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Sample records for tibial intramedullary canal

  1. The accuracy of intramedullary tibial guide of sagittal alignment of PCL-substituting total knee arthroplasty.

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    Han, Hyuk-Soo; Kang, Seung-Baik; Jo, Chris H; Kim, Sun-Hong; Lee, Jung-Ha

    2010-10-01

    Experimental and clinical studies on the accuracy of the intramedullary alignment method have produced different results, and few have addressed accuracy in the sagittal plane. Reported deviations are not only attributable to the alignment method but also to radiological errors. The purpose of this study was to evaluate the accuracy of the intramedullary alignment method in the sagittal plane using computed tomography (CT) and 3-dimensional imaging software. Thirty-one TKAs were performed using an intramedullary alignment method involving the insertion of a long 8-mm diameter rod into the medullary canal to the distal metaphysis of the tibia. All alignment instruments were set to achieve an ideal varus/valgus angle of 0° in the coronal plane and a tibial slope of 0° in the sagittal plane. The accuracy of the intramedullary alignment system was assessed by measuring the coronal tibial component angle and sagittal tibial slope angles, i.e., angles between the tibial anatomical axis and the tangent to the medial and lateral tibial plateau or the cut-surface. The mean coronal tibial component angle was 88.5° ± 1.2° and the mean tibial component slope in the sagittal plane was 1.6° ± 1.2° without anterior slope. Our intramedullary tibial alignment method, which involves passing an 8-mm diameter long rod through the tibial shaft isthmus, showed good accuracy (less than 3 degrees of variation and no anterior slope) in the sagittal plane in neutral or varus knees.

  2. Extramedullary versus intramedullary tibial cutting guides in megaprosthetic total knee replacement

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    Karade Vikas

    2012-10-01

    Full Text Available Abstract Background In a standard total knee replacement, tibial component alignment is a key factor for the long term success of the surgery. The purpose of this study is to compare the accuracy of extramedullary and intramedullary tibial cutting guides used in indigenous and imported implants respectively, in positioning of the tibial components in megaprosthetic knee replacements. Methods A comparative study of the accuracy of extramedullary and intramedullary tibial cutting guides was carried out in 92 megaprosthetic knee replacements for distal femoral tumors. For the proximal tibia cut for tibial component placement, an extramedullary guide was used in 65 patients and an intramedullary guide was used in 27 patients. Tibial component alignment angles were measured in postoperative X-rays with the help of CAD software. Results There was more varus placement in coronal plane with extramedullary cutting guide (−1.18 +/− 2.4 degrees than the intramedullary guide (−0.34 +/− 2.31 degrees but this did not reach statistical significance. The goal of 90 +/− 2 degrees alignment of tibial component was achieved in 54% of patients in the extramedullary group versus 67% in the intramedullary group. In terms of sagittal plane alignment, extramedullary guide showed less accurate results (2.09 +/− 2.4 degrees than intramedullary guide (0.50 +/− 3.80 degrees for tibial component alignment, though 78% of patients were aligned within the goal of 0–5 degrees of tibial slope angle in extramedullary group versus 63% in intramedullary group. The mean error in the measurements due to rotation of the knee during taking the X-rays was less than 0.1 degrees and distribution of the X-rays with the rotation of knee was similar in both the groups. Conclusions Overall, in megaprosthetic knee replacement intramedullary guides gave more accurate results in sagittal plane and exhibited similar variability as of extramedullary guides in coronal plane.

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

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    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.

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

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    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...

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

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    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.

  6. Intramedullary versus extramedullary alignment of the tibial component in the Triathlon knee

    LENUS (Irish Health Repository)

    Cashman, James P

    2011-08-20

    Abstract Background Long term survivorship in total knee arthroplasty is significantly dependant on prosthesis alignment. Our aim was determine which alignment guide was more accurate in positioning of the tibial component in total knee arthroplasty. We also aimed to assess whether there was any difference in short term patient outcome. Method A comparison of intramedullary versus extramedullary alignment jig was performed. Radiological alignment of tibial components and patient outcomes of 103 Triathlon total knee arthroplasties were analysed. Results Use of the intramedullary was found to be significantly more accurate in determining coronal alignment (p = 0.02) while use of the extramedullary jig was found to give more accurate results in sagittal alignment (p = 0.04). There was no significant difference in WOMAC or SF-36 at six months. Conclusion Use of an intramedullary jig is preferable for positioning of the tibial component using this knee system.

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

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    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

  8. 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.

  9. 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)

  10. 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.

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

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    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.

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

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    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.

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

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    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.

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

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    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.

  15. Semiextended approach for intramedullary nailing via a patellar eversion technique for tibial-shaft fractures: Evaluation of the patellofemoral joint.

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    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.

  16. Improving tibial component coronal alignment during total knee arthroplasty with use of a tibial planing device.

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    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

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

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    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.

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

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    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.

  19. 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.

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

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    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.

  1. Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion.

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    Hierholzer, Christian; Friederichs, Jan; Glowalla, Claudio; Woltmann, Alexander; Bühren, Volker; von Rüden, Christian

    2017-08-01

    The aim of this study was to evaluate a standardized treatment protocol regarding the rate of secondary bone union, complications, and functional outcome. This study was started as a prospective study in a single Level I Trauma Centre between 2003 and 2012. The study group consisted of 188 patients with the diagnosis of an aseptic tibial shaft nonunion. Exchange nailing was performed following a standardized surgical protocol. Long-term follow-up was analyzed for rate of bone healing and functional outcome. Osseous healing was achieved in 182 out of 188 patients (97 %). In 165 out of 188 patients (88 %), bone healing was observed timely and uneventfully after a single exchange nailing procedure. An open approach was necessary in 32 patients (17 %). Twenty-three patients (12 %) required additional therapy such as extracorporeal shock wave therapy. Post-operative complications were observed in seven patients (4 %). Almost all patients demonstrated osseous healing within 12 months, with the majority of osseous healing occurring within six months. A relevant shortening of the fractured tibia was observed in 20 out of 188 patients (11 %). After a median follow-up of 23 months (range 12-45 months), outcome was evaluated using the assessment system of Friedman/Wyman. In summary, 154 out of 188 patients (82 %) had a good functional long-term result. Reamed intramedullary exchange nailing including correction of axis alignment is a safe and effective treatment of aseptic tibial shaft nonunion with a high rate of bone healing and a good radiological and functional long-term outcome.

  2. 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...

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

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    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

  4. 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

  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. 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 ...

  7. 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...

  8. 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

  9. Removal of a Broken Cannulated Intramedullary Nail: Review of the Literature and a Case Report of a New Technique

    Directory of Open Access Journals (Sweden)

    Amr A. Abdelgawad

    2013-01-01

    Full Text Available Nonunion of long bones fixed with nails may result in implant failure. Removal of a broken intramedullary nail may be a real challenge. Many methods have been described to allow for removal of the broken piece of the nail. In this paper, we are reviewing the different techniques to extract a broken nail, classifying them into different subsets, and describing a new technique that we used to remove a broken tibial nail with narrow canal. Eight different categories of implant removal methods were described, with different methods within each category. This classification is very comprehensive and was never described before. We described a new technique (hook captured in the medulla by flexible nail introduced from the locking hole which is a valuable technique in cases of nail of a small diameter where other methods cannot be used because of the narrow canal of the nail. Our eight categories for broken nail removal methods simplify the concepts of nail removal and allow the surgeon to better plan for the removal procedure.

  10. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 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

  13. 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)

  14. TIBIAL LANDMARKS IN ACL ANATOMIC REPAIR

    Directory of Open Access Journals (Sweden)

    M. V. Demesсhenko

    2016-01-01

    Full Text Available Purpose: to identify anatomical landmarks on tibial articular surface to serve as reference in preparing tibial canal with respect to the center of ACL footprint during single bundle arthroscopic repair.Materials and methods. Twelve frozen knee joint specimens and 68 unpaired macerated human tibia were studied using anatomical, morphometric, statistical methods as well as graphic simulation.Results. Center of the tibial ACL footprint was located 13,1±1,7 mm anteriorly from posterior border of intercondylar eminence, at 1/3 of the distance along the line connecting apexes of internal and external tubercles and 6,1±0,5 mm anteriorly along the perpendicular raised to this point.Conclusion. Internal and external tubercles, as well as posterior border of intercondylar eminence can be considered as anatomical references to determine the center of the tibial ACL footprint and to prepare bone canals for anatomic ligament repair.

  15. 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

  16. 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.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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. Do biodegradable magnesium alloy intramedullary interlocking nails prematurely lose fixation stability in the treatment of tibial fracture? A numerical simulation.

    Science.gov (United States)

    Wang, Haosen; Hao, Zhixiu; Wen, Shizhu

    2017-01-01

    Intramedullary interlocking nailing is an effective technique used to treat long bone fractures. Recently, biodegradable metals have drawn increased attention as an intramedullary interlocking nailing material. In this study, numerical simulations were implemented to determine whether the degradation rate of magnesium alloy makes it a suitable material for manufacturing biodegradable intramedullary interlocking nails. Mechano-regulatory and bone-remodeling models were used to simulate the fracture healing process, and a surface corrosion model was used to simulate intramedullary rod degradation. The results showed that magnesium alloy intramedullary rods exhibited a satisfactory degradation rate; the fracture healed and callus enhancement was observed before complete dissolution of the intramedullary rod. Delayed magnesium degradation (using surface coating techniques) did not confer a significant advantage over the non-delayed degradation process; immediate degradation also achieved satisfactory healing outcomes. However, delayed degradation had no negative effect on callus enhancement, as it did not cause signs of stress shielding. To avoid risks of individual differences such as delayed union, delayed degradation is recommended. Although the magnesium intramedullary rod did not demonstrate rapid degradation, its ability to provide high fixation stiffness to achieve earlier load bearing was inferior to that of the conventional titanium alloy and stainless steel rods. Therefore, light physiological loads should be ensured during the early stages of healing to achieve bony healing; otherwise, with increased loading and degraded intramedullary rods, the fracture may ultimately fail to heal. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Tibial lengthening for unilateral Crowe type-IV developmental dysplasia of the hip

    Directory of Open Access Journals (Sweden)

    Jun Wan

    2014-01-01

    Conclusions: Tibial lengthening may effectively correct gait and satisfactorily improve body image in young patients with unilateral Crowe type-IV DDH. Mono-lateral external fixator allows for accelerated postoperative rehabilitation and optimal preservation of ankle movements. Lengthening along with intramedullary nails may significantly reduce the external fixation time and the risk of fixator-related complications.

  1. Influence of knee flexion and atraumatic mobilisation of infrapatellar fat pad on incidence and severity of anterior knee pain after tibial nailing.

    Science.gov (United States)

    Jankovic, Andrija; Korac, Zelimir; Bozic, Nenad-Bozo; Stedul, Ivan

    2013-09-01

    We evaluated the incidence and aetiology of anterior knee pain (AKP) in a series of patients that underwent intramedullary nailing for stabilisation of tibial fractures. During the preparation of the entry site no excision of the infrapatellar fat was allowed and electrical haemostasis was kept at the lowest level. Medullary canal was reamed and the nails inserted in position of knee flexion over 100 degrees. All fractures were fixed using medial paratendinous approach. Functional outcome was measured using Lysholm knee score. The knee range of movement and return to previous level of activity were also documented and analysed. Mean follow up was 38.9 months (range 12-84 months). In total 60 patients with 62 tibial shaft fractures were analysed. The mean age at the time of final follow up was 49.4 years (range 20-87). In 22 (35.5%) a newly developed and persisting pain in the anterior region of the operated knee was reported. According to VAP scale, the pain was mild (VAS 1-3) in 12 cases (19.4%) and moderate (VAS 4-6) in 10 (16.1%). In 16 cases (73%) the pain was noticed 6-12 months after injury and subjectively related to return to full range of working and recreational activities. The mean Lysholm knee score in the group without AKP was 90.8. In the AKP group with mild pain it was 88.4 and in the group with moderate AKP it was 79.9. Complete return to previous professional and recreational activities occurred in 49/60 patients (81.7%). Content with the treatment regarding expectations in recovery dynamics and return to desired level of activity was present in 98.3% of patients; one patient was unsatisfied with the treatment. Our results indicate that respecting the physiological motion of Hoffa pad and menisci during knee flexion, accompanied with atraumatic mobilisation of retrotendinous fat, reduces incidence and severity of anterior knee pain following intramedullary fixation of tibial shaft fractures. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Management of knee rheumatoid arthritis and tibia nonunion with one-stage total knee arthroplasty and intramedullary nailing: A report of two cases

    Directory of Open Access Journals (Sweden)

    Fahri Erdogan

    2018-01-01

    Full Text Available Total knee arthroplasty (TKA is a surgical procedure which is widely used in the treatment of gonarthrosis secondary to rheumatoid arthritis (RA. The incidence of stress fractures in tibia in the patients with RA is higher compared to normal patients. In this study, we report two cases of TKA and intramedullary nailing in RA patients with severe knee arthritis and tibial nonunion. Both patients had a satisfactory clinical outcome with radiological healing of the tibial fracture.

  3. A novel intramedullary nail for micromotion stimulation of tibial fractures.

    LENUS (Irish Health Repository)

    Dailey, Hannah L

    2011-09-20

    BACKGROUND: Animal studies and clinical trials have suggested that early application of controlled axial micromotion can accelerate healing of long bone fractures compared to rigid fixation. However, experimental investigations of micromotion constructs have been limited to external fixators, which have a higher incidence of complications than intramedullary nails. The purpose of this study was to assess whether a novel intramedullary nail design can generate stimulatory micromotion under minimal weight-bearing loads typical of the early healing period. METHODS: Eight cadaver tibiae were reamed, osteotomised, and implanted with commercially-available IM nails fitted with a custom insert that allowed 1mm of axial micromotion after proximal\\/distal interlocking. Specimens were mounted in a materials testing machine and subjected to cyclic axial loading while interfragmentary motion was measured using an extensometer. Implants were also tested in standard statically-locked mode. FINDINGS: The average force required to cause distraction of the fracture gap in micromotion mode was 37.0 (SD 21.7) N. The mean construct stiffness was 1046.8 (SD 193.6) N\\/mm in static locking mode and 512.4 (SD 99.6) N\\/mm in micromotion mode (significantly different, P<0.001). INTERPRETATION: These results support the development of a micromotion-enabled IM nail because the forces required to cause interfragmentary movements are very low, less than the weight of the hanging shank and foot. In contrast to rigid-fixation nails, which require significant weight-bearing to induce interfragmentary motion, the micromotion-enabled nail may allow movement in non-weight-bearing patients during the early healing period when the benefits of mechanical stimulation are most critical.

  4. Tibial shaft fractures in football players

    Directory of Open Access Journals (Sweden)

    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.

  5. Dosimetry during intramedullary nailing of the tibia.

    Science.gov (United States)

    Kirousis, George; Delis, Harry; Megas, Panagiotis; Lambiris, Elias; Panayiotakis, George

    2009-10-01

    Intramedullary nailing under fluoroscopic guidance is a common operation. We studied the intraoperative radiation dose received by both the patient and the personnel. 25 intramedullary nailing procedures of the tibia were studied. All patients suffered from tibial fractures and were treated using the Grosse-Kempf intramedullary nail, with free-hand technique for fixation of the distal screws, under fluoroscopic guidance. The exposure, at selected positions, was recorded using an ion chamber, while the dose area product (DAP) was measured with a DAP meter, attached to the tube head. Thermoluminescent dosimeters (TLDs) were used to derive the occupational dose to the personnel, and also to monitor the surface dose on the gonads of some of the patients. The mean operation time was 101 (48-240) min, with a mean fluoroscopic time of 72 seconds and a mean DAP value of 75 cGy x cm(2). The surface dose to the gonads of the patients was less than 8.8 mGy during any procedure, and thus cannot be considered to be a contraindication for the use of this technique. Occupational dose differed substantially between members of the operating personnel, the maximum dose recorded being to the operator of the fluoroscopic equipment (0.11 mSv). Our findings underscore the care required by the primary operator not to exceed the dose constraint of 10 mSv per year. The rest of the operating personnel, although they do not receive very high doses, should focus on the dose optimization of the technique.

  6. Fixation of a human rib by an intramedullary telescoping splint anchored by bone cement.

    Science.gov (United States)

    Liovic, Petar; Šutalo, Ilija D; Marasco, Silvana F

    2016-09-01

    A novel concept for rib fixation is presented that involves the use of a bioresorbable polymer intramedullary telescoping splint. Bone cement is used to anchor each end of the splint inside the medullary canal on each side of the fracture site. In this manner, rib fixation is achieved without fixation device protrusion from the rib, making the splint completely intramedullary. Finite element analysis is used to demonstrate that such a splint/cement composite can preserve rib fixation subjected to cough-intensity force loadings. Computational fluid dynamics and porcine rib experiments were used to study the anchor formation process required to complete the fixation.

  7. 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...

  8. 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

  9. 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.

  10. MR imaging of a ruptured intraspinal dermoid tumour with fat droplets in the central spinal canal

    International Nuclear Information System (INIS)

    Karadag, D.; Karaguelle, A.T.; Erden, A.; Erden, I.

    2002-01-01

    We report a patient with intramedullary ruptured spinal dermoid tumour. The MR imaging revealed an intramedullary lumbar mass heterogenous in intensity in all sequences. Fat droplets were observed in the subarachnoid space as well as in the dilated central spinal canal. Fat droplets in the subarachnoid space are frequently seen in the rupture of intraspinal dermoid tumours; however, fat droplets within the central canal is quite rare and was unexpected. Magnetic resonance imaging is a useful tool in the determination of spinal pathologies before they become large enough to cause severe symptoms and/or morbidity. Copyright (2002) Blackwell Science Pty Ltd

  11. Comparing hospital outcomes between open and closed tibia fractures treated with intramedullary fixation.

    Science.gov (United States)

    Smith, Evan J; Kuang, Xiangyu; Pandarinath, Rajeev

    2017-07-01

    Tibial shaft fractures comprise a large portion of operatively treated long bone fractures, and present with the highest rate of open injuries. Intramedullary fixation has become the standard of care for both open and closed injuries. The rates of short term complications and hospital length of stay for open and closed fractures treated with intramedullary fixation is not fully known. Previous series on tibia fractures were performed at high volume centers, and data were not generalizable, further they did not report on length of stay and the impact of preoperative variables on infections, complications and reoperation. We used a large surgical database to compare these outcomes while adjusting for preoperative risk factors. Data were extracted from the ACS-NSQIP database from 2005 to 2014. Cases were identified based on CPT codes for intramedullary fixation and categorized as closed vs open based on ICD9 code. In addition to demographic and case data, primary analysis examined correlation between open and closed fracture status with infection, complications, reoperation and hospital length of stay. Secondary analysis examined preoperative variables including gender, race, age, BMI, and diabetes effect on outcomes. There were 272 cases identified. There were no significant demographic differences between open and closed tibia fracture cases. Open fracture status did not increase the rate of infection, 30day complications, reoperation, or length of stay. The only preoperative factor that correlated with length of stay was age. There was no correlation between BMI, presence of insulin dependent and nondependent diabetes, and any outcome measure. When considering the complication rates for open and closed tibial shaft fractures treated with intramedullary fixation, there is no difference between 30-day complication rate, length of stay, or return to the operating room. Our reported postoperative infection rates were comparable to previous series, adding validity to

  12. Finite Element Analysis of Absorbable Sheath to Prevent Stress Shielding of Tibial Interlocking Intramedullary Nail

    Science.gov (United States)

    Dong, Yansheng; Wang, Yongqing; Dong, Limin; Jia, Peng; Lu, Fengcheng

    2017-07-01

    The nail with absorbable sheath (AS nail) is designed to reduce the stress shielding effect of internal fixation with interlocking intramedullary nail. In order to verify its feasibility, two types of the finite element models of internal fixation of tibia with the AS nail and the common metal nail (CM nail) are established using the Softwares of Mimics, Geomagic, SolidWorks and ANSYS according to the CT scanning data of tibia. The result of the finite element analysis shows that the AS nail has great advantages compared with the CM nail in reducing the stress shielding effect in different periods of fracture healing. The conclusion is that the AS nail can realize the static fixation to the dynamic fixation from the early to the later automatically to shorten the time of fracture healing, which also provides a new technique to the interlocking intramedullary nail.

  13. Intramedullary Recurrence of a Thoracic Meningioma-Presentation of an Unusual Case and Review of the Literature.

    Science.gov (United States)

    Piazza, Matthew A; Ramayya, Ashwin G; Geiger, Geoffrey A; Alonso-Basanta, Michelle; Nasrallah, MacLean P; Welch, William C; Ozturk, Ali K

    2016-08-01

    Spinal meningiomas are typically extra-axial, slow-growing, benign tumors that arise from the arachnoid cap cells. Intramedullary spinal meningiomas are exceedingly rare with few cases reported in the literature. A 64-year-old man with a history of grade I thoracic meningioma at the T4 level resected initially in 1989 and who required reoperation in 2013 for intradural, extramedullary recurrence of tumor presented again in 2015 with gait difficulty. Magnetic resonance imaging revealed a soft tissue mass at the T3 to T4 levels on the left side of the canal that was mildly enhancing on T1 contrasted sequences. The patient was taken to the operating room, where a purely intramedullary recurrence was discovered without extramedullary extension or a dural-based attachment. The intramedullary tumor was completely resected, and postoperatively the patient recovered well and was at his neurologic baseline. The patient ultimately underwent proton beam radiotherapy because this tumor, although benign, had recurred twice. Intramedullary spinal meningiomas, particularly intramedullary low-grade recurrence of a previously extramedullary tumor, are rare phenomena. Although the pathogenic mechanisms are not well understood, intramedullary recurrence as described in this patient may reflect extrinsic factors related to prior surgical resections in addition to histologic progression. When operating on recurrent extramedullary lesions, aggressive arachnoid dissection may predispose patients to unusual patterns of recurrence. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. 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.

  15. Intramedullary tuberculoma: A case report

    International Nuclear Information System (INIS)

    Maamar, M.; El Quessar, A.; El Fatemi, N.; El Hassani, My R.; Chakir, N.; Jiddane, M.

    2007-01-01

    Study design: We report a case of intra-medullary tuberculoma in a 22 year-old man with progressive paraparesis and sphincter dysfunction. Objectives: To present a case of intra-medullary tuberculosis and to describe the MRI's contribution to the diagnosis. Summary of background data: Intra-medullary spinal tuberculoma is a rare form of central nervous system tuberculosis. The subject and diagnosis methods: The patient, a 22 year-old man, presented with an intra-medullary tuberculoma of the dorsal spinal cord diagnosed after 6 month history of progressive paraparesis and sphincter dysfunction. MRI visualized ring enhancement of the intra-medullary dorsal lesion. Results: Total resection of the intra-medullary mass was performed through a posterior myelotomy. Histological examination revealed a granulomatous necrosis with caseum. The patient was treated with four anti-tuberculosis drugs in association with corticotherapy. The paraparesis and sphincter dysfunction improved. Conclusions: Intra-medullary spinal tuberculoma is rare, but must be considered in the differential diagnosis of spinal cord compression

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

    Science.gov (United States)

    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.

  17. Carbon fiber intramedullary nails reduce artifact in postoperative advanced imaging

    International Nuclear Information System (INIS)

    Zimel, Melissa N.; Hwang, Sinchun; Riedel, Elyn R.; Healey, John H.

    2015-01-01

    This study assessed whether radiolucent carbon fiber reinforced-polyetheretherketone (CFR-PEEK) intramedullary nails decreased hardware artifact on magnetic resonance imaging (MRI) and computed tomography (CT) in vitro and in an oncologic patient population. In vitro and clinical evaluations were done. A qualitative assessment of metal artifact was performed using CFR-PEEK and titanium nail MRI phantoms. Eight patients with a femoral or tibial prophylactic CFR-PEEK nail were retrospectively identified. All patients had postoperative surveillance imaging by MRI, CT, and were followed for a median 20 months (range, 12-28 months). CFR-PEEK images were compared to images from a comparative group of patients with titanium femoral intramedullary nails who had a postoperative MRI or CT. A musculoskeletal-trained radiologist graded visualization of the cortex, corticomedullary junction, and bone-muscle interface, on T1-weighted (T1W), STIR, and contrast-enhanced T1-weighted fat-saturated (T1W FS) sequences of both groups with a five-point scale, performing independent reviews 4 months apart. Statistical analysis used the Wilcoxon rank-sum test and a weighted kappa. Substantially less MRI signal loss occurred in the CFR-PEEK phantom than in the titanium phantom simulation, particularly as the angle increased with respect to direction of the static magnetic field. CFR-PEEK nails had less MRI artifact than titanium nails on scored T1W, STIR, and contrast-enhanced T1W FS MRI sequences (p ≤ 0.03). The mean weighted kappa was 0.64, showing excellent intraobserver reliability between readings. CFR-PEEK intramedullary nail fixation is a superior alternative to minimize implant artifact on MRI or CT imaging for patients requiring long bone fixation. (orig.)

  18. Carbon fiber intramedullary nails reduce artifact in postoperative advanced imaging

    Energy Technology Data Exchange (ETDEWEB)

    Zimel, Melissa N. [Memorial Sloan Kettering Cancer Center, Orthopaedic Surgery Service, Department of Surgery, New York, NY (United States); Hwang, Sinchun [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States); Riedel, Elyn R. [Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States); Healey, John H. [Memorial Sloan Kettering Cancer Center, Orthopaedic Surgery Service, Department of Surgery, New York, NY (United States); Weill Medical College of Cornell University, Department of Orthopaedic Surgery, New York, NY (United States)

    2015-09-15

    This study assessed whether radiolucent carbon fiber reinforced-polyetheretherketone (CFR-PEEK) intramedullary nails decreased hardware artifact on magnetic resonance imaging (MRI) and computed tomography (CT) in vitro and in an oncologic patient population. In vitro and clinical evaluations were done. A qualitative assessment of metal artifact was performed using CFR-PEEK and titanium nail MRI phantoms. Eight patients with a femoral or tibial prophylactic CFR-PEEK nail were retrospectively identified. All patients had postoperative surveillance imaging by MRI, CT, and were followed for a median 20 months (range, 12-28 months). CFR-PEEK images were compared to images from a comparative group of patients with titanium femoral intramedullary nails who had a postoperative MRI or CT. A musculoskeletal-trained radiologist graded visualization of the cortex, corticomedullary junction, and bone-muscle interface, on T1-weighted (T1W), STIR, and contrast-enhanced T1-weighted fat-saturated (T1W FS) sequences of both groups with a five-point scale, performing independent reviews 4 months apart. Statistical analysis used the Wilcoxon rank-sum test and a weighted kappa. Substantially less MRI signal loss occurred in the CFR-PEEK phantom than in the titanium phantom simulation, particularly as the angle increased with respect to direction of the static magnetic field. CFR-PEEK nails had less MRI artifact than titanium nails on scored T1W, STIR, and contrast-enhanced T1W FS MRI sequences (p ≤ 0.03). The mean weighted kappa was 0.64, showing excellent intraobserver reliability between readings. CFR-PEEK intramedullary nail fixation is a superior alternative to minimize implant artifact on MRI or CT imaging for patients requiring long bone fixation. (orig.)

  19. New Technique for Tibiotalar Arthrodesis Using a New Intramedullary Nail Device: A Cadaveric Study

    Directory of Open Access Journals (Sweden)

    Emmanuel D. Eisenstein

    2016-01-01

    Full Text Available Introduction. Ankle arthrodesis is performed in a variety of methods. We propose a new technique for tibiotalar arthrodesis using a newly designed intramedullary nail. Methods. We proposed development of an intramedullary device for ankle arthrodesis which spared the subtalar joint using a sinus tarsi approach. Standard saw bones models and computer assisted modeling and stress analysis were used to develop different nail design geometries and determine the feasibility of insertion. After the final design was constructed, the device was tested on three cadaveric specimens. Results. Four basic nail geometries were developed. The optimal design was composed of two relatively straight segments, each with a different radius of curvature for their respective tibial and talar component. We successfully implemented this design into three cadaveric specimens. Conclusion. Our newly designed tibiotalar nail provides a new technique for isolated tibiotalar fusion. It utilizes the advantages of a tibiotalar calcaneal nail and spares the subtalar joint. This design serves as the foundation for future research to include compression options across the tibiotalar joint and eventual transition to clinical practice.

  20. 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.

  1. Robotic technique improves entry point alignment for intramedullary nailing of femur fractures compared to the conventional technique: a cadaveric study.

    Science.gov (United States)

    Suero, Eduardo M; Westphal, Ralf; Citak, Musa; Hawi, Nael; Liodakis, Emmanouil; Krettek, Christian; Stuebig, Timo

    2017-08-11

    We aimed to test whether a robotic technique would offer more accurate access to the proximal femoral medullary cavity for insertion of an intramedullary nail compared to the conventional manual technique. The medullary cavity of ten femur specimens was accessed in a conventional fashion using fluoroscopic control. In ten additional femur specimens, ISO-C 3D scans were obtained and a computer program calculated the ideal location of the cavity opening based on the trajectory of the medullary canal. In both techniques, the surgeon opened the cavity using a drill and inserted a radiopaque tube that matched the diameter of the cavity. The mean difference in angle between the proximal opening and the medullary canal in the shaft of the femur was calculated for both groups. Robotic cavity opening was more accurate than the manual technique, with a mean difference in trajectory between the proximal opening and the shaft canal of 2.0° (95% CI 0.6°-3.5°) compared to a mean difference of 4.3° (95% CI 2.11°-6.48°) using the manual technique (P = 0.0218). The robotic technique was more accurate than the manual procedure for identifying the optimal location for opening the medullary canal for insertion of an intramedullary nail. Additional advantages may include a reduction in total radiation exposure, as only one ISO-C 3D scan is needed, as opposed to multiple radiographs when using the manual technique.

  2. REPARATIVE OSTEOGENESIS DURING TREATMENT OF FRACTURE UNDER TRANSOSSEOUS OSTEOSYNTHESIS AND INTRAMEDULLARY INSERTION OF WIRES WITH HYDROXYAPATITE COATING

    Directory of Open Access Journals (Sweden)

    Iurii M. Irianov, Arnold V. Popkov, Nikolay A. Kiryanov, Tatiana Iu. Karaseva, Evgenii A. Karasev

    2015-04-01

    Full Text Available Background: The problem of improving medical care for patients with the locomotor system injuries is very important especially last time. Material and Methods: Canine open comminuted tibial fractures modelled experimentally, wires with hydroxyapatite coating inserted intramedullary, osteosynthesis performed with the Ilizarov fixator. Regenerated bones investigated 14-360 days after surgery using the techniques of light microscopy, scanning and transmission electron microscopy, and X-ray electron probe microanalysis for histologic sections . Results: It has been found that a zone of active reparative osteo- and angiogenesis forms around the wires, as well as a bone sheath with the properties of osteogenesis conductor and inductor. Fracture consolidation occurs early according to the primary type without cartilaginous and connective tissue formation in bone adhesion. Presented morphological characteristics endovasal angiogenesis. Conclusion: The results of the study evidence of the positive effect of intramedullary wires with hydroxyapatite coating on the course and intensity of reparative osteogenesis during fracture healing

  3. Magnetic resonance imaging in the management of suspected spinal canal disease in patients with known malignancy

    International Nuclear Information System (INIS)

    Loughrey, Gareth J.; Collins, Conor D.; Todd, Susan M.; Brown, Nicola M.; Johnson, Richard J.

    2000-01-01

    AIM: The aim of this study was to examine the spectrum of spinal canal disease in patients with known malignancy using magnetic resonance imaging (MRI). MATERIALS AND METHODS: One hundred and fifty-five patients underwent a total of 159 spinal MRI examinations over a three-year period. Patients were examined using a 1.0T magnet and a phased array surface spine coil. Sagittal T1 weighted spin echo and STIR sequences were routinely employed. Axial T1 and T2 weighted spin echo images were obtained at sites of identified pathology. Contrast enhanced sagittal and axial T1 weighted spin echo images were acquired when the unenhanced appearances did not correlate with the clinical findings or when the images suggested intradural or intramedullary disease. RESULTS: Malignant disease affecting the spinal cord or cauda equina was noted in 104/159 (65%) patients (extradural n= 78, intradural n= 20, intramedullary n= 7); one patient had evidence of both intradural and intramedullary deposits. Multiple levels of extradural cord/cauda equina compression were present in 18/78 patients (23%). The thoracic spine was the most frequently affected (74%). Bone elements were the major component of extradural compression in 11/78 patients (14%). Intradural metastases were multiple in 15/20 patients (75%). Four of the six solitary intramedullary metastases were situated in the conus medullaris. CONCLUSION: Magnetic resonance imaging of the entire spine is the investigation of choice in patients with known malignancy and suspected spinal canal disease. Contrast-enhanced images should be acquired when the unenhanced appearances do not correlate with the clinical findings or when they suggest intradural or intramedullary disease. Loughrey, G.J. (2000)

  4. Magnetic resonance imaging in the management of suspected spinal canal disease in patients with known malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Loughrey, Gareth J.; Collins, Conor D.; Todd, Susan M.; Brown, Nicola M.; Johnson, Richard J

    2000-11-01

    AIM: The aim of this study was to examine the spectrum of spinal canal disease in patients with known malignancy using magnetic resonance imaging (MRI). MATERIALS AND METHODS: One hundred and fifty-five patients underwent a total of 159 spinal MRI examinations over a three-year period. Patients were examined using a 1.0T magnet and a phased array surface spine coil. Sagittal T1 weighted spin echo and STIR sequences were routinely employed. Axial T1 and T2 weighted spin echo images were obtained at sites of identified pathology. Contrast enhanced sagittal and axial T1 weighted spin echo images were acquired when the unenhanced appearances did not correlate with the clinical findings or when the images suggested intradural or intramedullary disease. RESULTS: Malignant disease affecting the spinal cord or cauda equina was noted in 104/159 (65%) patients (extradural n= 78, intradural n= 20, intramedullary n= 7); one patient had evidence of both intradural and intramedullary deposits. Multiple levels of extradural cord/cauda equina compression were present in 18/78 patients (23%). The thoracic spine was the most frequently affected (74%). Bone elements were the major component of extradural compression in 11/78 patients (14%). Intradural metastases were multiple in 15/20 patients (75%). Four of the six solitary intramedullary metastases were situated in the conus medullaris. CONCLUSION: Magnetic resonance imaging of the entire spine is the investigation of choice in patients with known malignancy and suspected spinal canal disease. Contrast-enhanced images should be acquired when the unenhanced appearances do not correlate with the clinical findings or when they suggest intradural or intramedullary disease. Loughrey, G.J. (2000)

  5. 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

  6. 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.

  7. Hydrocephalus: a rare initial manifestation of sporadic intramedullary hemangioblastoma : Intramedullary hemangioblastoma presenting as hydrocephalus.

    Science.gov (United States)

    Morais, Barbara Albuquerque; Cardeal, Daniel Dante; Ribeiro E Ribeiro, Renan; Frassetto, Fernando Pereira; Andrade, Fernanda Goncalves; Matushita, Hamilton; Teixeira, Manoel Jacobsen

    2017-08-01

    Intramedullary hemangioblastomas are rare benign vascular tumors, infrequent in pediatric patients. Clinical symptoms vary according to the age of presentation, tumor size, location, and concomitant syringomyelia. This is the second reported case of hemangioblastoma presenting with acute hydrocephalus. A 3-month-old infant with acute hydrocephalus was asymptomatic after a ventriculoperitoneal shunt was placed. She returned 3 months later with irritability, acute paraplegia, and respiratory distress. Magnetic resonance imaging (MRI) showed an intramedullary T8-T9 tumor with syringomyelia. She underwent surgical resection with good results during the 6-month follow-up. Intramedullary tumors may present as hydrocephalus and other nonspecific symptoms, with invariably delayed diagnosis in children, but must be considered in suspicious cases.

  8. Induced membrane technique combined with two-stage internal fixation for the treatment of tibial osteomyelitis defects.

    Science.gov (United States)

    Luo, Fei; Wang, Xiaohua; Wang, Shulin; Fu, Jingshu; Xie, Zhao

    2017-07-01

    The purpose of this study was to observe the effects of induced membrane technique combined with two-stage internal fixation in the treatment of tibial osteomyelitis defects. A retrospective analyses for 67 cases of tibialosteomyelitis defects were admitted to our department between September 2012 to February 2015, which were treated with induced membrane technique. At the first stage, implanted with a PMMA cement spacer in the defects after radical debridement and fixed with reconstructive locked plate. Bone grafting and exchanged the plate with intramedullary nail at the second stage. In current study, all patients were followed up for 18-35 months. Sixty-six patients achieved bone union with the average radiographic and clinical healing times of 5.55±2.19 and 7.45±1.69months, respectively. Seven patients required a second debridement before grafting, while four patients experienced a recurrence of infection or a relapse following second stage treatment. Twelve patients experienced either knee or ankle dysfunctions and 2 patients faced delayed wound healing. Donor site complications includes pain and infection were found in 7 and 3 patients, respectively with delayed stress fracture in 1 patient only. Induced membrane technique for the treatment of tibial osteomyelitis defects, seems a reliable method. The use of reconstructive locked plate as a temporary internal fixation at the first stage and exchanged with intramedullary nail at the second stage, potentially achieves good clinical efficacy. Care should be taken to restore the joint function especially in distal tibia. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Alignment After Intramedullary Nailing of Distal Tibia Fractures Without Fibula Fixation.

    Science.gov (United States)

    De Giacomo, Anthony F; Tornetta, Paul

    2016-10-01

    To evaluate the efficacy of intramedullary nailing of distal tibia fractures using modern techniques, without fibula fixation, in obtaining and maintaining alignment. Retrospective case review. Level-I academic trauma center. One hundred thirty-two consecutive patients with distal tibia fractures. Intramedullary nail of distal tibia fracture, without fibula fixation, was performed in consecutive patients using modern reduction techniques. Malalignment and malunion were defined as >5 degrees of varus/valgus angulation or anterior/posterior angulation on the initial postoperative or final anteroposterior and lateral x-rays. There were 122 consecutive patients (86 men and 36 women) 16-93 years of age (average, 43 years) with 36 (30%) open and 85 (70%) closed fractures with complete follow-up. Mechanism of injury did not predict the presence or level of fibula fracture. Upon presentation, varus/valgus and procurvatum/recurvatum angulation was greatest when the fibula was fractured at the level of the tibia fracture (P = 0.001 and 0.028). The most common intraoperative reduction aids were nailing in relative extension, transfixion external fixation, and clamps at the fracture site. The OTA fracture type or level/presence of fibula fracture did not influence malalignment (P = 0.86 and 0.66), malunion (P = 0.81 and 0.79), or the change in alignment during union, which averaged 0.9 degrees. We found an overall low rate of both malalignment (2%) and malunion (3%) after intramedullary nailing of distal tibial shaft fracture without fibula fixation. We conclude that when modern nailing techniques are used, which allow for confirmation of reduction by visualization in fluoroscopy, from nail placement to distal interlocking, fibula fixation is not necessary to obtain or maintain alignment. Furthermore, standard 2 medial to lateral screws distally afford adequate stability to hold the reduction during union with a 0.9-degree difference in the initial postoperative and final

  10. Magnetic resonance imaging of intramedullary meningioma of the spinal cord: case report and review of the literature

    International Nuclear Information System (INIS)

    Covert, S.; Gandhi, D.; Goyal, M.; Woulfe, J.; Belanger, E.; Miller, W.; Modha, A.

    2003-01-01

    Intramedullary meningioma of the spinal cord is an extremely rare tumour. To the best of our knowledge, only 4 cases have been reported in the English literature, and limited information on imaging features is available. We present a further case and review the literature on this entity. Meningiomas are among the most common tumours that occur in the spinal canal, representing about 25% of all adult intraspinal tumours. They are commonly found in the thoracic segment of the spine and are most often intradural-extramedullary. Their location is explained by the way in which they develop. Meningiomas are derived from persistent arachnoid cell remnants in the spinal coverings, most commonly from arachnoid. They are usually adherent to, but do not arise from, dura. We present a case of intramedullary meningioma, a rare clinical entity, discuss the magnetic resonance imaging (MRI) findings and review the 4 cases that have been previously reported. (author)

  11. 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.

  12. MR imaging of spine and spinal canal neoplasms: value of Gd-DTPA contrast enhancement

    International Nuclear Information System (INIS)

    Paprzycki, W.; Gradzki, J.; Sosnowski, P.; Stajgis, M.

    1994-01-01

    Value of Gadolinium-DTPA contrast enhancement in diagnosis of neoplastic diseases of spinal canal was estimated on the basis of retrospective analysis of MR examinations performed in 75 patients. The analyzed material consisted of 15 cases of intramedullary tumors (group 1.), 38 of subdural extramedullary (group 2.) and 22 extradural ones (group 3.). Contrast enhanced MR contributed significant information to the final diagnosis in all groups. The utmost significance of Gd-DTPA contrast enhancement was ascertained in group 1. Authors conclude that contrast enhancement with Gd-DTPA is indispensable in all these cases of spinal canal neoplasms, where non-contrast MR did not reveal pathologic changes in optimal manner. (author)

  13. [Locked plating with minimally invasive percutaneous plate osteosynthesis versus intramedullary nailing of distal extra-articular tibial fracture: a retrospective study].

    Science.gov (United States)

    Yao, Qi; Ni, Jie; Peng, Li-bin; Yu, Da-xin; Yuan, Xiao-ming

    2013-12-17

    To compare the efficacies of minimally invasive plate osteosynthesis (MIPPO) and interlocking intramedullary nailing (IMN) in the treatment of extra-articular fractures of distal tibia. Retrospective reviews were conducted for 126 patients with extra-articular distal tibia fractures. Treatment was either MIPPO (n = 61) or IMN (n = 65). The outcomes were assessed by comparing operating duration, time to union, the last follow-up American Orthopedic Foot and Ankle Society (AOFAS) score and complication rate. The average follow-up period was 23.7 (12-53) months. In the minimally invasive plate osteosynthesis group, there were deep infections (n = 2), superficial infections (n = 5), delayed union (n = 2), malunion (n = 2) and knee joint pain (n = 10) were observed. In addition, the average operating duration (85.9 ± 18.9 min), average time to union (17.3 ± 3.8 weeks) and average AOFAS (83.2 ± 11.9) were analyzed. In the interlocking intramedullary nailing group, there were delayed union (n = 3), malunion (n = 12) and knee joint pain (n = 22). And the average operating duration (83.3 ± 15.7 min), average time to union (16.5 ± 3.1 weeks) and average AOFAS (84.9 ± 12.0) were analyzed. No statistical significance existed in operating duration, time to union and the last follow-up AOFAS between two groups (P > 0.05). However, the rates of malformation and knee joint pain were higher in the intramedullary nail group than those in the plate group. And the difference was statistically significant (P = 0.015, P = 0.025). Both MIPPO and IMN are effective for extra-articular fractures of distal tibia. However, the former has the advantage of lowers rate of malformation and knee joint pain. Therefore a surgeon should consider the degree of injury while managing extra-articular fracture of distal tibia.

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

    Science.gov (United States)

    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.

  15. Comprehensive global evolution of intramedullary nailing of ...

    African Journals Online (AJOL)

    there has been great changes in design, materials and basic science ... proposed that the length of intramedullary implants be maximized to ... as intramedullary implant in 1917 (8). .... micro-movements and intermittent compression during.

  16. 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.

  17. Spinal cord edema with contrast enhancement mimicking intramedullary tumor in patient with cervical myelopathy: A case report and a brief literature review.

    Science.gov (United States)

    Gkasdaris, Grigorios; Chourmouzi, Danai; Karagiannidis, Apostolos; Kapetanakis, Stylianos

    2017-01-01

    Cervical myelopathy (CM) is a clinical diagnosis that may be associated with hyperintense areas on T2-weighted magnetic resonance imaging (MRI) scan. The use of contrast enhancement in such areas to differentiate between neoplastic and degenerative disease has rarely been described. We present a 41-year-old female with a 5-month course of progressive CM. The cervical MRI revealed spinal cord swelling, stenosis, and a hyperintense signal at the C5-C6 and C5-C7 levels. Both the neurologic and radiologic examinations were consistent with an intramedullary cervical cord tumor. To decompress the spinal canal, an anterior cervical discectomy and fusion was performed from C5 to C7 level. This resulted in immediate and significant improvement of the myelopathy. Postoperatively, over 1.5 years, the hyperintense, enhancing intramedullary lesion gradually regressed on multiple postoperative MRI scans. Spinal cord edema is occasionally seen on MR studies of the cervical spine in patients with degenerative CM. Contrast-enhanced MR studies may help differentiate hyperintense cord signals due to edema vs. atypical intramedullary tumors. Routine successive postoperative MRI evaluations are crucial to confirm the diagnosis of degenerative vs. neoplastic disease.

  18. Intramedullary capillary haemangioma.

    LENUS (Irish Health Repository)

    Kelleher, T

    2012-02-03

    Intramedullary capillary haemangioma is extremely rare and only four cases have been previously reported. We describe a further case, outlining the clinical, radiological, surgical and pathological features.

  19. 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

  20. Segmental transport after unreamed intramedullary nailing. Preliminary report of a "Monorail" system.

    Science.gov (United States)

    Raschke, M J; Mann, J W; Oedekoven, G; Claudi, B F

    1992-09-01

    The Ilizarov method of segmental bone transport has been shown to be an alternative to more conventional treatments of posttraumatic bony defects. After extensive clinical experience with the unreamed tibial nail in open fractures up to Grade IIIb, a new monorail fixation system for callus distraction and segmental bone transport was devised. This Monorail system is composed of an unreamed intramedullary (IM) nail and a unilateral AO distraction device. The new fixation method and the preliminary clinical experience are reported here. Four patients who previously sustained Grades II-IIIb open tibial fractures had an average bony defect of 9 cm. Two patients had previous bony infections. All patients had had serial debridements and myocutaneous flaps were required in three patients. An unreamed IM nail was inserted, and the transport device was applied. After an osteotomy, segmental transport was carried out until docking was achieved. The external fixator was removed after interlocking of the transported segment. The mean duration of external fixation was 17.9 days/cm and the mean period until roentgenographic consolidation of the distraction and nonunion site was 41.2 days/cm. There were two pin-tract infections but no IM infections. One nail broke after osseous consolidation of the regenerate at the distal interlocking site and required exchange. The goal of transport was achieved in all cases without angular or rotational deformity or length discrepancy. There were no neurovascular injuries.

  1. Visibility of the central canal on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Petit-Lacour, M.C.; Lasjaunias, P.; Iffenecker, C.; Benoudiba, F.; Hadj Rabia, M.; Doyon, D. [Service de Neuroradiologie, Faculte de Paris Sud (France); Hurth, M. [Department of Neurosurgery, Faculte Paris Sud, Kremlin-Bicetre (France)

    2000-10-01

    The central canal of the spinal cord is present at birth and becomes progressively obliterated. Cadaver studies have shown that it may persiste partially or completely. To our knowledge, this entity has not been described on MRI. We reviewed 794 MRI studies of the spinal cord, and found 12 patients (aged 14 to 65 years) who had an intramedullary cavity. The cavity was at the junction of the ventral {sup 1}/{sub 3} and dorsal {sup 2}/{sub 3} of the spinal cord, except at the level of the lumbar enlargement, where it was central. It was filiform in most cases, although sometimes fusiform (3 to 4 mm in diameter), and had regular contours. The cavity were thoracic in 69 % of cases. The clinical features were totally unrelated to the image, and there were no anatomical factors (Chiari malformation, dysraphism) predisposing to syringomyelia. The images were perfectly compatible with a persistent central canal, which we interpret as a variant of normal anatomy. Therefore it is important to regard these findings as normal, to avoid unnecessary treatment and follow-up. (orig.)

  2. Visibility of the central canal on MRI

    International Nuclear Information System (INIS)

    Petit-Lacour, M.C.; Lasjaunias, P.; Iffenecker, C.; Benoudiba, F.; Hadj Rabia, M.; Doyon, D.; Hurth, M.

    2000-01-01

    The central canal of the spinal cord is present at birth and becomes progressively obliterated. Cadaver studies have shown that it may persiste partially or completely. To our knowledge, this entity has not been described on MRI. We reviewed 794 MRI studies of the spinal cord, and found 12 patients (aged 14 to 65 years) who had an intramedullary cavity. The cavity was at the junction of the ventral 1 / 3 and dorsal 2 / 3 of the spinal cord, except at the level of the lumbar enlargement, where it was central. It was filiform in most cases, although sometimes fusiform (3 to 4 mm in diameter), and had regular contours. The cavity were thoracic in 69 % of cases. The clinical features were totally unrelated to the image, and there were no anatomical factors (Chiari malformation, dysraphism) predisposing to syringomyelia. The images were perfectly compatible with a persistent central canal, which we interpret as a variant of normal anatomy. Therefore it is important to regard these findings as normal, to avoid unnecessary treatment and follow-up. (orig.)

  3. Humeral Shaft Fracture: Intramedullary Nailing.

    Science.gov (United States)

    Konda, Sanjit R; Saleh, Hesham; Fisher, Nina; Egol, Kenneth A

    2017-08-01

    This video demonstrates the technique of intramedullary nailing for a humeral shaft fracture. The patient is a 30-year-old man who sustained a gunshot wound to his right arm. The patient was indicated for humeral nailing given the comminuted nature of the diaphysis and to allow for minimal skin incisions. Other relative indications include soft-tissue compromise about the arm precluding a large surgical exposure. This video presents a case of a comminuted humeral shaft fracture treated with an intramedullary nail. Anatomic reduction and stable fixation was obtained with this technique. This case demonstrates a soft-tissue sparing technique of humeral shaft fixation using a humeral intramedullary nail. The technique is easy to perform and has significant benefits in minimizing surgical exposure, decreasing operative time, and decreasing blood loss. In the correct clinical setting, humeral nailing provides an expeditious form of fixation that restores length, alignment, and rotation of the fracture humeral diaphysis.

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  6. 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.

  7. Radiographic study of the fifth metatarsal for optimal intramedullary screw fixation of Jones fracture.

    Science.gov (United States)

    Ochenjele, George; Ho, Bryant; Switaj, Paul J; Fuchs, Daniel; Goyal, Nitin; Kadakia, Anish R

    2015-03-01

    Jones fractures occur in the relatively avascular metadiaphyseal junction of the fifth metatarsal (MT), which predisposes these fractures to delayed union and nonunion. Operative treatment with intramedullary (IM) screw fixation is recommended in certain cases. Incorrect screw selection can lead to refractures, nonunion, and cortical blowout fractures. A better understanding of the anatomy of the fifth MT could aid in preoperative planning, guide screw size selection, and minimize complications. We retrospectively identified foot computed tomographic (CT) scans of 119 patients that met inclusion criteria. Using interactive 3-dimensional (3-D) models, the following measurements were calculated: MT length, "straight segment length" (distance from the base of the MT to the shaft curvature), and canal diameter. The diaphysis had a lateroplantar curvature where the medullary canal began to taper. The average straight segment length was 52 mm, and corresponded to 68% of the overall length of the MT from its proximal end. The medullary canal cross-section was elliptical rather than circular, with widest width in the sagittal plane and narrowest in coronal plane. The average coronal canal diameter at the isthmus was 5.0 mm. A coronal diameter greater than 4.5 mm at the isthmus was present in 81% of males and 74% of females. To our knowledge, this is the first anatomic description of the fifth metatarsal based on 3-D imaging. Excessive screw length could be avoided by keeping screw length less than 68% of the length of the fifth metatarsal. A greater than 4.5 mm diameter screw might be needed to provide adequate fixation for most study patients since the isthmus of the medullary canal for most were greater than 4.5 mm. Our results provide an improved understanding of the fifth metatarsal anatomy to guide screw diameter and length selection to maximize screw fixation and minimize complications. © The Author(s) 2014.

  8. 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.

