophysiology, and treatment options for diaphyseal long bone delayed unions and nonunions. Diaphyseal nonunions in the tibia and in the femur are estimated to occur 4.6-8% after modern intramedullary nailing of closed fractures with an even much higher risk in open fractures. There is a high socioeconomic burden for long bone nonunions mainly driven by indirect costs, such as productivity losses due to long treatment duration. The classic classification of Weber and Cech of the 1970s is based on the underlying biological aspect of the nonunion differentiating between "vital" (hypertrophic) and "avital" (hypo-/atrophic) nonunions, and can still be considered to represent the basis for basic evaluation of nonunions. The "diamond concept" units biomechanical and biological aspects and provides the pre-requisites for successful bone healing in nonunions. For humeral diaphyseal shaft nonunions, excellent results for augmentation plating were reported. In atrophic humeral shaft nonunions, compression plating with stimulation of bone healing by bone grafting or BMPs seem to be the best option. For femoral and tibial diaphyseal shaft fractures, dynamization of the nail is an atraumatic, effective, and cheap surgical possibility to achieve bony consolidation, particularly in delayed nonunions before 24 weeks after initial surgery. In established hypertrophic nonunions in the tibia and femur, biomechanical stability should be addressed by augmentation plating or exchange nailing. Hypotrophic or atrophic nonunions require additional biological stimulation of bone healing for augmentation plating.

  8. External fixation of tibial pilon fractures and fracture healing.

    Science.gov (United States)

    Ristiniemi, Jukka

    2007-06-01

    Distal tibial fractures are rare and difficult to treat because the bones are subcutaneous. External fixation is commonly used, but the method often results in delayed union. The aim of the present study was to find out the factors that affect fracture union in tibial pilon fractures. For this purpose, prospective data collection of tibial pilon fractures was carried out in 1998-2004, resulting in 159 fractures, of which 83 were treated with external fixation. Additionally, 23 open tibial fractures with significant > 3 cm bone defect that were treated with a staged method in 2000-2004 were retrospectively evaluated. The specific questions to be answered were: What are the risk factors for delayed union associated with two-ring hybrid external fixation? Does human recombinant BMP-7 accelerate healing? What is the role of temporary ankle-spanning external fixation? What is the healing potential of distal tibial bone loss treated with a staged method using antibiotic beads and subsequent autogenous cancellous grafting compared to other locations of the tibia? The following risk factors for delayed healing after external fixation were identified: post-reduction fracture gap of >3 mm and fixation of the associated fibula fracture. Fracture displacement could be better controlled with initial temporary external fixation than with early definitive fixation, but it had no significant effect on healing time, functional outcome or complication rate. Osteoinduction with rhBMP-7 was found to accelerate fracture healing and to shorten the sick leave. A staged method using antibiotic beads and subsequent autogenous cancellous grafting proved to be effective in the treatment of tibial bone loss. Healing potential of the bone loss in distal tibia was at least equally good as in other locations of the tibia.

  9. Management of simple (types A and B) closed tibial shaft fractures using percutaneous lag-screw fixation and Ilizarov external fixation in adults.

    Science.gov (United States)

    El-Sayed, Mohamed; Atef, Ashraf

    2012-10-01

    Although intramedullary fixation of closed simple (type A or B) diaphyseal tibial fractures in adults is well tolerated by patients, providing lower morbidity rates and better mobility, it is associated with some complications. This study evaluated the results of managing these fractures using percutaneous minimal internal fixation using one or more lag screws, and Ilizarov external fixation. This method was tested to evaluate its efficacy in immediate weight bearing, fracture healing and prevention of any post-immobilisation stiffness of the ankle and knee joints. This randomised blinded study was performed at a referral, academically supervised, level III trauma centre. Three hundred and twenty-four of the initial 351 patients completed this study and were followed up for a minimum of 12 (12-88) months. Patient ages ranged from 20 to 51 years, with a mean of 39 years. Ankle and knee movements and full weight bearing were encouraged immediately postoperatively. Solid union was assessed clinically and radiographically. Active and passive ankle and knee ranges of motion were measured and compared with the normal side using the Wilcoxon signed rank test for matched pairs. Subjective Olerud and Molander Ankle Score was used to detect any ankle joint symptoms at the final follow-up. No patient showed delayed or nonunion. All fractures healed within 95-129 days. Based on final clinical and radiographic outcomes, this technique proves to be adequate for managing simple diaphyseal tibial fractures. On the other hand, it is relatively expensive, technically demanding, necessitates exposure to radiation and patients are expected to be frame friendly.

  10. Incidence and epidemiology of tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Hansen, Sandra Hope

    2015-01-01

    Introduction: The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large....... The mean age at time of fracture was 38.5 (21.2SD) years. The incidence of tibial shaft fracture was 16.9/100,000/year. Males have the highest incidence of 21.5/100,000/year and present with the highest frequency between the age of 10 and 20, whereas women have a frequency of 12.3/100,000/year and have...... frequency of fractures while participating in sports activities and walking. Women present the highest frequency of fractures while walking and during indoor activities. Conclusion: This study shows an incidence of 16.9/100,000/year for tibial shaft fractures. AO-type 42-A1 was the most common fracture type...

  11. Feasibility of a reduction protocol in the emergency department for diaphyseal forearm fractures in children.

    Science.gov (United States)

    Pesenti, S; Litzelmann, E; Kahil, M; Mallet, C; Jehanno, P; Mercier, J-C; Ilharreborde, B; Mazda, K

    2015-09-01

    Diaphyseal forearm fractures are very common pediatric traumas. At present, distal radius metaphyseal fractures are often successfully treated with closed reduction by emergency physicians. However, the management of diaphyseal fractures remains controversial. The purpose of this study was to analyze the results of diaphyseal forearm fractures in the emergency department (ED) in children. In a prospective 2-year-study, all closed diaphyseal forearm fractures in patients under 15, with an angle of >15° and treated by closed reduction in the ED were included. Fractures with overlapping fragments were excluded. Reduction was performed by an emergency physician, with a standardized analgesic protocol (painkillers and nitrous oxide). Clinical tolerance was checked within the first 24hours, and the radiographic stability of reduction was assessed at days 8 and 15. Initial and final follow-up radiographs were analyzed. Elbow and wrist range of motion was assessed at the final follow-up. Sixty patients (41 boys and 19 girls) were included. Mean age was 5.2 years old (±3). At initial evaluation, the maximum angle was 30° (±11.3). After reduction, the maximum angle was significantly reduced (30° vs. 5°, P<0.001). Mean immobilization in a cast was 11.7 weeks (±2). There were no cast related complications in any of these children. There was no surgery for secondary displacement. Full range of motion was obtained in all patients at the final follow-up. The outcome of conservative treatment of closed diaphyseal forearm fractures, without overlapping fragments was excellent. However, reduction is usually performed in the operating room by orthopedic surgeons under general anesthesia and requires hospitalization, which is very expensive. The results of this study show that high quality care may be obtained in the ED by a trained and experienced team. These results are similar to those for distal metaphyseal fractures, which could extend the indications for reduction in the

  12. Tibial bone fractures occurring after medioproximal tibial bone grafts for oral and maxillofacial reconstruction.

    Science.gov (United States)

    Kim, Il-Kyu; Cho, Hyun-Young; Pae, Sang-Pill; Jung, Bum-Sang; Cho, Hyun-Woo; Seo, Ji-Hoon

    2013-12-01

    Oral and maxillofacial defects often require bone grafts to restore missing tissues. Well-recognized donor sites include the anterior and posterior iliac crest, rib, and intercalvarial diploic bone. The proximal tibia has also been explored as an alternative donor site. The use of the tibia for bone graft has many benefits, such as procedural ease, adequate volume of cancellous and cortical bone, and minimal complications. Although patients rarely complain of pain, swelling, discomfort, or dysfunction, such as gait disturbance, both patients and surgeons should pay close attention to such after effects due to the possibility of tibial fracture. The purpose of this study is to analyze tibial fractures that occurring after osteotomy for a medioproximal tibial graft. An analysis was intended for patients who underwent medioproximal tibial graft between March 2004 and December 2011 in Inha University Hospital. A total of 105 subjects, 30 females and 75 males, ranged in age from 17 to 78 years. We investigated the age, weight, circumstance, and graft timing in relation to tibial fracture. Tibial fractures occurred in four of 105 patients. There were no significant differences in graft region, shape, or scale between the fractured and non-fractured patients. Patients who undergo tibial grafts must be careful of excessive external force after the operation.

  13. Preexisting lesions associated with complete diaphyseal fractures of the third metacarpal bone in 12 Thoroughbred racehorses.

    Science.gov (United States)

    Gray, Sarah N; Spriet, Mathieu; Garcia, Tanya C; Uzal, Francisco A; Stover, Susan M

    2017-07-01

    We characterized features of complete diaphyseal fractures of third metacarpal bones in Thoroughbred racehorses. Given that stress fractures are known to occur in the third metacarpal bone, an additional aim was to determine if complete fractures are associated with signs of a preexisting incomplete stress fracture. Bilateral metacarpi from 12 Thoroughbred racehorses euthanized because of complete unilateral metacarpal diaphyseal fracture were examined visually and radiographically. Open, comminuted, transverse or short oblique fractures occurred in the middle of the diaphysis or supracondylar region. Periosteal surface discoloration and bone callus formation contiguous with the fracture line were present in fractured bones. All contralateral intact metacarpi had gross anatomic lesions, and 10 had radiographic abnormalities similar to those observed on fractured metacarpi. Catastrophic metacarpal fractures occurred in racehorses with bilateral evidence of preexisting bone injury.

  14. Minimally invasive plate osteosynthesis for humerus diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    M Shantharam Shetty

    2011-01-01

    Full Text Available Background: Minimally invasive plate osteosynthesis (MIPO technique is reported as a satisfactory procedure for the treatment of humeral shaft fractures by the anterior approach by several authors. However, none of the published reports had a significant follow-up nor have they reported patient outcomes. We evaluated the clinical, radiographic, and functional outcome over a minimum follow-up of 2 years using the same MIPO technique to humeral shaft fracture. Materials and Methods: 32 adult patients with diaphyseal fractures of the humerus treated with MIPO between June 2007 and October 2008 were included in the study. Patients with metabolic bone disease, polytrauma, and Gustilo and Anderson type 3 open fractures with injury severity score >16 were excluded from the study. All cases were treated with closed indirect reduction and locking plate fixation using the MIPO technique. The surgery time, radiation exposure, and time for union was noted. The shoulder and elbow function was assessed using the UCLA shoulder and Mayo elbow performance scores, respectively. Results: Of the 32 patients in the study, 19 were males and 13 were females. The mean age was 39 years (range: 22-70 years. Twenty-seven of the thirty-two patients (84.3% had the dominant side fractured. We had eight cases of C2 type; five cases of C1 and A2 type; four cases of B2 type; three cases each of B3, B1, and A1 type; and one case of A3 type of fracture. The mean surgical time was 91.5 minutes (range: 70-120 minutes and mean radiation exposure was 160.3 seconds (range: 100-220 seconds. The mean radiological fracture union time was 12.9 weeks (range: 10-20 weeks. Shoulder function was excellent in 27 cases (84.3% and good in remaining 5 cases (15.6% on the UCLA score. Elbow function was excellent in 26 cases (81.2%, good in 5 cases (15.6%, and fair in 1 case (3.1% who had an associated olecranon fracture that was fixed by tension band wire in the same sitting. Conclusion: MIPO of

  15. [Surgical approaches to tibial plateau fractures].

    Science.gov (United States)

    Krause, Matthias; Müller, Gunnar; Frosch, Karl-Heinz

    2018-06-06

    Intra-articular tibial plateau fractures can present a surgical challenge due to complex injury patterns and compromised soft tissue. The treatment goal is to spare the soft tissue and an anatomical reconstruction of the tibial articular surface. Depending on the course of the fracture, a fracture-specific access strategy is recommended to provide correct positioning of the plate osteosynthesis. While the anterolateral approach is used in the majority of lateral tibial plateau fractures, only one third of the joint surface is visible; however, posterolateral fragments require an individual approach, e. g. posterolateral or posteromedial. If necessary, osteotomy of the femoral epicondyles can improve joint access for reduction control. Injuries to the posterior columns should be anatomically reconstructed and biomechanically correctly addressed via posterior approaches. Bony posterior cruciate ligament tears can be refixed via a minimally invasive posteromedial approach.

  16. Ilizarov′s method for treatment of nonunion of diaphyseal fractures of the humerus

    Directory of Open Access Journals (Sweden)

    Kiran Manish

    2010-01-01

    Full Text Available Background: Nonunion in diaphyseal fractures of the humerus can be treated by various modalities like plating and bone grafting, exchange nailing, fibular strut grafting and Ilizarov′s method of ring fixation. To achieve union in infected nonunion in which multiple surgeries have already been done is further challenging. We conducted a prospective study wherein the outcome of the treatment of nonunion of diaphyseal fractures of the humerus by Ilizarov′s method was analyzed. Materials and Methods: Nineteen patients with diaphyseal nonunion of the humerus were treated by Ilizarov′s external fixator. These included nonunion after plating (n=11, intramedullary nailing (n=1 or conservative methods (n=7. In post-surgical infected nonunion (n=6, the implants were removed, debridement done, bone fragments were docked followed by application of ring fixator and compression. In aseptic nonunion (n=13, distraction for three weeks followed by compression was the protocol. Early shoulder and elbow physiotherapy was instituted. The apparatus was removed after clinical and radiological union and the results were assessed for bone healing and functional status. Results: Fracture union was achieved in all the 19 cases. Pin site infection was seen in 2 cases (10.52%. The bone healing results were excellent in eighteen cases (94.73% and good in one case (5.26%.The functional results were found to be excellent in fourteen cases (73.68%, good in four (21.05% and fair in one case (5.26%. Conclusion: Ilizarov′s method is an excellent option for treatment of septic and aseptic non union of diaphyseal fractures of the humerus as it addresses all the problems associated with non union of the humerus like infection, deformity and joint stiffness.

  17. Incomplete linear tibial fractures in two horses

    International Nuclear Information System (INIS)

    Johnson, P.J.; Allhands, R.V.; Baker, G.J.; Boero, M.J.; Foreman, J.H.; Hyyppa, T.; Huhn, J.C.

    1988-01-01

    Incomplete linear tibial fractures were identified in two horses with the aid of scintigraphy. Both horses were treated successfully by strict stall confinement, and both returned to normal athletic activity. Scintigraphy can be used to facilitate the generally difficult diagnosis of incomplete tibial fractures

  18. Pseudoarthrosis of medial tibial plateau fracture-role of alignment procedure

    Directory of Open Access Journals (Sweden)

    Devgan Ashish

    2013-04-01

    Full Text Available 【Abstract】 Nonunion in tibial plateau fractures is very rare. Limited literature is available on Pubmed search on intraarticular tibial nonunion. Most of the cases reported have been following failed surgical treatment and none was neglected fractures. Three patients of isolated and neglected medial tibial plateau nonunion with almost similar demo-graphic profile are reported in this paper. All the three pa-tients were managed by minimally invasive compression fixation using lag screws supplemented with limb realign-ment procedure of high tibial osteotomy. We discussed the injury mechanism, management and rehabilitation in such cases and reviewed the available literature regarding such a presentation. Key words: Fracture healing; Tibial fractures; Frac-ture fixation; Osteotomy

  19. Comparison of tibial shaft ski fractures in children and adults.

    Science.gov (United States)

    Hamada, Tomo; Matsumoto, Kazu; Ishimaru, Daichi; Sumi, Hiroshi; Shimizu, Katsuji

    2014-09-01

    To examine whether child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures. Descriptive epidemiological study. Prospectively analyzed the epidemiologic factors, injury types, and injury mechanisms at Sumi Memorial Hospital. This study analyzed information obtained from 276 patients with tibial fractures sustained during skiing between 2004 and 2012. We focused on 174 ski-related tibial shaft fractures with respect to the following factors: age, gender, laterality of fracture, skill level, mechanism of fracture (fall vs collision), scene of injury (steepness of slope), snow condition, and weather. Fracture pattern was graded according to Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification and mechanical direction [external (ER) or internal rotation (IR)]. Tibial shaft fractures were the most common in both children (89.3%) and adults (47.4%). There were no significant differences in gender, side of fracture, mechanism of fracture, snow condition, or weather between children and adults. Skill levels were significantly lower in children than in adults (P differences in some of these parameters, suggesting that child and adult skiers have different risk factors or mechanisms of injury for tibial shaft fractures.

  20. "Effect of Hydroxyapatite to Load Failure Value in Rat with Diaphyseal Femur Fracture"

    OpenAIRE

    Rinartha, Adi Surya; Rahyussalim, Rahyussalim

    2011-01-01

    Introduction. Calcium hydroxyapatite are non organic compound of the bone formed the fracture healing. In fracture healing, the parts of the compounds make up unordinary scaffold and producing an incredible amount of me- senchymal stem cell under bearing of the scaffold. This study is aimed to determine the effect of hydroxyapatite administration to load failure value in mice with diaphyseal femur fracture. Materials and methods. Research was done using Sprague Dawley rat undergone ...

  1. Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures.

    Science.gov (United States)

    Tisherman, R T; Hoellwarth, J S; Mendelson, S A

    2018-04-01

    Paediatric femur fractures are commonly encountered and often successfully managed with spica casting. Despite spica casting's long history there is little formal guidance for optimal outcomes and no consolidation of existing literature. The purpose of this study is to review the available literature regarding the use of spica casting for the management of paediatric diaphyseal femur fractures. The PubMed database was queried for all research articles including the phrase "spica". A total of 788 abstracts were reviewed for relevance to the current study. Data was extracted from all available research studies which specified tolerance for fracture angulation or shortening in the cast. Additionally, all articles describing alternative materials, methods for spica application, and complications of spica casting were reviewed. In all, 106 articles were found relevant to the management of diaphyseal femur fractures in the paediatric population. The aggregated, accepted fracture shortening decreased from 16 mm to 18 mm before age ten years to 12 mm to 14 mm after puberty. Aggregated, accepted angulation decreased from 14° to 16° varus/valgus and 18° to 22° pro/recurvatum before age two years, to 6° to 8° and 10° to 12° by puberty, respectively. The overall reported complication rate was 19.6%, with the most common complication being skin compromise in 8.2% of patients, followed by unacceptable angulation at the fracture site in 4.2% of patients and excessive limb shortening in 1.9% of patients. This article reviews the available spica casting literature and compiles the available data. Spica casting offers a safe, effective means for definitive management of paediatric diaphyseal femur fractures. Future research identifying the rate and pattern of remodelling as it relates to angulation and shortening at various patient ages, particularly beyond the aforementioned norms, would be valuable to identify true biological tolerances versus accepted expert opinion

  2. Critical differences between subtrochanteric and diaphyseal atypical femoral fractures: analyses of 51 cases at a single institution in Korean population.

    Science.gov (United States)

    Cho, Yoon-Je; Kang, Kyung-Chung; Chun, Young-Soo; Rhyu, Kee Hyung; Kim, Sang-Jun; Jang, Tae-Su

    2018-05-03

    There still remains controversy on the pathomechanism of atypical femoral fracture (AFF). The angle of lateral bowing and bone mineral density showed significant differences between subtrochanteric and diaphyseal atypical fracture groups. In addition to the use of bisphosphonate, mechanical factors might play important roles in the occurrence of AFFs. Although AFF could be divided into subtrochanteric and diaphyseal fracture according to the location of fractures, there is a lack of evidence regarding differences between two fractures and etiology of the occurrence. The aim of study is to determine differences between atypical subtrochanteric and diaphyseal fracture in Korean population. Between February 2010 and March 2015, 51 AFFs in 40 patients were included in this study. Their medical records were retrospectively reviewed. The AFF patients satisfied all the diagnostic criteria of the 2014 revised edition of the ASMBR. To analyze the differences according to the location of fracture, the AFFs were divided into subtrochanteric (n = 16) and diaphyseal (n = 35) fracture groups. The following factors were compared between two groups: patients' demographics, underlying diseases, laboratory findings (serum-25(OH) VitD3, osteocalcin, c-telopeptide, ALP, Ca, and P), bone mineral density (BMD), duration of bisphosphonate (BP) usage, and lateral bowing of the femur at time of the fracture. All AFFs happened in female patients (mean age, 73.8 years) who have received bisphosphonate treatments except three patients. The mean duration of bisphosphonate usage was 95.3 months. Between the two groups, demographic data (age, height, weight, and BMI), underlying diseases, laboratory findings, hip BMD, and duration of BP treatment were comparable to each other (p > 0.05). However, the subtrochanteric fracture group showed higher FNSBA (femoral neck shaft bowing angle, p group. Angle of lateral bowing (FNSBA) and spine BMD showed significant differences between

  3. Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study.

    Science.gov (United States)

    Yukata, Kiminori; Yamanaka, Issei; Ueda, Yuzuru; Nakai, Sho; Ogasa, Hiroyoshi; Oishi, Yosuke; Hamawaki, Jun-Ichi

    2017-06-18

    To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging (MRI). A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years (range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fracture and the geometry of the tibial plateau were reviewed and measured on MRI. Thirteen of 14 stress fractures were linear, and one of them stellated on MRI images. The location of fractures was classified into three types. Three fractures were located anteromedially (AM type), six posteromedially (PM type), and five posteriorly (P type) at the medial tibial plateau. In addition, tibial posterior slope at the medial tibial plateau tended to be larger when the fracture was located more posteriorly on MRI. We found that MRI showed three different localizations of medial tibial plateau stress fractures, which were associated with tibial posterior slope at the medial tibial plateau.

  4. Pathomorphism of spiral tibial fractures in computed tomography imaging.

    Science.gov (United States)

    Guzik, Grzegorz

    2011-01-01

    Spiral fractures of the tibia are virtually homogeneous with regard to their pathomorphism. The differences that are seen concern the level of fracture of the fibula, and, to a lesser extent, the level of fracture of the tibia, the length of fracture cleft, and limb shortening following the trauma. While conventional radiographs provide sufficient information about the pathomorphism of fractures, computed tomography can be useful in demonstrating the spatial arrangement of bone fragments and topography of soft tissues surrounding the fracture site. Multiple cross-sectional computed tomography views of spiral fractures of the tibia show the details of the alignment of bone chips at the fracture site, axis of the tibial fracture cleft, and topography of soft tissues that are not visible on standard radiographs. A model of a spiral tibial fracture reveals periosteal stretching with increasing spiral and longitudinal displacement. The cleft in tibial fractures has a spiral shape and its line is invariable. Every spiral fracture of both crural bones results in extensive damage to the periosteum and may damage bellies of the long flexor muscle of toes, flexor hallucis longus as well as the posterior tibial muscle. Computed tomography images of spiral fractures of the tibia show details of damage that are otherwise invisible on standard radiographs. Moreover, CT images provide useful information about the spatial location of the bone chips as well as possible threats to soft tissues that surround the fracture site. Every spiral fracture of the tibia is associated with disruption of the periosteum. 1. Computed tomography images of spiral fractures of the tibia show details of damage otherwise invisible on standard radiographs, 2. The sharp end of the distal tibial chip can damage the tibialis posterior muscle, long flexor muscles of the toes and the flexor hallucis longus, 3. Every spiral fracture of the tibia is associated with disruption of the periosteum.

  5. Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia

    Directory of Open Access Journals (Sweden)

    Mustafa Seyhan

    2018-02-01

    Full Text Available Objectives: Intramedullary nailing is the treatment of choice for fractures of the tibial shaft, which might necessitate the nail removal due to complications in the long-term. Although considered as a low-risk procedure, intramedullary nail removal is also associated with certain complications. Here, we compared the most commonly used stainless steel and titanium nails with respect to the complications during removal and clinical outcome for intramedullary nailing of diaphyseal fractures of the tibia. Patients and methods: Sixty-two patients (26 females, 36 males were included in this retrospective study. Of the removed nails, 24 were of stainless steel and 38 of titanium. Preoperative and intraoperative parameters, such as implant discomfort, anterior knee pain, operating time and amount of bleeding, and postoperative outcomes were evaluated for each patient. Results: Titanium nail group had more, but not statistically significant, intraoperative complications than stainless steel group during the removal of nails (p = .4498. Operating time and amount of intraoperative bleeding were significantly higher in titanium group than stainless steel group (p = .0306 and p < .001, respectively. Preoperative SF-36 physical component and KSS scores were significantly lower in patients who had removal of titanium nails than those of stainless steel nails, whereas there was no difference in terms of postoperative SF-36 and KSS scores. Conclusion: In conclusion, although greater bone contact with titanium increases implant stability, nail removal is more difficult, resulting in more longer surgical operation and more intraoperative bleeding. Therefore, we do not recommend titanium nail removal in asymptomatic patients. Keywords: Fractures of tibial shaft, Removal of intramedullary nailing, Stainless steel nail, Titanium nail

  6. Bone stress in runners with tibial stress fracture.

    Science.gov (United States)

    Meardon, Stacey A; Willson, John D; Gries, Samantha R; Kernozek, Thomas W; Derrick, Timothy R

    2015-11-01

    Combinations of smaller bone geometry and greater applied loads may contribute to tibial stress fracture. We examined tibial bone stress, accounting for geometry and applied loads, in runners with stress fracture. 23 runners with a history of tibial stress fracture & 23 matched controls ran over a force platform while 3-D kinematic and kinetic data were collected. An elliptical model of the distal 1/3 tibia cross section was used to estimate stress at 4 locations (anterior, posterior, medial and lateral). Inner and outer radii for the model were obtained from 2 planar x-ray images. Bone stress differences were assessed using two-factor ANOVA (α=0.05). Key contributors to observed stress differences between groups were examined using stepwise regression. Runners with tibial stress fracture experienced greater anterior tension and posterior compression at the distal tibia. Location, but not group, differences in shear stress were observed. Stepwise regression revealed that anterior-posterior outer diameter of the tibia and the sagittal plane bending moment explained >80% of the variance in anterior and posterior bone stress. Runners with tibial stress fracture displayed greater stress anteriorly and posteriorly at the distal tibia. Elevated tibial stress was associated with smaller bone geometry and greater bending moments about the medial-lateral axis of the tibia. Future research needs to identify key running mechanics associated with the sagittal plane bending moment at the distal tibia as well as to identify ways to improve bone geometry in runners in order to better guide preventative and rehabilitative efforts. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Tibial Fractures in Alpine Skiing and Snowboarding in Finland: A Retrospective Study on Fracture Types and Injury Mechanisms in 363 Patients.

    Science.gov (United States)

    Stenroos, A; Pakarinen, H; Jalkanen, J; Mälkiä, T; Handolin, L

    2016-09-01

    Alpine skiing and snowboarding share the hazards of accidents accounting for tibial fractures. The aim of this study was to evaluate the fracture patterns and mechanisms of injury of tibial fractures taking place in downhill skiing and snowboarding. All patients with tibial fracture due to alpine skiing or snowboarding accident treated in four trauma centers next to the largest ski resorts in Finland were analyzed between 2006 and 2012. The hospital records were retrospectively reviewed for data collection: equipment used (skis or snowboard), age, gender, and mechanism of injury. Fractures were classified according to AO-classification. There were 342 skiing and 30 snowboarding related tibial fractures in 363 patients. Tibial shaft fracture was the most common fracture among skiers (n = 215, 63%), followed by proximal tibial fractures (n = 92, 27%). Snowboarders were most likely to suffer from proximal tibial fracture (13, 43%) or tibial shaft fracture (11, 37%). Snowboarders were also more likely than skiers to suffer complex AO type C fractures (23% vs 9%, p jumping (46%). The most important finding was the relatively high number of the tibial plateau fractures among adult skiers. The fracture patterns between snowboarding and skiing were different; the most common fracture type in skiers was spiral tibial shaft fracture compared to proximal tibial fractures in snowboarders. Children had more simple fractures than adults. © The Finnish Surgical Society 2016.

  8. Cartilaginous avulsion fracture of the tibial spine in a 5-year-old girl

    International Nuclear Information System (INIS)

    Kim, Jung Ryul; Song, Ji Hun; Lee, Ju Hong; Lee, Sang Yong; Yoo, Wan Hee

    2008-01-01

    Fractures of the tibial spine usually occur in children aged 8 to 14 years. Usually, radiographs will demonstrate a tibial spine fracture, with the degree of displacement. Tibial spine fractures in younger children have not been reported in the previously published literature. We report a tibial spine fracture that occurred in 5-year-old girl. The cartilaginous avulsion fracture of the tibial spine was not revealed by radiographs because it was limited to the cartilaginous portion of the proximal tibia. (orig.)

  9. Tibial stress fractures in racing Standardbreds: 13 cases (1989-1993)

    International Nuclear Information System (INIS)

    Ruggles, A.J.; Moore, R.M.; Bertone, A.L.; Schneider, R.K.; Bailey, M.Q.

    1996-01-01

    To determine clinical signs, radiographic and scintigraphic findings, and performance outcome of racing Standardbreds with tibial stress fractures. Retrospective case series. 13 racing Standardbreds with tibial stress fractures. Information concerning clinical signs, diagnostic evaluation, and recommendations was obtained by review of the medical records. Performance information before and after diagnosis of the fracture was collected from racing records, and follow-up information was obtained from the owners or trainers by use of a telephone questionnaire. Horses with tibial stress fractures were moderately lame, and diagnosis was made by nuclear scintigraphy and radiography. Fractures were more likely to occur in 2-year-old horses than in older horses. The fracture location was unique for Standardbreds; 11 of 13 developed stress fractures in the mid-diaphysis of the tibia, whereas fractures in Thoroughbreds are usually in the proximal caudal or caudolateral cortex. Fractures occurred in young horses that had raced or were in advanced race training. All horses were treated with rest alone, and 10 of 13 horses raced after injury. The horses that raced after injury were able to return to a level of performance that was equal to or better than the level raced before injury. 8 of 10 horses established a lifetime-best winning time after injury. Tibial stress fractures are a cause of lameness in young racing Standardbreds. Diagnosis is aided by nuclear scintigraphy. The prognosis for return to previous level of performance after a tibial stress fracture is good

  10. Primary Ankle Arthrodesis for Severely Comminuted Tibial Pilon Fractures.

    Science.gov (United States)

    Al-Ashhab, Mohamed E

    2017-03-01

    Management of severely comminuted, complete articular tibial pilon fractures (Rüedi and Allgöwer type III) remains a challenge, with few treatment options providing good clinical outcomes. Twenty patients with severely comminuted tibial pilon fractures underwent primary ankle arthrodesis with a retrograde calcaneal nail and autogenous fibular bone graft. The fusion rate was 100% and the varus malunion rate was 10%. Fracture union occurred at a mean of 16 weeks (range, 13-18 weeks) postoperatively. Primary ankle arthrodesis is a successful method for treating highly comminuted tibial pilon fractures, having a low complication rate and a high satisfaction score. [Orthopedics. 2017; 40(2):e378-e381.]. Copyright 2016, SLACK Incorporated.

  11. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Eiken, Pia; Eastell, Richard

    2009-01-01

    Alendronate (aln) is a potent bisphosphonate with a prolonged duration of action. Recent reports have found long-term aln use to be common in patients with subtrochanteric or proximal diaphyseal femur fracture, raising concerns that these fractures could be a consequence of excessive suppression...

  12. Treatment of segmental tibial fractures with supercutaneous plating.

    Science.gov (United States)

    He, Xianfeng; Zhang, Jingwei; Li, Ming; Yu, Yihui; Zhu, Limei

    2014-08-01

    Segmental tibial fractures usually follow a high-energy trauma and are often associated with many complications. The purpose of this report is to describe the authors' results in the treatment of segmental tibial fractures with supercutaneous locking plates used as external fixators. Between January 2009 and March 2012, a total of 20 patients underwent external plating (supercutaneous plating) of the segmental tibial fractures using a less-invasive stabilization system locking plate (Synthes, Paoli, Pennsylvania). Six fractures were closed and 14 were open (6 grade IIIa, 2 grade IIIb, 4 grade II, and 2 grade I, according to the Gustilo classification). When imaging studies confirmed bone union, the plates and screws were removed in the outpatient clinic. Average time of follow-up was 23 months (range, 12-47 months). All fractures achieved union. Median time to union was 19 weeks (range, 12-40 weeks) for the proximal fractures and 22 weeks (range, 12-42 weeks) for the distal fractures. Functional results were excellent in 17 patients and good in 3. Delayed union of the fracture occurred in 2 patients. All patients' radiographs showed normal alignment. No rotational deformities and leg shortening were seen. No incidences of deep infection or implant failures occurred. Minor screw tract infection occurred in 2 patients. A new 1-stage protocol using supercutaneous plating as a definitive fixator for segmental tibial fractures is less invasive, has a lower cost, and has a shorter hospitalization time. Surgeons can achieve good reduction, soft tissue reconstruction, stable fixation, and high union rates using supercutaneous plating. The current patients obtained excellent knee and ankle joint motion and good functional outcomes and had a comfortable clinical course. Copyright 2014, SLACK Incorporated.

  13. Epidemiology of metatarsal stress fractures versus tibial and femoral stress fractures during elite training.

    Science.gov (United States)

    Finestone, Aharon; Milgrom, Charles; Wolf, Omer; Petrov, Kaloyan; Evans, Rachel; Moran, Daniel

    2011-01-01

    The training of elite infantry recruits takes a year or more. Stress fractures are known to be endemic in their basic training and the clinical presentation of tibial, femoral, and metatarsal stress fractures are different. Stress fracture incidence during the subsequent progressively more demanding training is not known. The study hypothesis was that after an adaptation period, the incidence of stress fractures during the course of 1 year of elite infantry training would fall in spite of the increasingly demanding training. Seventy-six male elite infantry recruits were followed for the development of stress fractures during a progressively more difficult training program composed of basic training (1 to 14 weeks), advanced training (14 to 26 weeks), and unit training (26 to 52 weeks). Subjects were reviewed regularly and those with clinical suspicion of stress fracture were assessed using bone scan and X-rays. The incidence of stress fractures was 20% during basic training, 14% during advanced training and 23% during unit training. There was a statistically significant difference in the incidence of tibial and femoral stress fractures versus metatarsal stress fractures before and after the completion of phase II training at week 26 (p=0.0001). Seventy-eight percent of the stress fractures during phases I and II training were either tibial or femoral, while 91% of the stress fractures in phase III training were metatarsal. Prior participation in ball sports (p=0.02) and greater tibial length (p=0.05) were protective factors for stress fracture. The study hypothesis that after a period of soldier adaptation, the incidence of stress fractures would decrease in spite of the increasingly demanding elite infantry training was found to be true for tibial and femoral fractures after 6 months of training but not for metatarsal stress fractures. Further studies are required to understand the mechanism of this difference but physicians and others treating stress fractures

  14. A PROSPECTIVE STUDY OF DISTAL TIBIAL FRACTURES BY MIPO (LCP)

    OpenAIRE

    Chandra Sekharam Naidu; Ch.Murali Krishna; Sankara Rao; Dharma Rao; Ashok Kumar

    2015-01-01

    INTRODUCTION: D istal tibial fractures represent a significant challenge to most of the surgeons even today. They constitute 1 - 10% of all lower extremity fractures . 1 The difficulty in treating the fractures of distal tibial end is exemplif ied by orthopedists, who in the first half of twentieth century, believed these injuries were so severe and fraught with so many complications, that these fractures wer...

  15. Local and Widespread Hyperalgesia After Isolated Tibial Shaft Fractures Treated with Intramedullary Nailing

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Graven-Nielsen, Thomas

    2016-01-01

    OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months postopera...... fracture treated with intramedullary nailing, although no widespread (extrasegmental) hyperalgesia was detected. Such observations may be important for developing the most adequate rehabilitation procedure following a tibial fracture.......OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months...... postoperatively after intramedullary nailing of tibial shaft fracture. METHODS: A total of 39 patients were included in this 12-month follow-up study. After 6 weeks, 3, 6, and 12 months postoperatively the pain intensity was measured on a visual analog scale (VAS) and the pressure pain sensitivity was assessed...

  16. Osteosynthesis with long volar locking plates for meta- physeal-diaphyseal fractures of the distal radius

    Directory of Open Access Journals (Sweden)

    Gogna Paritosh

    2013-12-01

    Full Text Available 【Abstract】Objective: Metaphyseal-diaphyseal fractures of the distal radius are a major treatment dilemma and orthopaedic surgeons have to pay due consideration to restoration of anatomy of distal radius together with ro- tation of the radial shaft and maintenance of radial bow and interosseous space. We performed this study to evaluate the clinic-radiological outcome of metaphyseal-diaphyseal fractures of the distal radius treated with long volar locking plates. Methods: This prospective study involved 27 pa- tients (22 males and 5 females with metaphyseal-diaphy- seal fracture of the distal radius. Their mean age was (30.12± 11.48 years (range 19-52 years and the follow-up was 26.8 months (range 22-34 months. All patients underwent open reduction and internal fixation with a long volar locking plate. According to AO/OTA classification, there were 7 type A3, 13 type C2 and 7 type C3 fractures. Subjective assessment was done based on the disabilities of the arm, shoulder and hand (DASH questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist and the radiological determinants included radial angle, radial length, volar angle and ulnar variance. The final as- sessment was done according to Gartland and Werley scor- ing system. Results: Postoperative radiological parameters were well maintained throughout the trial, and there was signifi- cant improvement in the functional parameters from 6 weeks to final follow-up. The average DASH scores improved from 37.5 at 6 weeks to 4.2 at final follow-up. Final assessment using Gartland and Werley scoring system revealed 66.67% (n=18 excellent and 33.33% (n=9 good results. There was one case of superficial infection which responded to antibi- otics and another carpel tunnel syndrome which was ma- naged conservatively. Conclusion: Volar locking plate fixation for metaphy- seal-diaphyseal fractures of distal radius is associated with excellent to good

  17. Displaced tibial shaft fractures treated with ASIF compression internal fixation

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Larsen, T K; Petersen, O C

    1990-01-01

    Fifty-one tibial shaft fractures treated by ASIF compression osteosynthesis were seen at follow-up at a median time of 46 weeks after injury. Twenty-four were open fractures and the patients received prophylactic antibiotics. The median stay in hospital was 15 days for open fractures and 6 days f...... for closed fractures. There were complications in 26 cases, with deep infection in 9 cases. At present we cannot advocate the use of ASIF compression osteosynthesis for displaced tibial fractures....

  18. Double segmental tibial fractures - an unusual fracture pattern

    Directory of Open Access Journals (Sweden)

    Bali Kamal

    2012-02-01

    Full Text Available 【Abstract】A case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis tech- nique with a pleasing outcome. Key words: Fracture, bone; Tibia; Fibula; Nails

  19. Understanding the etiology of the posteromedial tibial stress fracture.

    Science.gov (United States)

    Milgrom, Charles; Burr, David B; Finestone, Aharon S; Voloshin, Arkady

    2015-09-01

    Previous human in vivo tibial strain measurements from surface strain gauges during vigorous activities were found to be below the threshold value of repetitive cyclical loading at 2500 microstrain in tension necessary to reduce the fatigue life of bone, based on ex vivo studies. Therefore it has been hypothesized that an intermediate bone remodeling response might play a role in the development of tibial stress fractures. In young adults tibial stress fractures are usually oblique, suggesting that they are the result of failure under shear strain. Strains were measured using surface mounted unstacked 45° rosette strain gauges on the posterior aspect of the flat medial cortex just below the tibial midshaft, in a 48year old male subject while performing vertical jumps, staircase jumps and running up and down stadium stairs. Shear strains approaching 5000 microstrain were recorded during stair jumping and vertical standing jumps. Shear strains above 1250 microstrain were recorded during runs up and down stadium steps. Based on predictions from ex vivo studies, stair and vertical jumping tibial shear strain in the test subject was high enough to potentially produce tibial stress fracture subsequent to repetitive cyclic loading without necessarily requiring an intermediate remodeling response to microdamage. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Tibial Eminence Involvement With Tibial Plateau Fracture Predicts Slower Recovery and Worse Postoperative Range of Knee Motion.

    Science.gov (United States)

    Konda, Sanjit R; Driesman, Adam; Manoli, Arthur; Davidovitch, Roy I; Egol, Kenneth A

    2017-07-01

    To examine 1-year functional and clinical outcomes in patients with tibial plateau fractures with tibial eminence involvement. Retrospective analysis of prospectively collected data. Academic Medical Center. All patients who presented with a tibial plateau fracture (Orthopaedic Trauma Association (OTA) 41-B and 41-C). Patients were divided into fractures with a tibial eminence component (+TE) and those without (-TE) cohorts. All patients underwent similar surgical approaches and fixation techniques for fractures. No tibial eminence fractures received fixation specifically. Short musculoskeletal functional assessment (SMFA), pain (Visual Analogue Scale), and knee range-of-motion (ROM) were evaluated at 3, 6, and 12 months postoperatively and compared between cohorts. Two hundred ninety-three patients were included for review. Patients with OTA 41-C fractures were more likely to have an associated TE compared with 41-B fractures (63% vs. 28%, P knee ROM (75.16 ± 51 vs. 86.82 ± 53 degree, P = 0.06). At 6 months, total SMFA and knee ROM was significantly worse in the +TE cohort (29 ± 17 vs. 21 ± 18, P ≤ 0.01; 115.6 ± 20 vs. 124.1 ± 15, P = 0.01). By 12 months postoperatively, only knee ROM remained significantly worse in the +TE cohort (118.7 ± 15 vs. 126.9 ± 13, P time points. Knee ROM remains worse throughout the postoperative period in the +TE cohort. Functional outcome improves less rapidly in the +TE cohort but achieves similar results by 1 year. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  1. Anterior tibial stress fractures treated with anterior tension band plating in high-performance athletes.

    Science.gov (United States)

    Cruz, Alexandre Santa; de Hollanda, João Paris Buarque; Duarte, Aires; Hungria Neto, José Soares

    2013-06-01

    The non-surgical treatment of anterior tibial cortex stress fractures requires long periods of abstention from sports activities and often results in non-union. Many different surgical techniques have already been previously described to treat these fractures, but there is no consensus on the best treatment. We describe the outcome of treatment using anterior tibial tension band plating in three high-performance athletes (4 legs) with anterior tibial cortex stress fractures. Tibial osteosynthesis with a 3.5-mm locking compression plate in the anterolateral aspect of the tibia was performed in all patients diagnosed with anterior tibial stress fracture after September 2010 at Santa Casa Hospital. All of the fractures were consolidated within a period of 3 months after surgery, allowing for an early return to pre-injury levels of competitive sports activity. There were no infection, non-union, malunion or anterior knee pain complications. Anterior tibial tension band plating leads to prompt fracture consolidation and is a good alternative for the treatment of anterior tibial cortex stress fractures. Bone grafts were shown to be unnecessary.

  2. In vivo biomechanical evaluation of a novel angle-stable interlocking nail design in a canine tibial fracture model.

    Science.gov (United States)

    Déjardin, Loïc M; Cabassu, Julien B; Guillou, Reunan P; Villwock, Mark; Guiot, Laurent P; Haut, Roger C

    2014-03-01

    To compare clinical outcome and callus biomechanical properties of a novel angle stable interlocking nail (AS-ILN) and a 6 mm bolted standard ILN (ILN6b) in a canine tibial fracture model. Experimental in vivo study. Purpose-bred hounds (n = 11). A 5 mm mid-diaphyseal tibial ostectomy was stabilized with an AS-ILN (n = 6) or an ILN6b (n = 5). Orthopedic examinations and radiographs were performed every other week until clinical union (18 weeks). Paired tibiae were tested in torsion until failure. Callus torsional strength and toughness were statistically compared and failure mode described. Total and cortical callus volumes were computed and statistically compared from CT slices of the original ostectomy gap. Statistical significance was set at P dogs (P dogs by 10 weeks and in 3/5 ILN6b dogs at 18 weeks. Callus mechanical properties were significantly greater in AS-ILN than ILN6b specimens by 77% (failure torque) and 166% (toughness). Failure occurred by acute spiral (control and AS-ILN) or progressive transverse fractures (ILN6b). Cortical callus volume was 111% greater in AS-ILN than ILN6b specimens (P < .05). Earlier functional recovery, callus strength and remodeling suggest that the AS-ILN provides a postoperative biomechanical environment more conducive to bone healing than a comparable standard ILN. © Copyright 2014 by The American College of Veterinary Surgeons.

  3. Flexible intramedullary nailing for femoral diaphyseal fractures in children

    Directory of Open Access Journals (Sweden)

    Rojan Tamrakar

    2017-12-01

    Full Text Available Background & Objectives: Although various treatment options are available for the treatment of femoral diaphyesal fractures in children, the titanium flexible nailing has gained popularity because it is safe, easy procedure with rapid recovery and high success rate. The aim of this study was to evaluate the outcome of titanium elastic nails in treating paediatric femoral diaphyesal fractures at Patan Hospital.Materials & Methods: There were 35 cases which were all fixed with titanium flexible intramedullary nail under image intensifier at the Patan hospital from January 2013 and December 2015. Patients were evaluated in follow-ups to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, implant failure, range of movement of hip and knee joints, and time to unite the fracture. The final results were evaluated using criteria of titanium elastic nail (TEN outcome score described by Flynn et al.Results: The mean age of the patients was 8.51 years. Among 35 patients (22 boys and 13 girls, there were 19 mid-shaft fractures, nine proximal third fractures and seven distal third fractures. Fracture patterns were transverse (22, oblique (10, spiral (2, and comminuted (2. The mean time for fracture union was 8.17 weeks radiologically whereas 9.83 weeks clinically. According to TEN outcome score, excellent and good results were in 28 cases (80% and seven cases (20% respectively.Conclusion: Flexible titanium nailing is a safe and satisfactory treatment for diaphyseal femoral fractures in children, because it provides rapid recovery, short rehabilitation and immobilization as well as very high union rate with few complications.

  4. Titanium elastic nailing in pediatric femoral diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    Singh Roop

    2006-01-01

    Full Text Available Background: The need for operative fixation of pediatric femoral fractures is increasingly being recognised in the present decade. The conventional traction and casting method for management of pediatric femoral fractures is giving way for the operative stabilisation of the fracture. Methods : Thirty five pediatric patients in age group 6-14 years with diaphyseal femoral fractures were stabilised with two titanium nails. Patients were followed up clinically and radiologically for two years. The final results were evaluated using the criteria of Flynn et al. Technical problems and complications associated with the procedure were also analysed. Results : Overall results observed were excellent in 25, satisfactory in 8 and poor in 2 patients. Hospital time averaged 12.30 days in the series. All the fractures healed with an average time to union of 9.6 (6-14.4 weeks. Return to school was early with an average of 7.8 weeks. The soft tissue discomfort near the knee produced by the nails ends was the most common problem encountered. Shortening was observed in three cases and restriction of knee flexion in 5 patients. There was no delayed union, infection or refractures. Per operative technical problems included failure of closed reduction in 2 cases and cork screwing of nails in one case. Conclusion : We believe that with proper operative technique and aftercare TENs may prove to be an ideal implant for pediatric femoral fracture fixation. The most of the complication associated with the procedure are infact features of inexact technique and can be eliminated by strictly adhering to the basic principles and technical aspects.

  5. Biomechanical study in vitro on the use of self-designed external fixator in diaphyseal III metacarpal fractures in horses.

    Science.gov (United States)

    Turek, B; Potyński, A; Wajler, C; Szara, T; Czopowicz, M; Drewnowska, O

    2015-01-01

    Diaphyseal fractures of the III metacarpal bone represent 22% of all fractures of the long bones in horses. Treatment of such cases is difficult. The most popular solution used in these types of fractures is two plates applied directly to the bone surface, but they are not applicable on contaminated and infected fractures. External fixators are quite commonly used in human medicine, although in veterinary practice there is no typical stabilizer designed for the treatment of diaphyseal fractures of the III metacarpal bone so far. In this study, an external semicircular fixator of our own design was used and in vitro strength tests were conducted to determine the maximum force which would lead to the destruction of non-fractured bone and fractured bone treated with the stabilizer. On the basis of the strength tests, we can conclude that the stabilizer can be strong enough to allow the horse to stand up after surgery. It also has many favorable features which make it easy to assemble and to take care of a wound, while being safe enough for the animal at the same time.

  6. Hybrid external fixation in the treatment of tibial pilon fractures: A retrospective analysis of 162 fractures.

    Science.gov (United States)

    Galante, Vito N; Vicenti, Giovanni; Corina, Gianfranco; Mori, Claudio; Abate, Antonella; Picca, Girolamo; Conserva, Vito; Speciale, Domenico; Scialpi, Lorenzo; Tartaglia, Nicola; Caiaffa, Vincenzo; Moretti, Biagio

    2016-10-01

    To determine the efficacy of hybrid external fixation in the treatment of tibial pilon fractures. Retrospective, multicentre study. Adult patients with tibial pilon fractures treated with hybrid external fixation. Fracture reduction with ligamentotaxis and fixation with XCaliber hybrid external fixator. Fracture union, complications, functional outcome (Mazur Ankle Score). Union was obtained in 159 fractures at an average of 125days; there were three delayed unions and three non-unions. The most frequent complication was superficial pin-track infections (48), all of which responded to local wound care and antibiotics. There were no deep infections and no DVT. Only one fracture had loss of reduction that required frame revision. The overall functional scores were 91 (excellent) for AO/OTA type A fractures, 89 (good) for type B fractures, and 75 (satisfactory) for type C fractures. Hybrid external fixation is an effective method of stabilising tibial pilon fractures, particularly those with marked comminution. The minimally-invasive technique and stable fixation enable early mobilisation, with good functional results and minimal complications. Level IV Case series. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures.

    Science.gov (United States)

    Zelle, Boris A; Boni, Guilherme

    2015-01-01

    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

  8. [Tibial plateau fractures in winter sports. Current treatment options].

    Science.gov (United States)

    Zimmermann, V

    2014-01-01

    Tibial plateau fractures overall and especially in winter sports are rare. However, the incidence in recent years is increasing. In a retrospective study from 2009-2012, we found 52 injuries affiliated with winter sports. Noticeable was the high rate of severe injury patterns. In 20 of the 52 cases, there were complete articular or bicondylar fractures (38 %). In 25 cases (48 %), fragment dislocation corresponding to the Moore classification was observed. The operative algorithm was based on the initial soft tissue damage and the type of fracture. A two or more stage procedure with first line soft tissue management and temporary external fixation stabilization was performed 12 times. The final internal osteosynthesis was based on the morphology of the fracture, i.e., direct exposition and stabilization of relevant fracture patterns. In 24 cases (46 %), there was a need for two (or more) approaches. In the anterior aspect of the tibial head, customary implants were used; posterior pathologies were stabilized with low-dimension implants. Summarizing with regard to the literature, there is a more discriminating view of tibial plateau fractures, regarding all relevant fracture patterns. Thus, different options in operative access and choice of implants can be made.

  9. Minimally-invasive plate osteosynthesis in distal tibial fractures: Results and complications.

    Science.gov (United States)

    Vidović, Dinko; Matejčić, Aljoša; Ivica, Mihovil; Jurišić, Darko; Elabjer, Esmat; Bakota, Bore

    2015-11-01

    Distal tibial or pilon fractures are usually the result of combined compressive and shear forces, and may result in instability of the metaphysis, with or without articular depression, and injury to the soft tissue. The complexity of injury, lack of muscle cover and poor vascularity make these fractures difficult to treat. Surgical treatment of distal tibial fractures includes several options: external fixation, IM nailing, ORIF and minimally-invasive plate osteosynthesis (MIPO). Management of distal tibial fractures with MIPO enables preservation of soft tissue and remaining blood supply. This is a report of a series of prospectively studied closed distal tibial and pilon fractures treated with MIPO. A total of 21 patients with closed distal tibial or pilon fractures were enrolled in the study between March 2008 and November 2013 and completed follow-up. Demographic characteristics, mechanism of injury, time required for union, ankle range of motion and complications were recorded. Fractures were classified according to the AO/OTA classification. Nineteen patients were initially managed with an ankle-spanning external fixator. When the status of the soft tissue had improved and swelling had subsided enough, a definitive internal fixation with MIPO was performed. Patients were invited for follow-up examinations at 3 and 6 weeks and then at intervals of 6 to 8 weeks until 12 months. Mean age of the patients was 40.1 years (range 19-67 years). Eighteen cases were the result of high-energy trauma and three were the result of low-energy trauma. According to the AO/OTA classification there were extraarticular and intraarticular fractures, but only simple articular patterns without depression or comminution. The average time for fracture union was 19.7 weeks (range 12-38 weeks). Mean range of motion was 10° of dorsiflexion (range 5-15°) and 28.3° of plantar flexion (range 20-35°). Three cases were metalwork-related complications. Two patients underwent plate removal

  10. Neglected, semimembranosus osteochondral avulsion fracture of the posteromedial tibial plateau

    Directory of Open Access Journals (Sweden)

    Rakesh John

    2018-06-01

    Full Text Available Semimembranosus avulsion fracture is infrequently reported and is easy to miss on plain radiographs; the mechanism of injury is highly controversial. Initial reports linked it to anterior cruciate ligament and medial meniscal tears. We report an osteochondral semimembranosus avulsion fracture of the posteromedial tibial plateau with associated posterior cruciate ligament rupture. Also described is a novel surgical fixation technique for such osteochondral fractures where the surgical exposure is limited due to the obliquity of the fracture line resulting in a greater involvement of the articular cartilage than the small bony component. The fixation technique described may be used for osteochondral fractures where the application of a conventional compression screw may not be feasible. Keywords: Osteochondral fracture, Semimembranosus avulsion fracture, Posteromedial tibial plateau, Neglected, Nonunion

  11. Quantitative analysis of scintigraphic findings in tibial stress fractures in Thoroughbred racehorses.

    Science.gov (United States)

    Valdés-Martínez, Alejandro; Seiler, Gabriela; Mai, Wilfried; Bolt, David M; Mudge, Margaret; Dukti, Sarah A; Hubert, Jeremy D

    2008-07-01

    To develop a quantitative method of interpreting tibial scintigrams of Thoroughbred racehorses with tibial stress fractures that may facilitate diagnosis of fractures and to provide prognostic information regarding future performance of affected horses. 35 Thoroughbred racehorses. Static bone-phase scintigrams of tibial stress fractures were quantitatively analyzed by use of ratios of the mean radionuclide counts per pixel in a region of interest (ROI) drawn around the area of increased uptake of radiopharmaceutical to mean counts per pixel in a second ROI drawn around an apparently normal area of the tibial diaphysis. In horses with unilateral fractures, ratios for the contralateral tibia were determined by use of 2 ROIs drawn at the same positions as the ROIs in the fractured tibia. Ratios were compared between fractured versus apparently normal tibias, between horses that returned to racing versus those that did not, and among horses with various grades of lameness. The association between ratios for fractured tibias and intervals between diagnosis and return to racing was also assessed. Mean ratio of ROIs in apparently normal tibias was 1.35 (95% confidence interval [CI], 1.21 to 1.50); that in tibias with stress fractures was 3.55 (95% CI, 2.50 to 4.60). These ratios were significantly different. None of the associations between ratios for fractured tibias and grades of lameness or performance outcomes were significant. Tibial stress fracture scintigrams can be quantitatively analyzed. A prospective study with a controlled rehabilitation period is necessary to evaluate the possible applications of this method.

  12. Adult tibial intercondylar eminence fracture: evaluation with MR imaging

    International Nuclear Information System (INIS)

    Toye, Leon R.; Cummings, Dean P.; Armendariz, Gus

    2002-01-01

    Tibial intercondylar eminence (TIE) fractures are well described in the pediatric orthopedic literature. Adult TIEs are much less common, and limited literature exists on the subject. Adult knee hyperextension injuries commonly result in anterior cruciate ligament (ACL) injury; however, with significant trauma, a TIE enters the differential diagnosis. Identification and classification of TIE fractures typically has been provided by radiography. The incidence of concomitant injuries with magnetic resonance (MR) imaging in patients with adult TIE fractures has not been determined. We present a case of an adult type III TIE fracture seen on radiography that only with further MR imaging revealed a concomitant lateral tibial plateau fracture. Utilization of MR imaging altered the surgeon's course of treatment and postoperative care. Radiographic and MR images and a review of the literature are provided. (orig.)

  13. TIBIAL SHAFT FRACTURES.

    Science.gov (United States)

    Kojima, Kodi Edson; Ferreira, Ramon Venzon

    2011-01-01

    The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical parameters and constant clinical monitoring. Once the diagnosis has been made, fasciotomy should be performed. It is always difficult to assess consolidation, but the RUST method may help in this. Radiography is assessed in two projections, and points are scored for the presence of the fracture line and a visible bone callus. Today, the dogma of six hours for cleaning the exposed fracture is under discussion. It is considered that an early start to intravenous antibiotic therapy and the lesion severity are very important. The question of early or late closure of the lesion in an exposed fracture has gone through several phases: sometimes early closure has been indicated and sometimes late closure. Currently, whenever possible, early closure of the lesion is recommended, since this diminishes the risk of infection. Milling of the canal when the intramedullary nail is introduced is still a controversial subject. Despite strong personal positions in favor of milling, studies have shown that there may be some advantage in relation to closed fractures, but not in exposed fractures.

  14. Evaluation of Fibular Fracture Type vs Location of Tibial Fixation of Pilon Fractures.

    Science.gov (United States)

    Busel, Gennadiy A; Watson, J Tracy; Israel, Heidi

    2017-06-01

    Comminuted fibular fractures can occur with pilon fractures as a result of valgus stress. Transverse fibular fractures can occur with varus deformation. No definitive guide for determining the proper location of tibial fixation exists. The purpose of this study was to identify optimal plate location for fixation of pilon fractures based on the orientation of the fibular fracture. One hundred two patients with 103 pilon fractures were identified who were definitively treated at our institution from 2004 to 2013. Pilon fractures were classified using the AO/OTA classification and included 43-A through 43-C fractures. Inclusion criteria were age of at least 18 years, associated fibular fracture, and definitive tibial plating. Patients were grouped based on the fibular component fracture type (comminuted vs transverse), and the location of plate fixation (medial vs lateral) was noted. Radiographic outcomes were assessed for mechanical failures. Forty fractures were a result of varus force as evidenced by transverse fracture of the fibula and 63 were due to valgus force with a comminuted fibula. For the transverse fibula group, 14.3% mechanical complications were noted for medially placed plate vs 80% for lateral plating ( P = .006). For the comminuted fibular group, 36.4% of medially placed plates demonstrated mechanical complications vs 16.7% for laterally based plates ( P = .156). Time to weight bearing as tolerated was also noted to be significant between groups plated medially and laterally for the comminuted group ( P = .013). Correctly assessing the fibular component for pilon fractures provides valuable information regarding deforming forces. To limit mechanical complications, tibial plates should be applied in such a way as to resist the original deforming forces. Level of Evidence Level III, comparative study.

  15. Bilateral periprosthetic tibial stress fracture after total knee arthroplasty: A case report.

    Science.gov (United States)

    Ozdemir, Guzelali; Azboy, Ibrahim; Yilmaz, Baris

    2016-01-01

    Periprosthetic fractures around the knee after total knee arthroplasty can be seen in the femur, tibia and patella. The tibial fractures are rare cases. Our case with bilateral tibial stress fracture developed after total knee arthroplasty (TKA) is the first of its kind in the literature. 75-year-old male patient with bilateral knee osteoarthritis had not benefited from conservative treatment methods previously applied. Left TKA was applied. In the second month postoperatively, periprosthetic tibial fracture was identified and osteosynthesis was implemented with locked tibia proximal plate-screw. Bone union in 12 weeks was observed in his follow-ups. After 15 months of his first operation, TKA was applied to the right knee. Postoperatively in the second month, as in the first operation, periprosthetic tibial fracture was detected. Osteosynthesis with locking plate-screw was applied and union in 12 weeks was observed in his follow-up. He was seen mobilized independently and without support in the last control of the case made in the 24th month after the second operation. The number of TKA applications is expected to increase in the future. The incidence of periprosthetic fractures should also be expected to increase in these cases. Periprosthetic tibial fractures after TKA are rarely seen. The treatment of periprosthetic fractures around the knee after TKA can be difficult. In the case of persistent pain in the upper end of the tibia after the surgery, stress fracture should be considered. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients

    OpenAIRE

    Gupta, Rakesh K.; Rohilla, Rajesh Kumar; Sangwan, Kapil; Singh, Vijendra; Walia, Saurav

    2009-01-01

    Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-...

  17. Proximal tibial fracture following anterior cruciate ligament reconstruction surgery: a biomechanical analysis of the tibial tunnel as a stress riser.

    Science.gov (United States)

    Aldebeyan, Wassim; Liddell, Antony; Steffen, Thomas; Beckman, Lorne; Martineau, Paul A

    2017-08-01

    This is the first biomechanical study to examine the potential stress riser effect of the tibial tunnel or tunnels after ACL reconstruction surgery. In keeping with literature, the primary hypothesis tested in this study was that the tibial tunnel acts as a stress riser for fracture propagation. Secondary hypotheses were that the stress riser effect increases with the size of the tunnel (8 vs. 10 mm), the orientation of the tunnel [standard (STT) vs. modified transtibial (MTT)], and with the number of tunnels (1 vs. 2). Tibial tunnels simulating both single bundle hamstring graft (8 mm) and bone-patellar tendon-bone graft (10 mm) either STT or MTT position, as well as tunnels simulating double bundle (DB) ACL reconstruction (7, 6 mm), were drilled in fourth-generation saw bones. These five experimental groups and a control group consisting of native saw bones without tunnels were loaded to failure on a Materials Testing System to simulate tibial plateau fracture. There were no statistically significant differences in peak load to failure between any of the groups, including the control group. The fracture occurred through the tibial tunnel in 100 % of the MTT tunnels (8 and 10 mm) and 80 % of the DB tunnels specimens; however, the fractures never (0 %) occurred through the tibial tunnel of the standard tunnels (8 or 10 mm) (P = 0.032). In the biomechanical model, the tibial tunnel does not appear to be a stress riser for fracture propagation, despite suggestions to the contrary in the literature. Use of a standard, more vertical tunnel decreases the risk of ACL graft compromise in the event of a fracture. This may help to inform surgical decision making on ACL reconstruction technique.

  18. Negative pressure wound therapy for Gustilo Anderson grade IIIb open tibial fractures

    Directory of Open Access Journals (Sweden)

    Chul Hyun Park

    2016-01-01

    Conclusion: Staged treatment using NPWT decreased the risks of infection and requirement of flap surgeries in Gustilo Anderson grade IIIb open tibial fractures. Therefore, staged treatment using NPWT could be a useful treatment option for Gustilo Anderson grade IIIb open tibial fractures.

  19. Computed tomography of tibial plateau fractures

    International Nuclear Information System (INIS)

    Rafii, M.; Firooznia, H.; Golimbu, C.; Bonamo, J.

    1984-01-01

    Twenty patients with tibial plateau fractures were studied by conventional tomography and computed tomography (CT) in order to determine the role and feasibility of CT in management of such patients. CT resulted in less discomfort to the patient and provided optimal visualization of the plateau defect and the split fragments. It proved more accurate than conventional tomography in assessing depressed and split fractures when they involved the anterior or posterior border of the plateau and in demonstrating the extent of fracture comminution. Split fragments with an oblique plane of fracture also were seen better by CT. The degree of fracture depression and separation as measured by the computerized technique was often more accurate than measurements obtained from conventional tomograms

  20. Complications during removal of stainless steel versus titanium nails used for intramedullary nailing of diaphyseal fractures of the tibia.

    Science.gov (United States)

    Seyhan, Mustafa; Guler, Olcay; Mahirogullari, Mahir; Donmez, Ferdi; Gereli, Arel; Mutlu, Serhat

    2018-02-01

    Intramedullary nailing is the treatment of choice for fractures of the tibial shaft, which might necessitate the nail removal due to complications in the long-term. Although considered as a low-risk procedure, intramedullary nail removal is also associated with certain complications. Here, we compared the most commonly used stainless steel and titanium nails with respect to the complications during removal and clinical outcome for intramedullary nailing of diaphyseal fractures of the tibia. Sixty-two patients (26 females, 36 males) were included in this retrospective study. Of the removed nails, 24 were of stainless steel and 38 of titanium. Preoperative and intraoperative parameters, such as implant discomfort, anterior knee pain, operating time and amount of bleeding, and postoperative outcomes were evaluated for each patient. Titanium nail group had more, but not statistically significant, intraoperative complications than stainless steel group during the removal of nails (p = .4498). Operating time and amount of intraoperative bleeding were significantly higher in titanium group than stainless steel group (p = .0306 and p titanium nails than those of stainless steel nails, whereas there was no difference in terms of postoperative SF-36 and KSS scores. In conclusion, although greater bone contact with titanium increases implant stability, nail removal is more difficult, resulting in more longer surgical operation and more intraoperative bleeding. Therefore, we do not recommend titanium nail removal in asymptomatic patients.

  1. Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures.

    Science.gov (United States)

    van den Berg, Juriaan; Reul, Maike; Nunes Cardozo, Menno; Starovoyt, Anastasiya; Geusens, Eric; Nijs, Stefaan; Hoekstra, Harm

    2017-09-01

    INTRODUCTION: Although regularly ignored, there is growing evidence that posterior tibial plateau fractures affect the functional outcome. The goal of this study was to assess the incidence of posterior column fractures and its impact on functional outcome and general health status. We aimed to identify all clinical variables that influence the outcome and improve insights in the treatment strategies. A retrospective cohort study including 218 intra-articular tibial plateau fractures was conducted. All fractures were reclassified and applied treatment was assessed according to the updated three-column concept. Relevant demographic and clinical variables were studied. The patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Median follow-up was 45.5 (IQR 24.9-66.2) months. Significant outcome differences between operatively and non-operatively treated patients were found for all KOOS subscales. The incidence of posterior column fractures was 61.9%. Posterior column fractures, sagittal malalignment and an increased complication rate were associated with poor outcome. Patients treated according to the updated three-column concept, showed significantly better outcome scores than those patients who were not. We could not demonstrate the advantage of posterior column fracture fixation, due to a limited patient size. Our data indicates that implementation of the updated three-column classification concept may improve the surgical outcome of tibial plateau fractures. Failure to recognize posterior column fractures may lead to inappropriate utilization of treatment techniques. The current concept allows us to further substantiate the importance of reduction and fixation of posterior column fractures with restoration of the sagittal alignment. 3.

