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Sample records for open tibial fractures

  1. Tibial fractures.

    PubMed

    Seaman, Jeffrey A; Simpson, Amelia M

    2004-08-01

    Tibial fractures are common in small animal practice. As with other appendicular fractures, the patient's age, fracture location, and fracture type must be considered thoroughly. While methods for tibial fracture repair are similar to those used for appendicular fractures elsewhere, there are some unique considerations, both anatomically and functionally, that must be contemplated before repair. The following article will review the incidence of tibial fractures, tibial fracture types, and options for tibial fracture management and treatment. The use of external fixators, orthopedic bone plates, open reduction with internal fixation (ORIF), and external coaptation will be discussed. An emphasis will be placed on the most common types of tibial fractures, as well as those best suited for repair by general practitioners of veterinary medicine. Three case based examples will follow the overview.

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

    PubMed Central

    Jaña Neto, Frederico Carlos; de Paula Canal, Marina; Alves, Bernardo Aurélio Fonseca; Ferreira, Pablício Martins; Ayres, Jefferson Castro; Alves, Robson

    2016-01-01

    Objective To analyze the characteristics of patients with Gustilo–Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014. Methods This was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive); presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score) index; mortality rate; and infection rate. Results 116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%). Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75%) and IIIB (25%) predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group. Conclusion The profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions. PMID:27069881

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

    PubMed

    Jaña Neto, Frederico Carlos; de Paula Canal, Marina; Alves, Bernardo Aurélio Fonseca; Ferreira, Pablício Martins; Ayres, Jefferson Castro; Alves, Robson

    2016-01-01

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

  4. Severe open tibial fractures in combat trauma: management and preliminary outcomes.

    PubMed

    Penn-Barwell, J G; Bennett, P M; Fries, C A; Kendrew, J M; Midwinter, M J; Rickard, R F

    2013-01-01

    The aim of this study was to report the pattern of severe open diaphyseal tibial fractures sustained by military personnel, and their orthopaedic-plastic surgical management.The United Kingdom Military Trauma Registry was searched for all such fractures sustained between 2006 and 2010. Data were gathered on demographics, injury, management and preliminary outcome, with 49 patients with 57 severe open tibial fractures identified for in-depth study. The median total number of orthopaedic and plastic surgical procedures per limb was three (2 to 8). Follow-up for 12 months was complete in 52 tibiae (91%), and half the fractures (n = 26) either had united or in the opinion of the treating surgeon were progressing towards union. The relationship between healing without further intervention was examined for multiple variables. Neither the New Injury Severity Score, the method of internal fixation, the requirement for vascularised soft-tissue cover nor the degree of bone loss was associated with poor bony healing. Infection occurred in 12 of 52 tibiae (23%) and was associated with poor bony healing (p = 0.008). This series characterises the complex orthopaedic-plastic surgical management of severe open tibial fractures sustained in combat and defines the importance of aggressive prevention of infection.

  5. Molecular profiling of a simple rat model of open tibial fractures with hematoma and periosteum disruption

    PubMed Central

    Villafan-Bernal, Jose Rafael; Franco-De La Torre, Lorenzo; Sandoval-Rodriguez, Ana Soledad; Armendariz-Borunda, Juan; Alcala-Zermeno, Juan Luis; Cruz-Ramos, Jose Alfonso; Lopez-Armas, Gabriela; Ramirez-Bastidas, Blanca Estela; González-Enríquez, Gracia Viviana; Collazo-Guzman, Emerson Armando; Martinez-Portilla, Raigam Jafet; Sánchez-Enríquez, Sergio

    2016-01-01

    Bone fractures are a worldwide public health concern. Therefore, improving understanding of the bone healing process at a molecular level, which could lead to the discovery of potential therapeutic targets, is important. In the present study, a model of open tibial fractures with hematoma disruption, periosteal rupture and internal fixation in 6-month-old male Wistar rats was established, in order to identify expression patterns of key genes and their protein products throughout the bone healing process. A tibial shaft fracture was produced using the three-point bending technique, the hematoma was drained through a 4-mm incision on the medial aspect of the tibia and the fracture stabilized by inserting a needle into the medullary canal. Radiographs confirmed that the induced fractures were diaphyseal and this model was highly reproducible (kappa inter-rater reliability, 0.82). Rats were sacrificed 5, 14, 21, 28 and 35 days post-fracture to obtain samples for histological, immunohistochemical and molecular analysis. Expression of interleukin-1β (Il-1β), transforming growth factor-β2 (Tgf-β2), bone morphogenetic protein-6 (Bmp-6), bone morphogenetic protein-7 (Bmp-7) and bone γ-carboxyglutamic acid-containing protein (Bglap) genes was determined by reverse transcription quantitative polymerase chain reaction and protein expression was evaluated by immunohistochemistry, while histological examination allowed characterization of the bone repair process. Il-1β showed a biphasic expression, peaking 5 and 28 days post-fracture. Expression of Tgf-β2, Bmp-6 and Bmp-7 was restricted to the period 21 days post-fracture. Bglap expression increased gradually, peaking 21 days post-fracture, although it was expressed in all evaluated stages. Protein expression corresponded with the increased expression of their corresponding genes. In conclusion, a clear and well-defined expression pattern of the evaluated genes and proteins was observed, where their maximal expression

  6. Does human immunodeficiency virus status affect early wound healing in open surgically stabilised tibial fractures?: A prospective study.

    PubMed

    Howard, N E; Phaff, M; Aird, J; Wicks, L; Rollinson, P

    2013-12-01

    We compared early post-operative rates of wound infection in HIV-positive and -negative patients presenting with open tibial fractures managed with surgical fixation. The wounds of 84 patients (85 fractures), 28 of whom were HIV positive and 56 were HIV negative, were assessed for signs of infection using the ASEPIS wound score. There were 19 women and 65 men with a mean age of 34.8 years. A total of 57 fractures (17 HIV-positive, 40 HIV-negative) treated with external fixation were also assessed using the Checkett score for pin-site infection. The remaining 28 fractures were treated with internal fixation. No significant difference in early post-operative wound infection between the two groups of patients was found (10.7% (n = 3) vs 19.6% (n = 11); relative risk (RR) 0.55 (95% confidence interval (CI) 0.17 to 1.8); p = 0.32). There was also no significant difference in pin-site infection rates (17.6% (n = 3) vs 12.5% (n = 5); RR 1.62 (95% CI 0.44 to 6.07); p = 0.47). The study does not support the hypothesis that HIV significantly increases the rate of early wound or pin-site infection in open tibial fractures. We would therefore suggest that a patient's HIV status should not alter the management of open tibial fractures in patients who have a CD4 count > 350 cells/μl.

  7. Reaming Does Not Affect Functional Outcomes After Open and Closed Tibial Shaft Fractures: The Results of a Randomized Controlled Trial.

    PubMed

    Lin, Carol A; Swiontkowski, Marc; Bhandari, Mohit; Walter, Stephen D; Schemitsch, Emil H; Sanders, David; Tornetta, Paul

    2016-03-01

    We sought to determine the effect of reaming on 1-year 36-item short-form general health survey (SF-36) and short musculoskeletal function assessment (SMFA) scores from the Study to Prospectively Evaluate Reamed Intramedullary Nails in patients with Tibial Fractures. Prospective randomized controlled trial.1319 patients were randomized to reamed or unreamed nails. Fractures were categorized as open or closed. Twenty-nine academic and community health centers across the US, Canada, and the Netherlands. One thousand three hundred and nineteen skeletally mature patients with closed and open diaphyseal tibia fractures. Reamed versus unreamed tibial nails. SF-36 and the SMFA. Outcomes were obtained during the initial hospitalization to reflect preinjury status, and again at the 2-week, 3-month, 6-month, and 1-year follow-up. Repeated measures analyses were performed with P < 0.05 considered significant. There were no differences between the reamed and unreamed groups at 12 months for either the SF-36 physical component score [42.9 vs. 43.4, P = 0.54, 95% Confidence Interval for the difference (CI) -2.1 to 1.1] or the SMFA dysfunction index (18.0 vs. 17.6, P = 0.79. 95% CI, -2.2 to 2.9). At one year, functional outcomes were significantly below baseline for the SF-36 physical componentf score, SMFA dysfunction index, and SMFA bothersome index (P < 0.001). Time and fracture type were significantly associated with functional outcome. Reaming does not affect functional outcomes after intramedullary nailing for tibial shaft fractures. Patients with open fractures have worse functional outcomes than those with a closed injury. Patients do not reach their baseline function by 1 year after surgery. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

  8. Long-term quality of life in trauma patients following the full spectrum of tibial injury (fasciotomy, closed fracture, grade IIIB/IIIC open fracture and amputation).

    PubMed

    Giannoudis, Peter V; Harwood, Paul J; Kontakis, George; Allami, Mohamad; Macdonald, David; Kay, Simon P; Kind, Paul

    2009-02-01

    To measure long-term functional outcome and health-related quality of life following tibial fracture in association with the full spectrum of soft tissue injury. One hundred and thirty patients with different types of tibial injury were selected from our trauma database. This included 33 patients with compartment syndrome (no underlying fracture), 30 with closed diaphyseal tibial fractures, 45 with grade IIIB/IIIC open fractures and 22 requiring below knee amputation. Mean time to final follow-up was 37.4 months. The EQ-5D (EuroQol) questionnaire was used to assess these patients at this point. Patients had been treated according to standard unit protocols. Open fractures were jointly managed under the care of local plastic and orthopaedic surgeons using a policy of obtaining early soft tissue cover. Patients with reconstructed IIIB fractures reported problems with pain and carrying out their normal activities more frequently than amputees whilst still reporting problems with mobility just as frequently. Anxiety and depression were more common in the patients with open fractures and amputees as were problems with self-care, though the latter were unusual overall. Stepwise logistic regression revealed that tibial injury type was significantly predictive of all measured outcomes except self-care (p<0.0001). Age, ISS, sex and time to follow-up were not significant predictors of response. These results show that patients with these injuries still report long-term problems with their health-related quality of life, though to varying degrees. This information is useful when determining the treatment options for these patients and it is important that it is shared with the patient prior to surgery where possible.

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

    PubMed Central

    Kulshrestha, Vikas

    2008-01-01

    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. PMID:19753227

  10. Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-tibial amputation.

    PubMed

    Penn-Barwell, J G; Myatt, R W; Bennett, P M; Sargeant, I D

    2015-02-01

    Extremity injuries define the surgical burden of recent conflicts. Current literature is inconclusive when assessing the merits of limb salvage over amputation. The aim of this study was to determine medium term functional outcomes in military casualties undergoing limb salvage for severe open tibia fractures, and compare them to equivalent outcomes for unilateral trans-tibial amputees. Cases of severe open diaphyseal tibia fractures sustained in combat between 2006 and 2010, as described in a previously published series, were contacted. Consenting individuals conducted a brief telephone interview and were asked to complete a SF-36 questionnaire. These results were compared to a similar cohort of 18 military patients who sustained a unilateral trans-tibial amputation between 2004 and 2010. Forty-nine patients with 57 severe open tibia fractures met the inclusion criteria. Telephone follow-up and SF-36 questionnaire data was available for 30 patients (61%). The median follow-up was 4 years (49 months, IQR 39-63). Ten of the 30 patients required revision surgery, three of which involved conversion from initial fixation to a circular frame for non- or mal-union. Twenty-two of the 30 patients (73%) recovered sufficiently to complete an age-standardised basic military fitness test. The median physical component score of SF-36 in the limb salvage group was 46 (IQR 35-54) which was similar to the trans-tibial amputation cohort (p=0.3057, Mann-Whitney). Similarly there was no difference in mental component scores between the limb salvage and amputation groups (p=0.1595, Mann-Whitney). There was no significant difference in the proportion of patients in either the amputation or limb salvage group reporting pain (p=0.1157, Fisher's exact test) or with respect to SF-36 physical pain scores (p=0.5258, Mann-Whitney). This study demonstrates that medium term outcomes for military patients are similar following trans-tibial amputation or limb salvage following combat trauma

  11. Percutaneous or Open Reduction of Closed Tibial Shaft Fractures During Intramedullary Nailing Does Not Increase Wound Complications, Infection or Nonunion Rates.

    PubMed

    Auston, Darryl A; Meiss, Jordan; Serrano, Rafael; Sellers, Thomas; Carlson, Gregory; Hoggard, Timothy; Beebe, Michael; Quade, Jonathan; Watson, David; Simpson, Robert Bruce; Kistler, Brian; Shah, Anjan; Sanders, Roy; Mir, Hassan R

    2017-04-01

    To compare the incidence of complications (wound, infection, and nonunion) among those patients treated with closed, percutaneous, and open intramedullary nailing for closed tibial shaft fractures. Retrospective review. Multiple trauma centers. Skeletally mature patients with closed tibia fractures amenable to treatment with an intramedullary device. Intramedullary fixation with closed, percutaneous, or open reduction. Superficial wound complication, deep infection, nonunion. A total of 317 tibial shaft fractures in 315 patients were included in the study. Two-hundred fractures in 198 patients were treated with closed reduction, 61 fractures in 61 patients were treated with percutaneous reduction, and 56 fractures in 56 patients were treated with formal open reduction. The superficial wound complication rate was 1% (2/200) for the closed group, 1.6% (1/61) for the percutaneous group, and 3.6% (2/56) for the open group with no statistical difference between the groups (P = 0.179). The deep infection rate was 2% (4/200) for the closed group, 1.6% (1/61) for the percutaneous group, and 7.1% (4/56) for the open group with no significant difference between the groups (P = 0.133). Nonunion rate was 5.0% (10/200) for the closed group, 4.9% (3/61) for the percutaneous group, and 7.1% (4/56) for the open group, with no statistical difference between the groups (P = 0.492). This is the largest reported series of closed tibial shaft fractures nailed with percutaneous and open reduction. Percutaneous or open reduction did not result in increased wound complications, infection, or nonunion rates. Carefully performed percutaneous or open approaches can be safely used in obtaining reduction of difficult tibial shaft fractures treated with intramedullary devices. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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

    PubMed

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

    2017-05-01

    This study aimed to quantitatively summarize the risk factors associated with surgical site infection after open reduction and internal fixation of tibial plateau fracture. Medline, Embase, CNKI, Wanfang database and Cochrane central database were searched for relevant original studies from database inception to October 2016. Eligible studies had to meet quality assessment criteria according to the Newcastle-Ottawa Scale, and had to evaluate the risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture. Stata 11.0 software was used for this meta-analysis. Eight studies involving 2214 cases of tibial plateau fracture treated by open reduction and internal fixation and 219 cases of surgical site infection were included in this meta-analysis. The following parameters were identified as significant risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture (p < 0.05): open fracture (OR 3.78; 95% CI 2.71-5.27), compartment syndrome (OR 3.53; 95% CI 2.13-5.86), operative time (OR 2.15; 95% CI 1.53-3.02), tobacco use (OR 2.13; 95% CI 1.13-3.99), and external fixation (OR 2.07; 95% CI 1.05-4.09). Other factors, including male sex, were not identified as risk factors for surgical site infection. Patients with the abovementioned medical conditions are at risk of surgical site infection after open reduction and internal fixation of tibial plateau fracture. Surgeons should be cognizant of these risks and give relevant preoperative advice. Copyright © 2017. Published by Elsevier Ltd.

  13. [Retrograde nailing in a tibial fracture].

    PubMed

    Valls-Mellado, M; Martí-Garín, D; Fillat-Gomà, F; Marcano-Fernández, F A; González-Vargas, J A

    2014-01-01

    We describe a case of a severely comminuted type iiia open tibial fracture, with distal loss of bone stock (7 cm), total involvement of the tibial joint surface, and severe instability of the fibular-talar joint. The treatment performed consisted of thorough cleansing, placing a retrograde reamed calcaneal-talar-tibial nail with proximal and distal blockage, as well as a fibular-talar Kirschner nail. Primary closure of the skin was achieved. After 3 weeks, an autologous iliac crest bone graft was performed to fill the bone defect, and the endomedullary nail, which had protruded distally was reimpacted and dynamized distally. The bone defect was eventually consolidated after 16 weeks. Currently, the patient can walk without pain the tibial-astragal arthrodesis is consolidated. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  14. Composite vascularised osteocutaneous fibula and sural nerve graft for severe open tibial fracture--functional outcome at one year: a case report.

    PubMed

    Halim, A S; Yusof, I

    2004-06-01

    Management of severe open tibial fracture with neurovascular injury is difficult and controversial. Primary amputation is an acceptable option as salvaging the injured, insensate, and ischaemic limb may result in chronic osteomyelitis and non-functional limb. We report a case of open tibial fracture associated with segmental bone and soft tissue loss, posterior tibial nerve and artery injuries, which was further complicated by chronic osteo-myelitis treated with composite vascularised osteocutaneous fibula and sural nerve graft. Functional outcome of the injured limb at one-year follow-up was satisfactory: the patient was capable of achieving full weightbearing and was able to appreciate crude touch, pain, proprioception, and temperature at the plantar aspect of the foot. There was no pressure sore or ulceration.

  15. The use of secure anonymised data linkage to determine changes in healthcare utilisation following severe open tibial fractures.

    PubMed

    Page, Piers R J; Trickett, Ryan W; Rahman, Shakeel M; Walters, Angharad; Pinder, Leila M; Brooks, Caroline J; Hutchings, Hayley; Pallister, Ian

    2015-07-01

    Severe open fractures of the lower limbs are complex injuries requiring expert multidisciplinary management in appropriate orthoplastic centres. This study aimed to assess the impact of open fractures on healthcare utilisation and test the null hypotheses that there is no difference in healthcare utilisation between the year before and year after injury, and that there is no difference in healthcare utilisation in the year post-injury between patients admitted directly to an orthoplastic centre in keeping with the joint BOA/BAPRAS standards and those having initial surgery elsewhere. This retrospective cohort study utilising secure anonymised information linkage (SAIL), a novel databank of anonymised nationally pooled health records, recruited patients over 18 years of age sustaining severe open lower limb fractures managed primarily or secondarily at our centre and who had data available in the SAIL databank. 101 patients met inclusion criteria and 90 of these had records in the SAIL databank. The number of days in hospital, number of primary care attendances, number of outpatient attendances and number of emergency department attendances in the years prior and subsequent to injury were recorded. Patients sustaining open fractures had significantly different healthcare utilisation in the year after injury when compared with the year before, in terms of days spent in hospital (23.42 vs. 1.70, p=0.000), outpatient attendances (11.98 vs. 1.05, p=0.000), primary care attendances (29.48 vs. 11.99, p=0.000) and emergency department presentations (0.2 vs. 0.01, p=0.025). Patients admitted directly to orthoplastic centres had significantly fewer operations (1.78 vs. 3.31) and GP attendances (23.6 vs. 33.52) than those transferred in subsequent to initial management in other units. There is a significant increase in healthcare utilisation after open tibial fracture. Adherence to national standards minimises the impact of this on both patients and health services. Copyright

  16. Percutaneous plating of distal tibial fractures.

    PubMed

    Khoury, Amal; Liebergall, Meir; London, Eli; Mosheiff, Rami

    2002-09-01

    This article presents our experience with 24 patients who had distal tibial fractures and were treated by percutaneous plate fixation. Distribution of the fractures according to the AO/OTA classification was as follows: five patients suffered from a 43 A type fracture, six from a 43 B type fracture, and 13 from a 43 C type fractures. Four of the fractures were open. Exclusion criteria included 43 C3 fractures and Gustilo III open fractures. All fractures showed radiographic signs of union enough to enable full weightbearing within an average time of 12.3 weeks. All patients showed a good range of motion (average dorsiflexion 12 degrees and average plantiflexion 18 degrees). Two fractures united with mal-union: one with an 8 degrees valgus deformity and another with a 7 degrees varus deformity. Both cases, which had a metaphyseal component, were treated by means of a "soft" (flexible and manually adjustable) AO 3.5 mm reconstruction plate. Except for one case of superficial infection, no infections were detected in any of the patients. The biological percutaneous plate fixation of distal tibial fractures with no extensive intra-articular involvement is a good soft tissue preserving technique. It provides a rigid and anatomical fixation in most cases. We conclude that type B fractures with one intact column can be fixed with either "soft" or "rigid" plates, and type A and C fractures with a metaphyseal component should be fixed with "rigid" plates (AO 4.5 mm Dynamic Compression Plate). In these fractures the reduction should be performed cautiously due to the tendency of sagittal plane mal-reduction.

  17. The effect of intact fibula on functional outcome of reamed intramedullary interlocking nail in open and closed isolated tibial shaft fractures: A prospective study.

    PubMed

    Balaji, S Muthukumar; Chandra, P Madhu; Devadoss, Sathish; Devadoss, A

    2016-01-01

    Isolated tibial shaft (ITS) fracture with intact fibula is a common injury but records often fail to mention it. Our primary aim was to study the effect of the intact fibula in ITS fractures in closed and open injuries and that these fractures can unite without a primary fibulectomy. 56 patients who sustained an ITS fracture with an intact fibula who underwent closed or open reduction and reamed intramedullary interlocking nailing (IM IL nail) for closed and open fractures between August 2008 and April 2014 were included in this study. Four patients were lost to followup. One patient died due to causes not related to the surgery. At the time of final followup, 51 patients with 51 ITS fractures were available for the analysis. There were 33 closed and 18 open fractures. Patients were followed up at 4 weekly intervals until radiological signs of union were noted. They were assessed for functional outcome using the IOWA knee and ankle score systems at the time of final followup. The average time to union was 19.7 weeks. Closed fractures united in 17.7 weeks as compared to 23.5 weeks for open fractures (P < 0.05). A delay in union occurred in 6 patients (4 open) and in 3 patients fractures failed to unite (2 open). The functional outcome as per the knee score and ankle score evaluation system was 93.13 and 92.54, respectively. The knee scores were 93.81 and 91.8 for closed and open ITS fractures, respectively (P > 0.05). Similarly, the ankle scores were 94.96 and 88.1 for closed and open ITS fractures, respectively (P < 0.05). ITS fracture with intact fibula is a common occurrence, and they can be treated safely with reamed IM nailing that provides good union rates and the excellent functional result even in open fractures.

  18. Subatmospheric pressure dressings in the temporary treatment of soft tissue injuries associated with type III open tibial shaft fractures in children.

    PubMed

    Dedmond, Barnaby T; Kortesis, Bill; Punger, Kathleen; Simpson, Jordan; Argenta, Joseph; Kulp, Brenda; Morykwas, Michael; Webb, Lawrence X

    2006-01-01

    This study was designed to evaluate the use of subatmospheric pressure dressings on high-energy open tibial shaft fractures in children. We hypothesized that the use of a negative-pressure dressing in these fractures would result in a decreased incidence of infection and decreased need for pedicled muscle flaps and free tissue transfer. A retrospective case series of 15 consecutive pediatric patients with 16 type III open tibial shaft fractures (8 type IIIA, 7 type IIIB, and 1 type IIIC). The patients' age ranged from 2 to 17 years. All patients underwent a standard protocol of serial irrigation and debridement of the open wound with bony stabilization. Temporary coverage of the open wound was obtained with the use of a subatmospheric pressure dressing until definitive wound coverage or closure. Infection occurred in 5 of 16 fractures, 2 requiring antibiotics alone (1 type IIIA and 1 type IIIB) and 3 requiring surgical intervention (2 type IIIB and 1 type IIIC). Seven of 16 (3 type IIIA, 3 type IIIB, and 1 type IIIC) fractures required repeat surgical intervention to facilitate bony healing. Only 3 patients required free tissue transfers or rotational muscle flaps for coverage, a 50% decrease compared with the initial classification. Compared with other described methods, the use of subatmospheric pressure dressings in the temporary treatment of soft tissue wounds associated with high-energy open tibial shaft may reduce the need for major soft tissue coverage procedures. Its effect on infection and fracture healing rates requires further study. A reduction in the need for major soft tissue coverage procedures with the use of negative-pressure dressings in this setting should result in decreased morbidity for these patients and in decreased social and financial costs.

  19. Tibial shaft fractures in football players.

    PubMed

    Chang, Winston R; Kapasi, Zain; Daisley, Susan; Leach, William J

    2007-06-13

    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. 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 < 0.05). Return to activity was also different in the two groups, conservative 27.6 weeks versus operative 23.3 weeks (p < 0.05). The most common fracture pattern was AO Type 42A3 in 14/24 (58.3%). A high number 19/24 (79.2%) were simple transverse or short oblique fractures. There was a low non-union rate 1/24 (4.2%) and absence of any open injury in our series. 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.

  20. Reverse Segond Fracture Associated with Anteromedial Tibial Rim and Tibial Attachment of Anterior Cruciate Ligament Avulsion Fractures

    PubMed Central

    2017-01-01

    Reverse Segond fracture is an uncommon avulsion fracture of the tibial attachment of the deep portion of the medial collateral ligament of the knee. We report a reverse Segond fracture associated with anterior cruciate ligament tibial avulsion fracture and anteromedial tibial rim fracture. Unlike previous reports, the combination of reverse Segond fracture, anteromedial tibial rim fracture, and anterior cruciate ligament avulsion fracture was not associated with posterior cruciate ligament injury, posterolateral corner injury, or tibial plateau fracture. This new combination of injuries provides better understanding of the mechanisms of ligamentous injuries of the knee and highlights the importance of meticulous assessment of these injuries for accurate diagnosis and subsequent management. PMID:28951794

  1. Calf muscle wasting after tibial shaft fracture

    PubMed Central

    Khalid, M; Brannigan, A; Burke, T

    2006-01-01

    Objectives To study the long term effect of tibial shaft fractures treated by immobilisation in a long leg cast on the calf muscle bulk. Methods Computed tomography scans were performed at fixed points on the lower legs of 23 non‐professional athletes who sustained closed tibial fractures 16 years previously. Length of immobilisation was determined from the hospital records. All the fractures were treated non‐operatively. The cross sectional area of the various leg compartments was measured and compared with the non‐injured leg. Results There was a significant reduction in cross sectional area of the posterior compartment (p<0.001, Student's t test). No such difference was seen in the anterolateral compartment. Conclusion Tibial fractures treated non‐operatively are associated with significant long term calf muscle wasting. PMID:16720890

  2. Do Capactively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    DTIC Science & Technology

    2005-12-01

    medial tibial condylar stress fractures were investigated. Four imaging...Capacitively coupled electric fields did not accelerate tibial stress fracture healing of the group as a whole in comparison with placebo treatment (rest...but women took longer to recover from tibial stress fractures than men. Superior treatment compliance was positively associated with reduced time to healing. REFERENCES NA APPENDICES NA

  3. Insufficiency fractures of the tibial plateau

    SciTech Connect

    Manco, L.G.; Schneider, R.; Pavlov, H.

    1983-06-01

    An insufficiency fracture of the tibial plateau may be the cause of knee pain in patients with osteoporosis. The diagnosis is usually not suspected until a bone scan is done, as initial radiographs are often negative or inconclusive and clinical findings are nonspecific and may simulate osteoarthritis or spontaneous osteonecrosis. In five of 165 patients referred for bone scans due to nontraumatic knee pain, a characteristic pattern of intense augmented uptake of radionuclide confined to the tibial plateau led to a presumptive diagnosis of insufficiency fracture, later confirmed on radiographs.

  4. Usefulness of long tibial axis to measure medial tibial slope for opening wedge high tibial osteotomy.

    PubMed

    Akamatsu, Y; Sotozawa, M; Kobayashi, H; Kusayama, Y; Kumagai, K; Saito, T

    2016-11-01

    To assess which tibial slope measurements on knee, whole leg radiographs and three-dimensional reconstructed computed tomography (CT) were useful in clinical practice before and after opening wedge high tibial osteotomy. Medial and lateral tibial slopes on knee, whole leg radiographs and three-dimensional reconstructed CT were measured in 50 patients with knee osteoarthritis. To investigate the intraobserver reproducibility and interobserver reliability for each medial and lateral tibial slope on knee, whole leg radiographs and CT, the measurements were repeated twice by two observers. The statistical differences between the medial and lateral tibial slopes obtained by the three methods, and the differences and correlation coefficients for the medial and lateral tibial slopes between knee or whole leg radiographs and CT were calculated. The reproducibility and reliability of medial and lateral tibial slopes on CT were superior to those on whole leg or knee radiographs. The medial and lateral tibial slopes on whole leg radiographs had better reproducibility and reliability than those on knee radiographs. The mean medial tibial slopes on knee, whole leg radiographs and CT were 9.3 ± 3.4°, 12.3 ± 4.3° and 11.0 ± 3.9°, respectively. The mean lateral tibial slopes were 7.9 ± 3.1°, 9.6 ± 3.6° and 9.3 ± 2.9°, respectively. The medial tibial slopes on knee, whole leg radiographs and CT were significantly higher than the lateral tibial slopes (p < 0.01 for all). Tibial slope measurements using CT required time and specialized software. Therefore, measurements of the medial tibial slope using the long tibial axis on whole leg radiographs were more reproducible and reliable and could be an alternative to CT in clinical practice. III.

  5. Treatment of segmental tibial fractures with supercutaneous plating.

    PubMed

    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.

  6. Fracture of tibial tuberosity in an adult

    PubMed Central

    Albuquerque, Rodrigo Pires e; Campos, André Siqueira; de Araújo, Gabriel Costa Serrão; Gameiro, Vinícius Schott

    2013-01-01

    The fracture of tibial tuberosity is a rare lesion and still more unusual in adults. We describe a case in an adult who suffered a left knee injury due to a fall from height. No risk factors were identified. The lesion was treated with surgical reduction and internal fixation. The rehabilitation method was successful, resulting in excellent function and rage of motion of the knee. The aim of this study was to present an unusual case of direct trauma of the tibial tuberosity in an adult and the therapy performed. PMID:24293543

  7. Treatment strategy for tibial plateau fractures: an update

    PubMed Central

    Prat-Fabregat, Salvi; Camacho-Carrasco, Pilar

    2016-01-01

    Tibial plateau fractures are complex injuries produced by high- or low-energy trauma. They principally affect young adults or the ‘third age’ population. These fractures usually have associated soft-tissue lesions that will affect their treatment. Sequential (staged) treatment (external fixation followed by definitive osteosynthesis) is recommended in more complex fracture patterns. But one should remember that any type of tibial plateau fracture can present with soft-tissue complications. Typically the Schatzker or AO/OTA classification is used, but the concept of the proximal tibia as a three-column structure and the detailed study of the posteromedial and posterolateral fragment morphology has changed its treatment strategy. Limb alignment and articular surface restoration, allowing early knee motion, are the main goals of surgical treatment. Partially articular factures can be treated by minimally-invasive methods and arthroscopy is useful to assist and control the fracture reduction and to treat intra-articular soft-tissue injuries. Open reduction and internal fixation (ORIF) is the gold standard treatment for these fractures. Complex articular fractures can be treated by ring external fixators and minimally-invasive osteosynthesis (EFMO) or by ORIF. EFMO can be related to suboptimal articular reduction; however, outcome analysis shows results that are equal to, or even superior to, ORIF. The ORIF strategy should also include the optimal reduction of the articular surface. Anterolateral and anteromedial surgical approaches do not permit adequate reduction and fixation of posterolateral and posteromedial fragments. To achieve this, it is necessary to reduce and fix them through specific posterolateral or posteromedial approaches that allow optimal reduction and plate/screw placement. Some authors have also suggested that primary total knee arthroplasty could be an option in specific patients and with specific fracture patterns. Cite this article: Prat

  8. Biomechanical Factors in Tibial Stress Fractures

    DTIC Science & Technology

    2005-08-01

    OF TIBIAL STRESS FRACTURE? To be presented at the International Society of Biomechanics Annual Meeting, Cleveland, OH. 3. IS DYNAMIC HIP AND KNEE ...A Radiographic Analysis of the Relationship between the Size and Shape of the Intercondylar Notch and Anterior Cruciate Ligament Injury Knee surgery...Frontal Plane Mechanics during Walking between Patients with Medial and Lateral Knee Presented at the American American Society of Biomechanics Mtg

  9. Tosic external fixator in the management of proximal tibial fractures in adults.

    PubMed

    Tosic, A; Ebraheim, N A; Abou Chakra, I; Emara, K

    2001-06-01

    This retrospective clinical study assessed proximal tibial fractures managed with the Tosic external fixator. Nineteen patients with 21 proximal tibial fractures treated with the Tosic external fixator between July 1997 and October 1998 comprised the study population. Eleven fractures were graded as 41A2, 3 fractures as 41 A3, 4 fractures as 41C1, and 3 fractures as 41 C2. Fourteen fractures were closed, and 7 fractures were open. Average time to healing was 1 7 weeks. No revision of fixation was needed. There were five cases of pin tract infection. Average range of knee motion was 2 degrees-135 degrees. These results indicate the Tosic external fixator is an efficient and simple way to treat proximal tibial metaphyseal fractures.

  10. Return to sport following tibial plateau fractures: A systematic review.

    PubMed

    Robertson, Greg A J; Wong, Seng J; Wood, Alexander M

    2017-07-18

    To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods. A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords "tibial", "plateau", "fractures", "knee", "athletes", "sports", "non-operative", "conservative", "operative", "return to sport". All studies which recorded return rates and times to sport following tibial plateau fractures were included. Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management ( n = 3); 27 reported on the outcome of surgical management ( n = 917). Nine studies reported on Open Reduction Internal Fixation (ORIF) ( n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation (ARIF) ( n = 253) and 7 on Frame-Assisted Fixation (FRAME) ( n = 262). All studies recorded "return to sport" rates. Only one study recorded a "return to sport" time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF (OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME (OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME (OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo (median), from a study reporting on ORIF. Return rates to sport for tibial plateau

  11. Return to sport following tibial plateau fractures: A systematic review

    PubMed Central

    Robertson, Greg A J; Wong, Seng J; Wood, Alexander M

    2017-01-01

    AIM To systemically review all studies reporting return to sport following tibial plateau fracture, in order to provide information on return rates and times to sport, and to assess variations in sporting outcome for different treatment methods. METHODS A systematic search of CINAHAL, Cochrane, EMBASE, Google Scholar, MEDLINE, PEDro, Scopus, SPORTDiscus and Web of Science was performed in January 2017 using the keywords “tibial”, “plateau”, “fractures”, “knee”, “athletes”, “sports”, “non-operative”, “conservative”, “operative”, “return to sport”. All studies which recorded return rates and times to sport following tibial plateau fractures were included. RESULTS Twenty-seven studies were included: 1 was a randomised controlled trial, 7 were prospective cohort studies, 16 were retrospective cohort studies, 3 were case series. One study reported on the outcome of conservative management (n = 3); 27 reported on the outcome of surgical management (n = 917). Nine studies reported on Open Reduction Internal Fixation (ORIF) (n = 193), 11 on Arthroscopic-Assisted Reduction Internal Fixation (ARIF) (n = 253) and 7 on Frame-Assisted Fixation (FRAME) (n = 262). All studies recorded “return to sport” rates. Only one study recorded a “return to sport” time. The return rate to sport for the total cohort was 70%. For the conservatively-managed fractures, the return rate was 100%. For the surgically-managed fractures, the return rate was 70%. For fractures managed with ORIF, the return rate was 60%. For fractures managed with ARIF, the return rate was 83%. For fractures managed with FRAME was 52%. The return rate for ARIF was found to be significantly greater than that for ORIF (OR 3.22, 95%CI: 2.09-4.97, P < 0.001) and for FRAME (OR 4.33, 95%CI: 2.89-6.50, P < 0.001). No difference was found between the return rates for ORIF and FRAME (OR 1.35, 95%CI: 0.92-1.96, P = 0.122). The recorded return time was 6.9 mo (median), from a study

  12. Lateral epicondylar femoral avulsion fracture combined with tibial fracture: a counterpart to the arcuate sign.

    PubMed

    Yoo, Jae Ho; Yang, Bo Kyu; Ryu, Ho Kwang

    2008-01-01

    We present a case of femoral avulsion of the lateral collateral ligament (LCL) with complete tear of the posterior cruciate ligament (PCL) and popliteus tendon accompanied by demonstrable posterolateral rotary instability (PLRI) of the knee. A 55-year-old man was involved in a road traffic accident. Radiographs revealed an avulsion fracture of the lateral epicondyle of the femur and a fracture of the tibial shaft. An MRI scan showed the lateral epicondyle was avulsed by the LCL and the popliteus tendon. The PCL signal was absent. The tibial shaft fracture was fixed with an intra medullary nail. Sagging of the tibia, with loss of prominence of tibial tuberosity and a positive posterior drawer test, demonstrated a complete tear of the PCL. The avulsion fracture of the lateral epicondyle was treated by an open reduction and internal fixation with two staples. A ligament can be avulsed at either end, and to our knowledge, this pattern of injury as a counterpart to arcuate sign has never been documented in the literature. It is important not to dismiss a small avulsion fracture around the knee joint as insignificant, as it could indicate the presence of a major ligamentous injury.

  13. Radiographic predictors of compartment syndrome in tibial plateau fractures.

    PubMed

    Ziran, Bruce H; Becher, Stephen John

    2013-11-01

    The purpose of this article was to evaluate the relationship of radiographic features of tibial plateau fractures to the development of compartment syndrome. We hypothesized that the direction and degree of initial displacement of the femur on the tibia, and the amount of tibial widening (TW), were correlated with the development of compartment syndrome. Retrospective case-control study. Single level 1 trauma center. Retrospective evaluation of 158 patients with 162 plateau fractures. Grouping with and without compartment syndrome. The following data were obtained: age, sex, Schatzker and OTA/AO classification, open/closed status, TW, and femoral displacement (FD). A univariate statistical and a logistical regression analysis were performed to determine significance. The overall rate of compartment syndrome was 11%. Univariate analysis found both the TW and FD to be significant with respect to development of compartment syndrome (P < 0.05). Higher Schatzker (IV-VI) and OTA/AO grades were also correlated (P < 0.05) with increased incidence of compartment syndrome. Logistic regression found FD and Schatzker grade to be significant. Our study is the first to identify easily obtained radiographic parameters that correlate to the occurrence compartment syndrome. There may also be a relationship between TW and FD, as noted by regression result. This study helps to assess which patients with a fracture are at higher risk for developing a compartment syndrome. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  14. Treatment of tibial diaphyseal fractures following plateless tibial tuberosity advancement to manage cranial cruciate disease.

    PubMed

    De Sousa, R; Egan, P; Parsons, K; Butterworth, S; Calvo, I; Roch, S; Moores, A P

    2017-07-01

    To report diaphyseal fractures of the proximal tibia following tibial tuberosity advancement without plate stabilisation for the management of cranial cruciate ligament rupture in dogs. Members of the British Veterinary Orthopaedic Association's online discussion forum were invited to submit revision cases of tibial diaphyseal fracture following tibial tuberosity advancement without plate fixation. Data collected included signalment, surgical revision technique, pre- and postoperative revision radiographic findings, complications and veterinary assessment. Owners were invited to complete the Liverpool Osteoarthritis in Dogs questionnaire. A total of 17 dogs were included in the study. Eleven dogs had OrthoFoam-wedge modified Maquet procedures and six had the tibial tuberosity advancement rapid procedure. Tibial tuberosity advancement was maintained in 14/17 cases. Postrevision surgery complications occurred in eight cases: minor complications in 3/17 dogs; major in 5/17 and no catastrophic complications. Surgical site infection was the most common complication (4/8). Final clinical outcome found 8/17 of dogs to have excellent, 8/17 satisfactory and 1/17 poor clinical outcome. The median Liverpool Osteoarthritis in Dogs score was 12/52 (range 2 to 28). Final outcome was 6/13 owners that were very satisfied, 2/13 owners indifferent and 5/13 owners very disappointed. This is the first case series reporting tibial diaphyseal fractures following tibial tuberosity advancement without plate stabilisation. The authors report here a wide spectrum of potential fixation strategies should one of these fractures occur. © 2017 British Small Animal Veterinary Association.

  15. Multiple Tibial Insufficiency Fractures in the Same Tibia

    PubMed Central

    Defoort, Saartje; Mertens, Peter

    2011-01-01

    Stress fractures were first described by Briethaupt in 1855. Since then, there have been many discussions in the literature concerning stress fractures, which have been described in both weight-bearing and non-weight-bearing bones. Currently, the tibia is the most frequent location, but multiple stress fractures in the same tibia are rare. This paper presents an unusual case of a 60-year-old woman with multiple tibial stress fractures of spontaneous onset. PMID:23569673

  16. Tibial shaft fractures - management and treatment options. A review of the current literature.

    PubMed

    Bode, G; Strohm, P C; Südkamp, N P; Hammer, T O

    2012-01-01

    Treatment of tibial shaft fractures is still discussed controversial. In the present study current literature was reviewed with the objective to demonstrate current recommendations concerning tibial shaft fractures. Tibial shaft fractures are often caused by high-energy trauma with severe concomitant soft-tissue injuries. Solid bone union without hypertrophy, fast mobilization and full range of motion without further soft-tissue damages are the aims of the therapy. Non-displaced tibial shaft fractures in patients with good compliance can be treated conservatively. Deep venous thrombosis, compartment syndrome, soft tissue injury and chronic regional pain syndrome are the major risks of conservative treatment and need to be required. Operative treatment can be performed with several different implants. Intramedullary nailing with a huge biomechanical stability seems to be the implant of choice. Only rare indications for plate osteosynthesis can be found. The use of external fixation has declined even though external fixation is still the implant of choice in first line treatment of multiple trauma according to the damage control principles. Open fractures with precarious blood supply and weak soft tissue covering are vulnerable to complications and remain a challenge for every treating surgeon. Reconstruction of axis, length and rotation is essential for a good outcome. The choice of technique depends on fracture localization, type of fracture, history of concomitant disorders and soft tissue damage.

  17. Surgical Management of Tibial Plateau Fractures With 3.5 mm Simple Plates.

    PubMed

    Bagherifard, Abolfazl; Jabalameli, Mahmoud; Hadi, Hosseinali; Rahbar, Mohammad; Minator Sajjadi, Mohammadreza; Jahansouz, Ali; Karimi Heris, Hossein

    2016-05-01

    Tibial plateau fractures can be successfully fixed utilizing 3.5 mm locking plates. However, there are some disadvantages to using these plates. In the current prospective study, we investigated the outcome of treating different types of tibial plateau fractures with 3.5 mm simple plates which, to our knowledge, has not been evaluated in previous studies. Between 2011 and 2013, 32 patients aged 40 ± 0.2 years underwent open reduction and internal fixation for tibial plateau fractures with 3.5 mm simple plates. The patients were followed for 16.14 ± 2.1 months. At each patient's final visit, the articular surface depression, medial proximal tibial angle, and slope angle were measured and compared with measurements taken early after the operation. The functional outcomes were measured with the WOMAC and Lysholm knee scores. The mean union time was 13 ± 1.2 weeks. The mean knee range of motion was 116.8° ± 3.3°. The mean WOMAC and Lysholm scores were 83.5 ± 1.8 and 76.8 ± 1.6, respectively. On the early postoperative and final X-rays, 87.5% and 84% of patients, respectively, had acceptable reduction. Medial proximal tibial and slope angles did not change significantly by the last visit. No patient was found to have complications related to the type of plate. In this case series study, the fixation of different types of tibial plateau fractures with 3.5 mm simple non-locking and non-precontoured plates was associated with acceptable clinical, functional, and radiographic outcomes. Based on the advantages and costs of these plates, the authors recommend using 3.5 mm simple plates for different types of tibial plateau fractures.

  18. Arthroscopically assisted percutaneous osteosynthesis of lateral tibial plateau fractures.

    PubMed

    Kayali, Cemil; Oztürk, Hasan; Altay, Taskin; Reisoglu, Ali; Agus, Haluk

    2008-10-01

    The aim of our study was to evaluate the results of lateral tibial plateau fractures treated with arthroscopically assisted percutaneous osteosynthesis (AAPO). Twenty-one patients (14 men and 7 women) with a mean age of 41 years underwent AAPO to repair low-energy Schatzker I-III tibial plateau fractures. Under pneumatic tourniquet, we reduced and fixed the fracture with 1 or 2 subchondral cannulated screws. Accompanying lesions included 10 meniscus tears, which we partially excised in 9 patients and repaired in 1 patient. On the second postoperative day, patients began range-of-motion exercises. We encouraged partial and full weight-bearing by the sixth and tenth weeks, respectively. The mean follow-up period was 38 (range 12-96) months, and we evaluated the patients using Rasmussen's clinical and radiologic criteria. We used a t test for statistical analysis. There were 13 excellent (62%), 6 good (28%) and 2 fair (10%) clinical results, and 11 excellent (52%), 7 good (33%) and 3 fair (14%) radiologic results. We observed mild or moderate arthritic changes in 5 patients (24%). There were no infection or wound problems, but we removed hardware in 4 patients. Arthroscopically assisted treatment of lateral tibial plateau fractures yields satisfactory results and can be accepted as an alternative and effective method for the treatment of low-energy tibial plateau fractures.

  19. Bone stress in runners with tibial stress fracture.

    PubMed

    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.

  20. Complications and unplanned outcomes following operative treatment of tibial plateau fractures.

    PubMed

    Kugelman, David; Qatu, Abdullah; Haglin, Jack; Leucht, Phillip; Konda, Sanjit; Egol, Kenneth

    2017-10-01

    The operative management of tibial plateau fractures is challenging and post-operative complications do occur. The purpose of this study was three-fold. 1). To report complications and unplanned outcomes in patients who had sustained tibial plateau fractures and were operatively managed 2). To report predictors of these post-operative events 3). To report if differences in clinical outcomes exist in patients who sustained a post-operative event. Over 11 years, all tibial plateau fractures were prospectively followed. Clinical outcomes were assessed using the validated Short Musculoskeletal Functional Assessment (SMFA) score. Demographics, initial injury characteristics, surgical details and post-operative events were prospectively recorded. Student's t-tests were used for continuous variables and chi-squared analysis was used for categorical variables. Binary logistic regression and multivariate linear regression were conducted for independent predictors of post-operative events and complications and functional outcomes, respectively. 275 patients with 279 tibial plateau fractures were included in our analysis. Ten patients (3.6%) sustained a deep infection. Six patients (2.2%) developed a superficial infection. One patient (0.4%) presented with early implant failure. Two patients (0.7%) developed a fracture nonunion. Eight patients (2.9%) developed a venous thromboembolism. Seventeen patients (6.2%) went on to re-operation for symptomatic implant removal. Nine patients (3.3%) underwent a lysis of adhesions procedure. Univariate analysis demonstrated bicondylar tibial plateau fractures (P<0.001), Moore fracture-dislocations (P=0.005), open fractures (P=0.022), and compartment syndrome (P=0.001) to be associated with post-operative complications and unplanned outcomes. Long-term functional outcomes were worse among patients who developed a post-operative complication or unplanned outcome (P=0.031). Orthopaedic trauma surgeons should be aware of complications and

  1. Biomechanical Factors in Tibial Stress Fractures

    DTIC Science & Technology

    2004-08-01

    Retrocalcaneal bursitis 1 Sesamoid fracture 2 Sesamoiditis 4 Tarsal tunnel syndrome 1 Foot other 32 Other, region unspecified 21 TOTAL 728 30 Table 8: Summary...Retrocalcaneal bursitis 3 Sesamoid fracture 1 Foot other 33 Other, region unspecified 47 TOTAL 747 8) Degrees obtained that are supported by this

  2. Primary total knee arthroplasty for elderly complex tibial plateau fractures.

    PubMed

    Huang, Jie-Feng; Shen, Jian-Jian; Chen, Jun-Jie; Tong, Pei-Jian

    2016-12-01

    The aim of this study is to evaluate the clinical and radiologic results of primary Total Knee Arthroplasty (TKA) for elderly complex tibial plateau fractures. Between November 2010 and February 2012, six cases of elderly complex tibial plateau fractures were treated with primary TKA using the standard medial parapatellar approach. All six patients were available at follow up with mean duration of 32.3 months (range 25-41 months). There were 3 women and 3 men with an average age of 69.5 years (58-78 years) at the time of the arthroplasty. The mean Hospital for Special Surgery (HSS) knee score was 89.8 (range 85-94): 6/6 excellent. The mean knee flexion was 119.2° (105-130°). No significant postoperative complications were noted. None of these patients had significant postoperative knee pain required revision surgery, or had radiographic loosening of the components at the latest follow-up. TKA is a suitable solution for the treatment of elderly patients with complex tibial plateau fractures. Level IV, Therapeutic study. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  3. Recent progress in the diagnosis and treatment of posterior tibial plateau fractures

    PubMed Central

    Chen, Hongwei; Chang, Shimin; Pan, Jun

    2015-01-01

    The posterior tibial plateau fracture is drawing increasing attention from orthopedists in recent years with the popularity of CT. However, due to the particular and severity of posterior tibial plateau fracture, there is still controversy in its classification and treatment. It is very difficult to achieve the ideal reduction and fixation by conventional techniques and approaches. The modified posterior approach is favorable for posterior tibial plateau fracture, but disadvantages remain. Recently, the lateral approach is applied by doctors. It is ideal for treatment of posterior tibial plateau fracture. Because of the complexity of local anatomical structure, the operative management of posterior tibial plateau fractures is a contentious issue as revealed in the recent surge of published literature addressing the surgical approach. This review mainly summaries the diagnosis, classification and surgery of the posterior tibial plateau fractures. PMID:26131147

  4. Return to Sport After Tibial Shaft Fractures: A Systematic Review.

    PubMed

    Robertson, Greg A J; Wood, Alexander M

    2016-07-01

    Acute tibial shaft fractures represent one of the most severe injuries in sports. Return rates and return-to-sport times after these injuries are limited, particularly with regard to the outcomes of different treatment methods. To determine the current evidence for the treatment of and return to sport after tibial shaft fractures. OVID/MEDLINE (PubMed), EMBASE, CINAHL, Cochrane Collaboration Database, Web of Science, PEDro, SPORTDiscus, Scopus, and Google Scholar were all searched for articles published from 1988 to 2014. Inclusion criteria comprised studies of level 1 to 4 evidence, written in the English language, that reported on the management and outcome of tibial shaft fractures and included data on either return-to-sport rate or time. Studies that failed to report on sporting outcomes, those of level 5 evidence, and those in non-English language were excluded. Systematic review. Level 4. The search used combinations of the terms tibial, tibia, acute, fracture, athletes, sports, nonoperative, conservative, operative, and return to sport. Two authors independently reviewed the selected articles and created separate data sets, which were subsequently combined for final analysis. A total of 16 studies (10 retrospective, 3 prospective, 3 randomized controlled trials) were included (n = 889 patients). Seventy-six percent (672/889) of the patients were men, with a mean age of 27.7 years. Surgical management was assessed in 14 studies, and nonsurgical management was assessed in 8 studies. Return to sport ranged from 12 to 54 weeks after surgical intervention and from 28 to 182 weeks after nonsurgical management (mean difference, 69.5 weeks; 95% CI, -83.36 to -55.64; P < 0.01). Fractures treated surgically had a return-to-sport rate of 92%, whereas those treated nonsurgically had a return rate of 67% (risk ratio, 1.37; 95% CI, 1.20 to 1.57; P < 0.01). The general principles are to undertake surgical management for displaced fractures and to attempt nonsurgical

  5. Management of open fractures.

    PubMed

    Blease, Robert; Kanlić, Enes

    2005-11-01

    The large spectrum of open fractures is an amalgamation of injuries with the single variable in common of communication of the fractured bone with the outside environment, and thus an increased risk for infection. Contributing to the presence of bacteria within the fracture site is devascularized soft tissue, the degree of which can be directly attributed to the amount of energy imparted to the tissues. The currently used classification system aids in defining the degree of severity of these injuries and their subsequent risk for infection. The basic management principal for all of these injury patterns remains essentially the same, however: prevention of infection through debridement, wound management, antibiotic usage, and fracture stabilization. Frequently multiple surgical procedures will be required in order to obtain an infection free, united fracture with adequate soft tissue coverage (1).

  6. Intramedullary nailing without interlocking screws for femoral and tibial shaft fractures.

    PubMed

    Kreb, Dieuwertje L; Blokhuis, Taco J; van Wessem, Karlijn J P; Bemelman, Mike; Lansink, Koen W W; Leenen, Luke P H

    2013-08-01

    Intramedullary fixation is the treatment of choice for diaphyseal fractures of the femur and tibia. Locking the implant can sometimes be cumbersome and time consuming. In our institution, fractures with axial and rotational stability are treated with intramedullary nailing without interlocking. All consecutive patients presented in the University Medical Center Utrecht from October 2003 to August 2009 with acute traumatic diaphyseal fractures of the tibia or femur that were considered axial and rotational stable were included. They underwent internal fixation using intramedullary nails without interlocking. Patient records were evaluated for duration of surgery, perioperative complications, consolidation time and re-operations. Twenty-nine long bone fractures were treated in 27 patients: 20 men and 7 women, with an average age of 28.9 years (range 15.6-54.4). There were 12 femoral fractures and 17 tibial fractures. Sixteen fractures were closed and 13 were open (10 Gustilo 1, 3 Gustilo 2). The mean operating time was 43 min (range 18-68 min) for tibial fractures and 55 min (range 47-150 min) for femoral fractures. Postoperative complications occurred in six patients. Two patients (three fractures) were lost to follow-up. Healing occurred in 25 of the 26 remaining fractures (96 %) without additional interventions. One tibia was secondarily converted to a standard locked nail because of axial and rotational instability. All patients returned to their pre-injury level of activity. The use of intramedullary nailing without interlocking is associated with minimal complications in selected fractures. The advantages include a short operating time and the simplicity of its application.

  7. Treatment of complicated tibial plateau fractures with dual plating via a 2-incision technique.

    PubMed

    Zhang, Yong; Fan, De-gang; Ma, Bao-an; Sun, Si-guo

    2012-03-07

    The operative treatment of complicated bicondylar fractures of the tibial plateau remains a challenge to most surgeons. This retrospective study was designed to evaluate the clinical and radiological outcomes of dual plating via a 2-incision technique for the repair of complicated bicondylar tibial plateau fractures. A series of consecutive patients with bicondylar tibial plateau fractures treated by open reduction and internal fixation with a double buttress plate or a combination of locking plate and buttress plate via a 2-incision technique between March 2004 and March 2008 were retrospectively analyzed. Radiological and clinical results and complications of the 2 different fixation methods were compared. Seventy-nine patients matching the criteria of this study were followed up for at least 24 months. All of the fractures healed, with 3 cases of deep infection, 7 cases of secondary loss of reduction, 3 cases of secondary loss of alignment, and 10 cases of knee instability. At 24-month follow-up, mean Hospital for Special Surgery scores were 77.8±9.4 and 79.0±7.9 in the double buttress plate group and combination group, respectively. No significant differences in clinical or radiographic outcomes were found between the 2 groups, except that the combination group needed less bone graft. Dual plating with 2 incisions provided good exposition for the reduction and fixation of complicated bicondylar tibial plateau fractures. Using a combination of locking plate and buttress plate reduced the amount of bone graft compared with the double buttress plate technique. Copyright 2012, SLACK Incorporated.

  8. Treatment of ipsilateral high energy tibial plateau and calcaneal fractures by a circular wire fixator: a case report

    PubMed Central

    Butt, Mohammed Farooq; Ali, Murtaza Fazal; Mir, Mohammed Ramzan; Kawoosa, Altaf Ahmed

    2009-01-01

    Introduction High energy tibial plateau fractures along with calcaneal fractures individually produce several challenges for the orthopaedic surgeon. The principles of bony reconstruction include anatomic reduction and rigid internal fixation of intra-articular fractures and accurate restoration of the coronal, sagittal and transverse mechanical axes. Due to the tenuous nature of the soft tissue and devitalisation of the comminuted fragments with open reduction, external fixation of type 6 tibial plateau fractures is recommended. We report a case with ipsilateral high energy tibial plateau and calcaneal fractures both of which were managed with an ilizarov ring fixator. Case presentation A 55-year-old Kashmiri female presented to our department with an ipsilateral fracture of the tibial plateau and the calcaneum. Both were closed reduced and stabilized with an ilizarov ring fixator. Conclusion The circular wire fixator provides a viable method to manage such fractures especially if they are co existent. This is especially true in situations where the soft tissue is compromised. PMID:19830021

  9. Intramedullary nailing supplemented with Poller screws for proximal tibial fractures.

    PubMed

    Kulkarni, Sunil G; Varshneya, Ankit; Kulkarni, Shreenath; Kulkarni, Govind S; Kulkarni, Milind G; Kulkarni, Vidhisha S; Kulkarni, Ruta M

    2012-12-01

    To evaluate outcome of intramedullary nailing supplemented with Poller screws for proximal tibial fractures using small diameter nails. 50 men and 20 women (75 fractures) aged 18 to 65 (mean, 33) years underwent intramedullary nailing supplemented with Poller screws for acutely displaced fractures (n=60) or for delayed union (n=10) or mal-union (n=5) of the proximal metadiaphyseal tibia. 88% of the fractures were caused by road traffic accidents. 54 cases had closed fractures and 21 had grade I or II compound fractures. Clinical and radiological outcome was evaluated. In 69 cases, healing occurred after a mean of 4.2 (range, 3-9) months. In 5 cases, there was non-union, which was resolved by bone grafting. One case was mal-united. 63 patients recovered a full range of knee motion (0º-130º), and the remaining 7 attained flexion of 0º to 90º. According to the knee rating scale of the Hospital for Special Surgery, outcome was excellent in 50 patients, good in 14, poor in 3, and failed in 3 at month 12, and remained so after a mean follow-up of 30.8 months. Postoperatively, 74 cases had <5º of varus or valgus malalignment, and only one developed varus of +7º. 65 cases exhibited no deformity, 7 had a deformity of <3º, and 3 had a deformity of 4º to 9º. Poller screws help maintain fixation of intramedullary nailing and alignment of fractures.

  10. Tibial stress fractures in an active duty population: long-term outcomes.

    PubMed

    Kilcoyne, Kelly G; Dickens, Jonathan F; Rue, John-Paul

    2013-01-01

    Tibial stress fractures are a common overuse injury among military recruits. The purpose of this study was to determine what, if any, long-term effects that tibial stress fractures have on military personnel with respect to physical activity level, completion of military training, recurrence of symptoms, and active duty service. Twenty-six military recruits included in a previous tibial stress fracture study were contacted 10 years after initial injury and asked a series of questions related to any long-term consequences of their tibial stress fracture. Of the 13 patients available for contact, no patients reported any necessary limited duty while on active duty, and no patient reported being separated or discharged from the military as a result of stress fracture. Tibial stress fractures in military recruits are most often an isolated injury and do not affect ability to complete military training or reflect a long-term need for decreased physical activity.

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

    PubMed

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

    2017-06-01

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

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

    PubMed Central

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

    2017-01-01

    Abstract 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, 5 cases had postoperative complications and 1 in group B (P < .05). The mean bone healing time in group A was 6.9 months (range: 5–9 months) and 6.0 months (range: 5–8 months) 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). In group A, the mean knee joint range of motion was 122° (range: 95°–150°) and 135° (range: 100°–160°) 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. PMID:29019890

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

    PubMed

    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, 5 cases had postoperative complications and 1 in group B (P < .05). The mean bone healing time in group A was 6.9 months (range: 5-9 months) and 6.0 months (range: 5-8 months) 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). In group A, the mean knee joint range of motion was 122° (range: 95°-150°) and 135° (range: 100°-160°) 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.

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

    PubMed

    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.

  15. An en bloc avulsion fracture of tibial tuberosity and Gerdy's tubercle in an adolescent basketball player: a case report.

    PubMed

    Yoo, Jae Ho; Hahn, Sung Ho; Yang, Bo Kyu; Yi, Seung Rim; Ahn, Young Joon; Yoon, Dong Jin; Kim, Jin Hong

    2007-06-01

    We report a case of en bloc avulsion fracture of tibial tuberosity and Gerdy's tubercle, which has never been reported. A 14-year-old boy suffered from an acute pain in his left knee during running just before a jump. Simple radiographs showed an avulsion of the tibial tuberosity. On CT scans, the fractured fragment was attached not only to patellar tendon but also to iliotibial band (ITB) via Gerdy's tubercle. MRI evaluation revealed no intra-articular associated pathology. Open reduction and internal fixation with three cannulated screws were performed under lateral parapatellar approach to expose both the tibial tuberosity with patellar tendon and Gerdy's tubercle with ITB. At postoperative 1 year, he could walk, run, squat, and complained of no difficulty in activities on daily living with full range-of-motion of the knee. Radiographs showed well-healed fracture in situ. Gradually, he returned to sports activity. We believe that the injury was caused by the dynamic pull of quadriceps muscle via patellar tendon onto tibial tuberosity and the mostly static pull of ITB onto Gerdy's tubercle, both of which took a part in the fracture of the anterolateral portion of the unfused epiphysis of proximal tibia. The pes anserinus attaching on the anteromedial metaphysis of proximal tibia might exert the opposing deforming force. Preoperative planning including the determination of the extent of fracture and recognition of concomitant injury is a prerequisite for appropriate treatment.

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

    PubMed Central

    Lim, Hong Chul; 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 articulation. This is the first report of a polyethylene tibial post fracture of a Scorpio PS prosthesis. PMID:19885065

  17. Distal tibial fractures: evaluation of different fixation techniques.

    PubMed

    Jöstl, Julian; Tiefenböck, Thomas Manfred; Hofbauer, Marcus; Winnisch, Markus; Lang, Nikolaus; Hajdu, Stefan; Sarahrudi, Kambiz

    2017-03-01

    The purpose of this study was the comparison of the most commonly used surgical techniques (external fixation, intramedullary nailing, and plate fixation) for the treatment of distal tibial fractures (AO/OTA classification 42-A, B, C or 43-A, B1). A retrospective cohort study of patients who underwent surgical treatment for distal tibial fractures between 1992 and 2011 was performed. A total of 93 patients (52 male/41 female) met inclusion criteria. Statistically significant differences were found regarding the consolidation time of the intramedullary-nailing (147.32 ± 91.16 days) and the plate-fixation group (135.75 ± 110.75 days) versus the external-fixation group (163.12 ± 96.79 days; P = 0.001; P = 0.01). Significant differences were also observed in the range of motion (ROM) of the ankle joint in the intramedullary-nailing and plate-fixation group versus the ROM in the external-fixation group (P = 0.044; P = 0.025). The overall complication rate was 13/93 (14 %). Out of 66 patients treated with intramedullary nailing, 8 (12 %) suffered from complications. Out of the 15 patients treated with plate and 12 patients with external fixation, 2 (13 %) and 3 (25 %) showed complications, respectively. Our results demonstrate advantages in terms of shorter mobilization time and a better ROM of the ankle joint for intramedullary nailing and plate fixation compared with external fixation. Due to our results, we suggest internal fixation (intramedullary nailing or plate fixation) whenever patient's condition and the local fracture situation allow it.

  18. Outcomes after arthroscopic fixation of tibial eminence fractures with bioabsorbable nails in skeletally immature patients.

    PubMed

    Momaya, Amit M; Read, Connor; Steirer, Megan; Estes, Reed

    2018-01-01

    The aim of this paper is to report the outcomes and any complications with arthroscopic bioabsorbable nail fixation of tibial eminence fractures in skeletally immature patients. We retrospectively reviewed all surgically treated tibial eminence fractures treated by a single surgeon and seven patients were identified with a minimum 2-year follow-up. Mean deficits of flexion and extension were minimal. Satisfactory Tegner levels, Lysholm knee scores, and International Knee Documentation Committee subjective scores were reported. Arthroscopic fixation of tibial eminence fractures with bioabsorbable nails yields satisfactory outcomes for this uncommon injury and obviates the need for future hardware removal.

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

    PubMed

    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 < 0.05). Adult skiers had both wider variety of fractures and higher prevalence of proximal tibial fractures compared to children (49% vs 16%, p < 0.05). Skiers typically got injured due to falling down on the same level (70%) and snowboarders due to loss of control while 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.

  20. Change in Posterior Tibial Slope After Open-Wedge and Closed-Wedge High Tibial Osteotomy: A Meta-analysis.

    PubMed

    Nha, Kyung-Wook; Kim, Hyun-Jung; Ahn, Hyeong-Sik; Lee, Dae-Hee

    2016-11-01

    It is unclear whether open- or closed-wedge high tibial osteotomy (HTO) results in significant changes in posterior tibial slope, with no consensus on the magnitude of such changes. Furthermore, methods of measuring posterior tibial slope differ among studies. This meta-analysis was therefore designed to evaluate whether posterior tibial slope increases after open-wedge HTO and decreases after closed-wedge HTO and to quantify the magnitudes of the slope changes after open- and closed-wedge HTO using various methods of measuring posterior tibial slope. Posterior tibial slope increases after open-wedge and decreases after closed-wedge HTO. The magnitude of change is similar for the 2 methods, and the value obtained for posterior tibial slope change is affected by the method of measurement. Meta-analysis. Multiple comprehensive databases, including MEDLINE, EMBASE, the Cochrane Library, and KoreaMed, were searched for studies that evaluated the posterior slope of the proximal tibia in patients who had undergone open- and/or closed-wedge HTO. Studies were included that compared pre- and postoperative posterior tibial slopes, regardless of measurement method, including anterior and posterior tibial cortex or tibial shaft axis as a reference line, in patients who underwent open- or closed-wedge HTO. The quality of each included study was appraised with the Newcastle-Ottawa Scale. Twenty-seven studies were included in the meta-analysis. Pooled data, which included subgroups of 3 methods, showed that posterior tibial slope increased 2.02° (95% CI, 2.66° to 1.38°; P = .005) after open-wedge HTO and decreased 2.35° (95% CI, 1.38° to 3.32°; P < .001) after closed-wedge HTO. This meta-analysis confirmed that posterior tibial slope increased after open-wedge HTO and decreased after closed-wedge HTO when the results of a variety of measurement methods were pooled. The magnitude of change after open- and closed-wedge HTO was similar and small (approximately 2°), suggesting

  1. High-energy tibial plateau fractures: external fixation versus plate fixation.

    PubMed

    Yu, Liang; Fenglin, Zhong

    2015-04-01

    Whether external or plating fixation is more appropriate for high-energy tibial plateau fractures is still being disputed, our aim was to test the hypothesis whether external fixation can provide a fair outcome with fewer complications, when compared to the results with previously reported data of plating fixation for high-energy tibial plateau fractures. An Ovid of Medline, Embase, and Cochrane Library search was conducted for the relevant English orthopedic journals, and eligible studies, including twenty-four case series and one comparative study containing 885 patients associated with 892 fractures, were enrolled. The results showed there were a higher proportion of men, open fractures, malunion, knee instability, and posttraumatic arthritis occurred in external fixation group than those in plating group (P=0.007, P=0.000, P=0.024, P=0.006, P=0.000, respectively), while valgus deformity happened at a significantly higher rate in plate group (P=0.014). No significant differences were found between the two groups in terms of age, Schatzker type, follow-up, mean time to union, mean range of knee motion, and rate of reoperation. With regard to the functional and radiological outcome assessment, despite what assessment tools were used, most of these studies presented less than 90% good/excellent results in their high-energy fracture series. Besides, there was a trend for patients in plating group to have a higher risk than those in external fixation group in terms of heterotopic ossification and local irritation (1.23 vs 0.17%, 4 vs 1.94%, accordingly). Although lack of good quality randomized control trials, there are rather enough samples supporting the current available results. Meanwhile, future multicentered, randomized, controlled studies should be implemented to test these outcomes.

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

    PubMed

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

    2013-09-01

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

  3. [Clinical practice guideline on closed tibial plateau fractures in adulthood].

    PubMed

    Ocegueda-Sosa, Miguel Ángel; Valenzuela-Flores, Adriana Abigail; Aldaco-García, Víctor Daniel; Flores-Aguilar, Sergio; Manilla-Lezama, Nicolás; Pérez-Hernández, Jorge

    2013-01-01

    Closed tibiae plateau fractures are common injuries in the emergency room. The optimal treatment is not well defined or established. For this reason, there are several surgical management options: open reduction and internal fixation, closed reduction and percutaneous synthesis, external fixation, and even conservative treatment for this kind of fracture. The mechanism of production of this fracture is through large varus or valgus deformation to which is added a factor of axial load. The trauma may be direct or indirect. The degree of displacement, fragmentation and involvement of soft tissues like ligaments, menisci, vascular and nerve structures are determined by the magnitude of the force exerted. Any intra-articular fracture treatment can lead to an erroneous instability, deformity and limitation of motion with subsequent arthritic changes, leading to joint incongruity, limiting activity and significantly altering the quality of life. Open reduction and internal fixation with anatomic restitution is the method used in this type of fracture. However, the results of numerous publications can be questioned due to the inclusion in the same study of fractures treated with very different methods.

  4. Changes in posterior tibial slope angle in patients undergoing open-wedge high tibial osteotomy for varus gonarthrosis.

    PubMed

    Ozel, Omer; Yucel, Bulent; Mutlu, Serhat; Orman, Osman; Mutlu, Harun

    2017-01-01

    In this study, postoperative changes in the posterior tibial slope angle and clinical outcomes following open-wedge high tibial osteotomy were evaluated. This study included 39 knees (18 left, 21 right) of 35 patients (three male, 32 female; median age, 53 years; age range 37-64 years) with symptomatic isolated medial joint osteoarthritis who underwent open-wedge high tibial osteotomy and fixation with a Puddu plate. The patients were clinically assessed according to the Lysholm knee score, a visual analogue pain scale, and a patient satisfaction questionnaire. Radiological assessment was made according to the changes in the posterior tibial slope angle and the correlation between these changes and clinical signs. The median follow-up period was 11 years (range 7-14 years). Significant improvements were observed in the preoperative and postoperative clinical scores of the Lysholm knee scale, visual analogue pain scale, and patient satisfaction questionnaire (p < 0.05). Radiological assessment showed that the posterior tibial slope angle was significantly higher during the postoperative and follow-up periods (p  0.05). There was no correlation between the postoperative Lysholm scores and the increase in the posterior tibial slope angle (p = n.s.). We conclude that both the conventional Puddu plate design and its anteromedial plate placement are what increase the tibial slope after an opening-wedge proximal tibial osteotomy. Therefore, current new plate design may help preserve the posterior tibial slope angle. IV.