  9. Intramedullary disorders diagnosed by MRI. Clinical course in 23 cases

    International Nuclear Information System (INIS)

    Nagata, Kensei; Ohashi, Teruaki; Ishibashi, Kazumasa; Hirohashi, Akiyuki; Sato, Kimiaki

    1996-01-01

    We report the clinical course of 23 cases with intramedullary disorders diagnosed by MRI. Spinal vascular disease was the most common, and occurred in 11 cases, intramedullary tumor occurred in 6, and multiple sclerosis, myelitis, spinal edema each in 2. The characteristic MRI findings of the intramedullary disorders were spinal cord swelling on T1 weighted image and changes in the intensity on the T2 weighted image. Surgical treatment was performed in 5 of the 11 with spinal vascular disease and in 6 with an intra-medullary tumor. One patient with AV malformation underwent embolization of the spinal artery. The other 11 received conservative treatment. The period of follow-up ranged from 6 months to 9 years after onset. Complete recovery from symptoms was achieved in only 2 patients, some recovery was achieved in 8, no change in 10, and deterioration occurred in 3. In conclusion, it has become easy to diagnose intramedullary disorders by utilizing MRI. However, an accurate qualitative diagnosis is difficult except for spinal vascular disease. Complete recovery from the symptoms of intramedullary disorders remains difficult to achieve by available treatments. (author)

  10. Intramedullary disorders diagnosed by MRI. Clinical course in 23 cases

    Energy Technology Data Exchange (ETDEWEB)

    Nagata, Kensei; Ohashi, Teruaki; Ishibashi, Kazumasa; Hirohashi, Akiyuki; Sato, Kimiaki [Kurume Univ., Fukuoka (Japan). School of Medicine

    1996-09-01

    We report the clinical course of 23 cases with intramedullary disorders diagnosed by MRI. Spinal vascular disease was the most common, and occurred in 11 cases, intramedullary tumor occurred in 6, and multiple sclerosis, myelitis, spinal edema each in 2. The characteristic MRI findings of the intramedullary disorders were spinal cord swelling on T1 weighted image and changes in the intensity on the T2 weighted image. Surgical treatment was performed in 5 of the 11 with spinal vascular disease and in 6 with an intra-medullary tumor. One patient with AV malformation underwent embolization of the spinal artery. The other 11 received conservative treatment. The period of follow-up ranged from 6 months to 9 years after onset. Complete recovery from symptoms was achieved in only 2 patients, some recovery was achieved in 8, no change in 10, and deterioration occurred in 3. In conclusion, it has become easy to diagnose intramedullary disorders by utilizing MRI. However, an accurate qualitative diagnosis is difficult except for spinal vascular disease. Complete recovery from the symptoms of intramedullary disorders remains difficult to achieve by available treatments. (author)

  11. 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.

  12. [Intramedullary stabilisation of clavicula fractures].

    Science.gov (United States)

    Prokop, A; Schiffer, G; Jubel, A; Chmielnicki, M

    2013-10-01

    With an incidence of 64/100,000, clavicular shaft fractures are one of the most common fractures. Intramedullary fixation with Prevot nails was initially reported in the late 1990s. This procedure offers minimally invasive stabilization of the fracture, thus enabling immediate mobilization and rapid loading capacity. Using a case study, the positioning and procedure are demonstrated on video. The intramedullary implant accommodates the varying tension loading of the clavicle. This treatment is ideal for clavicular fractures with 2-3 fragments. Compared to patients treated conservatively, operated patients achieve more rapid and improved mobility. Employment disability is shorter, and malunion occurs less frequently. Georg Thieme Verlag KG Stuttgart · New York.

  13. Sacral nerve stimulation increases activation of the primary somatosensory cortex by anal canal stimulation in an experimental model.

    LENUS (Irish Health Repository)

    Griffin, K M

    2011-08-01

    Sacral and posterior tibial nerve stimulation may be used to treat faecal incontinence; however, the mechanism of action is unknown. The aim of this study was to establish whether sensory activation of the cerebral cortex by anal canal stimulation was increased by peripheral neuromodulation.

  14. 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.

  15. Strength of titanium intramedullary implant versus miniplate fixation of mandibular condyle fractures.

    Science.gov (United States)

    Frake, Paul C; Howell, Rebecca J; Joshi, Arjun S

    2012-07-01

    To test the strength of internal fixation of mandibular condyle fractures repaired with titanium miniplates versus titanium intramedullary implants. Prospective laboratory experimentation in urethane mandible models and human cadaveric mandibles. Materials testing laboratory at an academic medical center. Osteotomies of the mandibular condyle were created in 40 urethane hemimandible models and 24 human cadaveric specimens. Half of the samples in each group were repaired with traditional miniplates, and the other half were repaired with intramedullary titanium implants. Anteroposterior and mediolateral loads were applied to the samples, and the displacement was measured with reference to the applied force. Titanium intramedullary implants demonstrated statistically significant improved strength and stiffness versus miniplates in the urethane model experimental groups. Despite frequent plastic deformation and mechanical failures of the miniplates, a 1.6-mm-diameter titanium intramedullary pin did not mechanically fail in any of the cases. Intramedullary implantation failures were due to secondary fracture of the adjacent cortical bone or experimental design limitations including rotation of the smooth pin implant. Mechanical implant failures that were encountered with miniplate fixation were not seen with titanium intramedullary implants. These intramedullary implants provide stronger and more rigid fixation of mandibular condyle fractures than miniplates in this in vitro model.

  16. New Technique: A Novel Femoral Derotation Osteotomy for Malrotation following Intramedullary Nailing

    Directory of Open Access Journals (Sweden)

    S. Jagernauth

    2012-01-01

    Full Text Available A 19-year-old female patient sustained a closed spiral midshaft femoral fracture and subsequently underwent femoral intramedullary nail insertion. At followup she complained of difficulty in walking and was found to have a unilateral in-toeing gait. CT imaging revealed 30 degrees of internal rotation at the fracture site, which had healed. A circumferential osteotomy was performed distal to the united fracture site using a Gigli saw with the intramedullary femoral nail in situ. The static distal interlocking screws were removed and the malrotation was corrected. Two further static distal interlocking screws were inserted to secure the intramedullary nail in position. The osteotomy went on to union and her symptoms of pain, walking difficulty, and in-toeing resolved. Our paper is the first to describe a technique for derotation osteotomy following intramedullary malreduction that leaves the intramedullary nail in situ.

  17. 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.

  18. Long-term functional outcome following intramedullary nailing of femoral shaft fractures

    NARCIS (Netherlands)

    el Moumni, Mostafa; Voogd, Emma Heather; ten Duis, Henk Jan; Wendt, Klaus Wilhelm

    Background: The management of femoral shaft fractures using intramedullary nailing is a popular method. The purpose of this study was to evaluate the long-term functional outcome after antegrade or retrograde intramedullary nailing of traumatic femoral shaft fractures. We further determined

  19. [Treatment of multi-segment fracture of complex femoral shaft with instrument-assisted reduction combined with intramedullary interlocking nail fixation].

    Science.gov (United States)

    Fan, Ke-Jie; Chen, Ke; Ma, Wen-Long; Tian, Ke-Wei; Ye, Ye; Chen, Hong-Gan; Tang, Yan-Feng; Cai, Hong-Min

    2018-05-25

    To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft. From January 2013 to January 2016, 32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing, including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of 7 days. After admission, routine tibial tubercle or supracondylar bone traction was performed. The patient's general condition was evaluated, the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy, postoperative fracture healing, complications and postoperative recovery of limb function were observed. All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion, incision infection and internal fixation fracture, failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria, the result was excellent in 28 cases, good in 3 cases, fair in 1 case. According to Hohl knee function evaluation criteria, the result was excellent in 30 cases, good in 2 cases. Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has

  20. 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...

  1. Feasibility of purely endoscopic intramedullary fixation of mandibular condyle fractures.

    Science.gov (United States)

    Frake, Paul C; Goodman, Joseph F; Joshi, Arjun S

    2015-01-01

    The investigators of this study hypothesized that fractures of the mandibular condyle can be repaired using short-segment intramedullary implants and purely endoscopic surgical technique, using a basic science, human cadaver model in an academic center. Endoscopic instrumentation was used through a transoral mucosal incision to place intramedullary implants of 2 cm in length into osteotomized mandibular condyles. The surgical maneuvers that required to insert these implants, including condyle positioning, reaming, implant insertion, and seating of the mandibular ramus, are described herein. Primary outcome was considered as successful completion of the procedure. Ten cadaveric mandibular condyles were successfully repaired with rigid intramedullary internal fixation without the use of external incisions. Both insertion of a peg-type implant and screwing a threaded implant into the condylar head were possible. The inferior portion of the implant remained exposed, and the ramus of the mandible was manipulated into position on the implant using retraction at the sigmoid notch. The results of this study suggest that purely endoscopic repair of fractures of the mandibular condyle is possible by using short-segment intramedullary titanium implants and a transoral endoscopic approach without the need for facial incisions or punctures. The biomechanical advantages of these intramedullary implants, including improved strength and resistance to mechanical failure compared with miniplates, have been recently established. The combination of improved implant design and purely endoscopic technique may allow for improved fixation and reduced surgical- and implant-related morbidity in the treatment of condylar fractures.

  2. Primary malignant intramedullary lymphoma

    International Nuclear Information System (INIS)

    Orrego P, E.; Heinicke Y, H.; Arbaiza A, D.; Yepez R, V.

    1999-01-01

    A case of primary malignant intramedullary lymphoma, localized in the dorsal part of the spinal cord is presented. The clinical symptoms were associated with motor and sensitive deficit. Clinical investigations excluded the presence of lymphoma in other locations in the central nervous system and the extra neural organs. Postoperative radiotherapy and chemotherapy improved relict neurological symptoms. (authors)

  3. Do intramedullary implants improve survival in elderly patients with trochanteric fractures? A retrospective study.

    Science.gov (United States)

    Vermesan, D; Prejbeanu, R; Poenaru, D V; Petrescu, H; Apostol, E; Inchingolo, F; Dipalma, G; Abbinante, A; Caprio, M; Potenza, M A; Cagiano, R; Malcangi, G; Inchingolo, A D; Haragus, H

    2015-01-01

    There is currently no consensus regarding superiority of the intramedullary fixation over the sliding hip screw. Regional variation remains high and not backed up by solid evidence. Given these premises we aimed to analyze weather implant preference can influence the postoperative survival. Secondary objectives were determining the trend for implant choice and confounding factors associated with intramedullary nails compared to sliding hip screws. Retrospective data was obtained from patient charts with the main diagnosis of extracapsular/ trochanteric fractures, corresponding to ICD S72.1 codes. Between 2008-2012, 441 patients underwent osteosynthesis with a dynamic hip screw and 155 with intramedullary nail respectively. The living status was determined by comparing the patient identification number against the national population evidence records. The lifetable shows similar survival for both implants over the 5 year period. The yearly mortality was 19.4% for the dynamic hip screw and 21.8% for the intramedullary implant respectively, even though the later were used predominantly in older patients. This age difference is significant according to both parametric and non-parametric tests whereas duration of hospital stay are similar. We found a clear increase in the proportion of intramedullary implants, for a total of 11.2% over the 5 year period. There is no difference for the one year mortality and overall survival between sliding screw plates and intramedullary constructs. A clear increase in the use of intramedullary implants for trochanteric fractures was observed. This is even more apparent for older ages, presumably due to an higher surgeon confidence with the biomechanical stability of the intramedullary constructs.

  4. 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.)

  5. Treatments of intramedullary spinal cord tumors

    Energy Technology Data Exchange (ETDEWEB)

    Ueyama, Kazumasa; Okada, Akihiro; Echigoya, Naoki; Yokoyama, Toru; Harata, Seiko [Hirosaki Univ., Aomori (Japan). School of Medicine

    2001-04-01

    In order to establish a treatment for intramedullary spinal cord tumors, histology, symptoms (preoperative, upon discharge from the hospital, and at the final follow-up examination), postoperative combination therapy, postoperative complications, and recurrence were assessed in patients with intramedullary spinal cord tumors treated in the author's hospital during the past 19 years. There were 26 subjects (astrocytoma in 8, ependymoma in 6, intramedullary neurinoma in 3, lipoma in 3, hemangioblastoma in 3, cavernous angioma in 1, capillary hemangioma in 1, and enterogenous cyst in 1). Surgery had been performed in 24 of them, and 7 of the tumors were completely resected, 6 were incompletely resected, and 3 were partially resected. Radiotherapy had been performed to treat 7 astrocytomas and 2 ependymomas. Kyphosis was noted as a postoperative complication in 1 patient with an astrocytoma who had received postoperative radiotherapy. Postoperative improvement was better in the patients who had the ependymomas, lipoma, and angioma, and in 1 patient with an astrocytoma. The astrocytomas were very difficult to completely remove surgically, and postoperative radiotherapy was thought to be indispensable. The ependymomas, hemangioblastomas, and angiomas could be surgically resected, but the surgeon must has to exercise sufficient care during the operation. The lipomas were also difficult to resect surgically and intratumoral decompression or decompression should be performed. For adolescents spinal deformity should be considered as one of the postoperative complications. (K.H.)

  6. Treatments of intramedullary spinal cord tumors

    Energy Technology Data Exchange (ETDEWEB)

    Ueyama, Kazumasa; Okada, Akihiro; Echigoya, Naoki; Yokoyama, Toru; Harata, Seiko [Hirosaki Univ., Aomori (Japan). School of Medicine

    2001-04-01

    In order to establish a treatment for intramedullary spinal cord tumors, histology, symptoms (preoperative, upon discharge from the hospital, and at the final follow-up examination), postoperative combination therapy, postoperative complications, and recurrence were assessed in patients with intramedullary spinal cord tumors treated in the author's hospital during the past 19 years. There were 26 subjects (astrocytoma in 8, ependymoma in 6, intramedullary neurinoma in 3, lipoma in 3, hemangioblastoma in 3, cavernous angioma in 1, capillary hemangioma in 1, and enterogenous cyst in 1). Surgery had been performed in 24 of them, and 7 of the tumors were completely resected, 6 were incompletely resected, and 3 were partially resected. Radiotherapy had been performed to treat 7 astrocytomas and 2 ependymomas. Kyphosis was noted as a postoperative complication in 1 patient with an astrocytoma who had received postoperative radiotherapy. Postoperative improvement was better in the patients who had the ependymomas, lipoma, and angioma, and in 1 patient with an astrocytoma. The astrocytomas were very difficult to completely remove surgically, and postoperative radiotherapy was thought to be indispensable. The ependymomas, hemangioblastomas, and angiomas could be surgically resected, but the surgeon must has to exercise sufficient care during the operation. The lipomas were also difficult to resect surgically and intratumoral decompression or decompression should be performed. For adolescents spinal deformity should be considered as one of the postoperative complications. (K.H.)

  7. 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.

  8. Intramedullary cavernous hemangiomas, magnetic resonance studies in four patients

    International Nuclear Information System (INIS)

    Barrena, M.R.; Guelbenzu, S.; Garcia, S.; Bertrol, V.

    1998-01-01

    Intramedullary cavernous hemangiomas are vascular malformations that can be located throughout the entire central nervous system. They are more frequently found in brain than in spinal cord, where it is only possible to diagnose them by magnetic resonance (RM): We present four cases of intramedullary spinal cord cavernoma, three of which were located in the thoracic spine and one in cervical spine. Computed tomography was ineffective in their diagnosis. However, MR disclosed there presence of well-defined tumors producing a thickening of the spinal cord. The signal was heterogeneous in both T1 and T2-weighted images. There were low signal areas due to the presence of calcium and hemosiderin and high intensity signals provoked by methemoglobin within the lesions, which were scarcely enhanced by intravenous gadolinium administration. One of the lesions presented in the form of a large intramedullary hematoma. (Author) 8 refs

  9. Objective guidelines for removing an external fixator after tibial lengthening using pixel value ratio: a pilot study.

    Science.gov (United States)

    Zhao, Li; Fan, Qing; Venkatesh, K P; Park, Man S; Song, Hae Ryong

    2009-12-01

    During limb lengthening over an intramedullary nail, decisions regarding external fixator removal and weightbearing depend on the amount of callus seen at the lengthening area on radiographs. However, this method is subjective and objective evaluation of the amount of callus likely would minimize nail or interlocking screw breakage and refracture after fixator removal. We asked how many cortices with full corticalization of the newly formed bone at the lengthening area are needed to allow fixator removal and full weightbearing and how to radiographically determine the stage of corticalization. We retrospectively reviewed 17 patients (34 lengthenings) who underwent bilateral tibial lengthenings over an intramedullary nail. The average gain in length was 7.2 +/- 3.4 cm. We determined the pixel value ratio (ratio of pixel value of regenerate versus the mean pixel value of adjacent bone) of the lengthened area on radiographs. There were no nail or screw breakage and refracture. Partial weightbearing with crutches was permitted when the pixel value ratio was 1 in two cortices and full weightbearing without crutches was permitted when the pixel value ratio was 1 in three cortices. The pixel value ratio on radiographs can be an objective parameter for callus measurement and may provide guidelines for the timing of external fixator removal. We cannot determine from our limited data the minimum pixel value in how many cortices would suggest safe removal, but we can say our criteria were not associated with subsequent refracture.

  10. 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.

  11. Intramedullary spinal cord metastasis from colonic carcinoma presenting as Brown-Sequard syndrome: a case report

    LENUS (Irish Health Repository)

    Kaballo, Mohammed A

    2011-08-02

    Abstract Introduction Intramedullary spinal cord metastasis is very rare. The majority are discovered incidentally during autopsy. Most symptomatic patients present with rapidly progressive neurological deficits and require immediate examination. Few patients demonstrate features of Brown-Séquard syndrome. Radiotherapy is the gold-standard of therapy for Intramedullary spinal cord metastasis. The overall prognosis is poor and the mortality rate is very high. We present what is, to the best of our knowledge, the first case of Intramedullary spinal cord metastasis of colorectal carcinoma presenting as Brown-Séquard syndrome. Case presentation We present the case of a 71-year-old Caucasian man with colonic adenocarcinoma who developed Intramedullary spinal cord metastasis and showed features of Brown-Séquard syndrome, which is an uncommon presentation of Intramedullary spinal cord metastasis. Conclusion This patient had an Intramedullary spinal cord metastasis, a rare form of metastatic disease, secondary to colonic carcinoma. The metastasis manifested clinically as Brown-Séquard syndrome, itself a very uncommon condition. This syndrome is rarely caused by intramedullary tumors. This unique case has particular interest in medicine, especially for the specialties of medical, surgical and radiation oncology. We hope that it will add more information to the literature about these entities.

  12. Freezing of Rat Tibiae at -20°C Does Not Affect the Mechanical Properties of Intramedullary Bone/Implant-Interface: Brief Report

    Science.gov (United States)

    Diefenbeck, Michael; Mückley, Thomas; Zankovych, Sergiy; Bossert, Jörg; Jandt, Klaus D; Schrader, Christian; Schmidt, Jürgen; Finger, Ulrich; Faucon, Mathilde

    2011-01-01

    Background: The effects of freezing-thawing cycles on intramedullary bone-implant interfaces have been studied in a rat model in mechanical pull-out tests. Implants: Twenty TiAl6V4 rods (Ø 0.8 mm, length 10 mm) implanted in rat tibiae Methods: 10 rats underwent bilateral tibial implantation of titanium rods. At eight weeks, the animals were sacrificed and tibiae harvested for biomechanical testing. Eight tibiae were frozen and stored at -20°C for 14 days, the remaining eight were evaluated immediately post-harvest. Pull-out tests were used to determine maximum force and interfacial shear strength. Results: There were no significant differences between fresh and those of the frozen-thawed group in maximum force or in interfacial shear strength. Conclusion: Frozen Storage of rat tibiae containing implants at -20° C has no effects on the biomechanical properties of Bone/ Implant interface. PMID:21760868

  13. Choroid Plexus in the Central Canal of the Spinal Cord Causing Recurrent Syringomyelia.

    Science.gov (United States)

    Shtaya, Anan; Sadek, Ahmed-Ramadan; Nicoll, James A R; Nader-Sepahi, Ali

    2018-03-01

    Syringomyelia is a fluid-filled cavitation within the substance of the spinal cord. This condition usually follows a primary pathology that disrupts the normal cerebrospinal fluid circulation or disturbs the microcirculation and cytoarchitecture of the spinal cord parenchyma. However, an etiology of recurrent syringomyelia resulting from an ectopic choroid plexus (CP) has not been discussed. Ectopic CP rests may be found within the central nervous system. Although there has been a single report, describing ectopic intramedullary spinal cord CP, to our knowledge, extra-cranial nonmalignant CP in the central canal of the spinal cord has not been reported. We report CP in the central canal of the spinal cord in a 23-year-old male patient who had developmental delay and diabetes mellitus type I who presented with dissociated sensory changes and muscle wastage predominantly on the right upper and lower limbs. Magnetic resonance imaging demonstrated a multiloculated spinal cord syringomyelia stretching from cervical (C3) to the conus medullaris causing recurrent neurologic deficits. A biopsy of the central canal spinal cord lesion revealed CP. Decompression and syringosubarachnoid shunt insertion stabilized the patient's neurology. Our illustrative case reveals the presence of CP in the central canal of the spinal cord that may suggest a role in the etiology of recurrent syringomyelia. Although management poses a challenge to neurosurgeons, prompt decompression and shunting of the syringomyelia remains a favorable approach with acceptable outcomes. Further investigation into the pathophysiology of central canal CP ectopic causing recurrent syringomyelia and its correlation with spinal cord development may help future treatments. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Three-Dimensional Analysis of the Characteristics of the Femoral Canal Isthmus: An Anatomical Study

    Directory of Open Access Journals (Sweden)

    Xiu-yun Su

    2015-01-01

    Full Text Available Purpose. To establish a new approach for measuring and locating the femoral intramedullary canal isthmus in 3-dimensional (3D space. Methods. Based on the computed tomography data from 204 Chinese patients, 3D models of the whole femur and the corresponding femoral isthmus tube were reconstructed using Mimics software (Materialise, Haasrode, Belgium. The anatomical parameters of the femur and the isthmus, including the femur length and radius, and the isthmus diameter and height, were measured accordingly. Results. The mean ratio of the isthmus height versus the femoral height was 55 ± 4.8%. The mean diameter of the isthmus was 10.49 ± 1.52 mm. The femoral length, the isthmus diameter, and the isthmus tube length were significantly larger in the male group. Significant correlations were observed between the femoral length and the isthmus diameter (r=0.24, p<0.01 and between the femoral length and the isthmus height (r=0.6, p<0.01. Stepwise linear regression analyses demonstrated that the femoral length and radius were the most important factors influencing the location and dimension of the femoral canal isthmus. Conclusion. The current study developed a new approach for measuring the femoral canal and for optimization of customer-specific femoral implants.

  15. Nuclear magnetic resonance tomography of the cervical canal

    Energy Technology Data Exchange (ETDEWEB)

    Terwey, B.; Koschorek, F.; Jensen, H.P.

    1985-12-01

    170 patients with suspected lesions of the cervical part of the medulla were examined using nuclear magnetic resonance (NMR) tomography. 27 cases revealed no pathological changes in the regions of the cervical medulla, the cervical canal and of the cervical spine. 143 cases produced pathological findings whose diagnoses determined therapeutical approach. Verified pathological changes comprised anomalies of the cranio-cervical junction like basilar impression and Arnold-Chiari malformation, various types of cavity formation in the cervical medulla (syringomyelia, hydromyelia), demyelinization processes, intramedullary and extramedullary tumours, intervertebral disk degeneration processes, dislocation of intervertebral disks and spondylophytes with spinal stenoses. Sagittal sections in different functional positions allowed to demonstrate the biomechanical effects of extramedullary masses on the cervical medulla. However, proven tumours could not be differentiated successfully using histological methods. Nevertheless, NMR tomography will replace invasive methods like conventional cervical myelography and CT myelography in diagnostic clarification of diseases of the cervical medulla.

  16. 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.

  17. 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

  18. 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

  19. [Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail].

    Science.gov (United States)

    El Attal, R; Hansen, M; Rosenberger, R; Smekal, V; Rommens, P M; Blauth, M

    2011-12-01

    Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare and to maintain joint mobility. Good bony healing in closed and open fractures. Closed and open fractures of the tibia and complete lower leg fractures distal to the isthmus (AO 42), extraarticular fractures of the distal tibia (AO 43 A1/A2/A3), segmental fractures of the tibia with a fracture in the distal tibia, and certain intraarticular fractures of the distal tibia without impression of the joint line with the use of additional implants (AO 43 C1) Patient in reduced general condition (e.g., bed ridden), flexion of the knee of less than 90°, patients with knee arthroplasty of the affected leg, infection in the area of the nail's insertion, infection of the tibial cavity, complex articular fractures of the proximal or distal tibia with joint depression. Closed reduction of the fracture preferably on a fracture table or using a distractor or an external fixation frame. If necessary, use pointed reduction clamps or sterile drapery. In some cases, additional implants like percutaneous small fragment screws, poller screws or k-wires are helpful. Open reduction is rarely necessary and must be avoided. Opening of the proximal tibia in line with the medullary canal. Canulated insertion of the Expert(TM) tibia nail (ETN; Synthes GmbH, Oberdorf, Switzerland) with reaming of the medullary canal. Control of axis, length, and rotation. Distal interlocking with the radiolucent drill and proximal interlocking with the targeting device. Immediate mobilization of ankle and knee joint. Mobilization with 20 kg weight-bearing with crutches. X-ray control 6 weeks postoperatively and increased weight-bearing depending on the fracture status. In cases with simple fractures, good bony contact, or transverse fracture pattern, full weight-bearing at the end of week 6 is targeted. Between July 2004 and May 2005, 180 patients were included in a

  20. The tibial nerve compression test for the diagnosis of lumbar spinal canal stenosis-A simple and reliable physical examination for use by primary care physicians.

    Science.gov (United States)

    Adachi, Shu; Nakano, Atsushi; Kin, Akihiro; Baba, Ichiro; Kurokawa, Yoshitaka; Neo, Masashi

    2018-01-01

    In the present study, we aimed to evaluate the diagnostic accuracy and suitability of the 'Tibial Nerve Compression Test (TNCT)' as a screening tool for lumbar spinal canal stenosis (LSS). A total of 108 consecutive patients admitted to our hospital for surgical treatment or diagnosis of LSS were included in this study. Fifty healthy volunteers were examined as a control group. The severity of tenderness was scored (tenderness score) and measured on a visual analogue scale (P-VAS score). These scores were compared between the LSS and control groups. Moreover, they were compared before and after the operation among operated patients. The positive tenderness rate was significantly higher (92.6% [100/108]) in the LSS group than in the control group (30% [15/50]). The sensitivity and specificity of TNCT (95% confidence interval) were 0.93 (0.88-0.96) and 0.70 (0.61-0.77), respectively. Positive tenderness rates and P-VAS scores were significantly higher in the LSS group (p Test is a useful screening tool for LSS diagnosis in a primary care setting. Level II, diagnostic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  1. Articular cartilage damage with intramedullary lesion (bone bruise) in anterior cruciate ligament rupture

    International Nuclear Information System (INIS)

    Ide, Shuya; Ohdera, Toshihiro; Tokunaga, Masami; Hiroshima, Shiro; Yoshimoto, Eiji

    2002-01-01

    We evaluated the relationship between the intramedullary lesion on MRI and cartilage damage in patients associated with acute anterior cruciate ligament (ACL) rupture. Thirty-two cases documented by MRI and arthroscopy within one month from injury underwent ACL reconstruction using ST-G, and arthroscopy was performed again after surgery. The mean term between reconstruction and postoperative arthroscopy was twelve months. The cartilage damage on arthroscopy was compared with the intramedullary lesion on MRI. Cartilage damage was observed in 9 cases (28.1%) during the initial arthroscopy and in 16 cases (50.0%) during the second arthroscopy. Intramedullary lesion was detected in all 32 cases (total: 73 lesions) on MRI. Intramedullary lesion leading to cartilage damage was common in the geographic-type lateral femoral condyle. There was significant difference between the lateral meniscus tear and the cartilage damage of the lateral compartment. (author)

  2. ediatric femoral shaft fractures treated by flexible intramedullary nailing.

    Science.gov (United States)

    Kapil Mani, K C; Dirgha Raj, R C; Parimal, Acharya

    2015-01-01

    Nowadays pediatric femoral fractures are more commonly managed with operative treatment rather than conservative treatment because of more rapid recovery and avoidance of prolonged immobilization. Children between the ages of 5-13 years are treated either by traction plus hip spica and flexible/elastic stable retrograde intramedullary nail, or external fixators in the case of open fractures. The aim of this study is to evaluate the outcome of pediatric femoral shaft fractures treated by stainless steel flexible intramedullary nail in children between 5 and 13 years of age. There were 32 cases of femoral shaft fractures which were all fixed with stainless steel flexible intramedullary nail under fluoroscopy. Long leg cast was applied at the time of fixation. Partial weight bearing was started 2 weeks after surgery. Patients were evaluated in follow-up study to observe the alignment of fracture, infection, delayed union, nonunion, limb length discrepancy, motion of knee joint, and time to unite the fracture. We were able to follow up 28 out of 32 patients. The patients were 8.14 years of age on average. The mean hospital stay after operation was 4 days and fracture union time was 9.57 weeks. There were 3 cases of varus angulation, 2 cases of anterior angulation, and 4 cases of limb lengthening. Patients aged between 5 and 13 years treated with flexible intramedullary nail for closed femoral shaft fracture have rapid union and recovery, short rehabilitation period, less immobilization and psychological impact, and cost-effective.

  3. 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...

  4. 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

  5. Nuclear magnetic resonance tomography of the cervical canal

    International Nuclear Information System (INIS)

    Terwey, B.; Koschorek, F.; Jensen, H.P.

    1985-01-01

    170 patients with suspected lesions of the cervical part of the medulla were examined using nuclear magnetic resonance (NMR) tomography. 27 cases revealed no pathological changes in the regions of the cervical medulla, the cervical canal and of the cervical spine. 143 cases produced pathological findings whose diagnoses determined therapeutical approach. Verified pathological changes comprised anomalies of the cranio-cervical junction like basilar impression and Arnold-Chiari malformation, various types of cavity formation in the cervical medulla (syringomyelia, hydromyelia), demyelinization processes, intramedullary and extramedullary tumours, intervertebral disk degeneration processes, dislocation of intervertebral disks and spondylophytes with spinal stenoses. Sagittal sections in different functional positions allowed to demonstrate the biomechanical effects of extramedullary masses on the cervical medulla. However, proven tumours could not be differentiated successfully using histological methods. Nevertheless, NMR tomography will replace invasive methods like conventional cervical myelography and CT myelography in diagnostic clarification of diseases of the cervical medulla. (orig.) [de

  6. Case with high cervical intramedullary hemangioblastoma associated with arteriovenous fistula. CT with simultaneous intravenous and intrathecal injection of contrast medium

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Takao; Shoji, Shin-ichi; Yanagisawa, Nobuo; Tada, Tsuyoshi; Kobayashi, Naoki

    1988-02-01

    A 34-year-old woman complained of right hemiparesis and pain in the right hand. Routine X-ray of the cervical portion failed to reveal abnormal findings. CT with intravenous contrast medium showed a large high-density mass in the spinal canal at the level of C2. Right vertebral angiography showed a hypervascular mass. With simultaneous intravenous and intrathecal injections of contrast medium, the tumor was shown as a moderately high-density area and the parenchyma of cord as a thin low-density area surrounding the tumor stain on CT. These CT appearances led to the final diagnosis of high cervical intramedullary hemangioblastoma associated with arteriovenous fistulae. Pathological findings are typical of hemangioblastoma. The usefulness of CT in detecting the localization of hypervascular spinal cord lesions is stressed. (Namekawa, K.).

  7. 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.

  8. Bioactivity and osteointegration of hydroxyapatite-coated stainless steel and titanium wires used for intramedullary osteosynthesis.

    Science.gov (United States)

    Popkov, Arnold V; Gorbach, Elena N; Kononovich, Natalia A; Popkov, Dmitry A; Tverdokhlebov, Sergey I; Shesterikov, Evgeniy V

    2017-08-01

    A lot of research was conducted on the use of various biomaterials in orthopedic surgery. Our study investigated the effects of nanostructured calcium-phosphate coating on metallic implants introduced into the bone marrow canal. Stainless steel or titanium 2-mm wires (groups 1 and 2, respectively), and hydroxyapatite-coated stainless steel or titanium wires of the same diameter (groups 3 and 4, respectively) were introduced into the tibial bone marrow canal of 20 dogs (each group = 5 dogs). Hydroxyapatite coating was deposited on the wires with the method of microarc oxidation. Light microscopy to study histological diaphyseal transverse sections, scanning electron microscopy to study the bone marrow area around the implant and an X-ray electron probe analyzer to study the content of calcium and phosphorus were used to investigate bioactivity and osteointegration after a four weeks period. Osteointegration was also assessed by measuring wires' pull-off strength with a sensor dynamometer. Bone formation was observed round the wires in the bone marrow canal in all the groups. Its intensity depended upon the features of wire surfaces and implant materials. Maximum percentage volume of trabecular bone was present in the bone marrow canals of group 4 dogs that corresponded to a mean of 27.1 ± 0.14%, while it was only 6.7% in group 1. The coating in groups 3 and 4 provided better bioactivity and osteointegration. Hydroxyapatite-coated titanium wires showed the highest degree of bone formation around them and greater pull-off strength. Nanostructured hydroxyapatite coating of metallic wires induces an expressed bone formation and provides osteointegration. Hydroxyapatite-coated wires could be used along with external fixation for bone repair enhancement in diaphyseal fractures, management of osteogenesis imperfecta and correction of bone deformities in phosphate diabetes.

  9. Closed retrograde retrieval of the distal broken segment of femoral cannulated intramedullary nail using a ball-tipped guide wire.

    Science.gov (United States)

    Metikala, Sreenivasulu; Mohammed, Riazuddin

    2011-07-01

    Extracting broken segments of intramedullay nails from long bones can be an operative challenge, particularly from the distal end. We report a case series where a simple and reproducible technique of extracting broken femoral cannulated nails using a ball-tipped guide wire is described. This closed technique involves no additional equipment or instruments. Eight patients who underwent the described method were included in the study. The technique involves using a standard plain guide wire passed through the cannulated distal broken nail segment after extraction of the proximal nail fragment. The plain guide wire is then advanced distally into the knee joint carefully under fluoroscopy imaging. Over this wire, a 5-millimeter (mm) cannulated large drill bit is used to create a track up to the distal broken nail segment. Through the small knee wound, a ball-tipped guide wire is passed, smooth end first, till the ball engages the end of the nail. The guide wire is then extracted along with the broken nail through the proximal wound. The method was successfully used in all eight patients for removal of broken cannulated intramedullary nail from the femoral canal without any complications. All patients underwent exchange nailing with successful bone union in six months. None of the patients had any problems at the knee joint at the final follow-up. We report a technique for successful extraction of the distal fragment of broken femoral intramedullary nails without additional surgical approaches.

  10. [Tibial periostitis ("medial tibial stress syndrome")].

    Science.gov (United States)

    Fournier, Pierre-Etienne

    2003-06-01

    Medial tibial stress syndrome is characterised by complaints along the posteromedial tibia. Runners and athletes involved in jumping activities may develop this syndrome. Increased stress to stabilize the foot especially when excessive pronation is present explain the occurrence this lesion.

  11. Neurobrucellosis presenting as an intra-medullary spinal cord abscess

    Directory of Open Access Journals (Sweden)

    Patil Chidanand S

    2005-09-01

    Full Text Available Abstract Background Of the diverse presentation of neurobrucellosis, intra-medullary spinal cord abscess is extremely rare. Only four other cases have been reported so far. We present a case of spinal cord intra-medullary abscess due to Brucella melitensis. Case presentation A forty-year-old female presented with progressive weakness of both lower limb with urinary incontinence of 6 months duration. She was febrile. Neurological examination revealed flaccid areflexic paraplegia with T10 below sensory impairment including perianal region. An intramedullary mass was diagnosed on Magnetic Resonance Image (MRI scan extending from T12 to L2. At surgery, a large abscess was encountered at the conus medullaris, from which Brucella melitensis was grown on culture. She was started on streptomycin and doxycycline for 1 month, followed by rifampicin and doxycycline for 1 month. At 2-year follow-up, she had recovered only partially and continued to have impaired bladder function. Conclusion Neurobrucellosis, if not treated early, can result in severe neurological morbidity and sequale, which may be irreversible. Hence it is important to consider the possibility of neurobrucellosis in endemic region and treat aggressively.

  12. [Application of tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty].

    Science.gov (United States)

    Li, Guoliang; Han, Guangpu; Zhang, Jinxiu; Ma, Shiqiang; Guo, Donghui; Yuan, Fulu; Qi, Bingbing; Shen, Runbin

    2013-07-01

    To explore the application value of self-made tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty (TKA) for improving the lower extremity force line. Between January and August 2012, 13 cases (21 knees) of osteoarthritis with tibial extra-articular deformity were treated, including 5 males (8 knees) and 8 females (13 knees) with an average age of 66.5 years (range, 58-78 years). The disease duration was 2-5 years (mean, 3.5 years). The knee society score (KSS) was 45.5 +/- 15.5. Extra-articular deformities included 1 case of knee valgus (2 knees) and 12 cases of knee varus (19 knees). Preoperative full-length X-ray films of lower extremities showed 10-21 degrees valgus or varus deformity of tibial extra joint. Self-made tibial mechanical axis locator was used to determine and mark coronal tibial mechanical axis under X-ray before TKA, and then osteotomy was performed with extramedullary positioning device according to the mechanical axis marker.' All incisions healed by first intention, without related complications of infection and joint instability. All patients were followed up 5-12 months (mean, 8.3 months). The X-ray examination showed case of 2.9 degrees knee deviation angle at 3 days after operation, and the accurate rate was 95.2%. No loosening or instability of prosthesis occurred during follow-up. KSS score was 85.5 +/- 15.0 at last follow-up, showing significant difference when compared with preoperative score (t=12.82, P=0.00). The seft-made tibial mechanical axis locator can improve the accurate rate of the lower extremity force line in TKA for tibia extra-articular deformity.

  13. [Results of femoral lengthening over an intramedullary nail and external fixator].

    Science.gov (United States)

    Jasiewicz, Barbara; Kacki, Wojciech; Tesiorowski, Maciej; Potaczek, Tomasz

    2008-01-01

    Current techniques of operative limb lengthening usually are based on distraction osteogenesis. One of the techniques is limb lengthening over an intramedullary nail. The goal of this study is to evaluate the results of femoral lengthening over an intramedullary nail. Between 1999 and 200619 femoral "over nail" lengthenings were performed. There were 7 males and 12 females. Mean patients' age at surgery was 15.8 years, and mean initial femoral shortening was 5.1 cm. Operative technique consisted of one-stage implantation of intramedullary nail and external fixator. Ilizarov apparatus was used in 9 patients, monolateral fixator in 10 cases--ORTHOFIX in 9 patients, Wagner fixator--in 1 patient. Intramedullary nail was locked proximally with screws or Schanz pins from external fixator. After distraction phase, external fixator was removed and distal locking screws were applied. Evaluation criteria: obtained lengthening, time of external fixator, treatment time, healing index, external fixation index, range of motion in hip and knee joints and complications according to Paley. The mean lengthening was 4.6 cm, and mean distraction time was 66.6 days. Mean time of external fixation was 115.5 days, and external fixation index was 26.2 days for centimeter. Healing index was 36.9 days for centimeter. In cases with monolateral fixator, healing index did not differ with the whole group. During treatment 18 complications occurred, for a rate of 0.9 complication per segment. Lengthening over an intramedullary nail reduces the time of external fixator. Over nail femoral lengthening can prevent axis deviation following regenerate bending. Complication rate is similar to lengthenings with the classic Ilizarov technique. There are no differences in the treatment time in relation to the type of external fixator.

  14. 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

  15. MR imaging of intramedullary ischemia due to cervical spondylosis

    International Nuclear Information System (INIS)

    Dooms, G.; Mathurin, P.; Cornelis, G.; Hulcelle, P.

    1988-01-01

    A retrospective study was performed to assess the value of MR imaging for detecting intramedullary ischemia due to cervical spondylosis and to assess its clinical significance. One hundred consecutive unselected patients (70 men and 30 women, mean age = 62 years) were included in the study. All patients were treated surgically, either by anterior diskectomy and corporectomy or by posterior laminectomy. Clinical follow-up to 2 years was available for every patient. MR imaging was performed with a superconducting magnet (Philips Gyroscan S15) operating at 1.5T Sagittal T1-weighted (repetition time [TR] = 0.45 sec and echo time [TE] = 30 msec) and cardiac-gated T2-weighted (TR>1.2 sec and multiples TE of 50, 100 and 200 msc) imaging was performed in every patient. Cervical spondylosis was exquisitely demonstrated on MR images in every patient. With the sagittal plane, full extent and the degree of canalar stenosis were easily appreciated on T2-weighted images. A hyperintense intramedullary lesion was detected preoperatively in 24 of the patients and corresponded presumably to ischemic, edematous, and/or necrotic damage to the cord. It was usually located at the level or just below the level where the most severe canalar stenosis was demonstrated; it was identified only on T2-weighted images. In a comparison of the clinical outcome of the patients after surgery, there was a striking difference between the group of patients without and that with intramedullary lesions. In the first group, the relief of symptoms after surgery was partial or complete. In the other group, the clinical outcome was poor and symptom relief nearly absent. In conclusion, MR imaging is an exquisite modality for demonstrating necrotic intramedullary changes due to cervical spondylosis and thus may aid in determining the prognosis for surgery and clinical outcome of the patients

  16. Intramedullary cavernous angiomas of the spinal cord. Clinical characteristics of 13 lesions

    International Nuclear Information System (INIS)

    Aoyama, Takeshi; Hida, Kazutoshi; Houkin, Kiyohiro

    2011-01-01

    Magnetic resonance imaging has increased the incidence of the diagnosis of intramedullary cavernous angioma. Surgical therapy tends not to be recommended for asymptomatic lesions, but symptomatic lesions that bleed recurrently should be treated. The natural course of intramedullary cavernous angioma remains unknown and arguments have been raised against the surgical treatment of symptomatic lesions. We reviewed the clinical features of 13 intramedullary cavernous angiomas in 12 patients surgically treated between 1988 and 2009. The 7 men and 5 women were aged from 14 to 60 years, the preoperative interval ranged from 0 to 161 months, and the mean number of hemorrhages in the 13 lesions was 2.5. Sixteen operations were performed to treat the 13 lesions. The surgical approach depended on the lesion location. The outcome of patients with mild to moderate preoperative symptoms (McCormick grades I-III) was significantly better than that of patients with severe symptoms (McCormick grade IV) (p<0.05). Symptomatic intramedullary cavernous angioma tends to bleed repeatedly. The lesion should be surgically removed to avoid further deterioration due to recurrent hemorrhages. The shortest path approach should be selected based on preoperative images and complete removal should be attempted. Residual lesion may be masked by surrounding gliosis, so careful postoperative follow up is necessary. (author)

  17. Biomechanical Comparison of an Intramedullary and Extramedullary Free-Tissue Graft Reconstruction of the Acromioclavicular Joint Complex

    Science.gov (United States)

    Garg, Rishi; Javidan, Pooya; Lee, Thay Q.

    2013-01-01

    Background Several different surgical techniques have been described to address the coracoclavicular (CC) ligaments in acromioclavicular (AC) joint injuries. However, very few techniques focus on reconstructing the AC ligaments, despite its importance in providing stability. The purpose of our study was to compare the biomechanical properties of two free-tissue graft techniques that reconstruct both the AC and CC ligaments in cadaveric shoulders, one with an extramedullary AC reconstruction and the other with an intramedullary AC reconstruction. We hypothesized intramedullary AC reconstruction will provide greater anteroposterior translational stability and improved load to failure characteristics than an extramedullary technique. Methods Six matched cadaveric shoulders underwent translational testing at 10 N and 15 N in the anteroposterior and superoinferior directions, under AC joint compression loads of 10 N, 20 N, and 30 N. After the AC and CC ligaments were transected, one of the specimens was randomly assigned the intramedullary free-tissue graft reconstruction while its matched pair received the extramedullary graft reconstruction. Both reconstructed specimens then underwent repeat translational testing, followed by load to failure testing, via superior clavicle distraction, at a rate of 50 mm/min. Results Intramedullary reconstruction provided significantly greater translational stability in the anteroposterior direction than the extramedullary technique for four of six loading conditions (p < 0.05). There were no significant differences in translational stability in the superoinferior direction for any loading condition. The intramedullary reconstructed specimens demonstrated improved load to failure characteristics with the intramedullary reconstruction having a lower deformation at yield and a higher ultimate load than the extramedullary reconstruction (p < 0.05). Conclusions Intramedullary reconstruction of the AC joint provides greater stability in the

  18. Multiple intramedullary nailing of proximal phalangeal fractures of hand

    Directory of Open Access Journals (Sweden)

    Patankar Hemant

    2008-01-01

    Full Text Available Background: Proximal phalangeal fractures are commonly encountered fractures in the hand. Majority of them are stable and can be treated by non-operative means. However, unstable fractures i.e. those with shortening, displacement, angulation, rotational deformity or segmental fractures need surgical intervention. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of these fractures with joint-sparing multiple intramedullary nailing technique. Materials and Methods: Thirty-five patients with 35 isolated unstable proximal phalangeal shaft fractures of hand were managed by surgical stabilization with multiple intramedullary nailing technique. Fractures of the thumb were excluded. All the patients were followed up for a minimum of six months. They were assessed radiologically and clinically. The clinical evaluation was based on two criteria. 1. total active range of motion for digital functional assessment as suggested by the American Society for Surgery of Hand and 2. grip strength. Results: All the patients showed radiological union at six weeks. The overall results were excellent in all the patients. Adventitious bursitis was observed at the point of insertion of nails in one patient. Conclusion: Joint-sparing multiple intramedullary nailing of unstable proximal phalangeal fractures of hand provides satisfactory results with good functional outcome and fewer complications.

  19. Tibiotalocalcaneal arthrodesis with a curved, interlocking, intramedullary nail.

    Science.gov (United States)

    Budnar, Vijaya M; Hepple, Steve; Harries, William G; Livingstone, James A; Winson, Ian

    2010-12-01

    Tibiotalocalcaneal fusion with a straight rod has a risk of damaging the lateral plantar neurovascular structures and may interfere with maintaining normal heel valgus position.We report the results of a prospective study of tibiotalocalcaneal (TTC) arthrodesis with a short, anatomically curved interlocking, intramedullary nail. Forty-five arthrodesis in 42 patients, performed between Jan 2003 and Oct 2008, were prospectively followed. The mean followup was 48 (range, 10 to 74) months. The main indications for the procedure were failed ankle arthrodesis with progressive subtalar arthritis, failed ankle arthroplasty and complex hindfoot deformity. The outcome was measured by a combination of pre and postoperative clinical examination, AOFAS hindfoot scores, SF-12 scores and radiological assessment. Union rate was 89% (40/45). Eighty-two percent (37/45) reported improvement in pain and 73% (33/45) had improved foot function. Satisfactory hindfoot alignment was achieved in 84% (38/45). Postoperatively there was a mean improvement in the AOFAS score of 37. Complications included a below knee amputation for persistent deep infection, five nonunions, and three delayed unions. Four nails, six proximal and six distal locking screws were removed for various causes. Other complications included two perioperative fractures, four superficial wound infections and one case of lateral plantar nerve irritation. With a short, anatomically curved intramedullary nail, we had a high rate of tibiotalocalcaneal fusion with minimal plantar neurovascular complications. We believe a short, curved intramedullary nail, with its more lateral entry point, helped maintain hindfoot alignment.

  20. 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.

  1. Locally administrated perindopril improves healing in an ovariectomized rat tibial osteotomy model.

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    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.

  2. Metachronous brain and intramedullary spinal cord metastases from nonsmall-cell lung cancer: A case report

    Directory of Open Access Journals (Sweden)

    Wen-Chih Liu

    2012-05-01

    Full Text Available A 44-year-old man had a brain tumor secondary to lung adenocarcinoma and underwent craniectomy to remove the brain tumor. After postoperative whole-brain radiation therapy, he underwent pneumonectomy followed by chemotherapy, mediastinal radiotherapy, and target therapy for lung cancer. Thirty-six months after the initial brain surgery, he suffered from neck pain and right upper limb numbness that rapidly progressed to upper extremity weakness and paralysis in 2 months. Magnetic resonance imaging demonstrated an intramedullary spinal cord lesion at the C4 level. Laminectomy and gross intramedullary tumor removal were performed. The patient’s neurological function improved after the operation. Nevertheless, 4 months after the intramedullary tumor removal, he began to show multiple metastases. Unfortunately, the patient died from respiratory failure 8 months after diagnosis with intramedullary spinal cord metastasis. In this case, early diagnosis and aggressive surgical treatment combined with postoperative radiotherapy and chemotherapy might have provided this patient with a prolonged survival and better quality of life.

  3. The Effect of Malrotation of Tibial Component of Total Knee Arthroplasty on Tibial Insert during High Flexion Using a Finite Element Analysis

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    Kei Osano

    2014-01-01

    Full Text Available One of the most common errors of total knee arthroplasty procedure is a malrotation of tibial component. The stress on tibial insert is closely related to polyethylene failure. The objective of this study is to analyze the effect of malrotation of tibial component for the stress on tibial insert during high flexion using a finite element analysis. We used Stryker NRG PS for analysis. Three different initial conditions of tibial component including normal, 15° internal malrotation, and 15° external malrotation were analyzed. The tibial insert made from ultra-high-molecular-weight polyethylene was assumed to be elastic-plastic while femoral and tibial metal components were assumed to be rigid. Four nonlinear springs attached to tibial component represented soft tissues around the knee. Vertical load was applied to femoral component which rotated from 0° to 135° while horizontal load along the anterior posterior axis was applied to tibial component during flexion. Maximum equivalent stresses on the surface were analyzed. Internal malrotation caused the highest stress which arose up to 160% of normal position. External malrotation also caused higher stress. Implanting prosthesis in correct position is important for reducing the risk of abnormal wear and failure.

  4. Reconstrucción tibial: transferencia sóleo-peroné ipsilateral. Tibialización peroneal Tibial reconstruction: ipsilateral soleus-fibula transfer. Fibular tibialization

    Directory of Open Access Journals (Sweden)

    E. Revelo Jiron

    2009-12-01

    Full Text Available Las transferencias óseas peroneales en forma libre o ipsilateral han sido propuestas para la reconstrucción de grandes defectos tibiales. Están también descritas varias modificaciones al respecto, siendo una de ellas la constitución de un colgajo compuesto soleo-peroné realizado como transferencia libre. En este estudio presentamos nuestra experiencia con esta variante, pero en forma ipsilateral. logrando la reconstrucción del defecto tibial por medio de la tibialización peroneal. Escogimos realizar un colgajo compuesto soleo-peroné ipsilateral a flujo anterógrado o retrogrado para la reconstrucción de una serie personal de 14 pacientes consecutivos, 13 hombre y 1 mujer, con edad media de 30 años, y con amplios defectos tibiales y de tejidos blandos causados por accidentes de transito en 12 casos, 1 por proyectil balístico y 1 por artefacto explosivo artesanal. El promedio de tamaño del defecto tibial fue de 9.4 cm. Elegimos la forma ipsilateral por no disponer de infraestructura adecuada para realizar una transferencia libre. La serie de estudio se realizó durante el periodo comprendido entre Abril de 1995 y Abril del 2005. Todos los colgajos sobrevivieron. Dos pacientes desarrollaron pseudoartrosis. El apoyo completo y la marcha en 12 pacientes, se logró en un periodo promedio de 9 meses. El seguimiento postoperatorio ha sido de 3 a 6 años. Doce pacientes se han incorporado a la vida activa. Discutimos algunos aspectos prácticos de la técnica como resultado de la experiencia quirúrgica obtenida de esta serie personal. Consideramos que el método es fiable, fácil de realizar y proporciona excelentes resultados.Fibular flaps such as in there free form or as ipsilateral transfers have been proposed for reconstruction of large tibial defects. Several modifications have been described for the use of this flap. In this study we will present our experience using the ipsilateral transfer of an osteomuscular soleous fibular flap

  5. An arachnoid cyst presenting as an intramedullary tumour

    NARCIS (Netherlands)

    Willems, P. W.; van den Bergh, W. M.; Vandertop, W. P.

    2000-01-01

    A case of thoracic intradural extramedullary arachnoid cyst is presented in which an intramedullary low grade glioma was suspected preoperatively. The cyst was widely fenestrated and postoperatively, the patient experienced considerable improvement in her symptoms. As postoperative MRI studies also

  6. Skeletal traction and intramedullary nailing cost-effectiveness

    African Journals Online (AJOL)

    In the operative group 24 patients had union with one delayed union while in the traction group 12 patients had union, 9 with mal union and 4 delayed union. Conclusion: Intramedullary nailing is more cost-effective than skeletal traction. It met the dominant strategy, because it was significantly less costly than skeletal ...

  7. 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...