  2. Outcomes of Surgical Treatment for Anterior Tibial Stress Fractures in Athletes: A Systematic Review.

    Science.gov (United States)

    Chaudhry, Zaira S; Raikin, Steven M; Harwood, Marc I; Bishop, Meghan E; Ciccotti, Michael G; Hammoud, Sommer

    2017-12-01

    Although most anterior tibial stress fractures heal with nonoperative treatment, some may require surgical management. To our knowledge, no systematic review has been conducted regarding surgical treatment strategies for the management of chronic anterior tibial stress fractures from which general conclusions can be drawn regarding optimal treatment in high-performance athletes. This systematic review was conducted to evaluate the surgical outcomes of anterior tibial stress fractures in high-performance athletes. Systematic review; Level of evidence, 4. In February 2017, a systematic review of the PubMed, MEDLINE, Cochrane, SPORTDiscus, and CINAHL databases was performed to identify studies that reported surgical outcomes for anterior tibial stress fractures. Articles meeting the inclusion criteria were screened, and reported outcome measures were documented. A total of 12 studies, published between 1984 and 2015, reporting outcomes for the surgical treatment of anterior tibial stress fractures were included in this review. All studies were retrospective case series. Collectively, surgical outcomes for 115 patients (74 males; 41 females) with 123 fractures were evaluated in this review. The overall mean follow-up was 23.3 months. The most common surgical treatment method reported in the literature was compression plating (n = 52) followed by drilling (n = 33). Symptom resolution was achieved in 108 of 123 surgically treated fractures (87.8%). There were 32 reports of complications, resulting in an overall complication rate of 27.8%. Subsequent tibial fractures were reported in 8 patients (7.0%). Moreover, a total of 17 patients (14.8%) underwent a subsequent procedure after their initial surgery. Following surgical treatment for anterior tibial stress fracture, 94.7% of patients were able to return to sports. The available literature indicates that surgical treatment of anterior tibial stress fractures is associated with a high rate of symptom resolution and return

  3. Medial tibial plateau morphology and stress fracture location: A magnetic resonance imaging study

    OpenAIRE

    Yukata, Kiminori; Yamanaka, Issei; Ueda, Yuzuru; Nakai, Sho; Ogasa, Hiroyoshi; Oishi, Yosuke; Hamawaki, Jun-ichi

    2017-01-01

    AIM To determine the location of medial tibial plateau stress fractures and its relationship with tibial plateau morphology using magnetic resonance imaging (MRI). METHODS A retrospective review of patients with a diagnosis of stress fracture of the medial tibial plateau was performed for a 5-year period. Fourteen patients [three female and 11 male, with an average age of 36.4 years (range, 15-50 years)], who underwent knee MRI, were included. The appearance of the tibial plateau stress fract...

  4. Complications of Open Tibial Fracture Management: Risk Factors and Treatment

    OpenAIRE

    Lua, JYC; Tan, VH; Sivasubramanian, H; Kwek, EBK

    2017-01-01

    Open tibial fractures result in high rates of complications. This study aims to elucidate the risk factors causing these complications, and suggest antimicrobial regimens based on the organisms grown in post-operative infections. Over a period of five years, 173 patients had sustained open tibial fractures and undergone operative treatment at a single institution. All surgical data was gathered retrospectively through online medical records. Thirty-one patients (17.9%) had sustained post-oper...

  5. Therapeutical Management of the Tibial Plateau Fractures

    Directory of Open Access Journals (Sweden)

    Obada B.

    2016-11-01

    Full Text Available The study was aimed to identify the role of surgical treatment of tibial plateau fractures, its functional outcome and complications. Demographic data for the patients and details of current clinical and radiological follow-up findings were obtained to assess range of motion, clinical stability, alignment of the knee, and posttraumatic arthrosis (Kellgren/Lawrence score. 64 cases of tibial plateau fractures treated by different surgical methods and variuos implants type were studied from 2013 to 2015 and followed-up for minimum period of 6 months. The systematisation of the casuitry was made using Schatzker and AO classifications. The treatment methods consist of: percutaneous cannulated cancellous screws, ORIF with buttress plate with or without bone grafting, locking or nonlocking plates, external fixator. As complications we found: redepression 4 case, malunion 2 cases, knee stiffness 9, wound dehiscence in 1 cases and non-union or infection in none of our cases. The average flexion of the injured knee was significantly lower in comparison with the contralateral side (124.9°/135.2°. Knee stability did not differ statistically significantly. There were no signs of posttraumatic arthrosis in 45% of cases, mild signs in 30%, clear signs in 18%, and severe signs in 7%. As conclusion we found that surgical management of tibial plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion and reduce arthrosis risk and hence to achieve optimal knee function. The choice of optimal surgical methods, proper approach and implant is made in relation to fracture type according Schatzker and AO classification.

  6. Nontraumatic tibial polyethylene insert cone fracture in mobile-bearing posterior-stabilized total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Yohei Tanikake

    2016-12-01

    Full Text Available A 72-year-old male patient underwent mobile-bearing posterior-stabilized total knee arthroplasty for osteoarthritis. He experienced a nontraumatic polyethylene tibial insert cone fracture 27 months after surgery. Scanning electron microscopy of the fracture surface of the tibial insert cone suggested progress of ductile breaking from the posterior toward the anterior of the cone due to repeated longitudinal bending stress, leading to fatigue breaking at the anterior side of the cone, followed by the tibial insert cone fracture at the anterior side of the cone, resulting in fracture at the base of the cone. This analysis shows the risk of tibial insert cone fracture due to longitudinal stress in mobile-bearing posterior-stabilized total knee arthroplasty in which an insert is designed to highly conform to the femoral component.

  7. Expected long-term outcome after a tibial shaft fracture

    DEFF Research Database (Denmark)

    Faergemann, C; Frandsen, P A; Röck, N D

    1999-01-01

    OBJECTIVE: A prospective study of 207 laymen and professionals answered a questionnaire regarding the expectations of the long-term outcome 6 months after a unilateral tibial shaft fracture. The aim was (1) to disclose the expected outcome after unilateral tibial shaft fracture, and (2) to compare...... these expectations with the outcome measured in patients. METHODS: There were five groups of nonpatients: (1) 42 orthopedic surgeons, (2) 36 physiotherapists, (3) 42 students, (4) 49 white collar workers, and (5) 38 blue collar workers. Outcome was measured by Sickness Impact Profile (SIP). The SIP scores were...

  8. Locking internal fixator with minimally invasive plate osteosynthesis for the proximal and distal tibial fractures

    Directory of Open Access Journals (Sweden)

    TONG Da-ke

    2012-02-01

    Full Text Available 【Abstract】Objective: To investigate the efficacy of the locking internal fixator (LIF, which includes the locking compression plate (LCP and the less invasive stable system (LISS, in the proximal and distal tibial fractures. Methods: We did a retrospective study on a total of 98 patients with either proximal or distal tibial fractures from January 2003 to January 2007, who had received the opera- tion with LIF by the minimally invasive plate osteosynthesis (MIPO technique. The data consisted of 43 proximal tibial fractures (type AO41C3 and 55 distal tibial fractures (type AO43C3. Results: No complications were observed in all patients after operation. The mean healing time was 8.4 months (range 5-14 months. Only two cases of delayed union occurred at postoperative 10 months. No infections were reported after the definitive surgery even in the cases of open fractures. All patients reached a full range of motion at postoperative 6 to 9 months and regained the normal functions of knee and ankle joints. Conclusion: Using LIF in MIPO technique is a reliable approach towards the proximal and distal tibial fractures that are not suitable for intramedullary nailing. Key words: Internal fixator; Tibial fractures; Fracture fixation, intramedullary; Bone plates

  9. Immediate effects of modified landing pattern on a probabilistic tibial stress fracture model in runners.

    Science.gov (United States)

    Chen, T L; An, W W; Chan, Z Y S; Au, I P H; Zhang, Z H; Cheung, R T H

    2016-03-01

    Tibial stress fracture is a common injury in runners. This condition has been associated with increased impact loading. Since vertical loading rates are related to the landing pattern, many heelstrike runners attempt to modify their footfalls for a lower risk of tibial stress fracture. Such effect of modified landing pattern remains unknown. This study examined the immediate effects of landing pattern modification on the probability of tibial stress fracture. Fourteen experienced heelstrike runners ran on an instrumented treadmill and they were given augmented feedback for landing pattern switch. We measured their running kinematics and kinetics during different landing patterns. Ankle joint contact force and peak tibial strains were estimated using computational models. We used an established mathematical model to determine the effect of landing pattern on stress fracture probability. Heelstrike runners experienced greater impact loading immediately after landing pattern switch (Ptibial strains and the risk of tibial stress fracture in runners with different landing patterns (P>0.986). Immediate transitioning of the landing pattern in heelstrike runners may not offer timely protection against tibial stress fracture, despite a reduction of impact loading. Long-term effects of landing pattern switch remains unknown. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Locking plate fixation in distal metaphyseal tibial fractures: series of 79 patients.

    Science.gov (United States)

    Gupta, Rakesh K; Rohilla, Rajesh Kumar; Sangwan, Kapil; Singh, Vijendra; Walia, Saurav

    2010-12-01

    Open reduction and internal fixation in distal tibial fractures jeopardises fracture fragment vascularity and often results in soft tissue complications. Minimally invasive osteosynthesis, if possible, offers the best possible option as it permits adequate fixation in a biological manner. Seventy-nine consecutive adult patients with distal tibial fractures, including one patient with a bilateral fracture of the distal tibia, treated with locking plates, were retrospectively reviewed. The 4.5-mm limited-contact locking compression plate (LC-LCP) was used in 33 fractures, the metaphyseal LCP in 27 fractures and the distal medial tibial LCP in the remaining 20 fractures. Fibula fixation was performed in the majority of comminuted fractures (n = 41) to maintain the second column of the ankle so as to achieve indirect reduction and to prevent collapse of the fracture. There were two cases of delayed wound breakdown in fractures fixed with the 4.5-mm LC-LCP. Five patients required primary bone grafting and three patients required secondary bone grafting. All cases of delayed union (n = 7) and nonunion (n = 3) were observed in cases where plates were used in bridge mode. Minimally invasive plate osteosynthesis (MIPO) with LCP was observed to be a reliable method of stabilisation for these fractures. Peri-operative docking of fracture ends may be a good option in severely impacted fractures with gap. The precontoured distal medial tibial LCP was observed to be a better tolerated implant in comparison to the 4.5-mm LC-LCP or metaphyseal LCP with respect to complications of soft tissues, bone healing and functional outcome, though its contour needs to be modified.

  11. Intramedullary screw fixation with bone autografting to treat proximal fifth metatarsal metaphyseal-diaphyseal fracture in athletes: a case series

    Directory of Open Access Journals (Sweden)

    Tsukada Sachiyuki

    2012-07-01

    Full Text Available Abstract Background Delayed unions or refractures are not rare following surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fractures. Intramedullary screw fixation with bone autografting has the potential to resolve the issue. The purpose of this study was to evaluate the result of the procedure. Methods The authors retrospectively reviewed 15 athletes who underwent surgical treatment for proximal fifth metatarsal metaphyseal-diaphyseal fracture. Surgery involved intramedullary cannulated cancellous screw fixation after curettage of the fracture site, followed by bone autografting. Postoperatively, patients remain non weight-bearing in a splint or cast for two weeks and without immobilization for an additional two weeks. Full weight-bearing was allowed six weeks postoperatively. Running was permitted after radiographic bone union, and return-to-play was approved after gradually increasing the intensity. Results All patients returned to their previous level of athletic competition. Mean times to bone union, initiation of running, and return-to-play were 8.4, 8.8, and 12.1 weeks, respectively. Although no delayed unions or refractures was observed, distal diaphyseal stress fractures at the distal tip of the screw occurred in two patients and a thermal necrosis of skin occurred in one patient. Conclusions There were no delayed unions or refractures among patients after carrying out a procedure in which bone grafts were routinely performed, combined with adequate periods of immobilization and non weight-bearing. These findings suggest that this procedure may be useful option for athletes to assuring return to competition level.

  12. Ground reaction forces and bone parameters in females with tibial stress fracture.

    Science.gov (United States)

    Bennell, Kim; Crossley, Kay; Jayarajan, Jyotsna; Walton, Elizabeth; Warden, Stuart; Kiss, Z Stephen; Wrigley, Tim

    2004-03-01

    Tibial stress fracture is a common overuse running injury that results from the interplay of repetitive mechanical loading and bone strength. This research project aimed to determine whether female runners with a history of tibial stress fracture (TSF) differ in ground reaction force (GRF) parameters during running, regional bone density, and tibial bone geometry from those who have never sustained a stress fracture (NSF). Thirty-six female running athletes (13 TSF; 23 NSF) ranging in age from 18 to 44 yr were recruited for this cross-sectional study. The groups were well matched for demographic, training, and menstrual parameters. A force platform measured selected GRF parameters (peak and time to peak for vertical impact and active forces, and horizontal braking and propulsive forces) during overground running at 4.0 m.s.(-1). Lumbar spine, proximal femur, and distal tibial bone mineral density were assessed by dual energy x-ray absorptiometry. Tibial bone geometry (cross-sectional dimensions and areas, and second moments of area) was calculated from a computerized tomography scan at the junction of the middle and distal thirds. There were no significant differences between the groups for any of the GRF, bone density, or tibial bone geometric parameters (P > 0.05). Both TSF and NSF subjects had bone density levels that were average or above average compared with a young adult reference range. Factor analysis followed by discriminant function analysis did not find any combinations of variables that differentiated between TSF and NSF groups. These findings do not support a role for GRF, bone density, or tibial bone geometry in the development of tibial stress fractures, suggesting that other risk factors were more important in this cohort of female runners.

  13. Accelerated tibial fracture union in the third trimester of pregnancy: a case report

    Directory of Open Access Journals (Sweden)

    Ahmad Mudussar A

    2008-02-01

    Full Text Available Abstract Introduction We present a case of accelerated tibial fracture union in the third trimester of pregnancy. This is of particular relevance to orthopaedic surgeons, who must be made aware of the potentially accelerated healing response in pregnancy and the requirement for prompt treatment. Case presentation A 40 year old woman at 34 weeks gestational age sustained a displaced fracture of the tibial shaft. This was initially treated conservatively in plaster with view to intra-medullary nailing postpartum. Following an emergency caesarean section, the patient was able to fully weight bear without pain 4 weeks post injury, indicating clinical union. Radiographs demonstrated radiological union with good alignment and abundant callus formation. Fracture union occurred within 4 weeks, less than half the time expected for a conservatively treated tibial shaft fracture. Conclusion Long bone fractures in pregnancy require clear and precise management plans as fracture healing is potentially accelerated. Non-operative treatment is advisable provided satisfactory alignment of the fracture is achieved.

  14. Partial resection of fibula in treatment of ununited tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Butt Mohd Farooq

    2006-01-01

    Full Text Available Background : In management of fracture of both tibia and fibula, intact fibula may delay union of tibial fractures. Method : Twenty five cases of ununited fractures of tibia were managed between 1997 and 2004, by partial fibulectomy done after 20 weeks after fracture and a POP cast given for 4 weeks which was changed to a PTB cast and weight bearing encouraged at the earliest. Result : All fractures united at an average time of 14 weeks (range 6 to 20 weeks after partial fibulectomy with acceptable alignment in coronal and sagittal planes. There was no neurovascular complication, limitation of joint motion or problem at the osteotomy site. Conclusion : Partial fibulectomy is a viable option in the management of tibial delayed and non-union.

  15. Negative pressure wound therapy for Gustilo Anderson grade IIIb open tibial fractures.

    Science.gov (United States)

    Park, Chul Hyun; Shon, Oog Jin; Kim, Gi Beom

    2016-09-01

    Traditionally, Gustilo Anderson grade IIIb open tibial fractures have been treated by initial wide wound debridement, stabilization of fracture with external fixation, and delayed wound closure. The purpose of this study is to evaluate the clinical and radiological results of staged treatment using negative pressure wound therapy (NPWT) for Gustilo Anderson grade IIIb open tibial fractures. 15 patients with Gustilo Anderson grade IIIb open tibial fractures, treated using staged protocol by a single surgeon between January 2007 and December 2011 were reviewed in this retrospective study. The clinical results were assessed using a Puno scoring system for severe open fractures of the tibia at the last followup. The range of motion (ROM) of the knee and ankle joints and postoperative complication were evaluated at the last followup. The radiographic results were assessed using time to bone union, coronal and sagittal angulations and a shortening at the last followup. The mean score of Puno scoring system was 87.4 (range 67-94). The mean ROM of the knee and ankle joints was 121.3° (range 90°-130°) and 37.7° (range 15°-50°), respectively. Bone union developed in all patients and the mean time to union was 25.3 weeks (range 16-42 weeks). The mean coronal angulation was 2.1° (range 0-4°) and sagittal was 2.7° (range 1-4°). The mean shortening was 4.1 mm (range 0-8 mm). Three patients had partial flap necrosis and 1 patient had total flap necrosis. There was no superficial and deep wound infection. Staged treatment using NPWT decreased the risks of infection and requirement of flap surgeries in Gustilo Anderson grade IIIb open tibial fractures. Therefore, staged treatment using NPWT could be a useful treatment option for Gustilo Anderson grade IIIb open tibial fractures.

  16. Surgical treatment of refractory tibial stress fractures in elite dancers: a case series.

    Science.gov (United States)

    Miyamoto, Ryan G; Dhotar, Herman S; Rose, Donald J; Egol, Kenneth

    2009-06-01

    Treatment of tibial stress fractures in elite dancers is centered on rest and activity modification. Surgical intervention in refractory cases has important implications affecting the dancers' careers. Refractory tibial stress fractures in dancers can be treated successfully with drilling and bone grafting or intramedullary nailing. Case series; Level of evidence, 4. Between 1992 and 2006, 1757 dancers were evaluated at a dance medicine clinic; 24 dancers (1.4%) had 31 tibial stress fractures. Of that subset, 7 (29.2%) elite dancers with 8 tibial stress fractures were treated operatively with either intramedullary nailing or drilling and bone grafting. Six of the patients were followed up closely until they were able to return to dance. One patient was available only for follow-up phone interview. Data concerning their preoperative treatment regimens, operative procedures, clinical union, radiographic union, and time until return to dance were recorded and analyzed. The mean age of the surgical patients at the time of stress fracture was 22.6 years. The mean duration of preoperative symptoms before surgical intervention was 25.8 months. Four of the dancers were male and 3 were female. All had failed nonoperative treatment regimens. Five patients (5 tibias) underwent drilling and bone grafting of the lesion, and 2 patients (3 tibias) with completed fractures or multiple refractory stress fractures underwent intramedullary nailing. Clinical union was achieved at a mean of 6 weeks and radiographic union at 5.1 months. Return to full dance activity was at an average of 6.5 months postoperatively. Surgical intervention for tibial stress fractures in dancers who have not responded to nonoperative management allowed for resolution of symptoms and return to dancing with minimal morbidity.

  17. Real frequency of ordinary and atypical sub-trochanteric and diaphyseal fractures in France based on X-rays and medical file analysis.

    Science.gov (United States)

    Beaudouin-Bazire, Constance; Dalmas, Noémie; Bourgeois, Julie; Babinet, Antoine; Anract, Philippe; Chantelot, Christophe; Farizon, Frédéric; Chopin, Florence; Briot, Karine; Roux, Christian; Cortet, Bernard; Thomas, Thierry

    2013-03-01

    Atypical sub-trochanteric and femoral shaft fractures have been reported in patients treated with bisphosphonates. Their incidence has been determined from registered data analysis using international codes. Therefore, the aim of our study was to estimate the real frequency of typical and atypical sub-trochanteric or diaphyseal fractures, based on radiological and clinical data compared to registered data. In the registers of three large French University Hospitals, patients identified with International Classification of Diseases, 10th Revision diagnosis codes for sub-trochanteric or diaphyseal fracture were selected. Frequencies of ordinary and atypical fractures were calculated after both registered data, radiological and clinical files analysis. Among the 4592 patients hospitalized for a femoral fracture over 5 years, 574 were identified to have had a sub-trochanteric or femoral shaft fracture. 47.7% of the sub-trochanteric and femoral shaft fractures were misclassified, predominantly in the sub-trochanteric fractures subset. 12 patients had an atypical fracture (4% of the sub-trochanteric and femoral shaft fractures) and 11 fractures presented radiological features of atypical fractures, whereas clinical files analysis revealed they were pathological or traumatic fractures. Atypical fractures frequency is very low. Because of their low frequency and the unreliability of registered databases, the risk of atypical fractures is very difficult to estimate retrospectively. A prospective study is needed to clarify the risk factors associated with these fractures. Copyright © 2012 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  18. Management of open fractures of the tibial shaft in multiple trauma

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    Stanislaw Boltuc

    2008-01-01

    Full Text Available Background: The work presents the assessment of the results of treatment of open tibial shaft fractures in polytrauma patients. Materials and Methods: The study group comprised 28 patients who underwent surgical treatment of open fractures of the tibial shaft with locked intramedullary nailing. The mean age of the patients was 43 years (range from 19 to 64 years. The criterion for including the patients in the study was concomitant multiple trauma. For the assessment of open tibial fractures, Gustilo classification was used. The most common concomitant multiple trauma included craniocerebral injuries, which were diagnosed in 12 patients. In 14 patients, the surgery was performed within 24 h after the injury. In 14 patients, the surgery was delayed and was performed 8-10 days after the trauma. Results: The assessment of the results at 12 months after the surgery included the following features: time span between the trauma and the surgery and complications in the form of osteomyelitis and delayed union. The efficacy of gait, muscular atrophy, edema of the operated limb and possible disturbances of its axis were also taken under consideration. In patients operated emergently within 24 h after the injury, infected nonunion was observed in three (10.8% males. These patients had grade III open fractures of the tibial shaft according to Gustilo classification. No infectious complications were observed in patients who underwent a delayed operation. Conclusion: Evaluation of patients with open fractures of the tibial shaft in multiple trauma showed that delayed intramedullary nailing performed 8-10 days after the trauma, resulted in good outcome and avoided development of delayed union and infected nonunion. This approach gives time for stabilization of general condition of the patient and identification of pathogens from wound culture.

  19. Displaced tibial shaft fractures treated with ASIF compression internal fixation

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Larsen, T K; Petersen, O C

    1990-01-01

    Fifty-one tibial shaft fractures treated by ASIF compression osteosynthesis were seen at follow-up at a median time of 46 weeks after injury. Twenty-four were open fractures and the patients received prophylactic antibiotics. The median stay in hospital was 15 days for open fractures and 6 days f...

  20. "Push-past" reaming as a reduction aid with intramedullary nailing of metadiaphyseal and diaphyseal femoral shaft fractures.

    Science.gov (United States)

    Gary, Joshua L; Munz, John W; Burgess, Andrew R

    2014-06-01

    Eccentric reaming of cortical bone near a fracture site can introduce malalignment when an intramedullary nail is placed. The authors describe a technique of reaming metadiaphyseal and diaphyseal femur fractures in which maintaining reduction at the fracture site is not necessary to obtain an excellent alignment of long bone fractures after intramedullary nailing. They have found that central reaming proximal and distal to, but not at, the fracture site allows for excellent reduction of long bone fractures when the intramedullary nail is passed. The reamer is stopped just before the fracture site and then "pushed" across the fracture prior to resumption of reaming. The authors present "push-past" reaming as a technical trick to facilitate reduction of femoral fractures treated with intramedullary nails and a consecutive series of 18 cases in which excellent postoperative alignment was achieved. Copyright 2014, SLACK Incorporated.

  1. [Operative treatment for complex tibial plateau fractures].

    Science.gov (United States)

    Song, Qi-Zhi; Li, Tao

    2012-03-01

    To explore the surgical methods and clinical evaluation of complex tibial plateau fractures resulted from high-energy injuries. From March 2006 to May 2009,48 cases with complex tibial plateau fractures were treated with open reduction and plate fixation, including 37 males and 11 females, with an average age of 37 years (ranged from 18 to 63 years). According to Schatzker classification, 16 cases were type IV, 20 cases type V and 12 cases type VI. All patients were examined by X-ray flim and CT scan. The function of knee joint were evaluated according to postoperative follow-up X-ray and Knee Merchant Rating. Forty-eight patients were followed up with a mean time of 14 months. According to Knee Merchant Rating, 24 cases got excellent results, 16 cases good, 6 cases fair and 2 cases poor. Appropriate operation time, anatomical reduction, suitable bone graft and reasonable rehabilitation exercises can maximally recovery the function of knee joint.

  2. Acute changes in foot strike pattern and cadence affect running parameters associated with tibial stress fractures.

    Science.gov (United States)

    Yong, Jennifer R; Silder, Amy; Montgomery, Kate L; Fredericson, Michael; Delp, Scott L

    2018-05-18

    Tibial stress fractures are a common and debilitating injury that occur in distance runners. Runners may be able to decrease tibial stress fracture risk by adopting a running pattern that reduces biomechanical parameters associated with a history of tibial stress fracture. The purpose of this study was to test the hypothesis that converting to a forefoot striking pattern or increasing cadence without focusing on changing foot strike type would reduce injury risk parameters in recreational runners. Running kinematics, ground reaction forces and tibial accelerations were recorded from seventeen healthy, habitual rearfoot striking runners while running in their natural running pattern and after two acute retraining conditions: (1) converting to forefoot striking without focusing on cadence and (2) increasing cadence without focusing on foot strike. We found that converting to forefoot striking decreased two risk factors for tibial stress fracture: average and peak loading rates. Increasing cadence decreased one risk factor: peak hip adduction angle. Our results demonstrate that acute adaptation to forefoot striking reduces different injury risk parameters than acute adaptation to increased cadence and suggest that both modifications may reduce the risk of tibial stress fractures. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. Outcomes of The Isolated Closed Tibial Shaft Fractures Treated Nonsurgically

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    Dawood Jafari

    2011-05-01

    Full Text Available Background: Fractures of the tibia are important for their commonness and controversy in their management. Both conservative and surgical techniques have been introduced in an effort to speed time to union while minimizing the occurrence of complications. Standard treatment for low-energy tibial shaft fractures includes closed reduction and cast immobilization.The purpose of our study was to analyze retention of reduction after cast immobilization of simple isolated closed tibial fractures.Methods:All cases of the diagnosed isolated closed tibial shaft fracture treated non-surgically at Shafa Yahyaeian Hospital, between 2006 and 2009 were retrieved from medical records. We reviewed all medical records and radiographs of these patients to inquire about the patients’ demographic data used to analyze the outcomes of the non-surgical treatment.Results:Of the 26 patients examined, males were more commonly affected. The mean age was 27.46   (SD=7.58.The most common causes of injury were direct blow and motorcycle to pedestrian accident. Followup duration for each patient had an average of 9.12 months (SD=2.36. Using AO/OTA classification, distributed as 38.5% A1.1, 26.9% A2.1 and 34.6% A3.1 fractures. Most fractures were sustained in the lower third of the tibia (53.85%. All fractures eventually healed in an average of 13.7 weeks (SD=3.24. There was one case of delayed union in the 22nd week. In 92.3% of patients, shortening of bone was less than 1 cm, while in 7.7% patients, was more than 1.5 cm. We observed an anterior or posterior angulation > 10 ° in 2 (7.69% patients. Moreover, in 4 (15.38% patients we found varus angulation > 5°. Therefore, final deformity was observed in 8 (30.77% patients. No patient had non-union, rotational malalignment of more than 10 degrees, an infection, or a compartment syndrome.Conclusion : Our non-surgical treatment’s outcomes were not satisfactory, despite applying all principles for conservative treatment and

  4. Hindfoot Valgus following Interlocking Nail Treatment for Tibial Diaphysis Fractures: Can the Fibula Be Neglected?

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    Metin Uzun

    2014-01-01

    Full Text Available Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function. Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS and the Foot and Ankle Disability Index Score (FADI. Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%. Fibular shortening was identified in 42 fractures (68%. Mean fibular shortening was 1.2 cm (range, 0.5–2 cm. Clinical exams showed increased hindfoot valgus in 42 fractures (68%. The mean KOOS was 88.4, and the mean FADI score was 90. Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening.

  5. Asymmetry in gait pattern following tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Læssøe, Uffe; Rasmussen, Sten

    2017-01-01

    INTRODUCTION: Despite the high number of studies evaluating the outcomes following tibial shaft fractures, the literature lacks studies including objective assessment of patients' recovery regarding gait pattern. The purpose of the present study was to evaluate whether gait patterns at 6 and 12...... months post-operatively following intramedullary nailing of a tibial shaft fracture are different compared with a healthy reference population. PATIENTS AND METHODS: The study design was a prospective cohort study. The primary outcome measurement was the gait patterns at 6 and 12 months post......-operatively measured with a 6-metre-long pressure-sensitive mat. The mat registers footprints and present gait speed, cadence as well as temporal and spatial parameters of the gait cycle. Gait patterns were compared to a healthy reference population. RESULTS: 49 patients were included with a mean age of 43.1 years (18...

  6. Prolonged operative time increases infection rate in tibial plateau fractures.

    Science.gov (United States)

    Colman, Matthew; Wright, Adam; Gruen, Gary; Siska, Peter; Pape, Hans-Christoph; Tarkin, Ivan

    2013-02-01

    Fractures of the tibial plateau present a treatment challenge and are susceptible to both prolonged operative times and high postoperative infection rates. For those fractures treated with open plating, we sought to identify the relationship between surgical site infection and prolonged operative time as well as to identify other surgical risk factors. We performed a retrospective controlled analysis of 309 consecutive unicondylar and bicondylar tibial plateau fractures treated with open plate osteosynthesis at our institution's level I trauma centre during a recent 5-year period. We recorded operative times, injury characteristics, surgical treatment, and need for operative debridement due to infection. Operative times of infected cases were compared to uncomplicated surgical cases. Multivariable logistic regression analysis was performed to identify independent risk factors for postoperative infection. Mean operative time in the infection group was 2.8h vs. 2.2h in the non-infected group (p=0.005). 15 fractures (4.9%) underwent four compartment fasciotomies as part of their treatment, with a significantly higher infection rate than those not undergoing fasciotomy (26.7% vs. 6.8%, p=0.01). Open fracture grade was also significantly related to infection rate (closed fractures: 5.3%, grade 1: 14.3%, grade 2: 40%, grade 3: 50%, pinfection rates (13.9% vs. 8.7%, p=0.36). Multivariable logistic regression analysis of the entire study group identified longer operative times (OR 1.78, p=0.013) and open fractures (OR 7.02, psite infection. Operative times approaching 3h and open fractures are related to an increased overall risk for surgical site infection after open plating of the tibial plateau. Dual incision approaches with bicolumnar plating do not appear to expose the patient to increased risk compared to single incision approaches. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Fraturas do planalto tibial Tibial plateau fractures

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    Maurício Kfuri Júnior

    2009-01-01

    Full Text Available As fraturas do planalto tibial são lesões articulares cujos princípios de tratamento envolvem a redução anatômica da superfície articular e a restauração funcional do eixo mecânico do membro inferior. Contribuem para a tomada de decisões no tratamento dessas fraturas o perfil do paciente, as condições do envelope de tecidos moles, a existência de outros traumatismos associados e a infraestrutura disponível para abordagens cirúrgicas. Para as fraturas de alta energia, o tratamento estagiado, seguindo o princípio do controle de danos, tem como prioridade a manutenção do alinhamento do membro enquanto se aguarda a resolução das más condições de tecidos moles. Já nos traumas de baixa energia, desde que os tecidos moles não sejam um fator adverso, o tratamento deve ser realizado em tempo único, com osteossíntese definitiva. Fixação estável e movimento precoce são variáveis diretamente relacionadas com os melhores prognósticos. Desenvolvimentos recentes, como os implantes com estabilidade angular, substitutos ósseos e imagens tridimensionais para controle intraoperatório, deverão contribuir para cirurgias menos invasivas e melhores resultados.Tibial plateau fractures are joint lesions that require anatomical reduction of joint surface and functional restoration of mechanical axis of a lower limb. Patient profile, soft tissue conditions, presence of associated injuries and the available infrastructure for the treatment all contribute to the decision making about the best treatment for these fractures. High-energy fractures are usually approached in a staged manner respecting the principle of damage control, and are primarily targeted to maintain limb alignment while the resolution unfavorable soft tissue conditions is pending. Low-energy trauma can be managed on a single-stage basis, provided soft tissues are not an adverse factor, with open reduction and internal f-ixation. Stable fixation and early painless joint

  8. Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture.

    Science.gov (United States)

    Beaman, Douglas N; Gellman, Richard

    2014-12-01

    Posttraumatic arthritis and prolonged recovery are typical after a severely comminuted tibial pilon fracture, and ankle arthrodesis is a common salvage procedure. However, few reports discuss the option of immediate arthrodesis, which may be a potentially viable approach to accelerate overall recovery in patients with severe fracture patterns. (1) How long does it take the fracture to heal and the arthrodesis to fuse when primary ankle arthrodesis is a component of initial fracture management? (2) How do these patients fare clinically in terms of modified American Orthopaedic Foot and Ankle Society (AOFAS) scores and activity levels after this treatment? (3) Does primary ankle arthrodesis heal in an acceptable position when anterior ankle arthrodesis plates are used? During a 2-year period, we performed open fracture reduction and internal fixation in 63 patients. Eleven patients (12 ankles) with severely comminuted high-energy tibial pilon fractures were retrospectively reviewed after surgical treatment with primary ankle arthrodesis and fracture reduction. Average patient age was 58 years, and minimum followup was 6 months (average, 14 months; range, 6-22 months). Anatomically designed anterior ankle arthrodesis plates were used in 10 ankles. Ring external fixation was used in nine ankles with concomitant tibia fracture or in instances requiring additional fixation. Clinical evaluation included chart review, interview, the AOFAS ankle-hindfoot score, and radiographic evaluation. All of the ankle arthrodeses healed at an average of 4.4 months (range, 3-5 months). One patient had a nonunion at the metaphyseal fracture, which healed with revision surgery. The average AOFAS ankle-hindfoot score was 83 with 88% having an excellent or good result. Radiographic and clinical analysis confirmed a plantigrade foot without malalignment. No patients required revision surgery for malunion. Primary ankle arthrodesis combined with fracture reduction for the severely comminuted

  9. Taylor spatial frame in the treatment of open tibial shaft fractures

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    Al-Sayyad Mohammed

    2008-01-01

    Full Text Available Background: The Taylor spatial frame (TSF is a modern multiplanar external fixator that combines the ease of application and computer accuracy in the reduction of fractures. A retrospective review of our prospective TSF database for the use of this device for treating open tibial fractures in pediatric, adolescent, and adult patients was carried out to determine the effectiveness and complications of TSF in the treatment of these fractures. Materials and Methods: Nineteen male patients with open tibial fractures were included. Of these fractures, 10 were Gustilo Type II, five were Gustilo Type IIIA (two had delayed primary closure and three had split thickness skin grafting, and four were Gustilo Type IIIB (all had rotational flaps. Twelve of our patients presented immediately to the emergency room, and the remaining seven cases presented at a mean of 3 months (range, 2.2-4.5 months after the initial injury. The fractures were located in proximal third (n=1, proximal/middle junction (n=2, middle third (n=3, middle/distal junction (n=8, distal third (n=3, and segmental fractures (n=2. Patients were of an average age of 26 years (range, 6-45years. Mean duration of follow-up was 3.5 years. Results: All fractures healed over a mean of 25 weeks (range, 9-46 weeks. All were able to participate in the activities of daily living without any difficulty and most were involved in sports during the last follow-up. Postoperative complications included pin tract infection in 12 patients. Conclusion: The TSF is an effective definitive method of open tibial fracture care with the advantage of early mobilization, ease of soft tissue management through gradual fracture reduction, and the ability to postoperatively manipulate the fracture into excellent alignment.

  10. Fracture of a Polyethylene Tibial Post in a Scorpio Posterior-Stabilized Knee Prosthesis

    OpenAIRE

    Lim, Hong Chul; Bae, Ji Hoon; Hwang, Jin Ho; Kim, Seung Joo; Yoon, Ji Yeol

    2009-01-01

    We report the case of a polyethylene tibial post fracture in a 72-year-old woman 14 months after a Scorpio posterior-stabilized (PS) total knee arthroplasty. The polyethylene wear was found around the fracture site of the post, especially over the anterior aspect of the post base. The failure mechanism of the post fracture in the present case was anterior impingement with excessive wear over the base of the anterior aspect of the tibial post, which became a stress-riser of post and cam articu...

  11. Minimally invasive treatment of tibial pilon fractures through arthroscopy and external fixator-assisted reduction.

    Science.gov (United States)

    Luo, Huasong; Chen, Liaobin; Liu, Kebin; Peng, Songming; Zhang, Jien; Yi, Yang

    2016-01-01

    The aim of this study was to evaluate the clinical outcome of tibial pilon fractures treated with arthroscopy and assisted reduction with an external fixator. Thirteen patients with tibial pilon fractures underwent assisted reduction for limited lower internal fixation with an external fixator under arthroscopic guidance. The weight-bearing time was decided on the basis of repeat radiography of the tibia 3 months after surgery. Postoperative ankle function was evaluated according to the Mazur scoring system. Healing of fractures was achieved in all cases, with no complications such as severe infection, skin necrosis, or an exposed plate. There were 9 excellent, 2 good, and 2 poor outcomes, scored according to the Mazur system. The acceptance rate was 85%. Arthroscopy and external fixator-assisted reduction for the minimally invasive treatment of tibial pilon fractures not only produced less trauma but also protected the soft tissues and blood supply surrounding the fractures. External fixation could indirectly provide reduction and effective operative space for arthroscopic implantation, especially for AO type B fractures and partial AO type C1 fractures.

  12. Complex tibial fracture outcomes following treatment with low-intensity pulsed ultrasound.

    Science.gov (United States)

    Leung, Kwok-Sui; Lee, Wing-Sze; Tsui, Hon-For; Liu, Paul Po-Lung; Cheung, Wing-Hoi

    2004-03-01

    A clinical study was conducted to investigate the effect of low-intensity pulsed ultrasound (US) stimulation (LIPUS) on the healing of complex tibial fractures. Thirty complex tibial fractures were randomly assigned to the treatment with LIPUS (n = 16) or by a dummy machine (sham-exposed: n = 14). The fractures were immobilized by either internal or external fixations according to the clinical indications. LIPUS was given 20 min/day for 90 days. Fracture healing was monitored by clinical, radiological, densitometric and biochemical assessments. The LIPUS-treated group showed statistically significantly better healing, as demonstrated by all assessments. Complications were minimal in the LIPUS group. There were two cases of delayed union, with one in each group. There were two cases of infection in the control group. The delayed-union cases were subsequently treated by LIPUS and the infection cases were treated with standard protocol. Fracture healing in these patients was again treated by LIPUS.

  13. Distinct hip and rearfoot kinematics in female runners with a history of tibial stress fracture.

    Science.gov (United States)

    Milner, Clare E; Hamill, Joseph; Davis, Irene S

    2010-02-01

    Cross-sectional controlled laboratory study. To investigate the kinematics of the hip, knee, and rearfoot in the frontal and transverse planes in female distance runners with a history of tibial stress fracture. Tibial stress fractures are a common overuse injury in runners, accounting for up to half of all stress fractures. Abnormal kinematics of the lower extremity may contribute to abnormal musculoskeletal load distributions, leading to an increased risk of stress fractures. Thirty female runners with a history of tibial stress fracture were compared to 30 age-matched and weekly-running-distance-matched control subjects with no previous lower extremity bony injuries. Kinematic and kinetic data were collected using a motion capture system and a force platform, respectively, as subjects ran in the laboratory. Selected variables of interest were compared between the groups using a multivariate analysis of variance (MANOVA). Peak hip adduction and peak rearfoot eversion angles were greater in the stress fracture group compared to the control group. Peak knee adduction and knee internal rotation angles and all joint angles at impact peak were similar between the groups. Runners with a previous tibial stress fracture exhibited greater peak hip adduction and rearfoot eversion angles during the stance phase of running compared to healthy controls. A consequence of these mechanics may be altered load distribution within the lower extremity, predisposing individuals to stress fracture.

  14. COMPARATIVE STUDY BETWEEN TITANIUM ELASTIC NAILING (TENS AND DYNAMIC COMPRESSION PLATING (DCP IN THE TREATMENT OF FEMORAL DIAPHYSEAL FRACTURES IN CHILDREN

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    Ramasubba Reddy

    2015-08-01

    Full Text Available BACKGROUND : Orthopaedic surgeons have long maintained that all children who have sustained a diaphyseal fracture of femur recover with c onservative treatment, given the excellent remodeling ability of immature bone in children. Angulations, shortenings and malrotations are not always corrected by conservative treatment. Of many surgical options, titanium elastic nailing has been the newer implant which is being used regularly. Although good results have been reported with elastic intramedullary nails, plate fixation continues to be a viable alternative in surgical treatment of femoral shaft fractures. However there are not many studies comp aring the efficiency of titanium elastic nailing and plating for femoral diaphyseal fractures in pediatric age group. AIM : The present study aims to compare the surgical management of diaphyseal fractures of femur in children with Dynamic Compression Plati ng versus Titanium Elastic Nailing. DESIGN : This is a prospective study . MATERIALS AND METHODS : This prospective study was conducted in a tertiary hospital. Patients who presented to the out - patient department and casualty of the hospital with femoral diap hyseal fractures during April 2012 to June 2014 were considered for the study. Subjects fulfilling the predetermined inclusion and exclusion criteria were included in the study. STATISTICAL METHODS : Fisher Exact test, Chi - Square Test, Student t test (Two t ailed, independent . RESULTS : Patients in the age group of 6 - 14 years were considered for the study, Patients were divided into two groups and treated with DCP/TENS. The duration of surgery, hospital stay, and, amount of blood loss was minimal in TENS grou p. Callus was seen early in TENS group. Radiological union was early in TENS group by 2 - 3 weeks. Outcome was better in patients treated with TENS (Excellent - 70%; Satisfactory – 30%; Poor - 0% in comparison to DCP (Excellent - 70%; Satisfactory - 25%; Poor - 5%. CO NCLUSION : TENS

  15. Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation.

    Science.gov (United States)

    Simon, A-L; Apostolou, N; Vidal, C; Ferrero, E; Mazda, K; Ilharreborde, B

    2018-02-01

    Elastic stable intramedullary nailing is increasingly used for surgical treatment of tibial shaft fractures, but frequently requires immobilization and delayed full weight-bearing. Therefore, external fixation remains interesting. The aim was to report clinico-radiological outcomes of monolateral external fixation for displaced and unstable tibial shaft fractures in children. All tibial fractures consecutively treated by monolateral external fixation between 2008 and 2013 were followed. Inclusion criteria included skeletal immaturity and closed and open Gustilo I fractures caused by a direct impact. Patients were seen until two years postoperatively. Demographics, mechanism of injury, surgical data and complications were recorded. Anteroposterior and lateral side radiographs were performed at each visit. Full-limb 3D reconstructions using biplanar stereroradiography was performed for final limb length and alignment measures. A total of 45 patients (mean age 9.7 years ± 0.5) were included. In all, 17 were Gustilo I fractures, with no difference between open and closed fractures for any data. Mean time to full weight bearing was 18.2 days ± 0.7. After 15 days, 39 patients returned to school. Hardware removal (mean time to union 15.6 weeks ± 0.8) was performed during consultation under analgesic gas. There were no cases of nonunion. No fracture healed with > 10° of angulation (mean 5.1° ± 0.4°). Leg-length discrepancy > 10 mm was found for six patients. This procedure can be a safe and simple surgical treatment for children with tibial shaft fractures. Few complications and early return to school were reported, with the limitations of non-comparative study. IV.

  16. Diaphyseal Fractures of the Forearm in Adults, Plating Or Intramedullary Nailing Is a Better Option for the Treatment?

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    Tabet A. Al-Sadek

    2016-11-01

    Full Text Available BACKGROUND: Fractures of the radius and ulna occupy a large field of the modern traumatology. Therefore, these fractures are a major subject in modern orthopaedics and traumatology. The study of the mechanisms of the trauma, and the pathophysiological changes that occur are of great importance for the development of ever more efficient and varied ways of the treatment and prophylactics of this type of fracture. AIM: The aim of this paper was to study the pattern of the diaphyseal fractures of the forearm in adults, to decide the modalities of surgical management, to observe the period of fracture healing clinically and radiologically, as well to study the rehabilitation of the patients. MATERIAL AND METHODS: The present study included 45 cases of diaphyseal fractures of both bones forearm in adults presenting to the orthopaedic outpatient department. For all the patients a detailed history was taken. A thorough clinical examination was carried out, required X-rays were taken, and initial treatment was given and admitted as in all patients. After careful pre-operative planning and evaluation for anaesthetic fitness, patients were operated for the fractures of both bone forearms. Twenty-three cases with 46 fractures were treated by open reduction and rigid fixation with DCP & Semi-tubular plates and 22 cases with 44 fractures were treated by closed reduction and fixation with “Talwarkar” intramedullary square nails. RESULTS: United results were found in 100% of plating group vs. 86% in the nailing group. Delayed and non-union results were found in 9% of the nailing group only. Average time to union in weeks was 9.4 weeks in the plating group vs. 10.2 weeks in the nailing group. CONCLUSION: Open reduction and internal fixation with compression plates with strict adherence to surgical technique is the gold standard method of treatment in both bones forearm fractures with excellent results than closed reduction, internal fixation with

  17. Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method.

    Science.gov (United States)

    Milenković, Sasa; Mitković, Milorad; Micić, Ivan; Mladenović, Desimir; Najman, Stevo; Trajanović, Miroslav; Manić, Miodrag; Mitković, Milan

    2013-09-01

    Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In

  18. All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament

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    Gwinner, Clemens

    2016-01-01

    Full Text Available Background: The posterior cruciate ligament (PCL avulsion fracture from its tibial insertion is a rare condition. Despite the further technical advent in refixation of avulsion fractures, the reported failure rate of current approaches remains high and the optimal surgical technique has not been elucidated yet.The purpose of the current study is to present an all-inside arthroscopic reconstruction technique for bony tibial avulsion fractures of the PCL and initial clinical outcomes. Methods: Patients underwent a thorough clinical and radiological examination of both knees at 3, 6, 12, 18, and if possible also at 24 months.Clinical evaluation included subjective and objective IKDC 2000, Lysholm score, and KOOS score. Radiographic imaging studies included CT scans for assessment of osseous integration and anatomic reduction of the bony avulsion. In addition to that posterior stress radiographs of both knees using the Telos device (Arthrex, Naples, USA were conducted to measure posterior tibial translation.Results: A total of four patients (1 female, 3 male; ø 38 (± 18 years, who underwent arthroscopic refixation of a PCL avulsion fracture using the Tight Rope device were enrolled in this study. Mean follow up was 22 [18–24] months. The mean subjective IKDC was 72.6% (± 9.9%. Regarding the objective IKDC three patients accounted for grade A, one patient for grade C. The Lysholm score yielded 82 (± 6.9 points. The KOOS score reached 75% (± 13%; symptoms 76%, pain 81%, function 76%, sports 66%, QoL 64%.All patients showed complete osseous integration and anatomic reduction of the bony avulsion. The mean posterior tibial translation at final follow up was 2.8 [0–7] mm. Conclusions: All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament provides satisfactory clinical results in a preliminary patient cohort. It is a reproducible technique, which minimizes soft tissue damage and obviates a second surgery for

  19. Transfixation pinning and casting of tibial fractures in calves: five cases (1985-1989).

    Science.gov (United States)

    St-Jean, G; Clem, M F; DeBowes, R M

    1991-01-01

    Medical records of 5 calves with tibial fractures that were reduced and stabilized by transfixation pinning and casting were reviewed. Multiple Steinmann pins were placed transversely through proximal and distal fracture fragments, and the pin ends were incorporated in fiberglass cast material after fracture reduction. Cast material serves as an external frame to maintain pin position and fracture reduction. Calves were between 2 weeks and 6 months old and weighed between 40 and 180 kg. Three fractures were spiral in configuration and 2 were comminuted. One tibial fracture was open. After surgery, all calves were ambulatory within 24 hours. To improve tarsal flexion and achieve normal stance in 3 calves, cast revision was required on the caudal aspect of the limb. Good radiographic and clinical evidence of stability was observed in 5 to 10 weeks (mean 8 weeks), at which time the pis and cast were removed. Return to normal function was rapid and judged to be excellent at follow-up evaluation 3 to 12 months later. Advantages of transfixation pinning and casting in management of tibial fractures include flexibility in pin positioning, adequate maintenance of reduction, early return to weight-bearing status, joint mobility, and ease of ambulation. The inability to adjust fixation and alignment after cast application is a disadvantage of this technique compared with other external fixators.

  20. Paediatric tibial shaft fractures treated by open reduction and stabilization with monolateral external fixation

    Science.gov (United States)

    Simon, A.-L.; Apostolou, N.; Vidal, C.; Ferrero, E.; Mazda, K.; Ilharreborde, B.

    2018-01-01

    Abstract Purpose Elastic stable intramedullary nailing is increasingly used for surgical treatment of tibial shaft fractures, but frequently requires immobilization and delayed full weight-bearing. Therefore, external fixation remains interesting. The aim was to report clinico-radiological outcomes of monolateral external fixation for displaced and unstable tibial shaft fractures in children. Methods All tibial fractures consecutively treated by monolateral external fixation between 2008 and 2013 were followed. Inclusion criteria included skeletal immaturity and closed and open Gustilo I fractures caused by a direct impact. Patients were seen until two years postoperatively. Demographics, mechanism of injury, surgical data and complications were recorded. Anteroposterior and lateral side radiographs were performed at each visit. Full-limb 3D reconstructions using biplanar stereroradiography was performed for final limb length and alignment measures. Results A total of 45 patients (mean age 9.7 years ± 0.5) were included. In all, 17 were Gustilo I fractures, with no difference between open and closed fractures for any data. Mean time to full weight bearing was 18.2 days ± 0.7. After 15 days, 39 patients returned to school. Hardware removal (mean time to union 15.6 weeks ± 0.8) was performed during consultation under analgesic gas. There were no cases of nonunion. No fracture healed with > 10° of angulation (mean 5.1° ± 0.4°). Leg-length discrepancy > 10 mm was found for six patients. Conclusions This procedure can be a safe and simple surgical treatment for children with tibial shaft fractures. Few complications and early return to school were reported, with the limitations of non-comparative study. Level of Evidence IV PMID:29456750

  1. Bone Morphogenetic Protein for the Healing of Tibial Fracture: A Meta-Analysis of Randomized Controlled Trials.

    Directory of Open Access Journals (Sweden)

    Jiezhi Dai

    Full Text Available To review the evidence from RCTs on clinical outcomes and benefit of acute tibial fracture and nonunion treated with and without BMPs.We searched multiple databases (MEDLINE, EMABSE, BIOSIS and Cochrane central as well as reference lists of articles and contacted authors. Evaluated outcomes included union rate, revision rate, hardware failure and infection. The weighted and standard mean difference (WMD and SMD or the relative risk (RR was calculated for continuous or dichotomous data respectively. The quality of the trial was assessed, and meta-analyses were performed with the Cochrane Collaboration's REVMAN 5.0 software.Eight RCTs involving 1113 patients were included. For acute tibial fracture, BMP group was associated with a higher rate of union (RR, 1.16; 95% CI, 1.04 to 1.30 and a lower rate of revision (RR, 0.68; 95% CI, 0.54 to 0.85 compared with control group. No significant differences were found in rate of hardware failure and infection. The pooled RR for achieving union for tibial fracture nonunion was 0.98 (95% CI, 0.86 to 1.13. There was no significant difference between the two groups in the rate of revision (RR, 0.48; 95% CI, 0.13 to 1.85 and infection (RR, 0.61; 95% CI, 0.37 to 1.02.Study on acute tibial fractures suggests that BMP is more effective that controls, for bone union and for decreasing the rate of surgical revision to achieve union. For the treatment of tibial fracture nonunion, BMP leads to similar results to as autogenous bone grafting. Finally, well-designed RCTs of BMP for tibial fracture treatment are also needed.

  2. A CLINICAL STUDY ON SURGICAL MANAGEMENT OF TIBIAL PLATEAU FRACTURES - FUNCTIONAL AND RADIOLOGICAL EVALUATION

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    Bhavani

    2015-10-01

    Full Text Available BACKGROUND: Tremendous advance in mechanization and fastness of travel have been accompanied by steep increase in number and severity of fractures and those of tibial plateau are no exception. Knee being one of the major weight bearing joints of the body, fractures around it will be of paramount importance. AIM OF STUDY: This study is to analyze the functional outcome of CRIF or ORIF with or without bone grafting in tibial plateau fractures in adults. MATERIALS AND METHODS: 30 cases of tibial plateau fractures treated by various modalities were studied from 1 - 8 - 2012 to 31 - 1 - 2014 at our institution and followed for a minimum of 6 months. Fractures were evaluated using Modified Rasmussen’s Clinical, Radiological grading system. RESULTS : The selected patients were evaluated thoroughly and after the relevant investigations, were taken for surgery. The fractures were classified as per the SCHATZKER’S types and operated accordingly with CRIF with Percutaneous cannulated cancellous screws, ORIF with buttress plate/LCP with or without bone grafting. Immobilization of fractures continued for 3 weeks by POP slab. Early range of motion was then started. Weight bearing up to 6 - 8 weeks was not allowed. The full weight bearing deferred until 12 weeks or complete fracture union . The knee range of motion was excellent to very good, gait and weight bearing after complete union was satisfactory, knee stiffness in 3 cases , wound dehiscence and infection in 1 case and non - union in none of our cases was noted. CONCLUSION: Functional outcome is better in operatively treated tibial plateau fractures in adults, because it gives excellent anatomical reduction and rigid fixation to restore articular congruity and early motion thereby preventing knee stiffness.

  3. Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing?

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2004-01-01

    A convenience sample based on availability of tibial stress fracture cases a% local Sports Medicine Clinics will be selected over 4 years until forty subjects (20 male, 20 female) have been treated...

  4. Free flap reconstructions of tibial fractures complicated after internal fixation.

    Science.gov (United States)

    Nieminen, H; Kuokkanen, H; Tukiainen, E; Asko-Seljavaara, S

    1995-04-01

    The cases of 15 patients are presented where microvascular soft-tissue reconstructions became necessary after internal fixation of tibial fractures. Primarily, seven of the fractures were closed. Eleven fractures had originally been treated by open reduction and internal fixation using plates and screws, and four by intramedullary nailing. All of the patients suffered from postoperative complications leading to exposure of the bone or fixation material. The internal fixation material was removed and radical revision of dead and infected tissue was carried out in all cases. Soft tissue reconstruction was performed using a free microvascular muscle flap (11 latissimus dorsi, three rectus abdominis, and one gracilis). In eight cases the nonunion of the fracture indicated external fixation. The microvascular reconstruction was successful in all 15 patients. In one case the recurrence of deep infection finally indicated a below-knee amputation. In another case, chronic infection with fistulation recurred postoperatively. After a mean follow-up of 26 months the soft tissue coverage was good in all the remaining 13 cases. All the fractures united. Microvascular free muscle flap reconstruction of the leg is regarded as a reliable method for salvaging legs with large soft-tissue defects or defects in the distal leg. If after internal fixation of the tibial fracture the osteosynthesis material or fracture is exposed, reconstruction of the soft-tissue can successfully be performed by free flap transfer. By radical revision, external fixation, bone grafting, and a free flap the healing of the fracture can be achieved.

  5. Cumulative Alendronate Dose and the Long-Term Absolute Risk of Subtrochanteric and Diaphyseal Femur Fractures: A Register-Based National Cohort Analysis

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Eiken, Pia Agnete; Eastell, Richard

    2010-01-01

    are currently the subject of a U.S. Food and Drug Administration review. Objective: Our objective was to examine the risk of subtrochanteric/diaphyseal femur fractures in long term users of alendronate. Design: We conducted an age- and gender-matched cohort study using national healthcare data. Patients...

  6. Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2002-01-01

    A convenience sample based on availability of tibial stress fracture cases at local Sports Medicine Clinics will be selected over 2-3 years until forty subjects (20 male, 20 female) have been treated...

  7. Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    National Research Council Canada - National Science Library

    Hoffman, Andrew

    2003-01-01

    A convenience sample based on availability of tibial stress fracture cases at local Sports Medicine Clinics will be selected over 2-3 years until forty subjects (20 male, 20 female) have been treated...

  8. The “communication line” suggests occult posterior malleolar fracture associated with a spiral tibial shaft fracture

    International Nuclear Information System (INIS)

    Hou Zhiyong; Zhang Liping; Zhang Qi; Yao Shuangquan; Pan Jinshe; Irgit, Kaan; Zhang Yingze

    2012-01-01

    Objectives: To demonstrate radiographical characteristics of the relationship between distal spiral tibial shaft fractures and associated occult posterior malleolar fractures (PMF) that confirmed by CT and MRI. Materials and methods: X-rays for a ninety-six patients with spiral tibia fracture and associated PMF were reviewed. All patients additionally had an ankle CT. Patients with a negative CT scans underwent an ankle MRI. Radiographic observations included fracture location, characteristics, and a presence of a fracture line between the two injuries. Results: The spiral tibia fracture line was contiguous with PMF in 89 of 96 cases after evaluation with the CT and MRI. The line connecting the two injuries, which occurs between the medial inferior apex of the spiral tibia fracture line and the posterior superior apex of the PMF was identified as the “communication line”. In 47 of the 89 conjunction fractures, the “communication line” was detectable preoperatively and in 12 cases postoperatively by anteroposterior radiograph. By using the CT and MRI scans, we found that no “communication line” was present in only 7 cases. Conclusion: It is important to understand the nature of the association between distal spiral tibial shaft fractures and occult posterior malleolar fractures for optimal stabilization of the fracture and for appropriate rehabilitation. The “communication line” is a useful diagnostic clue for early recognition the occult PMF and alerts a closer evaluation of the lateral view and further CT examination.

  9. Comparison of Primary Hip Spica with Crossed Retrograde Intramedullary Rush Pins for the Management of Diaphyseal Femur Fractures in Children: A Prospective, Randomized Study

    Directory of Open Access Journals (Sweden)

    Mohammad Ruhullah

    2013-12-01

    Conclusions: Intra-medullary crossed Rush pinning is an effective method of paediatric diaphyseal femur fracture fixation as compared to primary hip spica in terms of early weight bearing and restoration of normal anatomy.

  10. Anterior avulsion fracture of the tibial tuberosity in adolescents - Two case reports

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    Aleilimar Teixeira da Silva Júnior

    Full Text Available ABSTRACT The objective here was to report two rare cases of anterior avulsion fracture of the tibial tuberosity in adolescents. Case 1 was a 15-year-old male who became injured through landing on his left knee and presented limited extension. Case 2 was a 16-year-old basketball player who presented sudden pain in the right knee and functional incapacity, after a jump. Imaging examinations (radiographs and computed tomography showed anterior avulsion fractures of the tibial tuberosity. Surgical fixation was performed using screws and anchors, while avoiding growth plate injury. The cases evolved without lower-limb deformities.

  11. Nontraumatic tibial polyethylene insert cone fracture in mobile-bearing posterior-stabilized total knee arthroplasty

    OpenAIRE

    Tanikake, Yohei; Hayashi, Koji; Ogawa, Munehiro; Inagaki, Yusuke; Kawate, Kenji; Tomita, Tetsuya; Tanaka, Yasuhito

    2016-01-01

    A 72-year-old male patient underwent mobile-bearing posterior-stabilized total knee arthroplasty for osteoarthritis. He experienced a nontraumatic polyethylene tibial insert cone fracture 27 months after surgery. Scanning electron microscopy of the fracture surface of the tibial insert cone suggested progress of ductile breaking from the posterior toward the anterior of the cone due to repeated longitudinal bending stress, leading to fatigue breaking at the anterior side of the cone, followed...

  12. Distal tibial pilon fractures (AO/OTA type B, and C treated with the external skeletal and minimal internal fixation method

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    Milenković Saša

    2013-01-01

    Full Text Available Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60 years. The average follow-up was 21.86 (from 12 to 48 months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20 weeks. There were 4 (12.19% infections around the pins of the external skeletal fixator and one (3.22% deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90% patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for

  13. Low-energy fracture of posterolateral tibial plateau: treatment by a posterolateral prone approach.

    Science.gov (United States)

    Yu, Guang-Rong; Xia, Jiang; Zhou, Jia-Qian; Yang, Yun-Feng

    2012-05-01

    Most of the posterolateral tibial plateau fractures are caused by low-energy injury. The posterior fracture fragment could not be exposed and reduced well through traditional approaches. The aim of this study was to review the results of surgical treatment of this kind of fracture using posterolateral approach with patient in prone position. The low-energy posterolateral fracture is defined as the main part of articular depression or split fragment limited within the posterior half of the lateral column. Direct reduction and buttress plate fixation through the posterolateral prone approach was applied in all the patients. In our series, 15 of 132 (11.4%) patients with tibial plateau fractures were identified as low-energy posterolateral fractures. The clinical outcomes were available in 14 of the 15 patients through phone interviews and chart reviews. Mean follow-up was 35.1 months (range: 24-48 months). All the patients had anatomic or good reductions (≤ 2 mm step/gap). Average range of motion was 0.7 degrees to 123.2 degrees (5-110 degrees to 0-140 degrees). The complications were limited to one superficial wound infection, two slight flexion contractures, and five implants removal. The average modified hospital for special surgery knee score was 93.4 (range: 86-100). The posterolateral prone approach provides excellent visualization, which can facilitate the reduction and posterior buttress plate fixation for low-energy posterolateral tibial plateau fractures and shows encouraging results. V, therapeutic study.

  14. Arthroscopic treatment of displaced tibial eminence fractures using a suspensory fixation

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    Philippe Loriaut

    2017-01-01

    Conclusion: The arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory system provided a satisfactory clinical and radiological outcome at a followup of 2 years.

  15. Effectiveness of Minimally Invasive Plate Osteosynthesis (MIPO on Comminuted Tibial or Femoral Fractures

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    Ali Andalib

    2017-09-01

    Full Text Available Background: Comminuted fractures happen frequently due to traumas. Fixation without opening the fracture site,known as minimally invasive plate osteosynthesis (MIPO, has recently become prevalent. This study has beendesigned to assess the outcomes of this treatment for tibial and femoral comminuted fractures.Methods: A total of 60 patients with comminuted femoral or tibial fractures were operated with MIPO method in thiscross-sectional study at Alzahra university hospital in 2015. Eleven patients were excluded due to lack of adequatefollow-ups. Patients’data including union time; infection in the fractured site; hip and knee range of motion; and anymalunion or deformities like limb length discrepancy were collected after the surgery in every session.Results: Among 32 femoral and 17 tibial fractures, union was completed in48 patients, while only one patient withfemoral fracture had nonunion. The mean union time was 18.57±2.42 weeks. Femur fractures healed faster than tibia(17.76±2.36 compared to 19±2.37 weeks, respectively, P=0.09. None of the patients suffered from infections or fistula.The range of motion in hip and knee remained intact in approximately all patients. Malunion happened in 3 patients; 100internal rotation in 1 patient; and 1cm limb shortening in 2 patients.Conclusion: According to the result of this study, MIPO is a simple and effective method of fixation with a high rateof union as well as minimal complications for comminuted fractures of long bones. Infection is rare, and malunion orany deformity is infrequent. MIPO appears to be a promising and safe treatment alternative for comminuted fractures.

  16. Simultaneous bilateral tibial tubercle avulsion fracture in a male teenager: case report and literature review.

    Science.gov (United States)

    Nicolini, Alexandre P; Carvalho, Rogerio T; Ferretti, Mario; Cohen, Moises

    2018-01-01

    Tibial tuberosity avulsion fractures are injuries accounting for less than 3% of all epiphyseal and 1% of all physeal injuries in adolescents. Bilateral injuries are very rare, with only 19 cases described in the literature. These types of fractures occur commonly in male teenagers during sport activities and are often associated with other orthopaedic disorders. We report the case of a male teenager with simultaneous bilateral tibial tubercle fractures, describe the evolution and treatment of this injury and review the literature on this subject. Case report.

  17. The arthroscopic treatment of displaced tibial spine fractures in children and adolescents using Meniscus Arrows(A (R))

    NARCIS (Netherlands)

    Wouters, Diederick B.; de Graaf, Joost S.; Hemmer, Patrick H.; Burgerhof, Johannes G. M.; Kramer, William L. M.

    This article summarises the results of a newly developed technique that utilises Meniscus Arrows(A (R)) for the arthroscopic fixation of displaced tibial spine fractures in children and adolescents. Twelve tibial spine fractures in the knees of eleven children between 6 and 15 years old, with an

  18. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

    Energy Technology Data Exchange (ETDEWEB)

    Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A. [Department of Magnetic Resonance Imaging, IDI Hospital Duran i Reynals, Ciutat Sanitaria i Universitaria de Bellvitge, Gran Via s/n, 08907, L' Hospitalet de Llobregat (Barcelona) (Spain)

    2003-08-01

    The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

  19. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

    International Nuclear Information System (INIS)

    Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A.