  5. Tibial spine fractures: an analysis of outcome in surgically treated type III injuries.

    PubMed

    Mulhall, K J; Dowdall, J; Grannell, M; McCabe, J P

    1999-05-01

    We analysed the outcome of open reduction and internal fixation of type III tibial spine fractures, assessing treatment and determining a treatment protocol. A total of 10 patients presented over 3 years to our institution with a mean age of 15 years (range 10-21), a male-to-female ratio of 8:2. left to right 6:4 and anterior to posterior spine fracture 9:1. Only one patient had associated meniscal injury noted at arthroscopy (no treatment required). The mode of injury was road traffic accidents four, sports injuries three and falls three. The mean follow-up was 9 months. There were seven excellent results and three good results. Those patients with good results exhibited either minimal quadriceps weakness, extensor lag (< 10 degrees) or antero-posterior laxity. This reflects the experience of other authors in dealing with these injuries in younger patients. There is widespread agreement that types I and II should be treated by plaster cast alone and that is also the policy at our institution. We recommend a routine treatment protocol in type III injuries of (1) examination under anaesthesia, (2) arthroscopy (evaluating the fracture, cruciate integrity and other associated injuries), (3) open reduction and screw fixation and (4) vigorous physiotherapy/rehabilitation of all type III fractures, as we feel this provides the best possible outcome in these injuries.

  6. Are knee mechanics during early stance related to tibial stress fracture in runners?

    PubMed

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

    2007-07-01

    Tibial stress fractures are a serious overuse injury in runners. Greater vertical loading rates and tibial shock have been found in runners with previous tibial stress fracture compared to controls. The timing of these variables occurs very early in the stance phase and suggests that conditions shortly after footstrike may be important in determining injury risk. The purpose of this study was to further investigate lower extremity mechanics in early stance in runners with a history of tibial stress fracture. In addition, the relationships between these variables were explored. Twenty-three runners with a history of tibial stress fracture were investigated. They were compared with 23 age and mileage matched control subjects with no previous lower extremity bony injuries. Data were collected as subjects ran at 3.7 m/s. All variables of interest were computed over the period from footstrike to the impact peak of the vertical ground reaction force. Independent t-tests and effect sizes were used to assess the differences between the groups. Pearson Product Moment correlations were used to determine whether initial stance variables were related to tibial shock in the two groups. Sagittal plane knee stiffness was significantly greater in the tibial stress fracture group. Stiffness was also positively correlated with shock. Knee excursion, knee angle at footstrike and shank angle at footstrike were not different between groups. These findings provide further support for the relationship between mechanics during initial loading and tibial stress fractures in runners. This relationship may be important in terms of retraining gait to reduce the risk of stress fracture in runners.

  7. Successful stabilisation of a type III paediatric tibial eminence fracture using a tensioned wire technique.

    PubMed

    Archer, Matthew; Parkin, Tom; Latimer, Mark David

    2016-09-19

    We report the case of an 11-year-old boy presenting with a type III tibial eminence fracture. The fracture fragment was reduced arthroscopically. Two 1.6 mm retrograde K-wires were inserted from the tibial metaphysis across the physis and into the fracture fragment using a standard anterior cruciate ligament tibial tunnel guide. Once the wires were clearly visible within the joint the tips were bent over by ∼120°. The wires were then tensioned around a single small fragment screw inserted into the tibial metaphysis. An exceptionally strong fixation was achieved. The boy was mobilised without a brace. The wires were removed at 12 weeks and he returned to full activity at 14 weeks. 2016 BMJ Publishing Group Ltd.

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

    PubMed

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

    2017-07-01

    Tibial plateau fractures are complex and the current evidence for postoperative rehabilitation is weak, especially related to the recommended postoperative weight bearing. The primary aim of this study was to investigate if loading in the first 12 weeks of recovery is associated with patient reported outcome measures at 26 and 52 weeks postoperative. We hypothesized that there would be no association between loading and patient reported outcome measures. Seventeen patients, with a minimum of 52-week follow-up following fragment-specific open reduction and internal fixation for tibial plateau fracture, were selected for this retrospective analysis. Postoperatively, patients were advised to load their limb to a maximum of 20kg during the first 6 weeks. Loading data were collected during walking using force platforms. A ratio of limb loading (affected to unaffected) was calculated at 2, 6 and 12 weeks postoperative. Knee Injury and Osteoarthritis Scores were collected at 6, 12, 26 and 52 weeks postoperative. The association between loading ratios and patient reported outcomes were investigated. Compliance with weight bearing recommendations and changes in the patient reported outcome measures are described. Fracture reduction and migration were assessed on plain radiographs. No fractures demonstrated any measurable postoperative migration at 52 weeks. Significant improvements were seen in all patient reported outcome measures over the first 52 weeks, despite poor adherence to postoperative weight bearing restrictions. There were no associations between weight bearing ratio and patient reported outcomes at 52 weeks postoperative. Significant associations were identified between the loading ratio at 2 weeks and knee-related quality of life at six months (R2=0.392), and between the loading ratio at 6 weeks combined with injury severity and knee-related quality of life at 26 weeks (R2=0.441). In summary, weight bearing as tolerated does not negatively affect the results

  9. Increased medial tibial slope in teenage pediatric population with open physes and anterior cruciate ligament injuries.

    PubMed

    Vyas, Shail; van Eck, Carola F; Vyas, Nina; Fu, Freddie H; Otsuka, Norman Y

    2011-03-01

    Variations in bony morphology have been associated with anterior cruciate ligament (ACL) injury risk. The primary aim of this study was to compare the tibial slope in the teenage pediatric population with open physes, with and without ACL injury. The secondary aims were to compare the notch width index (NWI) and determine the influence of gender and age on tibial slope and NWI. Thirty-nine teenage pediatric subjects were included in this study, 16 with and 23 without ACL injury. Medial tibial slope and lateral tibial slope and NWI as measured on plain radiographs were compared between the groups using an independent t-test. Comparison of tibial slope and NWI was also performed between male and female subjects. Pearson correlation coefficient between age and tibial slope and NWI was calculated. The medial tibial slope averaged 10.2 (±3.9) degrees, the lateral tibial slope 11.5 (±3.9) degrees, and the NWI 0.26. There was a significant difference in medial tibial slope between the ACL-injured (12.1 degrees) subjects and the controls (8.9 degrees) (P = 0.009). There was no significant difference in lateral tibial slope or NWI between the groups. There was no significant difference in the medial tibial slope and lateral tibial slope and NWI between the male and female subjects. Subject age was not correlated with medial tibial slope and lateral tibial slope or NWI. There was an increased medial tibial slope in ACL-injured teenagers with open physes, when compared to a control group of teenager with open physes without ACL injury.

  10. Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome.

    PubMed

    Dubina, Andrew G; Paryavi, Ebrahim; Manson, Theodore T; Allmon, Christopher; O'Toole, Robert V

    2017-02-01

    The aim of this study was to investigate the effects of compartment syndrome and timing of fasciotomy wound closure on surgical site infection (SSI) after surgical fixation of tibial plateau fractures. Our primary hypothesis was that SSI rate is increased for fractures with compartment syndrome versus those without, even accounting for confounders associated with infection. Our secondary hypothesis was that infection rates are unrelated to timing of fasciotomy closure or fixation. We conducted a retrospective cohort study of operative tibial plateau fractures with ipsilateral compartment syndrome (n=71) treated with fasciotomy at our level I trauma center from 2003 through 2011. A control group consisted of 602 patients with 625 operatively treated tibial plateau fractures without diagnosis of compartment syndrome. The primary outcome measure was deep SSI after ORIF. Fractures with compartment syndrome had a higher rate of SSI (25% versus 8%, p<0.001). The difference remained significant in our multivariate model (odds ratio, 7.27; 95% confidence interval, 3.8-13.9). Delay in timing of fasciotomy closure was associated with a 7% increase per day in odds of infection (95% confidence interval, 0.2-13; p<0.05). Tibial plateau fractures with ipsilateral compartment syndrome have a significant increase in rates of SSI compared with those without compartment syndrome (p<0.001). Delays in fasciotomy wound closure were also associated with increased odds of SSI (p<0.05). Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. New angle measurement device to control the posterior tibial slope angle in medial opening wedge high tibial osteotomy.

    PubMed

    Ogawa, Hiroyasu; Matsumoto, Kazu; Akiyama, Haruhiko

    2017-11-17

    Medial opening wedge high tibial osteotomy has been associated with an unintentional increase in the posterior tibial slope angle. We aimed to evaluate the effectiveness of a novel bone spreader angle rod to maintain the native posterior tibial slope angle in medial opening wedge high tibial osteotomy. Data from 92 consecutive knees in 83 patients who underwent medial opening wedge high tibial osteotomy for knee osteoarthritis between March 2015 and June 2016 were analysed. The osteotomy was performed without the use of a bone spreader angle rod in the first 50 cases (control group) and with the use of the angle rod in the subsequent 42 cases (angle rod group). The wedge insertion angle, defined as the angle between a line drawn along the posterior aspect of the wedge spacer and a line tangential to the posterior aspect of the femoral condyles, and the posterior tibial slope angle were evaluated on pre- and postoperative lateral knee radiographs and postoperative computed tomography images. Wedge insertion angle showed that wedge spacers were inserted in a more direct horizontal direction in the angle rod group than in the control group (16.0 ± 8.8° and 23.0 ± 10.0°, respectively, P < 0.001). The pre- to postoperative change in posterior tibial slope angle was significantly smaller in the angle rod group (0.6 ± 1.6°) compared to that in the control group (3.2 ± 3.2°; P < 0.0001). A change of posterior tibial slope angle > 3° (outlier) was identified in 1 case (2.4%) in the angle rod group compared to 27 cases in the control group (54.0%). The direct horizontal insertion of wedge spacers with the assistance of our novel bone spreader angle rod maintains the native posterior tibial slope angle better than conventional methods. IV.

  12. Infection after spanning external fixation for high-energy tibial plateau fractures: is pin site-plate overlap a problem?

    PubMed

    Laible, Catherine; Earl-Royal, Emily; Davidovitch, Roy; Walsh, Mike; Egol, Kenneth A

    2012-02-01

    The purpose of this study was to determine whether overlap between temporary external fixator pins and definitive plate fixation correlates with infection in high-energy tibial plateau fractures. Retrospective chart and radiographic review. Academic medical center. Seventy-nine patients with unilateral high-energy tibial plateau fractures formed the basis of this report. Placement of knee-spanning external fixation followed by delayed internal fixation for high-energy tibial plateau fractures treated at our institution between 2000 and 2008. Demographic patient information was reviewed. Radiographs were reviewed to assess for the presence of overlap between the temporary external fixator pins and the definitive plate fixation. Fisher exact and t test analyses were performed to compare those patients who had overlap and those who did not and were used to determine whether this was a factor in the development of a postoperative infection. Development of infection in those whose external fixation pin sites overlapped with the definitive internal fixation device compared with those whose pin sites did not overlap with definitive plate and screws. Six knees in six patients developed deep infections requiring serial irrigation and débridement and intravenous antibiotics. Of these six infections, three were in patients with closed fractures and three in patients with open fractures. Two of these six infections followed definitive plate fixation that overlapped the external fixator pin sites with an average of 4.2 cm of overlap. In the four patients who developed an infection and had no overlap, the average distance between the tip of the plate to the first external fixator pin was 6.3 cm. There was no correlation seen between infection and distance from pin to plate, pin-plate overlap distance, time in the external fixator, open fracture, classification of fracture, sex of the patient, age of the patient, or healing status of the fracture. Fears of definitive fracture

  13. Routine monitoring of compartment pressure in patients with tibial fractures: Beware of overtreatment!

    PubMed

    Janzing, H M; Broos, P L

    2001-06-01

    This prospective clinical study sought to evaluate the possible effects of routine compartment pressure monitoring in tibial fractures and to assess the previously published criteria. Pressures in the anterior compartment were measured in consecutive cases of tibial fractures. In 95 patients, the protocol was completed with a follow-up after 1 yr. An optimal threshold pressure with both good sensitivity and specificity could not be identified. Such monitoring is a useful tool in the diagnosis of compartment syndrome, mainly in symptomatic patients or those who are difficult to assess, but routine monitoring and the use of most popular threshold pressures, which have low specificity, can result in overtreatment.

  14. Bilateral tibial stress fracture in a young man due to hypercalciuric osteoporosis: a case report.

    PubMed

    Ofluoglu, Demet; Ofluoglu, Onder; Akyuz, Gulseren

    2006-03-01

    Osteoporosis is commonly thought of as a disease of postmenopausal women, and older men have a lower risk of fracture than women. A stress fracture is an overuse injury and an important cause of disability in the athletic population. Presented here is a 30-year-old healthy man with pain on the anterior surface of the bilateral tibia. He did not communicate any trauma or overuse activity. The neurologic and locomotor system examinations were normal. Radiological examinations revealed tibial stress fractures in both left and right tibia and he had low bone mineral density. Routine hematological tests, bone resorption and formation markers were normal, except for hypercalciuria. After analyzing the results of these tests, the patient was diagnosed with bilateral tibial stress fractures due to hypercalciuric secondary osteoporosis. Osteoporosis should be considered in the differential diagnosis of atraumatic insufficiency fractures, especially in young healthy adults.

  15. Different changes in slope between the medial and lateral tibial plateau after open-wedge high tibial osteotomy.

    PubMed

    Lustig, S; Scholes, C J; Costa, A J; Coolican, M J; Parker, D A

    2013-01-01

    In contrast to radiographic measurements, MRI provides multiple slices of the knee joint in the sagittal plane, making it possible to assess the medial and lateral tibial slope separately. The purpose of this study is to investigate the effect of medial open-wedge high tibial osteotomy (MOWHTO) on bony and meniscal slope in the medial and lateral tibiofemoral compartments. It was hypothesised that greater changes on the medial tibial plateau would be observed compared with the lateral one. A retrospective analysis of prospectively collected data was performed on pre- and post-operative MRIs from 21 patients (17 men and 4 women; age 52 ± 9 years). Inclusion criteria were varus alignment, medial compartment osteoarthritis and election for a primary MOWHTO. Each patient had a preoperative and a post-operative high-resolution MRI (3Tesla, Magnetom Trio, Siemens AG) at an average follow-up of 2.1 years. A previously published method was used to measure bony and meniscal slope for each compartment. The difference between pre- and post-operative tibial slope for both compartments was calculated and associated with the amount of frontal correction. There was a significant increase in bony tibial slope in both compartments following MOWHTO. When a change in bony tibial slope was detected in an individual patient, the change was larger in the medial compartment, with the average change also significantly greater (p < 0.01) in the medial compartment (2.4° ± 1.3°) compared with the lateral compartment (0.9° ± 1.1°). There was also a significant increase (p < 0.01) in the lateral tibial meniscal slope of 0.9° ± 1.4°, which was equivalent to the change in the bony lateral slope. The amount of frontal correction was not significantly associated with the amount of change in slope. The results suggest that the modification of the bony slope is larger in the medial compartment after MOWHTO, which is likely related to the location of the hinge on the lateral

  16. Spontaneous patella fracture associated with anterior tibial tubercle pseudarthrosis in a revised knee replacement following knee Arthrodesis

    PubMed Central

    2013-01-01

    Background Conversion of a knee arthrodesis to a Total Knee Arthroplasty is an uncommon procedure. Revision Total Knee Arthroplasty in this setting presents the surgeon with a number of challenges including the management of the extensor mechanism and patella. Case presentation We describe a unique case of a 69 years old Caucasian man who underwent a revision Total Knee Arthroplasty using a tibial tubercle osteotomy after a previous conversion of a knee arthrodesis without patella resurfacing. Unfortunately 9 months following surgery a tibial tubercle pseudarthrosis and spontaneous patella fracture occurred. Both were managed with open reduction and internal fixation. At 30 months follow-up the tibial tubercle osteotomy had completely consolidated while the patella fracture was still evident but with no signs of further displacement. The patient was completely satisfied with the outcome and had a painless range of knee flexion between 0-95°. Conclusions We believe that patients undergoing this type of surgery require careful counseling regarding the risk of complications both during and after surgery despite strong evidence supporting improved functional outcomes. PMID:24195600

  17. Surgical Fixation of Bilateral Simultaneous Avulsion Fractures of the Proximal Tibia in a 12-Year-Old with History of Conservatively Managed Unilateral Tibial Avulsion Fracture

    PubMed Central

    Musiienko, Dharsh; Law, Samuel

    2017-01-01

    Fractures of the proximal tibial epiphysis are rare, representing less than 3% of all epiphyseal and 1% of all physeal injuries in adolescents. Bilateral injuries are extremely rare. The specific anatomical and histological features of the proximal tibial epiphysis make it vulnerable to a specific fracture pattern that occurs when the tensile force of the quadriceps is greater than the fibrocartilaginous tissue underlying the tibial tuberosity. We report the first case to our knowledge of a 12-year-old boy who sustained simultaneous bilateral tibial avulsion fractures on the background of a previous conservatively managed unilateral tibial tuberosity avulsion fracture. We report this case for its uniqueness and as an educational review of the anatomy, the mechanism of injury, and the development of classifying these fractures and discussion of the stages of the growing physis that determine the treatment approach. PMID:28473935

  18. Arthroscopic Reduction and Fixation of Tibial Spine Avulsion Fractures by a Stainless Steel Wiring Technique.

    PubMed

    Abdelhamid, Mohamed M; Bayoumy, Maysara Abdelhalim; Elkady, Hesham A; Abdelkawi, Ayman Farouk

    2017-12-01

    Several techniques of arthroscopic treatment of tibial spine avulsion fractures have been described in the literature. These techniques include the use of various fixation devices such as screws, K-wires, wiring, sutures, and suture anchors. In this study, we evaluate a new wiring technique for the treatment of these injuries. This technique involves fixation by stainless steel tension wires passed over the fractured spine and tied over a bone bridge. The advantages of this technique are that it aids in reduction, allows for compression of the tibial spine fragment anatomically in its fracture bed, provides stable fixation in difficult comminuted fractures, and allows for early mobilization and weight bearing because of the solid fixation.

  19. Locking compression plate fixation of radial and tibial fractures in a young dog.

    PubMed

    Schwandt, C S; Montavon, P M

    2005-01-01

    A six-month-old, male Bernese Mountain Dog in which radius-ulna and tibia-fibula concomitant fractures were treated each with a 3.5 mm Locking Compression Plate (LCP) is presented. Both fractures were approached and plated medially. The tibial fracture had to be revised with a 4.5 mm intramedullary nail and a new 3.5 mm LCP at the second post-operative day because of fixation breakdown. The follow-up radiographs taken at days 14 and 53 revealed uneventful healing of both fractures. Implants were removed 53 days after surgery.

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

    PubMed

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

    2013-08-20

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

  1. Management of feline tibial diaphyseal fractures using orthogonal plates performed via minimally invasive plate osteosynthesis.

    PubMed

    Craig, Andrew; Witte, Philip G; Moody, Tristram; Harris, Karen; Scott, Harry W

    2018-01-01

    Objectives The objective was to assess the medium- and long-term outcomes (radiographic and owner questionnaire) of feline tibial diaphyseal fractures with orthogonal plate fixation via a minimally invasive plate osteosynthesis (MIPO) approach. Methods Medical records and radiographs of cats that had tibial diaphyseal fractures stabilised with orthogonal plates were obtained (2012-2016). Immediate postoperative radiographs were reviewed to assess the construct configuration and follow-up radiographs (where available) were used to assess bone healing and implant-related complications. An owner-completed questionnaire (feline musculoskeletal pain index [FMPI]) was used at a minimum of 6 months following surgery to assess the cats' ability to perform normal activities. Results Eight feline tibial diaphyseal fractures met the inclusion criteria. One major complication was observed, most likely due to an operative technical error. There were no further complications following revision surgery. Six of the eight cases that had radiographic follow-up either had clinical bone union or showed evidence of bone healing. All cases were classified as successful according to FMPI. Conclusions and relevance Orthogonal plating of feline tibial diaphyseal fractures via an MIPO approach resulted in successful outcomes and a lower complication rate compared with previously reported techniques.

  2. [Tibial plateau fractures in alpine skiing--return to the slopes or career end?].

    PubMed

    Müller, D; Sandmann, G H; Martetschläger, F; Stöckle, U; Kraus, T M

    2014-03-01

    Fractures of the tibial plateau are among the most severe injuries of the knee joint and are often the result of sports accidents, especially skiing accidents. Between January 2003 and March 2009, a total of 37 skiers with tibial plateau fractures were treated operatively at Klinikum rechts der Isar, Munich (level I trauma center); 28 patients with a minimum follow-up of 24 months were included in this study. Sporting activity was determined at the time of injury and at the time of survey at an average follow-up of 49.0 months postoperatively. At the time of the survey, 92.9% of all patients were engaged in sports; only 12 of the 28 patients returned to skiing. Of the competitive athletes (n = 5 at time of injury) no patient returned to competition. The number of different sporting activities declined significantly from 6.4 before the injury to 4.6 after the injury. The activity duration per week, being 5.0 hours at the time of injury, declined to 4.4 hours, although the difference is statistically not significant. The Lysholm score, 97.5 points before accident, illustrated a significant decline to 84.4 points. Activity levels according to the Tegner scale declined significantly from 6.1 to 4.7 after the tibial plateau fracture. The majority of patients could not return to their previous level of activity. For patients playing competitive sports, the tibial plateau fracture can be a career ender. Overall, 92.9% of the patients returned to sports, but we noticed a post-injury shift toward activities with less impact. Only 12 of the 28 (42.9%) skiers with tibial plateau fractures returned to skiing. © Georg Thieme Verlag KG Stuttgart · New York.

  3. Comparison of three fixation methods in treatment of tibial fracture in adolescents.

    PubMed

    Lin, Lixiang; Liu, Yang; Lin, Chuanlu; Zhou, Yifei; Feng, Yongzeng; Shui, Xiaolong; Yu, Kehe; Lu, Xiaolang; Hong, Jianjun; Yu, Yang

    2017-11-21

    Tibial fractures are the most common musculoskeletal injury in adolescents. The optimal management of tibial fractures in adolescents is controversial. In this study, we compared the outcomes including complications of three fixation methods in tibial fractures of adolescents and explored the factors associated with the complications. A retrospective cohort study about 83 diaphyseal tibial fractures in 79 children and adolescents, who were treated with plate fixation (PF), elastic stable intramedullary nail fixation (ESINF), or external fixation (EF), was conducted. After adjustment for age, weight, energy of the injury, polytrauma, fracture level and pattern, and extent of comminution, treatment outcomes were compared in accordance with the length of the hospital stay, time to union, and complication rates including many factors. The mean age of the patients was 13.4 years, and their mean weight was 44.2 kg. There was a loss of reduction in two of 33 fractures treated with ESINF and four of 13 treated with EF (P < 0.001). At the time of final follow-up, three patients (two treated with EF and one treated with ESINF) had ≥2.0 cm of shortening. Four of the 32 patients (33 fractures) treated with ESINF underwent a reoperation (two due to loss of reduction and one each because of delayed union and nonunion). Six patients treated with EF required a reoperation (four due to loss of reduction, one for malunion and one for replacement of a pin complicated by infection). Two fracture treated with PF required refixation attributing to nonunion and malunion. A multivariate analysis with adjustment for baseline differences showed that EF was associated with a 7.56-times (95% confidence interval 3.74-29.87) greater risk of loss of reduction and/or malunion than ESINF. All three treatments had satisfactory outcomes, and EF was correlated with the highest rate of complications in our series of adolescents treated with a tibial fracture. However, we cannot currently

  4. Use of a virtual 3D software for planning of tibial plateau fracture reconstruction.

    PubMed

    Suero, Eduardo M; Hüfner, Tobias; Stübig, Timo; Krettek, Christian; Citak, Musa

    2010-06-01

    Anatomical reconstruction of tibial plateau fractures is necessary to prevent pain, axial malalignment, knee join instability and posttraumatic arthritis. Computed tomography (CT) with 3D reconstruction is helpful in the accurate preoperative evaluation and reduction planning of the fracture site. The aim of this study was to describe the application of a virtual 3D reconstruction and segmentation software in the preoperative planning of tibial plateau fractures. CT scans of five tibial plateau fractures were preoperatively evaluated using the 3D planning software. Manual colour-coded segmentation was performed. The amount of time required for each planning session was recorded. Successful 3D reconstruction and segmentation was achieved in all cases. The mean time required for 3D virtual planning was 174.8 min (range 69-124 min). The mean time required for 3D virtual planning of B-type fractures was 96.5 min (range 69-124 min; SD=38.891 min; CI=349.421). The mean time required for planning of C-type fractures was 227 min (range 167-294 min; SD=63.789 min; CI=158.460) (Table 1). Successful segmentation was achieved in all cases. The 3D planning capabilities of this software may be a valuable tool for surgeons in learning about the nature of the injury in tibial plateau fracture cases and in formulating an appropriate surgical plan. However, the time requirement for the 3D reconstruction and segmentation analysis may be a current deterrent for its use in the clinical setting. Copyright 2009 Elsevier Ltd. All rights reserved.

  5. Factors influencing infection in 10 years of battlefield open tibia fractures.

    PubMed

    Penn-Barwell, J G; Bennett, P M; Mortiboy, D E; Fries, C A; Groom, A F G; Sargeant, I D

    2016-04-01

    The aim of this study was to characterise severe open tibial shaft fractures sustained by the UK military personnel over 10 years of combat in Iraq and Afghanistan. The UK military Joint Theatre Trauma Registry was searched for all such injuries, and clinical records were reviewed for all patients. One hundred Gustilo-Anderson III tibia fractures in 89 patients were identified in the 10 year study period; the majority sustained injuries through explosive weapons (63, 68 %) with the remainder being injured from gunshot wounds. Three fractures were not followed up for 12 months and were therefore excluded. Twenty-two (23 %) of the remaining 97 tibial fractures were complicated by infection, with S. aureus being the causative agent in 13/22 infected fractures (59 %). Neither injury severity, mechanism, the use of an external fixator, the need for vascularised tissue transfer nor smoking status was associated with subsequent infection. Bone loss was significantly associated with subsequent infection (p < 0.0001, Fisher's exact test). This study presents 10 years of open tibial fractures sustained in Iraq and Afghanistan. Most infection in combat open tibia fractures is caused by familiar organisms, i.e. S. aureus. While the overall severity of a casualty's injuries was not associated with infection, the degree of bone loss from the fracture was.

  6. The "Hoop" Plate for Posterior Bicondylar Shear Tibial Plateau Fractures: Description of a New Surgical Technique.

    PubMed

    Giordano, Vincenzo; Schatzker, Joseph; Kfuri, Mauricio

    2017-07-01

    High-energy fractures of the proximal tibia with extensive fragmentation of the posterior rim of the tibial plateau are challenging. This technique aims to describe a method on how to embrace the posterior rim of the tibial plateau by placing a horizontal precontoured one-third tubular plate wrapped around its corners. This method, which we named "hoop plating," is mainly indicated for cases of crushed juxta-articular rim fractures, aiming to restore cortical containment of the tibial plateau. Through a lateral approach with a fibular head osteotomy (Lobenhoffer approach), both anterolateral and posterolateral fragments are directly reduced and supported by a one-third tubular plate of adequate length. The plate is inserted from lateral to medial deep to all soft tissues, and its position is checked with fluoroscopy. The implant sits exactly on the posterior cortex of the tibial plateau and provides containment for the reduced juxta-articular posterior cortex and rim. We begin with immediate range of motion. Toe-touch weight-bearing with crutches is allowed with the operated knee in full extension. Weight-bearing is gradually increased only after 6 weeks as bone healing is taking place. Clinical follow-up is performed at 1, 3, 6, and 12 weeks. If the radiological exam confirms that the fracture is healed, the patient is allowed to proceed to muscle strengthening and bear weight entirely. The "hoop plating" may be a good option for the management in cases of extensive posterior tibial plateau articular surface fracture and impaction with rim and posterior cortical wall fragmentation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  7. Acute compartment syndrome in children and teenagers with tibial shaft fractures: incidence and multivariable risk factors.

    PubMed

    Shore, Benjamin J; Glotzbecker, Michael P; Zurakowski, David; Gelbard, Estee; Hedequist, Daniel J; Matheney, Travis H

    2013-11-01

    To identify the incidence of acute compartment syndrome (ACS) in children and teenagers with tibial shaft fractures and report associated risk factors. Retrospective Case Control. Level 1 pediatric trauma hospital. Two hundred sixteen tibial shaft fractures in 212 patients (160 males and 52 females; median age, 13 years) over a 5-year period were reviewed. One hundred thirty-two (61%) fractures were treated with closed reduction and casting, 36 with external fixation, 27 with locked intramedullary nails, and 21 with flexible intramedullary nails. ACS was diagnosed clinically or by intracompartment pressure. Multivariable logistic regression analysis tested age, gender, weight, physeal status, mechanism of injury, time to surgery, fracture type, and treatment intervention as possible risk factors for development of ACS. There were 25 (11.6%) cases of ACS. Multivariable predictors of ACS included age of 14 years and older (22/96 = 23% vs. 3/120 = 3%, P < 0.001) and motor vehicle accident (MVA) (13/57 = 23% vs. 12/159 = 8%, P < 0.001). Incidence of ACS was 48% among patients aged 14 years and older, who sustained MVA (12/25). Gender, physeal status, time to surgery, and surgical fixation were not predictive of ACS. This is the largest study in children and teenagers reporting the incidence of ACS from tibial shaft fractures. The incidence of 11.6% is higher than previously reported and much higher in patients older than14 years of age and involved in an MVA. Surgeons should be especially aware and suspicious of this diagnosis in teenagers with tibial shaft fractures. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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

    PubMed

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

    2017-04-01

    Virtual stress testing (VST) provides a non-invasive estimate of the strength of a healing bone through a biomechanical analysis of a patient's computed tomography (CT) scan. We asked whether VST could improve management of patients who had a tibia fracture treated with external fixation. In a retrospective case-control study of 65 soldier-patients who had tibia fractures treated with an external fixator, we performed VST utilizing CT scans acquired prior to fixator removal. The strength of the healing bone and the amount of tissue damage after application of an overload were computed for various virtual loading cases. Logistic regression identified computed outcomes with the strongest association to clinical events related to nonunion within 2 months after fixator removal. Clinical events (n = 9) were associated with a low tibial strength for compression loading (p < 0.05, AUC = 0.74) or a low proportion of failed cortical bone tissue for torsional loading (p < 0.005, AUC = 0.84). Using post-hoc thresholds of a compressive strength of four times body-weight and a proportional of failed cortical bone tissue of 5%, the test identified all nine patients who failed clinically (100% sensitivity; 40.9% positive predictive value) and over three fourths of those (43 of 56) who progressed to successful healing (76.8% specificity; 100% negative predictive value). In this study, VST identified all patients who progressed to full, uneventful union after fixator removal; thus, we conclude that this new test has the potential to provide a quantitative, objective means of identifying tibia-fracture patients who can safely resume weight bearing. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:805-811, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  9. Treatment of tibial fractures with plates using minimally invasive percutaneous osteosynthesis in dogs and cats.

    PubMed

    Schmökel, H G; Stein, S; Radke, H; Hurter, K; Schawalder, P

    2007-03-01

    The aim of the here described case series was to develop and evaluate the minimally invasive percutaneous osteosynthesis for the plate fixation of tibial fractures in dogs and cats. Six dogs and four cats with shaft fractures of the tibia were treated using minimally invasive percutaneous osteosynthesis. Follow-up radiographs four to six weeks after fracture fixation were evaluated for fracture healing. For the long-term follow-up (minimum 2.4 years), owners were contacted by phone to complete a questionnaire. All fractures healed without the need for a second procedure. Follow-up radiographs obtained after four to six weeks in seven cases showed advanced bony healing with callus formation and filling of the fracture gaps with calcified tissue in all seven. All the patients had a good to excellent long-term result with full limb function. The time needed for regaining full limb use was two to three months. Minimally invasive percutaneous osteosynthesis seems to be a useful technique for the treatment of tibial shaft fractures in dogs and cats.

  10. [BIOMECHANICAL STUDY ON SUTURE WITH NECKWEAR-KNOT-LOOP-LIGATURE FOR TIBIAL EMINENCE AVULSION FRACTURES].

    PubMed

    Wang, Jiangtao; Shen, Xuezhen; Liu, Chang; Qi, Wei; Qu, Feng; Yuan, Bangtuo; Zhao, Gang; Guo, Qi; Li, Hongliang; Lu, Xi; Zhu, Juanli; Liu, Yang; Liu, Yujie

    2015-09-01

    To study the biomechanical stability of neckwear-knot-loop-ligature fixation for tibial eminence avulsion fractures by comparing with cannulated screw fixation and suture anchor fixation. Twenty-four fresh porcine knee joints were selected. After the model of tibial eminence avulsion fracture (type III) was made, 24 samples were randomly divided into 3 groups: neckwear-knot-loop-ligature group (group A), cannulated screw group (group B), and suture anchor group (group C), 8 samples in each group. The Universal electromagnetic and mechanical testing machines were used for the biomechanical tests. After 200 cyclic tests, pull-out test was done until fixation failure. The maximum failure load, yield load, stiffness, and displacement were measured. Failure mode: the displacement was beyond limit in 8 samples of group A; screws extraction (5 samples) and bone fragment re-fracture (3 samples) were observed in group B; and suture anchor extraction (4 samples), suture rupture (3 samples), and suture thread cutting (1 sample) were found in group C. Biomechanical test: From groups A to C, the maximum failure load and yield load showed significant decreasing tendency (P<0.05), but the displacements showed significant increasing tendency (P<0.05). The stiffness also gradually decreased, but differences was not significant (P>0.05). Compared with cannulated screw and suture anchor, neckwear-knot-loop-ligature fixation for tibial eminence avulsion fracture has good biomechanical performance and the advantages of firm fixation and simple operation.

  11. Injury to the Posterior Tibial Tendon After Open Reduction Internal Fixation of the Medial Malleolus.

    PubMed

    DeMill, Shyler L; Bussewitz, Bradly W; Philbin, Terrence M

    2015-10-01

    The management of ankle fractures with open reduction and internal fixation (ORIF) has been a proven method to help prevent deformity and posttraumatic arthritis. The incidence of continued ankle pain due to retained hardware after ORIF of ankle fractures has been documented. The goal of this study was to determine if the starting point for medial malleolus screw placement is associated with posterior tibial tendon (PTT) damage when performing ORIF of the medial malleolus. Patients that had ORIF of the medial malleolus and subsequent repair of the PTT with medial malleolar hardware removal were identified. Zones were established and labeled 1 through 3 as described in the literature. This template was used as an overlay on lateral ankle radiographs to analyze the position and assign zones to the medial malleolus screws. Fifteen patients met the inclusion criteria. Three screws were found in zone 1, 11 in zone 2, and 1 in zone 3. The middle and posterior zones (zones 2 and 3) contained 80% of the screws, which may potentially cause risk to the PTT. We conclude that there is an increased probability that medial malleolar hardware in zones 2 and 3 can compromise the PTT. Therapeutic, Level IV: Case series. © 2015 The Author(s).

  12. Posteromedially placed plates with anterior staple reinforcement are not successful in decreasing tibial slope in opening-wedge proximal tibial osteotomy.

    PubMed

    Dean, Chase S; Chahla, Jorge; Matheny, Lauren M; Cram, Tyler R; Moulton, Samuel G; Dornan, Grant J; Mitchell, Justin J; LaPrade, Robert F

    2017-12-01

    To document the effectiveness of a novel technique to decrease tibial slope in patients who underwent a proximal opening-wedge osteotomy with an anteriorly sloped plate placed in a posteromedial position. The hypothesis was that posteromedial placement of an anteriorly sloped osteotomy plate with an adjunctive anterior bone staple on the tibia would decrease, and maintain, the tibial slope correction at a minimum of 6 months following the osteotomy. All patients who underwent biplanar medial opening-wedge proximal tibial osteotomy with anterior staple augmentation to decrease sagittal plane tibial slope were included, and data were collected prospectively and reviewed retrospectively. Indications for decreasing tibial slope included medial compartment osteoarthritis with at least one of the following: ACL deficiency, posterior meniscus deficiency, or flexion contracture. Preoperative, immediate postoperative, and 6-month postoperative radiographs were reviewed. Twenty-one patients (14 males and 7 females) were included in the study with a mean age of 36.5 years. Intrarater and interrater reliability of slope measurements were excellent at all time points (ICC ≥ 0.94, ICC ≥ 0.85). The osteotomy resulted in an average tibial slope decrease of 0.8 from preoperative (n.s.). At 6-month postoperative, average slope was not significantly different from time-zero postoperative slope (mean = +0.2°). The most important finding of this study was that posteromedial placement of an anteriorly angled osteotomy plate augmented with an anterior staple during a biplanar medial opening-wedge proximal tibial osteotomy did not decrease sagittal plane tibial slope. Whether a staple was effective in maintaining tibial slope from time zero to 6 months postoperatively was unable to be assessed due to no significant change in tibial slope from the preoperative postoperative states. The results of this study note that current osteotomy plate designs and surgical techniques are

  13. [Posttraumatic deformities of the knee joint : Intra-articular osteotomy after malreduction of tibial head fractures].

    PubMed

    Frosch, K-H; Krause, M; Frings, J; Drenck, T; Akoto, R; Müller, G; Madert, J

    2016-10-01

    Malreduction of tibial head fractures often leads to malalignment of the lower extremity, pain, limited range of motion and instability. The extent of the complaints and the degree of deformity requires an exact analysis and a standardized approach. True ligamentous instability should be distinguished from pseudoinstability of the joint. Also extra- and intra-articular deformities have to be differentiated. In intra-articular deformities the extent of articular surface displacement, defects and clefts must be accurately evaluated. A specific surgical approach is necessary, which allows adequate visualization, correct osteotomy and refixation of the fractured area of the tibial head. In the long-term course good clinical results are described for intra-articular osteotomies. If the joint is damaged to such an extent that it cannot be reconstructed or in cases of advanced posttraumatic osteoarthritis, total knee arthroplasty may be necessary; however, whenever possible and reasonable, anatomical reconstruction and preservation of the joint should be attempted.

  14. Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing

    DTIC Science & Technology

    2006-12-01

    1. Stimulating Bone: Current options. Orthopaedic Nurses Conference, Brisbane, Nov 5, 2004 (Invited state of the art talk. Did not report research...Fracture healing in the rabbit fibula when subjected to various capacitively coupled electrical fields. J Orthop Res 3:331-40, 1985 8. Brighton CT, Katz...Experimental stress fractures of the tibia: Biological and mechanical etiology in rabbits . J Bone Joint Surg 72:370-375, 1990 18. Chang K, Chang WH, Huang S

  15. Supracutaneous plating using a locking plate for the treatment of a tibial fracture in a cat

    PubMed Central

    Nicetto, Tommaso; Longo, Federico

    2017-01-01

    Radiographs revealed a slightly displaced long oblique diaphyseal tibial fracture with bone fissures running distally in a 2-year-old, 4.5 kg cat that had been hit by a car. An angle stable implant was applied in a supracutaneous fashion. The patient tolerated the external implant and had a satisfactory functional recovery. Radiographic follow-up after 60 days revealed sign of osseous union; therefore, the plate was removed. PMID:28588330

  16. Race and Ethnicity Have a Mixed Effect on the Treatment of Tibial Plateau Fractures.

    PubMed

    Driesman, Adam; Mahure, Siddharth A; Paoli, Albit; Pean, Christian A; Konda, Sanjit R; Egol, Kenneth A

    2017-10-01

    To determine whether racial or economic disparities are associated with short-term complications and outcomes in tibial plateau fracture care. Retrospective cohort study. All New York State hospital admissions from 2000 to 2014, as recorded by the New York Statewide Planning and Research Cooperative System database. Thirteen thousand five hundred eighteen inpatients with isolated tibial plateau fractures (OTA/AO 44), stratified in 4 groups: white, African American, Hispanic, and other. Closed treatment and operative fixation of the tibial plateau. Hospital length of stay (LOS, days), in-hospital complications/mortality, estimated total costs, and 30-day readmission. There were no significant differences regarding in-hospital mortality, infection, deep vein thrombosis/pulmonary embolism, or wound complications between races, even when controlling for income. There was a higher rate of nonoperatively treated fractures in the racial minority populations. Minority patients had on average 2 days longer LOS compared with whites (P < 0.001), costing on average $4000 more per hospitalization (P < 0.001). Multivariate logistic regression found that neither race nor estimated median family income were independent risk factors for readmission. Although nature of initial injury, use of external fixator, comorbidity burden, age, insurance type, and LOS were independent risk factors for readmission, race and estimated median family income were not. In patients who sustained a tibial plateau fracture, race and ethnicity seemed to affect treatment choice, but once treated racial minority groups did not demonstrate worse short-term complications, including increased mortality and postoperative readmission rates. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  17. Supracutaneous plating using a locking plate for the treatment of a tibial fracture in a cat.

    PubMed

    Nicetto, Tommaso; Longo, Federico

    2017-06-01

    Radiographs revealed a slightly displaced long oblique diaphyseal tibial fracture with bone fissures running distally in a 2-year-old, 4.5 kg cat that had been hit by a car. An angle stable implant was applied in a supracutaneous fashion. The patient tolerated the external implant and had a satisfactory functional recovery. Radiographic follow-up after 60 days revealed sign of osseous union; therefore, the plate was removed.

  18. Same-Level Fracture of the Tibial Metal Tray and Polyethylene Insert After Total Knee Arthroplasty.

    PubMed

    Kang, Jong Yeal; Lee, Yong Seuk

    2016-07-01

    The authors report a case of failure fracture of the tibial metal tray and polyethylene insert at the same level in a 73-year-old woman 10 years after total knee arthroplasty using the AMK Total Knee System (DePuy, Warsaw, Indiana). Causes of this fracture are analyzed and discussed, with the focus on the importance of component design, position, and size. The overall aim of this case report is for orthopedic surgeons to avoid this complication in total knee arthroplasty by paying attention to these controllable factors. [Orthopedics. 2016; 39(4):e787-e789.]. Copyright 2016, SLACK Incorporated.

  19. Biomechanical Factors in the Etiology of Tibial Stress Fractures

    DTIC Science & Technology

    2002-08-01

    Runners with Pes Cavus andPes Planus . Presented at the ACSM National Mtg in Indianapolis, IN, 6/00. Sahte, V, Ireland, ML, Ballantyne BT and McClay, IS...McKeown, K.A. (2002). Kinetic variables in subjects with previous lower extremity stress fractures. Medicine and Science in Sports and Exercise , 34(1...and without lower extremity stress fractures. Medicine and Science in Sports and Exercise , 34(1), s991. 19 4) Degrees obtained that are supported by

  20. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners.

    PubMed

    Yagi, Shigenori; Muneta, Takeshi; Sekiya, Ichiro

    2013-03-01

    Medial tibial stress syndrome (MTSS) and tibial stress fracture (SF) are common lower leg disorders in runners. A prospective study was done to identify the incidence of MTSS and SF in high school runners and to determine risk factors. A total of 230 runners participating in high school running teams were evaluated. All runners aged 15 years as first grade of high school were involved in the study. They were followed up for 3 years. The measured items included height, weight, body mass index (BMI), range of hip and ankle motion, straight leg raising (SLR), intercondylar and intermalleolar interval, Q-angle, navicular drop test, hip abductor strength and physical conditioning. Each runner was followed for 3 years to report occurrence of MTSS and SF. A total number of 102 MTSS (0.29 athlete exposures) and 21 SF (0.06 athlete exposures) were identified. In females, BMI significantly increased the risk of MTSS after adjustment for the other variables in this study (adjusted odds ratio, 0.51; 95 % confidence interval, 0.31-0.86). Increased internal rotation of the hip significantly increased the risk of MTSS (adjusted odds ratio, 0.91; 95 % confidence interval, 0.85-0.99). In males, limited SLR also significantly increased the risk of SF with adjustment for the other variables in this study (adjusted odds ratio, 1.38; 95 % confidence interval, 1.04-1.83). A significant relationship was found between BMI, internal hip rotation angle and MTSS in females, and between limited SLR and SF in males. Prospective cohort study, Level II.

  1. [A new case of tibial stress fracture as a complication of knee osteoarthritis].

    PubMed

    Sy, M H; Diouf, S; Ndoye, A; Coumé, M

    1995-01-01

    Transverse stress fractures of the proximal tibia are associated with osteoarthritis of the knee. This uncommon complication is presented in this case report as a non-union form along with a literature review. A fifty nine year old black African woman who had a thirteen-year history of osteoarthritis in both knees, was seen for increasing pain in the proximal part of the left leg without demonstrative traumatism. This homemaker measured 155 cm for 85 kgs. Clinical and radiological examination revealed a non-united stress fracture of the proximal part of the tibia and bilateral osteoarthritis of the knee with varus deformity (40 degrees on the left). A compression plate with bone grafting was used for treatment of the tibial non-union. Eleven other cases have been published on the rheumatological and orthopaedical literature. All the twelve patients were female, elderly, overweight, had marked varus deformities and a long history of osteoarthritis of the knee. A non-united stress fracture was a complication of osteoarthritis in four cases and treated with a compression plate. Stress fractures of the proximal tibia are an unusual mechanical and an uncommon complication of osteoarthritis of the knee. Biomechanic is perhaps one of the possible explication of these tibial stress fractures.

  2. Dipyrone has no effects on bone healing of tibial fractures in rats

    PubMed Central

    Gali, Julio Cesar; Sansanovicz, Dennis; Ventin, Fernando Carvalho; Paes, Rodrigo Henrique; Quevedo, Francisco Carlos; Caetano, Edie Benedito

    2014-01-01

    OBJECTIVE: To evaluate the effect of dipyrone on healing of tibial fractures in rats. METHODS: Fourty-two Wistar rats were used, with mean body weight of 280g. After being anesthetized, they were submitted to closed fracture of the tibia and fibula of the right posterior paw through manual force. The rats were randomly divided into three groups: the control group that received a daily intraperitoneal injection of saline solution; group D-40, that received saline injection containing 40mg/Kg dipyrone; and group D-80, that received saline injection containing 80mg/Kg dipyrone. After 28 days the rats were sacrificed and received a new label code that was known by only one researcher. The fractured limbs were then amputated and X-rayed. The tibias were disarticulated and subjected to mechanical, radiological and histological evaluation. For statistical analysis the Kruskal-Wallis test was used at a significance level of 5%. RESULTS: There wasn't any type of dipyrone effect on healing of rats tibial fractures in relation to the control group. CONCLUSION: Dipyrone may be used safely for pain control in the treatment of fractures, without any interference on bone healing. Level of Evidence II, Controlled Laboratory Study. PMID:25246852

  3. Arthroscopic Fixation of Tibial Eminence Fractures: A Biomechanical Comparative Study of Screw, Suture, and Suture Anchor.

    PubMed

    Li, Ji; Yu, Yang; Liu, Chunhui; Su, Xiangzheng; Liao, Weixiong; Li, Zhongli

    2018-01-31

    To compare biomechanical outcomes of 4 different arthroscopic techniques for fixation of tibial eminence fractures. Twenty-four skeletally mature, fresh-frozen cadaveric knees were divided into 4 comparison groups based on the fixation method: screw fixation (group A), traditional sutures fixation with 2 FiberWire sutures (group B), a modified suture technique with 2 FiberWire sutures that created neckwear knots to firmly trap the fracture fragment (group C), or suture anchors which was based on the suture bridge technique primarily used in the shoulder for repair of rotator cuff tears and greater tuberosity fractures (group D). A tibial eminence fracture was created in each knee for subsequent fixation. After fixation, each knee underwent cyclic loading of 100 N to assess the displacement change after 500 cycles of the fixation construct. Afterward, a single tensile failure test load was performed to assess the ultimate failure load, stiffness, and failure mode for each specimen. All specimens survived cyclic testing and were subsequently loaded to failure. Group C had the highest ultimate failure load (P < .05) and group D had the lowest displacement compared with the other 3 groups (P < .05). Different failure modes were found among the 4 groups. Suture fixation using the neckwear knots technique provides superior fixation with regard to higher ultimate failure load, and absorbable suture anchor fixation with the suture bridge technique provides less displacement under cyclic loading conditions. Both techniques exhibited superior biomechanical properties compared with traditional screw and suture fixation. The new techniques showed satisfactory biomechanical properties and provided more choice for surgeons in the treatment of tibial eminence fractures. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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

    PubMed

    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

  5. Prospective evaluation of minimally invasive plate osteosynthesis in 36 nonarticular tibial fractures in dogs and cats.

    PubMed

    Guiot, Laurent P; Déjardin, Loïc M

    2011-02-01

    To evaluate the clinical outcome of minimally invasive plate osteosynthesis (MIPO) for nonarticular tibial fractures stabilized using bone plates with or without an intramedullary rod (IMR). Prospective study. Dogs (n=28) and 8 cats. After closed reduction, fracture fixation was achieved using an epiperiosteal plate inserted percutaneously through epiphyseal small incisions. In some fractures, an IMR was inserted via medial parapatellar arthrotomy. Radiographs were recommended every 3 weeks until clinical union. Postoperative tibial length and alignment were compared with contralateral measurements (P<.05). Time to clinical union and complications were recorded. An IMR was used in 30.5% of the cases. Repaired tibiae were 1% shorter than contralateral tibiae (P<.05). Frontal and sagittal alignment were similar between repaired and contralateral tibiae (P>.05). Six dogs were lost for follow-up; owners indicated normal function. In 30 cases for which bone healing was documented, mean±SD healing time was 45±20.8 days; however, when considering the 23 cases, which completed preestablished scheduled follow-ups, healing time was 36±11.6 days. Minor complications occurred in 4 cases (11%). One major complication (3%) consisting of a plate fracture was successfully revised using MIPO with a larger plate. Consistent restoration of alignment was accomplished using MIPO techniques. Furthermore, MIPO appeared to yield faster healing times and lower complication rates than those reported with conventional plate osteosynthesis. © Copyright 2011 by The American College of Veterinary Surgeons.

  6. Type III fracture of the tibial tubercle with avulsion of the tibialis anterior muscle in the adolescent male athlete.

    PubMed

    Kaneko, Kazuo; Matsuda, Torahiro; Mogami, Atsuhiko; Obayashi, Osamu; Iwase, Hideaki; Kurosawa, Hisashi

    2004-09-01

    Type III fracture of the tibial tubercle by Watson-Jones, or type IIIa injury according to John Ogden's classification has been well described and its management is now well codified in standard orthopaedic textbooks. The authors present a case of type III fracture of the tibial tubercle associated with an avulsion of the tibialis anterior muscle. We demonstrated the effectiveness of bioabsorbable material for fixing the fracture preventing the need for removal of metalware, and that the anterior tibialis muscle had been stripped by the injury. A displaced type III fracture of the tibial tubercle may have an associated with avulsion of the tibialis anterior muscle, particularly in adolescent athletes. Prompt recognition and appropriate surgical treatment can give an excellent outcome.

  7. Biomechanical Analysis of Stability of Posterior Antiglide Plating in Osteoporotic Pronation Abduction Ankle Fracture Model With Posterior Tibial Fragment.

    PubMed

    Hartwich, Kathleen; Lorente Gomez, Alejandro; Pyrc, Jaroslaw; Gut, Radosław; Rammelt, Stefan; Grass, René

    2017-01-01

    We performed a biomechanical comparison of 2 methods for operative stabilization of pronation-abduction stage III ankle fractures; group 1: Anterior-posterior lag screws fixing the posterior tibial fragment and lateral fibula plating (LSLFP) versus group 2: locked plate fixation of the posterior tibial fragment and posterior antiglide plate fixation of the fibula (LPFP). Seven pairs of fresh-frozen osteoligamentous lower leg specimens (2 male, and 5 female donors) were used for the biomechanical testing. Bone mineral density (BMD) of each specimen was assessed by means of dual-energy x-ray absorptiometry. After open transection of the deltoid ligament, an osteotomy model of pronation abduction stage III ankle fracture was created. Specimens were systematically assigned to LSLFP (group 1, left ankles) or LPPFP (group 2, right ankles). After surgery, all specimens were evaluated via CT to verify reduction and fixation. Axial load was then applied onto each specimen using a servohydraulic testing machine starting from 0 N (Zwick/Roell, Ulm, Germany) at a speed of 10 N/s with the foot fixed in a 10 degrees pronation and 15 degrees dorsiflexion position. Construct stiffness, yield, and ultimate strength were measured and dislocation patterns were documented with a high-speed camera. The normal distribution of all data was analyzed using Shapiro-Wilk test. The group comparison was performed using paired Student t test. Statistical significance was assumed at a P value of .05. All specimens had BMD values consistent with osteoporosis. BMD values did not differ between the left and right ankles of the same pair ( P = .762). The mean BMD values between feet of men (0.603 g/cm 2 ) and women (0.329 g/cm 2 ) were statistically different ( P = .005). The ultimate strength for LSLFP (group 1) with 1139 ± 669 N and LPPFP (group 2) with 2008 ± 943 N was statistically different ( P = .036) as well as the yield in LSLFP (group 1) 812 ± 452 N and LPPFD (group 2) 1292 ± 625 N ( P

  8. Arthroscopic treatment of tibial eminence fracture: a systematic review of different fixation methods.

    PubMed

    Osti, Leonardo; Buda, Matteo; Soldati, Francesco; Del Buono, Angelo; Osti, Raffaella; Maffulli, Nicola

    2016-06-01

    Arthroscopy procedures are the gold standard for the management of tibial spine avulsion. This review evaluates and compares different arthroscopic treatment options for tibial spine fractures. PubMed, Medline, Ovid, Google Scholar and Embase databases were systematically searched with no limit regarding the year of publication. An arthroscopic approach compared with arthrotomy reduces complications such as soft-tissue lesions, post-operative pain and length of hospitalization. The use of suture techniques, compared to cannulated screw technique, avoids a second surgery for removal of the screws, but requires longer immobilization and partial weight bearing. Clinical outcomes and radiographic results do not seem to differ in relation to the chosen method of fixation. Further studies are needed to produce clear guidelines to define the best choice in terms of clinical outcomes, function and complications. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Arthroscopic treatment of tibial eminence fracture: a systematic review of different fixation methods

    PubMed Central

    Osti, Leonardo; Buda, Matteo; Soldati, Francesco; Del Buono, Angelo; Osti, Raffaella; Maffulli, Nicola

    2016-01-01

    Introduction Arthroscopy procedures are the gold standard for the management of tibial spine avulsion. This review evaluates and compares different arthroscopic treatment options for tibial spine fractures. Source of data PubMed, Medline, Ovid, Google Scholar and Embase databases were systematically searched with no limit regarding the year of publication. Areas of agreement An arthroscopic approach compared with arthrotomy reduces complications such as soft-tissue lesions, post-operative pain and length of hospitalization. Areas of controversy The use of suture techniques, compared to cannulated screw technique, avoids a second surgery for removal of the screws, but requires longer immobilization and partial weight bearing. Growing points Clinical outcomes and radiographic results do not seem to differ in relation to the chosen method of fixation. Areas timely for developing research Further studies are needed to produce clear guidelines to define the best choice in terms of clinical outcomes, function and complications. PMID:27151952

  10. Finite element analysis of Puddu and Tomofix plate fixation for open wedge high tibial osteotomy.

    PubMed

    Raja Izaham, Raja Mohd Aizat; Abdul Kadir, Mohammed Rafiq; Abdul Rashid, Abdul Halim; Hossain, Md Golam; Kamarul, T

    2012-06-01

    The use of open wedge high tibial osteotomy (HTO) to correct varus deformity of the knee is well established. However, the stability of the various implants used in this procedure has not been previously demonstrated. In this study, the two most common types of plates were analysed (1) the Puddu plates that use the dynamic compression plate (DCP) concept, and (2) the Tomofix plate that uses the locking compression plate (LCP) concept. Three dimensional model of the tibia was reconstructed from computed tomography images obtained from the Medical Implant Technology Group datasets. Osteotomy and fixation models were simulated through computational processing. Simulated loading was applied at 60:40 ratios on the medial:lateral aspect during single limb stance. The model was fixed distally in all degrees of freedom. Simulated data generated from the micromotions, displacement and, implant stress were captured. At the prescribed loads, a higher displacement of 3.25 mm was observed for the Puddu plate model (p<0.001). Coincidentally the amount of stresses subjected to this plate, 24.7 MPa, was also significantly lower (p<0.001). There was significant negative correlation (p<0.001) between implant stresses to that of the amount of fracture displacement which signifies a less stable fixation using Puddu plates. In conclusion, this study demonstrates that the Tomofix plate produces superior stability for bony fixation in HTO procedures. Copyright © 2011 Elsevier Ltd. All rights reserved.

  11. Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study.

    PubMed

    Gamulin, Axel; Lübbeke, Anne; Belinga, Patrick; Hoffmeyer, Pierre; Perneger, Thomas V; Zingg, Matthieu; Cunningham, Gregory

    2017-07-18

    The aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome. All consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome. The charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the development of acute compartment syndrome in multivariable regression analysis, while younger age (<45 years), male sex, higher Schatzker grade (IV-V-VI), higher tibial widening ratio (≥1.05) and higher femoral displacement ratio (≥0.08) were significantly associated in the analysis adjusted for age and sex. Two parameters related to the occurrence of ACS in tibial plateau fractures were highlighted in this study: the presence of a non-contiguous tibia fracture or knee dislocation, and higher AO/OTA classification. They may be especially useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients), and should rise the suspicion level of the treating surgeon. In these cases, regular clinical examinations and/or intra-compartmental pressure measurements should be performed before and after surgery, even if acute compartment syndrome seemed unlikely during initial assessment. However, larger studies are mandatory to confirm and

  12. Total Knee Arthroplasty for Osteoarthritis Secondary to Fracture of the Tibial Plateau. A Prospective Matched Cohort Study.

    PubMed

    Lizaur-Utrilla, Alejandro; Collados-Maestre, Isabel; Miralles-Muñoz, Francisco A; Lopez-Prats, Fernando A

    2015-08-01

    A prospective matched cohort study was performed to compare outcomes of total knee arthroplasties (TKA) between 29 patients with posttraumatic osteoarthritis (POA) after a fracture of tibial plateau and 58 patients underwent routine TKA. Mean follow-up was 6.7 years. There were no significant differences in KSS, WOMAC, SF12 scores or range of motion. In the control group there were no complications. In the posttraumatic group, complications occurred in 4 patients (13.7%) (P=0.010) including partial patellar tendon detachment, superficial infection, skin necrosis, and knee stiffness. Only this last patient required revision for manipulation under anesthesia. Also, there was a revision for tibial aseptic loosening in each group. TKA is an effective treatment for POA after tibial plateau fracture. We recommend the prior removal of hardware, as well as tibial tubercle osteotomy when necessary. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. 3D printing-assisted osteotomy treatment for the malunion of lateral tibial plateau fracture.

    PubMed

    Yang, Peng; Du, Di; Zhou, Zhibin; Lu, Nan; Fu, Qiang; Ma, Jun; Zhao, Liangyu; Chen, Aimin

    2016-12-01

    Osteotomy and internal fixation are usually the most effective way to treat the malunion of lateral tibial plateau fractures, and the accuracy of the osteotomy is still a challenge for surgeons. This is a report of a series of prospectively study of osteotomy treatment for the malunion of lateral plateau fractures with the aid of 3D printing technology. A total of 7 patients with malunion of lateral tibial plateau fractures were enrolled in the study between September 2012 to September 2014 and completed follow up. CT image data were used for 3D reconstruction, and individually 3D printed models were used for accurate measurements and detail osteotomy procedures planning. Under the premeditated operation plan, the osteotomy operations were performed. Patients were invited for follow-up examinations at 2 and 6 weeks and then at intervals of 6 to 8 weeks until 12 months or more. Mean age of the patients was 44 years (range 30-52 years), 3 cases were result of fall injuries, 2 were traffic accidents and 2 were sports injuries. Among the cases, one accompanied with craniocerebra trauma, one with pelvic fracture, one accompanied with both. According to the Schatzker Tibial Plateau classification, the original fracture type were 3 type I, 1 type II and 3 type III. The lateral tibial plateau collapse ranges from 4 mm-12mm, with an average of 9.4mm. All the operations were successfully completed, the average operation time was 77.1min (range 70-90 min), the average intraoperative blood loss was 121.4ml (range 90-180ml), the mean follow-up time was 14.4 months (range 12-18 months), and the average healing time of the osteotomy fragments was 12 weeks (range 11-13 weeks). The difference between preoperative and postoperative Rasmussen scores were statistically significant (P<0.05). All the patients were obtained functional recovery, with no complications. 3D printing technology is helpful to accurately design osteotomy operation, reduce the risk of postoperative deformity

  14. Clinical and demographic study on open fractures caused by motorcycle traffic accidents

    PubMed Central

    Matos, Marcos Almeida; do Nascimento, Júlia Milena; da Silva, Bruno Vieira Pinto

    2014-01-01

    OBJECTIVE: To assess socio-demographic characteristics of individuals that suffered open fractures caused by motorcycle traffic accident and evaluate infection rate in search of associated risk factors. METHODS: A retrospective study comprising 81 patients with open fractures caused by motorcycle accidents was carried out. Clinic and socio-demographic features were collected from patients' records. Comparison between infected and non-infected patients was performed to find out which variables were possibly associated to this complication. RESULTS: Patients were mostly young adults (mean 32.9 years old), of the masculine gender (83.9%), single (60.5%), from the country side (40.7%), mostly presenting tibial open fractures (48.2%). Fractures type IIIA and type IIIB were the most prevalent lesions (68,8%), and soft tissue damage graded as I and II were the most frequent (64.62%). Infection was present in 23.7% of the patients and it was associated to age higher than 40 years old (p=0.011), to time delay from trauma to first surgical procedure longer than 24 hours (p=0,012), and also to soft tissue damage extent (p=0.001). CONCLUSIONS: Patients with open fractures caused by motorcycle traffic accident were mostly young single men, coming from the state capital and presented severe tibial open fractures, which 23.7% of the cases progressed to infection. Level of Evidence III, Retrospective Comparative Study. PMID:25246853

  15. Clinical and radiological results of arthroscopically treated tibial spine fractures in childhood

    PubMed Central

    Basiglini, L.; Vadalà, A.; Ferretti, A.

    2008-01-01

    The objective of this study is to report the clinical and radiological long-term follow-up evaluation of young patients arthroscopically treated for anterior tibial eminence fracture. Ten patients (mean age: 13.5 years) were treated between 1992 and 2006. At follow-up they were clinically and radiologically evaluated. Moreover, they underwent assessment with the International Knee Documentation Committee (IKDC) forms, Lysholm and Tegner knee scales and measurement with the KT-1000 arthrometer. At a mean follow-up of 85.8 months, all of the patients reported a subjective good-excellent outcome. Objectively, the Lachman test was negative in seven patients and positive in three patients; six patients (60%) registered a slight (+) to mild (++) pivot-glide test. The mean value of KT-1000 arthrometer measurements was 3 mm; all knee scales showed satisfactory results. Radiological exam always showed good healing of the fracture. Fractures of the tibial spine often lead to anterior and rotational knee laxity. However, despite this instrumental finding, patients usually do not report any type of restriction in their functional or sports activities. PMID:19043709

  16. Locked plating as an external fixator in treating tibial fractures: A PRISMA-compliant systematic review.

    PubMed

    Luo, Peng; Xu, Ding; Wu, Jia; Chen, Yi-Heng

    2017-12-01

    This article is a systematic review of the published literature about the biomechanics, functional outcomes, and complications of a locked plate as an external fixator in treating tibial fractures. We searched the PubMed, Ovid Medline, Embase, ScienceDirect, and Cochrane Library databases to retrieve the relevant studies. Studies published in English and Chinese which assessed adult patients and more than 4 cases who had sustained any type of fresh tibial fracture treated with the external locking plate, provided that they reported functional outcomes, range of motion (ROM), union or complication rates, and the biomechanical studies of external locked plating are also included. The electronic search strategy revealed 248 studies, and 2 studies were identified as relevant through manual search of references. Finally, 12 studies were included in this systematic review. These consist of 3 pure biomechanical studies, 8 case series, and 1 study including both of biomechanics and case series. Due to the heterogeneity of biomechanical studies, we can only conclude that external locked plate shows inferior structural stiffness than internal locked plate. The clinical studies reported that external locked plating gave a satisfactory ROM of the knee and ankle, functional outcomes, union rate, and low complication rate. We can only conclude that external locked plate shows inferior structural stiffness than internal locked plate because of the heterogeneity of biomechanical studies. The clinical studies showed locked plating as an external fixator in treating tibial fractures can be considered as a safe and successful procedure. However, as yet, there is unconvincing evidence that it is superior to standard techniques with regards to clinical and functional outcomes. More and well-designed studies about this technique should be carried out.

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

    PubMed Central

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

    2017-01-01

    AIM To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome (ACS) and to correlate it with functional outcome. METHODS Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale (LEFS)] and complications were assessed. RESULTS Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk (10 to 54 wk) and 23.8 ± 9.2 wk (12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness (76%) that caused difficulty in walking, running and squatting. Of 21 patients who had paralysis at diagnosis, 13 (62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients (48.3%) with severe disability, 10 patients (34.5%) with moderate disability and 5 patients (17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmHg respectively (P < 0.001). CONCLUSION ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intra-compartmental pressure (ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome. PMID:28567342

  18. Spiral computed tomography with two- and three-dimensional reconstruction in the management of tibial plateau fractures.

    PubMed

    Liow, R Y; Birdsall, P D; Mucci, B; Greiss, M E

    1999-10-01

    Spiral computed tomography (CT) with three-dimensional and multiplanar reconstructions was used in the evaluation of tibial fractures in nine patients. Computed tomography added important information to that obtained by plain radiographs. Five (55%) fractures were reclassified. The degree of articular depression was often underappreciated on plain radiographs. Furthermore, the fracture complexity and the spatial relation of fragments could be readily demonstrated with 3-D reconstruction. This technique is useful in planning operative reconstruction.

  19. Total knee arthroplasty following tibial plateau fracture: a matched cohort study.

    PubMed

    Scott, C E H; Davidson, E; MacDonald, D J; White, T O; Keating, J F

    2015-04-01

    Radiological evidence of post-traumatic osteoarthritis (PTOA) after fracture of the tibial plateau is common but end-stage arthritis which requires total knee arthroplasty is much rarer. The aim of this study was to examine the indications for, and outcomes of, total knee arthroplasty after fracture of the tibial plateau and to compare this with an age and gender-matched cohort of TKAs carried out for primary osteoarthritis. Between 1997 and 2011, 31 consecutive patients (23 women, eight men) with a mean age of 65 years (40 to 89) underwent TKA at a mean of 24 months (2 to 124) after a fracture of the tibial plateau. Of these, 24 had undergone ORIF and seven had been treated non-operatively. Patients were assessed pre-operatively and at 6, 12 and > 60 months using the Short Form-12, Oxford Knee Score and a patient satisfaction score. Patients with instability or nonunion needed total knee arthroplasty earlier (14 and 13.3 months post-injury) than those with intra-articular malunion (50 months, p < 0.001). Primary cruciate-retaining implants were used in 27 (87%) patients. Complication rates were higher in the PTOA cohort and included wound complications (13% vs 1% p = 0.014) and persistent stiffness (10% vs 0%, p = 0.014). Two (6%) PTOA patients required revision total knee arthroplasty at 57 and 114 months. The mean Oxford knee score was worse pre-operatively in the cohort with primary osteoarthritis (18 vs 30, p < 0.001) but there were no significant differences in post-operative Oxford knee score or patient satisfaction (primary osteoarthritis 86%, PTOA 78%, p = 0.437). Total knee arthroplasty undertaken after fracture of the tibial plateau has a higher rate of complications than that undertaken for primary osteoarthritis, but patient-reported outcomes and satisfaction are comparable. Cite this article: Bone Joint J 2015;97-B:532-8. ©2015 The British Editorial Society of Bone & Joint Surgery.

  20. Raised compartment pressures are frequently observed with tibial shaft fractures despite the absence of compartment syndrome: A prospective cohort study.

    PubMed

    Ho, Kelvin Lor Kah; Sing, Nicholas Yeoh Ching; Wong, Khai Phang; Huat, Andy Wee Teck

    2017-01-01

    To measure the intracompartmental pressures surrounding tibial fractures not exhibiting any clinical evidence of compartment syndrome. Our hypothesis was that pressures often exceed the recommended threshold of fasciotomy despite the absence of compartment syndrome, and hence diagnosis based on pressure measurements alone is unreliable. Thirteen consecutive patients with closed tibial shaft fractures without clinical suspicion of compartment syndrome, and who were planned for intramedullary nailing, were prospectively enrolled. Compartment pressures ( P) in all four compartments of the affected leg were measured at the start of surgery and immediately after tibial reaming, and differential pressures (delta P) were calculated based on the diastolic blood pressure prior to induction of anaesthesia. No patients required reoperation in the post-operative period, as a result of an undiagnosed compartment syndrome. Using commonly quoted threshold pressure criteria, 62% (using P > 30 mmHg) and 23% of patients (using delta P < 30 mmHg) have been incorrectly diagnosed with compartment syndrome. We conclude that raised compartment pressures are frequently seen in patients with tibial shaft fractures; but in most cases, it does not equate to the presence of compartment syndrome. Diagnosis of compartment syndrome based on intracompartmental pressure measurements alone may result in unnecessary fasciotomies in a sizeable number of patients. Compartment syndrome remains a clinical diagnosis, and one which always needs to be considered when managing tibial fractures.