  8. Intramedullary tumours in patients with neurofibromatosis type 2: MRI features associated with a favourable prognosis

    Energy Technology Data Exchange (ETDEWEB)

    Rennie, A.T.M. [Department of Neuroradiology, West Wing, John Radcliffe Hospital, Headington, Oxford (United Kingdom)], E-mail: atmrennie@hotmail.com; Side, L. [Department of Clinical Genetics, Churchill Hospital, Headington, Oxford (United Kingdom); Kerr, R.S.C. [Department of Neurosurgery, West Wing, John Radcliffe Hospital, Headington, Oxford (United Kingdom); Anslow, P.; Pretorius, P. [Department of Neuroradiology, West Wing, John Radcliffe Hospital, Headington, Oxford (United Kingdom)

    2008-02-15

    Aim: To assess the magnetic resonance imaging (MRI) features and natural history of intramedullary tumours in patients with neurofibromatosis type 2 (NF2). Materials and methods: Eleven NF2 patients with intramedullary spinal cord tumours were identified from the database of the multidisciplinary NF2 clinic. All the imaging studies of these patients were individually reviewed by two neuroradiologists to evaluate the size, number, location, imaging characteristics, and interval growth of the intramedullary tumours. Results: Two of the 11 patients had lesions that required surgery. Both these lesions were in the cervical region, and extended over three and five segments respectively. Nine patients with a mean imaging follow-up period of 77 months had lesions that remained stable, apart from the development of small peritumoral cysts in three. The lesions were well circumscribed, often multiple, usually less than 1 cm in diameter, and were most frequently found in the cervical cord. Conclusion: The majority of intramedullary tumours in NF2 patients are very slow growing and share certain MRI features that differ from those of progressive or symptomatic lesions.

  9. Intramedullary capillary hemangioma of the thoracic spine: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Paul Santiago

    2009-07-01

    Full Text Available Capillary hemangiomas are benign vascular neoplasms. When associated with the spine, these growths frequently involve the vertebral body, but rarely have they been reported to occur as intradural lesions, while even more rarely occurring in a true intramedullary location. We report a rare case of an intrame-dullary capillary hemangioma of the thoracic spinal cord and a review of the literature.

  10. Radiographic quantitative assessment of cranial tibial subluxation before and after tibial plateau leveling osteotomy in dogs.

    Science.gov (United States)

    Kim, Stanley E; Lewis, Daniel D; Pozzi, Antonio; Seibert, Rachel L; Winter, Matthew D

    2011-03-01

    To determine the influence of stifle joint flexion angle, cranial cruciate ligament (CrCL) integrity, tibial plateau leveling osteotomy (TPLO), and cranial tibial subluxation on the distance between the location of the origin and insertion of the CrCL (CrCL(d)) in dogs. 4 pairs of pelvic limbs from adult dog cadavers weighing 23 to 34 kg. Procedures-Mediolateral projection radiographs of each stifle joint were obtained with the joint flexed at 90°, 105°, 120°, 135°, and 150°. Radiopaque markers were then placed at the sites of origin and insertion of the CrCL. Afterward, radiography was repeated in the same manner, before and after CrCL transection, with and without TPLO. Following CrCL transection, radiographs were obtained before and after inducing overt cranial tibial subluxation. Interobserver variation in measuring the CrCL(d) without fiduciary markers was assessed. The effect of CrCL integrity, cranial tibial subluxation, flexion angle, and TPLO on CrCL(d) was also determined. Interobserver agreement was strong, with an intraclass correlation coefficient of 0.859. The CrCL(d) was significantly shorter (Cranial tibial subluxation caused a 25% to 40% increase in CrCL(d). No effect of TPLO on CrCL(d) was found, regardless of CrCL integrity, forced stifle joint subluxation, or flexion angle. Overt cranial tibial subluxation in CrCL-deficient stifle joints can be detected on mediolateral projection radiographs by comparing CrCL(d) on neutral and stressed joint radiographs at joint angles between 105° and 150°, regardless of whether a TPLO has been performed.

  11. "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.

  12. Intramedullary Mg2Ag nails augment callus formation during fracture healing in mice.

    Science.gov (United States)

    Jähn, Katharina; Saito, Hiroaki; Taipaleenmäki, Hanna; Gasser, Andreas; Hort, Norbert; Feyerabend, Frank; Schlüter, Hartmut; Rueger, Johannes M; Lehmann, Wolfgang; Willumeit-Römer, Regine; Hesse, Eric

    2016-05-01

    Intramedullary stabilization is frequently used to treat long bone fractures. Implants usually remain unless complications arise. Since implant removal can become technically very challenging with the potential to cause further tissue damage, biodegradable materials are emerging as alternative options. Magnesium (Mg)-based biodegradable implants have a controllable degradation rate and good tissue compatibility, which makes them attractive for musculoskeletal research. Here we report for the first time the implantation of intramedullary nails made of an Mg alloy containing 2% silver (Mg2Ag) into intact and fractured femora of mice. Prior in vitro analyses revealed an inhibitory effect of Mg2Ag degradation products on osteoclast differentiation and function with no impair of osteoblast function. In vivo, Mg2Ag implants degraded under non-fracture and fracture conditions within 210days and 133days, respectively. During fracture repair, osteoblast function and subsequent bone formation were enhanced, while osteoclast activity and bone resorption were decreased, leading to an augmented callus formation. We observed a widening of the femoral shaft under steady state and regenerating conditions, which was at least in part due to an uncoupled bone remodeling. However, Mg2Ag implants did not cause any systemic adverse effects. These data suggest that Mg2Ag implants might be promising for intramedullary fixation of long bone fractures, a novel concept that has to be further investigated in future studies. Biodegradable implants are promising alternatives to standard steel or titanium implants to avoid implant removal after fracture healing. We therefore developed an intramedullary nail using a novel biodegradable magnesium-silver-alloy (Mg2Ag) and investigated the in vitro and in vivo effects of the implants on bone remodeling under steady state and fracture healing conditions in mice. Our results demonstrate that intramedullary Mg2Ag nails degrade in vivo over time without

  13. Preserving the PCL during the tibial cut in total knee arthroplasty.

    Science.gov (United States)

    Cinotti, G; Sessa, P; Amato, M; Ripani, F R; Giannicola, G

    2017-08-01

    Previous studies have shown that the PCL insertion may be damaged during the tibial cut performed in total knee arthroplasty. We investigated the maximum thickness of a tibial cut that preserves the PCL insertion and to what extent the posterior slope of the tibial cut and that of the patient's tibial plateaus affect the outcome. MR images of 83 knees were analysed. The maximum thickness of a tibial cut that preserves the PCL using a posterior slope of 0°, 3°, 5° and parallel to the patient's slope of the tibial plateau, was evaluated. Correlations between the results and the degrees of the posterior slope of the patient's tibial plateaus were also investigated. The maximum thickness of a tibial cut that preserves the entire PCL insertion was, on average, 5.5, 4.7, 4.2 and 3.1 mm when a posterior slope of 0°, 3°, 5° and parallel to the patients' tibial plateaus was used, respectively. When the 25th percentile was considered, the maximum thickness of a tibial cut that preserved the PCL was 4 and 3 mm with a tibial cut of 0° and 5° of posterior slope, respectively. The maximum thickness of a tibial cut that preserved the PCL was significantly greater in patients with a sagittal slope of the tibial plateaus more than 8° than in those with a sagittal slope less than 8°. In cruciate retaining implants, the PCL insertion may be spared in the majority of patients by performing a tibial cut of 4 mm, or even less when a posterior slope of 3°-5° is used. The clinical relevance of our study is that the execution of a conservative tibial cut, followed by a second tibial resection to achieve the thickness required for the tibial component to be implanted, may be an alternative technique to spare the PCL in CR TKA. II.

  14. Bypass grafting to the anterior tibial artery.

    Science.gov (United States)

    Armour, R H

    1976-01-01

    Four patients with severe ischaemia of a leg due to atherosclerotic occlusion of the tibial and peroneal arteries had reversed long saphenous vein grafts to the patent lower part of the anterior tibial artery. Two of these grafts continue to function 19 and 24 months after operation respectively. One graft failed on the fifth postoperative day and another occluded 4 months after operation. The literature on femorotibial grafting has been reviewed. The early failure rate of distal grafting is higher than in the case of femoropopliteal bypass, but a number of otherwise doomed limbs can be salvaged. Contrary to widely held views, grafting to the anterior tibial artery appears to give results comparable to those obtained when the lower anastomosis is made to the posterior tibial artery.

  15. Physeal growth arrest after tibial lengthening in achondroplasia

    Science.gov (United States)

    2012-01-01

    Background and purpose Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with acondroplasia. Methods We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years. Results Skeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis. Interpretation Our findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrence—especially when lengthening of more than 50% is attempted. PMID:22489887

  16. Total excision of intramedullary epidermoid cyst in one case

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    PU Ke

    2013-12-01

    Full Text Available Clinical experience of total excision in a 14-year-old female with intramedullary epidermoid cyst was reported. The patient with L3-4 intramedullary epidermoid cyst underwent total excision through posterior median approach under microscopy. The patient was admitted for progressive strephexopodia and urinary and fecal incontinence. Preoperative imaging examination showed scoliosis, incontionous L4-S1 and abnormal signal of L3-4. Total excision and spinal remodeling were performed under intraoperative neurophysiological monitoning. Epidermoid cyst and its membrane were totally removed without aseptic meningitis after surgery, and the neurologic symptoms of the patient were gradually improved. Completely removing the membrane of epidermoid cyst is the key point to prevent recurrence and aseptic meningitis postoperatively. Dissection should be strictly in accordance with the boundaries of the membrane and the spinal cord, in order to avoid spinal cord injury.

  17. Clinical Outcomes after Open Locked Intramedullary Nailing of ...

    African Journals Online (AJOL)

    2017-12-05

    Dec 5, 2017 ... joint stiffness due to prolonged immobilization.[8,9] Open reduction and internal fixation have reduced some of these complications by enabling early mobilization of the patient after surgery. The gold standard for treating closed femoral shaft fractures currently is closed locked intramedullary nailing.[10-13] ...

  18. Percutaneous Intramedullary Screw Fixation of Distal Fibula Fractures: A Case Series and Systematic Review.

    Science.gov (United States)

    Loukachov, Vladimir V; Birnie, Merel F N; Dingemans, Siem A; de Jong, Vincent M; Schepers, Tim

    The current reference standard for unstable ankle fractures is open reduction and internal fixation using a plate and lag screws. This approach requires extensive dissection and wound complications are not uncommon. The use of intramedullary screw fixation might overcome these issues. The aim of our study was to provide an overview of the published data regarding intramedullary screw fixation of fibula fractures combined with a small consecutive case series. We performed a search of published studies to identify the studies in which fibula fractures were treated with percutaneous intramedullary screw fixation. Additionally, all consecutive patients treated for an unstable ankle fracture in a level 1 trauma center using an intramedullary screw were retrospectively included. The literature search identified 6 studies with a total of 180 patients. Wound infection was seen in 1 patient (0.6%), anatomic reduction was achieved in 168 patients (93.3%), and a loss of reduction was seen in 2 patients (1.1%). Implant removal was deemed necessary in 3 patients (1.7%) and nonunion was seen is 2 patients (1.1%). A total of 11 patients, in whom no wound complications occurred, were included in our study. The follow-up duration was a minimum of 12 months. A secondary dislocation was seen in 1 patient, and delayed union was observed after 7.5 months in 1 other patient. In conclusion, intramedullary screw fixation is a safe and adequate method to use for fibula fractures, with a low risk of wound complications. Additional research regarding functional outcome is warranted. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Anterior cruciate ligament reconstruction with tibial attachment preserving hamstring graft without implant on tibial side

    Directory of Open Access Journals (Sweden)

    Skand Sinha

    2018-01-01

    Full Text Available Background: Tibial attachment preserving hamstring graft could prevent potential problems of free graft in anterior cruciate ligament (ACL reconstruction such as pull out before graft-tunnel healing or rupture before ligamentization. Different implants have been reportedly used for tibial side fixation with this technique. We investigated short-term outcome of ACL reconstruction (ACLR with tibial attachment sparing hamstring graft without implant on the tibial side by outside in technique. Materials and Methods: Seventy nine consecutive cases of ACL tear having age of 25.7 ± 6.8 years were included after Institutional Board Approval. All subjects were male. The mean time interval from injury to surgery was of 7.5 ± 6.4 months. Hamstring tendons were harvested with open tendon stripper leaving the tibial insertion intact. The free ends of the tendons were whip stitched, quadrupled, and whip stitched again over the insertion site of hamstring with fiber wire (Arthrex. Single bundle ACLR was done by outside in technique and the femoral tunnel was created with cannulated reamer. The graft was pulled up to the external aperture of femoral tunnel and fixed with interference screw (Arthrex. The scoring was done by Lysholm, Tegner, and KT 1000 by independent observers. All cases were followed up for 2 years. Results: The mean length of quadrupled graft attached to tibia was 127.65 ± 7.5 mm, and the mean width was 7.52 ± 0.78 mm. The mean preoperative Lysholm score of 47.15 ± 9.6, improved to 96.8 ± 2.4 at 1 year. All cases except two returned to the previous level of activity after ACLR. There was no significant difference statistically between preinjury (5.89 ± 0.68 and postoperative (5.87 ± 0.67 Tegner score. The anterior tibial translation (ATT (KT 1000 improved from 11.44 ± 1.93 mm to 3.59 ± 0.89 mm. The ATT of operated knee returned to nearly the similar value as of the opposite knee (3.47 ± 1.16 mm. The Pivot shift test was negative in

  20. Screw elastic intramedullary nail for the management of adult forearm fractures

    Directory of Open Access Journals (Sweden)

    Wasudeo Gadegone

    2012-01-01

    Full Text Available Background: The failure of the conventional nailing of both forearm bones or isolated fractures of radius and ulna pose a potential problem of nail migration and rotational instability, despite the best reduction. The purpose of this paper is to evaluate the results of screw elastic intramedullary nail for the treatment of adult diaphyseal fractures of both forearm bones, which effectively addresses the problems associated with the conventional nailing systems for the forearm fractures. Materials and Methods: Seventy-six adults with forearm fractures (radius and ulna or isolated fracture of the single bone were retrospectively evaluated. Fifty males and 26 females with the mean age of 38 years (range, 18-70 years underwent closed reduction and screw intramedullary nail fixation. Ten patients required limited open reduction. The fractures were classified according to the AO/OTA system. The average followup was 12 months (range, 6 to 18 months. Results: The mean surgical time was 45 minutes (35 to 65 minutes. The meantime to union was 14 weeks (10-21 weeks. The results were graded as excellent in 50, good in 18 patients, and acceptable in eight patients, using the criteria of Grace and Eversman. We had superficial infection in three cases, one case of delayed infection, painful bursa in two cases, delayed union in two cases, malunion with dislocation of the DRUJ in two cases, injury to the extensor tendon of the thumb in one case, and one case of incomplete radioulnar synostosis. Conclusion: Closed reduction and internal fixation of forearm fractures by screw intramedullary nails reestablishes the near normal relationship of the fractured fragments. Screw intramedullary nail effectively controls both rotatory forces and the migration of the nail. It produces excellent clinical results in isolated fractures of either bones, as well as both bones of the forearm in adults.

  1. Surgical management of spinal intramedullary tumors: radical and safe strategy for benign tumors.

    Science.gov (United States)

    Takami, Toshihiro; Naito, Kentaro; Yamagata, Toru; Ohata, Kenji

    2015-01-01

    Surgery for spinal intramedullary tumors remains one of the major challenges for neurosurgeons, due to their relative infrequency, unknown natural history, and surgical difficulty. We are sure that safe and precise resection of spinal intramedullary tumors, particularly encapsulated benign tumors, can result in acceptable or satisfactory postoperative outcomes. General surgical concepts and strategies, technical consideration, and functional outcomes after surgery are discussed with illustrative cases of spinal intramedullary benign tumors such as ependymoma, cavernous malformation, and hemangioblastoma. Selection of a posterior median sulcus, posterolateral sulcus, or direct transpial approach was determined based on the preoperative imaging diagnosis and careful inspection of the spinal cord surface. Tumor-cord interface was meticulously delineated in cases of benign encapsulated tumors. Our retrospective functional analysis of 24 consecutive cases of spinal intramedullary ependymoma followed for at least 6 months postoperatively demonstrated a mean grade on the modified McCormick functional schema of 1.8 before surgery, deteriorating significantly to 2.6 early after surgery ( 6 months after surgery). The risk of functional deterioration after surgery should be taken into serious consideration. Functional deterioration after surgery, including neuropathic pain even long after surgery, significantly affects patient quality of life. Better balance between tumor control and functional preservation can be achieved not only by the surgical technique or expertise, but also by intraoperative neurophysiological monitoring, vascular image guidance, and postoperative supportive care. Quality of life after surgery should inarguably be given top priority.

  2. Effects of counteracting external valgus moment on lateral tibial cartilage contact conditions and tibial rotation.

    Science.gov (United States)

    Shriram, Duraisamy; Parween, Rizuwana; Lee, Yee Han Dave; Subburaj, Karupppasamy

    2017-07-01

    Knee osteoarthritis that prevalently occurs at the medial compartment is a progressive chronic disorder affecting the articular cartilage of the knee joint, and lead to loss of joint functionality. Valgus braces have been used as a treatment procedure to unload the medial compartment for patients with medial osteoarthritis. Valgus braces through the application of counteracting external valgus moment shift the load from medial compartment towards the lateral compartment. Previous biomechanical studies focused only on the changes in varus moments before and after wearing the brace. The objective of this study was to investigate the influence of opposing external valgus moment applied by knee braces on the lateral tibial cartilage contact conditions using a 3D finite element model of the knee joint. Finite element simulations were performed on the knee joint model without and with the application of opposing valgus moment to mimic the unbraced and braced conditions. Lateral tibial cartilage contact pressures and contact area, and tibial rotation (varus-valgus and internal-external) were estimated for the complete walking gait cycle. The opposing valgus moment increased the maximum contact pressure and contact area on the lateral tibial cartilage compared to the normal gait moment. A peak contact pressure of 8.2 MPa and maximum cartilage loaded area of 28% (loaded cartilage nodes) on the lateral cartilage with the application of external valgus moment were induced at 50% of the gait cycle. The results show that the use of opposing valgus moment may significantly increase the maximum contact pressures and contact area on the lateral tibial cartilage and increases the risk of articular cartilage damage on the lateral compartment.

  3. Complications and Functional Recovery in Treatment of Femoral Shaft Fractures with Unreamed Intramedullary Nailing

    OpenAIRE

    Sadic, Sahmir; Custovic, Svemir; Smajic, Nedim; Fazlic, Mirsad; Vujadinovic, Aleksandar; Hrustic, Asmir; Jasarevic, Mahir

    2014-01-01

    ABSTRACT Introduction: Fracture of the femoral shaft is a common fracture encountered in orthopedic practice. In the 1939, K?ntscher introduced the concept of intramedullary nailing for stabilization of long bone fractures. Intramedullary nailing has revolutionized the treatment of fractures. Material and methods: The study included 37 male patients and 13 female patients, averaged 39?20,5 years (range, 16 to 76 years). Results and discussion: There were 31 left femurs and 21 right femurs fra...

  4. Bilateral double level tibial lengthening in dwarfism.

    Science.gov (United States)

    Burghardt, Rolf D; Yoshino, Koichi; Kashiwagi, Naoya; Yoshino, Shigeo; Bhave, Anil; Paley, Dror; Herzenberg, John E

    2015-12-01

    Outcome assessment after double level tibial lengthening in patients with dwarfism. Fourteen patients with dwarfism were analyzed after bilateral simultaneous double level tibial lengthening. Average age was 15.1 years. Average lengthening was 13.5 cm. The two levels were lengthened by an average of 7.5 cm proximally and 6.0 cm distally. Concomitant deformities were also addressed during lengthening. External fixation treatment time averaged 8.8 months. Healing index averaged 0.7 months/cm. Bilateral tibial lengthening for dwarfism is difficult, but the results are usually quite gratifying.

  5. 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.

  6. 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.)

  7. [Intramedullary nailing combined with cannulated screw in treating femoral condyles fractures].

    Science.gov (United States)

    Shen, Guo-Qing; Zhang, Hao; Long, Da-Fu; Li, Zheng-Wen; Tan, Ying-Dong

    2017-07-25

    To observe the clinical effects of retrograde intramedullary nailing and cannulated screws in the treatment of femoral condylar fracture. From June 2009 to June 2015, 13 patients with femoral condyles fracture were treated by retrograde intramedullary nailing and cannulated screws including 6 males and 7 females with an average age of 46.1 years old ranging from 16 to 76 years old. There were 10 cases of closed fractures, 3 cases of open fraetures. According to AO classification criteriam, 4 cases were type C1, 7 cases were type C2, 2 cases were type C3. Postoperative reduction of fracture and the knee joint function recovery were observed. All patients were followed up for 12 to 36 months with a mean of 24 months. X-ray examination showed that the union time of fracture was 18 to 24 weeks, 21 weeks on average. There were no cases of loosening, breakage of internal fixators and re-fracture. Hospital for Special Surgery(HSS) knee score was 90.07±4.99 at 1 year after the operation. The clinical efficacy for retrograde intramedullary nailing and cannulated screw for the treatment of femoral condyles fracture was excellent. It can improve the anatomical reattachment rate and reduce the complications and promote the knee functional recovery.

  8. Intramedullary tuberculomas: MR findings in seven patients

    International Nuclear Information System (INIS)

    Parmar, H.; Varma, R.; Shah, J.; Patkar, D.

    2000-01-01

    To describe the MR findings in intramedullary tuberculomas and to discuss the usefulness of MR in the management of this pathology. Material and Methods: A retrospective study of 7 patients from 21 to 60 years of age with clinical and radiological evidence of intramedullary tuberculomas was undertaken. Both T1- and T2-weighted images (WI) were obtained along with postcontrast T1WI. Signal intensities (SIs) of the granulomas were compared with SIs of the normal spinal cord. Results: Six patients showed focus of tuberculosis elsewhere in the body. Six out of 7 showed fusiform swelling of the cord. Ill-defined iso-intensity (in 4 patients) to hyperintensity (in 3 patients) was seen at the site of granuloma on T1WI. On T2WI, 2 patients revealed a hypointense area (with disc enhancement). An iso-hypointense rim was seen surrounding a hyperintense centre in 5 patients (with rim enhancement). Adjacent oedema was seen in all patients. In 2 patients meningeal enhancement was also seen. In 2 patients the histopathology following surgical biopsy confirmed the diagnosis. In the remaining 5 patients, another known focus of tuberculosis elsewhere in the body and a marked response to antitubercular treatment was considered confirmatory for tuberculomas. Conclusion: Hypo- or iso-intensity on T2WI within the spinal cord with surrounding hyperintense oedema is suggestive of intramedullary tuberculomas. Central hyperintensities are also detected at times due to a variable amount of caseous necrosis with liquefaction. On T1WI, fusiform swelling of the cord is seen along with iso- to hyperintense foci, surrounded by hypointense oedema of the cord. Such findings should prompt a contrast-enhanced study, which may show single or conglomerate disc- or ring-enhancing lesions. MR thus plays an important role not only in detection and diagnosis, but also in deciding the treatment options and in the follow-up of those patients

  9. Primary Intradural Hemangiopericytoma With Intramedullary Invasion

    Directory of Open Access Journals (Sweden)

    Chiang-Wei Chou

    2009-10-01

    Full Text Available Hemangiopericytoma (HPC is a rare tumor of the central nervous system and is usually found intracranially. Intraspinal HPCs are very rare and mostly involve the extradural bony structures. Primary intradural HPC has only been reported in 10 cases, all of which occurred in the extramedullary region. Intramedullary invasion has never been reported. Here, we describe a case of primary intradural HPC of the thoracic spine that presented initially with paresthesia and paraplegia of both legs. Magnetic resonance imaging of the thoracic spine showed an intradural dumbbell-shaped tumor at the T10 level. The initial impression was neurogenic tumor, meningioma, or metastasis. During operation, the tumor was found to have obvious intramedullary invasion. Gross-total removal was done, and the patient's neurological function improved; there was no recurrence at the 3-year follow-up. There is no consensus as to what constitutes the optimal treatment of HPC, but most neurosurgeons will advocate gross-total resection. A comparative analysis between intradural and extradural HPCs showed a higher chance of gross-total resection for intradural HPCs, while the recurrence rates showed no difference. The role of adjuvant radiotherapy remains uncertain. Due to the high risk of recurrence and metastasis of HPCs, close follow-up for a long period is mandatory. [J Chin Med Assoc 2009;72(10:536–541

  10. The value of 99mTc-HDP scan in the diagnosis of tibial avascular necrosis caused by thermal injury: a case with multi-image correlation analysis

    International Nuclear Information System (INIS)

    Bahk, Yong Whee

    2007-01-01

    Basic pathology in thermal injury is coagulative soft tissue necorsis that may occasionally be complicated by infection and later by scarring and vascular changes. Radiological features were discussed in detail by Resnick. The early changes consist of soft tissue defect, porosis and periostitis and the late changes include osteophytosis, periarticular calcification or ossification and arthropathy with ankylosis. Acromutilation can occur when small bones of the hand and foot are burned and scarred. This communication describes 99m Tc-HDP pnhole bone scan manifestations of thermal bone injuries observed in a case of skin-bone burns of the mid-tibial shaft that was complicated by infection, soft tissue scarring and osteonecrosis. Patient was a 49-year-old female thermal burn involving a mid-tibial shaft segment along with overlying skin. The injury was accidental to medullary rimming to fit intramedullary nail to fix fracture. The heat produced during drilling spread to burn the pretibial skin that is sparse in subcutaneous buffer tissue and vessels. The soft tissue burn was infected and healed by repeated skin grafts and scar over a period of 2 years. Concomitantly, the underlying bone was infected locally and treated but ensued in osteonecrosis that was accompanied by osteolysis. Indeed. pinhole 99m Tc-HDP scan played a unique role in this case in detecting that live lateral cortex had sustained the large dead bone that involved the main volume of the mid-tibial shaft. Importantly, the scan could confirm live cortex to have sustained dead bone uncollapsed. Anatomical and metabolic data gained from bone scanning prompted us to systematically scrutinize radiograph and CT to specifically identify the preserved lateral cortex. As mentioned the existence of healthy cortex is biomechanically and tactically vital to surgically replace and restore the devitalized bone

  11. Diffusion tensor imaging in inflammatory and neoplastic intramedullary spinal cord lesions: Focusing on fiber tracking

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyo Jin; Lee, Joon Woo; Lee, Eugene; Kim, Sung Gon; Kang, Yu Suhn; Ahn, Joong Mo; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2017-02-15

    Inflammatory and neoplastic intramedullary spinal cord lesions have overlapping clinical features, and it is occasionally difficult to distinguish one from the other on conventional magnetic resonance imaging. We aimed to compare diffusion tensor imaging findings between inflammatory and neoplastic intramedullary spinal cord lesions, with a specific focus on patterns of fiber tracking. Diffusion tensor imaging was performed in patients with either inflammatory or neoplastic intramedullary spinal cord lesions. The fiber tracking patterns (categorized as “intact,” “displaced,” or “interrupted”) were compared between these two groups. Eight patients were included in the study: 5 patients with pathologically or clinically confirmed inflammatory lesions and 3 patients with pathologically or clinically confirmed neoplastic lesions. Among the 5 patients with inflammatory lesions, 2 patients exhibited the displaced pattern and 3 patients exhibited the intact pattern. Among the 3 patients with neoplastic lesions, 1 patient exhibited the intact pattern, 1 patient exhibited the displaced pattern, and 1 patient exhibited the interrupted pattern. In this study, inflammatory and neoplastic intramedullary spinal cord lesions were not clearly differentiated by fiber tracking; both conditions can present with overlapping features such as displaced fibers. The exclusion of inflammatory conditions based on the presence of displaced fibers in fiber tracking images should be avoided.

  12. Intramedullary cavernous haemangioma of spinal cord: A case ...

    African Journals Online (AJOL)

    Thoracic myelography done showed bilateral symmetrical funnelling of the contrast at the level of T5 with widening of the spinal cord, which are typical characteristics of an intramedullary mass of spinal cord. T2-T6 Laminectomy was done. Near total excision of a 4 by 2.5 cm intradural, intramedulary bluish black, necrotic, ...

  13. Minimally invasive surgical treatment for unstable fractures of the proximal phalanx: intramedullary screw

    Directory of Open Access Journals (Sweden)

    Marcio Aurélio Aita

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To analyze the clinical-functional parameters and quality of life of patients undergoing minimally invasive surgical treatment for extra-articular fractures of the proximal phalanx, using an intramedullary screw (Acutrak(r. METHODS: Between January 2011 and September 2014, a prospective study was conducted on 41 patients (48 fingers with unstable extra-articular fractures of the proximal phalanx, who underwent minimally invasive surgical treatment using an intramedullary screw (Acutrak(r. These patients were evaluated 12 months after the surgery by means of the DASH quality-of-life questionnaire, VAS pain scale, measurement of range of motion (ROM, in degrees and radiographic assessment. RESULTS: All the patients achieved adequate reduction and consolidation of their fractures. There were statistically significant improvements in quality of life on the DASH scale, pain on the VAS scale and range of motion. CONCLUSION: The minimally invasive technique for treating unstable extra-articular fractures of the proximal phalanx using an intramedullary screw (Acutrak(r is effective and safe, and it presents satisfactory clinical-functional results.

  14. 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

  15. [Intramedullary osteosynthesis of distal metacarpal fractures with curved wires].

    Science.gov (United States)

    Schlageter, M; Winkel, R; Porcher, R; Haas, H G

    1997-07-01

    When intramedullary pinning is used to treat metacarpal fractures, as recently described by Förstner (1994) and Foucher (1995), the closed reduction technique developed by Jahss (1938) is applied in the same way as for conservative fracture treatment. It is not always possible to achieve complete anatomical reduction using this closed technique. The intramedullary pinning technique, that we have applied since 1989, involves a Kirschner wire which is bent at one end. Apart from reducing the fracture, the pre-set Kirschner wire serves as a butressing internal fixator. The elastic clamping of the wire acts as an internal wire spring splint, permitting early mobilisation. We have operated on 62 metacarpal fractures using the above-mentioned technique over a period of 6 years until 1995. Anatomic reduction was realized in 50 of 62 fractures. In the follow-up of 32 fractures, we noticed four complications: one infection, two paraesthesias, and one non-union.

  16. Primary unreamed intramedullary locked nailing in open fractures of tibia

    Directory of Open Access Journals (Sweden)

    Jain Vineet

    2005-01-01

    Full Text Available Background: Fractures of tibia are among the commonest fractures sustained in road traffic accidents. They are frequently open and contaminated. Unreamed nails are considered superior to external fixator in the management of open fractures of tibia. Method: Forty patients with open fractures of tibia, grade I, II, IIIa, IIIb were included in the study. They were managed by primary unreamed intramedullary nailing with adequate soft tissue management. Results: Functional results were excellent in 26 cases, good in 10 cases and fair in 4 cases. Four cases had delayed union. Average time of union was 16.9 weeks. Conclusion: Primary unreamed intramedullary nailing offers advantage of rigid fixation, low incidence of infection, non-union, good functional results and early return to work. An adequate soft tissue management is mandatory in treatment of these fractures.

  17. 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...

  18. 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.

  19. 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

  20. The value of {sup 99m}Tc-HDP scan in the diagnosis of tibial avascular necrosis caused by thermal injury: a case with multi-image correlation analysis

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee [Sung-Ae General Hospital, Seoul (Korea, Republic of)

    2007-10-15

    Basic pathology in thermal injury is coagulative soft tissue necorsis that may occasionally be complicated by infection and later by scarring and vascular changes. Radiological features were discussed in detail by Resnick. The early changes consist of soft tissue defect, porosis and periostitis and the late changes include osteophytosis, periarticular calcification or ossification and arthropathy with ankylosis. Acromutilation can occur when small bones of the hand and foot are burned and scarred. This communication describes {sup 99m}Tc-HDP pnhole bone scan manifestations of thermal bone injuries observed in a case of skin-bone burns of the mid-tibial shaft that was complicated by infection, soft tissue scarring and osteonecrosis. Patient was a 49-year-old female thermal burn involving a mid-tibial shaft segment along with overlying skin. The injury was accidental to medullary rimming to fit intramedullary nail to fix fracture. The heat produced during drilling spread to burn the pretibial skin that is sparse in subcutaneous buffer tissue and vessels. The soft tissue burn was infected and healed by repeated skin grafts and scar over a period of 2 years. Concomitantly, the underlying bone was infected locally and treated but ensued in osteonecrosis that was accompanied by osteolysis. Indeed. pinhole {sup 99m}Tc-HDP scan played a unique role in this case in detecting that live lateral cortex had sustained the large dead bone that involved the main volume of the mid-tibial shaft. Importantly, the scan could confirm live cortex to have sustained dead bone uncollapsed. Anatomical and metabolic data gained from bone scanning prompted us to systematically scrutinize radiograph and CT to specifically identify the preserved lateral cortex. As mentioned the existence of healthy cortex is biomechanically and tactically vital to surgically replace and restore the devitalized bone.

  1. 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.

  2. Measurement of Posterior Tibial Slope Using Magnetic Resonance Imaging.

    Science.gov (United States)

    Karimi, Elham; Norouzian, Mohsen; Birjandinejad, Ali; Zandi, Reza; Makhmalbaf, Hadi

    2017-11-01

    Posterior tibial slope (PTS) is an important factor in the knee joint biomechanics and one of the bone features, which affects knee joint stability. Posterior tibial slope has impact on flexion gap, knee joint stability and posterior femoral rollback that are related to wide range of knee motion. During high tibial osteotomy and total knee arthroplasty (TKA) surgery, proper retaining the mechanical and anatomical axis is important. The aim of this study was to evaluate the value of posterior tibial slope in medial and lateral compartments of tibial plateau and to assess the relationship among the slope with age, gender and other variables of tibial plateau surface. This descriptive study was conducted on 132 healthy knees (80 males and 52 females) with a mean age of 38.26±11.45 (20-60 years) at Imam Reza hospital in Mashhad, Iran. All patients, selected and enrolled for MRI in this study, were admitted for knee pain with uncertain clinical history. According to initial physical knee examinations the study subjects were reported healthy. The mean posterior tibial slope was 7.78± 2.48 degrees in the medial compartment and 6.85± 2.24 degrees in lateral compartment. No significant correlation was found between age and gender with posterior tibial slope ( P ≥0.05), but there was significant relationship among PTS with mediolateral width, plateau area and medial plateau. Comparison of different studies revealed that the PTS value in our study is different from other communities, which can be associated with genetic and racial factors. The results of our study are useful to PTS reconstruction in surgeries.

  3. 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.

  4. 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…

  5. Medial tibial stress syndrome: a critical review

    NARCIS (Netherlands)

    Moen, Maarten H.; Tol, Johannes L.; Weir, Adam; Steunebrink, Miriam; de Winter, Theodorus C.

    2009-01-01

    Medial tibial stress syndrome (MTSS) is one of the most common leg injuries in athletes and soldiers. The incidence of MTSS is reported as being between 4% and 35% in military personnel and athletes. The name given to this condition refers to pain on the posteromedial tibial border during exercise,

  6. Snapping scapular syndrome secondary to rib intramedullary fixation device

    Directory of Open Access Journals (Sweden)

    Ezequiel E. Zaidenberg

    2015-01-01

    Conclusion: Surgeons should pay attention to any protrusion of intramedullary rib implants, especially in the evaluation of routine X-rays following surgical treatment. We should be aware of the possibility of this rare cause of snapping scapula syndrome to avoid delayed diagnosis and consider removing the implant will resolve the pain.

  7. Spinal intramedullary ependymoma: surgical approaches and outcome.

    Science.gov (United States)

    Borges, Lawrence F

    2018-02-01

    Intramedullary ependymomas are uncommon tumors that can occur within the medullary substance of the spinal cord. Despite this difficult location, they are typically benign tumors that can most often be removed completely with an acceptable surgical risk. Therefore, the recommended management approach is usually surgical excision. This review will consider the historical context in which surgeons began treating these tumors and then review the more recent literature that guides their current management.

  8. 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.

  9. [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.

  10. 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.

  11. Pre-bent elastic stable intramedullary nail fixation for distal radial shaft fractures in children.

    Science.gov (United States)

    Ge, Yi-hua; Wang, Zhi-gang; Cai, Hai-qing; Yang, Jie; Xu, Yun-lan; Li, Yu-chan; Zhang, Yu-chen; Chen, Bo-chang

    2010-08-01

    To investigate the functional and radiographic outcomes of pre-bent elastic stable intramedullary nail in treatment of distal radial shaft fractures in children. From January 2006 to December 2008, 18 children with distal radial shaft fracture were treated by close reduction and internal fixation with a pre-bent elastic stable intramedullary nail. The age range was from 5 years to 15 years, with an average of 9 years and 8 months. The minimum follow-up was 12 months. All fractures maintained good alignment postoperatively, and 94.4% (17/18) of the patients regained a full range of rotation of the forearm. One patient has limitation of rotation to less than 10°, this had improved by final follow-up. Complications included soft tissue irritation at the site of nail insertion in one patient and transient scar hypersensitivity in another. Fixation with a pre-bent elastic stable intramedullary nail is an effective, safe and convenient method for treating distal radial shaft fractures in children. © 2010 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.

  12. Early effect of Ti-24Nb-4Zr-7.9Sn intramedullary nails on fractured bone

    International Nuclear Information System (INIS)

    Guo, Z.; Fu, J.; Zhang, Y.Q.; Hu, Y.Y.; Wu, Z.G.; Shi, L.; Sha, M.; Li, S.J.; Hao, Y.L.; Yang, R.

    2009-01-01

    A multifunctional titanium Ti-24Nb-4Zr-7.9Sn alloy (abbreviated as Ti2448) with ultra-low elastic modulus and high strength has been developed recently for potential biomedical applications. In this study, the bone healing and stability of implants in a rabbit tibial fracture model were investigated using intramedullary nails made of both the Ti2448 and Ti-6Al-4V ELI alloys. X-ray radiographic analysis showed that the volume fractions of new calluses formed around the fractured tibia increased with implantation times up to 4 weeks in both groups but no obvious difference was found between the alloys at the same time point. The micro-CT analysis revealed that, in the distal end of the tibia, there were many new calluses around nails made of the Ti2448 alloy that were confirmed by histological observations. The above analysis was consistent with tensile testing results performed 4 weeks after implantation. The mean maximum tensile force to failure of the newly formed calluses was similar between both groups whereas the mean maximum pull-out forces of the implanted nails were larger in the group of the Ti2448 alloy. Four weeks after fixation, no obvious difference in the degree of fracture healing was found between both groups. These results suggested that, in the early stage of fixation, the nails with ultra-low elastic modulus improved the new bone formation in the marrow cavity.

  13. Stability of guest molecules in urea canal complexes by canal polymerization

    International Nuclear Information System (INIS)

    Yoshii, Fumio; Makuuchi, Keizo

    1995-01-01

    It was found that various organic materials are attracted into urea canal by hexanediol diacrylate (HDDA) and long chain compounds. This means that materials which does not form complex by itself are induced in canal by HDDA and long chain compounds. To include with stability perfumes, insecticides, attractants and repellents in urea canal, leaf alcohol was used as a model compound for guest molecules in the canal. The leaf alcohol from the canal released gradually over many days and the release was inhibited for 15 days by long chain compounds and for 30 days by polymerized HDDA after irradiation. After releasing, the leaf alcohol in the canal remained 25 % stable for long chain compounds and 40 % for polymerized HDDA. The dose required for stabilization of leaf alcohol in the urea canal by canal polymerization of HDDA was 30 kGy. (author)

  14. 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.

  15. 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

  16. Root canal irrigants

    OpenAIRE

    Kandaswamy, Deivanayagam; Venkateshbabu, Nagendrababu

    2010-01-01

    Successful root canal therapy relies on the combination of proper instrumentation, irrigation, and obturation of the root canal. Of these three essential steps of root canal therapy, irrigation of the root canal is the most important determinant in the healing of the periapical tissues. The primary endodontic treatment goal must thus be to optimize root canal disinfection and to prevent reinfection. In this review of the literature, various irrigants and the interactions between irrigants are...

  17. Flexible intramedullary nailing for the treatment of unicameral bone cysts in long bones.

    Science.gov (United States)

    Roposch, A; Saraph, V; Linhart, W E

    2000-10-01

    Unicameral bone cyst is characterized by its tenacity and risk of recurrence. Pathological fracture is common and is often the presenting symptom. The objective of the present study was to evaluate the results of flexible intramedullary nailing for the treatment of a unicameral bone cyst with or without a pathological fracture. Flexible intramedullary nailing for the treatment of a unicameral bone cyst was performed in thirty-two patients. Thirty of these patients presented with a pathological fracture; twenty-four were managed immediately with intramedullary nailing, and the other six had been managed conservatively at other clinics before they were referred to our department. The remaining two cysts were detected incidentally. The cyst was located in the humerus in twenty-one patients, in the femur in nine, and in the radius in two. The mean age of the patients at the time of surgery was 9.8 years, and the mean duration of follow-up was 53.7 months. Radiographic evaluation was performed according to the criteria of Capanna et al., and the cyst was classified as completely healed, healed with residual radiolucency (osteolysis), recurred, or having no response. The healing period ranged from three to 105 months. Fourteen cysts healed completely, and sixteen healed with residual radiolucent areas visible on radiographs. There was recurrence of two cysts that had healed with residual radiolucency. All of the cysts in the present study responded to treatment. A change of nails was necessary in nine patients, as the nails had become too short after bone growth. No major complications were observed. Flexible intramedullary nailing provides early stability, which allows early mobilization and thus obviates the need for a plaster cast and decreases the prevalence of the most common complication: a pathological fracture. This method of treatment also allows for an early return to normal activity.

  18. Intramedullary spinal immature teratoma: resolution of quadriplegia following resection in a 4-week-old infant.

    Science.gov (United States)

    Nickols, Hilary Highfield; Chambless, Lola B; Carson, Robert P; Coffin, Cheryl M; Pearson, Matthew M; Abel, Ty W

    2010-12-01

    Intramedullary spinal cord teratomas are rare entities in infants. Management of these lesions is primarily surgical, with outcome dependent on rapid surgical decompression and complete gross-total tumor resection. The lesions are typically of the mature type, with immature teratomas displaying unique pathological features. The authors report a case of an extensive intramedullary immature teratoma in an infant with resolution of quadriplegia following gross-total radical resection. At the 1-year follow-up, there was radiographic evidence of tumor, and surgical reexploration yielded portions of immature teratoma and extensive gliosis.

  19. Systematic radiographic evaluation of tibial hemimelia with orthopedic implications

    Energy Technology Data Exchange (ETDEWEB)

    Kaplan-List, Katia [Rochester General Hospital, Department of Diagnostic Imaging, Rochester, NY (United States); Klionsky, Nina B. [University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY (United States); Golisano Children' s Hospital, Department of Radiology, Rochester, NY (United States); Sanders, James O. [University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY (United States); Golisano Children' s Hospital, Department of Orthopaedics, Rochester, NY (United States); Golisano Children' s Hospital, Department of Pediatrics, Rochester, NY (United States); Katz, Michael E. [St. Mary' s Medical Center and Palm Beach Children' s Hospital, Department of Radiology, West Palm Beach, FL (United States)

    2017-04-15

    Tibial hemimelia is a rare lower-extremity pre-axial longitudinal deficiency characterized by complete or partial absence of the tibia. The reported incidence is 1 in 1 million live births. In this pictorial essay, we define tibial hemimelia and describe associated conditions and principles of preoperative imaging assessment for a child with tibial hemimelia. We also indicate the imaging findings that might influence the choice of treatment, describe the most widely used classification systems, and briefly discuss current treatment approaches. (orig.)

  20. Systematic radiographic evaluation of tibial hemimelia with orthopedic implications

    International Nuclear Information System (INIS)

    Kaplan-List, Katia; Klionsky, Nina B.; Sanders, James O.; Katz, Michael E.

    2017-01-01

    Tibial hemimelia is a rare lower-extremity pre-axial longitudinal deficiency characterized by complete or partial absence of the tibia. The reported incidence is 1 in 1 million live births. In this pictorial essay, we define tibial hemimelia and describe associated conditions and principles of preoperative imaging assessment for a child with tibial hemimelia. We also indicate the imaging findings that might influence the choice of treatment, describe the most widely used classification systems, and briefly discuss current treatment approaches. (orig.)

  1. Gender differences in passive knee biomechanical properties in tibial rotation.

    Science.gov (United States)

    Park, Hyung-Soon; Wilson, Nicole A; Zhang, Li-Qun

    2008-07-01

    The anterior cruciate ligament (ACL) is the most commonly injured knee ligament with the highest incidence of injury in female athletes who participate in pivoting sports. Noncontact ACL injuries commonly occur with both internal and external tibial rotation. ACL impingement against the lateral wall of the intercondylar notch during tibial external rotation and abduction has been proposed as an injury mechanism, but few studies have evaluated in vivo gender-specific differences in laxity and stiffness in external and internal tibial rotations. The purpose of this study was to evaluate these differences. The knees of 10 male and 10 female healthy subjects were rotated between internal and external tibial rotation with the knee at 60 degrees of flexion. Joint laxity, stiffness, and energy loss were compared between male and female subjects. Women had higher laxity (p = 0.01), lower stiffness (p = 0.038), and higher energy loss (p = 0.008) in external tibial rotation than did men. The results suggest that women may be at greater risk of ACL injury resulting from impingement against the lateral wall of the intercondylar notch, which has been shown to be associated with external tibial rotation and abduction.

  2. The efficacy of single-stage open intramedullary nailing of neglected femur fractures.

    Science.gov (United States)

    Boopalan, P R J V C; Sait, Azad; Jepegnanam, Thilak Samuel; Matthai, Thomas; Varghese, Viju Daniel

    2014-02-01

    Neglected femur fractures are not rare in the developing world. Treatment options include single-stage open reduction and intramedullary nailing, or open release, skeletal traction, and then second-stage open intramedullary nailing, with bone grafting. Single-stage procedures have the potential advantage of avoiding neurovascular complications secondary to acute lengthening, but they require a second operation, with potentially increased resource use and infection risk. We sought to determine the (1) likelihood of union, (2) complications and reoperations, and (3) functional results with single-stage open intramedullary nailing without bone grafting in patients with neglected femur fractures. Between January 2003 and December 2007, 17 consecutive patients presented to our practice with neglected femoral shaft fractures. All were treated with single-stage nailing without bone grafting. There were 15 men and two women with a median age of 27 years. The average time from fracture to treatment was 13 weeks (range, 4-44 weeks). Eleven patients underwent open nailing with interlocked nails and six were treated with cloverleaf Kuntscher nails. Patients were followed for a minimum of 6 months (mean, 33 months; range, 6-72 months). The mean preoperative ROM of the knee was 28° (range, 10°-150°) and femoral length discrepancy was 3.1 cm (range, 1-5 cm). All fractures united and the mean time to union was 16 weeks (range, 7-32 weeks). There were no neurologic complications secondary to acute lengthening. The mean postoperative ROM of the knee was 130° (range, 60°-150°). All patients were able to return to preinjury work. Sixteen patients regained their original femoral length. One-stage open intramedullary nailing of neglected femoral diaphyseal fractures without bone grafting was safe and effective, and obviated the need for a two-stage approach. Although the findings need to be replicated in larger numbers of patients, we believe this technique may be useful in

  3. MR imaging of intramedullary tumors of the spinal cord: comparison with surgical findings

    International Nuclear Information System (INIS)

    Choe, Du Whan; Hwang, Hee Young; Lee, Hyeon Kyeong; Han, Moon Hee; Kim, In One; Kim, Hyen Jip; Chang, Kee Hyung

    1991-01-01

    To evaluate the capability of MR imaging to localize intramedullary tumors of the spinal cord and to distinguish solid from cystic components. MR images of 12 patients with surgically-proven intramedullary spinal cord tumor were retrospectively reviewed and correlated with surgical findings. Histologic diagnosis consisted of 3 astrocytomas, 4 ependymomas, 2 gangliogliomas, and one case of lipoma, lymphoma, and glioblastoma multiform each. MR scans were obtained on a 2.0T or a 0.5T with T1-and T2-weighted spin-echo pulse sequences in sagittal and axial planes. Contrast enhancement was performed with Gd-DTPA in 9 patients. All tumors expanded the spinal cord and showed an extent of involvement ranging from 2 to 5 vertebral heights, except for the gangliogliomas which involved the spinal cord more extensively. Contrast enhancement was seen in all 9 patients. Intratumoral cavities were observed in 1 out of 3 astrocytomas and 2 gangliogliomas. Peritumoral syringomyelia was seen in 2 out of 4 ependymonas and 2 gangliogliomas. In most cases, the MR findings correlated well with the surgical findings with respect to the extent, distinctness of the tumor margin, intratumoral cavity, and associated syringomyelia. It is concluded that MR imaging is a very useful diagnostic tool in the evaluation of intramedullary spinal cord tumors

  4. Nonunions of the distal tibia treated by reamed intramedullary nailing

    NARCIS (Netherlands)

    Richmond, Jeffrey; Colleran, Kevin; Borens, Olivier; Kloen, Peter; Helfet, David L.

    2004-01-01

    The purpose of this study is to determine the efficacy of reamed intramedullary nailing in the treatment of nonunions of the distal one-fourth of the tibia. Nonunions of the distal tibia are particularly difficult to treat given the short distal segment, the proximity to the ankle joint, and the

  5. Rotation of intramedullary alignment rods affects distal femoral cutting plane in total knee arthroplasty.

    Science.gov (United States)

    Maderbacher, Günther; Matussek, Jan; Keshmiri, Armin; Greimel, Felix; Baier, Clemens; Grifka, Joachim; Maderbacher, Hermann

    2018-02-17

    Intramedullary rods are widely used to align the distal femoral cut in total knee arthroplasty. We hypothesised that both coronal (varus/valgus) and sagittal (extension/flexion) cutting plane are affected by rotational changes of intramedullary femoral alignment guides. Distal femoral cuts using intramedullary alignment rods were simulated by means of a computer-aided engineering software in 4°, 6°, 8°, 10°, and 12° of valgus in relation to the femoral anatomical axis and 4° extension, neutral, as well as 4°, 8°, and 12° of flexion in relation to the femoral mechanical axis. This reflects the different angles between anatomical and mechanical axis in coronal and sagittal planes. To assess the influence of rotation of the alignment guide on the effective distal femoral cutting plane, all combinations were simulated with the rod gradually aligned from 40° of external to 40° of internal rotation. Rotational changes of the distal femoral alignment guides affect both the coronal and sagittal cutting planes. When alignment rods are intruded neutrally with regards to sagittal alignment, external rotation causes flexion, while internal rotation causes extension of the sagittal cutting plane. Simultaneously the coronal effect (valgus) decreases resulting in an increased varus of the cutting plane. However, when alignment rods are intruded in extension or flexion partly contradictory effects are observed. Generally the effect increases with the degree of valgus preset, rotation and flexion. As incorrect rotation of intramedullary alignment guides for distal femoral cuts causes significant cutting errors, exact rotational alignment is crucial. Coronal cutting errors in the distal femoral plane might result in overall leg malalignment, asymmetric extension gaps and subsequent sagittal cutting errors.

  6. [Custom-designed 3D tibial augmentation for knee replacement].

    Science.gov (United States)

    Jirman, R; Vavrík, P; Horák, Z

    2009-02-01

    Reconstruction with the use of custom-made implants aims at optimal replacement of lost or damaged bone structures and restoration of their funkction. In this study the development and construction of a custom-made implant and the operative technique used for the treatment of an extensive tibial defect are described. The patient was a 65-year-old man treated for over 20 years for psoriatic arthritis and severe instability of the right knee, particularly in the frontal plane, with a worsening varus deformity. The radiogram showed an extensive destruction of the medial tibial condyle that also deeply involved the lateral condyle. The extent of defect made it impossible to use any commercial tibial augmentation. The geometry of the custom-designed implant for the medial tibial condyle was constructed on the basis of a 3D defect model and the shape of the medial tibial condyle of the collateral knee seen on CT scans. After its correct shape was verified on a plastic model, its coordinates were set in the software of a machine tool, and a titanium augmentation otherwise compatible with a standard knee replacement was produced.The use of such a custom implant to complete standard total knee arthroplasty has so far been demanding in terms of organisation and manufacture. Its production in the future could be facilitated by substituting titanium for plastic material such as poly-ether-ether-ketone (PEEK). Key words: custom-made implant, tibial augmentation, knee prosthesis.

  7. 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.)

  8. The soleal line: a cause of tibial pseudoperiostitis.

    Science.gov (United States)

    Levine, A H; Pais, M J; Berinson, H; Amenta, P S

    1976-04-01

    An unusually prominent soleal line (a normal anatomic variant) may mimic periosteal reaction along the posterior margin of the proximal tibial shaft. This area of pseudoperiostitis is differentiated from hyperostoses arising from the anterior tibial tubercle and the interosseous membrane. It is always associated with normal, undisturbed architecture of the underlying bone.