    2003-01-01

    The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

  20. The Impact of Computed Tomography on Decision Making in Tibial Plateau Fractures.

    Science.gov (United States)

    Castiglia, Marcello Teixeira; Nogueira-Barbosa, Marcello Henrique; Messias, Andre Marcio Vieira; Salim, Rodrigo; Fogagnolo, Fabricio; Schatzker, Joseph; Kfuri, Mauricio

    2018-02-14

    Schatzker introduced one of the most used classification systems for tibial plateau fractures, based on plain radiographs. Computed tomography brought to attention the importance of coronal plane-oriented fractures. The goal of our study was to determine if the addition of computed tomography would affect the decision making of surgeons who usually use the Schatzker classification to assess tibial plateau fractures. Image studies of 70 patients who sustained tibial plateau fractures were uploaded to a dedicated homepage. Every patient was linked to a folder which contained two radiographic projections (anteroposterior and lateral), three interactive videos of computed tomography (axial, sagittal, and coronal), and eight pictures depicting tridimensional reconstructions of the tibial plateau. Ten attending orthopaedic surgeons, who were blinded to the cases, were granted access to the homepage and assessed each set of images in two different rounds, separated to each other by an interval of 2 weeks. Each case was evaluated in three steps, where surgeons had access, respectively to radiographs, two-dimensional videos of computed tomography, and three-dimensional reconstruction images. After every step, surgeons were asked to present how would they classify the case using the Schatzker system and which surgical approaches would be appropriate. We evaluated the inter- and intraobserver reliability of the Schatzker classification using the Kappa concordance coefficient, as well as the impact of computed tomography in the decision making regarding the surgical approach for each case, by using the chi-square test and likelihood ratio. The interobserver concordance kappa coefficients after each assessment step were, respectively, 0.58, 0.62, and 0.64. For the intraobserver analysis, the coefficients were, respectively, 0.76, 0.75, and 0.78. Computed tomography changed the surgical approach selection for the types II, V, and VI of Schatzker ( p  < 0.01). The addition of

  1. Posterolateral Corner Injury Associated with a Schatzker Type 2 Tibial Plateau Fracture

    Directory of Open Access Journals (Sweden)

    Boris A. Zelle

    2015-01-01

    Full Text Available Isolated posterolateral corner (PLC injuries are rarely seen with tibial plateau fractures and can be missed during the initial assessment. The objective of this paper is to present a case of a Schatzker type 2 tibial plateau fracture with associated isolated PLC injury and give a discussion on physical exam, diagnostic studies, and treatment options. A twenty-five-year-old female sustained a concomitant Schatzker type 2 fracture and PLC injury. Magnetic Resonance Imaging showed an isolated PLC disruption. Open reduction-internal fixation was performed with subsequent PLC repair. At sixteen months postoperatively, the patient had full range of motion and strength of her knee and no signs of laxity. This case emphasizes the importance of physical exam and appropriate imaging modalities in order to diagnose and treat this significant injury in a prompt fashion. In this case, surgical fracture fixation and subsequent repair of the PLC provided a good clinical outcome.

  2. Tension Band Plating for Chronic Anterior Tibial Stress Fractures in High-Performance Athletes.

    Science.gov (United States)

    Zbeda, Robert M; Sculco, Peter K; Urch, Ekaterina Y; Lazaro, Lionel E; Borens, Olivier; Williams, Riley J; Lorich, Dean G; Wellman, David S; Helfet, David L

    2015-07-01

    Anterior tibial stress fractures are associated with high rates of delayed union and nonunion, which can be particularly devastating to a professional athlete who requires rapid return to competition. Current surgical treatment strategies include intramedullary nailing, which has satisfactory rates of fracture union but an associated risk of anterior knee pain. Anterior tension band plating is a biomechanically sound alternative treatment for these fractures. Tension band plating of chronic anterior tibial stress fractures leads to rapid healing and return to physical activity and avoids the anterior knee pain associated with intramedullary nailing. Case series; Level of evidence, 4. Between 2001 and 2013, there were 13 chronic anterior tibial stress fractures in 12 professional or collegiate athletes who underwent tension band plating after failing nonoperative management. Patient charts were retrospectively reviewed for demographics, injury history, and surgical details. Radiographs were used to assess time to osseous union. Follow-up notes and phone interviews were used to determine follow-up time, return to training time, and whether the patient was able to return to competition. Cases included 13 stress fractures in 12 patients (9 females, 3 males). Five patients were track-and-field athletes, 4 patients played basketball, 2 patients played volleyball, and 1 was a ballet dancer. Five patients were Division I collegiate athletes and 7 were professional or Olympic athletes. Average age at time of surgery was 23.6 years (range, 20-32 years). Osseous union occurred on average at 9.6 weeks (range, 5.3-16.9 weeks) after surgery. Patients returned to training on average at 11.1 weeks (range, 5.7-20 weeks). Ninety-two percent (12/13) eventually returned to preinjury competition levels. Thirty-eight percent (5/13) underwent removal of hardware for plate prominence. There was no incidence of infection or nonunion. Anterior tension band plating for chronic tibial stress

  3. Sports activity after surgical treatment of intra-articular tibial plateau fractures in skiers.

    Science.gov (United States)

    Loibl, Markus; Bäumlein, Martin; Massen, Felix; Gueorguiev, Boyko; Glaab, Richard; Perren, Thomas; Rillmann, Paavo; Ryf, Christian; Naal, Florian D

    2013-06-01

    Tibial plateau fractures occur frequently while participating in winter sports, but there is no information on whether skiers can resume sports and recreational activities after internal fixation of these fractures. Skiers can resume low-impact sports activity after internal fixation of tibial plateau fractures. Case series; Level of evidence, 4. A total of 103 patients were surveyed by postal questionnaires to determine their sports activities at a mean of 7.8 ± 1.8 years after internal fixation of intra-articular tibial plateau fractures. The survey also included the Lysholm score, the Tegner activity scale, and a visual analog scale (VAS) for pain. At the time of the survey, 88% of the patients were engaged in sports activities (rate of return to sports, 88%), and 53% continued to participate in downhill skiing. The median number of different activities declined from 5 (range, 1-17) preoperatively to 4 (range, 0-11) postoperatively (P Sports frequency and duration per week did not change: 3 (range, 1-7) preoperatively versus 3 (range, 0-7) postoperatively (P = .275) and 4 hours (range, 1-16 hours) preoperatively versus 3.5 hours (range, 0-15 hours) postoperatively (P = .217), respectively. Median values of all outcome scores declined: Lysholm score, 100 (range, 85-100) preoperatively versus 94.5 (range, 37-100) postoperatively (P sports at the time of follow-up compared with the ability before the accident was rated as "similar" by 57 patients (62.0%) and as "worse" by 35 patients (38.0%). The more severe fracture types, B3 and C3 according to the AO classification system, were associated with poorer outcomes related to return to sports and functional scores. A large percentage of skiers with surgically treated intra-articular tibial plateau fractures cannot continue to participate in downhill skiing; however, the majority could resume an active lifestyle for several years after the trauma. Fracture type seems to be an important factor influencing physical

  4. A new mini-invasive technique in treating pediatric diaphyseal forearm fractures by bioabsorbable elastic stable intramedullary nailing: a preliminary technical report.

    Science.gov (United States)

    Sinikumpu, J-J; Keränen, J; Haltia, A-M; Serlo, W; Merikanto, J

    2013-01-01

    Operative treatment is often indicated in unstable pediatric diaphyseal forearm fractures. Recently minimally invasive reduction and elastic stable intramedullary nailing have been of increasing interest, instead of open reduction and internal fixation with plates. There are several disadvantages of metallic intramedullary implants, such as soft-tissue irritation and a risk of disturbing later imaging. Thus, they are generally removed in later operations. We aimed to develop a new technique to stabilize pediatric forearm fractures by the bioabsorbable intramedullary nailing. We developed a new, two-stage mini-invasive surgical technique to stabilize the unstable diaphyseal fractures in children. The procedure is bioabsorbable elastic stable intramedullary nailing. Ultra-high-strength bioabsorbable intramedullary nails of poly(lactide-co-glycolide) were manufactured for our purpose. The material has been widely proven to be biocompatible and stable enough for fracture treatment as screws and pins. We have used the new technique in the unstable both-bone diaphyseal forearm fractures in children between the ages of 5 and 15 years. We report the technique and our clinical experience in the series of those three cases that have been followed up for at least 12 months. The present series has been randomized for the procedure instead for titanium elastic stable intramedullary nailing, and the series represents a part of ongoing randomized trial. The reported cases operated by the new technique referred good union in the fractured bones and acceptable alignment in the follow-up. Removal of the implants was not required. No troubles with the procedure or implant per se were noticed, indicating good feasibility. One high-energy refracture occurred half year after the primary trauma. Traditional titanium implants were used to control the refracture. We report our preliminary experience of a new surgical mini-invasive procedure to stabilize the unstable pediatric forearm shaft

  5. Epidemiology of open tibial fractures in a teaching hospital ...

    African Journals Online (AJOL)

    Methods: This is a prospective observational study of all open tibial fractures seen at the Accident and Emergency department of the University of Port Harcourt Teaching Hospital (UPTH) over a twelve- month period (July 2002- June 2003). Data from a pre-designed proforma for the study was analyzed and descriptive ...

  6. [Establishment of Schatzker classification digital models of tibial plateau fractures and its application on virtual surgery].

    Science.gov (United States)

    Liu, Yong-gang; Zuo, Li-xin; Pei, Guo-xian; Dai, Ke; Sang, Jing-wei

    2013-08-20

    To explore the establishment of Schatzker classification digital model of tibial plateau fractures and its application in virtual surgery. Proximal tibial of one healthy male volunteer was examined with 64-slice spiral computed tomography (CT). The data were processed by software Mimics 10.01 and a model of proximal tibia was reconstructed. According to the Schatzker classification criteria of tibial plateau fractures, each type of fracture model was simulated.Screen-captures of fracture model were saved from different directions.Each type of fracture model was exported as video mode.Fracture model was imported into FreeForm modeling system.With a force feedback device, a surgeon could conduct virtual fracture operation simulation.Utilizing the GHOST of FreeForm modeling system, the software of virtual cutting, fracture reduction and fixation was developed.With a force feedback device PHANTOM, a surgeon could manipulate virtual surgical instruments and fracture classification model and simulate surgical actions such as assembly of surgical instruments, drilling, implantation of screw, reduction of fracture, bone grafting and fracture fixation, etc. The digital fracture model was intuitive, three-dimensional and realistic and it had excellent visual effect.Fracture could be observed and charted from optional direction and angle.Fracture model could rotate 360 ° in the corresponding video mode. The virtual surgical environment had a strong sense of reality, immersion and telepresence as well as good interaction and force feedback function in the FreeForm modeling system. The user could make the corresponding decisions about surgical method and choice of internal fixation according to the specific type of tibial plateau fracture as well as repeated operational practice in virtual surgery system. The digital fracture model of Schatzker classification is intuitive, three-dimensional, realistic and dynamic. The virtual surgery systems of Schatzker classifications make

  7. Conventional radiographic examination in the evaluation of sequelae after tibial plateau fractures

    International Nuclear Information System (INIS)

    Jensen, D.B.; Bjerg-Nielsen, A.; Laursen, N.; Glostrup Univ. Hospital

    1988-01-01

    Seventy patients with 72 conservatively treated tibial plateau fractures were re-examined after an average of 5 3/4 years. Among 55 fractured knees with a primary articular depression of 1-20 mm, the depression was still present radiographically in 47 knees. No correlation existed between the persistent radiographic depression and function of the knee. Moderate to severe osteoarthrosis was found in 10 knees; in five of these the osteoarthrosis was of clinical importance. More than 10 degrees of valgus/varus deformity was present in two knees. In two patients osteotomy had been performed to correct deformity. It is concluded that a persistent radiographic articular depression is of no clinical importance in tibial plateau fractures treated by conservative methods, which include early movement of the knee. The radiographic examination, however is, useful in the evaluation of valgus/varus deformity and osteoarthrosis. (orig.)

  8. Operative Versus Conservative Management of Displaced Tibial Shaft Fracture in Adolescents.

    Science.gov (United States)

    Kinney, Matthew C; Nagle, David; Bastrom, Tracey; Linn, Michael S; Schwartz, Alexandra K; Pennock, Andrew T

    2016-01-01

    Displaced tibial shaft fractures are common in adolescent patients, yet there is no standardized management strategy. We compared surgical fixation and closed reduction and casting (CRC) of these fractures to assess treatment outcomes and determine predictors of failure. We retrospectively reviewed all patients aged 12 to 18 who presented with a displaced tibial shaft fracture that required reduction over an 8-year period. Exclusion criteria included open fractures and lack of follow-up to radiographic union or to 6 months from the index procedure. Fractures were initially treated based on surgeon preference either with CRC or with immediate intramedullary nailing. Seventy-four patients met inclusion criteria: 57 were initially managed with CRC and 17 with operative fixation. Radiographic healing was defined as bridging of 3 cortices and adequacy of final alignment was defined as 20% (odds ratio=7.8, Palignment (92.5% vs. 72.4%, P=0.10) but required longer hospitalization (5.4 vs. 1.9 d, P<0.001) and had a higher incidence of anterior knee pain (20% vs. 0%, P<0.01). There was no significant difference between groups with respect to time to healing. Treatment outcomes between initial operative fixation and closed reduction of displaced tibia fractures in adolescents are similar, but patients must be counseled about the high failure rates with CRC. Predictors of CRC failure include initial fracture displacement and the presence of a fibula fracture-these variables should be considered when selecting a treatment method. Level III-Therapeutic study.

  9. The Valgus Inclination of the Tibial Component Increases the Risk of Medial Tibial Condylar Fractures in Unicompartmental Knee Arthroplasty.

    Science.gov (United States)

    Inoue, Shinji; Akagi, Masao; Asada, Shigeki; Mori, Shigeshi; Zaima, Hironori; Hashida, Masahiko

    2016-09-01

    Medial tibial condylar fractures (MTCFs) are a rare but serious complication after unicompartmental knee arthroplasty. Although some surgical pitfalls have been reported for MTCFs, it is not clear whether the varus/valgus tibial inclination contributes to the risk of MTCFs. We constructed a 3-dimensional finite elemental method model of the tibia with a medial component and assessed stress concentrations by changing the inclination from 6° varus to 6° valgus. Subsequently, we repeated the same procedure adding extended sagittal bone cuts of 2° and 10° in the posterior tibial cortex. Furthermore, we calculated the bone volume that supported the tibial component, which is considered to affect stress distribution in the medial tibial condyle. Stress concentrations were observed on the medial tibial metaphyseal cortices and on the anterior and posterior tibial cortices in the corner of cut surfaces in all models; moreover, the maximum principal stresses on the posterior cortex were larger than those on the anterior cortex. The extended sagittal bone cuts in the posterior tibial cortex increased the stresses further at these 3 sites. In the models with a 10° extended sagittal bone cut, the maximum principal stress on the posterior cortex increased as the tibial inclination changed from 6° varus to 6° valgus. The bone volume decreased as the inclination changed from varus to valgus. In this finite element method, the risk of MTCFs increases with increasing valgus inclination of the tibial component and with increased extension of the sagittal cut in the posterior tibial cortex. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. MRI diagnosis of trapped periosteum following incomplete closed reduction of distal tibial Salter-Harris II fracture

    International Nuclear Information System (INIS)

    Raman, Subha; Wallace, E.C.

    2011-01-01

    Irreducible fracture of the distal tibial physis due to interposed soft tissue including periosteum is well documented in the orthopedic literature but is uncommon. This condition has been associated with subsequent growth disturbance and requires open reduction. There are very few prior reports of MRI depiction of soft tissue interposition and none of periosteal interposition in the distal tibial physis. This is a relatively common location of physeal injury and related growth disturbance. We present a case of periosteum trapped in the distal tibial physis, diagnosed on MRI, in a Salter-Harris II fracture and its management implications. (orig.)

  11. Staged minimally invasive plate osteosynthesis of proximal tibial fractures with acute compartment syndrome.

    Science.gov (United States)

    Kim, Joon-Woo; Oh, Chang-Wug; Oh, Jong-Keon; Kyung, Hee-Soo; Park, Kyeong-Hyeon; Kim, Hee-June; Jung, Jae-Wook; Jung, Young-Soo

    2017-06-01

    High-energy proximal tibial fractures often accompany compartment syndrome and are usually treated by fasciotomy with external fixation followed by secondary plating. However, the initial soft tissue injury may affect bony union, the fasciotomy incision or external fixator pin sites may lead to postoperative wound infections, and the staged procedure itself may adversely affect lower limb function. We assess the results of staged minimally invasive plate osteosynthesis (MIPO) for proximal tibial fractures with acute compartment syndrome. Twenty-eight patients with proximal tibial fractures accompanied by acute compartment syndrome who underwent staged MIPO and had a minimum of 12 months follow-up were enrolled. According to the AO/OTA classification, 6 were 41-A, 15 were 41-C, 2 were 42-A and 5 were 42-C fractures; this included 6 cases of open fractures. Immediate fasciotomy was performed once compartment syndrome was diagnosed and stabilization of the fracture followed using external fixation. After the soft tissue condition normalized, internal conversion with MIPO was done on an average of 37 days (range, 9-158) after index trauma. At the time of internal conversion, the external fixator pin site grades were 0 in 3 cases, 1 in 12 cases, 2 in 10 cases and 3 in 3 cases, as described by Dahl. Radiographic assessment of bony union and alignment and a functional assessment using the Knee Society Score and American Orthopedic Foot and Ankle Society (AOFAS) score were carried out. Twenty-six cases achieved primary bony union at an average of 18.5 weeks. Two cases of nonunion healed after autogenous bone grafting. The mean Knee Society Score and the AOFAS score were 95 and 95.3 respectively, at last follow-up. Complications included 1 case of osteomyelitis in a patient with a grade IIIC open fracture and 1 case of malunion caused by delayed MIPO due to poor wound conditions. Duration of external fixation and the external fixator pin site grade were not related to the

  12. Moore I postero-medial articular tibial fracture in alpine skiers: Surgical management and return to sports activity.

    Science.gov (United States)

    Morin, Vincent; Pailhé, Régis; Sharma, Akash; Rouchy, René-Christopher; Cognault, Jérémy; Rubens-Duval, Brice; Saragaglia, Dominique

    2016-06-01

    Over the past 10 years, like many authors, we observed an increasing number of Moore I tibial plateau fractures related to alpine skiing for which the surgeon may face difficult choices regarding surgical approach and fixation means. Some authors have recently been suggesting a posterior approach associated to open reduction and osteosynthesis by a buttress plate. But in our knowledge there is no specific study on sports activity recovery after Moore I tibial fractures. The aim of this work was to assess sports activities and clinical outcomes after surgically treated Moore I tibial plateau fractures in an athletic population of skiers. We conducted a prospective case series between 2012 and 2014. This included fifteen patients aged 39.6±7 years whom presented with a Moore I tibial plateau fracture during a skiing accident. 12 cases (80%) presented with an associated tibial spine fracture. Treatment consisted of a standard antero-medial approach, with a medial para patellar arthrotomy to allow direct visualisation of articular reduction and spinal fixation. Two or three 6.5mm long cancellous bone screws were placed antero-posteriorly so as to ensure perfect compression of the fracture site. Radiological and functional results were assessed by an independent observer (Lysholm-Tegner, UCLA, KOOS scores) at the longest follow-up. Mean follow-up was 18.2±6 months (12-28). An immediate postoperative anatomical reduction was achieved in all cases and remained stable in time. At last follow-up Lysholm mean score was 85±14 points (59-100), UCLA score was 7.3±1.6 (4-10) and Tegner score was 4.6±1.3 (3-6). Mean KOOS score was 77±15 (54-97). 87% of patients had resumed their skiing activity and 93% were satisfied or very satisfied from their post-operative surgical outcome. We observed no pseudarthrosis or secondary varus displacement. In our series 87% of patients had resumed back to their sporting activities. Surgical management of Moore I tibial plateau fractures by

  13. Using external and internal locking plates in a two-stage protocol for treatment of segmental tibial fractures.

    Science.gov (United States)

    Ma, Ching-Hou; Tu, Yuan-Kun; Yeh, Jih-Hsi; Yang, Shih-Chieh; Wu, Chin-Hsien

    2011-09-01

    The tibial segmental fractures usually follow high-energy trauma and are often associated with many complications. We designed a two-stage protocol for these complex injuries. The aim of this study was to assess the outcome of tibial segmental fractures treated according to this protocol. A prospective series of 25 consecutive segmental tibial fractures were treated using a two-stage procedure. In the first stage, a low-profile locking plate was applied as an external fixator to temporarily immobilize the fractures after anatomic reduction had been achieved followed by soft-tissue reconstruction. The second stage involved definitive internal fixation with a locking plate using a minimally invasive percutaneous plate osteosynthesis technique. The median follow-up was 32 months (range, 20-44 months). All fractures achieved union. The median time for the proximal fracture union was 23 weeks (range, 12-30 weeks) and that for distal fracture union was 27 weeks (range, 12-46 weeks; p = 0.08). Functional results were excellent in 21 patients and good in 4 patients. There were three cases of delayed union of distal fracture. Valgus malunion >5 degrees occurred in two patients, and length discrepancy >1 cm was observed in two patients. Pin tract infection occurred in three patients. Use of the two-stage procedure for treatment of segmental tibial fractures is recommended. Surgeons can achieve good reduction with stable temporary fixation, soft-tissue reconstruction, ease of subsequent definitive fixation, and high union rates. Our patients obtained excellent knee and ankle joint motion, good functional outcomes, and a comfortable clinical course.

  14. [Comparison of LCP and locked intramedullary nailing fixation in treatment of tibial diaphysis fractures].

    Science.gov (United States)

    Huang, Peng; Tang, Peifu; Yao, Qi

    2007-11-01

    To evaluate the treatment results of LCP and locked intramedullary nailing for tibial diaphysis fractures. From October 2003 to April 2006, 55 patients with tibial diaphysis fractures (58 fractures) were treated. Of them there were 39 males and 16 females with an average of 39 years years ( 14 to 62 years). The fractures were on the left side in 27 patients and on the right side in 31 patients (3 patients had bilateral involvement). Thirty-four fractures were treated by intramedullary nailing (intramedullary nailing group) and 24 fractures by LCP fixation (LCP group). The average disease course was 3 days (intramedullary nailing group) and 3.1 days (LCP group). The operation time, the range of motion of knee and ankle joints, fracture healing time, and complications were evaluated. The patients were followed up 8-26 months (13 months on average). The operation time was 84.0+/-9.2 min (intramedullary nailing group) and 69.0+/-8.4 min (LCP group); the average cost in hospital was yen 19,297.78 in the intramedullary nailing group and yen 14,116.55 in the LCP group respectively, showing significant differences (P 0.05). The doral flexion and plantar flexion of ankle joint were 13.0+/-1.7 degrees and 41.0+/-2.6 degrees in intramedullary nailing group, and 10.0+/-1.4 degrees and 44.0+/-2.3 degrees in LCP group, showing no significant differences (P>0.05). The mean healing time was 3.3 months in intramedullary nailing group, and 3. 1 months in LCP group. Length discrepancy occurred in 1 case (2.5 cm), delayed union in 1 case and nailing end trouble in 3 cases in intramedullary nailing group; moreover rotation deformity occurred 1 case and anterior knee pain occurred in 6 cases (17.1%). One angulation and open fracture developed osteomyelitis in 1 case 1 week postoperatively and angulation deformity occurred in 1 case of distal-third tibial fractures in LCP group. LCP and locked intramedullary nailing can achieve satisfactory results in treating tibial diaphysis fracture

  15. Percutaneous locking plates for fractures of the distal tibia: our experience and a review of the literature.

    Science.gov (United States)

    Ahmad, Mudussar Abrar; Sivaraman, Alagappan; Zia, Ahmed; Rai, Amarjit; Patel, Amratlal D

    2012-02-01

    Distal tibial metaphyseal fractures pose many complexities. This study assessed the outcomes of distal tibial fractures treated with medial locking plates. Eighteen patients were selected based on the fracture pattern and classified using the AO classification and stabilized with an AO medial tibial locking plate. Time to fracture union, complications, and outcomes were assessed with the American Orthopedic Foot and Ankle Society Ankle score at 12 months. Sixteen of the 18 patients achieved fracture union, with 1 patient lost to follow-up. Twelve fractures united within 24 weeks, with an average union time of 23.1 weeks. Three delayed unions, two at 28 weeks and one at 56 weeks. The average time to union was 32 weeks in the smokers and 15.3 weeks in the nonsmokers. Five of the 18 patients (27%) developed complications. One superficial wound infection, and one chronic wound infection, resulting in nonunion at 56 weeks, requiring revision. Two patients required plate removal, one after sustaining an open fracture at the proximal end of the plate 6 months after surgery (postfracture union)and the other for painful hardware. One patient had implant failure of three proximal diaphyseal locking screws at the screwhead/neck junction, but successful fracture union. The average American Orthopedic Foot and Ankle Society ankle score was 88.8 overall, and 92.1 in fractures that united within 24 weeks. Distal tibial locking plates have high fracture union rates, minimum soft tissue complications, and good functional outcomes. The literature shows similar fracture union and complication rates in locking and nonlocking plates. Copyright © 2012 by Lippincott Williams & Wilkins

  16. Newly designed anterolateral and posterolateral locking anatomic plates for lateral tibial plateau fractures: a finite element study.

    Science.gov (United States)

    Chen, Pengbo; Lu, Hua; Shen, Hao; Wang, Wei; Ni, Binbin; Chen, Jishizhan

    2017-02-23

    Lateral column tibial plateau fracture fixation with a locking screw plate has higher mechanical stability than other fixation methods. The objectives of the present study were to introduce two newly designed locking anatomic plates for lateral tibial plateau fracture and to demonstrate their characteristics of the fixation complexes under the axial loads. Three different 3D finite element models of the lateral tibial plateau fracture with the bone plates were created. Various axial forces (100, 500, 1000, and 1500 N) were applied to simulate the axial compressive load on an adult knee during daily life. The equivalent maps of displacement and stress were output, and relative displacement was calculated along the fracture lines. The displacement and stresses in the fixation complexes increased with the axial force. The equivalent displacement or stress map of each fixation under different axial forces showed similar distributing characteristics. The motion characteristics of the three models differed, and the max-shear stress of trabecula increased with the axial load. These two novel plates could fix lateral tibial plateau fractures involving anterolateral and posterolateral fragments. Motions after open reduction and stable internal fixation should be advised to decrease the risk of trabecular microfracture. The relative displacement of the posterolateral fragments is different when using anterolateral plate and posterolateral plate, which should be considered in choosing the implants for different posterolateral plateau fractures.

  17. Fratura periprotética da tíbia combinada com fratura de fadiga da haste tibial de artroplastia total do joelho Tibial periprosthetic fracture combined with tibial stem stress fracture from total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Fernando Fonseca

    2011-01-01

    Full Text Available As complicações das artroplastias totais do joelho relacionadas com o próprio material são muito raras, exceto o desgaste do polietileno. Neste artigo os autores reportam o caso de uma paciente do sexo feminino de 58 anos referenciada ao pronto-socorro do nosso hospital por uma fratura periprotética tibial (tipo I da classificação da Mayo Clinic. Uma observação mais cuidadosa mostrou a presença concomitante da referida fratura da tíbia associada à fratura de fadiga da haste tibial. A prótese com a haste foi remetida a um laboratório de biomecânica independente onde foi avaliada e efetuada uma reconstrução com uso de sistema de elementos finitos em CAD de modo a verificar a existência de algum defeito de fabricação e as eventuais causas para o sucedido. Depois de avaliadas diversas hipóteses, concluiu-se que a fratura do material foi provocada por uma sobrecarga na zona de transição prato/haste secundária à falência óssea prévia (fratura. Da avaliação do caso ressalta-se novamente a necessidade de efetuar uma avaliação adequada da mineralização óssea e, em caso de dúvida, utilizar uma haste longa.Total knee arthroplasty complications related to the prosthetic material are very rare, except for polyethylene wear. We report the case of a 58-year-old woman who came to the emergency service of our hospital with a periprosthetic tibial fracture (Mayo Clinic type I. Careful examination showed that this fracture was concomitantly associated with a tibial stem fatigue fracture. The prosthesis and the stem were sent to an independent biomechanics laboratory for evaluation. A finite-element CAD system was used to make a reconstruction, so as to ascertain whether there had been any manufacturing defect and what the causes of the event might have been. After evaluation of several hypotheses, it was concluded that the fracture in the prosthetic material had been caused by overloading at the plate/stem transition zone

  18. Tibial avulsion fracture of the posterior root of the medial meniscus in children

    DEFF Research Database (Denmark)

    Iversen, Jonas Vestergård; Krogsgaard, Michael Rindom

    2012-01-01

    of displaced avulsion fractures of the posterior root of the medial meniscus in children are presented along with a concise report of the literature regarding avulsion fractures of the posterior root of the medial meniscus. Both avulsions were reattached arthroscopically by trans-tibial pull-out sutures...

  19. Percutaneous clamping of spiral and oblique fractures of the tibial shaft: a safe and effective reduction aid during intramedullary nailing.

    Science.gov (United States)

    Collinge, Cory A; Beltran, Michael J; Dollahite, Henry A; Huber, Florian G

    2015-06-01

    The reduction of tibial shaft fractures during intramedullary nailing is important if limb alignment is to be restored and successful clinical outcomes are expected. We have used a percutaneously applied (or open) clamp or clamps to achieve and maintain reduction during nailing of all amendable tibial shaft fractures. In this article, we describe the technique and preliminary results comparing closed, simple spiral and oblique tibial shaft fractures (OTA 42-A1 and A2) managed with percutaneous clamp-assisted nailing (CAN) versus nailing using manual reduction (MRN) held by the surgical team. In the MRN group, there were an increased fracture gap (P = 0.04) and trends toward malalignment (P = 0.07) and healing time (P = 0.06) compared with the CAN group. There were also trends in clinical; no wound complications occurred in either group. We have found that percutaneous CAN of closed, simple spiral and oblique tibial shaft fractures seems safe and allows for early predictable union with reproducible alignment compared with nailing using MRN.

  20. [Balloon osteoplasty as reduction technique in the treatment of tibial head fractures].

    Science.gov (United States)

    Freude, T; Kraus, T M; Sandmann, G H

    2015-10-01

    Tibial plateau fractures requiring surgery are severe injuries of the lower extremities. Depending on the fracture pattern, the age of the patient, the range of activity and the bone quality there is a broad variation in adequate treatment.  This article reports on an innovative treatment concept to address split depression fractures (Schatzker type II) and depression fractures (Schatzker type III) of the tibial head using the balloon osteoplasty technique for fracture reduction. Using the balloon technique achieves a precise and safe fracture reduction. This internal osteoplasty combines a minimal invasive percutaneous approach with a gently rise of the depressed area and the associated protection of the stratum regenerativum below the articular cartilage surface. This article lights up the surgical procedure using the balloon technique in tibia depression fractures. Using the balloon technique a precise and safe fracture reduction can be achieved. This internal osteoplasty combines a minimally invasive percutaneous approach with a gentle raising of the depressed area and the associated protection of the regenerative layer below the articular cartilage surface. Fracture reduction by use of a tamper results in high peak forces over small areas, whereas by using the balloon the forces are distributed over a larger area causing less secondary stress to the cartilage tissue. This less invasive approach might help to achieve a better long-term outcome with decreased secondary osteoarthritis due to the precise and chondroprotective reduction technique.

  1. Intramedullary nailing of proximal and distal one-third tibial shaft fractures with intraoperative two-pin external fixation.

    Science.gov (United States)

    Wysocki, Robert W; Kapotas, James S; Virkus, Walter W

    2009-04-01

    Fractures of the proximal and distal one thirds of the tibial shaft have historically higher malunion rates than those of the midshaft. This retrospective case series evaluates the postoperative radiographic outcome of intramedullary nailing of proximal and distal one-third tibial shaft fractures using intraoperative two-pin external fixation, often referred to as traveling traction. Between 2000 and 2005, 15 consecutive patients with proximal third and 27 consecutive patients with distal third displaced extra-articular fractures of the tibia were treated with statically locked intramedullary nailing and supplementary intraoperative two-pin rectangular frame external fixation. The external fixation was removed once the proximal and distal locking screws were in place. The alignment of the fractures was determined using standard postoperative anteroposterior and lateral radiographs. Postoperatively, 14 of 15 patients with proximal fractures and 25 of 27 patients with distal fractures had less than 5 degrees of angular deformity in both the coronal and sagittal planes and less than 1 cm shortening. Statically locked intramedullary nailing with simultaneous intraoperative traveling traction external fixation as treatment for proximal and distal one-third extra-articular tibial shaft fractures is successful in achieving a high rate of acceptable postoperative alignment.

  2. Management of Gustilo Anderson III B open tibial fractures by primary fascio-septo-cutaneous local flap and primary fixation: The 'fix and shift' technique.

    Science.gov (United States)

    Ramasamy, P R

    2017-01-01

    Open fractures of tibia have posed great difficulty in managing both the soft tissue and the skeletal components of the injured limb. Gustilo Anderson III B open tibial fractures are more difficult to manage than I, II, and III A fractures. Stable skeletal fixation with immediate soft tissue cover has been the key to the successful outcome in treating open tibial fractures, in particular, Gustilo Anderson III B types. If the length of the open wound is larger and if the exposed surface of tibial fracture and tibial shaft is greater, then the management becomes still more difficult. Thirty six Gustilo Anderson III B open tibial fractures managed between June 2002 and December 2013 with "fix and shift" technique were retrospectively reviewed. All the 36 patients managed by this technique had open wounds measuring >5 cm (post debridement). Under fix and shift technique, stable fixation involved primary external fixator application or primary intramedullary nailing of the tibial fracture and immediate soft tissue cover involved septocutaneous shift, i.e., shifting of fasciocutaneous segments based on septocutaneous perforators. Primary fracture union rate was 50% and reoperation rate (bone stimulating procedures) was 50%. Overall fracture union rate was 100%. The rate of malunion was 14% and deep infection was 16%. Failure of septocutaneous shift was 2.7%. There was no incidence of amputation. Management of Gustilo Anderson III B open tibial fractures with "fix and shift" technique has resulted in better outcome in terms of skeletal factors (primary fracture union, overall union, and time for union and malunion) and soft tissue factors (wound healing, flap failure, access to secondary procedures, and esthetic appearance) when compared to standard methods adopted earlier. Hence, "fix and shift" could be recommended as one of the treatment modalities for open III B tibial fractures.

  3. Trampoline fracture of the proximal tibial metaphysis in children may not progress into valgus: a report of seven cases and a brief review.

    Science.gov (United States)

    Kakel, R

    2012-06-01

    Fracture of the proximal tibial metaphysis in children is a rare injury but notorious for carrying the risk of subsequent valgus deformity of the tibia. Trampoline-caused fracture of the proximal tibial metaphysis in children may not progress into valgus. We followed up six children who collectively sustained seven fractures of the proximal tibial metaphysis while trampolining with other heavier and/or older children. Initial and follow-up x-rays were reviewed by an orthopaedic surgeons and two radiologists. None of the patients developed valgus deformity with follow-up. Trampoline is associated with a specific type of injury to the proximal tibia when children are trampolining with other heavier children even without falling off the trampoline. This fracture is linear and complete, often non-displaced. Unlike "other" proximal tibial metaphyseal fractures, trampoline-associated proximal tibial metaphysical fracture in children is not associated with a risk of subsequent valgus deformity. Level 4. case series. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  4. Application of Minimally Invasive Treatment of Locking Compression Plate in Schatzker Ⅰ-Ⅲ Tibial Plateau Fracture

    OpenAIRE

    Guohui Zhao

    2014-01-01

    Objective: To investigate the clinical effect of minimally invasive treatment of locking compression plate (LCP) in Schatzker Ⅰ-Ⅲ tibial plateau fracture. Methods: Thirty-eight patients with Schatzker Ⅰ-Ⅲ tibial plateau fracture in our hospital were given minimally invasive treatment of LCP, and the artificial bone was transplanted to the depressed bone. Adverse responses, wound healing time and clinical efficacy were observed. Results: All patients were followed-up for 14- 20 months, and the...

  5. [effectiveness of open reduction and internal fixation without opening joint capsule on tibial plateau fracture].

    Science.gov (United States)

    Chen, Qi; Xu, Xiaofeng; Huang, Yonghui; Cao, Xingbing; Meng, Chen; Cao, Xueshu; Wei, Changbao

    2014-12-01

    To introduce the surgery method to reset and fix tibial plateau fracture without opening joint capsule, and evaluate the safety and effectiveness of this method. Between July 2011 and July 2013, 51 patients with tibial plateau fracture accorded with the inclusion criteria were included. All of 51 patients, 17 cases underwent open reduction and internal fixation without opening joint capsule in trial group, and 34 cases underwent traditional surgery method in control group. There was no significant difference in gender, age, cause of injury, time from injury to admission, side of injury, and types of fracture between 2 groups (P > 0.05). The operation time, intraoperative blood loss, incision length, incision healing, and fracture healing were compared between 2 groups. The tibial-femoral angle and collapse of joint surface were measured on X-ray film. At last follow-up, joint function was evaluated with Hospital for Special Surgery (HSS) knee function scale. The intraoperative blood loss in trial group was significantly less than that in control group (P time and the rate of incision healing between 2 groups (P > 0.05). The patients were followed up 12-30 months (mean, 20.4 months) in trial group and 12-31 months (mean, 18.2 months) in control group. X-ray films indicated that all cases in 2 groups obtained fracture healing; there was no significant difference in the fracture healing time between 2 groups (t=1.382, P=0.173). On X-ray films, difference was not significant in tibial-femoral angle and collapse of joint surface between 2 groups (P > 0.05). HSS score of the knee in trial group was significantly higher than that of control group (t=3.161, P=0.003). It can reduce the intraoperative blood loss and shorten the incision length to use open reduction and internal fixation without opening joint capsule for tibial plateau fracture. Traction of joint capsule is helpful in the reduction and good recovery of joint surface collapse. In addition, the surgery without

  6. External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis.

    Science.gov (United States)

    Metcalfe, David; Hickson, Craig J; McKee, Lesley; Griffin, Xavier L

    2015-12-01

    It is uncertain whether external fixation or open reduction internal fixation (ORIF) is optimal for patients with bicondylar tibial plateau fractures. A systematic review using Ovid MEDLINE, Embase Classic, Embase, AMED, the Cochrane Library, Open Grey, Orthopaedic Proceedings, WHO International Clinical Trials Registry Platform, Current Controlled Trials, US National Institute for Health Trials Registry, and the Cochrane Central Register of Controlled Trials. The search was conducted on 3rd October 2014 and no language limits were applied. Inclusion criteria were all clinical study designs comparing external fixation with open reduction internal fixation of bicondylar tibial plateau fractures. Studies of only one treatment modality were excluded, as were those that included unicondylar tibial plateau fractures. Treatment effects from studies reporting dichotomous outcomes were summarised using odds ratios. Continuous outcomes were converted to standardized mean differences to assess the treatment effect, and inverse variance methods used to combine data. A fixed effect model was used for meta-analyses. Patients undergoing external fixation were more likely to have returned to preinjury activities by six and twelve months (P = 0.030) but not at 24 months follow-up. However, external fixation was complicated by a greater number of infections (OR 2.59, 95 % CI 1.25-5.36, P = 0.01). There were no statistically significant differences in the rates of deep infection, venous thromboembolism, compartment syndrome, or need for re-operation between the two groups. Although external fixation and ORIF are associated with different complication profiles, both are acceptable strategies for managing bicondylar tibial plateau fractures.

  7. Posterior coronal plating for tibial fractures: technique and advantages

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    Montu Jain

    2014-04-01

    Full Text Available Objective:Tibial shaft fractures are straightforward to treat but when associated with soft tissue injury particularly at the nail entry/plate insertion site or there is significant comminution proximally or a large butterfly fragment/a second split component in the posterior coronal plane, it is a challenge to the treating surgeon. The aim of the present report is to describe the technique of posterior coronal plating in such a scenario and its advantages. Methods:Between July 2008 and June 2011, 12 patients were pro spectively treated by this approach using 4.5 mm broad dynamic compression plates. Results:The time of bony consolidation and full weight bearing averaged 21.7 weeks (range, 16-26 weeks. Patients were followed up for at least 24 months (range, 24-48 months. At 1 year postoper atively, no loss in reduction or alignment was observed. Mean Hospital for Lower Extremity Measurement Functional Score was 72.8 (range, 64-78. All patients were satisfied with their treatment outcomes. Conclusion:Direct posterior approach and fixation using prone position helps to visualise the fracture fragments and provide rigid fixation. The approach is simple and extensile easily, apart from advantages of less soft tissue and hardware problems compared to standard medial or lateral plating. Key words: Tibial fractures; Bone plates; Orthopedic procedures

  8. Angular-stable locking plate fixation of tibial plateau fractures-clinical and radiological midterm results in 101 patients

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    Sven Mardian; Felix Landmann; Florian Wichlas; Norbert P Haas; Klaus-Dieter Schaser; Philipp Schwabe

    2015-01-01

    Background: Articular reconstruction and stable fixation of tibial plateau fractures and its various subtypes continue to represent a surgical challenge. Only few trials have studied results following angular stable plate fixation. The present study aimed to investigate the clinical, radiological, functional and quality of life results following tibial plateau fractures using angular stable plate fixation. Materials and Methods: 101 patients were retrospectively studied using functional (...

  9. Treatment preferences in Turkey for open fracture of the tibial diaphysis

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    Güzelali Özdemir

    2017-03-01

    Conclusion: A wide variation was observed among orthopedics and traumatology specialists in Turkey regarding treatment of open tibial diaphysis fracture in adults. Data obtained from this study together with the available literature may be useful to further develop therapeutic approaches.

  10. Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III

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    Frederico Carlos Jaña Neto

    2016-04-01

    Full Text Available OBJECTIVE: To analyze the characteristics of patients with Gustilo-Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014. METHODS: This was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive; presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score index; mortality rate; and infection rate. RESULTS: 116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%. Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75% and IIIB (25% predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group. CONCLUSION: The profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions.

  11. Surgical site infection after open reduction and internal fixation of tibial plateau fractures.

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    Lin, Shishui; Mauffrey, Cyril; Hammerberg, E Mark; Stahel, Philip F; Hak, David J

    2014-07-01

    The aim of this study was to identify risk factors for surgical site infections and to quantify the contribution of independent risk factors to the probability of developing infection after definitive fixation of tibial plateau fractures in adult patients. A retrospective analysis was performed at a level I trauma center between January 2004 and December 2010. Data were collected from a review of the patient's electronic medical records. A total of 251 consecutive patients (256 cases) were divided into two groups, those with surgical site infections and those without surgical site infections. Preoperative and perioperative variables were compared between these groups, and risk factors were determined by univariate analyses and multivariate logistic regression. Variables analyzed included age, gender, smoking history, diabetes, presence of an open fracture, presence of compartment syndrome, Schatzker classification, polytrauma status, ICU stay, time from injury to surgery, use of temporary external fixation, surgical approach, surgical fixation, operative time, and use of a drain. The overall rate of surgical site infection after ORIF of tibial plateau fractures during the 7 years of this study was 7.8% (20 of 256). The most common causative pathogens was Staphylococcus aureus (n=15, 75%). Independent predictors of surgical site infection identified by multivariate analyses were open tibial plateau fracture (odds ratio=3.9; 95% CI=1.3-11.6; p=0.015) and operative time (odds ratio=2.7; 95% CI=1.6-4.4; psite infection. Both open fracture and operative time are independent risks factors for postoperative infection.

  12. Limited open reduction is better for simple- distal tibial shaft fractures than minimally invasive plate osteosynthesis.

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    Li, Q; Zeng, B F; Luo, C F; Song, S; Zhang, C Q; Kong, W Q

    2014-07-24

    The aim of this study was to compare the effects and indications of minimally invasive plate osteosynthesis (MIPO) and limited open reduction (LOR) for managing distal tibial shaft fractures. A total of 79 cases of distal tibial shaft fractures were treated surgically in our trauma center. The 79 fracture cases were classified into type A, B, and C (C1) according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, with 28, 32, and 19 cases, respectively. Among the 79 fracture cases, 52 were closed fractures and 27 were open fractures (GUSTILO, I-II). After adequate preparation, 48 cases were treated with LOR and 31 cases were treated with MIPO. All cases were followed up for 12 to 18 months, with an average of 16.4 months. During the follow-up period, 76 fracture cases were healed in the first stage, whereas the 3 cases that developed non-union were treated by changing the fixation device and autografting. For types A, B, and some of C simple fractures (C1), LOR accelerated the fracture healing and lowered the non-union rate. One case suffered from regional soft tissue infection, which was controlled by wound dressing and intravenous antibiotics. Another case that developed local skin necrosis underwent local flap transplant. LOR promoted bone healing and lowered the non-union rate of several simple-distal tibial shaft fractures. Thereafter, the incidence of soft tissue complication was not significantly increased. However, for complex and comminuted fractures, MIPO was the preferred method for correcting bone alignment and protecting soft tissue, leading to functional recovery.

  13. Tibial shaft fracture and ankle injury - Case report

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    Caio Zamboni

    Full Text Available ABSTRACT The authors report on a case of tibial shaft fracture associated with ankle injury. The clinical, radiological and surgical characteristics are discussed. Assessment of associated injuries is often overlooked and these injuries are hard to diagnose. When torque occurs in the lower limb, the ankle becomes susceptible to simultaneous injury. It is essential to make careful assessment based on clinical, radiographic, intraoperative and postoperative characteristics in order to attain functional recovery.

  14. Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures.

    Science.gov (United States)

    Dong, Wen-Wei; Shi, Zeng-Yuan; Liu, Zheng-Xin; Mao, Hai-Jiao

    2016-12-01

    To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis (MIPPO) of tibial shaft fractures with the use of a distraction support. Between March 2011 and October 2014, 52 patients with a mean age of 48 years (16-72 years) sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goni- ometer measurement on preoperative and postoperative images. Preoperative radiographs revealed a mean of 7.6°(1.2°-28°) angulation in coronal plane and a mean of 6.8°(0.5°-19°) angulation in sagittal plane. Postoperative anteroposterior and lateral radio- graphs showed a mean of 0.8°(0°-4.0°) and 0.6°(0°-3.6°) of varus/valgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.

  15. Finite element analysis of intramedullary nailing and double locking plate for treating extra-articular proximal tibial fractures.

    Science.gov (United States)

    Chen, Fancheng; Huang, Xiaowei; Ya, Yingsun; Ma, Fenfen; Qian, Zhi; Shi, Jifei; Guo, Shuolei; Yu, Baoqing

    2018-01-16

    Proximal tibia fractures are one of the most familiar fractures. Surgical approaches are usually needed for anatomical reduction. However, no single treatment method has been widely established as the standard care. Our present study aims to compare the stress and stability of intramedullary nails (IMN) fixation and double locking plate (DLP) fixation in the treatment of extra-articular proximal tibial fractures. A three-dimensional (3D) finite element model of the extra-articular proximal tibial fracture, whose 2-cm bone gap began 7 cm from the tibial plateau articular surface, was created fixed by different fixation implants. The axial compressive load on an adult knee during single-limb stance was imitated by an axial force of 2500 N with a distribution of 60% to the medial compartment, while the distal end was fixed effectively. The equivalent von Mises stress and displacement of the model was used as the output measures for analysis. The maximal equivalent von Mises stress value of the system in the IMN model was 293.23 MPa, which was higher comparing against that in the DLP fixation model (147.04 MPa). And the mean stress of the model in the IMN model (9.25 MPa) was higher than that of the DLP fixation system in terms of equivalent von Mises stress (EVMS) (P tibial fractures of young patients.

  16. Anatomy and classification of the posterior tibial fragment in ankle fractures.

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    Bartoníček, Jan; Rammelt, Stefan; Kostlivý, Karel; Vaněček, Václav; Klika, Daniel; Trešl, Ivo

    2015-04-01

    The aim of this study was to analyze the pathoanatomy of the posterior fragment on the basis of a comprehensive CT examination, including 3D reconstructions, in a large patient cohort. One hundred and forty one consecutive individuals with an ankle fracture or fracture-dislocation of types Weber B or Weber C and evidence of a posterior tibial fragment in standard radiographs were included in the study. The mean patient age was 49 years (range 19-83 years). The exclusion criteria were patients below 18 years of age, inability to provide written consent, fractures of the tibial pilon, posttraumatic arthritis and pre-existing deformities. In all patients, post-injury radiographs were obtained in anteroposterior, mortise and lateral views. All patients underwent CT scanning in transverse, sagittal and frontal planes. 3D CT reconstruction was performed in 91 patients. We were able to classify 137 cases into one of the following four types with constant pathoanatomic features: type 1: extraincisural fragment with an intact fibular notch, type 2: posterolateral fragment extending into the fibular notch, type 3: posteromedial two-part fragment involving the medial malleolus, type 4: large posterolateral triangular fragment. In the 4 cases it was not possible to classify the type of the posterior tibial fragment. These were collectively termed type 5 (irregular, osteoporotic fragments). It is impossible to assess the shape and size of the posterior malleolar fragment, involvement of the fibular notch, or the medial malleolus, on the basis of plain radiographs. The system that we propose for classification of fractures of the posterior malleolus is based on CT examination and takes into account the size, shape and location of the fragment, stability of the tibio-talar joint and the integrity of the fibular notch. It may be a useful indication for surgery and defining the most useful approach to these injuries.

  17. Management and follow up of tibial plateau fractures by ′T′ clamp external fixator and limited internal fixation

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    Thimmegowda M

    2005-01-01

    Full Text Available Background: Tibial plateau fractures are difficult to treat especially when soft tissue is compromised by open reduction and internal fixation. Many methods have be1en tried in the past to manage these cases of which external fixation were shown to be effective as they limit the soft tissue and wound complications. Methods: Complex tibial plateau fractures of sixteen patients were treated by closed reduction, fixation of articular fragments by screws and application of unilateral external fixator. The external fixator was kept in place till fracture united clinically and radiologically. The patients were followed up for at least one year to assess the function of the knee joint Results: The average duration of external fixation was 13 weeks. All the fractures healed. Pin track infection (five patients and instability (six patients of the knee were encountered with this procedure. The average duration of follow up was 62 weeks. The mean range of motion was 1250 arc. The IOWA knee score averaged 90.3 points. Conclusions: External fixation with limited internal fixation may be effective in the management of complex tibial plateau fractures which requires further support from studies with large sample size. ′T′ clamp external fixation with limited Internal fixation is the procedure of choice when alignment, stability, early mobilisation is required in a soft tissue compromised tibial plateau fractures.

  18. Treatment Results Of Diaphyseal Forearm Fractures With Dynamique Compression Plate A Retrospective study of 156 Cases.

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    Hassan BOUSSAKRI

    2015-12-01

    Full Text Available This retrospective study addresses a series of 156 cases of forearm fractures. These 156 cases were managed in the trauma-orthopedic department (B4 of Fez University Hospital, Morocco, from May 2008 till January 2013. The purpose of this study is to analyze epidemiological and clinical factors of diaphyseal forearm fractures and the results of their treatment with dynamic compression plate (DCP, as well as the complications and therapeutic errors of this surgical technique. The frequency of hospitalization in the trauma-orthopedic department was 3,96%. Ages ranged between 16 and 83, the average age was 32. 132 patients were male (85%. 90% were managed at the day of trauma. Traffic accidents were the most frequent cause in 52% patients. The fracture was in the left forearm in 65% of patients. 53% of fracture lines were in the middle third of the forearm. 38 fractures were open, and 30 were admitted for polytrauma. Osteosynthesis was performed with dynamic compression plate for all patients. In comparison with the literature, our series shows the predominance of young male patients, with traffic accidents being the cause. Osteosynthesis with dynamic compression plate remains the treatment of choice that provides satisfactory results if the accuracy in this technique was respected.

  19. Management of Gustilo Anderson III B open tibial fractures by primary fascio-septo-cutaneous local flap and primary fixation: The ′fix and shift′ technique

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    P R Ramasamy

    2017-01-01

    Full Text Available Background: Open fractures of tibia have posed great difficulty in managing both the soft tissue and the skeletal components of the injured limb. Gustilo Anderson III B open tibial fractures are more difficult to manage than I, II, and III A fractures. Stable skeletal fixation with immediate soft tissue cover has been the key to the successful outcome in treating open tibial fractures, in particular, Gustilo Anderson III B types. If the length of the open wound is larger and if the exposed surface of tibial fracture and tibial shaft is greater, then the management becomes still more difficult. Materials and Methods: Thirty six Gustilo Anderson III B open tibial fractures managed between June 2002 and December 2013 with "fix and shift" technique were retrospectively reviewed. All the 36 patients managed by this technique had open wounds measuring >5 cm (post debridement. Under fix and shift technique, stable fixation involved primary external fixator application or primary intramedullary nailing of the tibial fracture and immediate soft tissue cover involved septocutaneous shift, i.e., shifting of fasciocutaneous segments based on septocutaneous perforators. Results: Primary fracture union rate was 50% and reoperation rate (bone stimulating procedures was 50%. Overall fracture union rate was 100%. The rate of malunion was 14% and deep infection was 16%. Failure of septocutaneous shift was 2.7%. There was no incidence of amputation. Conclusion: Management of Gustilo Anderson III B open tibial fractures with "fix and shift" technique has resulted in better outcome in terms of skeletal factors (primary fracture union, overall union, and time for union and malunion and soft tissue factors (wound healing, flap failure, access to secondary procedures, and esthetic appearance when compared to standard methods adopted earlier. Hence, "fix and shift" could be recommended as one of the treatment modalities for open III B tibial fractures.

  20. External fixation using locking plate in distal tibial fracture: a finite element analysis.

    Science.gov (United States)

    Zhang, Jingwei; Ebraheim, Nabil; Li, Ming; He, Xianfeng; Schwind, Joshua; Liu, Jiayong; Zhu, Limei

    2015-08-01

    External fixation of tibial fractures using a locking plate has been reported with favorable results in some selected patients. However, the stability of external plate fixation in this fracture pattern has not been previously demonstrated. We investigated the stability of external plate fixation with different plate-bone distances. In this study, the computational processing model of external fixation of a distal tibial metaphyseal fracture utilizing the contralateral femoral less invasive stabilization system plate was analyzed. The plate was placed on the anteromedial aspect of tibia with different plate-bone distances: 1, 10, 20, and 30 mm. Under axial load, the stiffness of construct in all groups was higher than intact tibia. Under axial load with an internal rotational force, the stiffness of construct with 1 and 10 mm plate-bone distances was similar to that of an intact tibia and the stiffness of the construct with 20 and 30 mm distances was lower than that of an intact tibia. Under axial load with an external rotational force, the stiffness of the construct in all groups was lower than that of an intact tibia. The maximum plate stresses were concentrated at the two most distal screws and were highest in the construct with the 10 mm plate-bone distance, and least in the construct with a 1 mm plate-bone distance. To guarantee a stable external plate fixation in distal tibial fracture, the plate-bone distance should be less than 30 mm.

  1. [Treatment of Schatzker IV tibial plateau fractures with arthroscopy combined with MIPPO technique].

    Science.gov (United States)

    Li, Jian-Wen; Ye, Feng; Bi, Da-Wei; Zheng, Xiao-Dong; Chen, Jian-Liang

    2018-02-25

    To discusses the clinical effects of arthroscopy combined with minimally invasive percutaneous plate osteosynthesis(MIPPO) technology in treating Schatzker IV tibial plateau fractures. From January 2012 to January 2016, 19 patients with Schatzker type IV tibial plateau fractures were treated with arthroscopy combined with minimally invasive technique including 12 males and 7 females with an average age of 46.5 years old ranging from 19 to 78 years old. Patients were suffering knee pain, swelling, flexion and extension limited, and other symptoms preoperative. Patients were followed up and assessed by Rasmussen knee function score. No infection, traumatic arthritis, and knee joint valgus occurred after operation. Nineteen cases were followed up for 12 to 24 months with an average of 18.6 months. Fracture healing time was 3 to 5 months with an average of 3.8 months. The knee pain and limited mobility improved significantly. The range of autonomic movement of joints was from 90 to 136 degrees. According to Rasmussen functional score criteria, the total score was 27.00±2.49, the result was excellent in 16 cases, good in 2 cases, fair in 1 case. Arthroscopic treatment for Schatzker type IV tibial plateau fractures combined with MIPPO can simultaneously treat internal structural injuries such as meniscus and other knee joints, with less trauma, fewer complications, and faster joint function recovery, but we must strictly grasp surgical indications and avoid expanding injuries. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

  2. SIMULTANEOUS BILATERAL AVULSION FRACTURE OF THE TIBIAL TUBEROSITY IN A TEENAGER: CASE REPORT AND THERAPY USED.

    Science.gov (United States)

    E Albuquerque, Rodrigo Pires; Giordano, Vincenzo; Carvalho, Antônio Carlos Pires; Puell, Thiago; E Albuquerque, Maria Isabel Pires; do Amaral, Ney Pecegueiro

    2012-01-01

    Simultaneous bilateral avulsion fracture of the tibial tuberosity in teenagers is a rare lesion. We describe the first case in the literature, in a teenage girl who sustained a fall while jumping during a volleyball match. No predisposing factors were iden tified. The lesions were treated with open surgical reduction and internal fixation. The aim of the present study was to present a case of simultaneous bilateral avulsion fracture of the tibial tuberosity in a teenage girl and the therapy used.

  3. Segmental transports for posttraumatic lower extremity bone defects: are femoral bone transports safer than tibial?

    Science.gov (United States)

    Liodakis, Emmanouil; Kenawey, Mohamed; Krettek, Christian; Ettinger, Max; Jagodzinski, Michael; Hankemeier, Stefan

    2011-02-01

    The long-term outcomes following femoral and tibial segment transports are not well documented. Purpose of the study is to compare the complication rates and life quality scores of femoral and tibial transports in order to find what are the complication rates of femoral and tibial monorail bone transports and if they are different? We retrospectively analyzed the medical records of 8 femoral and 14 tibial consecutive segment transports performed with the monorail technique between 2001 and 2008 in our institution. Mean follow-up was 5.1 ± 2.1 years with a minimum follow-up of 2 years. Aetiology of the defects was posttraumatic in all cases. Four femoral (50%) and nine tibial (64%) fractures were open. The Short Form-36 (SF-36) health survey was used to compare the life quality after femoral and tibial bone transports. The Mann-Whiney U test, Fisher exact test, and the Student's two tailed t-test were used for statistical analysis. P ≤ 0.05 was considered to be statistically significant. The tibial transport was associated with higher rates of severe complications and additional procedures (1.5 ± 0.9 vs. 3.4 ± 2.7, p = 0.048). Three patients of the tibial group were amputated because of recurrent infections and one developed a complete regenerate insufficiency that was treated with partial diaphyseal tibial replacement. Contrary to that none of patients of the femoral group developed a complete regenerate insufficiency or was amputated. Tibial bone transports have a higher rate of complete and incomplete regenerate insufficiency and can more often end in an amputation. The authors suggest systematic weekly controls of the CRP value and of the callus formation in patients with posttraumatic tibia bone transports. Further comparative studies comparing the results of bone transports with and without intramedullary implants are necessary.

  4. MRI in diagnostic of soft tissue damages by fractures of lateral tibial plate

    International Nuclear Information System (INIS)

    Dimitrova, D.; Proichev, V.; Popov, I.

    2015-01-01

    Full text: The knee is one of the most often injured joint. Fractures of tibial condyles are the most common articular damages. Koton and Berg call them „bumper“ fractures the tibia plateau is vulnerable to both high- and low-energy injury mechanisms due to its vulnerable position in the lower extremity. It must bear significant weight and sustain significant impact and deceleration forces with little skeletal constraint, and has scant surrounding soft tissue and a tethered medial and lateral integument. Furthermore, the tibial plateau has relatively forgiving ligamentous attachments that must allow for a large range of motion in a single plane. Not surprisingly, given the diversity of injury, management of these fractures has come to include a wide variety of treatment strategies. traditionally, ligament injury associated with plateau fractures has been diagnosed indirectly with stress radiographs and physical examination. With increasing use of more sensitive MRI and arthroscopy, associated ligament and meniscus injuries have been found in significant percentages of plateau fractures. these soft tissue injuries consist primarily of MCL lesions, meniscal injuries, and ACL disruptions. However, studies addressing associated soft tissue injuries all agree that neither the type of plateau fracture nor the presence or absence of ligament injury correlates with the incidence of meniscal tears

  5. External fixation combined with delayed internal fixation in treatment of tibial plateau fractures with dislocation.

    Science.gov (United States)

    Tao, Xingguang; Chen, Nong; Pan, Fugen; Cheng, Biao

    2017-10-01

    The aim of this study was to evaluate the clinical efficacy of external fixation, delayed open reduction, and internal fixation in treating tibial plateau fracture with dislocation.Clinical data of 34 patients diagnosed with tibial plateau fracture complicated with dislocation between January 2009 and May 2015 were retrospectively analyzed. Fifteen patients in group A underwent early calcaneus traction combined with open reduction and internal fixation and 19 in group B received early external fixation combined with delayed open reduction and internal fixation. Operation time, postoperative complication, bone healing time, knee joint range of motion, initial weight-bearing time, Rasmussen tibial plateau score, and knee function score (HSS) were statistically compared between 2 groups.The mean follow-up time was 18.6 months (range: 5-24 months). The mean operation time in group A was 96 minutes, significantly longer than 71 minutes in group B (P  .05). In group A, initial weight-bearing time in group A was (14.0 ± 3.6) weeks, significantly differing from (12.9 ± 2.8) weeks in group B (P  0.05). Rasmussen tibial plateau score in group A was slightly lower than that in group B (P > .05). The excellent rate of knee joint function in group A was 80% and 84.21% in group B (P > .05).External fixation combined with delayed open reduction and internal fixation is a safer and more efficacious therapy of tibial plateau fracture complicated with dislocation compared with early calcaneus traction and open reduction and internal fixation.

  6. Reliability of a four-column classification for tibial plateau fractures.

    Science.gov (United States)

    Martínez-Rondanelli, Alfredo; Escobar-González, Sara Sofía; Henao-Alzate, Alejandro; Martínez-Cano, Juan Pablo

    2017-09-01

    A four-column classification system offers a different way of evaluating tibial plateau fractures. The aim of this study is to compare the intra-observer and inter-observer reliability between four-column and classic classifications. This is a reliability study, which included patients presenting with tibial plateau fractures between January 2013 and September 2015 in a level-1 trauma centre. Four orthopaedic surgeons blindly classified each fracture according to four different classifications: AO, Schatzker, Duparc and four-column. Kappa, intra-observer and inter-observer concordance were calculated for the reliability analysis. Forty-nine patients were included. The mean age was 39 ± 14.2 years, with no gender predominance (men: 51%; women: 49%), and 67% of the fractures included at least one of the posterior columns. The intra-observer and inter-observer concordance were calculated for each classification: four-column (84%/79%), Schatzker (60%/71%), AO (50%/59%) and Duparc (48%/58%), with a statistically significant difference among them (p = 0.001/p = 0.003). Kappa coefficient for intr-aobserver and inter-observer evaluations: Schatzker 0.48/0.39, four-column 0.61/0.34, Duparc 0.37/0.23, and AO 0.34/0.11. The proposed four-column classification showed the highest intra and inter-observer agreement. When taking into account the agreement that occurs by chance, Schatzker classification showed the highest inter-observer kappa, but again the four-column had the highest intra-observer kappa value. The proposed classification is a more inclusive classification for the posteromedial and posterolateral fractures. We suggest, therefore, that it be used in addition to one of the classic classifications in order to better understand the fracture pattern, as it allows more attention to be paid to the posterior columns, it improves the surgical planning and allows the surgical approach to be chosen more accurately.

  7. Minimally invasive surgical technique: Percutaneous external fixation combined with titanium elastic nails for selective treatment of tibial fractures.

    Science.gov (United States)

    Tu, Kai-Kai; Zhou, Xian-Ting; Tao, Zhou-Shan; Chen, Wei-Kai; Huang, Zheng-Liang; Sun, Tao; Zhou, Qiang; Yang, Lei

    2015-12-01

    Several techniques have been described to treat tibial fractures, which respectively remains defects. This article presents a novel intra- and extramedullary fixation technique: percutaneous external fixator combined with titanium elastic nails (EF-TENs system). The purpose of this study is to introduce this new minimally invasive surgical technique and selective treatment of tibial fractures, particularly in segmental fractures, diaphysis fractures accompanied with distal or proximal bone subfissure, or fractures with poor soft-tissue problems. Following ethical approval, thirty-two patients with tibial fractures were treated by the EF-TENs system between January 2010 and December 2012. The follow-up studies included clinical and radiographic examinations. All relevant outcomes were recorded during follow-up. All thirty-two patients were achieved follow-ups. According to the AO classification, 3 Type A, 9 Type B and 20 Type C fractures were included respectively. According to the Anderson-Gustilo classification, there were 5 Type Grade II, 3 Type Grade IIIA and 2 Type Grade IIIB. Among 32 patients, 8 of them were segmental fractures. 12 fractures accompanied with bone subfissure. Results showed no nonunion case, with an average time of 23.7 weeks (range, 14-32 weeks). Among them, there were 3/32 delayed union patients and 0/32 malunion case. 4/32 patients developed a pin track infection and no patient suffered deep infection. The external fixator was removed with a mean time of 16.7 weeks (range, 10-26 weeks). Moreover, only 1/32 patient suffered with the restricted ROM of ankle, none with the restricted ROM of knee. This preliminary study indicated that the EF-TENs system, as a novel intra- and extramedullary fixation technique, had substantial effects on selective treatment of tibial fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. [Close reduction combined with minimally invasive percutaneous plate osteosynthesis for proximal and distal tibial fractures: a report of 56 patients].