  1. Effects of fatigue on running mechanics associated with tibial stress fracture risk.

    PubMed

    Clansey, Adam C; Hanlon, Michael; Wallace, Eric S; Lake, Mark J

    2012-10-01

    The purpose of this study was to investigate the acute effects of progressive fatigue on the parameters of running mechanics previously associated with tibial stress fracture risk. Twenty-one trained male distance runners performed three sets (Pre, Mid, and Post) of six overground running trials at 4.5 m.s(-1) (± 5%). Kinematic and kinetic data were collected during each trial using a 12-camera motion capture system, force platform, and head and leg accelerometers. Between tests, each runner ran on a treadmill for 20 min at their corresponding lactate threshold (LT) speed. Perceived exertion levels (RPE) were recorded at the third and last minute of each treadmill run. RPE scores increased from 11.8 ± 1.3 to 14.4 ± 1.5 at the end of the first LT run and then further to 17.4 ± 1.6 by the end of the second LT run. Peak rearfoot eversion, peak axial head acceleration, peak free moment and vertical force loading rates were shown to increase (P < 0.05) with moderate-large effect sizes during the progression from Pre to Post tests, although vertical impact peak and peak axial tibial acceleration were not significantly affected by the high-intensity running bouts. Previously identified risk factors for impact-related injuries (such as tibial stress fracture) are modified with fatigue. Because fatigue is associated with a reduced tolerance for impact, these findings lend support to the importance of those measures to identify individuals at risk of injury from lower limb impact loading during running.

  2. On Subsurface Fracture Opening and Closure

    NASA Astrophysics Data System (ADS)

    Wang, Y.

    2016-12-01

    Mechanistic understanding of fracture opening and closure in geologic media is of significant importance to nature resource extraction and waste management, such as geothermal energy extraction, oil/gas production, radioactive waste disposal, and carbon sequestration and storage). A dynamic model for subsurface fracture opening and closure has been formulated. The model explicitly accounts for the stress concentration around individual aperture channels and the stress-activated mineral dissolution and precipitation. A preliminary model analysis has demonstrated the importance of the stress-activated dissolution mechanism in the evolution of fracture aperture in a stressed geologic medium. The model provides a reasonable explanation for some key features of fracture opening and closure observed in laboratory experiments, including a spontaneous switch from a net permeability reduction to a net permeability increase with no changes in a limestone fracture experiment.

  3. Intramedullary nailing in opening wedge high tibial osteotomy-in vitro test for validation of a method of fixation.

    PubMed

    Burchard, Rene; Katerla, Denise; Hammer, Marina; Pahlkötter, Anke; Soost, Christian; Dietrich, Gerhard; Ohrndorf, Arne; Richter, Wolfgang; Lengsfeld, Markus; Christ, Hans-Jürgen; Graw, Jan Adriaan; Fritzen, Claus-Peter

    2018-02-01

    Opening wedge high tibial osteotomy (HTO) as a treatment in unicompartimental osteoarthritis of the knee can significantly relieve pain and prevent or at least delay an early joint replacement. The fixation of the osteotomy has undergone development and refinements during the last years. The angle-stable plate fixator is currently one of the most commonly used plates in HTOs. The angular stable fixation between screws and the plate offers a high primary stability to retain the correction with early weight-bearing protocols. This surgical technique is performed as a standard of care and generally well tolerated by the patients. Nevertheless, some studies observed that many patients complained about discomfort related to the implant. Therefore, the stability of two different intramedullary nails, a short implant used in humeral fractures and a long device used in tibial fractures for stabilization in valgus HTOs, was investigated as an alternative fixation technique. The plate fixator was defined as reference standard. Nine synthetic tibia models were standardly osteotomized and stabilized by one of the fixation devices. Axial compression was realized using a special testing machine and two protocols were performed: a multi-step fatigue test and a load-to-failure test. Overall motion, medial, and lateral displacements were documented. Fractures always occurred at the lateral cortex. Axial cyclic loading up to 800 N was tolerated by all implants without failure. The tibia nail provided highest fatigue strength under the load-to-failure conditions. The results suggest that intramedullary nailing might be used as an alternative concept in HTO.

  4. Improved accuracy of 3D-printed navigational template during complicated tibial plateau fracture surgery.

    PubMed

    Huang, Huajun; Hsieh, Ming-Fa; Zhang, Guodong; Ouyang, Hanbin; Zeng, Canjun; Yan, Bin; Xu, Jing; Yang, Yang; Wu, Zhanglin; Huang, Wenhua

    2015-03-01

    This study was aimed to improve the surgical accuracy of plating and screwing for complicated tibial plateau fracture assisted by 3D implants library and 3D-printed navigational template. Clinical cases were performed whereby complicated tibial plateau fractures were imaged using computed tomography and reconstructed into 3D fracture prototypes. The preoperative planning of anatomic matching plate with appropriate screw trajectories was performed with the help of the library of 3D models of implants. According to the optimal planning, patient-specific navigational templates produced by 3D printer were used to accurately guide the real surgical implantation. The fixation outcomes in term of the deviations of screw placement between preoperative and postoperative screw trajectories were measured and compared, including the screw lengths, entry point locations and screw directions. With virtual preoperative planning, we have achieved optimal and accurate fixation outcomes in the real clinical surgeries. The deviations of screw length was 1.57 ± 5.77 mm, P > 0.05. The displacements of the entry points in the x-, y-, and z-axis were 0.23 ± 0.62, 0.83 ± 1.91, and 0.46 ± 0.67 mm, respectively, P > 0.05. The deviations of projection angle in the coronal (x-y) and transverse (x-z) planes were 6.34 ± 3.42° and 4.68 ± 3.94°, respectively, P > 0.05. There was no significant difference in the deviations of screw length, entry point and projection angle between the ideal and real screw trajectories. The ideal and accurate preoperative planning of plating and screwing can be achieved in the real surgery assisted by the 3D models library of implants and the patient-specific navigational template. This technology improves the accuracy and efficiency of personalized internal fixation surgery and we have proved this in our clinical applications.

  5. Application of Orthopedic Dual Sliding Compression Plate (ODSCP) in High Medial Tibial Open Wedge Osteotomies.

    PubMed

    Samani, Seyed Salman; Kachooei, Amir Reza; Ebrahimzadeh, Mohammad Hosein; Omidi Kashani, Farzad; Mahdavian Naghashzargar, Reza; Razi, Shiva

    2013-04-01

    Angular deformities about the knee are one of the common disorders. High Tibial osteotomy is a way of correcting the deformity. Although the general agreement is focused toward the open wedge technique, discussion about the type of device is a subject to debate. This current study has attempted to evaluate the results of Orthopedic Dual Sliding Compression Plate (ODSCP) in high medial open wedge osteotomies of the tibia. In this cross-sectional study, 16 patients with genuvarum undergone high medial tibial open wedge osteotomy and fixed by Orthopedic Dual Sliding Compression Plate. At the time of the last follow up visit, Lysholm score was gathered. The mean follow-up time was 9.33 ± 1.87 month. The average age was 45.13 ± 7.25 years. Three patients were male and 13 patients were female. The lysholm score showed a significant difference before and after surgery. The ODSCP has many advantages over the other type of plates. It can help the surgeon to operate with a relaxed mind and it is advisable for high tibial medial open wedge osteotomies.

  6. Incidence of transcortical tibial fractures with self-tapping and non-self-tapping screws in a canine TPLO model.

    PubMed

    Boekhout, Christina; Cross, Alan

    2012-10-01

    To compare the incidence of radiographically apparent transcortical diaphyseal tibial fractures between self-tapping screws (STS) and non-self-tapping screws (NSTS) in a canine tibial plateau leveling osteotomy (TPLO) model. Case series. Dogs (n = 106) that had TPLO. NSTS (n = 107), STS titanium (n = 104), or STS stainless steel (n = 105) screws were used for TPLO. Effect of STS and NSTS were compared by reviewing postoperative craniocaudal and lateral radiographic projections taken immediately after TPLO. Three screws distal to the tibial osteotomy served as the in vivo model for canine cortical bone. A transcortical fracture was defined as the presence of a saucer-shaped radiolucent defect on the periosteal surface of the trans-cortex surrounding the screw and the presence of radiopaque material (bone) separate from the transcortical periosteal surface. The effect of screw type and STS material (stainless steel or titanium) on the incidence of transcortical fractures was evaluated. STS had a significantly higher (P = .006) incidence of transcortical fractures (18.0%) compared with NSTS (0.8%). The effect of STS material on the incidence of transcortical fractures was not significant (P = .485). No cis-cortical factures were identified. We suspect the increased incidence of transcortical fractures with STS is because of the shorter cutting flutes as compared with those of a tap used with a NSTS. © Copyright 2012 by The American College of Veterinary Surgeons.

  7. In vivo study effect of particulate Bioglass in the prevention of infection in open fracture fixation.

    PubMed

    Xie, Zong-Ping; Zhang, Chang-Qing; Yi, Cheng-Qing; Qiu, Jian-Jun; Wang, Jian-Qiang; Zhou, Juan

    2009-07-01

    There are many in vitro experiments showing that particulate bioactive glasses have a broad and certain antibacterial effect, but there is no report about this antibacterial effect in vivo so far. The aim of this study is to examine the efficacy of particulate Bioglass in reducing the rate of infection with Staphylococcus aureus after the fixation of open tibial fractures in rabbits. The test in vivo was carried out with male rabbits split into two groups infected with Staphylococcus aureus at the right tibial fracture sites fixed with plate and screw, either with or without bioactive glass respectively. Culture results show that six of ten rabbits from the control group had a positive culture for the strain of Staphylococcus aureus ATCC25923, compared with six of the nine rabbits from the Bioglass group. The median radiographic score is 4.5 points for the rabbits from the control group and 4 points for the rabbits from the Bioglass group. The median histopathological score was 2.5 points for the rabbits in the control group and 3 points for the rabbits in the Bioglass group. In conclusion, this study showed no significant difference between the rates of infection of two groups. Particulate Bioglass did not reduce the rate of infection with Staphylococcus aureus after the fixation of open tibial fractures in rabbits. (c) 2008 Wiley Periodicals, Inc.

  8. Seismic Imaging of Open Subsurface Fractures

    NASA Astrophysics Data System (ADS)

    Myers, S. C.; Pitarka, A.; Matzel, E.; Aguiar, A. C.

    2015-12-01

    Injection of high-pressure fluid into the subsurface is proven to stimulate geothermal, oil, and gas production by opening cracks that increase permeability. The effectiveness of increasing permeability by high-pressure injection has been revolutionized by the introduction of "proppants" into the injected fluid to keep cracks open after the pressure of the stimulation activity ends. The network of fractures produced during stimulation is most commonly inferred by the location of micro-earthquakes. However, existing (closed) fractures may open aseismically, so the whole fracture network may not be imaged by micro-seismic locations alone. Further, whether all new fractures remain open and for how long remains unclear. Open cracks, even fluid-filled cracks, scatter seismic waves because traction forces are not transmitted across the gap. Numerical simulation confirms that an open crack with dimensions on the order of 10 meters can scatter enough seismic energy to change the coda of seismic signals. Our simulations show that changes in seismic coda due to newly opened fractures are only a few percent of peak seismogram amplitudes, making signals from open cracks difficult to identify. We are developing advanced signal processing methods to identify candidate signals that originate from open cracks. These methods are based on differencing seismograms that are recorded before and after high-pressure fluid injection events to identify changes in the coda. The origins of candidate signals are located using time-reversal techniques to determine if the signals are indeed associated with a coherent structure. The source of scattered energy is compared to micro-seismic event locations to determine whether cracks opened seismically or aseismically. This work performed under the auspices of the U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344. LLNL-ABS-675612.

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

    PubMed

    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.

  10. A case of fracture of posterior margin of lateral tibial plateau by pivot shift mechanism in chronic ACL insufficiency.

    PubMed

    Yoo, Jae Ho; Yang, Bo Kyu; Ryu, Ho Kwang

    2009-03-01

    We present a case of the fracture of the posterior margin of the lateral tibial plateau, probably by pivot shift mechanism in a chronic anterior cruciate ligament (ACL) insufficient knee. Multitudes of direct and indirect signs of ACL injury were evident on MRI, including anterior translation of the lateral tibial plateau, buckling of the posterior cruciate ligament, deep sulcus sign, and the fracture of the posterior aspect of lateral tibial plateau. With careful interpretation of the history and arthroscopic findings, the main insult of the current case was identified as the fracture of the posterior margin of the lateral tibial plateau with antecedent chronic ACL insufficiency, rather than as the acute or subacute ACL rupture. This type of injury is worth due attention as a late complication of chronic ACL insufficiency, and the clinicians should be careful in constructing the clinical scenario for the temporal relationship of injury. To the best of our knowledge, this type of injury as a late complication of chronic ACL insufficiency has never been reported in the literature.

  11. Fractography and oxidative analysis of gamma inert sterilized posterior-stabilized tibial insert post fractures: report of two cases.

    PubMed

    Ansari, Farzana; Chang, Jennifer; Huddleston, James; Van Citters, Douglas; Ries, Michael; Pruitt, Lisa

    2013-12-01

    Highly crosslinked ultra-high molecular weight polyethylene (UHMWPE) has shown success in reducing wear in hip arthroplasty but there remains skepticism about its use in Total Knee Replacement (TKR) inserts that are known to experience fatigue loading and higher local cyclic contact stresses. Two Legacy Posterior-Stabilized (LPS) Zimmer NexGen tibial implants sterilized by gamma irradiation in an inert environment with posts that fractured in vivo were analyzed. Failure mechanisms were determined using optical and scanning electron microscopy along with oxidative analysis via Fourier Transform Infra-Red (FTIR) spectroscopy. Micrographs of one retrieval revealed fatigue crack initiation on opposite sides of the post and quasi-brittle micromechanisms of crack propagation. FTIR of this retrieval revealed no oxidation. The fracture surface image of the second retrieval indicated a brittle fracture process and FTIR revealed oxidation in the explant. These two cases suggest that crosslinking of UHMWPE as a manufacturing process or sterilization method in conjunction with designs that incorporate high stress concentrations, such as the tibial post, may reduce material strength. Moreover, free radicals generated from ionizing radiation can render the polymer susceptible to oxidative embrittlement. Our findings suggest that tibial post fractures may be the results of in vivo oxidation and low level crosslinking. These and previous reports of fractured crosslinked UHMWPE devices implores caution when used with high stress concentrations, particularly when considering the potential for in vivo oxidation in TKR. Copyright © 2013 Elsevier B.V. All rights reserved.

  12. [Biomechanic study on length of plate in treatment of tibial shaft fracture].

    PubMed

    Hu, Xinji; Yang, Shuhua; Xiao, Deming; Lin, Bowen; Wang, Hua; Xu, Zhongshi; Zhao, Weidong; Zhang, Meichao

    2008-11-01

    To research the biomechanical effect of different length bone plates on treatment of tibial shaft fracture. Forty-five tibia specimens from fresh adult corpse (20-40 years old) were donated (30-38 cm in length, 34 cm on average) and were divided into 3 groups randomly (n = 15). Under the following three conditions, the experiment was made separately. Compression stress-strain indexes of whole tibia were determined under the reverse, three spots curving and compression. The vertical elastic strain was 0-1 000 N, the reverse angle was 0-3 degrees, and three bending stress was 0-400 N. Then the center-section squint non-damage bone fracture model was made, fracture was fixed by 6, 10, 14 stainless steel AO LC-DCP, respectively. The compression stress-strain indexes were determined under reverse angle, three spots curving and compression, statistical analysis was done. The vertical direction strain value of 6, 10 and 14 hole steel plate under vertical compressions, was 0.449 +/- 0.241, 0.093 +/- 0.003, 0.139 +/- 0.005, respectively; showing significant difference between 10 and 14 hole steel plates and 6 steel plate (P < 0.01) and no significant difference between 10 and 14 hole steel plate (P > 0.05). The lateral strain value of 6, 10 and 14 hole steel plate was 0.120 0 +/- 0.000 4, 0.127 5 +/- 0.010 0, 0.237 0 +/- 0.000 6 respectively, indicating a significant difference between stell plates of 6 and 10 hole and 14 hole steel plate (P < 0.01) and no difference between 6 and 10 hole steel plate (P > 0.05). The torque of 6, 10 and 14 hole steel plate was (5.066 +/- 2.715) x 10(-3), (5.671 +/- 2.527) x 10(-3) and (4.570 +/- 2.228) x 10(-3) Nm, respectively and three spot curving vertical direction strain value was 0.049 +/- 0.009, 0.124 +/- 0.017, 0.062 +/- 0.009, respectively. There were significant differences between various steel plates (P < 0.01). For the fixation of tibial oblique fracture, 14 hole steel plate's stabilities of anti-vertical compression, anti

  13. Open tibia fractures in HIV positive patients.

    PubMed

    Harrison, W J

    2009-12-01

    Open tibia fractures are common injuries, particularly in developing countries.Pedestrian or bicycle to motor car contact is the most common mechanism. These injuries result in high morbidity and often long-term disability. HIV infection complicates open fractures by raising the incidence of infectionin the open wound (5 of 7 patients in our series). This risk may be compounded if internal fixation techniques are used (5 of 12 HIV patients with internal fixation of any open fracture). There is also a suggestion that HIV may delay bone union (4 of 7 patients united at 6 months). External fixation offers an alternative method of fracture stabilisation. It avoids the risks associated with putting metal-ware in the wound, but creates a new issue of pin track sepsis. We found that pin track infection was more common in patients with HIV, but the rate at which pins required removal was 7%. We consider external fixation to be a lower-risk strategy than internal fixation in such patients but open fracture wound sepsis remains a problem. We have not yet demonstrated a difference in severity or frequency of complications in patients of low CD4 count, but logically one expects septic complications to increase as CD4 count falls. Antiretroviral medication decreases viral load and elevates the CD4 count. Research is underway regarding potential effectiveness of such drugs in reducing wound and fracture healing complications. Above all, meticulous and timely all-round care is required to achieve satisfactory results in immune-compromised patients. This includes, debridement, bony stability, and soft-tissue reconstruction.

  14. Intraobserver and interobserver reliability assessment of tibial plateau fracture classification systems.

    PubMed

    Taşkesen, Anıl; Demirkale, İsmail; Okkaoğlu, Mustafa Caner; Özdemir, Mahmut; Bilgili, Mustafa Gökhan; Altay, Murat

    2017-12-01

    This study aims to assess the intra- and interobserver reliability of commonly used tibial plateau fracture classification systems. This retrospective cohort study included computed tomography (CT) and plain radiographic images (lateral and anteroposterior X-rays) of 60 patients (40 males, 20 females; mean age 45.9 years; range 18 to 80 years) who presented to two orthopaedic clinics between January 2011 and January 2015 with unilateral tibial plateau fractures. All plain X-rays (XR) and CT images were evaluated by four observers on two separate occasions, 1.5 months apart. All fractures were classified according to the Arbeitsgemeinschaft für Osteosynthesefragen-Orthopaedic Trauma Association (AO-OTA), Schatzker, Hohl and Moore, Luo and revised Duparc systems. Intraobserver reliability was measured with Cohen's kappa (κ) coefficient and interobserver reliability with Fleiss' kappa coefficient. When Schatzker classification was performed, interobserver reliability was in moderate level for (κ=0.51) for XR and in substantial level for CT (κ=0.61). When AO/OTA classification was used, interobserver reliability was in moderate level for both methods of diagnosis (κXR=0.43 and κCT=0.54, respectively). In the Hohl and Moore classification, the interobserver reliability was also moderate for both methods of diagnosis (κXR=0.45 and κCT=0.51, respectively). Revised Duparc classification showed the lowest interobserver reliability ranging from fair to moderate level (κXR=0.27-0.55 and κCT=0.44-0.61). Interobserver reliability for Luo classification was κCT=0.47. Intraobserver reliability for CT in Luo classification was in substantial level for observers 1, 2 and 3 (κCT=0.67-0.71) and in perfect level for observer 4 (κCT=0.84). Intraobserver reliability was in substantial level in Schatzker classification and in moderate level at the other classifications. Among the classification systems compared in this study, Schatzker was the most reliable particularly when

  15. Effect of rhBMP-2 on tibial plateau fractures in a canine model.

    PubMed

    Schaefer, Susan L; Lu, Yan; Seeherman, Howard; Li, X Jian; Lopez, Mandi J; Markel, Mark D

    2009-04-01

    This study was to determine the efficacy of recombinant human bone morphogenetic protien-2 (rhBMP-2)/calcium phosphate matrix (CPX) paste to accelerate healing in a canine articular fracture model with associated subchondral defect. rhBMP-2/CPX (BMP), CPX alone (CPX) or autogenous bone graft (ABG) was administered to a canine articular tibial plateau osteotomy with a subchondral defect in each of 21 female dogs. The unoperated contralateral limbs served as controls. Ground reaction forces, synovial fluid, radiographic changes, mechanical testing, bone density, and histology of bone and synovium were analyzed at 6 weeks after surgery. Radiographic analysis demonstrated that the BMP and CPX groups showed improved bony healing compared to the ABG group at week 6. Histomorphometric analysis demonstrated that the BMP group had significantly increased trabecular bone volume compared to the CPX and ABG groups. Mechanical testing revealed that the BMP group had significantly greater maximum failure loads than the ABG group. Histological analysis demonstrated that the BMP group had significantly less sub-synovial inflammation than CPX group. This study demonstrated that rhBMP-2/CPX accelerated healing of articular fractures with subchondral defect compared to ABG in most of the parameters evaluated, and had less subsynovial inflammation than the CPX alone in a canine model.

  16. Surgical treatment of avulsion fractures at the tibial insertion of the posterior cruciate ligament: functional result☆

    PubMed Central

    Barros, Marcos Alexandre; Cervone, Gabriel Lopes de Faria; Costa, André Luis Serigatti

    2015-01-01

    Objective To objectively and subjectively evaluate the functional result from before to after surgery among patients with a diagnosis of an isolated avulsion fracture of the posterior cruciate ligament who were treated surgically. Method Five patients were evaluated by means of reviewing the medical files, applying the Lysholm questionnaire, physical examination and radiological examination. For the statistical analysis, a significance level of 0.10 and 95% confidence interval were used. Results According to the Lysholm criteria, all the patients were classified as poor (<64 points) before the operation and evolved to a mean of 96 points six months after the operation. We observed that 100% of the posterior drawer cases became negative, taking values less than 5 mm to be negative. Conclusion Surgical methods with stable fixation for treating avulsion fractures at the tibial insertion of the posterior cruciate ligament produce acceptable functional results from the surgical and radiological points of view, with a significance level of 0.042. PMID:27218073

  17. Epidemiology of Anterior Tibial Spine Fractures in Young Patients: A Retrospective Cohort Study of 122 Cases.

    PubMed

    Axibal, Derek P; Mitchell, Justin J; Mayo, Meredith H; Chahla, Jorge; Dean, Chase S; Palmer, Claire E; Campbell, Kristen; Vidal, Armando F; Rhodes, Jason T

    2017-09-22

    Historically, bicycle accidents were described as the most common mechanism for pediatric anterior tibial spine fractures (ATSFs). There is a paucity of current literature examining the demographic factors associated with these injuries. The purpose of this cohort study was to characterize the epidemiology of ATSFs presenting to a single tertiary referral pediatric hospital. A consecutive cohort of 122 pediatric patients with ATSFs between 1996 and 2014 were reviewed. Radiographic variables, classification of fractures (Meyers and McKeever type), age, sex, height, weight, body mass index, and mechanism of injury were retrieved. Categories of mechanism of injury included organized sports (football, soccer, basketball, lacrosse, wrestling, and gymnastics), bicycling, outdoor sports (skiing, skateboarding, and sledding), fall, motor vehicle collision/pedestrian versus motor vehicle, and trampoline. Organized sports-related injuries represented the most common cause of ATSFs (36%). Other common mechanisms of injury included bicycle accidents (25%), outdoor sports (18%), and falls (11%). There was a higher proportion of males (69%) compared with females (31%). Males (mean age, 11.6 y) were significantly older than females (mean age, 9.8 y) (P=0.004). Younger patients (aged 11.5 y and below) were more likely to have displaced fractures (type III), whereas type I and type II were more common in patients above 11.5 years (P=0.02). Patients with fracture type I were significantly taller than patients with fracture type III. No other variables were found to differ significantly according to fracture severity, including sex, weight, and body mass index. To our knowledge, our study represents both the largest (n=122) and most up-to-date epidemiological ATSF study in pediatric patients. A higher rate of ATSF occurs due to organized sports rather than bicycling or motor vehicle collision. This 18-year data collection represents a change in the paradigm, and is likely

  18. Ability of an intentionally smaller anterior than posterior gap to reduce the sagittal tibial slope in opening wedge high tibial osteotomy.

    PubMed

    Han, Seung-Beom; Park, Hyung-Jun; Lee, Dae-Hee

    2016-05-18

    We utilized in vivo 3- dimensional (D) computed tomography (CT) to determine whether the preoperatively planned anterior and posterior opening gap heights correlated with the real gaps following opening wedge high tibial osteotomy (HTO), as well as the relationships between anterior and posterior gap heights and change in sagittal tibial slope. This prospective study involved 41 patients (41 knees) undergoing navigation HTO for primary medial osteoarthritis. Mechanical axis (MA), weight-bearing line (WBL) ratio, and posterior tibial slope were measured on radiographs preoperatively and after 3 months. The anterior and posterior opening gaps created by osteotomy were measured using in vivo 3D CT and the patients were classified into a larger anterior or posterior gap group. Of the 41 patients, 24 (59 %) had larger anterior and 17 (41 %) had larger posterior gaps. There were no between group differences in preoperative and postoperative slopes, or in change in slope. The correlation between preoperatively planned and postoperative posterior gaps was good, whereas the correlation of anterior gaps was only fair. Bland-Altman plots showed poor agreement for both preoperative and postoperative anterior and posterior gaps. The mean systematic difference (bias) was 2.3 mm (p < 0.001) for anterior and -1.0 mm (p = 0.033) for posterior gaps. Preoperatively calculated opening gaps, which were planned to be larger posteriorly than anteriorly to minimize the change in slope after surgery, did not correspond with postoperative opening gaps on 3D CT. In addition, postoperative tibial slope did not increase, even when the anterior gap was larger than the posterior gap. KCT0001905 , April 29, 2016.

  19. Epidemiology of open fractures in sport: One centre’s 15-year retrospective study

    PubMed Central

    Wood, Alexander M; Robertson, Greg A J; MacLeod, Kirsty; Porter, Anna; Court-Brown, Charles M

    2017-01-01

    AIM To describe the epidemiology of sport-related open fractures from one centre’s adult patient population over a 15-year period. METHODS A retrospective review of a prospectively-collected database was performed: The database contained information all sport-related open fractures, sustained from 1995 to 2009 in the Edinburgh, Mid and East Lothian Populations. RESULTS Over the 15-year period, there were 85 fractures recorded in 84 patients. The annual incidence of open sport-related fractures was 0.01 per 1000 population. The mean age at injury was 29.2 years (range 15-67). There were 70 (83%) males and 14 females (17%). The 6 most common sports were soccer (n = 19, 22%), rugby (n = 9, 11%), cycling (n = 8, 9%), hockey (n = 8, 9%); horse riding (n = 6, 7%) and skiing (n = 6, 7%). The five most common anatomical locations were finger phalanges (n = 30, 35%); tibial diaphysis (n = 19, 23%); forearm (n = 12, 14%); ankle (n = 7, 8%) and metacarpals (n = 5, 6%). The mean injury severity score was 7.02. According to the Gustilo-Anderson classification system, 45 (53%) fractures were grade 1; 28 (33%) fractures were grade 2; 8 (9%) fractures were grade 3a; and 4 (5%) fractures were grade 3b. Out of the total number of fractures, 7 (8%) required plastic surgical intervention as part of management. The types of flaps used were split skin graft (n = 4), fasciocutaneous flaps (n = 2); and adipofascial flap (n = 1). CONCLUSION We analysed the epidemiology of open fractures secondary to sport in one centre over a 15-year period. Soccer and rugby were the most common causative sports while fractures of the finger phalanx and of the tibial diaphysis were the most common sites. Open fractures are uncommon in sport; however, when they are sustained they usually occur on muddy sport fields or forest tracks and therefore must be treated appropriately. It is important that clinicians and sports therapists have knowledge of these injuries, in order to ensure they are managed

  20. Posteromedial tibial plateau injury including avulsion fracture of the semimembranous tendon insertion site: ancillary sign of anterior cruciate ligament tear at MR imaging.

    PubMed

    Chan, K K; Resnick, D; Goodwin, D; Seeger, L L

    1999-06-01

    To evaluate posteromedial tibial plateau injuries of or about the semimembranous tendon insertion site and their association with anterior cruciate ligament (ACL) tears on magnetic resonance (MR) images. A retrospective study of MR images and conventional radiographs was performed in 10 patients with posteromedial tibial plateau injuries, including avulsion fractures of the semimembranous tendon insertion site. Associated abnormalities were analyzed, including ACL tears, medial meniscal tears, and other lateral femorotibial compartment injuries. Findings from the clinical history and physical examination were correlated with radiographic and MR imaging findings. Nine patients had arthroscopically or surgically documented ACL tears. All 10 patients had ACL tears at MR imaging. Five patients had posteromedial tibial plateau fractures: Four had avulsion fractures of the tendon insertion site, and one had a fracture lateral to the site. Five patients had posteromedial tibial plateau bruises: Two had bruises at the tendon insertion site. Five patients had tears of the posterior horn of the medial meniscus. Two patients had posterior meniscocapsular separations. Three patients showed evidence of the O'Donoghue triad. Six patients had bruises of the lateral tibial plateau and of the lateral femoral condyle. There appears to be an association between posteromedial tibial plateau injuries and ACL tears. Posteromedial tibial plateau injuries may be predictive of ACL status.

  1. Can tibial plateau fractures be reduced and stabilised through an angiosome-sparing antero-lateral approach?

    PubMed

    Solomon, Lucian B; Boopalan, P R J V C; Chakrabarty, Adhiraj; Callary, Stuart A

    2014-04-01

    Tibial plateau fractures (TPFs) are an independent, non-modifiable risk factor for surgical site infections (SSIs). Current antero-lateral approaches to the knee dissect through the anterior tibial angiosome (ATA), which may contribute to a higher rate of SSIs. The aim of this study was to develop an angiosome-sparing antero-lateral approach to allow reduction and fixation of lateral TPFs and to investigate its feasibility in a consecutive cohort. Twenty cadaveric knees were dissected to define the position of the vessels supplying the ATA from the lateral tibial condyle to the skin perforators. Based on these results, an angiosome-sparing surgical approach to treat lateral TPFs was developed. Fifteen consecutive patients were subsequently treated through this approach. Clinical outcomes included assessment of SSI and Lysholm score. Fracture healing and stability were assessed using the Rasmussen score and radiostereometric analysis (RSA). At the latest follow-up between 1 and 4 years, there was no report of SSI. Nine patients (60%) had good or excellent Lysholm scores. The mean Rasmussen score at final follow-up was 17 (median 18, range 14-18) with 10 patients (66%) graded as excellent. Fracture fragment migration measured using RSA was below 2mm in all cases. This study has demonstrated that an angiosome-sparing antero-lateral approach to the lateral tibial plateau is feasible. Adequate stability of these fracture types was achieved by positioning a buttress plate away from the bone and superficial to the regional fascial layer as an 'internal-external fixator'. The angiosome-sparing approach developed was able to be used in a prospective cohort and the clinical results to date are encouraging. Future clinical studies need to investigate the potential benefits of this surgical approach when compared with the previously described antero-lateral approaches. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  2. Reinforcement strategy for lateral rafting plate fixation in posterolateral column fractures of the tibial plateau: The magic screw technique.

    PubMed

    Sun, Hui; Zhu, Yi; He, Qi-Fang; Shu, Lin-Yuan; Zhang, Wei; Chai, Yi-Min

    2017-12-01

    A posterolateral column fracture of the tibial plateau (PLCF) is not uncommon, especially lateral and bicondylar tibial plateau fractures. Currently, there is no consensus on the methods of surgical treatment for PLCF, including the surgical approach or the fixation strategy. Though various posterior approaches have been explored and can allow posterior buttress plate fixation, the necessity of a posterior approach with fixation for PLCFs is increasingly questioned. Meanwhile, there is no literature to analyse the morphological features of PLCFs. None of the available surgical techniques can solve all of the problems of PLCFs. From February 2016 to June 2016, an inconsecutive series of 16 patients who suffered Schatzker type II tibial plateau fractures involving the posterolateral column were selected based on an analysis of the morphological characteristics of PLCFs. The patients were all treated by lateral rafting plate fixation with magic screw implantation through the extended lateral approach. According to PLCF morphology, 4 patients had mild slope-type depression fractures (MSDF) of the articular surface, and the other 12 patients had block-type splitting fractures (BSF). After a 12-month follow-up period, there were no complications related to the fixation technique and no significant changes in limb alignment. At the final follow-up, the average range of motion (ROM) of the affected knees was 2.3°-125°, and the average HSS score was 94.2. The selected patients who suffered Schatzker type II fractures involving the posterolateral column could be successfully treated via lateral rafting plate fixation with the magic screw technique. For PLCF treatment, magic screw fixation is a valuable technique that may reduce the utilization of posterior approaches and posterior fixations. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Displaced Tibial Shaft Fractures With Intact Fibula in Children: Nonoperative Management Versus Operative Treatment With Elastic Stable Intramedullary Nailing.

    PubMed

    Canavese, Federico; Botnari, Alexei; Andreacchio, Antonio; Marengo, Lorenza; Samba, Antoine; Dimeglio, Alain; Pereira, Bruno; Mansour, Mounira; Rousset, Marie

    2016-01-01

    The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced tibial shaft fractures with intact fibula in children after nonoperative management and operative treatment by elastic stable intramedullary nailing. A study was performed on 80 consecutive children, 56 males, 24 females from 2 Institutions, with displaced and closed tibial shaft fracture with intact fibula. All patients underwent regular clinical and radiographic follow-up visits for at least 2 years after injury. In total, 26 patients (group A-Institution I) were treated surgically by elastic stable intramedullary nailing and 54 patients (18 patients from group B-Institution I and 36 patients from group C-Institution II) were treated nonoperatively with closed reduction and casting. groups A, B, and C did not significantly differ on sex (P=0.37), side (P=0.54), and fracture site (P=0.14).Valgus deformity was significantly controlled in group A patients only (P=0.001); during follow-up in group B patients (P=0.017), and showed no significant change between pretreatment images and last follow-up in group C patients (P=0.71). Procurvatum deformity was significantly controlled in group A patients only (P=0.001); it showed no significant improvement after conservative treatment in group B (P=0.73) and C patients (P=0.8). Recurvatum was significantly improved in group A (P<0.001) and C patients (P<0.001) but remained unchanged in group B patients (P=0.15). Varus deformity improved significantly in all patient groups.Immobilization time was significantly shorter in group A compared with group B and C patients (P<0.001).However, numerical differences, although statistically significant, were not clinically relevant for all variables but immobilization time. This study showed good functional and radiologic outcomes in the pediatric population who had sustained closed, traumatic, displaced fracture of tibial diaphysis without associated fibula fracture

  4. The service impact of failed locking plate fixation of distal tibial fractures: a service and financial evaluation at a major trauma centre.

    PubMed

    Kent, Michael; Mumith, Aadil; McEwan, Jo; Hancock, Nicholas

    2015-12-01

    The surgical treatment of distal tibial fractures is challenging and controversial. Recently, locking plate fixation has become popular, but the outcomes of this treatment are mixed with complication rates as high as 50 % in the published literature. There are no reports specifically relating to the financial and resource costs of failed treatment in the literature. Retrospective service analysis of patients who had undergone locking plate fixation of a distal third tibial fracture between 2008 and 2011 with at least 12 months follow-up. Rates of readmission, reoperation, bony union and infection were ascertained. The financial and resource (hospital stay and number of outpatient appointments) implications of failed treatment were calculated. Forty-two patients were identified. There were 31 type A fractures, one type B fracture and 10 type C fractures. Three injuries were open. Twenty patients were treated with minimally invasive percutaneous osteosynthesis (MIPO). The readmission and reoperation rates were 26 % (n = 11) and 19 % (n = 8), respectively. A total of 89 % of readmissions were due to infection. All patients had received appropriate antibiotic regimens. The average costs of successful and failed treatment were £ 5538 and £ 18,335, respectively. The average time to union was 24.5 weeks. The rate of non-union was 21 % (n = 9). The rate of infection was 28 % (n = 12), with all patients with open fracture incurring an infection. Tourniquet time had no effect on the incidence of complications. Smokers were more likely to incur a complication (p < 0.05), and non-union was lower in the MIPO group (p < 0.05). The length and total cost of inpatient care were significantly lower in the MIPO group (p < 0.05). MIPO patients were five times less likely to incur readmission or reoperation. Failed treatment was three times more expensive and four times longer than successful treatment. The study identified a large burden to the service following failure of locking

  5. Analysis of single-incision versus dual-incision fasciotomy for tibial fractures with acute compartment syndrome.

    PubMed

    Bible, Jesse E; McClure, D Jake; Mir, Hassan R

    2013-11-01

    To analyze the rate of postoperative infection and nonunion after tibial fractures in patients treated for acute compartment syndrome (ACS) using (1) single-incision versus (2) dual-incision fasciotomy technique. Retrospective. Level I trauma center. Review of all adult tibial fractures operatively treated (n = 2756) over a 12-year period identified 175 patients with concurrent ACS requiring fasciotomy. Of 60 patients treated with intramedullary nails, 36 patients had single-incision fasciotomy and 24 had dual-incision fasciotomy. Of 81 patients treated with plate fixation, 59 patients had single-incision fasciotomy and 22 had dual-incision fasciotomy. Tibial fixation with fasciotomy for ACS. Occurrence of postoperative infection and nonunion. Both fasciotomy groups were similar across recorded patient and treatment characteristics. Need for skin graft was similar between fasciotomy groups. For patients treated with intramedullary nail (n = 60), 1 infection (2.8%) occurred in single-incision group versus 2 (8.3%) in dual-incision group (P = 0.558). Seven nonunions (19.4%) occurred in single-incision group versus 3 (12.5%) in dual-incision group (P = 0.726). For plate fixation patients (n = 81), 15 infections (25.4%) occurred with single-incision fasciotomy versus 5 infections (22.7%) with dual-incision fasciotomy (P = 1.000). Seven nonunions (11.9%) occurred with single-incision group versus 4 nonunions (18.2%) with dual-incision group (P = 0.479). This is the first study to compare a single-incision fasciotomy technique to a dual-incision technique in the setting of tibial fractures with ACS, with similar infection and nonunion rates with either technique. The choice of fasciotomy technique can be based on surgeon experience or patient condition as opposed to a suspected elevated infection or nonunion risk with either technique. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  6. Absorbable and non-absorbable suture fixation results in similar outcomes for tibial eminence fractures in children and adolescents.

    PubMed

    Brunner, Stefan; Vavken, Patrick; Kilger, Robert; Vavken, Julia; Rutz, Erich; Brunner, Reinald; Camathias, Carlo

    2016-03-01

    To evaluate efficacy and safety of extraphyseal tibial eminence avulsion fracture repair with absorbable sutures and a distal bone bridge fixation in comparison to previously described technique with non-absorbable sutures and distal screw fixation. In a physeal-sparing technique, tibial eminence fractures (n = 25; McKeever type II/III n = 11/14) were either treated in group A (n = 15, follow-up 28.1 months) using an absorbable suture fixed over a bone bridge or in group B (n = 10, follow-up 47.4 months) with a non-absorbable suture wrapped around an extraarticular tibial screw. IKDC and Lysholm scores were assessed, and the difference between the surgical and contralateral knee in anteroposterior (AP) translation, measured with a Rolimeter. There was no significant difference between group A and group B in IKDC and Lysholm scores with 90.1 points ± 10.2 and 94.1 points ± 8.1, respectively (n.s.). AP translation did not differ between groups (n.s.). Eight of ten screws in group B had to be removed in a second intervention. A total of four arthrofibroses were counted (three in group A). Extraphyseal tibial eminence repair with absorbable sutures and a distal bone bridge fixation results in similar rates of radiographic and clinical healing at 3 months after surgery as non-absorbable sutures tied around a screw, while avoiding the need for hardware removal. The minimal invasive technique to fix an eminence fracture without any permanent sutures or hardware is advantageous for children. To our knowledge, this is the first study that compares non-absorbable with absorbable sutures for a physeal-sparing technique. III.

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

    PubMed

    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

  8. [Utilization of a porous alumina ceramic spacer in tibial valgus open-wedge osteotomy: fifty cases at 16 months mean follow-up].

    PubMed

    Bové, J C

    2002-09-01

    The aim of this work was to study the behavior of an inert porous alumina ceramic spacer used with a plate fixation for open-wedge tibial valgus osteotomy in patients with osteoarthritis of the knee and genu varum. The population included 50 patients who underwent surgery between October 1994 and December 2000. There were 31 women and 19 men, mean age 55 years at surgery (26 right knees and 24 left knees). Patients were reviewed at 3 weeks, 6 weeks, 3 months, 6 months, and one year, then every 2 years. Clinical and radiological data were available for all patients. Mean follow-up was 16 months. Two patients were lost to follow-up at 5 and 6 months. The results of the open-wedge tibial osteotomy were in agreement with the usual outcome reported in the literature concerning pain relief, functional recovery, joint motion, angle correction, and good preservation of the clinical and radiological result. Three fracture lines were observed on the lateral tibial plateau but did not affect final outcome or angle correction. There was however one case with loss of correction due to fracture of the screws. Radiographically, at 6 months, there were 9 thin lucent lines around the spacer (24%) which did not affect final outcome. Bone healing was achieved at 3 months on the average in all cases except 2 (4%) where healing was achieved at 8 and 13 months. The porous alumine spacer is a reliable biocompatible and mechanically stable element helpful for achieving bone healing. Integration into bone tissue was radiographically satisfactory. There were no specific complications related to use of the spacer.

  9. Combined tibial tubercle osteotomy with medial opening wedge high tibial osteotomy minimizes changes in patellar height: a prospective cohort study with historical controls.

    PubMed

    Longino, P David; Birmingham, Trevor B; Schultz, William J; Moyer, Rebecca F; Giffin, J Robert

    2013-12-01

    Medial opening wedge high tibial osteotomy (HTO) for the treatment of varus gonarthrosis can be associated with inadvertent decreases in patellar height. Decreases in patellar height observed after medial opening wedge HTO can be minimized with the addition of a tibial tubercle osteotomy (TTO). Cohort study; Level of evidence, 3. Twenty-nine patients undergoing medial opening wedge HTO with a concurrent TTO were matched with 29 controls who previously underwent medial opening wedge HTO without a TTO. Both groups had substantial varus malalignment (mean mechanical axis angle, -10° ± 3°) requiring large corrections. Measurements of patellar height and posterior tibial slope were calculated from standing lateral radiographs and compared preoperatively and 6 months postoperatively. Patellar height measures included the Blackburne-Peel index, Caton-Deschamps index, Miura-Kawamura index, Insall-Salvati ratio, and modified Insall-Salvati ratio. The changes in the Blackburne-Peel, Caton-Deschamps, and Miura-Kawamura indices were significantly less in the HTO/TTO group versus the HTO group. There were 3 of 29 (10%) new cases that met the radiographic criteria for patella infera in the HTO/TTO group versus 11 of 29 (38%) new cases of patella infera found postoperatively in the HTO group, suggesting an absolute risk reduction of 28% with TTO. The changes in the Blackburne-Peel and Caton-Deschamps indices were correlated to a larger preoperative varus deformity in the coronal plane (r = 0.52 and r = 0.41, respectively). The addition of a TTO when performing a medial opening wedge HTO minimizes the decreases in patellar height associated with the procedure.

  10. Experimental and finite element analysis of tibial stress fractures using a rabbit model

    PubMed Central

    Franklyn, Melanie; Field, Bruce

    2013-01-01

    AIM: To determine if rabbit models can be used to quantify the mechanical behaviour involved in tibial stress fracture (TSF) development. METHODS: Fresh rabbit tibiae were loaded under compression using a specifically-designed test apparatus. Weights were incrementally added up to a load of 30 kg and the mechanical behaviour of the tibia was analysed using tests for buckling, bone strain and hysteresis. Structural mechanics equations were subsequently employed to verify that the results were within the range of values predicted by theory. A finite element (FE) model was developed using cross-sectional computer tomography (CT) images scanned from one of the rabbit bones, and a static load of 6 kg (1.5 times the rabbit's body weight) was applied to represent running. The model was validated using the experimental strain gauge data, then geometric and elemental convergence tests were performed in order to find the minimum number of cross-sectional scans and elements respectively required for convergence. The analysis was then performed using both the model and the experimental results to investigate the mechanical behaviour of the rabbit tibia under compressive load and to examine crack initiation. RESULTS: The experimental tests showed that under a compressive load of up to 12 kg, the rabbit tibia demonstrates linear behaviour with little hysteresis. Up to 30 kg, the bone does not fail by elastic buckling; however, there are low levels of tensile stress which predominately occur at and adjacent to the anterior border of the tibial midshaft: this suggests that fatigue failure occurs in these regions, since bone under cyclic loading initially fails in tension. The FE model predictions were consistent with both mechanics theory and the strain gauge results. The model was highly sensitive to small changes in the position of the applied load due to the high slenderness ratio of the rabbit’s tibia. The modelling technique used in the current study could have applications

  11. Experimental and finite element analysis of tibial stress fractures using a rabbit model.

    PubMed

    Franklyn, Melanie; Field, Bruce

    2013-01-01

    To determine if rabbit models can be used to quantify the mechanical behaviour involved in tibial stress fracture (TSF) development. Fresh rabbit tibiae were loaded under compression using a specifically-designed test apparatus. Weights were incrementally added up to a load of 30 kg and the mechanical behaviour of the tibia was analysed using tests for buckling, bone strain and hysteresis. Structural mechanics equations were subsequently employed to verify that the results were within the range of values predicted by theory. A finite element (FE) model was developed using cross-sectional computer tomography (CT) images scanned from one of the rabbit bones, and a static load of 6 kg (1.5 times the rabbit's body weight) was applied to represent running. The model was validated using the experimental strain gauge data, then geometric and elemental convergence tests were performed in order to find the minimum number of cross-sectional scans and elements respectively required for convergence. The analysis was then performed using both the model and the experimental results to investigate the mechanical behaviour of the rabbit tibia under compressive load and to examine crack initiation. The experimental tests showed that under a compressive load of up to 12 kg, the rabbit tibia demonstrates linear behaviour with little hysteresis. Up to 30 kg, the bone does not fail by elastic buckling; however, there are low levels of tensile stress which predominately occur at and adjacent to the anterior border of the tibial midshaft: this suggests that fatigue failure occurs in these regions, since bone under cyclic loading initially fails in tension. The FE model predictions were consistent with both mechanics theory and the strain gauge results. The model was highly sensitive to small changes in the position of the applied load due to the high slenderness ratio of the rabbit's tibia. The modelling technique used in the current study could have applications in the development of

  12. [Posterior medial approach inverted L-shaped incision combined with reconstruction plate for posterior condylar fracture of tibial plateau].

    PubMed

    Hong, Feng; Wang, Nan; Chen, Guan-Jun

    2016-11-25

    To study the clinical therapeutic effects of posterior medial approach inverted L-shaped incision combined with reconstruction plate fixation in treating posterior tibial plateau condylar fracture. From February 2011 to February 2015, 19 patients that were clearly diagnosed with combined posterior tibial plateau condylar fracture were treated with internal fixation of reconstruction plate through the posterior medial approach L-shaped incision under direct vision, involved 14 males and 5 females with an average age of 45.5 years ranging from 28 to 71 years. The intervals between injury and operation ranged from 6 to 15 days with a mean of 9.2 days. According to Schatzker Classification, there were 6 cases in type II, 2 in type IV, 7 in type V, 4 in type VI In accordance with the three-column theory proposed by Luo Congfeng, 2 cases were medial column combined with posterior column fracture, 6 were lateral column combined with posterior column fracture, and 11 were three-column fracture. The major clinical symptoms before treatment were swelling and deformity of the knee, as well as limitation of motion. X-ray and CT examination were completed. The American Hospital for Special Surgery score(HSS) was used to evaluate clinical effect. One case developed skin infection in the posteromedial incision postoperatively, but other complications, such as neurovascular injury, deep venous thrombosis of lower limb, cracking and failure of internal fixation, and fracture re-displacement were not seen. The patients were followed up for an average of 12.5 months (10 to 24 months). The fracture healing time ranged from 5 to 11 months with a mean of 8.2 months. According to HSS, the total score was 82.1±7.3, 9 patients got an excellent result, 7 good, 2 poor and 1 bad. Regular postoperative re-check X-ray indicated that all fracture showed stage I healing. The difference was not significant on varus angle, post-dip angle and femorotibial angle between 3 days and 1 year after

  13. Personalized implant for high tibial opening wedge: combination of solid freeform fabrication with combustion synthesis process.

    PubMed

    Zhim, Fouad; Ayers, Reed A; Moore, John J; Moufarrège, Richard; Yahia, L'Hocine

    2012-09-01

    In this work a new generation of bioceramic personalized implants were developed. This technique combines the processes of solid freeform fabrication (SFF) and combustion synthesis (CS) to create personalized bioceramic implants with tricalcium phosphate (TCP) and hydroxyapatite (HA). These porous bioceramics will be used to fill the tibial bone gap created by the opening wedge high tibial osteotomy (OWHTO). A freeform fabrication with three-dimensional printing (3DP) technique was used to fabricate a metallic mold with the same shape required to fill the gap in the opening wedge osteotomy. The mold was subsequently used in a CS process to fabricate the personalized ceramic implants with TCP and HA compositions. The mold geometry was designed on commercial 3D CAD software. The final personalized bioceramic implant was produced using a CS process. This technique was chosen because it exploits the exothermic reaction between P₂O₅ and CaO. Also, chemical composition and distribution of pores in the implant could be controlled. To determine the chemical composition, the microstructure, and the mechanical properties of the implant, cylindrical shapes were also fabricated using different fabrication parameters. Chemical composition was performed by X-ray diffraction. Pore size and pore interconnectivity was measured and analyzed using an electronic microscope system. Mechanical properties were determined by a mechanical testing system. The porous TCP and HA obtained have an open porous structure with an average 400 µm channel size. The mechanical behavior shows great stiffness and higher load to failure for both ceramics. Finally, this personalized ceramic implant facilitated the regeneration of new bone in the gap created by OWHTO and provides additional strength to allow accelerated rehabilitation.

  14. [High, open wedge tibial osteotomy: finite element analysis of five internal fixation modalities].

    PubMed

    Stepanović, Zeljko; Zivković, Miroslav; Vulović, Snezana; Aćimović, Ljubisa; Ristić, Branko; Matić, Aleksandar; Grujović, Zoran

    2011-10-01

    Medial open wedge tibial osteotomy is one of the most widely accepted method of treatment for varus knee deformity in younger patient population. Its success depends on the quality of fixation and preservation of the outer cortex of the tibia. The aim of the study was to evaluate stress distribution in five numerically designed plate configurations which can be used in open wedge tibial osteotomy. The paper describes the 3D numerical model of the tibia with 10 degrees varus deformity correction obtained by an optical scanner ATOS. The simulation anticipated axial compressive loads of 700 N, 1 400 N and 2 100 N. We used a modification of the standard T-plate in all of the five tested models. Modalities were tested with and without a metal block, and with and without a stable angle fixation plates and screws. Software PAK was used in the analysis of stress distribution. With exception for the standard T-plate configuration without the supporting block, the loads up to 1400 N did not result in critical stresses on the outer cortex of the tibia in the remaining four models. There is an objective risk of possible failure of the outer cortex and loss of correction at a load of 2100 N in all configurations. The plate model with the angle stable fixation and the supporting metal block showed the most optimal distribution of stresses on the plate-bone composite compared to other models. The standard T-plate configuration without supporting metal block is not sufficient to stabilize the open wedge osteotomy of the tibia. Numerical models of the angle stable T-plate and the supporting metal block achieved a favorable distribution of stresses on the bone and implant which require further biomechanical testing.

  15. Simultaneous posterior dislocation of primary total knee arthroplasty with ipsilateral tibial shaft fracture: A case report and review of literature.

    PubMed

    Öztürk, Alpaslan; Akalin, Yavuz; Çevik, Nazan; Akça, Mustafa Çınar

    2016-01-01

    Dislocation following total knee arthroplasty (TKA) is a rare but serious complication. Here, a 74-year-old woman with posterior dislocation of her right cruciate-retaining TKA and ipsilateral tibia diaphysis fracture was presented. She only slipped down on the ground with a quick twist of her right leg. She underwent revision semiconstrained TKA and osteosynthesis of tibial fracture with plate and screw. Her partially avulsed patellar tendon was repaired as well. She was ambulatory with a cane and satisfied with revision operation at last control. Extensor mechanism and functional posterior cruciate ligament is especially important in patients receiving cruciate-retaining TKA. As far as we know, simultaneous dislocation of TKA with fracture of tibia diaphysis has never been reported before.

  16. Effectiveness of Serial Measurement of Differential Pressure in Closed Tibial Diaphyseal Fractures in Diagnosing Acute Compartment Syndrome using Whiteside's Technique.

    PubMed

    Ramprasath, D R; Thirunarayanan, V; David, J; Anbazhagan, S

    2016-03-01

    Acute Compartment Syndrome is a limb-threatening emergency and it occurs most commonly after fractures. The aim of our study is to find out the effectiveness of serial measurement of differential pressure in closed tibial diaphyseal fractures, in diagnosing acute compartment syndrome, using Whiteside's technique. A total of 52 cases in the age group of 15 to 55 years admitted with closed fractures were studied for serial compartment pressure as well as serial differential pressure. Eight patients had persistent compartment pressure > 40mmHg, out of which only two patients had persistent differential pressure < 30mmHg and these two patients underwent fasciotomy. Thus, by measuring the compartment pressure serially and calculating differential pressure serially, acute compartment syndrome can be diagnosed or ruled out with higher precision, so that unnecessary fasciotomies can be avoided.

  17. Arthroscopic Fixation of Tibial Eminence Fractures: A Clinical Comparative Study of Nonabsorbable Sutures Versus Absorbable Suture Anchors.

    PubMed

    Liao, Weixiong; Li, Zhongli; Zhang, Hao; Li, Ji; Wang, Ketao; Yang, Yimeng

    2016-08-01

    To compare clinical outcomes of arthroscopic therapy for tibial eminence fracture with nonabsorbable suture and absorbable suture anchor. Between February 2010 and September 2012, a total of 60 tibial eminence fracture patients were treated with nonabsorbable suture fixation or absorbable suture anchor fixation under arthroscopy. Patients with tibial plateau fractures and other significant injuries, including osteochondral lesions, meniscal tear, and anterior cruciate ligament (ACL) or mutiligament injuries, were excluded from the study. Radiographs, anterior drawer test (ADT), Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) 2000 subjective score were employed to evaluate clinical outcomes in follow-up. A total of 41 patients were analyzed. Among these patients, 22 were treated with nonabsorbable suture fixation and 19 with absorbable suture anchor fixation. According to the modified Meyers-McKeever classification, 15 cases were categorized as type II, 21 as type III, and 5 as type IV fractures. The mean time from injury to surgery was 7.1 days (range, 3 to 12 days). All patients were followed up for a median period of 33.7 months (range, 24 to 45 months). Radiographic evaluation showed optimal reduction immediately after operation and bone union within 3 months in all patients. At the final follow-up, there was no limitation of knee motion range in any patient. Grade II laxity was found in 2 cases from suture group and 1 from suture anchor group, showing no significant difference based on ADT (χ(2) = 0.538, P = .764) and Lachman test (χ(2) = 0.550, P = .760). Lysholm and IKDC 2000 subjective scores were significantly improved (P < .001). However, there were no significant differences in the improvement of Lysholm (t = 0.522, P = .604) and IKDC 2000 subjective scores (t = 0.644, P = .523) between the 2 groups. Nonabsorbable suture fixation and absorbable suture anchor fixation are equivalent techniques in terms of the

  18. Clinical and radiological outcomes of arthroscopically assisted cannulated screw fixation for tibial eminence fracture in children and adolescents.

    PubMed

    Shin, Chang Ho; Lee, Doo Jae; Choi, In Ho; Cho, Tae-Joon; Yoo, Won Joon

    2018-02-06

    The purpose of this study was to determine the efficacy and complications of arthroscopically assisted reduction and fixation with cannulated screws for tibial eminence fracture in skeletally immature patients. This was a retrospective case series study. Forty-eight patients who were skeletally immature at the time of tibial eminence fracture were treated in a tertiary children's hospital between May 2004 and August 2015. Twenty-one patients were excluded due to non-operative treatment (n = 10), other surgical treatments (n = 9), multiple fracture (n = 1), and follow-up < 1 year (n = 1). Twenty-seven knees of 27 patients were analyzed. Avulsed fragment was reduced arthroscopically. One to three cannulated screws (4.0 mm or 5.0 mm in diameter) were used for fixation. Passive knee motion was started in 3-4 weeks. Clinical outcomes were evaluated by Lysholm score, instability of the knee, and complications. Radiological outcomes including nonunion and malunion of the avulsed fragment and physeal growth disturbance were evaluated. Mean age at the time of surgery was 10.1 years (range, 6.2 to 13.8 years). Patients were followed up for a mean of 3.9 years (range, 1.0 to 7.6 years). Fracture types included type III (n = 13), type II (n = 12), and type IV (n = 2) according to Zaricznyj modification of Meyers and McKeever classification. Meniscus was entrapped in five patients. Six patients showed concomitant meniscal tear. Mean Lysholm score at the latest follow-up was 95 (range, 78 to 100). Joint instability was not observed in any patient except one (instability of 5-10 mm). All patients showed full range of knee motion except one (10 degrees of flexion contracture). Screw head impingement against intercondylar notch of the femur was observed in two patients during screw removal procedure. Five knees showed prominent tibial eminence without symptoms. The injured lower limb was longer than the contralateral normal side by a mean of 6

  19. Fracture opening/propagation behavior and their significance on pressure-time records during hydraulic fracturing

    SciTech Connect

    Takashi Kojima; Yasuhiko Nakagawa; Koji Matsuki; Toshiyuki Hashida

    1992-01-01

    Hydraulic fracturing with constant fluid injection rate was numerically modeled for a pair of rectangular longitudinal fractures intersecting a wellbore in an impermeable rock mass, and numerical calculations have been performed to investigate the relations among the form of pressure-time curves, fracture opening/propagation behavior and permeability of the mechanically closed fractures. The results have shown that both permeability of the fractures and fluid injection rate significantly influence the form of the pressure-time relations on the early stage of fracture opening. Furthermore it has been shown that wellbore pressure during fracture propagation is affected by the pre-existing fracture length.

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

    PubMed

    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 (P<0.05). The delayed union rate in 6 months was 4.3% in experimental group but 10.9% in control group(P<0.05). The nonunion rate in 12 months was 6.5% in experimental group but 19.6% in control group(P<0.05). In 3, 6, 12 months postoperatively, VAS score and Lane-Sandhu score in experimental group had more significantly difference than them in control group. RSSS can intermittently provide dynamic mechanical load and stimulate callus formation, promote lower tibial bone union, reduce bone delayed union or nonunion rate. It is an adjuvant therapy for promoting bone union after lower tibial bone fracture.

  1. Improving clinical examination in acute tibial fractures by enhancing visual cues: the case for always 'cutting back' a tibial back-slab and marking the dorsalis pedis pulse.

    PubMed

    Thomas, Alasdair; Kimber, Cheryl; Bramwell, Donald; Jaarsma, Ruurd

    2016-08-01

    Look, feel, move is a simple and widely taught sequence to be followed when undertaking a clinical examination in orthopaedics (Maher et al., 1994; McRae, 1999; Solomon et al., 2010). The splinting of an acute tibial fracture with a posterior back-slab is also common practice; with the most commonly taught design involving covering the dorsum of the foot with bandaging (Charnley, 1950; Maher et al., 1994; McRae, 1989). We investigated the effect of the visual cues provided by exposing the dorsum of the foot and marking the dorsalis pedis pulse. We used a clinical simulation in which we compared the quality of the recorded clinical examination undertaken by 30 nurses. The nurses were randomly assigned to assess a patient with either a traditional back-slab or one in which the dorsal bandaging had been cut back and the dorsalis pedis pulse marked. We found that the quality of the recorded clinical examination was significantly better in the cut-back group. Previous studies have shown that the cut-back would not alter the effectiveness of the back-slab as a splint (Zagorski et al., 1993). We conclude that all tibial back-slabs should have the bandaging on the dorsum of the foot cut back and the location of the dorsalis pedis pulse marked. This simple adaptation will improve the subsequent clinical examinations undertaken and recorded without reducing the back-slab's effectiveness as a splint. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Editorial: Spatial arrangement of faults and opening-mode fractures

    NASA Astrophysics Data System (ADS)

    Laubach, Stephen E.; Lamarche, Juliette; Gauthier, Bertand D. M.; Dunne, William M.

    2018-03-01

    This issue of the Journal of Structural Geology titled Spatial arrangement of faults and opening-mode fractures explores a fundamental characteristic of fault and fracture arrays. The pattern of fault and opening-mode fracture positions in space defines structural heterogeneity and anisotropy in a rock volume, governs how faults and fractures affect fluid flow, and impacts our understanding of the initiation, propagation and interactions during the formation of fracture patterns. This special issue highlights recent progress with respect to characterizing and understanding the spatial arrangements of fault and fracture patterns, providing examples over a wide range of scales and structural settings.

  3. Ipsilateral fracture dislocations of the hip and knee joints with contralateral open fracture of the leg: a rare case and its management principles.

    PubMed

    Sen, Ramesh-Kumar; Tripathy, Sujit-Kumar; Krishnan, Vibhu; Goyal, Tarun; Jagadeesh, Vanyambadi

    2011-06-01

    This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracture-dislocations of the left hip (Pipkin's type IV) and knee (Moore II) joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin's fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabilized with lateral buttress plate and a transarticular spanning fixator. The open fracture on the other leg was debrided and fixed with an external fixator. There was no instability in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appropriate intervention can provide good functional outcome to the patient in this situation.

  4. Clinical Efficacy of an Arthroscopic Surgery in Open Wedge High Tibial Osteotomy.

    PubMed

    Kim, Chang-Wan; Lee, Chang-Rack; Seo, Seung-Suk; Gwak, Heui-Chul; Kim, Jung-Han; Jeong, Jun-Woo

    2017-05-01

    Few studies have identified the effects of arthroscopic surgery on the clinical outcomes when open wedge high tibial osteotomy (OWHTO) and arthroscopic surgery were performed together. The purpose of this study was to evaluate the clinical efficacy of arthroscopic surgery in patients who had varus osteoarthritic knee and were treated with OWHTO combined with arthroscopic surgery. Among the 98 knees (88 patients) who underwent OWHTO between January 2008 and March 2013, 79 knees (71 patients) with more than 2 years of follow-up were reviewed retrospectively. The patients were divided into two groups: Group 1 (24 knees) underwent only OWHTO and Group 2 (55 knees) underwent OWHTO combined with arthroscopic surgery. For clinical evaluation, the range of motion (ROM), pain visual analog scale, Knee Society knee score, Knee Society function score, and complication were used. For radiologic evaluation, Kellgren-Lawrence grade, mechanical femorotibial angle, and posterior tibial slope were used. The average follow-up period was 29.1 months. Group 2 showed a significant increase in the ROM at the last follow-up (133.2  ± 6.0 degrees) compared with the preoperative time point (128.3 ± 7.7 degrees) (p < 0.001). In the comparison of radiologic parameters between Groups 1 and 2, there was no significant difference. In the minimum 24-month follow-up, when OWHTO combined with arthroscopic surgery was performed, arthroscopic surgery helped increase the ROM of patients with mechanical symptoms. However, the amount of the ROM increase of 4.9 degrees was of unknown clinical significance. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor.

    PubMed

    Hapa, Onur; Barber, F Alan; Süner, Ganim; Özden, Raif; Davul, Serkan; Bozdağ, Ergun; Sünbüloğlu, Emin

    2012-05-01

    To biomechanically compare anterior cruciate ligament (ACL) tibial bony avulsion fixation by suture anchors, EndoButtons (Smith & Nephew, Andover, MA), and high-strength sutures subjected to cyclic loading. Type III tibial eminence fractures were created in 49 ovine knees, and 7 different types of repairs were performed. Each repair group contained 7 specimens. The repair groups were as follows: No. 2 FiberWire (Arthrex, Naples, FL); No. 2 UltraBraid (Smith & Nephew); No. 2 MaxBraid (Arthrotek, Warsaw, IN); No. 2 Hi-Fi (ConMed Linvatec, Largo, FL); No. 2 OrthoCord (DePuy Mitek, Raynham, MA); Ti-Screw suture anchor (Arthrotek); and titanium EndoButton. These constructs were cyclically loaded (500 cycles, 0 to 100 N, 1 Hz) in the direction of the native ACL and loaded to failure (100 mm/min). Endpoints included ultimate failure load (in Newtons); pullout stiffness (in Newtons per millimeter); cyclic displacement (in millimeters) after 100 cycles, between 100 and 500 cycles, and after 500 cycles; and mode of failure. Bone density testing was performed in all knees. Bone density was not different among the groups. The EndoButton group had a higher ultimate failure load than the FiberWire, UltraBraid, Hi-Fi, and suture anchor groups (P < .05). The MaxBraid and OrthoCord groups had higher failure loads than the suture anchor group (P < .05). The MaxBraid group also had a higher failure load than the Hi-Fi group (P < .05). Stiffness was not statistically different for the various tested constructs. After 100 cycles, the EndoButton group had less displacement than the FiberWire, UltraBraid, MaxBraid, and Hi-Fi groups (P < .05). The suture anchor group had less displacement than the Hi-Fi and FiberWire groups (P < .05). The displacements of the different tested constructs between 100 and 500 cycles and total displacements after 500 cycles were not statistically different. The predominant failure mode was suture rupture. Under cyclic loading conditions in an ovine model

  6. [Current problems in the treatment of open fractures].

    PubMed

    Weller, S

    1975-01-01

    The paper evidently does not discuss several important problems of the management of open fractures, but it is confined to the exposition of some fundamental rules of their traitment. Nowadays, the treatment of open fractures is to be decided individually for all cases. A great number of patients with open fracture owe their recovery to the proper first aid care at scence of accident. This is also in respect of the further treatment in the hospital of great importance. Exagerated activity is usually superfluous in the treatment of open fractures. Less and more proper management is often more useful for the injured patient.

  7. The stability of three commercially available implants used in medial opening wedge high tibial osteotomy.

    PubMed

    Dorsey, William O P; Miller, Bruce S; Tadje, Jared P; Bryant, Cari R

    2006-04-01

    This biomechanical study tested three commercially available fixation devices for medial opening wedge high tibial osteotomy (HTO). A medial opening wedge HTO model was created on replicate tibias. Fixation was achieved with one of three fixation devices: VS Osteotomy plate (EBI, Parsippany, NJ), Arthrex Osteotomy plate (Arthrex, Naples, Fla), and OsteoTrac plate (DJ Orthopedics Inc, Vista, Calif). For each fixation system, seven specimens were cyclically loaded in compression and torsion under physiologic loads on a servohydraulic machine. Mean axial stiffness was 2425 N/mm, 2358 N/mm and 2258 N/mm, respectively, for the EBI, Arthrex, and Alaron surgical plates. Mean torsional stiffness was 4.5 Nm/degree, 4.1 Nm/degree and 4.0 Nm/degree, respectively, for the EBI, Arthrex, and DJ Orthopedics surgical plates. Though the differences are not statistically significant between the three fixation devices (P=.74 for mean axial stiffness and P=.10 for mean torsional stiffness), there is insufficient statistical power to rule out a true difference. Using this replicate tibia model, all three fixation devices tested appear to successfully stabilize the osteotomy site with regards to physiologic axial and torsional loads.

  8. The effect of wedge and tibial slope angles on knee contact pressure and kinematics following medial opening-wedge high tibial osteotomy.

    PubMed

    Black, Marianne S; d'Entremont, Agnes G; McCormack, Robert G; Hansen, Gregory; Carr, Derek; Wilson, David R

    2018-01-01

    High tibial osteotomy is a surgical procedure to treat medial compartment osteoarthritis in varus knees. The reported success rates of the procedure are inconsistent, which may be due to sagittal plane alignment of the osteotomy. The objective of this study was to determine the effect of changing tibial slope, for a range of tibial wedge angles in high tibial osteotomy, on knee joint contact pressure location and kinematics during continuous loaded flexion/extension. Seven cadaveric knee specimens were cycled through flexion and extension in an Oxford knee-loading rig. The osteotomy on each specimen was adjusted to seven clinically relevant wedge and slope combinations. We used pressure sensors to determine the position of the centre of pressure in each compartment of the tibial plateau and infrared motion capture markers to determine tibiofemoral and patellofemoral kinematics. In early knee flexion, a 5° increase in tibial slope shifted the centre of pressure in the medial compartment anteriorly by 4.5mm (P≤0.001), (from the neutral slope/wedge position). Increasing the tibial slope also resulted in the tibia translating anteriorly (P≤0.001). Changes to the tibial slope during high tibial osteotomy for all tested wedge angles shifted the centre of pressure in both the medial and lateral compartments substantially and altered knee kinematics. Tibial slope should be controlled during high tibial osteotomy to prevent unwanted changes in tibial plateau contact loads. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Open Periprosthetic Patellar Fracture after Total Knee Replacement

    PubMed Central

    Masmoudi, Karim; Grissa, Yamen; Benzarti, Sofien; Cheikhrouhou, Hassen; Mensi, Zied

    2016-01-01

    Introduction: Periprosthetic patellar fracture after total knee arthroplasty (TKA) is a rare complication. Their management can be very challenging with unpredictable results. Literature analysis showed few articles about this complication, but no publication has described the management of open patella fracture around total knee arthroplasty. Case Presentation: We report a unique case of an open patellar fracture above a total knee arthroplasty, sustained by a 56-year-old female patient. Conclusion: Despite the poor outcome of operative management in patellar periprosthetic fracture, this approach should be considered for acute and post traumatic fractures in young patients with a good remaining bone stock. PMID:27703946

  10. [EFFECTIVENESS OF ARTHROSCOPIC ULTRA-Braid SUTURE PLANE FIXATION FOR ANTERIOR CRUCIATE LIGAMENT TIBIAL EMINENCE AVULSION FRACTURES].