  9. Spinal diffusion tensor tractography for differentiation of intramedullary tumor-suspected lesions

    Energy Technology Data Exchange (ETDEWEB)

    Egger, K., E-mail: karl.egger@uniklinik-freiburg.de [Department of Neuroradiology, University Medical Center Freiburg, Breisacher Straße 64, 79106 Freiburg (Germany); Hohenhaus, M. [Department of Neurosurgery, University Medical Center Freiburg, Breisacher Straße 64, 79106 Freiburg (Germany); Van Velthoven, V. [Department of Neurosurgery, UZ Brussel, Laarbeeklaan 101, 1090 Brussel (Belgium); Heil, S.; Urbach, H. [Department of Neuroradiology, University Medical Center Freiburg, Breisacher Straße 64, 79106 Freiburg (Germany)

    2016-12-15

    Background and purpose: Primary MRI diagnosis of spinal intramedullary tumor-suspected lesions can be challenging and often requires spinal biopsy or resection with a substantial risk of neurological deficits. We evaluated whether Diffusion Tensor Imaging (DTI) tractography can facilitate the differential diagnosis. Materials and methods: Twenty-five consecutive patients with an intramedullary tumor-suspected lesion considered for spinal surgery were studied with a Diffusion-weighted multi-shot read out segmented EPI sequence (RESOLVE). White matter tracts (“streamlines”) were calculated using the FACT algorithm and visually co-registered to a T2-weighted 3D sequence. The fused images were assessed concerning spinal streamline appearance as normal, displaced or terminated. Definite diagnosis was verified by histological analysis or further clinical work-up. Results: All patients with normal appearing streamlines (n = 6) showed an acute inflammatory demyelinating pathology in the further clinical work-up. In 10 patients streamline displacing lesions were found from which 5 patients underwent a surgical treatment with histologically confirmed low-grade tumors like ependymomas and pilocytic astrocytomas. In nine patients streamlines were terminated, from which 6 patients received a histology proven diagnoses with a more heterogenous spectrum (3 cases of high grade tumor, 1 case of low grade tumor with intralesional hemorrhage and 2 cases with gliosis but no tumor cells). Conclusion: Using multi-shot DTI spinal tractography acute inflammatory lesions can be differentiated from other tumorous intramedullary lesions. The entity diagnosis of spinal tumors seems to be more challenging, primarily due to the variety of factors like invasivity, expansion or intralesional hemorrhage.

  10. Intrinsic factors associated with medial tibial stress syndrome in ...

    African Journals Online (AJOL)

    Intrinsic factors associated with medial tibial stress syndrome in athletes: A large case-control study. ... Medial tibial stress syndrome (MTSS) is the most common lower-leg injury in athletes, and is thought to be caused by ... from 32 Countries:.

  11. Tibial and fibular developmental fields defects

    International Nuclear Information System (INIS)

    Khoury, N.J.; Haddad, M.C.; Hourani, M.H.

    1999-01-01

    Malformations of the lower limbs are rare and heterogeneous anomalies. To explain the diversity and complexity of these abnormalities, authors introduced the concept of tibial and fibular developmental fields. Defects in these fields are responsible for different malformations, which have been described, to our knowledge, in only one report in the radiology literature. We present a case of a newborn with femoral bifurcation, absent fibulae and talar bones, ankle and foot malformations, and associated atrial septal defect. Our case is an example of defects in both fibular and tibial developmental fields. (orig.)

  12. Importance of tibial slope for stability of the posterior cruciate ligament deficient knee.

    Science.gov (United States)

    Giffin, J Robert; Stabile, Kathryne J; Zantop, Thore; Vogrin, Tracy M; Woo, Savio L-Y; Harner, Christopher D

    2007-09-01

    Previous studies have shown that increasing tibial slope can shift the resting position of the tibia anteriorly. As a result, sagittal osteotomies that alter slope have recently been proposed for treatment of posterior cruciate ligament (PCL) injuries. Increasing tibial slope with an osteotomy shifts the resting position anteriorly in a PCL-deficient knee, thereby partially reducing the posterior tibial "sag" associated with PCL injury. This shift in resting position from the increased slope causes a decrease in posterior tibial translation compared with the PCL-deficient knee in response to posterior tibial and axial compressive loads. Controlled laboratory study. Three knee conditions were tested with a robotic universal force-moment sensor testing system: intact, PCL-deficient, and PCL-deficient with increased tibial slope. Tibial slope was increased via a 5-mm anterior opening wedge osteotomy. Three external loading conditions were applied to each knee condition at 0 degrees, 30 degrees, 60 degrees, 90 degrees, and 120 degrees of knee flexion: (1) 134-N anterior-posterior (A-P) tibial load, (2) 200-N axial compressive load, and (3) combined 134-N A-P and 200-N axial loads. For each loading condition, kinematics of the intact knee were recorded for the remaining 5 degrees of freedom (ie, A-P, medial-lateral, and proximal-distal translations, internal-external and varus-valgus rotations). Posterior cruciate ligament deficiency resulted in a posterior shift of the tibial resting position to 8.4 +/- 2.6 mm at 90 degrees compared with the intact knee. After osteotomy, tibial slope increased from 9.2 degrees +/- 1.0 degrees in the intact knee to 13.8 degrees +/- 0.9 degrees. This increase in slope reduced the posterior sag of the PCL-deficient knee, shifting the resting position anteriorly to 4.0 +/- 2.0 mm at 90 degrees. Under a 200-N axial compressive load with the osteotomy, an additional increase in anterior tibial translation to 2.7 +/- 1.7 mm at 30 degrees was

  13. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia.

    Science.gov (United States)

    Guo, J J; Tang, N; Yang, H L; Tang, T S

    2010-07-01

    We compared the outcome of closed intramedullary nailing with minimally invasive plate osteosynthesis using a percutaneous locked compression plate in patients with a distal metaphyseal fracture in a prospective study. A total of 85 patients were randomised to operative stabilisation either by a closed intramedullary nail (44) or by minimally invasive osteosynthesis with a compression plate (41). Pre-operative variables included the patients' age and the side and pattern of the fracture. Peri-operative variables were the operating time and the radiation time. Postoperative variables were wound problems, the time to union of the fracture, the functional American Orthopaedic Foot and Ankle surgery score and removal of hardware. We found no significant difference in the pre-operative variables or in the time to union in the two groups. However, the mean radiation time and operating time were significantly longer in the locked compression plate group (3.0 vs 2.12 minutes, p fractures had united. Patients who had intramedullary nailing had a higher mean pain score (40 = no pain, 0 = severe pain), [corrected] but better function, alignment and total American Orthopaedic Foot and Ankle surgery scores, although the differences were not statistically significant (p = 0.234, p = 0.157, p = 0.897, p = 0.177 respectively). Three (6.8%) patients in the intramedullary nailing group and six (14.6%) in the locked compression plate group showed delayed wound healing, and 37 (84.1%) in the former group and 38 (92.7%) in the latter group expressed a wish to have the implant removed. We conclude that both closed intramedullary nailing and a percutaneous locked compression plate can be used safely to treat Orthopaedic Trauma Association type-43A distal metaphyseal fractures of the tibia. However, closed intramedullary nailing has the advantage of a shorter operating and radiation time and easier removal of the implant. We therefore prefer closed intramedullary nailing for patients with

  14. ROLE OF INTRAMEDULLARY NAILING IN DEFORMITY CORRECTION OF LONG BONES

    Directory of Open Access Journals (Sweden)

    Anne

    2016-03-01

    Full Text Available INTRODUCTION Correction of multi-apical long bone deformities in lower limbs is a challenging task. Correction of these deformities with Ilizarov–type external fixators, treating one segment at a time increases the total time of correction and decreases the patients’ compliance with considerable discomfort. Hence we preferred intramedullary nail devices which combines accuracy, minimal invasiveness, with patient compliance and with excellent functional outcome. Temporary external fixator used per-operatively in some cases to retain the correction till the insertion of the nail. Eight patients in the age group of 12-35 yrs. presented to us over the last 1 year with multi-apical lower limb deformities. The radiological parameters described by Paley et al 1 were used to assess the pre and post–operative radiographs. With the help of anatomical axes the CORA was identified. Percutaneous osteotomy and stabilization with intramedullary nail was done to correct the deformity. 13 Femora and 7 Tibiae were subjected to correction by this technique and followed up over a period of 1 year (Nov-2014 to Nov-2015 at MIMS Vizianagaram hospital.

  15. Tibial torsion in non-arthritic Indian adults: A computer tomography study of 100 limbs

    Directory of Open Access Journals (Sweden)

    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.

  16. Comparative analysis of uniplanar external fixator and retrograde intramedullary nailing for ankle arthrodesis in diabetic Charcot′s neuroarthropathy

    Directory of Open Access Journals (Sweden)

    Nakul S Shah

    2011-01-01

    Results: All five (100% patients treated by intramedullary nailing achieved radiological union on an average follow-up of 16 weeks. The external fixation group had significantly higher rate of complications with one amputation, four non unions (66.7% and a delayed union which went on to full osseous union. Conclusion: The retrograde intramedullary nailing for tibio-talar arthrodesis in Charcot′s neuroarthropathy yielded significantly better outcomes as compared to the use of uniplanar external fixator.

  17. Chlorhexidine-releasing implant coating on intramedullary nail reduces infection in a rat model

    Directory of Open Access Journals (Sweden)

    SM Shiels

    2018-03-01

    Full Text Available The use of internal intramedullary nails for long bone fracture fixation is a common practice among surgeons. Bacteria naturally attach to these devices, increasing the risk for wound infection, which can result in non- or malunion, additional surgical procedures and extended hospital stays. Intramedullary nail surface properties can be modified to reduce bacterial colonisation and potentially infectious complications. In the current study, a coating combining a non-fouling property with leaching chlorhexidine for orthopaedic implantation was tested. Coating stability and chlorhexidine release were evaluated in vitro. Using a rat model of intramedullary fixation and infection, the effect of the coating on microbial colonisation and fracture healing was evaluated in vivo by quantitative microbiology, micro-computed tomography, plain radiography, three-point bending and/or histology. Low dose systemic cefazolin was administered to increase the similarities to clinical practice, without overshadowing the effect of the anti-infective coating. When introduced into a contaminated wound, the non-fouling chlorhexidine-coated implant reduced the overall bacteria colonisation within the bone and on the implant, reduced the osteolysis and increased the radiographic union, confirming its potential for reducing complications in wounds at high risk of infection. However, when implanted into a sterile wound, non-union increased. Further studies are required to best optimise the anti-microbial effectiveness, while not sacrificing fracture union.

  18. [Extramedullary fixation combined with intramedullary fixation in the surgical reduction of sagittal mandibular condylar fractures].

    Science.gov (United States)

    Chuanjun, Chen; Xiaoyang, Chen; Jing, Chen

    2016-10-01

    This study aimed to evaluate the clinical effect of extramedullary fixation combined with intramedullary fixation during the surgical reduction of sagittal mandibular condylar fractures. Twenty-four sagittal fractures of the mandibular condyle in18 patients were fixed by two appliances: intramedullary with one long-screw osteosynthesis or Kirschner wire and extramedullary with one micro-plate. The radiologically-recorded post-operative stability-associated com-plications included the screw/micro-plate loosening, micro-plate twisting, micro-plate fractures, and fragment rotation. The occluding relations, the maximalinter-incisal distances upon mouth opening, and the mandibular deflection upon mouth opening were evaluated based on follow-up clinical examination. Postoperative panoramic X-ray and CT scans showed good repositioning of the fragment, with no redislocation or rotation, no screw/plate loosening, and no plate-twisting or fracture. Clinical examination showed that all patients regained normal mandibular movements, ideal occlusion, and normal maximal inter-incisal distances upon mouth opening. Extramedullary fixation combined with intramedullary fixation is highly recommended for sagittal condylar fractures because of the anti-rotation effect of the fragment and the reasonable place-ment of the fixation appliances.

  19. Peak stresses shift from femoral tunnel aperture to tibial tunnel aperture in lateral tibial tunnel ACL reconstructions: a 3D graft-bending angle measurement and finite-element analysis.

    Science.gov (United States)

    Van Der Bracht, Hans; Tampere, Thomas; Beekman, Pieter; Schepens, Alexander; Devriendt, Wouter; Verdonk, Peter; Victor, Jan

    2018-02-01

    To investigate the effect of tibial tunnel orientation on graft-bending angle and stress distribution in the ACL graft. Eight cadaveric knees were scanned in extension, 45°, 90°, and full flexion. 3D reconstructions with anatomically placed anterior cruciate ligament (ACL) grafts were constructed with Mimics 14.12 ® . 3D graft-bending angles were measured for classic medial tibial tunnels (MTT) and lateral tibial tunnels (LTT) with different drill-guide angles (DGA) (45°, 55°, 65°, and 75°). A pivot shift was performed on 1 knee in a finite-element analysis. The peak stresses in the graft were calculated for eight different tibial tunnel orientations. In a classic anatomical ACL repair, the largest graft-bending angle and peak stresses are seen at the femoral tunnel aperture. The use of a different DGA at the tibial side does not change the graft-bending angle at the femoral side or magnitude of peak stresses significantly. When using LTT, the largest graft-bending angles and peak stresses are seen at the tibial tunnel aperture. In a classic anatomical ACL repair, peak stresses in the ACL graft are found at the femoral tunnel aperture. When an LTT is used, peak stresses are similar compared to classic ACL repairs, but the location of the peak stress will shift from the femoral tunnel aperture towards the tibial tunnel aperture. the risk of graft rupture is similar for both MTTs and LTTs, but the location of graft rupture changes from the femoral tunnel aperture towards the tibial tunnel aperture, respectively. I.

  20. Nonunited humerus shaft fractures treated by external fixator augmented by intramedullary rod

    Directory of Open Access Journals (Sweden)

    Mahmoud A El-Rosasy

    2012-01-01

    Full Text Available Background: Nonunion of humeral shaft fractures after previously failed surgical treatment presents a challenging therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. It would be beneficial to combine the use of external fixation technique and intramedullary rod in the treatment of such cases. The present study evaluates the results of using external fixator augmented by intramedullary rod and autogenous iliac crest bone grafting (ICBG for the treatment of humerus shaft nonunion following previously failed surgical treatment. Materials and Methods: Eighteen patients with atrophic nonunion of the humeral shaft following previous implant surgery with no active infection were included in the present study. The procedure included exploration of the nonunion, insertion of intramedullary rod (IM rod, autogenous ICBG and application of external fixator for compression. Ilizarov fixator was used in eight cases and monolateral fixator in ten cases. The monolateral fixator was preferred for females and obese patients to avoid abutment against the breast or chest wall following the use of Ilizarov fixator. The fixator was removed after clinical and radiological healing of the nonunion, but the IM rod was left indefinitely. The evaluation of results included both bone results (union rate, angular deformity and limb shortening and functional outcome using the University of California, Los Angeles (UCLA rating scale. Results: The mean follow-up was 35 months (range 24 to 52 months. Bone union was obtained in all cases. The functional outcome was satisfactory in 15 cases (83% and unsatisfactory in 3 cases (17% due to joint stiffness. The time to bone healing averaged 4.2 months (range 3 to 7 months. The external fixator time averaged 4.5 months (range 3.2 to 8 months. Superficial pin tract infection occurred in 39% (28/72 of the pins. No cases of nerve palsy, refracture, or deep infection were encountered

  1. tibialization of the fibula in a child with chronic osteomyelitis of the ...

    African Journals Online (AJOL)

    used in tibial reconstruction after resection of Ewing's sarcoma (6). A case report from Congo detailed how a 10-centimeter tibial bone loss was treated by inter- tibiofibula bone grafting, resulting in tibialization of the fibula. The patient was reviewed after 10 years; and the clinical result was satisfactory and stable (7).

  2. Cervical high-intensity intramedullary lesions in achondroplasia : Aetiology, prevalence and clinical relevance

    NARCIS (Netherlands)

    Brouwer, Patrick A.; Lubout, Charlotte M.; van Dijk, J. Marc C.; Vleggeert-Lankamp, Carmen L.

    2012-01-01

    In achondroplastic patients with slight complaints of medullary compression the cervical spinal cord regularly exhibits an intramedullary (CHII) lesion just below the craniocervical junction with no signs of focal compression on the cord. Currently, the prevalence of the lesion in the general

  3. 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.

  4. 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.

  5. Computerized axial tomography in traumatic cervical lesions

    International Nuclear Information System (INIS)

    Koyama, Tsunemaro

    1982-01-01

    Although plain computerized axial tomography cannot routinely demonstrate the spinal cord, it does provide excellent visualization of the bony outline of the spinal canal and vertebral column. So it should be reasonable to use this technique in cases of cervical traumatic disorders. In this paper we presented 10 cases of cervical traumatic lesions; 3 atlanto-axial dislocation, 2 cervical canal stenosis, 3 OPLL, 1 intramedullary hematoma and 1 C 2 -neurinoma. In some patients neurologic deficits were induced by cervical trauma. Bony lesions appeared more adequately deliniated than intraspinal lesions, however, in some cases intramedullary changes could also be demonstrated. The use of metrizamide with high resolution CT-scanner could improve the usefullness of this technique. (author)

  6. Canal shaping of different single-file systems in curved root canals

    Directory of Open Access Journals (Sweden)

    Maurizio D'Amario

    2017-12-01

    Full Text Available Background/Purpose: This study compared maintenance of canal anatomy, occurrence of apical transportation, and working time observed after instrumentation with One Shape New Generation rotary system (Micro-Mega, with those observed after instrumentation with Reciproc (VDW and WaveOne (Dentsply-Maillefer reciprocating systems. Materials and methods: The mesial canals of 45 mandibular molars (curvature angles between 35° and 45° were selected. Specimens were randomly divided into three groups, and canal preparations were performed using One Shape, Reciproc, or WaveOne systems (size #25. A digital double radiographic technique was used to determine apical transportation and change in angle of curvature. Also, working time and instrument failures were recorded. Data were statistically analyzed. Results: During preparation, no file fractured. No statistically significant differences were found among groups. No system showed a significantly faster preparation time than others (P>0.05. All instruments maintained the original canal curvature well and were safe to use. Conclusion: Both continuous rotary instrument and reciprocating systems did not have any influence on the presence of apical transportation or caused an alteration in angle of canal curvature. Keywords: canal curvature, canal straightening, endodontics, reciprocating motion, single file instrumentation

  7. 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.

  8. A patient specific finite element simulation of intramedullary nailing to predict the displacement of the distal locking hole.

    Science.gov (United States)

    Mortazavi, Javad; Farahmand, Farzam; Behzadipour, Saeed; Yeganeh, Ali; Aghighi, Mohammad

    2018-05-01

    Distal locking is a challenging subtask of intramedullary nailing fracture fixation due to the nail deformation that makes the proximally mounted targeting systems ineffective. A patient specific finite element model was developed, based on the QCT data of a cadaveric femur, to predict the position of the distal hole of the nail postoperatively. The mechanical interactions of femur and nail (of two sizes) during nail insertion was simulated using ABAQUS in two steps of dynamic pushing and static equilibrium, for the intact and distally fractured bone. Experiments were also performed on the same specimen to validate the simulation results. A good agreement was found between the model predictions and the experimental observations. There was a three-point contact pattern between the nail and medullary canal, only on the proximal fragment of the fractured bone. The nail deflection was much larger in the sagittal plane and increased for the larger diameter nail, as well as for more distally fractured or intact femur. The altered position of the distal hole was predicted by the model with an acceptable error (mean: 0.95; max: 1.5 mm, in different tests) to be used as the compensatory information for fine tuning of proximally mounted targeting systems. Copyright © 2018 IPEM. Published by Elsevier Ltd. All rights reserved.

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. 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.

  14. Impact of Fixed-Bearing and Mobile-Bearing Tibial Insert in Unicondylar Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Mehmet Faruk Çatma

    2016-06-01

    Full Text Available INTRODUCTION: The aim of the study is to investigate the impact of fixed or mobile-bearing tibial inserts on patellofemoral arthrosis and evaluate which one to be preferred for patients with patellofemoral arthrosis. METHODS: Operated in our clinic between January 2009 and February 2013, 33 with patellofemoral arthritis together with anteromedial compartment arthritis were included in the study. Patellofemoral joints of patients were evaluated according to the scoring system defined by Fulkerson-Shea. RESULTS: Unicondylar knee arthroplasty with fixed-bearing tibial insertsand 22 (66,6% (male: 3, female: 19 and unicondylar knee arthroplasty with mobile-bearing tibial inserts 11 (33,9 % (male: 2, female: 9 were implanted.Average knee flexion was found to be 116,5 (100-135 degrees in 22 patients with mobile-bearing tibial inserts, and 114,5 (95-135 in 11 patients with fixed-bearing tibial inserts. DISCUSSION AND CONCLUSION: Patellofemoral arthrosis is an important factor for unicondylar knee arthroplasty prognosis and one of the determinants of patient satisfaction. Significantly less patellofemoral complaints were seen with UKA with fixed-bearing tibial insert compared to mobile-bearing tibial insert.

  15. 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...

  16. 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.

  17. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be implanted...

  18. [Root canal treatment of mandibular first premolar with 4 root canals: a case report].

    Science.gov (United States)

    Liu, Xin-yang; Zhan, Fu-Liang

    2015-10-01

    The mandibular first premolar can be considered one of the most challenging teeth to treat, due to the complexity of its root canal morphology and increased incidence of multiple canals. A case of endodontic treatment of a mandibular first premolar exhibiting a total of 4 distinct root canals and 4 apical foramina was described. Anatomic variation of root canal morphology should be considered in endodontic treatment to ensure a favorable healing outcome, and its identification could be enhanced by careful examination using a dental operating microscope. Obturation of root canals using a warm vertical compaction technique with a highly-radiopaque root canal sealer, such as AH Plus, after careful ultrasonic activated irrigation might allow the flow of sealer into the narrowed but unprepared part of the canal, thereby facilitating optimum chemo-mechanical debridement of the root canal system.

  19. MR imaging findings of medial tibial crest friction

    International Nuclear Information System (INIS)

    Klontzas, Michail E.; Akoumianakis, Ioannis D.; Vagios, Ilias; Karantanas, Apostolos H.

    2013-01-01

    Objective: Medial tibial condyle bone marrow edema (BME), associated with soft tissue edema (STe) surrounding the medial collateral ligament, was incidentally observed in MRI examinations of young and athletic individuals. The aim of the present study was to 1. Prospectively investigate the association between these findings and coexistence of localized pain, and 2. Explore the possible contribution of the tibial morphology to its pathogenesis. Methods: The medial tibial condyle crest was evaluated in 632 knee MRI examinations. The angle and depth were measured by two separate evaluators. The presence of STe and BME was recorded. A third evaluator blindly assessed the presence of pain at this site. Results: BME associated with STe was found in 24 patients (with no history of previous trauma, osteoarthritis, tumor or pes anserine bursitis). The mean crest angle was 151.3° (95%CI 147.4–155.3°) compared to 159.4° (95%CI 158.8–160°) in controls (Mann–Whitney test, P < 0.0001). MRI findings were highly predictive of localized pain (sensitivity 92% specificity 99%, Fisher's exact test, P < 0.0001). Conclusion: Friction at the medial tibial condyle crest is a painful syndrome. MRI is a highly specific and sensitive imaging modality for its diagnosis

  20. Contact Stress Generation on the UHMWPE Tibial Insert

    Directory of Open Access Journals (Sweden)

    S. Petrović Savić

    2014-12-01

    Full Text Available Total knee replacement (TKR is considered, during last years, as a very successful surgical technique for removing knee joint deformities and eliminating pain caused by cartilage damage. In literature, as primary causes for knee joint endoprothesis damage are cited complex movements which cause occurrences of complex stress conditions, sagital radius conformity, sliding, types of materials etc. Aim of this study is analysis of contact stresses that occur on tibial implant for 15°, 45° and 60° knee flexion and 50 kg, 75 kg, 100 kg and 125 kg weight. Knee joint prosthesis model and finite elements method (FEM analysis are done in software Catia V5. For this analysis we used ultra-high molecular weight polyethylene (UHMWPE for tibial implant material and AISI 316, AISI 317, AISI 321, 17-4PH, CoCrMo, Ti6Al4V and SAE A-286 for femoral component materials. Results show that area of maximal contact stress is identified in medial and lateral part of tibial implant. Von Mises stress values vary regarding of flexion degree and weight, but values are approximate for types of chosen materials. Contact stress location corresponds to damage that occur on tibial implant during exploitation.

  1. MR imaging findings of medial tibial crest friction

    Energy Technology Data Exchange (ETDEWEB)

    Klontzas, Michail E., E-mail: miklontzas@gmail.com; Akoumianakis, Ioannis D., E-mail: ioannis.akoumianakis@gmail.com; Vagios, Ilias, E-mail: iliasvagios@gmail.com; Karantanas, Apostolos H., E-mail: akarantanas@gmail.com

    2013-11-01

    Objective: Medial tibial condyle bone marrow edema (BME), associated with soft tissue edema (STe) surrounding the medial collateral ligament, was incidentally observed in MRI examinations of young and athletic individuals. The aim of the present study was to 1. Prospectively investigate the association between these findings and coexistence of localized pain, and 2. Explore the possible contribution of the tibial morphology to its pathogenesis. Methods: The medial tibial condyle crest was evaluated in 632 knee MRI examinations. The angle and depth were measured by two separate evaluators. The presence of STe and BME was recorded. A third evaluator blindly assessed the presence of pain at this site. Results: BME associated with STe was found in 24 patients (with no history of previous trauma, osteoarthritis, tumor or pes anserine bursitis). The mean crest angle was 151.3° (95%CI 147.4–155.3°) compared to 159.4° (95%CI 158.8–160°) in controls (Mann–Whitney test, P < 0.0001). MRI findings were highly predictive of localized pain (sensitivity 92% specificity 99%, Fisher's exact test, P < 0.0001). Conclusion: Friction at the medial tibial condyle crest is a painful syndrome. MRI is a highly specific and sensitive imaging modality for its diagnosis.

  2. Longitudinal tibial epiphyseal bracket in Nievergelt syndrome

    International Nuclear Information System (INIS)

    Burnstein, M.I.; De Smet, A.A.; Breed, A.L.; Thomas, J.R.; Hafez, G.R.

    1989-01-01

    A patient is described with lower extremity mesomelic dwarfism associated with bilateral congenital elbow, hip, and knee dislocations. Rhomboid-shaped tibiae and delayed ossification of the primary fibular ossification centers were demonstrated at birth. Plain films and magnetic resonance imaging revealed that the tibial deformities were due to the presence of longitudinal epiphyseal brackets. These brackets were observed at surgery and confirmed histologically. Recognition of the longitudinal epiphyseal bracket and its relationship to the tibial deformities seen in this patient with Nievergelt syndrome is important for planning surgical treatment. (orig.)

  3. Longitudinal tibial epiphyseal bracket in Nievergelt syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Burnstein, M.I.; De Smet, A.A.; Breed, A.L.; Thomas, J.R.; Hafez, G.R.

    1989-04-01

    A patient is described with lower extremity mesomelic dwarfism associated with bilateral congenital elbow, hip, and knee dislocations. Rhomboid-shaped tibiae and delayed ossification of the primary fibular ossification centers were demonstrated at birth. Plain films and magnetic resonance imaging revealed that the tibial deformities were due to the presence of longitudinal epiphyseal brackets. These brackets were observed at surgery and confirmed histologically. Recognition of the longitudinal epiphyseal bracket and its relationship to the tibial deformities seen in this patient with Nievergelt syndrome is important for planning surgical treatment. (orig.).

  4. Complex Medial Meniscus Tears Are Associated With a Biconcave Medial Tibial Plateau.

    Science.gov (United States)

    Barber, F Alan; Getelman, Mark H; Berry, Kathy L

    2017-04-01

    To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears. A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos. Based on the arthroscopy findings, medial tibial plateaus were classified as either biconcave or not biconcave. A transverse coronal plane ridge, separating the front of the tibial plateau from the back near the inner margin of the posterior body of the medial meniscus, was defined as biconcave. The medial plateau slope was calculated with MRI sagittal views. General demographic information, body mass index, and arthroscopically confirmed knee pathology were recorded. A total of 179 consecutive knees were studied from July 2014 through August 2015; 49 (27.2%) biconcave medial tibial plateaus and 130 (72.8%) controls were identified at arthroscopy. Complex medial meniscus tears were found in 103. Patients with a biconcave medial tibial plateau were found to have more complex medial meniscus tears (69.4%) than those without a biconcavity (53.1%) (P = .049) despite having lower body mass index (P = .020). No difference in medial tibial plateau slope was observed for biconcavities involving both cartilage and bone, bone only, or an indeterminate group (P = .47). Biconcave medial tibial plateaus were present in 27.4% of a consecutive series of patients undergoing knee arthroscopy. A biconcave medial tibial plateau was more frequently associated with a complex medial meniscus tear. Level III, case-control study. Copyright © 2016 Arthroscopy Association of North America. All rights reserved.

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

    Science.gov (United States)

    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.

  6. Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Ghazikhanian, Varand [Brigham and Women' s Hospital, Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Beltran, Javier [Maimonides Medical Center, Brooklyn, NY (United States); Nikac, Violeta [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Bencardino, Jenny T. [NYU Hospital for Joint Diseases, New York, NY (United States); Feldman, Marina

    2012-11-15

    Tunnel cyst formation is a rare complication after anterior cruciate ligament reconstruction, usually occurring 1-5 years post-operatively, which may occasionally be symptomatic. There are multiple proposed theories regarding the etiology of tunnel cysts. Theories include necrosis, foreign-body reaction, lack of complete graft osteo-integration, and intravasation of articular fluid. It is important to know if the tunnel cysts are communicating or not communicating with the joint, as surgical management may be different. Imaging characteristics on magnetic resonance images (MRI) include tibial tunnel widening, multilocular or unilocular cyst formation in the graft or tibial tunnel, with possible extension into the pretibial space, intercondylar notch, and/or popliteal fossa. The MR imaging differential diagnosis of tibial tunnel cysts includes infection, foreign-body granuloma, or tibial screw extrusion. Importantly, to the best of our knowledge, graft failure or instability has not been reported in association with tibial tunnel cysts. (orig.)

  7. The medial tibial stress syndrome score: Item generation for a new ...

    African Journals Online (AJOL)

    The medial tibial stress syndrome score: Item generation for a new patient reported outcome measure. ... instrument that evaluates injury severity and treatment effects for medial tibial stress syndrome (MTSS) patients. ... from 32 Countries:.

  8. MULTIPLE SPINAL CANAL MENINGIOMAS

    Directory of Open Access Journals (Sweden)

    Nandigama Pratap Kumar

    2016-10-01

    Full Text Available BACKGROUND Meningiomas of the spinal canal are common tumours with the incidence of 25 percent of all spinal cord tumours. But multiple spinal canal meningiomas are rare in compare to solitary lesions and account for 2 to 3.5% of all spinal meningiomas. Most of the reported cases are both intra cranial and spinal. Exclusive involvement of the spinal canal by multiple meningiomas are very rare. We could find only sixteen cases in the literature to the best of our knowledge. Exclusive multiple spinal canal meningiomas occurring in the first two decades of life are seldom reported in the literature. We are presenting a case of multiple spinal canal meningiomas in a young patient of 17 years, who was earlier operated for single lesion. We analysed the literature, with illustration of our case. MATERIALS AND METHODS In September 2016, we performed a literature search for multiple spinal canal meningiomas involving exclusively the spinal canal with no limitation for language and publication date. The search was conducted through http://pubmed.com, a wellknown worldwide internet medical address. To the best of our knowledge, we could find only sixteen cases of multiple meningiomas exclusively confined to the spinal canal. Exclusive multiple spinal canal meningiomas occurring in the first two decades of life are seldom reported in the literature. We are presenting a case of multiple spinal canal meningiomas in a young patient of 17 years, who was earlier operated for solitary intradural extra medullary spinal canal meningioma at D4-D6 level, again presented with spastic quadriparesis of two years duration and MRI whole spine demonstrated multiple intradural extra medullary lesions, which were excised completely and the histopathological diagnosis was transitional meningioma. RESULTS Patient recovered from his weakness and sensory symptoms gradually and bladder and bowel symptoms improved gradually over a period of two to three weeks. CONCLUSION Multiple

  9. Tibial internal rotation negatively affects clinical outcomes in total knee arthroplasty: a systematic review.

    Science.gov (United States)

    Panni, Alfredo Schiavone; Ascione, Francesco; Rossini, Marco; Braile, Adriano; Corona, Katia; Vasso, Michele; Hirschmann, Michael T

    2017-12-15

    The aim of this systematic review is to analyze the effect of tibial rotational alignment after total knee arthroplasty (TKA) on clinical outcomes and assess the eventual cut-off values for tibial TKA rotation leading to poor outcomes. A detailed and systematic search from 1997 to 2017 of the Pubmed, Medline, Cochrane Reviews, and the Google Scholar databases was performed using the keyword terms "total knee arthroplasty", "total knee replacement", "tibial alignment", "tibial malalignement", "tibial rotation", "rotational error", "axis", "angle", "tibial malrotation", "clinical outcome", in several combinations. The modified Coleman scoring methodology (mCMS) was used. All the primary TKAs studies analyzing correlation between clinical results and tibial rotation were included. Five articles met the inclusion criteria. A total of 333 arthroplasties were included in this review; 139 had tibial component malalignment, while 194 were in control groups. The mean age of patients was 67.3 (SD 0.57) years. The mean average postoperative follow-up delay was 34.7 months (range 21-70). The mean mCMS score was 59.2 points indicating good methodological quality in the included studies. Functional outcomes were assessed through KSS, OKS, KOOS and VAS, negatively related to tibial internal rotation. Our review confirmed that excessive internal rotation of the tibial TKA component represents a significant risk factor for pain and inferior functional outcomes after TKA (> 10° of internal rotation demonstrated the common value), since external rotation does not affect the results. However, a universal precise cut-off value has not been found in the available literature and there remains a debate about CT rotation assessment and surgical intra-operative landmarks. III.

  10. Effect of tibial slope on the stability of the anterior cruciate ligament-deficient knee.

    Science.gov (United States)

    Voos, James E; Suero, Eduardo M; Citak, Musa; Petrigliano, Frank P; Bosscher, Marianne R F; Citak, Mustafa; Wickiewicz, Thomas L; Pearle, Andrew D

    2012-08-01

    We aimed to quantify the effect of changes in tibial slope on the magnitude of anterior tibial translation (ATT) in the anterior cruciate ligament (ACL)-deficient knee during the Lachman and mechanized pivot shift tests. We hypothesized that increased posterior tibial slope would increase the amount of ATT of an ACL-deficient knee, while leveling the slope of the tibial plateau would decrease the amount of ATT. Lachman and mechanized pivot shift tests were performed on hip-to-toe cadaveric specimens, and ATT of the lateral and the medial compartments was measured using navigation (n = 11). The ACL was then sectioned. Stability testing was repeated, and ATT was recorded. A proximal tibial osteotomy in the sagittal plane was then performed achieving either +5 or -5° of tibial slope variation after which stability testing was repeated (n = 10). Sectioning the ACL resulted in a significant increase in ATT in both the Lachman and mechanized pivot shift tests (P slope of the tibial plateau had no effect on ATT during the Lachman test (n.s.). During the mechanized pivot shift tests, a 5° increase in posterior slope resulted in a significant increase in ATT compared to the native knee (P slope reduced ATT to a level similar to that of the intact knee. Tibial slope changes did not affect the magnitude of translation during a Lachman test. However, large changes in tibial slope variation affected the magnitude of the pivot shift.

  11. 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.

  12. a simple technique for on-table confirmation of locking screw ...

    African Journals Online (AJOL)

    2012-09-06

    Sep 6, 2012 ... Background: Locked intramedullary nailing is the standard of care for femoral and tibial shaft fractures. Correct placement of locking ... It can be used with any cannulated nailing system. It is simple, in-expensive and ... include computer assisted navigation systems (3), as well as use of devices that use a ...

  13. Nerve canals at the fundus of the internal auditory canal on high-resolution temporal bone CT

    International Nuclear Information System (INIS)

    Ji, Yoon Ha; Youn, Eun Kyung; Kim, Seung Chul

    2001-01-01

    To identify and evaluate the normal anatomy of nerve canals in the fundus of the internal auditory canal which can be visualized on high-resolution temporal bone CT. We retrospectively reviewed high-resolution (1 mm thickness and interval contiguous scan) temporal bone CT images of 253 ears in 150 patients who had not suffered trauma or undergone surgery. Those with a history of uncomplicated inflammatory disease were included, but those with symptoms of vertigo, sensorineural hearing loss, or facial nerve palsy were excluded. Three radiologists determined the detectability and location of canals for the labyrinthine segment of the facial, superior vestibular and cochlear nerve, and the saccular branch and posterior ampullary nerve of the inferior vestibular nerve. Five bony canals in the fundus of the internal auditory canal were identified as nerve canals. Four canals were identified on axial CT images in 100% of cases; the so-called singular canal was identified in only 68%. On coronal CT images, canals for the labyrinthine segment of the facial and superior vestibular nerve were seen in 100% of cases, but those for the cochlear nerve, the saccular branch of the inferior vestibular nerve, and the singular canal were seen in 90.1%, 87.4% and 78% of cases, respectiveIy. In all detectable cases, the canal for the labyrinthine segment of the facial nerve was revealed as one which traversed anterolateralIy, from the anterosuperior portion of the fundus of the internal auditory canal. The canal for the cochlear nerve was located just below that for the labyrinthine segment of the facial nerve, while that canal for the superior vestibular nerve was seen at the posterior aspect of these two canals. The canal for the saccular branch of the inferior vestibular nerve was located just below the canal for the superior vestibular nerve, and that for the posterior ampullary nerve, the so-called singular canal, ran laterally or posteolateralIy from the posteroinferior aspect of

  14. Nerve canals at the fundus of the internal auditory canal on high-resolution temporal bone CT

    Energy Technology Data Exchange (ETDEWEB)

    Ji, Yoon Ha; Youn, Eun Kyung; Kim, Seung Chul [Sungkyunkwan Univ., School of Medicine, Seoul (Korea, Republic of)

    2001-12-01

    To identify and evaluate the normal anatomy of nerve canals in the fundus of the internal auditory canal which can be visualized on high-resolution temporal bone CT. We retrospectively reviewed high-resolution (1 mm thickness and interval contiguous scan) temporal bone CT images of 253 ears in 150 patients who had not suffered trauma or undergone surgery. Those with a history of uncomplicated inflammatory disease were included, but those with symptoms of vertigo, sensorineural hearing loss, or facial nerve palsy were excluded. Three radiologists determined the detectability and location of canals for the labyrinthine segment of the facial, superior vestibular and cochlear nerve, and the saccular branch and posterior ampullary nerve of the inferior vestibular nerve. Five bony canals in the fundus of the internal auditory canal were identified as nerve canals. Four canals were identified on axial CT images in 100% of cases; the so-called singular canal was identified in only 68%. On coronal CT images, canals for the labyrinthine segment of the facial and superior vestibular nerve were seen in 100% of cases, but those for the cochlear nerve, the saccular branch of the inferior vestibular nerve, and the singular canal were seen in 90.1%, 87.4% and 78% of cases, respectiveIy. In all detectable cases, the canal for the labyrinthine segment of the facial nerve was revealed as one which traversed anterolateralIy, from the anterosuperior portion of the fundus of the internal auditory canal. The canal for the cochlear nerve was located just below that for the labyrinthine segment of the facial nerve, while that canal for the superior vestibular nerve was seen at the posterior aspect of these two canals. The canal for the saccular branch of the inferior vestibular nerve was located just below the canal for the superior vestibular nerve, and that for the posterior ampullary nerve, the so-called singular canal, ran laterally or posteolateralIy from the posteroinferior aspect of

  15. 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.

  16. Comparison of long-term results between osteo-odonto-keratoprosthesis and tibial bone keratoprosthesis.

    Science.gov (United States)

    Charoenrook, Victor; Michael, Ralph; de la Paz, Maria Fideliz; Temprano, José; Barraquer, Rafael I

    2018-04-01

    To compare the anatomical and the functional results between osteo-odonto-keratoprosthesis (OOKP) and keratoprosthesis using tibial bone autograft (Tibial bone KPro). We reviewed the charts of 258 patients; 145 had OOKP whereas 113 had Tibial bone KPro implanted. Functional success was defined as best corrected visual acuity ≥0.05 on decimal scale and anatomical success as retention of the keratoprosthesis lamina. Kaplan-Meier survival curves were calculated for anatomical and functional survival as well as to estimate the probability of post-op complications. The anatomical survival for both KPro groups was not significantly different and was estimated as 67% for OOKP and 54% for Tibial bone KPro at 10 years after surgery. There was also no difference found after subdividing for primary diagnosis groups such as chemical injury, thermal burn, trachoma and all autoimmune cases combined. Estimated functional survival at 10 years post-surgery was 49% for OOKP and 25% for Tibial bone KPro, which was significantly different. The probability of patients with Tibial bone KPro developing one or more post-operative complications at 10 years after surgery (65%) was significantly higher than those with OOKP (40%). Mucous membrane necrosis and retroprosthetic membrane formation were more common in Tibial bone KPro than OOKP. Both types of autologous biological KPro, OOKP and Tibial bone KPro, had statistically similar rate of keratoprosthesis extrusion. Although functional success rate was significantly higher in OOKP, it may have been influenced by a better visual potential in the patients in this group. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. Outcomes following femoral lengthening: An initial comparison of the Precice intramedullary lengthening nail and the LRS external fixator monorail system.

    Science.gov (United States)

    Laubscher, M; Mitchell, C; Timms, A; Goodier, D; Calder, P

    2016-10-01

    Patients undergoing femoral lengthening by external fixation tolerate treatment less well when compared to tibial lengthening. Lengthening of the femur with an intramedullary device may have advantages. We reviewed all cases of simple femoral lengthening performed at our unit from 2009 to 2014. Cases of nonunions, concurrent deformities, congenital limb deficiencies and lengthening with an unstable hip were excluded, leaving 33 cases (in 22 patients; 11 patients had bilateral procedures) for review. Healing index, implant tolerance and complications were compared. In 20 cases (15 patients) the Precice lengthening nail was used and in 13 cases (seven patients) the LRS external fixator system. The desired length was achieved in all cases in the Precice group and in 12 of 13 cases in the LRS group. The mean healing index was 31.3 days/cm in the Precice and 47.1 days/cm in the LRS group (p < 0.001). This was associated with an earlier ability to bear full weight without aids in the Precice group. There were more complications with LRS lengthening, including pin site infections and regenerate deformity. Implant tolerance and the patients' perception of the cosmetic result were better with the Precice treatment. Femoral lengthening with the Precice femoral nail achieved excellent functional results with fewer complications and greater patient satisfaction when compared with the LRS system in our patients. Cite this article: Bone Joint J 2016;98-B:1382-8. ©2016 The British Editorial Society of Bone & Joint Surgery.

  18. Scanning electron microscopy investigation of canal cleaning after canal preparation with nickel titanium files

    Directory of Open Access Journals (Sweden)

    Živković Slavoljub

    2010-01-01

    Full Text Available Introduction. Root canal preparation is the most important phase of endodontic procedure and it consists of adequate canal space cleaning and shaping. In recent years, rotary instruments and techniques have gained importance because of the great efficacy, speed and safety of the preparation procedure. Objective. The aim of this research was to investigate the influence of different NiTi files on the canal wall cleaning quality, residual dentine debris and smear layer. Methods. The research was conducted on extracted human teeth in vitro conditions. Teeth were divided in 7 main groups depending on the kind of instruments used for root canal preparation: ProTaper, GT, ProFile, K-3, FlexMaster, hand ProTaper and hand GT. Root canal preparation was accomplished by crown-down technique. Prepared samples were assessed on scanning electron microscopy JEOL, JSM-6460 LV. The evaluation of dentine debris was done with 500x magnification, and the evaluation of smear layer with 1,000 times magnification. Quantitive assessment of dentine debris and smear layer was done according to the criteria of Hulsmann. Results. The least amount of debris and smear layer has been found in canals shaped with ProFile instruments, and the largest amount in canals shaped with FlexMaster instruments. Canal cleaning efficacy of hand GT and ProTaper files has been similar to cleaning efficacy of rotary NiTi files. Statistic analysis has shown a significant difference in amount of dentine debris and smear layer on the canal walls between sample groups shaped with different instruments. Conclusion. Completely clean canals have not been found in any tested group of instruments. The largest amount of debris and smear layer has been found in the apical third of all canals. The design and the type of endodontic instruments influence the efficacy of the canal cleaning.

  19. Curved canals: Ancestral files revisited

    Directory of Open Access Journals (Sweden)

    Jain Nidhi

    2008-01-01

    Full Text Available The aim of this article is to provide an insight into different techniques of cleaning and shaping of curved root canals with hand instruments. Although a plethora of root canal instruments like ProFile, ProTaper, LightSpeed ® etc dominate the current scenario, the inexpensive conventional root canal hand files such as K-files and flexible files can be used to get optimum results when handled meticulously. Special emphasis has been put on the modifications in biomechanical canal preparation in a variety of curved canal cases. This article compiles a series of clinical cases of root canals with curvatures in the middle and apical third and with S-shaped curvatures that were successfully completed by employing only conventional root canal hand instruments.

  20. 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

  1. Clinical study of intramedullary route as an alternative for fluid administration in young dogs

    Directory of Open Access Journals (Sweden)

    Pedro Luiz de Camargo

    1996-12-01

    accomplished and rapidly performed. Our results show that intramedullary route is safe and may be of great value as an alternative on the treatment of young dogs with critical hemodynamic alterations when the intravenous route is not accessible.

  2. Contemporary management of subtrochanteric fractures.

    Science.gov (United States)

    Joglekar, Siddharth B; Lindvall, Eric M; Martirosian, Armen

    2015-01-01

    Cephalomedullary interlocking nails that allow for trochanteric entry and minimally invasive fixation have revolutionized the contemporary management of subtrochanteric fractures with improved union rates and decreased incidence of fixation failure. The most successful alternative to intramedullary fixation remains the angled blade plate. Despite biomechanical superiority of contemporary intramedullary implants to previous intramedullary devices, the importance of achieving and maintaining satisfactory fracture reduction prior to and during hardware insertion cannot be overemphasized. In comminuted and more challenging fractures, additional techniques, such as limited open reduction with clamps and/or cables, can allow for canal restoration and more anatomic reductions prior to and/or during nail insertion. Published by Elsevier Inc.

  3. [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.

  4. Coverage of extensive tibial bone exposure in burn patients with ...

    African Journals Online (AJOL)

    Covering tibial bone exposure from third degree burns to the lower limbs is a challenging task for the plastic surgeon. We present our experience of covering tibial exposure from burns in three different patients, where four limbs were involved and three muscular flaps were used in conjunction with one another; i.e. the ...

  5. Aneurisma verdadeiro bilateral de artéria tibial posterior True bilateral aneurysm of the posterior tibial artery

    Directory of Open Access Journals (Sweden)

    Silvio Romero de Barros Marques

    2006-03-01

    Full Text Available Neste artigo, faz-se o relato de um caso de aneurisma verdadeiro bilateral da artéria tibial posterior em paciente de 57 anos. Os aneurismas surgiram em épocas diferentes. Os aspectos clínicos, diagnósticos e terapêuticos deste caso são discutidos. Este relato é importante, pois os autores não têm conhecimento de caso semelhante na literatura consultada.This article reports a case of true bilateral aneurysm of the tibial posterior artery in a 57 year-old patient. The aneurysms occurred at different times. The clinical, diagnostic and therapeutic aspects of this case are discussed. This report is important because the authors did not find a similar description in the literature.

  6. A 3D finite element model to investigate prosthetic interface stresses of different posterior tibial slope.

    Science.gov (United States)

    Shen, Yi; Li, Xiaomiao; Fu, Xiaodong; Wang, Weili

    2015-11-01

    Posterior tibial slope that is created during proximal tibial resection in total knee arthroplasty has emerged as an important factor in the mechanics of the knee joint and the surgical outcome. But the ideal degree of posterior tibial slope for recovery of the knee joint function and preventions of complications remains controversial and should vary in different racial groups. The objective of this paper is to investigate the effects of posterior tibial slope on contact stresses in the tibial polyethylene component of total knee prostheses. Three-dimensional finite element analysis was used to calculate contact stresses in tibial polyethylene component of total knee prostheses subjected to a compressive load. The 3D finite element model of total knee prosthesis was constructed from the images produced by 3D scanning technology. Stresses in tibial polyethylene component were calculated with four different posterior tibial slopes (0°, 3°, 6° and 9°). The 3D finite element model of total knee prosthesis we presented was well validated. We found that the stress distribution in the polythene as evaluated by the distributions of the von Mises stress, the maximum principle stress, the minimum principle stress and the Cpress were more uniform with 3° and 6° posterior tibial slopes than with 0° and 9° posterior tibial slopes. Moreover, the peaks of the above stresses and trends of changes with increasing degree of knee flexion were more ideal with 3° and 6° posterior slopes. The results suggested that the tibial component inclination might be favourable to 7°-10° so far as the stress distribution is concerned. The range of the tibial component inclination also can decrease the wear of polyethylene. Chinese posterior tibial slope is bigger than in the West, and the current domestic use of prostheses is imported from the West, so their demands to tilt back bone cutting can lead to shorten the service life of prostheses; this experiment result is of important

  7. Results of Closed Intramedullary Nailing using Talwarkar Square Nail in Adult Forearm Fractures

    Directory of Open Access Journals (Sweden)

    Nadeem A Lil

    2012-07-01

    Full Text Available The aim of the study was to evaluate results of closed intramedullary nailing using Talwarkar square nails in adult forearm fractures. We prospectively evaluated 34 patients with both bone forearm fractures. The average time to union was 12.8 (SD +3.2 weeks with cast support for a mean of 8.2 weeks. Union was achieved in 31 out of 34 patients. Using the Grace and Eversmann rating system, 17 patients were excellent, 10 were good, and 4 had an acceptable result. Three patients had non-unions, 2 for the radius and one for the ulna. There were two cases of superficial infection, one subject had olecranon bursitis, and one case of radio-ulnar synostosis. Complication rates associated with the use of square nails were lower compared to plate osteosynthesis and locked intramedullary nails. To control rotation post- operatively, there is a need for application of an above-elbow cast after nailing.

  8. Estimation of bone perfusion as a function of intramedullary pressure in sheep

    International Nuclear Information System (INIS)

    Rosenthal, M.S.; Lehner, C.E.; Pearson, D.W.; Kanikula, T.M.; Adler, G.G.; Venci, R.; Lanphier, E.H.; De Luca, P.M.

    1985-01-01

    It has been reported previously that following decompression (i.e. diving ascents) the intramedullary pressure (IMP) in bone can rise dramatically and possibly by the mechanism which can induce dysbaric osteonecrosis or the ''silent bends''. If the blood supply for the bone transverses the marrow compartment, than an increase in IMP could cause a temporary decrease in perfusion or hemostasis and hence ischemia leading to bone necrosis. To test this hypothesis, the authors measured the perfusion of bone in sheep as a function of IMP. The bone perfusion was estimated by measuring the perfusion-limited clearance of Ar-41 (Eγ=1293 keV, T/sub 1/2/=1.83 h) from the bone mineral matrix of sheep's tibia. The argon gas was formed in vivo by the fast neutron activation of Ca-44 to Ar-41 following the Ca-44(n,α) reaction. Clearance of Ar-41 was measured by time gated gamma-ray spectroscopy. These results indicate that an elevation of intramedullary pressure can decrease perfusion in bone and may cause bone necrosis

  9. Effects of diabetic peripheral neuropathy on gait in vascular trans-tibial amputees.

    Science.gov (United States)

    Nakajima, Hiroshi; Yamamoto, Sumiko; Katsuhira, Junji

    2018-07-01

    Patients with diabetes often develop diabetic peripheral neuropathy, which is a distal symmetric polyneuropathy, so foot function on the non-amputated side is expected to affect gait in vascular trans-tibial amputees. However, there is little information on the kinematics and kinetics of gait or the effects of diabetic peripheral neuropathy in vascular trans-tibial amputees. This study aimed to clarify these effects, including the biomechanics of the ankle on the non-amputated side. Participants were 10 vascular trans-tibial amputees with diabetic peripheral neuropathy (group V) and 8 traumatic trans-tibial amputees (group T). Each subject's gait was analyzed at a self-selected speed using a three-dimensional motion analyzer and force plates. Ankle plantarflexion angle, heel elevation angle, and peak and impulse of anterior ground reaction force were smaller on the non-amputated side during pre-swing in group V than in group T. Center of gravity during pre-swing on the non-amputated side was lower in group V than in group T. Hip extension torque during loading response on the prosthetic side was greater in group V than in group T. These findings suggest that the biomechanical function of the ankle on the non-amputated side during pre-swing is poorer in vascular trans-tibial amputees with DPN than in traumatic trans-tibial amputees; the height of the center of gravity could not be maintained during this phase in vascular trans-tibial amputees with diabetic peripheral neuropathy. The hip joint on the prosthetic side compensated for this diminished function at the ankle during loading response. Copyright © 2018 Elsevier Ltd. All rights reserved.