    Science.gov (United States)

    Liu, Yin-Wen; Kuang, Yong; Gu, Xin-Feng; Zheng, Yu-Xin; Li, Zhi-Qiang; Wei, Xiao-En; Zhang, Ming-Cai; Zhan, Hong-Sheng; Shi, Yin-yu

    2013-03-01

    To evaluate the clinical effects of close reduction combined with minimally invasive percutanous plate osteosynthesis (MIPPO) for proximal and distal tibial fractures. From March 2007 to December 2010, 56 patients with proximal and distal tibial fractures were treated with close reduction combined with MIPPO technique. There were 39 males and 17 females,aged from 22 to 67 years with an average of 41.3 years. Left fracture was in 25 cases and right fracture was in 31 cases; proximal tibial fracture was in 15 cases and distal tibial fractures was in 41 cases; 34 cases caused by fall down and 22 cases caused by road accident. The mean time from injury to operation was 1.7 d. Clinical manifestation included pain, swelling of leg with limitation of activity. According to the standard of Johner-Wruhs, clinical effects were evaluated. The mean operative time was 46 min in 56 patients. All fractures obtained satisfactory reduction and the location of plate was good. Incisions healed with one-stage and no superficial or deep infection was found. All the patients were followed up from 8 to 23 months with an average of 14.2 months. Only one fracture complication with delayed union,and after auto grafting with ilium bone,the fracture got union. Other 55 cases obtained bone healing in 15 to 20 weeks after operation and no internal fixation failure was found. The time of walking was 4-6 months after operation,without limping at 7 months after operation. Both lower extremities were symmetrical and the function of knee and ankle got complete recovery. According to the criteria of Johner-Wruhs score,46 cases obtained excellent results,9 good and 2 fair. Treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can not only preserve soft tissue,simplify operative procedure and decrease wound, but also can obtain rigid internal fixation and guarantee early function exercises of knee and ankle joints. The method has the advantages of less soft tissue

  9. [Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures].

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    Lobenhoffer, P; Gerich, T; Bertram, T; Lattermann, C; Pohlemann, T; Tscheme, H

    1997-12-01

    Tibial plateau fractures with depression of posterior aspects of the proximal tibia cause significant therapeutic problems. Posterior fractures on the medial side are mainly highly instable fracture-dislocations (Moore type I). Posterolateral fractures usually cause massive depression and destruction of the chondral surface. Surgical exposure of these fractures from anterior requires major soft tissue dissection and has a significant complication rate. However, incomplete restoration of the joint surface results in chronic postero-inferior joint subluxation, osteoarthritis and pain. We present new specific approaches for posterior fracture types avoiding large skin incisions, but allowing for atraumatic exposure, reduction and fixation. Posteromedial fracture-dislocations are exposed by a direct posteromedial skin incision and a deep incision between medial collateral ligament and posterior oblique ligament. The posteromedial pillar and the posterior flare of the proximal tibia are visualized. The inferior extent of the joint fragment can be reduced by indirect techniques or direct manipulation of the fragment. Fixation is achieved with subchondral lag screws and an anti-glide plate at the tip of the fragment. Posterolateral fractures are exposed by a transfibular approach: the skin is incised laterally, the peroneal nerve is dissected free. The fibula neck is osteotomized, the tibiofibular syndesmosis is divided and the fibula neck is reflected upwards in one layer with the meniscotibial ligament and the iliotibial tract attachment. Reflexion of the fibula head relaxes the lateral collateral ligament, allows for lateral joint opening and internal rotation of the tibia and thus exposes the posterolateral and posterior aspect of the tibial plateau. Fixation and buttressing on the posterolateral side can be achieved easily with this approach. In closure, the fibula head is fixed back with a lag screw or a tension-band system. These two exposures can be combined in

  10. Distal tibial fracture treated by minimally invasive plate osteosynthesis after external fixation Retrospective clinical and radiographic assessment

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    Al. Șerban

    2014-02-01

    Full Text Available Fractures of the horizontal surface of the distal tibia are known commonly as pylon or plafond fractures, and represent 1-5% of lower extremity fractures, 7-10% of all tibial fractures. The protocol consisted of immediate (within eight to 24 hours open reduction and internal fixation of the fibula, using a fibular plate or one third tubular plate and application of an external fixator spanning the ankle joint. In the second stage, the treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can preserve soft tissue, simplify operative procedure and decrease wound, obtain rigid internal fixation and guarantee early function exercises of ankle joint. In this study we evaluated 22 patients treated in Clinical Emergency Hospital Constanta between April 2012 - July 2013 diagnosed with multifragmentary fractures of the distal tibia. This study evaluates the treatment of complex fractures of distal tibia with locked plate after external fixation. There were 17 males and 5 females of mean age 51,7 years (31-68. The mean follow-up period was 14 weeks. (Ranging from 9-16 weeks. All patients were fully weight bearing at 16 weeks (ranging 9-16 weeks showing radiological union. There were no cases of failures of fixation, or rotational misalignment. No significant complication was observed in our patients. MIPO is an effective method of treatment for distal tibial fractures, reduce surgical trauma and maintain a more biologically favorable environment for fracture healing, reducing risks of infection and nonunion.

  11. The Effect of Sagittal Plane Deformities after Tibial Plateau Fractures to Functions and Instability of Knee Joint.

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    Erdil, M; Yildiz, F; Kuyucu, E; Sayar, Ş; Polat, G; Ceylan, H H; Koçyiğit, F

    2016-01-01

    The objective of this study is to evaluate the effect of posterior tibial slope after fracture healing on antero-posterior knee laxity, functional outcome and patient satisfaction. 126 patients who were treated for tibial plateau fractures between 2008-2013 in the orthopedics and traumatology department of our institution were evaluated for the study. Patients were treated with open reduction and internal fixation, arthroscopy assisted minimally invasive osteosynthesis or conservative treatment. Mean posterior tibial slope after the treatment was 6.91 ± 5.11 and there was no significant difference when compared to the uninvolved side 6.42 ± 4,21 (p = 0.794). Knee laxity in anterior-posterior plane was 6.14 ± 2.11 and 5.95 ± 2.25 respectively on healthy and injured side. The difference of mean laxity in anterior-posterior plane between two sides was statistically significant. In this study we found no difference in laxity between the injured and healthy knees. However Tegner score decreased significantly in patients who had greater laxity difference between the knees. We did not find significant difference between fracture type and laxity, IKDC functional scores independent of the ligamentous injury. In conclusion despite coronal alignment is taken into consideration in treatment of tibial plateau fractures, sagittal alignment is reasonably important for stability and should not be ignored.

  12. Utility of cement injection to stabilize split-depression tibial plateau fracture by minimally invasive methods: A finite element analysis.

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    Belaid, D; Vendeuvre, T; Bouchoucha, A; Brémand, F; Brèque, C; Rigoard, P; Germaneau, A

    2018-05-08

    Treatment for fractures of the tibial plateau is in most cases carried out by stable fixation in order to allow early mobilization. Minimally invasive technologies such as tibioplasty or stabilization by locking plate, bone augmentation and cement filling (CF) have recently been used to treat this type of fracture. The aim of this paper was to determine the mechanical behavior of the tibial plateau by numerically modeling and by quantifying the mechanical effects on the tibia mechanical properties from injury healing. A personalized Finite Element (FE) model of the tibial plateau from a clinical case has been developed to analyze stress distribution in the tibial plateau stabilized by balloon osteoplasty and to determine the influence of the cement injected. Stress analysis was performed for different stages after surgery. Just after surgery, the maximum von Mises stresses obtained for the fractured tibia treated with and without CF were 134.9 MPa and 289.9 MPa respectively on the plate. Stress distribution showed an increase of values in the trabecular bone in the treated model with locking plate and CF and stress reduction in the cortical bone in the model treated with locking plate only. The computed results of stresses or displacements of the fractured models show that the cement filling of the tibial depression fracture may increase implant stability, and decrease the loss of depression reduction, while the presence of the cement in the healed model renders the load distribution uniform. Copyright © 2018 Elsevier Ltd. All rights reserved.

  13. From guidelines to standards of care for open tibial fractures.

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    Trickett, R W; Rahman, S; Page, P; Pallister, I

    2015-09-01

    The standards for the management of open fractures of the lower limb published by the British Association of Plastic, Reconstructive and Aesthetic surgeons (BAPRAS) and British Orthopaedic Association (BOA) were introduced to improve the treatment received by patients after open injury to the lower limb. These Standards were released after BAPRAS/BOA published Guidelines for the management of open tibial fractures. We wished to determine the impact of these Standards upon the surgical management of open tibial fractures by comparing patients admitted to an orthoplastic centre in the 45 months concluding December 2009 (the Guidelines era) with those admitted during 2011 (the Standards era). Surgical procedures required during the first 30 days and 12 months after injury were determined. Cases were divided into 'directly admitted patients' (DAP) and 'transferred patients' (TP). Standards-era patients were divided further into those who had surgery exclusively at the orthoplastic centre (orthoplastic patients (OPP)) and those transferred after surgery (TASP). The number of TP trebled in frequency in the Standards era, 25% of whom were transferred before surgery. Significantly fewer surgical procedures were required for DAP and OPP groups compared with TP (and TASP) groups in both eras (Mann-Whitney U-test, p=0.05). DAP and OPP groups during the Standards era underwent the fewest procedures, with the vast majority of cases treated with two or fewer procedures in the first 12 months (88% and 80%, respectively, compared with 61% in the Guidelines era). In the Guidelines era, 44% of TP cases and in the Standards era 39% of TP and 29% of TASP groups underwent two or fewer procedures. Approximately two-thirds of open tibial fractures managed in our orthoplastic centre were patients transferred after surgery. The greatest impact of the Standards was evident for those who underwent surgery exclusively in the orthoplastic centre, reflecting a more deliberate combined strategy

  14. Early prophylactic autogenous bone grafting in type III open tibial fractures.

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    Kesemenli, Cumhur C; Kapukaya, Ahmet; Subaşi, Mehmet; Arslan, Huseyin; Necmioğlu, Serdar; Kayikçi, Cuma

    2004-08-01

    The authors report the results achieved in patients with type III open tibial fractures who underwent primary autogenous bone grafting at the time of debridement and skeletal stabilisation. Twenty patients with a mean age of 35.8 years (range, 24-55) were treated between 1996 and 1999. Eight fractures were type IIIA, 11 were type IIIB, and 1 was type IIIC. At the index procedure, wound debridement, external fixation and autogenous bone grafting with bone coverage were achieved. The mean follow-up period was 46 months (range, 34-55). The mean time to fixator removal was 21 weeks (range, 14-35), and the mean time to union was 28 weeks (range, 19-45). Skin coverage was achieved by a myocutaneous flap in 2 patients, late primary closure in 4, and split skin grafting in 14. One (5%) of the patients experienced delayed union, and 1 (5%) developed infection. In tibial type III open fractures, skin coverage may be delayed, using the surrounding soft tissue to cover any exposed bone after thorough débridement and wound cleansing. Primary prophylactic bone grafting performed at the same time reduces the rate of delayed union, shortens the time to union, and does not increase the infection rate.

  15. Temporary Stabilization with External Fixator in 'Tripolar' Configuration in Two Steps Treatment of Tibial Pilon Fractures.

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    Daghino, Walter; Messina, Marco; Filipponi, Marco; Alessandro, Massè

    2016-01-01

    The tibial pilon fractures represent a complex therapeutic problem for the orthopedic surgeon, given the frequent complications and outcomes disabling. The recent medical literature indicates that the best strategy to reduce amount of complications in tibial pilon fractures is two-stages procedure. We describe our experience in the primary stabilization of these fractures. We treated 36 cases with temporary external fixation in a simple configuration, called "tripolar": this is an essential structure (only three screws and three rods), that is possible to perform even without the availability of X-rays and with simple anesthesia or sedation. We found a sufficient mechanical stability for the nursing post-operative, in absence of intraoperative and postoperative problems. The time between trauma and temporary stabilization ranged between 3 and 144 hours; surgical average time was 8.4 minutes. Definitive treatment was carried out with a delay of a minimum of 4 and a maximum of 15 days from the temporary stabilization, always without problems, both in case of ORIF (open reduction, internal fixation) or circular external fixation. Temporary stabilization with external fixator in 'tripolar' configuration seems to be the most effective strategy in two steps treatment of tibial pilon fractures. These preliminary encouraging results must be confirmed by further studies with more cases.

  16. Application of Minimally Invasive Treatment of Locking Compression Plate in Schatzker Ⅰ-Ⅲ Tibial Plateau Fracture

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    Guohui Zhao

    2014-06-01

    Full Text Available Objective: To investigate the clinical effect of minimally invasive treatment of locking compression plate (LCP in Schatzker Ⅰ-Ⅲ tibial plateau fracture. Methods: Thirty-eight patients with Schatzker Ⅰ-Ⅲ tibial plateau fracture in our hospital were given minimally invasive treatment of LCP, and the artificial bone was transplanted to the depressed bone. Adverse responses, wound healing time and clinical efficacy were observed. Results: All patients were followed-up for 14- 20 months, and the mean duration was 16 months. Within 1 week after operation, 1 patient suffered from short-term rejection reaction to artificial bone, but he healed after corresponding measures were taken. There were no complications like skin necrosis and externally-exposed steel plate among the patients. In addition, all fractures were recovered, and the recovery time was 2.6 - 4.1 months, with the mean duration being 3.4 months. The recovery of knee function was favorable, in which 20 cases were excellent, 14 were good, and 4 were general. The excellent and good rate was 89.5%. Conclusion: Minimally invasive treatment of LCP for Schatzker Ⅰ - Ⅲ tibial plateau fracture can reduce the postoperative relocation loss, and has small trauma and stable fixation.

  17. [Treatment of complex tibial plateau fractures with bilateral locking plate and bone graft].

    Science.gov (United States)

    Yan, Ying-Jie; Cheng, Zhan-Wei; Feng, Kai; Yan, Shao-Hua

    2012-07-01

    To explore the effective methods for the treatment of complex tibial plateau fractures. From May 2008 to April 2011, 28 patients with complex tibial plateau fractures were treated indirect reduction techniques, bilateral locking plate fixation combined with autologous bone grafts. There were 21 males and 7 females, with an average age of 43 years ranging from 21 to 65. There were 11 cases in Schatzker type V, 17 in VI. The effect was evaluated by Rasmussen standard on clinical and radiological. All patients were followed-up for 7 to 36 months (averaged of 21.5 months). Healing time of fracture was from 3 to 8 months (averaged 5.5 months). The results of Rasmussen scores in clinical was 4.50 +/- 1.32 in pain, 4.32 +/- 1.63 in walking ability, 4.07 +/- 1.34 in knee activity, 4.78 +/- 1.27 in stability of the knee, 4.85 +/- 1.12 in stretch knee; the results in radiation was 5.07 +/- 0.92 in articular surface collapse, 5.00 +/- 0.98 in platform widened, 5.14 +/- 0.85 in knee external varus. The effect result was excellent in 8 cases, good in 15, fair in 3 and poor in 2. The key for the treatment of complex tibial plateau fractures was to fully assess the damage as much as possible to protect the soft tissue, select the appropriate timing of surgery and surgical incision, application of indirect reduction techniques, limited incision and effective internal fixation to restore joint surface smooth and good limb alignment, early exercise, in order to achieve maximum recovery of joint function.

  18. Section modulus is the optimum geometric predictor for stress fractures and medial tibial stress syndrome in both male and female athletes.

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    Franklyn, Melanie; Oakes, Barry; Field, Bruce; Wells, Peter; Morgan, David

    2008-06-01

    Various tibial dimensions and geometric parameters have been linked to stress fractures in athletes and military recruits, but many mechanical parameters have still not been investigated. Sedentary people, athletes with medial tibial stress syndrome, and athletes with stress fractures have smaller tibial geometric dimensions and parameters than do uninjured athletes. Cohort study; Level of evidence, 3. Using a total of 88 subjects, male and female patients with either a tibial stress fracture or medial tibial stress syndrome were compared with both uninjured aerobically active controls and uninjured sedentary controls. Tibial scout radiographs and cross-sectional computed tomography images of all subjects were scanned at the junction of the midthird and distal third of the tibia. Tibial dimensions were measured directly from the films; other parameters were calculated numerically. Uninjured exercising men have a greater tibial cortical cross-sectional area than do their sedentary and injured counterparts, resulting in a greater value of some other cross-sectional geometric parameters, particularly the section modulus. However, for women, the cross-sectional areas are either not different or only marginally different, and there are few tibial dimensions or geometric parameters that distinguish the uninjured exercisers from the sedentary and injured subjects. In women, the main difference between the groups was the distribution of cortical bone about the centroid as a result of the different values of section modulus. Last, medial tibial stress syndrome subjects had smaller tibial cross-sectional dimensions than did their uninjured exercising counterparts, suggesting that medial tibial stress syndrome is not just a soft-tissue injury but also a bony injury. The results show that in men, the cross-sectional area and the section modulus are the key parameters in the tibia to distinguish exercise and injury status, whereas for women, it is the section modulus only.

  19. The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures: A novel surgical technique.

    Science.gov (United States)

    Hu, Sun-Jun; Chang, Shi-Min; Zhang, Ying-Qi; Ma, Zhuo; Du, Shou-Chao; Zhang, Kai

    2016-02-01

    The posterolateral (PL) tibial plateau quadrant is laterally covered by the fibular head and posteriorly covered by a mass of muscle ligament and important neurovascular structures. There are several limitations in exposing and fixing the PL tibial plateau fractures using a posterior approach. The aim of this study is to present a novel anterolateral supra-fibular-head approach for plating PL tibial plateau fractures. Five fresh and ten preserved knee specimens were dissected to measure the following parameters:1) the vertical distance from the apex of the fibular head to the lateral plateau surface, 2) the transverse distance between the PL platform and fibula collateral ligament (FCL), and 3) the tension of the FCL in different knee flexion positions. Clinically, isolated PL quadrant tibial plateau fractures were treated via an anterolateral supra-fibular-head approach and lateral rafting plate fixation. The outcome of the patients was assessed after a short to medium follow-up period. The distance from the apex of the fibular head to the lateral condylar surface was 12.2 ± 1.6 mm on average. With the knee extended and the FCL tensioned, the transverse distance between the PL platform and the FCL was 6.7 ± 1.1 mm. With the knee flexed to 60° and the FCL was in the most relaxed position, the distance increased to 21.1 ± 3.0 mm. Clinically, a series of 7 cases of PL tibial plateau fractures were treated via this anterolateral supra-fibular-head approach. The patient was placed in a lateral decubitus position with the knee flexed to approximately 60 degrees. After the posterior retraction of the FCL, the plate was placed more posteriorly to provide a raft or horizontal belt fixation of the PL tibial plateau fragment. After an average of 14.3 months of follow up, the knee range of motion(ROM) was 121.4° ± 8.8° (range: 105°-135°), the HSS score was 96.7 ± 2.6 (range: 90-100), and the SMFA dysfunction score was 22.4 ± 3.8 (range: 16-28) points. The

  20. [Effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation].

    Science.gov (United States)

    Ge, Qihang; Wan, Chunyou; Liu, Yabei; Ji, Xu; Ma, Jihai; Cao, Haikun; Yong, Wei; Liu, Zhao; Zhang, Ningning

    2017-08-01

    To investigate the effect of axial stress stimulation on tibial and fibular open fractures healing after Taylor space stent fixation. The data of 45 cases with tibial and fibular open fractures treated by Taylor space stent fixation who meet the selection criteria between January 2015 and June 2016 were retrospectively analysed. The patients were divided into trial group (23 cases) and control group (22 cases) according to whether the axial stress stimulation was performed after operation. There was no significant difference in gender, age, affected side, cause of injury, type of fracture, and interval time from injury to operation between 2 groups ( P >0.05). The axial stress stimulation was performed in trial group after operation. The axial load sharing ratio was tested, and when the value was less than 10%, the external fixator was removed. The fracture healing time, full weight-bearing time, and external fixator removal time were recorded and compared. After 6 months of external fixator removal, the function of the limb was assessed by Johner-Wruhs criteria for evaluation of final effectiveness of treatment of tibial shaft fractures. There were 2 and 3 cases of needle foreign body reaction in trial group and control group, respectively, and healed after symptomatic anti allergic treatment. All the patients were followed up 8-12 months with an average of 10 months. All the fractures reached clinical healing, no complication such as delayed union, nonunion, or osteomyelitis occurred. The fracture healing time, full weight-bearing time, and external fixator removal time in trial group were significantly shorter than those in control group ( P good in 6 cases, fair in 3 cases, and poor in 1 case in trial group, with an excellent and good rate of 82.6%; and was excellent in 5 cases, good in 10 cases, fair in 4 cases, and poor in 3 cases in control group, with an excellent and good rate of 68.2%, showing significant difference between 2 groups ( Z =-2.146, P =0

  1. Immediate versus delayed intramedullary nailing for open fractures of the tibial shaft: a multivariate analysis of factors affecting deep infection and fracture healing.

    Science.gov (United States)

    Yokoyama, Kazuhiko; Itoman, Moritoshi; Uchino, Masataka; Fukushima, Kensuke; Nitta, Hiroshi; Kojima, Yoshiaki

    2008-10-01

    The purpose of this study was to evaluate contributing factors affecting deep infection and fracture healing of open tibia fractures treated with locked intramedullary nailing (IMN) by multivariate analysis. We examined 99 open tibial fractures (98 patients) treated with immediate or delayed locked IMN in static fashion from 1991 to 2002. Multivariate analyses following univariate analyses were derived to determine predictors of deep infection, nonunion, and healing time to union. The following predictive variables of deep infection were selected for analysis: age, sex, Gustilo type, fracture grade by AO type, fracture location, timing or method of IMN, reamed or unreamed nailing, debridement time (6 h), method of soft-tissue management, skin closure time (1 week), existence of polytrauma (ISS or =18), existence of floating knee injury, and existence of superficial/pin site infection. The predictive variables of nonunion selected for analysis was the same as those for deep infection, with the addition of deep infection for exchange of pin site infection. The predictive variables of union time selected for analysis was the same as those for nonunion, excluding of location, debridement time, and existence of floating knee and superficial infection. Six (6.1%; type II Gustilo n=1, type IIIB Gustilo n=5) of the 99 open tibial fractures developed deep infections. Multivariate analysis revealed that timing or method of IMN, debridement time, method of soft-tissue management, and existence of superficial or pin site infection significantly correlated with the occurrence of deep infection (Prate in type IIIB + IIIC was significantly higher than those in type I + II and IIIA (P = 0.016). Nonunion occurred in 17 fractures (20.3%, 17/84). Multivariate analysis revealed that Gustilo type, skin closure time, and existence of deep infection significantly correlated with occurrence of nonunion (P < 0.05). Gustilo type and existence of deep infection were significantly correlated

  2. One-stage treatment and reconstruction of Gustilo Type III open tibial shaft fractures with a vascularized fibular osteoseptocutaneous flap graft.

    Science.gov (United States)

    Zhen, Ping; Hu, Yun-Yu; Luo, Zhuo-Jing; Liu, Xing-Yan; Lu, Hao; Li, Xu-Sheng

    2010-12-01

    This study evaluated the usefulness of a single-stage, free-fibular vascularized osteoseptocutaneous flap transfer for Type III open tibial shaft fractures with segmental bone loss for the reconstruction of combined bone and soft tissue defects. Nonrandomized retrospective study. University Level I trauma center. All Gustilo Type III open tibial shaft fractures with segmental bone loss that were treated at one institution between 2000 and 2007 were identified from a trauma registry. The study group consisted of 28 patients with Type III open tibial fractures: 27 were Gustilo-Anderson Type IIIB and one was Grade IIIC. The cause of tibial injury included eight industrial accidents, seven motor vehicle accidents, five crushing injuries caused by heavy objects, five falls from a height, and three motorcycle crashes. The lengths of the preoperative segmental tibial bone loss ranged from 9 to 17 cm and the size of the associated soft tissue defects ranged from 8 × 6 cm to 15 × 7 cm. The free fibular vascularized osteoseptocutaneous flap was used to graft and reconstruct combined bone and soft tissue defects. The radical wound débridement, soft tissue and bone revision, fracture stabilization, and early soft tissue coverage were achieved by this technique in a one-stage procedure. The average duration from injury to one-stage reconstruction was 15.8 hours (range, 5.3 hours to 6.5 days). Radiographic and functional evaluation of the lower extremity. All free fibular osteoseptocutaneous flaps survived completely. The average time to overall union for the entire group was 32 weeks after surgery (range, 26-41 weeks). None of the patients in this series had a nonunion. Acceptable radiographic alignment, defined as 5° of angulation in any plane, was obtained in 22 patients (78.6%). Malunion affected six (21.4%) fractures. According to the lower extremity functional assessment, excellent and good results were achieved for 82.1% (23 of 28), fair results were seen in 14

  3. Distal tibial fractures are a poorly recognised complication with fibula free flaps.

    Science.gov (United States)

    Durst, A; Clibbon, J; Davis, B

    2015-09-01

    The fibula free flap is ideal for complex jaw reconstructions, with low reported donor and flap morbidity. We discuss a distal tibial stress fracture two months following a vascularised fibula free flap procedure. Despite being an unrecognised complication, a literature review produced 13 previous cases; only two were reported in the reconstructive surgery literature, with the most recent claiming to be the first. The majority of these studies treated this fracture non-operatively; none reported their patient follow-up. Each case presented with ipsilateral leg pain, which has been cited as an early donor site morbidity in as many as 40% of fibula free flap cases. It is known that the fibula absorbs at least 15% of leg load on weight bearing. Studies have shown severe valgus deformities in up to 25% of patients with fibulectomies. We treated our patient operatively, first correcting his worsening valgus deformity with an external fixator, then reinforcing his healed fracture with a long distal tibial plate. We believe that this complication is underreported, unexpected and not mentioned during the consenting process. By highlighting the management of our case and the literature, we aim to increase awareness (and thus further reporting and appropriate management) of this debilitating complication.

  4. OPTIMAL SURGICAL MANAGEMENT OF HIGH VELOCITY POSTERIOR TIBIAL PLATEAU FRACTURE SUBLUXATIONS (DUPARC, REVISED CLASSIFICATION, GROUP – V: POSTERO - MEDIAL FRACTURE BY DIRECT, DORSAL APPROACH – A CHANGING TREND: A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Pardhasaradhi

    2015-10-01

    Full Text Available INTRODUCTION : High - energy tibial plateau fractures are infrequent and technically demanding to treat especially if those are shearing type, coronal plane, displaced fractures. The most widely used the Schatzker system of classification , [1] ( B ased on the AP radiograph is more than likely to miss postero - medial and postero - lateral shear fractures, best visible on the lateral, than the AP radiograph. These fractures have recently been characterised by two studies, highlighti ng their clinical relevance [ 2,3] and showing that less invasive surgery and indirect reduction techniques are often inadequate. Hohl described unicondylar c oronal plane splitting fractures of the medial tibial plateau, noted that these injuries be considered as fracture - dislocations. Connolly and others have suggested that the mechanism involved in this fracture pattern is one of knee flexion, varus, and inter nal rotation of the medial femoral condyle . [4,5,6 ] Consistent among these and other authors is that the occurrence of this fragment is relatively unusual and that the use of a posteriorly based exposure with direct fracture visualization, anatomic reductio n and absolute stability appears to result in satisfactory outcomes. Though variations of a postero - medial approach been previously described ( by Trickey et al and also by Burks et al.,, more recently, Lobenhoffer et al described direct posterior exposure , Wang et al described postero - medial approach and Luo et al. described the approach for the management of posterior bicondylar tibial plateau fractures . [7,8] These approaches have been used in isolation or as a dual - incision approach for treating tibial plateau fractures . [9,10,11,12,13,14, 15] PURPOSE : The purpose of this study is to describe this unfamiliar direct posterior surgical (Medial Gastrocnemius approach to a general orthopod, highlighting the relevant anatomy and presenting our experience using this approach in treating a

  5. Ball-joint versus single monolateral external fixators for definitive treatment of tibial shaft fractures.

    Science.gov (United States)

    Beltsios, Michail; Mavrogenis, Andreas F; Savvidou, Olga D; Karamanis, Eirineos; Kokkalis, Zinon T; Papagelopoulos, Panayiotis J

    2014-07-01

    To compare modular monolateral external fixators with single monolateral external fixators for the treatment of open and complex tibial shaft fractures, to determine the optimal construct for fracture union. A total of 223 tibial shaft fractures in 212 patients were treated with a monolateral external fixator from 2005 to 2011; 112 fractures were treated with a modular external fixator with ball-joints (group A), and 111 fractures were treated with a single external fixator without ball-joints (group B). The mean follow-up was 2.9 years. We retrospectively evaluated the operative time for fracture reduction with the external fixator, pain and range of motion of the knee and ankle joints, time to union, rate of malunion, reoperations and revisions of the external fixators, and complications. The time for fracture reduction was statistically higher in group B; the rate of union was statistically higher in group B; the rate of nonunion was statistically higher in group A; the mean time to union was statistically higher in group A; the rate of reoperations was statistically higher in group A; and the rate of revision of the external fixator was statistically higher in group A. Pain, range of motion of the knee and ankle joints, rates of delayed union, malunion and complications were similar. Although modular external fixators are associated with faster intraoperative fracture reduction with the external fixator, single external fixators are associated with significantly better rates of union and reoperations; the rates of delayed union, malunion and complications are similar.

  6. Virtual stress testing of fracture stability in soldiers with severely comminuted tibial fractures.

    Science.gov (United States)

    Petfield, Joseph L; Hayeck, Garry T; Kopperdahl, David L; Nesti, Leon J; Keaveny, Tony M; Hsu, Joseph R

    2017-04-01

    Virtual stress testing (VST) provides a non-invasive estimate of the strength of a healing bone through a biomechanical analysis of a patient's computed tomography (CT) scan. We asked whether VST could improve management of patients who had a tibia fracture treated with external fixation. In a retrospective case-control study of 65 soldier-patients who had tibia fractures treated with an external fixator, we performed VST utilizing CT scans acquired prior to fixator removal. The strength of the healing bone and the amount of tissue damage after application of an overload were computed for various virtual loading cases. Logistic regression identified computed outcomes with the strongest association to clinical events related to nonunion within 2 months after fixator removal. Clinical events (n = 9) were associated with a low tibial strength for compression loading (p fracture patients who can safely resume weight bearing. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:805-811, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  7. Plate Versus Intramedullary Nail Fixation of Anterior Tibial Stress Fractures: A Biomechanical Study.

    Science.gov (United States)

    Markolf, Keith L; Cheung, Edward; Joshi, Nirav B; Boguszewski, Daniel V; Petrigliano, Frank A; McAllister, David R

    2016-06-01

    Anterior midtibial stress fractures are an important clinical problem for patients engaged in high-intensity military activities or athletic training activities. When nonoperative treatment has failed, intramedullary (IM) nail and plate fixation are 2 surgical options used to arrest the progression of a fatigue fracture and allow bone healing. A plate will be more effective than an IM nail in preventing the opening of a simulated anterior midtibial stress fracture from tibial bending. Controlled laboratory study. Fresh-frozen human tibias were loaded by applying a pure bending moment in the sagittal plane. Thin transverse saw cuts, 50% and 75% of the depth of the anterior tibial cortex, were created at the midtibia to simulate a fatigue fracture. An extensometer spanning the defect was used to measure the fracture opening displacement (FOD) before and after the application of IM nail and plate fixation constructs. IM nails were tested without locking screws, with a proximal screw only, and with proximal and distal screws. Plates were tested with unlocked bicortical screws (standard compression plate) and locked bicortical screws; both plate constructs were tested with the plate edge placed 1 mm from the anterior tibial crest (anterior location) and 5 mm posterior to the crest. For the 75% saw cut depth, the mean FOD values for all IM nail constructs were 13% to 17% less than those for the saw cut alone; the use of locking screws had no significant effect on the FOD. The mean FOD values for all plate constructs were significantly less than those for all IM nail constructs. The mean FOD values for all plates were 28% to 46% less than those for the saw cut alone. Anterior plate placement significantly decreased mean FOD values for both compression and locked plate constructs, but the mean percentage reductions for locked and unlocked plates were not significantly different from each other for either plate placement. The percentage FOD reductions for all plate

  8. Anterior tension band plating for anterior tibial stress fractures in high-performance female athletes: a report of 4 cases

    NARCIS (Netherlands)

    Borens, Olivier; Sen, Milan K.; Huang, Russel C.; Richmond, Jeffrey; Kloen, Peter; Jupiter, Jesse B.; Helfet, David L.

    2006-01-01

    Stress fracture of the anterior tibial cortex is an extremely challenging fracture to treat, especially in the high-performance female athlete who requires rapid return to competition. Previous reports have not addressed treating these fractures in the world-class athlete with anterior plating. We

  9. Immediate versus delayed intramedullary nailing for open fractures of the tibial shaft: A multivariate analysis of factors affecting deep infection and fracture healing

    Directory of Open Access Journals (Sweden)

    Yokoyama Kazuhiko

    2008-01-01

    Full Text Available Background: The purpose of this study was to evaluate contributing factors affecting deep infection and fracture healing of open tibia fractures treated with locked intramedullary nailing (IMN by multivariate analysis. Materials and Methods: We examined 99 open tibial fractures (98 patients treated with immediate or delayed locked IMN in static fashion from 1991 to 2002. Multivariate analyses following univariate analyses were derived to determine predictors of deep infection, nonunion, and healing time to union. The following predictive variables of deep infection were selected for analysis: age, sex, Gustilo type, fracture grade by AO type, fracture location, timing or method of IMN, reamed or unreamed nailing, debridement time (≤6 h or> 6 h, method of soft-tissue management, skin closure time (≤1 week or> 1 week, existence of polytrauma (ISS< 18 or ISS≥18, existence of floating knee injury, and existence of superficial/pin site infection. The predictive variables of nonunion selected for analysis was the same as those for deep infection, with the addition of deep infection for exchange of pin site infection. The predictive variables of union time selected for analysis was the same as those for nonunion, excluding of location, debridement time, and existence of floating knee and superficial infection. Results: Six (6.1%; type II Gustilo n=1, type IIIB Gustilo n=5 of the 99 open tibial fractures developed deep infections. Multivariate analysis revealed that timing or method of IMN, debridement time, method of soft-tissue management, and existence of superficial or pin site infection significantly correlated with the occurrence of deep infection ( P < 0.0001. In the immediate nailing group alone, the deep infection rate in type IIIB + IIIC was significantly higher than those in type I + II and IIIA ( P = 0.016. Nonunion occurred in 17 fractures (20.3%, 17/84. Multivariate analysis revealed that Gustilo type, skin closure time, and

  10. Effectiveness of various isometric exercises at improving bone strength in cortical regions prone to distal tibial stress fractures.

    Science.gov (United States)

    Florio, C S

    2018-06-01

    A computational model was used to compare the local bone strengthening effectiveness of various isometric exercises that may reduce the likelihood of distal tibial stress fractures. The developed model predicts local endosteal and periosteal cortical accretion and resorption based on relative local and global measures of the tibial stress state and its surface variation. Using a multisegment 3-dimensional leg model, tibia shape adaptations due to 33 combinations of hip, knee, and ankle joint angles and the direction of a single or sequential series of generated isometric resultant forces were predicted. The maximum stress at a common fracture-prone region in each optimized geometry was compared under likely stress fracture-inducing midstance jogging conditions. No direct correlations were found between stress reductions over an initially uniform circular hollow cylindrical geometry under these critical design conditions and the exercise-based sets of active muscles, joint angles, or individual muscle force and local stress magnitudes. Additionally, typically favorable increases in cross-sectional geometric measures did not guarantee stress decreases at these locations. Instead, tibial stress distributions under the exercise conditions best predicted strengthening ability. Exercises producing larger anterior distal stresses created optimized tibia shapes that better resisted the high midstance jogging bending stresses. Bent leg configurations generating anteriorly directed or inferiorly directed resultant forces created favorable adaptations. None of the studied loads produced by a straight leg was significantly advantageous. These predictions and the insight gained can provide preliminary guidance in the screening and development of targeted bone strengthening techniques for those susceptible to distal tibial stress fractures. Copyright © 2018 John Wiley & Sons, Ltd.

  11. Rap system of stress stimulation can promote bone union after lower tibial bone fracture: a clinical research.

    Science.gov (United States)

    Yao, Jian-fei; Shen, Jia-zuo; Li, Da-kun; Lin, Da-sheng; Li, Lin; Li, Qiang; Qi, Peng; Lian, Ke-jian; Ding, Zhen-qi

    2012-01-01

    Lower tibial bone fracture may easily cause bone delayed union or nonunion because of lacking of dynamic mechanical load. Research Group would design a new instrument as Rap System of Stress Stimulation (RSSS) to provide dynamic mechanical load which would promote lower tibial bone union postoperatively. This clinical research was conducted from January 2008 to December 2010, 92 patients(male 61/female 31, age 16-70 years, mean 36.3 years) who suffered lower tibial bone closed fracture were given intramedullary nail fixation and randomly averagely separated into experimental group and control group(according to the successively order when patients went for the admission procedure). Then researchers analysed the clinical healing time, full weight bearing time, VAS (Visual Analogue Scales) score and callus growth score of Lane-Sandhu in 3,6,12 months postoperatively. The delayed union and nonunion rates were compared at 6 and 12 months separately. All the 92 patients had been followed up (mean 14 months). Clinical bone healing time in experimental group was 88.78±8.80 days but control group was 107.91±9.03 days. Full weight bearing time in experimental group was 94.07±9.81 days but control group was 113.24±13.37 days respectively (Ptibial bone union, reduce bone delayed union or nonunion rate. It is an adjuvant therapy for promoting bone union after lower tibial bone fracture.

  12. Temporary Stabilization with External Fixator in ‘Tripolar’ Configuration in Two Steps Treatment of Tibial Pilon Fractures

    Science.gov (United States)

    Daghino, Walter; Messina, Marco; Filipponi, Marco; Alessandro, Massè

    2016-01-01

    Background: The tibial pilon fractures represent a complex therapeutic problem for the orthopedic surgeon, given the frequent complications and outcomes disabling. The recent medical literature indicates that the best strategy to reduce amount of complications in tibial pilon fractures is two-stages procedure. We describe our experience in the primary stabilization of these fractures. Methods: We treated 36 cases with temporary external fixation in a simple configuration, called "tripolar": this is an essential structure (only three screws and three rods), that is possible to perform even without the availability of X-rays and with simple anesthesia or sedation. Results: We found a sufficient mechanical stability for the nursing post-operative, in absence of intraoperative and postoperative problems. The time between trauma and temporary stabilization ranged between 3 and 144 hours; surgical average time was 8.4 minutes. Definitive treatment was carried out with a delay of a minimum of 4 and a maximum of 15 days from the temporary stabilization, always without problems, both in case of ORIF (open reduction, internal fixation) or circular external fixation Conclusion: Temporary stabilization with external fixator in ‘tripolar’ configuration seems to be the most effective strategy in two steps treatment of tibial pilon fractures. These preliminary encouraging results must be confirmed by further studies with more cases. PMID:27123151

  13. A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures.

    Science.gov (United States)

    Hoekstra, H; Kempenaers, K; Nijs, S

    2017-10-01

    Variable angle locking compression plates allow for lateral buttress and support of the posterolateral joint surface of tibial plateau fractures. This gives room for improvement of the surgical 3-column classification approach. Our aim was to revise and validate the 3-column classification approach to better guide the surgical planning of tibial plateau fractures extending into the posterolateral corner. In contrast to the 3-column classification approach, in the revised approach the posterior border of the lateral column in the revised approach lies posterior instead of anterior of the fibula. According to the revised 3-column classification approach, extended lateral column fractures are defined as single lateral column fractures extending posteriorly into the posterolateral corner. CT-images of 36 patients were reviewed and classified twice online according to Schatzker and revised 3-column classification approach by five observers. The intraobserver reliability was calculated using the Cohen's kappa and the interobserver reliability was calculated using the Fleiss' kappa. The intraobserver reliability showed substantial agreement according to Landis and Koch for both Schatzker and the revised 3-column classification approach (0.746 vs. 0.782 p = 0.37, Schatzker vs. revised 3-column, respectively). However, the interobserver reliability of the revised 3-column classification approach was significantly higher as compared to the Schatzker classification (0.531 vs. 0.669 p column, respectively). With the introduction of variable angle locking compression plates, the revised 3-column classification approach is a very helpful tool in the preoperative surgical planning of tibial plateau fractures, in particular, lateral column fractures that extend into the posterolateral corner. The revised 3-column classification approach is rather a practical supplement to the Schatzker classification. It has a significantly higher interobserver reliability as compared to the

  14. [Application of rafting K-wire technique for tibial plateau fractures].

    Science.gov (United States)

    Zhang, Xing-zhou; Yu, Wei-zhong; Li, Yun-feng; Liu, Yan-hui

    2015-12-01

    To summarize application of rafting K-wires technique for tibial plateau fractures. From January 2013 to January 2015,45 patients with tibial plateau fractures were treated by locking plate with rafting K-wires, including 33 males and 12 females with an average of 44.2 years old ranging from 22 to 56 years old. According to Schatzker classification, 6 cases were type II, 8 were type Ill, 4 were type IV, 4 were type V, and 5 were type VI. Allogeneic bone graft were performed for bone defects. All patients were fixed with two to five K-wires. Part of weight loading were encouraged at 3 months after operation,and full weight-loading were done at 5 months after operation. Postoperative complications were observed,and Rasmussen clinical and radiological assessment were used to evaluate clinical results. All Patients were followed up from 10 to 23 months with average of 14 months. According to Rasmussen clinical and radiological assessment, clinical scores 23.58 ± 6.33, radiological scores were 14.00 ± 6.33; and excellent and good rates were 82.2% and 77.8% respectively. Four patients occurred severe osteoporosis and collapse of articular surface; 5 patients occurred traumatic arthritis. Rafting K-wires technique with anatomized armor plate could effective fix and support platform collapse and joint bone fragments, increase support surface area and reduce postoperative reduction loss rate.

  15. "Shin splint" syndrome and tibial stress fracture in the same patient diagnosed by means of (99m)Tc-HMDP SPECT/CT.

    Science.gov (United States)

    Vicente, Justo Serrano; Grande, Maria Luz Domínguez; Torre, Jose Rafael Infante; Madrid, Juan Ignacio Rayo; Barquero, Carmen Durán; Bernardo, Lucía García; Sánchez, Román Sánchez

    2013-04-01

    We show a patient who presented leg pain triggered by intense exercise. The most likely diagnosis was a possible tibial stress fracture or a "shin splint" syndrome (soleus enthesopathy). We performed a bone scintigraphy including SPECT/CT that revealed the presence of the two concomitant pathologies. SPECT/CT identified the hot spot superimposed with bone lesion in the tibial stress fracture and only remodeling activity without evidence of cortical lesions in the enthesopathy processes.

  16. [An improved reduction technique for depression fractures of lateral tibial plateau].

    Science.gov (United States)

    Wang, Hongchuan; Lou, Hua; Liu, Kai; Jiang, Junwei

    2013-01-01

    To investigate the improved reduction technique for depression fractures of the lateral tibial plateau and its effectiveness. Between January 2008 and December 2010; 48 patients (48 knees) with depression fractures of the lateral tibial plateau (Schatzker II or III fractures) were treated. There were 32 males and 16 females with an average age of 45.8 years (range, 16-79 years). All fractures were fresh closed fractures, which were caused by traffic accident in 27 cases, by falling from height in 5 cases, by crushing in 8 cases, and by sustained falls in 8 cases. According to Schatzker classification, 29 cases were classified as type II and 19 cases as type III. The lateral cortex was cut off to expose the depression and compacted cancellous bone was elevated to reset the articular surface. After reduction, autologous iliac bone graft and locking plate internal fixation were used. Healing of incision by first intention was achieved in all patients, and no complication occurred. All patients were followed up 1.7 years on average (range, 1-3 years). At last follow-up, the knee extension was (-0.5 +/- 0.3) degrees, and the knee flexion was (136.9 +/- 8.8) degrees. X-ray films showed that the fracture healing time was 52 weeks and no breakage of internal fixation occurred. According to Rasmussen clinical score, the results were excellent in 35 cases, good in 10 cases, and fair in 3 cases. According to Rasmussen radiographical score, the results were excellent in 41 cases, good in 7 cases; there were 41 excellent scores and 7 good scores of articular reduction; all gained good recovery of coronal and sagittal alignment and condylar width. The articular surface collapse was (1.0 +/- 0.7) mm at immediate postoperatively and (1.2 +/- 0.7) mm at last follow-up, showing no significant difference (t = -1.42, P = 0.20), but significant differences were found when compared with that at preoperation [(12.2 +/- 8.0) mm, P fracture reduction and can avoid loss of reduction. The

  17. Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates

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    G Thiruvengita Prasad

    2013-01-01

    Full Text Available Background: Dual plate fixation in comminuted bicondylar tibial plateau fractures remains controversial. Open reduction and internal fixation, specifically through compromised soft tissues, has historically been associated with major wound complications. Alternate methods of treatment have been described, each with its own merits and demerits. We performed a retrospective study to evaluate the functional outcome of lateral and medial plate fixation of Schatzker type V and VI fractures through an anterolateral approach, and a medial minimally invasive approach or a posteromedial approach. Materials and Methods: We treated 46 tibial plateau fractures Schatzker type V and VI with lateral and medial plates through an anterolateral approach and a medial minimal invasive approach over an 8 years period. Six patients were lost to followup. Radiographs in two planes were taken in all cases. Immediate postoperative radiographs were assessed for quality of reduction and fixation. The functional outcome was evaluated according to the Oxford Knee Score criteria on followup. Results: Forty patients (33 men and 7 women who completed the followup were included in the study. There were 20 Schatzker type V fractures and 20 Schatzker type VI fractures. The mean duration of followup was 4 years (range 1-8 years. All patients had a satisfactory articular reduction defined as ≤2 mm step-off or gap as assessed on followup. All patients had a good coronal and sagittal plane alignment, and articular width as assessed on supine X-rays of the knee in the anteroposterior (AP and lateral views. The functional outcome, as assessed by the Oxford Knee Score, was excellent in 30 patients and good in 10 patients. All patients returned to their pre-injury level of activity and employment. There were no instances of deep infection. Conclusions: Dual plate fixation of severe bicondylar tibial plateau fractures is an excellent treatment option as it provides rigid fixation and

  18. Concomitant posterior hip dislocation, ipsilateral intertrochanteric- and proximal tibial- fractures with popliteal artery injury: a challenging trauma mélange

    Directory of Open Access Journals (Sweden)

    Pranit N. Chotai

    2015-12-01

    Full Text Available Constellation of ipsilateral posterior hip dislocation, intertrochanteric- and proximal tibial fracture with popliteal artery injury is rare. Management of this presentation is challenging. A motor vehicle accident victim presented with these injuries, but without any initial signs of vascular compromise. Popliteal artery injury was diagnosed intra-operatively and repaired. This was followed by external fixation of tibial fracture, open reduction of dislocated hip and internal fixation of intertrochanteric fracture. Patient regained bilateral complete weight bearing and returned to pre-accident activity level. Apt surgical management including early repair of vascular injury in such a trauma mélange allows for a positive postoperative outcome.

  19. [Clinical application of blocking screws and rooting technique in the treatment of distal tibial fracture with interlocking intramedullary nail].

    Science.gov (United States)

    Zhu, Hai-Bing; Wu, Li-Guo; Fang, Zhi-Song; Luo, Cong-Feng; Wang, Qing-Feng; Ma, Yi-Ping; Gao, Hong; Fu, Guo-Hai; Hu, Cheng-Ting

    2012-07-01

    To introduce the clinical method of blocking screws and rooting technique in the treatment of distal tibial fracture with interlocking intramedullary nails. From June 2006 to March 2011, 26 patients with distal tibial fracture were treated with interlocking intramedullary nails using blocking screws and rooting technique, included 18 males and 8 females with an average age of 46.2 years old ranging from 24 to 64 years. According to AO classification: 10 cases of type A1, 4 cases of type A2, 8 cases of type B1, 4 cases of type B2. The average distance of the fractures end to the ankle joint was 85 mm ranging from 55 to 125 mm, the mean time between injured and operation was 4.5 days. The patients were evaluated with pain, range of motion, walking. All cases were followed-up for 6 to 22 months (averaged 15 months). According to Iowa ankle joint grading system,the score was improved from preoperative (66.8 +/- 8.2) to postoperative (94.6 +/- 4.8). All fractures had united, and got satisfactory reduction and stable fixation with no complications had happen such as breakage of screw. Fixation with interlocking intramedullary nail using blocking screws and rooting technique in treating distal tibial fracture, is a safe and effective technique for the improvement of stability.

  20. Effects of long-term administration of carprofen on healing of a tibial osteotomy in dogs.

    Science.gov (United States)

    Ochi, Hiroki; Hara, Yasushi; Asou, Yoshinori; Harada, Yasuji; Nezu, Yoshinori; Yogo, Takuya; Shinomiya, Kenichi; Tagawa, Masahiro

    2011-05-01

    To evaluate effects of long-term administration of carprofen on healing of a tibial osteotomy in dogs. 12 healthy female Beagles. A mid-diaphyseal transverse osteotomy (stabilized with an intramedullary pin) of the right tibia was performed in each dog. The carprofen group (n = 6 dogs) received carprofen (2.2 mg/kg, PO, q 12 h) for 120 days; the control group (6) received no treatment. Bone healing and change in callus area were assessed radiographically over time. Dogs were euthanized 120 days after surgery, and tibiae were evaluated biomechanically and histologically. The osteotomy line was not evident in the control group on radiographs obtained 120 days after surgery. In contrast, the osteotomy line was still evident in the carprofen group. Callus area was significantly less in the carprofen group, compared with the area in the control group, at 20, 30, and 60 days after surgery. At 120 days after surgery, stiffness, elastic modulus, and flexural rigidity in the carprofen group were significantly lower than corresponding values in the control group. Furthermore, histologic evaluation revealed that the cartilage area within the callus in the carprofen group was significantly greater than that in the control group. Long-term administration of carprofen appeared to inhibit bone healing in dogs that underwent tibial osteotomy. We recommend caution for carprofen administration when treating fractures that have delays in healing associated with a reduction in osteogenesis as well as fractures associated with diseases that predispose animals to delays of osseous repair.

  1. Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures: a systematic review and meta-analysis.

    Science.gov (United States)

    Yang, Liqing; Sun, Yuefeng; Li, Ge

    2018-06-14

    Optimal surgical approach for tibial shaft fractures remains controversial. We perform a meta-analysis from randomized controlled trials (RCTs) to compare the clinical efficacy and prognosis between infrapatellar and suprapatellar intramedullary nail in the treatment of tibial shaft fractures. PubMed, OVID, Embase, ScienceDirect, and Web of Science were searched up to December 2017 for comparative RCTs involving infrapatellar and suprapatellar intramedullary nail in the treatment of tibial shaft fractures. Primary outcomes were blood loss, visual analog scale (VAS) score, range of motion, Lysholm knee scores, and fluoroscopy times. Secondary outcomes were length of hospital stay and postoperative complications. We assessed statistical heterogeneity for each outcome with the use of a standard χ 2 test and the I 2 statistic. The meta-analysis was undertaken using Stata 14.0. Four RCTs involving 293 participants were included in our study. The present meta-analysis indicated that there were significant differences between infrapatellar and suprapatellar intramedullary nail regarding the total blood loss, VAS scores, Lysholm knee scores, and fluoroscopy times. Suprapatellar intramedullary nailing could significantly reduce total blood loss, postoperative knee pain, and fluoroscopy times compared to infrapatellar approach. Additionally, it was associated with an improved Lysholm knee scores. High-quality RCTs were still required for further investigation.

  2. Sequential Proximal Tibial Stress Fractures associated with Prolonged usage of Methotrexate and Corticosteroids: A Case Report

    Directory of Open Access Journals (Sweden)

    Tan TJL

    2015-11-01

    Full Text Available Stress fractures of the proximal tibia metaphysis are rare in the elderly. We present a case of a 65-year old male who developed sequential proximal tibia stress fractures associated with prolonged usage of methotrexate and prednisolone within a span of 18 months. Magnetic Resonance Imaging revealed an incomplete stress fracture involving the medial proximal tibial region. The patient was treated with stemmed total knee arthroplasty (TKA bilaterally. Stress fractures should be considered in patients with atypical knee pain who have a history of methotrexate and prednisolone usage. TKA is an effective treatment in stress fractures of the proximal tibia.

  3. Incidence and risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture: A systematic review and meta-analysis.

    Science.gov (United States)

    Shao, Jiashen; Chang, Hengrui; Zhu, Yanbin; Chen, Wei; Zheng, Zhanle; Zhang, Huixin; Zhang, Yingze

    2017-05-01

    This study aimed to quantitatively summarize the risk factors associated with surgical site infection after open reduction and internal fixation of tibial plateau fracture. Medline, Embase, CNKI, Wanfang database and Cochrane central database were searched for relevant original studies from database inception to October 2016. Eligible studies had to meet quality assessment criteria according to the Newcastle-Ottawa Scale, and had to evaluate the risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture. Stata 11.0 software was used for this meta-analysis. Eight studies involving 2214 cases of tibial plateau fracture treated by open reduction and internal fixation and 219 cases of surgical site infection were included in this meta-analysis. The following parameters were identified as significant risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture (p operative time (OR 2.15; 95% CI 1.53-3.02), tobacco use (OR 2.13; 95% CI 1.13-3.99), and external fixation (OR 2.07; 95% CI 1.05-4.09). Other factors, including male sex, were not identified as risk factors for surgical site infection. Patients with the abovementioned medical conditions are at risk of surgical site infection after open reduction and internal fixation of tibial plateau fracture. Surgeons should be cognizant of these risks and give relevant preoperative advice. Copyright © 2017. Published by Elsevier Ltd.

  4. Treatment of open tibial shaft fracture with soft tissue and bone defect caused by aircraft bomb--case report.

    Science.gov (United States)

    Golubović, Zoran; Vidić, Goran; Trenkić, Srbobran; Vukasinović, Zoran; Lesić, Aleksandar; Stojiljković, Predrag; Stevanović, Goran; Golubović, Ivan; Visnjić, Aleksandar; Najman, Stevo

    2010-01-01

    Aircraft bombs can cause severe orthopaedic injuries. Tibia shaft fractures caused by aircraft bombs are mostly comminuted and followed by bone defects, which makes the healing process extremely difficult and prone to numerous complications. The goal of this paper is to present the method of treatment and the end results of treatment of a serious open tibial fracture with soft and bone tissue defects resulting from aircraft bomb shrapnel wounds. A 26-year-old patient presented with a tibial fracture as the result of a cluster bomb shrapnel wound. He was treated applying the method of external bone fixation done two days after wounding, as well as of early coverage of the lower leg soft tissue defects done on the tenth day after the external fixation of the fracture. The external fixator was removed after five months, whereas the treatment was continued by means of functional plaster cast for another two months. The final functional result was good. Radical wound debridement, external bone fixation of the fracture, and early reconstruction of any soft tissue and bone defects are the main elements of the treatment of serious fractures.

  5. Arthroscopy-assisted reduction of posteromedial tibial plateau fractures with buttress plate and cannulated screw construct.

    Science.gov (United States)

    Chiu, Chih-Hao; Cheng, Chun-Ying; Tsai, Min-Chain; Chang, Shih-Sheng; Chen, Alvin Chao-Yu; Chen, Yeung-Jen; Chan, Yi-Sheng

    2013-08-01

    To present the radiologic and clinical results of posteromedial fractures treated with arthroscopy-assisted reduction and buttress plate and cannulated screw fixation. Twenty-five patients with posteromedial tibial plateau fractures treated by the described technique were included in this study. According to the Schatzker classification, there were 5 type IV fractures (20%), 2 type V fractures (8%), and 18 type VI fractures (72%). The mean age at operation was 46 years (range, 21 to 79 years). The mean follow-up period was 86 months (range, 60 to 108 months). Clinical and radiologic outcomes were scored by the Rasmussen system. Subjective data were collected to assess swelling, difficulty climbing stairs, joint stability, ability to work and participate in sports, and overall patient satisfaction with recovery. Secondary osteoarthritis was diagnosed when radiographs showed a narrowed joint space in the injured knee at follow-up in comparison with the films taken at the time of injury. The mean postoperative Rasmussen clinical score was 25.9 (range, 18 to 29), and the mean radiologic score was 15.8 (range, 10 to 18). All 25 fractures achieved successful union, and 92% had good or excellent clinical and radiologic results. The 3 fracture types did not significantly differ in Rasmussen scores or rates of satisfactory results (P > .05). Secondary osteoarthritis was noted in 6 injured knees (24%). Arthroscopy-assisted reduction with buttress plate and cannulated screw fixation can restore posteromedial tibial plateau fractures of the knee with well-documented radiographic healing, good clinical outcomes, and low complication rates. Level IV, therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  6. [ARTHROSCOPIC TREATMENT OF ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE IN ADOLESCENTS WITH EPIPHYSEAL UNCLOSURE].

    Science.gov (United States)

    Liu, Yang; Sun, Xuebin; Zhang, Keyuan; Li, Gang; Ni, Jiati

    2015-06-01

    To evaluate the clinical results of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fractures in adolescents with epiphyseal unclosure. Between January 2011 and October 2013, 35 knees with ACL tibial eminence avulsion fractures (35 patients with epiphyseal unclosure) were arthroscopically treated with suture fixation. There were 25 males and 10 females, aged 8-16 years (mean, 14.7 years). The causes included sports injury in 24 cases, traffic accident injury in 9 cases, and daily life injury in 2 cases. According to Meyers-McKeever classification criteria, there were 27 cases of type II and 8 cases of type III. Five cases had meniscus injury. The preoperative the International Knee Documentation Committee (IKDC) score was 48.7 ± 3.2, and Lysholm score was 51.2 ± 4.5. The time from injury to operation was 2-16 days (mean, 5 days). Primary healing of incision was obtained in all patients. The mean follow-up time was 22.4 months (range, 12-32 months). Anatomical reduction was achieved in 28 cases and satisfactory reduction in 7 cases. X-ray films showed all fractures healing at last follow-up. There was no limb shortening deformity, varus knee, or valgus knee. Lachman test results were all negative. The other knees had normal range of motion except 1 knee with limited flexion, whose range of motion returned to 0-120° after treatment. At last follow-up, the IKDC score was significantly improved to 93.2 ± 4.1 (t = -53.442, P = 0.000), and the Lysholm score was significantly increased to 96.2 ± 2.5 (t = -56.242, P = 0.000). The arthroscopic fixation technique has satisfactory results for the reduction and fixation of ACL tibial eminence avulsion fracture in the adolescents with epiphyseal unclosure because of little trauma and quick recovery.

  7. Case report: multifocal subchondral stress fractures of the femoral heads and tibial condyles in a young military recruit.

    Science.gov (United States)

    Yoon, Pil Whan; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

    2012-03-01

    Subchondral stress fractures of the femoral head may be either of the insufficiency-type with poor quality bone or the fatigue-type with normal quality bone but subject to high repetitive stresses. Unlike osteonecrosis, multiple site involvement rarely has been reported for subchondral stress fractures. We describe a case of multifocal subchondral stress fractures involving femoral heads and medial tibial condyles bilaterally within 2 weeks. A 27-year-old military recruit began having left knee pain after 2 weeks of basic training, without any injury. Subsequently, right knee, right hip, and left hip pain developed sequentially within 2 weeks. The diagnosis of multifocal subchondral stress fracture was confirmed by plain radiographs and MR images. Nonoperative treatment of the subchondral stress fractures of both medial tibial condyles and the left uncollapsed femoral head resulted in resolution of symptoms. The collapsed right femoral head was treated with a fibular strut allograft to restore congruity and healed without further collapse. There has been one case report in which an insufficiency-type subchondral stress fracture of the femoral head and medial femoral condyle occurred within a 2-year interval. Because the incidence of bilateral subchondral stress fractures of the femoral head is low and multifocal involvement has not been reported, multifocal subchondral stress fractures can be confused with multifocal osteonecrosis. Our case shows that subchondral stress fractures can occur in multiple sites almost simultaneously.

  8. Postoperative weight bearing and patient reported outcomes at one year following tibial plateau fractures.

    Science.gov (United States)

    Thewlis, Dominic; Fraysse, Francois; Callary, Stuart A; Verghese, Viju Daniel; Jones, Claire F; Findlay, David M; Atkins, Gerald J; Rickman, Mark; Solomon, Lucian B

    2017-07-01

    Tibial plateau fractures are complex and the current evidence for postoperative rehabilitation is weak, especially related to the recommended postoperative weight bearing. The primary aim of this study was to investigate if loading in the first 12 weeks of recovery is associated with patient reported outcome measures at 26 and 52 weeks postoperative. We hypothesized that there would be no association between loading and patient reported outcome measures. Seventeen patients, with a minimum of 52-week follow-up following fragment-specific open reduction and internal fixation for tibial plateau fracture, were selected for this retrospective analysis. Postoperatively, patients were advised to load their limb to a maximum of 20kg during the first 6 weeks. Loading data were collected during walking using force platforms. A ratio of limb loading (affected to unaffected) was calculated at 2, 6 and 12 weeks postoperative. Knee Injury and Osteoarthritis Scores were collected at 6, 12, 26 and 52 weeks postoperative. The association between loading ratios and patient reported outcomes were investigated. Compliance with weight bearing recommendations and changes in the patient reported outcome measures are described. Fracture reduction and migration were assessed on plain radiographs. No fractures demonstrated any measurable postoperative migration at 52 weeks. Significant improvements were seen in all patient reported outcome measures over the first 52 weeks, despite poor adherence to postoperative weight bearing restrictions. There were no associations between weight bearing ratio and patient reported outcomes at 52 weeks postoperative. Significant associations were identified between the loading ratio at 2 weeks and knee-related quality of life at six months (R 2 =0.392), and between the loading ratio at 6 weeks combined with injury severity and knee-related quality of life at 26 weeks (R 2 =0.441). In summary, weight bearing as tolerated does not negatively affect the

  9. [Ultrabraid SUTURE WITH FOOTPRINT RIVET FOR ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURE IN ADOLESCENTS UNDER ARTHROSCOPY].

    Science.gov (United States)

    Liang, Jinying; Zheng, Jiapeng; Ll, Qiang; Zhong, Shuyu; Chen, Minzhen

    2015-06-01

    To investigate the clinical effects of the Ultrabraid suture with FOOTPRINT rivet by arthroscopic technique for the treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture. Between May 2011 and December 2013, 19 adolescent patients with ACL tibial eminence avulsion fracture were treated with arthroscopic reduction and fixation by Ultrabraid sutures with FOOTPRINT rivet. There were 13 males and 6 females with an average age of 15.8 years (range, 8-18 years). The left knees were involved in 10 cases and the right knees in 9 cases. The injury causes included traffic accident injury in 8 cases, sport injury in 6 cases, and sprain injury in 5 cases. Three patients had old fractures, and the others had fresh fractures. The results of Lachman test and anterior drawer test were both positive. The International Knee Documentation Committee (IKDC) subject score was 54.2 ± 4.0. Based on Meyers-McKeever classification, there were 3 cases of type II, 10 cases of type III, and 6 cases of type IV. The operation time was 50-60 minutes (mean, 55.2 minutes). X-ray film showed satisfactory fracture reduction at 1 day after operation. Primary healing of incision was obtained with no infection. Eighteen patients were followed up for 1-3 years (mean, 1.7 years). All fractures healed with smooth joint surface on the X-ray film at 3 months after operation. The results of Lachman test and anterior drawer test were both negative in 17 cases, and the results was negative for anterior drawer test and was weakly positive for Lachman test in 1 case. The IKDC subject score was significantly improved to 96.1 ± 2.1 at last follow-up (t = 34.600, P = 0.000). It could achieve early restoration of knee joint function to treat the ACL tibial eminence avulsion fracture by arthroscopic technique of the Ultrabraid suture with FOOTPRINT rivet because of satisfactory reduction, reliable fixation, small wound, and early rehabilitation.

  10. Role of Appositional Screw Fixation in Minimally Invasive Plate Osteosynthesis for Distal Tibial Fracture.

    Science.gov (United States)

    Yang, Kyu-Hyun; Won, Yougun; Kang, Dong-Hyun; Oh, Jin-Cheol; Kim, Sung-Jun

    2015-09-01

    To determine the effect of interfragmentary appositional (gap-closing) screw fixation in minimally invasive plate osteosynthesis (MIPO) for distal tibial fractures on the clinical and radiologic results. Prospective nonrandomized study. Level I trauma center. Sixty patients who were diagnosed as distal metadiaphyseal oblique or spiral tibial fracture without displaced articular fragment. Thirty patients (group A) of the 60 patients were treated with MIPO without appositional screw fixation, and the other 30 (group B) were treated with the screw. Radiologic union, clinical union, clinical functional score [American Orthopaedic Foot and Ankle Society (AOFAS) score], and complications. The time for initial callus formation and radiologic union was significantly longer in group A than those in group B (76.8 vs. 58.0 days, P = 0.044; 409 vs. 258.7 days, P = 0.002, respectively). The rate of clinical union during 1 year was significantly higher in group B than in group A (P = 0.0063). Four nonunion patients in group A achieved bone union after placement of an additional bone graft. None of the patients in group B diagnosed with delayed union or nonunion (P fracture promoted callus formation and union rate compared with MIPO without appositional screw fixation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  11. Post-Traumatic Periprosthetic Tibial and Fibular Fracture After Total Ankle Arthroplasty: A Case Report.