    PubMed

    Wang, Jing; Weng, Xiaojun; Li, Jing; Chen, Xintong

    2015-11-01

    To investigate the surgical technique and effectiveness of arthroscopic ULTRA-Braid suture plane fixation for anterior cruciate ligament (ACL) tibial eminence avulsion fractures. Between June 2012 and October 2014, 16 cases of ACL tibial eminence avulsion fracture were treated with ULTRA-Braid suture plane fixation under arthroscopy. There werg 10 males and 6 females, aged from 17 to 38 years (mean, 25.8 years). The left knee was involved in 5 cases and the right knee in 11 cases. The causes were traffic accident injury in 9 cases, falling from height injury in 4 cases, and sports injury in 3 cases. The average interval from injury to operation was 7 days (range, 5-10 days) except 1 patient who received operation at 6 weeks after injury. The knee joint swelling was obvious; the result of Lachman test was positive; and the knee joint Lysholm score was 45.38 ± 9.87. According to classification standard introduced by Meyers-McKeever-Zaricnyj, 7 cases were rated as type II, 8 cases as type III, and 1 case as type IV, excluding ligament and meniscus injury. All the incisions healed by first intention. The patients received follow-up of 6-18 months (mean, 10 months). The postoperative X-ray and CT showed anatomic reduction (12 cases) or near anatomic reduction (4 cases); all fractures healed at 6 months after operation. The result of Lachman test was negative in the other 15 patients except 1 patient (II degree). One patient had slight knee pain at 6 months postoperatively, and pain symptom disappeared after 1 year; the other cases resumed daily activities. Lysholm score at last follow-up was 98.13 ± 2.34, showing significant difference when compared with preoperative score (t = -20.801, P = 0.000). Arthroscopic ULTRA-Braid suture plane fixation for ACL tibial eminence avulsion fractures is an effective procedure with the advantages of minimal trauma, reliable fixation, satisfactory functional recovery, and simultaneously avoiding the second surgery.

  11. Treatment of Patellar Lower Pole Fracture with Modified Titanium Cable Tension Band Plus Patellar Tibial Tunnel Steel "8" Reduction Band.

    PubMed

    Li, Jiaming; Wang, Decheng; He, Zhiliang; Shi, Hao

    2018-01-08

    To determine the efficacy of modified titanium tension band plus patellar tendon tunnel steel 8 "reduction band" versus titanium cable tension band fixation for the treatment of patellar lower pole fracture. 58 patients with lower patella fracture were enrolled in this study, including 30 patients treated with modified titanium cable tension band plus patellar tibial tunnel wire "8" tension band internal fixation (modified group), and 28 patients with titanium cable tension band fixation. All patients were followed up for 9∼15 months with an average of 11.6 months. Knee flexion was significantly improved in the modified group than in the titanium cable tension band group (111.33 ± 13 degrees versus 98.21 ± 21.70 degrees, P = 0.004). The fracture healing time showed no significant difference. At the end of the follow-up, the improvement excellent rate was 93.33% in the modified group, and 82.14% in the titanium cable tension band group. Titanium cable tension band internal fixation loosening was found in 2 cases, including 1 case of treatment by two surgeries without loose internal fixation. The modified titanium cable tension band with "8" tension band fixation showed better efficacy for lower patella fractures than titanium cable tension band fixation.

  12. Opening the medial tibiofemoral compartment by pie-crusting the superficial medial collateral ligament at its tibial insertion: a cadaver study.

    PubMed

    Roussignol, X; Gauthe, R; Rahali, S; Mandereau, C; Courage, O; Duparc, F

    2015-09-01

    Arthroscopic treatment of tears in the middle and posterior parts of the medial meniscus can be difficult when the medial tibiofemoral compartment is tight. Passage of the instruments may damage the cartilage. The primary objective of this cadaver study was to perform an arthroscopic evaluation of medial tibiofemoral compartment opening after pie-crusting release (PCR) of the superficial medial collateral ligament (sMCL) at its distal insertion on the tibia. The secondary objective was to describe the anatomic relationships at the site of PCR (saphenous nerve, medial saphenous vein). We studied 10 cadaver knees with no history of invasive procedures. The femur was held in a vise with the knee flexed at 45°, and the medial aspect of the knee was dissected. PCR of the sMCL was performed under arthroscopic vision, in the anteroposterior direction, at the distal tibial insertion of the sMCL, along the lower edge of the tibial insertion of the semi-tendinosus tendon. Continuous 300-N valgus stress was applied to the ankle. Opening of the medial tibiofemoral compartment was measured arthroscopically using graduated palpation hooks after sequential PCR of the sMCL. The compartment opened by 1mm after release of the anterior third, 2.3mm after release of the anterior two-thirds, and 3.9mm after subtotal release. A femoral fracture occurred in 1 case, after completion of all measurements. Both the saphenous nerve and the medial saphenous vein were located at a distance from the PCR site in all 10 knees. PCR of the sMCL is chiefly described as a ligament-balancing method during total knee arthroplasty. This procedure is usually performed at the joint line, where it opens the compartment by 4-6mm at the most, with some degree of unpredictability. PCR of the sMCL at its distal tibial insertion provides gradual opening of the compartment, to a maximum value similar to that obtained with PCR at the joint space. The lower edge of the semi-tendinosus tendon is a valuable landmark

  13. Spatial arrangement of faults and opening-mode fractures

    NASA Astrophysics Data System (ADS)

    Laubach, S. E.; Lamarche, J.; Gauthier, B. D. M.; Dunne, W. M.; Sanderson, David J.

    2018-03-01

    Spatial arrangement is a fundamental characteristic of fracture arrays. The pattern of fault and opening-mode fracture positions in space defines structural heterogeneity and anisotropy in a rock volume, governs how faults and fractures affect fluid flow, and impacts our understanding of the initiation, propagation and interactions during the formation of fracture patterns. This special issue highlights recent progress with respect to characterizing and understanding the spatial arrangements of fault and fracture patterns, providing examples over a wide range of scales and structural settings. Five papers describe new methods and improvements of existing techniques to quantify spatial arrangement. One study unravels the time evolution of opening-mode fracture spatial arrangement, which are data needed to compare natural patterns with progressive fracture growth in kinematic and mechanical models. Three papers investigate the role of evolving diagenesis in localizing fractures by mechanical stratigraphy and nine discuss opening-mode fracture spatial arrangement. Two papers show the relevance of complex cluster patterns to unconventional reservoirs through examples of fractures in tight gas sandstone horizontal wells, and a study of fracture arrangement in shale. Four papers demonstrate the roles of folds in fracture localization and the development spatial patterns. One paper models along-fault friction and fluid pressure and their effects on fault-related fracture arrangement. Contributions address deformation band patterns in carbonate rocks and fault size and arrangement above a detachment fault. Three papers describe fault and fracture arrangements in basement terrains, and three document fracture patterns in shale. This collection of papers points toward improvement in field methods, continuing improvements in computer-based data analysis and creation of synthetic fracture patterns, and opportunities for further understanding fault and fracture attributes in

  14. Open-Wedge High Tibial Osteotomy: RCT 2 Years RSA Follow-Up.

    PubMed

    Lind-Hansen, Thomas Bruno; Lind, Martin Carøe; Nielsen, Poul Torben; Laursen, Mogens Berg

    2016-11-01

    We investigated the influence of three different bone grafting materials on stability and clinical outcome of the healing open-wedge high tibial osteotomy (OW-HTO) with immediate partial weight bearing. A total of 45 (3 × 15) patients were randomized to injectable calcium phosphate cement (Calcibon; Biomet-Merck Biomaterials GmbH, Darmstadt, Germany), local bone autograft, or iliac crest autograft. Stability of the bony healing was evaluated with radiostereometric analysis (RSA) up to 24 months postoperatively. Clinical outcome was evaluated with the knee injury and osteoarthritis outcome score (KOOS). RSA revealed translations and rotations close to zero regardless of bone grafting material, with no statistically significant differences between the groups. Clinically, the Calcibon group had lower quality of life KOOS subscore at 2 years follow-up. We conclude that with a stable implant and 6 weeks of partial weight bearing, local autografting is sufficient to achieve solid bone consolidation following OW-HTO. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  15. Biomechanical effects of plate area and locking screw on medial open tibial osteotomy.

    PubMed

    Luo, Chu-An; Lin, Shang-Chih; Hwa, Su-Yang; Chen, Chun-Ming; Tseng, Ching-Shiow

    2015-01-01

    Medial open high tibial osteotomy (HTO) has been used to treat osteoarthritis of the medial compartment of the knee. However, weaker plate strength, unstable plate/screw junction and improper surgery technique are highly related to the HTO outcomes. Two π-shape plates were designed and eight variations (two supporting area × four locking stiffness) were compared by finite-element method. The computed tomography-based tibia was reconstructed and both wedge micromotion and implant stresses were chosen as the comparison indices. The construct was subjected to surgical and physiological loads. The medial-posterior region is the most loaded region and the load through the posterior leg is about four times that through the anterior leg. This indicates that the two-leg design can form a force-couple mechanism to effectively reduce the implant stresses. The use of locking screws significantly decrease the screw and hole stresses. However, the extending plate reduces the stresses of screws and holes above the wedge but makes the distal screws and holes much stressed. Wedge micromotion is affected by extending plate rather than locking screw. Three factors contribute to effective stabilisation of unstable HTO wedge: (1) intimate tibia-plate contact at medial-posterior regions, (2) sufficient rigidity at plate-screw junctions and (3) effective moment-balancing design at distal tibia-plate interfaces.

  16. Combined approaches for fixation of Schatzker type II tibial plateau fractures involving the posterolateral column: a prospective observational cohort study.

    PubMed

    Sun, Hui; Zhai, Qi-Lin; Xu, Ya-Feng; Wang, Yu-Kai; Luo, Cong-Feng; Zhang, Chang-Qing

    2015-02-01

    This study aimed to investigate the surgical techniques and the clinical efficacy of combined approaches for the treatment of Schatzker type II tibial plateau fractures involving the posterolateral column [lateral and posterolateral columns (LPCs) fractures] in a prospective cohort. From January 2007 through December 2010, a total of 65 patients with LPCs underwent dual-plate fixation via a combined anterior and posterior approach. The anterior and posterior approaches were the conventional anterolateral approach and a posteromedial inverted L-shaped approach, respectively, with the patients in a floating position. Ultimately, 41 patients were followed up for a mean period of 52.5 months. All fractures healed. The mean time to radiographic bony union was 15.2 weeks and the mean time to full weight-bearing was 18.7 weeks. No parameter associated with knee alignment changed significantly between immediately postoperation and 2 years postoperation. No collapse of the reduced articular surface was detected. Two years postoperation, the mean Hospital for Special Surgery score was 92.3; the mean Short Form-36 score was 90.1, and the mean range of knee motion was 1.7°-123.6° (extension-flexion). Two patients suffered dehiscence of the anterolateral incision and another suffered partial necrosis at the margin of the posteromedial incision postoperatively. All healed in response conservative treatment. Another two patients experienced numbness in the posteromedial inferior region of the calf. No implant loosening, breakage, fixation failure, or other complication was observed during follow-up. LPCs are not uncommon. Careful preoperative analysis of computed tomography images and impeccable preparation are necessary to avoid neglecting a posterolateral column fracture. It is inappropriate to generalize one scenario for all Schatzker type II fractures: a single approach cannot address all subtypes of these fractures. Dual-plate fixation via a combined approach is an

  17. High incidence of screw penetration in the proximal and distal tibiofibular joints after intramedullary nailing of tibial fractures-A prospective cohort and mapping study.

    PubMed

    Cain, Megan E; Doornberg, Job N; Duit, Robin; Clarnette, Jock; Jaarsma, Ruurd; Jadav, Bhavin

    2018-03-01

    Intramedullary-nails (IMN) are the treatment of choice for most tibial shaft fractures due to their minimally-invasive nature and non-demanding surgical technique. However, a potential iatrogenic pitfall is intra-articular interlocking screw positioning within the proximal (PTFJ) and distal (DTFJ) tibiofibular joints that may go unrecognized. To evaluate the incidence of intra-articular screw penetration of the PTFJ and DTFJs after interlocking of IMN for tibial fractures. Reamed IMN using modern techniques, including proximal interlocking via standard aiming jig and distal interlocking either freehand or using SureShot ® . Prospective series of 165 consecutive patients with a tibial shaft fracture managed with an IMN. Diagnosis and incidence of penetration of the PTFJ and DTFJ was assessed on protocolled low-dose postoperative CT-scans (standardized clinical practice for assessing rotational alignment). The degree of penetration of the TFJ's was graded as: Grade 1-slight breach of the tibial cortex; Grade 2-clear penetration of the tibial cortex with intra-articular screw tip; and Grade 3-penetration of both tibial- and fibular cortices with screw tip in fibula. Of the 165 tibial shaft fractures, using the AO/OTA classification, 69% were simple, 16% wedge and 15% complex fractures. Following IMN 42% of patients had intra-articular screw penetration of their PTFJ whilst 39% had penetration of their DTFJ. 66% of patients had penetration of either one- or both of their TFJs. The grading of PTFJ violation was distributed as follows: Grade 1 in 24 patients; Grade 2 in 26 patients and Grade 3 in 19 patients. DTFJ violation was graded as: Grade 1 in 21 patients; 40 patients had Grade 2 violation; and four patients had a Grade 3 penetration. This diagnostic imaging study reports a high rate of intra-articular screw penetration of the PTFJ and DTFJ after interlocking of IMN for tibia shaft fractures. A prospective cohort study is underway to evaluate its clinical

  18. Mechanical strength assessment of a drilled hole in the contralateral cortex at the end of the open wedge for high tibial osteotomy.

    PubMed

    Diffo Kaze, Arnaud; Maas, Stefan; Hoffmann, Alexander; Pape, Dietrich

    2017-12-01

    This study aimed to investigate, by means of finite element analysis, the effect of a drill hole at the end of a horizontal osteotomy to reduce the risk of lateral cortex fracture while performing an opening wedge high tibial osteotomy (OWHTO). The question was whether drilling a hole relieves stress and increases the maximum correction angle without fracture of the lateral cortex depending on the ductility of the cortical bone. Two different types of osteotomy cuts were considered; one with a drill hole (diameter 5 mm) and the other without the hole. The drill holes were located about 20 mm distally to the tibial plateau and 6 mm medially to the lateral cortex, such that the minimal thickness of the contralateral cortical bone was 5 mm. Based on finite element calculations, two approaches were used to compare the two types of osteotomy cuts considered: (1) Assessing the static strength using local stresses following the idea of the FKM-guideline, subsequently referred to as the "FKM approach" and (2) limiting the total strain during the opening of the osteotomy wedge, subsequently referred to as "strain approach". A critical opening angle leading to crack initiation in the opposite lateral cortex was determined for each approach and was defined as comparative parameter. The relation to bone aging was investigated by considering the material parameters of cortical bones from young and old subjects. The maximum equivalent (von-Mises) stress was smaller for the cases with a drill hole at the end of the osteotomy cut. The critical angle was approximately 1.5 times higher for the specimens with a drill hole compared to those without. This corresponds to an average increase of 50%. The calculated critical angle for all approaches is below 5°. The critical angle depends on the used approach, on patient's age and assumed ductility of the cortical bone. Drilling a hole at the end of the osteotomy reduces the stresses in the lateral cortex and increases the critical

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

    PubMed

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

    2014-03-01

    To compare clinical outcome and callus biomechanical properties of a novel angle stable interlocking nail (AS-ILN) and a 6 mm bolted standard ILN (ILN6b) in a canine tibial fracture model. Experimental in vivo study. Purpose-bred hounds (n = 11). A 5 mm mid-diaphyseal tibial ostectomy was stabilized with an AS-ILN (n = 6) or an ILN6b (n = 5). Orthopedic examinations and radiographs were performed every other week until clinical union (18 weeks). Paired tibiae were tested in torsion until failure. Callus torsional strength and toughness were statistically compared and failure mode described. Total and cortical callus volumes were computed and statistically compared from CT slices of the original ostectomy gap. Statistical significance was set at P < .05 RESULTS: From 4 to 8 weeks, lameness was less pronounced in AS-ILN than ILN6b dogs (P < .05). Clinical union was reached in all AS-ILN dogs by 10 weeks and in 3/5 ILN6b dogs at 18 weeks. Callus mechanical properties were significantly greater in AS-ILN than ILN6b specimens by 77% (failure torque) and 166% (toughness). Failure occurred by acute spiral (control and AS-ILN) or progressive transverse fractures (ILN6b). Cortical callus volume was 111% greater in AS-ILN than ILN6b specimens (P < .05). Earlier functional recovery, callus strength and remodeling suggest that the AS-ILN provides a postoperative biomechanical environment more conducive to bone healing than a comparable standard ILN. © Copyright 2014 by The American College of Veterinary Surgeons.

  20. Risk of Osteosarcoma in Dogs After Open Fracture Fixation.

    PubMed

    Arthur, Elizabeth G; Arthur, Gerald L; Keeler, Matthew R; Bryan, Jeffrey N

    2016-01-01

    To critically evaluate whether open fracture fixation is a significant risk factor for latent osteosarcoma development. Case-control study. Dogs undergoing open fracture repair and dogs diagnosed with osteosarcoma. Records were retrieved from the Veterinary Medical Database VMDB (1970-2000) for dogs undergoing surgical repair of a fracture and dogs diagnosed with osteosarcoma. Dogs with open reduction of joint luxation, dogs diagnosed with bacterial cystitis, and dogs diagnosed with urinary bladder transitional cell carcinoma (UBTCC) were queried as comparison populations. Relative risk for osteosarcoma development was determined. From a population of 19,041 fractures treated surgically, 15 of those dogs subsequently appeared in the VMDB with osteosarcoma affecting the same bone. The relative risk of a fracture repair and associated orthopedic implants and osteosarcoma occurrence was equivalent to the relative risk of open joint reduction and osteosarcoma occurrence (95% confidence interval; 0.998-1.00). The relative risk of having bacterial cystitis and appearing again in the VMDB with UBTCC was higher than the risk of open fracture repair and a subsequent diagnosis of osteosarcoma (P < .02). The incidence of fracture-related osteosarcoma may be significantly less than previously estimated based on cases queried from the VMDB. Although possible cases of implant-associated osteosarcoma were identified, their occurrence was rare. Elective implant removal for the purpose of reducing the risk of osteosarcoma after fracture repair may not be warranted and merits further investigation. © Copyright 2015 by The American College of Veterinary Surgeons.

  1. The effect of three-dimensional computed tomography reconstructions on preoperative planning of tibial plateau fractures: a case-control series.

    PubMed

    Dodd, Andrew; Oddone Paolucci, Elizabeth; Korley, Robert

    2015-06-13

    Tibial plateau fractures are a common intra-articular injury for which computed tomography (CT) scans are routinely used for preoperative planning. Three-dimensional reconstructions of CT scans have been increasingly investigated in recent years, however their role has yet to be defined. We wish to investigate the role of three-dimensional computed tomography reconstructions (3D-CT) in the preoperative planning of tibial plateau fractures. Twelve cases of tibial plateau fractures including plain film radiographs and conventional CT scans were distributed to 21 observers (orthopaedic residents and consultants). The observers filled out a preoperative plan checklist created for this study. Three months later the same cases were distributed, in random order, this time including 3D-CT reconstructions. The same preoperative checklists were completed, and compared to the previous checklists. The preoperative plan checklist was able to detect differences between cases and between observers. No significant differences were detected between the total plan scores when comparing conventional CT to 3D-CT. Sub-analysis of plan specifics (incisions, hardware, adjuncts) was also not significantly different. The level of training of the observer or the fracture complexity did not affect these results. No significant changes were made to observer's preoperative plans with the addition of 3D-CT. 3D-CT reconstructions come at a cost to the system, and therefore their usefulness should be investigated prior to widespread use. Our study demonstrates that the addition of 3D-CT reconstructions to the preoperative workup of tibial plateau fractures did not change management plans when compared to plans made using traditional CT-scans.

  2. Treatment of canine and feline diaphyseal radial and tibial fractures with low-stiffness external skeletal fixation.

    PubMed

    Gemmill, T J; Cave, T A; Clements, D N; Clarke, S P; Bennett, D; Carmichael, S

    2004-02-01

    The healing of 62 cases of radial and tibial fractures treated with low-stiffness Kirschner-Ehmer external skeletal fixation frames (frame types 1a, 1a plus intramedullary pin [1aIMP], 1b and 2b) was evaluated. The mean time to clinical union was 65 days. All cases treated with 1b, 2b or 1aIMP frames healed. Four of 25 cases treated with 1a frames failed to heal due to premature pin loosening; these failures were in heavier patients than 1a cases which healed (P=0.041). Complications occurred in 40 of 62 cases, and were more common in cases treated with type 2b frames. Pin loosening was the most frequent complication (35 cases) and most commonly involved the most proximal pin (P<0.001). In type 2b frames, full pins loosened more frequently than half pins (P<0.001). This study indicates that canine and feline fractures can heal readily when treated with these frames, suggesting that more rigid type 2a or type 3 frames are unnecessary in the majority of cases. Increased morbidity compared with the use of more rigid frames need not be expected, but 1a frames should be avoided in heavier patients.

  3. Medial opening wedge high tibial osteotomy alters knee moments in multiple planes during walking and stair ascent.

    PubMed

    Leitch, Kristyn M; Birmingham, Trevor B; Dunning, Cynthia E; Giffin, J Robert

    2015-07-01

    Medial opening wedge high tibial osteotomy is a surgical procedure intended to redistribute loads on the knee in patients with medial compartment knee osteoarthritis (OA). The surgery may affect moments in multiple planes during ambulation, with potential beneficial or detrimental effects on joint loads. The objective of this study was to investigate three-dimensional external knee moments before and after medial opening wedge high tibial osteotomy during level walking and during stair ascent. Fourteen patients with varus alignment and osteoarthritis primarily affecting the medial compartment of the tibiofemoral joint were assessed. Three-dimensional motion analyses during level walking and stair ascent was evaluated using inverse dynamics before, 6 and 12 months after surgery. Mean changes at 12 months suggested decreases in the peak knee adduction, flexion and internal rotation moments, with standardized response means ranging from 0.15 to 2.54. These decreases were observed despite increases in speed. Changes in alignment were associated with changes in the adduction and internal rotation moments, but not the flexion moment. Both pre- and postoperatively, the peak knee adduction moment was significantly lower (p=0.001) during stair ascent than during level walking, while the flexion and internal rotation moments were significantly higher (p<0.01). There were no changes in the knee moments on the non-surgical limb. Medial opening wedge high tibial osteotomy is associated with sustained (12 months) changes in knee moments in all three planes of motion during ambulation, suggesting substantial alterations of the loads on the knee during ambulation. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. [Proximal tibial fractures sustained during alpine skiing - incidence and risk factors].

    PubMed

    Pätzold, R; Spiegl, U; Wurster, M; Augat, P; Gutsfeld, P; Gonschorek, O; Bühren, V

    2013-12-01

    Prior to introduction of carving skis, complex fractures of the proximal tibia were rarely seen. Recently these fractures are being seen more frequently in connection with alpine skiing. The aim of this study was to find out the incidence of proximal tibia fractures in alpine skiing and to identify possible risk factors. All patients with proximal tibia fractures related to alpine skiing in a large German ski resort were included. Fracture type, patient and skiing related factors were recorded. Incidence of fractures was determined by using the number of all registered skiers. Multinomial logistic regression analysis was used to calculate the odds ratios for risk factors. Between 2007 and 2010 a total of 188 patients was treated for proximal tibia fractures caused by alpine skiing. Forty-three patients had a type-A injury, 96 patients a type-B injury, and 49 patients a type-C injury. The incidence of injury increased continuously, starting from 2.7 and climbing to 7.0 per 10⁵ skiing days. The risk factors compared to patients with type-A fractures, type-C fracture occurred in older (OR 0.93; 0.89 - 0.97) and heavier (OR 0.86; 0.74 - 0.99) individuals and were more likely on icy snow conditions (OR 0.22; 0.05 - 0.96), higher speed (OR 0.29; 0.09 - 0.97) and skiing skill (OR 0.35; 0.13 - 0.95). These was also seen in artificial and icy snow conditions (OR 0.25; 0.07 - 0.87) when compared to type-B fractures. The incidence of proximal tibia fractures related to skiing has increased over the past four years. Risk factors such as age, BMI, snow conditions, speed, and the skill of the skiers, were identified as causes contributing to complex fractures. © Georg Thieme Verlag KG Stuttgart · New York.

  5. A cross-sectional study of the effects of load carriage on running characteristics and tibial mechanical stress: implications for stress fracture injuries in women

    DTIC Science & Technology

    2017-03-23

    effects of load carriage on running characteristics and tibial mechanical stress: implications for stress-fracture injuries in women Chun Xu1, Amy Silder2...cross-sectional study using an integrated musculoskeletal-finite-element model to analyze how the amount of load carriage in women affected the...extensor muscles in women are the main power generators when running with load carriage. When comparing running with walking, finite element analysis

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

    PubMed

    Pamukoff, Derek N; Blackburn, J Troy

    2015-02-01

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

  7. Current management of open fractures: results from an online survey.

    PubMed

    Gümbel, Denis; Matthes, Gerrit; Napp, Matthias; Lange, Jörn; Hinz, Peter; Spitzmüller, Romy; Ekkernkamp, Axel

    2016-12-01

    Open fractures are orthopaedic emergencies that carry a high risk for infection, non-union and soft tissue complications. Evidence-based treatment is impeded by the lack of high-quality evidence-based studies. The aim of this investigation was to elucidate the current practice of open fracture management in Germany and to determine major differences in treatment. Surgeons were asked to complete an online questionnaire consisting of 45 items developed by an expert consensus. The first part covered questions on general principles of open fracture management. The second part included questions on soft tissue management, the preferred method of initial surgical stabilisation, microbiological testing, employment of pulsatile lavage and local antibiotics, antibiotic regimen, second-look operations, and blood testing. Of 653 respondents, 364 (65 %) completed the first part and 314 (48 %) completed the second part of the online survey. 55 % answered that a standard operating procedure for the diagnosis and treatment of patients with open fractures exists in their hospital. Only 25 % leave pre-hospitalisation applied dressings intact until arrival of the patient in the operating room, and 40 % make this decision depending on information provided by pre-hospitalisation emergency personnel. 84 % participants exclude the use of antibiotic-coated implants in the treatment of open fractures. The favoured stabilisation method in Gustilo type I fractures is definitive internal osteosynthesis and primary wound closure for 61 % of respondents. In Gustilo type II (74 %) and type III fractures (93 %), temporary external fixation is preferred. High-pressure pulsatile lavage is used by 22 % responding surgeons in Gustilo type I fractures, 53 % for type II fractures and 67 % for type III fractures. Open fracture management differs considerably among surgeons in Germany. Further studies are needed to deliver high-quality evidence concerning primary fracture stabilisation, soft

  8. A Prospective Randomized Trial to Assess Fixation Strategies for Severe Open Tibia Fractures: Modern Ring External Fixators Versus Internal Fixation (FIXIT Study).

    PubMed

    OʼToole, Robert V; Gary, Joshua L; Reider, Lisa; Bosse, Michael J; Gordon, Wade T; Hutson, James; Quinnan, Stephen M; Castillo, Renan C; Scharfstein, Daniel O; MacKenzie, Ellen J

    2017-04-01

    The treatment of high-energy open tibia fractures is challenging in both the military and civilian environments. Treatment with modern ring external fixation may reduce complications common in these patients. However, no study has rigorously compared outcomes of modern ring external fixation with commonly used internal fixation approaches. The FIXIT study is a prospective, multicenter randomized trial comparing 1-year outcomes after treatment of severe open tibial shaft fractures with modern external ring fixation versus internal fixation among men and women of ages 18-64. The primary outcome is rehospitalization for major limb complications. Secondary outcomes include infection, fracture healing, limb function, and patient-reported outcomes including physical function and pain. One-year treatment costs and patient satisfaction will be compared between the 2 groups, and the percentage of Gustilo IIIB fractures that can be salvaged without soft tissue flap among patients receiving external fixation will be estimated.

  9. Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial.

    PubMed

    Lansdaal, Joris Radboud; Mouton, Tanguy; Wascher, Daniel Charles; Demey, Guillaume; Lustig, Sebastien; Neyret, Philippe; Servien, Elvire

    2017-12-01

    The need for a period of non-weight bearing after medial opening wedge high tibial osteotomy remains controversial. It is hypothesized that immediate weight bearing after medial opening wedge high tibial osteotomy would have no difference in functional scores at one year compared to delayed weight bearing. Fifty patients, median age 54 years (range 40-65), with medial compartment osteoarthritis, underwent a medial opening wedge high tibial osteotomy utilizing a locking plate without bone grafting. Patients were randomized into an Immediate or a Delayed (2 months) weight bearing group. All patients were assessed at one-year follow-up and the two groups compared. The primary outcome measure was the IKS score. Secondary outcome measures included the IKDC score, the VAS pain score and rate of complications. The functional scores significantly improved in both groups. The IKS score increased from 142 ± 31 to 171 ± 26 in the Immediate group (p < 0.001) and from 148 ± 22 to 178 ± 23 in the Delayed group (p < 0.001). The IKDC score increased from 49 ± 17 pre-operatively to 68 ± 14 one-year post-operatively in the Immediate group (p < 0.0001) and from 44 ± 16 to 69 ± 19 in the Delayed group (p < 0.001). The average VAS for pain 2 months after surgery was 3 ± 3 in the Immediate group and 3 ± 2 in the Delayed (n.s.). There was no significant difference between the two groups in any of the outcome measures. The mean mechanical femorotibial angle changed from 6° of varus (0°-15° of varus, SD = 3°) to 4° of valgus (5°-11° of valgus, SD = 3°) in the Immediate group and from 5° of varus (0°-10° of varus, SD = 3°) to 3° of valgus (2° of varus to 8° of valgus, SD = 3°) in the Delayed group. No difference was seen between groups, and no loss of correction was observed in any patient. Two cases of non-union occurred, one in each group. One infection and one deep vein thrombosis occurred in the Immediate group. Immediate

  10. [Comparison of open versus percutaneous treatment for humeral head fracture].

    PubMed

    Kralinger, F; Irenberger, A; Lechner, C; Wambacher, M; Golser, K; Sperner, G

    2006-05-01

    The hypothesis of this study was that percutaneous techniques lower the risk of post-traumatic avascular necrosis. In this retrospective study 83 patients were followed up clinically and radiologically for signs of avascular necrosis and nonunion after open or percutaneous treatment of proximal humerus fractures. Mean age was 50 years. Fractures were classified in 22 patients (26.5%) as two part, in 21 patients (25.3%) as three part, in 39 patients (47%) as four part, and in 1 patient (1.2%) as fracture dislocation (Neer classification). Fractures were treated in 12 patients (14.5%) by ORIF (open reduction and internal fixation) and in 71 patients (85.5%) by CRPF (closed reduction and percutaneous fixation). Both groups were statistically equally distributed according to fracture type (Mann-Whitney U, p=0.267) and age (One-way-Annova, p=0.740). The postoperative regime did not differ between the two groups. Patients suffered significantly more avascular necrosis after open treatment [five patients (50%) versus eight patients (12.7%) in the percutaneous group, Mann-Whitney, p=0.004]. The risk for avascular necrosis and nonunion increased with age. Mean age of patients with avascular necrosis was 57 years, and the age of patients with nonunion was 67 years. Percutaneous treatment of humeral head fractures seems to be a reliable method for lowering the risk of avascular necrosis in young patients.

  11. Particle Swarms in Fractures: Open Versus Partially Closed Systems

    NASA Astrophysics Data System (ADS)

    Boomsma, E.; Pyrak-Nolte, L. J.

    2014-12-01

    In the field, fractures may be isolated or connected to fluid reservoirs anywhere along the perimeter of a fracture. These boundaries affect fluid circulation, flow paths and communication with external reservoirs. The transport of drop like collections of colloidal-sized particles (particle swarms) in open and partially closed systems was studied. A uniform aperture synthetic fracture was constructed using two blocks (100 x 100 x 50 mm) of transparent acrylic placed parallel to each other. The fracture was fully submerged a tank filled with 100cSt silicone oil. Fracture apertures were varied from 5-80 mm. Partially closed systems were created by sealing the sides of the fracture with plastic film. The four boundary conditions study were: (Case 1) open, (Case 2) closed on the sides, (Case 3) closed on the bottom, and (Case 4) closed on both the sides and bottom of the fracture. A 15 μL dilute suspension of soda-lime glass particles in oil (2% by mass) were released into the fracture. Particle swarms were illuminated using a green (525 nm) LED array and imaged with a CCD camera. The presence of the additional boundaries modified the speed of the particle swarms (see figure). In Case 1, enhanced swarm transport was observed for a range of apertures, traveling faster than either very small or very large apertures. In Case 2, swarm velocities were enhanced over a larger range of fracture apertures than in any of the other cases. Case 3 shifted the enhanced transport regime to lower apertures and also reduced swarm speed when compared to Case 2. Finally, Case 4 eliminated the enhanced transport regime entirely. Communication between the fluid in the fracture and an external fluid reservoir resulted in enhanced swarm transport in Cases 1-3. The non-rigid nature of a swarm enables drag from the fracture walls to modify the swarm geometry. The particles composing a swarm reorganize in response to the fracture, elongating the swarm and maintaining its density. Unlike a

  12. Characteristics of postoperative weight bearing and management protocols for tibial plateau fractures: Findings from a scoping review.

    PubMed

    Arnold, John B; Tu, Chen Gang; Phan, Tri M; Rickman, Mark; Varghese, Viju Daniel; Thewlis, Dominic; Solomon, Lucian B

    2017-12-01

    To identify and describe the characteristics of existing practices for postoperative weight bearing and management of tibial plateau fractures (TPFs), identify gaps in the literature, and inform the design of future research. Seven electronic databases and clinical trial registers were searched from inception until November 17th 2016. Studies were included if they reported on the surgical management of TPFs, had a mean follow-up time of ≥1year and provided data on postoperative management protocols. Data were extracted and synthesized according to study demographics, patient characteristics and postoperative management (weight bearing regimes, immobilisation devices, exercises and complications). 124 studies were included involving 5156 patients with TPFs. The mean age across studies was 45.1 years (range 20.8-72; 60% male), with a mean follow-up of 34.9 months (range 12-264). The most frequent fracture types were AO/OTA classification 41-B3 (29.5%) and C3 (25%). The most commonly reported non-weight bearing time after surgery was 4-6 weeks (39% of studies), with a further 4-6 weeks of partial weight bearing (51% of studies), resulting in 9-12 weeks before full weight bearing status was recommended (55% of studies). Loading recommendations for initial weight bearing were most commonly toe-touch/<10kg (28%), 10kg-20kg (33%) and progressive (39%). Time to full weight bearing was positively correlated with the proportion of fractures of AO/OTA type C (r=0.465, p=0.029) and Schatzker type IV-VI (r=0.614, p<0.001). Similar rates of rigid (47%) and hinged braces were reported (58%), most frequently for 3-6 weeks (43% of studies). Complication rates averaged 2% of patients (range 0-26%) for abnormal varus/valgus and 1% (range 0-22%) for non-union or delayed union. Postoperative rehabilitation for TPFs most commonly involves significant non-weight bearing time before full weight bearing is recommended at 9-12 weeks. Partial weight bearing protocols and brace use were

  13. Biomechanical assessment and 3D finite element analysis of the treatment of tibial fractures using minimally invasive percutaneous plates

    PubMed Central

    Hu, Xin-Jia; Wang, Hua

    2017-01-01

    The aim of the present study was to investigate the biomechanical effects of varying the length of a limited contact-dynamic compression plate (LC-DCP) and the number and position of screws on middle tibial fractures, and to provide biomechanical evidence regarding minimally invasive plate osteosynthesis (MIPO). For biomechanical testing, 60 tibias from cadavers (age at mortality, 20–40 years) were used to create middle and diagonal fracture models without defects. Tibias were randomly grouped and analyzed by biomechanic and three-dimensional (3D) finite element analysis. The differences among LC-DCPs of different lengths (6-, 10- and 14-hole) with 6 screws, 14-hole LC-DCPs with different numbers of screws (6, 10 and 14), and 14-hole LC-DCPs with 6 screws at different positions with regard to mechanical characteristics, including compressing, torsion and bending, were examined. The 6-hole LC-DCP had greater vertical compression strain compared with the 10- and 14-hole LC-DCPs (P<0.01), and the 14-hole LC-DCP had greater lateral strain than the 6- and 10-hole LC-DCPs (P<0.01). Furthermore, significant differences in torque were observed among the LC-DPs of different lengths (P<0.01). For 14-hole LC-DCPs with different numbers of screws, no significant differences in vertical strain, lateral strain or torque were detected (P>0.05). However, plates with 14 screws had greater vertical strain compared with those fixed with 6 or 10 screws (P<0.01). For 4-hole LC-DCPs with screws at different positions, vertical compression strain values were lowest for plates with screws at positions 1, 4, 7, 8, 11 and 14 (P<0.01). The lateral strain values and vertical strain values for plates with screws at positions 1, 3, 6, 9, 12 and 14 were significantly lower compared with those at the other positions (P<0.01), and torque values were also low. Thus, the 14-hole LC-DCP was the most stable against vertical compression, torsion and bending, and the 6-hole LC-DCP was the least stable

  14. Lateral meniscus allograft transplantation: clinical and anatomic outcomes after arthroscopic implantation with tibial tunnels versus open implantation without tunnels.

    PubMed

    Faivre, B; Boisrenoult, P; Lonjon, G; Pujol, N; Beaufils, P

    2014-05-01

    Meniscus allograft transplantation (MAT) is used to treat patients with knee pain after total or subtotal meniscectomy. The graft can be inserted during open or arthroscopic surgery. The objectives are anatomic horn positioning and strong fixation to the bone and capsule of an appropriately sized graft. Arthroscopic MAT with trans-tibial bone fixation ensures better mid-term functional outcomes and limits allograft extrusion. We conducted a retrospective single-centre study of 23 consecutive patients who underwent MAT between 2001 and 2010. Among them, 11 had open surgery and anchoring of the horns without tunnels and 12 had arthroscopically-assisted surgery with bony fixation of the horns through trans-tibial tunnels. The two groups were comparable at baseline. Mean follow-up was 66.1 months. Post-operative outcomes were assessed using the IKDC score and KOOS, standard radiographs of both knees, and either magnetic resonance imaging or computed arthrotomography. We measured joint space narrowing, meniscal extrusion in the sagittal and coronal planes; and the degree of cartilage coverage by the graft using an index developed for this study. The overall failure rate was 17.4% (4/23, two cases each of complete and partial graft removal). Joint space narrowing increased by 28% versus the pre-operative value (P=0.009). IKDC and KOOS values were not significantly different between the two groups. Absolute meniscus extrusion was greater in the arthroscopy group (4mm vs. 3mm, P=0.03). Osteoarthritis of the transplanted compartment is unavoidable. Open surgery is associated with less meniscal extrusion. The clinical outcomes are independent from the technique used. Other factors require investigation, including graft rehabilitation, quality peripheral suturing, and intermeniscal ligament reconstruction. IV, retrospective study. Copyright © 2014. Published by Elsevier Masson SAS.

  15. Open reduction of nasal bone fractures through an intercartilaginous incision.

    PubMed

    Kim, Ji Heui; Lee, Jun Ho; Hong, Seok Min; Park, Chan Hum

    2013-01-01

    Open reduction through an intercartilaginous incision was useful for treating delayed-diagnosed nasal bone fractures because it resulted in a successful outcome with minimal complications. Nasal bone fractures are generally managed with closed reduction, which is usually inadequate and results in airway obstruction with a delayed diagnosis of nasal bone fracture when bone healing and fibrotic adhesions around the bone fragment have progressed. This study investigated the surgical outcome of open reduction through an intercartilaginous incision for delayed-diagnosis nasal bone fractures. The study enrolled 18 patients who underwent open reduction through an intercartilaginous incision to correct delayed-diagnosis nasal bone fractures. Three independent otorhinolaryngologists evaluated the outcomes 4-35 months (average 12.7 months) postoperatively as excellent, fair or poor. The time from injury to surgery was 11-39 days (20-39 days in adults and 11-30 days in children). The 18 cases included 16 primary repairs and two revisions. A Kirschner wire was inserted in six (33.3%) patients who had unstable reduced nasal bones. Postoperatively, l5 (83%) patients had excellent results, two (11%) had fair, and one (6%) had a poor outcome. No patient experienced any complication.

  16. Open Fractures of the Hand: Review of Pathogenesis and Introduction of a New Classification System.

    PubMed

    Tulipan, Jacob E; Ilyas, Asif M

    2018-02-01

    Open fractures of the hand are a common and varied group of injuries. Although at increased risk for infection, open fractures of the hand are more resistant to infection than other open fractures. Numerous unique factors in the hand may play a role in the altered risk of postinjury infection. Current systems for the classification of open fractures fail to address the unique qualities of the hand. This article proposes a novel classification system for open fractures of the hand, taking into account the factors unique to the hand that affect its risk for developing infection after an open fracture. Copyright © 2017. Published by Elsevier Inc.

  17. Open Fractures of the Hand: Review of Pathogenesis and Introduction of a New Classification System.

    PubMed

    Tulipan, Jacob E; Ilyas, Asif M

    2016-01-01

    Open fractures of the hand are a common and varied group of injuries. Although at increased risk for infection, open fractures of the hand are more resistant to infection than other open fractures. Numerous unique factors in the hand may play a role in the altered risk of postinjury infection. Current systems for the classification of open fractures fail to address the unique qualities of the hand. This article proposes a novel classification system for open fractures of the hand, taking into account the factors unique to the hand that affect its risk for developing infection after an open fracture. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Medial gastrocnemius muscle flap for treating wound complications after double-plate fixation via two-incision approach for complex tibial plateau fractures.

    PubMed

    Chou, Ying-Chao; Wu, Chi-Chuan; Chan, Yi-Sheng; Chang, Chung-Hsun; Hsu, Yung-Heng; Huang, Yu-Chih

    2010-01-01

    In medical literature, few articles have reported the treatment of wound complications occurring after double-plate fixation via a two-incision approach for complex tibial plateau fractures. A retrospective study was conducted to evaluate the efficacy of a medial gastrocnemius muscle flap transfer in treating this complicated disability. We treated 16 consecutive adult patients, including 6 cases of wound complications without previous deep infection and 10 cases of wound complications with deep wound infection. A one-stage medial gastrocnemius muscle flap transfer was performed after excision of gangrened eschar in cases with wound complication after fracture fixation without infection. A staged flap transfer was performed after debridement and antibiotic administration in cases with wound complication after fracture fixation and wound infection. Bone grafting supplementation was performed in cases where a sequestrectomy had been performed. All 16 patients were followed up for an average of 31 months (range, 13-50 months). The wound complications were successfully treated in 93.8% (15/16) of patients by medial gastrocnemius flap transfer. The fracture healed in 93.8% (15/16) of patients within an average period of 17.2 weeks (range, 10-51 weeks). One patient had gastrocnemius muscle necrosis with fracture nonunion and was treated with free vascularized muscle and osseous flap transfers. Knee function was satisfactory in 62.5% (10/16) of patients. Medial gastrocnemius muscle flap transfer is a reliable technique for treating wound complications that occur after double-plate fixation via a two-incision approach in the treatment of complex tibial plateau fractures. A high success rate of wound healing with bone union can normally be achieved. We, therefore, recommend its widespread use in candidate patients.

  19. Increased bone turnover, osteoporosis, progressive tibial bowing, fractures, and scoliosis in a patient with a final-exon SATB2 frameshift mutation.

    PubMed

    Boone, Philip M; Chan, Yiu Man; Hunter, Jill V; Pottkotter, Louis E; Davino, Nelson A; Yang, Yaping; Beuten, Joke; Bacino, Carlos A

    2016-11-01

    Haploinsufficiency of SATB2 causes cleft palate, intellectual disability with deficient speech, facial and dental abnormalities, and other variable features known collectively as SATB2-associated syndrome. This phenotype was accompanied by osteoporosis, fractures, and tibial bowing in two previously reported adult patients; each possessed SATB2 mutations either predicted or demonstrated to escape nonsense-mediated decay, suggesting that the additional bone defects result from a dominant negative effect and/or age-dependent penetrance. These hypotheses remain to be confirmed, as do the specific downstream defects causing bone abnormalities. We report a SATB2 mutation (c.2018dupA; p.(H673fs)) in a 15-year-old patient whose SATB2-associated syndrome phenotype is accompanied by osteoporosis, fractures, progressive tibial bowing, and scoliosis. As this homeodomain-disrupting and predicted truncating mutation resides within the final exon of SATB2, escape from nonsense-mediated decay is likely. Thus, we provide further evidence of bone phenotypes beyond those typically associated with SATB2-associated syndrome in individuals with potential dominant-negative SATB2 alleles, as well as evidence for age-dependence of bone features. Elevations in alkaline phosphatase, urinary N-telopeptide/creatinine ratio, and osteocalcin in the patient indicate increased bone turnover. We propose surveillance and treatment with osteoclast inhibitors to prevent fractures and to slow progressive bone deformities. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  20. Treatment of open fractures with a computer-assisted external fixator system without the use of fluoroscopy.

    PubMed

    Kara, Adnan; Celik, Haluk; Seker, Ali; Karakoyun, Ozgur; Armagan, Raffi; Kuyucu, Ersin; Erdil, Mehmet

    2016-04-26

    Developed for the treatment of deformity correction, computer-assisted circular external fixators in recent years have also been used for fracture fixation. In this study, we aimed to present the efficacy of computer-assisted circular external fixator use in open long bone fractures with our new technique. Between February 2013 and June 2014, 14 patients (mean age 24.5 (range 20-32)) with open tibial or femoral open fractures were treated with the computer-assisted fixation system (Spider Frame-Tasarım Medikal, Istanbul, Turkey). In all patients, appropriate positions of the rings and Schanz screws were determined by measurements on preoperative radiographs. The length of the Schanz screws were determined by depth measure marks on drill bits. Obvious deformities were corrected intraoperatively by manipulations, but residual deformities were corrected by a software program (Spiderfix, Tasarım Medikal, Istanbul, Turkey). We did not use fluoroscopy during the procedures. Ten patients had tibia diaphyseal and four patients had femoral diaphyseal fractures. Mean surgical time was 24.2 (range 18-28) min. Average follow-up time was 10.2 (range 9-14) months. Mean time for deformity correction was 3.1 (2-5) days. Complete union was observed in all patients with a mean of 4.9 (range 3-9) months. There were two grade 2 pin site infections treated with oral antibiotherapy and pin site care. We did not detect any Schanz screw breakage, loosening, deep infection, nonunion, or malunion. Computer-assisted external fixation systems can be used in the treatment of open fractures, and they provide the chance for acute or gradual correction. Preoperative planning and assistant devices with depth measures may decrease the procedure time and the need for fluoroscopy use.

  1. Static and fatigue strength of a novel anatomically contoured implant compared to five current open-wedge high tibial osteotomy plates.

    PubMed

    Diffo Kaze, Arnaud; Maas, Stefan; Belsey, James; Hoffmann, Alexander; Pape, Dietrich

    2017-12-08

    The purpose of the present study was to compare the mechanical static and fatigue strength of the size 2 osteotomy plate "Activmotion" with the following five other common implants for the treatment of medial knee joint osteoarthritis: the TomoFix small stature, the TomoFix standard, the Contour Lock, the iBalance and the second generation PEEKPower. Six fourth-generation tibial bone composites underwent a medial open-wedge high tibial osteotomy (HTO), according to standard techniques, using size 2 Activmotion osteotomy plates. All bone-implant constructs were subjected to static compression load to failure and load-controlled cyclic fatigue failure testing, according to a previously defined testing protocol. The mechanical stability was investigated by considering different criteria and parameters: maximum forces, the maximum number of loading cycles, stiffness, the permanent plastic deformation of the specimens during the cyclic fatigue tests, and the maximum displacement range in the hysteresis loops of the cyclic loading responses. In each test, all bone-implant constructs with the size 2 Activmotion plate failed with a fracture of the lateral cortex, like with the other five previously tested implants. For the static compression tests the failure occurred in each tested implant above the physiological loading of slow walking (> 2400 N). The load at failure for the Activmotion group was the highest (8200 N). In terms of maximum load and number of cycles performed prior to failure, the size 2 Activmotion plate showed higher results than all the other tested implants except the ContourLock plate. The iBalance implant offered the highest stiffness (3.1 kN/mm) for static loading on the lateral side, while the size 2 Activmotion showed the highest stiffness (4.8 kN/mm) in cyclic loading. Overall, regarding all of the analysed strength parameters, the size 2 Activmotion plate provided equivalent or higher mechanical stability compared to the previously tested

  2. Lower Limb Length Discrepancy After High Tibial Osteotomy: Prospective Randomized Controlled Trial of Lateral Closing Versus Medial Opening Wedge Osteotomy.

    PubMed

    Kim, Joong Il; Kim, Bo Hyun; Lee, Ki Woung; Lee, Osung; Han, Hyuk Soo; Lee, Sahnghoon; Lee, Myung Chul

    2016-12-01

    High tibial osteotomy (HTO) produces valgus limb alignment, and this change can affect lower limb length. To compare the change in lower limb length and the discrepancy compared with the contralateral limb after unilateral lateral closing wedge HTO (CWHTO) and medial opening wedge HTO (OWHTO). Randomized controlled trial; Level of evidence, 1. In this study, 30 knees undergoing unilateral CWHTO and 30 knees undergoing unilateral OWHTO for medial compartmental osteoarthritis were analyzed with 1-year follow-up. The tibial length, lower limb length, and lower limb length discrepancy were measured preoperatively and 1 year postoperatively. The patients' subjective sensation of, and discomfort due to, the lower limb length discrepancy were recorded 1 year postoperatively. Univariate and multivariate linear regression analyses were conducted to identify predictors related to the change in lower limb length. The mean lengths of the tibia and lower limb increased significantly after OWHTO (5.2 ± 3.7 and 7.6 ± 2.1 mm, respectively; P < .001). The mean tibial length decreased significantly after CWHTO (-6.0 ± 2.1 mm; P < .001); however, the mean lower limb length change was not significant (-0.8 ± 2.5 mm; P = .073). The mean lower limb length discrepancy increased significantly after OWHTO (-0.5 ± 0.7 to 7.2 ± 2.1 mm; P < .001) but not after CWHTO (-0.7 ± 0.6 to -1.0 ± 2.5 mm; P = .539). A significantly greater proportion of patients in the OWHTO group were aware of (70% vs 20%, respectively; P = .002), and uncomfortable because of (37% vs 7%, respectively; P = .010), the lower limb length discrepancy compared with those in the CWHTO group. The strongest predictor of a change in lower limb length was the wedge length in the OWHTO group and the preoperative hip-knee-ankle angle in the CWHTO group. The lower limb length change and discrepancy were significant after unilateral OWHTO, whereas they were negligible after unilateral CWHTO. CWHTO was more beneficial in

  3. Reattachment of subgingivally fractured central incisor with an open apex.

    PubMed

    Eden, Ece; Yanar, Saniye Ciçek; Sönmez, Sule

    2007-06-01

    A case report of a 6-year-old girl with a fractured maxillary left central incisor with an open apex is presented. The procedure used to repair the fracture included flap surgery with an intrasulcular incision and endodontic treatment. The patient was called for 3 months regular follow-up to check the root formation. At the end of 32 months just before the root was obturated by guttaperka, she fractured the same tooth. Flap surgery was repeated and the tooth was restored. The root canal was obturated with a root filling paste and guttaperka as the apex was closed. Examination 10 months after treatment revealed good periodontal health, aesthetics and normal function.

  4. Effect of opening-wedge high tibial osteotomy on the three-dimensional kinematics of the knee.

    PubMed

    d'Entremont, A G; McCormack, R G; Horlick, S G D; Stone, T B; Manzary, M M; Wilson, D R

    2014-09-01

    Although it is clear that opening-wedge high tibial osteotomy (HTO) changes alignment in the coronal plane, which is its objective, it is not clear how this procedure affects knee kinematics throughout the range of joint movement and in other planes. Our research question was: how does opening-wedge HTO change three-dimensional tibiofemoral and patellofemoral kinematics in loaded flexion in patients with varus deformity?Three-dimensional kinematics were assessed over 0° to 60° of loaded flexion using an MRI method before and after opening-wedge HTO in a cohort of 13 men (14 knees). Results obtained from an iterative statistical model found that at six and 12 months after operation, opening-wedge HTO caused increased anterior translation of the tibia (mean 2.6 mm, p < 0.001), decreased proximal translation of the patella (mean -2.2 mm, p < 0.001), decreased patellar spin (mean -1.4°, p < 0.05), increased patellar tilt (mean 2.2°, p < 0.05) and changed three other parameters. The mean Western Ontario and McMaster Universities Arthritis Index improved significantly (p < 0.001) from 49.6 (standard deviation (sd) 16.4) pre-operatively to a mean of 28.2 (sd 16.6) at six months and a mean of 22.5 (sd 14.4) at 12 months. The three-dimensional kinematic changes found may be important in explaining inconsistency in clinical outcomes, and suggest that measures in addition to coronal plane alignment should be considered. ©2014 The British Editorial Society of Bone & Joint Surgery.

  5. Assessing the local mechanical environment in medial opening wedge high tibial osteotomy using finite element analysis.

    PubMed

    Pauchard, Yves; Ivanov, Todor G; McErlain, David D; Milner, Jaques S; Giffin, J Robert; Birmingham, Trevor B; Holdsworth, David W

    2015-03-01

    High-tibial osteotomy (HTO) is a surgical technique aimed at shifting load away from one tibiofemoral compartment, in order the reduce pain and progression of osteoarthritis (OA). Various implants have been designed to stabilize the osteotomy and previous studies have been focused on determining primary stability (a global measure) that these designs provide. It has been shown that the local mechanical environment, characterized by bone strains and segment micromotion, is important in understanding healing and these data are not currently available. Finite element (FE) modeling was utilized to assess the local mechanical environment provided by three different fixation plate designs: short plate with spacer, long plate with spacer and long plate without spacer. Image-based FE models of the knee were constructed from healthy individuals (N = 5) with normal knee alignment. An HTO gap was virtually added without changing the knee alignment and HTO implants were inserted. Subsequently, the local mechanical environment, defined by bone compressive strain and wedge micromotion, was assessed. Furthermore, implant stresses were calculated. Values were computed under vertical compression in zero-degree knee extension with loads set at 1 and 2 times the subject-specific body weight (1 BW, 2 BW). All studied HTO implant designs provide an environment for successful healing at 1 BW and 2 BW loading. Implant von Mises stresses (99th percentile) were below 60 MPa in all experiments, below the material yield strength and significantly lower in long spacer plates. Volume fraction of high compressive strain ( > 3000 microstrain) was below 5% in all experiments and no significant difference between implants was detected. Maximum vertical micromotion between bone segments was below 200 μm in all experiments and significantly larger in the implant without a tooth. Differences between plate designs generally became apparent only at 2 BW loading. Results suggest that

  6. Displaced Posterior Cruciate Ligament Avulsion Fractures: A Retrospective Comparative Study Between Open Posterior Approach and Arthroscopic Single-Tunnel Suture Fixation.

    PubMed

    Sabat, Dhananjaya; Jain, Atul; Kumar, Vinod

    2016-01-01

    To retrospectively compare the clinical outcomes of displaced tibial-side posterior cruciate ligament (PCL) avulsion fractures treated with open reduction and screw fixation versus arthroscopic suture fixation. From 2005 to 2013, all displaced PCL tibial-side avulsion fractures treated surgically-initially by an open posterior approach and later by arthroscopic-assisted suture fixation-were retrospectively reviewed. The cases with radiographic evidence of greater than 3 mm of displacement and/or grade II or III laxity on the posterior drawer test were included in the study group. The associated injuries were duly treated. A conservative rehabilitation protocol was followed until radiologic fracture union occurred. The patients' clinicoradiologic assessment data at 1 year of follow-up were used for comparison between the open and arthroscopic groups. Forty-seven patients were available with 1 year of follow-up: 27 in the open group and 20 in the arthroscopic group. More than 90% of patients in both groups rated their knee function as normal or nearly normal. At 1 year of follow-up, knee function in terms of the Lysholm score (mean of 95.3 with 95% confidence interval [CI] 92.85 to 97.75 in open group and mean of 94.8 with 95% CI 91.38 to 98.22 in arthroscopic group; P = .812), Tegner activity level (mean of 6.8 with 95% CI 6.16 to 7.44 in open group and mean of 7.0 with 95% CI 6.44 to 7.66 in arthroscopic group, P = .677), International Knee Documentation Committee evaluation, and 1-leg hop test was comparable in both groups. The postoperative arthrometric laxity measurements with a KT-2000 arthrometer (MEDmetric, San Diego, CA) were better in the arthroscopic group, with 0 to 3 mm of laxity in 85% of cases in the arthroscopic group versus 74% in the open group. Avulsed fracture fragments were usually united by 3 months after surgery. No significant complication was noted. Both arthroscopic and open methods of treatment for PCL tibial-side avulsion injuries

  7. Open-book pelvic fractures with perineal open wounds: a significant morbid combination.

    PubMed

    Duchesne, Juan C; Bharmal, Husain M; Dini, Arash A; Islam, Tareq; Schmieg, Robert E; Simmons, Jon D; Wahl, Georgia M; Davis, John A; Krause, Peter; McSwain, Norman E

    2009-12-01

    Open-book pelvic fractures (OBPF) with concomitant intra-abdominal injuries carry a high morbidity and mortality; the significance of associated perineal open wound (OBPF-POW) has not been defined. We hypothesize that the presence of perineal open wounds increases morbidity, mortality, and concomitant use of hospital resources. Patients diagnosed with OBPF over a 5-year period at a Level I trauma center were identified by trauma registry review, and were retrospectively reviewed under an Institutional Review Board-approved protocol. Patients with OBPF without a perineal open wound were compared with those with OBPF-POW. Data collected included patient demographics, injury details, management, and outcomes. A total of 1,635 patients with blunt pelvic fractures were identified, of which 177 (10.8%) had OBPF. OBPF-POW (36/177) significantly increased the use of angioembolization, occurrence of sepsis, pelvic sepsis, ARDS, and multi-organ system failure. Patients with OBPF-POW had an increase of 13 days in length of hospitalization compared with the OBPF group (P < 0.001), with cost of $120,647.30 and $62,952.72 respectively (P < 0.001). Perineal open wounds complicate open-book pelvic fractures with significant increase in hospital resource utilization. Aggressive multidisciplinary evaluation and management is appropriate to detect and prevent complications.

  8. S100A8 contributes to postoperative cognitive dysfunction in mice undergoing tibial fracture surgery by activating the TLR4/MyD88 pathway.

    PubMed

    Lu, Shun-Mei; Yu, Chan-Juan; Liu, Ya-Hua; Dong, Hong-Quan; Zhang, Xiang; Zhang, Su-Su; Hu, Liu-Qing; Zhang, Feng; Qian, Yan-Ning; Gui, Bo

    2015-02-01

    Neuro-inflammation plays a key role in the occurrence and development of postoperative cognitive dysfunction (POCD). Although S100A8 and Toll-like receptor 4 (TLR4) have been increasingly recognized to contribute to neuro-inflammation, little is known about the interaction between S100A8 and TLR4/MyD88 signaling in the process of systemic inflammation that leads to neuro-inflammation. Firstly, we demonstrated that C57BL/6 wide-type mice exhibit cognitive deficit 24h after the tibial fracture surgery. Subsequently, increased S100A8 and S100A9 expression was found in the peripheral blood mononuclear cells (PBMCs), spleen, and hippocampus of C57BL/6 wide-type mice within 48h after the surgery. Pre-operative administration of S100A8 antibody significantly inhibited hippocampal microgliosis and improved cognitive function 24h after the surgery. Secondly, we also observed TLR4/MyD88 activation in the PBMCs, spleen, and hippocampus after the surgery. Compared with those in their corresponding wide-type mice, TLR4(-/-) and MyD88(-/-) mice showed lower immunoreactive area of microglia in the hippocampal CA3 region after operation. TLR4 deficiency also led to reduction of CD45(hi)CD11b(+) cells in the brain and better performance in both Y maze and open field test after surgery, suggesting a new regulatory mechanism of TLR4-dependent POCD. At last, the co-location of S100A8 and TLR4 expression in spleen after operation suggested a close relationship between them. On the one hand, S100A8 could induce TLR4 activation of CD11b(+) cells in the blood and hippocampus via intraperitoneal or intracerebroventricular injection. On the other hand, TLR4 deficiency conversely alleviated S100A8 protein-induced hippocampal microgliosis. Furthermore, the increased expression of S100A8 protein in the hippocampus induced by surgery sharply decreased in both TLR4 and MyD88 genetically deficient mice. Taken together, these data suggest that S100A8 exerts pro-inflammatory effect on the

  9. Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy.

    PubMed

    Lee, Dae-Hee; Park, Sung-Chul; Park, Hyung-Joon; Han, Seung-Beom

    2016-12-01

    Open-wedge high tibial osteotomy (HTO) cannot always accurately correct limb alignment, resulting in under- or over-correction. This study assessed the relationship between soft tissue laxity of the knee joint and alignment correction in open-wedge HTO. This prospective study involved 85 patients (86 knees) undergoing open-wedge HTO for primary medial osteoarthritis. The mechanical axis (MA), weight-bearing line (WBL) ratio, and joint line convergence angle (JLCA) were measured on radiographs preoperatively and after 6 months, and the differences between the pre- and post-surgery values were calculated. Post-operative WBL ratios of 57-67 % were classified as acceptable correction. WBL ratios <57 and >67 % were classified as under- and over-corrections, respectively. Preoperative JLCA correlated positively with differences in MA (r = 0.358, P = 0.001) and WBL ratio (P = 0.003). Difference in JLCA showed a stronger correlation than preoperative JLCA with differences in MA (P < 0.001) and WBL ratio (P < 0.001). Difference in JLCA was the only predictor of both difference in MA (P < 0.001) and difference in WBL ratio (P < 0.001). The difference between pre- and post-operative JLCA differed significantly between the under-correction, acceptable-correction, and over-correction groups (P = 0.033). Preoperative JLCA, however, did not differ significantly between the three groups. Neither preoperative JLCA nor difference in JLCA correlated with change in posterior slope. Preoperative degree of soft tissue laxity in the knee joint was related to the degree of alignment correction, but not to alignment correction error, in open-wedge HTO. Change in soft tissue laxity around the knee from before to after open-wedge HTO correlated with both correction amount and correction error. Therefore, a too large change in JLCA from before to after open-wedge osteotomy may be due to an overly large reduction in JLCA following osteotomy, suggesting alignment over

  10. Mini-open reduction and intramedullary interlocking nailing of fracture shaft of tibia without an image intensifier.

    PubMed

    Giri, S K; Adhikari, B R; Gurung, G B; Rc, Dr; Bajracharya, A R; Khatri, K

    2008-06-01

    Intramedullary interlocking tibial nailing is usually performed using an image intensifier. But being expensive, it is not available in the most of the hospitals of resource-poor countries of the world. The purpose of this study is to analyze the results of interlocking nailing without the use of an image intensifier. This is the retrospective study of 55 diaphyseal tibial fractures treated with minimally open reduction and internal fixation with interlocked intramedullary nail fixation. The proximal locking of the nail with the screws was made using external jig and for the distal locking direct visualization of the hole was carried out. There were 15 females and 40 males. The average age in years was 32 with a range of 18 to 64 years. The surgical approach was medial parapatellar. The average follow up period was 4 months. This period ranged from 3 months to 14 months. The union time in an average was 4 months. The complication mainly was distal screw loosening leading to valgus deformity and shortening in 1 case. It is, therefore, concluded that interlocking intramedullary nailing can be performed with proximal and distal locking accurately without the use of an image intensifier.

  11. Development and Validation of an Instrument to Predict Functional Recovery in Tibial Fracture Patients: The Somatic Pre-Occupation and Coping (SPOC) Questionnaire

    PubMed Central

    Busse, Jason W.; Bhandari, Mohit; Guyatt, Gordon H.; Heels-Ansdell, Diane; Kulkarni, Abhaya V.; Mandel, Scott; Sanders, David; Schemitsch, Emil; Swiontkowski, Marc; Tornetta, Paul; Wai, Eugene; Walter, Stephen D.

    2011-01-01

    Objective To explore the role of patients’ beliefs in their likelihood of recovery from severe physical trauma. Methods We developed and validated an instrument designed to capture the impact of patients’ beliefs on functional recovery from injury; the Somatic Pre-occupation and Coping (SPOC) questionnaire. At 6-weeks post-surgical fixation, we administered the SPOC questionnaire to 359 consecutive patients with operatively managed tibial shaft fractures. We constructed multivariable regression models to explore the association between SPOC scores and functional outcome at 1-year, as measured by return to work and short form-36 (SF-36) physical component summary (PCS) and mental component summary (MCS) scores. Results In our adjusted multivariable regression models that included pre-injury SF-36 scores, SPOC scores at 6-weeks post-surgery accounted for 18% of the variation in SF-36 PCS scores and 18% of SF-36 MCS scores at 1-year. In both models, 6-week SPOC scores were a far more powerful predictor of functional recovery than age, gender, fracture type, smoking status, or the presence of multi-trauma. Our adjusted analysis found that for each 14 point increment in SPOC score at 6-weeks (14 chosen on the basis of half a standard deviation of the mean SPOC score) the odds of returning to work at 1-year decreased by 40% (odds ratio = 0.60; 95% CI = 0.50 to 0.73). Conclusion The SPOC questionnaire is a valid measurement of illness beliefs in tibial fracture patients and is highly predictive of their long-term functional recovery. Future research should explore if these results extend to other trauma populations and if modification of unhelpful illness beliefs is feasible and would result in improved functional outcomes. PMID:22011635

  12. Definitive Management of Open Tibia Fractures Using Limb Reconstruction System.

    PubMed

    Patil, Mahantesh Yellangouda; Gupta, Srinath Myadam; Kurupati, Sri Krishna Chaitanya; Agarwal, Saumya; Chandarana, Vishal

    2016-07-01

    Open fractures are treated as surgical emergency and early administration of intravenous antibiotic coupled with early irrigation and debridement decreases the infection rate dramatically. Limb Reconstruction System (LRS) is a unilateral rail system which consists of Shanz pins, rail rods and sliding clamps. It is specifically designed to enable the surgeon to perform simple and effective surgery as it offers rigid fixation of fracture fragments, allowing early weight bearing and reduces economic burden. To determine the efficacy of Limb Reconstruction System for treatment of compound tibia fractures. A prospective study was carried out where in 54 cases out of 412 compound tibia fractures having Modified Gustilo Anderson Type IIIA and IIIB with a mean age of 42±5 years were treated using LRS over a period of 26 months. Limb reconstruction system was used in acute docking mode or with corticotomy and bone transport was done depending upon the bone loss. The soft tissue condition was assessed and split thickness skin grafting and flap repairs were done as per the need. Clinical and radiological assessment was done at every follow-up. Bony and functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI) criteria. Among 54 patients, bony results as per ASAMI score were excellent in 36, good in 14, fair in 2 and poor in 2 patients. Functional results were excellent in 43, good in 7, fair in 4 patients. The average fracture union time was 8 months. Post-surgery patient satisfaction was excellent since fixation allowed weight bearing immediately. Average hospital stay was 7 days and financial burden was reduced by 40% as compared to multi staged surgery. The average time of return to work was 20 days. LRS is an easy, simple and definitive surgical procedure that allows immediate full weight bearing walking. It reduces hospital stay, is cost effective with excellent patient compliance and can also be used for bone

  13. WhatsApp Messenger is useful and reproducible in the assessment of tibial plateau fractures: inter- and intra-observer agreement study.