  10. Stress analysis of the tibial plateau according to the difference of blade path entry in opening wedge high tibial osteotomy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jun Woo; Xin, YuanZhu; Yang, Seok Jo [Chungnam National University, Daejeon (Korea, Republic of); Ji, Jong Hun; Panchal, Karnav; Kwon, Oh Soo [The Catholic University of Korea, Daejeon (Korea, Republic of)

    2015-03-15

    High tibial osteotomy (HTO) has been used to successfully treat patients with genu varus deformities that can improve mechanical function and condition in the knee joint. Clinical studies have reported that bow legs often occur with a concentrated load on the varus of the tibia. This study aimed to analyze and verify the clinical test data result by utilizing the three-dimensional (3D) static finite element method (FEM). The 3D model of lower extremities, which include the femur, tibia, meniscus, and knee articular cartilage, was created using the images from a computer tomography scan and magnetic resonance imaging. In this report, we compared changes in stress distribution and force reaction on the tibial plateau because of critical problems caused by unexpected changes in the tibial posterior-slope angle because of HTO. The results showed that the 5 .deg. wedge-angle virtual opening wedge HTO without and with the posterior-slope angle shows has a load concentration of approximately 60% and 45% in the medial region, respectively.

  11. [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.

  12. Endoscopic root canal treatment.

    Science.gov (United States)

    Moshonov, Joshua; Michaeli, Eli; Nahlieli, Oded

    2009-10-01

    To describe an innovative endoscopic technique for root canal treatment. Root canal treatment was performed on 12 patients (15 teeth), using a newly developed endoscope (Sialotechnology), which combines an endoscope, irrigation, and a surgical microinstrument channel. Endoscopic root canal treatment of all 15 teeth was successful with complete resolution of all symptoms (6-month follow-up). The novel endoscope used in this study accurately identified all microstructures and simplified root canal treatment. The endoscope may be considered for use not only for preoperative observation and diagnosis but also for active endodontic treatment.

  13. 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

  14. Training effect of using Touch Surgery for intramedullary femoral nailing.

    Science.gov (United States)

    Sugand, Kapil; Mawkin, Mala; Gupte, Chinmay

    2016-02-01

    Simulation in orthopaedic training is becoming increasingly popular and has been widely used in formal curricula. However, these resources are expensive and not easily accessible to every trainee. Other means of disseminating surgical education through virtual reality (VR) multimedia can act as useful adjunct to traditional methods of teaching. One validated VR platform is Touch Surgery, a cognitive task simulation and rehearsal app. The primary objective of this study was to identify the training effect of Touch Surgery intramedullary femoral nailing (IFN) modules using objective performance metrics over six consecutive attempts. Secondary objectives consisted of validated multiple choice questions (MCQ) testing before the first (pre) and after the sixth (post) attempts. 27 medical undergraduates were recruited to complete the decision-making process six consecutive times for four modules on the procedural steps of IFN. The modules consisted of (i) preparing the patient and equipment, (ii) femoral canal preparation, (iii) nail insertion and proximal locking, and (iv) distal locking and closure. Real-time objective performance metrics were obtained, stored electronically and analysed using the median and Bonett-Price 95% confidence intervals from the participants' attempts to assess training effect. Significance was calculated using the Mann-Whitney U test for independent data whilst the Wilcoxon signed ranked test was used for paired data. Significance was set as 2-tailed p-value <0.05. Median performance scores per attempt for all four modules demonstrated a significant improvement ranging from 58 to 115%. Scoring variability and distribution was reduced and more predictable per attempt. Logarithmic learning curves elicited strong positive correlations between the number of attempts and scoring. Mean scores for pre and post-study MCQs tests significantly improved from 83 to 94% in all modules. IFN modules on Touch Surgery app demonstrated a significant training

  15. Pseudoaneurysm of the Anterior Tibial Artery following Ankle Arthroscopy in a Soccer Player

    Directory of Open Access Journals (Sweden)

    Ichiro Tonogai

    2017-01-01

    Full Text Available Ankle arthroscopy carries a lower risk of vascular complications when standard anterolateral and anteromedial portals are used. However, the thickness of the fat pad at the anterior ankle affords little protection for the thin-walled anterior tibial artery, rendering it susceptible to indirect damage during procedures performed on the anterior ankle joint. To our knowledge, only 11 cases of pseudoaneurysm involving the anterior tibial artery after ankle arthroscopy have been described in the literature. Here we reported a rare case of a 19-year-old soccer player who presented with pseudoaneurysm of the anterior tibial artery following ankle arthroscopy using an ankle distraction method and underwent anastomosis for the anterior tibial artery injury. Excessive distraction of the ankle puts the neurovascular structures at greater risk for iatrogenic injury of the anterior tibial artery during ankle arthroscopy. Surgeons should look carefully for postoperative ankle swelling and pain after ankle arthroscopy.

  16. Long-term complications following tibial plateau levelling osteotomy in small dogs with tibial plateau angles > 30°.

    Science.gov (United States)

    Knight, Rebekah; Danielski, Alan

    2018-04-21

    Tibial plateau levelling osteotomy (TPLO) is commonly performed for surgical management of cranial cruciate ligament (CCL) disease. It has been suggested that small dogs may have steeper tibial plateau angles (TPAs) than large dogs, which has been associated with increased complication rates after TPLO. A retrospective study was performed to assess the rate and nature of long-term complications following TPLO in small dogs with TPAs>30°. Medical records were reviewed for dogs with TPAs>30° treated for CCL rupture by TPLO with a 2.0 mm plate over a five-year period. Radiographs were assessed to determine TPA, postoperative tibial tuberosity width and to identify any complication. Up-to-date medical records were obtained from the referring veterinary surgeon and any complications in the year after surgery were recorded. The effects of different variables on complication rate were assessed using logistic regression analysis. Minor complications were reported in 22.7 per cent of cases. This is similar to or lower than previously reported complication rates for osteotomy techniques in small dogs and dogs with steep TPAs. A smaller postoperative TPA was the only variable significantly associated with an increased complication rate. No major complications were identified. © British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Decreased levels of matrix metalloproteinase-2 in root-canal exudates during root canal treatment.

    Science.gov (United States)

    Pattamapun, Kassara; Handagoon, Sira; Sastraruji, Thanapat; Gutmann, James L; Pavasant, Prasit; Krisanaprakornkit, Suttichai

    2017-10-01

    To determine the matrix metalloproteinase-2 (MMP-2) levels in root-canal exudates from teeth undergoing root-canal treatment. The root-canal exudates from six teeth with normal pulp and periradicular tissues that required intentional root canal treatment for prosthodontic reasons and from twelve teeth with pulp necrosis and asymptomatic apical periodontitis (AAP) were sampled with paper points for bacterial culture and aspirated for the detection of proMMP-2 and active MMP-2 by gelatin zymography and the quantification of MMP-2 levels by ELISA. By gelatin zymography, both proMMP-2 and active MMP-2 were detected in the first collection of root-canal exudates from teeth with pulp necrosis and AAP, but not from teeth with normal pulp, and their levels gradually decreased and disappeared at the last collection. Consistently, ELISA demonstrated a significant decrease in MMP-2 levels in the root-canal exudates of teeth with pulp necrosis and AAP following root canal procedures (papical lesions, similar to the clinical application of MMP-8 as a biomarker. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Standing balance in people with trans-tibial amputation due to vascular causes: A literature review.

    Science.gov (United States)

    Seth, Mayank; Lamberg, Eric

    2017-08-01

    Balance is an important variable to consider during the rehabilitation process of individuals with trans-tibial amputation. Limited evidence exists on the balance abilities of people with trans-tibial amputation due to vascular causes. The purpose of this article is to review literature and determine if standing balance is diminished in people with trans-tibial amputation due to vascular causes. Literature review. Data were obtained from PubMed, Google Scholar, OandP.org , CINHAL, and Science Direct. Studies were selected only if they included standing balance assessment of people with unilateral trans-tibial amputation due to vascular causes. The review yielded seven articles that met the inclusion criteria. The general test methodology required participants to stand still on force platforms, with feet together, while center of pressure or postural sway was recorded. According to the findings of this review, individuals with trans-tibial amputees due to vascular causes have diminished balance abilities. Limited evidence suggests their balance might be further diminished as compared to individuals with trans-tibial amputation due to trauma. Although the evidence is limited, because of the underlying pathology and presence of comorbidities in individuals with trans-tibial amputation due to vascular causes, one cannot ignore these findings, as even a minor injury from a fall may develop into a non-healing ulcer and affect their health and well-being more severely than individuals with trans-tibial amputation due to trauma. Clinical relevance Individuals with trans-tibial amputation due to vascular causes have diminished balance abilities compared to healthy individuals and individuals with trans-tibial amputation due to trauma. This difference should be considered when designing and fabricating prostheses. Prosthetists and rehabilitation clinicians should consider designing amputation cause-specific rehabilitation interventions, focussing on balance and other

  19. Intramedullary rodding in type III osteogenesis imperfecta. Effects on neuromotor development in 10 children

    NARCIS (Netherlands)

    Engelbert, R. H.; Helders, P. J.; Keessen, W.; Pruijs, H. E.; Gooskens, R. H.

    1995-01-01

    We studied retrospectively gross motor development and the impact of intramedullary rodding in 10 children with type III osteogenesis imperfecta (OI). There was a pronounced delay in motor development and the order in achieving gross motor milestones differed from the normal developmental sequence.

  20. Physeal growth arrest after tibial lengthening in achondroplasia: 23 children followed to skeletal maturity.

    Science.gov (United States)

    Song, Sang-Heon; Agashe, Mandar Vikas; Huh, Young-Jae; Hwang, Soon-Young; Song, Hae-Ryong

    2012-06-01

    Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with achondroplasia. We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years. Skeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis. Our findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrence-especially when lengthening of more than 50% is attempted.

  1. The Tibial Slope in Patients With Achondroplasia: Its Characterization and Possible Role in Genu Recurvatum Development.

    Science.gov (United States)

    Brooks, Jaysson T; Bernholt, David L; Tran, Kevin V; Ain, Michael C

    2016-06-01

    Genu recurvatum, a posterior resting position of the knee, is a common lower extremity deformity in patients with achondroplasia and has been thought to be secondary to ligamentous laxity. To the best of our knowledge, the role of the tibial slope has not been investigated, and no studies describe the tibial slope in patients with achondroplasia. Our goals were to characterize the tibial slope in children and adults with achondroplasia, explore its possible role in the development of genu recurvatum, and compare the tibial slope in patients with achondroplasia to that in the general population. We reviewed 252 lateral knee radiographs of 130 patients with achondroplasia seen at our clinic from November 2007 through September 2013. Patients were excluded if they had previous lower extremity surgery or radiographs with extreme rotation. We analyzed patient demographics and, on all radiographs, the tibial slope. We then compared the mean tibial slope to norms in the literature. Tibial slopes >90 degrees had an anterior tibial slope and received a positive prefix. Statistical analysis included intraclass and interclass reliability, Pearson correlation coefficient, and the Student t tests (significance, Pachondroplasia than in the general population; however, this difference diminishes as patients' age. An anterior tibial slope may predispose to a more posterior resting knee position, also known as genu recurvatum. Level IV-retrospective case series.

  2. 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.

  3. High resolution ultrasonography of the tibial nerve in diabetic peripheral neuropathy.

    Science.gov (United States)

    Singh, Kunwarpal; Gupta, Kamlesh; Kaur, Sukhdeep

    2017-12-01

    High-resolution ultrasonography of the tibial nerve is a fast and non invasive tool for diagnosis of diabetic peripheral neuropathy. Our study was aimed at finding out the correlation of the cross sectional area and maximum thickness of nerve fascicles of the tibial nerve with the presence and severity of diabetic peripheral neuropathy. 75 patients with type 2 diabetes mellitus clinically diagnosed with diabetic peripheral neuropathy were analysed, and the severity of neuropathy was determined using the Toronto Clinical Neuropathy Score. 58 diabetic patients with no clinical suspicion of diabetic peripheral neuropathy and 75 healthy non-diabetic subjects were taken as controls. The cross sectional area and maximum thickness of nerve fascicles of the tibial nerves were calculated 3 cm cranial to the medial malleolus in both lower limbs. The mean cross sectional area (22.63 +/- 2.66 mm 2 ) and maximum thickness of nerve fascicles (0.70 mm) of the tibial nerves in patients with diabetic peripheral neuropathy compared with both control groups was significantly larger, and statistically significant correlation was found with the Toronto Clinical Neuropathy Score ( p peripheral neuropathy had a larger mean cross sectional area (14.40 +/- 1.72 mm 2 ) and maximum thickness of nerve fascicles of the tibial nerve (0.40 mm) than healthy non-diabetic subjects (12.42 +/- 1.01 mm 2 and 0.30 mm respectively). The cross sectional area and maximum thickness of nerve fascicles of the tibial nerve is larger in diabetic patients with or without peripheral neuropathy than in healthy control subjects, and ultrasonography can be used as a good screening tool in these patients.

  4. 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.

  5. Mediolateral Differences of Proteoglycans Distribution at the ACL Tibial Footprint: Experimental Study of 16 Cadaveric Knees

    Directory of Open Access Journals (Sweden)

    Joon Ho Wang

    2018-01-01

    Full Text Available This study aimed to identify the staining pattern of ACL attachment blended with cartilage of the medial tibial plateau at the tibial insertion and histologically characterize the tibial footprint. Sixteen fresh frozen cadaveric knees (mean age: 52.0±6.2 years were used for this study. The specimens were bisected in the coronal plane, in accordance with the fiber orientation of the ACL tibial attachment. Adjacent sections were then stained with hematoxylin and eosin (H&E to observe the morphology of the ACL insertion and with fast green and Safranin-O protocols to evaluate for collagen and proteoglycans (PG. The insertion area on the tibial footprint was divided into five zones in the medial to lateral direction, which was determined by division of the section from most prominent medial tibial spine to most lateral margin of ACL attachment. Then rectangular area with a vertical length that is twice the width of respective five zones was set. Stained areas of all images were quantified positively by using ImageJ software, and the value for staining area measured was defined in percentage by multiplying whole image area by 100. The mean proportion of Safranin-O staining is significantly greater nearer to the medial tibial spine (59% in zone 1, 32% in zone 2, 13% in zone 3, 13% in zone 4, and 4% in zone 5, P<0.001. The medial section of the tibial insertion area grew in size and increased in PG staining with more densely organized collagen arrangement with more fibrocartilage cells. The ACL tibial insertion showed a medially eccentric staining pattern by histological evaluation of the ACL attachment to cartilage. Our histological results of the eccentric biomaterial property in the medial tibial spine of ACL insertion area can be considered in making a more functional anatomic tibial tunnel placement.

  6. Tibial nerve intraneural ganglion cyst in a 10-year-old boy

    Energy Technology Data Exchange (ETDEWEB)

    Squires, Judy H. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati, OH (United States); Emery, Kathleen H.; Johnson, Neil [Cincinnati Children' s Hospital Medical Center, Division of Radiology, Cincinnati, OH (United States); Sorger, Joel [Cincinnati Children' s Hospital Medical Center, Division of Orthopedics, Cincinnati, OH (United States)

    2014-04-15

    Intraneural ganglion cysts are uncommon cystic lesions of peripheral nerves that are typically encountered in adults. In the lower extremity, the peroneal nerve is most frequently affected with involvement of the tibial nerve much less common. This article describes a tibial intraneural ganglion cyst in a 10-year-old boy. Although extremely rare, intraneural ganglion cysts of the tibial nerve should be considered when a nonenhancing cystic structure with intra-articular extension is identified along the course of the nerve. This report also details the unsuccessful attempt at percutaneous treatment with US-guided cyst aspiration and steroid injection, an option recently reported as a viable alternative to open surgical resection. (orig.)

  7. 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.

  8. 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.

  9. Transverse pinning versus intramedullary pinning in fifth metacarpal's neck fractures: A randomized controlled study with patient-reported outcome.

    Science.gov (United States)

    Galal, Sherif; Safwat, Wael

    2017-01-01

    The 5th metacarpal fractures accounts for 38% of all hand fractures given that the neck is the weakest point in metacarpals, so neck fracture is the most common metacarpal fracture. Surgical fixation is also advocated for such fractures to prevent mal-rotation of the little finger which will lead to fingers overlap in a clenched fist. Various methods are available for fixation of such fractures, like intramedullary & transverse pinning. There are very few reports in the literature comparing both techniques. Authors wanted to compare outcomes and complications of transverse pinning versus intramedullary pinning in fifth metacarpal's neck fractures. A single-center, parallel group, prospective, randomized study was conducted at an academic Level 1 Trauma Center from October 2014 to December 2016. A total of 80 patients with 5th metacarpal's neck fractures were randomized to pinning using either transverse pinning (group A) or intramedullary pinning (group B). Patients were assessed clinically on range of motion, patient-reported outcome using the Quick-DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire & radiographically. Two blinded observers assessed outcomes. At final follow up for each patient (12 months) the statistically significant differences were observed in operative time, the transverse pinning group showed shorter operative time, as well as complication rate as complications were observed only in intramedullary pinning group. No differences were found in range of motion or the Quick -DASH score. Both techniques are equally safe and effective treatment option for 5th metacarpal's neck fractures. The only difference was shorter operative time & less incidence of complications in transverse pinning group. Level II, Therapeutic study.

  10. Percutaneous Intramedullary Screw Fixation of Distal Fibula Fractures: A Case Series and Systematic Review

    NARCIS (Netherlands)

    Loukachov, Vladimir V.; Birnie, Merel F. N.; Dingemans, Siem A.; de Jong, Vincent M.; Schepers, Tim

    2017-01-01

    The current reference standard for unstable ankle fractures is open reduction and internal fixation using a plate and lag screws. This approach requires extensive dissection and wound complications are not uncommon. The use of intramedullary screw fixation might overcome these issues. The aim of our

  11. 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.

  12. 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...

  13. 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.

  14. Combined spinal intramedullary arteriovenous malformation and lipomyelomeningocele

    Energy Technology Data Exchange (ETDEWEB)

    Weon, Y.C.; Roh, H.G.; Byun, H.S. [Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Radiology, Seoul (Korea); Chung, J.I. [Medimoa Hospital, Department of Radiology, Seoul (Korea); Eoh, W. [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea)

    2005-10-01

    Combined spinal arteriovenous malformation and lipomyelomeningocele are extremely rare. We present a rare combined case of a lipomyelomeningocele with an intramedullary arteriovenous malformation (AVM) occurred at the L3-L4 level in a 30-year-old man who suffered from low back pain radiating to the lower extremities, dysuria, and frequency for 5 years. The MR studies showed an intradural mass with high-signal intensity on both T1-weighted and T2-weighted images, intermingled with multiple signal-void structures. The mass extended extradurally toward a subcutaneously forming fatty mass on the patient's back. Spinal angiography showed an AVM supplied by the radiculopial branches of the lumbar arteries and drained by tortuous, dilated, perimedullary veins. Endovascular embolization and surgical resection were performed. (orig.)

  15. Recurrent intramedullary epidermoid cyst of conus medullaris.

    LENUS (Irish Health Repository)

    Fleming, Christina

    2011-01-01

    Spinal intramedullary epidermoid cyst is a rare condition. Recurrent epidermoid cyst in the spine cord is known to occur. The authors describe a case of recurrent conus medullaris epidermoid cyst in a 24-year-old female. She initially presented at 7 years of age with bladder disturbance in the form of diurnal enuresis and recurrent urinary tract infection. MRI lumbar spine revealed a 4 cm conus medullaris epidermoid cyst. Since the initial presentation, the cyst had recurred seven times in the same location and she underwent surgical intervention in the form of exploration and debulking. This benign condition, owing to its anatomical location, has posed a surgical and overall management challenge. This occurrence is better managed in a tertiary-care centre requiring multi-disciplinary treatment approach.

  16. Design of canals

    CERN Document Server

    Swamee, P K

    2015-01-01

    The book presents firsthand material from the authors on design of hydraulic canals. The book discusses elements of design based on principles of hydraulic flow through canals. It covers optimization of design based on usage requirements and economic constraints. The book includes explicit design equations and design procedures along with design examples for varied cases. With its comprehensive coverage of the principles of hydraulic canal design, this book will prove useful to students, researchers, and practicing engineers. End-of-chapter pedagogical elements make it ideal for use in graduate courses on hydraulic structures offered by most civil engineering departments across the world.

  17. 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.

  18. Exposure of surgeons-in-training to radiation during intramedullary fixation of femoral shaft fractures

    International Nuclear Information System (INIS)

    Coetzee, J.C.; Van der Merwe, E.J.

    1992-01-01

    Owing to the continuous turnover of registrars and radiographers, most of the trauma-related orthopedic surgery in this academic hospital is done by inexperienced surgeons-in-training and the fluoroscopy by junior radiographers. This could result in excessive radiation doses. Calibrated lithium fluoride thermoluminescent chips were secured to various parts of the primary surgeon's body to quantify the radiation dose received during the insertion of an intramedullary nail. Closed intramedullary fixation of 15 fractures of the femur was done with interlocking as necessary. The total average exposure time was 14 minutes 45 seconds per procedure. Distal locking took up 31% of this time. The mean radiation dose to the surgeon's eyes and thyroid was 0,13 mGy and to the dominant hand 2,10 mGy. This would allow the performance of about 350 such procedures per year before the maximum permissible dose level was reached. Recommendations to decrease irradiation dosage are made. 6 refs., 6 tabs

  19. An evaluation of canal curvature at the apical one third in type II mesial canals of mandibular molars

    Directory of Open Access Journals (Sweden)

    Hye-Rim Yun

    2012-05-01

    Full Text Available Objectives The purpose of this study was to evaluate the buccolingual curvature at the apical one third in type II mesial canals of mandibular molars using the radius and angle of curvature. Materials and Methods Total 100 mandibular molars were selected. Following an endodontic access in the teeth, their distal roots were removed. #15 H- or K-files (Dentsply Maillefer were inserted into the mesiobuccal and mesiolingual canals of the teeth. Radiographs of the teeth were taken for the proximal view. Among them, type II canals were selected and divided into two subgroups, IIa and IIb. In type IIa, two separate canals merged into one canal before reaching the apex and in type IIb, two separate canals merged into one canal within the apical foramen. The radius and angle of curvature of specimens were examined. Results In type II, mean radius of curvature in mesiolingual and mesiobuccal canals were 2.82 mm and 3.58 mm, respectively. The radius of the curvature of mesiolingual canals were significantly smaller than that of mesiobuccal canals in type II, and especially in type IIa. However, there were no statistically significant differences in radius of curvature between mesiobuccal and mesiolingual canals in type IIb and there were no significant differences in angle of curvature between type IIa and IIb. Conclusion In this study, type II mesial canals of mandibular molars showed severe curvature in the proximal view. Especially, mesiolingual canals of type IIa had more abrupt curvature than mesiobuccal canals at the apical one third.

  20. Osmolarity and root canal antiseptics.

    Science.gov (United States)

    Rossi-Fedele, G; Guastalli, A R

    2014-04-01

    Antiseptics used in endodontics for disinfection purposes include root canal dressings and irrigants. Osmotic shock is known to cause the alteration of microbial cell viability and might have a role in the mechanism of action of root canal antiseptics. The aim of this review was to determine the role of osmolarity on the performance of antiseptics in root canal treatment. A literature search using the Medline electronic database was conducted up to 30 May 2013 using the following search terms and combinations: 'osmolarity AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmolality AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmotic AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; osmosis AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm; sodium chloride AND root canal or endodontic or antiseptic or irrigation or irrigant or medication or dressing or biofilm'. Publications were included if the effects of osmolarity on the clinical performance of antiseptics in root canal treatment were stated, if preparations with different osmolarities values were compared and if they were published in English. A hand search of articles published online, 'in press' and 'early view', and in the reference list of the included papers was carried out following the same criteria. A total of 3274 publications were identified using the database, and three were included in the review. The evidence available in endodontics suggests a possible role for hyperosmotic root canal medicaments as disinfectants, and that there is no influence of osmolarity on the tissue dissolution capacity of sodium hypochlorite. There are insufficient data to obtain a sound conclusion regarding the role of hypo-osmosis in root canal disinfection, or osmosis in any further desirable

  1. 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.

  2. Continuous decompression with intramedullary nailing for the treatment of unicameral bone cysts.

    Science.gov (United States)

    Masquijo, Julio Javier; Baroni, Eduardo; Miscione, Horacio

    2008-08-01

    To evaluate the efficacy of decompression of unicameral bone cysts (UBCs) of the long bones with intramedullary nailing and to compare responses to treatment according to location. We evaluated 48 consecutive patients treated between January 1988 and June 2000. Mean age was 10.3 years. Mean follow-up was 9.8 years. Evaluation was performed according to the radiographic criteria of Capanna. UBCs were located in the proximal humerus (n = 24), humeral shaft (n = 2), proximal femur (n = 19), distal tibia (n = 2) and fibula (n = 1). A total of 62.5% presented a pathological fracture. Successful results were observed in 89.5% (26 total healing, 17 healing with residual radiolucent areas), and there were four recurrences and, in one case, no response to treatment. There was more healing in the humerus than in the femur (92.3% versus 84.2%), and more tendency to restitution ad integrum, although the difference was not statistically significant (P = 0.1499). Intramedullary nailing is a minimally invasive method, which permits early stability and decompresses the cyst allowing healing. Significant differences were not observed among results from different locations.

  3. Nonunion of the humerus following intramedullary nailing treated by Ilizarov hybrid fixation.

    Science.gov (United States)

    Raschke, M; Khodadadyan, C; Maitino, P D; Hoffmann, R; Südkamp, N P

    1998-02-01

    A case of a posttraumatic humeral shaft nonunion, after intramedullary stabilization with a Seidel nail, is presented. Severe osteoporosis, an oligotrophic nonunion, subclinical infection, and adhesive capsulitis of the glenohumeral joint were present. Due to the subclinical infection and severe osteoporosis, other major invasive therapeutic options such as intramedullary nailing or compression plating and bone grafting were not applicable. Nonoperative treatment was also not indicated secondary to the pain and disability present. External fixation with the Ilizarov hybrid fixator seemed to offer a minimally invasive treatment modality without the need of additional bone grafting. After fourteen weeks of "callus massage," consisting of closed alternating compression and distraction with an Ilizarov hybrid fixator, osseous consolidation was achieved. Eight months after Ilizarov treatment the patient had returned to work as a mechanic. At the one-year follow-up examination, the patient presented pain free and with near normal shoulder and elbow motion, with stable osseous consolidation of the humerus. In some cases of nonunion of the humerus shaft, when standard treatment options are not recommended, external fixation with an Ilizarov hybrid fixator may offer a salvage procedure with a successful clinical outcome.

  4. The stability of a hip fracture determines the fatigue of an intramedullary nail.

    Science.gov (United States)

    Eberle, S; Bauer, C; Gerber, C; von Oldenburg, G; Augat, P

    2010-01-01

    The purpose of this study was to address the question of how the stability of a proximal hip fracture determines the fatigue and failure mechanism of an intramedullary implant. To answer this question, mechanical experiments and finite element simulations with two different loading scenarios were conducted. The two load scenarios differed in the mechanical support of the fracture by an artificial bone sleeve, representing the femoral head and neck. The experiments confirmed that an intramedullary nail fails at a lower load in an unstable fracture situation in the proximal femur than in a stable fracture. The nails with an unstable support failed at a load 28 per cent lower than the nails with a stable support by the femoral neck. Hence, the mechanical support of a fracture is crucial to the fatigue failure of an implant. The simulation showed why the fatigue fracture of the nail starts at the aperture of the lag screw. It is the location of the highest von Mises stress, which is the failure criterion for ductile materials.

  5. [Mobility of a polyethylene tibial insert in a mobile total knee prosthesis].

    Science.gov (United States)

    Castel, E; Roger, B; Camproux, A; Saillant, G

    1999-03-01

    We have studied the mobility of a mobile tibial implant in total knee arthroplasty (TKA) by a radiographical evaluation. We analyzed mobility of the polyethylene tibial insert of 15 "G2S" TKA implanted for one year or more. We established a dynamic radiographical evaluation. We used 3 weight-bearing radiographs: AP in extension and two lateral (one in extension and one at 90 degrees of flexion), two AP with femoral internal and external rotation, 2 strict lateral X-rays in neutral rotation in antero-posterior replacement with a 25 kilograms strength Telos, and 2 AP in varus and valgus with Telos. Wilcoxon's test and Fisher's exact test were used for statistical evaluation. Our study demonstrated preservation of the polyethylene mobility in tibial TKA implant in all movements: in rotation, in antero-posterior translation with Telos, and even in antero-posterior translation during physiological condition with flexion-extension weight-bearing radiographs. Statistical tests were very significant. We noticed that flexion induced anterior translation of tibial polyethylene when PCL was preserved. This study answered to our question whether mobility of TKA tibial implant persists after implantation. This mobility should reduce loosening forces to the tibia and stress in the polyethylene component. Now we have to determine the amplitude of mobility required to reach this objective.

  6. Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures - postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate.

    Science.gov (United States)

    Paulsson, Johnny; Stig, Josefine Corin; Olsson, Ola

    2017-08-24

    In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension. All orthopedic surgeries are registered in a regional database. All consecutive trochanteric fracture operations during 2011-2012 (n = 856) and subsequent technical reoperations (n = 40) were derived from the database. Reoperations were analysed and classified into the categories adjustment (percutaneous removal of the locking screw of the Medoff sliding plate or the intramedullary nail, followed by fracture healing) or minor, intermediate (reosteosynthesis) or major (hip joint replacement, Girdlestone or persistent nonunion) technical complications. The relative risk of intermediate or major technical complications was 4.2 (1.2-14) times higher in unstable pertrochanteric fractures and 4.6 (1.1-19) times higher in subtrochanteric fractures with treatment protocol: intramedullary nail/dynamic hip screw, compared to treatment protocol: Medoff sliding plate/dynamic hip screw. Overall rates of intermediate and major technical complications in unstable pertrochanteric and subtrochanteric fractures were with biaxial Medoff sliding plate 0.68%, with uniaxial Medoff sliding plate 1.4%, with dynamic hip screw 3.4% and with intramedullary nail 7.2%. The

  7. [Continuous observation of canal aberrations in S-shaped simulated root canal prepared by hand-used ProTaper files].

    Science.gov (United States)

    Xia, Ling-yun; Leng, Wei-dong; Mao, Min; Yang, Guo-biao; Xiang, Yong-gang; Chen, Xin-mei

    2009-08-01

    To observe the formation of canal aberrations in S-shaped root canals prepared by every file of hand-used ProTaper. Fifteen S-shaped simulated resin root canals were selected. Each root canal was prepared by every file of hand-used ProTaper following the manufacturer instruction. The images of canals prepared by S1, S2, F1, F2 and F3 were taken and stored, which were divided into group S1, S2, F1, F2 and F3. One image of canal unprepared was superposed with the images of the same root canal in these five groups respectively to observe the types and number of canal aberrations, which included unprepared area, danger zone, ledge, elbow, zip and perforation. SPSS12.0 software pakage was used for Fisher's exact probabilities in 2x2 table. Unprepared area decreased following preparation by every file of ProTaper, but it still existed when the canal preparation was finished. The incidence of danger zone, elbow and zip in group F1 was 15/15, 11/15, 4/15, respectively, which was significantly higher than that in group S2(2/15,0,0) (PProTaper.The presence of unprepared area suggests that it is essential to rinse canal abundantly during complicated canal preparation and canal antisepsis after preparation.

  8. 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

  9. 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.

  10. Anatomic study on mental canal and incisive nerve canal in interforaminal region in Chinese population.

    Science.gov (United States)

    Xu, Yun; Suo, Ning; Tian, Xiufen; Li, Fei; Zhong, Guangxin; Liu, Xiaoran; Bao, Yongxing; Song, Tao; Tian, Hua

    2015-08-01

    This study was aimed to detect the positions of mental canal and incisive nerve canal as well as the prolongation of mandibular canal in interforaminal region in Chinese population to supply the reference data of the surgical safe zone in chin for clinicians. A total of 80 formalin-fixed semi-mandibles of Chinese adult cadavers were dissected, the positions and courses of mental canal and incisive nerve canal as well as the prolongation of mandibular canal in interforaminal region were measured. The mental foramina were present in all cases (100 %), and most of them were located below 2nd premolar (58.75 %). Accessory mental foramina were observed in 5 %. The anterior end of mandibular canal, extending along the course of 7.37 ± 1.10 mm above the lower border of mandible to interforaminal region about 3.54 ± 0.70 mm medial to the mental foramen, most often ended below between the two premolars (73.75 %), where it continued as the incisive nerve canal (100 %) and the mental canal (96.25 %). Mental canal, with the wall formed by compact bone, being 2.60 ± 0.60 mm in diameter and 4.01 ± 1.20 mm in length, opened into mental foramen. Incisive nerve canal, with the wall formed by thin compact bone and/or partly or completely by spongy bone, being 1.76 ± 0.27 mm in diameter and 24.87 ± 2.23 mm in length, extended to the incisor region along the course of 9.53 ± 1.43 mm above the lower border of mandible, and most often ended below the lateral incisor (70.00 %). This research recommended for chin operations in Chinese population: the surgical safe zone could be set in the region about over 4 mm anterior to the mental foramen, and over 12 mm above inferior border of mandible for anterior alveolar surgery, or within 9 mm above inferior border of mandible for genioplasty.

  11. Intramedullary nailing for the treatment of aseptic femoral shaft non-unions after plating failure: effectiveness and timing.

    Science.gov (United States)

    Megas, Panagiotis; Syggelos, Spyros A; Kontakis, Georgios; Giannakopoulos, Andreas; Skouteris, Georgios; Lambiris, Elias; Panagiotopoulos, Elias

    2009-07-01

    This retrospective, multicentre study aimed to evaluate reamed intramedullary nailing (IMN) for the treatment of 30 cases of aseptic femoral shaft non-union after plating failure. Following nailing, 29 non-unions had healed by a mean 7.93 months. In one case a hypertrophic non-union required renailing after 8 months, using a nail of greater diameter, and united within five further months. Healing times were not related to whether the fracture was open or closed, the type non-union or the type of fracture. The delay from the initial plating to intramedullary nailing had a statistically significant effect on healing time and final outcome. This treatment is cost effective and should be implemented as soon as the non-union is diagnosed.

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

    Science.gov (United States)

    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.

  13. THE RESULT OF INTRAMEDULLARY NAILING WITH BONE GRAFTING OF TIBIA'S PATHOLOGIC FRACTURE

    Directory of Open Access Journals (Sweden)

    V. M. Shapovalov

    2010-01-01

    Full Text Available The authors give the clinical case of successful surgical treatment of patient with tibia's pathologic fracture by intramedullary nailing with bone grafting. The disadvantages of such patients' treatment by plaster immobilization and by some invasive methods like vascular autografting by Ilizarov's method and bone plating were also discussed. The obvious benefits of proposed surgical treatment technique of observed patient category are shown.

  14. Human tibial torsion - Morphometric assessment and clinical relevance

    Directory of Open Access Journals (Sweden)

    Swati Gandhi

    2014-02-01

    Full Text Available Background: Tibial torsion is an important anatomical parameter in clinical practice and displays variability among individuals. These variations are extremely significant in view of alignment guides such as those related to rotational landmarks of tibia in total knee arthroplasty. Further, precise knowledge and information pertaining to angle of tibial torsion also helps in correction of traumatic malunion or congenital maltorsion of tibia. Methods: The present study was carried out to determine the angle of tibial torsion in 100 adult dry tibia bones in the Department of Anatomy, Government Medical College, Amritsar. The study group comprised 50 males and 50 females with equal number of right- and left-sided bones. The measurements were meticulously recorded and the data were subjected to statistical analysis. The results were analyzed and discussed in the light of existing literature. Results: On the right side, it was found to be 29.84° ± 4.86°° (range = 22.00° -38.00° in males and 28.92° ± 5.10°° (range = 15.00°-38.00° in females. On the left side, it was found to be 28.00° ± 4.94°° (range = 20.00°-40.00°° in males and 28.12° ± 4.28°° (range = 20.00°-37.00°° in females. Conclusion: The present study is an endeavor to provide baseline data with reference to the angle of tibial torsion in the Indian population. The results of the study assume special importance in view of the technical advancements in reconstructive surgical procedures in orthopedic practice.

  15. 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.

  16. Periapical repair after root canal filling with different root canal sealers.

    Science.gov (United States)

    Tanomaru-Filho, Mário; Tanomaru, Juliane Maria Guerreiro; Leonardo, Mario Roberto; da Silva, Lea Assed Bezerra

    2009-01-01

    The aim of this study was to evaluate periapical repair after root canal filling with different endodontic sealers. Sixty-four root canals from dog s teeth were filled, divided into 4 groups (n=16). Root canals were instrumented with K-type files and irrigated with 1% sodium hypochlorite solution. Root canals were filled in the same session by active lateral condensation of the cones and sealers: Intrafill, AH Plus, Roeko Seal and Resilon/Epiphany System. After 90 days, the animals were euthanized and the tissues to be evaluated were processed and stained with hematoxylin and eosin. For histopathological analysis, the following parameters were evaluated: inflammatory process, mineralized tissue resorption, and apical mineralized tissue deposition. Histopathological analysis demonstrated that Intrafill had less favorable results in terms of apical and periapical repair, compared to the other sealers (p0.05). In conclusion, AH Plus and the materials Roeko Seal and Epiphany are good options for clinical use in Endodontics.

  17. Tibial rotational osteotomy for idiopathic torsion. A comparison of the proximal and distal osteotomy levels.

    Science.gov (United States)

    Krengel, W F; Staheli, L T

    1992-10-01

    A retrospective analysis was done of 52 rotational tibial osteotomies (RTOs) performed on 35 patients with severe idiopathic tibial torsion. Thirty-nine osteotomies were performed at the proximal or midtibial level. Thirteen were performed at the distal tibial level with a technique previously described by one of the authors. Serious complications occurred in five (13%) of the proximal and in none of the distal RTOs. For severe and persisting idiopathic tibial torsion, the authors recommend correction by RTO at the distal level. Proximal level osteotomy is indicated only when a varus or valgus deformity required concurrent correction.

  18. A comparative evaluation of the increase in root canal surface area and canal transportation in curved root canals by three rotary systems: A cone-beam computed tomographic study

    Science.gov (United States)

    Prasanthi, Nalam NVD; Rambabu, Tanikonda; Sajjan, Girija S; Varma, K Madhu; Satish, R Kalyan; Padmaja, M

    2016-01-01

    Aim: The aim of this study was to measure the increase in root canal surface area and canal transportation after biomechanical preparation at 1, 3, and 5 mm short of the apex with three different rotary systems in both continuous rotary and reciprocating rotary motions. Materials and Methods: Sixty freshly extracted human mandibular molars with mesial root canal curvatures between 20° and 30° were included in the study. Teeth were randomly distributed into three groups (n = 20). Biomechanical preparations were done in all the mesial canals. In Group 1, instrumentation was done with ProTaper universal rotary files, Group 2, with K3XF rotary files, and Group 3, with LSX rotary files. Each group was further subdivided into subgroups A and B (n = 10) where instrumentation was done by continuous rotary and reciprocating rotary techniques, respectively. Increase in root canal surface area and canal transportation was measured using the preoperative and postoperative cone-beam computed tomography scans. Statistical Analysis: The data were analyzed by one-way ANOVA followed by Tukey pairwise multiple comparison tests. Results: Increase in root canal surface area was significantly more (P 0.05) in increase of root canal surface area and canal transportation between continuous rotary and reciprocating rotary techniques for ProTaper Universal, K3XF and LSX groups. Conclusion: LSX rotary system showed minimal increase of root canal surface area and minimal canal transportation when compared to ProTaper and K3XF rotary systems. PMID:27656062

  19. Staged Custom, Intramedullary Antibiotic Spacers for Severe Segmental Bone Loss in Infected Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Atul F. Kamath

    2011-01-01

    Full Text Available Introduction. Total hip arthroplasty (THA infections with severe bone loss pose significant reconstructive challenges. We present our experience with two-stage hip reimplantation using an intramedullary, antibiotic-impregnated nail. Methods. Three patients with infected THA with severe proximal femoral bone loss (Mallory type IIIB or greater were treated using a custom antibiotic spacer. Clinical outcomes and any complications were recorded. Average followup was 49 months from final reimplantation. Results. Mean age at spacer placement (stage 1 was 53 years. The mean Harris Hip Score at final followup was 80. Two patients had asymptomatic heterotopic ossification, and one patient had a 2 cm leg-length discrepancy. Conclusions. A custom intramedullary nail antibiotic spacer is a reliable option in the staged management of the infected THA with severe proximal femoral bone loss. Benefits of this technique include limb salvage with maintenance of leg length, soft tissue tension, and functional status.

  20. 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...

  1. Posterior semicircular canal dehiscence: a morphologic cause of vertigo similar to superior semicircular canal dehiscence

    International Nuclear Information System (INIS)

    Krombach, G.A.; Schmitz-Rode, T.; Haage, P.; Guenther, R.W.; DiMartino, E.; Prescher, A.; Kinzel, S.

    2003-01-01

    Heading Abstract.The aim of this study was to assess imaging findings of posterior semicircular dehiscence on computed tomography and to evaluate incidence of posterior and superior semicircular canal dehiscence in patients presenting with vertigo, sensorineuronal hearing loss or in a control group without symptoms related to the inner ear. Computed tomography was performed in 507 patients presenting either with vertigo (n=128; 23 of these patients suffered also from sensorineuronal hearing loss), other symptoms related to the inner ear, such as hearing loss or tinnitus (n=183) or symptoms unrelated to the labyrinth (n=196). All images were reviewed for presence of dehiscence of the bone, overlying the semicircular canals. Twenty-nine patients had superior semicircular canal dehiscence. Of these patients, 83% presented with vertigo, 10% with hearing loss or tinnitus and the remaining 7% with symptoms unrelated to the inner ear. In 23 patients dehiscence of the posterior semicircular canal was encountered. Of these patients, 86% presented with vertigo, 9% with hearing loss or tinnitus and 5% with symptoms unrelated to the inner ear. Defects of the bony overly are found at the posterior semicircular canal, in addition to the recently introduced superior canal dehiscence syndrome. Significant prevalence of vertigo in these patients suggests that posterior semicircular canal dehiscence can cause vertigo, similar to superior semicircular canal dehiscence. (orig.)

  2. Posterior semicircular canal dehiscence: a morphologic cause of vertigo similar to superior semicircular canal dehiscence

    Energy Technology Data Exchange (ETDEWEB)

    Krombach, G A; Schmitz-Rode, T; Haage, P; Guenther, R W [Department of Diagnostic Radiology, University of Technology, Pauwelstrasse 30, 52057, Aachen (Germany); DiMartino, E [Department of Otorhinolaryngology, University of Technology, Pauwelstrasse 30, 52057, Aachen (Germany); Prescher, A [Department of Anatomy, University of Technology, Pauwelstrasse 30, 52057, Aachen (Germany); Kinzel, S [Department of Experimental Veterinarian Medicine, University of Technology, Pauwelstrasse 30, 52057, Aachen (Germany)

    2003-06-01

    Heading Abstract.The aim of this study was to assess imaging findings of posterior semicircular dehiscence on computed tomography and to evaluate incidence of posterior and superior semicircular canal dehiscence in patients presenting with vertigo, sensorineuronal hearing loss or in a control group without symptoms related to the inner ear. Computed tomography was performed in 507 patients presenting either with vertigo (n=128; 23 of these patients suffered also from sensorineuronal hearing loss), other symptoms related to the inner ear, such as hearing loss or tinnitus (n=183) or symptoms unrelated to the labyrinth (n=196). All images were reviewed for presence of dehiscence of the bone, overlying the semicircular canals. Twenty-nine patients had superior semicircular canal dehiscence. Of these patients, 83% presented with vertigo, 10% with hearing loss or tinnitus and the remaining 7% with symptoms unrelated to the inner ear. In 23 patients dehiscence of the posterior semicircular canal was encountered. Of these patients, 86% presented with vertigo, 9% with hearing loss or tinnitus and 5% with symptoms unrelated to the inner ear. Defects of the bony overly are found at the posterior semicircular canal, in addition to the recently introduced superior canal dehiscence syndrome. Significant prevalence of vertigo in these patients suggests that posterior semicircular canal dehiscence can cause vertigo, similar to superior semicircular canal dehiscence. (orig.)

  3. The transverse ligament as a landmark for tibial sagittal insertions of the anterior cruciate ligament: a cadaveric study.

    Science.gov (United States)

    Kongcharoensombat, Wirat; Ochi, Mitsuo; Abouheif, Mohamed; Adachi, Nobuo; Ohkawa, Shingo; Kamei, Goki; Okuhara, Atushi; Shibuya, Hoyatoshi; Niimoto, Takuya; Nakasa, Tomoyuki; Nakamae, Atsuo; Deie, Masataka

    2011-10-01

    The purpose of this study was to determine the relation between the position of the transverse ligament, the anterior edge of the anterior cruciate ligament (ACL) tibial footprint, and the center of the ACL tibial insertion. We used arthroscopy for localization of the anatomic landmarks, followed by insertions of guide pins under direct visualization, and then the position of these guide pins was checked on plain lateral radiographs. The transverse ligament and the anterior aspect of the ACL tibial footprint were identified by arthroscopy in 20 unpaired cadaveric knees (10 left and 10 right). Guide pins were inserted with tibial ACL adapter drill guides under direct observation at the transverse ligament, the anterior aspect of the tibial footprint, and the center of tibial insertion of the ACL. Then, plain lateral radiographs of specimens were taken. The Amis and Jakob line was used to define the attachment of the ACL tibial insertion and the transverse ligament. A sagittal percentage of the location of the insertion point was determined and calculated from the anterior margin of the tibia in the anteroposterior direction. The transverse ligament averaged 21.20% ± 4.1%, the anterior edge of the ACL tibial insertion averaged 21.60% ± 4.0%, and the center of the ACL tibial insertion averaged 40.30% ± 4.8%. There were similar percent variations between the transverse ligament and the anterior edge of the ACL tibial insertion, with no significant difference between them (P = .38). Intraobserver and interobserver reliability was high, with small standard errors of measurement. This study shows that the transverse ligament coincides with the anterior edge of the ACL tibial footprint in the sagittal plane. The transverse ligament can be considered as a new landmark for tibial tunnel positioning during anatomic ACL reconstruction. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  4. Unpredictable Root Canal Morphology: Expect the Unexpected

    Directory of Open Access Journals (Sweden)

    Sohez J Makani

    2015-01-01

    Full Text Available Background: A maxillary first molar with more than four canals is an interesting example of anatomic variations, especially when two of these canals are detected, with separate apical foramen in the distal root. The inability to locate the unexpected canals of various anatomical configuration and subsequently treat them , may lead to therapeutic failures. Endodontic retreatment is usually the modality of choice in such cases. This report describes a case of a maxillary first molar with five canals (two mesial canals in mesial root, two distal canals in two distal roots and a palatal canal in palatal root. Additionally it shows a rare anatomic configuration and emphasizes the importance of identifying additional canals.

  5. Effect of cranial cruciate ligament deficiency, tibial plateau leveling osteotomy, and tibial tuberosity advancement on contact mechanics and alignment of the stifle in flexion.

    Science.gov (United States)

    Kim, Stanley E; Pozzi, Antonio; Banks, Scott A; Conrad, Bryan P; Lewis, Daniel D

    2010-04-01

    To assess contact mechanics and 3-dimensional (3-D) joint alignment in cranial cruciate ligament (CCL)-deficient stifles before and after tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA) with the stifle in 90 degrees of flexion. In vitro biomechanical study. Cadaveric pelvic limb pairs (n=8) from dogs weighing 28-35 kg. Contralateral limbs were assigned to receive TPLO or TTA. Digital pressure sensors were used to measure femorotibial contact area, peak and mean contact pressure, and peak pressure location with the limb under a load of 30% body weight and stifle flexion angle of 90 degrees . 3-D poses were obtained using a Microscribe digitizer. Specimens were tested under normal, CCL deficient, and treatment conditions. Significant disturbances in alignment were not observed after CCL transection, although medial contact area was 10% smaller than normal (P=.003). There were no significant differences in contact mechanics or alignment between normal and TTA conditions; TPLO induced 6 degrees varus angulation (PCranial tibial subluxation is nominal in CCL-deficient stifles loaded in flexion. Stifle alignment and contact mechanics are not altered by TTA, whereas TPLO causes mild varus and a subsequent increase in medial compartment loading. Cranial tibial subluxation of CCL-deficient stifles may not occur during postures that load the stifle in flexion. The significance of minor changes in loading patterns after TPLO is unknown.

  6. Prediction of Tibial Rotation Pathologies Using Particle Swarm Optimization and K-Means Algorithms.

    Science.gov (United States)

    Sari, Murat; Tuna, Can; Akogul, Serkan

    2018-03-28

    The aim of this article is to investigate pathological subjects from a population through different physical factors. To achieve this, particle swarm optimization (PSO) and K-means (KM) clustering algorithms have been combined (PSO-KM). Datasets provided by the literature were divided into three clusters based on age and weight parameters and each one of right tibial external rotation (RTER), right tibial internal rotation (RTIR), left tibial external rotation (LTER), and left tibial internal rotation (LTIR) values were divided into three types as Type 1, Type 2 and Type 3 (Type 2 is non-pathological (normal) and the other two types are pathological (abnormal)), respectively. The rotation values of every subject in any cluster were noted. Then the algorithm was run and the produced values were also considered. The values of the produced algorithm, the PSO-KM, have been compared with the real values. The hybrid PSO-KM algorithm has been very successful on the optimal clustering of the tibial rotation types through the physical criteria. In this investigation, Type 2 (pathological subjects) is of especially high predictability and the PSO-KM algorithm has been very successful as an operation system for clustering and optimizing the tibial motion data assessments. These research findings are expected to be very useful for health providers, such as physiotherapists, orthopedists, and so on, in which this consequence may help clinicians to appropriately designing proper treatment schedules for patients.

  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. Robust identification and localization of intramedullary nail holes for distal locking using CBCT: a simulation study.

    Science.gov (United States)

    Kamarianakis, Z; Buliev, I; Pallikarakis, N

    2011-05-01

    Closed intramedullary nailing is a common technique for treatment of femur and tibia fractures. The most challenging step in this procedure is the precise placement of the lateral screws that stabilize the fragmented bone. The present work concerns the development and the evaluation of a method to accurately identify in the 3D space the axes of the nail hole canals. A limited number of projection images are acquired around the leg with the help of a C-arm. On two of them, the locking hole entries are interactively selected and a rough localization of the hole axes is performed. Perpendicularly to one of them, cone-beam computed tomography (CBCT) reconstructions are produced. The accurate identification and localization of the hole axes are done by an identification of the centers of the nail holes on the tomograms and a further 3D linear regression through principal component analysis (PCA). Various feature-based approaches (RANSAC, least-square fitting, Hough transform) have been compared for best matching the contours and the centers of the holes on the tomograms. The robustness of the suggested method was investigated using simulations. Programming is done in Matlab and C++. Results obtained on synthetic data confirm very good localization accuracy - mean translational error of 0.14 mm (std=0.08 mm) and mean angular error of 0.84° (std=0.35°) at no radiation excess. Successful localization can be further used to guide a surgeon or a robot for correct drilling the bone along the nail openings. Copyright © 2010 IPEM. Published by Elsevier Ltd. All rights reserved.

  9. Canine stifle joint biomechanics associated with tibial plateau leveling osteotomy predicted by use of a computer model.

    Science.gov (United States)

    Brown, Nathan P; Bertocci, Gina E; Marcellin-Little, Denis J

    2014-07-01

    To evaluate effects of tibial plateau leveling osteotomy (TPLO) on canine stifle joint biomechanics in a cranial cruciate ligament (CrCL)-deficient stifle joint by use of a 3-D computer model simulating the stance phase of gait and to compare biomechanics in TPLO-managed, CrCL-intact, and CrCL-deficient stifle joints. Computer simulations of the pelvic limb of a Golden Retriever. A previously developed computer model of the canine pelvic limb was used to simulate TPLO stabilization to achieve a tibial plateau angle (TPA) of 5° (baseline value) in a CrCL-deficient stifle joint. Sensitivity analysis was conducted for tibial fragment rotation of 13° to -3°. Ligament loads, relative tibial translation, and relative tibial rotation were determined and compared with values for CrCL-intact and CrCL-deficient stifle joints. TPLO with a 5° TPA converted cranial tibial translation to caudal tibial translation and increased loads placed on the remaining stifle joint ligaments, compared with results for a CrCL-intact stifle joint. Lateral collateral ligament load was similar, medial collateral ligament load increased, and caudal cruciate ligament load decreased after TPLO, compared with loads for a CrCL-deficient stifle joint. Relative tibial rotation after TPLO was similar to that of a CrCL-deficient stifle joint. Stifle joint biomechanics were affected by TPLO fragment rotation. In the model, stifle joint biomechanics were partially improved after TPLO, compared with CrCL-deficient stifle joint biomechanics, but TPLO did not fully restore CrCL-intact stifle joint biomechanics. Overrotation of the tibial fragment negatively influenced stifle joint biomechanics by increasing caudal tibial translation.