    Science.gov (United States)

    Brock, Amanda K; Tan, Eric W; Shafiq, Babar

    Periprosthetic fractures after total ankle arthroplasty are uncommon, with most cases occurring intraoperatively. We describe a post-traumatic periprosthetic fracture of the distal tibia and fibula after total ankle arthroplasty that was treated with minimally invasive plate osteosynthesis. It is important for orthopedic surgeons not only to recognize the risk factors for postoperative periprosthetic total ankle arthroplasty fractures, but also to be familiar with the treatment options available to maximize function and minimize complications. The design of the tibial prosthesis and surgical techniques required to prepare the ankle joint for implantation are important areas of future research to limit the risk of periprosthetic fractures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  12. [Effectiveness of arthroscopic treatment of anterior cruciate ligament tibial eminence avulsion fracture with non-absorbable suture fixation combined with mini-plate].

    Science.gov (United States)

    Wang, Suiyuan; Xiao, Yang; Tong, Zuoming; Li, Guiqiu; Jiang, Juhua; Yao, Jinghui; Wu, Zhiyong; Li, Tengfei; Wu, Qun

    2013-09-01

    To evaluate the surgical techniques and effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture with non-absorbable suture fixation combined with the miniplate. Between January 2009 and March 2012, 32 patients with ACL tibial eminence avulsion fractures were treated. There were 18 males and 14 females, aged 12-40 years (mean, 17.5 years). The injury causes included traffic accident injury in 15 cases, sport injury in 6 cases, and falling injury in 11 cases. The time from injury to operation ranged 7-18 days with an average of 9.5 days. Before operation, the results of Lachman test were all positive; the Lysholm score was 52.13 +/- 4.22 and the International Knee Documentation Committee (IKDC) score was 44.82 +/- 2.44. According to Meyers-McKeever classification criteria, there were 12 cases of type II and 20 cases of type III. After arthroscopic poking reduction of fracture, tibial eminence avulsion fractures were fixed with the Ethibond non-absorbable sutures bypass figure-of-eight tibial tunnel combined with the metacarpal and phalangeal mini-plate. Primary healing was obtained in all incisions; no joint infection or skin necrosis occurred after operation. All patients were followed up with an average time of 22.4 months (range, 12-50 months). The patients showed negative Lachman test at 12 weeks after operation. Except 3 patients having knee extension limitation at last follow-up, the knee extension range of motion (ROM) was normal in the other patients; the knee flexion ROM was normal in all patients. The Lysholm score and IKDC score were significantly improved to 94.19 +/- 0.93 and 94.35 +/- 1.22 at last follow-up, showing significant differences when compared with preoperative values (t = 55.080, P = 0.000; t = 101.715, P = 0.000). The arthroscopic treatment of ACL tibial eminence avulsion fracture with Ethibond non-absorbable suture fixation combined with mini-plate is an effective procedure with the

  13. A review of forty five open tibial fractures covered with free flaps. Analysis of complications, microbiology and prognostic factors

    DEFF Research Database (Denmark)

    Olesen, Ulrik Kähler; Juul, Rasmus; Bonde, Christian Torsten

    2015-01-01

    whether early flap coverage improved the clinical outcome and whether we could improve our antibiotic treatment of open fractures. METHODS: From 2002 to 2013 we treated 56 patients with an open tibial fracture covered with a free flap. We reviewed patient records and databases for type of trauma, smoking...

  14. Comparison of two-staged ORIF and limited internal fixation with external fixator for closed tibial plafond fractures.

    Science.gov (United States)

    Wang, Cheng; Li, Ying; Huang, Lei; Wang, Manyi

    2010-10-01

    To compare the results of two-staged open reduction and internal fixation (ORIF) and limited internal fixation with external fixator (LIFEF) for closed tibial plafond fractures. From January 2005 to June 2007, 56 patients with closed type B3 or C Pilon fractures were randomly allocated into groups I and II. Two-staged ORIF was performed in group I and LIFEF in group II. The outcome measures included bone union, nonunion, malunion, pin-tract infection, wound infection, osteomyelitis, ankle joint function, etc. These postoperative data were analyzed with Statistical Package for Social Sciences (SPSS) 13.0. Incidence of superficial soft tissue infection (involved in wound infection or pin-tract infection) in group I was lower than that in group II (P delayed union, and arthritis symptoms, with no statistical significance. Both groups resulted similar ankle joint function. Logistic regression analysis indicated that smoking and fracture pattern were the two factors significantly influencing the final outcomes. In the treatment of closed tibial plafond fractures, both two-staged ORIF and LIFEF offer similar results. Patients undergo LIFEF carry significantly greater radiation exposure and higher superficial soft tissue infection rate (usually occurs on pin tract and does not affect the final outcomes).

  15. [A case of anterior tibial arteriovenous fistula after closed fracture of the leg].

    Science.gov (United States)

    Touzard, R C

    1975-01-01

    This case permits one to emphasize the great rareness of arteriovenous fistula after closed fractures of the shaft of the tibia. Fistulas in this anterior tibial position are remarkably latent, cause no symptoms below the fistula nor symptoms of heart failure. Treatment by several ligatures, permitted this patient to return to work 15 days after operation without any further treatment. The patient no longer has any symptoms.

  16. Balloon osteoplasty--a new technique for reduction and stabilisation of impression fractures in the tibial plateau: a cadaver study and first clinical application.

    Science.gov (United States)

    Ahrens, Philipp; Sandmann, Gunther; Bauer, Jan; König, Benjamin; Martetschläger, Frank; Müller, Dirk; Siebenlist, Sebastian; Kirchhoff, Chlodwig; Neumaier, Markus; Biberthaler, Peter; Stöckle, Ulrich; Freude, Thomas

    2012-09-01

    Fractures of the tibial plateau are among the most severe injuries of the knee joint and lead to advanced gonarthrosis if the reduction does not restore perfect joint congruency. Many different reduction techniques focusing on open surgical procedures have been described in the past. In this context we would like to introduce a novel technique which was first tested in a cadaver setup and has undergone its successful first clinical application. Since kyphoplasty demonstrated effective ways of anatomical correction in spine fractures, we adapted the inflatable instruments and used the balloon technique to reduce depressed fragments of the tibial plateau. The technique enabled us to restore a congruent cartilage surface and bone reduction. In this technique we see a useful new method to reduce depressed fractures of the tibial plateau with the advantages of low collateral damage as it is known from minimally invasive procedures.

  17. Proximal tibial stress fracture associated with mild osteoarthritis of the knee: case report.

    Science.gov (United States)

    Curković, Marko; Kovac, Kristina; Curković, Bozidar; Babić-Naglić, Durda; Potocki, Kristina

    2011-03-01

    Stress fractures are considered as multifactorial overuse injuries occurring in 0.3%-0.8% of patients suffering from rheumatic diseases, with rheumatoid arthritis being the most common underlying condition. Stress fractures can be classified according to the condition of the bone affected as: 1) fatigue stress fractures occurring when normal bone is exposed to repeated abnormal stresses; and 2) insufficiency stress fractures that occur when normal stress is applied to bone weakened by an underlying condition. Stress fractures are rarely associated with severe forms of knee osteoarthritis, accompanied with malalignment and obesity. We present a patient with a proximal tibial stress fracture associated with mild knee osteoarthritis without associated malalignment or obesity. Stress fracture should be considered when a patient with osteoarthritis presents with sudden deterioration, severe localized tenderness to palpation and localized swelling or periosteal thickening at the pain site and elevated local temperature. The diagnosis of stress fractures in patients with rheumatic diseases may often be delayed because plain film radiographs may not reveal a stress fracture soon after the symptom onset; moreover, evidence of a fracture may never appear on plain radiographs. Triple phase nuclear bone scans and magnetic resonance imaging are more sensitive in the early clinical course than plain films for initial diagnosis.

  18. Detection of tibial condylar fractures using 3D imaging with a mobile image amplifier (Siemens ISO-C-3D): Comparison with plain films and spiral CT

    International Nuclear Information System (INIS)

    Kotsianos, D.; Rock, C.; Wirth, S.; Linsenmaier, U.; Brandl, R.; Fischer, T.; Pfeifer, K.J.; Reiser, M.; Euler, E.; Mutschler, W.

    2002-01-01

    Purpose: To analyze a prototype mobile C-arm 3D image amplifier in the detection and classification of experimental tibial condylar fractures with multiplanar reconstructions (MPR). Method: Human knee specimens (n=22) with tibial condylar fractures were examined with a prototype C-arm (ISO-C-3D, Siemens AG), plain films (CR) and spiral CT (CT). The motorized C-arm provides fluoroscopic images during a 190 orbital rotation computing a 119 mm data cube. From these 3D data sets MP reconstructions were obtained. All images were evaluated by four independent readers for the detection and assessment of fracture lines. All fractures were classified according to the Mueller AO classification. To confirm the results, the specimens were finally surgically dissected. Results: 97% of the tibial condylar fractures were easily seen and correctly classified according to the Mueller AO classification on MP reconstruction of the ISO-C-3D. There is no significant difference between ISO-C and CT in detection and correct classification of fractures, but ISO-CD-3D is significant by better than CR. (orig.) [de

  19. Acute simultaneous bilateral avulsion fractures of the tibial tubercles in a 15-year-old male hurler: case report and literature review.

    LENUS (Irish Health Repository)

    Hanley, C

    2012-02-01

    BACKGROUND: Avulsion fractures of the tibial tubercle are an unusual injury pattern generally occurring in the adolescent male during sporting activities. Bilateral simultaneous fractures are extremely rare. They are often associated with other underlying orthopaedic pathology. AIMS: We present a case of bilateral tibial tubercle avulsions occurring in a 15 year-old male hurler. We describe the management and necessary investigations required for this type of trauma and present a literature review on this rarely encountered injury. CONCLUSION: Although this type of atypical fracture pattern is associated with high energy trauma and other underlying pathology, we have shown that once treated, the patient can expect to make a prompt return to sporting activities with no significant long-term functional deficit.

  20. Tension band plating of a nonunion anterior tibial stress fracture in an athlete.

    Science.gov (United States)

    Merriman, Jarrad A; Villacis, Diego; Kephart, Curtis J; Rick Hatch, George F

    2013-07-01

    The authors present a rare technique of tension band plating of the anterior tibia in the setting of a nonunion stress fracture. Surgical management with an intramedullary nail is a viable and proven option for treating such injuries. However, in treating elite athletes, legitimate concerns exist regarding the surgical disruption of the extensor mechanism and the risk of anterior knee pain associated with intramedullary nail use. The described surgical technique demonstrates the use of tension band plating as an effective treatment of delayed union and nonunion anterior tibial stress fractures in athletes without the potential risks of intramedullary nail insertion. Copyright 2013, SLACK Incorporated.

  1. Do stress fractures induce hypertrophy of the grafted fibula? A report of three cases received free vascularized fibular graft treatment for tibial defects.

    Science.gov (United States)

    Qi, Yong; Sun, Hong-Tao; Fan, Yue-Guang; Li, Fei-Meng; Lin, Zhou-Sheng

    2016-06-01

    The presence of large segmental defects of the diaphyseal bone is challenging for orthopedic surgeons. Free vascularized fibular grafting (FVFG) is considered to be a reliable reconstructive procedure. Stress fractures are a common complication following this surgery, and hypertrophy is the main physiological change of the grafted fibula. The exact mechanism of hypertrophy is not completely known. To the best of our knowledge, no studies have examined the possible relationship between stress fractures and hypertrophy. We herein report three cases of patients underwent FVFG. Two of them developed stress fractures and significant hypertrophy, while the remaining patient developed neither stress fractures nor significant hypertrophy. This phenomenon indicates that a relationship may exist between stress fractures and hypertrophy of the grafted fibula, specifically, that the presence of a stress fracture may initiate the process of hypertrophy.

  2. The influence of procedure delay on resource use: a national study of patients with open tibial fracture.

    Science.gov (United States)

    Sears, Erika Davis; Burke, James F; Davis, Matthew M; Chung, Kevin C

    2013-03-01

    The purpose of this study was to (1) understand national variation in delay of emergency procedures in patients with open tibial fracture at the hospital level and (2) compare length of stay and cost in patients cared for at the best- and worst-performing hospitals for delay. The authors retrospectively analyzed the 2003 to 2009 Nationwide Inpatient Sample. Adult patients with open tibial fracture were included. Hospital probability of delay in performing emergency procedures beyond the day of admission was calculated. Multilevel linear regression random-effects models were created to evaluate the relationship between the treating hospital's tendency for delay (in quartiles) and the log-transformed outcomes of length of stay and cost. The final sample included 7029 patients from 332 hospitals. Patients treated at hospitals in the fourth (worst) quartile for delay were estimated to have 12 percent (95 percent CI, 2 to 21 percent) higher cost compared with patients treated at hospitals in the first quartile. In addition, patients treated at hospitals in the fourth quartile had an estimated 11 percent (95 percent CI, 4 to 17 percent) longer length of stay compared with patients treated at hospitals in the first quartile. Patients with open tibial fracture treated at hospitals with more timely initiation of surgical care had lower cost and shorter length of stay than patients treated at hospitals with less timely initiation of care. Policies directed toward mitigating variation in care may reduce unnecessary waste.

  3. Implant failure in lower limb long bone diaphyseal fractures at a tertiary hospital in Ile- Ife. Nigeria.

    Science.gov (United States)

    Esan, O; Ikem, I C; Orimolade, E A; Esan, O T

    2014-06-01

    This included determining aetiology of failure and comparing the failure rate in implant fixations using solid intramedullary nail and DCP. A retrospective study conducted at the Orthopaedic Department, Obafemi Awolowo University Teaching Hospital, Ile-Ife,Nigeria. Records of all operated cases of lower limb long bone diaphyseal fractures including those with failed fixations from August 2006-July 2011 were reviewed. Data retrieved included type of implant used, aetiology and characteristics of Implant failure. Data were analysed using SPSS version 16. Frequency distribution of the variables of interest was done. Difference in failure rate of intramedullary nail versus DCP was tested using chi-square. Statistical significance was inferred at pfractures and met inclusion criteria, of which 135 had intramedullary nail fixation and 86 had DCP. The rate of implant failure in intramedullary nail was 1.5% while it was 5.8% in patients with DCP (p=0.113; 0R=4.10; 95% CI=0.65- 43.77). Implant fracture was the commonest type of failure seen (100% versus 60%) and non union was the commonest cause of failure seen (50% versus 40%) in the intramedullary nailing and DCP groups respectively. The likelihood of a failed implant is higher in fixations done with DCP compared with intramedullary nail though the difference was not statistically significant. Commonest reason for failure in both groups was non-union. Findings from this study may guide surgeons in choice of implant in the management of long bone fractures.

  4. Effect of different surgical methods on traumatic response degree and osteoblast-osteoclast balance in patients with distal tibial fracture

    Directory of Open Access Journals (Sweden)

    Yun-Qiang Fan

    2017-01-01

    Full Text Available Objective: To study the effect of different surgical methods on trauma response degree and osteoblast-osteoclast balance in patients with distal tibial fracture. Methods: 58 cases of patients with distal tibial fracture who received open reduction and internal fixation in Orthopedics Department of our hospital from May 2013 to October 2015 were selected as research subjects and divided into delayed group (n = 29 and routine group (n = 29 according to different timing of surgery. Delayed group received open reduction and internal fixation 7–15 d after trauma and routine group received open reduction and internal fixation within 24 h after trauma. Levels of serum stress response indicators and osteoblast-osteoclast markers were compared between two groups. Results: On the day after operation, serum adrenocorticotropic hormone, cortisol, renin, angiotensin II, epinephrine and norepinephrine levels of delayed group were significantly lower than those of control group (P<0.05; on the 7th day after operation, serum osteocalcin, procollagen type I carboxyl-terminal peptide and bone alkaline phosphatase of delayed group were significantly higher than those of control group (P<0.05 while cross-linked carboxyl-terminal telopeptide of type I collagen and tartrate-resistant acid phosphatase isoform 5b levels were significantly lower than those of control group (P<0.05. Conclusions: Delayed open reduction and internal fixation treatment of distal tibial fracture can reduce the trauma caused by surgical procedures, increase osteoblast viability and inhibit osteoclast viability, which are conducive to fracture healing.

  5. Quantitative early phase scintigraphy in the prediction of healing of tibial fractures

    International Nuclear Information System (INIS)

    Wallace, A.L.; Strachan, R.K.; Hughes, S.P.F.

    1992-01-01

    Imaging with technetium-99m methylene diphsophonate ( 99m Tc-MDP) is established in the diagnosis of infection, neoplasia and ischaemic necrosis in orthopaedic practice, but its role in fracture healing is less well-defined. Previous studies have shown a relationship between fracture site activity (region A), activity in adjacent normal bone (region C) and time to union. The predictive value of the A/C ratio of the image obtained 300-800 s after injection was assessed in a prospective study of 50 patients with closed tibial fractures managed with plaster casts, external fixators and intramedullary nails. There were significant differences in absolute uptake and A/C ratio between the three groups (P 99m -Tc-MDP uptake so as to reduce the A/C ratio (1.10±0.20), but there is a promissing role for early phase bone scanning in non-operative (A/C=1.40±0.21) or externally fixed (A/C=1.26±0.22) fractures in conjunction with other non-invasive methods of monitoring the biomechanical environment. (orig.)

  6. Comparison of Outcomes of Operatively Treated Bicondylar Tibial Plateau Fractures by External Fixation and Internal Fixation

    Directory of Open Access Journals (Sweden)

    CC Chan

    2012-03-01

    Full Text Available The outcome of bicondylar tibial plateau fractures treated with either external fixation (35 patients or internal fixation (24 patients was reviewed. Outcome measures included the Rasmussen score, clinical complications, development of osteoarthritis and the requirement for total knee replacement (TKR. Twenty-two (92% anatomical reductions were achieved in the internal fixation group compared to 27 (77% in the external fixation group. Infective complications were more common in the external fixation group (9 patients, 26% due to pin tract infection. There were no deep infections in the internal fixation group. The mean Rasmussen score was not significantly different (mean score 32 in external fixation and 29 in internal fixation between the two groups and the incidence of osteoarthritis was the same in both groups. Four patients in the external fixation group underwent a TKR compared to 5 patients in the internal fixation group. Bicondylar tibial plateau fractures have similar outcomes following external or internal fixation.

  7. Age-related variation in limb bone diaphyseal structure among Inuit foragers from Point Hope, northern Alaska.

    Science.gov (United States)

    Wallace, I J; Nesbitt, A; Mongle, C; Gould, E S; Grine, F E

    2014-01-01

    Age-related deterioration of limb bone diaphyseal structure is documented among precontact Inuit foragers from northern Alaska. These findings challenge the concept that bone loss and fracture susceptibility among modern Inuit stem from their transition away from a physically demanding traditional lifestyle toward a more sedentary Western lifestyle. Skeletal fragility is rare among foragers and other traditional-living societies, likely due to their high physical activity levels. Among modern Inuit, however, severe bone loss and fractures are apparently common. This is possibly because of recent Western influences and increasing sedentism. To determine whether compromised bone structure and strength among the Inuit are indeed aberrant for a traditional-living group, data were collected on age-related variation in limb bone diaphyseal structure from a group predating Western influences. Skeletons of 184 adults were analyzed from the Point Hope archaeological site. Mid-diaphyseal structure was measured in the humerus, radius, ulna, femur, and tibia using CT. Structural differences were assessed between young, middle-aged, and old individuals. In all bones examined, both females and males exhibited significant age-related reductions in bone quantity. With few exceptions, total bone (periosteal) area did not significantly increase between young and old age in either sex, nor did geometric components of bending rigidity (second moments of area). While the physically demanding lifestyles of certain traditional-living groups may protect against bone loss and fracture susceptibility, this is not the case among the Inuit. It remains possible, however, that Western characteristics of the modern Inuit lifestyle exacerbate age-related skeletal deterioration.

  8. Gait characteristics before hardware removal in patients operated upon for tibial plateau fractures.

    Science.gov (United States)

    Deleanu, Bogdan; Prejbeanu, Radu; Crisan, Dan; Predescu, Vlad; Popa, Iulian; Poenaru, Dan V

    2015-07-01

    The reporting of gait analysis data on operated fractures of the tibial plateau, while extensive for studies of knee osteoarthritis of mostly undisclosed aetiology and ACL deficient knees, is rather limited in literature. In the present study we investigated 25 tibial plateau fractures classified as Schatzker II, IV, V and VI that underwent operative reduction and lateral plate osteosynthesis. Apart from routine radiographic exploration and patient completed (KOOS) scores at three (mean of 3.2 months), six (mean of 5.6 months) and 12 months (mean of 11.3 months) postoperatively, gait analysis was performed at these intervals as well. Cadence, step time and knee flexion were the gait parameters that were selected for the comparison at six and 12 months postoperatively. The analysed gait parameters were significantly improved between the six and the 12-month session and statistically significant differences were found between the two groups of values. Cadence had a mean value of 41 steps/minute at six months and 45 steps/minute at 12 months (p = 0.99). Step time was a mean of 0.74 seconds at six months while at 12 months the median value was 0.66 seconds (p = 0.94). Knee flexion angles evolved in a similar manner with mean values of 58° at six months and 69° at 12 months (p = 0.95). The mean KOOS scores were 42.4, 56.3 and 67.99 at three, six and 12 months postoperatively, respectively. Complex intra-articular fractures, classified as Schatzker IV, V and VI, had a higher impact on joint function than Schatzker II fractures treated with similar techniques and implants. There were statistically significant improvements in the recovery status at 12 months postoperatively compared to six months with extended chances for improvement.

  9. Atypical subtrochanteric and diaphyseal femoral fractures

    DEFF Research Database (Denmark)

    Shane, Elizabeth; Burr, David; Abrahamsen, Bo

    2014-01-01

    Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients with no exp......Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients...... with no exposure to these drugs. In this report, we review studies on the epidemiology, pathogenesis, and medical management of AFFs, published since 2010. This newer evidence suggests that AFFs are stress or insufficiency fractures. The original case definition was revised to highlight radiographic features...... a minor to a major feature. The association with specific diseases and drug exposures was removed from the minor features, because it was considered that these associations should be sought rather than be included in the case definition. Studies with radiographic review consistently report significant...

  10. Heterogeneity of blood flow in tibial cortical bone: An experimental investigation using microspheres

    International Nuclear Information System (INIS)

    Willans, S.M.; McCarthy, I.D.

    1991-01-01

    The distribution of tibial blood flow was measured by injecting approximately (600-1000) x 10(3) 15 mu microspheres, labelled with either tin-113 (113Sn) or cobalt-57 (57Co) into femoral arteries of five mature greyhounds. The diaphyseal cortex, stripped of periosteum and devoid of marrow, was sawn into 40 pieces (10 transverse sections x 4 anatomical quarters/section). Relative deposition densities of the 113Sn microspheres in 40 pieces of cortex were found. These values, together with their associated masses, proved, from a statistical point of view, that flow rate heterogeneity was substantial in the diaphysis. In particular, for the diaphyseal cortex, distribution of relative deposition densities (flow rates) in six bones was found to be positively-skewed with a relative dispersion ((SD/mean) x 100) of approximately 40%

  11. [Medial versus lateral plating in distal tibial fractures: a prospective study of 40 fractures].

    Science.gov (United States)

    Encinas-Ullán, C A; Fernandez-Fernandez, R; Rubio-Suárez, J C; Gil-Garay, E

    2013-01-01

    Tibial plafond fractures are one of the most challenging injuries in orthopaedic surgery. Their results could be improved by following the new guidelines for the management, and modern plating techniques. The results and complication rate between anteromedial and anterolateral approach for open reduction and internal fixation of these fractures were compared. A study was conducted on 40 patients treated by open reduction an internal fixation between 2007 and 2008. The surgical approach was selected by the surgeon in charge, depending on fracture pattern and skin situation. Patients were evaluated clinically and radiographically by an independent orthopaedic surgeon, not involved in the surgical procedure, using clinical (American Orthopaedic Foot and Ankle Society score) and radiological criteria at a minimum of two years. The appearance of complications after both approaches was recorded. Forty patients were included. The mean age was 53 years, with 24 males and 16 females. Seventeen of the injuries were of high energy, and there were 8 open fractures (3 of type i, 4 type ii and one type iii), and 12 of the closed injuries were grade ii or iii in the Tscherne classification. Six patients (15%) had associated injuries. At final follow-up there were 33 (82%) excellent or good results. No statistical differences were found between either surgical approach regarding time to bone union, rate of delayed union and infection rate. Three plates of the anteromedial group and none of the anterolateral group needed to be removed. Open reduction and internal fixation of distal tibia fractures produced reliable results, with no statistical differences found between anteromedial and anterolateral surgical approaches. Clinical and radiological results and complication rate were mainly related to the fracture type. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  12. The impact of clinical data on the evaluation of tibial fracture healing

    Directory of Open Access Journals (Sweden)

    Dijkman Bernadette G

    2011-11-01

    Full Text Available Abstract Background Radiographic healing is a common outcome measure in orthopedic trials and adjudication by outcome assessors is often conducted on the basis of plain films alone. The degree to which this process reflects clinical practice, in which both plain films and clinical notes are available, is uncertain. We explored the effect of adding clinical notes to radiographs in the adjudication process of a feasibility trial of tibial shaft fractures. Methods Radiographic and clinical data from a multicenter randomized controlled trial of 51 patients with operatively treated tibial fractures formed the basis of the study data. At the completion of the trial, serial radiographs (anteroposterior and lateral were independently evaluated for progression of fracture healing, defined as bridging of at least 3 of 4 cortices, by an adjudication committee comprised of 3 blinded orthopaedic trauma surgeons. Immediately after determination of radiographic time to healing, each surgeon was provided with clinical notes associated with each radiographic follow up visit and asked to re-visit their initial impression. Consensus was achieved for both adjudications. We calculated the percentage of time to healing consensus decisions that changed after evaluation of clinical notes. We further examined the contents of clinical notes and their relative influence on the committee's decisions. Results 47 of 51 patients were determined to have healed radiographically during the trial follow-up period, and consideration of clinical notes resulted in a change of 40% (19 of 47 of time to healing consensus decisions; however, revised decisions were equally likely to support an earlier or a later time to healing. Clinical notes that resulted in a change to either a 'healed' or a 'not healed' decision contained significantly more comments of either pain resolution or deterioration, respectively, resumption of or failure to resume weightbearing, or either return or no

  13. Rotational Mal-Alignment after Reamed Intramedullary Nailing for tibial shaft fracture.

    Science.gov (United States)

    Khan, Sher Baz; Mohib, Yasir; Rashid, Rizwan Haroon; Rashid, Haroonur

    2016-10-01

    Intra-medullary (IM) nailing is standard of care for unstable tibial shaft fractures. Malrotation is very common but it is under-recognised, inpart because of variation in normal anatomy and partly due to difficulty in accurately assessing rotation. This study was planned to evaluate the frequency of rotational mal-alignment after reamed tibia IMnailing. This cross-sectional study was conducted at Aga khan University Hospital, Karachi, and comprised patients with tibia shaft fractures managed with IMnailing from January to December 2014. All the patients were assessed intra-operatively for rotational alignment using the knee and ankle fluoroscopic images. There were 81 patients with a mean age of 38±16.9 years. There were 64(79%) male patients. Overall the incidence of malrotation was in 20(24.7%) cases. Rotational mal-alignment is one of the preventable complications after IMnailing which can be assesed intra-operatively under fluoroscope.

  14. [Double-plate fixation via combined approaches for the treatment of old tibial plateau fractures of Schatzker type IV].

    Science.gov (United States)

    Tan, Hong-Lue; Dai, Peng-Yi; Liu, Wei-Feng; Yuan, Yan-Hao

    2017-10-25

    To explore the clinical efficacy of double-plate fixation for the treatment of old tibial plateau fractures with Schatzker type IV through anterior midline and posteromedial approaches. From July 2013 to July 2015, 15 patients with old tibial plateau fractures were treated with internal fixation using locking reconstructive plate for the posteromedial fragment and anatomical locking plate for anteromedial fragment through antero midline and posteromedial approaches. There were 9 males and 6 females, with an average age of 49.2 years old (ranged, 21 to 61 years old). Eight patients had injured in the left side and 7 in the right side. According to Schatzker classification, all patients were type IV. The mean interval from injury to operation was 26.5 days (ranged, 21 to 65 days). The main clinical symptoms before operation were knee joint swelling, pain, deformity and limitation of motion. The X-ray and CT confirmed the fracture type. The indexes such as tibial plateau tibial shaft angle (TPA), femoral tibial angle (FTA) and posterior slope angle (PSA) were compared between immediate postoperation and final follow-up using postoperative X-ray film. The knee functions were evaluated using the HSS (Hospital for Special Surgery) knee score system. Two patients had incision complications which healed by correct treatment, 1 patient had traumatic arthritis. All patients were followed up for mean 16.6 months (ranged, 13 to 24 months). No infections, deep venous thrombosis, implant loosening and breakage, fragment displacement, plateau surface collapse and bone nonunion found. The bone union time ranged from 3 to 8 months (mean 6.07 months) after operation. The average immediate postoperative value of TPA, FTA and PSA were(86.81±1.67)°, (168.00±3.29)° and(10.20±1.47)° respectively; and(86.47±1.67)°, (168.53±3.03)° and (10.54±1.21)° respectively at the final follow-up evaluation, showing no statistical differences( P >0.05). According to the HSS score system, 26

  15. Arthroscopic suture fixation in patients with a tibial intercondylar eminence fracture using a simple device to penetrate the anterior cruciate ligament

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    Masato Aratake

    2014-04-01

    Full Text Available Displaced tibial intercondylar eminence fractures require early reduction and stable fixation to prevent nonunion, knee instability, and a lack of extension. Many types of surgical procedure are recommended including arthrotomy or an arthroscopic technique to stabilize the fracture segment using Kirschner wire, screws, staples, and suture fixation. However, contemporary arthroscopic techniques and devices can facilitate intra-articular surgery and have been applied to the treatment of this fracture. In our current report, we describe a simple suture fixation method under arthroscopy for the treatment of tibial intercondylar eminence fractures. We treated eight knees of eight patients. One patient had a Type II fracture and seven patients had a Type III fracture according to Meyer's classification. Following the arthroscopic inspection of concomitant injuries, debridement of hematoma, and reduction of the fragment, two nonabsorbable sutures (Ethibond No. 2, Johnson & Johnson, Somerville, NJ, USA were advanced through the suture passer device, which is used to penetrate the anterior cruciate ligament (ACL near to the insertion site of the displaced fragment. Two surgical sutures were pulled out by the suture retriever from the anterior proximal tibia hole and were fixed to the tibia cortex bone with a double-spike plate. At follow-up, radiographic examinations showed that bone union was achieved in all cases. All but one patient could resume normal activities with no restrictions and no ligamentous instability. All knees had a negative Lachman's test and showed a gain of stable ligament function by KT2000 arthrometer evaluation. One patient had an insignificant extension limitation and experienced slight pain after walking but these symptoms were minimal. In conclusion current arthroscopic surgery techniques for tibial intercondylar fractures can be easily performed and reproducibly achieve secure fixation and early mobilization of the knee.

  16. Diaphyseal medullary stenosis (sclerosis) with bone malignancy (malignant fibrous histiocytoma): hardcastle syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Norton, K.I. [Department of Radiology, Box 1234, Mount Sinai Hospital and Mount Sinai School of Medicine, City University of New York, One Gustave L. Levy Place, New York, NY 10029-6574 (United States)]|[Department of Pediatrics, Mount Sinai Hospital, New York, New York (United States); Wagreich, J.M. [Department of Radiology, Box 1234, Mount Sinai Hospital and Mount Sinai School of Medicine, City University of New York, One Gustave L. Levy Place, New York, NY 10029-6574 (United States); Granowetter, L. [Division of Pediatric Hematology-Oncology, Mount Sinai Hospital New York, New York (United States); Martignetti, J.A. [Department of Pediatrics, Mount Sinai Hospital, New York, New York (United States)

    1996-09-01

    Hardcastle syndrome is a rare, autosomally dominant inherited skeletal dysplasia, characterized by diaphyseal sclerosis, medullary stenosis, pathological fractures, bony infarction, and malignant transformation. A 19-year-old proband is presented and discussed, adding a fourth family to the world literature. Radiographic screening of family members is suggested from puberty onward. Thallium scanning is proposed as a more tumor-sensitive screening agent in affected individuals. (orig.). With 2 figs.

  17. Surgical management of complete diaphyseal third metacarpal and metatarsal bone fractures: clinical outcome in 10 mature horses and 11 foals.

    Science.gov (United States)

    Bischofberger, A S; Fürst, A; Auer, J; Lischer, C

    2009-05-01

    Osteosynthesis of third metacarpal (McIII) and third metatarsal (MtIII) bone fractures in horses is a surgical challenge and complications surrounding the repair are common. Retrospective studies evaluating surgical repair, complications and outcome are necessary to increase knowledge and improve success of long bone fracture repair in the horse. To evaluate clinical findings, surgical repair, post operative complications and outcome of 10 mature horses and 11 foals with McIII or MtIII fractures that were treated with open reduction and internal fixation (ORIF). Medical records were reviewed and follow-up information obtained by means of radiographs and/or telephone questionnaire. Survival was achieved in 62% of the horses (3 mature/10 foals). On long-term evaluation (> 6 months) 11 horses (2 mature/9 foals) were fit for their intended activity, one mature horse had a chronic low grade lameness, and one foal was lost to follow-up because it was sold. The main fracture types were simple transverse (333%) or simple oblique (28.6%) and 71.4% of the fractures were open, 3 Type I (one mature/2 foals) and 12 type II (7 mature/5 foals). The preoperative assessment revealed inadequate emergency treatment in 10 horses (5 mature/5 foals; 47.6%). Survival rate of horses with open fractures was 12.5% (1/8) in mature and 85.7% (6/7) in foals. Post operative incisional infection (4 mature, 3 foals) was only managed successfully in 2 foals. Fracture instability related to inadequate fracture fixation technique occurred in 4 horses (all mature) and was always associated with unsuccessful outcome. Age, bodyweight and infection are strongly associated with outcome in treatment of complete McIII/MtIII fractures. Rigid fixation using plates and screws can be successful in treatment of closed or open, complete diaphyseal McIII/MtIII fractures in mature horses and foals. Instable fixation, infection and a bodyweight > 320 kg are major risk factors for unsuccessful outcome.

  18. Does morbid obesity negatively affect the hospital course of patients undergoing treatment of closed, lower-extremity diaphyseal long-bone fractures?

    Science.gov (United States)

    Baldwin, Keith D; Matuszewski, Paul E; Namdari, Surena; Esterhai, John L; Mehta, Samir

    2011-01-03

    Obesity is prevalent in the developed world and is associated with significant costs to the health care system. The effect of morbid obesity in patients operatively treated for long-bone fractures of the lower extremity is largely unknown. The National Trauma Data Bank was accessed to determine if morbidly obese patients (body mass index >40) with lower extremity fractures have longer length of hospital stay, higher cost, greater rehabilitation admission rates, and more complications than nonobese patients. We identified patients with operatively treated diaphyseal femur (6920) and tibia (5190) fractures. Polytrauma patients and patients younger than 16 years were excluded. Morbidly obese patients were identified by ICD-9 and database comorbidity designation (femur, 131 morbidly obese; tibia, 75 morbidly obese). Patients meeting these criteria who were not morbidly obese were used as controls. Sensitivity analyses were performed to analyze patients with isolated trauma to the tibia or femur. Morbidly obese patients were more likely to be admitted to a subacute facility. Length of stay trended higher in morbidly obese patients. There was no significant relationship between obesity and inpatient mortality or inpatient complications. These trends held true when considering patients with multiple injuries and patients who had isolated long-bone injuries. Our study showed that morbidly obese patients may have greater rehabilitation needs following long-bone fractures in the lower extremity. Our study showed no difference in mortality or complications, although further studies are needed to confirm these findings. Copyright 2011, SLACK Incorporated.

  19. [The randomized controlled trial of influences of T shape approach on the function of knee joint in the treatment of proximal tibial fractures].

    Science.gov (United States)

    Peng, Wei-xiong; Zhang, Zhi; Liang, Jie-hong

    2008-04-01

    To investigate the clinical value of T shape approach in the treatment of proximal tibial fractures. One handrend and thirteen patients of proximal tibial fractures were randomly divided into two groups. Group A: 62 cases underwent the traditional exposure approach. According to Schatzker classification,the cases of II to VI type was 25, 10, 16, 6, 5 respectively. Group B:51 cases underwent T shape approach ahead of knee joint, the cases of II to VI type was 21, 8, 13, 5, 4 respectively. All data were analyzed by SPSS 10.0 to compare operation time, blood loss, duration of hospitalization, healing time, the time of osseous union and complications after operation. Sixty patients in group A and 50 patients in group B were followed-up from 12 to 24 months. (1) Operation time:group B was longer than A (P time:group B was shorter. (4) Mean time of osseous union: 48 group B was shorter. Function of knee: group B was better than group A. (Complication: group B was less than group A. As compared with traditional exposure approach, T shape approach of knee joint had advantages of small scar, fewer complications, faster union of fracture and earlier recovery of joint function. The approach is valuable for the treatment of proximal tibial fractures.

  20. A Prospective Randomized Study on Operative Treatment for Simple Distal Tibial Fractures-Minimally Invasive Plate Osteosynthesis Versus Minimal Open Reduction and Internal Fixation.

    Science.gov (United States)

    Kim, Ji Wan; Kim, Hyun Uk; Oh, Chang-Wug; Kim, Joon-Woo; Park, Ki Chul

    2018-01-01

    To compare the radiologic and clinical results of minimally invasive plate osteosynthesis (MIPO) and minimal open reduction and internal fixation (ORIF) for simple distal tibial fractures. Randomized prospective study. Three level 1 trauma centers. Fifty-eight patients with simple and distal tibial fractures were randomized into a MIPO group (treatment with MIPO; n = 29) or a minimal group (treatment with minimal ORIF; n = 29). These numbers were designed to define the rate of soft tissue complication; therefore, validation of superiority in union time or determination of differences in rates of delayed union was limited in this study. Simple distal tibial fractures treated with MIPO or minimal ORIF. The clinical outcome measurements included operative time, radiation exposure time, and soft tissue complications. To evaluate a patient's function, the American Orthopedic Foot and Ankle Society ankle score (AOFAS) was used. Radiologic measurements included fracture alignment, delayed union, and union time. All patients acquired bone union without any secondary intervention. The mean union time was 17.4 weeks and 16.3 weeks in the MIPO and minimal groups, respectively. There was 1 case of delayed union and 1 case of superficial infection in each group. The radiation exposure time was shorter in the minimal group than in the MIPO group. Coronal angulation showed a difference between both groups. The American Orthopedic Foot and Ankle Society ankle scores were 86.0 and 86.7 in the MIPO and minimal groups, respectively. Minimal ORIF resulted in similar outcomes, with no increased rate of soft tissue problems compared to MIPO. Both MIPO and minimal ORIF have high union rates and good functional outcomes for simple distal tibial fractures. Minimal ORIF did not result in increased rates of infection and wound dehiscence. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

  1. Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients.

    NARCIS (Netherlands)

    Janssen, K.W.; Biert, J.; Kampen, A. van

    2007-01-01

    A study of 24 patients who sustained an extra-articular fracture of the distal third of the tibial shaft was performed to determine the effect of the type of treatment, open reduction and internal fixation (ORIF) or closed reduction and intramedullary (IM) nailing, on the occurrence of malalignment.

  2. Evaluation of Fracture and Osteotomy Union in the Setting of Osteogenesis Imperfecta: Reliability of the Modified Radiographic Union Score for Tibial Fractures (RUST).

    Science.gov (United States)

    Franzone, Jeanne M; Finkelstein, Mark S; Rogers, Kenneth J; Kruse, Richard W

    2017-09-08

    Evaluation of the union of osteotomies and fractures in patients with osteogenesis imperfecta (OI) is a critical component of patient care. Studies of the OI patient population have so far used varied criteria to evaluate bony union. The radiographic union score for tibial fractures (RUST), which was subsequently revised to the modified RUST, is an objective standardized method of evaluating fracture healing. We sought to evaluate the reliability of the modified RUST in the setting of the tibias of patients with OI. Tibial radiographs of 30 patients with OI fractures, or osteotomies were scored by 3 observers on 2 separate occasions. Each of the 4 cortices was given a score (1=no callus, 2=callus present, 3=bridging callus, and 4=remodeled, fracture not visible) and the modified RUST is the sum of these scores (range, 4 to 16). The interobserver and intraobserver reliabilities were evaluated using intraclass coefficients (ICC) with 95% confidence intervals. The ICC representing the interobserver reliability for the first iteration of scores was 0.926 (0.864 to 0.962) and for the second series was 0.915 (0.845 to 0.957). The ICCs representing the intraobserver reliability for each of the 3 reviewers for the measurements in series 1 and 2 were 0.860 (0.707 to 0.934), 0.994 (0.986 to 0.997), and 0.974 (0.946 to 0.988). The modified RUST has excellent interobserver and intraobserver reliability in the setting of OI despite challenges related to the poor quality of the bone and its dysplastic nature. The application and routine use of the modified RUST in the OI population will help standardize our evaluation of osteotomy and fracture healing. Level III-retrospective study of nonconsecutive patients.

  3. A qualitative approach to recovery after open tibial fracture: the road to a novel, patient-derived recovery scale.

    Science.gov (United States)

    Trickett, R W; Mudge, Elizabeth; Price, Patricia; Pallister, Ian

    2012-07-01

    The aim of this study was to describe how patients perceive their recovery following open tibial fractures using a qualitative approach. Following the appropriate ethical approval, adult patients with a diagnosis of open tibial fracture were recruited after completion of their surgical treatment and discharge from Morriston Hospital, a centre with orthoplastic surgical care. A purposive sampling method was employed to ensure that a range of injuries as well as clinical outcomes were included. All patients took part in an in-depth semi-structured interview, exploring aspects of their injury, treatment, rehabilitation and psychosocial and financial situations. Interviews were completed with two interviewers present and were recorded for verbatim transcription. Interview transcripts were analysed to identify items important to patients during their recovery. Nine patients with a mean injury to interview interval of 2.3 years were interviewed. A total of 538 items were identified and subsequently mapped onto 18 categories: pain; mobility; flexibility; temperature (effects on symptoms); fear; appearance; sleep; diet/weight; employment; social; finance; impact on others; self-care; recovery (patient perceptions of recovery); frustration; goal setting (by patients and health-care providers); and adaptation (both physical and mental). There is a wide range of factors that our cohort found important during their recovery from open tibial fracture. Despite being considered as 'healed' by the medical staff, patients did not report a corresponding full recovery and return to pre-injury normality. The categories identified will enable the development of a patient-reported recovery scale to be used in lower-limb trauma. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. MR imaging appearance of insufficiency fractures of the medial tibial plateau

    International Nuclear Information System (INIS)

    Laredo, J.D.; Savy, J.M.; Oreel, P.; Liote, F.; Kuntz, D.; Kaplan, G.

    1990-01-01

    This paper reports on the etiology of a painful syndrome of the medial tibial plateau (MTP) in elderly patients. Findings include acute pain of the medial aspect of the knee, normal plain radiographs, and increased uptake of the MTP on bone scans. It has been related to osteonecrosis in most cases and, more rarely, to an insufficiency fracture. To our knowledge, no MR studies of patients with this syndrome have been previously reported. Five patients presenting with this syndrome (age > 59 years) were studied with MR imaging. In all five cases, initial plain radiographs were normal and increased uptake of the MTP was found on bone scans

  5. [Revision of Schatzker type Ⅵ tibial plateau fracture failure focus on the recovery of lower limb alignment].

    Science.gov (United States)

    Cong, R J; Liu, J F; Jiang, Y; Dilixiati, Duolikun; Hou, X D; Zheng, L P

    2018-03-01

    Objective: To explore the influence of the lower extremity abnormal alignment and the joint surface, and to explore the surgical skills. Methods: Twenty-two cases of tibial plateau Schatzker Ⅵ fracture internal fixation failure revision from January 2012 to January 2017 in Department of Orthopedics, Shanghai 10(th) Hospital.One year follow-up after initial surgery to make sure of failure.Three-dimensional CT scan, radiography, infection index, gait analysis, knee joint ROM, femur tibia angle, tibial plateau tibial shaft angle and posterior slope if tibial plateau were observed. The medial approach and bi-planer osteotoma were used.Autogenous iliac bone graft, postoperative fast recovery channel were used.Follow-up point included preoperative and postoperative 7 days, 6 weeks, 3 months, and 6 months.Obvervational index included double lower limbs radiography, knee society score(KSS), complications such as infection, skin necrosis, joint main passive activity, double lower limbs alignment the last follow-up SF-36 scale.Rate was compared by χ(2) test, measurement data using paired sample t test.Correlation was analyzed by Pearson correlation regression testing. Results: Twenty-two patients received follow-up.KSS, more than 21 cases were benign, with good gait.One case was poor, with claudication gait.Not skin necrosis, no deep infection cases, 1 case get blisters 2 days postoperatively, and disappear after 5 days with detumescence and cold therapy.Whether restoring force line affect the KSS significantly(χ(2)=22.000, P =0.000). Knee joint ROM, SF-36 score, KSS and lower limb alignment were improved significantly. In different individual the articular surface and anatomical angle recovered greatly but the posterior slope angle was quite difference which has no correlation with KSS and SF-36 scale( P >0.01). Conclusions: Revision of Schatzker type Ⅵ tibial plateau fracture failure should focus on the recovery of lower limb alignment.moderate overcorrect bone

  6. Treatment of Lateral Tibial Condylar Fractures Using Bioactive, Bioresorbable Forged Composites of Raw Particulate Unsintered Hydroxyapatite/Poly-L-Lactide Screws.

    Science.gov (United States)

    Kuroyanagi, Gen; Yoshihara, Hiroyuki; Yamamoto, Naohiro; Suzuki, Hiroyuki; Yamada, Kunio; Yoshida, Yukio; Otsuka, Takanobu; Takada, Naoya

    2018-05-01

    Forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide (F-u-HA/PLLA) devices possess high mechanical strength, bioactivity, and radio-opacity. The aim of this study was to assess the efficacy of F-u-HA/PLLA screws in the treatment of lateral tibial condylar fractures. From January 2005 to December 2010, a total of 7 patients with displaced closed lateral tibial condylar fractures (Schatzker type II) were treated using F-u-HA/PLLA screws. Open reduction and internal fixation was performed using 2 or 3 F-u-HA/PLLA screws. After surgery, weight bearing was not allowed for 6 weeks. Range of motion exercise was initiated after removal of the plaster splint. Radiographs were evaluated for fracture healing, joint depression, and the radioopacity of F-u-HA/PLLA screws. Clinical outcomes and postoperative complications were also assessed. Average follow-up was 44 months. All fractures were successfully healed. Average values for joint depression were 4.7 mm (range, 2-9 mm) preoperatively, 0.4 mm (range, 0-1 mm) postoperatively, and 0.4 mm (range, 0-1 mm) at final follow-up. Whole shadows of F-u-HA/PLLA screws were observed during the follow-up period. Breakage of screws, osteolysis, and a radiolucent zone around the screws were not observed at final follow-up. Average knee flexion and extension were 134° (range, 110° to 150°) and -1° (range, -10° to 0°), respectively. No patient had wound infection, late aseptic tissue response, or foreign body reaction postoperatively. None of the patients reported pain at final follow-up. These results suggest that F-u-HA/PLLA screws could be an alternative option for the treatment of lateral tibial condylar fractures. [Orthopedics. 2018; 41(3):e365-e368.]. Copyright 2018, SLACK Incorporated.

  7. Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury?

    International Nuclear Information System (INIS)

    Mui, Leonora W.; Engelsohn, Eliyahu; Umans, Hilary

    2007-01-01

    (1) To determine the accuracy of computed tomography (CT) in the evaluation of ligament tear and avulsion in patients with tibial plateau fracture. (2) To evaluate whether the presence or severity of fracture gap and articular depression can predict meniscal injury. A fellowship-trained musculoskeletal radiologist retrospectively reviewed knee CT and MRI examinations of 41 consecutive patients presenting to a level 1 trauma center with tibial plateau fractures. Fracture gap, articular depression, ligament tear and footprint avulsions were assessed on CT examinations. The MRI studies were examined for osseous and soft tissue injuries, including meniscal tear, meniscal displacement, ligament tear, and ligament avulsion. CT demonstrated torn ligaments with 80% sensitivity and 98% specificity. Only 2% of ligaments deemed intact on careful CT evaluation had partial or complete tears on MRI. Although the degree of fracture gap and articular depression was significantly greater in patients with meniscal injury compared with those without meniscal injury, ROC analysis demonstrated no clear threshold for gap or depression that yielded a combination of high sensitivity and specificity. In the acute setting, CT offers high sensitivity and specificity for depicting osseous avulsions, as well as high negative predictive value for excluding ligament injury. However, MRI remains necessary for the preoperative detection of meniscal injury. (orig.)

  8. An unusual stress fracture: Bilateral posterior longitudinal stress fracture of tibia.

    Science.gov (United States)

    Malkoc, Melih; Korkmaz, Ozgur; Ormeci, Tugrul; Oltulu, Ismail; Isyar, Mehmet; Mahirogulları, Mahir

    2014-01-01

    Stress fractures (SF) occur when healthy bone is subjected to cyclic loading, which the normal carrying range capacity is exceeded. Usually, stress fractures occur at the metatarsal bones, calcaneus, proximal or distal tibia and tends to be unilateral. This article presents a 58-year-old male patient with bilateral posterior longitudinal tibial stress fractures. A 58 years old male suffering for persistent left calf pain and decreased walking distance for last one month and after imaging studies posterior longitudinal tibial stress fracture was detected on his left tibia. After six months the patient was admitted to our clinic with the same type of complaints in his right leg. All imaging modalities and blood counts were performed and as a result longitudinal posterior tibial stress fractures were detected on his right tibia. Treatment of tibial stress fracture includes rest and modified activity, followed by a graded return to activity commensurate with bony healing. We have applied the same treatment protocol and our results were acceptable but our follow up time short for this reason our study is restricted for separate stress fractures of the posterior tibia. Although the main localization of tibial stress fractures were unilateral, anterior and transverse pattern, rarely, like in our case, the unusual bilateral posterior localization and longitudinal pattern can be seen. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. A Meta-Analysis for Postoperative Complications in Tibial Plafond Fracture: Open Reduction and Internal Fixation Versus Limited Internal Fixation Combined With External Fixator.

    Science.gov (United States)

    Wang, Dong; Xiang, Jian-Ping; Chen, Xiao-Hu; Zhu, Qing-Tang

    2015-01-01

    The treatment of tibial plafond fractures is challenging to foot and ankle surgeons. Open reduction and internal fixation and limited internal fixation combined with an external fixator are 2 of the most commonly used methods of tibial plafond fracture repair. However, conclusions regarding the superior choice remain controversial. The present meta-analysis aimed to quantitatively compare the postoperative complications between open reduction and internal fixation and limited internal fixation combined with an external fixator for tibial plafond fractures. Nine studies with 498 fractures in 494 patients were included in the present study. The meta-analysis found no significant differences in bone healing complications (risk ratio [RR] 1.17, 95% confidence interval [CI] 0.68 to 2.01, p = .58], nonunion (RR 1.09, 95% CI 0.51 to 2.36, p = .82), malunion or delayed union (RR 1.24, 95% CI 0.57 to 2.69, p = .59), superficial (RR 1.56, 95% CI 0.43 to 5.61, p = .50) and deep (RR 1.89, 95% CI 0.62 to 5.80) infections, arthritis symptoms (RR 1.20, 95% CI 0.92 to 1.58, p = .18), or chronic osteomyelitis (RR 0.31, 95% CI 0.05 to 1.84, p = .20) between the 2 groups. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Comparison of plantar flexor musculotendinous stiffness, geometry, and architecture in male runners with and without a history of tibial stress fracture.

    Science.gov (United States)

    Pamukoff, Derek N; Blackburn, J Troy

    2015-02-01

    Greater lower extremity joint stiffness may be related to the development of tibial stress fractures in runners. Musculotendinous stiffness is the largest contributor to joint stiffness, but it is unclear what factors contribute to musculotendinous stiffness. The purpose of this study was to compare plantar flexor musculotendinous stiffness, architecture, geometry, and Achilles tendon stiffness between male runners with and without a history of tibial stress fracture. Nineteen healthy runners (age = 21 ± 2.7 years; mass = 68.2 ± 9.3 kg; height = 177.3 ± 6.0 cm) and 19 runners with a history of tibial stress fracture (age = 21 ± 2.9 years; mass = 65.3 ± 6.0 kg; height = 177.2 ± 5.2 cm) were recruited from community running groups and the university's varsity and club cross-country teams. Plantar flexor musculotendinous stiffness was estimated from the damped frequency of oscillatory motion about the ankle follow perturbation. Ultrasound imaging was used to measure architecture and geometry of the medial gastrocnemius. Dependent variables were compared between groups via one-way ANOVAs. Previously injured runners had greater plantar flexor musculotendinous stiffness (P < .001), greater Achilles tendon stiffness (P = .004), and lesser Achilles tendon elongation (P = .003) during maximal isometric contraction compared with healthy runners. No differences were found in muscle thickness, pennation angle, or fascicle length.

  11. Influence of phototherapies on the outcome of complete tibial fractures grafted or not with MTA: Raman spectroscopic study on rabbits

    Science.gov (United States)

    Pinheiro, Antônio L. B.; Soares, Luiz G. P.; da Silva, Aline C. P.; Santos, Nicole R. S.; da Silva, Anna Paula L. T.; Neves, Bruno Luiz R. C.; Soares, Amanda P.; Silveira, Landulfo

    2018-02-01

    The aim of the present study was to assess, by means of Raman spectroscopy, the repair of complete surgical tibial fractures fixed with wire osteosynthesis or miniplates treated or not with infrared laser (λ780 nm) or infrared LED (λ850 +/- 10 nm) lights, 142.8 J/cm2 per treatment, associated or not to the use of mineral trioxide aggregate (MTA) cement. Surgical fractures were created on 36 rabbits and fixed with WO or miniplates and some groups were grafted with MTA. Irradiated groups received lights at every other day for 15 days and sacrifice occurred after 30 days. The results showed that only irradiation with either laser or LED influenced the peaks of phosphate ( 960 cm-1) and carbonated ( 1,070 cm-1) hydroxyapatite. Collagen peak (1,450 cm-1) was influenced by both the use of MTA and irradiation with either laser or LED. It is concluded that the use of either laser or LED phototherapy associated to MTA cement was efficacious on improving the repair of complete tibial fractures treated with wire osteosynthesis or miniplates.

  12. Complex tibial fractures are associated with lower social classes and predict early exit from employment and worse patient-reported QOL: a prospective observational study of 46 complex tibial fractures treated with a ring fixator.

    Science.gov (United States)

    Elsoe, Rasmus; Larsen, Peter; Petruskevicius, Juozas; Kold, Søren

    2018-04-01

    The long-term outcomes following complex fractures of the tibia are reported to carry a risk of knee pain, malalignment, articular injury and post-traumatic osteoarthritis. The main objective of this study was to account for the patient-reported quality of life (QOL) 12 months after ring fixator removal in patients with a complex tibial fracture. Secondary objectives included a review of the socio-economic characteristics of the patient group and the rate of return to work in the study period. A prospective follow-up study was conducted of 60 patients with complex fractures of the tibia treated with ring external fixation. Patient-reported outcomes, radiological outcomes and socio-economic status including employment status of the patients were obtained 12 months after frame removal. Forty-six patients completed the assessment 12 months after frame removal (77%). The mean age of the patient at the time of fracture was 54.6 years (range 31-86). There were 19 males and 27 females. At 12 months after frame removal, the mean EQ5D-5L index was 0.66 (CI 0.60-0.72). The mean EQ5D-5L VAS was 69 (CI 61-76). When this was compared to the established reference population from Denmark, the study population showed a significantly worse EQ5D-5L index. The majority of patients (87%) were in the lower social classes suggesting a higher degree of social deprivation in the study population. Twenty-seven per cent of patients who were employed prior to injury had returned to employment at approximately 19 months following fracture. The onset of post-traumatic osteoarthritis was present in the knee joint in 29% of patients following a proximal intra-articular fracture, whereas osteoarthritis was present at the ankle joint in 35% of patients following a distal intra-articular fracture 12 months after frame removal. This study indicates that at 12 months after frame removal there are poorer patient-reported QOL as when compared to reference populations. Furthermore, this study

  13. Comparative characteristics of osteosynthesis techniques in patients with comminuted diaphyseal femoral fractures

    Directory of Open Access Journals (Sweden)

    A. P. Barabash

    2013-01-01

    Full Text Available The comparative analysis of the results of the surgical treatment of 130 patients with closed comminuted unilateral diaphyseal femoral fractures, including assessment of anatomic functional outcomes of treatment according to the technique of the standardized investigations in traumatology and orthopedy and determination of quality of life according to SF-36 method is carried out. Osteosynthesis with the help of external fixation devices was performed in 36 patients, intramedullary interlocking osteosynthesis - in 57 patients, compression plating - in 37 patients. Level of anatomic functional rehabilitation of the patients in the early postoperative period made up 69-79 %, 6 months later increased up to 74-92%, and after the expiration of 12 months the level of rehabilitation reached 85-99%. During the treatment quality of life concerning physical component was within the limits from 36,8 up to 55,5 %, and concerning mental component - 54,3-60,8 %. After the expiration of a year increase in the parameters of physical and mental components up to 55,7 - 59,8 % and 57,2-65,8 % is detected respectively. In the group where the transosseous osteosynthesis technique was applied we got 93,7-95 % of positive outcomes, with the average disability period of 212,3±18,1 days. In 47,2 % of cases the following complications are observed: knee contracture - 7; inflammation of the soft tissues located near the transosseous fixators - 5 (13,9%; shortening of the limb less than 5% of its length - 3; false joint formation - 1; fracture union with formation of varus deformity in the femoral bone - 1. When using intramedullary interlocking osteosynthesis we had positive results in 96,5 % of cases, with the average period of disability 176±17,8 days. In 10,5 % cases the following complications are observed: suture sinus - 1(1,75 %; femoral osteomyelitis - 1; break of the design - 1; false joint formation - 1; knee contracture - 1; shortening of the limb less than 5

  14. Spontaneous osteonecrosis of the knee associated with ipsilateral tibial plateau stress fracture: report of two patients and review of the literature

    International Nuclear Information System (INIS)

    Sokoloff, R.M.; Farooki, S.; Resnick, D.

    2001-01-01

    Two cases are presented of spontaneous osteonecrosis of the knee (SONK) associated with stress fractures of the tibial plateau. This association lends further credence to the postulate that SONK has a traumatic etiology. (orig.)

  15. Tibial Stress Injuries: Decisive Diagnosis and Treatment of "Shin Splints."

    Science.gov (United States)

    Couture, Christopher J.; Karlson, Kristine A.

    2002-01-01

    Tibial stress injuries, commonly called shin splints, often result when bone remodeling processes adopt inadequately to repetitive stress. Physicians who are caring for athletic patients must have a thorough understanding of this continuum of injuries, including medial tibial stress syndrome and tibial stress fractures, because there are…

  16. Medial tibial pain. A prospective study of its cause among military recruits.

    Science.gov (United States)

    Milgrom, C; Giladi, M; Stein, M; Kashtan, H; Margulies, J; Chisin, R; Steinberg, R; Swissa, A; Aharonson, Z

    1986-12-01

    In a prospective study of 295 infantry recruits during 14 weeks of basic training, 41% had medial tibial pain. Routine scintigraphic evaluation in cases of medial tibial bone pain showed that 63% had abnormalities. A stress fracture was found in 46%. Only two patients had periostitis. None had ischemic medial compartment syndrome. Physical examination could not differentiate between cases with medial tibial bone pain secondary to stress fractures and those with scintigraphically normal tibias. When both pain and swelling were localized in the middle one-third of the tibia, the lesion most likely proved to be a stress fracture.

  17. [Current treatment situation and progress on bone defect of collapsed tibial plateau fractures].

    Science.gov (United States)

    Luo, Chang-qi; Fang, Yue; Tu, Chong-qi; Yang, Tian-fu

    2016-02-01

    Characteristics of collapsed tibial plateau fracture determines that the joint surface must remain anatomical reduction,line of force in tibial must exist and internal fixation must be strong. However, while renewing articular surface smoothness, surgeons have a lot of problems in dealing with bone defect under the joint surface. Current materials used for bone defect treatment include three categories: autologous bone, allograft bone and bone substitutes. Some scholars think that autologous bone grafts have a number of drawbacks, such as increasing trauma, prolonged operation time, the limited source, bone area bleeding,continuous pain, local infection and anesthesia,but most scholars believe that the autologous cancellous bone graft is still the golden standard. Allograft bone has the ability of bone conduction, but the existence of immune responses, the possibility of a virus infection, and the limited source of the allograft cannot meet the clinical demands. Likewise, bone substitutes have the problem that osteogenesis does not match with degradation in rates. Clinical doctors can meet the demand of the patient's bone graft according to patient's own situation and economic conditions.

  18. A comparative study of intramedullary interlocking nailing and minimally invasive plate osteosynthesis in extra articular distal tibial fractures.

    Science.gov (United States)

    Daolagupu, Arup K; Mudgal, Ashwani; Agarwala, Vikash; Dutta, Kaushik K

    2017-01-01

    Extraarticular distal tibial fractures are among the most challenging fractures encountered by an orthopedician for treatment because of its subcutaneous location, poor blood supply and decreased muscular cover anteriorly, complications such as delayed union, nonunion, wound infection, and wound dehiscence are often seen as a great challenge to the surgeon. Minimally invasive plate osteosynthesis (MIPO) and intramedullary interlocking nail (IMLN) are two well-accepted and effective methods, but each has been historically related to complications. This study compares clinical and radiological outcome in extraarticular distal tibia fractures treated by intramedullary interlocking nail (IMLN) and minimally invasive plate osteosynthesis (MIPO). 42 patients included in this study, 21 underwent IMLN and 21 were treated with MIPO who met the inclusion criteria and operated between June 2014 and May 2015. Patients were followed up for clinical and radiological evaluation. In IMLN group, average union time was 18.26 weeks compared to 21.70 weeks in plating group which was significant ( P ankle stiffness, and infection, were seen in interlocking group as compared to plating group. Average functional outcome according to American Orthopedic Foot and Ankle Society score was measured which came out to be 96.67. IMLN group was associated with lesser duration of surgery, earlier weight bearing and union rate, lesser incidence of infection and implant irritation which makes it a preferable choice for fixation of extra-articular distal tibial fractures. However, larger randomized controlled trials are required for confirming the results.

  19. Angular stable plates in proximal meta-epiphyseal tibial fractures: study of joint restoration and clinical and functional evaluation.

    Science.gov (United States)

    Giannotti, S; Giovannelli, D; Dell'Osso, G; Bottai, V; Bugelli, G; Celli, F; Citarelli, C; Guido, G

    2016-04-01

    The tibial plateau fractures involve one of the main weight bearing joints of the human body. The goals of surgical treatment are anatomical reduction, articular surface reconstruction and high primary stability. The aim of this study was to evaluate the clinical and functional outcomes after internal plate fixation of this kind of fractures. From January 2009 to December 2012, we treated 75 cases of tibial plateau fracture with angular stable plates. We used Rasmussen Score and the Knee Society Score for the clinical and functional evaluation. Twenty-five cases that underwent hardware removal had arthroscopic and CT evaluation of the joint. No complications occurred. The clinical and functional evaluation, performed by the KSS and Rasmussen Score, highlighted the high percentage of good-to-excellent results (over 90 %). In every case, the range of motion was good with flexion >90°. Arthroscopy showed the presence of chondral damage in 100 % of patients. In all the cases, we found that X-ray images seem better than the CT images. Angular stable plates allow to obtain a good primary stability, permitting an early joint recovery with an excellent range of motion. Avoiding to perform a knee arthrotomy at the time of fracture reduction could prove to be an advantage in terms of functional recovery. The meniscus on the injured bone should be preserved in order to maintain good function of the joint. X-ray images remain the gold standard in checking the progression of post-traumatic osteoarthritis.

  20. Variation in tibial functionality and fracture susceptibility among healthy, young adults arises from the acquisition of biologically distinct sets of traits.

    Science.gov (United States)

    Jepsen, Karl J; Evans, Rachel; Negus, Charles H; Gagnier, Joel J; Centi, Amanda; Erlich, Tomer; Hadid, Amir; Yanovich, Ran; Moran, Daniel S

    2013-06-01

    Physiological systems like bone respond to many genetic and environmental factors by adjusting traits in a highly coordinated, compensatory manner to establish organ-level function. To be mechanically functional, a bone should be sufficiently stiff and strong to support physiological loads. Factors impairing this process are expected to compromise strength and increase fracture risk. We tested the hypotheses that individuals with reduced stiffness relative to body size will show an increased risk of fracturing and that reduced strength arises from the acquisition of biologically distinct sets of traits (ie, different combinations of morphological and tissue-level mechanical properties). We assessed tibial functionality retrospectively for 336 young adult women and men engaged in military training, and calculated robustness (total area/bone length), cortical area (Ct.Ar), and tissue-mineral density (TMD). These three traits explained 69% to 72% of the variation in tibial stiffness (p stress fracture based on radiography and scintigraphy. K-means cluster analysis was used to segregate men and women into subgroups based on robustness, Ct.Ar, and TMD adjusted for body size. Stiffness varied 37% to 42% among the clusters (p stress fracture cases segregated to three clusters (p fracture risk. Our results have important implications for developing personalized preventative diagnostics and treatments. Copyright © 2013 American Society for Bone and Mineral Research.