    PubMed

    Giordano, Vincenzo; Koch, Hilton Augusto; Mendes, Carlos Henrique; Bergamin, André; de Souza, Felipe Serrão; do Amaral, Ney Pecegueiro

    2015-02-01

    The aim of this study was to evaluate the inter- and intra-observer agreement in the initial diagnosis and classification by means of plain radiographs and CT scans of tibial plateau fractures photographed and sent via WhatsApp Messenger. The increasing popularity of smartphones has driven the development of technology for data transmission and imaging and generated a growing interest in the use of these devices as diagnostic tools. The emergence of WhatsApp Messenger technology, which is available for various platforms used by smartphones, has led to an improvement in the quality and resolution of images sent and received. The images (plain radiographs and CT scans) were obtained from 13 cases of tibial plateau fractures using the iPhone 5 (Apple Inc., Cupertino, CA, USA) and were sent to six observers via the WhatsApp Messenger application. The observers were asked to determine the standard deviation and type of injury, the classification according to the Schatzker and the Luo classifications schemes, and whether the CT scan changed the classification. The six observers independently assessed the images on two separate occasions, 15 days apart. The inter- and intra-observer agreement for both periods of the study ranged from excellent to perfect (0.75<κ<1.0) across all survey questions. When asked if the inclusion of the CT images would change their final X-ray classification (Schatzker or Luo), the inter- and intra-observer agreement was perfect (k=1) on both assessment occasions. We found an excellent inter- and intra-observer agreement in the imaging assessment of tibial plateau fractures sent via WhatsApp Messenger. The authors now propose the systematic use of the application to facilitate faster documentation and obtaining the opinion of an experienced consultant when not on call. Finally, we think the use of the WhatsApp Messenger as an adjuvant tool could be broadened to other clinical centres to assess its viability in other skeletal and non

  14. Effect of Pulsed Wave Low-Level Laser Therapy on Tibial Complete Osteotomy Model of Fracture Healing With an Intramedullary Fixation

    PubMed Central

    Mostafavinia, Atarodalsadat; Masteri Farahani, Reza; Abbasian, Mohammadreza; Vasheghani Farahani, Mohammadmehdi; Fridoni, Mohammadjavad; Zandpazandi, Sara; Ghoreishi, Seyed Kamran; Abdollahifar, Mohammad Amin; Pouriran, Ramin; Bayat, Mohammad

    2015-01-01

    Background: Fractures pose a major worldwide challenge to public health, causing tremendous disability for the society and families. According to recent studies, many in vivo and in vitro experiments have shown the positive effects of PW LLLT on osseous tissue. Objectives: The aim of this study was to evaluate the outcome of infrared pulsed wave low-level laser therapy (PW LLLT) on the fracture healing process in a complete tibial osteotomy in a rat model, which was stabilized by an intramedullary pin. Materials and Methods: This experimental study was conducted at Shahid Beheshti University of Medical Sciences in Tehran, Iran. We performed complete tibial osteotomies in the right tibias for the population of 15 female rats. The rats were divided randomly into three different groups: I) Control rats with untreated bone defects; II) Rats irradiated by a 0.972 J/cm2 PW LLLT; and III) Rats irradiated by a 1.5 J/cm2 PW LLLT. The right tibias were collected six weeks following the surgery and a three-point bending test was performed to gather results. Immediately after biomechanical examination, the fractured bones were prepared for histological examinations. Slides were examined using stereological method. Results: PW LLLT significantly caused an increase in maximum force (N) of biomechanical repair properties for osteotomized tibias in the first and second laser groups (30.0 ± 15.9 and 32.4 ± 13.8 respectively) compared to the control group (8.6 ± 4.5) LSD test, P = 0.019, P = 0.011 respectively). There was a significant increase in the osteoblast count of the first and second laser groups (0.53 ± 0.06, 0.41 ± 0.06 respectively) compared to control group (0.31 ± 0.04) (LSD test, P = 0001, P = 0.007 respectively). Conclusions: This study confirmed the efficacy of PW LLLT on biomechanical strength, trabecular bone volume, callus volume, and osteoblast number of repairing callus in a complete tibial osteotomy animal model at a relatively late stage of the bone

  15. Infectious Complications of Open Type III Tibial Fractures among Combat Casualties

    DTIC Science & Technology

    2007-08-15

    nonunion wound; this organisim was a methicillin- resistant Staphylococcus aureus strain that was inadvertently not treated. Five of 35 patients...Johnson et al. infections seen during the Vietnam conflict, with an increase in the frequency of drug- resistant infection. Recovery of mul- tidrug... resistant gram-negative organisms, notably Acinetobacter calcoaceticus-baumannii complex, Pseudomonas aeruginosa, and Klebsiella pneumoniae, is increasingly

  16. Minimally invasive fixation in tibial plateau fractures using an pre-operative and intra-operative real size 3D printing.

    PubMed

    Giannetti, Silvio; Bizzotto, Nicola; Stancati, Andrea; Santucci, Attilio

    2017-03-01

    The purpose of our study was to compare the outcome after minimally invasive reconstruction and internal fixation with and without the use of pre- and intra-operative real size 3D printing for patients with displaced tibial plateau fractures (TPFs). We prospectively followed up 40 consecutive adult patients with closed TPF who underwent surgical treatment of reconstruction of the tibial plateau with the use of minimally invasive fixation. Sixteen patients (group 1) were operated using a pre-operative and intra-operative real size 3D-model, while 24 patients (group 2) were operated without 3D-model printing, but using only pre-operative and intra-operative 3D Tc-scan images. The mean operating time was 148.2±15.9min for group 1 and 174.5±22.2min for group 2 (p=0.041). In addition, the mean intraoperative blood loss was less in group 1 (520mL) than in group 2 (546mL) (p=0.534). After discharge, all patients were followed up at 6 weeks, 12 weeks, 6 months, 1year and then every year post surgically and radiographic evaluation was carried out each time using clinical and radiological Rasmussen's score, with no significant differences between the two groups. Two patients (group 2) developed infection which resolved within 3 weeks after usage of antibiotics. Neither superficial nor deep infections were present in group 1. In all patients, no non-union occurred. No intraoperative, perioperative, or postoperative complications, such as loss of valgus correction, bone fractures, or metallic plate failures were detected at follow-up. In patients operated with the use of 3D-model printing, we found a significant reduction in surgical time. Moreover, the technique without a 3D-model increased the patient's and the surgeon's exposure to radiation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Land-Surface Subsidence and Open Bedrock Fractures in the Tully Valley, Onondaga County, New York

    USGS Publications Warehouse

    Hackett, William R.; Gleason, Gayle C.; Kappel, William M.

    2009-01-01

    Open bedrock fractures were mapped in and near two brine field areas in Tully Valley, New York. More than 400 open fractures and closed joints were mapped for dimension, orientation, and distribution along the east and west valley walls adjacent to two former brine fields. The bedrock fractures are as much as 2 feet wide and over 50 feet deep, while linear depressions in the soil, which are 3 to 10 feet wide and 3 to 6 feet deep, indicate the presence of open bedrock fractures below the soil. The fractures are probably the result of solution mining of halite deposits about 1,200 feet below the land surface.

  18. Fractures

    MedlinePlus

    A fracture is a break, usually in a bone. If the broken bone punctures the skin, it is called an open ... falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the ...

  19. The role of primary plastic surgery in the management of open fractures.

    PubMed

    Court-Brown, Charles M; Honeyman, Calum S; Clement, Nick D; Hamilton, Stuart A; McQueen, Margaret M

    2015-12-01

    A study was undertaken to determine the requirement for primary plastic surgery in the treatment of open fractures. We reviewed 3297 consecutive open fractures in a 22-year period in a defined population. Analysis showed that 12.6% of patients required primary plastic surgery with 5.6% being treated with split skin grafting and 7.2% with a flap. Only 3.5% of open upper limb fractures required primary plastic surgery compared to 27.9% of open lower limb fractures. The fractures that required most primary plastic surgery were those of the femoral diaphysis and all fractures between the proximal tibia and the midfoot. The incidence of open fractures that require primary plastic surgery was 28/10(6)/year. The incidence in open upper and lower limb fractures was 5.3/10(6)/year and 22.7/10(6)/year respectively. Using these figures it is possible to estimate the numbers of open fractures that will require primary plastic surgery each year in the United Kingdom. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Proportion of and risk factors for open fractures of the appendicular skeleton in dogs and cats.

    PubMed

    Millard, Ralph P; Weng, Hsin-Yi

    2014-09-15

    To evaluate the proportion of and risk factors for open fractures of the appendicular skeleton in dogs and cats that were a result of acute trauma. Cross-sectional and case-control study. 84,629 dogs and 26,675 cats. Dogs and cats examined at Purdue University Veterinary Teaching Hospital from January 1993 through February 2013 were identified; the proportion of open fractures was estimated from the medical records. Additionally, all incident cases of open (77 dogs and 33 cats) and closed (469 dogs and 80 cats) fractures between January 1993 and February 2013 and a random sample of nonfracture patients (722 dogs and 330 cats) in 2010 were used to assess risk factors for open appendicular fractures. Proportion of open fractures for the 20-year period was 0.09% (95% confidence interval [CI], 0.07% to 0.11%) in dogs and 0.12% (95% CI, 0.09% to 0.17%) in cats. Seventy-seven of 546 (14.1%) and 33 of 113 (29.2%) traumatic fractures were classified as open in dogs and cats, respectively. Comminuted fractures were more likely than other configurations to be open in dogs (OR, 5.9; 95% CI, 2.9 to 12.2) and cats (OR, 3.5; 95% CI, 1.0 to 12.0). Vehicle-related trauma was a significant risk factor for open fractures in dogs (OR, 13.8; 95% CI, 3.1 to 61.8). The proportion of incident open fractures in dogs and cats was low. Age, body weight, affected bone or bone segment, fracture configuration, and method of trauma were associated with an open fracture.

  1. Tibial stress injuries: decisive diagnosis and treatment of 'shin splints'.

    PubMed

    Couture, Christopher J; Karlson, Kristine A

    2002-06-01

    Tibial stress injuries, commonly called 'shin splints,' often result when bone remodeling processes adapt inadequately to repetitive stress. Physicians who care for athletic patients need a thorough understanding of this continuum of injuries, including medial tibial stress syndrome and tibial stress fractures, because there are implications for appropriate diagnosis, management, and prevention.

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

    ERIC Educational Resources Information Center

    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…

  3. Non-linear hydrotectonic phenomena: Part I - fluid flow in open fractures under dynamical stress loading

    SciTech Connect

    Archambeau, C.B.

    1994-01-01

    A fractured solid under stress loading (or unloading) can be viewed as behaving macroscopically as a medium with internal, hidden, degrees of freedom, wherein changes in fracture geometry (i.e. opening, closing and extension) and flow of fluid and gas within fractures will produce major changes in stresses and strains within the solid. Likewise, the flow process within fractures will be strongly coupled to deformation within the solid through boundary conditions on the fracture surfaces. The effects in the solid can, in part, be phenomenologically represented as inelastic or plastic processes in the macroscopic view. However, there are clearly phenomena associated with fracture growth and open fracture fluid flows that produce effects that can not be described using ordinary inelastic phenomenology. This is evident from the fact that a variety of energy release phenomena can occur, including seismic emissions of previously stored strain energy due to fracture growth, release of disolved gas from fluids in the fractures resulting in enhanced buoyancy and subsequent energetic flows of gas and fluids through the fracture system which can produce raid extension of old fractures and the creation of new ones. Additionally, the flows will be modulated by the opening and closing of fractures due to deformation in the solid, so that the flow process is strongly coupled to dynamical processes in the surrounding solid matrix, some of which are induced by the flow itself.

  4. [Biomechanical comparison of two different wire stretching methods in the treatment of tibial plateau fractures with the Ilizarov echnique and the related clinical results].

    PubMed

    Cavuşoğlu, Turgay; Ozsoy, M Hakan; Dinçel, V Ercan; Senköylü, Alpaslan; Sakaoğullari, Abdurrahman

    2009-01-01

    In this study, the divergent wire stretching method used to fix the fractured pieces in the Ilizarov technique is biomechanically compared with the olive wire fixation method. Between 1999 and 2005, 36 tibial plateau fractures of 34 patients (27 males, 7 females; mean age 48.4; range 26 to 81 years) were treated with the Ilizarov technique. Divergent wire stretching technique was used in all cases. Patients were mobilized regardless of fracture type and with full load bearing in the shortest possible time after the operation. In the second stage of this study, in order to achieve interfragmentary compression, the reciprocal olive wire method was compared with the divergent wire stretching method developed by us on tibia models at the biomechanic laboratory. All cases were mobilized with full weight bearing at the early postoperative period. The fusion period was 14 weeks and fixators were removed at an average of 19 weeks. No deep infection was observed in any of the cases. No other surgical intervention was required for nonunion or reduction failure. More than 2 mm separation was detected in 12 cases during 24 weeks of observation. But this has not been considered to be clinically significant. In 29 cases, the knee range of motion was 0-135 degrees. In the biomechanical phase of the study, no distinct difference was observed between the classic olive wire stretching method and the divergent wire stretching method regarding the preservation of the interfragmentary compression under weight. The divergent wire stretching method was significantly superior in achieving an homogeneous interfragmentary compression. The divergent wire stretching technique applied parallel to the Ilizarov fixation technique is an effective method for the early and unrestricted mobilization of the patients and the preservation of the range-of-motion of the joint.

  5. Predicting the occurrence of open natural fractures in shale reservoirs

    SciTech Connect

    Decker, A.D.; Klawitter, A.L. )

    1996-01-01

    Prolific oil and gas production has been established from naturally fractured shale reservoirs. For example, in the last few years over 4 Tcf of gas reserves have been established within the self-sourcing Antrim Shale of the Michigan Basin. Historically, locating subsurface fracture systems essential for commercial production has proven elusive and costly. An integrated exploration approach utilizing available geologic, geophysical, and remote sensing data has successfully located naturally fractured zones within the Antrim Shale. It is believed that fracturing of the Antrim shale was a result of basement involved tectonic processes. Characteristic integrated stacked signatures of known fracture systems within the Antrim were built using gravity and magnetic data, structure maps, fracture identification logs, and Landsat imagery. Wireline fracture logs pinpointed the locations and geometries of subsurface fracture systems. Landsat imagery was interpreted to reveal surficial manifestations of subsurface structures.

  6. Predicting the occurrence of open natural fractures in shale reservoirs

    SciTech Connect

    Decker, A.D.; Klawitter, A.L.

    1996-12-31

    Prolific oil and gas production has been established from naturally fractured shale reservoirs. For example, in the last few years over 4 Tcf of gas reserves have been established within the self-sourcing Antrim Shale of the Michigan Basin. Historically, locating subsurface fracture systems essential for commercial production has proven elusive and costly. An integrated exploration approach utilizing available geologic, geophysical, and remote sensing data has successfully located naturally fractured zones within the Antrim Shale. It is believed that fracturing of the Antrim shale was a result of basement involved tectonic processes. Characteristic integrated stacked signatures of known fracture systems within the Antrim were built using gravity and magnetic data, structure maps, fracture identification logs, and Landsat imagery. Wireline fracture logs pinpointed the locations and geometries of subsurface fracture systems. Landsat imagery was interpreted to reveal surficial manifestations of subsurface structures.

  7. Bifocal osseous avulsion of the patellar tendon from the distal patella and tibial tuberosity in a child.

    PubMed

    Hermansen, Lars L; Freund, Knud G

    2016-03-01

    This case report describes a 12-year-old boy, who suffered an injury to the right knee in a skateboard accident. Radiographs and surgery confirmed the extremely rare bifocal avulsion fracture including the distal patellar pole and tibial tuberosity. Open reduction and internal fixation was accomplished, and 4-month follow-up demonstrated a good outcome.

  8. A cross-sectional study of the effects of load carriage on running characteristics and tibial mechanical stress: implications for stress-fracture injuries in women.

    PubMed

    Xu, Chun; Silder, Amy; Zhang, Ju; Reifman, Jaques; Unnikrishnan, Ginu

    2017-03-23

    Load carriage is associated with musculoskeletal injuries, such as stress fractures, during military basic combat training. By investigating the influence of load carriage during exercises on the kinematics and kinetics of the body and on the biomechanical responses of bones, such as the tibia, we can quantify the role of load carriage on bone health. We conducted a cross-sectional study using an integrated musculoskeletal-finite-element model to analyze how the amount of load carriage in women affected the kinematics and kinetics of the body, as well as the tibial mechanical stress during running. We also compared the biomechanics of walking (studied previously) and running under various load-carriage conditions. We observed substantial changes in both hip kinematics and kinetics during running when subjects carried a load. Relative to those observed during running without load, the joint reaction forces at the hip increased by an average of 49.1% body weight when subjects carried a load that was 30% of their body weight (ankle, 4.8%; knee, 20.6%). These results indicate that the hip extensor muscles in women are the main power generators when running with load carriage. When comparing running with walking, finite element analysis revealed that the peak tibial stress during running (tension, 90.6 MPa; compression, 136.2 MPa) was more than three times as great as that during walking (tension, 24.1 MPa; compression, 40.3 MPa), whereas the cumulative stress within one stride did not differ substantially between running (15.2 MPa · s) and walking (13.6 MPa · s). Our findings highlight the critical role of hip extensor muscles and their potential injury in women when running with load carriage. More importantly, our results underscore the need to incorporate the cumulative effect of mechanical stress when evaluating injury risk under various exercise conditions. The results from our study help to elucidate the mechanisms of stress fracture in women.

  9. Tibial plateau levelling osteotomy locking-compression plates for stabilisation of canine and feline ilial body fractures.

    PubMed

    Guthrie, J W; Kalff, S

    2017-12-12

    To evaluate the clinical and radiographic outcomes following surgical stabilisation of ilial fractures in dogs and cats using a laterally applied Synthes TPLO locking compression plate. Medical records and radiographs of seven dogs and two cats which had undergone surgical repair of an ilial body fracture with a TPLO locking compression plate were reviewed. Long-term clinical follow-up was obtained from an owner or referring veterinarian questionnaire. Fracture reduction was anatomic in six of nine ilia and near-anatomic in three of nine. All but one fracture achieved osseous union by 6 weeks after surgery. No screw loosening or implant-related complications occurred in any patient. There was pelvic canal narrowing in six of nine patients (median reduction in pelvic canal diameter was 4·9%). No intraoperative or postoperative complications were reported. Lateral plating of canine and feline ilial fractures with a Synthes TPLO locking compression plate was associated with a low complication rate and satisfactory radiographic and clinical outcomes in this small case series. © 2017 British Small Animal Veterinary Association.

  10. Complication rate following high tibial open-wedge osteotomy with spacer plates for incipient osteoarthritis of the knee with varus malalignment.

    PubMed

    Osti, Michael; Gohm, Alexander; Schlick, Bernd; Benedetto, Karl Peter

    2015-07-01

    Medial open-wedge high tibial osteotomy (HTO) with spacer plates is recommended to correct varus malalignment of the knee with symptomatic overload of the medial compartment. Fifty-five knees in 50 patients were assessed. Intra- and post-operative complications were recorded, and Tegner, Lysholm and IKDC scores were used to evaluate functional results. Radiological parameters consisted of medial proximal tibial angle (aMPTA), femorotibial angle (aFTA), posterior proximal tibial angle, lateral distal femur angle, mechanical axis deviation (MAD) and osteoarthritis score (Jäger and Wirth). Duration of follow-up was 5.0 ± 1.4 years. Overall and implant-related complication rates were 27.3 and 10.9 %, respectively. No statistical association could be detected between overall and implant-related complication rates and age, gender, wedge size, angle of correction or body mass index. Mean improvement in Lysholm score was 26.8. Overall IKDC scores at follow-up were A25, B26, C2 and D2. Post-operative correction of MPTA and FTA averaged to 89.6° and 173° and to 89° and 173.5° at follow-up, respectively. Initial MAD of 21.8 mm was corrected to 11.8 mm at follow-up. Osteoarthritis score increased from 1.4 ± 0.9 to 1.9 ± 0.9 points. HTO with spacer plates improves knee function and is an effective procedure in selected patients. Overall and implant-related complication rates should be considered and seem to be lower with a smaller angle of correction corresponding to incipient osteoarthritis and less varus deformity. Retrospective case series, Level IV.

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

    PubMed

    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.

  12. Combat-related acetabular fractures: Outcomes of open versus closed injuries.

    PubMed

    Purcell, Richard L; Donohue, Michael A; Saxena, Sameer K; Gordon, Wade T; Lewandowski, Louis L

    2018-02-01

    Since the onset of the Global War on Terror close to 50,000 United States service members have been injured in combat, many of these injuries would have previously been fatal. Among these injuries, open acetabular fractures are at an increased number due to the high percentage of penetrating injuries such as high velocity gunshot wounds and blast injuries. These injuries lead to a greater degree of contamination, and more severe associated injuries. There is a significantly smaller proportion of the classic blunt trauma mechanism typically seen in civilian trauma. We performed a retrospective review of the Department of Defense Trauma Registry into which all US combat-injured patients are enrolled, as well as reviewed local patient medical records, and radiologic studies from March 2003 to April 2012. Eighty seven (87) acetabular fractures were identified with 32 classified as open fractures. Information regarding mechanism of injury, fracture pattern, transfusion requirements, Injury Severity Score (ISS), and presence of lower extremity amputations was analyzed. The mechanism of injury was an explosive device in 59% (n=19) of patients with an open acetabular fracture; the remaining 40% (n=13) were secondary to ballistic injury. In contrast, in the closed acetabular fracture cohort 38% (21/55) of fractures were due to explosive devices, and all remaining (n=34) were secondary to blunt trauma such as falls, motor vehicle collisions, or aircraft crashes. Patients with open acetabular fractures required a median of 17units of PRBC within the first 24h after injury. The mean ISS was 32 in the open group compared with 22 in the closed group (p=0.003). In the open fracture group nine patients (28%) sustained bilateral lower extremity amputations, and 10 patients (31%) ultimately underwent a hip disarticulation or hemi-pelvectomy as their final amputation level. Open acetabular fractures represent a significant challenge in the management of combat-related injuries. High

  13. Decreased QOL and muscle strength are persistent 1 year after intramedullary nailing of a tibial shaft fracture: a prospective 1-year follow-up cohort study.

    PubMed

    Larsen, Peter; Elsoe, Rasmus; Laessoe, Uffe; Graven-Nielsen, Thomas; Eriksen, Christian Berre; Rasmussen, Sten

    2016-10-01

    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. The design was a prospective, follow-up cohort study. QOL 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 were recorded at 6 and 12 months. Forty-nine patients were included. The mean age at the time of fracture was 43.1 years (18-79 years). Twelve months postoperatively, the mean Eq5D-5L index was 0.792 (95 % CI 0.747-0.837). Throughout the 12 months postoperatively, patients reported worse 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 < 0.001). Twelve months postoperatively, increasing relative difference in muscle strength during knee extension show a fair correlation to worse QOL (R = 0.541, P < 0.001). Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Muscle strength in the non-injured leg improved over time and was higher after 6 and 12 months compared with the injured leg.

  14. Current Concepts and Ongoing Research in the Prevention and Treatment of Open Fracture Infections

    PubMed Central

    Hannigan, Geoffrey D.; Pulos, Nicholas; Grice, Elizabeth A.; Mehta, Samir

    2015-01-01

    Significance: Open fractures are fractures in which the bone has violated the skin and soft tissue. Because of their severity, open fractures are associated with complications that can result in increased lengths of hospital stays, multiple operative interventions, and even amputation. One of the factors thought to influence the extent of these complications is exposure and contamination of the open fracture with environmental microorganisms, potentially those that are pathogenic in nature. Recent Advances: Current open fracture care aims to prevent infection by wound classification, prophylactic antibiotic administration, debridement and irrigation, and stable fracture fixation. Critical Issues: Despite these established treatment paradigms, infections and infection-related complications remain a significant clinical burden. To address this, improvements need to be made in our ability to detect bacterial infections, effectively remove wound contamination, eradicate infections, and treat and prevent biofilm formation associated with fracture fixation hardware. Future Directions: Current research is addressing these critical issues. While culture methods are of limited value, culture-independent molecular techniques are being developed to provide informative detection of bacterial contamination and infection. Other advanced contamination- and infection-detecting techniques are also being investigated. New hardware-coating methods are being developed to minimize the risk of biofilm formation in wounds, and immune stimulation techniques are being developed to prevent open fracture infections. PMID:25566415

  15. Use of intramedullary fully-threaded pins in the fixation of feline and canine humeral, femoral and tibial fractures.

    PubMed

    Altunatmaz, K; Ozsoy, S; Mutlu, Z; Devecioglu, Y; Guzel, O

    2012-01-01

    Intramedullary fully-threaded pins were manufactured from an alloy of titanium, aluminium and vanadium in a fully-threaded style. Pins were produced in various diameters, ranging from 4 mm to 11 mm. Pin lengths varied from 5 cm to 22 cm. The proximal end of the pins was designed to fit into a hexagonal screwdriver, while the distal end was slightly tapered to allow for ease of entry into cancellous bone. Treatment using the fully-threaded intra- medullary pin was carried out in a total of 175 fractures of the humerus, femur, and tibia in 95 cats (bilateral femur in 1 case) and 77 dogs (bilateral femur in 2 cases). Radiographic follow-up for the cases was performed at monthly intervals. Non-union developed in one dog with a femoral fracture in which cerclage wire had also been used. Delayed healing and lameness were observed in two other dogs. Healing with excessive callus formation was observed in 16 dogs. However, there were not any problems noted in these dogs in regards to limb usage. Clinical and radiological results obtained for the remaining cases were found to be very good. Normal, complete fracture healing occurred between four to 14 weeks in dogs, and between four to 12 weeks in cats. Pins were removed upon observation of satisfactory functional and radiographic recovery. Pins could not be removed from 26 cats and 21 dogs as the owners had declined pin removal, or because the owners were lost to follow-up.

  16. High Tibial Osteotomy

    PubMed Central

    Byun, Seong Joon

    2012-01-01

    High tibial osteotomy (HTO) is a widely performed procedure to treat medial knee arthrosis. In general, published studies on HTO report good long-term results with a correct patient selection and a precise surgical technique. The ideal candidate for an HTO is a middle aged patient (60 to 65 years of age), with isolated medial osteoarthritis, with good range of motion and without ligamentous instability. Some issues that need resolution remain; these include the choice between opening and closing wedge tibial osteotomy, the graft selection in opening wedge osteotomies, the type of fixation, the comparison with unicompartmental knee arthroplasty and whether HTO significantly affects a subsequent total joint replacement. Precise indication, preoperative planning, and operative technique selection are essential to achieve good results. PMID:22708105

  17. OPEN PELVIC FRACTURES: THE UNIVERSITY OF TENNESSEE MEDICAL CENTER AT KNOXVILLE EXPERIENCE OVER TEN YEARS

    PubMed Central

    Black, Emily Anne; Lawson, Christy M; Smith, Scott; Daley, Brian J

    2011-01-01

    Introduction Open fractures of the pelvis remain a devastating injury with a high mortality and morbidity. Such injuries require an aggressive treatment plan and the coordination of trauma and orthopaedic surgeons to achieve the best outcomes. We report our experience at the University of Tennessee Medical Center at Knoxville with open pelvic fractures over the last ten years. Methods After IRB and institutional approval, we reviewed patients admitted with a diagnosis of open fracture of the pelvis from 1999 to 2009. Demographic and admission data were recorded in the trauma registry (TRACS) of the Level I Trauma Center, serving the 1.2 million people living in the regions of east Tennessee, western North Carolina and southeastern Kentucky. Data on fractures were obtained from review of the medical records and radiographs within the chart Results There were 3053 pelvic fractures from January 1999 to December 2009. There were 231 deaths in this group (6%) and ages ranged from 18 to 89 years old and Injury Severity Scores ranged from 4 to 75, with a mean of 18.3. Seventy five percent of patients were able to be discharged home. Fifty-two fractures were open. There were 43 men and the mean age was 39 years old. Average ISS was 23 and ranged from 5 to 50. There were 10 deaths (19%) and eight patients underwent an-gioembolization for control of bleeding (3 deaths). Motorcycle crashes were the most frequent cause of an open fracture, with lateral compression injuries representing 71%. A defined algorithm for fracture management has been in place and employed to assure adequate resuscitation and fracture care and is presented. Discussion Open pelvic fractures are usually the result of a high energy transfer, and convey a high morbidity and mortality. A defined resuscitation and fixation strategy improves outcome from historical reports. Injuries from penetrating mechanisms are associated with less morbidity and lower mortality. PMID:22096441

  18. Anterior tibial striations.

    PubMed

    Daffner, R H

    1984-09-01

    Radiolucent horizontal striations of the anterior cortex of the tibia were seen in 10 athletes who were evaluated for "shin-splints." There were seven basketball players, two professional dancers, and one hurdler. Each patient's history included vigorous leaping in performance of athletic feats. All the lesions were similar in location and appearance and were accompanied by thickening of the anterior tibial cortex. These striations are considered stress fractures and were not observed in a group of runners who were evaluated for shin-splints.

  19. The role of local stress perturbation on the simultaneous opening of orthogonal fractures

    NASA Astrophysics Data System (ADS)

    Boersma, Quinten; Hardebol, Nico; Barnhoorn, Auke; Bertotti, Giovanni; Drury, Martyn

    2016-04-01

    Orthogonal fracture networks (ladder-like networks) are arrangements that are commonly observed in outcrop studies. They form a particularly dense and well connected network which can play an important role in the effective permeability of tight hydrocarbon or geothermal reservoirs. One issue is the extent to which both the long systematic and smaller cross fractures can be simultaneously critically stressed under a given stress condition. Fractures in an orthogonal network form by opening mode-I displacements in which the main component is separation of the two fracture walls. This opening is driven by effective tensile stresses as the smallest principle stress acting perpendicular to the fracture wall, which accords with linear elastic fracture mechanics. What has been well recognized in previous field and modelling studies is how both the systematic fractures and perpendicular cross fractures require the minimum principle stress to act perpendicular to the fracture wall. Thus, these networks either require a rotation of the regional stress field or local perturbations in stress field. Using a mechanical finite element modelling software, a geological case of layer perpendicular systematic mode I opening fractures is generated. New in our study is that we not only address tensile stresses at the boundary, but also address models using pore fluid pressure. The local stress in between systematic fractures is then assessed in order to derive the probability and orientation of micro crack propagation using the theory of sub critical crack growth and Griffith's theory. Under effective tensile conditions, the results indicate that in between critically spaced systematic fractures, local effective tensile stresses flip. Therefore the orientation of the least principle stress will rotate 90°, hence an orthogonal fracture is more likely to form. Our new findings for models with pore fluid pressures instead of boundary tension show that the magnitude of effective tension

  20. CERAMENT treatment of fracture defects (CERTiFy): protocol for a prospective, multicenter, randomized study investigating the use of CERAMENT™ BONE VOID FILLER in tibial plateau fractures.

    PubMed

    Nusselt, Thomas; Hofmann, Alexander; Wachtlin, Daniel; Gorbulev, Stanislav; Rommens, Pol Maria

    2014-03-08

    Bone graft substitutes are widely used for reconstruction of posttraumatic bone defects. However, their clinical significance in comparison to autologous bone grafting, the gold-standard in reconstruction of larger bone defects, still remains under debate. This prospective, randomized, controlled clinical study investigates the differences in pain, quality of life, and cost of care in the treatment of tibia plateau fractures-associated bone defects using either autologous bone grafting or bioresorbable hydroxyapatite/calcium sulphate cement (CERAMENT™|BONE VOID FILLER (CBVF)). CERTiFy (CERament™ Treatment of Fracture defects) is a prospective, multicenter, controlled, randomized trial. We plan to enroll 136 patients with fresh traumatic depression fractures of the proximal tibia (types AO 41-B2 and AO 41-B3) in 13 participating centers in Germany. Patients will be randomized to receive either autologous iliac crest bone graft or CBVF after reduction and osteosynthesis of the fracture to reconstruct the subchondral bone defect and prevent the subsidence of the articular surface. The primary outcome is the SF-12 Physical Component Summary at week 26. The co-primary endpoint is the pain level 26 weeks after surgery measured by a visual analog scale. The SF-12 Mental Component Summary after 26 weeks and costs of care will serve as key secondary endpoints. The study is designed to show non-inferiority of the CBVF treatment to the autologous iliac crest bone graft with respect to the physical component of quality of life. The pain level at 26 weeks after surgery is expected to be lower in the CERAMENT bone void filler treatment group. CERTiFy is the first randomized multicenter clinical trial designed to compare quality of life, pain, and cost of care in the use of the CBVF and the autologous iliac crest bone graft in the treatment of tibia plateau fractures. The results are expected to influence future treatment recommendations. ClinicalTrials.gov: NCT01828905.

  1. SUPRA AND INTRACONDYLAR OPEN FRACTURE OF THE FEMUR IN A MOTOCROSS ATHLETE: CASE REPORT

    PubMed Central

    Filho, Jorge Sayum; Sayum, Jorge; de Carvalho, Rogério Teixeira; Nicolini, Alexandre; Matsuda, Marcelo Mitsuro; Cheng, Wu Tu; Cohen, Moisés

    2015-01-01

    The authors report the case of a patient (amateur motocross competitor) who suffered a fall during a motocross competition resulting in a supra and intracondylar open fracture in the right femur. PMID:27027061

  2. Muscle-bone Interactions During Fracture Healing

    DTIC Science & Technology

    2015-03-01

    Harry et al. observed faster fracture healing in muscu- locutaneous compared to fasciocutaneous flaps, despite the musculocutaneous flaps having...The work of Zacks and Sheff confirmed the importance of studying the trophic influence of muscle on bone. As previously mentioned, Harry et al...study conducted by Harry et al.27, Gopal et al.124 specifically examined the treatment of open tibial fractures with fasciocutaneous flaps versus muscle

  3. MRI of Polyethylene Tibial Inserts in Total Knee Arthroplasty: Normal and Abnormal Appearances.

    PubMed

    Li, Angela E; Sneag, Darryl B; Miller, Theodore T; Lipman, Joseph D; Padgett, Douglas E; Potter, Hollis G

    2016-06-01

    The purpose of this study was to describe the normal and abnormal MRI appearances of polyethylene tibial inserts. Subjects who underwent MRI before revision total knee arthroplasty were identified. The polyethylene tibial insert's shape was categorized on MRI, and the presence of abnormalities was noted. The shape of the polyethylene tibial insert varied with the design. Polyethylene tibial insert abnormalities seen on MRI included displacement and fracture. MRI distinguishes various designs of polyethylene tibial inserts and can show associated abnormalities.

  4. Management of Open Lower Extremity Wounds With Concomitant Fracture Using a Porcine Urinary Bladder Matrix.

    PubMed

    Kraemer, Bruce A; Geiger, Scott E; Deigni, Oliver A; Watson, John Tracy

    2016-11-01

    Open wounds of the distal third of the leg and foot with exposed bone, fractures, and hardware are challenging wounds for which to achieve stable coverage. The orthopedic advances in lower extremity fracture management over the last 30 years have allowed a rethinking of the standard operative approach to close these complex wounds. The ability of extracellular matrix (ECM) products to facilitate constructive remodeling of a wound seemed a reasonable approach for treatment, especially in patients who are often poor surgical candidates for more advanced reconstructive procedures. The authors reviewed 9 patients with 11 open fractures of the leg, ankle, or foot treated with a newer ECM wound healing device to total closure. The clinical course and patient management are reviewed. The authors conclude that newer ECM products can provide a reasonable method of management for patients who have wounds with exposed hardware, distal leg wounds, and open foot fractures compared to prolonged negative pressure wound therapy or complex reconstructive operative procedures.

  5. Compartment syndrome after tibial plateau fracture☆

    PubMed Central

    Pitta, Guilherme Benjamin Brandão; dos Santos, Thays Fernanda Avelino; dos Santos, Fernanda Thaysa Avelino; da Costa Filho, Edelson Moreira

    2014-01-01

    Fractures of the tibial plateau are relatively rare, representing around 1.2% of all fractures. The tibia, due to its subcutaneous location and poor muscle coverage, is exposed and suffers large numbers of traumas, not only fractures, but also crush injuries and severe bruising, among others, which at any given moment, could lead compartment syndrome in the patient. The case is reported of a 58-year-old patient who, following a tibial plateau fracture, presented compartment syndrome of the leg and was submitted to decompressive fasciotomy of the four right compartments. After osteosynthesis with internal fixation of the tibial plateau using an L-plate, the patient again developed compartment syndrome. PMID:26229779

  6. Partial proximal tibia fractures

    PubMed Central

    Raschke, Michael J.; Kittl, Christoph; Domnick, Christoph

    2017-01-01

    Partial tibial plateau fractures may occur as a consequence of either valgus or varus trauma combined with a rotational and axial compression component. High-energy trauma may result in a more complex and multi-fragmented fracture pattern, which occurs predominantly in young people. Conversely, a low-energy mechanism may lead to a pure depression fracture in the older population with weaker bone density. Pre-operative classification of these fractures, by Müller AO, Schatzker or novel CT-based methods, helps to understand the fracture pattern and choose the surgical approach and treatment strategy in accordance with estimated bone mineral density and the individual history of each patient. Non-operative treatment may be considered for non-displaced intra-articular fractures of the lateral tibial condyle. Intra-articular joint displacement ⩾ 2 mm, open fractures or fractures of the medial condyle should be reduced and fixed operatively. Autologous, allogenic and synthetic bone substitutes can be used to fill bone defects. A variety of minimally invasive approaches, temporary osteotomies and novel techniques (e.g. arthroscopically assisted reduction or ‘jail-type’ screw osteosynthesis) offer a range of choices for the individual and are potentially less invasive treatments. Rehabilitation protocols should be carefully planned according to the degree of stability achieved by internal fixation, bone mineral density and other patient-specific factors (age, compliance, mobility). To avoid stiffness, early functional mobilisation plays a major role in rehabilitation. In the elderly, low-energy trauma and impression fractures are indicators for the further screening and treatment of osteoporosis. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160067. Originally published online at www.efortopenreviews.org PMID:28630761

  7. Risk factors for infectious complications after open fractures; a systematic review and meta-analysis.

    PubMed

    Kortram, Kirsten; Bezstarosti, Hans; Metsemakers, Willem-Jan; Raschke, Michael J; Van Lieshout, Esther M M; Verhofstad, Michael H J

    2017-10-01

    The purpose of this study was to identify risk factors for the development of infection after open fracture fixation. A comprehensive search in all scientific literature of the last 30 years was performed in order to identify patient-, trauma-, diagnosis- and treatment-related risk factors. Studies were included when infectious complications were assessed in light of one or more risk factors. A meta-analysis was performed. Risk ratios (RR) or risk differences (RD) with 95% confidence intervals were calculated. A total of 116 manuscripts were included. Male gender (RR 1.42), diabetes mellitus (DM) (RR 1.72), smoking (RR1.29), a lower extremity fracture (RR 1.94), Gustilo-Anderson grade III open fracture (RR 3.01), contaminated fracture (RR 7.85) and polytrauma patients (RR 1.49) were identified as statistically significant risk factors for the development of infectious complications. Of the treatment-related risk factors, only pulsatile lavage was associated with a higher infectious complication rate (RR 2.70). A number of risk factors for the development of infections after open fractures have been identified in the available literature. These factors should still be tested for independence in a multivariable model. Prospective, observational studies are needed to identify and quantify individual risk factors for infection after open fracture fixation.

  8. Risk Factors for Open Malleolar Fractures: An Analysis of the National Trauma Data Bank (2007 to 2011).

    PubMed

    Shibuya, Naohiro; Liu, George T; Davis, Matthew L; Grossman, Jordan P; Jupiter, Daniel C

    2016-01-01

    A limited number of studies have described the epidemiology of open fractures, and the epidemiology of open ankle fractures is not an exception. Therefore, the risk factors associated with open ankle fractures have not been extensively evaluated. The frequencies and proportions of open ankle fractures among all the recorded malleolar fractures in the US National Trauma Data Bank data set from January 2007 to December 2011 were analyzed. Clinically relevant variables captured in the data set were also used to evaluate the risk factors associated with open ankle fractures, adjusting for other covariates. The entire cohort was further subdivided into "lower" and "higher" energy trauma groups and the same analysis performed for each group separately. We found that a body mass index of >40 kg/m(2) and farm location were risk factors for open ankle fractures and impaired sensorium was protective against open ankle fractures. In the "lower energy" group, male gender, alcohol use, peripheral vascular disease, other injuries, and injury occurring at a farm location were risk factors for open fractures. In the "higher energy" group, female gender, work-related injury, and injury at a farm or industry location demonstrated statistically significantly associations with open fractures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Arthroscopy-assisted fracture fixation.

    PubMed

    Atesok, Kivanc; Doral, M Nedim; Whipple, Terry; Mann, Gideon; Mei-Dan, Omer; Atay, O Ahmet; Beer, Yiftah; Lowe, Joseph; Soudry, Michael; Schemitsch, Emil H

    2011-02-01

    the purpose of this article was to systematically analyze the results of published studies in the literature which evaluated the use of arthroscopically assisted techniques in intra-articular fracture fixation. published investigations to date were analyzed by classifying them according to joints that were involved with intra-articular fractures including: knee, ankle, hip, shoulder, elbow, and wrist joints. The results were studied to assess the feasibility, efficiency, and outcomes of arthroscopy-assisted fracture fixation. arthroscopy-assisted techniques have been used successfully for the treatment of fractures of the tibial plateau, tibial eminence, malleoli, pilon, calcaneus, femoral head, glenoid, greater tuberosity, distal clavicle, radial head, coronoid, distal radius, and scaphoid. The major advantages of arthroscopic fracture fixation over open methods are direct visualization of the intra-articular space, decreased invasiveness, and the possibility for multitask interventions through which fixation of the fracture, and repair of the soft tissues and the cartilage can be performed simultaneously. The time-consuming and technically demanding nature of the procedures with a prolonged learning curve and limited fixation alternatives are the main disadvantages of this technique. arthroscopic fixation is increasingly utilized for certain intra-articular fracture types due to the minimally invasive nature of the procedures and high accuracy. Randomized controlled trials are needed to justify wider use of arthroscopy-assisted techniques for treatment of intra-articular fractures.

  10. Antibiotic related acute kidney injury in patients treated for open fractures.

    PubMed

    Pannell, William C; Banks, Kian; Hahn, Joseph; Inaba, Kenji; Marecek, Geoffrey S

    2016-03-01

    Antibiotic administration during the treatment of open fractures has been shown to reduce infection rates and is considered a critical step in the management of these injuries. The purpose of this study was to determine if aminoglycoside administration during the treatment of open fractures leads to acute kidney injury. Patient records at a level I trauma centre were reviewed for adult patients who presented in 2014 with open fractures were screened for inclusion. Patients were excluded with fractures of the phalanges, metatarsals, and metacarpals, with isolated traumatic arthrotomies, or pre-existing renal dysfunction. Charts were reviewed for patient age, gender, race, past medical history, medication history, injury severity score, intravenous dye studies and fracture type. Patients were divided into those given cefazolin (Group A) and cefazolin with gentamicin (Group B). Laboratory values were used to determine which patients developed kidney dysfunction as measured using the RIFLE criteria. Wilcoxon-Mann-Whitney test and Chi-square were used to compare interval and categorical variables, respectively. Significance was set at P<0.05. One-hundred and fifty-nine patients met inclusion criteria. Forty-one (25%) patients were given cefazolin alone and 113 (68%) patients were given cefazolin with gentamicin. Ten (18%) patients with Gustilo-Anderson type III fractures were given cefazolin alone and 67 (67%) patients with types I or II fractures were given a cefazolin with gentamicin. Baseline characteristics and risk factors for renal dysfunction did not vary between groups. Two (4.8%) patients in Group A and 5 (4%) patients in Group B developed acute kidney injury (P=0.599). Gentamicin use during the treatment of open fractures does not lead to increased rates of renal dysfunction when used in patients with normal baseline renal function. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Antibiotic-impregnated calcium sulfate use in combat-related open fractures.

    PubMed

    Helgeson, Melvin D; Potter, Benjamin K; Tucker, Christopher J; Frisch, H Michael; Shawen, Scott B

    2009-05-01

    This article presents our experience with the use of antibiotic-impregnated calcium sulfate in the management of comminuted open fractures with a bony defect caused by combat-related blast injuries and high-energy wounds. Calcium sulfate was used 19 times in 15 patients (17 fractures) as a bone graft substitute and a carrier for antibiotics. The anatomic sites of the graft were as follows: 6 calcanei, 1 midfoot, 1 metatarsal, 5 tibiae, 3 femorae, and 1 humerus. The average number of procedures prior to grafting was 6.2 (range, 2-10; median, 6) with grafting performed at an average 28 days after injury (range, 9-194 days; median, 14 days). Average radiographic follow-up of 12 fractures not requiring repeat grafting or amputation was 8.5 months (range 1-19 months; median, 7 months), and all of these fractures demonstrated clinical and radiographic evidence of fracture healing and consolidation. Four patients subsequently underwent 5 transtibial amputations: 2 for persistent infection, 1 when the patient changed his mind against limb salvage acutely, and 2 for severe neurogenic pain. Including the 2 amputations for persistent infection, 4 patients (22.2%) required further surgical management of infection. Three patients (17.6%) subsequently developed heterotopic ossification at the graft site, which required surgical excision. Antibiotic-impregnated calcium sulfate is effective in treating severe, contaminated open fractures by reducing infection and assisting with fracture union.

  12. Recovery of mouth-opening after closed treatment of a fracture of the mandibular condyle: a longitudinal study.

    PubMed

    Niezen, E T; Stuive, I; Post, W J; Bos, R R M; Dijkstra, P U

    2015-02-01

    The aim of this retrospective study was to assess recovery of mouth opening after closed treatment of fractures of the mandibular condyle, and analyse which characteristics might influence recovery. We measured mouth opening in 142 patients (mean (SD) age 30 (14) years, 96 of whom were male) during follow-up at 3, 6, 13, 26, and 52 weeks after the injury. Fractures were assessed on radiographs. Data were analysed using a multilevel analysis. Half the fractures were of the low condylar neck (n=71). Thirty-seven patients had bilateral condylar fractures, 29 had dislocated fractures, and in 80 the fracture was displaced. One or more additional mandibular fractures were present in 68. During follow-up mean (SD) mouth opening increased to: 33.6 (9.6) at 3 weeks, 40.1 (10.0) at 6 weeks, 45.1 (9.6) at 13 weeks, 49.8 (9.5) at 26 weeks, and 52.6 (7.5) at 52 weeks. Older age, female sex, displaced fracture, bilateral fractures, additional mandibular fractures, and the interaction between follow-up time and additional mandibular fractures, were predictors of a less favourable recovery of mouth opening. Clinicians can use the results of this study to predict recovery of mouth opening after closed treatment of fractures of the mandibular condyle at first consultation. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Three-dimensional mandibular motion after closed and open reduction of unilateral mandibular condylar process fractures.

    PubMed

    Sforza, Chiarella; Ugolini, Alessandro; Sozzi, Davide; Galante, Domenico; Mapelli, Andrea; Bozzetti, Alberto

    2011-06-01

    To detect the changes in 3D mandibular motion after two types of condylar fracture therapies. Using a 3D motion analyzer, free mandibular border movements were recorded in 21 patients successfully treated for unilateral fractures of the mandibular condylar process (nine patients: open reduction, rigid internal fixation, and functional treatment; 12 patients: closed reduction and functional treatment; follow-up: 6-66 months), and in 25 control subjects. No differences were found among the groups at maximum mouth opening (MO), protrusion and in lateral excursions. During opening, the patients had a larger maximal deviation to the fractured side than the controls (controls 2.3 mm, open treatment 3.9 mm, closed treatment 4.2 mm; Kruskal-Wallis test, p=0.014; closed treatment vs. controls, p=0.004), with a larger coronal plane angle (controls 2.4°, open treatment 3.6°, closed treatment 4.4°; p=0.016; closed treatment vs. controls, p=0.013). In the closed treatment patients, a longer follow-up was related to increased maximum MO (p=0.04), sagittal plane angle (p=0.03), and reduced lateral mandibular deviation during MO (p=0.03). Mandibular condylar fractures can recover good function; some kinematic variables of mandibular motion were more similar to the norm in the open treatment patients than in closed treatment patients. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  14. A matched-pair comparison of two different locking plates for valgus-producing medial open-wedge high tibial osteotomy: peek-carbon composite plate versus titanium plate.

    PubMed

    Cotic, Matthias; Vogt, Stephan; Hinterwimmer, Stefan; Feucht, Matthias J; Slotta-Huspenina, Julia; Schuster, Tibor; Imhoff, Andreas B

    2015-07-01

    The first purpose of this study was to compare the clinical and radiographic outcome of two different locking plates used for valgus-producing medial open-wedge high tibial osteotomy (HTO). The second purpose was to histologically evaluate peek-carbon wear for biocompatibility. Twenty-six consecutive patients undergoing open-wedge HTO using the first-generation PEEKPower HTO-Plate® (Group I) were matched with 26 patients after open-wedge HTO with the TomoFix™ plate (Group II). Clinical scores (visual analogue scale for pain, WOMAC, Lysholm score) were obtained preoperatively and at a minimum follow-up of 24 months postoperatively. Fixation stability was evaluated radiographically by comparing the medial proximal tibial angle (MPTA) and tibial slope 2 days after open-wedge HTO and after implant removal. Tissue samples of Group I were collected at the time of implant removal for histologic evaluation. Implant-related complications occurred in 15 % (n = 4) of Group I and 0 % of Group II. Out of them, 3 implant replacements were excluded from statistical analyses. After a final median follow-up of 25 months (range 24-31), the clinical scores in both groups showed significant improvements compared to preoperatively (visual analogue scale, WOMAC, Lysholm score; p < 0.001), without significant group differences (visual analogue scale, n.s.; WOMAC, n.s.; Lysholm score, n.s.). No significant differences between baseline and follow-up measurements for MPTA and tibial slope were observed within each group (MPTA: Gr. I, n.s.; Gr. II, n.s.; tibial slope: Gr. I, n.s.; Gr. II, n.s.) or between the two groups (MPTA, n.s.; tibial slope, n.s.). In histologic samples, CF PEEK abrasion did not induce inflammation or tissue necrosis. The first-generation PEEKPower HTO-Plate® provided a higher rate of implant-related complications compared to the TomoFix™ plate at a minimum follow-up of 24 months after valgus-producing open-wedge HTO. Therefore, it is not recommended to use the

  15. Displaced acetabular fractures in the elderly: results after open reduction and internal fixation.

    PubMed

    Li, Yuan-Lei; Tang, Yuan-Yuan

    2014-12-01

    The optimal management of elderly patients with displaced acetabular fractures remains controversial. This paper aims to summarize the clinical results of open reduction and internal fixation (ORIF) and the possible factors influencing them. Radiographic and clinical data on 52 elderly patients with displaced acetabular fractures that were treated by ORIF between May 2000 and May 2008 were retrospectively analysed. Data, such as fracture type (Letournel's classification system), quality of reduction, clinical outcomes (Harris hip score and modified Merle d'Aubigne-Postel score), and radiological outcomes (Matta score), were evaluated. Good to excellent clinical and radiological outcomes were recorded in 43 (82.7%) and 37 patients (71.2%), respectively. Acetabular fractures without radiographic features, such as quadrilateral plate fracture, Gull sign, posterior dislocation of hip, posterior wall marginal impaction, comminuted posterior wall fracture, and femoral head injury, can still achieve good to excellent outcomes. However, patients with the abovementioned radiographic features tend to achieve fair or poor outcomes. When an acetabular fracture with the aforementioned features, except for femoral head injury, can achieve and maintain anatomic reduction until complete fracture healing, the difference between fractures with and without the radiographic features is no longer significant. The results indicate that the outcomes are more affected by reduction rather than radiographic features. ORIF may be suggested for displaced acetabular fractures in the elderly. Good to excellent outcomes and a high degree of patient satisfaction can be achieved in majority of the patients. We recommend ORIF as the preferred treatment for displaced acetabular fractures without the abovementioned radiographic features. Therapeutic level IV. Published by Elsevier Ltd.

  16. Clinical outcome of pediatric calcaneal fractures treated with open reduction and internal fixation.

    PubMed

    Pickle, Andrew; Benaroch, Thierry E; Guy, Pierre; Harvey, Edward J

    2004-01-01

    The results of displaced intra-articular calcaneal fractures treated with open reduction and internal fixation in skeletally immature children at one institution were reviewed. Six children with seven displaced intra-articular calcaneal fractures treated with open reduction and internal fixation were reviewed at an average of 30 months after surgery (range 18-48 months). All children were treated by one of two surgeons and followed by the same surgeon. The preoperative workup included computed tomography scans, which showed that all had displaced intra-articular fractures and five had comminuted fractures. At follow-up all children were pain-free with normal activities. All were able to return to full activities at an average of 10 months after surgery. All had normal ankle range of motion, but five had decreased subtalar range of motion. There were no postoperative complications, shoe wear problems, or peroneal tendinitis. This study demonstrates that open reduction and internal fixation for displaced intra-articular fractures in children yields encouraging results.

  17. Implementing a fracture liaison service open model of care utilizing a cloud-based tool.

    PubMed

    Greenspan, S L; Singer, A; Vujevich, K; Marchand, B; Thompson, D A; Hsu, Y-J; Vaidya, D; Stern, L S; Zeldow, D; Lee, D B; Karp, S; Recker, R

    2018-02-10

    Although half of women and one-quarter of men aged 50 and older will sustain an acute low-trauma fracture, less than a quarter receive appropriate secondary fracture prevention. The goal of this quality improvement demonstration project was to implement a Fracture Liaison Service (FLS) focused on secondary prevention of an osteoporotic fracture in three open health care systems aided by a cloud-based tool. The pre-post study design examined the proportion of men and women over age 50 who received appropriate assessment (bone mineral density, vitamin D levels) and treatment (calcium/vitamin D, pharmacologic therapy) in the six months following a recently diagnosed fracture. The pre-study (Pre FLS) included a retrospective chart review for baseline data (N = 344 patients) within each health care system. In the post-evaluation (Post FLS, N = 148 patients), the FLS coordinator from each health care system examined these parameters following enrollment and for 6 months following the recently diagnosed fracture. Data were managed in the cloud-based FLS application tool. Ninety-three participants completed the program. The FLS program increased the percentage of patients receiving bone mineral density testing from 21% at baseline to 93% (p < 0.001) Post FLS implementation. Assessments of vitamin D levels increased from 25 to 84% (p < 0.001). Patients prescribed calcium/vitamin D increased from 36% at baseline to 93% (p < 0.001) and those prescribed pharmacologic treatment for osteoporosis increased on average from 20 to 54% (p < 0.001) Post FLS. We conclude that the FLS model of care in an open health care system, assisted by a cloud-based tool, significantly improved assessment and/or treatment of patients with a recently diagnosed osteoporotic fracture. Future studies are necessary to determine if this model of care is scalable and if such programs result in prevention of fractures. Mini-Abstract: The goal was to implement a Fracture Liaison

  18. A model to predict limb salvage in severe combat-related open calcaneus fractures.

    PubMed

    Bevevino, Adam J; Dickens, Jonathan F; Potter, Benjamin K; Dworak, Theodora; Gordon, Wade; Forsberg, Jonathan A

    2014-10-01

    Open calcaneus fractures can be limb threatening and almost universally result in some measure of long-term disability. A major goal of initial management in patients with these injuries is setting appropriate expectations and discussing the likelihood of limb salvage, yet there are few tools that assist in predicting the outcome of this difficult fracture pattern. We developed two decision support tools, an artificial neural network and a logistic regression model, based on presenting data from severe combat-related open calcaneus fractures. We then determined which model more accurately estimated the likelihood of amputation and which was better suited for clinical use. Injury-specific data were collected from wounded active-duty service members who sustained combat-related open calcaneus fractures between 2003 and 2012. One-hundred fifty-five open calcaneus fractures met inclusion criteria. Median followup was 3.5 years (interquartile range: 1.5, 5.1 years), and amputation rate was 44%. We developed an artificial neural network designed to estimate the likelihood of amputation, using information available on presentation. For comparison, a conventional logistic regression model was developed with variables identified on univariate analysis. We determined which model more accurately estimated the likelihood of amputation using receiver operating characteristic analysis. Decision curve analysis was then performed to determine each model's clinical utility. An artificial neural network that contained eight presenting features resulted in smaller error. The eight features that contributed to the most predictive model were American Society of Anesthesiologist grade, plantar sensation, fracture treatment before arrival, Gustilo-Anderson fracture type, Sanders fracture classification, vascular injury, male sex, and dismounted blast mechanism. The artificial neural network was 30% more accurate, with an area under the curve of 0.8 (compared to 0.65 for logistic

  19. Effect of the Osteotomy Length on the Change of the Posterior Tibial Slope With a Simple Distraction of the Posterior Gap in the Uni- and Biplanar Open-Wedge High Tibial Osteotomy.

    PubMed

    Lee, Yong Seuk; Kang, Jong Yeal; Lee, Myung Chul; Oh, Won Seok; Elazab, Ashraf; Song, Min Kyu

    2016-02-01

    To (1) determine the length of the osteotomy at the anterior and posterior cortex, (2) compare between uni- and biplanar osteotomy, and (3) evaluate the relationship between the extent of the osteotomy and change of the posterior tibial slope. A prospective comparative study of 24 uniplanar and 30 biplanar osteotomies was performed. To evaluate the length of osteotomy, osteotomy lines of the anterior and posterior cortex were analyzed in the 3-dimensional surface models. For slope measurement, the intramedullary axis of the proximal tibia (slope P), posterior cortical line of the proximal tibia (slope C), and anterior cortical line of the proximal fibula (slope F) were used. An analysis of the changes in the posterior tibial slope was performed independently using a pre- and postoperative lateral plane radiograph. In the uniplanar osteotomy, ratios of the osteotomized length to the total cortical length aligned with the osteotomized plane were larger in the anterior cortex (0.91 in uniplanar v 0.46 in biplanar; P = 0) and posterior cortex (0.97 in uniplanar v 0.79 ratio in biplanar; P = 0). Furthermore, the posterior tibial slope was maintained in both groups and the ratios between the anterior and posterior gap in both groups were 0.57 and 0.63, respectively. The maintenance of the slope was not related to any specific variables. Additionally, these phenomena did not differ between those patients who underwent uni- and those who underwent biplanar osteotomy. Increase in the posterior tibial slope was prevented with appropriate uni- or biplanar osteotomy with a simple distraction at the most posterior gap. However, in the uniplanar osteotomy, the ratio of the osteotomized length to the total cortical length was larger in both the anterior and posterior cortex. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  20. Assessment of bone healing on tibial fractures treated with wire osteosynthesis associated or not with infrared laser light and biphasic ceramic bone graft (HATCP) and guided bone regeneration (GBR): Raman spectroscopy study

    NASA Astrophysics Data System (ADS)

    Bastos de Carvalho, Fabíola; Aciole, Gilberth Tadeu S.; Aciole, Jouber Mateus S.; Silveira, Landulfo, Jr.; Nunes dos Santos, Jean; Pinheiro, Antônio L. B.

    2011-03-01

    The aim of this study was to evaluate, through Raman spectroscopy, the repair of complete tibial fracture in rabbits fixed with wire osteosynthesis - WO, treated or not with infrared laser light (λ 780nm, 50mW, CW) associated or not to the use of HATCP and GBR. Surgical fractures were created under general anesthesia (Ketamine 0.4ml/Kg IP and Xilazine 0.2ml/Kg IP), on the tibia of 15 rabbits that were divided into 5 groups and maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet and had water ad libidum. On groups II, III, IV and V the fracture was fixed with WO. Animals of groups III and V were grafted with hydroxyapatite + GBR technique. Animals of groups IV and V were irradiated at every other day during two weeks (16J/cm2, 4 x 4J/cm2). Observation time was that of 30 days. After animal death the specimens were kept in liquid nitrogen for further analysis by Raman spectroscopy. Raman spectroscopy showed significant differences between groups (p<0.001). It is concluded that IR laser light was able to accelerate fracture healing and the association with HATCP and GBR resulted on increased deposition of calcium hydroxyapatite.

  1. Predisposing factors for early infection in patients with open fractures and proposal for a risk score.

    PubMed

    Matos, Marcos Almeida; Lima, Lucynara Gomes; de Oliveira, Luiz Antonio Alcântara

    2015-09-01

    The primary goals of orthopedic treatment of open fractures are to prevent infection, stabilize bone injury and restore limb function. The objective of the current study was to identify risk factors associated with infection in patients suffering from open fractures, using the strength of association of these factors to propose a score that enables risk stratification in initial care. A retrospective analysis was performed on 122 patients who underwent open fracture treatment. Clinical and demographic data were collected and the results were divided into two groups: those without infection and those with infection. Both groups were evaluated searching for associated factors that could lead to infection. Thirty-one patients out of 122 were infected (25.4 %). Infection was significantly associated with exposure time up to 24 h (mean 30.3 h; p = 0.007). Fractures classified as Gustilo III had a greater chance of infection (74.2 %; p = 0.042), especially type IIIB (41.9 %). Fractures classified as Tscherne II and III had a greater chance of infection (48.4 and 25.8 %, respectively; p = 0.001). It was possible to show that the exposure time and the types of fracture classified as Gustilo III and Tscherne II and III are associated with the outcome of infection. It was also possible to create a risk score (IRS) for predicting infection in these types of fractures, which can be used in the initial care of the patient, with a sensitivity of 0.840, specificity of 0.544, cut-off of 6.5 and area under the curve of 0.709 (p = 0.002). Level III.

  2. Severe open bite due to traumatic condylar fractures treated nonsurgically with implanted miniscrew anchorage.

    PubMed

    Yanagita, Takeshi; Adachi, Rie; Kamioka, Hiroshi; Yamashiro, Takashi

    2013-04-01

    This case report illustrates the use of miniscrews to treat a patient with an open bite caused by mandibular condylar fractures. The patient was 36 years old when she visited our hospital with a chief complaint of difficulty with chewing. She had suffered condylar and maxillary bone fractures in a traffic accident 6 months before her visit. She had an anterior open bite and Angle Class II molar relationships. Her mandibular midline was deviated to the right relative to the maxilla. The cephalometric analysis showed a skeletal Class II relationship. Titanium miniscrews were implanted in the bilateral maxillary buccal areas. The maxillary dentition was retracted and intruded by using elastomeric chains and miniscrews. After this treatment, an Angle Class I molar relationship was achieved, her overjet and overbite became ideal, and a good facial appearance was obtained. The total active orthodontic treatment period was 33 months. Treating an open bite with molar intrusion often leads to counterclockwise rotation of the mandible; however, in this patient, the mandible was moved anteriorly and upward. We believe that this movement was caused by the patient's condylar fractures and the subsequent remodeling. Although there was some relapse, our results suggest that implant anchorage is useful for correcting anterior open bites originating from condylar fractures. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  3. Early Conversion of External Fixation to Interlocked Nailing in Open Fractures of Both Bone Leg Assisted with Vacuum Closure (VAC) - Final Outcome

    PubMed Central

    Raj, Manish; Kumar, Sunil; Singh, Pulkesh; Kumar, Dinesh; Singh, Jasveer; Deep, Akash

    2016-01-01

    Introduction Management of compound grade III fractures of both bone leg includes external stabilization for long period, followed by various soft tissue coverage procedures. Primary interlocking of tibia had been also done with variable results. External fixation for long time without any bone loss often leads to infected nonunion, loss of reduction, pin tract infection and failure of fixation, primary interlocking in compound grade III fractures had shown high medullary infection rate. We managed all cases of compound grade III A/B fractures with primary external fixation, simultaneous wound management using vacuum assisted closure (VAC) followed by early conversion to interlocking within 2 weeks of fixator application. Aim To determine the effectiveness of vacuum assisted closure (VAC) for the early conversion of external fixator to definitive interlocking in open fractures of the both bone leg. Materials and Methods In current study we selected 84 cases of compound grade IIIA/B diaphyseal fractures of both bone leg during period of May 2010 to September 2013. We managed these cases by immediate debridement and application of external fixation followed by repeated debridement, application of vacuum assisted closure (VAC) and conversion to interlocking within two weeks. Results Out of 84 cases union was achieved in 80(95%) of cases with definitive tibial interlocking. Excellent to good result were obtained in 77(91.8%) of cases and fair to poor result seen in rest of 7(8.2%) of cases according to modified Ketenjian’s criteria. 5 out of these 7 poor result group cases were from Compound Grade III B group to start with. Deep infection rate in our series were 7% i.e. total 6 cases and 4 out of these were from compound Grade III B group to start with. Conclusion Vacuum assisted closure (VAC) give a good help for rapid closure of the wound and help in early conversion to definitive intramedullary nailing. Reamed nail could well be used in compound grade IIIA

  4. Conversion of external fixation to open reduction and internal fixation for complex distal radius fractures.

    PubMed

    Natoli, R M; Baer, M R; Bednar, M S

    2016-05-01

    Distal radius fractures are common injuries treated in a multitude of ways. One treatment paradigm not extensively studied is initial treatment by external fixation (EF) followed by conversion to open reduction internal fixation (ORIF). Such a paradigm may be beneficial in damage control situations, when there is extensive soft tissue injury, or when appropriate personnel/hospital resources are not available for immediate internal fixation. There is no increased risk of infection when converting EF to ORIF in the treatment of complex distal radius fractures when conversion occurs early or if EF pin sites are overlapped by the definitive fixation. Using an IRB approved protocol, medical records over nine years were queried to identify patients with distal radius fractures that had undergone initial EF and were later converted to ORIF. Charts were reviewed for demographic data, injury characteristics, operative details, time to conversion from EF to ORIF, assessment of whether the EF pin sites overlapped the definitive fixation, presence of infection after ORIF, complications, and occupational therapy measurements of range of motion and strength. In total, 16 patients were identified, only one of which developed an infection following conversion to ORIF. Fisher's exact testing showed that infection did not depend on open fracture, time to conversion of one week or less, presence of EF pin sites overlapping definitive fixation, fracture classification, high energy mechanism of injury, or concomitant injury to the DRUJ. Planned staged conversion from EF to ORIF for complex distal radius fractures does not appear to result in an increased rate of infection if conversion occurs early or if the EF pin sites are overlapped by definitive fixation. This treatment paradigm may be reasonable for treating complex distal radius fractures in damage control situations, when there is extensive soft tissue injury, or when appropriate personnel/hospital resources are not available

  5. Results of open reconstruction of anterior glenoid rim fractures following shoulder dislocation.

    PubMed

    Osti, Michael; Gohm, Alexander; Benedetto, Karl Peter

    2009-09-01

    The present study evaluates the clinical and radiological outcome following open reconstruction of avulsion fractures of the anterior glenoid rim in traumatic shoulder dislocation. A total of 20 patients (mean age 49.4 years) were treated with open reduction and cannulated screw fixation. Eighteen patients were available for clinical and radiological follow-up after 3.1 (2.0-6.5) years. The average Constant Score was 78 and the average Rowe Score was 90 points. Documented complications were implant failure in one and neurological dysfunction in one patient. Radiographs revealed the bony fragment located in an unimproved displaced position in one patient and a progress in osteoarthritic changes in three patients. No recurrent subluxation or dislocation was observed. Open reconstruction of glenoid rim fractures is a valuable procedure regarding medium-term subjective and objective outcome measures. Recurrent dislocation, glenoid defects and early onset of osteoarthritic degeneration can be avoided.

  6. Decreased Time to Antibiotic Prophylaxis for Open Fractures at a Level One Trauma Center.

    PubMed

    Johnson, Joey P; Goodman, Avi D; Haag, Adam M; Hayda, Roman A

    2017-11-01

    To determine whether time to administration of antibiotics decreased after the implementation of an open fracture working group and antibiotic prophylaxis protocol. Retrospective cohort study. One Level 1 Trauma Center. Patients 18 years of age and older who sustained an open fracture and presented directly to our emergency department. Prompt irrigation and debridement in the operating room and fracture stabilization dictated by the treating surgeon. Fifty patients were reviewed as the preintervention group, comprising the period before conception and before intervention. Fifty patients were included after the initiation of our protocol during the same time period 1 year later. Time from entrance to the emergency department to ordering of antibiotics, time from ordering to administration of antibiotics, and time from entrance to the emergency department to administration of antibiotics. After protocol implementation, time from admission to antibiotic administration decreased significantly from 123.1 to 35.7 minutes (P = 0.0003). Each component decreased significantly: admission to order decreased from 94.1 to 26.1 minutes, and order to administration decreased from 29.0 to 9.5 minutes (P = 0.0046 and P = 0.0003). Our study demonstrates a significantly reduced time to antibiotic prophylaxis for patients with open fractures after the implementation of a multidisciplinary working group. We hope that this provides a model for institutions to improve care and outcomes of these injuries. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  7. Treatment of open periarticular shoulder fractures sustained in combat-related injuries.

    PubMed

    Mack, Andrew W; Groth, Adam T; Frisch, H Michael; Doukas, William C

    2008-03-01

    Open periarticular shoulder fractures present a tremendous challenge for orthopedic surgeons. These injuries, albeit rare, are typically caused by high-energy mechanisms and are associated with insult to multiple organ systems resulting in high morbidity and mortality. Although the civilian trauma literature includes several articles on outcomes of closed periarticular shoulder fractures, only 1 peer-reviewed article has focused on this specific open injury pattern. No standard management technique has been adopted for these injuries, and treatment patterns have anecdotally evolved from war to war. In this article, we review evacuation of patients, management of combat-related open periarticular shoulder injuries, and the pertinent literature; we supplement this review with a description of the recent experience of Drs. HMF and WCD. All cases of combat-related open fractures treated at our institution between March 2003 and January 2007 were reviewed. We identified 44 patients with open periarticular shoulder fractures (33 IIIA, 1 IIIB, 10 IIIC). Inpatient and outpatient medical records, x-rays, laboratory culture data, and photographic documentation records were reviewed. Mean follow-up was 34 months (range, 12-49 months). Rates of associated neurologic and vascular injury were 41% (18/44 patients), and 23% (10/44 patients), respectively. Other associated significant injuries occurred in 38/44 patients (86%). Internal fixation was used as definitive treatment in 26/44 patients (59%). Radiographic union occurred by a mean of 4.5 months (range, 3-9 months) after surgery. Postoperative deep infection/osteomyelitis occurred in 5/35 patients (14%) with more than 1-year follow-up data available. The overall amputation rate was 9%. Open combat-related periarticular shoulder fractures are complicated injuries, often associated with several traumatic comorbidities that together present difficult challenges to treatment. Meticulous surgical débridement is essential in

  8. Institutional and Seasonal Variations in the Incidence and Causative Organisms for Posttraumatic Infection following Open Fractures.