  10. Intraoperative study on anthropometry and gender differences of the proximal tibial plateau at the arthroplasty resection surface.

    Science.gov (United States)

    Yang, Bo; Yu, Jiakuo; Gong, Xi; Chen, Lianxu; Wang, Yongjian; Wang, Jian; Wang, Haijun; Zhang, Jiying

    2014-01-01

    The tibial plateau is asymmetric with a larger medial plateau. We observed from clinical practice that the shape of the tibial plateau does not always present a larger medial plateau. Tibial plateau also showed other shapes. The purpose of this study was to analyze the anthropometric data of the proximal tibia in a large group of Chinese patients undergoing total knee arthroplasty and to investigate the morphology of the resected proximal tibial surface and its gender differences. A total of 822 knees (164 males, 658 females) from the Chinese population were measured intraoperatively for medial anteroposterior (MAP) and lateral anteroposterior (LAP) dimensions of the resected proximal tibial surface. The difference of MAP and LAP (DML) was also calculated as MAP minus LAP. We then classified the data into three groups based on the DML (2 mm) to analyze the morphology of the proximal tibia and its distribution between male and female. The shape of proximal tibial plateau was of three types: larger medial plateau type, symmetric type, and larger lateral plateau type. There were significant differences between males and females in relation to the shape distribution of the proximal tibial plateau (P 2 mm and 120 of 822 (14.6%) tibia having a DMLDMLs to better match the different anthropometry of the resected tibial surface.

  11. Intramedullary nailing appears to be superior in pertrochanteric hip fractures with a detached greater trochanter

    DEFF Research Database (Denmark)

    Palm, Henrik; Lysén, Charlotte; Krasheninnikoff, Michael

    2011-01-01

    In recent years, intramedullary nails (INs) for the treatment of pertrochanteric hip fractures have gained prominence relative to conventional, sliding hip screws (SHSs). There is little empirical background for this development, however. A previous series of ours suggested that the use of SHS wa...

  12. 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.

  13. The medial tibial stress syndrome. A cause of shin splints.

    Science.gov (United States)

    Mubarak, S J; Gould, R N; Lee, Y F; Schmidt, D A; Hargens, A R

    1982-01-01

    The medial tibial stress syndrome is a symptom complex seen in athletes who complain of exercise-induced pain along the distal posterior-medial aspect of the tibia. Intramuscular pressures within the posterior compartments of the leg were measured in 12 patients with this disorder. These pressures were not elevated and therefore this syndrome is a not a compartment syndrome. Available information suggests that the medial tibial stress syndrome most likely represents a periostitis at this location of the leg.

  14. Metachronous Bilateral Posterior Tibial Artery Aneurysms in Ehlers-Danlos Syndrome Type IV

    International Nuclear Information System (INIS)

    Hagspiel, Klaus D.; Bonatti, Hugo; Sabri, Saher; Arslan, Bulent; Harthun, Nancy L.

    2011-01-01

    Ehlers-Danlos syndrome type IV is a life-threatening genetic connective tissue disorder. We report a 24-year-old woman with EDS-IV who presented with metachronous bilateral aneurysms/pseudoaneurysms of the posterior tibial arteries 15 months apart. Both were treated successfully with transarterial coil embolization from a distal posterior tibial approach.

  15. End-threaded intramedullary positive profile screw ended self-tapping pin (Admit pin) - A cost-effective novel implant for fixing canine long bone fractures.

    Science.gov (United States)

    Chanana, Mitin; Kumar, Adarsh; Tyagi, Som Prakash; Singla, Amit Kumar; Sharma, Arvind; Farooq, Uiase Bin

    2018-02-01

    The current study was undertaken to evaluate the clinical efficacy of end-threaded intramedullary pinning for management of various long bone fractures in canines. This study was conducted in two phases, managing 25 client-owned dogs presented with different fractures. The technique of application of end-threaded intramedullary pinning in long bone fractures was initially standardized in 6 clinical patients presented with long bone fractures. In this phase, end-threaded pins of different profiles, i.e., positive and negative, were used as the internal fixation technique. On the basis of results obtained from standardization phase, 19 client-owned dogs clinically presented with different fractures were implanted with end-threaded intramedullary positive profile screw ended self-tapping pin in the clinical application phase. The patients, allocated randomly in two groups, when evaluated postoperatively revealed slight pin migration in Group-I (negative profile), which resulted in disruption of callus site causing delayed union in one case and large callus formation in other two cases whereas no pin migration was observed in Group-II (positive profile). Other observations in Group-I was reduced muscle girth and delayed healing time as compared to Group-II. In clinical application, phase 21 st and 42 nd day post-operative radiographic follow-up revealed no pin migration in any of the cases, and there was no bone shortening or fragment collapse in end-threaded intramedullary positive profile screw ended self-tapping pin. The end-threaded intramedullary positive profile screw ended self-tapping pin used for fixation of long bone fractures in canines can resist pin migration, pin breakage, and all loads acting on the bone, i.e., compression, tension, bending, rotation, and shearing to an extent with no post-operative complications.

  16. A posterior tibial tendon skipping rope

    NARCIS (Netherlands)

    van Sterkenburg, M. N.; Haverkamp, D.; van Dijk, C. N.; Kerkhoffs, G. M. M. J.

    2010-01-01

    This report presents an athletic patient with swelling and progressive pain on the posteromedial side of his right ankle on weight bearing. MRI demonstrated tenosynovitis and suspicion of a length rupture. On posterior tibial tendoscopy, there was no rupture, but medial from the tendon a tissue cord

  17. Quadriceps force and anterior tibial force occur obviously later than vertical ground reaction force: a simulation study

    OpenAIRE

    Ueno, Ryo; Ishida, Tomoya; Yamanaka, Masanori; Taniguchi, Shohei; Ikuta, Ryohei; Samukawa, Mina; Saito, Hiroshi; Tohyama, Harukazu

    2017-01-01

    Background: Although it is well known that quadriceps force generates anterior tibial force, it has been unclear whether quadriceps force causes great anterior tibial force during the early phase of a landing task. The purpose of the present study was to examine whether the quadriceps force induced great anterior tibial force during the early phase of a landing task. Methods: Fourteen young, healthy, female subjects performed a single-leg landing task. Muscle force and anterior tibial force w...

  18. 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

  19. Fraturas do planalto tibial Tibial plateau fractures

    Directory of Open Access Journals (Sweden)

    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

  20. Comparing two intramedullary devices for treating trochanteric fractures: A prospective study

    Directory of Open Access Journals (Sweden)

    Kontogeorgakos Vasileios

    2010-02-01

    Full Text Available Abstract Background Intertrochanteric fractures are surgically treated by using different methods and implants. The optional type of surgical stabilization is still under debate. However, between devices with the same philosophy, different design characteristics may substantially influence fracture healing. This is a prospective study comparing the complication and final functional outcome of two intramedullary devices, the intramedullary hip screw (IMHS and the ENDOVIS nail. Materials and methods Two hundred fifteen patients were randomized on admission in two treatment groups. Epidemiology features and functional status was similar between two treatment groups. Fracture stability was assessed according to the Evan's classification. One hundred ten patients were treated with IMHS and 105 with ENDOVIS nail. Results There were no significant statistical differences between the two groups regarding blood loss, transfusion requirements and mortality rate. In contrast, the number of total complications was significantly higher in the ENDOVIS nail group. Moreover, the overall functional and walking competence was superior in the patients treated with the IMHS nail. Conclusions These results indicate that the choice of the proper implant plays probably an important role in the final outcome of surgical treatment of intertrochanteric fractures. IMHS nail allows for accurate surgical technique, for both static and dynamic compression and high rotational stability. IMHS nail proved more reliable in our study regarding nail insertion and overall uncomplicated outcome.

  1. 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

  2. Mandibular second premolar with three canals: Re-treatment of a case with unusual root canal anatomy

    Directory of Open Access Journals (Sweden)

    Niranjan Desai

    2011-01-01

    Full Text Available A thorough knowledge of root canal anatomy along with the anatomical variations that may be present is essential for success of endodontic therapy. Unusual presentations in the number of the roots or the canals should be expected in every tooth. Mandibular second premolars are thought of as having a single root and canal. Studies have stated that the prevalence of three canals with three orifices in this tooth is 0.4%. The mandibular second premolar is particularly difficult to treat owing to the fact that a wide variation in the number, location and curvature of the roots and canals exist. Added to this is the fact that the access opening is restricted and location of the lingually placed orifices is difficult. This case report details the re-treatment of a mandibular second premolar with three canals and three separate orifices using the surgical microscope.

  3. 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....

  4. 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.

  5. What is the optimal alignment of the tibial and femoral components in knee arthroplasty?

    DEFF Research Database (Denmark)

    Gromov, Kirill; Korchi, Mounim; Thomsen, Morten G

    2014-01-01

    of positioning on survival and functional outcome was considered. Results - Many definitions exist when evaluating placement of femoral and tibial components. Implant alignment plays a role in both survival and functional outcome following primary TKA, as component malalignment can lead to increased failure......Background - Surgeon-dependent factors such as optimal implant alignment are thought to play a significant role in outcome following primary total knee arthroplasty (TKA). Exact definitions and references for optimal alignment are, however, still being debated. This overview of the literature...... describes different definitions of component alignment following primary TKA for (1) tibiofemoral alignment in the AP plane, (2) tibial and femoral component placement in the AP plane, (3) tibial and femoral component placement in the sagittal plane, and (4) rotational alignment of tibial and femoral...

  6. Open wedge high tibial osteotomy using three-dimensional printed models: Experimental analysis using porcine bone.

    Science.gov (United States)

    Kwun, Jun-Dae; Kim, Hee-June; Park, Jaeyoung; Park, Il-Hyung; Kyung, Hee-Soo

    2017-01-01

    The purpose of this study was to evaluate the usefulness of three-dimensional (3D) printed models for open wedge high tibial osteotomy (HTO) in porcine bone. Computed tomography (CT) images were obtained from 10 porcine knees and 3D imaging was planned using the 3D-Slicer program. The osteotomy line was drawn from the three centimeters below the medial tibial plateau to the proximal end of the fibular head. Then the osteotomy gap was opened until the mechanical axis line was 62.5% from the medial border along the width of the tibial plateau, maintaining the posterior tibial slope angle. The wedge-shaped 3D-printed model was designed with the measured angle and osteotomy section and was produced by the 3D printer. The open wedge HTO surgery was reproduced in porcine bone using the 3D-printed model and the osteotomy site was fixed with a plate. Accuracy of osteotomy and posterior tibial slope was evaluated after the osteotomy. The mean mechanical axis line on the tibial plateau was 61.8±1.5% from the medial tibia. There was no statistically significant difference (P=0.160). The planned and post-osteotomy correction wedge angles were 11.5±3.2° and 11.4±3.3°, and the posterior tibial slope angle was 11.2±2.2° pre-osteotomy and 11.4±2.5° post-osteotomy. There were no significant differences (P=0.854 and P=0.429, respectively). This study showed that good results could be obtained in high tibial osteotomy by using 3D printed models of porcine legs. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain

    Energy Technology Data Exchange (ETDEWEB)

    Jones, R.B. [Dept. of Physiology, School of Medicine, East Carolina Univ., Greenville, NC (United States); Bartlett, E.C. [Dept. of Surgery, School of Medicine, East Carolina Univ., Greenville, NC (United States); Vainright, J.R. [Dept. of Radiology, School of Medicine, East Carolina Univ., Greenville, NC (United States); Carrol, R.G. [Dept. of Physiology, School of Medicine, East Carolina Univ., Greenville, NC (United States)

    1995-10-01

    Using CT imaging with computerized technique to measure anatomic relationships, we evaluated patients (n = 50) with anterior knee pain for excessive lateralization of the tibial tubercle. The symptomatic knee of each patient was compared with their asymptomatic knee as well as with the knees of patients with other causes of anterior knee pain (n = 10) and with the knees of asymptomatic controls (n = 10). The symptomatic knee of patients with suspected patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle (12.2 {+-} 0.5 mm) than did the asymptomatic knee (9.0 {+-} 0.7 mm). The symptomatic knees of patients with patellofemoral malalignment also demonstrated significantly greater lateralization of the tibial tubercle than did the knees of patients with other causes of anterior knee pain (5.9 {+-} 0.9 mm). When a control population was added to the analysis, the patients with symptomatic patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle than did the controls (6.4 {+-} 0.4 mm). Using a critical value of 9 mm lateralization, the CT diagnosis of patellofemoral malalignment had a specificity of 95% and a sensitivity of 85%. We conclude that CT determination of tibial tubercle position assists the diagnosis of patellofemoral malalignment. (orig./MG)

  8. CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain

    International Nuclear Information System (INIS)

    Jones, R.B.; Bartlett, E.C.; Vainright, J.R.; Carrol, R.G.

    1995-01-01

    Using CT imaging with computerized technique to measure anatomic relationships, we evaluated patients (n = 50) with anterior knee pain for excessive lateralization of the tibial tubercle. The symptomatic knee of each patient was compared with their asymptomatic knee as well as with the knees of patients with other causes of anterior knee pain (n = 10) and with the knees of asymptomatic controls (n = 10). The symptomatic knee of patients with suspected patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle (12.2 ± 0.5 mm) than did the asymptomatic knee (9.0 ± 0.7 mm). The symptomatic knees of patients with patellofemoral malalignment also demonstrated significantly greater lateralization of the tibial tubercle than did the knees of patients with other causes of anterior knee pain (5.9 ± 0.9 mm). When a control population was added to the analysis, the patients with symptomatic patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle than did the controls (6.4 ± 0.4 mm). Using a critical value of 9 mm lateralization, the CT diagnosis of patellofemoral malalignment had a specificity of 95% and a sensitivity of 85%. We conclude that CT determination of tibial tubercle position assists the diagnosis of patellofemoral malalignment. (orig./MG)

  9. Posterior tibial neuropathy by a Baker's cyst: case report.

    Science.gov (United States)

    Lee, J H; Jun, J B; Lee, H S; Yun, H R; Choi, C H; Park, S B; Hong, E K; Yoo, D H; Kim, S Y

    2000-01-01

    Baker's cysts are rare cause of peripheral nerve entrapment and only a few cases of tibial nerve entrapment resulting from the popliteal cyst in the calf muscle have been reported in the literature. We present a case of rheumatoid arthritis complicated by a Baker's cyst with a tibial nerve entrapment. It is important to diagnose a Baker's cyst early and to differentiate it from thrombophlebitis, a popliteal aneurysm, tumor or muscle tear to effect optimal therapy and to obviate a potential neuropathy. Prompt recognition of these cases may save the patients unnecessary procedures and delay in treatment.

  10. Tibial and fibular angles in homozygous sickle cell disease

    International Nuclear Information System (INIS)

    Akamaguna, A.I.; Odita, J.C.; Ugbodaga, C.I.; Okafor, L.A.

    1986-01-01

    Measurements of the tibial and fibular angles made on ankle radiographs of 34 patients with sickle cell disease were compared with those of 36 normal Nigerians. Widening of the fibular angle, which is an indication of tibiotalar slant, was demonstrated in about 79% of sickle cell disease patients. By using fibular angle measurements as an objective method of assessing subtle tibiotalar slant, it is concluded that the incidence of this deformity is much higher among sickle cell disease patients than previously reported. The mean values of tibial and fibular angles in normal Nigerians are higher than has been reported amongst Caucasians. (orig.)

  11. Quality of life after antegrade intramedullary nail fixation of humeral fractures: a survey in a selected cohort of Brazilian patients.

    Science.gov (United States)

    Cocco, Luiz Fernando; Ejnisman, Benno; Belangero, Paulo Santoro; Cohen, Moises; Dos Reis, Fernando Baldy

    2018-01-01

    The treatment of humeral fractures remains controversial. Systematic reviews demonstrate similar results between dynamic compression plating and locked intramedullary nailing in the surgical treatment of these fractures. However, it appears that antegrade intramedullary nailing causes higher residual pain in the shoulder. The proposal of this work is to evaluate through the WORC protocol (Western Ontario Rotator Cuff Index) the consequences in the quality of life of patients submitted to osteosynthesis of the humerus with antegrade locked intramedullary nailing. This work is a cohort retrospective study in addition to the application of a questionnaire for self-rated quality of life with its 05 domains (WORC - Western Ontario Rotator Cuff Index) for patients ( N  = 26) classified in the Trauma Sector of the Department of Orthopedics and Traumatology of the Federal University of São Paulo (DOT/UNIFESP) submitted to Humerus Osteosynthesis with Antegrade Locked Intramedullary Nailing. There was also the inclusion of data related to the time since surgery, age, sex, surgical laterality, dominance among members and work leave, which were not considered in the original protocol. After, the data were statistically assessed to evaluate the association between numerical and categorical variables. The overall WORC score was 82.75 ± 17.00 (Mean ± SD) and was not different considering sex, age and postoperative period. Among the WORC domains, both Work and Sport / Recreation Protocols were the most unfavorable factors in the evaluation of patients. Although not statistically significant, those who had the procedure on the dominant side presented a lower quality of life score than those who had the surgery on the non-dominant side. Although non-significant again, those who were away from work had an overall lower quality of life score than those who were not. The WORC Quality of Life Protocol shows good results for evaluating patients submitted to humerus

  12. Sphenoid Sinus Carcinoma with Intramedullary Spinal Cord Metastasis and Syringomyelia - Report of A Case -

    International Nuclear Information System (INIS)

    Oh, Yoon Kyeong; Kim, Young Sook

    1996-01-01

    Purpose : Primary sphenoid carcinoma is rare. It accounts for 0.3% of all primary paranasal sinus malignancies. Because of the rarity of sphenoid carcinoma, large series of patients with outcome and survival statistics are currently unavailable. So we followed up the 1 case of sphenoid sinus carcinoma treated in our hospital and reported the course of the disease. In a review of case reports and small series of patients, 2-year survival was 7%. Our case is alive at 29 months after diagnosis of sphenoid sinus carcinoma. Intramedullary spinal cord metastasis (ISCM) is an unusual complication of cancer. In our case rapidly progressive paraparesis and urinary retention developed at 25 months after diagnosis of sphenoid sinus carcinoma. MRI of the thoracic spines showed the intramedullary spinal cord tumor mass at T3 and T4 level with accompanying syringomyelia. Here we report a case of ISCM associated with syringomyelia which has developed after primary sphenoid sinus carcinoma with a review of literature about the clinical behavior and treatment of this lesion

  13. Complications and functional recovery in treatment of femoral shaft fractures with unreamed intramedullary nailing.

    Science.gov (United States)

    Sadic, Sahmir; Custovic, Svemir; Smajic, Nedim; Fazlic, Mirsad; Vujadinovic, Aleksandar; Hrustic, Asmir; Jasarevic, Mahir

    2014-01-01

    Fracture of the femoral shaft is a common fracture encountered in orthopedic practice. In the 1939, Küntscher introduced the concept of intramedullary nailing for stabilization of long bone fractures. Intramedullary nailing has revolutionized the treatment of fractures. The study included 37 male patients and 13 female patients, averaged 39 +/- 20.5 years (range, 16 to 76 years). There were 31 left femurs and 21 right femurs fractured. 46 fractures were the result of blunt trauma. Low energy trauma was the cause of fractures in six patients, of which five in elderly females. 49 fractures were closed. Healing time given in weeks was 19.36 +/- 6.1. The overall healing rate was 93.6%. There were three (6.25%) major complications nonunion. There were one (2%) delayed union, one (2%) rotational malunion and no infection. The shortening of 1 cm were in two patients. Antercurvatum of 10 degrees was found in one patient. There was no statistically significant reduction of a motion in the hip and knee (p knee extensors) muscle weakness (p fractures.

  14. Open grade III fractures of femoral shaft: Outcome after early reamed intramedullary nailing.

    Science.gov (United States)

    Singh, D; Garg, R; Bassi, J L; Tripathi, S K

    2011-09-01

    Open grade III fractures of femur are a challenging therapeutic problem as most of them are associated with multiple trauma. Method used for skeletal stabilization of these fractures should limit further soft tissue damage, bacterial spread and morbidity in addition to its ease of application, providing mechanical support and restoring normal alignment. Forty-six patients with open grade III fractures of femoral shaft were included in the study. There were 10 grade IIIA, 34 grade IIIB and two grade IIIC fractures that were treated with early reamed intramedullary nailing with adequate management of soft tissue. Patients were reviewed retrospectively. Mean time of union was 27 weeks. Infection rate was 4% and non-union rate was 9%. There were two cases (4%) with limb shortening. No case of angular or rotational deformity was noted. Early reamed intramedullary nailing for open grade III fractures of femoral shaft, after giving due respect to the soft tissue injury, gives satisfactory results with proper alignment, good range of motion, short rehabilitation period and low infection rate. Level IV. Retrospective therapeutic study. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  15. Passive Posterior Tibial Subluxation on Routine Knee MRI as a Secondary Sign of PCL Tear

    International Nuclear Information System (INIS)

    Degnan, A.J.; Adam, R.J.; Maldjian, C.; Harner, Ch.D.

    2014-01-01

    The posterior drawer test is an accurate clinical test to diagnose posterior cruciate ligament (PCL), indicating laxity of the PCL that allows posterior tibial translation. This study aimed to determine whether posterior tibial translation relative to the femur on routine MRI could serve as an additional sign of PCL tear. Routine knee MRI in eleven patients (7 males, 4 females) with arthroscopically confirmed isolated PCL tears were reviewed independently by two musculoskeletal radiologists. Measurements of tibial translation were made in the medial and lateral compartments of patients and controls (10 males, 12 females) without clinical or MRI evidence of ligament injury. Significant medial compartment posterior tibial translation was present in patients with PCL tear compared to controls (+2.93 mm versus +0.03 mm, Ρ=0.002) with excellent interobserver agreement (intraclass correlation coefficient (ICC) = 0.94). No significant difference in lateral compartment tibial translation was observed (+0.17 mm versus -0.57 mm, Ρ=0.366) despite excellent interobserver agreement (ICC = 0.96). Posterior tibial translation in the midmedial compartment may be a secondary sign of isolated PCL tear on routine knee MRI with passive extension without manipulation or weight bearing. Additional work in a larger cohort may better address the accuracy of this finding

  16. Ischial hypoplasia, tibial hypoplasia and facial abnormalities: a new syndrome?

    International Nuclear Information System (INIS)

    Nishimura, G.; Haga, Yoshihiko; Aoki, Katsuhiko; Hasegawa, Tomoko

    1998-01-01

    A child with facial abnormalities, short stature and a variety of skeletal alterations is reported. The facial abnormalities comprised low-set ears, short nose with a long philtrum, micrognathia and cleft palate. The skeletal alterations included ischial hypoplasia, malformations of the cervical spine, hypoplasia of the lesser trochanters, tibial hypoplasia with bowing of the lower legs, tibio-fibular diastasis with malformed distal tibial epiphyses, clubfeet and brachymesophalangy. The constellation of clinical and radiological findings in the present patient do not fit any known malformation syndrome. (orig.)

  17. Posterior Tibial Neuropathy by a Baker’s Cyst: Case Report

    OpenAIRE

    Lee, Ji-Hyun; Jun, Jae-Bum; Choi, Choong-Hyeok; Park, Si-Bog; Yoo, Dae-Hyun; Hong, Eun-Kyung; Kim, Seong Yoon

    2000-01-01

    Baker’s cysts are rare cause of peripheral nerve entrapment and only a few cases of tibial nerve entrapment resulting from the popliteal cyst in the calf muscle have been reported in the literature. We present a case of rheumatoid arthritis complicated by a Baker’s cyst with a tibial nerve entrapment. It is important to diagnose a Baker’s cyst early and to differentiate it from thrombophlebitis, a popliteal aneurysm, tumor or muscle tear to effect optimal therapy and to obviate a potential ne...

  18. The enlargement of geniculate fossa of facial nerve canal: a new CT finding of facial nerve canal fracture

    International Nuclear Information System (INIS)

    Gong Ruozhen; Li Yuhua; Gong Wuxian; Wu Lebin

    2006-01-01

    Objective: To discuss the value of enlargement of geniculate fossa of facial nerve canal in the diagnosis of facial nerve canal fracture. Methods: Thirty patients with facial nerve canal fracture underwent axial and coronal CT scan. The correlation between the fracture and the enlargement of geniculate fossa of facial nerve canal was analyzed. The ability of showing the fracture and enlargement of geniculate fossa of facial nerve canal in axial and coronal imaging were compared. Results: Fracture of geniculate fossa of facial nerve canal was found in the operation in 30 patients, while the fracture was detected in CT in 18 patients. Enlargement of geniculate ganglion of facial nerve was detected in 30 patients in the operation, while the enlargement of fossa was found in CT in 28 cases. Enlargement and fracture of geniculate fossa of facial nerve canal were both detected in CT images in 18 patients. Only the enlargement of geniculate fossa of facial nerve canal was shown in 12 patients in CT. Conclusion: Enlargement of geniculate fossa of facial nerve canal was a useful finding in the diagnosis of fracture of geniculate fossa in patients with facial paralysis, even no fracture line was shown on CT images. (authors)

  19. Quantitative Comparison of the Microscopic Anatomy of the Human ACL Femoral and Tibial Entheses

    Science.gov (United States)

    Beaulieu, Mélanie L.; Carey, Grace E.; Schlecht, Stephen H.; Wojtys, Edward M.; Ashton-Miller, James A.

    2015-01-01

    The femoral enthesis of the human anterior cruciate ligament (ACL) is known to be more susceptible to injury than the tibial enthesis. To determine whether anatomic differences might help explain this difference, we quantified the microscopic appearance of both entheses in 15 unembalmed knee specimens using light microscopy, toluidine blue stain and image analysis. The amount of calcified fibrocartilage and uncalcified fibrocartilage, and the ligament entheseal attachment angle were then compared between the femoral and tibial entheses via linear mixed-effects models. The results showed marked differences in anatomy between the two entheses. The femoral enthesis exhibited a 3.9-fold more acute ligament attachment angle than the tibial enthesis (p fibrocartilage tissue area (p fibrocartilage depth (p fibrocartilage and a more acute ligament attachment angle than the tibial enthesis, which provides insight into why it is more vulnerable to failure. PMID:26134706

  20. Industrial canal waterfronts in The Netherlands : transforming the canal zones of B5

    NARCIS (Netherlands)

    Curulli, G.I.

    2012-01-01

    Industrial Canal Waterfronts in The Netherlands provides a comprehensive presentation of the characteristics and challenges of five interconnected and dismissed industrial canal zones located in the Dutch Brabant cities of Eindhoven, Breda, Tilburg, s’-Hertogenbosch and Helmond (B5). Through the

  1. Diagnosis and root canal treatment in a mandibular premolar with three canals.

    Science.gov (United States)

    Soares, Lanuce Rosa; Arruda, Marcos; de Arruda, Marcos Pôrto; Rangel, Andréa Leão; Takano, Edson; de Carvalho Júnior, Jacy Ribeiro; Saquy, Paulo Cesar

    2009-01-01

    This paper presents a case report of a left mandibular second premolar with three canals and three different apical foramina. A 39-year-old male patient presented to our clinic with pain in the mandibular left second premolar. Initially, pain was caused by cold stimulus and later was spontaneously. The intraoral clinical examination revealed a fractured amalgam restoration with occlusal caries. Percussion and cold (Endo-Frost) tests were positive. The radiographic examination showed the presence of two roots. The probable diagnosis was an acute pulpitis. After access cavity, it was observed remaining roof of the pulp chamber and mild bleeding in the tooth lingual area, indicating the possible presence of a third canal. The endodontic treatment was completed in a single session using Root ZX apex locator and K3 NiTi rotary system with surgical diameter corresponding to a .02/45 file in the three canals and irrigation with 1% sodium hypochlorite. The canals were obtured with gutta-percha cones and Sealer 26 using the lateral condensation technique. After 1 year of follow-up, the tooth was asymptomatic and periapical repair was observed radiographically. Internal alterations should be considered during the endodontic treatment of mandibular second premolars. The correct diagnosis of these alterations by the analysis of preoperative radiographs can help the location of two or more canals, thereby avoiding root therapy failure.

  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. Ischial hypoplasia, tibial hypoplasia and facial abnormalities: a new syndrome?

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, G. [Department of Radiology, Dokkyo University School of Medicine (Japan); Haga, Yoshihiko [Department of Orthopaedics, Shizuoka Children`s Hospital, Shizuoka (Japan); Aoki, Katsuhiko [Department of Radiology, Shizuoka Children`s Hospital, Shizuoka (Japan); Hasegawa, Tomoko [Division of Clinical Genetics, Shizuoka Children`s Hospital, Shizuoka (Japan)

    1998-12-01

    A child with facial abnormalities, short stature and a variety of skeletal alterations is reported. The facial abnormalities comprised low-set ears, short nose with a long philtrum, micrognathia and cleft palate. The skeletal alterations included ischial hypoplasia, malformations of the cervical spine, hypoplasia of the lesser trochanters, tibial hypoplasia with bowing of the lower legs, tibio-fibular diastasis with malformed distal tibial epiphyses, clubfeet and brachymesophalangy. The constellation of clinical and radiological findings in the present patient do not fit any known malformation syndrome. (orig.) With 4 figs., 8 refs.

  4. 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.

  5. Does Tibial Slope Affect Perception of Coronal Alignment on a Standing Anteroposterior Radiograph?

    Science.gov (United States)

    Schwartz, Adam J; Ravi, Bheeshma; Kransdorf, Mark J; Clarke, Henry D

    2017-07-01

    A standing anteroposterior (AP) radiograph is commonly used to evaluate coronal alignment following total knee arthroplasty (TKA). The impact of coronal alignment on TKA outcomes is controversial, perhaps due to variability in imaging and/or measurement technique. We sought to quantify the effect of image rotation and tibial slope on coronal alignment. Using a standard extramedullary tibial alignment guide, 3 cadaver legs were cut to accept a tibial tray at 0°, 3°, and 7° of slope. A computed tomography scan of the entire tibia was obtained for each specimen to confirm neutral coronal alignment. Images were then obtained at progressive 10° intervals of internal and external rotation up to 40° maximum in each direction. Images were then randomized and 5 blinded TKA surgeons were asked to determine coronal alignment. Continuous data values were transformed to categorical data (neutral [0], valgus [L], and varus [R]). Each 10° interval of external rotation of a 7° sloped tibial cut (or relative internal rotation of a tibial component viewed in the AP plane) resulted in perception of an additional 0.75° of varus. The slope of the proximal tibia bone cut should be taken into account when measuring coronal alignment on a standing AP radiograph. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Hydrocele of the canal of Nuck

    Directory of Open Access Journals (Sweden)

    Nourah ALSaleh

    2018-02-01

    Full Text Available Hydrocele of the canal of Nuck is a rare condition in female children caused by a failure of complete obliteration of the canal of Nuck. The canal of Nuck is an abnormal patent pouch of the peritoneum extending anterior to the round ligament of the uterus into the labia majora. Incomplete obliteration of this canal (patent processus vaginalis can result in either an inguinal hernia or a hydrocele. Here, we report two cases of hydrocele of the canal of Nuck presented within a two-month period. In the first case, incarcerated right-sided inguinal hernia was suspected while the second case was clinically diagnosed as encysted hydrocele of canal of Nuck. Both patients underwent surgical exploration. Hydrocelectomy with high ligation was also performed. One month after the surgery, the first patient showed signs of hydrocele on contralateral side, while the other patient showed no sign of contralateral hydrocele or hernia.

  7. Assessment of three root canal preparation techniques on root canal geometry using micro-computed tomography: In vitro study

    Directory of Open Access Journals (Sweden)

    Shaikha M Al-Ali

    2012-01-01

    Full Text Available Aim: To assess the effects of three root canal preparation techniques on canal volume and surface area using three-dimensionally reconstructed root canals in extracted human maxillary molars. Materials and Methods: Thirty extracted Human Maxillary Molars having three separate roots and similar root shape were randomly selected from a pool of extracted teeth for this study and stored in normal saline solution until used. A computed tomography scanner (Philips Brilliance CT 64-slice was used to analyze root canals in extracted maxillary molars. Specimens were scanned before and after canals were prepared using stainless steel K-Files, Ni-Ti rotary ProTaper and rotary SafeSiders instruments. Differences in dentin volume removed, the surface area, the proportion of unchanged area and canal transportation were calculated using specially developed software. Results: Instrumentation of canals increased volume and surface area. Statistical analysis found a statistically significant difference among the 3 groups in total change in volume (P = 0.001 and total change in surface area (P = 0.13. Significant differences were found when testing both groups with group III (SafeSiders. Significant differences in change of volume were noted when grouping was made with respect to canal type (in MB and DB (P < 0.05. Conclusion: The current study used computed tomography, an innovative and non destructive technique, to illustrate changes in canal geometry. Overall, there were few statistically significant differences between the three instrumentation techniques used. SafeSiders stainless steel 40/0.02 instruments exhibit a greater cutting efficiency on dentin than K-Files and ProTaper. CT is a new and valuable tool to study root canal geometry and changes after preparation in great details. Further studies with 3D-techniques are required to fully understand the biomechanical aspects of root canal preparation.

  8. [Intramedullary nailing of the tibia with the expert tibia nail].

    Science.gov (United States)

    Hansen, Matthias; El Attal, René; Blum, Jochen; Blauth, Michael; Rommens, Pol Maria

    2009-12-01

    Restoration of axis, length, and rotation of the lower leg. Sufficient primary stability of the osteosynthesis for functional aftercare. Early functional aftercare to maintain joint mobility. Good bony healing in closed and open fractures. All closed and open fractures of the tibia and complete lower leg fractures (AO 42). Certain extraarticular fractures of the proximal and distal tibia (AO 41 A2/A3; AO 43 A1/A2/A3). Segmental fractures of the tibia. Certain intraarticular fractures of the tibia with use of additional implants (AO 41 C1/C2; AO 43 C1/C2). Stabilization during and after segmental bone transport or callus distraction of the tibia. Patients in poor general condition (e.g., bedridden). Flexion of the knee of less than 90 degrees . Infection in the nail's insertion area. Infection of the tibial cavity. Complex articular fractures of the proximal or distal tibia with joint depression. Closed reduction of the fracture. If necessary, use of reduction clamps through additional stab incisions or open surgical procedures. In some cases, additional osteosynthesis procedures are necessary (e.g., screws). Positioning of the patient may be performed on a radiolucent table or a traction table. Opening of the proximal tibia in line with the medullary canal. Cannulated or noncannulated insertion of the Expert Tibia Nail((R)) with or without reaming of the medullary canal depending on the fracture type and soft-tissue condition. Control of axis, length, and rotation. Distal interlocking with the radiolucent drill and proximal interlocking with the targeting device. Immediate mobilization of ankle joint and knee joint. Depending on the type of fracture, mobilization with 20 kg partial weight bearing or pain-dependent full weight bearing with crutches. X-ray control 6 weeks postoperatively and increased weight bearing depending on the fracture status. In a prospective, international multicentric study, 181 patients with 186 fractures were included between July 2004 and

  9. 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.

  10. 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.

  11. The occult nature of intramedullary spinal cord metastases from renal cell carcinoma.

    LENUS (Irish Health Repository)

    Zakaria, Zaitun

    2012-01-01

    Renal cell carcinomas (RCC) are characterised by a tendency to metastasise widely, often while remaining occult. Intramedullary spinal cord metastases (ISCM) from RCC may be the presenting feature of the disease or present at any time in the disease course. This case report discusses an ISCM from RCC which became manifested at the time of resection of the primary tumour. We review the literature published on ISCM from RCC from 1990 to date comparing disease characteristics and presentations.

  12. The Effect of Patient-Specific Instrumentation Incorporating an Extramedullary Tibial Guide on Operative Efficiency for Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Oh-Ryong Kwon

    2017-01-01

    Full Text Available This retrospective study was to determine if patient-specific instrumentation (PSI for total knee arthroplasty (TKA leads to shortened surgical time through increased operating room efficiency according to different tibial PSI designs. 166 patients underwent primary TKA and were categorized into three groups as follows: PSI without extramedullary (EM tibial guide (group 1, n=48, PSI with EM tibial guide (group 2, n=68, and conventional instrumentation (CI group (group 3, n=50. Four factors were compared between groups, namely, operative room time, thickness of bone resection, tibial slope, and rotation of the component. The mean surgical time was significantly shorter in the PSI with EM tibial guide group (group 2, 63.9±13.6 min compared to the CI group (group 3, 82.8±24.9 min (P<0.001. However, there was no significant difference in the PSI without EM tibial guide group (group 1, 75.3±18.8 min. This study suggests that PSI incorporating an EM tibial guide may lead to high operative efficiency in TKA compared to CI. This trial is registered with KCT0002384.

  13. [True/Flex intramedullary nailing for forearm shaft fractures. Long-term results].

    Science.gov (United States)

    Trlica, J; Počepcov, I; Kočí, J; Frank, M; Holeček, T; Dědek, T

    2012-01-01

    Presentation of technical experience and the clinical and functional results of intramedullary fixation of forearm shaft fractures. Between January 1994 and December 2009, a total of 96 patients with 144 radial and/or ulnar fractures (ulna, 33; radius,15; both, 48) were treated by nailing (True/Flex®). According to the AO classification there were 22-A, 22-B and 22-C type fractures in 39 (41%), 44 (46%) and 13 (13%).cases, respectively. Of these, 82 (85%) were closed (types: 0, 48; I, 33; II, 1) and 14 (15%) were open (types: I, 13; II, 1; III, 0) fractures. Seventy-eight patients (81%) were followed up and their functional outcomes were evaluated according to the criteria of Anderson et al. The average interval between the operation and final follow-up was 28 months (15 to 96 months) The average time to surgery was 2.2 days (0 to 25 days). Early complications were recorded in 4% of the patients (1x bursitis olecrani; 1x end cup replacement; 1x bending of nails) and late complications in 15% (5x non-union; 2x delay union; 4x bursitis olecrani; 1x ruptured tendon). Bone healing was achieved in 95% of the cases and took on average 16 weeks (7 to 34 weeks). No infection, refracture or synostosis occurred. Primary loss of reduction was recorded in four cases due to distraction in one, bent nails in two and a wrong size of the implant in one; secondary loss of reduction was found in three cases, with two cases of radius shortening and one 10°malrotation. No primary malrotation was recorded, but secondary loss of alignment was seen in the distal part of the radius and the proximal part of the ulna. Functional results according to the Anderson criteria were excellent and good in 87% of the cases. Intramedullary mailing provides good stability to mid- and distal-third shaft fractures of the ulna and mid- and proximalthird shaft fractures of the radius, particularly in AO type A and type B fractures. The technical aspects of the method are analysed in detail in this paper

  14. 21 CFR 872.3810 - Root canal post.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Root canal post. 872.3810 Section 872.3810 Food... DEVICES DENTAL DEVICES Prosthetic Devices § 872.3810 Root canal post. (a) Identification. A root canal... of the platinum group intended to be cemented into the root canal of a tooth to stabilize and support...

  15. 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.

  16. Semiconductor laser irradiation improves root canal sealing during routine root canal therapy

    Science.gov (United States)

    Hu, Xingxue; Wang, Dashan; Cui, Ting; Yao, Ruyong

    2017-01-01

    Objective To evaluate the effect of semiconductor laser irradiation on root canal sealing after routine root canal therapy (RCT). Methods Sixty freshly extracted single-rooted human teeth were randomly divided into six groups (n = 10). The anatomic crowns were sectioned at the cementoenamel junction and the remaining roots were prepared endodontically with conventional RCT methods. Groups A and B were irradiated with semiconductor laser at 1W for 20 seconds; Groups C and D were ultrasonically rinsed for 60 seconds as positive control groups; Groups E and F without treatment of root canal prior to RCT as negative control groups. Root canal sealing of Groups A, C and E were evaluated by measurements of apical microleakage. The teeth from Groups B, D and F were sectioned, and the micro-structures were examined with scanning electron microscopy (SEM). One way ANOVA and LSD-t test were used for statistical analysis (α = .05). Results The apical sealing of both the laser irradiated group and the ultrasonic irrigated group were significantly different from the control group (pirrigated group (p>0.5). SEM observation showed that most of the dentinal tubules in the laser irradiation group melted, narrowed or closed, while most of the dentinal tubules in the ultrasonic irrigation group were filled with tooth paste. Conclusion The application of semiconductor laser prior to root canal obturation increases the apical sealing of the roots treated. PMID:28957407

  17. 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...

  18. VAC Therapy Direct to the Medullary Cavity for Chronic Tibial Osteomyelitis.

    Science.gov (United States)

    Miyamura, Satoshi; Tsuji, Shigeyoshi; Iwai, Takao; Hamada, Masayuki

    2016-06-01

    Vacuum-assisted wound closure (VAC) is useful for difficult wound beds, although sites where bleeding or infection is expected are usually regarded as problematic for this therapy. This report outlines the treatment of chronic tibial osteomyelitis (Cierny- Mader type III) due to mixed infection with Nocardia spp and Bacteroi- des fragilis by postoperative VAC therapy direct to the medullary cavity, followed by wound coverage with a gastrocnemius myocutaneous skin flap. A 64-year-old man developed chronic left tibial os- teomyelitis after a work injury. The nonviable tissues were debrided, including a sequestrum. Nocardia spp and B. fragilis were isolated from surgical bone specimens, and chronic tibial osteomyelitis due to mixed infection was diagnosed. Postoperatively, VAC therapy was performed directly to the open medullary cavity of the tibia and sub- sequently covered the residual soft tissue defect with a gastrocnemius myocutaneous flap. The authors could not find any English literature on VAC therapy direct to the medullary cavity combined with transplantation of a myocutaneous flap for osteomyelitis. Nocardia spp can cause a variety of infections, among which osteomyelitis occupies a relatively small percentage. This case raises the possibil- ity of treating chronic tibial osteomyelitis caused by mixed infection with Nocardia spp and B. fragilis by applying postoperative VAC ther- apy directly to the medullary cavity and covering the residual wound with a gastrocnemius myocutaneous flap.

  19. Incidence of Avascular Necrosis of the Femoral Head After Intramedullary Nailing of Femoral Shaft Fractures

    Science.gov (United States)

    Kim, Ji Wan; Oh, Jong-Keon; Byun, Young-Soo; Shon, Oog-Jin; Park, Jai Hyung; Oh, Hyoung Keun; Shon, Hyun Chul; Park, Ki Chul; Kim, Jung Jae; Lim, Seung-Jae

    2016-01-01

    Abstract The goal of this study was to determine the incidence of avascular necrosis of the femoral head (AVNFH) after intramedullary nailing of femoral shaft fractures and to identify risk factors for developing AVNFH. We retrospectively reviewed all patients with femoral shaft fractures treated with antegrade intramedullary nailing at 10 institutions. Among the 703 patients enrolled, 161 patients were excluded leaving 542 patients in the study. Average age was 42.1 years with average follow-up of 26.3 months. Patient characteristics and fracture patterns as well as entry point of femoral nails were identified and the incidence of AVNFH was investigated. Patients were divided into 2 groups according to open versus closed physis, open versus closed fractures, and age (<20 versus ≥20 years). Overall incidence of AVNFH was 0.2% (1 of 542): the patient was 15-year-old boy. Of 25 patients with open physis, the incidence of AVNFH was 4%, whereas none of 517 patients with closed physis developed AVNFH (P < 0.001). The incidence of AVNFH in patients aged < 20 versus ≥20 years was 1.1% (1 of 93) and 0.0% (0 of 449), respectively (P = 0.172), which meant that the incidence of AVNFH was 0% in adult with femur shaft fracture. Of 61 patients with open fractures, the incidence of AVNFH was 0%. The number of cases with entry point at the trochanteric fossa or tip of the greater trochanter (GT) was 324 and 218, respectively, and the incidence of AVNFH was 0.3% and 0.0%, respectively (P = 0.412). In patients aged ≥20 years with isolated femoral shaft fracture, there was no case of AVNFH following antegrade intramedullary nailing regardless of the entry point. Therefore, our findings suggest that the risk of AVNFH following antegrade femoral nailing is extremely low in adult patients. PMID:26844518

  20. The clinical application of absorbable intramedullary nail and claw plate on treating multiple rib fractures.

    Science.gov (United States)

    Chai, X; Lin, Q; Ruan, Z; Zheng, J; Zhou, J; Zhang, J

    2013-08-01

    The absorption intramedullary nail and claw plate indications and efficacy were investigated in the treatment of a life-threatening multiple rib fractures. A retrospective analysis of 248 surgically treated rib fracture patients was performed who admitted to our hospital from March 2007 to December 2012. Intramedullary nailing was performed in 28 cases, a claw-type bone plate was fixed in 141 cases, and a combination of both was fixed in 79 cases. All internal fixation patients were clinically cured except 1 patient died 14 days after a massive pulmonary embolism. The patients with flail chest and floating chest wall causing respiratory and circulatory disorders were promptly corrected. Routine follow-up was from 1 to 2 years, displaced fractures were in 2 cases, and there were 11 cases of internal fixation and extraction. Internal fixation is a simple and reliable method for the treatment of multiple rib fractures. Both internal fixation materials have their pros and cons but the claw bone plate is more robust. The actual selection of appropriate treatment options helps to improve the treatment efficacy.

  1. The effect of posterior tibial slope on simulated laxity tests in cruciate-retaining TKA

    NARCIS (Netherlands)

    Marra, Marco A.; Strzelczak, Marta; Heesterbeek, Petra J.C.; van de Groes, Sebastiaan; Janssen, Dennis; Koopman, Bart F.J.M.; Wymenga, Ate B.; Verdonschot, Nico

    2017-01-01

    INTRODUCTION: Tibial slope can affect the outcomes of Total Knee Arthroplasty (TKA). More posterior slope potentially helps releasing a too tight flexion gap and it is generally associated with a wider range of post-operative knee flexion. However, the mechanism by which tibial slope affects the

  2. Bactericidal properties of silver films on intramedullary implants

    Science.gov (United States)

    Gallagher, C.; Walker, C.; Cortes, E.; Hettinger, Jeffrey; Krchnavek, R.; Caputo, G. A.; Ostrum, R.

    2011-03-01

    We report on investigations of silver films on titanium and stainless steel substrates as anti-bacterial coatings for intramedullary nails used in orthopedic trauma. Silver films are deposited using a magnetron sputtering technique from a single elemental target. The deposition parameter (energy, pressure, and temperature) dependence of the silver film microstructure and adhesion will be presented. Preliminary measurements of the effectiveness of the silver films as a bactericide on S. aureus bacteria demonstrate that the films are effective destroying the bacteria. The process of this investigation will be presented. Preliminary transmission electron microscopy measurements will also presented which image healthy and damaged bacteria helping to identify the fundamental mechanism leading to the effectiveness of silver as an anti-bacterial coating. We acknowledge the support of Rowan University, College of Liberal Arts and Sciences.

  3. The shape of the human lumbar vertebral canal A forma do canal vertebral lombar humano

    Directory of Open Access Journals (Sweden)

    Edmundo Zarzur

    1996-09-01

    Full Text Available Literature on the anatomy of the human vertebral column characterizes the shape of the lumbar vertebral canal as triangular. The purpose of the present study was to determine the precise shape of the lumbar vertebral canal. Ten lumbar vertebral columns of adult male cadavers were dissected. Two transverse sections were performed in the third lumbar vertebra. One section was performed at the level of the lower border of the ligamenta flava, and the other section was performed at the level of the pedicles. The shape of the lumbar vertebral canal at the level of the pedicles tends to be oval or circular, whereas the shape of the lumbar vertebral canal at the level of the lower border of the ligamenta flava is triangular. Thus, the shape of the human lumbar vertebral canal is not exclusively triangular, as reported in the literature. It is related to the level of the transversal section performed on the lumbar vertebra. This finding should be taken into consideration among factors involved in the spread of solutions introduced into the epidural space.A literatura sobre a anatomia da coluna vertebral descreve como sendo triangular o formato do canal vertebral na região lombar. O objetivo deste estudo é determinar a real forma do canal da coluna vertebral lombar.Dez colunas vertebrais de cadáveres de homens adultos foram dissecadas. Dois cortes transversais foram executados na terceira vértebra lombar. Um corte foi feito no nível das bordas inferiores de dois ligamentos amarelos vizinhos e o outro corte foi transversal, no nível dos pedículos. A forma do canal vertebral variou: no nível dos pedículos ela tende a ser oval ou circular e junto às bordas inferiores dos ligamentos amarelos passa a ser triangular. Portanto, a forma do canal vertebral lombar não é somente triangular; ela depende do nível em que se faz o corte transversal da vértebra. Estes achados devem ser levados em consideração entre os fatores envolvidos na difusão das

  4. 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-...

  5. [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.

  6. Dorello's Canal for Laymen: A Lego-Like Presentation.

    Science.gov (United States)

    Ezer, Haim; Banerjee, Anirban Deep; Thakur, Jai Deep; Nanda, Anil

    2012-06-01

    Objective Dorello's canal was first described by Gruber in 1859, and later by Dorello. Vail also described the anatomy of Dorello's canal. In the preceding century, Dorello's canal was clinically important, in understanding sixth nerve palsy and nowadays it is mostly important for skull base surgery. The understanding of the three dimensional anatomy, of this canal is very difficult to understand, and there is no simple explanation for its anatomy and its relationship with adjacent structures. We present a simple, Lego-like, presentation of Dorello's canal, in a stepwise manner. Materials and Methods Dorello's canal was dissected in five formalin-fixed cadaver specimens (10 sides). The craniotomy was performed, while preserving the neural and vascular structures associated with the canal. A 3D model was created, to explain the canal's anatomy. Results Using the petrous pyramid, the sixth nerve, the cavernous sinus, the trigeminal ganglion, the petorclival ligament and the posterior clinoid, the three-dimensional structure of Dorello's canal was defined. This simple representation aids in understanding the three dimensional relationship of Dorello's canal to its neighboring structures. Conclusion Dorello's canal with its three dimensional structure and relationship to its neighboring anatomical structures could be reconstructed using a few anatomical building blocks. This method simplifies the understanding of this complex anatomical structure, and could be used for teaching purposes for aspiring neurosurgeons, and anatomy students.

  7. Traumatic Dislodgement of Tibial Polyethylene Insert after a High-Flex Posterior-Stabilized Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Juan Felix Astoul Bonorino

    2015-01-01

    Full Text Available Many pathologic entities can produce a painful total knee replacement (TKR that may lead to potential prosthetic failure. Polyethylene insert dissociation from the tibial baseplate has been described most frequently after mobile-bearing and cruciate-retaining TKRs. However, only 3 tibial insert dislocations in primary fixed-bearing High-Flex posterior-stabilized TKRs have been reported. We present a new case of tibial insert dislocation in a High-Flex model that shares similarities and differences with the cases reported, facilitating the analysis of the potential causes, which still remain undefined.

  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. Treatment of humeral shaft fractures with antegrade intramedullary locking nail.

    Science.gov (United States)

    Tsourvakas, Stefanos; Alexandropoulos, Christos; Papachristos, Ioannis; Tsakoumis, Grigorios; Ameridis, Nikolaos

    2011-12-01

    Antegrade interlocked humeral nailing for stabilization of humeral fractures was introduced many years ago, and studies on this method in the orthopedic literature have shown mixed results. The purpose of this investigation was to document the clinical outcome and complications associated with the use of an antegrade intramedullary nail (T2, Stryker) for the humeral fractures. Between 2005 and 2008, 52 fractures of the humeral shaft were treated operatively with this intramedullary nail in our department. Eight patients were polytraumatized, and four patients had an open fracture. The mean age of patients was 51.7 years. Forty-eight patients had an adequate duration of clinical follow-up (a mean of 18 months) for analysis. Complications were recorded, and the time to union was measured. Shoulder and elbow functions were assessed using the Constant Score and the Morrey Score, respectively. Forty-six fractures healed, with a mean time to clinical union of 10.3 weeks. Two patients developed pseudarthroses. There were four adverse events: two proximal screws backed out, one superficial infection at the insertion point, and one fracture at the distal end of the nail. Ninety-one percentage of patients had an excellent or good shoulder function. Five further operations were necessary: two for treatment of pseudarthroses, two for removal the backed out proximal screws, and one wound debridement for superficial infection. Antegrade humeral nailing is a valid therapeutic option for stabilization of humeral shaft fractures. By strictly adhering to the operation technique, the number and the severity of complications can be reduced. When good fracture alignment and stability are obtained, uneventful bone healing with good functional results is the rule.