  1. Magnetic resonance imaging findings of periosteal interposition in a distal tibial Salter-Harris type I fracture with surgical correlation: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Nara; Jung, Jee Young; Kang, Ki Ser [Chung-Ang University Hospital, Seoul (Korea, Republic of)

    2013-08-15

    The complication of growth disturbance after physeal fracture of the distal tibia has been well recognized. Although irreducible fractures of the physis due to trapped soft tissue, including periosteum, are not common, it could still cause growth disturbances. Therefore, the detection of periosteal interposition with physeal injury on imaging study is important. We present a case of a 10-year-old girl with surgically confirmed periosteal interposition in the distal tibial Salter-Harris type I fracture, through magnetic resonance imaging findings.

  2. Magnetic resonance imaging findings of periosteal interposition in a distal tibial Salter-Harris type I fracture with surgical correlation: A case report

    International Nuclear Information System (INIS)

    Kim, Nara; Jung, Jee Young; Kang, Ki Ser

    2013-01-01

    The complication of growth disturbance after physeal fracture of the distal tibia has been well recognized. Although irreducible fractures of the physis due to trapped soft tissue, including periosteum, are not common, it could still cause growth disturbances. Therefore, the detection of periosteal interposition with physeal injury on imaging study is important. We present a case of a 10-year-old girl with surgically confirmed periosteal interposition in the distal tibial Salter-Harris type I fracture, through magnetic resonance imaging findings.

  3. Is intramedullary nailing applicable for distal tibial fractures with ankle joint extension?

    Science.gov (United States)

    Beytemür, Ozan; Albay, Cem; Adanır, Oktay; Yüksel, Serdar; Güleç, Mehmet Akif

    2016-12-01

    This study aims to evaluate the functional and radiographic results and treatment complications of AO/OTA (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association) type 43C1 and C2 fractures treated with intramedullary nailing. We retrospectively evaluated 35 AO/OTA type 43C1 and C2 patients (26 males, 9 females; mean age 39.8±16.9 years; range 19 to 82 years) treated with intramedullary nailing. Two interfragmentary screws out of nail were applied in 10 patients (29%), while one interfragmentary screw out of nail was applied in 17 patients (49%). Intramedullary nailing was applied in eight patients (23%) without external screws. Fracture union, union time, alignment problems, and complications were evaluated. Clinical evaluation of patients was conducted using the Olerud and Molander score and by measuring the ankle joint range of motion. Union was achieved in all 35 patients. Mean union time was 16.5±2.8 weeks (range 12 to 24 weeks) and mean Olerud and Molander score was 88±8.24. Varus deformity was detected in one patient, valgus deformity was detected in two patients, and rotation deformity was detected in one patient. Superficial infection was detected in three patients (9%). Deep infection was not detected in any patient. Intramedullary nailing is not contraindicated for simple intra-articular distal tibial fractures. In these fractures, intramedullary nailing performed in accordance with its technique, with an additional percutaneous screw if necessary, is a successful treatment option with high fracture union rates, high functional results, and low complication rates.

  4. The cost of infection in severe open tibial fractures treated with a free flap

    DEFF Research Database (Denmark)

    Olesen, Ulrik Kähler; Pedersen, Nicolas Jones; Eckardt, Henrik

    2017-01-01

    procedures performed, including medications and intensive care. We analysed indirect cost in terms of absenteeism and unemployment benefits. The primary goal was to establish the extra cost incurred by an infection. RESULTS: We analysed 46 injuries in 45 patients. Infection increased the LOS from 41 to 74...... rate from 60 to 27 %. CONCLUSIONS: Severe open tibial fractures covered with free flaps, cause over a year of absenteeism. Infection increases direct cost of treatment over 60 % and roughly doubles LOS. Early soft-tissue cover and correct antibiotics have been shown to improve outcomes...

  5. The healing stages of an intramedullary implanted tibia: A stress strain comparative analysis of the calcification process

    Science.gov (United States)

    Filardi, Vincenzo

    2015-01-01

    Aims The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. Unreamed nailing favours biology at the expense of the achievable mechanical stability, it is therefore of interest to define the limits of the clinical indications for this method. Extra-articular fractures of the distal tibial metaphysis, meta-diaphyseal junction, and adjacent diaphysis are distinct in their management from impaction derived ‘‘pilon’’ type fractures and mid-diaphyseal fractures. The goals of this work were to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bones in a fractured tibia. With this purpose a complete model of the human leg was realised, simulating a mid-diaphyseal fracture, classified as A2 type 1, according to the AO classification. The analysis of the entire chain allows to have a complete picture of the stress distribution and of the most stressed bones and soft tissues, but, more importantly can overcome problems connected with boundary conditions imposed at single bony components. Methods Model consists of six bony structures: pelvis, femur, patella, fibula, tibia, and a simplified lump of the feet, configured in a standing up position. Their articular cartilage layers, were simulated by 3D membranes of opportune stiffness connecting the different segments. Moreover an unreamed intra-medullary nail Expert Tibial Nail (DePuy Synthes®) stabilized the fractured tibia. A load of 700 N has been applied at the top of pelvis and a part the feet, at the tip, was rigidly fixed. Five different contact interfaces have been imposed at the different bony surfaces in contact. Results Three different conditions were analysed: the initially healthy tibia, the A2 type 1 fractured tibia with the Expert tibial nail implanted, and the follow up stage after complete healing of tibia. Non-linear finite element analysis of the models were performed

  6. Sequential avulsions of the tibial tubercle in an adolescent basketball player.

    Science.gov (United States)

    Huang, Ying Chieh; Chao, Ying-Hao; Lien, Fang-Chieh

    2010-05-01

    Tibial tubercle avulsion is an uncommon fracture in physically active adolescents. Sequential avulsion of tibial tubercles is extremely rare. We reported a healthy, active 15-year-old boy who suffered from left tibial tubercle avulsion fracture during a basketball game. He received open reduction and internal fixation with two smooth Kirschner wires and a cannulated screw, with every effort to reduce the plate injury. Long-leg splint was used for protection followed by programmed rehabilitation. He recovered uneventfully and returned to his previous level of activity soon. Another avulsion fracture happened at the right tibial tubercle 3.5 months later when he was playing the basketball. From the encouragement of previous successful treatment, we provided him open reduction and fixation with two small-caliber screws. He recovered uneventfully and returned to his previous level of activity soon. No genu recurvatum or other deformity was happening in our case at the end of 2-year follow-up. No evidence of Osgood-Schlatter disease or osteogenesis imperfecta was found. Sequential avulsion fractures of tibial tubercles are rare. Good functional recovery can often be obtained like our case if we treat it well. To a physically active adolescent, we should never overstate the risk of sequential avulsion of the other leg to postpone the return to an active, functional life.

  7. Management of long bone fractures using SIGN nail: experience ...

    African Journals Online (AJOL)

    Background: Intramedullary nailing with interlocking nails has become the treatment of choice for closed diaphyseal fractures of femur and tibia. When possible locked nailing should be performed as a closed procedure. Fractures fixed by interlocking nailing have comparatively less complications in fracture healing.

  8. [Comparison study on locking compress plate external fixator and standard external fixator for treatment of tibial open fractures].

    Science.gov (United States)

    Wu, Gang; Luo, Xiaozhong; Tan, Lun; Lin, Xu; Wu, Chao; Guo, Yong; Zhong, Zewei

    2013-11-01

    To compare the clinical results of locking compress plate (LCP) as an external fixator and standard external fixator for treatment of tibial open fractures. Between May 2009 and June 2012, 59 patients with tibial open fractures were treated with LCP as an external fixator in 36 patients (group A), and with standard external fixator in 23 patients (group B). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, location, and interval between injury and surgery between 2 groups (P > 0.05). The time of fracture healing and incision healing, the time of partial weight-bearing, the range of motion (ROM) of knee and ankle, and complications were compared between 2 groups. The incidence of pin-track infection in group A (0) was significantly lower than that in group B (21.7%) (P=0.007). No significant difference was found in the incidence of superficial infection and deep infection of incision, and the time of incision healing between 2 groups (P > 0.05). Deep vein thrombosis occurred in 5 cases of group A and 2 cases of group B, showing no significant difference (Chi(2)=0.036, P=0.085). All patients were followed up 15.2 months on average (range, 9-28 months) in group A, and 18.6 months on average (range, 9-47 months) in group B. The malunion rate and nonunion rate showed no significant difference between groups A and B (0 versus 13.0% and 0 versus 8.7%, P > 0.05); the delayed union rate of group A (2.8%) was significantly lower than that of group B (21.7%) (Chi(2)=5.573, P=0.018). Group A had shorter time of fracture healing, quicker partial weight-bearing, greater ROM of the knee and ankle than group B (P fracture, and has good patients' compliance, so it is helpful to do functional exercise, improve fracture healing and function recovery, and reduce the complication incidence.

  9. Dual small fragment plating improves screw-to-screw load sharing for mid-diaphyseal humeral fracture fixation: a finite element study.

    Science.gov (United States)

    Kosmopoulos, Victor; Luedke, Colten; Nana, Arvind D

    2015-01-01

    A smaller humerus in some patients makes the use of a large fragment fixation plate difficult. Dual small fragment plate constructs have been suggested as an alternative. This study compares the biomechanical performance of three single and one dual plate construct for mid-diaphyseal humeral fracture fixation. Five humeral shaft finite element models (1 intact and 4 fixation) were loaded in torsion, compression, posterior-anterior (PA) bending, and lateral-medial (LM) bending. A comminuted fracture was simulated by a 1-cm gap. Fracture fixation was modelled by: (A) 4.5-mm 9-hole large fragment plate (wide), (B) 4.5-mm 9-hole large fragment plate (narrow), (C) 3.5-mm 9-hole small fragment plate, and (D) one 3.5-mm 9-hole small fragment plate and one 3.5-mm 7-hole small fragment plate. Model A showed the best outcomes in torsion and PA bending, whereas Model D outperformed the others in compression and LM bending. Stress concentrations were located near and around the unused screw holes for each of the single plate models and at the neck of the screws just below the plates for all the models studied. Other than in PA bending, Model D showed the best overall screw-to-screw load sharing characteristics. The results support using a dual small fragment locking plate construct as an alternative in cases where crutch weight-bearing (compression) tolerance may be important and where anatomy limits the size of the humerus bone segment available for large fragment plate fixation.

  10. Measurement of tibial torsion by computer tomography

    Energy Technology Data Exchange (ETDEWEB)

    Jend, H.H.; Heller, M.; Dallek, M.; Schoettle, H. (Hamburg Univ. (Germany, F.R.))

    1981-01-01

    A CT procedure for objective measurements of tibial torsion independent of axial rotation in the nearby joints is described. Transverse sections in defined planes of the tibia permit easy calculation of normal and abnormal congenital or posttraumatic angles of torsion. In 69 limbs normal tibial torsion was 40/sup 0/+-9/sup 0/. In a series of 42 limbs with complicated healing of a fracture of both bones of the leg it is shown that tibial maltorsion is a deformity which in most cases leads to arthrosis of the ankle joint.

  11. Measurement of tibial torsion by computer tomography

    International Nuclear Information System (INIS)

    Jend, H.-H.; Heller, M.; Dallek, M.; Schoettle, H.

    1981-01-01

    A CT procedure for objective measurements of tibial torsion independent of axial rotation in the nearby joints is described. Transverse sections in defined planes of the tibia permit easy calculation of normal and abnormal congenital or posttraumatic angles of torsion. In 69 limbs normal tibial torsion was 40 0 +-9 0 . In a series of 42 limbs with complicated healing of a fracture of both bones of the leg it is shown that tibial maltorsion is a deformity which in most cases leads to arthrosis of the ankle joint. (Auth.)

  12. A STUDY OF THE MANAGEMENT OF OPEN FRACTURES OF TIBIA BY UNREAMED INTERLOCKING NAIL

    Directory of Open Access Journals (Sweden)

    Kuppa Srinivas

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES: To evaluate the results of closed interlocking intramedullary nailing without reaming in the treatment of open fractures of t he tibial shaft and study the difficulties (complications encountered during the operative study. To compare the efficacy of interlocking intramedullary nailing without reaming in treating open fractures of tibia, Time required for the union of fracture, Range of motion of ankle and knee joint, Rate of malunion and mal rotation and Pain at the knee joint. RESULTS: The average age of patient is 32 years,83.33% are males, road traffic accidents account for majority(79.16%,right side involved in 58.33%,gustillo type II and type I compound fractures are common, full range of movements is seen in 66.67% by 12 weeks and union occurred in 95.83% by 9 months. Thirteen (54.17% patients had excellent results, six (25% patients had good results, four (1 6.67% patients had fair results and one (4.16 patient had poor result. CONCLUSION: Unreamed interlocking intramedullary nailing with the help of image intensifier seems feasible in open diaphyseal fractures of tibia with the advantages of minimal blood l oss, low risk of infection, early mobilisation , earlier soft tissue coverage , Promotes early union , minimal hospital stay and early returns to activities

  13. Acute Traumatic Patellar Tendon Rupture at the Tibial Tuberosity Attachment without Avulsion Fracture

    Directory of Open Access Journals (Sweden)

    Shuichi Miyamoto

    2017-01-01

    Full Text Available Patellar tendon rupture in children is especially rare. The fact that the area of traumatic rupture has wide variations makes surgical treatment difficult. We present an 11-year-old boy with acute traumatic patellar tendon rupture at the tibial tuberosity attachment without avulsion fracture. Primary end-to-end repair and reinforcement using 1.5 mm stainless steel wires as a surgical strategy were undertaken. Early range of motion began with a functional knee brace and the reinforced stainless wire was removed 3 months after surgery. Knee function at the final follow-up was satisfactory. We suggest that this strategy may provide a useful option for surgical treatment.

  14. Negative magnetic resonance imaging in three cases of anterior tibial cortex stress fractures

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Ralph; Moghal, M.; Newton, J.L.; Jones, N. [Oxford University Hospitals NHS Foundation Trust, Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford (United Kingdom); Teh, J. [Oxford University Hospitals NHS Foundation Trust, Department of Radiology, Nuffield Orthopaedic Centre Oxford, Oxford (United Kingdom)

    2017-12-15

    Anterior mid-tibial cortex stress fractures (ATCSF) are uncommon and notoriously challenging to treat. They are termed high risk due to their predilection to prolonged recovery, nonunion and complete fracture. Early diagnosis is essential to avoid progression and reduce fracture complications. Imaging plays a key role in confirming the diagnosis. Magnetic resonance imaging (MRI) is accepted as the gold standard modality due to its high accuracy and nonionizing properties. This report describes three cases of ATCSFs in recreational athletes who had positive radiographic findings with no significant MRI changes. Two athletes had multiple striations within their tibias. Despite the radiographic findings, their severity of symptoms were low with mild or no tenderness on examination. Clinicians should be mindful that the ATCSFs may not present with typical acute stress fracture symptoms. We recommend that plain radiographs should be used as the first line investigation when suspecting ATCSFs. Clinicians should be aware that despite MRI being considered the gold standard imaging modality, we report three cases where the MRI was unremarkable, whilst radiographs and computed tomography confirmed the diagnosis. We urge clinicians to continue to use radiographs as the first line imaging modality for ATCSFs and not to directly rely on MRI. Those who opt directly for MRI may be falsely reassured causing a delay in diagnosis. (orig.)

  15. Negative magnetic resonance imaging in three cases of anterior tibial cortex stress fractures

    International Nuclear Information System (INIS)

    Smith, Ralph; Moghal, M.; Newton, J.L.; Jones, N.; Teh, J.

    2017-01-01

    Anterior mid-tibial cortex stress fractures (ATCSF) are uncommon and notoriously challenging to treat. They are termed high risk due to their predilection to prolonged recovery, nonunion and complete fracture. Early diagnosis is essential to avoid progression and reduce fracture complications. Imaging plays a key role in confirming the diagnosis. Magnetic resonance imaging (MRI) is accepted as the gold standard modality due to its high accuracy and nonionizing properties. This report describes three cases of ATCSFs in recreational athletes who had positive radiographic findings with no significant MRI changes. Two athletes had multiple striations within their tibias. Despite the radiographic findings, their severity of symptoms were low with mild or no tenderness on examination. Clinicians should be mindful that the ATCSFs may not present with typical acute stress fracture symptoms. We recommend that plain radiographs should be used as the first line investigation when suspecting ATCSFs. Clinicians should be aware that despite MRI being considered the gold standard imaging modality, we report three cases where the MRI was unremarkable, whilst radiographs and computed tomography confirmed the diagnosis. We urge clinicians to continue to use radiographs as the first line imaging modality for ATCSFs and not to directly rely on MRI. Those who opt directly for MRI may be falsely reassured causing a delay in diagnosis. (orig.)

  16. Knee ligament injuries associated with long bone fractures

    Directory of Open Access Journals (Sweden)

    Kaseb M.H

    2007-06-01

    Full Text Available Background: Tibial and femoral fractures, commonly seen in emergency departments, may be associated with various knee ligament injuries. The aim of this study was to determine the prevalence of such fracture-associated knee ligament problems, with especial attention to rapid diagnosis. Methods: This study was carried out in patients with femoral or tibial fractures who were operated on in Imam Khomeini Medical Center from March 2003 to March 2005. All patients underwent surgical repair immediately after acute fracture, followed by a thorough knee examination. Patients with positive clinical findings were further evaluated using the stress view and arthroscopy. Results: We enrolled 470 cases in this study, of which 266 were tibial and 204 were femoral fractures. There were 404 men and 67 women, with an average age of tibial fracture patients was 34.5 and 44.6 years for those with femoral fractures. Of all fractures, 66% were due to car accidents, 16% to industrial accidents and 8% due to falling. The overall prevalence of ligament injuries in tibial fractures was as follows: 6.58% ACL tearing, 2.5% PCL, 21.95% MCL and 14.63% LCL. The overall prevalence of ligament injuries in femoral fractures was as follows: 6% ACL tearing, 3% PCL, 14% MCL and 8% LCL. Conclusion: The prevalence of ligament injuries of the knee was highest in distal femoral and tibial plateau fractures. It is prudent to perform a thorough knee examination once the fracture is stabilized in the operating room for the early detection of ligament injuries and prevention of further complications.

  17. [Curative efficacies of mini-invasive percutaneous osteosynthesis versus supercutaneous plating for distal tibial fractures].

    Science.gov (United States)

    He, Xianfeng; Zhu, Limei; Zhang, Jingwei; Li, Ming; Yu, Yihui

    2014-12-30

    To compare the clinical efficacies of mini-invasive percutaneous osteosynthesis (MIPO) versus supercutaneous plating with closed reduction in the treatment of distal tibial fractures. A total of 48 patients with close distal tibial fractures were treated between January 2010 and January 2012. The MIPO group included 16 males and 8 females with an average age of 36 years. And the types were A (n = 15), B (n = 6) and C (n = 3) according to the classification scheme of Association for the Study of Internal Fixation (AO/ASIF). The supercutaneous plating group also included 16 males and 8 females with an average age of 37 years. And the types were A (n = 15), B (n = 6) and C (n = 3). And the operative duration, hospital stay, union time, postoperative complications and function of ankle were compared between two groups. The mean follow-up period was 18.5 (12-26) months. There was no instance of nonunion, hardware breakdown or deep infection. Patients in supercutaneous plating group had significantly shorter mean operative duration, hospital stay and union time. Three patients and 1 patient in MIPO group presented with superficial infection and delayed union respectively while there was no occurrence in supercutaneous plating group. And the differences were not statistically significant. Fifteen patients (62.5%) complained of implant impingement or discomfort. And stripping occurred at an incidence of 15.6% during the removal time of locking screws in MIPO group. While in supercutaneous plating group, there as no complaint of skin irritation and removal of supercutaneous plate was easily performed without anesthesia. The mean AOFAS score was 90.7 ± 3.8 in supercutaneous plating group versus 88.9 ± 4.1 in MIPO group (P = 0.070). Distal tibia fractures may be treated successfully with MIPO or supercutaneous plating. However, supercutaneous plating offers multiple advantages in terms of mean operative duration, hospital stay, union time, skin irritation and implant

  18. The percutaneous use of a pointed reduction clamp during intramedullary nailing of distal third tibial shaft fractures.

    Science.gov (United States)

    Forman, Jordanna M; Urruela, Adriana M; Egol, Kenneth A

    2011-12-01

    The purpose of this retrospective chart and radiographic review is to describe an effective reduction technique during intramedullary nailing of distal metaphyseal tibia fractures with the use of a pointed percutaneous clamp. Between 2007 and 2010, 100 patients who sustained 102 tibia fractures were definitively treated with an intramedullary nail at one of two medical centers. Diaphyseal fractures and injuries with an associated disruption of the distal tibiofibular joint were excluded from our study. A total of 27 patients with 27 distal metaphyseal tibia fractures (OTA types 42-A, 43-A, and 43-B) were included. All 27 patients underwent IM nailing of their fractures with anatomic reduction achieved using a percutaneously placed pointed reduction clamp prior to insertion of the IM implant. Fracture alignment and angular deformity was assessed using goniometric measurement functions on the PACS system (GE, Waukeshau, WI) obtained from preoperative and postoperative anteroposterior and lateral images for all subjects. Malalignment was defined as more than 5 degrees of angulation in any plane. Fourteen of the fractures were classified as OTA 42-A, 9 were OTA 43-A, and 4 were OTA 43-B. Analysis of post-closed reduction, preoperative anteroposterior radiographs revealed a mean of 7.9 degrees of coronal plane (range: 0.9 degrees-26 degrees) angulation. Post closed reduction preoperative lateral radiographs revealed a mean of 6.8 degrees sagittal plane (range: 0 degrees-24.6 degrees) angulation. Postoperative anteroposterior and lateral radiographs showed the distal segment returned to its anatomical alignment with a mean angulation of 0.5 degrees (range, 0 degrees-3.5 degrees) and 0.7 degrees (range, 0 degrees-4.2 degrees) of varus/ valgus and apex anterior/posterior angulation, respectively. These results showed an acceptable postopertative alignment in all 27 distal third fractures. No intra-operative or postoperative complications were noted in the study group. This

  19. Metaphyseal and diaphyseal chondroblastomas

    Energy Technology Data Exchange (ETDEWEB)

    Maheshwari, Aditya V. [State University of New York Downstate Medical Center, Department of Orthopaedics and Rehabilitation, Brooklyn, NY (United States); Washington Hospital Center, Department of Orthopedic Oncology, Washington, DC (United States); Jelinek, James S.; Song, Albert J. [Washington Hospital Center, Department of Radiology, Washington, DC (United States); Nelson, Kenneth J.; Henshaw, Robert M. [Washington Hospital Center, Department of Orthopedic Oncology, Washington, DC (United States); Murphey, Mark D. [The American Institute for Radiologic Pathology, Silver Spring, MD (United States)

    2011-12-15

    Epiphyseal/apophyseal locations are important diagnostic radiological features of chondroblastomas (CB). Although the tumor may secondarily involve the metaphysis, reports of primary metaphyseal or diaphyseal CB without any epiphyseal or apophyseal involvement are exceptionally rare and frequently present as a diagnostic dilemma. The purpose of this study was to present seven cases of pure metaphyseal and/or diaphyseal CB along with a review of pertinent literature. A retrospective review of databases at two major referral centers revealed 390 cases of CB between 1960 and 2009. Out of these, seven histologically proven CB cases (1.8%) were found to be radiologically located in metaphysis and/or diaphysis, without involving the epiphysis and/or apophysis, and formed the study cohort. There were four males and three females (age range 2-25 years). Locations included proximal femur (n = 1), distal femur (2), proximal humerus (2), clavicle (1), and proximal radius (1). All lesions showed marginal sclerosis. A periosteal reaction was seen in five cases (71%), cortical expansion in four cases (57%), and chondroid matrix in four cases (57%). A CT (two cases) demonstrated a matrix in both cases. An MR (one case) showed extensive perilesional edema. Bone scan (one case) showed intense uptake. Pure metaphyseal and/or diaphyseal CB are exceedingly rare. A presumptive diagnosis may be considered in the appropriate age group in the presence of chondroid matrix, perilesional edema, periosteal reaction, and marginal sclerosis. Regardless of all the diagnostic possibilities, biopsy may still be required. However, knowledge of this entity will help make the final diagnosis and guide the correct treatment. (orig.)

  20. Epidemiologie et Aspects Anatomo-Pathologique des Fractures du ...

    African Journals Online (AJOL)

    Ils sont suivis des fractures de la tête fémorale (9,30%), les fractures des massifs trochantériens (9,11%). Les fractures de la diaphyse fémorale étaient de 50%, avec une prédilection au tiers moyen. Les fractures de l'extrémité inférieure ont représenté (9,10%) avec une prédominance des fractures supra condyliennes.

  1. Anterior cruciate ligament reconstruction failure after tibial shaft malunion.

    Science.gov (United States)

    LaFrance, Russell M; Gorczyca, John T; Maloney, Michael D

    2012-02-17

    Anterior cruciate ligament (ACL) reconstruction is common, with >100,000 procedures performed each year in the United States. Several factors are associated with failure, including poor surgical technique, graft incorporation failure, overly aggressive rehabilitation, and trauma. Tibial shaft fracture is also common and frequently requires operative intervention. Failure to reestablish the anatomic alignment of the tibia may cause abnormal forces across adjacent joints, which can cause degenerative joint disease or attritional failure of the surrounding soft tissues. This article describes a case of ACL reconstruction failure after a tibial fracture that resulted in malunion. Excessive force across the graft from lower-extremity malalignment and improper tunnel placement likely contributed to the attritional failure of the graft. This patient required a staged procedure for corrective tibial osteotomy followed by revision ACL reconstruction. This article describes ACL reconstruction failure, tibial shaft malunions, their respective treatments, the technical details of each procedure, and the technical aspects that must be considered when these procedures are done in a staged manner by 2 surgeons. Copyright 2012, SLACK Incorporated.

  2. Functional outcome of tibial fracture with acute compartment syndrome and correlation to deep posterior compartment pressure.

    Science.gov (United States)

    Goyal, Saumitra; Naik, Monappa A; Tripathy, Sujit Kumar; Rao, Sharath K

    2017-05-18

    To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome (ACS) and to correlate it with functional outcome. Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale (LEFS)] and complications were assessed. Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk (10 to 54 wk) and 23.8 ± 9.2 wk (12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness (76%) that caused difficulty in walking, running and squatting. Of 21 patients who had paralysis at diagnosis, 13 (62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients (48.3%) with severe disability, 10 patients (34.5%) with moderate disability and 5 patients (17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmHg respectively ( P fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intra-compartmental pressure (ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.

  3. Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review

    NARCIS (Netherlands)

    Mallee, Wouter H.; Weel, Hanneke; van Dijk, C. Niek; van Tulder, Maurits W.; Kerkhoffs, Gino M.; Lin, Chung-Wei Christine

    2015-01-01

    To compare surgical and conservative treatment for high-risk stress fractures of the anterior tibial cortex, navicular and proximal fifth metatarsal. Systematic searches of CENTRAL, MEDLINE, EMBASE, CINAHL, SPORTDiscus and PEDro were performed to identify relevant prospective and retrospective

  4. Fractures of the shafts of the tibia and fibula

    International Nuclear Information System (INIS)

    Bender, C.E.; Campbell, D.C.

    1985-01-01

    Fractures of the shafts of the tibia and fibula are the most common long bone fractures. This chapter discusses tibial and fibular shaft fractures. Treatment of tibial and fibular fractures is similar and, therefore, reference is primarily made to the tibia. Diagnostic techniques are also evaluated

  5. Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review

    NARCIS (Netherlands)

    Mallee, W.H.; Weel, H.; van Dijk, C.N.; van Tulder, M.W.; Kerkhoffs, G.M.; Lin, C.W.C.

    2015-01-01

    Aim To compare surgical and conservative treatment for high-risk stress fractures of the anterior tibial cortex, navicular and proximal fifth metatarsal. Methods Systematic searches of CENTRAL, MEDLINE, EMBASE, CINAHL, SPORTDiscus and PEDro were performed to identify relevant prospective and

  6. Fixator-assisted medial tibial plateau elevation to treat severe Blount's disease: outcomes at maturity.

    Science.gov (United States)

    Fitoussi, F; Ilharreborde, B; Lefevre, Y; Souchet, P; Presedo, A; Mazda, K; Penneçot, G F

    2011-04-01

    Severe forms of Blount's disease may be associated with medial tibial plateau (MTP) depression. Management should then take account of joint congruence, laxity, limb axis, torsional abnomality, leg length discrepancy (LLD) and eventual recurrence history. Eight knees (six patients) were managed in a single step comprising MTP elevation osteotomy, lateral epiphysiodesis and proximal tibia osteotomy to correct varus and rotational deformity. Fixation was achieved using an Ilizarov external fixator. Mean age was 10.5 years. Mean hip-knee-ankle (HKA) angle was 151°; distal femoral varus, 94°; metaphyseal-diaphyseal angle (MDA), 27°; and angle of depression of the medial tibial plateau (ADMTP), 42°. Predicted residual proximal tibial growth was 2.6 cm. At a mean 48 months' follow-up, results were good in six cases, medium in one and poor (due to incomplete lateral epiphysiodesis) in one. Mean lateral tibial torsion was 9° and final LLD 11 mm. Weight-bearing was resumed at 2 months, and the fixator was removed at 5.5 months postoperatively. At end of follow-up, mean HKA angle was 179.6°, MDA 7.3° and ADMTP 5.4°. This technically demanding procedure gave satisfactory results in terms of axes and congruence; longer term assessment remains needed. Level IV. Retrospective study. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  7. The effect of retained intramedullary nails on tibial bone mineral density.

    Science.gov (United States)

    Allen, J C; Lindsey, R W; Hipp, J A; Gugala, Z; Rianon, N; LeBlanc, A

    2008-07-01

    Intramedullary nailing has become a standard treatment for adult tibial shaft fractures. Retained intramedullary nails have been associated with stress shielding, although their long-term effect on decreasing tibial bone mineral density is currently unclear. The purpose of this study was to determine if retained tibial intramedullary nails decrease tibial mineral density in patients with successfully treated fractures. Patients treated with statically locked intramedullary nails for isolated, unilateral tibia shaft fractures were studied. Inclusion required that fracture had healed radiographically and that the patient returned to the pre-injury activity level. Data on patient demographic, fracture type, surgical technique, implant, and post-operative functional status were tabulated. Dual energy X-ray absorptiometry was used to measure bone mineral density in selected regions of the affected tibia and the contralateral intact tibia. Image reconstruction software was employed to ensure symmetry of the studied regions. Twenty patients (mean age 43; range 22-77 years) were studied at a mean of 29 months (range 5-60 months) following intramedullary nailing. There was statistically significant reduction of mean bone mineral density in tibiae with retained intramedullary nails (1.02 g/cm(2) versus 1.06 g/cm(2); P=0.04). A significantly greater decrease in bone mineral density was detected in the reamed versus non-reamed tibiae (-7% versus +6%, respectively; P<0.05). The present study demonstrates a small, but statistically significant overall bone mineral density decrease in healed tibiae with retained nails. Intramedullary reaming appears to be a factor potentiating the reduction of tibia bone mineral density in long-term nail retention.

  8. Attritional rupture of extensor pollicis longus: a rare complication following elastic stable intramedullary nailing of a paediatric radial fracture.

    LENUS (Irish Health Repository)

    Sproule, James A

    2011-01-01

    Elastic stable intramedullary nail fixation has become established as an acceptable method of treatment for diaphyseal fractures of both forearm bones in the paediatric population. It is considered safe, minimally invasive and does not compromise physeal growth. We report a case of delayed rupture of extensor pollicis longus due to attrition over the sharp edges of a protruding nail end after elastic stable intramedullary nailing of a paediatric radial diaphyseal fracture.

  9. Characterizing the Learning Effect in Response to Biofeedback Aimed at Reducing Tibial Acceleration during Running

    Directory of Open Access Journals (Sweden)

    Linda M. A. van Gelder

    2018-02-01

    Full Text Available Increased tibial acceleration has been found to be an important risk factor for tibial stress fractures. Interventions aimed at reducing this variable which found a beneficial effect include the use of biofeedback in gait retraining. However, no studies have focused on the time participants take to modify tibial acceleration, therefore we aimed to find the start of a learning plateau in this study. Six participants ran on a treadmill while multisensory feedback was given. A single-subject analysis was used to characterise the learning effects. All participants changed peak tibial acceleration within the first step of running in the feedback condition. Two participants further reduced tibial acceleration to reach a plateau within 120 steps. In four of the six participants a strong effect of the feedback was still present after a week. Further research is needed to optimise the use of biofeedback in reducing the prevalence of tibial stress fractures.

  10. Initial intramuscular perfusion pressure predicts early skeletal muscle function following isolated tibial fractures

    Directory of Open Access Journals (Sweden)

    Haas Norbert P

    2008-04-01

    Full Text Available Abstract Background The severity of associated soft tissue trauma in complex injuries of the extremities guides fracture treatment and decisively determines patient's prognosis. Trauma-induced microvascular dysfunction and increased tissue pressure is known to trigger secondary soft tissue damage and seems to adversely affect skeletal muscle function. Methods 20 patients with isolated tibial fractures were included. Blood pressure and compartment pressure (anterior and deep posterior compartment were measured continuously up to 24 hours. Corresponding perfusion pressure was calculated. After 4 and 12 weeks isokinetic muscle peak torque and mean power of the ankle joint in dorsal and plantar flexion were measured using a Biodex dynamometer. Results A significant inverse correlation between the anterior perfusion pressure at 24 hours and deficit in dorsiflexion at 4 weeks was found for both, the peak torque (R = -0.83; p Conclusion The functional relationship between the decrease in intramuscular perfusion pressures and muscle performance in the early rehabilitation period indicate a causative and prognostic role of early posttraumatic microcirculatory derangements and skeletal muscle function. Therapeutic concepts aimed at effective muscle recovery, early rehabilitation, and decreased secondary tissue damage, should consider the maintenance of an adequate intramuscular perfusion pressure.

  11. The changing epidemiology of open fractures in vehicle occupants, pedestrians, motorcyclists and cyclists.

    Science.gov (United States)

    Winkler, Dennis; Goudie, Stuart T; Court-Brown, Charles M

    2018-02-01

    To investigate the changing epidemiology of open fractures in vehicle occupants, pedestrians, motorcyclists and cyclists. Data on all non-spinal open fractures admitted to the Royal Infirmary of Edinburgh after a road traffic accident between 1988 and 2010 were collected and analysed to provide information about the changing epidemiology in different patient groups. Demographic information was collected on all patients with the severity of injury being analysed with the Injury Severity Score (ISS), Musculoskeletal Index (MSI) and the number of open fractures. The severity of the open fractures was analysed using the Gustilo classification. The 23-year study period was divided into four shorter periods and the results were compared. There were 696 patients treated in 23 years. Analysis showed that the incidence of RTA open fractures initially fell in both males and females and continued to fall in females during the 23 years. In males it levelled off about 2000. The age of the female patients also fell during the study period but it did not change in males. The only patient group to show an increased incidence of open fractures were cyclists. In vehicle occupants the incidence fell throughout the study period but it levelled off in pedestrians and motorcyclists. There was no difference in the severity of injury in any group during the study period. The most severe open fractures were those of the distal femur and femoral diaphysis although open tibial diaphyseal fractures were the most common fracture in all patient groups. Improved car design and road safety legislation has resulted in a reduction in the incidence of open fractures in vehicle occupants, pedestrians and motorcyclists. The most obvious group to have benefitted from this are older female pedestrians. The only group to show an increase in age during the study period were male motorcyclists. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Comminuted intraarticular fractures of the tibial plateau lead to posttraumatic osteoarthritis of the knee: Current treatment review

    Directory of Open Access Journals (Sweden)

    Matthias Aurich

    2018-03-01

    Full Text Available Posttraumatic osteoarthritis (PTOA of the knee is a common complication after intra- and extra-articular fractures. Moreover, PTOA may also be a result of isolated cartilage defects, meniscus resections, and ligament injuries. There are various methods of treatment of knee joint fractures. However, in the final stage of a PTOA, when nonoperative treatment fails, endoprosthetic joint replacement is the method of choice. Primary total knee replacement (TKR for the treatment for a fracture of the knee joint is a rare indication, even at major treatment centers. It is performed in elderly patients with the inability to be mobilized with partial- or non-weight bearing; in cases with considerable bone destruction; in cases with symptomatic osteoarthritis (OA in the elderly; and, it is often associated with the primary use of a modular implant. However, TKR in the acute situation should always be an individual decision. Secondary TKR after knee joint fracture shows overall good functional results. However, the results are inferior when compared with TKR for primary OA. In addition, the complication rates of TKR for PTOA are much higher. Problems with the extensor mechanism after tibial plateau fractures are common. There are also problems caused by preexisting scars, nonunion (possibly due to a low grade infection, malalignment, restricted movement, or instability.

  13. Biomechanical Factors in Tibial Stress Fracture

    Science.gov (United States)

    2001-08-01

    Relationship between Loading Rates and Tibial Accelerometry in Forefoot Strike Runners. Presented at the Annual American Society of Biomechanics Mtg...of the APTA, Seattle, WA, 2/99. McClay, IS, Williams, DS, and Manal, KT. Lower Extremity Mechanics of Runners with a Converted Forefoot Strike ...Management, Inc, 1998-1999 The Effect of Different Orthotic Devices on Lower Extremity Mechanics of Rearfoot and Forefoot Strikers, $3,500. Foot Management

  14. A new surgical technique for traumatic dislocation of posterior tibial tendon with avulsion fracture of medial malleolus.

    Science.gov (United States)

    Jeong, Soon-Taek; Hwang, Sun-Chul; Kim, Dong-Hee; Nam, Dae-Cheol

    2015-01-01

    We introduce a case of traumatic dislocation of the posterior tibial tendon with avulsion fracture of the medial malleolus in a 52-year-old female patient who was treated surgically with periosteal flap and suture anchor fixation. Based in the posteromedial ridge of the distal tibia, a quadrilateral periosteal flap was created and folded over the tendon, followed by fixation on the lateral aspect of the groove by use of multiple suture anchors. Clinical and radiological findings 25 months postoperatively showed well-preserved function of the ankle joint with stable tendon gliding.

  15. Incarceration of the intermeniscal ligament in tibial eminence injury: a block to closed reduction identified using MRI

    International Nuclear Information System (INIS)

    Archibald-Seiffer, Noah; Jacobs, John; Zbojniewicz, Andrew; Shea, Kevin

    2015-01-01

    Tibial eminence fractures are a relatively uncommon injury, but most frequently occur in children and adolescents with open physes. Entrapment of the intermeniscal ligament or the meniscus itself can occur in the setting of a tibial eminence fracture and when present, poses a significant obstacle to successful closed or surgical reduction. Identification of these entrapped structures on preoperative imaging may be helpful to the physicians caring for these patients and assist with preoperative planning. We present a case of a 13-year-old male who sustained a tibial eminence fracture while playing football. Review by the orthopedic surgeon identified entrapment of the intermeniscal ligament. Subsequently, a closed reduction attempt under anesthesia prior to surgery was unsuccessful and arthroscopy was needed to remove the entrapped intermeniscal ligament and reduce the tibial eminence fracture. Pre-operative knowledge of entrapped soft tissue structures under the fracture plane, particularly the meniscus and intermeniscal ligament, provides the surgeon with valuable insight as to how to best counsel patients on the success of treatment options, how to best prepare for operative treatment, and can guide the surgeon during open reduction to maximize treatment success. (orig.)

  16. Incarceration of the intermeniscal ligament in tibial eminence injury: a block to closed reduction identified using MRI

    Energy Technology Data Exchange (ETDEWEB)

    Archibald-Seiffer, Noah; Jacobs, John [University of Utah School of Medicine, Salt Lake City, UT (United States); Zbojniewicz, Andrew [University of Cincinnati Department of Radiology, Cincinnati, OH (United States); Cincinnati Children' s Hospital Medical Center, Division of Pediatric Radiology, Cincinnati, OH (United States); Shea, Kevin [University of Utah School of Medicine, Salt Lake City, UT (United States); St. Luke' s Health System, Boise, ID (United States); St. Luke' s Sports Medicine, Boise, ID (United States)

    2015-05-01

    Tibial eminence fractures are a relatively uncommon injury, but most frequently occur in children and adolescents with open physes. Entrapment of the intermeniscal ligament or the meniscus itself can occur in the setting of a tibial eminence fracture and when present, poses a significant obstacle to successful closed or surgical reduction. Identification of these entrapped structures on preoperative imaging may be helpful to the physicians caring for these patients and assist with preoperative planning. We present a case of a 13-year-old male who sustained a tibial eminence fracture while playing football. Review by the orthopedic surgeon identified entrapment of the intermeniscal ligament. Subsequently, a closed reduction attempt under anesthesia prior to surgery was unsuccessful and arthroscopy was needed to remove the entrapped intermeniscal ligament and reduce the tibial eminence fracture. Pre-operative knowledge of entrapped soft tissue structures under the fracture plane, particularly the meniscus and intermeniscal ligament, provides the surgeon with valuable insight as to how to best counsel patients on the success of treatment options, how to best prepare for operative treatment, and can guide the surgeon during open reduction to maximize treatment success. (orig.)

  17. Management of a type two avulsion fracture of the tibial intercondylar eminence in children: arthroscopic suture fixation versus conservative immobilization.

    Science.gov (United States)

    Zhao, Chen; Bi, Qing; Bi, Mingguang

    2018-06-01

    Treatment of a type II tibial eminence avulsion fracture was controversial. The aim of this study was to compare the clinical outcomes of a modified arthroscopic suture fixation versus conservative immobilization in treatment of this type fracture in immature population. A total of 43 type II avulsion fractures of tibial intercondylar eminence in immature patients were retrospectively enrolled in the study. Twenty-two (13 males, 9 females) were treated with arthroscopic suture fixation and 21(12 males, 9 females) with conservative cast immobilization. Radiograph, Lachman test, anterior drawer test (ADT), International Knee Documentation Committee (IKDC) 2000 subjective score, and Lysholm score were used to evaluate clinical outcomes in follow-up. All 43 paediatric or adolescent patients with a mean of 11.3 years (range, 8-16 years) were followed up for a median period of 34.5 months (range, 24-46 months). Radiographic evaluation showed optimal reduction immediately after surgery and bone union within three months. At the final follow-up, no limitation of knee motion range was found in any children. Grade II laxity was found in one case from surgical group and six from conservation group, showing significant difference based on ADT (χ2 = 7.927, P = 0.005) and Lachman tests (χ2 = 9.546, P = 0.002). IKDC and Lysholm scores were significantly improved; however, there were significant differences in the IKDC score (91.7 ± 4.34 vs. 84.7 ± 6.11, t = 4.35, P < 0.001) and Lysholm score (93.4 ± 4.04 vs. 87.1 ± 5.24, t = 4.53, P < 0.001), and the improvement of IKDC value (40.2 ± 7.83 vs. 31.4 ± 8.4, t = 3.57, P = 0.001) and Lysholm value (43.8 ± 6.55 vs. 35.4 ± 5.97, t = 4.36, P < 0.001) between the surgical group and the nonsurgical group. In treatment of type II tibial eminence avulsion fracture, a modified, 8 shape suture fixation under arthroscopy showed superior clinical

  18. All-Polyethylene Tibial Components: An Analysis of Long-Term Outcomes and Infection.

    Science.gov (United States)

    Houdek, Matthew T; Wagner, Eric R; Wyles, Cody C; Watts, Chad D; Cass, Joseph R; Trousdale, Robert T

    2016-07-01

    There is debate regarding tibial component modularity and composition in total knee arthroplasty (TKA). Biomechanical studies have suggested improved stress distribution in metal-backed tibias; however, these results have not translated clinically. The purpose of this study was to analyze the outcomes of all-polyethylene components and to compare the results to those with metal-backed components. We reviewed 31,939 patients undergoing a primary TKA over a 43-year period (1970-2013). There were 28,224 (88%) metal-backed and 3715 (12%) all-polyethylene tibial components. The metal-backed and all-polyethylene groups had comparable demographics with respect to gender, age and body mass index (BMI). Mean follow-up was 7 years. The mean survival for all primary TKAs at the 5-, 10-, 20- and 30-year time points was 95%, 89%, 73%, and 57%, respectively. All-polyethylene tibial components were found to have a significantly improved (P tibial components were also found to have a significantly lower rate of infection, instability, tibial component loosening, and periprosthetic fracture. The all-polyethylene group had improved survival rates in all age groups, except in patients 85 years old or greater, where there was no significant difference. All-polyethylene tibial components had improved survival for all BMI groups except in the morbidly obese (BMI ≥ 40) where there was no significant difference. All-polyethylene tibial components had significantly improved implant survival, reduced rates of postoperative infection, fracture, and tibial component loosening. All polyethylene should be considered for most of the patients, regardless of age and BMI. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Unusual longitudinal stress fractures of the femoral diaphysis: report of five cases

    International Nuclear Information System (INIS)

    Williams, M.; Timsit, M.A.; Karneff, A.; Pertuiset, E.

    1999-01-01

    We present five cases of a distinctive type of longitudinal stress fracture of the upper femoral shaft in which the fracture line is parallel to the outer surface of the bone, in contrast to the perpendicular orientation to the cortical surface in previously reported cases of diaphyseal stress fractures. In two cases the fracture recurred after 15 and 18 months, respectively. (orig.)

  20. Age variations in the properties of human tibial trabecular bone and cartilage

    DEFF Research Database (Denmark)

    Ding, Ming

    2000-01-01

    , such as apparent, apparent ash and collagen densities of human tibial trabecular bone have significant relationships with age. Tissue density and mineral concentration remain constant throughout life. Trabecular bone is tougher in the younger age, i.e. fracture requires more energy. Collagen density was the single......Initiated and motivated by clinical and scientific problems such as age-related bone fracture, prosthetic loosening, bone remodeling, and degenerative bone diseases, much significant research on the properties of trabecular bone has been carried out over the last two decades. This work has mainly...... focused on the central vertebral trabecular bone, while little is known about age-related changes in the properties of human peripheral (tibial) trabecular bone. Knowledge of the properties of peripheral (tibial) trabecular bone is of major importance for the understanding of degenerative diseases...

  1. Plate Fixation With Autogenous Calcaneal Dowel Grafting Proximal Fourth and Fifth Metatarsal Fractures: Technique and Case Series.

    Science.gov (United States)

    Seidenstricker, Chad L; Blahous, Edward G; Bouché, Richard T; Saxena, Amol

    Metaphyseal and proximal diaphyseal fractures of the lateral column metatarsals can have problems with healing. In particular, those involving the fifth metatarsal have been associated with a high nonunion rate with nonoperative treatment. Although intramedullary screw fixation results in a high union rate, delayed healing and complications can occur. We describe an innovative technique to treat both acute and chronic injuries involving the metatarsal base from the metaphysis to the proximal diaphyseal bone of the fourth and fifth metatarsals. The surgical technique involves evacuation of sclerotic bone at the fracture site, packing the fracture site with compact cancellous bone, and plate fixation. In our preliminary results, 4 patients displayed 100% radiographic union at a mean of 4.75 (range 4 to 6) weeks with no incidence of refracture, at a mean follow-up point of 3.5 (range 1 to 5) years. The early results with our small series suggest that this technique is a useful treatment choice for metaphyseal and proximal diaphyseal fractures of the fourth and fifth metatarsals. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Ankle fractures have features of an osteoporotic fracture.

    Science.gov (United States)

    Lee, K M; Chung, C Y; Kwon, S S; Won, S H; Lee, S Y; Chung, M K; Park, M S

    2013-11-01

    We report the bone attenuation of ankle joint measured on computed tomography (CT) and the cause of injury in patients with ankle fractures. The results showed age- and gender-dependent low bone attenuation and low-energy trauma in elderly females, which suggest the osteoporotic features of ankle fractures. This study was performed to investigate the osteoporotic features of ankle fracture in terms of bone attenuation and cause of injury. One hundred ninety-four patients (mean age 51.0 years, standard deviation 15.8 years; 98 males and 96 females) with ankle fracture were included. All patients underwent CT examination, and causes of injury (high/low-energy trauma) were recorded. Mean bone attenuations of the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis were measured on CT images. Patients were divided into younger age (fractures than the younger age group. With increasing age, bone attenuations tended to decrease and the difference of bone attenuation between the genders tended to increase in the talus, medial malleolus, lateral malleolus, and distal tibial metaphysis. Ankle fracture had features of osteoporotic fracture that is characterized by age- and gender-dependent low bone attenuation. Ankle fracture should not be excluded from the clinical and research interest as well as from the benefit of osteoporosis management.

  3. Longitudinal stress fracture: patterns of edema and the importance of the nutrient foramen

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    Craig, Joseph G.; Widman, David; Holsbeeck, Marnix van [Department of Radiology, Henry Ford Hospital, Detroit, MI 48202 (United States)

    2003-01-01

    We reviewed the MR appearances of six cases of longitudinal stress fracture of the lower extremity.Results. One fracture was in the femur and five were in the tibia. Four of the tibial fractures showed edema starting in the mid-tibia at the level of the nutrient foramen with the fracture on the anteromedial cortex. The other tibial fracture started at the nutrient foramen. Three fractures (two tibial and the femur fracture) showed eccentric marrow edema; all fractures showed either eccentric periosteal reaction or soft tissue edema.Conclusion. Primary diagnosis of longitudinal stress fracture is made by finding a vertical cleft on one or more axial images. Secondary signs of position of the nutrient foramen and patterns of edema may be useful. (orig.)

  4. Stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture: a comparative finite element study.

    Science.gov (United States)

    Huang, Xiaowei; Zhi, Zhongzheng; Yu, Baoqing; Chen, Fancheng

    2015-11-25

    The purpose of this study is to compare the stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type IV medial tibial plateau fracture. A three-dimensional (3D) finite element model of the medial tibial plateau fracture (Schatzker type IV fracture) was created. An axial force of 2500 N with a distribution of 60% to the medial compartment was applied to simulate the axial compressive load on an adult knee during single-limb stance. The equivalent von Mises stress, displacement of the model relative to the distal tibia, and displacement of the implants were used as the output measures. The mean stress value of the plate-screw fixation system was 18.78 MPa, which was significantly (P stress value of the triangular fragment in the plate-screw fixation system model was 42.04 MPa, which was higher than that in the screw fixation model (24.18 MPa). But the mean stress of the triangular fractured fragment in the screw fixation model was significantly higher in terms of equivalent von Mises stress (EVMS), x-axis, and z-axis (P < 0.001). This study demonstrated that the load transmission mechanism between plate-screw fixation system and screw fixation system was different and the stability provided by the plate-screw fixation system was superior to the screw fixation system.

  5. Complications of close interlock nailing in the management of close tibial fracture

    International Nuclear Information System (INIS)

    Saeed, M.; Inam, M.; Khan, I.; Satar, A.; Arif, M.

    2015-01-01

    Objective: The objective of this study is to find out the frequency of complications of locally made interlock nailing in tibia after nine months of surgery. Material and Method:. This case series study was done from March 2004 to February 14 in the Department of Orthopedic and Trauma Postgraduate Medical Institute Hayatabad Medical Complex Peshawar. A total of 58 adults ( after the closure of epiphysis) patients were randomly selected provided that they have; Close diaphysial fracture of tibia which is located 7 cm below the knee joint and 4 cm above the ankle joint and fracture less than one week old. Results: Total numbers of patients were 58. Anterior Knee pain was observed in 14(24.1%), delayed union in 10(17.2%), external of 100 rotation in 4(6.9%) and internal rotation of 50 in 1(1.7%), non union in 4(6.9%), intramedullay infection in 3(5.2%), shortening of 1 centimeter (cm) in 2(3.4), 2 cm in 1(1.7%) and 1.5 cm in 3(5.2%) cases, distal screw broken in 2(3.4%), proximal screw broken in 1(1.7%), Nail broken in 2(3.4), infection at proximal screw in 2(3.4%) and at distal screw was 2(3.4%), Restriction of knee flexion in 1(1.7%), Restricted ankle movements in 1(1.7%), varus angulation of 100 in 1(1.7%), valgus angulation of 100 in 1(1.7%), Ankle pain in 1(1.7%) and deep vein thrombosis in 1(1.7%). Conclusion: interlocking nail is considered to be the gold standard for management of tibial fracture but it is not free of complication especially knee pain and angular rotation. (author)

  6. Management of paediatric tibial fractures using two types of circular external fixator: Taylor spatial frame and Ilizarov circular fixator.

    Science.gov (United States)

    Tafazal, Suhayl; Madan, Sanjeev S; Ali, Farhan; Padman, Manoj; Swift, Simone; Jones, Stanley; Fernandes, James A

    2014-05-01

    The use of circular fixators for the treatment of tibial fractures is well established in the literature. The aim of this study was to compare the Ilizarov circular fixator (ICF) with the Taylor spatial frame (TSF) in terms of treatment results in consecutive patients with tibial fractures that required operative management. A retrospective analysis of patient records and radiographs was performed to obtain patient data, information on injury sustained, the operative technique used, time duration in frame, healing time and complications of treatment. The minimum follow-up was 24 months. Ten patients were treated with ICF between 2000 and 2005, while 15 patients have been treated with TSF since 2005. Two of the 10 treated with ICF and 5 of the 15 treated with TSF were open fractures. All patients went on to achieve complete union. Mean duration in the frame was 12.7 weeks for ICF and 14.8 weeks for the TSF group. Two patients in the TSF group had delayed union and required additional procedures including adjustment of fixator and bone grafting. There was one malunion in the TSF group that required osteotomy and reapplication of frame. There were seven and nine pin-site infections in the ICF and TSF groups, respectively, all of which responded to antibiotics. There were no refractures in either group. In an appropriate patient, both types of circular fixator are equally effective but have different characteristics, with TSF allowing for postoperative deformity correction. Of concern are the two cases of delayed union in the TSF group, all in patients with high-energy injuries. We feel another larger study is required to provide further clarity in this matter. Level II-comparative study.

  7. Ultra-som pulsado de baixa intensidade em fraturas diafisárias: aplicação clínica em cães Low-intensity pulsed ultrasound in diaphyseal fractures: clinical application in dogs

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    Valéria Lima de Sousa

    2008-08-01

    Full Text Available Os efeitos da estimulação ultra-sônica sobre a consolidação óssea têm sido demonstrados por trabalhos experimentais e clínicos. Este estudo teve por objetivo investigar a aplicação clínica do ultra-som pulsado de baixa intensidade como tratamento adjuvante de fraturas diafisárias em cães. Foram utilizados 16 cães de raças variadas, com faixa etária entre sete meses e seis anos, peso corpóreo entre 2,5 e 43kg, portadores de fraturas diafisárias fechadas recentes localizadas no rádio e ulna, fêmur ou tíbia e fíbula, estabilizadas por procedimentos de osteossíntese (fixação esquelética externa, pinos intramedulares ou a associação desses métodos. Os cães foram divididos em dois grupos: fraturas estabilizadas tratadas por ultra-som de baixa intensidade (grupo tratado, n=8; fraturas estabilizadas, não tratadas por estimulação ultra-sônica, (grupo controle, n=8. Os animais foram avaliados por exames clínicos e radiográficos nos períodos pré-operatório, pós-operatório imediato e a cada 30 dias posteriores aos procedimentos cirúrgicos. Realizou-se tratamento com ultra-som pulsado (sinal senoidal com freqüência de 1,5MHz, largura de pulso de 200µs e freqüência de repetição de 1kHz de baixa intensidade (30mW cm-2, aplicado de modo estacionário no foco de fratura. A terapia ultra-sônica foi realizada 20 minutos por dia, durante 21 dias consecutivos, a partir do período compreendido entre o 1° e o 9° dia pós-operatório. O teste t de Student, empregado na análise estatística, mostrou diferença significante (PThe effects of ultrasound stimulation on bone healing have been demonstrated in experimental and clinical studies. The purpose of this study was to investigate the clinical application of low-intensity pulsed ultrasound as an adjuvant for the treatment of diaphyseal fractures in dogs. Sixteen dogs of different breeds, ages ranging from seven months to six years, weighing from 2.5 to 43kg, were

  8. Novel implant for peri-prosthetic proximal tibia fractures.

    Science.gov (United States)

    Tran, Ton; Chen, Bernard K; Wu, Xinhua; Pun, Chung Lun

    2018-03-01

    Repair of peri-prosthetic proximal tibia fractures is very challenging in patients with a total knee replacement or arthroplasty. The tibial component of the knee implant severely restricts the fixation points of the tibial implant to repair peri-prosthetic fractures. A novel implant has been designed with an extended flange over the anterior of tibial condyle to provide additional points of fixation, overcoming limitations of existing generic locking plates used for proximal tibia fractures. Furthermore, the screws fixed through the extended flange provide additional support to prevent the problem of subsidence of tibial component of knee implant. The design methodology involved extraction of bone data from CT scans into a flexible CAD format, implant design and structural evaluation and optimisation using FEM as well as prototype development and manufacture by selective laser melting 3D printing technology with Ti6Al4 V powder. A prototype tibia implant was developed based on a patient-specific bone structure, which was regenerated from the CT images of patient's tibia. The design is described in detail and being applied to fit up to 80% of patients, for both left and right sides based on the average dimensions and shape of the bone structure from a wide range of CT images. A novel tibial implant has been developed to repair peri-prosthetic proximal tibia fractures which overcomes significant constraints from the tibial component of existing knee implant. Copyright © 2018 Elsevier Ltd. All rights reserved.

  9. Midshaft clavicle fractures with associated ipsilateral acromioclavicular joint dislocations: Incidence and risk factors.

    Science.gov (United States)

    Ottomeyer, Christina; Taylor, Benjamin C; Isaacson, Mark; Martinez, Lara; Ebaugh, Pierce; French, Bruce G

    2017-02-01

    Simultaneous ipsilateral clavicle and acromioclavicular (AC) joint injury have been infrequently reported in the literature at this time. The purpose of this study was to assess incidence as well as assess risk factors for this dual injury pattern. We performed a retrospective review of a prospectively collected database (Level III evidence), evaluating 383 adult patients without previous shoulder girdle injury or trauma with a minimum 1-year follow-up who sustained a displaced diaphyseal clavicle fracture. All patients in the study underwent either nonoperative management or surgical reduction and stabilization of a diaphyseal clavicle fracture with a plate and screw construct. Study subjects were followed with serial radiographs. Clavicle and shoulder radiographs, as well as chest radiographs and contralateral films in questionable cases, were used to assess for acromioclavicular joint injury in both operative and nonoperative groups. Additional data was collected on concurrent injuries, patient demographics, fracture characteristics, fixation techniques, surgical/post-operative data, and operative or nonoperative treatment. We found that 13/183 (7.1%) of patients undergoing fixation of a diaphyseal clavicle fracture had an ipsilateral AC joint injury, while 13/200 (6.5%) of patients undergoing conservative management had an ipsilateral AC joint injury. Critical analysis of the data revealed that presence of ipsilateral scapular body fractures, and a likely incidental association with superior plating fixation, were associated with an increased rate of this injury pattern. Ipsilateral clavicle fracture and AC joint injury is much more common than traditionally believed, with an incidence of 6.8% overall. It is unknown how the presence of an associated AC injury influences outcome, as AC injury was not universally symptomatic. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Radial and tibial bone indices in athletes participating in different endurance sports: a pQCT study.

    Science.gov (United States)

    Oosthuyse, Tanja; McVeigh, Joanne A; Micklesfield, Lisa K; Meiring, Rebecca M

    2017-03-01

    Low magnitude bone-loading sports may benefit bone structure and strength in the exercised limbs. This study compared peripheral quantitative computed tomography measures of radial and tibial diaphyseal strength (strength-strain index, SSI), structure (total area (ToA) and cortical area (CoA), density (CoD) and thickness (CT), and circumferences), muscle cross-sectional area (MCSA) and strength (one-repetition maximum, 1-RM) in male endurance athletes taking part in (i) non-weight-bearing and non-impact sports: swimmers (SWIM, n = 13) and road cyclists (RC, n = 10), (ii) non-weight-bearing, impact sport: mountain bikers (MB, n = 10), (iii) weight bearing and impact sport: runners (RUN, n = 9). All athlete groups were also compared to sedentary controls (CON, n = 10). Arm MCSA, 1-RM and radial bone size and strength tended to be greater in SWIM than CON and/or RC (ToA, %difference  ± 95%CI, SWIM-CON: 14.6% ± 12.7%; SWIM-RC: 12.9% ± 10.7%) but not different to MB and RUN. RUN had bigger tibial CoA than CON, SWIM and RC (CoA, RUN-CON: 12.1% ± 10.7%; RUN-SWIM: 10.9% ± 9.4%; RUN-RC: 15.8% ± 9.5%) without marked changes in tibial strength indices, lower-limb MCSA or 1-RM. Both MB and RC failed to display any difference in tibial indices, lower-limb MCSA and 1-RM compared to CON. In swimmers, the bone structure and strength of the primary exercised limbs, the arms, is greater than controls and road cyclists. Conversely, although runners experience impact and weight-bearing loading, tibial structure is greater without a substantial difference in tibial strength compared to controls and non-impact sports. Failure to observe a difference in tibial indices in MB and RC compared to controls is unexpected.

  11. Salvage of tibial pilon fractures using fusion of the ankle with a 90 degrees cannulated blade-plate: a preliminary report.

    Science.gov (United States)

    Morgan, S J; Thordarson, D B; Shepherd, L E

    1999-06-01

    Six patients with ankle joint destruction and delayed metaphyseal union after tibial plafond fracture were surgically treated with tibiotalar arthrodesis and metaphyseal reconstruction, using a fixed-angle cannulated blade-plate. The procedure was performed through a posterior approach in five cases and a lateral approach in one case. The subtalar joint was preserved in all cases. Metaphyseal union and a stable arthrodesis were obtained in all cases without loss of fixation and with no mechanical failure of the blade-plate. Union was obtained in an average of 26 weeks. No secondary procedures were required to obtain union. All six patients were ambulatory at last follow-up. Stable internal fixation for simultaneous tibiotalar fusion and metaphyseal reconstruction can be achieved with a cannulated blade-plate while preserving the subtalar joint in complex plafond fractures.

  12. Chronic shin splints. Classification and management of medial tibial stress syndrome.

    Science.gov (United States)

    Detmer, D E

    1986-01-01

    A clinical classification and treatment programme has been developed for chronic medial tibial stress syndrome. Medial tibial stress syndrome has been reported to be either tibial stress fracture or microfracture, tibial periostitis, or distal deep posterior chronic compartment syndrome. Three chronic types exist and may coexist: Type I (tibial microfracture, bone stress reaction or cortical fracture); type II (periostalgia from chronic avulsion of the periosteum at the periosteal-fascial junction); and type III (chronic compartment syndrome syndrome). Type I disease is treated nonoperatively. Operations for resistant types II and III medial tibial stress syndrome were performed in 41 patients. Bilaterality was common (type II, 50% type III, 88%). Seven had coexistent type II/III; one had type I/II. Preoperative symptoms averaged 24 months in type II, 6 months in type III, and 33 months in types II/III. Mean age was 22 years (15 to 51). Resting compartment pressures were normal in type II (mean 12 mm Hg) and elevated in type III and type II/III (mean 23 mm Hg). Type II and type II/III patients received fasciotomy plus periosteal cauterisation. Type III patients had fasciotomy only. All procedures were performed on an outpatient basis using local anaesthesia. Follow up was complete and averaged 6 months (2 to 14 months). Improved performance was as follows: type II, 93%, type III, 100%; type II/III, 86%. Complete cures were as follows: type II, 78%; type III, 75%; and type II/III, 57%. This experience suggests that with precise diagnosis and treatment involving minimal risk and cost the athlete has a reasonable chance of return to full activity.