    PubMed

    Sagi, H Claude; Donohue, David; Cooper, Seth; Barei, David P; Siebler, Justin; Archdeacon, Michael T; Sciadini, Marcus; Romeo, Michelle; Bergin, Patrick F; Higgins, Thomas; Mir, Hassan

    2017-02-01

    The current literature focuses on wound severity, time to debridement, and antibiotic administration with respect to risk of infection after open fracture. The purpose of this analysis was to determine if either the incidence of posttraumatic infection or causative organism varies with treating institution or the season in which the open fracture occurred. Retrospective review. Seven level 1 regional referral trauma centers located in each of the 7 climatic regions of the continental United States (Northwest, High Plains, Midwest/Ohio Valley, New England/Mid-Atlantic, Southeast, South, and Southwest). Five thousand one hundred twenty-seven skeletally mature patients with open extremity fractures treated between 2008 and 2012 at one of the 7 institutions. Open reduction and internal fixation of fracture following institutional protocol for antibiotic prophylaxis, debridement, and soft-tissue management. Seasonal variation on the incidence of infection and the causative organism after treatment for open fracture as recorded by each individual treating institution. Charts were analyzed to extract information regarding date of injury, Gustilo-Anderson type of open fracture, subsequent treatment for a posttraumatic wound infection, and the causative organisms. Patients were placed into one of the 4 groups based on the time of year that the injury occurred: spring (March-May), summer (June-August), fall (September-November), and winter (December-February). Univariate/multivariate analyses and Fisher test were used to assess whether any observed differences were of statistical significance. The overall incidence of infection for all open fractures across the 7 different institutions was 7.6% and this did not vary significantly by season. There were, however, significant differences in overall infection rates between the different institutions: Southeast 4.3%, Northwest 13%, Northeast 7.7%, Southwest 9.3%, Midwest/Ohio Valley 5.5%, High Plains 14.6%, and South 7.4%. The

  9. Closed Versus Open Supracondylar Fractures of the Humerus in Children: A Comparison of Clinical and Radiographic Presentation and Results.

    PubMed

    Lewine, Eliza; Kim, Jaehon M; Miller, Patricia E; Waters, Peter M; Mahan, Susan T; Snyder, Brian; Hedequist, Daniel; Bae, Donald S

    2018-02-01

    The purpose of this investigation was to compare the presentation and postoperative results of children treated for open and closed, completely displaced type III supracondylar humerus fractures (SCFs). Thirty patients with open and 66 patients with closed, completely displaced type III SCFs were evaluated. Open fractures underwent irrigation and debridement, and all patients were treated by open or closed reduction and pin fixation. Medical records were reviewed to obtain demographic information as well as preoperative and postoperative clinical data regarding mechanism of injury, neurovascular status, associated injuries, postoperative range of motion, infections, and pain. Radiographs were evaluated to quantify displacement, Baumann's angle, humeral capitellar angle, position of the anterior humeral line, and adequacy of reduction. Outcomes were assessed using Flynn criteria. Mean clinical follow-up for the open and closed fracture groups was 8.9 and 5.7 months, respectively. Both groups were similar with respect to age, sex distribution, weight and body mass index, laterality of involvement, and mechanism of injury. At presentation, 35% of closed SCFs and 23% of open SCFs presented with abnormal neurovascular status. There was a higher prevalence of diminished/absent pulses or distal limb ischemia in patients with open injuries (27%) compared with closed fractures (18%). Conversely, severely displaced closed fractures were more commonly associated with nerve injury/palsy at presentation (35%) than those with open fractures (23%). Spontaneous nerve recovery was seen in 87% within 3 to 6 months. Postoperative loss of reduction and malunion were more common in the closed fracture group. However, 84% of patients achieved good-to-excellent results by Flynn criteria, with no appreciable difference based upon open versus closed fractures. With timely wound and fracture treatment, the clinical and radiographic results of children treated for open SCFs is similar to

  10. Irrigation solutions in open fractures of the lower extremities: evaluation of isotonic saline and distilled water.

    PubMed

    Olufemi, Olukemi Temiloluwa; Adeyeye, Adeolu Ikechukwu

    2017-01-01

    Open fractures are widely considered as orthopaedic emergencies requiring immediate intervention. The initial management of these injuries usually affects the ultimate outcome because open fractures may be associated with significant morbidity. Wound irrigation forms one of the pivotal principles in the treatment of open fractures. The choice of irrigation fluid has since been a source of debate. This study aimed to evaluate and compare the effects of isotonic saline and distilled water as irrigation solutions in the management of open fractures of the lower extremities. Wound infection and wound healing rates using both solutions were evaluated. This was a prospective hospital-based study of 109 patients who presented to the Accident and Emergency department with open lower limb fractures. Approval was sought and obtained from the Ethics Committee of the Hospital. Patients were randomized into either the isotonic saline (NS) or the distilled water (DW) group using a simple ballot technique. Twelve patients were lost to follow-up, while 97 patients were available until conclusion of the study. There were 50 patients in the isotonic saline group and 47 patients in the distilled water group. Forty-one (42.3%) of the patients were in the young and economically productive strata of the population. There was a male preponderance with a 1.7:1 male-to-female ratio. The wound infection rate was 34% in the distilled water group and 44% in the isotonic saline group (p = 0.315). The mean time ± SD to wound healing was 2.7 ± 1.5 weeks in the distilled water group and 3.1 ± 1.8 weeks in the isotonic saline group (p = 0.389). It was concluded from this study that the use of distilled water compares favourably with isotonic saline as an irrigation solution in open fractures of the lower extremities. © The Authors, published by EDP Sciences, 2017.

  11. The AO unreamed tibial nail: a 14-month follow-up of the 1992 TT experience.

    PubMed

    Sargeant, I D; Lovell, M; Casserley, H; Green, A D

    1994-09-01

    This paper reports early experiences with the immediate use of the AO unreamed tibial nail, the immediate complications and the 14 months follow-up of 13 patients with Gustilo grades I, II and IIIa open tibial fractures. The nail insertion technique was found to be clear and quickly acquired by the surgeons unfamiliar with it. There were two equipment complications associated with insertion and one early compartment syndrome. Two patients needed a split skin graft and one other patient required hyperbaric oxygen therapy with a split skin graft to bring about impact wound closure. At 14 months two nails had been electively removed. There had been four cases of locking bolt failure leading to metalwork exchange in two cases, metalwork exchange and bone graft in one case and nail removal in one cases. Two patients had undergone bone graft with nail removal or exchange. Five patients had undergone no further bony procedures. Four patients had not achieved bony union. There were no cases of early or late bone or soft-tissue infection. The authors suggest that the unreamed nail principle has a valuable place in the early management of open tibial fractures.

  12. Functional Outcomes of Symptomatic Implant Removal Following Ankle Fracture Open Reduction and Internal Fixation.

    PubMed

    Williams, Benjamin R; McCreary, Dylan L; Chau, Michael; Cunningham, Brian P; Pena, Fernando; Swiontkowski, Marc F

    2018-02-01

    Orthopedic implant removal following open reduction internal fixation of a fracture is a common procedure, especially in the foot and ankle. The purpose of this study was to evaluate functional change after the removal of symptomatic implants following ankle fracture open reduction internal fixation (ORIF) using the Short Musculoskeletal Function Assessment (SMFA) outcome score. We hypothesized that implant removal after ankle fracture would result in improved functional outcomes. Retrospective review of prospectively collected data on patients with a closed ankle fracture between 2013 and 2016 was performed. Inclusion criteria were skeletal maturity, symptomatic ankle implants and completion of the SMFA questionnaire prior to and 6 months after removal. Exclusion criteria were development of a nonunion, prior or current infection, peripheral neuropathy or ongoing litigation surrounding the surgery. The primary outcome was change in SMFA score from baseline to follow-up using Wilcoxon signed-rank test. Additional logistic regression models evaluated the effects of age, sex, body mass index, smoking status, and patient American Society of Anesthesiologists scores. The study population consisted of 43 patients. There was a statistically significant improvement in function, represented by a decrease in SMFA scores from baseline to the 6-month follow-up period (∆ = -4.1 [95% confidence interval, -7.0, -1.3]; P = .003). Secondary outcome measures of the bother index and daily activities domain also demonstrated significant improvements ( P = .005 and P = .002, respectively). Additional logistical regression models identified no significant effects by assessed covariates for change in SMFA scores. Patients with symptomatic implants following ankle fracture ORIF had a statistically significant improvement in function following implant removal. There appears to be value in removing implants from the ankle in patients who report discomfort during daily activities. Further

  13. A retrospective study comparing percutaneous and open pedicle screw fixation for thoracolumbar fractures with spinal injuries.

    PubMed

    Wang, Bowen; Fan, Yong; Dong, Jingjing; Wang, Hu; Wang, Faqi; Liu, Zhichen; Liu, Haoyuan; Feng, Yafei; Chen, Fengrong; Huang, Zheyuan; Chen, Ruisong; Lei, Wei; Wu, Zixiang

    2017-09-01

    The purpose of this study was to evaluate the effectiveness between percutaneous and open pedicle screw fixation for treating thoracolumbar fractures with spinal injuries. A total of 105 patients with thoracolumbar fractures and spinal injuries were divided into a percutaneous pedicle screw fixation (PPSF) group with 56 patients, who underwent percutaneous pedicle screw fixation, and an open pedicle screw fixation (OPSF) group with 49 patients, who underwent open pedicle screw fixation in accordance with the treatment project. Relative operation indexes, radiologic, and effectiveness parameters were assessed and compared between the 2 groups. Demographic and clinical features including age, body mass index, gender, fracture level, fracture classification, and Frankel grade in both groups were not significantly different (all P >.05). The PPSF group exhibits significantly lower operation time, intraoperative blood loss, postoperative drainage volume, and hospital stay on average compared with the OPSF group (all P < .05). Besides, the average postoperative radiologic parameters, including Cobb angle (CA), vertebral wedge angle (VWA), vertebral front height percentage (VFHP), and sagittal index (SI), in both the groups were not significantly different (all P > .05). Nevertheless, both visual analogue scale (VAS) and Oswestry disability index (ODI) after surgery decreased more substantially in the PPSF group than in the OPSF group (all P < .05) while no significant difference in VAS scores or ODI during the last follow-up period was demonstrated in both the groups (both P > .05). Frankel classifications were stimulated in both the groups during the last follow-up period. PPSF has a smaller incision, less intraoperative blood loss, shorter recovery time, higher safety measures on average compared with OPSF with respect to managing thoracolumbar fractures with spinal injuries.

  14. Open vs. closed reduction combined with minimally invasive plate osteosynthesis in humeral fractures.

    PubMed

    Liu, Yin-Wen; Wei, Xiao-En; Kuang, Yong; Zheng, Yu-Xin; Gu, Xin-Feng; Zhan, Hong-Sheng; Shi, Yin-Yu

    2016-08-01

    Aim To explore a more effective surgical procedure, the outcomes of closed manipulative reduction (CMR) combined with minimally invasive plate osteosynthesis (MIPO) and conventional open reduction and internal fixation (ORIF) for treating proximal humeral fractures were compared. Material and methods In a retrospective study of patients operated for humerus shaft fractures from April 2008 to July 2011, the outcomes of 33 patients treated with CMR/MIPO were compared with the outcomes of 42 patients treated with ORIF. The fractures were classified, and the incision length, blood transfusion, operating time, as well as the VAS (Visual Analog Scale) pain scores were analyzed. The neck-shaft angles of the proximal humerus were detected, and the postoperative function of the shoulder was evaluated. Results The mean values of incision length, blood transfusion, and VAS pain scores at the 1st and 3rd day after CMR/MIPO and operation time were lower than that of ORIF. The postoperative radiographs verified good position of all screws and satisfactory bone fracture reduction in both groups. Meanwhile, in the ORIF group, nonunion (three cases) and humeral head necrosis (four cases) were detected. Conclusions The MR/MIPO technique showed smaller incisions, easier operation, less blood transfusion and more effective recovery of shoulder joint function for treating proximal humeral fractures than ORIF.

  15. Infrared thermography sensing for mapping open fractures in deep-seated rockslides and unstable cliffs

    NASA Astrophysics Data System (ADS)

    Baroň, Ivo; Bečkovský, David; Míča, Lumír

    2013-04-01

    The contribution presents in detail the new approach of infrared thermography (IRT) mapping open cracks, tension fractures and pseudo-karst caves within rock slope instabilities presented by Baroň et al. (2012). The method consists in high-resolution ground-based and airborne IRT sensing and it is restricted to cold seasons. Its utility is demonstrated through case studies from the Flysch Belt of the Outer West Carpathians (rockslides at Kopce Hill, Mt. Kněhyně, Křížový Hill, Smrdutá Hill, Pustevny Rockslide and Záryje Rockslide in E Czech Republic) and from the Northern Calcareous Alps (deep-seated gravitational slope deformations in Gschliefgraben / Mt. Traunstein in Austria). The approach is based on a contrast between temperatures deep within the rock, which at a depth of several meters represent local mean annual values, and winter-time temperatures of the ground surface. In winter, warmer, buoyant air from depth rises to the ground surface through open cracks and joints, and the temperature contrast can be detected by IRT. For temperature sensing, we used a Flir B360 thermal camera. Our test survey was conducted in February and December 2012, in order to achieve the best contrast between temperatures around open tension cracks and the adjacent ground surfaces. IRT results conclusively revealed the presence of open cracks, loosened rock zones, and pseudo-karst caves over a distance sometimes greater than 1 km. The IRT approach proved to be useful for rapidly assessing the distribution of open cracks and tension fractures, which is key information required for assessing rockfall and rockslide hazard. Baroň I., Bečkovský D. & Míča L. (2012): Application of infrared thermography for mapping open fractures in deep-seated rockslides and unstable cliffs. - Landslides, Springer Verlag. On-line First. DOI 10.1007/s10346-012-0367-z

  16. The effect of HIV on early wound healing in open fractures treated with internal and external fixation.

    PubMed

    Aird, J; Noor, S; Lavy, C; Rollinson, P

    2011-05-01

    There are 33 million people worldwide currently infected with human immunodeficiency virus (HIV). This complex disease affects many of the processes involved in wound and fracture healing, and there is little evidence available to guide the management of open fractures in these patients. Fears of acute and delayed infection often inhibit the use of fixation, which may be the most effective way of achieving union. This study compared fixation of open fractures in HIV-positive and -negative patients in South Africa, a country with very high rates of both HIV and high-energy trauma. A total of 133 patients (33 HIV-positive) with 135 open fractures fulfilled the inclusion criteria. This cohort is three times larger than in any similar previously published study. The results suggest that HIV is not a contraindication to internal or external fixation of open fractures in this population, as HIV is not a significant risk factor for acute wound/implant infection. However, subgroup analysis of grade I open fractures in patients with advanced HIV and a low CD4 count (< 350) showed an increased risk of infection; we suggest that grade I open fractures in patients with advanced HIV should be treated by early debridement followed by fixation at an appropriate time.

  17. Opening-mode fracture patterns and their shearing: an assessment of the state of knowledge and prediction capability

    NASA Astrophysics Data System (ADS)

    Aydin, A.

    2012-12-01

    Two common opening-mode fracture patterns include those comprising one set (Figure 1a) and two orthogonal sets (Figure 1b). It is also possible to have three mutually orthogonal opening-mode fractures, but this situation is rare. The prediction of the orientation and dimensional attributes of these simple systems requires a basic knowledge of the medium in which they occur (lithology, bedding, shape and distribution of initial flaws, elastic modulus, subcritical index and other environmental conditions) and the driving stresses or strains responsible for their formation. The issues related to fracture patterns become more complex when initial patterns of predominantly opening-mode fractures were later subjected to shearing. Shearing of a single set of opening-mode fractures (Figure 1c) produces splay fractures whose orientations and lengths show a significant variation. Given the attributes of the initial set and the orientation and relative magnitudes of the new stress components responsible for the shearing, and the mechanical behavoir of the fractures, it is possible to constrain the splay geometry. It turns out that the natural progression of the system is such that the new splays are sheared in a sequential manner to form remarkably consistent fracture domain patterns, which may be called "apparent conjugate." Well-documented case studies, some of which will be used in this presentation as templates, indicate that these fracture domain patterns can be visualized, but mapping their variation (local orientation and geometry of the individual components) is not a trivial task and may require knowledge both of some of the parameters referred to above and of the stress distribution about larger regional structures such as folds and faults. The shearing of orthogonal arrays of opening-mode fractures produces splay fractures diagonal to both orthogonal sets (Figure 1d). New through-going shear fractures, again in apparent conjugate patterns, utilize both members of

  18. Construct failure after open reduction and plate fixation of displaced midshaft clavicular fractures.

    PubMed

    Meeuwis, M A; Pull Ter Gunne, A F; Verhofstad, M H J; van der Heijden, F H W M

    2017-03-01

    Worldwide, implants mostly used for fixation of displaced midshaft clavicular fractures (DMCF) are the easily to bend reconstruction plate and the stiffer small fragment locking compression plate. Construct failure rates after plate fixation of DMCF are reported around 5 percent. Possible risk factors for construct failure are implant type and fracture type. However, little is known about the influence of fracture fixation method on construct failure. The aim of this study was to assess construct failure in plate fixation of DMCF and to identify possible risk factors. All consecutive patients treated in a level 1 trauma centre with open reduction and fixation of DMCF using a 3.5-mm reconstruction plate or 3.5-mm small fragment locking compression plate between 2007 and 2015 were evaluated. Potential risk factors for construct failure were analysed using univariate analysis. Two hundred and fifty-nine patients were analysed. Fifty DMCF (19%) were fixated with a reconstruction plate and 209 (81%) with a small fragment locking compression plate. Construct failure was seen in 18 patients (6.9%), including 5 broken plates and 13 with screw loosening. Eight percent of all reconstruction plates broke in contrast to 0.5 percent of all small fragment locking compression plates (p=0.001). All broken implants were used as a bridging plate. Loosening of screws was seen in older patients and when the plate was fixated with less than three bicortical screws on one side of the fracture (p=0.002). Overall construct failure after open reduction and plate fixation of DMCF occurred in 6.9 percent. Risk factors for plate breakage were the use of a reconstruction plate and a bridging method for fracture fixation. Risk factors for screw loosening were an increasing patient age and plate fixation with less than three bicortical screws on one side of the fracture. Based on the results of this study our recommendation is to use a small fragment locking compression plate for open reduction

  19. [Fractures of the lower extremity in skiing - the influence of ski boots and injury pattern].

    PubMed

    Bürkner, A; Simmen, H P

    2008-12-01

    Though the injury patterns of the lower extremities in skiing have changed since 1970, tibial fractures remain daily work of hospitals near ski slopes. A lot of medical studies have analysed the relevance of well adjusted bindings of the common lesions of the knee joint ligaments. However the influence of the flexibility of the ski boot and the injury pattern has been neglected. 49 tibial fractures have been analysed in a hospital near a large ski resort in the alpes. All fractures occurred during alpine skiing. The type of the fracture, according to the AO-classification and the injury pattern have been documented. Also demographic data, ski experience and specification concerning the ski boot have been questioned. The type of the ski boot and the grade of flexibility, have been documented if possible. It has also been recorded whether the binding opened. In contrast to other studies our patients are represented in widely spread age-groups with a large share of elderly and experienced persons. Young or unexperienced sportsmen suffer primarily from fractures of the tibial diaphysis. With increasing skiing experience the injury pattern is widening on the whole leg. 62 % of all fractures are caused by rotation traumas. Compression, dorsal forces and direct collisions are the other causes. In 59 % of all accidents the binding failed to open. There is an increased risk of complex fractures in the proximal or distal epiphysis if the binding has not opened. 23 % of all fractures occurred with rented ski boots. Only 16 % of all ski boots are labelled with a flexibility index. There is no standardized value for the flexibility of ski boots. The trend can be derived that rigid ski boots with a high flexibility index cause above all fractures of the diaphysis. 10 % of all fractures happened to patients wearing "snowblades". These short skis without safety bindings contributed a considerable share to tibial fractures, even though there is no big leverage. Tibial fractures are

  20. Ilizarov trifocal lengthening followed by intramedullary nailing for massive posttraumatic tibial bone defects.

    PubMed

    Selim, Naser M

    2013-12-01

    The treatment of massive tibial bone defects takes a very long time. An Ilizarov trifocal approach decreases the lengthening time. Subsequent intramedullary fixation decreases the complications of the conventional Ilizarov method. This technique was applied between June 2010 and June 2011 in 10 male patients with a mean age of 30 years. All had grade III open tibial fractures. The patients were treated at Mansoura University Hospital and a private hospital. The sequence of treatment included trifocal lengthening using the Ilizarov method, followed by removal of the fixator, temporary plaster cast immobilisation and subsequent intramedullary fixation until complete union was achieved. The length of the tibial bone defect ranged between 6-12 cm; the lengthening time ranged between 45-75 days and the consolidation time ranged between 90-160 days. The results were evaluated according to Paley's bone and functional assessment scores. The bone results were excellent in 7 patients and good in 3. Two patients had non union and one patient had pin tract infection. The functional results were excellent in 7 patients and good in 3. Two patients had equinus deformity and one patient had limited range of knee motion. There were no deep infections, DVTs or leg length discrepancies greater than 2.5 cm. Ilizarov trifocal lengthening followed by delayed intramedullary fixation appeared in this study as a good method of treatment for massive posttraumatic tibial bone defects. It reduced fixator time and minimized the complications associated with the Ilizarov fixation.

  1. Open versus closed treatment of distal tibia physeal fractures: a systematic review and meta-analysis.

    PubMed

    Asad, Waleed A; Younis, Manaf H S; Ahmed, Abdulaziz F; Ibrahim, Talal

    2017-10-19

    Distal tibia physeal fractures can lead to growth complications such as premature physeal closure (PPC), angular deformity and leg length discrepancy. The aim of our study was to systematically review the literature to assess whether open reduction and internal fixation (ORIF) is associated with lower rates of PPC compared to closed treatment. We searched several databases from 1966 to 2016 for studies that evaluated ORIF versus closed treatment of distal tibia physeal fractures. We performed a meta-analysis using a random effects model to pool odds ratios (OR) for the comparison of PPC rate between children undergoing ORIF versus closed treatment. We also investigated the PPC rate in Salter-Harris (S-H) type I and II fractures. Descriptive, quantitative and qualitative data were extracted. Out of the 253 articles identified, six retrospective cohort studies were eligible, with a total of 970 distal tibia physeal fractures. The pooled OR of PPC between ORIF and closed treatment showed no statistically significant difference [OR = 0.98, 95% confidence interval (CI) 0.48, 1.97; I 2 = 49.8%, p = 0.076]. No significant difference in the rate of PPC was detected in S-H type I and II fractures with ORIF and closed treatment [OR = 1.25, 95% CI 0.72, 2.16; I 2 = 32.1%, p = 0.22]. The cumulative evidence at present does not indicate an association between the method of treatment of distal tibia physeal fractures and the risk of PPC. Both treatment types are feasible, but less surgical-related complications are associated with closed treatment. III.

  2. Assessment of fracture healing after minimally invasive plate osteosynthesis or open reduction and internal fixation of coexisting radius and ulna fractures in dogs via ultrasonography and radiography.

    PubMed

    Pozzi, Antonio; Risselada, Marije; Winter, Matthew D

    2012-09-15

    To evaluate fracture healing after minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF) of coexisting radius and ulna fractures in dogs via ultrasonography and radiography. Prospective cohort study. 16 dogs with radius-ulna fractures that underwent MIPO (n = 9; 2 dogs were subsequently not included in the analyses because of incomplete follow-up information) or ORIF (7). Dogs in the 2 treatment groups were matched by age, body weight, and configuration of the fractures. Fracture healing was evaluated with ultrasonography, power Doppler ultrasonography, and radiography every 3 to 4 weeks until healing was complete; a semiquantitative score based on the number of Doppler signals was used to characterize neovascularization, and subjective B-mode ultrasonographic and radiographic scores were assigned to classify healing. Fractures in dogs that underwent MIPO healed in significantly less time than did fractures in dogs that underwent ORIF (mean ± SD; 30 ± 10.5 days and 64 ± 10.1 days, respectively). Radiography revealed that fractures in dogs that underwent MIPO healed with significantly more callus formation than did fractures in dogs that underwent ORIF. Although Doppler ultrasonography revealed abundant vascularization in fractures that were healing following MIPO, no significant difference in neovascularization scores was found between groups. For dogs with radius-ulna fractures, data indicated that bridging osteosynthesis combined with a minimally invasive approach contributed to rapid healing after MIPO. The MIPO technique may offer some clinical advantage over ORIF, given that complete radius-ulna fracture healing was achieved in a shorter time with MIPO.

  3. Novel external fixation fracture method with circular locking mechanism compared with the application of dynamic axial external fixator on experimental tibial model ensures better stability in bending and favourable performance in dynamic loads.

    PubMed

    Pavic, Arsen; Kodvanj, Janos; Sabalic, Srecko; Cukelj, Fabijan; Bakota, Bore

    2013-09-01

    The aim of this study was to compare the biomechanical properties of a novel tibial external bone fracture fixator with a circular locking mechanism with standard dynamic axial external fixator. In order to investigate the prototype usability in experimental conditions, a biomechanical study was performed in which 42 polyacetal tubes set in 14 experimental groups and subgroups represented the fractured tibia that were fixed by a standard dynamic axial external fixator and a novel fixator. Displacements under static and dynamic loads were measured, with static ones corresponding to three directions of fragment movement and dynamic simulating the human gait. Analysis was performed in SPSS v13, with significance set at P<0.05. The novel fixator showed biomechanical superiority in "fragments apart" study groups, while the standard dynamic axial external fixator outperformed the novel one in the situations of bending with "fragments in contact" study groups. There were no significant differences in dynamic load, despite better numerical result of the novel fixator. The novel fixator is expectedly faster applicable and offers greater extent of external fixation flexibility. Further developments of this model thus seems justified in both construction improvement and on clinical application. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

    PubMed

    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.

  5. Effect of Osteotomy Position and Tibial Plateau Rotation on the Tensile Force Required for Failure of the Canine Quadriceps Mechanism.

    PubMed

    Hamilton, Katie; Tarlton, John; Parsons, Kevin; Toscano, Mike; Burton, Neil

    2015-08-01

    To measure the tensile force required for failure of the quadriceps mechanism with different tibial tuberosity widths and different degrees of rotation of the tibial plateau after radial osteotomy of the proximal tibia. Ex vivo study, randomized unblocked design Thirty-five hind limbs from 18 adult Greyhound cadavers. Part 1 (15 limbs)--The center of rotation of the proximal tibial radial osteotomy was advanced craniodistally, progressively reducing absolute tibial tuberosity width (ATTW) for 5 different widths. Part 2 (21 limbs)-Tibial plateau rotation was performed at a set ATTW. Rotation was varied as a function of tibial tuberosity position with rotation proximal, level with, or distal to the tuberosity. All 35 limbs were tested with force applied via the quadriceps mechanism until construct failure occurred. All but 2 limbs failed by fracture of the tibial tuberosity. The tensile force required for failure of the quadriceps mechanism increased linearly with increasing ATTW. Significantly less force (P = .016) was required for failure of the quadriceps mechanism when the rotation of the tibial plateau was distal to the level of the patella tendon (mean 1,877 N) compared to when it was above the level of the patella tendon (mean 2,533 N). Rotation of the tibial plateau distal to the level of the patella tendon insertion point resulted in fracture at the base of the tibial tuberosity, level with the tibial plateau buttress. The overwhelming mode of failure of the quadriceps mechanism was by tibial tuberosity fracture, thus this was the weakest part of the construct. Reducing the tibial tuberosity width and rotation of the tibial plateau segment below the patella tendon insertion decreased the force required for tibial tuberosity fracture. These results support the idea of a safe point with the tibial plateau segment providing buttress to the tibial tuberosity. © Copyright 2015 by The American College of Veterinary Surgeons.

  6. Nonlinear hydrotectonic phenomena: Part I - fluid flow in open fractures under dynamical stress loading. Special report No. 12

    SciTech Connect

    Archambeau, C.B.

    1993-09-01

    A fractured solid under stress loading (or unloading) can be viewed as behaving macroscopically as a medium with internal, hidden, degrees of freedom, wherein changes in fracture geometry (i.e. opening, closing and extension) and flow of fluid and gas within fractures will produce major changes in stresses and strains within the solid. Likewise, the flow process within fractures will be strongly coupled to deformation within the solid through boundary conditions on the fracture surfaces. The effects in the solid can, in part, be phenomenologically represented as inelastic or plastic processes in the macroscopic view. However, there are clearly phenomena associated with fracture growth and open fracture fluid flows that produce effects that can not be described using ordinary inelastic phenomenology. This is evident from the fact that a variety of energy release phenomena can occur, including seismic emissions of previously stored strain energy due to fracture growth, release of dissolved gas from fluids in the fractures resulting in enhanced buoyancy and subsequent energetic flows of gas and fluids through the fracture system which can produce rapid extension of old fractures and the creation of new ones. Additionally, the flows will be modulated by the opening and closing of fractures due to deformation in the solid, so that the flow process is strongly coupled to dynamical processes in the surrounding solid matrix, some of which are induced by the flow itself. In studying such highly interactive, non-linear fluid-gas-solid systems, and attempting to quantitatively describe them with some degree of generality and accuracy, one approach is to first break down this complicated non-linear problem into its basic elemental parts. Here the idea would be to solve component problems in sufficient generality so that they can be combined together in a way that allows the complete interactive phenomena to be represented, at least in some well defined degree of approximation.

  7. Open reduction and internal fixation of posterior pilon fractures with buttress plate.

    PubMed

    Chen, Da-Wei; Li, Bing; Aubeeluck, Ashwin; Yang, Yun-Feng; Zhou, Jia-Qian; Yu, Guang-Rong

    2014-01-01

    Posterior pilon fractures are rare injuries and have not yet gained well recognition. The purpose of this study was to present the treatment outcome for patients with posterior pilon fractures treated with buttress plate. In this retrospective study we identified patients with posterior pilon fractures of the distal tibia who had undergone open reduction and internal fixation at our institute. Between January 2007 and December 2009, 10 patients (mean age, 46.5 years) who had undergone buttress plating via either a posterolateral approach or a dual posterolateral-posteromedial approach, were selected. All 10 patients were available for follow-up. The clinical outcome was evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS). The radiological evaluation was performed using the osteoarthritis-score (OA-score). Satisfactory reduction and stable fixation were accomplished in all patients. At a mean follow-up of 36.2 months, all patients had good radiological results and showed satisfactory clinical recovery. The mean AOFAS sore was 87.8, the mean OA-score was 0.6, and the mean VAS scores during rest, active motion, and weight-bearing walking were 0.6, 0.8, and 1.4, respectively. Buttress plating for posterior pilon fractures gave satisfactory clinical outcomes. It also ensured rigid fixation which in turn enabled earlier postoperative mobilization. Level of Evidence IV, Retrospective Study.

  8. [Clinical and radiological results in distal tibial physeal injuries].

    PubMed

    Taşkıran, Mustafa Can; Turgut, Ali; Kalenderer, Onder; Ağuş, Haluk

    2012-11-01

    In this study, we evaluated the clinical and radiological results of the distal tibial epiphyseal fractures in children treated with surgery. We evaluated 59 patients (33 boys, 26 girls) retrospectively. Physeal fractures were classified according to the Salter-Harris classification: 4 fractures were type I, 22 type II, 29 type III, and the remaining 4 type IV. Closed reduction and internal fixation were performed in 29 patients, while open reduction and internal fixation were performed in 30 patients. Mean age at the time of trauma was 10.9 years (6-14). Patients were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score. Patients were operated in a mean of 3.8 hours (3-72). Fixation was performed with Kirschner (K)-wire in 50 patients, with screw in 6 patients, and with both K-wire and screw in 3 patients. Mean follow-up time was 71.7 months (12-149). Due to premature physeal arrest, 1 cm shortening and valgus deformity were seen in only one patient. However, no infection, nonunion, or osteonecrosis was observed in any patient. Mean AOFAS score was 86.6 (65-100) at the last follow-up. Successful results with fewer complications could be obtained in ankle physeal fractures with early management through adequate reduction and stabilized fixation.

  9. Outcome of displaced distal tibial metaphyseal fractures in children between 6 and 15 years of age treated by elastic stable intramedullary nails.

    PubMed

    Cravino, Mattia; Canavese, Federico; De Rosa, Vincenzo; Marengo, Lorenza; Samba, Antoine; Rousset, Marie; Mansour Khamallah, Mounira; Andreacchio, Antonio

    2014-12-01

    From June 1995 to August 2012, 18 children were treated surgically using elastic stable intramedullary nails for displaced closed fractures of the distal metaphysis of the tibia. The patients were followed radiographically and clinically on a regular basis until union was clinically and radiographically achieved. Thirteen boys and five girls with a mean age at trauma of 11 ± 2.9 years (range 6-15) were included in the study. Radiographically, all fractures healed without evidence of delayed union, re-fracture, hardware migration. All patients were pain free at last follow-up and all regained full, normal activities including sports. IV.

  10. A simplified fracture network model for studying the efficiency of a single well semi open loop heat exchanger in fractured crystalline rock

    NASA Astrophysics Data System (ADS)

    de La Bernardie, Jérôme; de Dreuzy, Jean-Raynald; Bour, Olivier; Thierion, Charlotte; Ausseur, Jean-Yves; Lesuer, Hervé; Le Borgne, Tanguy

    2016-04-01

    Geothermal energy is a renewable energy source particularly attractive due to associated low greenhouse gas emission rates. Crystalline rocks are in general considered of poor interest for geothermal applications at shallow depths (< 100m), because of the low permeability of the medium. In some cases, fractures may enhance permeability, but thermal energy storage at these shallow depths is still remaining very challenging because of the complexity of fractured media. The purpose of this study is to test the possibility of efficient thermal energy storage in shallow fractured rocks with a single well semi open loop heat exchanger (standing column well). For doing so, a simplified numerical model of fractured media is considered with few fractures. Here we present the different steps for building the model and for achieving the sensitivity analysis. First, an analytical and dimensional study on the equations has been achieved to highlight the main parameters that control the optimization of the system. In a second step, multiphysics software COMSOL was used to achieve numerical simulations in a very simplified model of fractured media. The objective was to test the efficiency of such a system to store and recover thermal energy depending on i) the few parameters controlling fracture network geometry (size and number of fractures) and ii) the frequency of cycles used to store and recover thermal energy. The results have then been compared to reference shallow geothermal systems already set up for porous media. Through this study, relationships between structure, heat exchanges and storage may be highlighted.

  11. Comparison of Cable Method and Miniaci Method Using Picture Archiving and Communication System in Preoperative Planning for Open Wedge High Tibial Osteotomy.

    PubMed

    Yoon, Seong-Dae; Zhang, GuoFeng; Kim, Hee-June; Lee, Byoung-Joo; Kyung, Hee-Soo

    2016-12-01

    The purpose was to compare the accuracy of Miniaci method using picture archiving and communication system (PACS) with a cable method in high tibial osteotomy (HTO). This study analyzed 47 patients (52 knees) with varus deformity and medial osteoarthritis. From 2007 to 2013, patients underwent HTO using either a cable method (20 knees) or Miniaci method based on a PACS image (32 knees). In the cable method, the 62.5% point of the mediolateral tibial plateau width was located using an electrocautery cord under fluoroscopy (cable group). The Miniaci method used preoperative radiographs to shift the weight bearing axis (PACS group). Full-length lower limb radiographs obtained preoperatively and at the sixth postoperative week were used to compare the percentage of crossing point of the weight bearing line on the tibial plateau with respect to the medial border. The weight bearing line on the tibial plateau was corrected from a preoperative 11.0±7.0% to a postoperative 47.2±7.4% in the cable group and from 12.7±4.9% to 59.5±5.3% in the PACS group. The mechanical femorotibial angle was corrected from varus 8.9±3.7° to valgus 0.3±4.0° in the cable group and from varus 9.0±3.3° to valgus 2.9±2.6° in the PACS group. In HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method.

  12. Measuring water quality from individual fractures in open wellbores using hydraulic isolation and the dissolved oxygen alteration method

    NASA Astrophysics Data System (ADS)

    Vitale, Sarah A.; Robbins, Gary A.

    2017-11-01

    This study describes a low-cost method for sampling individual fractures in open wellbores in crystalline bedrock utilizing naturally occurring flow conditions in the well. The method entails using the dissolved oxygen alteration method (DOAM) to identify transmissive fractures and vertical flow direction. After obtaining information about relative hydraulic gradients, flow direction in the well is modified using a single control pump to isolate fractures of interest for sampling. Additional dissolved oxygen, injected during the DOAM procedure, serves as a tracer to ensure the water quality in the sampling zone is characteristic of the fracture of interest by requiring a tracer-free zone prior to sampling. Sampling procedures are described conceptually for nine bedrock wells with varying flow conditions containing one, two, or three transmissive inflowing fractures. The method was demonstrated in two crystalline bedrock wells containing one and two transmissive inflowing fractures.

  13. The effect of high tibial osteotomy on the posterior tibial slope.

    PubMed

    Dragosloveanu, Serban; Cristea, Stefan; Dragosloveanu, Calin

    2014-06-01

    High tibial osteotomy remains a useful procedure for delaying total knee arthroplasty for young patients with unicompartimental medial osteoarthritis of the knee. The tibial posterior slope is essential for both ligament function and knee kinematics. Even though many articles were published in the literature, the long term influence of open wedge high tibial osteotomy on the posterior slope of the tibial plateau remains unknown. We assessed the relationship among the degree of correction, the surgical technique, the postoperative modification of tibial slope, knee flexion and Knee score at the two years. We used for evaluation a calibrated x-rays with correction factor. All the measures were done with Cedara I-View 6.3.2 application. All 47 patients were operated in our hospital between 2008-2011, with the same technique, open wedge high tibial osteotomy with an acrylic cement wedge. All patients postponed weight bearing for 6 weeks. We found that there is no statistical significance (p=0.2) between the preoperative varus and the after surgery tibial slope, but the resulting posterior inclination after surgery influences the tibial posterior slope at 2 years (p<=0.005).The degree of correction has a strong influence over the increase or decrease of tibial posterior slope(p<0.005). An increase in tibial slope increases the knee flexion by 1.45° for every degree of inclination (p<0.05). Functional results are not influenced by small modifications in tibial inclination (p>0.05). From this findings we may conclude that the most important factors that changes the posterior inclination of the tibia surface are the height of the cement wedge and the surgical technique, by placing the acrylic cement wedge more anteriorly. We have found that the vast majority of our high tibial osteotomies are in fact "flexion" osteotomies. At the 2 years control we have found a slight increase in tibial slope angle (average 1.77°) and knee flexion (average 2.56°) with no functional

  14. Open Intramedullary Nailing for Segmental Long Bone Fractures: An Effective Alternative in a Resource-restricted Environment.

    PubMed

    Babalola, Olasunkanmi M; Ibraheem, Gbadebo Hakeem; Ahmed, Bola A; Olawepo, Ayokunle; Agaja, Samuel B; Adeniyi, Adebowale

    2016-01-01

    Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98-100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries. Segmental long bone fractures are often a result of high-energy trauma and hence often associated with a lot of injuries to the surrounding soft tissues. This consequently results in higher rates of delayed or nonunion. This study was proposed to review the outcome of management of segmental fractures with locked intramedullary nails, using an open method of reduction. A retrospective analysis was made of data obtained from all segmental long bone fractures treated with intramedullary nailing over a 1-year period. Records were retrieved from the folders of patients operated on from January 2011 to December 2011. Patients were followed up for a minimum of 1 year after the surgery. We managed a total of 12 segmental long bone fractures in 11 patients. Eight of the 12 fractures were femoral fractures and 10 of the fractures were closed fractures. All but one fracture (91.7%) achieved union within 4 months with no major complications. Open method of locked intramedullary nailing achieves satisfactory results when used for the management of long bone fractures. The method can be used for segmental fractures of the humerus, femur, and tibia, with high union rates. This is particularly useful in low-income societies where the use of intraoperative imaging may be unavailable or unaffordable. It gives patients in such societies, a chance for comparable outcomes in terms of union rates as well as avoidance of major complications. Larger prospective studies will be necessary to conclusively validate the efficacy of this fixation method in this environment.

  15. Nutritional status and wound healing in open fractures of the lower limb.

    PubMed

    Dwyer, A J; John, B; Mam, M K; Antony, P; Abraham, R; Joshi, M

    2005-08-01

    Forty-three patients averaging 28.2 (range 16--74) years with open fractures of the lower limbs were studied prospectively for 40 weeks using anthropometrical, biochemical and haematological parameters to ascertain their relationship to wound healing following injury. Nearly half (21/43) of the patients were malnourished at admission and the number increased to 22 a week after injury. Dietary advice and better food intake improved nutritional status with only 13 patients remaining malnourished at the 40th week. Wound healing was earlier when creatinine-height index was normal throughout the course of treatment and was delayed when serum albumin level was low.

  16. Influence of open and sealed fractures on fluid flow and water saturation in sandstone cores using Magnetic Resonance Imaging

    NASA Astrophysics Data System (ADS)

    Baraka-Lokmane, S.; Teutsch, G.; Main, I. G.

    2001-11-01

    We use Magnetic Resonance Imaging (MRI) to image the imbibition of water by capillary action in a right-cylindrical sample of a porous sedimentary rock with low iron content. In the method some 55 repeat images are taken over a period of approximately two hours, covering five vertical sections. The evolution of the water flood front and the degree of water saturation can be observed by examining snapshots of proton density. The results clearly show (a) the development of a rising wetting front in the rock matrix (b) preferential flow along open fractures observed on the core surface, and (c) reduced flow associated with sealed fractures. The inferred location, orientation and connectivity of conducting and sealing fractures are confirmed by impregnating the sample after the test with an appropriate low-viscosity setting resin and taking serial thin sections in destructive mode. The results validate the utility of MRI as a non-destructive analytical tool for visualizing the distribution of water inside fractured porous media with low iron content. The technique identifies paths of high and low permeability in the sample, and quantifies the fracture location, orientation, and connectivity in sedimentary rocks. Preferential fluid flow in open fractures during capillary imbibition implies that the fractures are more water-wet than the clasts within the matrix. This may be due to due to differences in the age, morphology and mineral structure on the surface of the pores and the fractures.

  17. ADFNE: Open source software for discrete fracture network engineering, two and three dimensional applications

    NASA Astrophysics Data System (ADS)

    Fadakar Alghalandis, Younes

    2017-05-01

    Rapidly growing topic, the discrete fracture network engineering (DFNE), has already attracted many talents from diverse disciplines in academia and industry around the world to challenge difficult problems related to mining, geothermal, civil, oil and gas, water and many other projects. Although, there are few commercial software capable of providing some useful functionalities fundamental for DFNE, their costs, closed code (black box) distributions and hence limited programmability and tractability encouraged us to respond to this rising demand with a new solution. This paper introduces an open source comprehensive software package for stochastic modeling of fracture networks in two- and three-dimension in discrete formulation. Functionalities included are geometric modeling (e.g., complex polygonal fracture faces, and utilizing directional statistics), simulations, characterizations (e.g., intersection, clustering and connectivity analyses) and applications (e.g., fluid flow). The package is completely written in Matlab scripting language. Significant efforts have been made to bring maximum flexibility to the functions in order to solve problems in both two- and three-dimensions in an easy and united way that is suitable for beginners, advanced and experienced users.

  18. Fracture Mechanical Analysis of Open Cell Ceramic Foams Under Thermal Shock Loading

    NASA Astrophysics Data System (ADS)

    Settgast, C.; Abendroth, M.; Kuna, M.

    2016-11-01

    Ceramic foams made by replica techniques containing sharp-edged cavities, which are potential crack initiators and therefore have to be analyzed using fracture mechanical methods. The ceramic foams made of novel carbon bonded alumina are used as filters in metal melt filtration applications, where the filters are exposed to a thermal shock. During the casting process the filters experience a complex thermo-mechanical loading, which is difficult to measure. Modern numerical methods allow the simulation of such complex processes. As a simplified foam structure an open Kelvin cell is used as a representative volume element. A three-dimensional finite element model containing realistic sharp-edged cavities and three-dimensional sub-models along these sharp edges are used to compute the transient temperature, stress and strain fields at the Kelvin foam. The sharp edges are evaluated using fracture mechanical methods like the J-integral technique. The results of this study describe the influence of the pore size, relative density of the ceramic foam, the heat transfer and selected material parameters on the fracture mechanical behaviour.

  19. Early Revision Surgery for Tibial Plateau Non-union and Mal-union.

    PubMed

    Van Nielen, Dominic L; Smith, Christopher S; Helfet, David L; Kloen, Peter

    2017-02-01

    Although relatively rare, non-unions and mal-unions of tibial plateau fractures present significant challenges for the orthopedic surgeon. With careful pre-operative planning, tibial plateau mal-union or non-union revision surgery with intra-articular and varus opening osteotomies can provides good functional results when performed early (within 1 year) after primary surgical procedure. We present our treatment algorithm for approaching and treating non-union or mal-union of tibial plateau fractures. Our aim is to give surgeons treating these difficult injuries an overview of the pertinent literature as well as describe the challenges and pitfalls we have experienced when treating non-union or mal-union of tibial plateau fractures. Using two case examples from our institution, one for mal-union and one for mal-reduction, we describe our treatment algorithm and surgical technique for managing these difficult injuries. We also provide a brief literature review outlining relevant studies and summarizing outcomes for similar injuries. A systematic literature review was conducted with the aim of determining the methods and outcomes commonly reported in the literature regarding revision surgery following tibial plateau non-union or mal-union. Due to the nature of revision surgery, there are no long-term randomized trials dealing with outcomes, but rather several smaller case series exist from which larger conclusions have to be drawn. To date, we have successfully treated approximately 35 patients with this technique, and clinical follow-up continues to show good functional outcomes with reduced pain and little radiographic evidence of arthritic changes. Restoring long leg alignment, anatomic reduction of the articular surface, and achieving stable internal fixation are paramount in achieving the best long-term outcome. Due to the shallow soft tissue envelope around the proximal tibia, and the tendency for these fractures to fall into progressive valgus collapse, these

  20. Microcirculation in open vs. minimally invasive dorsal stabilization of thoracolumbar fractures.

    PubMed

    Ganse, Bergita; Pishnamaz, Miguel; Kobbe, Philipp; Herren, Christian; Gradl-Dietsch, Gertraud; Böhle, Franziska; Johannes, Bernd; Kim, Bong-Sung; Horst, Klemens; Knobe, Matthias

    2017-01-01

    Standard open and percutaneous minimally invasive surgical procedures co-exist in the treatment of fractures of the thoracolumbar spine. Shorter skin incisions just above the pedicles are used in minimally invasive procedures. Full-length skin incisions and invasive preparations are applied in the standard open approach. While both methods show equivalent rates of intraoperative surgical complications and comparable clinical and radiological outcomes, blood loss and operation time have shown to be decreased in minimally invasive treatment. However, no study so far has investigated differences in microcirculation. This study hypothesized less impairment of microcirculation in the minimally invasive approach compared to the open approach and an improvement of microcirculation over time. A prospective cohort study was conducted using non-invasive laser-Doppler spectrophotometry (an O2C "oxygen to see" device) for measurement of cutaneous and subcutaneous blood oxygenation (SO2), haemoglobin concentration (Hb), and blood flow at depths of 2, 8, and 15 mm at six locations on the skin. Measurements were performed before surgery, 8 and 24 h after surgery, and 2, 4, 7, 12 and 20 days after surgery, however the number of patients measured decreased towards the later time points. Forty patients were included in the study, 20 with each approach (18 females and 22 males). Pair-wise comparison of the types of surgical procedure for each measurement point revealed a significantly higher flow value in the minimally invasive group at one of the measurement points located between the incisions (P = .041). The point-wise analyses of SO2 and Hb did not show significant differences between the approaches. In conclusion, significantly albeit moderately higher flow values could be found in minimally invasive procedures compared to open operations of thoracolumbar fractures in the area of skin that is spared by the incisions.

  1. Pulmonary thromboembolism after operation for bilateral open distal radius fractures: a case report.

    PubMed

    Igeta, Yuka; Naito, Kiyohito; Sugiyama, Yoichi; Kaneko, Kazuo; Obayashi, Osamu

    2014-01-14

    Pulmonary thromboembolism after upper extremity operation is rare. We report a patient with thromboembolism after debridement open reduction and internal fixation for bilateral open distal radius fractures. The Japanese patient was an 80-year-old previously healthy female who was able to walk on her own. She fell down and was taken to our hospital. She was diagnosed with bilateral open distal radius fractures and we performed debridement open reduction and internal fixation on the same day. Although she could not walk and was depressed, she was discharged on the ninth postoperative day. However, on the eleventh postoperative day, she returned to our emergency department with complaints of dyspnea and cold sweat. Her serum D-dimer level was 19.0 μg/dl, troponin T was positive, and urgent contrast computed tomography scan of her thorax revealed thrombosis in the bilateral main pulmonary artery. She was diagnosed with pulmonary thromboembolism and admitted to our hospital again. On the second admission, although she had breathing problems, she did not require a respirator. Oxygen was supplied as well as anticoagulants. On the seventh day after being diagnosed with embolism, thrombosis in the bilateral main pulmonary arteries had disappeared. The patient did not have any "strong" risk factors as reported in the Japanese Orthopedic Association Clinical Practice Guideline on the Prevention of Venous Thromboembolism in Patients Undergoing Orthopedic Treatments. In general, upper extremity operation carries a low risk for pulmonary thromboembolism. For patients with decreased activity of daily living and depression, we should consider postponing discharge and performing rehabilitation until activity of daily living is improved.

  2. Seepage into an Underground Opening Constructed in Unsaturated Fractured Rock Under Evaporative Conditions

    SciTech Connect

    R. C. Trautz; Joseph S. Y. Wang

    2001-06-07

    Liquid-release tests, performed in boreholes above an underground opening constructed in unsaturated fractured rock, are used in this study to evaluate seepage into a waste emplacement drift. Evidence for the existence of a capillary barrier at the ceiling of the drift is presented, based on field observations (including spreading of the wetting front across the ceiling and water movement up fractures exposed in the ceiling before seepage begins). The capillary barrier mechanism has the potential to divert water around the opening, resulting in no seepage when the percolation flux is at or below the seepage threshold flux. Liquid-release tests are used to demonstrate that a seepage threshold exists and to measure the magnitude of the seepage threshold flux for three test zones that seeped. The seepage data are interpreted using analytical techniques to estimate the test-specific strength of the rock capillary forces ({alpha}{sup -1}) that prevent water from seeping into the drift. Evaporation increases the seepage threshold flux making it more difficult for water to seep into the drift and producing artificially inflated {alpha}{sup -1} values. With adjustments for evaporation, the minimum test-specific threshold is 1,600 mm/yr with a corresponding {alpha}{sup -1} of 0.027 m.

  3. Impacted stapler pin in fractured maxillary central incisor with open apex: Advanced endodontic management using biodentine as innovative apical matrix.

    PubMed

    Sharma, Vikram; Tanwar, Renu; Gupta, Vidhi; Mehta, Palkin

    2015-01-01

    The presence of foreign objects in the pulp chamber of fractured permanent teeth is a rare phenomenon and often diagnosed accidently .These foreign bodies are most commonly self inflicted by young patients and remain impacted within the pulp canal thereby acting as potential source of infection and painful conditions. In the present case report, we present successful endodontic management of stapler pin lodged in fractured maxillary central incisor with challenge of open apex in young patient using biodentine as a novel apical matrix.

  4. Minimal invasive para-rectus approach for limited open reduction and percutaneous fixation of displaced acetabular fractures.

    PubMed

    Farouk, Osama; Kamal, Ayman; Badran, Mahmoud; El-Adly, Wael; El-Gafary, Kamal

    2014-06-01

    Minimal invasive fixation has been reported as an alternative option for treatment of acetabular fractures to avoid blood loss and complications of extensive approaches. Closed reduction and percutaneous lag screw fixation can be done in minimally displaced acetabular fractures. Open reduction is indicated, if there is wide displacement. In this study, we report the use of a mini-open anterior approach to manipulate and reduce anteriorly displaced transverse acetabular fractures combined with percutaneous lag screw fixation. This report included eight patients. All had anterior displaced simple transverse acetabular fractures. An oblique mini-incision was made above and medial to the mid-inguinal point, and lateral to the lateral border of rectus abdominis muscle. The external abdominal oblique aponeurosis was incised along its fibres. The arched fibres of internal abdominal oblique were displaced medially above the inguinal ligament to expose and incise the fascia transversalis. Care was taken to avoid injury of ilioinguinal nerve, inferior epigastric vessels, and spermatic cord. The external iliac vessels were palpated and protected laterally. A blunt long bone impactor was introduced through this small incision to manipulate and reduce the fracture under fluoroscopic control. Fluoroscopic guided percutaneous lag screw fixation was done in all patients. The average time to operation was 4 days. Average blood loss was 110mL. Operative time averaged 95min. Maximum fracture displacement averaged 10mm preoperatively and 1.3mm postoperatively. According to Matta score, anatomical reduction of the fracture was achieved in five patients and imperfect in three. Follow up averaged 27 months. Wound healing occurred without complications and fracture union was achieved without secondary displacement in all patients. Average time to fracture healing was 14 weeks. According to the modified Merle d'Aubigné score, functional outcome was good to excellent in all patients

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

    PubMed

    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.

  6. Reoperation following open reduction and plate fixation of displaced mid-shaft clavicle fractures.

    PubMed

    Ashman, Bradley D; Slobogean, Gerard P; Stone, Trevor B; Viskontas, Darius G; Moola, Farhad O; Perey, Bertrand H; Boyer, Dory S; McCormack, Robert G

    2014-10-01

    Operative fixation of displaced, mid-shaft clavicle fractures has become an increasingly common practice. With this emerging trend, data describing patient outcomes with longer follow-up are necessary. We retrospectively reviewed the medical records of subjects treated with plate fixation for displaced mid-shaft clavicle fractures from 2003 to 2009 at a Level I trauma hospital. All subjects were greater than 12 months post-index surgery. Treatment involved ORIF with either a low-contact dynamic compression plate (LCDC) or a contoured plate (pre-contoured or pelvic reconstruction plate). Our primary outcome was reoperation for any indication. 143 subjects were included. The mean age was 36 ± 14 years and the mean time to reoperation or chart review was 33 months. Contoured plates were used in 64% of cases and LCDC plates were used in the remaining subjects. Twenty-nine subjects (20%) underwent reoperation: 23.5% of subjects treated with LCDC plates and 18.5% of subjects treated with contoured plates (p=0.52). Indications for reoperation included implant irritation (n=25), implant failure (n=2), and non-union (n=2). There was near statistically significant association with reoperation and female gender (p=0.05) but no association between reoperation and age (p=0.14), fracture class (p=0.53), plate type (p=0.49), or plate location (p=0.93). The mean QuickDASH score for the population surveyed was 8.8 (5.5-12.1; 95% CI) with near statistically significant and clinically relevant difference between those considering reoperation and those not 22.3 (8.6-36.0; 95% CI) versus 6.7 (3.6-9.8; 95% CI). This study represents a large series of displaced clavicle fractures treated with open reduction and plate fixation. Reoperation following plate fixation is relatively common, but primarily due to implant irritation. No difference in reoperation rates between plate types or location could be detected in our current sample size. Also, excellent functional outcomes continue to be

  7. High tibial osteotomy in knee laxities: Concepts review and results

    PubMed Central

    Robin, Jonathan G.; Neyret, Philippe

    2016-01-01

    Patients with unstable, malaligned knees often present a challenging management scenario, and careful attention must be paid to the clinical history and examination to determine the priorities of treatment. Isolated knee instability treated with ligament reconstruction and isolated knee malalignment treated with periarticular osteotomy have both been well studied in the past. More recently, the effects of high tibial osteotomy on knee instability have been studied. Lateral closing-wedge high tibial osteotomy tends to reduce the posterior tibial slope, which has a stabilising effect on anterior tibial instability that occurs with ACL deficiency. Medial opening-wedge high tibial osteotomy tends to increase the posterior tibia slope, which has a stabilising effect in posterior tibial instability that occurs with PCL deficiency. Overall results from recent studies indicate that there is a role for combined ligament reconstruction and periarticular knee osteotomy. The use of high tibial osteotomy has been able to extend the indication for ligament reconstruction which, when combined, may ultimately halt the evolution of arthritis and preserve their natural knee joint for a longer period of time. Cite this article: Robin JG, Neyret P. High tibial osteotomy in knee laxities: Concepts review and results. EFORT Open Rev 2016;1:3-11. doi: 10.1302/2058-5241.1.000001. PMID:28461908

  8. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds.

    PubMed

    Bhandari, Mohit; Jeray, Kyle J; Petrisor, Brad A; Devereaux, P J; Heels-Ansdell, Diane; Schemitsch, Emil H; Anglen, Jeff; Della Rocca, Gregory J; Jones, Clifford; Kreder, Hans; Liew, Susan; McKay, Paula; Papp, Steven; Sancheti, Parag; Sprague, Sheila; Stone, Trevor B; Sun, Xin; Tanner, Stephanie L; Tornetta, Paul; Tufescu, Ted; Walter, Stephen; Guyatt, Gordon H

    2015-12-31

    The management of open fractures requires wound irrigation and débridement to remove contaminants, but the effectiveness of various pressures and solutions for irrigation remains controversial. We investigated the effects of castile soap versus normal saline irrigation delivered by means of high, low, or very low irrigation pressure. In this study with a 2-by-3 factorial design, conducted at 41 clinical centers, we randomly assigned patients who had an open fracture of an extremity to undergo irrigation with one of three irrigation pressures (high pressure [>20 psi], low pressure [5 to 10 psi], or very low pressure [1 to 2 psi]) and one of two irrigation solutions (castile soap or normal saline). The primary end point was reoperation within 12 months after the index surgery for promotion of wound or bone healing or treatment of a wound infection. A total of 2551 patients underwent randomization, of whom 2447 were deemed eligible and included in the final analyses. Reoperation occurred in 109 of 826 patients (13.2%) in the high-pressure group, 103 of 809 (12.7%) in the low-pressure group, and 111 of 812 (13.7%) in the very-low-pressure group. Hazard ratios for the three pairwise comparisons were as follows: for low versus high pressure, 0.92 (95% confidence interval [CI], 0.70 to 1.20; P=0.53), for high versus very low pressure, 1.02 (95% CI, 0.78 to 1.33; P=0.89), and for low versus very low pressure, 0.93 (95% CI, 0.71 to 1.23; P=0.62). Reoperation occurred in 182 of 1229 patients (14.8%) in the soap group and in 141 of 1218 (11.6%) in the saline group (hazard ratio, 1.32, 95% CI, 1.06 to 1.66; P=0.01). The rates of reoperation were similar regardless of irrigation pressure, a finding that indicates that very low pressure is an acceptable, low-cost alternative for the irrigation of open fractures. The reoperation rate was higher in the soap group than in the saline group. (Funded by the Canadian Institutes of Health Research and others; FLOW Clinical

  9. Treatment of an open medial tibiotalar dislocation with no associated fracture.

    PubMed

    Bhullar, Preetinder S; Grant, Daniel R; Foreman, Mark; Krueger, Chad A

    2014-01-01

    Tibiotalar dislocations without associated fractures are very uncommon in adults, and only a few studies have been published regarding this injury. More than 50% of these dislocations will be posteromedial, with a high incidence of open injuries, and 25% are pure posterior dislocations. In the present report, we discuss our experience and management of a medial tibiotalar dislocation with no associated fracture. In the present case, the patient was brought to the operating room on presentation to our facility and underwent irrigation and debridement with primary closure of his wound. He was immobilized postoperatively. The patient tolerated the operation well and did not sustain any postoperative complications. He was able to regain function of the injured extremity until he was lost to follow-up. Regarding treatment, the surgery should be speedy, gentle to the soft tissue, and with as little implanted material as possible. Although we do not advocate that our management and treatment of this injury become the standard, the present case provides a good example of some of the challenges often encountered when treating these injuries. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  10. [Plate Osteosynthesis of Distal Ulna Fractures with Associated Distal Radius Fractures Treated by Open Reduction and Internal Fixation. Short-Term Functional and Radiographic Results].

    PubMed

    Meluzinová, P; Kopp, L; Dráč, P; Edelmann, K; Obruba, P

    2015-01-01

    treatment was shown by the average Mayo wrist score and Quick DASH score of 84 (55-100) and 7.4 (0-47.7) points, respectively. The functional outcome of treatment in our patients corresponded to the severity of their distal forearm fractures. The patients with more serious distal radius fractures, frequently associated with ulnar head fractures, had poorer functional results than the patients with less serious fractures. According to the AO classification, in the distal radius fractures, prevailing fracture types were 23-C3 (78%) and 23-C2 (16%). In relation to the distal ulna fracture type, the patients with ulnar styloid base fractures had better functional results than the patients with ulnar head fractures, because a fracture of the styloid process does not affect the congruency of the distal radioulnar joint (DRUJ). Fractures of the ulnar styloid process base, following distal radius fracture osteosynthesis, were invariably associated with DRUJ instability. This fracture type is always accompanied by injury to the distal radioulnar ligament of the triangular fibrocartilage complex (TFCC) and, in case of a displaced fracture, surgical management is indicated. In agreement with the results of other authors it was found in our study that, when the anatomical position of the distal radioulnar joint had been achieved, both the functional and the radiographic findings were post-operatively very good. The final average values for the range of wrist and forearm motion, hand grip strength and hand and arm function were assessed as very good. CONCLUSIONS The assessment of our results and their comparison with the literature data showed that osteosynthesis of distal ulna fractures with concurrent distal radius fractures managed by open reduction and internal fixation are indicated in displaced fractures of the ulnar styloid process base, displaced comminuted fractures of the ulnar head where fragments interfere with DRUJ congruency, and unstable displaced subcapital fractures of

  11. Closed rupture of the posterior tibial artery secondary to a soccer injury.

    PubMed Central

    Tytherleigh, M. G.; Charnley, G. J.; Wilkins, D. C.

    1998-01-01

    Arterial damage following blunt trauma is uncommon and is usually the result of high-energy injury. We report a case of posterior tibial artery rupture after a closed distal tibial fracture, sustained during a low-energy soccer tackle. Images Figure 1 Figure 2 PMID:9771227

  12. Impact of Body Mass Index and Bacterial Resistance in Osteomyelitis after Antibiotic Prophylaxis of Open Lower-Extremity Fractures.

    PubMed

    Bremmer, Derek; Bookstaver, Brandon; Cairns, Mark; Lindley, Kenneth; Durkin, Martin; Koon, David; Quidley, April Miller

    2017-04-01

    We investigated the clinical effectiveness of antimicrobial prophylaxis in lower-extremity open fractures following the Eastern Association for the Surgery of Trauma Guidelines. This observational, retrospective, single-center study included adults with lower-extremity open fractures of the ankle, tibia, fibula, or femur. The primary endpoint was the incidence of osteomyelitis within 12 months of the fracture. Secondary endpoint comparisons were the time of antibiotic initiation and drug selection. A total of 90 patients were included. Patients suffered from Gustilo and Anderson grades I (14%), II (54.7%), and III (31.3%) fractures. Almost all patients received cefazolin (98%). Among grade III fractures, 59.3% (16/27) of patients received additional gram-negative coverage as recommended by the guidelines. The osteomyelitis rate was 8.9%. There was no difference in osteomyelitis rates among patients with grade III fractures who received or did not receive additional gram-negative coverage: 18.8% (3/16) and 0 (0/11) (p = 0.248), respectively. There was no correlation between median antibiotic start time or antibiotic stop time after closure and the development of osteomyelitis, respectively. Resistant organisms caused 50% (4/8) of the osteomyelitis cases. On univariate analysis, obesity had the most significant association with osteomyelitis (p = 0.026). Bacterial resistance was common among cases of osteomyelitis in our cohort. Obesity was associated with a higher rate of osteomyelitis.

  13. Does a Retromandibular Transparotid Approach for the Open Treatment of Condylar Fractures Result in Facial Nerve Injury?

    PubMed

    Kanno, Takahiro; Sukegawa, Shintaro; Tatsumi, Hiroto; Karino, Masaaki; Nariai, Yoshiki; Nakatani, Eiji; Furuki, Yoshihiko; Sekine, Joji

    2016-10-01

    The retromandibular transparotid approach (RMA) to condylar fractures of the mandible provides excellent access, but can increase the risk of complications. The aim of this study was to estimate the frequency of facial nerve paralysis (FNP) and associated postoperative complications after open reduction and rigid internal fixation (ORIF) of subcondylar fractures through the RMA. This was a retrospective cohort study of patients with condylar fractures requiring ORIF through the RMA. The inclusion criteria were 1) a medical record of surgical treatment of a subcondylar fracture by RMA; 2) preoperative and postoperative radiographs; 3) mental status permitting an adequate neuromotor examination; 4) absence of a post-injury or pretreatment functional facial nerve deficit; and 5) regular postoperative follow-up longer than 6 months with documentation of complications, functional results, and fixation stability. The predictive variables were age, gender, fracture site, fracture pattern, concomitant fractures, etiology, and plate types. The outcome variable was FNP. Univariate, bivariate, and multiple logistic regression statistics were computed. Fifty patients with 55 displaced mandibular subcondylar fractures (35 men, 15 women; mean age, 44.5 yr; range, 17 to 87 yr) met the inclusion criteria. The condylar fracture involved the neck in 35 patients (63.6%) and the base in 20 patients (36.4%). The fracture pattern was deviation in 11 patients (20.0%), displacement in 23 (41.8%), and dislocation in 21 (38.2%). Precise ORIF with double-buttress fixation resulted in immediate functional recovery in all patients. Seven fractures (12.7%) were associated with FNP that resolved completely within 6 months. Further statistical analysis showed that dislocated and displaced condylar neck fractures were significant risk factors for postoperative FNP (P < .05). Other postoperative complications were minimal. The RMA for subcondylar fractures is feasible and safe. Dislocated

  14. Some open issues in the analysis of the storage and migration properties of fractured carbonate reservoirs

    NASA Astrophysics Data System (ADS)

    Agosta, Fabrizio

    2017-04-01

    Underground CO2 storage in depleted hydrocarbon reservoirs may become a common practice in the future to lower the concentration of greenhouse gases in the atmosphere. Results from the first experiments conducted in carbonate rocks, for instance the Lacq integrated CCS Pilot site, SW France, are quite exciting. All monitored parameters, such as the CO2 concentration at well sites, well pressures, cap rock integrity and environmental indicators show the long-term integrity of this type of geological reservoirs. Other positive news arise from the OXY-CFB-300 Compostilla Project, NW Spain, where most of the injected CO2 dissolved into the formation brines, suggesting the long-term security of this method. However, in both cases, the CO2- rich fluids partially dissolved the carbonate minerals during their migration through the fractured reservoir, modifying the overall pore volume and pressure regimes. These results support the growing need for a better understanding of the mechanical behavior of carbonate rocks over geological time of scales. In fact, it is well known that carbonates exhibit a variety of deformation mechanisms depending upon many intrinsic factors such as composition, texture, connected pore volume, and nature of the primary heterogeneities. Commonly, tight carbonates are prone to opening-mode and/or pressure solution deformation. The interplay between these two mechanisms likely affects the petrophysical properties of the fault damage zones, which form potential sites for CO2 storage due to their high values of both connected porosity and permeability. On the contrary, cataclastic deformation produces fault rocks that often form localized fluid barriers for cross-fault fluid flow. Nowadays, questions on the conditions of sealing/leakage of carbonate fault rocks are still open. In particular, the relative role played by bulk crushing, chipping, cementation, and pressure solution on connected porosity of carbonate fault rocks during structural

  15. Medial tibial stress syndrome: case report.

    PubMed

    Jovicić, Milica; Jovicić, Vladimir; Hrković, Marija; Lazović, Milica

    2014-01-01

    Although it can be difficult to differentiate pain in lower legs, it is important for clinicians to differentiate medial tibial stress syndrome, which is a rather benign condition, from acute compartment syndrome, which is an emergency, as well as from different types of stress fractures described in this region. The aim of this case report was to present medial tibial stress syndrome as a clinical diagnosis, possible dilemmas in differential diagnosis and the efficacy of rehabilitation treatment. A 25-year old male patient sought medical help complaining of the pain along the distal third of tibia. The pain was present on palpation of the distal two-thirds of the lateral and medial tibial border over the length of 9 cm and on muscle manual testing of foot flexors. The patient underwent physical and exercise treatment for three weeks. The recovery was monitored by visual analogue scale, which measured the lower leg pain, pain on palpation and manual muscle testing. In addition, the patient himself assessed his ability to resume sport activities on the 5-point Likert scale. The final evaluation and measurements showed his complete functional recovery. The results obtained in this case show the importance of accurate clinical diagnosis and rehabilitation for medial tibial stress syndrome.

  16. Retrospective comparison of minimally invasive plate osteosynthesis and open reduction and internal fixation of radius-ulna fractures in dogs.

    PubMed

    Pozzi, Antonio; Hudson, Caleb C; Gauthier, Christopher M; Lewis, Daniel D

    2013-01-01

    To compare the efficacy of reduction, time to union, and clinical outcome of radius and ulna fractures stabilized using either minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF). Retrospective, case-controlled study. Dogs with radius and ulna fractures stabilized with plates applied using MIPO (n = 15) or ORIF (n = 15). Dogs in each stabilization group were matched for type and location of fracture, age, and body weight. Outcome measures including surgical time, fracture alignment, gap width, plate length, plate bridging and span ratio, working length and screw density, and time to union were compared between the groups using an unpaired t-test. Statistical significance was set at P < .05. All fractures obtained radiographic union although infection developed in 1 dog in each stabilization group. Dogs treated with MIPO had a significant longer plate working length and lesser screw-density (P < .05). No statistical difference was found in operating time, postoperative alignment, gap width, or time to union (MIPO: 51.9 ± 18.4 days; ORIF: 49.5 ± 26.5 days). Radius and ulna fractures managed with MIPO had similar alignment, reduction, and time to union as fractures managed with ORIF. Future prospective clinical studies are warranted and should assess healing more frequently and in a standardized manner to compare MIPO to ORIF in a larger population of dogs. © Copyright 2012 by The American College of Veterinary Surgeons.