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

    Science.gov (United States)

    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.

  11. Microbiological examination of infected dental root canals.

    Science.gov (United States)

    Gomes, B P F A; Pinheiro, E T; Gadê-Neto, C R; Sousa, E L R; Ferraz, C C R; Zaia, A A; Teixeira, F B; Souza-Filho, F J

    2004-04-01

    The aim of this study was to investigate the root canal microbiota of primary and secondary root-infected canals and the association of constituent species with specific endodontic signs and symptoms. Microbial samples were taken from 60 root canals, 41 with necrotic pulp tissues (primary infection) and 19 with failed endodontic treatment (secondary infection). Strict anaerobic techniques were used for serial dilution, plating, incubation and identification. A total of 224 cultivable isolates were recovered belonging to 56 different bacterial species. Individual root canals yielded a maximum of 10 bacterial species. Of the bacterial isolates, 70% were either strict anaerobes or microphilic. The anaerobes most frequently isolated were: Peptostreptococcus micros (35%), Fusobacterium necrophorum (23.3%), Fusobacterium nucleatum (11.7%), Prevotella intermedia/nigrescens (16.7%), Porphyromonas gingivalis (6.7%) and Porphyromonas endodontalis (5%). The root canal microflora of untreated teeth with apical periodontitis was found to be mixed, comprising gram-negative and gram-positive and mostly anaerobic microorganisms and usually containing more than 3 species per canal. On the other hand, facultative anaerobic and gram-positive bacteria predominated in canals with failed endodontic treatment, which harbored 1-2 species per canal. Suggested relationships were found between anaerobes, especially gram-negatives, and the presence or history of pain, tenderness to percussion and swelling (PEubacterium spp. (both Pspp. (Pspp. (Pspp. (Pspp. (Pspp. (Pspp. (Pspp. (Pspp., P. micros, F. necrophorum (P<0.05). Our findings indicate potential complex interactions of species resulting in characteristic clinical pictures which cannot be achieved by individual species alone. They also indicate that the microbiota of primary infected canals with apical periodontitis differs in number and in species from the secondary infected canals by using the culture technique.

  12. External dose conversion factor from canal water

    International Nuclear Information System (INIS)

    Bhargava, Pradeep; Chitra, S.; Mhatre, Arti S.; Singh, Kapil Deo

    2016-01-01

    External dose needs to be estimated for the radioactivity discharged into the canal, as it constitutes one of the pathways of exposure to the public. Two activities are considered here: i) a walk along the bank of the canal ii) and the walk on the bridge. A concentration of 1 Bq/l is assumed here for the gross beta activity for the estimation of the dose conversion factor. A canal of width 14.39 m and the depth of 2.5 m is considered for this study. Length of the canal is taken to be infinite. Canal side wall is assumed to be the 25 cm thick concrete. Two points are selected, one on the bank, and the second on a bridge 1 m above the top surface of canal water. Dose Conversion factors for the person moving on the Bridge (at one meter above the water surface) and standing on bank of canal is estimated by using the QAD CG code for 137 Cs. Dose conversion factors for the location mentioned above are found to be 1.11E-10 Sv/hr/(Bq/l) and 1.55 E-11 Sv/hr/(Bq/l) for bridge and bank of canal respectively. (author)

  13. Clinical significance of dental root canal microflora.

    Science.gov (United States)

    Gomes, B P; Lilley, J D; Drucker, D B

    1996-01-01

    Previous work by this group has shown that a significant association exists between pain and the presence of either Prevotella or Peptostreptococcus spp. in dental root canals. The aim of this study was to examine a more extensive series of canals microbiologically, to determine whether any other particular endodontic symptoms or clinical signs showed specific associations with individual bacterial species. Seventy root canals were examined microbiologically and clinical data collected to investigate in detail such associations. Of the canals studied, 37 were associated with pain, 49 with tenderness to percussion, 23 with swelling, six with purulent exudate and 57 presented with wet root canals. Anaerobes were isolated from 70.3% of painful canals and from 29.7% of pain-free canals. Significant associations were found between (a) pain and either Prevotella spp. or peptostreptococci, both with P spp. (P Eubacterium spp. (P spp. or Pstr. micros, both with P spp. (each P Eubacterium, Peptostreptococcus, Prevotella or Propionibacterium (each P < 0.05). It was concluded that several different endodontic clinical signs and symptoms are significantly associated with specific bacterial species.

  14. El Canal del Atazar I

    Directory of Open Access Journals (Sweden)

    López de Berges y de los Santos, Emilio

    1967-03-01

    Full Text Available The Atazar Canal helps to supply Madrid with water, from the rivers Lozoya, Jarama and Sorbe. The section which operates at present starts at the Torrelaguna dam and finishes at the El Goloso reservoir. Later a further section will be added, from the Atazar dam, on the Lozoya river, to link up with the control dam at Torrelaguna. The canal capacity is 16 m3/sec, and it is 43.47 km long. It has a slope of 4/10.000. The cross section is similar to that of the Jarama canal, already built. There are interconnections between this canal and the Canal Alto, which previously supplied the high and medium part of Madrid. To overcome the ground unevenness 5 syphons have been built, the most important of which is the Colmenar Goloso syphon, which is 10.88 km in length. Construction commenced on December 10, 1962, and water reached Madrid on June 15th, 1966. The initial budget for this project was 1,500 million pesetas.El canal del Atazar refuerza considerablemente el abastecimiento de aguas a Madrid, procedentes de los ríos Lozoya, Jarama y, en un próximo futuro, del Sorbe. El tramo, actualmente en funcionamiento, empieza en el salto de Torrelaguna y finaliza en los depósitos de El Goloso. Más adelante se completará su trazado mediante un nuevo tramo que partirá del embalse de Atazar, en el Lozoya, para unirse al actual en el depósito regulador de Torrelaguna. Su capacidad es de 16 m3/s; su longitud, 43,471 km, y su pendiente, 4 diezmilésimas. La sección tipo es análoga a la del canal del Jarama, de construcción anterior. Mediante la oportuna obra de transvase se realizan intercambios entre este Canal y el Canal Alto que abastecía anteriormente la parte media y alta de la capital. Para salvar los desniveles del terreno se han construido 5 sifones, siendo el más importante el de Colmenar-Goloso, con una longitud de 10,8S4 km. El comienzo de las obras tuvo lugar el 10 de diciembre de 1962, y el agua llegó a Madrid el 15 de junio de 1966. Su

  15. Detection of Mesiobuccal Canal in Maxillary Molars and Distolingual Canal in Mandibular Molars by Dental CT: A Retrospective Study of 100 Cases

    Directory of Open Access Journals (Sweden)

    Sushma Rathi

    2010-01-01

    Full Text Available Objective. To detect presence of MB2 canal in maxillary molars and distolingual canal in mandibular molars by Dental CT. Material and Methods. A retrospective study of 100 Dental CTs was done. Axial and paraxial images obtained were used to assess the presence of MB2 canal in maxillary molars and distolingual canal in mandibular molars. Results. The youngest patient was of 11 years while the eldest patient was of 77 years. Males were 58 in number and females were 42 in number. MB2 canals were present in 57 patients and distolingual canal was present in 18 patients. Maximum MB2 canals were present in age group between 51 and 60 years, while distolingual canals were present in age group of 21–30 years. Conclusion. Dental CT allows adequate visualization of variation in root canal morphology and can be important diagnostic tool for successful endodontic therapy.

  16. [The geometry of the keel determines the behaviour of the tibial tray against torsional forces in total knee replacement].

    Science.gov (United States)

    García David, S; Cortijo Martínez, J A; Navarro Bermúdez, I; Maculé, F; Hinarejos, P; Puig-Verdié, L; Monllau, J C; Hernández Hermoso, J A

    2014-01-01

    The keel design of the tibial tray is essential for the transmission of the majority of the forces to the peripheral bone structures, which have better mechanical proprieties, thus reducing the risk of loosening. The aim of the present study was to compare the behaviour of different tibial tray designs submitted to torsional forces. Four different tibial components were modelled. The 3-D reconstruction was made using the Mimics software. The solid elements were generated by SolidWorks. The finite elements study was done by Unigraphics. A torsional force of 6 Nm. applied to the lateral aspects of each tibial tray was simulated. The GENUTECH® tibial tray, with peripheral trabecular bone support, showed a lower displacement and less transmitted tensions under torsional forces. The results suggest that a tibial tray with more peripheral support behaves mechanically better than the other studied designs. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  17. Reconstruction of bilateral tibial aplasia and split hand-foot syndrome in a father and daughter.

    Science.gov (United States)

    Al Kaissi, Ali; Ganger, Rudolf; Klaushofer, Klaus; Grill, Franz

    2014-01-01

    Tibial aplasia is of heterogeneous aetiology, the majority of reports are sporadic. We describe the reconstruction procedures in two subjects - a daughter and father manifested autosomal dominant (AD) inheritance of the bilateral tibial aplasia and split hand-foot syndrome. Reconstruction of these patients required multiple surgical procedures and orthoprosthesis was mandatory. The main goal of treatment was to achieve walking. Stabilization of the ankle joint by fibular-talar-chondrodesis on both sides, followed by bilateral Brown-procedure at the knee joint level has been applied accordingly. The outcome was with improved function of the deformed limbs and walking was achieved with simultaneous designation of orthotic fitting. This is the first study encompassing the diagnosis and management of a father and daughter with bilateral tibial aplasia associated with variable split hand/foot deformity without foot ablation. Our patients showed the typical AD pattern of inheritance of split-hand/foot and tibial aplasia.

  18. 77 FR 42644 - Safety Zone; Canal Fest of the Tonawandas, Erie Canal, Tonawanda, NY

    Science.gov (United States)

    2012-07-20

    .... ACTION: Temporary final rule. SUMMARY: The Coast Guard is establishing a temporary safety zone on the... Canal during the Canal Fest of the Tonawandas Fireworks display. This temporary safety zone is necessary to protect spectators and vessels from the hazards associated with a fireworks display. DATES: This...

  19. Water Environment Evolution along the China Grand Canal

    International Nuclear Information System (INIS)

    Mao, F; Wu, Y X; Yang, B F; Li, X J

    2014-01-01

    The China Grand Canal is one of the earliest canals in the world, having lasted for nearly 3000 years. Even its section canals have a rich history, such as the North-South Grand Canal that was established during the Sui Dynasty, whereas the Beijing-Hangzhou Canal was excavated during the Yuan Dynasty and the east line of the South-to-North Water Diversion. As one of the longest in the world, the China Grand Canal's total length is over 3500 kilometers. This length includes the navigable, unnavigable, and underground sections. Making the best use of situations and according to local conditions, the Chinese people harmoniously constructed the Beijing-Hangzhou Canal with nature. Tens of millions of workers took nearly 3000 years to complete the great shipping system. Navigable sections still exist for up to 900 kilometers and the volume of freight traffic is approximately 300 million tons. The canal remains the main logistical channel of the North-to-South Coal Transportation, South-to-North Water Diversion, and resources circulation. To date, China is promoting the success of heritage application. Part of these efforts is the declaration of the China Grand Canal as a World Cultural Heritage by 2014. In addition, the east route of the South-to-North Water Transfer project is planned to be navigable by 2016. The ancient Beijing-Hangzhou Grand Canal will usher in the new ecological civilization and cultural revival along the canal. This paper presents technical methods of water environment evolution research on the river system, river, and water quality along the Beijing-Hangzhou Canal through the integration of historical literature and modern remote sensing image data. The study carried out water environment investigation and analysis along the Beijing-Hangzhou canal by using ETM, SPOT image data, and GPS measurement data. Spatial and temporal evolution characteristics and regulations of the Beijing-Hangzhou Grand Canal regional water environment in the span of

  20. Computed tomography of the facial canal

    International Nuclear Information System (INIS)

    Kiuchi, Sousuke

    1983-01-01

    The radiological details of the facial canal was investigated by computed tomography. In the first part of this study, dry skulls were used to delineate the full course of the facial canal by computed tomography. In the second part of this study, the patients with chronic otitis media and secondary cholesteatoma were evaluated. The labyrinthine and tympanic parts of the canal were well demonstrated with the axial scanning, and the mastoid part with the coronal scanning. Moreover, computed tomography showed excellent delineation of the middle ear contents. In patients with secondary cholesteatoma, the destructions of the intratympanic course of the bony facial canal were also assessed preoperatively. (author)

  1. Radiation-induced external ear canal cholesteatoma-like disease

    Energy Technology Data Exchange (ETDEWEB)

    Ishihara, Akiko; Okuno, Hideji; Noguchi, Keisuke; Komatsuzaki, Atsushi [Tokyo Medical and Dental Univ. (Japan). School of Medicine

    1999-06-01

    Three cases of cholesteatoma-like disease in the ear canals after radiation therapy for head and neck tumor were reported. Effect of irradiation on bone and soft tissue including skin brings about pathological reaction to the external ear canal as well. Two types of disease resembling cholesteatomas have been recognized: keratosis obturans (KO) and external auditory canal cholesteatoma (EACC). KO appears to be derived from disease of canal skin involved with keratinization, creating a widning of the canal. EACC, on the other hand, seems to develop in the disease of bony canal where a localized absorption of its bone with invasion of squamous epithelium takes place. (author)

  2. Mating of a PROSTALAC spacer with an intramedullary nail for reconstruction of an infected interprosthetic femoral shaft fracture: a case report.

    Science.gov (United States)

    Kamath, Atul F; Austin, Daniel; Lee, Gwo-Chin

    2012-08-01

    Reconstruction for concurrent infection of an ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) is a challenge. We report a 2-stage reconstruction of a THA for chronic infection of both the THA and TKA with severe femoral bone loss secondary to interprosthetic fractures. The reconstruction involved using a custom-made, temporary, antibiotic-impregnated PROSTALAC spacer mated with an intramedullary nail. The acetabulum was then exposed and the necrotic cartilage was removed and curetted. The acetabulum was reamed to accept a PROSTALAC acetabular shell. The shell was cemented into the acetabulum with antibiotic cement. The custom-made spacer was then inserted distally first into the tibia. The distal end of the intramedullary nail was interlocked with a bicortical bolt to minimise nail rotation. Antibiotic-impregnated cement was moulded around the nail and spacer. The proximal end of the spacer was then reduced into the acetabular socket, and the joint was irrigated and the wound closed. A customised abduction brace was fitted, and partial weight bearing was allowed. Sufficient leg length, soft-tissue tension, and range of hip motion were restored, and a total femur and constrained liner was re-implanted 4 months later. Mating of an intramedullary nail with a PROSTALAC spacer is a viable reconstructive option.

  3. 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.

  4. Acceleration induced water removal from ear canals.

    Science.gov (United States)

    Kang, Hosung; Averett, Katelee; Jung, Sunghwan

    2017-11-01

    Children and adults commonly experience having water trapped in the ear canals after swimming. To remove the water, individuals will shake their head sideways. Since a child's ear canal has a smaller diameter, it requires more acceleration of the head to remove the trapped water. In this study, we theoretically and experimentally investigated the acceleration required to break the surface meniscus of the water in artificial ear canals and hydrophobic-coated glass tubes. In experiments, ear canal models were 3D-printed from a CT-scanned human head. Also, glass tubes were coated with silane to match the hydrophobicity in ear canals. Then, using a linear stage, we measured the acceleration values required to forcefully eject the water from the artificial ear canals and glass tubes. A theoretical model was developed to predict the critical acceleration at a given tube diameter and water volume by using a modified Rayleigh-Taylor instability. Furthermore, this research can shed light on the potential of long-term brain injury and damage by shaking the head to push the water out of the ear canal. This research was supported by National Science Foundation Grant CBET-1604424.

  5. Hood Canal Steelhead - Hood Canal Steelhead Supplementation Experiment

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Hood Canal Steelhead Project is a 17-year before-after-control-impact experiment that tests the effects of supplementation on natural steelhead populations in...

  6. Canal Centring Ability of ProTaper and Mtwo Rotary Systems in Curved Canals

    Directory of Open Access Journals (Sweden)

    Turkaydin Dilek Erbay

    2014-07-01

    Full Text Available The purpose of this investigation was to compare centring ratio of ProTaper and Mtwo rotary systems. 60 mandibular molar teeth which had 25, 30 and 35 degree curvature in mesio-buccal root canal were used. Group 1 had 25°, Group 2 had 30°, and Group 3 had 35° curvatures. The roots were sectioned horizontally at 2 mm away from the apex. The apical region was then observed under a stereo-microscope. In each group, teeth were instrumented using ProTaper and Mtwo systems. After canal preparation, digital images of apical part of canals were taken. These images were then superimposed by using Adobe Photoshop CS2 programme. The data were analyzed using ANOVA and Student’s t-test.

  7. Effect of canal preparation with TRUShape and Vortex rotary instruments on three-dimensional geometry of oval root canals.

    Science.gov (United States)

    Arias, Ana; Paqué, Frank; Shyn, Stephanie; Murphy, Sarah; Peters, Ove A

    2018-04-01

    The purpose of this study was to assess the geometry of non-round root canals after preparation with TRUShape (a novel instrument with s-shaped longitudinal design) in comparison to conventional rotary instrumentation using micro-computed tomography. Twenty distal root canals of mandibular molars were randomly distributed in two groups to be shaped with either TRUShape or Vortex rotaries. Percentages of unprepared surface and volume of dentin removal for the entire canal and for the apical 4 mm were calculated. Canal transportation and the structure model index (SMI) were assessed. Data were compared with Student t-tests. Shaping with both techniques resulted in similar prepared surface and volume of dentin removed, as well as the extent of canal transportation. The SMI shape factor was significantly lower for TRUShape preparations (P = 0.04) suggesting less rounding during rotary preparation. Although both instruments were suitable for the preparation of oval canals, TRUShape appeared to better conform to the original ribbon-shaped anatomy. © 2017 Australian Society of Endodontology Inc.

  8. Radioanatomy of the singular nerve canal

    Energy Technology Data Exchange (ETDEWEB)

    Muren, C. [Dept. of Diagnostic Radiology, Sabbatsbergs Hospital, Stockholm (Sweden); Wadin, K. [University Hospital, Uppsala (Sweden); Dimopoulos, P. [University Hospital, Uppsala (Sweden)

    1991-08-01

    The singular canal conveys vestibular nerve fibers from the ampulla of the posterior semicircular canal to the posteroinferior border of the internal auditory meatus. Radiographic identification of this anatomic structure helps to distinguish it from a fracture. It is also a landmark in certain surgical procedures. Computed tomography (CT) examinations of deep-frozen temporal bone specimens were compared with subsequently prepared plastic casts of these bones, showing good correlation between the anatomy and the images. The singular canal and its variable anatomy were studied in CT examinations of 107 patients. The singular canal could be identified, in both the axial and in the coronal planes. Its point of entry into the internal auditory meatus varied considerably. (orig.)

  9. Reconstruction of bilateral tibial aplasia and split hand-foot syndrome in a father and daughter

    Directory of Open Access Journals (Sweden)

    Ali Al Kaissi

    2014-01-01

    Full Text Available Background: Tibial aplasia is of heterogeneous aetiology, the majority of reports are sporadic. We describe the reconstruction procedures in two subjects - a daughter and father manifested autosomal dominant (AD inheritance of the bilateral tibial aplasia and split hand-foot syndrome. Materials and Methods: Reconstruction of these patients required multiple surgical procedures and orthoprosthesis was mandatory. The main goal of treatment was to achieve walking. Stabilization of the ankle joint by fibular-talar-chondrodesis on both sides, followed by bilateral Brown-procedure at the knee joint level has been applied accordingly. Results: The outcome was with improved function of the deformed limbs and walking was achieved with simultaneous designation of orthotic fitting. Conclusion: This is the first study encompassing the diagnosis and management of a father and daughter with bilateral tibial aplasia associated with variable split hand/foot deformity without foot ablation. Our patients showed the typical AD pattern of inheritance of split-hand/foot and tibial aplasia.

  10. Study of the anatomy of the tibial nerve and its branches in the distal medial leg

    Science.gov (United States)

    Torres, André Leal Gonçalves; Ferreira, Marcus Castro

    2012-01-01

    Objective Determine, through dissection in fresh cadavers, the topographic anatomy of the tibial nerve and its branches at the ankle, in relation to the tarsal tunnel. Methods Bilateral dissections were performed on 26 fresh cadavers and the locations of the tibial nerve bifurcation and its branches were measured in millimeters. For the calcaneal branches, the amount and their respective nerves of origin were also analyzed. Results The tibial nerve bifurcation occurred under the tunnel in 88% of the cases and proximally in 12%. As for the calcaneal branches, the medial presented with one (58%), two (34%) and three (8%) branches, with the most common source occurring in the tibial nerve (90%) and the lower with a single branch per leg and lateral plantar nerve as the most common origin (70%). Level of Evidence, V Expert opinion. PMID:24453596

  11. Medial tibial stress syndrome: a critical review.

    Science.gov (United States)

    Moen, Maarten H; Tol, Johannes L; Weir, Adam; Steunebrink, Miriam; De Winter, Theodorus C

    2009-01-01

    Medial tibial stress syndrome (MTSS) is one of the most common leg injuries in athletes and soldiers. The incidence of MTSS is reported as being between 4% and 35% in military personnel and athletes. The name given to this condition refers to pain on the posteromedial tibial border during exercise, with pain on palpation of the tibia over a length of at least 5 cm. Histological studies fail to provide evidence that MTSS is caused by periostitis as a result of traction. It is caused by bony resorption that outpaces bone formation of the tibial cortex. Evidence for this overloaded adaptation of the cortex is found in several studies describing MTSS findings on bone scan, magnetic resonance imaging (MRI), high-resolution computed tomography (CT) scan and dual energy x-ray absorptiometry. The diagnosis is made based on physical examination, although only one study has been conducted on this subject. Additional imaging such as bone, CT and MRI scans has been well studied but is of limited value. The prevalence of abnormal findings in asymptomatic subjects means that results should be interpreted with caution. Excessive pronation of the foot while standing and female sex were found to be intrinsic risk factors in multiple prospective studies. Other intrinsic risk factors found in single prospective studies are higher body mass index, greater internal and external ranges of hip motion, and calf girth. Previous history of MTSS was shown to be an extrinsic risk factor. The treatment of MTSS has been examined in three randomized controlled studies. In these studies rest is equal to any intervention. The use of neoprene or semi-rigid orthotics may help prevent MTSS, as evidenced by two large prospective studies.

  12. Three distal root canals in mandibular first molar with different canal configurations: Report of two cases and literature review

    Directory of Open Access Journals (Sweden)

    Parul Bansal

    2015-01-01

    Full Text Available With the increasing number of reports of aberrant root canal morphology, the clinician needs to be aware of the variable anatomy. Various case reports have been published with the finding of middle mesial canal in mandibular first molar, however finding of three distal canals in distal roots of mandibular first molar is rare. This article reports endodontic management of two mandibular first molars presented with three distal canals present in a single distal root (Sert and Bayirli type XVIII and distal and distolingual root.

  13. canal24

    Data.gov (United States)

    California Natural Resource Agency — Canal system center lines in the Central Valley of California and adjacent areas captured from 1:24,000-scale USGS topographic maps. Updates and modifications made...

  14. The clinico-anatomic explanation for tibial intraneural ganglion cysts arising from the superior tibiofibular joint

    Energy Technology Data Exchange (ETDEWEB)

    Spinner, Robert J. [Mayo Clinic, Department of Neurologic Surgery, Rochester, Minnesota (United States); Mayo Clinic, Department of Orthopedic Surgery, Rochester, Minnesota (United States); Mayo Clinic, Department of Anatomy, Rochester, Minnesota (United States); Mokhtarzadeh, Ali; Schiefer, Terry K. [Mayo Clinic College of Medicine, Rochester, Minnesota (United States); Krishnan, Kartik G. [Carl Gustav Carus University Hospital, Department of Neurological Surgery, Dresden (Germany); Kliot, Michel [University of Washington, Department of Neurosurgery, Seattle, Washington (United States); Amrami, Kimberly K. [Mayo Clinic, Department of Radiology, Rochester, Minnesota (United States)

    2007-04-15

    To demonstrate that tibial intraneural ganglia in the popliteal fossa are derived from the posterior portion of the superior tibiofibular joint, in a mechanism similar to that of peroneal intraneural ganglia, which have recently been shown to arise from the anterior portion of the same joint. Retrospective clinical study and prospective anatomic study. The clinical records and MRI findings of three patients with tibial intraneural ganglion cysts were analyzed and compared with those of one patient with a tibial extraneural ganglion cyst and one volunteer. Seven cadaveric limbs were dissected to define the articular anatomy of the posterior aspect of the superior tibiofibular joint. The condition of the three patients with intraneural ganglia recurred because their joint connections were not identified initially. In two patients there was no cyst recurrence when the joint connection was treated at revision surgery; the third patient did not wish to undergo additional surgery. The one patient with an extraneural ganglion had the joint connection identified at initial assessment and had successful surgery addressing the cyst and the joint connection. Retrospective evaluation of the tibial intraneural ganglion cysts revealed stereotypic features, which allowed their accurate diagnosis and distinction from extraneural cases. The intraneural cysts had tubular (rather than globular) appearances. They derived from the postero-inferior portion of the superior tibiofibular joint and followed the expected course of the articular branch on the posterior surface of the popliteus muscle. The cysts then extended intra-epineurially into the parent tibial nerves, where they contained displaced nerve fascicles. The extraneural cyst extrinsically compressed the tibial nerve but did not directly involve it. All cadaveric specimens demonstrated a small single articular branch, which derived from the tibial nerve to the popliteus. The branch coursed obliquely across the posterior

  15. The fluid mechanics of root canal irrigation.

    Science.gov (United States)

    Gulabivala, K; Ng, Y-L; Gilbertson, M; Eames, I

    2010-12-01

    Root canal treatment is a common dental operation aimed at removing the contents of the geometrically complex canal chambers within teeth; its purpose is to remove diseased or infected tissue. The complex chamber is first enlarged and shaped by instruments to a size sufficient to deliver antibacterial fluids. These irrigants help to dissolve dying tissue, disinfect the canal walls and space and flush out debris. The effectiveness of the procedure is limited by access to the canal terminus. Endodontic research is focused on finding the instruments and clinical procedures that might improve success rates by more effectively reaching the apical anatomy. The individual factors affecting treatment outcome have not been unequivocally deciphered, partly because of the difficulty in isolating them and in making the link between simplified, general experimental models and the complex biological objects that are teeth. Explicitly considering the physical processes within the root canal can contribute to the resolution of these problems. The central problem is one of fluid motion in a confined geometry, which makes the dispersion and mixing of irrigant more difficult because of the absence of turbulence over much of the canal volume. The effects of treatments can be understood through the use of scale models, mathematical modelling and numerical computations. A particular concern in treatment is that caustic irrigant may penetrate beyond the root canal, causing chemical damage to the jawbone. In fact, a stagnation plane exists beyond the needle tip, which the irrigant cannot penetrate. The goal is therefore to shift the stagnation plane apically to be coincident with the canal terminus without extending beyond it. Needle design may solve some of the problems but the best design for irrigant penetration conflicts with that for optimal removal of the bacterial biofilm from the canal wall. Both irrigant penetration and biofilm removal may be improved through canal fluid

  16. The fluid mechanics of root canal irrigation

    International Nuclear Information System (INIS)

    Gulabivala, K; Ng, Y-L; Gilbertson, M; Eames, I

    2010-01-01

    Root canal treatment is a common dental operation aimed at removing the contents of the geometrically complex canal chambers within teeth; its purpose is to remove diseased or infected tissue. The complex chamber is first enlarged and shaped by instruments to a size sufficient to deliver antibacterial fluids. These irrigants help to dissolve dying tissue, disinfect the canal walls and space and flush out debris. The effectiveness of the procedure is limited by access to the canal terminus. Endodontic research is focused on finding the instruments and clinical procedures that might improve success rates by more effectively reaching the apical anatomy. The individual factors affecting treatment outcome have not been unequivocally deciphered, partly because of the difficulty in isolating them and in making the link between simplified, general experimental models and the complex biological objects that are teeth. Explicitly considering the physical processes within the root canal can contribute to the resolution of these problems. The central problem is one of fluid motion in a confined geometry, which makes the dispersion and mixing of irrigant more difficult because of the absence of turbulence over much of the canal volume. The effects of treatments can be understood through the use of scale models, mathematical modelling and numerical computations. A particular concern in treatment is that caustic irrigant may penetrate beyond the root canal, causing chemical damage to the jawbone. In fact, a stagnation plane exists beyond the needle tip, which the irrigant cannot penetrate. The goal is therefore to shift the stagnation plane apically to be coincident with the canal terminus without extending beyond it. Needle design may solve some of the problems but the best design for irrigant penetration conflicts with that for optimal removal of the bacterial biofilm from the canal wall. Both irrigant penetration and biofilm removal may be improved through canal fluid

  17. 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

  18. Anterior Tibial Artery Pseudoaneurysm: Case Report

    Directory of Open Access Journals (Sweden)

    Funda Tor

    2012-06-01

    Full Text Available The aneurysmsatic changes of the infrapopliteal arteries are rarely seen. They are pseudoaneurysms rather than true aneursyms. The most important cause of them is trauma. There is not a standart treatment for infrapopliteal aneursyms. In this study, we have evaluated a case operated for anterior tibial artery pseudoaneurysm developed after penetrant trauma and diagnosed two weeks later. [Cukurova Med J 2012; 37(3.000: 172-175

  19. MR evaluation of femoral neck version and tibial torsion

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, James Karl; Dwek, Jerry R. [University of California, San Diego, Children' s Hospital and Health Center, Department of Radiology, San Diego, CA (United States); Pring, Maya E. [Rady Children' s Hospital, Department of Pediatric Orthopedic Surgery, San Diego, CA (United States)

    2012-01-15

    Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. (orig.)

  20. 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.)

  1. Some History and Hydrology of the Panama Canal

    National Research Council Canada - National Science Library

    Pabst, Arthur

    2000-01-01

    At the request of the Panama Canal Commission (now Panama Canal Authority), the Hydrologic Engineering Center participated in the development of a model to simulate the existing operation of the Panama Canal System...

  2. 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.

  3. Increasing lateral tibial slope: is there an association with articular cartilage changes in the knee?

    Energy Technology Data Exchange (ETDEWEB)

    Khan, Nasir; Shepel, Michael; Leswick, David A.; Obaid, Haron [University of Saskatchewan, Department of Medical Imaging, Royal University Hospital, and College of Medicine, Saskatoon, Saskatchewan (Canada)

    2014-04-15

    The geometry of the lateral tibial slope (LTS) plays an important role in the overall biomechanics of the knee. Through this study, we aim to assess the impact of LTS on cartilage degeneration in the knee. A retrospective analysis of 93 knee MRI scans (1.5 T or 3 T) for patients aged 20-45 years with no history of trauma or knee surgery, and absence of internal derangement. The LTS was calculated using the circle method. Chondropathy was graded from 0 (normal) to 3 (severe). Linear regression analysis was used for statistical analysis (p < 0.05). In our cohort of patients, a statistically significant association was seen between increasing LTS and worsening cartilage degenerative changes in the medial patellar articular surface and the lateral tibial articular surface (p < 0.05). There was no statistically significant association between increasing LTS and worsening chondropathy of the lateral patellar, medial trochlea, lateral trochlea, medial femoral, lateral femoral, and medial tibial articular surfaces. Our results show a statistically significant association between increasing LTS and worsening cartilage degenerative changes in the medial patella and the lateral tibial plateau. We speculate that increased LTS may result in increased femoral glide over the lateral tibial plateau with subsequent increased external rotation of the femur predisposing to patellofemoral articular changes. Future arthroscopic studies are needed to further confirm our findings. (orig.)

  4. Increasing lateral tibial slope: is there an association with articular cartilage changes in the knee?

    International Nuclear Information System (INIS)

    Khan, Nasir; Shepel, Michael; Leswick, David A.; Obaid, Haron

    2014-01-01

    The geometry of the lateral tibial slope (LTS) plays an important role in the overall biomechanics of the knee. Through this study, we aim to assess the impact of LTS on cartilage degeneration in the knee. A retrospective analysis of 93 knee MRI scans (1.5 T or 3 T) for patients aged 20-45 years with no history of trauma or knee surgery, and absence of internal derangement. The LTS was calculated using the circle method. Chondropathy was graded from 0 (normal) to 3 (severe). Linear regression analysis was used for statistical analysis (p < 0.05). In our cohort of patients, a statistically significant association was seen between increasing LTS and worsening cartilage degenerative changes in the medial patellar articular surface and the lateral tibial articular surface (p < 0.05). There was no statistically significant association between increasing LTS and worsening chondropathy of the lateral patellar, medial trochlea, lateral trochlea, medial femoral, lateral femoral, and medial tibial articular surfaces. Our results show a statistically significant association between increasing LTS and worsening cartilage degenerative changes in the medial patella and the lateral tibial plateau. We speculate that increased LTS may result in increased femoral glide over the lateral tibial plateau with subsequent increased external rotation of the femur predisposing to patellofemoral articular changes. Future arthroscopic studies are needed to further confirm our findings. (orig.)

  5. The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method.

    Science.gov (United States)

    Megas, Panagiotis; Saridis, Alkis; Kouzelis, Antonis; Kallivokas, Alkiviadis; Mylonas, Spyros; Tyllianakis, Minos

    2010-03-01

    The purpose of this study was to demonstrate the effectiveness of the Ilizarov method and circular external fixator in order to eradicate the infection and restore bone union, limb anatomy and functionality in cases with infected nonunion of the tibia following intramedullary nailing. During 7 years nine patients suffering from infected nonunion of the tibia after intramedullary nailing were treated in our department. The series comprised seven men and two women with an average age of 39.7 years (range 21-75 years). The patients had previously undergone an average of 4.8 operations (range 3-6 operations). Active purulent bone infection occurred in all nine patients. Bone defect was present in all patients with a mean size of 5 cm (range 2-12 cm). In three cases with bone defect less than 2 cm, monofocal compression osteosynthesis technique was used. In the rest cases where bone defect exceeded 2 cm, bifocal consecutive distraction-compression osteosynthesis technique was applied. Three patients required a local gastrocnemius flap. The mean follow-up period was 26.6 months (range 13-42 months). Results were evaluated using Paley's functional and radiological scoring system. Bone union was achieved in all nine patients without recurrence of infection during the follow-up period. Bone results were graded as excellent in five cases and good in the rest four cases. Functional results were graded as excellent in three cases, good in four and fare in two cases. Mean external fixation time was 187.4 days (range 89-412 days) and mean lengthening index was 32 days/cm (range 27-39 days/cm). Complications observed included eight grade II pin tract infections, axial deformity at the lengthening site in two cases and at the nonunion site in another two cases. Ankle joint stiffness was detected in five cases. The Ilizarov method may be an effective method in infected nonunions of the tibia following intramedullary nailing. Copyright 2009 Elsevier Ltd. All rights reserved.

  6. Combined CT-based and image-free navigation systems in TKA reduces postoperative outliers of rotational alignment of the tibial component.

    Science.gov (United States)

    Mitsuhashi, Shota; Akamatsu, Yasushi; Kobayashi, Hideo; Kusayama, Yoshihiro; Kumagai, Ken; Saito, Tomoyuki

    2018-02-01

    Rotational malpositioning of the tibial component can lead to poor functional outcome in TKA. Although various surgical techniques have been proposed, precise rotational placement of the tibial component was difficult to accomplish even with the use of a navigation system. The purpose of this study is to assess whether combined CT-based and image-free navigation systems replicate accurately the rotational alignment of tibial component that was preoperatively planned on CT, compared with the conventional method. We compared the number of outliers for rotational alignment of the tibial component using combined CT-based and image-free navigation systems (navigated group) with those of conventional method (conventional group). Seventy-two TKAs were performed between May 2012 and December 2014. In the navigated group, the anteroposterior axis was prepared using CT-based navigation system and the tibial component was positioned under control of the navigation. In the conventional group, the tibial component was placed with reference to the Akagi line that was determined visually. Fisher's exact probability test was performed to evaluate the results. There was a significant difference between the two groups with regard to the number of outliers: 3 outliers in the navigated group compared with 12 outliers in the conventional group (P image-free navigation systems decreased the number of rotational outliers of tibial component, and was helpful for the replication of the accurate rotational alignment of the tibial component that was preoperatively planned.

  7. Influence of a glide path on apical extrusion of debris during canal preparation using single-file systems in curved canals.

    Science.gov (United States)

    Topçuoğlu, H S; Düzgün, S; Akpek, F; Topçuoğlu, G; Aktı, A

    2016-06-01

    To evaluate the effect of a glide path on the amount of apically extruded debris during canal preparation using single-file systems in curved canals. Ninety extracted mandibular molar teeth were randomly assigned to six groups (n = 15 for each group) for canal instrumentation. Endodontic access cavities were prepared in each tooth. In three of the six groups, a glide path was not created whereas a glide path was created using PathFile instruments on the mesial canals of all teeth in the remaining three groups. The mesial canals of the teeth were then instrumented with the following single-file instrument systems: WaveOne, Reciproc and OneShape. Debris extruded apically during instrumentation was collected into pre-weighed Eppendorf tubes. The tubes were then stored in an incubator at 70 °C for 5 days. The weight of the dry extruded debris was established by subtracting the pre-instrumentation and post-instrumentation weight of the Eppendorf tubes for each group. The data obtained were analysed using one-way analysis of variance (anova) and Tukey's post hoc tests. The OneShape file was associated with less debris extrusion than the Reciproc and WaveOne files when canal instrumentation was performed without a glide path (P files (P > 0.05). There was no significant difference amongst the OneShape, Reciproc and WaveOne files when a glide path was created before canal preparation in curved root canals (P > 0.05). All systems extruded significantly less debris in groups with a glide path than in groups without a glide path (P < 0.05). All instruments were associated with apical extrusion of debris. Creating a glide path prior to canal instrumentation reduced the amount of apically extruded debris in curved canals. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  8. Flexible Intramedullary Nailing for Paediatric Shaft of Femur Fractures – Does the Number of Nails Alter the Outcome?

    Directory of Open Access Journals (Sweden)

    B Kanthimathi

    2011-07-01

    Full Text Available BACKGROUND: The use of flexible intramedullary nailing, allowing micro movement at the fracture site, results in excellent outcomes regardless of the number of nails used. We undertook analysis of the outcomes of flexible nailing with reference to the number of nails used. METHODS: Twenty patients with diaphyseal femur fracture aged 5-15 years were treated with retrograde flexible intramedullary nailing. The number of nails varied from single to multiple. The results were analysed with regard to the number of nails used. RESULTS: The mean patient age was 7.9 years; patients were followed up for a mean duration of 13.2 months. Those with two and three nails had similar results. CONCLUSION: A minimum of two flexible nails is needed for optimal fixation in paediatric femur shaft fractures. Also, limiting the number of implants to two is cost effective, decreases operative time, reduces radiation exposure and offers equal results to that of three nails.

  9. Quantitative comparison of the microscopic anatomy of the human ACL femoral and tibial entheses.

    Science.gov (United States)

    Beaulieu, Mélanie L; Carey, Grace E; Schlecht, Stephen H; Wojtys, Edward M; Ashton-Miller, James A

    2015-12-01

    The femoral enthesis of the human anterior cruciate ligament (ACL) is known to be more susceptible to injury than the tibial enthesis. To determine whether anatomic differences might help explain this difference, we quantified the microscopic appearance of both entheses in 15 unembalmed knee specimens using light microscopy, toluidine blue stain and image analysis. The amount of calcified fibrocartilage and uncalcified fibrocartilage, and the ligament entheseal attachment angle were then compared between the femoral and tibial entheses via linear mixed-effects models. The results showed marked differences in anatomy between the two entheses. The femoral enthesis exhibited a 3.9-fold more acute ligament attachment angle than the tibial enthesis (p<0.001), a 43% greater calcified fibrocartilage tissue area (p<0.001), and a 226% greater uncalcified fibrocartilage depth (p<0.001), with the latter differences being particularly pronounced in the central region. We conclude that the ACL femoral enthesis has more fibrocartilage and a more acute ligament attachment angle than the tibial enthesis, which provides insight into why it is more vulnerable to failure. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  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. Arthroscopic guided biopsy and radiofrequency thermoablation of a benign neoplasm of the tibial spines area: a treatment option

    Directory of Open Access Journals (Sweden)

    Zoccali Carmine

    2012-04-01

    Full Text Available Abstract Background Lesions located in the area of the tibial spines are rare. In most cases, treatment follows histological diagnosis, but when imaging and clinical data are considered to be "very" characteristic for benign lesions, such as chondroblastoma or osteoid osteoma, treatment may be performed without biopsy. Traditional curettage requires opening the joint, which presents a high risk of contamination of the joint itself and surrounding structures, such as the popliteal area, with possible contamination of the neurovascular bundle when performing curettage with the posterior approach. In this case, the re-excision of a local recurrence would be extremely difficult. Results We describe a technique using arthroscopic guidance for radiofrequency thermoablation of a benign lesion in the tibial spines area. We report on an illustrative case. The patient so treated, reported immediate relief from the pain, and after two weeks, was free of pain. The biopsy performed before the treatment confirmed the radiological diagnosis of chondroblastoma. At one year of follow-up, the patient is without pain, with a 0-130°range of motion, has no activity limitations and is apparently free of disease. Conclusion This technique allows a radiofrequency thermoablation of a lesion in the tibial spines area and in the posterior tibial surface to be performed without opening the joint, monitoring the tibial plateau surface, probably decreasing the risk of cartilage damage. Unfortunately, in the case presented, the high pressure from the arthroscopy's pump broke the tibial plateau surface creating a communication to the tibial tunnel used for thermoablation.

  12. A STUDY ON TIBIAL TORSION IN ADULT DRY TIBIA OF EAST AND SOUTH INDIAN POPULATION

    Directory of Open Access Journals (Sweden)

    Jami Sagar Prusti

    2017-05-01

    Full Text Available BACKGROUND Rotational deformities of the lower limbs are very common. There is increasing evidence that abnormal torsion in the tibia is associated with severe knee and ankle arthritis. Primary knee osteoarthritis is a leading cause of disability in older persons. Varus or valgus alignment increases the risk of osteoarthritis. Coexistence of tibial torsional deformity may increase the risk further. Variability in the tibial torsion has been reported and is due to the torsional forces applied on tibia during development. The aim of the study is to estimate the angle of tibial torsion on both sides and both sexes. The present study was an attempt to provide baseline data of tibial torsion in the East and South Indian population. MATERIALS AND METHODS The study was conducted mechanically on 100 dry adult unpaired human tibia, i.e. 50 male and 50 female bones. The measurements were recorded and statistically analysed using Student’s unpaired t-test using GraphPad Prism 5.0 (free trial version. RESULTS Out of the 100 tibia undertaken, mean value of tibial torsion angle obtained is 25.8°. In males, it is 23.68° and in females it is about 27.86°. Statistical analysis revealed significant greater average angle of tibial torsion in female bones. The angle of the right-sided bones was more and this was statistically significant. CONCLUSION The gender variation for the angle could be the result of the difference in lifestyle in day-to-day activities. The knowledge of the angle in a population could be helpful in understanding the incidence of pathogenesis related to gait and knee osteoarthritis and in view of reconstructive surgeries in orthopaedic practice.

  13. Canal of Nuck hernia: a multimodality imaging review

    Energy Technology Data Exchange (ETDEWEB)

    Rees, Mitchell A. [University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); Squires, James E. [Children' s Hospital of Pittsburgh of UPMC, Department of Gastroenterology, Pittsburgh, PA (United States); Tadros, Sameh; Squires, Judy H. [University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); Children' s Hospital of Pittsburgh of UPMC, Department of Radiology, Pittsburgh, PA (United States)

    2017-07-15

    Canal of Nuck abnormalities are a rare but important cause of morbidity in girls, most often those younger than 5 years of age. The canal of Nuck, which is the female equivalent of the male processus vaginalis, is a protrusion of parietal peritoneum that extends through the inguinal canal and terminates in the labia majora. The canal typically obliterates early in life, but in some cases the canal can partially or completely fail to close, potentially resulting in a hydrocele or hernia of pelvic contents. Recognition of this entity is especially important in cases of ovarian hernia due to the risk of incarceration and torsion. We aim to increase awareness of this condition by reviewing the embryology, anatomy and diagnosis of canal of Nuck disorders with imaging findings on US, CT and MRI using several cases from a single institution. (orig.)

  14. Canal of Nuck hernia: a multimodality imaging review

    International Nuclear Information System (INIS)

    Rees, Mitchell A.; Squires, James E.; Tadros, Sameh; Squires, Judy H.

    2017-01-01

    Canal of Nuck abnormalities are a rare but important cause of morbidity in girls, most often those younger than 5 years of age. The canal of Nuck, which is the female equivalent of the male processus vaginalis, is a protrusion of parietal peritoneum that extends through the inguinal canal and terminates in the labia majora. The canal typically obliterates early in life, but in some cases the canal can partially or completely fail to close, potentially resulting in a hydrocele or hernia of pelvic contents. Recognition of this entity is especially important in cases of ovarian hernia due to the risk of incarceration and torsion. We aim to increase awareness of this condition by reviewing the embryology, anatomy and diagnosis of canal of Nuck disorders with imaging findings on US, CT and MRI using several cases from a single institution. (orig.)

  15. Comparison of fixed-bearing and mobile-bearing total knee arthroplasty after high tibial osteotomy.

    Science.gov (United States)

    Hernigou, Philippe; Huys, Maxime; Pariat, Jacques; Roubineau, François; Flouzat Lachaniette, Charles Henri; Dubory, Arnaud

    2018-02-01

    There is no information comparing the results of fixed-bearing total knee replacement and mobile-bearing total knee replacement in the same patients previously treated by high tibial osteotomy. The purpose was therefore to compare fixed-bearing and mobile-bearing total knee replacements in patients treated with previous high tibial osteotomy. We compared the results of 57 patients with osteoarthritis who had received a fixed-bearing prosthesis after high tibial osteotomy with the results of 41 matched patients who had received a rotating platform after high tibial osteotomy. The match was made for length of follow-up period. The mean follow-up was 17 years (range, 15-20 years). The patients were assessed clinically and radiographically. The pre-operative knee scores had no statistically significant differences between the two groups. So was the case with the intra-operative releases, blood loss, thromboembolic complications and infection rates in either group. There was significant improvement in both groups of knees, and no significant difference was observed between the groups (i.e., fixed-bearing and mobile-bearing knees) for the mean Knee Society knee clinical score (95 and 92 points, respectively), or the Knee Society knee functional score (82 and 83 points, respectively) at the latest follow-up. However, the mean post-operative knee motion was higher for the fixed-bearing group (117° versus 110°). In the fixed-bearing group, one knee was revised because of periprosthetic fracture. In the rotating platform mobile-bearing group, one knee was revised because of aseptic loosening of the tibial component. The Kaplan-Meier survivorship for revision at ten years of follow-up was 95.2% for the fixed bearing prosthesis and 91.1% for the rotating platform mobile-bearing prosthesis. Although we did manage to detect significant differences mainly in clinical and radiographic results between the two groups, we found no superiority or inferiority of the mobile

  16. The effect of tibial slope on the biomechanics of cruciate-retaining TKA : a musculoskeletal simulation study

    NARCIS (Netherlands)

    Marra, Marco A.; Strzelczak, Marta; Heesterbeek, Petra J.C.; van de Groes, Sebastiaan; Janssen, Dennis W.; Koopman, Bart F.J.M.; Wymenga, Ate B.; Verdonschot, Nico J.J.

    2017-01-01

    INTRODUCTION: Tibial slope can affect the outcomes of Total Knee Arthroplasty (TKA). More posterior slope potentially helps releasing a too tight flexion gap and it is generally associated with a wider range of post-operative knee flexion. However, the mechanism by which tibial slope affects the

  17. Chronic exertional compartment syndrome with medial tibial stress syndrome in twins.

    Science.gov (United States)

    Banerjee, Purnajyoti; McLean, Christopher

    2011-06-14

    Chronic exertional compartment syndrome and medial tibial stress syndrome are uncommon conditions that affect long-distance runners or players involved in team sports that require extensive running. We report 2 cases of bilateral chronic exertional compartment syndrome, with medial tibial stress syndrome in identical twins diagnosed with the use of a Kodiag monitor (B. Braun Medical, Sheffield, United Kingdom) fulfilling the modified diagnostic criteria for chronic exertional compartment syndrome as described by Pedowitz et al, which includes: (1) pre-exercise compartment pressure level >15 mm Hg; (2) 1 minute post-exercise pressure >30 mm Hg; and (3) 5 minutes post-exercise pressure >20 mm Hg in the presence of clinical features. Both patients were treated with bilateral anterior fasciotomies through minimal incision and deep posterior fasciotomies with tibial periosteal stripping performed through longer anteromedial incisions under direct vision followed by intensive physiotherapy resulting in complete symptomatic recovery. The etiology of chronic exertional compartment syndrome is not fully understood, but it is postulated abnormal increases in intramuscular pressure during exercise impair local perfusion, causing ischemic muscle pain. No familial predisposition has been reported to date. However, some authors have found that no significant difference exists in the relative perfusion, in patients, diagnosed with chronic exertional compartment syndrome. Magnetic resonance images of affected compartments have indicated that the pain is not due to ischemia, but rather from a disproportionate oxygen supply versus demand. We believe this is the first report of chronic exertional compartment syndrome with medial tibial stress syndrome in twins, raising the question of whether there is a genetic predisposition to the causation of these conditions. Copyright 2011, SLACK Incorporated.

  18. Intramedullary stabilization and over-nail lengthening as two-stage treatment of femoral nonunion with shortening. Case study.

    Science.gov (United States)

    Kącki, Wojciech; Jasiewicz, Barbara; Radło, Paweł

    2014-01-01

    Nonunion is one of the most serious complications of long bone fractures. It may be accompanied by a shortening of the segment. The authors describe the case of a 21-year-old woman with a post-traumatic nonunion with shortening of the femur. Treatment was divided into two stages: first, a previously placed nail was removed and new intramedullary stabilization was carried out while bone defects were filled with a bone graft substitute and platelet rich plasma was administered. After the nonunion had healed, the femur was lengthened over an external fixator and an intramedullary nail, resulting in equality of limb length. After eight years of follow-up, the lower limbs remain equal with a properly aligned long axis of the lower limb operated on and a full range of motion in the joints. The treatment strategy described in our article may be an alternative to one-stage surgery if the patient does not consent to it or in the presence of contraindications, but it is associated with a longer treatment time and necessity of additional surgeries.

  19. EMG and tibial shock upon the first attempt at barefoot running.

    Science.gov (United States)

    Olin, Evan D; Gutierrez, Gregory M

    2013-04-01

    As a potential means to decrease their risk of injury, many runners are transitioning into barefoot running. Habitually shod runners tend to heel-strike (SHS), landing on their heel first, while barefoot runners tend to mid-foot or toe-strike (BTS), landing flat-footed or on the ball of their foot before bringing down the rest of the foot including the heel. This study compared muscle activity, tibial shock, and knee flexion angle in subjects between shod and barefoot conditions. Eighteen habitually SHS recreational runners ran for 3 separate 7-minute trials, including SHS, barefoot heel-strike (BHS), and BTS conditions. EMG, tibial shock, and knee flexion angle were monitored using bipolar surface electrodes, an accelerometer, and an electrogoniometer, respectively. A one-way MANOVA for repeated measures was conducted and several significant changes were noted between SHS and BTS, including significant increases in average EMG of the medial gastrocnemius (p=.05), average and peak tibial shock (pknee flexion angle (pinjurious, these data indicate that habitually SHS runners who choose to transition into a BTS technique must undertake the process cautiously. Copyright © 2012 Elsevier B.V. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

  1. 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

  2. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture.

    Science.gov (United States)

    Dejour, David; Saffarini, Mo; Demey, Guillaume; Baverel, Laurent

    2015-10-01

    Revision ACL reconstruction requires careful analysis of failure causes particularly in cases of two previous graft ruptures. Intrinsic factors as excessive tibial slope or narrow femoral notch increase failure risks but are rarely addressed in revision surgery. The authors report outcomes, at minimum follow-up of 2 years, for second revision ACL reconstructions combined with tibial deflexion osteotomy for correction of excessive slope (>12°). Nine patients that underwent second revision ACL reconstruction combined with tibial deflexion osteotomy were retrospectively studied. The mean age was 30.3 ± 4.4 years (median 28; range 26-37), and mean follow-up was 4.0 ± 2.0 years (median 3.6; range 2.0-7.6). Autografts were harvested from the quadriceps tendon (n = 8) or hamstrings (n = 1), and tibial osteotomy was done by anterior closing wedge, without detachment of the patellar tendon, to obtain a slope of 3° to 5°. All patients had fused osteotomies, stable knees, and there were no intraoperative or postoperative complications. The mean posterior tibial slope decreased from 13.2° ± 2.6° (median 13°; range 12°-18°) preoperatively to 4.4° ± 2.3° (median 4°; range 2°-8°) postoperatively. The mean Lysholm score was 73.8 ± 5.8 (median 74; range 65-82), and the IKDC-SKF was 71.6 ± 6.1 (median 72.8; range 62.2-78.5). The satisfactory results of second revision ACL reconstruction combined with tibial deflexion osteotomy at minimum follow-up of 2 years suggest that tibia slope correction protects reconstructed ACL from fatigue failure in this study. The authors stress the importance of careful analysis failure causes prior to revision ACL reconstruction, and recommend correction of tibial slope if it exceeds 12°, to reduce the risks of graft retear. III.