  13. Resultados do tratamento das fraturas da diáfise do fêmur ipsilaterais às do colo ou transtrocantérica Outcomes in treatment of diaphiseal femur fractures ipsilateral to the neck or transtrocanteric fracture

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    Nelson Astur Neto

    2010-01-01

    Full Text Available OBJETIVO: Avaliação radiográfica, funcional e das complicações do tratamento cirúrgico das fraturas diafisárias do fêmur associadas à fratura transtrocantérica ou do colo do mesmo fêmur. MÉTODOS: De 2002 a 2007 foram tratados 17 pacientes. Eram masculinos 88% e a idade média foi de 31 anos e três meses. Dez (59% apresentavam associação com fratura do colo do fêmur e sete (41% com a fratura transtrocantérica. Foram avaliados a dor residual e a amplitude de movimento articular do quadril e joelho, a consolidação radiográfica e o tipo de implante utilizado, pela avaliação atual e retrospectivamente pelo prontuário, com um seguimento médio de 48 meses. RESULTADOS: Todas as fraturas transtrocantéricas evoluíram para consolidação sem deformidade residual. Das fraturas do colo, três (30% apresentaram retardo da consolidação, e duas consolidaram em varo. Dois pacientes apresentaram retardo de consolidação da fratura diafisária. Todas as fraturas associadas trans-diáfise apresentaram resultado funcional excelente ou bom. Das associadas colo-diáfise, sete (70% apresentaram resultado funcional excelente ou bom, dois regular e um ruim. CONCLUSÃO: As fraturas associadas da diáfise do fêmur com fratura transtrocantérica apresentaram melhor resultado radiográfico e funcional com menos complicações que a associação da fratura diafisária com a fratura do colo do fêmurOBJECTIVE: To perform a radiographic and functional evaluation of the complications of diaphyseal fractures of the femur associated with ipsilateral fractures of the trochanter or the neck of the femur. METHODS: From 2002 to 2007, seventeen patients were treated, of which 88% were men, with a mean age of thirty-one years and three months. Ten (59% had associated fractures of the femoral neck and seven (41% had associated trochanteric fractures. The final range of motion of the hip and knee, the radiographic fracture consolidation, and the type of

  14. Primary diaphyseal osteosarcoma in long bones: Imaging features and tumor characteristics

    International Nuclear Information System (INIS)

    Wang, Cheng-Sheng; Yin, Qi-Hua; Liao, Jin-Sheng; Lou, Jiang-Hua; Ding, Xiao-Yi; Zhu, Yan-Bo; Chen, Ke-Min

    2012-01-01

    Objective: This study aims to assess retrospectively the imaging features of diaphyseal osteosarcoma and compare its characteristics with that of metaphyseal osteosarcoma. Materials and methods: Eighteen pathologically confirmed diaphyseal osteosarcomas were reviewed. Images of X-ray (n = 18), CT (n = 12) and MRI (n = 15) were evaluated by two radiologists. Differences among common radiologic findings of X-ray, CT and MRI, and between diaphyseal osteosarcomas and metaphyseal osteosarcomas in terms of tumor characteristics were compared. Results: The common imaging features of diaphyseal osteosarcoma were bone destruction, lamellar periosteal reaction with/without Codman triangle, massive soft tissue mass/swelling, neoplastic bone and/or calcification. CT and MRI had a higher detection rate in detecting bone destruction (P = 0.001) as compared with that of X-ray. X-ray and CT resulted in a higher percentage in detecting periosteal reaction (P = 0.018) and neoplastic bone and/or calcification (P = 0.043) as compared with that of MRI. There was no difference (P = 0.179) in detecting soft tissue mass among three imaging modalities. When comparing metaphyseal osteosarcoma to diaphyseal osteosarcoma, the latter had the following characteristics: a higher age of onset (P = 0.022), a larger extent of tumor (P = 0.018), a more osteolytic radiographic pattern (P = 0.043). Conclusion: As compared with metaphyseal osteosarcoma, diaphysial osteosarcoma is a special location of osteosarcoma with a lower incidence, a higher age of onset, a larger extent of tumor, a more osteolytic radiographic pattern. The osteoblastic and mixed types are diagnosed easily, but the osteolytic lesion should be differentiated from Ewing sarcoma. X-ray, CT and MRI can show imaging features from different aspects with different detection rates.

  15. [Magnetic resonance imaging of tibial periostitis].

    Science.gov (United States)

    Meyer, X; Boscagli, G; Tavernier, T; Aczel, F; Weber, F; Legros, R; Charlopain, P; Martin, J P

    1998-01-01

    Tibial periostitis frequently occurs in athletes. We present our experience with MRI in a series of 7 patients (11 legs) with this condition. The clinical presentation and scintigraphic scanning suggested the diagnosis. MRI exploration of 11 legs demonstrated a high band-like juxta-osseous signal enhancement of SE and IR T2 weighted sequences in 6 cases, a signal enhancement after i.v. contrast administration in 4. Tibial periostitis is a clinical diagnosis and MRI and scintigraphic findings can be used to assure the differential diagnosis in difficult cases with stress fracture. MRI can visualize juxta-osseous edematous and inflammatory reactions and an increased signal would appear to be characteristic when the band-like image is fixed to the periosteum.

  16. Ankle fracture spur sign is pathognomonic for a variant ankle fracture.

    Science.gov (United States)

    Hinds, Richard M; Garner, Matthew R; Lazaro, Lionel E; Warner, Stephen J; Loftus, Michael L; Birnbaum, Jacqueline F; Burket, Jayme C; Lorich, Dean G

    2015-02-01

    The hyperplantarflexion variant ankle fracture is composed of a posterior tibial lip fracture with posterolateral and posteromedial fracture fragments separated by a vertical fracture line. This infrequently reported injury pattern often includes an associated "spur sign" or double cortical density at the inferomedial tibial metaphysis. The objective of this study was to quantitatively establish the association of the ankle fracture spur sign with the hyperplantarflexion variant ankle fracture. Our clinical database of operative ankle fractures was retrospectively reviewed for the incidence of hyperplantarflexion variant and nonvariant ankle fractures as determined by assessment of injury radiographs, preoperative advanced imaging, and intraoperative observation. Injury radiographs were then evaluated for the presence of the spur sign, and association between the spur sign and variant fractures was analyzed. The incidence of the hyperplantarflexion variant fracture among all ankle fractures was 6.7% (43/640). The spur sign was present in 79% (34/43) of variant fractures and absent in all nonvariant fractures, conferring a specificity of 100% in identifying variant fractures. Positive predictive value and negative predictive value were 100% and 99%, respectively. The ankle fracture spur sign was pathognomonic for the hyperplantarflexion variant ankle fracture. It is important to identify variant fractures preoperatively as patient positioning, operative approach, and fixation construct of variant fractures often differ from those employed for osteosynthesis of nonvariant fractures. Identification of the spur sign should prompt acquisition of advanced imaging to formulate an appropriate operative plan to address the variant fracture pattern. Level III, retrospective comparative study. © The Author(s) 2014.

  17. Results of Patello-Tibial Cerclage Wire Technique for Comminuted Patella Fractures Treated with Partial Patellectomy

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    Ender Alagöz

    2014-12-01

    Full Text Available Aim: Partial patellectomy and patellotibial cerclage technique used in comminuted inferior pole patellar fractures were evaluated and the results were discussed. Methods: Thirteen patients who have undergone partial distal patellar excision were evaluated in the study. In all patients, the inferior pole of the patella was resected, patellar tendon was sutured to the proximal patellar fragment and patellotibial cerclage was performed. At the last visit, the patients were evaluated using measurement of the distance between the superior pole of the patella and the tibial tubercle, the Lysholm knee scoring scale, knee range of motion and thigh circumference measurement. Results: The mean flexion value was 131.10 (±4.6 in normal knees and 117.20 (±8.0 in operated knees. The mean thigh diameter was 49.5 (±3.7 cm and 46.4 (±4.5 cm in normal knees and in operated knees, respectively. The mean Lysholm knee score in the patient group was 84.3 (±17.1 points. The mean distance between the superior pole of the patella and the tibial tubercle was 10.6 (±1.0 cm in normal knees and 10.1 (±1.2 cm in operated knees. The exstensor mechanism was intact in all patients and no revision surgery was performed. Conclusion: Patellotibial cerclage technique performed after partial patellectomy permits early motion and protects patients from harmful effects of immobilization; and good functional results are obtained if patients start early knee motion.

  18. Value of lateral blood pool imaging in patients with suspected stress fractures of the tibia.

    Science.gov (United States)

    Mohan, Hosahalli K; Clarke, Susan E M; Centenara, Martin; Lucarelli, Amanda; Baron, Daniel; Fogelman, Ignac

    2011-03-01

    To critically evaluate the use of lateral blood pool imaging in athletes with lower limb pain and with a clinical suspicion of stress fracture. Two experienced nuclear medicine physicians evaluated 3-phase bone scans using 99mTc-methylene diphosphonate performed in 50 consecutive patients referred from a specialist sports injury clinic for suspected tibial stress fracture. The vascularity to the tibia as seen on the blood pool (second phase) images in the anterior/posterior views was compared with the lateral/medial view assessments. Stress fractures were presumed to be present when on the delayed images (third phase) there was a focal or fusiform area of increased tracer uptake involving the tibial cortex. Shin splints which are a recognized cause of lower limb pain in athletes mimicking stress fracture were diagnosed if increased tracer uptake was seen extending along the posterior tibial surface with no significant focal or fusiform area of uptake within this. Inter-reviewer agreement for the assessment of vascularity was also assessed using Cohen's Kappa scores. Twenty-four stress fractures in 24 patients and 66 shin splints in 40 patients were diagnosed. In 18 patients stress fracture and shin splints coexisted. In 10 patients no tibial pathology was identified. Of the 24 patients diagnosed with stress fractures, lateral/medial blood pool imaging was superior in the assessment of blood pool activity (P tibial stress fractures, lateral views of the tibia provide the optimal method for evaluation of vascularity. Prospective studies with quantitative or semi-quantitative assessment of skeletal vascularity could provide supplementary information relating to the pathophysiology of stress fractures, for example, the time scale of vascular changes after a tibial stress fracture, and potentially could have clinical relevance as to the assessment of the severity of stress fractures and their prognosis.

  19. Use of Titanium Elastic Nails in the Adult Diaphyseal Humerus Fractures

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    Upadhyay AS

    2017-07-01

    Full Text Available INTRODUCTION: Humerus shaft fractures in adults can be managed conservatively with functional braces or operatively with plate osteosynthesis or with intramedullary nailing. Conventionally humerus intramedullary nailing is done either using humerus interlocking nails or Enders nails. In this study we analyse the outcome of humerus shaft fractures (upper and middle third managed with closed ante- grade intramedullary titanium elastic nailing in terms of union rates, union time, functional results and complications. MATERIALS AND METHODS: A retrospective analysis of 25 patients treated with ante-grade intramedullary titanium elastic nailing was done during the period of August 2014 to June 2016 at our tertiary care centre. Skeletally mature patients with closed and acute fractures of the upper and middle shaft humerus of both sexes were included in the study. RESULTS: Twenty-five (100% fractures united with an average consolidation time of 14.98 weeks (10-32 weeks, and no fractures ended in non-union. Nail impingement was seen in two (8%, shoulder stiffness in one (4%. Functional results were excellent in 22 (88%, moderate in two (8% and poor in one (4%. There were 17 males and eight females with an average age of 39.08 years (range: 18-65 years. The average duration of hospital stay was 3.84±2.30 days. CONCLUSION: Closed ante-grade intramedullary titanium elastic nailing offers a safe and reliable method of fixing fractures of upper humeral shaft in adults. This method provides early fracture union, high union rates and less complications, in addition to early rehabilitation and reduces the hospital stay.

  20. Tibiofibula Transposition in High-Energy Fractures

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    Peter R. Loughenbury

    2016-01-01

    Full Text Available We report two cases of failed attempts at closed reduction of high-energy tibial fractures with an associated fibula fracture. The first case was a 39-year-old male involved in high-speed motorbike collision, while the second was a 14-year-old male who injured his leg following a fall of three metres. Emergency medical services at the scenes of the accidents reported a 90-degree valgus deformity of the injured limb and both limbs were realigned on scene and stabilized. Adequate alignment of the tibia could not be achieved by manipulation under sedation or anaesthesia. Open reduction and exposure of the fracture sites revealed that the distal fibula fragment was “transposed” and entrapped in the medulla of the proximal tibial fragment. Reduction required simulation of the mechanism of injury in order to disengage the fragments and allow reduction. Tibiofibula transposition is a rare complication of high-energy lower limb fractures which has not previously been reported and may prevent adequate closed reduction. Impaction of the distal fibula within the tibial medulla occurs as the limb is realigned by paramedic staff before transfer to hospital. We recommend that when this complication is identified the patient is transferred to the operating room for open reduction and stabilization of the fracture.

  1. Treatment of open tibial fracture with bone defect caused by high velocity missiles: A case report

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    Golubović Zoran

    2013-01-01

    Full Text Available Introduction .Tibia fracture caused by high velocity missiles is mostly comminuted and followed by bone defect which makes their healing process extremely difficult and prone to numerous complications. Case Outline. A 34-year-old male was wounded at close range by a semi-automatic gun missile. He was wounded in the distal area of the left tibia and suffered a massive defect of the bone and soft tissue. After the primary treatment of the wound, the fracture was stabilized with an external fixator type Mitkovic, with convergent orientation of the pins. The wound in the medial region of the tibia was closed with the secondary stitch, whereas the wound in the lateral area was closed with the skin transplant after Thiersch. Due to massive bone defect in the area of the rifle-missile wound six months after injury, a medical team placed a reconstructive external skeletal fixator type Mitkovic and performed corticotomy in the proximal metaphyseal area of the tibia. By the method of bone transport (distractive osteogenesis, the bone defect of the tibia was replaced. After the fracture healing seven months from the secondary surgery, the fixator was removed and the patient was referred to physical therapy. Conclusion. Surgical treatment of wounds, external fixation, performing necessary debridement, adequate antibiotic treatment and soft and bone tissue reconstruction are essential in achieving good results in patients with the open tibial fracture with bone defect caused by high velocity missiles. Reconstruction of bone defect can be successfully treated by reconstructive external fixator Mitkovic. [Projekat Ministarstva nauke Republike Srbije, br. III 41017 i br. III 41004

  2. An Incidental Finding of a Talonavicular and Talocalcaneal Joint Coalition After a Tibial Pilon Fracture: A Case Report.

    Science.gov (United States)

    Godoy, Heidi M; Micciche, Mark J

    It has been proposed that patients with talocalcaneal and talonavicular coalitions have decreased ankle joint range of motion. It has also been reported that rotational forces regularly absorbed by the talocalcaneal joint are transferred to the ankle joint in patients with coalitions, increasing the stress on the ankle joint after trauma. To the best of our knowledge, only 1 reported study has detailed the increased stress placed on the ankle joint secondary to a coalition. We present a case study of a 53-year-old female who experienced a traumatic fall and subsequent right ankle fracture. Advanced imaging studies revealed a comminuted tibial pilon fracture and talocalcaneal and talonavicular joint coalitions. She underwent open reduction and internal fixation for treatment of the fracture, and the coalitions were not treated because they were asymptomatic. She was kept non-weightbearing for 6 weeks postoperatively and was returned to a regular sneaker at 10 weeks postoperatively. The postoperative films revealed stable intact fixation and pain-free gait with no increased restriction in her ankle joint range of motion. The hardware was removed at 13 months postoperatively. She had not experienced increased pain or arthritic changes at 15 months postoperatively. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Treatment of Patellar Lower Pole Fracture with Modified Titanium Cable Tension Band Plus Patellar Tibial Tunnel Steel "8" Reduction Band.

    Science.gov (United States)

    Li, Jiaming; Wang, Decheng; He, Zhiliang; Shi, Hao

    2018-01-08

    To determine the efficacy of modified titanium tension band plus patellar tendon tunnel steel 8 "reduction band" versus titanium cable tension band fixation for the treatment of patellar lower pole fracture. 58 patients with lower patella fracture were enrolled in this study, including 30 patients treated with modified titanium cable tension band plus patellar tibial tunnel wire "8" tension band internal fixation (modified group), and 28 patients with titanium cable tension band fixation. All patients were followed up for 9∼15 months with an average of 11.6 months. Knee flexion was significantly improved in the modified group than in the titanium cable tension band group (111.33 ± 13 degrees versus 98.21 ± 21.70 degrees, P = 0.004). The fracture healing time showed no significant difference. At the end of the follow-up, the improvement excellent rate was 93.33% in the modified group, and 82.14% in the titanium cable tension band group. Titanium cable tension band internal fixation loosening was found in 2 cases, including 1 case of treatment by two surgeries without loose internal fixation. The modified titanium cable tension band with "8" tension band fixation showed better efficacy for lower patella fractures than titanium cable tension band fixation.

  4. External fixation of the metacarpal fracture with transcortical pins and fiberglass east in Simmental calf

    International Nuclear Information System (INIS)

    Martins, E.A.N.; Camargo, L.M.

    2003-01-01

    A six-month-old 245 kg male Simmental calf was referred to the Veterinary Hospital in Cuiabá, MT, with closed comminuted diaphyseal fracture in metacarpus. It was given preference to external fixation as means of fracture immobilization, and transcortical pins and fiberglass cast were used. This technique showed effective immobilization of the fracture, less expensive and feasible to be done in the field [pt

  5. Tibial torsion in non-arthritic Indian adults: A computer tomography study of 100 limbs

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    Mullaji Arun

    2008-01-01

    Full Text Available Background: Knowledge of normal tibial torsion is mandatory during total knee replacement (TKR, deformity correction and fracture management of tibia. Different values of tibial torsion have been found in different races due to biological and mechanical factors. Value of normal tibial torsion in Indian limbs is not known, hence this study to determine the norm of tibial torsional value in normal Indian population. Materials and Methods: Computer tomography (CT scans were performed in 100 non-arthritic limbs of 50 Indian adults (42 males, eight females; age 26-40 years. Value of tibial torsion was measured using dorsal tangent to tibial condyles proximally and bimalleolar axis distally. Results: Normal tibial torsion was found to be 21.6 ± 7.6 (range 4.8 to 39.5 with none of the values in internal rotation. Right tibia was externally rotated by 2 degrees as compared to the left side ( P 0.029. No significant difference was found in male and female subjects. Value of tibial torsion was less than in Caucasian limbs, but was comparable to Japanese limbs when studies using similar measurement technique were compared. Conclusions: Indian limbs have less tibial torsion than Caucasian limbs but the value of tibial torsion is comparable to Japanese limbs.

  6. [Correlation between morphogical factor of lateral plateau fracture and meniscus injury].

    Science.gov (United States)

    Bai, L; Zhou, W; Zhang, W T; Huang, W; You, T; Chen, P; Zhang, H L

    2016-04-18

    To analyze morphological character of lateral tibial plateau fracture fragment, and its correlation to the presence of a meniscus injury in tibial plateau fractures. A total of 79 consecutive patients of the simple lateral tibial plateau fractures from July 2011 to July 2015 were included in this study, with 65 males and 14 females with an average age of (34.3±7.2) years and 22-61 years. According to Schatzker classification, 21 cases were of Type I, 41 cases Type II, and 17 cases Type III. The characteristics of lateral tibial plateau fractures were evaluated by plain X-ray and magnetic resonance imaging (MRI). The type and severity of meniscus injury were diagnosed by MRI scan. Three-dimensional measurements of the lateral fragment width (LFW), the lateral plateau depression (LPD), the coronal angulation of lateral fragment (CALF), and tibial plateau widening (TPW) were measured with Picture Archiving and Communication Systems(PACS) software. The patients with and without meniscus injuries were divided into different groups and analyzed respectively. Comparison of the above measurements between the two groups was analyzed by independent t test. In all the 79 lateral tibial plateau fracture patients, 26 cases (32.9%) of meniscus injuries were detected by MRI. Among all the meniscus injury cases, 3 were of Schatzker I, 16 Schatzker II, and 7 Schatzker III. In meniscus intact group, the average LFW was (22.0±2.8) mm while in meniscus injury group it was (21.3± 3.3) mm (t=-1.008, P=0.317).The average LPD of non meniscus injury group was (5.4±2.8) mm, while in meniscus injury group was (8.7±2.8) mm (t=4.98, P=0.001). The average CALF of the two groups were 9.1°±6.1°and 10.6°± 7.1°, and there was no significant difference between the two groups (t=0.38, P=0.831). The average TPW was (3.0± 1.1) mm, and (4.8±1.7) mm of the two groups. There were significant differences between the two groups (t=5.216, P=0.001). There was no obvious correlation between the

  7. Ostosintesis of low profile in the treatment of the fractures of the tibial pylon

    International Nuclear Information System (INIS)

    Agudelo R, Juan Fernando; Kalb H, Juan Pedro

    2001-01-01

    The preliminary results are presented, among January 1999 - September 2000, in the General Hospital of Medellin - Clinica Leon XIII. Eight cases were revised of patient with intraarticular fractures of the tibial pylon, treaties with open reduction and osteosintesis of low profile following the modified protocol of Ruedi-Allgower, with the objective of describing the quality of the reduction and the postoperative complications. The data were obtained of the clinical history and personal interview with the patients. The time of pursuit average was of 5,2 months. Of the eight fractures, seven (87.5%) they were consequence of accidents of traffic and one for firearm projectile. Two fractures were presented type I (25%), three type II (37.5%) and three type III (37.5%), according to the classification of Ruedi-Allgower. The surgery was carries out on the average to the 13.4 days. In all the cases it uses traction transcalcanea intraoperative; six patients required osteosintesis of the fibula: The plaques of low profile in tibia were modeled to the anterolateral surface to diminish the medial desperiostization. In six cases the quality of the radiological reduction was good according to the approaches of Burwell and Charnley in one to regulate and in one bad. In all the cases it begins passive and active rehabilitation after the first week and the support was restricted by three months. In two cases superficial dehiscence of the surgical wound those were presented, which they evolved satisfactorily, and a case of asintomatic no union has not required reintervention. The results suggest that the osteosintesis of low profile is a sure method of treatment of these lesions if it is carried out when the conditions of soft tissues are good and the medial desperiostization is limited

  8. Delayed flap reconstruction with vacuum-assisted closure management of the open IIIB tibial fracture.

    Science.gov (United States)

    Hou, Zhiyong; Irgit, Kaan; Strohecker, Kent A; Matzko, Michelle E; Wingert, Nathaniel C; DeSantis, Joseph G; Smith, Wade R

    2011-12-01

    Vacuum-assisted closure (VAC) therapy has been shown to be effective at reducing bacterial counts in wounds until definitive bony coverage. However, there is continued debate over timing and type of definitive wound coverage even with VAC therapy application. From 2004 to 2009, 32 patients with Gustilo type IIIB open tibia fractures were initially treated with VAC therapy were included. The number of debridements, length of treatment with VAC dressing, definitive wound coverage management, and length of hospital stay, flap-related complications, and time to radiographic fracture healing were recorded. The mean Injury Severity Score was 17.3 ± 2.0. All wounds closed after being treated with the primary VAC closure. The mean interval between the initial injury and definitive intervention was 10.9 days ± 0.3 days. Twenty of 27 patients (74%) underwent rotational muscle flaps; four received free muscle flaps and three only with split-thickness skin grafts for definitive wound coverage. Nine of 32 patients (28%) underwent below knee amputation, five without flap coverage after several VAC sessions and four after definitive flap coverage. The average time to union was 10.0 months ± 2.0 months. Eight patients developed nonunion and 11 patients developed infections. The average follow-up time is 2.4 years ± 0.2 years. Patients were divided into two groups for analysis according to the interval time. The rate of infection was significantly increased in patients who had an interval of more than 7 days from the time of injury to flap coverage. The VAC therapy may help to reduce the flap size and need for a flap transfer for type IIIB open tibial fractures. However, prolonged periods of VAC usage, greater than 7 days, should be avoided to reduce higher infection and amputation risks.

  9. Advantage and limitations of a minimally-invasive approach and early weight bearing in the treatment of tibial shaft fractures with locking plates.

    Science.gov (United States)

    Adam, P; Bonnomet, F; Ehlinger, M

    2012-09-01

    Intramedullary nailing is a common method of treating tibial shaft fractures. However, precise control of reduction at the proximal and distal quarters is difficult to achieve. The purpose of this study was to assess the results of plating using locking screws and the feasibility of a minimally-invasive approach. All patients with tibial shaft fracture treated by means of locking plates from January 2004 to October 2006. Thirty-two fractures were treated in 32 patients with a mean age of 43.8 years. Internal fixation with a locking plate and screw construct, using a minimally-invasive or standard approach. Surgical approach, time to weight bearing, complications and their type, time to bone union, alignment in the frontal and sagittal planes on anteroposterior and lateral radiographs. The minimally-invasive approach was performed in 28 cases and immediate full weight bearing allowed in 25 cases. At a mean follow-up of 27 months, two patients had died and two patients were lost to follow-up. The mean time to bone union was 9.1 weeks. Four cases had a complicated course: one infection, one compartment syndrome, one hardware breakage and one pseudarthrosis. Six cases ended up with valgus malunion exceeding 5° in the frontal plane, already present at the time of surgery. Where a minimally-invasive approach can be performed, immediate pain-free weight bearing can be allowed without further displacement at follow-up. The observed rate of malunion underlines the need for adequate reduction and shows that the rationale for success does not solely depend on the plate anatomic design but also on the skills of the operating surgeon. Level I university regional hospital Cohort study. Copyright © 2012. Published by Elsevier Masson SAS.

  10. MULTIPLE DAMAGE OF THE TIBIAL POLYETHYLENE INSERT IN KNEE JOINT PROSTHESIS (CAN EXCELLENT POSTOPERATIVE OUTCOME BE THE CAUSE OF FRACTURE OF THE TIBIAL INSERT? CASE REPORT AND LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    E. Song

    2016-01-01

    Full Text Available Despite improvements in prosthesis technology and use of high-quality materials in recent years, the number of revisions related to implant failures (4.7% remains high. Several phenomena were reported in literature as reasons for dislocation and fracture of tibial insert in mobile bearing prosthesis: incorrect positioning of components, discrepancy of extension and flexion balancing or ligament weakness. However, in our cases neither of these causes were observed. The authors consider that bio-physiological and biomechanical aspects of total knee arthroplasty and knee joint prosthesis should be thoroughly studied and implemented into the clinical practice. In the described cases, multiple damage of the insert due to flexion instability and “twist-hyperflexion” in overweight patients is perceived as the reason for failures.

  11. Reconstruction of malunited diaphyseal fractures of the forearm

    OpenAIRE

    Jayakumar, Prakash; Jupiter, Jesse B

    2014-01-01

    The forearm is a complex anatomical and functional unit with unique osseous, soft tissue and articular relationships. Disruption of these important relations can have a significant impact, leading to pain, instability of the radio-ulnar articulation and reduced range of motion. The gold standard for treating forearm fractures in adults remains anatomic reduction, stable plate fixation and preservation of the surrounding blood supply. Failure to achieve these goals may lead to malunion, requir...

  12. Tibial valgus aperture osteotomy

    International Nuclear Information System (INIS)

    De los Rios G, Adolfo Leon; Saavedra Abadia, Adolfo Leon; Palacios, Julio

    2005-01-01

    This study is based on work carried out a The knee clinic at the arthroscopic surgery unit of the Institute of osteo-articular diseases, Imbanaco Medical Centre, The University Hospital of the Valle (Cali-Colombia) and The Fractures Clinic Ltd. (Palmira-Valle). This is a descriptive study, which demonstrates very positive outcomes for aperture osteotomy, without detracting from the importance of, and the progress made in uni-compartmental and total joint articular replacements of the knee. 10 patients were treated with a highs tibial open osteotomy between November 1988 and December 2002: 3 had post-traumatic deformities, without arthrosic alterations; 1 had pseudo-arthrosis caused by a failed corrective procedure; 1 had complex instability of the knee with osseous varus; 6 had a degenerative lesion of the medial meniscus with medial condral alterations. Follow-up was form 12 to 54 months. Treatment involved a tibial valgus aperture osteotomy and osteo-synthesis. Evaluation was carried out using the International Knee Documentation Committee (IKDC) scale, the For Special Surgery and The Knee Society Score

  13. An unusual stress fracture: Bilateral posterior longitudinal stress fracture of tibia

    OpenAIRE

    Malkoc, Melih; Korkmaz, Ozgur; Ormeci, Tugrul; Oltulu, Ismail; Isyar, Mehmet; Mahirogulları, Mahir

    2014-01-01

    INTRODUCTION Stress fractures (SF) occur when healthy bone is subjected to cyclic loading, which the normal carrying range capacity is exceeded. Usually, stress fractures occur at the metatarsal bones, calcaneus, proximal or distal tibia and tends to be unilateral. PRESENTATION OF CASE This article presents a 58-year-old male patient with bilateral posterior longitudinal tibial stress fractures. A 58 years old male suffering for persistent left calf pain and decreased walking distance for las...

  14. Ilizarov fixator in management of nonunited and infected tibial shaft fractures

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    Abhinay Singh

    2015-01-01

    Full Text Available Background: Management of nonunion with bony defect and infection in long bones is a challenging problem for orthopedic surgeons. Objectives: Evaluation of Ilizarov circular fixation method of treatment for the management of nonunited and infected fractures of tibia. Materials and Methods: This prospective study was conducted in a tertiary care hospital of eastern region of India on 30 subjects in a time span of 3 years after taking clearance of the Institutional Ethical Committee and informed consent of the patients. Results: All the patients had infected nonunion before undergoing Ilizarov procedure. Following initial injury, 22 patients were treated with external fixation and 8 cases were treated with internal fixation. At the time of presentation, 18 patients had infected gap nonunion, 5 patients had infected hypertrophic and 2 patients had atrophic nonunion. The Ilizarov fixator was kept for an average period of 303.7 days. Based on Association for the Study and Application of Methods of Ilizarov scoring system, bony and functional results were assessed. The bony result was excellent in 16 patients, good in eight, fair in four and poor in two. The functional result was excellent in 10 patients, good in 16, fair in two, poor in two. Conclusion: Ilizarov ring fixator still remains an excellent treatment modality for tibial nonunion with a defect, regarding bone union, deformity correction, infection eradication, limb-length achievement, and limb function.

  15. WhatsApp Messenger is useful and reproducible in the assessment of tibial plateau fractures: inter- and intra-observer agreement study.

    Science.gov (United States)

    Giordano, Vincenzo; Koch, Hilton Augusto; Mendes, Carlos Henrique; Bergamin, André; de Souza, Felipe Serrão; do Amaral, Ney Pecegueiro

    2015-02-01

    The aim of this study was to evaluate the inter- and intra-observer agreement in the initial diagnosis and classification by means of plain radiographs and CT scans of tibial plateau fractures photographed and sent via WhatsApp Messenger. The increasing popularity of smartphones has driven the development of technology for data transmission and imaging and generated a growing interest in the use of these devices as diagnostic tools. The emergence of WhatsApp Messenger technology, which is available for various platforms used by smartphones, has led to an improvement in the quality and resolution of images sent and received. The images (plain radiographs and CT scans) were obtained from 13 cases of tibial plateau fractures using the iPhone 5 (Apple Inc., Cupertino, CA, USA) and were sent to six observers via the WhatsApp Messenger application. The observers were asked to determine the standard deviation and type of injury, the classification according to the Schatzker and the Luo classifications schemes, and whether the CT scan changed the classification. The six observers independently assessed the images on two separate occasions, 15 days apart. The inter- and intra-observer agreement for both periods of the study ranged from excellent to perfect (0.75WhatsApp Messenger. The authors now propose the systematic use of the application to facilitate faster documentation and obtaining the opinion of an experienced consultant when not on call. Finally, we think the use of the WhatsApp Messenger as an adjuvant tool could be broadened to other clinical centres to assess its viability in other skeletal and non-skeletal trauma situations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. Stress fractures in military training

    International Nuclear Information System (INIS)

    Jofre, M.J.; Sierralta, M.P.

    2002-01-01

    During military training, the incidence of overuse injuries like stress fractures increase. The aim of the study was to investigate the utility of bone scan in a military population with clinical suspected stress fractures or periostitis. Material and methods: A three-year retrospective analysis was made on patients who were clinically diagnosed with stress fractures at the Military Hospital Nuclear Medicine Department. Thirty-seven patients were studied (mean age 23. +/- 8 y.o; 31 males), 28 cases of which (76%) had tibial stress syndrome. Other localizations were lumbar spine, femoral, fibular, tarsal or metatarsal. Bone scintigraphy was performed injecting 1036 MBq of Tc99m-MDP i.v. Whole body images and lateral projections of lower extremities were done. Results: Bone scan in tibial syndrome was positive for 23 cases (82%), 65% of them were bilateral and 13% also had femoral injuries. X-rays were done in 10 cases and were all negative. In other localizations, the bone scans were negative, but demonstrated other degenerative lesions. All stress fractures were conservatively treated with non-steroidal anti-inflammatories and suspension of physical activity. Conclusions: Bone scan is a reliable confirmatory tool for tibial stress syndrome diagnosis. In addition, it helps to determine both the severity and extension of the injury as well as support the indication of rest in the military population

  17. Stress fractures in military training

    Energy Technology Data Exchange (ETDEWEB)

    Jofre, M J; Sierralta, M P [Military Hospital Nuclear Medicine Department, Santiago (Chile)

    2002-09-01

    During military training, the incidence of overuse injuries like stress fractures increase. The aim of the study was to investigate the utility of bone scan in a military population with clinical suspected stress fractures or periostitis. Material and methods: A three-year retrospective analysis was made on patients who were clinically diagnosed with stress fractures at the Military Hospital Nuclear Medicine Department. Thirty-seven patients were studied (mean age 23. +/- 8 y.o; 31 males), 28 cases of which (76%) had tibial stress syndrome. Other localizations were lumbar spine, femoral, fibular, tarsal or metatarsal. Bone scintigraphy was performed injecting 1036 MBq of Tc99m-MDP i.v. Whole body images and lateral projections of lower extremities were done. Results: Bone scan in tibial syndrome was positive for 23 cases (82%), 65% of them were bilateral and 13% also had femoral injuries. X-rays were done in 10 cases and were all negative. In other localizations, the bone scans were negative, but demonstrated other degenerative lesions. All stress fractures were conservatively treated with non-steroidal anti-inflammatories and suspension of physical activity. Conclusions: Bone scan is a reliable confirmatory tool for tibial stress syndrome diagnosis. In addition, it helps to determine both the severity and extension of the injury as well as support the indication of rest in the military population.

  18. Simultaneous bilateral tibal tubercle avulsion: A rare fracture

    Directory of Open Access Journals (Sweden)

    Hasan Metineren

    2013-12-01

    Full Text Available Tibial tuberosity avulsion is a rare fracture in adolescence.Due to the shear forces on the immature epiphysis. Thirteenyears old girl was admitted to the emergency departmentwith knee pain and tenderness in both knees afterjumping from a height of about one meter. İn examinationshe had tenderness and swelling over both tibial tuberosities.The patient could not do active knee extension. TypeIIA fracture on the left and type IIIA fracture on the rightknee were detected. For the patient’s fractures, closedreduction and fixation with 3 smooth Kirschner wires wasperformed. After immobilization in long-leg brace for threeweeks the brace was removed and she include in therehabilitation program. In this report, we discuss similarcases in the literature and the results of the treatment appliedto our patient.Key words: Tuberositas tibia, avulsion fracture, percutaneouspinning

  19. Staphylococcal diaphyseal subacute osteomyelitis of the ulna in a child: an unusual cause of post-traumatic forearm swelling.

    LENUS (Irish Health Repository)

    Kearns, S R

    2004-01-01

    Paediatric subacute osteomyelitis (SAO) presents a diagnostic and therapeutic challenge to clinicians. Typically located in the metaphysis of long bones, diaphyseal SAO of the upper limb is rare. We present the case of a three-year-old girl referred to our fracture clinic as an occult fracture following trauma to her forearm with normal initial radiographs. Follow-up radiographs one week later showed cortical erosion of the distal ulna, while a subsequent MRI scan showed soft tissue swelling with an area of high signal in the distal ulna. A limited biopsy diagnosed staphylococcal subacute osteomyelitis of the ulna. The patient responded to high dose antibiotic therapy and made a full recovery. We present this case to highlight the high index of suspicion required to diagnose and appropriately manage this insidious condition, which may easily be confused with any number of benign and malignant bony lesions and provide a review of the relevant literature.

  20. Posterior Cruciate Ligament Tibial Avulsion treated with Open Reduction and Internal Fixation through the Burks and Schaffer Approach

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    Khatri K

    2015-07-01

    Full Text Available Objective: To report functional outcome in Posterior Cruciate Ligament (PCL tibial avulsion fractures treated with open reduction and internal fixation through Burks and Schaffer approach. The patient specific functional outcome measures like IKDC grading together with objective grading with stress radiographs have rarely been used to assess PCL tibial avulsion fractures. Material and Methods: Twenty seven patients (21 males and 6 females were included in the study. The mean follow up duration was 22.30±6.82 months. They were assessed using international knee documentation committee (IKDC grades, Lysholm scoring and stress radiography. The injury severity scores (ISS of the patients were also recorded. Results: The mean Lysholm scores at the time of last follow up was 90.85±5.58. The IKDC grades achieved were normal in 20 patients, near normal in five and abnormal in two. The PCL laxity determined on active hamstring contraction stress radiography was grade I in 20 cases and grade II in seven cases. All patients had achieved bony union of tibial avulsion fractures at the time of last follow up. Statistically significant association was found between higher ISS and lower Lysholm scores. (t=3.455, p=0.0019. Good IKDC grades were associated with higher Lysholm scores (analysis of variance, F=32.51, p<.0001.There was no correlation between PCL laxity and functional outcome (t=.857, p =0.399. Conclusion: PCL tibial avulsion fractures treated through Burk and Schaffer approach with open reduction and internal fixation produces good results. The early rehabilitation without cast immobilisation prevents arthrofibrosis.

  1. Complex tibial plateau fractures treated by hybrid external fixation system: A correlation of followup computed tomography derived quality of reduction with clinical results

    Directory of Open Access Journals (Sweden)

    Konstantinos Kateros

    2018-01-01

    Full Text Available Background: Tibial plateau fractures are common due to high energy injuries. The principles of treatment include respect for the soft tissues, restoring the congruity of the articular surface and reduction of the anatomic alignment of the lower limb to enable early movement of the knee joint. There are various surgical fixation methods that can achieve these principles of treatment. Recognition of the particular fracture pattern is important, as this guides the surgical approach required in order to adequately stabilize the fracture. This study evaluates the results of the combined treatment of external fixator and limited internal fixation along with the advantages using postoperative computed tomography (CT scan after implant removal. Materials and Methods: 55 patients with a mean age of 42 years (range 17–65 years with tibial plateau fracture, were managed in our institution between October 2010 and September 2013., Twenty fractures were classified as Schatzker VI and 35 as Schatzker V. There were 8 open fractures (2 Gustilo Anderson 3A and 6 Gustilo Anderson 2. All fractures were treated with closed reduction and hybrid external fixation (n = 21/38.2% or with minimal open reduction internal fixation and a hybrid system (n = 34/61.8%. After the removal of the fixators, CT-scan was programmed for all the cases, for correlation with the results. At final followup, the American Knee Society Score (AKSS was administered. Results: All patients were evaluated with a minimum of 12 months (range 12–21 months followup. Average time to union was 15.5 weeks (range 13–19 weeks. The postoperative joint congruity as evaluated in the postoperative CT-scan was 5° in 19 cases (35%. Patients with residual joint depression 4.5 mm displayed a 100% chance of getting poor-fair scores both in AKSS knee and AKSS function score. The association of a postoperative mechanical axis within 5° of the contralateral limb and improved knee scores was statistically

  2. Traumatic Foot Fractures in Hard Working Donkeys

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    M.A. Semieka

    2012-10-01

    Full Text Available The present study was carried out on 45 hard working donkeys suffering from different types of traumatic foot fractures. These animals were selected from the clinical cases admitted to the Veterinary Teaching Hospital, Assiut University during the period of 2007-2010. Based on history, clinical signs and radiographic examination, various types of traumatic foot fractures were diagnosed and recorded. These fractures were affect metacarpal bones (N. =16, metatarsal bones (N. =9, proximal phalanx (N. = 13, middle phalanx (N. = 3, distal phalanx (N. = 2 and proximal sesamoid bones (N. = 2. It could be concluded that fractures of the large metacarpal bones are the most common types followed by fractures of the proximal phalanx of the thoracic limb then fractures of the metatarsal bones. Fractures of the middle phalanx, distal phalanx and proximal sesamoid bone are less common in donkeys. Single fractures of the metacarpal and metatarsal bones are more common than comminuted one, in addition diaphyseal fractures of these bones are more common than metaphyseal or epiphyseal fractures. In the proximal phalanx, comminuted fractures are more common than single fractures.

  3. Novel management of distal tibial and fibular fractures with Acumed fibular nail and minimally invasive plating osteosynthesis technique: A case report.

    Science.gov (United States)

    Wang, Tie-Jun; Ju, Wei-Na; Qi, Bao-Chang

    2017-03-01

    Anatomical characteristics, such as subcutaneous position and minimal muscle cover, contribute to the complexity of fractures of the distal third of the tibia and fibula. Severe damage to soft tissue and instability ensure high risk of delayed bone union and wound complications such as nonunion, infection, and necrosis. This case report discusses management in a 54-year-old woman who sustained fractures of the distal third of the left tibia and fibula, with damage to overlying soft tissue (swelling and blisters). Plating is accepted as the first choice for this type of fracture as it ensures accurate reduction and rigid fixation, but it increases the risk of complications. Closed fracture of the distal third of the left tibia and fibula (AO: 43-A3). After the swelling was alleviated, the patient underwent closed reduction and fixation with an Acumed fibular nail and minimally invasive plating osteosynthesis (MIPO), ensuring a smaller incision and minimal soft-tissue dissection. At the 1-year follow-up, the patient had recovered well and had regained satisfactory function in the treated limb. The Kofoed score of the left ankle was 95. Based on the experience from this case, the operation can be undertaken safely when the swelling has been alleviated. The minimal invasive technique represents the best approach. Considering the merits and good outcome in this case, we recommend the Acumed fibular nail and MIPO technique for treatment of distal tibial and fibular fractures.

  4. Ballistic fractures: indirect fracture to bone.

    Science.gov (United States)

    Dougherty, Paul J; Sherman, Don; Dau, Nathan; Bir, Cynthia

    2011-11-01

    Two mechanisms of injury, the temporary cavity and the sonic wave, have been proposed to produce indirect fractures as a projectile passes nearby in tissue. The purpose of this study is to evaluate the temporal relationship of pressure waves using strain gauge technology and high-speed video to elucidate whether the sonic wave, the temporary cavity, or both are responsible for the formation of indirect fractures. Twenty-eight fresh frozen cadaveric diaphyseal tibia (2) and femurs (26) were implanted into ordnance gelatin blocks. Shots were fired using 9- and 5.56-mm bullets traversing through the gelatin only, passing close to the edge of the bone, but not touching, to produce an indirect fracture. High-speed video of the impact event was collected at 20,000 frames/s. Acquisition of the strain data were synchronized with the video at 20,000 Hz. The exact time of fracture was determined by analyzing and comparing the strain gauge output and video. Twenty-eight shots were fired, 2 with 9-mm bullets and 26 with 5.56-mm bullets. Eight indirect fractures that occurred were of a simple (oblique or wedge) pattern. Comparison of the average distance of the projectile from the bone was 9.68 mm (range, 3-20 mm) for fractured specimens and 15.15 mm (range, 7-28 mm) for nonfractured specimens (Student's t test, p = 0.036). In this study, indirect fractures were produced after passage of the projectile. Thus, the temporary cavity, not the sonic wave, was responsible for the indirect fractures.

  5. [Clinical experience with various techniques integrated treat the wounded with gunshot fractures of limbs].

    Science.gov (United States)

    Kozlov, V K; Akhmedov, B G; Chililov, A M

    To increase an efficiency of complex treatment of patients with diaphyseal gunshot fractures of long bones by introduction of modern minimally invasive surgical techniques of internal osteosynthesis into clinical practice of civil health care and to improve the outcomes in victims. Prospective comparative clinical trial included 104 victims from the Republic of Yemen with gunshot wounds of limbs of various severity for the period 2009-2011. There were diaphyseal fractures of long bones of limbs associated with soft tissue injuries. Men were predominant (80.7%). Age ranged from 15 to 80 years (mean 38,5 ± 5,7 years). Various surgical techniques of simultaneous and staged treatment were used for gunshot fractures of long bones of limbs. Additional immune therapy was prescribed to prevent infectious complications in the most severe cases. Victims were comprehensively treated according to different staged treatment: conventional surgical treatment with external fixation devices or early primary minimally invasive functionally stable osteosynthesis with LCP/BIOS plates were applied for low-energy fractures; in case of high-energy fractures the first stage included external fixation devices deployment followed by their subsequent replacement during delayed minimally invasive osteosynthesis. The essence of improvement is pursuit to simultaneous minimally invasive surgery by using of current plates for osteosynthesis and preventive immunotherapy of immune dysfunction to eliminate infectious complications. As a result, we obtained 2-fold decrease of surgical invasiveness (r≤0,01) and hospital-stay (r≤0,01). Repeated osteosynthesis was not made. Also 4-fold and 40-fold reduction of infectious and noninfectious complications was observed. This management was accompanied by reduced rehabilitation tine and significantly improved quality of life. Improved technique and algorithm of complex treatment of diaphyseal gunshot fractures of long bones of limbs were described

  6. Decreased QOL and muscle strength are persistent 1 year after intramedullary nailing of a tibial shaft fracture

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsoe, Rasmus; Laessoe, Uffe

    2016-01-01

    was measured with the questionnaire Eq5D-5L and compared to norm data from a reference population. Recordings of pain and contralateral muscle strength (isometric maximal voluntary contraction (MVC) for knee flexion and extension were collected at 6 weeks, 3, 6, and 12 months postoperatively. Ipsilateral MVCs......INTRODUCTION:To evaluate the development in patient-reported quality of life (QOL) and muscle strength in the period from surgery to 12 months postoperatively after intramedullary nailing of a tibial shaft fracture. MATERIALS AND METHODS:The design was a prospective, follow-up cohort study. QOL...... compared to the reference population. Six and 12 months after surgery patients demonstrated decreased muscle strength in the injured leg compared to the non-injured leg for knee extension and flexion (P strength during knee...

  7. Clavicle fractures - incidence of supraclavicular nerve injury

    Directory of Open Access Journals (Sweden)

    Pedro Jose Labronici

    2013-08-01

    Full Text Available OBJECTIVE: To analyze retrospectively 309 fractures in the clavicle and the relation with injury of the supraclavicular nerve after trauma. METHODS: It was analyzed 309 patients with 312 clavicle fractures. The Edinburgh classification was used. Four patients had fractures in the medial aspect of the clavicle, 33 in the lateral aspect and 272 in the diaphyseal aspect and three bilateral fractures. RESULTS: 255 patients were analyzed and five had paresthesia in the anterior aspect of the thorax. Four patients had type 2 B2 fracture and one type 2 B1 fracture. All patients showed spontaneous improvement, in the mean average of 3 months after the trauma. CONCLUSION: Clavicle fractures and/ or shoulder surgeries can injure the lateral, intermediary or medial branches of the supraclavicular nerve and cause alteration of sensibility in the anterior aspect of the thorax. Knowledge of the anatomy of the nerve branches helps avoid problems in this region.

  8. [Fractures of the lower extremity in skiing - the influence of ski boots and injury pattern].

    Science.gov (United States)

    Bürkner, A; Simmen, H P

    2008-12-01

    Though the injury patterns of the lower extremities in skiing have changed since 1970, tibial fractures remain daily work of hospitals near ski slopes. A lot of medical studies have analysed the relevance of well adjusted bindings of the common lesions of the knee joint ligaments. However the influence of the flexibility of the ski boot and the injury pattern has been neglected. 49 tibial fractures have been analysed in a hospital near a large ski resort in the alpes. All fractures occurred during alpine skiing. The type of the fracture, according to the AO-classification and the injury pattern have been documented. Also demographic data, ski experience and specification concerning the ski boot have been questioned. The type of the ski boot and the grade of flexibility, have been documented if possible. It has also been recorded whether the binding opened. In contrast to other studies our patients are represented in widely spread age-groups with a large share of elderly and experienced persons. Young or unexperienced sportsmen suffer primarily from fractures of the tibial diaphysis. With increasing skiing experience the injury pattern is widening on the whole leg. 62 % of all fractures are caused by rotation traumas. Compression, dorsal forces and direct collisions are the other causes. In 59 % of all accidents the binding failed to open. There is an increased risk of complex fractures in the proximal or distal epiphysis if the binding has not opened. 23 % of all fractures occurred with rented ski boots. Only 16 % of all ski boots are labelled with a flexibility index. There is no standardized value for the flexibility of ski boots. The trend can be derived that rigid ski boots with a high flexibility index cause above all fractures of the diaphysis. 10 % of all fractures happened to patients wearing "snowblades". These short skis without safety bindings contributed a considerable share to tibial fractures, even though there is no big leverage. Tibial fractures are

  9. Tibial hyperostosis: A diagnostic approach

    International Nuclear Information System (INIS)

    Touraine, Sébastien; Parlier-Cuau, Caroline; Bousson, Valérie; Sverzut, Jean-Michel; Genah, Idan

    2013-01-01

    Tibial hyperostosis may be encountered in musculoskeletal imaging, incidentally or during the investigation of a leg pain. Hyperostosis involves the exuberant production of osseous tissue and results in cortical, periosteal and/or endosteal thickening of the bone. As a long bone with thick cortices, the tibia has a significant probability of being affected by ubiquitous bone diseases. As a tubular long bone, the tibia is likely to be involved in extensive infectious conditions such as osteomyelitis. As a bone of the lower limb, the tibia undergoes high stresses and may be affected by decrease in bone strength or repetitive submaximal stress. The tibia is also particularly involved in some bone sclerosing dysplasias and Paget's disease. In this work, we aim at highlighting the main conditions leading to tibial hyperostosis and try to provide key elements to narrow down the several diagnostic possibilities. Osteoid osteomas, fatigue or insufficiency fractures, infectious conditions, vascular lesions, sclerosing bone dysplasias and Paget's disease represent the main challenging diagnoses to discuss

  10. Tibial hyperostosis: A diagnostic approach

    Energy Technology Data Exchange (ETDEWEB)

    Touraine, Sébastien, E-mail: sebastien.touraine@lrb.aphp.fr [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Parlier-Cuau, Caroline, E-mail: caroline.parlier@lrb.aphp.fr [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Bousson, Valérie, E-mail: valerie.bousson@lrb.aphp.fr [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Sverzut, Jean-Michel, E-mail: jmsverzut21@hotmail.com [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Centre d’imagerie du centre cardiologique du Nord, 32-36 rue des Moulins Gémeaux, 93200 Saint-Denis (France); Genah, Idan, E-mail: idan.genah@lrb.aphp.fr [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); and others

    2013-12-01

    Tibial hyperostosis may be encountered in musculoskeletal imaging, incidentally or during the investigation of a leg pain. Hyperostosis involves the exuberant production of osseous tissue and results in cortical, periosteal and/or endosteal thickening of the bone. As a long bone with thick cortices, the tibia has a significant probability of being affected by ubiquitous bone diseases. As a tubular long bone, the tibia is likely to be involved in extensive infectious conditions such as osteomyelitis. As a bone of the lower limb, the tibia undergoes high stresses and may be affected by decrease in bone strength or repetitive submaximal stress. The tibia is also particularly involved in some bone sclerosing dysplasias and Paget's disease. In this work, we aim at highlighting the main conditions leading to tibial hyperostosis and try to provide key elements to narrow down the several diagnostic possibilities. Osteoid osteomas, fatigue or insufficiency fractures, infectious conditions, vascular lesions, sclerosing bone dysplasias and Paget's disease represent the main challenging diagnoses to discuss.

  11. Scintigraphic diagnosis of stress-induced incomplete fractures of the proximal tibia

    International Nuclear Information System (INIS)

    Collier, B.D.; Johnson, R.P.; Carrera, G.F.; Akhtar, K.; Isitman, A.T.

    1984-01-01

    Incomplete stress fractures of the proximal tibial diaphysis can be diagnosed by bone scintigraphy. The scintigraphic appearance of incomplete rather than complete tibial stress fractures is apparently reported for the first time in this article. With no treatment other than restricted activity, this injury heals rapidly and completely in 4 to 6 weeks. The major threat to the patient's welfare is unfounded suspicion of tumor or infection which may lead to biopsy or inappropriate therapy

  12. Anthropometric measurements of tibial plateau and correlation with the current tibial implants.

    Science.gov (United States)

    Erkocak, Omer Faruk; Kucukdurmaz, Fatih; Sayar, Safak; Erdil, Mehmet Emin; Ceylan, Hasan Huseyin; Tuncay, Ibrahim

    2016-09-01

    The aim of the study was to make an anthropometric analysis at the resected surfaces of the proximal tibia in the Turkish population and to compare the data with the dimensions of tibial components in current use. We hypothesized that tibial components currently available on the market do not fulfil the requirements of this population and a new tibial component design may be required, especially for female patients with small stature. Anthropometric data from the proximal tibia of 226 knees in 226 Turkish subjects were measured using magnetic resonance imaging. We measured the mediolateral, middle anteroposterior, medial and lateral anteroposterior dimensions and the aspect ratio of the resected proximal tibial surface. All morphological data were compared with the dimensions of five contemporary tibial implants, including asymmetric and symmetric design types. The dimensions of the tibial plateau of Turkish knees demonstrated significant differences according to gender (P < 0.05). Among the different tibial implants reviewed, neither asymmetric nor symmetric designs exhibited a perfect conformity to proximal tibial morphology in size and shape. The vast majority of tibial implants involved in this study tend to overhang anteroposteriorly, and a statistically significant number of women (21 %, P < 0.05) had tibial anteroposterior diameters smaller than the smallest available tibial component. Tibial components designed according to anthropometric measurements of Western populations do not perfectly meet the requirements of Turkish population. These data could provide the basis for designing the optimal and smaller tibial component for this population, especially for women, is required for best fit. II.

  13. Fracture of the proximal tibia after revision total knee arthroplasty with an extensor mechanism allograft.

    Science.gov (United States)

    Klein, Gregg R; Levine, Harlan B; Sporer, Scott M; Hartzband, Mark A

    2013-02-01

    Extensor mechanism reconstruction with an extensor mechanism allograft (EMA) remains one of the most reliable methods for treating the extensor mechanism deficient total knee arthroplasty. We report 3 patients who were treated with an EMA who sustained a proximal tibial shaft fracture. In all 3 cases, a short tibial component was present that ended close to the level of the distal extent of the bone block. When performing an EMA, it is important to recognize that the tibial bone block creates a stress riser and revision to a long-stemmed tibial component should be strongly considered to bypass this point to minimize the risk of fracture. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. Peri-prosthetic fractures around tumor endoprostheses: a retrospective analysis of eighteen cases.

    Science.gov (United States)

    Barut, Nicolas; Anract, Philippe; Babinet, Antoine; Biau, David

    2015-09-01

    Tumour hip and knee endoprostheses have become the mainstay for reconstruction of patients with bone tumours. Fixation into host bone has improved over time. However, some patients present with a peri-prosthetic fracture over follow-up. The objective of this study was to analyse the mode of presentation and survival of implant after a peri-prosthetic fracture around a tumour endoprosthesis. Eighteen peri-prosthetic fractures (17 patients) were included. All patients were treated at a tertiary care center. There were 11 (65%) women; the median age at the time of fracture was 38 years old. All implants were cemented and all knee endoprostheses were fixed-hinge. Twelve (67%) fractures occurred after femoral resection and six (33%) fractures after proximal tibial resection. There were three femoral neck fractures (UCS C), three femoral shaft type C fractures, two femoral shaft type B1, one tibial shaft type B2, three tibial shaft type C, three ankle fractures (UCS C) and three patella fractures (UCS F). Two fractures were treated conservatively and 16 were operated on. Only one patient had the implant revised. There were eight (44%) failures over follow-up; none of the conservative treatment failed. The cumulative probability of failure for any reason was 27% (8-52) and 55% (22-79) at five and ten years, respectively. Peri-prosthetic fractures around massive endoprostheses are different from that of standard implants. There are more type C fractures; internal fixation is an attractive option at the time of presentation but the risk of revision over follow-up is high and patients should be informed accordingly.

  15. Fratura proximal de tíbia após cirurgia extracapsular para correção de ruptura de ligamento cruzado cranial em cão Tibial fracture caused by complications after an extracapsular suture for the repair of cranial cruciate ligament rupture in a dog

    Directory of Open Access Journals (Sweden)

    Jaqueline França dos Santos

    2013-03-01

    Full Text Available Ruptura de ligamento cruzado cranial (RLCCr é a afecção ortopédica mais frequente no joelho de cães e a sutura fabelo-tibial é frequentemente utilizada na sua correção. Essa técnica pode estar associada com complicações incisionais, lesão tardia de menisco, edema associado ao material de sutura e infecção. O objetivo desta nota foi relatar a ocorrência de fratura proximal de tíbia em um cão, causada por complicação em sutura fabelo-tibial para correção de RLCCr. Um canino atendido em outro serviço foi submetido à osteossíntese com placa 2,0mm para correção de complicação em técnica extra-capsular, na qual houve fratura da tíbia na região do orifício criado para confecção da sutura fabelo-tibial. Houve falha dos implantes e a placa foi removida. A fratura foi estabilizada com fixador esquelético externo circular, sendo constatada, após 120 dias, consolidação.Cranial cruciate ligament rupture (CCLR is one of the most common orthopedic diseases in dogs and extracapsular suture with nylon is often used for its correction. This technique may be associated with incisional complications, post-surgical meniscus injury, swelling associated with suture material and infection. The objective of this study is to report a tibial fracture in a dog, caused by complications after an extracapsular suture for the repair of CCLR. An adult dog, which suffered a tibial fracture after an extracapsular fixation for a CCLR, underwent surgery for the fixation of the fracture with a 2.0mm plate, by a referring veterinarian, but the implant failed. The plate was removed and the fracture was stabilized with a circular fixator. Bone consolidation was observed after 120 days.

  16. Ultrasound Guidance in Performing a Tendoscopic Surgery to Treat Posterior Tibial Tendinitis: A Useful Tool?

    Directory of Open Access Journals (Sweden)

    Akinobu Nishimura

    2016-01-01

    Full Text Available A 25-year-old man with a pronation-external rotation type of fracture was surgically treated using a fibular plate. Five years later, he underwent resection of bone hyperplasia because of the ankle pain and limitation of range of motion. Thereafter, the left ankle became intermittently painful, which persisted for about one year. He presented at the age of 43 with persistent ankle pain. Physical and image analysis findings indicated a diagnosis of posttraumatic posterior tibial tendinitis, which we surgically treated using tendoscopy. Endoscopic findings showed tenosynovitis and fibrillation on the tendon surface. We cleaned and removed the synovium surrounding the tendon and deepened the posterior tibial tendon groove to allow sufficient space for the posterior tibial tendon. Full weight-bearing ambulation was permitted one day after surgery and he returned to his occupation in the construction industry six weeks after surgery. The medial aspect of the ankle was free of pain and symptoms at a review two years after surgery. Although tendoscopic surgery for stage 1 posterior tibial tendon dysfunction has been reported, tendoscopic surgery to treat posttraumatic posterior tibial tendinitis has not. Our experience with this patient showed that tendoscopic surgery is useful not only for stage 1 posterior tibial dysfunction, but also for posttraumatic posterior tibial tendinitis.

  17. Bilateral Simultaneous Avulsion Fractures of the Proximal Tibia in a 14-Year-Old Athlete with Vitamin-D Deficiency

    Directory of Open Access Journals (Sweden)

    Ziad Harb

    2015-01-01

    Full Text Available Fractures involving the proximal tibial epiphysis are rare and form 0.5% of all epiphyseal injuries. The specific anatomical and developmental features of the proximal tibial epiphysis make it vulnerable to unique patterns of fractures. Vitamin-D plays a vital role in bone homeostasis and its deficiency has an impact on fracture risk and healing. We present the first ever reported case of simultaneous bilateral proximal tibial physeal fractures in an athlete with vitamin-D deficiency. Treatment consisted of plaster immobilisation, and the patient made a full recovery and returned to preinjury level of activities. We report this case for its uniqueness and as an educational review of the importance of the developmental anatomy of the proximal tibia. We review the literature and discuss how the stages of the growing physis determine the type of fracture sustained.

  18. For early diagnosis of the fracture healing, nonunion and avascular necorsis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problems. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necorsis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of national Medical Center during the period form August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography one. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 case of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the bony on 12 months after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  19. For early diagnosis of the fracture healing, nonunion and avascular necorsis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Y C; Lee, S H; Lee, Y C; Whang, I S; Kim, H S [National Medical Center, Seoul (Korea, Republic of)

    1981-09-15

    Complications of non-union and avascular necrosis during fracture healing process are the most important problems. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necorsis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of national Medical Center during the period form August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography one. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 case of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the bony on 12 months after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis.

  20. Medial tibial “spackling” to lessen chronic medial tibial soft tissue irritation

    Directory of Open Access Journals (Sweden)

    J. Ryan Martin, MD

    2016-09-01

    Full Text Available We describe a unique, utilitarian reconstructive treatment option known as tibial “spackling” for chronic, localized medial joint line pain corresponding with progressive radiographic peripheral medial tibial bone loss beneath a well-fixed revision total knee arthroplasty tibial baseplate. It is believed that this localized pain is due to chronic irritation of the medial capsule and collateral ligament from the prominent medial edge of the tibial component. In the setting of failed nonoperative treatment, our experience with utilizing bone cement to reconstruct the medial tibial bone defect and create a smooth medial tibial surface has been successful in eliminating chronic medial soft tissue irritation.

  1. Honey preserved cortical allografts in the repair of diaphyseal femoral defect in dogs: clinical and radiographic

    International Nuclear Information System (INIS)

    Alievi, Marcelo Meller; Wallau Schossler, João Eduardo; Christo de Oliveira, Ana Néri; Almeida Ferreira, Carolina Kist TraeslelIV Patrícia; Dambrósio Guimarães, Luciana

    2007-01-01

    Fourteen adult mongrel dogs were used to evaluate the honey preserved cortical allografts in the repair of diaphyseal femoral defect. The allografts were inserted into a 5cm segmental defect created in the mid-diaphysis of the right femur in each dog. The bones were stabilized with a dynamic compression plate and eight bone screws. Healing was followed clinically and femora were evaluated radiographically, periodically. Nineteen (79.2%) of the twenty-four host-graft interfaces were radiographically incorporated. Average time to allograft incorporation was 67.1 days (range 45 days to 90 days). There was no statistical difference in the allograft incorporation time between proximal and distal host-graft interfaces. Complications observed were nonunion, allograft fracture, and allograft resorption. The conclusion is that despite the complications, honey preserved cortical allografts are a viable option to bone reconstruction [pt

  2. Postpartum osteoporosis associated with proximal tibial stress fracture

    Energy Technology Data Exchange (ETDEWEB)

    Clemetson, I.A.; Anderson, S.E. [Department of Radiology, University Hospital of Bern, Inselspital, 3010, Bern (Switzerland); Popp, A.; Lippuner, K. [Department of Osteology, University Hospital of Bern, Inselspital, 3010, Bern (Switzerland); Ballmer, F. [Knee and Sports Medicine Unit, Lindenhofspital Bern, 3012, Bern (Switzerland)

    2004-02-01

    A 33-year-old woman presented with acute nonspecific knee pain, 6 months postpartum. MR imaging, computed tomography and radiography were performed and a proximal tibia plateau insufficiency fracture was detected. Bone densitometry demonstrated mild postpartum osteoporosis. To our knowledge these findings have not been described in this location and in this clinical setting. The etiology of the atraumatic fracture of the tibia is presumed to be due to a low bone mineral density. The bone loss was probably due to pregnancy, lactation and postpartum hormonal changes. There were no other inciting causes and the patient was normocalcemic. We discuss the presence of a postpartum stress fracture in a hitherto undescribed site in a patient who had lactated following an uncomplicated pregnancy and had no other identifiable cause for a stress fracture. (orig.)

  3. Postpartum osteoporosis associated with proximal tibial stress fracture

    International Nuclear Information System (INIS)

    Clemetson, I.A.; Anderson, S.E.; Popp, A.; Lippuner, K.; Ballmer, F.

    2004-01-01

    A 33-year-old woman presented with acute nonspecific knee pain, 6 months postpartum. MR imaging, computed tomography and radiography were performed and a proximal tibia plateau insufficiency fracture was detected. Bone densitometry demonstrated mild postpartum osteoporosis. To our knowledge these findings have not been described in this location and in this clinical setting. The etiology of the atraumatic fracture of the tibia is presumed to be due to a low bone mineral density. The bone loss was probably due to pregnancy, lactation and postpartum hormonal changes. There were no other inciting causes and the patient was normocalcemic. We discuss the presence of a postpartum stress fracture in a hitherto undescribed site in a patient who had lactated following an uncomplicated pregnancy and had no other identifiable cause for a stress fracture. (orig.)

  4. Adult periarticular locking plates for the treatment of pediatric and adolescent subtrochanteric hip fractures.

    Science.gov (United States)

    Sanders, Samuel; Egol, Kenneth A

    2009-01-01

    Two cases are presented in which adult, precontoured, lower-extremity periarticular locking plates were utilized for fixation of subtrochanteric femur fractures in pediatric patients. Recognition of the fact that a distal tibial locking plate in a small child and a proximal tibial locking plate in an adolescent anatomically ft the proximal femur in each case may provide a surgeon treating subtrochanteric hip fractures in this population increased options for operative stabilization.

  5. O emprego de hastes intramedulares bloqueadas no tratamento das fraturas diafisárias do úmero Use of blocked intramedullary shaft for the treatment of humeral diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    Fernando Baldy dos Reis

    2005-01-01

    Full Text Available Estudamos os resultados clínicos e radiográficos de 31 pacientes portadores de fraturas diafisárias do úmero que foram operados com hastes intramedulares. Destes quatro apresentaram fraturas no local da inserção da haste e foram tratados com outro método. Dos 27 pacientes restantes o índice de consolidação foi de 96,1 % e que durou em média de 63,4 dias. Cinco queixaram-se de dor no ombro e em apenas um apresentou limitação da abdução. Paralisia temporária do nervo radial foi constatada em dois pacientes e pseudartrose em um que após 5 meses da cirurgia foi submetido a nova intervenção cirúrgica com o emprego de placa e enxerto ósseo autólogo. Concluímos que embora o emprego de hastes intramedulares bloqueadas apresentou alto índice de a via de acesso retrógrada pode levar a fraturas no seu ponto de entrada e via anterógrada com violação do manguito rotador pode gerar dores no ombro.Clinical and radiographic outcomes of 31 patients with humeral diaphyseal fractures submitted to surgery with intramedullary shafts were studied. From these, four patients presented fractures at the shaft insertion site and were treated using a different method. From the 27 patients left, the healing rate was 96.1%, with an average duration of 63.4 days. Five of them complained of pain in the shoulder and only one presented abduction limitation. Temporary palsy of the radial nerve was found in two patients and pseudoarthrosis in one of them, who was submitted to a new surgical intervention with plate and autologous bone graft, after 5 months. It was concluded that, although blocked intramedullary shafts presents a high incidence of the retrograde access port leading to fractures in its insertion site and the anterograde port causing pain in the shoulder.