  17. Antibiotic Impregnated Bone Cement for the Treatment of Osteomelitis and Severe Open Fractures: Expanded Options for Surgeons

    DTIC Science & Technology

    2008-06-01

    viable antibiotic combinations in bone cement for the treatment of multiple drug resistant organisms. The project has successfully developed...infections. In today’s era of emerging multiple drug resistant bacteria and atypical infections encountered in severe open fractures and...Emphasis will be directed towards establishing viable antibioti c combinations in bone cement for the treatment of multiple drug resistant organisms

  18. Flow Through Cement Fracture Under Geological Carbon Sequestration Conditions: Critical Residence Time as a Unifying Parameter for Fracture Opening or Self-Sealing Behavior

    NASA Astrophysics Data System (ADS)

    Li, L.; Brunet, J. P. L.; Karpyn, Z.; Huerta, N. J.

    2016-12-01

    During geological carbon sequestration (GCS) large quantities of CO2 are injected in underground formations. Cement fractures represent preferential leakage pathways in abandoned wells upon exposure to CO2-rich fluid. Contrasting self- healing and fracture opening behavior have been observed while a unifying framework is still missing. The modelling of this process is challenging as it involves complex chemical, mechanical and transport interactions. We developed a process-based reactive transport model that explicitly simulates flow and multi-component reactive transport in fractured cement by reproducing experimental observations of sharp flow rate reduction during exposure to carbonated water. Mechanical interactions have not been included. The simulation shows a similar reaction network as in diffusion-controlled systems without flow. That is, CO2-rich water induced portlandite dissolution, releasing calcium that further reacted with carbonate to form calcite. This created localized changes in porosity and permeability inducing large differences in the long term response of the system through a complex positive feedback loop (e.g., a decrease in local permeability induces a decrease in flow that in turn amplifies the precipitation of calcite through a reduced acidic brine flow). The calibrated model was used to generate 250 numerical experiments of CO2-flooding in cement fractures with varying initial hydraulic apertures (b) and residence times (τ) defined as the ratio of fracture volume over flow rate. A long τ leads to slow replenishment of carbonated water, calcite precipitation, and self-sealing. The opposite occurs when τ is small with short fractures and fast flow rates. Simulation results indicate that a critical residence time τc - the minimum τ required for self-sealing -divides the conditions that trigger the diverging opening and self-sealing behavior. The τc value depends on the initial aperture size (see figure). Among the 250 simulated

  19. Reduced ultrasound velocity in tibial bone of young ballet dancers.

    PubMed

    Foldes, A J; Danziger, A; Constantini, N; Popovtzer, M M

    1997-05-01

    Young ballet dancers are at risk both for osteopenia, due to low body weight, inadequate nutrition and gonadal dysfunction, as well as for lower limbs stress fractures. However, a direct relationship between stress fractures and bone mass in dancers could not be demonstrated, raising the possibility that qualitative aspects of bone, such as elasticity, may be adversely affected in the dancers. To test this hypothesis, speed of sound, a physical parameter that reflects both quantitative and qualitative properties of bone, was determined at the tibial bone of 27 dance students and 27 non-dance students. The results were compared to bone mineral density at the tibia and the lumbar spine, measured by dual-energy x-ray absorptiometry. All three bone measurements were lower in the dance group, but the difference was statistically significant only for the tibial speed of sound. The role of tibial speed of sound measurement in assessing bone status in athletes warrants further exploration.

  20. Early full weight-bearing versus 6-week partial weight-bearing after open wedge high tibial osteotomy leads to earlier improvement of the clinical results: a prospective, randomised evaluation.

    PubMed

    Schröter, S; Ateschrang, A; Löwe, W; Nakayama, H; Stöckle, U; Ihle, C

    2017-01-01

    Open wedge high tibial osteotomy is a widespread treatment option in patients with varus malalignment and medial compartment osteoarthritis. There is no standardised protocol for post-operative rehabilitation available. The purpose of this study was to compare two post-operative rehabilitation protocols and to evaluate the clinical outcome of early full weight-bearing after open wedge HTO. One hundred and twenty consecutive patients with varus malalignment and medial compartment osteoarthritis received an open wedge HTO using an angular locking plate fixation between December 2008 and December 2011. All patients were assigned randomly into one of two groups with different post-operative rehabilitation protocols (11-day vs. 6-week 20-kg partial weight-bearing). Clinical outcome was evaluated using established instruments (Lequesne, Lysholm, HSS and IKDC scores) preoperatively, 6, 12 and 18 months post-operatively. Deformity analysis was performed preoperatively and during follow-up. All clinical scores showed a significant pre- to post-operative improvement. After 6 months, there was a higher improvement in the group of early full weight-bearing. The difference between preoperative and 6-month follow-up for the group with early full weight-bearing and for the group with 20-kg PWB for 6 weeks was 28 ± 26 and 18 ± 22, respectively, for the Lysholm score and -5.0 ± 5.1 and -3.0 ± 3.6, respectively, for the Lequesne score. Early full weight-bearing (11-day 20-kg partial weight-bearing) after open wedge HTO without bone graft leads to earlier improvement of the clinical results and can be recommended for post-operative rehabilitation after open wedge HTO and fixation with an angular locking plate. Therapeutic study, Level I.

  1. [Magnetic resonance imaging of tibial periostitis].

    PubMed

    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.

  2. Callus Formation and Mineralization after Fracture with Different Fixation Techniques: Minimally Invasive Plate Osteosynthesis versus Open Reduction Internal Fixation

    PubMed Central

    Ding, Haoliang; Qin, Hui; An, Zhiquan

    2015-01-01

    Minimally invasive plate osteosynthesis(MIPO) has been considered as an alternative for fracture treatment. Previous study has demonstrated that MIPO technique has the advantage of less soft tissue injury compared with open reduction internal fixation (ORIF). However, the comparison of callus formation and mineralization between two plate osteosynthesis methods remains unknown. In this experiment, ulna fracture model was established in 42 beagle dogs. The fractures underwent reduction and internal fixation with MIPO or ORIF. Sequential fluorescent labeling and radiographs were applied to determine new callus formation and mineralization in two groups after operation. At 4, 8 and 12 weeks postoperatively, the animals were selected to be sacrificed and the ulna specimens were analyzed by Micro-CT. The sections were also treated with Masson staining for histological evaluation. More callus formation was observed in MIPO group in early stage of fracture healing. The fracture union rate has no significant difference between two groups. The results indicate that excessive soft tissue stripping may impact early callus formation. As MIPO technique can effectively reduce soft tissue injury with little incision, it is considered to be a promising alternative for fracture fixation. PMID:26444295

  3. Effects of Bone Marrow Mesenchymal Stem Cells-Conditioned Medium on Tibial Partial Osteotomy Model of Fracture Healing in Hypothyroidism Rats

    PubMed

    Sefati, Niloofar; Norouzian, Mohsen; Abbaszadeh, Hojjat-Allah; Abdollahifar, Mohammad-Amin; Amini, Abdollah; Bagheri, Mohammad; Aryan, Arefeh; Fadaei Fathabady, Fatemeh

    2018-03-01

    Hypothyroidism is associated with dysfunction of the bone turnover with reduced osteoblastic bone formation and osteoclastic bone resorption. Mesenchyme stem cells (MSCs) secrete various factors and cytokines that may stimulate bone regeneration. The aim of this study was to determine the effects of MSCs-conditioned medium (CM) in hypothyroidism male rats after inducing bone defect. : In this study, 24 male rats were randomly assigned to three groups: (I) hypothyroidism+bone defect (HYPO), (II) hypothyroidism+bone defect+CM (HYPO+CM), and (III) no hypothyroidism+bone defect (control). Four weeks after surgery, the right tibia was removed, and immediately, biomechanical and histological examinations were performed. The results showed a significant reduction in bending stiffness (32.64±3.99), maximum force (14.63±1.89), high stress load (7.59±2.31), and energy absorption (12.68±2.12) at the osteotomy site in hypothyroidism rats in comparison to the control and hypothyroidism+condition medium groups (P<0.05). There was also a significant decrease in the trabecular bone volume (3.86±3.88) and the number of osteocytes (5800±859.8) at the osteotomy site in hypothyroidism rats compared to the control and hypothyroidism+condition medium groups (P<0.01 and P<0.02, respectively). The present study suggests that the use of the CM can improve the fracture regeneration and accelerates bone healing at the osteotomy site in hypothyroidism rats.

  4. Percutaneous versus traditional and paraspinal posterior open approaches for treatment of thoracolumbar fractures without neurologic deficit: a meta-analysis.

    PubMed

    Sun, Xiang-Yao; Zhang, Xi-Nuo; Hai, Yong

    2017-05-01

    This study evaluated differences in outcome variables between percutaneous, traditional, and paraspinal posterior open approaches for traumatic thoracolumbar fractures without neurologic deficit. A systematic review of PubMed, Cochrane, and Embase was performed. In this meta-analysis, we conducted online searches of PubMed, Cochrane, Embase using the search terms "thoracolumbar fractures", "lumbar fractures", ''percutaneous'', "minimally invasive", ''open", "traditional", "posterior", "conventional", "pedicle screw", "sextant", and "clinical trial". The analysis was performed on individual patient data from all the studies that met the selection criteria. Clinical outcomes were expressed as risk difference for dichotomous outcomes and mean difference for continuous outcomes with 95 % confidence interval. Heterogeneity was assessed using the χ 2 test and I 2 statistics. There were 4 randomized controlled trials and 14 observational articles included in this analysis. Percutaneous approach was associated with better ODI score, less Cobb angle correction, less Cobb angle correction loss, less postoperative VBA correction, and lower infection rate compared with open approach. Percutaneous approach was also associated with shorter operative duration, longer intraoperative fluoroscopy, less postoperative VAS, and postoperative VBH% in comparison with traditional open approach. No significant difference was found in Cobb angle correction, postoperative VBA, VBA correction loss, Postoperative VBH%, VBH correction loss, and pedicle screw misplacement between percutaneous approach and open approach. There was no significant difference in operative duration, intraoperative fluoroscopy, postoperative VAS, and postoperative VBH% between percutaneous approach and paraspianl approach. The functional and the radiological outcome of percutaneous approach would be better than open approach in the long term. Although trans-muscular spatium approach belonged to open fixation methods

  5. Tibial osteotomy - slideshow

    MedlinePlus

    ... GO GO About MedlinePlus Site Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Tibial osteotomy - series—Normal anatomy URL of this page: //medlineplus.gov/ency/presentations/ ...

  6. Partially to fully saturated flow through smooth, clean, open fractures: qualitative experimental studies

    NASA Astrophysics Data System (ADS)

    Jones, Brendon R.; Brouwers, Luke B.; Dippenaar, Matthys A.

    2017-11-01

    Fractures are both rough and irregular but can be expressed by a simple model concept of two smooth parallel plates and the associated cubic law governing discharge through saturated fractures. However, in natural conditions and in the intermediate vadose zone, these assumptions are likely violated. This paper presents a qualitative experimental study investigating the cubic law under variable saturation in initially dry free-draining discrete fractures. The study comprised flow visualisation experiments conducted on transparent replicas of smooth parallel plates with inlet conditions of constant pressure and differing flow rates over both vertical and horizontal inclination. Flow conditions were altered to investigate the influence of intermittent and continuous influx scenarios. Findings from this research proved, for instance, that saturated laminar flow is not likely achieved, especially in nonhorizontal fractures. In vertical fractures, preferential flow occupies the minority of cross-sectional area despite the water supply. Movement of water through the fractured vadose zone therefore becomes a matter of the continuity principle, whereby water should theoretically be transported downward at significantly higher flow rates given the very low degree of water saturation. Current techniques that aim to quantify discrete fracture flow, notably at partial saturation, are questionable. Inspired by the results of this study, it is therefore hypothetically improbable to achieve saturation in vertical fractures under free-draining wetting conditions. It does become possible under extremely excessive water inflows or when not free-draining; however, the converse is not true, as a wet vertical fracture can be drained.

  7. High-velocity gunshot wounds of the tibial plafond managed with Ilizarov external fixation: a report of 13 cases.

    PubMed

    Yildiz, Cemil; Ateşalp, A Sabri; Demiralp, Bahtiyar; Gür, Ethem

    2003-07-01

    To report the results of using Ilizarov fixation for the treatment of open tibial plafond fractures caused by high-velocity gunshot injuries. DESIGN Retrospective review of consecutive patients. Military academic hospital. Using the AO classification, three type C1, five type C2, and five type C3 open tibial plafond fractures due to high-velocity gunshot injuries were treated with irrigation, débridement, primary closure, and Ilizarov fixation. Eleven of the fractures were type IIIA, and the remaining two were type IIIB according to the Gustilo-Anderson classification. There were also multiple traumas in one case. Plafond fractures were treated by Ilizarov technique in all 13 cases. In three of the cases, additional osseous transport to eliminate a skeletal defect was performed. Results were evaluated according to Bone's clinical grading system. Average follow-up was 38.4 months (range 26 to 50 months). Callus began to form in 21 to 35 days (average 27.9 days). The fractures united in 126 to 154 days (average 137.6 days), and the apparatus was removed from the limb at that time. There were six good, three fair, and four poor results. Minimal skin necrosis around the wound was seen in four cases, wound infection and purulent discharge were seen in two cases, and angular deformity was seen in two cases. Delayed union and reflex sympathetic dystrophy were not seen in any cases. Although tibiotalar narrowing was seen in four cases, no cases required tibiotalar arthrodesis or subsequent bony reconstruction at the time of their most recent follow-up. The average residual ankle range of motion was plantar flexion 18.5 degrees and dorsiflexion 11.5 degrees. Early aggressive débridement of nonviable tissues, stabilization with an Ilizarov external fixator, and either primary or delayed primary closure followed by early ankle range of motion and weight bearing is an alternative treatment method of these injuries.

  8. Long-term follow up of single-stage anterior cruciate ligament reconstruction and high tibial osteotomy and its relation with posterior tibial slope.

    PubMed

    Arun, G R; Kumaraswamy, Vinay; Rajan, David; Vinodh, K; Singh, Ashutosh Kumar; Kumar, Pradeep; Chandrasekaran, Karthik; Santosh, Sahanand; Kishore, Chandan

    2016-04-01

    Open-wedge high tibial osteotomy is considered to be an effective treatment for medial compartmental osteoarthritis. It is generally admitted that tibial slope increases after open-wedge high tibial osteotomy and decreases after closing-wedge high tibial osteotomy. Young patients with anterior cruciate ligament (ACL) deficiency along with medial compartment osteoarthritis need a combined procedure of ACL reconstruction along with high tibial osteotomy to regain physiological knee kinematics and to avoid chondral damage. We retrospectively analysed data from 30 patients who underwent arthroscopic ACL reconstruction along with medial opening-wedge osteotomy from Jan 2004 to June 2012 with a minimum follow up of 2 years. The pre-operative and post-operative posterior tibial slopes were measured. Functional outcome was analysed using clinico-radiological criteria, IKDC scoring and Lysholm score. Post-operative patients improved both clinically and functionally. The patients who had posterior tibial slope >5° decrease, compared to patients who had less <5° decrease, had better functional scores (IKDC and Lysholm score), which was statistically significant (p < 0.05). Our study has shown that decreasing the tibial slope >5° compared to pre-operative value has functionally favourable effect on the reconstructed ACL graft and outcome. It is known that increasing slope causes an anterior shift in tibial resting position that is accentuated under axial loads. This suggests that decreasing tibial slope may be protective in an ACL deficient knee. Hence by placing the tricortical graft posterior to midline in the opening wedge reduces the posterior tibial slope and thereby reduces the stress on the graft leading to better functional outcome.

  9. Use of the TRPV1 Agonist Capsaicin to Provide Long-Term Analgesia in a Rat Limb Fracture/Open Repair, Internal Fixation Model

    DTIC Science & Technology

    2012-10-01

    W81XWH-10-2-0093 TITLE: Use of the TRPV1 Agonist Capsaicin to Provide Long-Term Analgesia in a Rat Limb Fracture/Open Repair, Internal Fixation Model...2. REPORT TYPE Final 3. DATES COVERED (From - To) 30September2010-29September2012 4. TITLE AND SUBTITLE Use of the TRPV1 Agonist Capsaicin to...capsaicin around the fracture site. 15. SUBJECT TERMS Femur fracture, Rat Model, Pain, Capsaicin, Trauma, TRPV1 16. SECURITY CLASSIFICATION OF

  10. Tibial stress injuries. An aetiological review for the purposes of guiding management.

    PubMed

    Beck, B R

    1998-10-01

    In the last 30 years, few advances have been made in the management of tibial stress injuries such as tibial stress fracture and medial tibial stress syndrome (MTSS). Tibial overuse injuries are a recognised complication of the chronic, intensive, weight-bearing training commonly practised by athletic and military populations. Generally, the most effective treatment is considered to be rest, often for prolonged periods. This is a course of action that will significantly disrupt an active lifestyle, and sometimes end activity-related careers entirely. There is now considerable knowledge of the nature of tibial stress injuries, such that presently accepted management practices can be critically evaluated and supplemented. Most recent investigations suggest that tibial stress injuries are a consequence of the repetitive tibial strain imposed by loading during chronic weight-bearing activity. Evidence is presented in this article for an association between repeated tibial bending and stress injury as a function of: (i) strain-related modelling (in the case of MTSS), and (ii) a strain-related positive feedback mechanism of remodelling (in the case of stress fracture). Factors that influence the bending response of the tibia to loading are reviewed. Finally, a guide for injury prevention and management based on research observations is presented.

  11. Mechanical testing of a new osteotomy design for tibial tuberosity advancement using the Modified Maquet Technique.

    PubMed

    Brunel, L; Etchepareborde, S; Barthélémy, N; Farnir, F; Balligand, M

    2013-01-01

    To evaluate the mechanical properties of the distal cortical hinge associated with a new osteotomy design for the Modified Maquet Technique (MMT). Ex vivo mechanical study. The osteotomy was started 10 mm caudal to the tibial tuberosity and extended over 150% of the length of the tibial crest; it was slightly curved distally to stay at a distance of 2 to 4 mm from the cranial cortex, according to the body weight. Ninety-six tibiae were tested in advancement, and 60 tibiae were axially loaded perpendicular to the tibial plateau, until failure of the crest. Desired advancement was measured using the common tangent method in 60 tibiae. Angle of opening, thickness, and area of the cortical hinge were recorded. Desired advancement of 6 mm, 9 mm, 12 mm and 15 mm was recorded in 16, 12, 18 and 14 tibiae respectively. Mean maximal advancement in these bones was 15.6 ± 6.4 mm, 20.8 ± 5.2 mm, 21.3 ± 5.2 mm and 22.7 ± 5.2 mm respectively. The desired advancement was reached in all but one tibia. Advancement was mainly influenced by the angle of opening and the stiffness of the cortical hinge. Mean ultimate load to failure was 6.12 ± 2.4 times the body weight. It was significantly associated with the body weight, thickness, and area of the cortical hinge. Mean maximal advancement was higher than clinically required without occurrence of fissure or fracture. Ultimate load to failure and maximal advancement could be predicted using calculated formulae.

  12. Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

    PubMed Central

    Eckardt, Henrik; Lind, Dennis; Toendevold, Erik

    2015-01-01

    Background and purpose — During acetabular fracture surgery, the acetabular roof is difficult to visualize with 2-dimensional fluoroscopic views. We assessed whether intraoperative 3-dimensional (3D) imaging can aid the surgeon to achieve better articular reduction and improve implant fixation. Patients and methods — We operated on 72 acetabular fractures using intraoperative 3D imaging and compared the operative results, duration of surgery, and complications with those for 42 consecutive acetabular fracture operations conducted using conventional fluoroscopic imaging. Postoperative reduction was evaluated on reconstructed coronal and sagittal images of the acetabulum. Results — The fracture severity and patient characteristics were similar in the 2 groups. In the 3D group, 46 of 72 patients (0.6) had a perfect result after open reduction and internal fixation, and in the control group, 17 of 42 (0.4) had a perfect result. The mean difference in postoperative articular incongruity was 0.5 mm (95% CI: 0.4–0.7). In 29 of 72 operations, the intraoperative 3D scans led to intraoperative correction of the reduction and an improved result. The duration of surgery and infection rate were similar in the 2 groups. Interpretation — Intraoperative 3D imaging, which is not time-consuming, allowed the surgeon to correct malreductions and screw placement in 29 of 72 operations, leading to better articular reduction and more precise screw placement than in operations where conventional fluoroscopic imaging was used to control the reduction. PMID:26012545

  13. Radiographic Evaluation of Ankle Joint Stability After Calcaneofibular Ligament Elevation During Open Reduction and Internal Fixation of Calcaneus Fracture.

    PubMed

    Wang, Chien-Shun; Tzeng, Yun-Hsuan; Lin, Chun-Cheng; Huang, Ching-Kuei; Chang, Ming-Chau; Chiang, Chao-Ching

    2016-09-01

    The aim of this prospective study was to evaluate the influence of sectioning the calcaneofibular ligament (CFL) during an extensile lateral approach during open reduction and internal fixation (ORIF) of calcaneal fractures on ankle joint stability. Forty-two patients with calcaneal fractures that received ORIF were included. Talar tilt stress and anterior drawer radiographs were performed on the operative and contralateral ankles 6 months postoperatively. The average degree of talar tilt on stress radiographs was 3.4 degrees (range, 0-12 degrees) on the operative side and 3.2 degrees (range, 0-14 degrees) on the contralateral side. The mean anterior drawer on stress radiographs of the CFL incised ankle was 6.1 mm (range, 2.4-11.8 mm) and on the contralateral ankle was 5.7 mm (range, 2.6-8.6 mm). There was no statistically significant difference of talar tilt and anterior drawer between the CFL incised side and the contralateral side (P = .658 and .302, respectively). The results suggest that sectioning of the CFL without any repair during ORIF of a calcaneal fracture does not have a negative effect on stability of the ankle. Repair of the CFL is, thus, probably not necessary following extended lateral approach for ORIF of calcaneal fractures. Level II, comparative study. © The Author(s) 2016.

  14. GHGfrack: An Open-Source Model for Estimating Greenhouse Gas Emissions from Combustion of Fuel during Drilling and Hydraulic Fracturing.

    PubMed

    Vafi, Kourosh; Brandt, Adam

    2016-07-19

    This paper introduces GHGfrack, an open-source engineering-based model that estimates energy consumption and associated GHG emissions from drilling and hydraulic fracturing operations. We describe verification and calibration of GHGfrack against field data for energy and fuel consumption. We run GHGfrack using data from 6927 wells in Eagle Ford and 4431 wells in Bakken oil fields. The average estimated energy consumption in Eagle Ford wells using lateral hole diameters of 8 (3)/4 and 6 (1)/8 in. are 2.25 and 2.73 TJ/well, respectively. The average estimated energy consumption in Bakken wells using hole diameters of 6 in. for horizontal section is 2.16 TJ/well. We estimate average greenhouse gas (GHG) emissions of 419 and 510 tonne of equivalent CO2 per well (tonne of CO2 eq/well) for the two aforementioned assumed geometries in Eagle Ford, respectively, and 417 tonne of CO2 eq/well for the case of Bakken. These estimates are limited only to GHG emissions from combustion of diesel fuel to supply energy only for rotation of drill string, drilling mud circulation, and fracturing pumps. Sensitivity analysis of the model shows that the top three key variables in driving energy intensity in drilling are the lateral hole diameter, drill pipe internal diameter, and mud flow rate. In hydraulic fracturing, the top three are lateral casing diameter, fracturing fluid volume, and length of the lateral.

  15. Reverse total shoulder arthroplasty for failed open reduction and internal fixation of fractures of the proximal humerus.

    PubMed

    Grubhofer, Florian; Wieser, Karl; Meyer, Dominik C; Catanzaro, Sabrina; Schürholz, Katharina; Gerber, Christian

    2017-01-01

    Open reduction and internal fixation (ORIF) of complex fractures of the proximal humerus may yield unsatisfactory results. This study analyzed the results obtained after revision of failed ORIF of proximal humeral fractures using reverse total shoulder arthroplasty (RTSA). Fifty-four shoulders of 53 patients with a subjectively unacceptable outcome after ORIF of a complex fracture of the proximal humerus were revised with RTSA. At a minimum follow-up of 2 years (mean follow-up, 46 months; range, 24-108 months), 44 shoulders were clinically and radiographically reviewed for the purpose of this study. Six patients had been lost to follow-up, and 4 patients (7%) were excluded from functional analysis because of revision surgeries. The mean absolute Constant score improved from 26 (range, 4-54) to 55 (range, 19-80) points; the mean relative Constant score improved from 32% (range, 4%-85%) to 67% (range, 27%-94%) of an age- and gender-matched, normal shoulder. The mean subjective shoulder value improved from 29% (range, 0%-90%) preoperatively to 67% (range, 5%-95%) at final follow-up. Nineteen patients rated their outcome excellent, 16 good, and 7 fair; 2 patients were dissatisfied. RTSA is a valuable salvage procedure after failed ORIF of a proximal humeral fracture with relatively low revision rates. Shoulder function, patient satisfaction, and pain levels can be reliably improved. Copyright © 2017. Published by Elsevier Inc.

  16. Biomechanical Factors in Tibial Stress Fracture

    DTIC Science & Technology

    2001-08-01

    McClay, IS. Injury Patterns in Runners with Pes Cavus andPes Planus . Presented at the ACSM National Mtg in Indianapolis, IN, 6/00. Sahte, V, Ireland...Mass. Exercise Science EMPLOYMENT Director of Research, Joyner Sportsmedicine Institute, (6/97 - present) Development of research within the...Dimensional Kinetic Analysis of Running: Significance of Secondary Planes of Motion. Medicine and Science in Sports and Exercise 31(11)1629-1637

  17. Biomechanical Factors in Tibial Stress Fractures

    DTIC Science & Technology

    2003-08-01

    witii Pes Cavus andPes Planus . Presented at the ACSM National Mtg in Mdianapolis, IN, 6/00. Sahte, V, Ireland, ML, Ballantyne BT and McClay, IS. Acute...syndrome in competitive female runners". It will be submitted to Medicine and Science in Sport and Exercise by the end of 2003. Abstract Submission...Sports and Exercise , 35, S91. McClay Davis, I., Ferber, R., Hamill, J. & Pollard, CD. (2003). Rearfoot mechanics in competitive runners who had

  18. On the Relationship Between J-Integral and Crack Tip Opening Displacement in Elastic-Plastic Fracture Mechanics

    NASA Astrophysics Data System (ADS)

    Pereira, Marcos Venicius; Darwish, Fathi Aref; Campelo, Eduardo

    2013-08-01

    The relationship between J-integral ( J) and crack tip opening displacement (δ), considered fundamental for elastic-plastic fracture mechanics, can be established based on prior knowledge of the constraint factor m, which depends on the work hardening exponent and the material's yield strain. Both J and δ were simultaneously determined at fracture initiation and at different points along the resistance curves for a number of structural steels. The corresponding m values were calculated and then compared with the predictions made by different models. The results indicate that the experimentally determined m values are in fair agreement with the predictions made by ASTM over the whole range of flow parameters considered in this study. The Hutchinson-Rice-Rosengren singularity-based predictions result in overestimating m for steels considered to be of low strength and high strain hardening exponent. Predictions made by other models are predominantly higher in comparison with their experimental counterparts.

  19. Non-invasive repair of an iatrogenic tibial artery branch pseudoaneurysm after intramedullary nailing.

    PubMed

    Hanson, Cameron G; Hanson, Logan F

    2017-11-01

    Tibial fractures are a commonly seen injury in orthopedic surgery. Intramedullary nailing is considered the standard of care, as complications are rare. Those of a vascular nature, including iatrogenically induced pseudoaneurysms of the tibial artery have been previously described in the literature, however each reported case has required surgical repair. In the current case, we describe a repair of a tibial artery branch pseudoaneurysm, after direct contact with an interlocking screw from tibial intramedullary nailing, via ultrasound-guided thrombin injection. To the authors' knowledge, this is the first reported case of a tibial artery pseudoaneurysm repaired non-surgically. This adds support to the promising literature on non-invasive repair of orthopedically related pseudoaneurysms.

  20. Infection rate in adult patients with open fractures treated at the emergency hospital and at the ULBRA university hospital in Canoas, Rio Grande do Sul, Brazil.

    PubMed

    Guerra, Marcelo Teodoro Ezequiel; Gregio, Fernando Machado; Bernardi, Adriane; Castro, Cyntia Cordeiro de

    2017-01-01

    To identify the infection rate in adult patients with open fractures treated at two tertiary hospitals in the city of Canoas, Rio Grande do Sul, Brazil. This quantitative descriptive study was conducted at Hospital de Pronto Socorro de Canoas. Eligible participants were adults aged 18-60 years with open fractures who were admitted to the orthopedic trauma service from January to May 2014 and followed-up for one year. A total of 133 patients with open fractures were included; most were men (92.48%), with a mean age of 36 years. There was a predominance of Gustilo-Anderson type III fractures. The infection rate was 18.80%, being more frequent in Gustilo-Anderson type III fractures (72.00%). The most commonly observed bacteria were Staphylococcus aureus and Enterobacter aerogenes . The infection rate in open fractures of patients initially treated at the emergency department of HPSC was 18.8%. The infections occurred predominantly in Gustilo-Anderson type III fractures. The bacteria with the highest incidence in infections were Staphylococcus aureus and Enterobacter aerogenes .

  1. Wound irrigation does not affect health-related quality of life after open fractures: results of a randomized controlled trial.

    PubMed

    Sprague, S; Petrisor, B; Jeray, K; McKay, P; Heels-Ansdell, D; Schemitsch, E; Liew, S; Guyatt, G; Walter, S D; Bhandari, M

    2018-01-01

    The Fluid Lavage in Open Fracture Wounds (FLOW) trial was a multicentre, blinded, randomized controlled trial that used a 2 × 3 factorial design to evaluate the effect of irrigation solution (soap versus normal saline) and irrigation pressure (very low versus low versus high) on health-related quality of life (HRQL) in patients with open fractures. In this study, we used this dataset to ascertain whether these factors affect whether HRQL returns to pre-injury levels at 12-months post-injury. Participants completed the Short Form-12 (SF-12) and the EuroQol-5 Dimensions (EQ-5D) at baseline (pre-injury recall), at two and six weeks, and at three, six, nine and 12-months post-fracture. We calculated the Physical Component Score (PCS) and the Mental Component Score (MCS) of the SF-12 and the EQ-5D utility score, conducted an analysis using a multi-level generalized linear model, and compared differences between the baseline and 12-month scores. We found no clinically important differences between irrigating solutions or pressures for the SF-12 PCS, SF-12 MCS and EQ-5D. Irrespective of treatment, participants had not returned to their pre-injury function at 12-months for any of the three outcomes (p < 0.001). Neither the composition of the irrigation solution nor irrigation pressure applied had an effect on HRQL. Irrespective of treatment, patients had not returned to their pre-injury HRQL at 12 months post-fracture. Cite this article: Bone Joint J 2018;100-B:88-94. ©2018 Sprague et al.

  2. Osthole Promotes Bone Fracture Healing through Activation of BMP Signaling in Chondrocytes

    PubMed Central

    Wang, Pinger; Ying, Jun; Luo, Cheng; Jin, Xing; Zhang, Shanxing; Xu, Taotao; Zhang, Lei; Mi, Meng; Chen, Di; Tong, Peijian; Jin, Hongting

    2017-01-01

    Osthole is a bioactive coumarin derivative and has been reported to be able to enhance bone formation and improve fracture healing. However, the molecular mechanism of Osthole in bone fracture healing has not been fully defined. In this study we determined if Osthole enhances bone fracture healing through activation of BMP2 signaling in mice. We performed unilateral open transverse tibial fracture procedure in 10-week-old C57BL/6 mice which were treated with or without Osthole. Our previous studies demonstrated that chondrocyte BMP signaling is required for bone fracture healing, in this study we also performed tibial fracture procedure in Cre-negative and Col2-Cre;Bmp2flox/flox conditional knockout (KO) mice (Bmp2Col2Cre) to determine if Osthole enhances fracture healing in a BMP2-dependent manner. Fracture callus tissues were collected and analyzed by X-ray, micro-CT (μCT), histology, histomorphometry, immunohistochemistry (IHC), biomechanical testing and quantitative gene expression analysis. In addition, mouse chondrogenic ATDC5 cells were cultured with or without Osthole and the expression levels of chondrogenic marker genes were examined. The results demonstrated that Osthole promotes bone fracture healing in wild-type (WT) or Cre- control mice. In contrast, Osthole failed to promote bone fracture healing in Bmp2Col2Creconditional KO mice. In the mice receiving Osthole treatment, expression of cartilage marker genes was significantly increased. We conclude that Osthole could promote bone strength and enhance fracture healing by activation of BMP2 signaling. Osthole may be used as an alternative approach in the orthopaedic clinic for the treatment of fracture healing. PMID:28924381

  3. Results of open reduction and internal fixation of severe fractures of the proximal humerus in elderly patients☆☆☆

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Filho, João Manoel Fonseca; Ferreira, Marco Tonding; Filho, Paulo Roberto Davanso; Checchia, Sergio Luiz

    2014-01-01

    Objective To evaluate clinical and radiological results with open reduction and internal fixation of severe fractures of the proximal humerus in the patients over the age of 60 years. Methods Between June 1992 and February 2011, 21 patients with FGEPU over the age of 60 years were treated by open reduction and internal fixation at the Group of Shoulder and Elbow Department of Orthopaedics and Traumatology of Santa Casa de São Paulo Medical School. 18 patients were reviewed. Results Two patients had excellent results, 12 good, three regular and one bad. Therefore, we find that 77.7% of these had good and excellent results. All patients were satisfied with the treatment and only three patients did not return to previous activities. Mean postoperative mobilities were 122° elevation (90–150°), 39 lateral rotation (20–60°) and medial rotation of T11 (T5 to sacro iliac joint). Conclusion Open reduction and internal fixation of FGEPU may also be indicated for elderly patients and obtained 77.7% of good and excellent results. Statistically (p < 0.05), the anatomical reduction of the fracture was found to be important for obtaining good results. PMID:26229768

  4. Opening wedge high tibial osteotomy performed without filling the defect but with locking plate fixation (TomoFix™) and early weight-bearing: prospective evaluation of bone union, precision and maintenance of correction in 51 cases.

    PubMed

    Brosset, T; Pasquier, G; Migaud, H; Gougeon, F

    2011-11-01

    A medial opening wedge high tibial osteotomy (HTO), where the osteotomy site is filled, is often preferred to a lateral closing osteotomy, but filling the defect can lead to certain complications. A medial opening HTO can be performed without filling the bone defect if fixation is carried out with a specially-designed stiff locking plate. Fifty-one patients, 37 to 72 years of age where followed prospectively and continuously from 2003 to 2006. A single surgical technique was used: medial opening HTO with locked plate fixation (TomoFix™, Synthes) but without filling the defect. The preoperative genu varum could not exceed 15°. The following were evaluated: time to return to weight-bearing, IKS functional score, long-leg standing film performed preoperative, postoperative and at follow-up to evaluate limb alignment and validate the precision of the correction and its stability over time. A measurement of the area of bone union in the osteotomy site was used to quantify the rate of union. Bone union occurred at 4.5 months on average; two cases of incomplete union (7%) were found and revised with an autograft at 7 and 9 months. Lower-limb alignment was 7.5° of varus on average before surgery (3° to 15° varus, SD=2.85) and 1.2° of valgus on average after the surgery (4° varus to 5° valgus, SD=1.78). The correction was maintained at 1 year post-surgery. The average IKS knee score went from 69±15.5 (range 25 to 96) before surgery to 90±7.4 (range 66 to 98) at follow-up (P=0.0001). Full weight-bearing without assistance was possible after 3 months on average (range 1.5 to 8, SD=1.21). Forty-seven patients (92%) were fully weight-bearing after 2 months. Forty-eight patients were able to return to work and sporting activities at the same or a higher level than before the procedure. Bone union seems to happen more slowly when the defect is filled; however, there are doubts about radiological evaluation of bone union in different published studies. When osteotomy

  5. Application of critical COD and plastic instability concepts to fracture of shells. [Crack Opening Displacement

    NASA Technical Reports Server (NTRS)

    Erdogan, F.; Ratwani, M.

    1974-01-01

    The paper deals with the initiation, growth, and possible arrest of fracture in shell structures containing initial defects which may be approximated by an isolated part-through crack. The main study is restricted to the structures in which the net section of the shell wall around the defect zone is fully yielded. The problem is solved by using an 8th order shallow shell theory with a conventional plastic strip model to account for the plastic deformations. Using the critical COD or the plastic instability as fracture criterion, the results are applied to the fracture propagation and arrest in shells. The calculated results are then compared with those obtained from the experiments on zircaloy, aluminum, and steel pipes.

  6. Continuous lumbar plexus block for acute postoperative pain management after open reduction and internal fixation of acetabular fractures.

    PubMed

    Chelly, Jacques E; Casati, Andrea; Al-Samsam, Tameem; Coupe, Kevin; Criswell, Allen; Tucker, Jeffery

    2003-05-01

    To assess the efficacy of postoperative continuous lumbar plexus blocks for postoperative pain control in patients undergoing open reduction and internal fixation of an acetabular fracture. Twenty-six patients who underwent open reduction and internal fixation of an acetabular fracture. DESIGN/PERSPECTIVE: According to a case-control study design, patients were divided into 2 groups: Group 1 (n = 13) received postoperatively a continuous lumbar plexus block with 0.2% ropivacaine (10 mL/hr for 48 hours), and group 2 (n = 13) received postoperatively patient-controlled analgesia with morphine (1 mg; lock-out time, 10 minutes; total 6 mg/hr). Postoperative morphine consumption, time to unassisted ambulation, and clinical and radiographic outcomes. No significant differences in demographics, surgical procedure, or duration of surgery were reported between the two groups. The lumbar plexus catheter group showed a lower requirement for morphine in the postanesthesia care unit (6 mg [0-14 mg]) and during the first 2 days (20 mg [6-55 mg] on day 1 and 29 mg [4-56 mg] on day 2) than the control group (51 mg [20-100 mg] on day 1 and 50 mg [10-93 mg] on day 2) (P = 0.001 and P = 0.021). Effective unassisted ambulation was recovered earlier in patients with the lumbar plexus catheter (3 days; range 2-4 days) than in the control group (4 days; range 3-7 days) (P = 0.015). Continuous lumbar plexus block represents an interesting alternative for postoperative pain control in patients undergoing open reduction and internal fixation of an acetabular fracture.

  7. Silver ion doped ceramic nano-powder coated nails prevent infection in open fractures: In vivo study.

    PubMed

    Kose, Nusret; Çaylak, Remzi; Pekşen, Ceren; Kiremitçi, Abdurrahman; Burukoglu, Dilek; Koparal, Savaş; Doğan, Aydın

    2016-02-01

    Despite improvement in operative techniques and antibiotic therapy, septic complications still occur in open fractures. We developed silver ion containing ceramic nano powder for implant coating to provide not only biocompatibility but also antibacterial activity to the orthopaedic implants. We hypothesised silver ion doped calcium phosphate based ceramic nano-powder coated titanium nails may prevents bacterial colonisation and infection in open fractures as compared with uncoated nails. 33 rabbits divided into three groups. In the first group uncoated, in the second group hydroxyapatite coated, and in the third group silver doped hydroxyapatite coated titanium nails were inserted left femurs of animals from knee regions with retrograde fashion. Before implantation of nails 50 μl solution containing 10(6)CFU/ml methicillin resistance Staphylococcus aureus (MRSA) injected intramedullary canal. Rabbits were monitored for 10 weeks. Blood was taken from rabbits before surgery and on 2nd, 6th and 10th weeks. Blood was analysed for biochemical parameters, blood count, C-reactive protein and silver levels. At the end of the 10 weeks animals were sacrificed and rods were extracted in a sterile fashion. Swab cultures were taken from intramedullary canal. Bacteria on titanium rods were counted. Liver, heart, spleen, kidney and central nervous tissues samples were taken for determining silver levels. Histopathological evaluation of bone surrounding implants was also performed. No significant difference was detected between the groups from hematologic, biochemical, and toxicological aspect. Microbiological results showed that less bacterial growth was detected with the use of silver doped ceramic coated implants compared to the other two groups (p=0.003). Accumulation of silver was not detected. No cellular inflammation was observed around the silver coated prostheses. No toxic effect of silver on bone cells was seen. Silver ion doped calcium phosphate based ceramic nano

  8. Fluid lavage of open wounds (FLOW): a multicenter, blinded, factorial pilot trial comparing alternative irrigating solutions and pressures in patients with open fractures.

    PubMed

    Petrisor, Bradley; Sun, Xin; Bhandari, Mohit; Guyatt, Gordon; Jeray, Kyle J; Sprague, Sheila; Tanner, Stephanie; Schemitsch, Emil; Sancheti, Parag; Anglen, Jeff; Tornetta, Paul; Bosse, Michael; Liew, Susan; Walter, Stephen

    2011-09-01

    Open fractures are an important source of morbidity and are associated with delayed union, nonunion, and infection. Preventing infection through meticulous irrigation and debridement is an important goal in management, and different lavage fluids and irrigation techniques (e.g., high- or low-pressure lavage) have been described for this purpose. However, there are a limited number of randomized trials comparing irrigating solutions or irrigating technique. We compared the use of castile soap versus normal saline and high- versus low-pressure pulsatile lavage on the rates of reoperations and complications in patients with open fracture wounds. We conducted a multicenter, blinded, randomized 2 × 2 factorial pilot trial of 111 patients in whom an open fracture wound was treated with either castile soap solution or normal saline and either high- or low-pressure pulsatile lavage. The primary composite outcome of reoperation, measured at 12 months after initial operative procedure, included infection, wound healing problems, and nonunion. Planned reoperations were not included. Secondary outcomes included all infection, all wound healing problems, and nonunion as well as functional outcomes scores (EuroQol-5 dimensions and short form-12). Eighty-nine patients completed the 1-year follow-up. Among all patients, 13 (23%) in the castile soap group and 13 (24%) in the saline group had a primary outcome event (hazard ratio, 0.91, 95% confidence interval: 0.42-2.00, p = 0.52). Sixteen patients (28%) in the high-pressure group and 10 patients (19%) in the low-pressure group had a primary outcome event (hazard ratio 0.55, 95% confidence interval: 0.24-1.27, p = 0.17). Functional outcome scores showed no significant differences at any time point between groups. The fluid lavage of open wounds pilot randomized controlled trial demonstrated the possibility that the use of low pressure may decrease the reoperation rate for infection, wound healing problems, or nonunion. We have

  9. Short-term outcome and complications of TPLO using anatomically contoured locking compression plates in small/medium-breed dogs with "excessive" tibial plateau angle.

    PubMed

    Barnes, D C; Trinterud, T; Owen, M R; Bush, M A

    2016-06-01

    To report short-term radiographic and clinical outcome and complications following tibial plateau levelling osteotomy for the treatment of cranial cruciate ligament insufficiency in dogs less than 18·1 kg with tibial plateau angle greater than 35° using anatomically contoured six-hole locking compression plates. Retrospective data were collected on: preoperative, postoperative and follow-up tibial plateau angles, plateau segment rotation, tibial tuberosity width and length of the cranial aspect of tibial tuberosity segment from the patellar tendon insertion and rotation of the tibial plateau below the level of the insertion of the patellar ligament. In 26 small dogs (29 stifles in total), mean preoperative, postoperative and follow-up tibial plateau angles were 38·2°, 4·8°, and 4·4°, respectively. Documented postoperative complications were limited to patellar tendinopathy in a single case (3·4%) and tibial tuberosity or fibula fracture were not observed. Short-term radiographic and clinical outcome of tibial plateau levelling osteotomy stabilised with anatomically contoured six-hole locking compression plates for the treatment of small dogs with large tibial plateau angle suggests a very low risk of complications. Rotation beyond the "safe point" is necessary to perform full rotation in some cases, but does not appear to incur an increased risk of tibial tuberosity fracture. © 2016 British Small Animal Veterinary Association.

  10. Pediatric Tibial Osteomyelitis.

    PubMed

    Stone, Brad; Street, Matthew; Leigh, Warren; Crawford, Haemish

    2016-01-01

    Osteomyelitis shows a strong predilection for the tibia in the pediatric population and is a significant source of complications. The purpose of this article is to retrospectively review a large series of pediatric patients with tibial osteomyelitis. We compare our experience with that in the literature to determine any factors that may aid diagnosis and/or improve treatment outcomes. A 10-year retrospective review was performed of clinical records of all cases of pediatric tibial osteomyelitis managed at the 2 children's orthopaedic departments in the Auckland region. The Osteomyelitis Database was used to identify all cases between 1997 and 2007, at Starship Children's Hospital, and 1998 and 2008 at Middlemore's Kids First Hospital. One hundred ninety-one patients fulfilled the inclusion criteria, and had a review of clinical notes and relevant investigations. The average duration of symptoms before presentation to hospital was 5.7 days. Less than 40% of patients had a recent episode of trauma. Almost 60% of patients could not bear weight on admission. Over 40% of patients had a temperature above 38°C. Erythrocyte sedimentation rate was elevated in 78% and the C-reactive protein was elevated in 90% of patients. In total, 42% of blood cultures and almost 75% of tissue cultures were positive, with Staphylococcus aureus being the most commonly cultured organism. X-rays, bone scans, and magnetic resonance imaging were all used to aid the diagnosis. About 43% of patients had surgery. Treatment length was an average of 2 weeks 6 days of intravenous antibiotics followed by 3 weeks 2 days of oral treatment. Six postsurgical complications and 46 readmissions were noted: 25 for relapse, with the remainder due to social and antibiotic-associated complications. Although generally diagnosed on presentation, pediatric tibial osteomyelitis can require more sophisticated investigations and prolonged management. Treatment with intravenous and oral antibiotics and surgical

  11. Open Reduction and Internal Fixation of Scapula Fractures in a Geriatric Series

    PubMed Central

    Cole, Peter A.; Jacobson, Aaron R.

    2015-01-01

    The purpose of this small descriptive series was to report patient and injury characteristics, as well as, surgical and functional outcomes in patients aged 70 years or older, with operative scapular fracture. A retrospective review of 214 scapula fractures identified 6 consecutive geriatric patients aged 70 years or older and formed the basis for this study. Outcomes reported include surgical complications; disabilities of the arm, shoulder, and hand (DASH); range of motion (ROM); and strength assessment at the 6-month postoperative interval and final follow-up. All patients were community ambulators and 5 of the 6 patients routinely performed recreational activities that required shoulder strength and/or motion. Outcomes were attained on all patients at greater than 1 year with a mean of 23.2 months. There were no surgical complications and all fractures united. The mean ROM expressed as a percentage of contralateral ROM ranged from 82% to 100% at both 6-month and final follow-up. The mean strength expressed as a percentage of contralateral strength ranged from 63% to 82% at the 6-month follow-up and 94% to 100% at the final follow-up. The mean DASH score was 12.3 at final follow-up. Our conclusion is that operative treatment for displaced scapula fractures appears to be safe and can yield good functional results in patients aged 70 years and older. PMID:26328233

  12. Early Initial Antibiotics and Debridement Independently Reduce Infection in an Open Fracture Model

    DTIC Science & Technology

    2012-01-01

    collagen soaked with 1×105 colony-forming units (CFUs) of Staphylococcus aureus in 0.5 ml of saline. The (Xenogen 36) strain of Staph . aureus used, derived...and with a proton- count camera to confirm that they were the strain of Staph . aureus used to contaminate the fracture. In addition to the operative

  13. Open reduction in trapdoor-type blowout fractures using absorbable mesh plates.

    PubMed

    Kim, Young Jin; Choi, Seung Ho; Jun, Young Joon; Seo, Byung Chul

    2011-11-01

    In many cases of trapdoor-type orbital blowout fracture, the bony segment has a stable hinge consisting of a greenstick fracture and the sinus mucoperiosteum that is attached to the intact orbital wall. If the displaced bony segment opposite the hinge will be reduced into its original position and will be fixed onto the unaffected bone, the orbital fracture may be reconstructed via the internal fixation of the bony segment itself rather than requiring substitution with an alloplastic implant or a bone graft. A retrospective study was conducted from January 2008 to February 2010 in 34 patients with blowout fracture, via retrospective chart review, including detailed preoperative and postoperative evaluations, age, sex, symptoms, and signs, and based on the postoperative complications. The subciliary, transconjunctival, and transcaruncular approaches were used to expose the orbital floor under general anesthesia. The herniated orbital soft tissue was carefully reduced. The displaced bony segment was carefully pulled up and placed in its original anatomic position with a skin hook. A small absorbable mesh plate was inserted between the normal orbital wall and the bony segment, tangential to the edge of the bony defect at the dependent portion. Postoperative examinations such as the traction and forced duction tests showed no eye movement limitation and surgical complications. During the follow-up period, no complications occurred, and the orbital wall was accurately reconstructed in its original anatomic position, as confirmed by postoperative computed tomography scans. The advantages of internal fixation include anatomic reconstruction of the orbital wall, preservation of the original orbital bone and the mucoperiosteum of the sinus resulting in rapid wound healing and normal mucus drainage function of the sinus, simplicity of the procedure, and the absence of surgery-related complications. This technique is presented as one of the preferred treatments for trapdoor

  14. Comparative analysis of osteosynthesis of mandibular anterior fractures following open reduction using 'stainless steel lag screws and mini plates'.

    PubMed

    Bhatnagar, Aditi; Bansal, Vishal; Kumar, Sanjeev; Mowar, Apoorva

    2013-06-01

    The purpose of this study was to compare the outcome of open treatment of mandibular fracture (symphysis or parasymphysis) using lag screw or mini plate clinically as well as radiologically in young (age range 12-45 years) and healthy individuals of poor socioeconomic status. This prospective study was conducted on 30 patients diagnosed as cases of displaced mandibular anterior fractures treated with open reduction and internal fixation. The patients were then randomly allocated to either of two groups--Group A: Two 2.5 mm stainless steel lag screws were placed in 15 patients. Group B: Two 2.5 mm stainless steel mini plates were placed in 15 patients for the fixation of fractures. Subsequent follow up was done on 2nd, 4th, 6th and 8th week postoperatively. During every follow up patient was assessed clinically for infection, malocclusion, loosening of plate/screw, sensory disturbance, plate fracture, malunion/non-union, devitalisation of associated dentoalveolar segment and masticatory efficiency. Radiographs were taken if necessary and patients were further assessed for any complaint. Pain was objectively measured using a visual analogue scale, bite force was measured using a bite force transducer at biweekly interval. The data collected was subjected to unpaired t test and paired t test for statistical analysis. During follow up period a significant improvement in bite force was present in both the groups, with more improvement seen in the lag screw group (p < 0.01). There was a significant pain reduction present in the lag screw group (p < 0.01) and also masticatory efficiency showed a steadier improvement in lag screw group while mini plate group patients showed a tendency to masticate only food items of medium hard consistency. The sample size is small to conclude lag screws are better than mini plates but the result of our study provides a basis for further studies done to conclude that the application of LAG SCREW is an effective, inexpensive, quick

  15. A Thermo-Hydro-Mechanical modeling of fracture opening and closing due heat extraction from geothermal reservoir

    NASA Astrophysics Data System (ADS)

    Nand Pandey, Sachchida; Chaudhuri, Abhijit; Kelkar, Sharad

    2015-04-01

    -water injection. The initial fracture aperture was taken 1mm. The Young's modulus of rock matrix and joint stiffness were taken as 15GPa and 15GPa/m respectively. Our results show that the contraction of rock due to cooling causes the opening of the fracture near injection well. However in some regions where temperature drop is insignificant the compressive stress develops and fracture closes. As the heat extraction continues with time, further contraction of rock causes more aperture growth between the wells. For the above-mentioned computational domain, due to cold-water (20 °C) at mass flow rate 4kg/s, the aperture in the vicinity of the injection well increases by 75%. Our simulation for joint stiffness equal to 50GPa/m, show that the magnitudes of normal tensile and compressive stresses in the fracture/joint are almost same but the aperture alteration is proportionally reduced. Since the joint stiffness is a nonlinear function of opening, it is important to include a suitable nonlinear model for joint opening/closing while simulating the fracture transmissivity alter during heat extraction.

  16. Relaxation of the MCL after an Open-Wedge High Tibial Osteotomy results in decreasing contact pressures of the knee over time.

    PubMed

    van Egmond, N; Hannink, G; Janssen, D; Vrancken, A C; Verdonschot, N; van Kampen, A

    2017-03-01

    The objective of this study was to investigate the effect of a medial open-wedge osteotomy (OWO) and the release of the superficial medial collateral ligament (MCL) on the tibiofemoral cartilage pressure, the MCL tension and the valgus laxity of the knee. Seven fresh-frozen, human cadaveric knees were used. Medial and lateral mean contact pressure (CP), peak contact pressure (peakCP), and contact area (CA) were measured using a pressure-sensitive film (I-Scan; Tekscan, Boston, MA). The MCL tension was measured using a custom-made device. These measurements were continuously recorded for 5 min after an OWO of 10°. After the osteotomy, the valgus laxity was measured with a handheld Newtonmeter. For one knee, the measurements were continued for 24 h. At the end, a complete release of the superficial MCL was performed and the measurements were repeated at 10°. There was relaxation of the MCL after the osteotomy; the tension dropped in 5 min with 10.7% (mean difference 20.5 N (95% CI 16.1-24.9)), and in 24 h, the tension decreased by 24.2% (absolute difference 38.8 N) (one knee). After the osteotomy, the mean CP, peakCP and CA increased in the medial compartment (absolute difference 0.17 MPa (95% CI 0.14-0.20), 0.27 MPa (95% CI 0.24-0.30), 132.9mm2 (95% CI 67.7-198.2), respectively), and decreased in the lateral compartment (absolute difference 0.02 MPa (95% CI 0.03 -0.01), 0.08 MPa (95% CI 0.11 - 0.04), 47.0 mm2 (95% CI -105.8 to 11.8), respectively). Only after a release of the superficial MCL, the mean CP, peak CP and CA significantly decreased in the medial compartment (absolute difference 0.17, 0.27 MPa, 119.8 mm2, respectively), and increased in the lateral compartment (absolute difference 0.02, 0.11 MPa, 52.4 mm2, respectively). After the release of the superficial MCL, a mean increase of 7.9° [mean difference - 0.1° (95% CI -1.9 to 1.6)] of the valgus laxity was found. A release of the superficial MCL helps achieve the goal of reducing

  17. Flow zone characterisation in a fractured aquifer using spring and open-well T and EC monitoring.

    NASA Astrophysics Data System (ADS)

    Agbotui, Prodeo; West, Landis; Bottrell, Simon

    2017-04-01

    The Cretaceous Chalk is a very important aquifer in England, and its relatively high transmissivity derives essentially from a well-developed network of solutionally-enhanced fractures and conduits. Like other fractured aquifers, characterisation and delineation of flow pathways and hence catchment boundaries is important. Determination of flow pathways for source catchment delineation (e.g. identification of safeguarding zones around wells) is critical for the effective management and protection of the groundwater resource. It also determines the areal extent of contamination from known sources, and enables the targeted sampling of flow zones e.g. for monitored natural attenuation (MNA). A rather simplistic conceptualisation of the unconfined chalk aquifer of East Yorkshire is currently used as a basis for numerical simulations: linearly reducing hydraulic conductivity (K) with depth below the maximum groundwater elevation, reducing to a minimum value below the zone of groundwater table fluctuation. This study represents an attempt to improve this conceptualisation via improved characterisation of permeable zones within the aquifer. The methods used are: pumping test drawdown analyses for transmissivity, ambient open-well dilution testing; rainfall, groundwater head, and spring / open-well specific electrical conductance (SEC) and temperature monitoring. Pumping test analyses yield overall well transmissivity; the open-well dilution/monitoring approach identifies inflow, outflow, crossflow zones and direction and rate of flow in wells; seasonal changes in flows in wells and springs reflect the annual recharge and recession cycle and the impact of seasonal hydraulic head variation on the activation/deactivation of permeable pathways. Variations in spring and well-water electrical conductivity / temperature provide insight into groundwater residence times and the degree of isolation of groundwater from atmospheric and soil zone sources of CO2. The results of the

  18. Modeling of transport processes through large-scale discrete fracture networks using conforming meshes and open-source software

    NASA Astrophysics Data System (ADS)

    Ngo, Tri Dat; Fourno, André; Noetinger, Benoit

    2017-11-01

    Most industrial and field studies of transport processes in Discrete Fracture Networks (DFNs) involve strong simplifying assumptions, especially at the meshing stage. High-accuracy simulations are therefore required for validating these simplified models and their domain of validity. The present paper proposes an efficient workflow based on open-source software to obtain transport simulations. High-quality computational meshes for DFNs are first generated using the conforming meshing approach FraC. Then, a tracer transport model implemented in the open-source code DuMux is used for simulating tracer transport driven by the advection-dispersion equation. We adopt the box method, a vertex-centered finite volume scheme for spatial discretization, which ensures concentration continuity and mass conservation at intersections between fractures. Numerical results on simple networks for validation purposes and on complex realistic DFNs are presented. An a-posteriori convergence study of the discretization method shows an order of convergence O(h) for tracer concentration with h the mesh size.

  19. A viscoelastic Unitary Crack-Opening strain tensor for crack width assessment in fractured concrete structures

    NASA Astrophysics Data System (ADS)

    Sciumè, Giuseppe; Benboudjema, Farid

    2017-05-01

    A post-processing technique which allows computing crack width in concrete is proposed for a viscoelastic damage model. Concrete creep is modeled by means of a Kelvin-Voight cell while the damage model is that of Mazars in its local form. Due to the local damage approach, the constitutive model is regularized with respect to finite element mesh to avoid mesh dependency in the computed solution (regularization is based on fracture energy).

  20. Potential seal bypass and caprock storage produced by deformation-band-to-opening-mode-fracture transition at the reservoir/caprock interface

    DOE PAGES

    Raduha, S.; Butler, D.; Mozley, P. S.; ...

    2016-06-18

    Here, we examined the potential impact on CO 2 transport of zones of deformation bands in reservoir rock that transition to opening-mode fractures within overlying caprock. Sedimentological and petrophysical measurements were collected along an approximately 5 m × 5 m outcrop of the Slick Rock and Earthy Members of the Entrada Sandstone on the eastern flank of the San Rafael Swell, Utah, USA. Measured deformation band permeability (2 mD) within the reservoir facies is about three orders of magnitude lower than the host sandstone. Average permeability of the caprock facies (0.0005 mD) is about seven orders of magnitude lower thanmore » the host sandstone. Aperture-based permeability estimates of the opening-mode caprock fractures are high (3.3 × 10 7 mD). High-resolution CO 2–H 2O transport models incorporate these permeability data at the millimeter scale. We then varied fault properties at the reservoir/caprock interface between open fractures and deformation bands as part of a sensitivity study. Numerical modeling results suggest that zones of deformation bands within the reservoir strongly compartmentalize reservoir pressures largely blocking lateral, cross-fault flow of supercritical CO 2. Significant vertical CO 2 transport into the caprock occurred in some scenarios along opening-mode fractures. The magnitude of this vertical CO 2 transport depends on the small-scale geometry of the contact between the opening-mode fracture and the zone of deformation bands, as well as the degree to which fractures penetrate caprock. Finally, the presence of relatively permeable units within the caprock allows storage of significant volumes of CO 2, particularly when the fracture network does not extend all the way through the caprock.« less

  1. Potential seal bypass and caprock storage produced by deformation-band-to-opening-mode-fracture transition at the reservoir/caprock interface

    SciTech Connect

    Raduha, S.; Butler, D.; Mozley, P. S.; Person, M.; Evans, J.; Heath, J. E.; Dewers, T. A.; Stauffer, P. H.; Gable, C. W.; Kelkar, S.

    2016-06-18

    Here, we examined the potential impact on CO2 transport of zones of deformation bands in reservoir rock that transition to opening-mode fractures within overlying caprock. Sedimentological and petrophysical measurements were collected along an approximately 5 m × 5 m outcrop of the Slick Rock and Earthy Members of the Entrada Sandstone on the eastern flank of the San Rafael Swell, Utah, USA. Measured deformation band permeability (2 mD) within the reservoir facies is about three orders of magnitude lower than the host sandstone. Average permeability of the caprock facies (0.0005 mD) is about seven orders of magnitude lower than the host sandstone. Aperture-based permeability estimates of the opening-mode caprock fractures are high (3.3 × 107 mD). High-resolution CO2–H2O transport models incorporate these permeability data at the millimeter scale. We then varied fault properties at the reservoir/caprock interface between open fractures and deformation bands as part of a sensitivity study. Numerical modeling results suggest that zones of deformation bands within the reservoir strongly compartmentalize reservoir pressures largely blocking lateral, cross-fault flow of supercritical CO2. Significant vertical CO2 transport into the caprock occurred in some scenarios along opening-mode fractures. The magnitude of this vertical CO2 transport depends on the small-scale geometry of the contact between the opening-mode fracture and the zone of deformation bands, as well as the degree to which fractures penetrate caprock. Finally, the presence of relatively permeable units within the caprock allows storage of significant volumes of CO2, particularly when the fracture network does not extend all the way through the caprock.

  2. [Structural changes in the tibial bones from an excessive load].

    PubMed

    Moshiashvili, B I

    1977-10-01

    80 cases of pathological reconstruction of the tibia in young men at the age of 18--20 are described. The pathology developed as a result of intense regular physical exercise. In 53 patients the process was localized in the upper third of the tibia, in 20--in the middle third and in 7--in the lower third of the bone. In 6 cases the fracture of the tibial proximal metaphysis happened against the background of pathological reconstruction of the tibia; 3 of them sustained simultaneously a fracture of the fibular head. Some recommendations of practical importance are suggested.

  3. Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

    PubMed

    Liao, Weixiong; Zhang, Hao; Li, Zhongli; Li, Ji

    2016-05-01

    Arthroscopic double-row suture-anchor fixation and open reduction and internal fixation (ORIF) are used to treat displaced greater tuberosity fractures, but there are few data that can help guide the surgeon in choosing between these approaches. We therefore asked: (1) Is there a difference in surgical time between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (2) Are there differences in the postoperative ROM and functional scores between arthroscopic double-row suture anchor fixation and ORIF for isolated displaced greater tuberosity fractures? (3) Are there differences in complications resulting in additional operations between the two approaches? Between 2006 and 2012, we treated 79 patients surgically for displaced greater tuberosity fractures. Of those, 32 (41%) were considered eligible for our study based on inclusion criteria for isolated displaced greater tuberosity fractures with a displacement of at least 5 mm but less than 2 cm. During that time, we generally treated patients with displaced greater tuberosity fractures with a displacement greater than 1 cm or with a fragment size greater than 3×3 cm with open treatment, and patients with displaced greater tuberosity fractures with a displacement less than 1 cm or with a fragment size less than 3×3 cm with arthroscopic treatment. Fifty-three underwent open treatment based on those indications, and 26 underwent arthroscopic treatment, of whom 17 (32%) and 15 (58%) were available for followup at a mean of 34 months (range, 24-28 months). All patients with such fractures identified from our institutional database were treated by these two approaches and no other methods were used. Surgical time was defined as the time from initiation of the incision to the time when suture of the incision was finished, and was determined by an observer with a stopwatch. Patients were followed up in the outpatient department at 6, 12, and 24 weeks, and every 6

  4. Hydraulic Properties of Closely Spaced Dipping Open Fractures Intersecting a Fluid-Filled Borehole Derived From Tube Wave Generation and Scattering

    NASA Astrophysics Data System (ADS)

    Minato, Shohei; Ghose, Ranajit; Tsuji, Takeshi; Ikeda, Michiharu; Onishi, Kozo

    2017-10-01

    Fluid-filled fractures and fissures often determine the pathways and volume of fluid movement. They are critically important in crustal seismology and in the exploration of geothermal and hydrocarbon reservoirs. We introduce a model for tube wave scattering and generation at dipping, parallel-wall fractures intersecting a fluid-filled borehole. A new equation reveals the interaction of tube wavefield with multiple, closely spaced fractures, showing that the fracture dip significantly affects the tube waves. Numerical modeling demonstrates the possibility of imaging these fractures using a focusing analysis. The focused traces correspond well with the known fracture density, aperture, and dip angles. Testing the method on a VSP data set obtained at a fault-damaged zone in the Median Tectonic Line, Japan, presents evidences of tube waves being generated and scattered at open fractures and thin cataclasite layers. This finding leads to a new possibility for imaging, characterizing, and monitoring in situ hydraulic properties of dipping fractures using the tube wavefield.

  5. [Metal/alumine metallosis on tibial osteotomy. A case report].

    PubMed

    Mathieu, G; Roue, J; Poignard, A; Hernigou, P

    2008-05-01

    Metallosis is mainly described in the hip joint at the time of wear or inappropriate use. Cases have also been reported in patients with a knee prosthesis, but never after tibial osteotomy. We report a rare case of metallosis resulting from metal-alumina contact after open wedge tibial osteotomy. The patient complained of pain, which was relieved after removal of the plate nine months after the first operation. Intraoperative inspection revealed metallosis at the synthesis site and local plate wear at zone of contact with the ceramic filler. Removal of the plate and cleaning of the metallosis zone led to full relief of the pain at one and a half months.

  6. Pitfalls associated with open reduction and internal fixation of fractured ribs.

    PubMed

    Sarani, Babak; Schulte, Leah; Diaz, Jose J

    2015-12-01

    Rib fracture is exceedingly common and remains a leading cause of death in patients with chest injury. Probability of death increases by 19% with each broken rib, and the probability of death increases further with age. Treatment is centered on pain control and early mobilization to provide adequate pulmonary hygiene. Multimodality interventions, such as incentive spirometry, postural changes, and coughing, are pivotal in minimizing the risk of pneumonia and death. Recently, many studies have found mortality benefit to operation fixation (ORIF) of ribs in select patients. However, this procedure remains underutilized partly due to lack of familiarity with its technique and pitfalls by trauma surgeons, in particular. Whereas there are publications on operative technique, there are no studies describing pitfalls associated with this procedure. The purpose of this paper is to describe pitfalls on the technical aspects of ORIF of the ribs based on the medical literature where possible and based on our experience in instances where peer reviewed evidence is lacking. The paper is not meant to serve as a protocol for managing rib fractures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Groundwater flow into underground openings in fractured crystalline rocks: an interpretation based on long channels

    NASA Astrophysics Data System (ADS)

    Black, John H.; Woodman, Nicholas D.; Barker, John A.

    2017-03-01

    Rethinking an old tracer experiment in fractured crystalline rock suggests a concept of groundwater flow in sparse networks of long channels that is supported by results from an innovative lattice network model. The model, HyperConv, can vary the mean length of `strings' of connected bonds, and the gaps between them, using two independent probability functions. It is found that networks of long channels are able to percolate at lower values of (bond) density than networks of short channels. A general relationship between mean channel length, mean gap length and probability of percolation has been developed which incorporates the well-established result for `classical' lattice network models as a special case. Using parameters appropriate to a 4-m diameter drift located 360 m below surface at Stripa Mine Underground Research Laboratory in Sweden, HyperConv is able to reproduce values of apparent positive skin, as observed in the so-called Macropermeability Experiment, but only when mean channel length exceeds 10 m. This implies that such channel systems must cross many fracture intersections without bifurcating. A general relationship in terms of flow dimension is suggested. Some initial investigations using HyperConv show that the commonly observed feature, `compartmentalization', only occurs when channel density is just above the percolation threshold. Such compartments have been observed at Kamaishi Experimental Mine (Japan) implying a sparse flow network. It is suggested that compartments and skin are observable in the field, indicate sparse channel systems, and could form part of site characterization for deep nuclear waste repositories.

  8. Motorcyclists and pillion passengers with open lower-limb fractures: a study using TARN data 2007-2014.

    PubMed

    Hay-David, Agc; Stacey, T; Pallister, I

    2018-03-01

    Introduction We aimed to identify population demographics of motorcyclists and pillion passengers with isolated open lower-limb fractures, to ascertain the impact of the revised 2009 British Orthopaedic Association/British Association of Plastic Reconstructive and Aesthetic Surgeons joint standards for the management of open fractures of the lower limb (BOAST 4), in terms of time to skeletal stabilisation and soft-tissue coverage, and to observe any impact on patient movement. Methods Retrospective cohort data was collected by the Trauma Audit and Research Network (TARN). A longitudinal analysis was performed between two timeframes in England (pre-and post-BOAST 4 revision): 2007-2009 and 2010-2014. Results A total of 1564 motorcyclists and 64 pillion passengers were identified. Of these, 93% (1521/1628) were male. The median age for males was 30.5 years and 36.7 years for females. There was a statistically significant difference in the number of patients who underwent skeletal stabilisation (49% vs 65%, P < 0.0001), the time from injury to skeletal stabilisation (7.33 hours vs 14.3 hours, P < 0.0001) and the proportion receiving soft-tissue coverage (26% vs 43%, P < 0.0001). There was no difference in the time from injury to soft-tissue coverage (62.3 hours vs 63.7 hours, P = 0.726). The number of patients taken directly to a major trauma centre (or its equivalent) increased between the two timeframes (12.5% vs, 41%, P < 0.001). Conclusions Since the 2009 BOAST 4 revision, there has been no difference in the time taken from injury to soft-tissue coverage but the time from injury to skeletal stabilisation is longer. There has also been an increase in patient movement to centres offering joint orthopaedic and plastic care.