  3. 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.

  4. Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail.

    Science.gov (United States)

    Chen, Qing-Yu; Kou, Dong-Quan; Cheng, Xiao-Jie; Zhang, Wei; Wang, Wei; Lin, Zhang-Qin; Cheng, Shao-Wen; Shen, Yue; Ying, Xiao-Zhou; Peng, Lei; Lv, Chuan-Zhu

    2011-01-01

    Studies showed elastic stable intramedullary nailing (ESIN) of displaced midclavicular fractures has excellent outcomes, as well as high complication rates and specific problems. The aim was to discuss ESIN of midshaft clavicular fractures. Totally 60 eligible patients (aged 18-63 years) were randomized to either ESIN group or non-operative group between January 2007 and May 2008. Clavicular shortening was measured after trauma and osseous consolidation. Radiographic union and complications were assessed. Function analysis including Constant shoulder scores and disabilities of the arm, shoulder and hand (DASH) scores were performed after a 15-month follow-up. ESIN led to a signifcantly shorter time to union, especially for simple fractures. In ESIN group, all patients got fracture union, of which 5 cases had medial skin irritation and 1 patient needed revision surgery because of implant failure. In the nonoperative group, there were 3 nonunion cases and 2 symptomatic malunions developed requiring corrective osteotomy. At 15 months after intramedullary stabilization, patients in the ESIN group were more satisfied with the appearance of the shoulder and overall outcome, and they benefited a lot from the great improvement of post-traumatic clavicular shortening. Furthermore, DASH scores were lower and Constant scores were significantly higher in contrast to the non-operative group. ESIN is a safe minimally invasive surgical technique with lower complication rate, faster return to daily activities, excellent cosmetic and better functional results, restoration of clavicular length for treating mid-shaft clavicular fractures, resulting in high overall satisfaction, which can be regard as an alternative to plate fixation or nonoperative treatment of mid-shaft clavicular fractures.

  5. Cystic degeneration of the tibial nerve. Magnetic resonance neurography and sonography appearances of an intraneural ganglion cyst

    Energy Technology Data Exchange (ETDEWEB)

    Sampaio Silveira, Claudio Regis [Sao Carlos Imaging/Sao Carlos Hospital, Musculoskeletal Imaging Division, Fortaleza, CE (Brazil); Maia Vieira, Clarissa Gadelha; Machado Pereira, Brenda [Sao Carlos Imaging/Sao Carlos Hospital, Fortaleza, CE (Brazil); Pinto Neto, Luiz Holanda [Articular Clinic, Fortaleza, CE (Brazil); Chhabra, Avneesh [UT Southwestern, Radiology and Orthopaedic Surgery, Dallas, TX (United States)

    2017-12-15

    Extra- and intraneural ganglion cysts have been described in the literature. The tibial nerve ganglion is uncommon and its occurrence without intra-articular extension is atypical. The pathogenesis of cystic degeneration localized to connective and perineural tissue secondary to chronic mechanical irritation or idiopathic mucoid degeneration is hypothesized. Since the above pathology is extremely rare and the magnetic resonance imaging examination detects the defining characteristics of the intrinsic alterations of the tibial nerve, the authors illustrate such a case of tibial intaneural ganglion cyst with its magnetic resonance neurography and sonography appearances. (orig.)

  6. Type III apical transportation of root canal

    Directory of Open Access Journals (Sweden)

    Shiv P Mantri

    2012-01-01

    Full Text Available Procedural accidents leading to complications such as canal transportation have been ascribed to inapt cleaning and shaping concepts. Canal transportation is an undesirable deviation from the natural canal path. Herewith a case of apical transportation of root canal resulting in endodontic retreatment failure and its management is presented. A healthy 21-year-old young male presented discomfort and swelling associated with painful endodontically retreated maxillary incisor. Radiograph revealed periradicular radiolucency involving underfilled 11 and overfilled 12. Insufficiently obturated 11 exhibited apical transportation of canal. This type III transportation was treated by periradicular surgery and repair using white mineral trioxide aggregate (MTA. Comfortable asymptomatic patient presented uneventful healing at third and fourth month recall visits. A decrease in the size of radiolucency in radiograph supported the clinical finding. In the present case, MTA is useful in repairing the transportation defect. The result of these procedures is predictable and successful.

  7. 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

  8. 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.

  9. Mandibular molar with five root canals.

    Science.gov (United States)

    Barletta, Fernando Branco; Dotto, Sidney Ricardo; Reis, Magda de Sousa; Ferreira, Ronise; Travassos, Rosana Maria Coelho

    2008-12-01

    The purpose of this study was to demonstrate the importance of knowledge of the internal anatomy of root canals for the success of endodontic treatment. Lack of knowledge of anatomic variations and their characteristics in different teeth has been pointed out as one of the main causes of endodontic therapy failure. In this report, the authors describe the endodontic treatment of a mandibular first molar with five root canals, evaluate the rate of occurrence of this number of canals, and discuss the importance of their identification and treatment.

  10. Lumbar Vertebral Canal Diameters in Adult Ugandan Skeletons ...

    African Journals Online (AJOL)

    Background: Normal values of lumbar vertebral canal diameters are useful in facilitating diagnosis of lumbar vertebral canal stenosis. Various studies have established variation on values between different populations, gender, age, and ethnic groups. Objectives: To determine the lumbar vertebral canal diameters in adult ...

  11. Ten-year survival and patient-reported outcomes of a medial unicompartmental knee arthroplasty incorporating an all-polyethylene tibial component.

    Science.gov (United States)

    Scott, Chloe E H; Wade, Frazer A; MacDonald, Deborah; Nutton, Richard W

    2018-05-01

    Biomechanical studies have suggested that proximal tibial strain is elevated in UKAs incorporating all-polyethylene tibial components with concern that this leads to premature failure. This study reports minimum 10-year outcomes for a UKA incorporating an all-polyethylene tibial component to determine whether these concerns were realised. 109 fixed bearing UKAs (97 patients, mean age 68 (range 48-87), 54/97 (56%) female) with all-polyethylene tibial components were followed up for ≥ 10 years with Oxford Knee Scores, Forgotten Joint Scores and Kaplan-Meier analysis. 106/109 implants were 7 mm, 3 were 9.5 mm. Ten-year survival was 85.5% (78.6-92.4 95% CI) with the end-point failure for any reason. Unexplained pain was the commonest mode of failure (6/17) followed by lateral compartment osteoarthritis (5/17) and tibial subsidence/loosening (4/17). Revision rate was highest at 2-5 years due to revisions for unexplained pain. Ten-year survival was worse in patients  30 (p = 0.017) and in those with postoperative increases in medial tibial sclerosis (p  30 was 2.9 (1.2-6.9 95% CI). In those with intact UKAs at 10 years, mean Oxford Knee Score was 34.8 ± 10.7, Forgotten Joint Score was 37.9 ± 26.7 and 96% were satisfied with their knee. The high rate of early failure between 2 and 5 years in this all-polyethylene tibial component UKA did not persist in the long term. Though medial proximal tibial metabolic changes appear to persist they are not necessarily symptomatic. BMI > 30 and age < 65 years were significant risk factors for revision.

  12. CT Assessment of the axial deviation of the femoral and tibial prosthetic components in total knee arthroplasty; Valutazione con Tomografia Computerizzata della rotazione delle componenti femorale e tibiale nell'artroprotesi totale del ginocchio

    Energy Technology Data Exchange (ETDEWEB)

    Rimondi, E.; Molinari, M.; Moio, A.; Busacca, M. [Istituto Ortopedico Rizzoli, Bologna (Italy). Servizio di Diagnostica per Immagini; Trentani, F.; Trentani, P.; Tigani, D. [Istituto Ortopedico Rizzoli, Bologna (Italy). VII Div.; Nigrosoli, M. [Istituto Ortopedico Rizzoli, Bologna (Italy). IV Div.

    2000-06-01

    CT assessment of the axial deviation of the femoral and tibial prosthetic components in total knee arthroplasty. From January to July 1999, 17 patients, 10 males and 7 females, mean age 66 years (standard deviation plus or minus 4) were examined after total knee arthroplasty. Exclusion criteria were prosthesis loosening and severe (equal or superior to 7 degrees) varus o valgus deviation. All patients were examined with knee radiography in the standing position completed by axial projection of patella and by CT scanning. It was used a modification of Berger technique and carried out comparative CT scans extended lower limbs and acquisitions perpendicular to the mechanical axis of the knee, from the femoral supracondylar region down to the plane crossing the distal end of the tibial prosthetic component. Reference lines were then drawn electronically on given scanning planes to reckon the axial deviation of the femoral and tibial prosthetic components. Six patients, one female and 5 males with normal rotational values of femoral and tibial prosthetic components presented no clinical symptoms. Eight patients, 4 females and 4 males, with abnormal values presented the following clinical symptoms: medial impingement, (incomplete) dislocation patella, and lateral instability. One female patient with a normal rotational value of femoral prosthetic component and an altered value of tibial prosthetic component presented medial impingement. Finally two patients, one female and one male, were absolutely asymptomatic although the rotational values of the two prosthetic components were beyond the normal range. Total knee arthroplasty is presently a standard treatment for many conditions involving this joint. There are several possible postoperative complications, namely fractures, dislocations (a)septic losening and femoropatellar instability. The latter condition is the most frequent complication among implant failures and is caused by bad orientation of the femoral and tibial

  13. Close Intramedullary Interlocking Nailing Versus Locking Compression Plating In the Treatment of Closed Fracture Shaft of the Tibia.

    Science.gov (United States)

    Kundu, I K; Datta, N K; Chowdhury, A Z; Das, K P; Tarik, M M; Faisal, M A

    2016-07-01

    Fracture of tibial shaft is the commonest site of long bone fractures due to its superficial location involving young or middle-age people. Proper management is an important issue regarding the future effective movements. In this study patients were grouped in closed Intra medullary interlocking nailing and locking compression plating. Post-operative follow up at 2 weeks, 6 weeks, 12 weeks and 3 months thereafter up to 6 months were done. Each of the patients was evaluated clinically and radiologically by tucker criteria of Tuker et al. Patients were assessed for pain on full weight bearing and kneeling, shortening and range of motion of knee and ankle joints. Radiological assessment for union of fracture, alignment of fracture and angulations and position of nail and screws and infection were observed during follow up. A total number of 32 patients were selected but only 27 patients were available for follow up for a period of 6 months. They were grouped into Group A, consisting of 15 patients who took the treatment in the form of closed intramedullary interlocking nailing and Group B, consisting of 12 patients those underwent ORIF with locking compression plating. In both of the groups Motor Vehicle Accident was the main mechanism of trauma. Fracture involving the middle 3rd of the tibia is common in both the groups. During post-operative follow up, four patients in Group A complained anterior knee pain, one patient in Group B had superficial infection, most of the patients had no restriction of movement in the ankle and knee joints and a single patient in Group B showed 1.5cm shortening of the lower limb. Period of hospital stay and fracture union time were less in Group A, which was statistically significant. Both groups showed excellent result with minimum complications. So this study permits to conclude that close IM interlocking nailing and open reduction and internal fixation by locking compression plating is equally effective for the management of close

  14. Impact of canal water shortages on groundwater in the Lower Bari Doab Canal system in Pakistan

    International Nuclear Information System (INIS)

    Shakir, A.S.; Rehman, H.U.; Khan, N.M.; Qazi, A.U.

    2011-01-01

    This paper presents rigorous analysis of shortage of canal water supplies, crop water requirements, and groundwater use and its quality in the command of Lower Bari Doab Canal, Pakistan. The annual canal water supplies are 36% less than the crop water requirements. This shortage further increases to 56% if actual canal supplies (averaged over last ten years) are compared with the crop water requirement. The groundwater levels are depleting at the rate of 30 to 40 cm per year in most parts of the LBDC command and this tendency of lowering may increase in future due to further increase in crop water requirements. The analysis of data for the last seven years indicate that quality of groundwater in most parts of LBDC command is generally good (64% of the area) or marginally acceptable (28%) for irrigation use. However, declining trends in groundwater quality are visible and can create long term sustain ability problems if proper remedial actions are not taken well in time. (author)

  15. Gender and laterality in semicircular canal dehiscence syndrome.

    Science.gov (United States)

    Karimnejad, K; Czerny, M S; Lookabaugh, S; Lee, D J; Mikulec, A A

    2016-08-01

    To determine if there is gender or laterality predilection in patients with semicircular canal dehiscence syndrome. A multi-institutional chart review was performed to identify patients diagnosed with semicircular canal dehiscence between 2000 and 2015. A systematic literature search was conducted using PubMed to further identify patients with semicircular canal dehiscence. Age, gender and laterality data were collected. Statistical analysis was performed to evaluate for gender or laterality preponderance. A total of 682 patients with semicircular canal dehiscence were identified by literature and chart review. Mean age of diagnosis was 49.75 years (standard deviation = 15.33). Semicircular canal dehiscence was associated with a statistically significant female predominance (chi-square = 7.185, p = 0.007); the female-to-male ratio was 1.2 to 1. Left-sided semicircular canal dehiscence was most common, followed by right-sided then bilateral (chi-square = 23.457, p < 0.001). Semicircular canal dehiscence syndrome is most commonly left-sided and exhibits a female predominance. This may be secondary to morphological cerebral hemisphere asymmetries in both sexes and a predilection of women to seek more medical care than men.

  16. Environmental pollution and shipping feasibility of the Nicaragua Canal

    International Nuclear Information System (INIS)

    Chen, Jihong; Zeng, Xin; Deng, Yibing

    2016-01-01

    In recent years, the Nicaraguan government's renewed interest in constructing this interoceanic canal has once again aroused widespread concern, particularly in the global shipping industry. The project's immense ecological risks, coupled with the recent expansions of both the Panama Canal and the Suez Canal, have raised questions among scientists and experts about its viability. Whether the Nicaragua Canal is really feasible for international shipping, given its high marine pollution risks, requires the further study. This paper discusses and analyses the feasibility of the Nicaragua Canal in the context of its environmental impact and value as a shipping service. This paper aims to provide an important information reference to inform strategic decision-making among policymakers and stakeholders. Our research results indicate that the environmental complexity, economic costs and safety risks of building a new transoceanic canal are simply too high to justify the project. - Highlights: • The Nicaragua Canal is a long-standing controversial maritime project. • We develop specific analysis of the high environmental pollution risks of the canal. • The shipping service feasibility of the canal is faced with great uncertainty. • The government and stakeholders are suggested to be discreet to the mega project.

  17. Posterior Tibial Slope Angle Correlates With Peak Sagittal and Frontal Plane Knee Joint Loading During Robotic Simulations of Athletic Tasks

    Science.gov (United States)

    Bates, Nathaniel A.; Nesbitt, Rebecca J.; Shearn, Jason T.; Myer, Gregory D.; Hewett, Timothy E.

    2017-01-01

    Background Tibial slope angle is a nonmodifiable risk factor for anterior cruciate ligament (ACL) injury. However, the mechanical role of varying tibial slopes during athletic tasks has yet to be clinically quantified. Purpose To examine the influence of posterior tibial slope on knee joint loading during controlled, in vitro simulation of the knee joint articulations during athletic tasks. Study Design Descriptive laboratory study. Methods A 6 degree of freedom robotic manipulator positionally maneuvered cadaveric knee joints from 12 unique specimens with varying tibial slopes (range, −7.7° to 7.7°) through drop vertical jump and sidestep cutting tasks that were derived from 3-dimensional in vivo motion recordings. Internal knee joint torques and forces were recorded throughout simulation and were linearly correlated with tibial slope. Results The mean (6SD) posterior tibial slope angle was 2.2° ± 4.3° in the lateral compartment and 2.3° ± 3.3° in the medial compartment. For simulated drop vertical jumps, lateral compartment tibial slope angle expressed moderate, direct correlations with peak internally generated knee adduction (r = 0.60–0.65), flexion (r = 0.64–0.66), lateral (r = 0.57–0.69), and external rotation torques (r = 0.47–0.72) as well as inverse correlations with peak abduction (r = −0.42 to −0.61) and internal rotation torques (r = −0.39 to −0.79). Only frontal plane torques were correlated during sidestep cutting simulations. For simulated drop vertical jumps, medial compartment tibial slope angle expressed moderate, direct correlations with peak internally generated knee flexion torque (r = 0.64–0.69) and lateral knee force (r = 0.55–0.74) as well as inverse correlations with peak external torque (r = −0.34 to 20.67) and medial knee force (r = −0.58 to −0.59). These moderate correlations were also present during simulated sidestep cutting. Conclusion The investigation supported the theory that increased posterior

  18. Intramedullary Venous Drainage System for Distal Fingertip Replantations.

    Science.gov (United States)

    Purisa, Husrev; Ozturk, Muhammed Besir; Kabakas, Fatih; Mersa, Berkan; Ozcelik, Ismail Bulent; Sezer, Ilker

    2017-08-01

    The number of venous anastomoses performed during fingertip replantation is one of the most important factors affecting the success of replantation. However, because vessel diameters decrease in the zone 1 level, vessel anastomoses, especially vein anastomoses, are technically difficult and, thus, cannot be performed in most cases. Alternative venous drainage methods are crucial when any reliable vein repair is not possible. In the literature, so many artery-only replantation techniques have been defined, such as arteriovenous anastomoses, forming an arteriovenous or venocutaneous fistula, manual milking and massage, puncturing, and external bleeding via a fishmouth incision and using a medical leech. It has been shown that, in distal fingertip replantations, the medullary cavity may also be a good way for venous return. In this study, we introduce an alternative intramedullary venous drainage system we developed to facilitate venous drainage in artery-only fingertip replantations. The results of 24 fingertip replantations distal to the nail fold by using this system are presented with a literature review.

  19. The failures of root canal preparation with hand ProTaper.

    Science.gov (United States)

    Bătăiosu, Marilena; Diaconu, Oana; Moraru, Iren; Dăguci, C; Tuculină, Mihaela; Dăguci, Luminiţa; Gheorghiţă, Lelia

    2012-07-01

    The failures of root canal preparation are due to some anatomical deviation (canal in "C" or "S") and some technique errors. The technique errors are usually present in canal root cleansing and shaping stage and are the result of endodontic treatment objectives deviation. Our study was made on technique errors while preparing the canal roots with hand ProTaper. Our study was made "in vitro" on 84 extracted teeth (molars, premolars, incisors and canines). The canal root of these teeth were cleansed and shaped with hand ProTaper by crown-down technique and canal irrigation with NaOCl(2,5%). The dental preparation control was made by X-ray. During canal root preparation some failures were observed like: canal root overinstrumentation, zipping and stripping phenomenon, discarded and/or fractured instruments. Hand ProTaper represents a revolutionary progress of endodontic treatment, but a deviation from accepted rules of canal root instrumentation can lead to failures of endodontic treatment.

  20. The effect of canal fill on paediatric femur fractures treated with titanium elastic nails.

    Science.gov (United States)

    Nielsen, E; Bonsu, N; Andras, L M; Goldstein, R Y

    2018-02-01

    Traditional teaching for fixation of paediatric femur fractures recommends 80% nail diameter/medullary canal diameter ratio (ND/MCD) for successful maintenance of reduction. Prior studies have investigated this with stainless steel Enders nails. Our aim was to assess the impact of ND/MCD on maintenance of reduction and malunion rates in paediatric femur fractures treated with flexible intramedullary nails (FINs). Retrospective data was collected on all paediatric patients treated with FINs for diaphyseal femur fractures at a single tertiary care institution over a ten-year period. Patients with co-morbidities affecting bone quality were excluded. Patients were subdivided into groups based on ND/MCD. A total of 66 patients met inclusion criteria. Mean ND/MCD was 76.3% (32.9% to 98.8%, SD 14.3). In all, 50% (n = 33/66) of patients had > 80% ND/MCD, and only 13.6% (n = 9/66) of patients had less than 60% ND/MCD. When controlling for fracture stability, ND/MCD had no correlation with mean shortening (p = 0.07) There was no correlation between ND/MCD and angulation in the sagittal (p = 0.96) or coronal plane (p = 0.20). Three patients fit malunion criteria. ND/MCD for these patients were 40%, 67% and 79%. There was no correlation between ND/MCD and shortening or malangulation. The majority of patients in this series with less than 80% fill with FIN healed within acceptable parameters. III.

  1. 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...

  2. 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

  3. Infected Hydrocele of the Canal of Nuck

    Directory of Open Access Journals (Sweden)

    Parkash Mandhan

    2013-01-01

    Full Text Available Hydrocele of the canal of Nuck in children is rare. It may present as incarcerated inguinal hernia and necessitates emergency exploration. Risk of infection in hydrocele of the canal of nuck is very rare. We present a case report of a 5-year-old girl who presented with a left tender inguinolabial region swelling with fever, tachycardia, and mild dehydration. The clinical features were suggestive of strangulated left inguinal hernia and further imaging and surgical exploration revealed it to be an infected hydrocele of the canal of Nuck. High ligation and hydrocelectomy were performed. Hydrocele of the canal of Nuck in a female child presenting with an inguinal swelling should be considered in differential diagnosis.

  4. The effect of proximal tibial slope on dynamic stability testing of the posterior cruciate ligament- and posterolateral corner-deficient knee.

    Science.gov (United States)

    Petrigliano, Frank A; Suero, Eduardo M; Voos, James E; Pearle, Andrew D; Allen, Answorth A

    2012-06-01

    Proximal tibial slope has been shown to influence anteroposterior translation and tibial resting point in the posterior cruciate ligament (PCL)-deficient knee. The effect of proximal tibial slope on rotational stability of the knee is unknown. Change in proximal tibial slope produced via osteotomy can influence both static translation and dynamic rotational kinematics in the PCL/posterolateral corner (PLC)-deficient knee. Controlled laboratory study. Posterior drawer, dial, and mechanized reverse pivot-shift (RPS) tests were performed on hip-to-toe specimens and translation of the lateral and medial compartments measured utilizing navigation (n = 10). The PCL and structures of the PLC were then sectioned. Stability testing was repeated, and compartmental translation was recorded. A proximal tibial osteotomy in the sagittal plane was then performed achieving either +5° or -5° of tibial slope variation, after which stability testing was repeated (n = 10). Analysis was performed using 1-way analysis of variance (ANOVA; α = .05). Combined sectioning of the PCL and PLC structures resulted in a 10.5-mm increase in the posterior drawer, 15.5-mm increase in the dial test at 30°, 14.5-mm increase in the dial test at 90°, and 17.9-mm increase in the RPS (vs intact; P slope (high tibial osteotomy [HTO] +5°) in the PCL/PLC-deficient knee reduced medial compartment translation by 3.3 mm during posterior drawer (vs deficient; P slope (HTO -5°) caused a 4.8-mm increase in medial compartment translation (vs deficient state; P slope diminished static posterior instability of the PCL/PLC-deficient knee as measured by the posterior drawer test but had little effect on rotational or dynamic multiplanar stability as assessed by the dial and RPS tests, respectively. Conversely, decreasing posterior slope resulted in increased posterior instability and a significant increase in the magnitude of the RPS. These results suggest that increasing posterior tibial slope may improve

  5. The effect of intramedullary bone endoscopy on the endosteal blood supply in long bones. An experimental study in sheep.

    Science.gov (United States)

    Herget, Georg W; Haberstroh, Jörg; Südkamp, Norbert; Riede, Ursus; Oberst, Michael

    2011-02-01

    This study investigated whether the Intramedullary Bone Endoscopy (IBE) procedure within the cavity of an intact long bone will interfere with the local endosteal blood supply. In a sheep model, 10 animals underwent the IBE procedure with complete perioperative anaesthesiology monitoring. After the femora were harvested, histological analysis was performed to examine destruction of the endosteum and consecutive reduction in perfusion. Only one animal showed evidence of detachment of the endosteum with destruction of several microns of the endosteum, although this did not interfere with the cortical perfusion. None of the vessels were occluded by fat or other causes of occlusion, e.g. blood coagulation. Our findings indicate that with the IBE procedure under visual control there is a potential risk to damage the endosteum. However, the interference was limited to a small part of the endosteum and did not lead to a reduction in the cortical perfusion. Clinical use could be in localized intramedullary lesions such as osteomyelitis or benign bone tumours.

  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. Preliminary evaluation of the tibial tuberosity-trochlear groove measurement

    DEFF Research Database (Denmark)

    Miles, James Edward; Kirpensteijn, Jolle; Svalastoga, Eiliv Lars

    guide surgical treatment. The TTTG measures tibial tuberosity position relative to the axis of the femoral trochlea. A preliminary investigation of TTTG measurement was performed using the red fox (Vulpes vulpes) cadavers as a morphologically similar and homogenous substitute for dog cadavers. CT...

  9. Incidence and characteristics of mandibular accessory canals: A radiographic investigation.

    Science.gov (United States)

    Borgonovo, Andrea Enrico; Taschieri, Silvio; Vavassori, Virna; Re, Dino; Francetti, Luca; Corbella, Stefano

    2017-11-01

    The aim of the present study was to explore, through tridimensional reconstructions of cone-beam computed tomography (CBCT) scans, the presence and the characteristics of mandibular accessory canals. For each included participant, the presence of accessory canals was recorded. The diameter of the canal, as well as the distance between the canal walls and the walls of the mandibular bone (lingual, buccal, cranial and caudal), were measured and recorded. Mandibular accessory canals could be found in 8.8% of participants. Retromolar canals were the most frequently found accessory mandibular canals. Accessory mandibular canals were found in a relatively high number of participants through the examination of CBCT scans and tridimensional reconstruction. The presence of such structures should be considered cautiously when planning and performing surgical interventions in mandibular area. © 2017 John Wiley & Sons Australia, Ltd.

  10. 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...

  11. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments

    OpenAIRE

    Franklyn, Melanie; Oakes, Barry

    2015-01-01

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imagin...

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Anterior referencing of tibial slope in total knee arthroplasty considerably influences knee kinematics : a musculoskeletal simulation study

    NARCIS (Netherlands)

    Marra, Marco Antonio; Strzelczak, Marta; Heesterbeek, Petra J.C.; van de Groes, Sebastiaan A.W.; Janssen, Dennis W.; Koopman, Bart F.J.M.; Wymenga, Ate B.; Verdonschot, Nico J.J.

    2017-01-01

    Purpose: In total knee arthroplasty (TKA), the posterior tibial slope is not always reconstructed correctly, and the knee ligaments may become too tight in flexion. To release a tight flexion gap, surgeons can increase the posterior tibial slope using two surgical resection techniques: the anterior

  14. 21 CFR 872.3820 - Root canal filling resin.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Root canal filling resin. 872.3820 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3820 Root canal filling resin. (a) Identification. A root canal filling resin is a device composed of material, such as methylmethacrylate, intended...

  15. Patella height changes post high tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Siew Ghim Gooi

    2017-01-01

    Full Text Available Background: Medial opening wedge high tibial osteotomy (HTO is a well-described treatment in early medial compartmental osteoarthritis of the knee. However, two undesirable sequelae may follow –patella baja and changes in the posterior tibial slope (TS. Materials and Methods: We conducted a retrospective study in patients who underwent HTO in our center between September 2009 and February 2017. Preoperative and 6-week postoperative long-leg weight bearing films and lateral knee radiographs were assessed. Pre- and postoperative radiological measurements include the Caton-Deschamps Index (CDI, the mechanical axis deviation (MAD, and the posterior TS. Independant t-test and Pearson correlation test were performed. Results: A total of 106 knees were recruited. The mean age was 48.8 ± 10.8 years. 66 (62.3% and 40 (37.7% knees were from males and females, respectively. The mean pre- and postoperative measurements was (−9.70° ± 3.67° to 0.08° ± 2.80° (−varus; +valgus for the MAD, (7.14° ± 1.78° to 8.72° ± 3.11° for posterior TS, and (0.93° ± 0.084° to 0.82° ± 0.13° for CDI (P ≤ 0.001 for all. The association between patella height change and the level of osteotomy (supra-tubercle vs. infra-tubercle was statistically significant (P < 0.001. A supra-tubercle osteotomy cut significantly lowering patella height (P = 0.011. There was otherwise no statistically significant correlations between patella height changes and the correction angle (P = 0.187 or posterior TS change (P = 0.744. Conclusions: A medial opening wedge HTO above the tibial tubercle was significantly associated with lowering patella height or reducing CDI postoperatively. Based on our results, we would recommend the use of an infra-tubercle osteotomy during the corrective surgery to prevent the complication of patella baja.

  16. Mejoras en el canal de Panamá

    Directory of Open Access Journals (Sweden)

    Brandl, Charles McG.

    1963-07-01

    Full Text Available The Panama Canal, together with the Suez Canal, is an engineering accomplishment which is now regarded as a master work marking the initiation of modern civil engineering. Other projects, also of great magnitude, do not seem to maintain the reputation of the above two, because they cannot continue to serve their function with sustained usefulness in the new circumstances of today. The Panama Canal, with its limited dock capacity, and the narrow, so called Serpent, canal, has had to cope with a continuously increasing volume of shipping traffic; a natural consequence of commercial evolution. In order to keep up with these increasing demands, it has been necessary to carry out an almost uninterrupted series of modifications and improvements, affecting both the method of operation and organisation, and the actual nature of the canal. Thanks to these alterations the Panama Canal has continued to maintain, at least nominally, an adequate standard of functional efficiency. At present the canal is being widened over certain sections to enable the easy passage of ships of great displacement. The work is being done very rapidly, and in order to gain time, it has been distributed to various contractors simultaneously.El canal a través del ismo de Panamá es una obra de ingeniería civil que, junto con el de Suez, empiezan ya a clasificarse como obras maestras que señalan el primer jalón del desarrollo de la ingeniería moderna. Otras obras, también importantes, no conservan, sin embargo, la misma reputación que aquéllas, por no seguir un paralelismo con las exigencias en cada época. El canal de Panamá, con sus exclusas, y angosto paso llamado de la. Culebra, ha tenido que afrontar un tráfico creciente de navíos que siguen la evolución del tiempo. Para conseguir este paralelismo, tanto el material de explotación como la organización, dragados y mejoras, han tenido que conocer una sucesión ininterrumpida de modificaciones que han permitido

  17. 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...

  18. Comparison of the rheological properties of four root canal sealers

    Institute of Scientific and Technical Information of China (English)

    Seok Woo Chang; Kwang Shik Bae; Young-Kyu Lee; Qiang Zhu; Won Jun Shon; Woo Cheol Lee; Kee Yeon Kum; Seung Ho Baek; In Bog Lee; Bum-Soon Lim

    2015-01-01

    The flowability of a root canal sealer is clinically important because it improves the penetration of the sealer into the complex root canal system. The purpose of this study was to compare the flowabilities of four root canal sealers, measured using the simple press method (ISO 6876), and their viscosities, measured using a strain-controlled rheometer. A newly developed, calcium phosphate-based root canal sealer (Capseal) and three commercial root canal sealers (AH Plus, Sealapex and Pulp Canal Sealer EWT) were used in this study. The flowabilities of the four root canal sealers were measured using the simple press method (n55) and their viscosities were measured using a strain-controlled rheometer (n55). The correlation between these two values was statistically analysed using Spearman’s correlation test. The flow diameters and the viscosities of the root canal sealers were strongly negatively correlated (r520.8618). The viscosity of Pulp Canal Sealer EWT was the lowest and increased in the following order:AH Plus,Sealapex,Capseal (P,0.05). All of the tested root canal sealers showed characteristic time-and temperature-dependent changes in their rheological properties. The viscosities measured using the strain-controlled rheometer were more precise than the flowabilities measured using the simple press method, suggesting that the rheometer can accurately measure the rheological properties of root canal sealers.

  19. Management of Acquired Atresia of the External Auditory Canal.

    Science.gov (United States)

    Bajin, Münir Demir; Yılmaz, Taner; Günaydın, Rıza Önder; Kuşçu, Oğuz; Sözen, Tevfik; Jafarov, Shamkal

    2015-08-01

    The aim was to evaluate surgical techniques and their relationship to postoperative success rate and hearing outcomes in acquired atresia of the external auditory canal. In this article, 24 patients with acquired atresia of the external auditory canal were retrospectively evaluated regarding their canal status, hearing, and postoperative success. Acquired stenosis occurs more commonly in males with a male: female ratio of 2-3:1; it seems to be a disorder affecting young adults. Previous ear surgery (13 patients, 54.2%) and external ear trauma (11 patients, 45.8%) were the main etiological factors of acquired ear canal stenosis. Mastoidectomy (12/13) and traffic accidents (8/11) comprise the majority of these etiological factors. Endaural incision is performed in 79.2% and postauricular incision for 20.8% of cases during the operation. As types of surgical approach, transcanal (70.8%), transmastoid (20.8%), and combined (8.4%) approaches are chosen. The atretic plate is generally located at the bony-cartilaginous junction (37.5%) and in the cartilaginous canal (33.3%); the bony canal is involved in a few cases only. Preserved healthy canal skin, split- or full-thickness skin grafts, or pre- or postauricular skin flaps are used to line the ear canal, but preserved healthy canal skin is preferred. The results of surgery are generally satisfactory, and complications are few if surgical principles are followed.

  20. High-resolution axial MR imaging of tibial stress injuries

    Directory of Open Access Journals (Sweden)

    Mammoto Takeo

    2012-05-01

    Full Text Available Abstract Purpose To evaluate the relative involvement of tibial stress injuries using high-resolution axial MR imaging and the correlation with MR and radiographic images. Methods A total of 33 patients with exercise-induced tibial pain were evaluated. All patients underwent radiograph and high-resolution axial MR imaging. Radiographs were taken at initial presentation and 4 weeks later. High-resolution MR axial images were obtained using a microscopy surface coil with 60 × 60 mm field of view on a 1.5T MR unit. All images were evaluated for abnormal signals of the periosteum, cortex and bone marrow. Results Nineteen patients showed no periosteal reaction at initial and follow-up radiographs. MR imaging showed abnormal signals in the periosteal tissue and partially abnormal signals in the bone marrow. In 7 patients, periosteal reaction was not seen at initial radiograph, but was detected at follow-up radiograph. MR imaging showed abnormal signals in the periosteal tissue and entire bone marrow. Abnormal signals in the cortex were found in 6 patients. The remaining 7 showed periosteal reactions at initial radiograph. MR imaging showed abnormal signals in the periosteal tissue in 6 patients. Abnormal signals were seen in the partial and entire bone marrow in 4 and 3 patients, respectively. Conclusions Bone marrow abnormalities in high-resolution axial MR imaging were related to periosteal reactions at follow-up radiograph. Bone marrow abnormalities might predict later periosteal reactions, suggesting shin splints or stress fractures. High-resolution axial MR imaging is useful in early discrimination of tibial stress injuries.

  1. High-resolution axial MR imaging of tibial stress injuries

    Science.gov (United States)

    2012-01-01

    Purpose To evaluate the relative involvement of tibial stress injuries using high-resolution axial MR imaging and the correlation with MR and radiographic images. Methods A total of 33 patients with exercise-induced tibial pain were evaluated. All patients underwent radiograph and high-resolution axial MR imaging. Radiographs were taken at initial presentation and 4 weeks later. High-resolution MR axial images were obtained using a microscopy surface coil with 60 × 60 mm field of view on a 1.5T MR unit. All images were evaluated for abnormal signals of the periosteum, cortex and bone marrow. Results Nineteen patients showed no periosteal reaction at initial and follow-up radiographs. MR imaging showed abnormal signals in the periosteal tissue and partially abnormal signals in the bone marrow. In 7 patients, periosteal reaction was not seen at initial radiograph, but was detected at follow-up radiograph. MR imaging showed abnormal signals in the periosteal tissue and entire bone marrow. Abnormal signals in the cortex were found in 6 patients. The remaining 7 showed periosteal reactions at initial radiograph. MR imaging showed abnormal signals in the periosteal tissue in 6 patients. Abnormal signals were seen in the partial and entire bone marrow in 4 and 3 patients, respectively. Conclusions Bone marrow abnormalities in high-resolution axial MR imaging were related to periosteal reactions at follow-up radiograph. Bone marrow abnormalities might predict later periosteal reactions, suggesting shin splints or stress fractures. High-resolution axial MR imaging is useful in early discrimination of tibial stress injuries. PMID:22574840

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

    Directory of Open Access Journals (Sweden)

    Chandra Sekharam Naidu

    2015-05-01

    Full Text Available 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 were deemed not amenable for surgical reconstruction . 2 Conservative treatment by POP cast l ead to prolonged immobilization, leading to ankle and knee stiffness affecting quality of life of the patient . 3 Operative treatment is indicated for most tibial fractures caused by high energy trauma. Operative treatment allows early motion, and avoids sho rtening and other complications associated with prolonged immobilization . 4 The fundamental goal of treatment of distal tibial fractures is restoration of normal or near normal alignment and articular congruity and finally to obtain a well healed fracture; pain free weight bearing ; and functional ROM of ankle joint. For the past decade, plating has been successful in treating complex fractures of the lower extremity especially distal tibia . 5 Conventional ORIF have been associated with complications like infe ction and delayed or non - union due to devitalisation of bony fragments and additional damage to the soft tissues . 6 To improve fracture healing, more “biological” methods have been developed in the last decade to lessen the surgical dissection, preserving b lood supply to bony fragments and containing at least partially the fracture haematoma . 7 Recently, the trend is towards use of a Locking compression plate for treatment of fractures of the distal part of the tibia 8 . Compared with a conventional plate, a Lo cking compression plate imparts a higher degree of stability and provides better protection against primary and secondary losses of reduction and minimization of bone

  3. 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.

  4. Strain measurements of the tibial insert of a knee prosthesis using a knee motion simulator.

    Science.gov (United States)

    Sera, Toshihiro; Iwai, Yuya; Yamazaki, Takaharu; Tomita, Tetsuya; Yoshikawa, Hideki; Naito, Hisahi; Matsumoto, Takeshi; Tanaka, Masao

    2017-12-01

    The longevity of a knee prosthesis is influenced by the wear of the tibial insert due to its posture and movement. In this study, we assumed that the strain on the tibial insert is one of the main reasons for its wear and investigated the influence of the knee varus-valgus angles on the mechanical stress of the tibial insert. Knee prosthesis motion was simulated using a knee motion simulator based on a parallel-link six degrees-of-freedom actuator and the principal strain and pressure distribution of the tibial insert were measured. In particular, the early stance phase obtained from in vivo X-ray images was examined because the knee is applied to the largest load during extension/flexion movement. The knee varus-valgus angles were 0° (neutral alignment), 3°, and 5° malalignment. Under a neutral orientation, the pressure was higher at the middle and posterior condyles. The first and second principal strains were larger at the high and low pressure areas, respectively. Even for a 3° malalignment, the load was concentrated at one condyle and the positive first principal strain increased dramatically at the high pressure area. The negative second principal strain was large at the low pressure area on the other condyle. The maximum equivalent strain was 1.3-2.1 times larger at the high pressure area. For a 5° malalignment, the maximum equivalent strain increased slightly. These strain and pressure measurements can provide the mechanical stress of the tibial insert in detail for determining the longevity of an artificial knee joint.

  5. 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

  6. Middle mesial canals in mandibular molars: incidence and related factors.

    Science.gov (United States)

    Nosrat, Ali; Deschenes, Raney J; Tordik, Patricia A; Hicks, M Lamar; Fouad, Ashraf F

    2015-01-01

    Although the internal anatomy of mandibular molars has been extensively studied, information about middle mesial (MM) canals is limited. The primary aim of this retrospective study was to evaluate the incidence of MM canals in mandibular first and second molars. The secondary aim was to correlate the incidence of MM canals with variables of molar type, sex, age, ethnicity, and presence of a second distal canal. All mature permanent first and second mandibular molars treated from August 2012 to May 2014 were included in the analysis. After completion of root canal instrumentation in all main canals, the clinician inspected the isthmus area of the mesial root using the dental operating microscope. If there was a catch point in this area with a file or explorer, the operator spent more time attempting to negotiate an MM canal. Seventy-five mandibular first and second molars were treated during the specified period. Fifteen (20%) teeth had negotiable MM canals. The incidence of MM canals was 32.1% in patients ≤ 20 years old, 23.8% in patients 21-40 years old, and 3.8% in patients > 40 years. Analysis of data revealed a significant difference in the distribution of MM canals among different age groups (P molar type, and presence of a second distal canal were not significant. The incidence of negotiable MM canals overall and their frequency of identification in younger patients were higher than in previous reports. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  7. Inverse relationship between the complexity of midfoot kinematics and muscle activation in patients with medial tibial stress syndrome

    DEFF Research Database (Denmark)

    Rathleff, M S; Samani, Afshin; Olesen, C G

    2011-01-01

    Medial tibial stress syndrome is a common overuse injury characterized by pain located on the medial side of the lower leg during weight bearing activities such as gait. The purpose of this study was to apply linear and nonlinear methods to compare the structure of variability of midfoot kinematics...... and surface electromyographic (SEMG) signals between patients with medial tibial stress syndrome and healthy controls during gait. Fourteen patients diagnosed with medial tibial stress syndrome and 11 healthy controls were included from an orthopaedic clinic. SEMG from tibialis anterior and the soleus muscles...... as well as midfoot kinematics were recorded during 20 consecutive gait cycles. Permuted sample entropy and permutation entropy were used as a measure of complexity from SEMG signals and kinematics. SEMG signals in patients with medial tibial stress syndrome were characterized by higher structural...

  8. The effect of polyethylene creep on tibial insert locking screw loosening and back-out in prosthetic knee joints.

    Science.gov (United States)

    Sanders, Anthony P; Raeymaekers, Bart

    2014-10-01

    A prosthetic knee joint typically comprises a cobalt-chromium femoral component that articulates with a polyethylene tibial insert. A locking screw may be used to prevent micromotion and dislodgement of the tibial insert from the tibial tray. Screw loosening and back-out have been reported, but the mechanism that causes screw loosening is currently not well understood. In this paper, we experimentally evaluate the effect of polyethylene creep on the preload of the locking screw. We find that the preload decreases significantly as a result of polyethylene creep, which reduces the torque required to loosen the locking screw. The torque applied to the tibial insert due to internal/external rotation within the knee joint during gait could thus drive locking screw loosening and back-out. The results are very similar for different types of polyethylene. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Radiographic evaluation of the quality of root canal obturation of single-matched cone Gutta-percha root canal filling versus hot lateral technique

    Directory of Open Access Journals (Sweden)

    Randa Suleiman Obeidat

    2014-01-01

    Full Text Available Aim: The aim of this study is to evaluate radiographically the quality of root canal filling in mesiodistal and buccolingual view when comparing matched cone condensation and warm lateral Gutta-percha condensation using system B heating instrument in a low-heat warm lateral condensation technique in0 vitro. Materials and Methods: A total of 40 mandibular premolars with straight single canals were divided into two groups with 20 each. The root canals were shaped by hand file and Revo-S rotary files to size (25, 0.06 at the end point, then they filled by Gutta-percha cone and meta-seal sealer. In group A, a single matched cone technique was used to fill the root canals. In group B, a hot lateral condensation using system B instrument at 101°C was performed. Result: The result of this study showed no significant difference in density of Gutta-percha fill in apical and coronal two-third when comparing matched cone root canal filling and hot lateral technique (P > 0.05. The only significant difference (P < 0.05 was in matched cone between buccolingual and mesiodistal view in the coronal two-third. Conclusion: Within the limitation of this study, single matched cone technique has a good density in the apical one-third as that of the hot lateral technique so it may be used for filling narrow canals. In the coronal two-third of the root canal, single matched cone technique showed inferior density of root canal filling which can be improved by using accessory cones Gutta-percha in wide canal.

  11. MRI signal-based quantification of subchondral bone at the tibial plateau: a population study

    Energy Technology Data Exchange (ETDEWEB)

    MacKay, James W. [Norfolk and Norwich University Hospital, Department of Radiology, Norwich (United Kingdom); Norfolk and Norwich University Hospital, Radiology Academy, Cotman Centre, Norwich (United Kingdom); Godley, Keith C.; Toms, Andoni P. [Norfolk and Norwich University Hospital, Department of Radiology, Norwich (United Kingdom)

    2014-11-15

    To determine whether differences in subchondral sclerosis at the tibial plateau could be detected with magnetic resonance (MR) imaging in two different age groups. This was a retrospective hypothesis-testing study. Thirty-two knees in group A (25-30 year olds) and 32 knees in group B (45-50 years old) were included. Participants had no MR features of osteoarthritis (OA). On coronal images, tibial articular cartilage thickness was measured, and regions of interest were created in the medial and lateral tibial plateau subchondral bone and in the tibial metaphysis. The measure of heterogeneity at the tibial plateaux was the ratio of the standard deviation of the signal in the medial/lateral compartment to the standard deviation of the signal in the metaphysis (ratio of standard deviations - RSS{sub medial}/RSS{sub lateral}). Differences between groups were assessed using unpaired Student's t-tests. Mean RSS{sub medial} was 2.61 (standard deviation, SD = 0.77) in group A and 2.97 (SD = 0.59) in group B. Mean RSS{sub lateral} in group A was 1.86 (SD = 0.63) and 1.89 (SD = 0.43) in group B. Mean total cartilage thickness (in mm) in group A was 3.38 (SD = 0.90) for the medial and 3.90 (SD = 1.09) for the lateral compartment and 3.44 (SD = 0.74) for the medial and 3.96 (SD = 0.96) for the lateral compartment in group B. The only parameter to show a statistically significant difference between groups was RSS{sub medial} (p = 0.04). A difference in medial subchondral bone sclerosis between two age groups was demonstrated in the absence of MR features of OA. This may represent the earliest OA change detectable on MR imaging. (orig.)

  12. Less-invasive stabilization of rib fractures by intramedullary fixation: a biomechanical evaluation.

    Science.gov (United States)

    Bottlang, Michael; Helzel, Inga; Long, William; Fitzpatrick, Daniel; Madey, Steven

    2010-05-01

    This study evaluated intramedullary fixation of rib fractures with Kirschner wires and novel ribs splints. We hypothesized that rib splints can provide equivalent fixation strength while avoiding complications associated with Kirschner wires, namely wire migration and cutout. The durability, strength, and failure modes of rib fracture fixation with Kirschner wires and rib splints were evaluated in 22 paired human ribs. First, intact ribs were loaded to failure to determine their strength. After fracture fixation with Kirschner wires and rib splints, fixation constructs were dynamically loaded to 360,000 cycles at five times the respiratory load to determine their durability. Finally, constructs were loaded to failure to determine residual strength and failure modes. All constructs sustained dynamic loading without failure. Dynamic loading caused three times more subsidence in Kirschner wire constructs (1.2 mm +/- 1.4 mm) than in rib splint constructs (0.4 mm +/- 0.2 mm, p = 0.09). After dynamic loading, rib splint constructs remained 48% stronger than Kirschner wire constructs (p = 0.001). Five of 11 Kirschner wire constructs failed catastrophically by cutting through the medial cortex, leading to complete loss of stability and wire migration through the lateral cortex. The remaining six constructs failed by wire bending. Rib splint constructs failed by development of fracture lines along the superior and interior cortices. No splint construct failed catastrophically, and all splint constructs retained functional reduction and fixation. Because of their superior strength and absence of catastrophic failure mode, rib splints can serve as an attractive alternative to Kirschner wires for intramedullary stabilization of rib fractures, especially in the case of posterior rib fractures where access for plating is limited.

  13. Newer Root Canal Irrigants in Horizon: A Review

    Directory of Open Access Journals (Sweden)

    Sushma Jaju

    2011-01-01

    Full Text Available Sodium hypochloride is the most commonly used endodontic irrigant, despite limitations. None of the presently available root canal irrigants satisfy the requirements of ideal root canal irrigant. Newer root canal irrigants are studied for potential replacement of sodium hypochloride. This article reviews the potential irrigants with their advantages and limitations with their future in endodontic irrigation.

  14. Posterior tibial tendon dysfunction by bone imprisonment | Zejjari ...

    African Journals Online (AJOL)

    The posterior tibial muscle is the main functional support of the plantar arch its dysfunction is the main cause of acquired flat foot. This is a 32 year old patient who consults for progressive pain of the inside of the ankle and right foot with a considerable decrease in its sporting and professional activity. Examination reveals a ...

  15. 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.

  16. Neuronal hyperplasia in the anal canal

    DEFF Research Database (Denmark)

    Fenger, C; Schrøder, H D

    1990-01-01

    In a consecutive series of minor surgical specimens from the anal canal, neuronal hyperplasia was found in nine of 56 haemorrhoidectomy specimens and in four of 23 fibrous polyps. In an additional series of 14 resections of the anal canal, neuronal hyperplasia was present in six cases, of which f...

  17. 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.

  18. THE BUSINESS OF THE CANAL: THE ECONOMICS AND POLITICS OF THE CARTER ADMINISTRATION’S PANAMA CANAL ZONE INITIATIVE, 1978

    Directory of Open Access Journals (Sweden)

    Mary C. Swilling

    2004-01-01

    Full Text Available The Carter-Torrijos Treaty of 1978, the initiative to relinquish controi of the Panama Canal Zone to the Republic of Panama, allowed Panama for the first time in its short history to become an autonomous nation and to take control of its destiny as a global trading crossroads. Conservatives rallied against President Carter and accused him of jeopardizing U. S. security and hegemony. Fears were that Panama did not have the economic or technical resources to maintain Canal operations, lacked the administrative knowledge and resources to manage the business of the Canal, lacked the military presence to insure security of the Canal, and did not have the political and social will to maintain the environmental integrity of the region. In short, disastrous results were predicted. Carter prevailed. December 31, 1999 saw the surrender of the Canal Zone, and all its facilities, to Panama. This paper discusses events that precipitated Carter’s decision, economic and political arguments presented during the 1977-78 debate, implementation of the treaty, and an evaluation of the ‘business of the Canal’ today.

  19. Hydrology and environmental aspects of Erie Canal (1817-99)

    Science.gov (United States)

    Langbein, Walter Basil

    1976-01-01

    As the first major water project in the United States, the old Erie Canal provides an example of the hydrological and environmental consequences of water development. The available record shows that the project aroused environmental fears that the canal might be impaired by the adverse hydrologic effects of land development induced by the canal. Water requirements proved greater than anticipated, and problems of floods and hydraulic inefficiencies beset navigation throughout its history. The Erie Canal proved the practicality of major hydraulic works to the extent that operations and maintenance could cope with the burdens of deficiencies in design. The weight of prior experience that upland streams, such as the Potomac and Mohawk Rivers, had proved unsatisfactory for dependable navigation, led to a decision to build an independent canal which freed the location from the constraints of river channels and made possible a cross-country water route directly to Lake Erie. The decision on dimensioning the canal prism--chiefly width and depth-involved balance between a fear of building too small and thus not achieving the economic potentials, and a fear of building too expensively. The constraints proved effective, and for the first part of its history the revenues collected were sufficient to repay all costs. So great was the economic advantage of the canal that the rising trend in traffic soon induced an enlargement of the canal cross section, based upon a new but riskier objective-build as large as the projected trend in toll revenues would finance. The increased revenues did not materialize. Water supplies were a primary concern for both the planners and the operators of the canal. Water required for lockage, although the most obvious to the planners, proved to be a relatively minor item compared with the amounts of water that were required to compensate for leakage through the bed and banks of the canal. Leakage amounted to about 8 inches of depth per day. The total

  20. Femoral shaft fractures in children: elastic stable intramedullary nailing in 31 cases

    DEFF Research Database (Denmark)

    Houshian, Shirzad; Gøthgen, Charlotte Buch; Pedersen, Niels Wisbech

    2004-01-01

    We report our experience with elastic stable intramedullary titanium nailing (ESIN) of femoral shaft fractures in children. From 1998 to 2001, we treated 31 children (20 boys), median age 6 (4-11) years, with ESIN for 29 closed and 2 grade I open femoral shaft fractures. We reviewed 30 children...... clinically after median 1.5 (1-3) years. Their median hospital stay was 6 (2-20) days. All fractures were radiographically united at a median of 7 (5-9) weeks. The nails were removed in 29 children after a median of 22 (6-38) weeks postoperatively. At follow-up, we found a leg-length discrepancy up to 1 cm...