  6. SUPRAPATELLAR VERSUS INFRAPATELLAR TIBIAL NAIL INSERTION- A PROSPECTIVE, RANDOMISED CONTROL PILOT STUDY

    Directory of Open Access Journals (Sweden)

    Sreekumar K

    2017-06-01

    Full Text Available BACKGROUND The standard for treating tibial shaft fractures are by intramedullary nails currently. After the procedure, one of the most frequent complication is knee pain, after consolidation even more chronically. Chronic knee pain can affect more than 50% of the cases, which was said by most authors. Alternative routes of inserting the nail is used, which includes by means of lateral patellar paratendon, medial patellar paratendon or transtendon to avoid the symptom. The aim of the study is to study the clinical and functional outcomes of suprapatellar versus infrapatellar tibial nail insertion. MATERIALS AND METHODS This is a prospective study, which was done from January 2014 to February 2015 and 50 patients who were skeletally mature were selected and randomised into IP and SP nail insertion groups. They were also given informed consent and only after they agreed, they were taken into the study. The technique of nail insertion was revealed to both the surgeon and the patient at that time. Exclusion Criteria- Pregnant women, patients with intra-articular involvement, periprosthetic fractures, nonunions, ipsilateral injuries, previous knee injuries, history of gout, rheumatoid, osteoarthritis, spinal injury and incarceration. SP insertion was performed percutaneously with the help of a special cannula system. RESULTS A total of 50 patients were selected in this study. 31 SP and 19 IP. 10 SP and 2 IP did not show up for follow up examinations, so only 38 patients were present for 12 months. At last, there were 21 SP and 17 IP patients. The time from when the index procedure was done to follow up was 14.6 months, i.e. it ranged from 12-28 months. 12 were males and 9 were females with suprapatellar, 9 were males and 8 were females in infrapatellar. Average age of suprapatellar was 42 and that of infrapatellar was 44. Open fractures were 5 and closed fractures were 33. VAS score was 0.78 in suprapatellar and 1.87 in infrapatellar. Data analysis

  7. Osteomedullography: for early diagnosis of the fracture healing, nonunion and avascular necrosis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problem. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necrosis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of National Medical Center during the period from August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography once. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 cases of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the body on 12 month after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  8. Osteomedullography: for early diagnosis of the fracture healing, nonunion and avascular necrosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Y C; Lee, S H; Lee, Y C; Whang, I S; Kim, H S [National Medical Center, Seoul (Korea, Republic of)

    1981-12-15

    Complications of non-union and avascular necrosis during fracture healing process are the most important problem. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necrosis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of National Medical Center during the period from August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography once. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 cases of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the body on 12 month after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis.

  9. Semiextended approach for intramedullary nailing via a patellar eversion technique for tibial-shaft fractures: Evaluation of the patellofemoral joint.

    Science.gov (United States)

    Yasuda, Tomohiro; Obara, Shu; Hayashi, Junji; Arai, Masayuki; Sato, Kaoru

    2017-06-01

    Intramedullary nail fixation is a common treatment for tibial-shaft fractures, and it offers a better functional prognosis than other conservative treatments. Currently, the primary approach employed during intramedullary nail insertion is the semiextended position is the suprapatellar approach, which involves a vertical incision of the quadriceps tendon Damage to the patellofemoral joint cartilage has been highlighted as a drawback associated with this approach. To avoid this issue, we perform surgery using the patellar eversion technique and a soft sleeve. This method allows the articular surface to be monitored during intramedullary nail insertion. We arthroscopically assessed the effect of this technique on patellofemoral joint cartilage. The patellar eversion technique allows a direct view and protection of the patellofemoral joint without affecting the patella. Thus, damage to the patellofemoral joint cartilage can be avoided. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Influence of Bone Remodeling Inhibition on the Development of Experimental Stress Fractures

    National Research Council Canada - National Science Library

    Schaffler, Mitchell B

    2005-01-01

    .... Using a bisphosphonate (BIS) to suppress remodeling in the rabbit tibial stress fracture model, we found that antiresorptive therapy reduced the intensity of the stress fracture response in this model...

  11. Combined three-part humeral anterior fracture-dislocation and humeral shaft fracture treated with one-stage long stem shoulder hemiarthroplasty in an active elderly patient

    Directory of Open Access Journals (Sweden)

    Herzberg Guillaume

    2017-01-01

    Full Text Available Introduction: Injuries combining a humeral head fracture-dislocation and a shaft fracture of the ipsilateral humerus are very rare. They should be separated from extended fractures of the humeral head to the shaft [1]. Case report: We present the case of an active 84-year-old man who sustained a three-part fracture-dislocation of the proximal humerus combined with a long spiral humeral middle third diaphyseal fracture, after a ski fall. We were unable to find a similar case in the literature. He was treated with a long stem hemiarthroplasty, associated with screw osteosynthesis of the long spiral shaft fracture. The result after 30 months of follow-up was excellent, with good shoulder range of motion, good bone integration of the prosthesis and uneventful healing of the fracture. Conclusion: This treatment allowed this intrepid elderly patient to recover a normal quality of life, including driving his car and to return to skiing.

  12. Characteristics of postoperative weight bearing and management protocols for tibial plateau fractures: Findings from a scoping review.

    Science.gov (United States)

    Arnold, John B; Tu, Chen Gang; Phan, Tri M; Rickman, Mark; Varghese, Viju Daniel; Thewlis, Dominic; Solomon, Lucian B

    2017-12-01

    To identify and describe the characteristics of existing practices for postoperative weight bearing and management of tibial plateau fractures (TPFs), identify gaps in the literature, and inform the design of future research. Seven electronic databases and clinical trial registers were searched from inception until November 17th 2016. Studies were included if they reported on the surgical management of TPFs, had a mean follow-up time of ≥1year and provided data on postoperative management protocols. Data were extracted and synthesized according to study demographics, patient characteristics and postoperative management (weight bearing regimes, immobilisation devices, exercises and complications). 124 studies were included involving 5156 patients with TPFs. The mean age across studies was 45.1 years (range 20.8-72; 60% male), with a mean follow-up of 34.9 months (range 12-264). The most frequent fracture types were AO/OTA classification 41-B3 (29.5%) and C3 (25%). The most commonly reported non-weight bearing time after surgery was 4-6 weeks (39% of studies), with a further 4-6 weeks of partial weight bearing (51% of studies), resulting in 9-12 weeks before full weight bearing status was recommended (55% of studies). Loading recommendations for initial weight bearing were most commonly toe-touch/bearing was positively correlated with the proportion of fractures of AO/OTA type C (r=0.465, p=0.029) and Schatzker type IV-VI (r=0.614, pbearing time before full weight bearing is recommended at 9-12 weeks. Partial weight bearing protocols and brace use were varied. Type of rehabilitation may be an important factor influencing recovery, with future high quality prospective studies required to determine the impact of different protocols on clinical and radiological outcomes. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  13. THE FUNCTIONAL OUTCOME OF MANAGEMENT OF SCHATZKER TYPE II AND III TIBIAL PLATEAU FRACTURES TREATED WITH INDIRECT ELEVATION, PERCUTANEOUS FIXATION AND BONE GRAFTING

    Directory of Open Access Journals (Sweden)

    Sheshagiri

    2016-02-01

    Full Text Available INTRODUCTION Damage to the joint is more extensive in tibia plateau fractures than the roentgenograms Indicate. It may be associated with soft tissue trauma, ligament injuries (4-33% medial Collateral ligament being the most common, meniscal injuries (20%, lateral collateral Ligament injury (3%, peroneal nerve injuries (3%. Posttraumatic arthritis is associated with residual instability or axial malalignment rather than joint depression. So we use minimally invasive approach to the depressed tibial plateau fractures (Schatzker type II & III. MATERIALS AND METHODS 32 patients were studied. They were followed up for maximum of 3yrs and a minimum of 1.5yrs with an average of 2.2yrs. Inclusion criteria included those patients with an age group between 20yrs and 60yrs, joint depression more than 3mm. Patients with open fracture, severe osteoporotic bones and with radiographic evidence of osteoarthritis are excluded from the study. CT was done in all patients. Mean age group was 28.8yrs and 19(76% were males; the mean articular depression was 11.32 mm measured in CT. Pre-op evaluation includes x-rays of the knee, stress x-rays if needed, and CT was done with 2mm limited cuts. Cancellous Bone graft was taken from opposite tibia through a 3-4cm long incision made below the tibial tuberosity over the medial aspect of the tibia. Cortical window was made in the affected limb, just enough to introduce the punch, and its position was confirmed under c-arm and depressed fragment was elevated with punch and reduction was held with k wires in subarticular plane and later two cannulated cancellous screws was introduced and the defect packed with bone grafts, Post-operatively all patients were immobilized with plaster of Paris (POP for 3 weeks and then mobilized. RESULTS The mean duration of the follow up was 2.2yrs. Results were excellent in 21 patients (84%, good 3(12% and fair in 1 patients (4% according to anatomic and functional criteria by Hohl and Luck

  14. Minimally invasive percutaneous plate fixation of distal tibia fractures.

    LENUS (Irish Health Repository)

    Bahari, Syah

    2007-10-01

    We report a series of 42 patients reviewed at a mean of 19.6 months after treatment of distal tibial and pilon fractures using the AO distal tibia locking plate with a minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Mean time to union was 22.4 weeks. All fractures united with acceptable alignment and angulation. Two cases of superficial infection were noted, with one case of deep infection. Mean SF36 score was 85 and mean AOFAS score was 90 at a mean of 19 months follow-up. We report satisfactory outcomes with the use of the AO distal tibia locking plate in treatment of unstable distal tibial fractures. Eighty-nine percent of the patients felt that they were back to their pre injury status and 95% back to their previous employment.

  15. Early Conversion of External Fixation to Interlocked Nailing in Open Fractures of Both Bone Leg Assisted with Vacuum Closure (VAC) - Final Outcome.

    Science.gov (United States)

    Gill, Simrat Pal Singh; Raj, Manish; Kumar, Sunil; Singh, Pulkesh; Kumar, Dinesh; Singh, Jasveer; Deep, Akash

    2016-02-01

    Management of compound grade III fractures of both bone leg includes external stabilization for long period, followed by various soft tissue coverage procedures. Primary interlocking of tibia had been also done with variable results. External fixation for long time without any bone loss often leads to infected nonunion, loss of reduction, pin tract infection and failure of fixation, primary interlocking in compound grade III fractures had shown high medullary infection rate. We managed all cases of compound grade III A/B fractures with primary external fixation, simultaneous wound management using vacuum assisted closure (VAC) followed by early conversion to interlocking within 2 weeks of fixator application. To determine the effectiveness of vacuum assisted closure (VAC) for the early conversion of external fixator to definitive interlocking in open fractures of the both bone leg. In current study we selected 84 cases of compound grade IIIA/B diaphyseal fractures of both bone leg during period of May 2010 to September 2013. We managed these cases by immediate debridement and application of external fixation followed by repeated debridement, application of vacuum assisted closure (VAC) and conversion to interlocking within two weeks. Out of 84 cases union was achieved in 80(95%) of cases with definitive tibial interlocking. Excellent to good result were obtained in 77(91.8%) of cases and fair to poor result seen in rest of 7(8.2%) of cases according to modified Ketenjian's criteria. 5 out of these 7 poor result group cases were from Compound Grade III B group to start with. Deep infection rate in our series were 7% i.e. total 6 cases and 4 out of these were from compound Grade III B group to start with. Vacuum assisted closure (VAC) give a good help for rapid closure of the wound and help in early conversion to definitive intramedullary nailing. Reamed nail could well be used in compound grade IIIA/B fractures without increasing the risk of infection. It gives

  16. Experimental and finite element analysis of tibial stress fractures using a rabbit model.

    Science.gov (United States)

    Franklyn, Melanie; Field, Bruce

    2013-01-01

    To determine if rabbit models can be used to quantify the mechanical behaviour involved in tibial stress fracture (TSF) development. Fresh rabbit tibiae were loaded under compression using a specifically-designed test apparatus. Weights were incrementally added up to a load of 30 kg and the mechanical behaviour of the tibia was analysed using tests for buckling, bone strain and hysteresis. Structural mechanics equations were subsequently employed to verify that the results were within the range of values predicted by theory. A finite element (FE) model was developed using cross-sectional computer tomography (CT) images scanned from one of the rabbit bones, and a static load of 6 kg (1.5 times the rabbit's body weight) was applied to represent running. The model was validated using the experimental strain gauge data, then geometric and elemental convergence tests were performed in order to find the minimum number of cross-sectional scans and elements respectively required for convergence. The analysis was then performed using both the model and the experimental results to investigate the mechanical behaviour of the rabbit tibia under compressive load and to examine crack initiation. The experimental tests showed that under a compressive load of up to 12 kg, the rabbit tibia demonstrates linear behaviour with little hysteresis. Up to 30 kg, the bone does not fail by elastic buckling; however, there are low levels of tensile stress which predominately occur at and adjacent to the anterior border of the tibial midshaft: this suggests that fatigue failure occurs in these regions, since bone under cyclic loading initially fails in tension. The FE model predictions were consistent with both mechanics theory and the strain gauge results. The model was highly sensitive to small changes in the position of the applied load due to the high slenderness ratio of the rabbit's tibia. The modelling technique used in the current study could have applications in the development of

  17. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner

    2010-01-01

    Project. The data consisted of 21,219 3D elements with a cortical shell and a trabecular core. Three types of load of torsion, a direct lateral load and axial compression were applied. RESULTS: The finite element linear static analysis resulted in relevant fracture localizations and indicated relevant...

  18. MINIMAL INVASIVE PLATE OSTEOSYNTHESIS- AN EFFECTIVE TREATMENT METHOD FOR DISTAL TIBIA INTRAARTICULAR (PILON FRACTURES- AN 18 MONTHS FOLLOW UP

    Directory of Open Access Journals (Sweden)

    Saket Jati

    2016-12-01

    Full Text Available BACKGROUND Tibial pilon fracture though requires operative treatment is difficult to manage. Conventional osteosynthesis is not suitable, because distal tibia is subcutaneous bone with poor vascularity. Closed reduction and Minimally Invasive Plate Osteosynthesis (MIPO for distal tibia has emerged as an alternative treatment option because it respects fracture biology and haematoma and also provides biomechanically stable construct. The aim of the study is to evaluate the results of minimally invasive plate osteosynthesis using locking plates in treating tibial pilon fractures in terms of fracture union, restoration of ankle function and complications. MATERIALS AND METHODS 30 patients with closed tibial pilon fractures (Ruedi and Allgower type I (14, type II (13, type III (3 treated with MIPO with Locking Compression Plates (LCP were prospectively followed for average duration of 18 months. RESULTS Average duration of injury-hospital and injury-surgery interval was as 12.05 hrs. and 3.50 days, respectively. All fractures got united with an average duration of 20.8 weeks (range 14-28 weeks. Olerud and Molander score was used for evaluation at 3 months, 6 months and 18 months. One patient had union with valgus angulation of 15 degrees, but no nonunion was found. CONCLUSION The present study shows that MIPO with LCP is an effective treatment method in terms of union time and complications rate for tibial pilon fracture promoting early union and early weight bearing.

  19. Outcome of limb fracture repair in rabbits: 139 cases (2007-2015).

    Science.gov (United States)

    Sasai, Hiroshi; Fujita, Daisuke; Seto, Eiko; Denda, Yuki; Imai, Yutaro; Okamoto, Kanako; Okamura, Kensaku; Furuya, Masaru; Tani, Hiroyuki; Sasai, Kazumi

    2018-02-15

    OBJECTIVE To evaluate outcome of limb fracture repair in rabbits. DESIGN Retrospective case series. ANIMALS 139 client-owned rabbits with limb fractures treated between 2007 and 2015. PROCEDURES Medical records were reviewed for information on fracture location, fracture treatment, and time to fracture healing. RESULTS 25 rabbits had fractures involving the distal aspects of the limbs (ie, metacarpal or metatarsal bones, phalanges, and calcaneus or talus). Fractures were treated in 23 of these 25 rabbits (external coaptation, n = 17; external skeletal fixation, 4; and intramedullary pinning, 2) and healed in all 23, with a median healing time of 28 days (range, 20 to 45 days). One hundred ten rabbits had long bone fractures, and fractures were treated in 100 of the 110 (external skeletal fixation, n = 89; bone plating, 1; intramedullary pinning, 3; and external coaptation, 7). The percentage of fractures that healed was significantly lower for open (14/18) than for closed (26/26) tibial fractures and was significantly lower for femoral (19/26) and treated humeral (4/6) fractures than for radial (23/24) or closed tibial (26/26) fractures. Micro-CT was used to assess fracture realignment during external skeletal fixator application and to evaluate fracture healing. CONCLUSIONS AND CLINICAL RELEVANCE The prognosis for rabbits with limb fractures was good, with fractures healing in most rabbits following fracture repair (109/123). Micro-CT was useful in assessing fracture realignment and evaluating fracture healing.

  20. Reconstruction of large diaphyseal bone defect by simplified bone transport over nail technique: A 7-case series.

    Science.gov (United States)

    Ferchaud, F; Rony, L; Ducellier, F; Cronier, P; Steiger, V; Hubert, L

    2017-11-01

    Reconstruction of large diaphyseal bone defect is complex and the complications rate is high. This study aimed to assess a simplified technique of segmental bone transport by monorail external fixator over an intramedullary nail.A prospective study included 7 patients: 2 femoral and 5 tibial defects. Mean age was 31years (range: 16-61years). Mean follow-up was 62 months (range: 46-84months). Defects were post-traumatic, with a mean length of 7.2cm (range: 4 to 9.5cm). For 3 patients, reconstruction followed primary failure. In 4 cases, a covering flap was necessary. Transport used an external fixator guided by an intramedullary nail, at a rate of 1mm per day. One pin was implanted on either side of the distraction zone. The external fixator was removed 1 month after bone contact at the docking site. Mean bone transport time was 11 weeks (range: 7-15 weeks). Mean external fixation time was 5.1months (range: 3.5 to 8months). Full weight-bearing was allowed 5.7months (range: 3.5-13months) after initiation of transport. In one patient, a pin had to be repositioned. In 3 patients, the transported segment re-ascended after external fixatorablation, requiring repeat external fixation and resumption of transport. There was just 1 case of superficial pin infection. Reconstruction quality was considered "excellent" on the Paley-Marr criteria in 6 cases. The present technique provided excellent reconstruction quality in 6 of the 7 cases. External fixation time was shorter and resumption of weight-bearing earlier than with other reconstruction techniques, notably including bone autograft, vascularized bone graft or the induced membrane technique. Nailing facilitated control of limb axis and length. The complications rate was 50%, comparable to other techniques. This study raises the question of systematic internal fixation of the docking site, to avoid any mobilization of the transported segment. The bone quality, axial control and rapidity shown by the present technique make

  1. Comparative Study Using Intramedullary K-wire Fixation Over Titanium Elastic Nail in Paediatric Shaft Femur Fractures.

    Science.gov (United States)

    Kumar, Sanjiv; Anand, Tushar; Singh, Sudhir

    2014-11-01

    Fracture shaft femur is common paediatric trauma leading to significant morbidity. Conservative treatments available are associated with prolonged periods of immobilization. Use of flexible intramedullary implant allows early rehabilitation in diaphyseal fractures of femur in children. The aim of the present study is to compare fixation of diaphyseal femur fracture by titanium elastic nail and intramedullary K-wires in children. Prospective randomized study in a tertiary care hospital. Fifty-two children between 6 years and 14 years of age with femoral shaft fracture were assigned either in Group I or Group II based on computer generated random numbers. In Group I closed percutaneous intramedullary K- wire fixation and in Group II closed percutaneous intramedullary titanium elastic nail was used to fix the fractures. Partial weight bearing was allowed after 6 weeks of surgery and full weight bearing at clinico-radiological union. Average time of radiological union was 6 to 10 weeks in both groups. In both the groups two cases had entry site irritation which resolved with early implant removal. One case in both the groups had unacceptable mal-alignment. Both the groups had few cases of limb-length discrepancy, which was in acceptable limit, except two cases of TENS. There was no statistically significant difference between the results of both the groups. But, using K-wires significantly reduced the cost of treatment. Most of such fractures in our society are neglected because of high cost of treatment. Providing a cheaper alternative in form of K-wires may be beneficial for the patients from low socio-economic status.

  2. Medial collateral ligament tear entrapped within a proximal tibial physeal separation: imaging findings and operative reduction

    Energy Technology Data Exchange (ETDEWEB)

    McAnally, James L.; Eberhardt, Steven C.; Mlady, Gary W. [University of New Mexico, Department of Radiology, Albuquerque, NM (United States); Fitzpatrick, Jennifer; Bosch, Patrick [University of New Mexico, Department of Orthopaedics and Rehabilitation, Albuquerque, NM (United States)

    2008-10-15

    Entrapped soft tissues such as periosteum and tendons have been described within joints and physeal fractures in the literature and frequently result in irreducible fractures and posttraumatic growth disturbances. We believe this case represents a novel presentation of acute, preoperative, magnetic resonance (MR) imaging diagnosis of a torn medial collateral ligament entrapped within a proximal tibial physeal separation. This case is presented with MR imaging and operative correlation of the findings. (orig.)

  3. Medial collateral ligament tear entrapped within a proximal tibial physeal separation: imaging findings and operative reduction

    International Nuclear Information System (INIS)

    McAnally, James L.; Eberhardt, Steven C.; Mlady, Gary W.; Fitzpatrick, Jennifer; Bosch, Patrick

    2008-01-01

    Entrapped soft tissues such as periosteum and tendons have been described within joints and physeal fractures in the literature and frequently result in irreducible fractures and posttraumatic growth disturbances. We believe this case represents a novel presentation of acute, preoperative, magnetic resonance (MR) imaging diagnosis of a torn medial collateral ligament entrapped within a proximal tibial physeal separation. This case is presented with MR imaging and operative correlation of the findings. (orig.)

  4. MR imaging of occult fractures of the knee

    International Nuclear Information System (INIS)

    Mink, J.H.; Deutsch, A.L.

    1988-01-01

    The authors encountered 65 radiographically occult fractures that they classified into five types. Bone bruises were a result of direct trauma or were associated with ligamentous injury. They were characterized by geographic foci of decreased signal on short repetition time (TR), short echo time (TE) sequences. Stress fractures were linear or globular foci of low signal on short TR, short TE sequences. Osteochondral fractures were displaced or impacted types; the latter were often associated with an anterior cruciate ligament tear. Tibial fractures were minimally displaced, vertically oriented fractures extending into the plateaus. Femoral fractures were Y-shaped, extending across the supracondylar region

  5. Comparison of our self-designed rotary self-locking intramedullary nail and interlocking intramedullary nail in the treatment of long bone fractures.

    Science.gov (United States)

    Liu, Bailian; Xiong, Ying; Deng, Hong; Gu, Shao; Jia, Fu; Li, Qunhui; Wang, Daxing; Gan, Xuewen; Liu, Wei

    2014-07-21

    The purpose of this study is to compare the clinical effects of our self-designed rotary self-locking intramedullary nail (RSIN) and interlocking intramedullary nail (IIN) for long bone fractures. A retrospective study was performed in 1,704 patients who suffered bone fractures and underwent RSIN or IIN operation in our hospital between March 1999 and March 2013, including 494 with femoral fractures, 572 with humeral fractures, and 638 with tibial fractures. Among them, 634 patients were followed up for more than 1 year. The operative time, intraoperative blood loss, postoperative complications, healing rate, and the excellent and good rate of functional recovery were compared between two groups. Compared with IIN group, RSIN group exhibited significantly shorter operative time and less intraoperative blood loss no matter for humeral, femoral, or tibial fractures (all p fractures (both p fracture. In IIN group, nail breakage or loosening occurred in 7 patients with femoral fractures and 16 patients with tibial fractures, radial nerve injury was observed in 8 patients with humeral fractures, and incision infection was present in 2 patients with humeral fractures and 1 patient with femoral fracture. The complication rate of IIN group was significantly higher than that of RSIN group (p knee, and ankle joint functional recovery between RSIN group and IIN group. RSIN may be a reliable and practical alternative method for the treatment of long bone fractures.

  6. Repeated Stress Fractures in an Amenorrheic Marathoner: A Case Conference.

    Science.gov (United States)

    Sutton, John R.; Nilson, Karen L.

    1989-01-01

    Presents a case conference by 2 experts on the relationship between a 26-year-old marathoner's amenorrhea and her sustained unusual stress fractures in 4 ribs (plus previous similar fractures of the calcaneal, navicular, metatarsal, and tibial bones). The experts conclude that she suffers many manifestations of overtraining. (SM)

  7. Computed tomography of stress fracture

    International Nuclear Information System (INIS)

    Murcia, M.; Brennan, R.E.; Edeiken, J.

    1982-01-01

    An athletic young female developed gradual onset of pain in the right leg. Plain radiographs demonstrated solid periosteal reaction in the tibia compatible with stress fracture. She stopped sport activites but her pain continued. Follow-up radiographs of the tibia revealed changes suspicious for osteoid osteoma. Computed tomography (CT) scan demonstrated periosteal reaction, but in addition, lucent fracture lines in the tibial cortex were evident. CT obviated the need for more invasive diagnostic procedures in this patient. In selected cases CT may be useful to confirm the diagnosis of stress fracture when plain radiographic or routine tomographic studies are not diagnostic. (orig.)

  8. Computed tomography of stress fracture

    International Nuclear Information System (INIS)

    Murcia, M.; Brennan, R.E.; Edeiken, J.

    1982-01-01

    An athletic young female developed gradual onset of pain in the right leg. Plain radiographs demonstrated solid periosteal reaction in the tibia compatible with stress fracture. She stopped sport activites but her pain continued. Follow-up radiographs of the tibia revealed changes suspicious for osteoid osteoma. Computed tomography (CT) scan demonstrated periosteal reaction, but in addition, lucent fracture lines in the tibial cortex were evident. CT obviated the need for more invasive diagnostic procedures in this patient. In selected cases CT may be useful to confirm the diagnosis of stress fracture when plain radiographic or routine tomographic studies are not diagnostic

  9. Relationship between blood flow and radiostrontium uptake in the healing bone fracture

    International Nuclear Information System (INIS)

    Schuemichen, C.; Mundriziewski, L.; Tischler, E.; Hoffmann, G.

    1979-01-01

    The healing of a diaphyseal tibia fracture was followed in the rat. Callus formation, blood flow and Sr-85 uptake were assessed by a ratio comparison of the fractured to the contralateral side. No correlation was found between blood flow and Sr-85 deposition in the callus and the adjacent bone of the same extremity. It is concluded that the deposition of a radiopharmaceutical in bone is primarily related to the presence of calcifiable organic bone matrix and only secondarily to the bone formation rate and to variations in the local blood flow. (orig.) 891 MG/orig. 892 MBE [de

  10. Vascularized fibular graft in infected tibial bone loss

    Directory of Open Access Journals (Sweden)

    C Cheriyan Kovoor

    2011-01-01

    Full Text Available Background : The treatment options of bone loss with infections include bone transport with external fixators, vascularized bone grafts, non-vascularized autogenous grafts and vascularized allografts. The research hypothesis was that the graft length and intact ipsilateral fibula influenced hypertrophy and stress fracture. We retrospectively studied the graft hypertrophy in 15 patients, in whom vascularized fibular graft was done for post-traumatic tibial defects with infection. Materials and Methods : 15 male patients with mean age 33.7 years (range 18 - 56 years of post traumatic tibial bone loss were analysed. The mean bony defect was 14.5 cm (range 6.5 - 20 cm. The mean length of the graft was 16.7 cm (range 11.5 - 21 cm. The osteoseptocutaneous flap (bone flap with attached overlying skin flap from the contralateral side was used in all patients except one. The graft was fixed to the recipient bone at both ends by one or two AO cortical screws, supplemented by a monolateral external fixator. A standard postoperative protocol was followed in all patients. The hypertrophy percentage of the vascularized fibular graft was calculated by a modification of the formula described by El-Gammal. The followup period averaged 46.5 months (range 24 - 164 months. The Pearson correlation coefficient (r was worked out, to find the relationship between graft length and hypertrophy. The t-test was performed to find out if there was any significant difference in the graft length of those who had a stress fracture and those who did not and to find out whether there was any significant difference in hypertrophy with and without ipsilateral fibula union. The Chi square test was performed to identify whether there was any association between the stress fracture and the fibula union. Given the small sample size we have not used any statistical analysis to determine the relation between the percentage of the graft hypertrophy and stress fracture. Results : Graft

  11. Anatomic single-bundle ACL surgery: consequences of tibial tunnel diameter and drill-guide angle on tibial footprint coverage.

    Science.gov (United States)

    Van der Bracht, H; Verhelst, L; Stuyts, B; Page, B; Bellemans, J; Verdonk, P

    2014-05-01

    To investigate the consequences of differences in drill-guide angle and tibial tunnel diameter on the amount of tibial anatomical anterior cruciate ligament (ACL) footprint coverage and the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. Twenty fresh-frozen adult human knee specimens with a median age of 46 years were used for this study. Digital templates mimicking the ellipsoid aperture of tibial tunnels with a different drill-guide angle and a different diameter were designed. The centres of these templates were positioned over the geometric centre of the tibial ACL footprint. The amount of tibial ACL footprint coverage and overhang was calculated. Risk factors for overhang were determined. Footprint coverage and the risk of overhang were also compared between a lateral tibial tunnel and a classic antero-medial tibial tunnel. A larger tibial tunnel diameter and a smaller drill-guide angle both will create significant more footprint coverage and overhang. In 45% of the knees, an overhang was created with a 10-mm diameter tibial tunnel with drill-guide angle 45°. Furthermore, a lateral tibial tunnel was found not to be at increased risk of overhang. A larger tibial tunnel diameter and a smaller drill-guide angle both will increase the amount of footprint coverage. Inversely, larger tibial tunnel diameters and smaller drill-guide angles will increase the risk of overhang of the tibial tunnel aperture over the edges of the native tibial ACL footprint. A lateral tibial tunnel does not increase the risk of overhang.

  12. A novel combined method of osteosynthesis in treatment of tibial fractures: a comparative study on sheep with application of rod-through-plate fixator and bone plating.

    Science.gov (United States)

    Tralman, G; Andrianov, V; Arend, A; Männik, P; Kibur, R T; Nõupuu, K; Uksov, D; Aunapuu, M

    2013-04-01

    The study compares the efficiency of a new bone fixator combining periostal and intramedullary osteosynthesis to bone plating in treatment of tibial fractures in sheep. Experimental osteotomies were performed in the middle third of the left tibia. Animals were divided into two groups: in one group (four animals) combined osteosynthesis (rod-through-plate fixator, RTP fixator) was applied, and in the other group (three animals) bone plating was used. The experiments lasted for 10 weeks during which fracture union was followed by radiography, and the healing process was studied by blood serum markers reflecting bone turnover and by histological and immunohistochemical investigations. In the RTP fixator group, animals started to load body weight on the operated limbs the next day after the surgery, while in the bone plating group, this happened only on the seventh day. In the RTP fixator group, consolidation of fractures was also faster, as demonstrated by radiographical, histological, and immunohistochemical investigations and in part by blood serum markers for bone formation. It can be concluded that application of RTP fixation is more efficient than plate fixation in the treatment of experimental osteotomies of long bones in sheep. © 2012 Blackwell Verlag GmbH.

  13. [Treatment of postoperative nonunion of fracture of lower limb with bone grafting by intervertebral disc endoscope].

    Science.gov (United States)

    Zhang, Jianlin; Tan, Yu'e; Ye, Jun; Han, Fangmin

    2012-02-01

    To explore the effectiveness of bone grafting by intervertebral disc endoscope for postoperative nonunion of fracture of lower limb. Between August 2004 and August 2008, 40 patients (23 males and 17 females) with postoperative nonunion of femoral and tibial fracture, aged 20-63 years (mean, 41.5 years) were treated. Nonunion of fracture occurred at 10-16 months after internal fixation. During the first operation, the internal fixation included interlocking intramedullary nailing of femoral fracture in 12 cases and plate in 16 cases, and interlocking intramedullary nailing of tibial fractures in 9 cases and plate in 3 cases. The X-ray films showed hypertrophic nonunion in 24 cases, common nonunion in 3 cases, and atrophic nonunion in 13 cases. The average operation time was 61 minutes (range, 40-80 minutes), and the blood loss was 80-130 mL (mean, 100 mL). The hospitalization time were 6-11 days (mean, 8.1 days). Incisions healed by first intention in all patients with no complication of infection or neurovascular injury. Forty patients were followed up 10-16 months (mean, 12.3 months). The X-ray films showed that all patients achieved healing of fracture after 4-10 months (mean, 6.8 months). No pain, disfunction, or internal fixation failure occurred. Bone grafting by intervertebral disc endoscope is an effective method for treating postoperative nonunion of femoral and tibial fracture.

  14. Treament of Tibial Plateau Schatzker Type VI Fractures with the Ilizarov Technique Using Ring External Fixators Across the Knee: A Retrospective Review

    Directory of Open Access Journals (Sweden)

    IR Ranatunga

    2010-07-01

    Full Text Available This is a retrospective review of 18 patients with tibial plateau fractures Schatzker type VI. These cases were performed in our medical centre from January 2003 to December 2004. The Ilizarov technique (Russian technique using the ring external fixator was the technique performed. Articular reconstruction and joint alignment were achieved with traction and olive wires with washers. One case required percutaneous elevation of the articular surface and bone grafting through a cortical window. Average clinical union was achieved within 4 months of trauma. Mean final knee flexion was 85°, which is compatible with walking. All patients successfully returned to their previous occupations. In conclusion, the Ilizarov technique has been shown to be a good option and a viable tool in the management of these complex and unstable injuries.

  15. Exposure to Secondhand Smoke Impairs Fracture Healing in Rats.

    Science.gov (United States)

    Santiago, Hildemberg A R; Zamarioli, Ariane; Sousa Neto, Manoel D; Volpon, Jose B

    2017-03-01

    Nonsmokers may be affected by environmental tobacco smoke (secondhand smoke), but the effects of such exposure on fracture healing have not been well studied. To explore the possible effects of passive inhalation of tobacco smoke on the healing of a diaphyseal fracture in femurs of rats. We hypothesized that secondhand exposure to tobacco smoke adversely affects fracture healing. A mid-diaphyseal fracture was created in the femur of 41 female Wistar rats and fixed with an intramedullary metallic pin; 14 rats were excluded (nine for inadequate fractures and five for K wire extrusion). Tobacco exposure was provided by a smoking machine on a daily basis of four cigarettes a day. Each cigarette yielded 10 mg tar and 0.8 mg nicotine, and was puffed by alternating injections of fresh air for 30 seconds and smoke air for 15 seconds. The smoke exposure was previously adjusted to provide serum levels of cotinine similar to human secondhand tobacco exposure. Cotinine is a predominant catabolite of nicotine that is used as a biological biomarker for exposure to tobacco smoke. In one group (n = 11), the animals were intermittently exposed to tobacco smoke before sustaining the fracture but not afterward. In another group (n = 7), the exposure occurred before and after the fracture. The control group (n = 9) was sham-exposed before and after the fracture. We evaluated the specimens 28 days after bone fracture. The callus quality was measured by dual-energy x-ray absorptiometry (bone mineral density [BMD], bone mineral content [BMC], and callus area), μCT (callus volume and woven bone fraction), and mechanical bending (maximum force and stiffness). Tobacco exposure resulted in delayed bone callus formation, which is represented by decreased BMD (Control: 0.302 ± 0.008 g/cm 2 vs Preexposed: 0.199 ± 0.008 g/cm 2 and Pre- and Postexposed: 0.146 ± 0.009 g/cm 2 ; mean difference = 0.103 g/cm 2 , 95% CI, 0.094-0.112 g/cm 2 and mean difference = 0.156 g/cm 2 , 95% CI, 0.147-0.167 g

  16. Artroplastia total do joelho com o apoio tibial móvel: avaliação dos resultados a médio prazo Total knee arthroplasty with a mobile tibial bearing: medium-term follow-up results

    Directory of Open Access Journals (Sweden)

    Luiz Gabriel Betoni Guglielmetti

    2010-01-01

    Full Text Available OBJETIVO: Avaliações dos resultados a médio prazo da aplicação da prótese com apoio tibial móvel. MÉTODOS: Noventa e seis pacientes (107 joelhos foram submetidos a artroplastia total do joelho realizada com um modelo de prótese com mobilidade rotatória no componente tibial. Os pacientes foram avaliados após um seguimento médio de 52,7 meses - desvio padrão 21,94 (mínimo de 24 meses e máximo de 120 meses, através do protocolo de avaliação "Knee Society Clinical Rating System" (KSCRS, com uma média de 78,22 pontos. RESULTADOS: Entre as complicações transoperatórias e pós operatórias imediatas ocorreram uma deiscência de sutura, com cura espontânea, duas fraturas de patela, uma fratura do côndilo medial do fêmur, três paresias do nervo fibular lateral e uma distrofia nervosa simpático reflexa. As complicações tardias foram uma fratura da patela, uma fratura distal do fêmur, quatro solturas assépticas e quatro infecções profundas, que necessitaram de revisão. CONCLUSÃO: Excluindo-se os casos que necessitaram de uma revisão, por soltura séptica ou asséptica, os autores concluem serem bons os resultados clínicos e funcionais obtidos com a prótese com o apoio tibial móvel num seguimento a médio prazo.OBJECTIVE: Evaluation of mid-term follow up results of the application of a total knee replacement with a mobile tibial bearing design. METHODS: Ninety six patients (107 knees were submitted to total knee Arthroplasty, performed with a model of prosthesis with rotating mobility in the tibial component. The patients were evaluated after a mean follow-up of 52.7 months - standard deviation 21.94 (minimum 24 months and maximum 120 months through the Knee Society Clinical Rating System (KSCRS, with a mean outcome of 78.22 points. RESULTS: The complications that occurred immediately after or during the surgery included: one wound dehiscence with spontaneous healing, two patellar fractures, one fracture of the medial

  17. Lower trabecular volumetric BMD at metaphyseal regions of weight-bearing bones is associated with prior fracture in young girls.

    Science.gov (United States)

    Farr, Joshua N; Tomás, Rita; Chen, Zhao; Lisse, Jeffrey R; Lohman, Timothy G; Going, Scott B

    2011-02-01

    Understanding the etiology of skeletal fragility during growth is critical for the development of treatments and prevention strategies aimed at reducing the burden of childhood fractures. Thus we evaluated the relationship between prior fracture and bone parameters in young girls. Data from 465 girls aged 8 to 13 years from the Jump-In: Building Better Bones study were analyzed. Bone parameters were assessed at metaphyseal and diaphyseal sites of the nondominant femur and tibia using peripheral quantitative computed tomography (pQCT). Dual-energy X-ray absorptiometry (DXA) was used to assess femur, tibia, lumbar spine, and total body less head bone mineral content. Binary logistic regression was used to evaluate the relationship between prior fracture and bone parameters, controlling for maturity, body mass, leg length, ethnicity, and physical activity. Associations between prior fracture and all DXA and pQCT bone parameters at diaphyseal sites were nonsignificant. In contrast, lower trabecular volumetric BMD (vBMD) at distal metaphyseal sites of the femur and tibia was significantly associated with prior fracture. After adjustment for covariates, every SD decrease in trabecular vBMD at metaphyseal sites of the distal femur and tibia was associated with 1.4 (1.1-1.9) and 1.3 (1.0-1.7) times higher fracture prevalence, respectively. Prior fracture was not associated with metaphyseal bone size (ie, periosteal circumference). In conclusion, fractures in girls are associated with lower trabecular vBMD, but not bone size, at metaphyseal sites of the femur and tibia. Lower trabecular vBMD at metaphyseal sites of long bones may be an early marker of skeletal fragility in girls. Copyright © 2011 American Society for Bone and Mineral Research.

  18. Locally administrated perindopril improves healing in an ovariectomized rat tibial osteotomy model.

    Directory of Open Access Journals (Sweden)

    Xiong Zhao

    Full Text Available Angiotensin-converting enzyme inhibitors are widely prescribed to regulate blood pressure. High doses of orally administered perindopril have previously been shown to improve fracture healing in a mouse femur fracture model. In this study, perindopril was administered directly to the fracture area with the goal of stimulating fracture repair. Three months after being ovariectomized (OVX, tibial fractures were produced in Sprague-Dawley rats and subsequently stabilized with intramedullary wires. Perindopril (0.4 mg/kg/day was injected locally at the fractured site for a treatment period of 7 days. Vehicle reagent was used as a control. Callus quality was evaluated at 2 and 4 weeks post-fracture. Compared with the vehicle group, perindopril treatment significantly increased bone formation, increased biomechanical strength, and improved microstructural parameters of the callus. Newly woven bone was arranged more tightly and regularly at 4 weeks post-fracture. The ultimate load increased by 66.1 and 76.9% (p<0.01, and the bone volume over total volume (BV/TV increased by 29.9% and 24.3% (p<0.01 at 2 and 4 weeks post-fracture, respectively. These findings suggest that local treatment with perindopril could promote fracture healing in ovariectomized rats.

  19. [Clinical practice guideline on closed tibial plateau fractures in adulthood].

    Science.gov (United States)

    Ocegueda-Sosa, Miguel Ángel; Valenzuela-Flores, Adriana Abigail; Aldaco-García, Víctor Daniel; Flores-Aguilar, Sergio; Manilla-Lezama, Nicolás; Pérez-Hernández, Jorge

    2013-01-01

    Closed tibiae plateau fractures are common injuries in the emergency room. The optimal treatment is not well defined or established. For this reason, there are several surgical management options: open reduction and internal fixation, closed reduction and percutaneous synthesis, external fixation, and even conservative treatment for this kind of fracture. The mechanism of production of this fracture is through large varus or valgus deformation to which is added a factor of axial load. The trauma may be direct or indirect. The degree of displacement, fragmentation and involvement of soft tissues like ligaments, menisci, vascular and nerve structures are determined by the magnitude of the force exerted. Any intra-articular fracture treatment can lead to an erroneous instability, deformity and limitation of motion with subsequent arthritic changes, leading to joint incongruity, limiting activity and significantly altering the quality of life. Open reduction and internal fixation with anatomic restitution is the method used in this type of fracture. However, the results of numerous publications can be questioned due to the inclusion in the same study of fractures treated with very different methods.

  20. Improving tibial component coronal alignment during total knee arthroplasty with use of a tibial planing device.

    Science.gov (United States)

    Patil, Shantanu; D'Lima, Darryl D; Fait, James M; Colwell, Clifford W

    2007-02-01

    The outcomes of knee arthroplasty have been shown to be affected by component alignment. Intramedullary and extramedullary alignment instrumentation are fairly effective for achieving the desired mean tibial component coronal alignment. However, there are outliers representing >3 degrees of varus or valgus alignment with respect to the anatomic tibial shaft axis. We measured the efficacy of a custom tibial planing device for reducing the outliers in tibial alignment. We designed a tibial planing tool in an effort to improve tibial alignment. In one cohort (100 knees), we used traditional intramedullary alignment instrumentation to make the tibial bone cut. In a second cohort (120 knees), we used intramedullary alignment instrumentation to make the cut and also used a custom tool to check the cut and to correct an inexact cut. Tibial tray alignment relative to the long axis of the tibial shaft was measured in the coronal and sagittal planes on postoperative radiographs. The target coronal alignment was 90 degrees with respect to the tibial shaft axis (with alignment). A total of 100 anteroposterior radiographs and sixty-five lateral radiographs were analyzed for the group that was treated with traditional instrumentation alone, and a total of 120 anteroposterior radiographs and fifty-five lateral radiographs were analyzed for the group that was treated with use of the custom tibial planing device. The mean coronal alignment of the tibial component was 89.5 degrees +/- 2.1 degrees in the group that was treated with traditional instrumentation alone and 89.6 degrees +/- 1.4 degrees in the group that was treated with use of the custom planing device. Although the mean coronal alignment was not significantly different, the number of outliers was substantially reduced when the custom planing device was used. All 120 components that had been aligned with use of the custom planing device were within 3 degrees of the target coronal alignment, compared with only eighty

  1. Reconstruction of Acute Traumatic Tibial Fractures with the Ilizarov ...

    African Journals Online (AJOL)

    The average time for application of the apparatus to fracture healing was 4.3 months. One fracture required autogenous bone graft for union. One patient is undergoing callus transportation for bone replacement. The most common complication was pin tract infection seen in nine (25.7%) patients. Conclusion: We treated 35 ...

  2. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis.

    Science.gov (United States)

    Mandell, Jacob C; Khurana, Bharti; Smith, Stacy E

    2017-09-01

    Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.

  3. Do running speed and shoe cushioning influence impact loading and tibial shock in basketball players?

    Directory of Open Access Journals (Sweden)

    Wing-Kai Lam

    2018-05-01

    Full Text Available Background Tibial stress fracture (TSF is a common injury in basketball players. This condition has been associated with high tibial shock and impact loading, which can be affected by running speed, footwear condition, and footstrike pattern. However, these relationships were established in runners but not in basketball players, with very little research done on impact loading and speed. Hence, this study compared tibial shock, impact loading, and foot strike pattern in basketball players running at different speeds with different shoe cushioning properties/performances. Methods Eighteen male collegiate basketball players performed straight running trials with different shoe cushioning (regular-, better-, and best-cushioning and running speed conditions (3.0 m/s vs. 6.0 m/s on a flat instrumented runway. Tri-axial accelerometer, force plate and motion capture system were used to determine tibial accelerations, vertical ground reaction forces and footstrike patterns in each condition, respectively. Comfort perception was indicated on a 150 mm Visual Analogue Scale. A 2 (speed × 3 (footwear repeated measures ANOVA was used to examine the main effects of shoe cushioning and running speeds. Results Greater tibial shock (P 0.14; η2 = 0.13. Discussion There may be an optimal band of shoe cushioning for better protection against TSF. These findings may provide insights to formulate rehabilitation protocols for basketball players who are recovering from TSF.

  4. GESSO SINTÉTICO E PINOS TRANSCORTICAIS NA REDUÇÃO DE FRATURA DE TÍBIA EM UMA BEZERRA FIBERGLASS CAST AND TRANSCORTICAL PINS IN TIBIAL FRACTURE REDUCTION IN A CALF

    Directory of Open Access Journals (Sweden)

    Edivaldo Aparecido Nunes Martins

    2001-02-01

    Full Text Available Relata-se um caso de fratura de tíbia em uma bezerra de sete meses de idade, 200kg de peso, apresentando fratura fechada, cominutiva em diáfise. A fixação externa foi preferida como método de imobilização óssea, utilizando-se pinos transcorticais e gesso sintético. Obteve-se eficiente imobilização da fratura, com rápida recuperação do animal, dispendendo-se pouco tempo para o pós-operatório (52 dias. A técnica demonstrou ser de fácil realização e passível de ser executada a campo.A case of tibial fracture in a 7-month-old calf is reported, with closed comminuted diaphysial fracture. It has been given preference to external fixation as means of fracture immobilization, and transcortical pins and fiberglass cast have been used. Effective immobilization of the fracture and fast recovering of the animal as well as less time consuming toward the postoperative have been obtained. This technique has showed feasible to be done in the field.

  5. The fracture sites of atypical femoral fractures are associated with the weight-bearing lower limb alignment.

    Science.gov (United States)

    Saita, Yoshitomo; Ishijima, Muneaki; Mogami, Atsuhiko; Kubota, Mitsuaki; Baba, Tomonori; Kaketa, Takefumi; Nagao, Masashi; Sakamoto, Yuko; Sakai, Kensuke; Kato, Rui; Nagura, Nana; Miyagawa, Kei; Wada, Tomoki; Liu, Lizu; Obayashi, Osamu; Shitoto, Katsuo; Nozawa, Masahiko; Kajihara, Hajime; Gen, Hogaku; Kaneko, Kazuo

    2014-09-01

    Atypical femoral fractures (AFFs) are stress-related fractures that are speculated to associate with long-term treatment with bisphosphonates for osteoporosis. A history of AFF is a high risk factor for the development of a subsequent AFF in the same location of the contralateral femur, suggesting that a patient's individual anatomical factor(s) are related to the fracture site of AFFs. In this study, we investigated the radiographs of fourteen AFFs (four bilateral fractures among ten patients) treated at six hospitals associated with our university between 2005 and 2010. The fracture site and standing femorotibial angle (FTA), which reflects the mechanical axis of the lower limb, were measured on weight-bearing lower limb radiographs. The fracture site and FTA of patients with typical femoral fractures (TFF) were compared to those of patients with AFFs. The correlations were examined using Spearman's rank correlation coefficients. The fracture locations in the femora were almost the same in the patients with bilateral AFFs. There was a positive correlation between the fracture site and the standing FTA in the patients with AFFs (r=0.82, 95% confidence interval; 0.49 to 0.94), indicating that the larger the standing FTA (varus alignment), the more distal the site of the fracture in the femur. The FTA of the patients with atypical diaphyseal femoral fracture were significantly larger compared to that of those with not only atypical subtrochanteric fractures but also TFFs. In conclusion, the fracture sites of AFFs are associated with the standing lower limb alignment, while those of TFFs are not. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Role of fasciocutaneous flaps as a method of soft tisssue coverage in type 111 - b open tibial fractures

    International Nuclear Information System (INIS)

    Pahore, M.K.

    2014-01-01

    To determine the role of fasciocutaneous flap as soft tissue coverage in type 111 - B open tibial fractures. An experience by orthopaedic surgeons at LUMHS Jamshoro. Material and Methods: This prospective study was containing 41 patients with type 111 - B fracture of tibia. All cases were managed in department of ortho paedic surgery and traumatology LUMHS Jamshoro from 2008 - 2012. Patients with diabetes mellitus and peripheral vascular disease were excluded from study. After resuscitation and antibiotic cover debridement done and back slab applied. On next day after routine investigations debridement was done and fracture was stabilized with external fixator. After multiple debridements as wound became clean and ready for flap, it is covered with appropriate fasciocuaneous flap. Dressing changed after 5 days and stitches removed after 2 weeks. Patients were assessed for their basic data, site of injury, type of fasciocutaneous flap their acceptance and complications. Results: Average age was 31.8 years, According to site of injury 7 (16.66%) cases sustained in proximal tibia, 12 (28.57%) in middle tibia, 17 (40.47%) in distal tibia, 4 (9.52%) in middle 2/3 rd of tibia and 2 (4.76%) in distal 2/3 rd of tiba. The pattern of executed flaps were proximal based medial flaps in 4(9.52), proximal based lateral in 3 (7.14%), distal based med- ial in 8 (19%), distal based lateral in 17 (40.47%), cross leg in 2 (4.76%), sural flap in 2 (4.76%), distal lateral retrograde in 4 (9.52%), random pattern flaps in 2 (4.76%) and soleus muscle flaps in 2 (4.76%) cases. Out of 42 cases 33 (78.57%) were good, 6 (14.28%) fair and 3 (7.14%) poor. Complications noted were marginal necrosis in 6 (14.28|%), partial or complete (necrosis in 3 (7.14%), superficial infection in 3 (14.28%) and deep infection in 5 (11). (author)

  7. 'Trampoline fracture' of the proximal tibia in children: report of 3 cases and review of literature.

    Science.gov (United States)

    Bruyeer, E; Geusens, E; Catry, F; Vanstraelen, L; Vanhoenacker, F

    2012-01-01

    We present three cases of fracture of the proximal tibia in young children who were jumping on a trampoline. The typical radiological findings and the underlying mechanism of trauma are discussed. The key radiological features are: a transverse hairline fracture of the upper tibia often accompanied by a buckle fracture of the lateral or medial tibial cortex, buckling of the anterior upper tibial cortex and anterior tilting of the epiphyseal plate. New types of injuries related to specific recreational activities are recognized. It is often helpful to associate a typical injury with a particular activity. Trampoline related injuries have increased dramatically over the last years. The most common lesions are fractures and ligamentous injuries, in particular a transverse fracture of the proximal tibia. However the radiological findings can be very subtle and easily overlooked. It is therefore important to be aware of the typical history and radiological findings.

  8. A cross-sectional study of the effects of load carriage on running characteristics and tibial mechanical stress: implications for stress-fracture injuries in women.

    Science.gov (United States)

    Xu, Chun; Silder, Amy; Zhang, Ju; Reifman, Jaques; Unnikrishnan, Ginu

    2017-03-23

    Load carriage is associated with musculoskeletal injuries, such as stress fractures, during military basic combat training. By investigating the influence of load carriage during exercises on the kinematics and kinetics of the body and on the biomechanical responses of bones, such as the tibia, we can quantify the role of load carriage on bone health. We conducted a cross-sectional study using an integrated musculoskeletal-finite-element model to analyze how the amount of load carriage in women affected the kinematics and kinetics of the body, as well as the tibial mechanical stress during running. We also compared the biomechanics of walking (studied previously) and running under various load-carriage conditions. We observed substantial changes in both hip kinematics and kinetics during running when subjects carried a load. Relative to those observed during running without load, the joint reaction forces at the hip increased by an average of 49.1% body weight when subjects carried a load that was 30% of their body weight (ankle, 4.8%; knee, 20.6%). These results indicate that the hip extensor muscles in women are the main power generators when running with load carriage. When comparing running with walking, finite element analysis revealed that the peak tibial stress during running (tension, 90.6 MPa; compression, 136.2 MPa) was more than three times as great as that during walking (tension, 24.1 MPa; compression, 40.3 MPa), whereas the cumulative stress within one stride did not differ substantially between running (15.2 MPa · s) and walking (13.6 MPa · s). Our findings highlight the critical role of hip extensor muscles and their potential injury in women when running with load carriage. More importantly, our results underscore the need to incorporate the cumulative effect of mechanical stress when evaluating injury risk under various exercise conditions. The results from our study help to elucidate the mechanisms of stress fracture in women.

  9. Treatment of malreduced pilon fracture: A case report and the result in the long-term follow-up.

    Science.gov (United States)

    Balioğlu, Mehmet Bulent; Akman, Yunus Emre; Bahar, Hakan; Albayrak, Akif

    2016-01-01

    The risk for post-traumatic osteoarthritis (POA) following tibial plafond joint trauma has been reported to be as high as 70-75%. In the treatment of more severe joint pathologies, with incongruity and intra-articular defects, internal or external fixations techniques may be required. We report the orthopedic management of a pilon fracture in a 30-year-old male with malunion and implant failure after initial mal-reduction of the fracture 9-months earlier. Tricortical iliac crest autologous bone grafting (TCG) was used in combination with internal fixation to restore distal tibial articular. The procedure resulted in a pain free ankle, sufficient range of motion for function and patient satisfaction. Early surgical intervention and anatomical reduction with appropriate fixation are recommended for intra-articular tibial pilon fractures. Autogenous bone grafting is a reliable treatment option to augment structural stability, bone defects and bone-healing. Indications for bone grafting include delayed union or nonunion, malunion, arthrodesis, limb salvage, and reconstruction of bone voids or defects. The application of TCG in the management of a malreduced tibial plafond fracture has not been described before. We performed TCG with internal fixation in order to restore stability, congruency and alignment in a young patient in whom a biological restoration was feasible due to good bone quality. In suitable cases, TCG might provide an alternative to arthrodesis or arthroplasty. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  10. The effect of tibial plateau leveling osteotomy position on cranial tibial subluxation: an in vitro study.

    Science.gov (United States)

    Kowaleski, Michael P; Apelt, Detlef; Mattoon, John S; Litsky, Alan S

    2005-01-01

    To compare centered versus distal tibial plateau leveling osteotomy (TPLO) position on cranial tibial subluxation, postoperative tibial plateau angle (TPA), and tibial long axis shift (TLAS). In vitro biomechanical evaluation. Six pairs of canine cadaveric hind limbs. One limb of each pair was randomly assigned to the distal (TPLO-D) or centered (TPLO-C) osteotomy group. Cranial tibial subluxation (CTS) under load was quantified sequentially under 3 conditions: intact, after cranial cruciate ligament transection, and after TPLO; a corrected CTS value was also calculated. Postoperative TPA and TLAS were measured. Comparisons were made using 1-way repeated measures ANOVA with a Tukey's multiple comparison post hoc test for CTS, and a Wilcoxon's sign rank test for TPA and TLAS. Significance was set at Pcranial tibial thrust. The centered osteotomy position is geometrically more precise, and biomechanically more effective than the distal position.

  11. Efficacy and Safety of Interlocked Intramedullary Nailing for Open Fracture Shaft of Tibia

    International Nuclear Information System (INIS)

    Ahmad, N.; Awan, A. S.; Sultan, S.; Saifullah, K.; Afridi, S. A.; Afridi, S. K.; Lodhi, F. S.

    2016-01-01

    Background: Due to increasing population and changing human habits the number of accidents and high energy trauma is rising. Management of open fracture tibia is a complex problem and is a challenge for both orthopaedic and plastic surgeons. The study was carried out to ascertain the efficacy and safety of interlocked intra-medullary nailing for open shaft tibial fractures in patients presenting at or after 24 hr of injury. Methods: In this descriptive case series, over a period of 6 moths, 163 consecutive cases of open fracture of tibial shaft were reviewed in terms of clinical profile, time of presentation, and gender distribution. Results: In this study mean age was 30±0.02 years. Males comprised 85 percent of study population while 15 percent were females. Gustilo-I type fracture and Gustilo-II type fracture was diagnosed in 90 percent and 10 percent patients respectively. Thirty three percent patients had wound infection while fracture union was found in 15 percent cases. Moreover interlocked intramedullary nailing for open fracture shaft of tibia was safe in 80 percent patients while this procedure was effective in 85 percent. Conclusion: Un-reamed, interlocked intra-medullary nailing may be considered as a suitable option for treatment of open fractures of tibia. (author)

  12. Proximal tibial osteophytes and their relationship with the height of the tibial spines of the intercondylar eminence: paleopathological study

    International Nuclear Information System (INIS)

    Hayeri, Mohammad Reza; Shiehmorteza, Masoud; Trudell, Debra J.; Resnick, Donald; Hefflin, Tori

    2010-01-01

    Tibial spiking (i.e., spurring of tibial spines), eburnation, and osteophytes are considered features of osteoarthritis. This investigation employed direct inspection of the medial and lateral tibial plateaus in paleopathological specimens to analyze the frequency and morphological features of osteoarthritis and to define any relationship between the size of osteophytes and that of the intercondylar tibial spines. A total of 35 tibial bone specimens were evaluated for the degree of osteoarthritis and presence of eburnation. Each plateau was also divided into four quadrants and the presence and size of bone outgrowths were recorded in each quadrant. The ''medial/lateral tibial intercondylar spine index'' for each specimen was calculated as follows: (medial/lateral intercondylar tibial spine height)/(anteroposterior width of the superior tibial surface). The relationships between medial and lateral tibial height indexes with the degree of osteoarthritis were then tested. Osteophytes were observed more frequently in the anterior quadrants of both tibial plateaus than in the posterior quadrants (29 vs 16 for the medial tibial plateau [p = 0.01] and 28 vs 20 for the lateral tibial plateau [p = 0.04]). Eburnation was seen more frequently in the posterior regions of both tibial plateaus than in the anterior regions (17 vs 5, p < 0.01). In specimens with no signs of osteoarthritis the lateral intercondylar tibial index was significantly lower than that in specimens with some degree of osteoarthritis (p = 0.02). The medial intercondylar tibial index of the specimens with no signs of osteoarthritis was not significantly different from that of the specimens with some degree of osteoarthritis (p = 0.45). There was a positive correlation between the lateral spine height index and the overall grading of osteoarthritis, (r = 0.6, p < 0.01). In the anteromedial and posteromedial quadrants of the lateral tibial plateau, the association between the lateral intercondylar tibial spine

  13. Proximal tibial osteophytes and their relationship with the height of the tibial spines of the intercondylar eminence: paleopathological study

    Energy Technology Data Exchange (ETDEWEB)

    Hayeri, Mohammad Reza [Children' s National Medical Center, Department of Radiology, Washington, DC (United States); Shiehmorteza, Masoud; Trudell, Debra J.; Resnick, Donald [University of California San Diego, Department of Radiology, San Diego, CA (United States); Hefflin, Tori [Museum of Man San Diego, San Diego, CA (United States)

    2010-09-15

    Tibial spiking (i.e., spurring of tibial spines), eburnation, and osteophytes are considered features of osteoarthritis. This investigation employed direct inspection of the medial and lateral tibial plateaus in paleopathological specimens to analyze the frequency and morphological features of osteoarthritis and to define any relationship between the size of osteophytes and that of the intercondylar tibial spines. A total of 35 tibial bone specimens were evaluated for the degree of osteoarthritis and presence of eburnation. Each plateau was also divided into four quadrants and the presence and size of bone outgrowths were recorded in each quadrant. The ''medial/lateral tibial intercondylar spine index'' for each specimen was calculated as follows: (medial/lateral intercondylar tibial spine height)/(anteroposterior width of the superior tibial surface). The relationships between medial and lateral tibial height indexes with the degree of osteoarthritis were then tested. Osteophytes were observed more frequently in the anterior quadrants of both tibial plateaus than in the posterior quadrants (29 vs 16 for the medial tibial plateau [p = 0.01] and 28 vs 20 for the lateral tibial plateau [p = 0.04]). Eburnation was seen more frequently in the posterior regions of both tibial plateaus than in the anterior regions (17 vs 5, p < 0.01). In specimens with no signs of osteoarthritis the lateral intercondylar tibial index was significantly lower than that in specimens with some degree of osteoarthritis (p = 0.02). The medial intercondylar tibial index of the specimens with no signs of osteoarthritis was not significantly different from that of the specimens with some degree of osteoarthritis (p = 0.45). There was a positive correlation between the lateral spine height index and the overall grading of osteoarthritis, (r = 0.6, p < 0.01). In the anteromedial and posteromedial quadrants of the lateral tibial plateau, the association between the lateral

  14. Triplane fracture of the distal tibial epiphysis: radiographic and CT studies

    International Nuclear Information System (INIS)

    Cone, R.O. III; Nguyen, V.; Flournoy, J.G.; Guerra, J. Jr.

    1984-01-01

    The authors analyzed six cases of triplane fracture of the ankle and reviewed the literature. A previously underscribed fracture pattern was identified in one patient. CT studies proved to be useful diagnostic tools in the evaluation of triplane fractures when operative reduction was contemplated

  15. Fractures of the Distal Tibia Treated with Polyaxial Locking Plating

    OpenAIRE

    Gao, Hong; Zhang, Chang-Qing; Luo, Cong-Feng; Zhou, Zu-Bin; Zeng, Bing-Fang

    2008-01-01

    We evaluated the healing rate, complications, and functional outcomes in 32 adult patients with very short metaphyseal fragments in fractures of the distal tibia treated with a polyaxial locking system. The average distance from the distal extent of the fracture to the tibial plafond was 11 mm. All fractures healed and the average time to union was 14 weeks. Six patients (19%) reported occasional local disturbance over the medial malleolus. There were two cases of postoperative superficial in...

  16. Drifting Diaphyses: Asymmetry in Diametric Growth and Adaptation Along the Humeral and Femoral Length.

    Science.gov (United States)

    Maggiano, Isabel S; Maggiano, Corey M; Tiesler, Vera G; Chi-Keb, Julio R; Stout, Sam D

    2015-10-01

    This study quantifies regional histomorphological variation along the human humeral and femoral diaphysis in order to gain information on diaphyseal growth and modeling drift patterns. Three thin sections at 40, 50, and 60% bone length were prepared from a modern Mexican skeletal sample with known age and sex to give a longitudinal perspective on the drifting cortex (12 adults and juveniles total, 7 male and 5 female). Point-count techniques were applied across eight cross-sectional regions of interest using the starburst sampling pattern to quantify percent periosteal and endosteal primary lamellar bone at each diaphyseal level. The results of this study show a posterio-medial drift pattern in the humerus with a posterior rotational trend along the diaphysis. In the femur, we observed a consistent lateral to anteriolateral drift and an increase in primary lamellar bone area of both, periosteal and endosteal origin, towards the distal part of the diaphysis. These observations characterize drifting diaphyses in greater detail, raising important questions about how to resolve microscopic and macroscopic cross-sectional analysis towards a more complete understanding of bone growth and mechanical adaptation. Accounting for modeling drift has the potential to positively impact age and physical activity estimation, and explain some of the significant regional variation in bone histomorphology seen within (and between) bone cross-sections due to differing ages of tissue formation. More study is necessary, however, to discern between possible drift scenarios and characterize populational variation. © 2015 Wiley Periodicals, Inc.

  17. Pylon fractures of the ankle: A distinct clinical and radiological entity

    International Nuclear Information System (INIS)

    Mainwaring, B.L.; Daffner, R.H.; Riemer, B.L.

    1987-01-01

    Pylon fractures are a distinct clinical and radiological entity that should not be confused with trimalleolar fractures. Radiographic and clinical comparison of 20 cases of each fracture type revealed definite distinguishing features. First, pylon fractures inevitably were associated with profound comminution of the distal tibia. The trimalleolar injury was associated with fractures of the medial, lateral, and posterior malleoli without comminution. Second, in contrast to timalleolar fractures, pylon fractures had intraarticular extension of at least one tibial fracture through the dome of the plafond. Third, 60% of all pylon fractures were associated with a fractured talus; the talus was intact in all trimalleolar fractures. Fourth, the distal tibiofibular syndesmosis was constant in the pylon fractures but was separated in all trimalleolar fractures

  18. Bone grafting via reamer-irrigator-aspirator for nonunion of open Gustilo-Anderson type III tibial fractures treated with multiplanar external fixator

    Directory of Open Access Journals (Sweden)

    Kusnezov Nicholas

    2017-01-01

    Full Text Avai