  9. Higher division of the tibial nerve in the leg: gross anatomical study with clinical implications.

    PubMed

    Norzana, A G; Farihah, H S; Fairus, A; Teoh, S L; Nur, A K; Faizah, O; Das, S

    2013-01-01

    Tibial nerve is a branch of the sciatic nerve and it is the main nerve innervating the muscles of the back of the leg. The tibial nerve divides into medial and lateral plantar nerves. The level of division may be important for surgical purpose. The main aim of the present study was to observe the exact level of division of the tibial nerve and discuss its clinical implications. A total of 20 cadaveric limbs (irrespective of left or right side) were taken randomly. The posterior compartment of the thigh and leg was dissected to trace the tibial nerve and its branches. The specimens were subjected to measurements with respect to an arbitrary horizontal line passing through tip of medial malleolus and the calcaneum. All the specimens were photographed. In 5 cases (25%), the tibial nerve divided deep to the flexor retinaculum. In 15 cases (75%) cases, the tibial nerve divided at a distance of 3.5 cm - 6.5 cm (average 5 cm) above the medial malleolus. The tibial nerve and its divisions are important for performing successful nerve blocks and insertion of plates while treating fractures. Variations may account for the various discrepancies between the electromyographic tests and clinical tests.

  10. Outcome of isolated olecranon fractures in skeletally immature patients: comparison of open reduction and tension band wiring fixation versus closed reduction and percutaneous screw fixation.

    PubMed

    Corradin, Marco; Marengo, Lorenza; Andreacchio, Antonio; Paonessa, Matteo; Giacometti, Vanessa; Samba, Antoine; Rousset, Marie; Canavese, Federico

    2016-07-01

    The olecranon fracture is an uncommon injury reported to incur many possible complications in children. The aim of this study was to compare the outcome of two different surgical techniques in isolated olecranon fracture. We retrospectively evaluated 22 children with isolated olecranon fracture treated by open reduction and tension band wiring fixation versus closed reduction and percutaneous screw fixation. We compared the dislocation before and after surgery by radiography. The patients were evaluated clinically with Quick DASH(®). Both techniques showed good radiological and clinical outcome (Quick DASH(®) 1.82 vs. 3.42) with no statistically significance difference (p > 0.05). In two cases (16.6 %) of the group treated with cannulated screw, it was necessary to convert into open reduction to obtain optimal reduction of the fracture. All the children returned to previous activity. In four cases, the extension of the elbow was slightly reduced (15°-20°), with no statistically significant difference in the two groups. It is not contraindicated to operate skeletally immature patients with displaced olecranon fracture. However, results were essentially the same, and so either method is a satisfactory choice for pediatric displaced olecranon fractures, with equally acceptable radiological results and similar rate of complications and clinical outcome at final follow-up. III.

  11. Quantifying opening-mode fracture spatial organization in horizontal wellbore image logs, core and outcrop: Application to Upper Cretaceous Frontier Formation tight gas sandstones, USA

    NASA Astrophysics Data System (ADS)

    Li, J. Z.; Laubach, S. E.; Gale, J. F. W.; Marrett, R. A.

    2018-03-01

    The Upper Cretaceous Frontier Formation is a naturally fractured gas-producing sandstone in Wyoming. Regionally, random and statistically more clustered than random patterns exist in the same upper to lower shoreface depositional facies. East-west- and north-south-striking regional fractures sampled using image logs and cores from three horizontal wells exhibit clustered patterns, whereas data collected from east-west-striking fractures in outcrop have patterns that are indistinguishable from random. Image log data analyzed with the correlation count method shows clusters ∼35 m wide and spaced ∼50 to 90 m apart as well as clusters up to 12 m wide with periodic inter-cluster spacings. A hierarchy of cluster sizes exists; organization within clusters is likely fractal. These rocks have markedly different structural and burial histories, so regional differences in degree of clustering are unsurprising. Clustered patterns correspond to fractures having core quartz deposition contemporaneous with fracture opening, circumstances that some models suggest might affect spacing patterns by interfering with fracture growth. Our results show that quantifying and identifying patterns as statistically more or less clustered than random delineates differences in fracture patterns that are not otherwise apparent but that may influence gas and water production, and therefore may be economically important.

  12. Outcome after operative treatment of Vancouver type B1 and C periprosthetic femoral fractures: open reduction and internal fixation versus revision arthroplasty.

    PubMed

    Laurer, Helmut L; Wutzler, Sebastian; Possner, Susann; Geiger, Emanuel V; El Saman, André; Marzi, Ingo; Frank, Johannes

    2011-07-01

    The rate of periprosthetic femoral fractures after hip arthroplasty is rising and the estimated current lifetime incidence is 0.4-2.1%. While most authors recommend revision arthroplasty in patients with loose femoral shaft components, treatment options for patients with stable stem are not fully elucidated. Against this background we performed a retrospective chart analysis with clinical follow-up examination of 32 cases that sustained a Vancouver type B1 or C periprosthetic fracture (stable stem). Overall 16 cases were treated by open reduction and internal fixation (ORIF) by plate osteosynthesis and 16 cases by revision arthroplasty (RA). Both groups were comparable regarding age, gender, follow-up time interval, time interval from primary hip arthroplasty to fracture and rate of cemented femoral components, but more type C fractures were treated by ORIF. Functional outcome expressed by the median timed "Up and Go" test did not differ significantly (30 s ORIF vs. 24 s RA, P = 0.19). However, by comparable systemic complications surgery-related complications were significantly more frequent in plate osteosynthesis (ORIF n = 10 vs. RA n = 3, P = 0.03). Based on our results, further studies, preferable via a multicenter approach, should focus on identifying patients that benefit from ORIF in periprosthetic fractures. A misinterpretation of type B2 fractures with loose implant as type B1 fractures may cause implant failure in case of ORIF. The use of angular stable implants, additional cable wires or bone enhancing means is recommended.

  13. Medial tibial stress syndrome.

    PubMed

    Reshef, Noam; Guelich, David R

    2012-04-01

    MTSS is a benign, though painful, condition, and a common problem in the running athlete. It is prevalent among military personnel, runners, and dancers, showing an incidence of 4% to 35%. Common names for this problem include shin splints, soleus syndrome, tibial stress syndrome, and periostitis. The exact cause of this condition is unknown. Previous theories included an inflammatory response of the periosteum or periosteal traction reaction. More recent evidence suggests a painful stress reaction of bone. The most proven risk factors are hyperpronation of the foot, female sex, and history of previous MTSS. Patient evaluation is based on meticulous history taking and physical examination. Even though the diagnosis remains clinical, imaging studies, such as plain radiographs and bone scans are usually sufficient, although MRI is useful in borderline cases to rule out more significant pathology. Conservative treatment is almost always successful and includes several options; though none has proven more superior to rest. Prevention programs do not seem to influence the rate of MTSS, though shock-absorbing insoles have reduced MTSS rates in military personnel, and ESWT has shortened the duration of symptoms. Surgery is rarely indicated but has shown some promising results in patients who have not responded to all conservative options.

  14. All-Polyethylene Tibial Components: An Analysis of Long-Term Outcomes and Infection.

    PubMed

    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 < .0001) survivorship when compared with their metal-backed counterparts. All-polyethylene 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.

  15. THE EFFECTS OF MODIFIED POSTERIOR TIBIAL SLOPE ON ACL STRAIN AND KNEE KINEMATICS: A HUMAN CADAVERIC STUDY

    PubMed Central

    Fening, Stephen D.; Kovacic, Jeffrey; Kambic, Helen; McLean, Scott; Scott, Jacob; Miniaci, Anthony

    2008-01-01

    Increases to the posterior tibial slope can lead to an anterior shift in tibial resting position. However, the effect of this shift on anterior cruciate ligament (ACL) strain has not been investigated sufficiently. This study examined the relationship between increased tibial slope and ACL strain, as well as the subsequent kinematics of the tibiofemoral joint. We hypothesized increases in slope would shift the tibia anterior relative to the femur and increase ACL strain. ACL strain measurements and tibiofemoral kinematics were compared for 5 intact and experimental knees subject to anterior opening wedge osteotomy. Combinations of both compressive and AP loading were applied. As slope increased, the resting position of the tibia shifted anteriorly, external tibial rotation increased, and tibial translation remained unchanged. Contrary to our hypothesis, ACL strain decreased. The clinical implication of these findings is that alterations to the posterior tibial slope should not increase strain in the ACL. PMID:18686482

  16. Amputation versus conservative treatment in severe open lower-limb fracture: A functional and quality-of-life study.

    PubMed

    Fioravanti, M; Maman, P; Curvale, G; Rochwerger, A; Mattei, J-C

    2018-01-31

    Severe lower-limb trauma is a major event in a patient's life, and treatment is a challenge that has not been sufficiently studied. The main objective of the present study was to assess the difference in disability between amputees and patients who kept their leg after severe open lower-limb fracture. The study hypothesis was that amputation allows better functional recovery and quality of life, in the same time-frame. All male and female patients aged over 18 years admitted to one of the trauma centers of Marseille (France) for major lower-limb trauma with Gustilo IIIb or IIIc fracture were included. Minimum follow-up was 2 years. Two groups were distinguished according to primary treatment: lower-limb salvage, or amputation. Rates of infection and of surgical revision, hospital stay, functional parameters (walking distance, standing, use of canes, running, jumping, driving, and physical and occupational activity) and quality of life (MOS SF-36 score) were compared between groups. The conservative treatment group comprised 27 patients, and the amputation group 24. Rates of infection and of surgical revision and hospital stay were significantly lower in the amputation group (P<0.02). All functional parameters (except return to work) and overall quality of life were significantly better in the amputation group. There was no significant inter-group difference in MOS mental score. In severe lower-limb trauma, amputation seems to give better functional and quality-of-life results. It did not, however, improve return to work, and was not better accepted psychologically than long and complex conservative management. IV, retrospective study. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  17. Risk of Hip Arthroplasty After Open Reduction Internal Fixation of a Fracture of the Acetabulum: A Matched Cohort Study.

    PubMed

    Henry, Patrick D G; Si-Hyeong Park, Sam; Paterson, J Michael; Kreder, Hans J; Jenkinson, Richard; Wasserstein, David

    2018-03-01

    To determine what proportion of operatively treated acetabular fracture patients proceeded to total hip arthroplasty (THA), over what time period, and quantify the influence of patient, provider, and surgical factors on rates of THA. Retrospective matched cohort prognostic study using administrative data. This study used the large population database of Ontario (population 13,125,000 in 2010), Canada. Patients who underwent open reduction internal fixation (ORIF) of an acetabulum fracture between 1996 and 2010 in the province of Ontario were identified from administrative health databases. Each patient was matched to 4 individuals from the general population according to age, sex, income, and urban/rural residence. The rates of THA at 2, 5, and 10 years were compared using time-to-event analysis. The influence of patient, provider, and surgical factors on the risk of eventual THA was examined using a Cox model. The primary intervention was ORIF of the acetabulum. The primary outcome measurement was THA. A total of 1725 eligible patients were identified and were matched to 6900 controls. Among cases, there was a 13.9% (N = 240) rate of hip arthroplasty after a median of 6.25 (interquartile range 3.5-10.1) years, compared with 0.6% (N = 38) among matched controls (relative risk = 25.26). The greatest difference in risk of eventually undergoing a THA was in the first 10 years, after which time the risk in the group that had undergone ORIF acetabulum trended down toward that of the control group. Among surgical patients, risk factors for eventual hip arthroplasty included older age [hazard ratio (HR) 1.035 (1.027, 1.044); P < 0.0001]; female sex [HR 1.65 (1.257, 2.165); P = 0.0003]. Higher surgeon volume revealed a 2.6% decreased risk of arthroplasty for each acetabulum ORIF performed above 10 per year [HR 0.974 (0.960, 0.989); P = 0.0007]. Patients who underwent acetabulum fracture ORIF had a 25 times higher prevalence of hip arthroplasty compared with matched

  18. Compliance to The Joint Commission proposed Core Measure set on osteoporosis-associated fracture: review of different secondary fracture prevention programs in an open medical system from 2010 to 2015.

    PubMed

    Fojas, Ma Conchitina; Southerland, Lauren T; Phieffer, Laura S; Stephens, Julie A; Srivastava, Tanya; Ing, Steven W

    2017-12-01

    There are care gaps in the evaluation and treatment of osteoporosis after a fragility fracture. The Joint Commission is considering adoption of core measures. We compared compliance between two secondary fracture prevention programs in our institution. Incorporating strengths of both may provide the best outcomes for secondary fracture prevention. There are significant care gaps in the evaluation and treatment of osteoporosis after occurrence of fragility fracture. The Joint Commission is considering adoption of a core measure set on osteoporosis-associated fractures, including laboratory assessment, bone density testing, and osteoporosis pharmacologic therapy. We compared compliance to these proposed measures between two secondary fracture prevention programs in patients hospitalized for acute fracture in an open medical system. We conducted a retrospective, single center medical records review of a nurse practitioner-led Fracture Liaison Service (FLS), a physician-led Fracture Prevention Program (FPP), and a historical time without any secondary fracture prevention program (Usual Care) for baseline care. Primary outcomes were the completion of five laboratory tests (calcium, 25-hydroxy vitamin D, renal function, liver function, and complete blood count), order placement and completion of dual x-ray absorptiometry (DXA) scan within 3 months, prescription of osteoporosis medication within 3 months, and medication adherence at 6 months after hospital discharge. Completion of all five laboratory tests was higher in FPP versus FLS (84.7 vs. 36.9%, p < 0.001). DXA scan completion was higher in FPP than FLS but not statistically significant (66.7 vs. 54.9%, p = 0.11). Medication prescription at 3 months and adherence at 6 months were significantly higher in FPP versus FLS (65.3 vs. 24.0%, p < 0.001 and 70.8 vs. 27.7%, p < 0.001, respectively). Incorporating strengths of both FLS (care coordination) and FPP (physician direction) may provide the best outcomes

  19. Changes in microarchitectural characteristics at the tibial epiphysis induced by collagen-induced rheumatoid arthritis over time

    PubMed Central

    Lee, Joo Hyung; Chun, Keyoung Jin; Kim, Han Sung; Kim, Sang Ho; Lee, Kwon-Yong; Kim, Dae Jun; Lim, Dohyung

    2012-01-01

    Background Little is known about the time course of changes in the microarchitecture of the tibial epiphysis with rheumatoid arthritis (RA), although such information would be valuable in predicting risk of fracture. Therefore, we used in vivo microcomputed tomography (μ-CT) to assess patterns of microarchitectural alterations in the tibial epiphysis using collagen-induced RA in an animal model. Methods Bovine type II collagen was injected intradermally into the tails of rats for induction of RA. The tibial joints were scanned by in vivo μ-CT at 0, 4, and 8 weeks following injection. Microarchitectural parameters were measured to evaluate alteration patterns of bone microarchitecture at the tibial epiphysis. Results The microarchitectural alterations in an RA group were significantly different from those in a control group from 0 to 4 weeks and from 4 to 8 weeks following injection (P < 0.05). The distribution of trabecular bone thickness and trabecular bone separation from 0 weeks to 8 weeks differed significantly (P < 0.05). Conclusion These results indicate that the patterns of microarchitectural alterations at the tibial epiphysis are strongly affected by collagen-induced progression of RA and entail a severe risk of fracture at the tibial epiphysis. This study represents a valuable first approach to tracking periodic and continuous changes in the microarchitectural characteristics of the tibial epiphysis with collagen-induced RA. PMID:23049249

  20. Clavicle fractures.

    PubMed

    Ropars, M; Thomazeau, H; Huten, D

    2017-02-01

    Management of clavicle fracture has progressed over the last decade, notably with wider use of surgery in midshaft fracture, and new techniques for lateral fracture. Midshaft clavicle fracture treatment needs to be personalized and adapted to the patient's activity level. Whichever the segment involved, treatment for non-displaced fracture is functional; elbow-to-body sling immobilization seems the best tolerated. Apart from regular surgical indications (shoulder impaction, floating shoulder, open fracture or fracture with neurovascular complications), surgery is recommended in case of bone shortening exceeding 1.5cm in young active patients. The technique needs to take account of clavicle anatomy: notably periosteal vascularization in midshaft fracture and acromioclavicular ligament integrity and location in case of lateral fracture. Plate osteosynthesis should take account of bone diameter and 3D curvature; intramedullary fixation should take account of intramedullary canal morphology. Although iatrogenic vascular complications are rare, vessel relations and variants need to be known, especially in the medial end of the clavicle and midshaft. Lateral segment fractures are a particular entity. Large-scale randomized studies are needed to assess indications and results for the various possible internal fixation techniques: isolated or associated to ligament reconstruction, rigid or flexible, and open or arthroscopic. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  1. Development of Compartment Syndrome Negatively Impacts Length of Stay and Cost After Tibia Fracture.

    PubMed

    Crespo, Alexander M; Manoli, Arthur; Konda, Sanjit R; Egol, Kenneth A

    2015-07-01

    To quantify the impact of compartment syndrome in the setting of tibial shaft fracture on hospital length of stay (LOS) and total hospital charges. Retrospective case-control study. All New York State hospital admissions from 2001 to 2011, as recorded by the New York Statewide Planning and Research Cooperative System database. Thirty three thousand six hundred twenty-nine inpatients with isolated open or closed fractures of the tibia and/or fibula (AO/OTA 41-43). Six hundred ninety-two patients developed a compartment syndrome in the setting of tibia fracture. All patients were filtered to ensure none had other complications or medical comorbidities that would increase LOS or total hospital charges. Fasciotomy and delayed closure in patients who developed a compartment syndrome. Hospital LOS (days) and total inflation-adjusted hospital charges. A total of 33,629 patients with tibial shaft fracture were included in the study. There were 32,937 patients who did not develop a compartment syndrome. For this group, the mean LOS was 6 days, and the mean inflation-adjusted hospital charges were $34,000. Patients who developed compartment syndrome remained in-house for an average of 14 days with average charges totaling $79,000. These differences were highly significant for both lengths of stay and hospital charges (P < 0.001). Besides the obvious physical detriment experienced by patients with compartment syndrome, there is also a significant economic impact to the healthcare system. Compartment syndrome after a tibial fracture more than doubles LOS and total hospital charges. These findings highlight the need for a standardized care algorithm aimed toward efficiently and adequately treating acute compartment syndrome. Such an algorithm would optimize cost of care and presumably decrease LOS. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  2. Current developments concerning medial tibial stress syndrome.

    PubMed

    Craig, Debbie I

    2009-12-01

    Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in athletes who run. Studies have reported MTSS to occur in 4% to 20% of this population. It can be defined as an overuse injury that creates pain over an area covering the distal to middle third of the posteriomedial tibial border, which occurs during exercise and creates cyclic loading. Differential diagnosis includes ischemic disorders and stress fractures. Although the pathology of this injury is understood, the etiology is less agreed upon. This makes it difficult for clinicians to diagnose and treat this common injury. The purpose of this article is to present health care practitioners with the most current information regarding MTSS so they can better diagnose and treat this common injury. To this end, a literature review was conducted, with the most current results presented. The areas of etiological theories, imaging techniques, and treatment options for MTSS were searched. Five of the most prevalent etiological theories are presented with supporting evidence. Of the imaging tools available to the clinician, magnetic resonance imaging (MRI) and bone scintigraphy have comparable specificity and sensitivity. Clinicians should first make the clinical diagnosis of MTSS, however, because of high percentages of positive MRI scans in asymptomatic patients. There have been few randomized controlled trials investigating treatment options for athletes with MTSS. Those that have been performed rendered no significant findings, leading researchers to conclude that rest is equal to or better than other treatment options. Given the evidence, treatment suggestions for practitioners caring for athletes with MTSS are provided.

  3. Response of Natural Fractures to Hydraulic Fracturing

    NASA Astrophysics Data System (ADS)

    Duan, B.

    2015-12-01

    We extend a dynamic earthquake rupture simulation code to model propagation of both shear and tensile fractures and seismic waves radiated from these fractures. We particularly aim to explore how pre-existing natural fractures respond to hydraulic fracturing treatment. We use split nodes to define fractures in the finite element mesh. By appropriately implementing jump conditions on the two different types of fractures, we can simulate dynamics propagation of shear and tensile fractures using the finite element code. Shear failure is governed by the Mohr-Coulomb criterion and a slip-weakening friction law dictates friction evolution on shear fractures during shear sliding. Tensile failure occurs when the effective normal stress acting on a fracture reaches tensile strength. In our models, pressurization and propagation of a hydraulic fracture due to fluid injection drive deformation. Our preliminary results show that natural fractures that are parallel or perpendicular to the hydraulic fracture, which are commonly assumed in many hydraulic fracturing models, are unlikely to be activated by hydraulic fracturing, if no natural fractures in other orientations exist. However, activation of natural fractures that are optimally oriented in the initial stress field may trigger sliding or opening of natural fractures in other orientations. These results suggest important roles both static stress and dynamic stress play in response of natural fractures to hydraulic fracturing.

  4. Stress fractures in 51 runners.

    PubMed

    Sullivan, D; Warren, R F; Pavlov, H; Kelman, G

    1984-01-01

    A prospective study was initiated in 1976 to investigate runners who are at risk for incurring stress fractures and how these fractures can be prevented. Fifty-one runners incurred 57 stress fractures. Tibial fractures were most common (25), followed by fibula (12) and metatarsal (8). Seven runners had previously sustained stress fractures, and six developed two stress fractures simultaneously. Five women over 30 years old had pelvic stress fractures. Stress fracture development was positively correlated with the presence of pes planus, weekly training distances greater than 20 miles, hard training surfaces, and training regimen modifications. The incidence did not correlate with generalized musculoskeletal laxity or tightness. Forty-four of 51 patients had initially positive roentgenograms. Five of five bone scans were positive. The average duration of rest before running was resumed was 7.4 weeks.

  5. Eighteen-year follow-up after rotationplasty for a grade IIIC open fracture of the distal femur.

    PubMed

    Petri, M; Omar, M; Horstmann, H; Brand, S; Krettek, C

    2013-03-01

    We report the 18-year follow-up of a patient who underwent rotationplasty for severe bone loss and infection after an grade IIIC open fracture of the distal femur. The patient is now 49 years old and fully satisfied with his life. During the follow-up period, he has never had significant physical or psychological problems directly concerning the rotationplasty. The analysis of quality of life using the SF36 questionnaire revealed even higher scores than the normal healthy population in seven out of eight sub-categories. Clinical examination revealed bland soft tissues without hyperkeratosis or other signs of maladaptation. Articular and cutaneous proprioception was intact all over the left leg. The active extension/flexion of the prosthetic knee was 0°-0°-100° and 10°-0°-70° of the ankle joint. Manual testing of motor strength revealed grade five of five for dorsiflexion and plantar flexion of the ankle. Gait patterns including climbing slopes and stairs were close to normal. Examination in sports physiology showed lower maximum power of hip and knee muscles compared to the healthy side, but better muscular endurance. These findings emphasize that rotationplasty can be a good alternative to arthrodesis or amputation in trauma patients providing high satisfaction and activity levels in the long-term follow-up.

  6. Multiple noncontiguous spinal fractures and occipitocervical dislocation in a patient with ankylosing spondylitis treated with a hybrid open and percutaneous spinal fixation technique: a case report.

    PubMed

    Sebastian, Arjun S; Fogelson, Jeremy L; Dekutoski, Mark B; Nassr, Ahmad N

    2015-05-01

    Spinal fractures occur with a greater frequency in ankylosing spondylitis (AS) patients. Treatment of these fractures is complicated because of a higher incidence of medical comorbidities, higher rate of neurologic deficits, and higher risk of neurologic deterioration. To report a case report of a novel, combined open and percutaneous surgical techniques used for the treatment of multiple noncontiguous spinal fractures in a patient with AS. We describe the surgical treatment and the outcome of a patient with AS that sustained an occipitocervical dislocation and two noncontiguous three-column extension injuries using a hybrid technique with open occipital to T3 fusion and percutaneous T5-L1 instrumentation at a tertiary care facility. A 77-year-old man with multiple comorbidities and newly diagnosed AS. Two-year clinical and radiographic outcome of a patient treated surgically for multiple spine injuries in the setting of an ankylosed spine. The patient was treated with a hybrid approach using both open fusion and percutaneous instrumentation techniques. At 2 years postoperatively, the patient had recovered ambulatory ability and had a good clinical outcome. We describe a unique case of noncontiguous spinal trauma in a medically complex patient with AS treated with a hybrid open and percutaneous technique to minimize surgical insult and blood loss, with a good clinical and radiographic outcome 2 years postoperatively. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Incidence of infection following internal fixation of open and closed tibia fractures in India (INFINITI): a multi-centre observational cohort study.

    PubMed

    Doshi, Prakash; Gopalan, Hitesh; Sprague, Sheila; Pradhan, Chetan; Kulkarni, Sunil; Bhandari, Mohit

    2017-04-14

    Trauma is a major public health problem, particularly in India due to the country's rapid urbanization. Tibia fractures are a common and often complicated injury that is at risk of infection following surgical fixation. The primary objectives of this cohort study were to determine the incidence of infection within one year of surgery and to describe the distribution of infections by location and time of diagnosis for tibia fractures in India. We conducted a multi-center, prospective cohort study. Patients who presented with an open or closed tibia fracture treated with internal fixation to one of the participating hospitals in India were invited to participate in the study. Participants attended follow-up visits at 3, 6, and 12 months post-surgery, where they were assessed for infections, fracture healing, and health-related quality of life as measured by the EurQol-5 Dimensions (EQ-5D). Seven hundred eighty-seven participants were included in the study and 768 participants completed the 12 month follow-up. The overall incidence of infection was 2.9% (23 infections). The incidence of infection was 1.6% (10 infections) in closed and 8.0% (13 infections) in open fractures. There were 7 deep and 16 superficial infections, with 5 being early, 7 being delayed, and 11 being late infections. Intra-operative antibiotics were given to 92.1% of participants and post-operative antibiotics were given to 96.8% of participants. Antibiotics were prescribed for an average of 8.3 days for closed fractures and 9.1 days for open fractures. Infected fractures took significantly longer to heal, and participants who had an infection had significantly lower EQ-5D scores. The incidence of infection within this cohort is similar to those seen in developed countries. The duration of prophylactic antibiotic use was longer than standard practice in North America, raising concern for the potential development of antibiotic resistant microbes within Indian orthopaedic settings. Future

  8. Subtrochanteric fractures in elderly people treated with intramedullary fixation: quality of life and complications following open reduction and cerclage wiring versus closed reduction.

    PubMed

    Codesido, Pablo; Mejía, Ana; Riego, Jonathan; Ojeda-Thies, Cristina

    2017-08-01

    Subtrochanteric fractures are more difficult to treat than other proximal femoral fractures. The aim of this study was to report the outcomes for patients with subtrochanteric fractures treated using a cephalomedullary nail following open reduction and cerclage wiring versus closed reduction alone, regarding health-related quality of life (HRQoL) and social function. We performed a prospective cohort study including patients aged 60 years or older suffering fragility subtrochanteric fractures of the femur treated with cephalomedullary nails, with a minimum 2-year follow-up. We defined two treatment groups: one treated with closed reduction manoeuvres (60 patients), and another treated with open reduction and cerclage wiring (30 patients). The outcomes were mortality, orthopaedic complications (reoperation and no-union), social function (Jensen Index), and HRQoL (EQ-5D index score). There were no differences regarding sex, age, side affected, type of implant, anaesthetic risk, 1-year mortality, and orthopaedic complications. Surgical time was longer in the cerclage wire group, but length of stay was 2 days shorter for the cerclage group and reduction was better. Patients treated with cerclage wiring had significantly better EQ-ED at 12 months (0.66 ± 0.22 points vs. 0.78 ± 0.15 points); and social status at 12 and 18 months (2.77 ± 1.00 points vs. 2.10 ± 1.22 points). Better reduction is achieved when using cerclage wires for fragility subtrochanteric fractures. These fractures had a negative effect on quality of life and social function, but better outcomes were observed in the cerclage group.

  9. Primary total knee arthroplasty for acute fracture around the knee.

    PubMed

    Parratte, S; Ollivier, M; Argenson, J-N

    2018-02-01

    Relatively poor results have been reported with open reduction and internal fixation of complex fractures around the knee in elderly osteoporotic patients, and primary total knee arthroplasty (TKA) has been proposed as an alternative solution. While limiting the number of procedures, it meets two prerequisites: (1) to save the patient's life, thanks to early weight-bearing, to limit decubitus complications; and (2) to save knee function and patient autonomy, thanks to early knee mobilization. There are 3 main indications: complex articular fractures in elderly patients with symptomatic osteoarthritis prior to fracture; complex articular fractures of the tibial plateau in elderly patients whose bone quality makes internal fixation hazardous; and major destruction of the distal femur in younger patients. Although admitted in emergency, these patients require adequate preoperative management, including a multidisciplinary approach to manage comorbidities, control of anemia and pain, and assessment and management of vascular and cutaneous conditions. Preoperative planning is crucial, to order appropriate implants and materials that may be needed intraoperatively. Surgical technique is based on the basic principles of revision surgery as regards choice of implant, steps of reconstruction, bone defect management and implant fixation. For complex fractures of the distal femur, primary temporary reduction is a useful "trick", to determine the level of the joint line and femoral rotation. Complementary internal fixation may be required in case of diaphyseal extension of the fracture and to prevent inter-prosthetic fractures. In the literature, the results of primary TKA for fracture are encouraging and better than for secondary TKA after failure of non-operative treatment or internal fixation, with lower rates of revision and complications, earlier full weight-bearing and better functional results. Loss of autonomy is, however, frequent, and 1-year mortality is high

  10. Use of the TRPV1 Agonist Capsaicin to Provide Long-Term Analgesia in a Rat Limb Fracture/Open Repair, Internal Fixation Model

    DTIC Science & Technology

    2011-10-01

    AD_________________ Award Number: W81XWH-10-2-0093 TITLE: Use of the TRPV1 Agonist Capsaicin to...TITLE AND SUBTITLE 5a. CONTRACT NUMBER Use of the TRPV1 Agonist Capsaicin to Provide Long-Term Analgesia in a Rat Limb Fracture/Open Repair...Trauma, TRPV1 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 19a. NAME OF RESPONSIBLE PERSON USAMRMC a

  11. Fracture mechanics of bone.

    PubMed

    Melvin, J W

    1993-11-01

    This paper reviews the progress that has been made in applying the principles of fracture mechanics to the topic of fracture of long bones. Prediction of loading conditions which result in the propagation of fractures in bones has been of interest to the field of trauma biomechanics and orthopedics for over one hundred years. Independent verifications, by various investigators, of bone fracture mechanics parameters are reviewed and investigations of the effects of bone density and specimen thickness on the critical fracture mechanics parameters and of other factors such as critical crack length and plastic zone size in bovine femoral bone, and the effects of crack velocity on fracture mechanics parameters in bovine tibial bone are discussed. It took over ten years for the techniques of bone fracture mechanics to be applied to human compact bone, due primarily to geometric constraints from the smaller size of human bones. That work will be reviewed along with other continuing work to define the orientation dependence of the fracture mechanics parameters in bone and to refine the experimental techniques needed to overcome the geometric constraints of specimen size. A discussion is included of work still needed to determine fracture mechanics parameters for transverse and longitudinal crack propagation in human bone and to establish the effects of age on those parameters. Finally, a discussion will be given of how this knowledge needs to be extended to allow prediction of whole bone fracture from external loading to aid in the design of protective systems.

  12. A comparison of the effect of shoes on human tibial axial strains recorded during dynamic loading.

    PubMed

    Milgrom, C; Burr, D; Fyhrie, D; Hoshaw, S; Finestone, A; Nyska, M; Davidson, R; Mendelson, S; Giladi, M; Liebergall, M; Lehnert, B; Voloshin, A; Simkin, A

    1998-02-01

    Percutaneous axial extensometers were mounted on the medial cortex of the midtibial diaphysis in seven male volunteers and the effect of three different shoes on in vivo peak-to-peak axial compression-tension strains measured during dynamic loading. Zohar shoes had lower axial strains and strain rates during treadmill walking than Nike Air Max running shoes or Israeli infantry boots. During running on a running track, there was no statistically significant difference between the axial strains or strain rates between the shoes tested. Shoe gear can modify tibial strains and strain rates that contribute to the development of tibial stress fractures.

  13. Radiographic prevalence of CAM-type femoroacetabular impingement after open reduction and internal fixation of femoral neck fractures.

    PubMed

    Mathew, G; Kowalczuk, M; Hetaimish, B; Bedi, A; Philippon, M J; Bhandari, M; Simunovic, N; Crouch, S; Ayeni, O R

    2014-04-01

    The purpose of this study was to estimate the radiographic prevalence of CAM-type femoroacetabular impingement (FAI) in elderly patients (≥ 50 years) who have undergone internal fixation for femoral neck fracture. A total of 187 frog-leg lateral radiographs of elderly patients who underwent internal fixation for a femoral neck fracture were reviewed by two independent reviewers. The alpha angle, beta angle, and femoral head-neck offset ratio were calculated. The presence of two abnormal radiographic parameters was deemed to be diagnostic of radiographic CAM-type impingement. Radiographic CAM-type FAI was identified in 157 out of 187 (84 %) patients who underwent internal fixation for fractures of the femoral neck. Moderate-to-good inter-observer reliability was achieved in the measurement of radiographic parameters. With reference to fracture subtypes and prevalence of radiographic features of CAM-type morphology, 97 (72 %) out of 134 patients were positive for CAM in Garden subtypes I and II, whereas 49 (85.9 %) out of 57 patients had radiographic CAM in Garden III and IV subtypes. There was a high prevalence of CAM-type FAI in patients that underwent surgical fixation of femoral neck fractures. This is significantly higher than the reported prevalence in non-fracture patient populations. The high prevalence of CAM morphology could be related to several factors, including age, fracture morphology, quality of reduction, type of fixation, and fracture healing.

  14. Causes of open fractures: orthopaedic injuries related to home-made agricultural vehicles in the eastern Black Sea region of Turkey.

    PubMed

    Say, Ferhat; Coşkun, Hüseyin Sina; Erdoğan, Murat; Bülbül, Ahmet Murat; Gürler, Deniz

    2016-06-23

    Small vehicles known locally as pat-pats, which are used in agricultural work, are forbidden in traffic. The inherent instability of the vehicle may result in accidents, both on farmland and in traffic. The aim of this study was to evaluate orthopaedic injuries related to pat-pats. Patients hospitalised for pat-pat accidents in two central hospitals in Samsun between December 2006 and October 2013 were scanned using ICD codes. A total of 46 patients with orthopaedic injuries (43 male, 3 female) with a mean age of 36 ± 13.3 years were evaluated. The most injured age group was between 10 and 49 years (n = 40, 87%), and accidents occurred most in summer (n = 30, 65%). Open fractures were determined in 42 (91%) patients. Amputation was necessary in 4 (8%) patients. The hospitalisation period was a mean of 17.1 ± 14 days. A statistically significant relationship was determined between open fracture type and the hospitalisation period (P < 0.001). As most of the orthopaedic injuries related to home-made agricultural machines are open fractures, it is important to guard against these types of injuries. The regulations that these machines are not used in traffic should be enforced and safer practices should be applied for use in agriculture.

  15. Low Incidence of Neurovascular Complications After Placement of Proximal Tibial Traction Pins.

    PubMed

    Sobol, Garret; Gibson, Peter; Patel, Param; Koury, Kenneth; Sirkin, Michael; Reilly, Mark; Adams, Mark

    2017-11-01

    Skeletal tibial traction is a temporizing measure used preoperatively for femoral fractures to improve the length and alignment of the limb and provide pain relief. The goal of this study was to identify possible neurovascular morbidity associated with the use of bedside skeletal tibial traction to treat femur fractures. All femoral fractures treated with proximal tibial traction during a 10-year period at an urban level I trauma center were retrospectively reviewed. The medical record was reviewed to determine whether a pin-related complication had occurred. Records also were reviewed to identify ipsilateral multi-ligamentous knee injuries that were not diagnosed until after the application of traction. In total, 303 proximal tibial traction pins were placed. A total of 7 (2.3%; 95% confidence interval, 0.60%-4.0%) pin-related neurologic complications and zero vascular complications were noted. All complications involved motor and/or sensory deficits in the distribution of the peroneal nerve. Of the 7 complications, 6 resolved fully after surgery and removal of the pin. After traction placement, 6 (2.0%) ipsilateral multiligamentous knee injuries were diagnosed. None of these patients had a neurovascular complication. This study suggests that bedside placement of proximal tibial traction for femoral fractures is associated with a low incidence of neurovascular complications and that traction can be safely placed at the bedside by residents. A thorough neurovascular examination should be performed before insertion, and care should be taken to identify the proper starting point and reduce soft tissue trauma during pin placement. [Orthopedics. 2017; 40(6):e1004-e1008.]. Copyright 2017, SLACK Incorporated.

  16. Minimally invasive plate osteosynthesis with a locking compression plate is superior to open reduction and internal fixation in the management of the proximal humerus fractures.

    PubMed

    Lin, Tao; Xiao, Baojun; Ma, Xiucai; Fu, Dehao; Yang, Shuhua

    2014-06-16

    The use of minimally invasive plate osteosynthesis (MIPO) via anterolateral deltoid splitting has good outcomes in the management of proximal humerus fractures. While using this approach has several advantages, including minimal soft tissue disruption, preservation of natural biology and minimal blood loss, there is an increased risk for axillary nerve damage. This study compared the advantages and clinical and radiological outcomes of MIPO or open reduction and internal fixation (ORIF) in patients with proximal humerus fractures. A matched-pair analysis was performed, and patient groups were matched according to age (±3 years), sex and fracture type. Forty-three pairs of patients (average age: MIPO, 63 and ORIF, 61) with a minimum follow-up of 12 months were enrolled in the study group. The patients were investigated radiographically and clinically using the Constant score. The MIPO technique required less surgery time and caused less blood loss compared to ORIF (p < 0.01). In addition, MIPO required a smaller incision, resulted in less scarring, and was cosmetically more appealing and acceptable to female patients than ORIF. Following MIPO, patients had better functional results at 3 and 6 months, with better outcomes, less pain, higher satisfaction in activities of daily living, and a higher range of motion when compared to ORIF (p < 0.05). Fracture configuration, according to the AO/ASIF(Association for the Study of Internal Fixation) fracture classification, did not significantly influence the functional results. The complication rate was comparable between both groups. The use of MIPO with a locking compression plate in the management of proximal humerus fractures is a safe and superior option compared to ORIF.

  17. Application of nanoscale zero-valent iron tracer to delineate groundwater flow paths between a screened well and an open well in fractured rock

    NASA Astrophysics Data System (ADS)

    Chuang, P. Y.; Chiu, Y.; Liou, Y. H.; Teng, M. H.; Chia, Y.

    2016-12-01

    Fracture flow is of importance for water resources as well as the investigation of contaminant pathways. In this study, a novel characterization approach of nanoscale zero-valent iron (nZVI) tracer test was developed to accurately identify the connecting fracture zones of preferential flow between a screened well and an open well. Iron nanoparticles are magnetic and can be attracted by a magnet. This feature make it possible to design a magnet array for attracting nZVI particles at the tracer inlet to characterize the location of incoming tracer in the observation well. This novel approach was tested at two experiment wells with well hydraulic connectivity in a hydrogeological research station in central Taiwan. A heat-pulse flowmeter can be used to detect changes in flow velocity for delineating permeable fracture zones in the borehole and providing the design basis for the tracer test. Then, the most permeable zone in the injection well was hydraulically isolated by well screen to prevent the injected nZVI particles from being stagnated at the hole bottom. Afterwards, another hydraulic test was implemented to re-examine the hydraulic connectivity between the two wells. When nZVI slurry was injected in the injection well, they migrated through connected permeable fractures to the observation well. A breakthrough curve, observed by the fluid conductivity sensor in the observation well, indicated the arrival of nZVI slurry. The iron nanoparticles attracted to the magnets in the observation well provide the position of tracer inlet, which corroborates well with the depth of a permeable zone delineated by the flowmeter. This article demonstrates the potential of nano-iron tracer test to provide the quantitative information of fracture flow paths in fractured rock.

  18. A Comparison of the Mini-Open Wiltse Approach with Pedicle Screw Fixation and the Percutaneous Pedicle Screw Fixation for Neurologically Intact Thoracolumbar Fractures

    PubMed Central

    Fan, Yong; Zhang, JiaNan; He, Xin; Hang, YunFei; Wu, QiNing; Hao, DingJun

    2017-01-01

    Background The thoracolumbar AO type A3 fracture is an incomplete burst fracture, which affects one vertebral body endplate. The objective of this study was to determine which of two minimal invasive techniques was more suitable for A3 fractures based on clinical and radiographic results. Material/Methods We studied 112 patients with A3 subtype fractures without neurological deficits. A total of 63 patients received percutaneous pedicle screw fixation (PPSF), and 49 patients were treated using mini-open Wiltse approach with pedicle screw fixation (MWPSF). The clinical outcomes, surgery-related results, and the pre-operative and post-operative radiological findings were compared between the two groups. Results The length of incision, intra-operative blood loss, post-operative hospitalization time, visual analog score (VAS), Oswestry disability index (ODI), and accuracy rate of pedicle screw placement were compared between the PPSF and MWPSF groups, with no significant differences found (p>0.05). However, the vertebral body angle (VBA) and Cobb’s angle in the MWPSF group was much better than in the PPSF group (p<0.05). The operating time and C-arm exposure time of the MWPSF group were significantly lower than the PPSF group (p<0.05). The operative and post-operative costs of the PPSF group were significantly higher than the MWPSF group (p<0.05). Conclusions Our study found no significant differences in some clinical outcomes between the two groups. Both treatments were safe and effective for A3 subtype fractures. Nevertheless, given the radiation exposure, reduction of kyphosis, special equipment required, learning curve and hospitalization costs associated with PPSF, we concluded that MWPSF was a better choice for A3 subtype fractures. PMID:29151568

  19. Open reduction and internal fixation of acetabulum fractures: does timing of surgery affect blood loss and OR time?

    PubMed

    Dailey, Steven K; Archdeacon, Michael T

    2014-09-01

    The purpose of this study was to investigate the timing of surgical intervention for fractures of the acetabulum and its influence on perioperative factors. Retrospective review. Level I trauma center. Two hundred eighty-eight consecutive patients who sustained either posterior wall (PW), associated both column (ABC), or anterior column posterior hemitransverse (ACPHT) acetabulum fractures were included in the study. One hundred seventy-six PW fractures were treated through a Kocher-Langenbeck approach, and 112 ABC/ACPHT fractures were treated through an anterior intrapelvic approach. Estimated blood loss (EBL), operative time. EBL (800 vs. 400 mL), operative time (270 vs.154 minutes), and hospital stay (11 vs. 7 days) were greater for the ABC/ACPHT fractures compared with the PW fractures. When comparing early (≤48 hours) versus late (>48 hours) treatment of PW fractures, there was no difference in EBL (400 vs. 400 mL, P = 0.37) or operative time (150 vs. 156 minutes, P = 0.50). In comparison of early versus late treatment of ABC/ACPHT fractures, no significant difference was noted in EBL (725 vs. 800 mL, P = 0.30) or operative time (258.5 vs. 272 minutes, P = 0.21). We found no advantage or disadvantage in terms of EBL or operative time for early (≤48 hours) versus late (>48 hours) fixation for either PW or ABC/ACPHT acetabular fractures. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

  20. True aneurysm of the anterior tibial artery.

    PubMed

    Leoce, Brian M; Bernik, Jack T; Gupta, Anjuli M; Dardik, Herbert; Bernik, Thomas R

    2018-02-05

    The majority of anterior tibial aneurysm cases described in the literature are pseudoaneurysms resulting from trauma 1-6 . Since 1967, only eight cases published on true anterior tibial artery aneurysms were atraumatic 7-9,16,17 . Recent experience with an atraumatic aneurysm of the anterior tibial artery prompted a literature review regarding their incidence, and accordingly, we feel the need exists for greater recognition and understanding of this entity. Copyright © 2018. Published by Elsevier Inc.

  1. Comparison of fracture resistance of simulated immature teeth with an open apex using Biodentine and composite resin: An in vitro study.

    PubMed

    Zhabuawala, Murtuza Saifuddin; Nadig, Roopa R; Pai, Veena S; Gowda, Yashwanth

    2016-01-01

    To evaluate the fracture resistance in simulated immature teeth that had been backfilled using composite resin and Biodentine after using Biodentine as an apical plug material immediately and after 3 months of aging. Sixty extracted human maxillary central incisors were simulated in an immature open apex. The roots of all the specimens were then standardized to a length of 10 mm and canals were instrumented to obtain the radicular dentin thickness around 1.5 mm. All the specimens were then randomly divided into three groups of twenty teeth each. Group I (control) - 4 mm apical plug of Biodentine backfilled with thermoplasticized gutta-percha. Group II - 4 mm apical plug of Biodentine and then backfilled with ParaCore. Group III - completely filled with Biodentine. Ten samples from each group were randomly divided into two subgroups. In subgroup A: Specimens were stored for 1 week. In subgroup B: Specimens were stored in phosphate-buffered saline solution for 3 months and were subjected to universal testing machine. Statistical analysis was done using one-way analysis. No significant difference in fracture resistance between the groups was observed when tested immediately. After 3 months of aging, only Biodentine group showed a significant reduction in fracture resistance without significant reduction with other two groups. Biodentine group has shown a drastic reduction in fracture resistance after 3 months of aging, and hence cannot be recommended as a reinforcement material in immature teeth with thin dentin walls.

  2. Open reduction and internal fixation of humeral shaft fractures versus conservative treatment with a functional brace: a study protocol of a randomised controlled trial embedded in a cohort

    PubMed Central

    Taimela, Simo; Lepola, Vesa; Malmivaara, Antti; Lähdeoja, Tuomas; Paavola, Mika

    2017-01-01

    Introduction Humeral shaft fractures represent 1%–3% of all fractures and 20% of humeral fractures in adults. The treatment of these fractures is mainly conservative and operative treatment is usually reserved for specific circumstances. To date, no randomised controlled trial (RCT) has compared operative treatment of humeral shaft fractures with conservative treatment. Methods and analysis We will conduct an RCT to compare the effectiveness and cost-effectiveness of surgical and conservative treatment of humeral shaft fractures. After providing informed consent, 80 patients from 18 years of age with humeral shaft fracture will be randomly assigned to open reduction and internal fixation with locking plate or conservative treatment with functional bracing. We will follow the patients for 10 years and compare the results at different time points. The primary outcome will be Disabilities of Arm, Shoulder and Hand (DASH) at 12 months. The secondary outcomes will include Numerical Rating Scale for pain at rest and in activities, Constant Score and quality of life instrument 15D. Patients not willing to participate in the RCT will be asked to participate in a prospective cohort follow-up study, ‘the declined cohort’. This cohort will be followed up at the same time points as the randomised patients to assess the potential effect of participation bias on RCT results and to enhance the external validity of the RCT. In one of the recruiting centres, all cooperative patients with humeral shaft fractures not eligible for randomisation will be asked to participate in a ‘non-eligible cohort’ study. We will use blinded data interpretation of the randomised cohort to avoid biased interpretation of outcomes. Our null hypothesis is that there is no clinically relevant difference in the primary outcome measure between the two treatment groups. We will consider a difference of a minimum of 10 points in DASH clinically relevant. Ethics and dissemination The institutional

  3. Chronic shin splints. Classification and management of medial tibial stress syndrome.

    PubMed

    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.

  4. Clinical effectiveness and cost-effectiveness of bone morphogenetic proteins in the non-healing of fractures and spinal fusion: a systematic review.

    PubMed

    Garrison, K R; Donell, S; Ryder, J; Shemilt, I; Mugford, M; Harvey, I; Song, F

    2007-08-01

    To assess the clinical effectiveness and cost-effectiveness of bone morphogenetic protein (BMP) for the treatment of spinal fusions and the healing of fractures compared with the current standards of care. Electronic databases, related journals and references from identified studies were searched in January 2006, with an updated search only for randomised controlled trials (RCTs) in November 2006. A systematic review of available data was conducted. The data from selected studies were then analysed and graded according to quality and processed to give a value to the efficacy of BMP. Existing models were modified or updated to evaluate the cost-effectiveness of BMP for open tibial fractures and spinal fusion. All selected trials were found to have several methodological weaknesses. Insufficient sample size in most trials, meant that patient baseline comparability between trial arms was not achieved and the statistical power to detect a moderate effect was low. Data did indicate that BMP increased fracture union among patients with acute tibial fractures and found that high-dose BMP is more effective than a lower dose for open tibial fractures. The healing rate in the BMP group was not found to be statistically significantly different from that in the autogenous bone grafting group for patients with tibial non-union fractures, but BMP reduced the number of secondary interventions in patients with acute tibial fractures compared with controls. There was very limited evidence that BMP in scaphoid non-union was safe and may help to accelerate non-union healing when used in conjunction with either autograft or allograft. There was evidence that BMP-2 is more effective than autogenous bone graft for radiographic fusion in patients with single-level degenerative disc disease. No significant difference was found when BMP-7 was compared with autograft for degenerative spondylolisthesis with spinal stenosis and spondylolysis. The use of BMP was associated with a reduced

  5. Experimental study of stable imbibition displacements in a model open fracture. II. Scale-dependent avalanche dynamics

    NASA Astrophysics Data System (ADS)

    Clotet, Xavier; Santucci, Stéphane; Ortín, Jordi

    2016-01-01

    We report the results of an experimental investigation of the spatiotemporal dynamics of stable imbibition fronts in a disordered medium, in the regime of capillary disorder, for a wide range of experimental conditions. We have used silicone oils of various viscosities μ and nearly identical oil-air surface tension, and forced them to slowly invade a model open fracture at very different flow rates v . In this second part of the study we have carried out a scale-dependent statistical analysis of the front dynamics. We have specifically analyzed the influence of μ and v on the statistical properties of the velocity Vℓ, the spatial average of the local front velocities over a window of lateral size ℓ . We have varied ℓ from the local scale defined by our spatial resolution up to the lateral system size L . Even though the imposed flow rate is constant, the signals Vℓ(t ) present very strong fluctuations which evolve systematically with the parameters μ , v , and ℓ . We have verified that the non-Gaussian fluctuations of the global velocity Vℓ(t ) are very well described by a generalized Gumbel statistics. The asymmetric shape and the exponential tail of those distributions are controlled by the number of effective degrees of freedom of the imbibition fronts, given by Neff=ℓ /ℓc (the ratio of the lateral size of the measuring window ℓ to the correlation length ℓc˜1 /√{μ v } ). The large correlated excursions of Vℓ(t ) correspond to global avalanches, which reflect extra displacements of the imbibition fronts. We show that global avalanches are power-law distributed, both in sizes and durations, with robustly defined exponents—independent of μ , v , and ℓ . Nevertheless, the exponential upper cutoffs of the distributions evolve systematically with those parameters. We have found, moreover, that maximum sizes ξS and maximum durations ξT of global avalanches are not controlled by the same mechanism. While ξS are also determined by

  6. Open reduction and internal fixation of osteoporotic acetabular fractures through the ilio-inguinal approach: use of buttress plates to control medial displacement of the quadrilateral surface.

    PubMed

    Peter, Robin E

    2015-01-01

    The number of acetabular fractures in the geriatric population requiring open reduction and internal fixation is increasing. Fractures with medial or anterior displacement are the most frequent types, and via the ilio-inguinal approach buttress plates have proved helpful to maintain the quadrilateral surface or medial acetabular wall. Seven to ten hole 3.5 mm reconstruction plates may be used as buttress plates, placed underneath the usual pelvic brim plate. This retrospective study presents our results with this technique in 13 patients at a minimum follow-up of 12 months (average, 31 months). 85% of the patients had a good result. The early onset of post-traumatic osteoarthritis necessitated total hip arthroplasty in two patients (15%) at 12 and 18 months follow-up, respectively. This treatment option should be considered in the surgeon's armamentarium when fixing these challenging cases. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. A bio-artificial poly([d,l]-lactide-co-glycolide) drug-eluting nanofibrous periosteum for segmental long bone open fractures with significant periosteal stripping injuries

    PubMed Central

    Chou, Ying-Chao; Cheng, Yi-Shiun; Hsu, Yung-Heng; Yu, Yi-Hsun; Liu, Shih-Jung

    2016-01-01

    Biodegradable poly([d,l]-lactide-co-glycolide) (PLGA) nanofibrous membrane embedded with two drug-to-polymer weight ratios, namely 1:3 and 1:6, which comprised PLGA 180 mg, lidocaine 20 mg, vancomycin 20 mg, and ceftazidime 20 mg, and PLGA 360 mg, lidocaine 20 mg, vancomycin 20 mg, and ceftazidime 20 mg, respectively, was produced as an artificial periosteum in the treatment of segmental femoral fractures. The nanofibrous membrane’s drug release behavior was assessed in vitro using high-performance liquid chromatography and the disk-diffusion method. A femoral segmental fracture model with intramedullary Kirschner-wire fixation was established for the in vivo rabbit activity study. Twenty-four rabbits were divided into two groups. Twelve rabbits in group A underwent femoral fracture fixation only, and 12 rabbits in group B underwent femoral fracture fixation and were administered the drug-loaded nanofibers. Radiographs obtained at 2, 6, and 12 weeks postoperatively were used to assess the bone unions. The total activity counts in animal behavior cages were also examined to evaluate the clinical performance of the rabbits. After the animals were euthanized, both femoral shafts were harvested and assessed for their torque strengths and toughness. The daily in vitro release curve for lidocaine showed that the nanofibers eluted effective levels of lidocaine for longer than 3 weeks. The bioactivity studies of vancomycin and ceftazidime showed that both antibiotics had effective and sustained bactericidal capacities for over 30 days. The findings from the in vivo animal activity study suggested that the rabbits with the artificial drug-eluting periosteum exhibited statistically increased levels of activity and better clinical performance outcomes compared with the rabbits without the artificial periosteum. In conclusion, this artificial drug-eluting periosteum may eventually be used for the treatment of open fractures. PMID:27022261

  8. Surgical treatment of a proximal diaphyseal tibial deformity associated with partial caudal and cranial cruciate ligament deficiency and patella baja.

    PubMed

    Vincenti, S; Knell, S; Pozzi, A

    2017-04-01

    Caudal cruciate ligament injury can be a complication following tibial plateau leveling osteotomy (TPLO) (Slocum und Slocum, 1993) especially if the post-operative Tibial Plateau Angle (TPA) is less than 5 degree. We describe a case of negative TPA associated with partial cranial and caudal ligament rupture treated with a center of rotation of angulation (CORA) based cranial tibial opening wedge osteotomy and tibial tuberosity transposition. A 13 kg, mixed breed dog was presented for right pelvic limb lameness. Radiographically a bilateral patella baja and a malformed tibia tuberosity along with a bilateral TPA of -8 degree were detected. Arthroscopically a partial rupture of the cranial and caudal cruciate ligaments were found. A cranial tibial opening wedge osteotomy of 23 degree and a fibular ostectomy were performed. The osteotomy was fixed with a 8 holes ALPS 9 (KYON, Switzerland) and a 3-holes 2.0mm UniLock plate (Synthes, Switzerland). Then a proximal tibial tuberosity transposition of 10mm was performed and fixed with a pin and tension band construct. The postoperative TPA was 15 degree. The radiographic controls at 6, 10 weeks, 6 months and 1 year after surgery revealed an unchanged position of the implants and progressive healing of the osteotomies. At the 6 and 12 months recheck evaluation the dog had no evidence of lameness or stifle pain and radiographs revealed complete healing of the osteotomy site and no implant failure. The diaphyseal CORA based osteotomy allowed accurate correction of a proximal tibial deformity associated with negative TPA.

  9. Stress fractures: diagnosis, treatment, and prevention.

    PubMed

    Patel, Deepak S; Roth, Matt; Kapil, Neha

    2011-01-01

    Stress fractures are common injuries in athletes and military recruits. These injuries occur more commonly in lower extremities than in upper extremities. Stress fractures should be considered in patients who present with tenderness or edema after a recent increase in activity or repeated activity with limited rest. The differential diagnosis varies based on location, but commonly includes tendinopathy, compartment syndrome, and nerve or artery entrapment syndrome. Medial tibial stress syndrome (shin splints) can be distinguished from tibial stress fractures by diffuse tenderness along the length of the posteromedial tibial shaft and a lack of edema. When stress fracture is suspected, plain radiography should be obtained initially and, if negative, may be repeated after two to three weeks for greater accuracy. If an urgent diagnosis is needed, triple-phase bone scintigraphy or magnetic resonance imaging should be considered. Both modalities have a similar sensitivity, but magnetic resonance imaging has greater specificity. Treatment of stress fractures consists of activity modification, including the use of nonweight-bearing crutches if needed for pain relief. Analgesics are appropriate to relieve pain, and pneumatic bracing can be used to facilitate healing. After the pain is resolved and the examination shows improvement, patients may gradually increase their level of activity. Surgical consultation may be appropriate for patients with stress fractures in high-risk locations, nonunion, or recurrent stress fractures. Prevention of stress fractures has been studied in military personnel, but more research is needed in other populations.

  10. Clinical Follow-up on Sagittal Fracture at the Temporal Root of the Zygomatic Arch: Does It Need Open Reduction?

    PubMed Central

    Cheon, Ji Seon; Seo, Bin Na; Son, Kyung Min

    2013-01-01

    Background The zygoma is a major portion of the midfacial contour. When deformity occurs in this area, a reduction should be conducted to correct it. If a sagittal fracture at the temporal root of the zygomatic arch occurs, this also requires reduction, but it is difficult to approach due to its anatomical location, and the possibility of fixation is also limited. Thus, the authors attempted the reduction of sagittal fracture by two- or three-point fixation and the Gillies approach without direct manipulation. The preoperative and postoperative results of the patients were evaluated. Follow-up was performed to establish a treatment guideline. Methods A retrospective study was done with 40 patients who had sagittal fractures at the temporal root of the zygomatic arch from March 2009 to June 2012. Only two- or three-point fixation was performed for the accompanying zygomatic-orbital-maxillary fracture. The Gillies approach was used for complex fractures of the zygomatic arch, while the temporal root of the zygomatic arch was only observed without reduction. Preoperative and postoperative computed tomography and X-ray scans were performed to examine the results. Results The result of the paired t-test on preoperative and postoperative bone gap differences, the depression level, and the degree of temporal protrusion showed a marked decrease in the mean difference at a 95% confidence interval. The results were acceptable. Conclusions In the treatment of sagittal fractures at the temporal root of the zygomatic arch, it is acceptable to use indirect reduction and non-fixation methods. This leads to a satisfactory aesthetic and functional outcome. PMID:24086808

  11. Clinical Follow-up on Sagittal Fracture at the Temporal Root of the Zygomatic Arch: Does It Need Open Reduction?

    PubMed

    Cheon, Ji Seon; Seo, Bin Na; Yang, Jeong Yeol; Son, Kyung Min

    2013-09-01

    The zygoma is a major portion of the midfacial contour. When deformity occurs in this area, a reduction should be conducted to correct it. If a sagittal fracture at the temporal root of the zygomatic arch occurs, this also requires reduction, but it is difficult to approach due to its anatomical location, and the possibility of fixation is also limited. Thus, the authors attempted the reduction of sagittal fracture by two- or three-point fixation and the Gillies approach without direct manipulation. The preoperative and postoperative results of the patients were evaluated. Follow-up was performed to establish a treatment guideline. A retrospective study was done with 40 patients who had sagittal fractures at the temporal root of the zygomatic arch from March 2009 to June 2012. Only two- or three-point fixation was performed for the accompanying zygomatic-orbital-maxillary fracture. The Gillies approach was used for complex fractures of the zygomatic arch, while the temporal root of the zygomatic arch was only observed without reduction. Preoperative and postoperative computed tomography and X-ray scans were performed to examine the results. The result of the paired t-test on preoperative and postoperative bone gap differences, the depression level, and the degree of temporal protrusion showed a marked decrease in the mean difference at a 95% confidence interval. The results were acceptable. In the treatment of sagittal fractures at the temporal root of the zygomatic arch, it is acceptable to use indirect reduction and non-fixation methods. This leads to a satisfactory aesthetic and functional outcome.

  12. Clinical outcomes of minimally invasive open reduction and internal fixation by screw and washer for displaced greater tuberosity fracture of the humerus.

    PubMed

    Yoon, Tae-Hwan; Choi, Chong-Hyuk; Choi, Yun-Rak; Oh, Jong-Taek; Chun, Yong-Min

    2018-01-03

    The purpose of this study was to investigate clinical and radiologic outcomes of open reduction and internal fixation with a screw and washer for a displaced greater tuberosity fracture of the proximal humerus through a small incision. We retrospectively reviewed 29 patients who underwent open reduction and internal fixation with a screw and washer for a greater tuberosity fracture of the proximal humerus. After surgery, the patients were immobilized in a brace for 4 weeks. To determine clinical outcomes, we evaluated a visual analog scale pain score; the Subjective Shoulder Value; the University of California, Los Angeles shoulder score; the American Shoulder and Elbow Surgeons score; and active range of motion. All patients achieved bone union within 3 months after surgery. At the 2-year follow-up, the mean visual analog scale pain score was 1.1 ± 1.1; Subjective Shoulder Value, 93.4 ± 5.3; University of California, Los Angeles shoulder score, 31.2 ± 2.7; and American Shoulder and Elbow Surgeons score, 92.6 ± 6.7. Mean active forward flexion, external rotation, and internal rotation were 144° ± 16°, 33° ± 11°, and 13.3 ± 1.7, respectively. Postoperatively, 9 patients (31%) had stiffness and pain refractory to conservative treatment and underwent arthroscopic release. Although minimal open reduction and screw and washer fixation resulted in bone union in all cases, the incidence of postoperative stiffness was relatively high in patients with displaced greater tuberosity fractures because of prolonged immobilization after surgery. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  13. Tensile, Compression, Open-Hole Compression and Double Cantilever Beam Fracture Toughness Testing of Multiple NASA Langley Research Center Composite Materials

    NASA Technical Reports Server (NTRS)

    Adams, Donald F.

    1999-01-01

    The attached data summarizes the work performed by the Composite Materials Research Group at the University of Wyoming funded by the NASA LaRC Research Grant NAG-1-1294. The work consisted primarily of tension, compression, open-hole compression and double cantilever beam fracture toughness testing performed an a variety of NASA LaRC composite materials. Tests were performed at various environmental conditions and pre-conditioning requirements. The primary purpose of this work was to support the LaRC material development efforts. The data summaries are arranged in chronological order from oldest to newest.

  14. Fluid Lavage of Open Wounds (FLOW): design and rationale for a large, multicenter collaborative 2 × 3 factorial trial of irrigating pressures and solutions in patients with open fractures

    PubMed Central

    2010-01-01

    Background Open fractures frequently result in serious complications for patients, including infections, wound healing problems, and failure of fracture healing, many of which necessitate subsequent operations. One of the most important steps in the initial management of open fractures is a thorough wound irrigation and debridement to remove any contaminants. There is, however, currently no consensus regarding the optimal approach to irrigating open fracture wounds during the initial operative procedure. The selection of both the type of irrigating fluid and the pressure of fluid delivery remain controversial. The primary objective of this study is to investigate the effects of irrigation solutions (soap vs. normal saline) and pressure (low vs. high; gravity flow vs. high; low vs. gravity flow) on re-operation within one year among patients with open fractures. Methods/Design The FLOW study is a multi-center, randomized controlled trial using a 2 × 3 factorial design. Surgeons at clinical sites in North America, Europe, Australia, and Asia will recruit 2 280 patients who will be centrally randomized into one of the 6 treatment arms (soap + low pressure; soap + gravity flow pressure; soap + high pressure; saline + low pressure; saline + gravity flow pressure; saline + high pressure). The primary outcome of the study is re-operation to promote wound or bone healing, or to treat an infection. This composite endpoint of re-operation includes a narrow spectrum of patient-important procedures: irrigation and debridement for infected wound, revision and closure for wound dehiscence, wound coverage procedures for infected or necrotic wound, bone grafts or implant exchange procedures for established nonunion in patients with postoperative fracture gaps less than 1 cm, intramedullary nail dynamizations in the operating room, and fasciotomies for compartment syndrome. Patients, outcome adjudicators, and data analysts will be blinded. We will compare rates of re-operation at

  15. [Open reduction and internal fixation of displaced ankle fractures in patients older than 65 years of age. Analysis of results at five-year follow-up].

    PubMed

    Tomé-Bermejo, F; Santacruz Arévalo, A; Ruiz Micó, N

    2016-01-01

    The aim of this study was to evaluate the long term outcome of surgical treatment for displaced ankle fractures in patients over 65 years of age, and determine the influence of age and comorbidity in the occurrence of complications. Retrospective descriptive study on 40 patients, with a mean age of 72.7 years (range: 65-88), who underwent open reduction and internal fixation for the treatment of a displaced ankle fracture. The patients were clinically evaluated according to the AOFAS criteria (functional outcome). Data collection also included the presence of comorbidities, radiographic evaluation, the occurrence of postoperative complications, and a questionnaire on satisfaction with treatment received. The mean follow-up was 5.73 years. At the end of the follow-up, according to the AOFAS criteria, excellent/good results were obtained in 75% of the patients (n=30), with 38 patients referring to be quite/very happy with the result. Wound skin problems and metal work migration were the most common post-operative complications. No statistically significant relationship was found between increased age or a high number of comorbidities and an increased occurrence of postoperative complications (p>.05). Only 3 patients needed postoperative rehabilitation, and 95% of the patients (n=38) returned to their activities of normal daily living. Surgical treatment of displaced ankle fractures in the elderly patient facilitates the early resumption of the activities of daily living. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  16. Novel implant for peri-prosthetic proximal tibia fractures.

    PubMed

    Tran, Ton; Chen, Bernard K; Wu, Xinhua; Pun, Chung Lun

    2018-02-02

    Repair of peri-prosthetic proximal tibia fractures is very challenging in patients with a total knee replacement or arthroplasty. The tibial component of the knee implant severely restricts the fixation points of the tibial implant to repair peri-prosthetic fractures. A novel implant has been designed with an extended flange over the anterior of tibial condyle to provide additional points of fixation, overcoming limitations of existing generic locking plates used for proximal tibia fractures. Furthermore, the screws fixed through the extended flange provide additional support to prevent the problem of subsidence of tibial component of knee implant. The design methodology involved extraction of bone data from CT scans into a flexible CAD format, implant design and structural evaluation and optimisation using FEM as well as prototype development and manufacture by selective laser melting 3D printing technology with Ti6Al4 V powder. A prototype tibia implant was developed based on a patient-specific bone structure, which was regenerated from the CT images of patient's tibia. The design is described in detail and being applied to fit up to 80% of patients, for both left and right sides based on the average dimensions and shape of the bone structure from a wide range of CT images. A novel tibial implant has been developed to repair peri-prosthetic proximal tibia fractures which overcomes significant constraints from the tibial component of existing knee implant. Copyright © 2018 Elsevier Ltd. All rights reserved.

  17. Traumatic Fracture in a patient of Osteopoikilosis with Review of Literature.

    PubMed

    Bansal, Rohan; Pathak, Aditya C; Sheth, Binoti; Patil, Atul K

    2013-01-01

    Osteopoikilosis or osteopathia condensans disseminata is a rare hereditary autosomal dominant sclerosing bone dysplasia. Patients are usually asymptomatic and the diagnosis is usually made incidentally on radiographs which show presence of symmetric, multiple, well defined, small ovoid areas of increased radiodensity clustered in peri-articular osseous regions with propensity for epiphyseal and metaphyseal involvement. There are no increased risks of pathological fracture in a case of osteopoikilosis and traumatic fracture healing in a case of osteopoikilosis is similar to fracture occurring in other normal patients. A 34 years male, electrician came with history of accidental fall from height while working in office leading to development of pain and swelling over left lower leg and ankle diagnosed with Ruedi-Allgower classification type I pilon fracture(without fibula fracture) no distal neuro-vascular deficit. Patient was offered surgical treatment in form of open reduction and internal fixation of tibial fracture by plate osteosynthesis using antero-medial approach, showed complete union and was followed up for eight months. Osteopoikilosis has a benign course and it should always be kept as a possible differential diagnosis for osteoblastic metastasis to avoid diagnositic dilemma. Diagnosis can be settled by routine x-rays (for type, extent and site of lesions, bones affected), clinical features of patient, histopathology and other systemic or pre-existing conditions.

  18. Traumatic Fracture in a patient of Osteopoikilosis with Review of Literature

    PubMed Central

    Bansal, Rohan; Pathak, Aditya C; Sheth, Binoti; Patil, Atul K

    2013-01-01

    Introduction: Osteopoikilosis or osteopathia condensans disseminata is a rare hereditary autosomal dominant sclerosing bone dysplasia. Patients are usually asymptomatic and the diagnosis is usually made incidentally on radiographs which show presence of symmetric, multiple, well defined, small ovoid areas of increased radiodensity clustered in peri-articular osseous regions with propensity for epiphyseal and metaphyseal involvement. There are no increased risks of pathological fracture in a case of osteopoikilosis and traumatic fracture healing in a case of osteopoikilosis is similar to fracture occurring in other normal patients. Case Report: A 34 years male, electrician came with history of accidental fall from height while working in office leading to development of pain and swelling over left lower leg and ankle diagnosed with Ruedi-Allgower classification type I pilon fracture(without fibula fracture) no distal neuro-vascular deficit. Patient was offered surgical treatment in form of open reduction and internal fixation of tibial fracture by plate osteosynthesis using antero-medial approach, showed complete union and was followed up for eight months. Conclusion: Osteopoikilosis has a benign course and it should always be kept as a possible differential diagnosis for osteoblastic metastasis to avoid diagnositic dilemma. Diagnosis can be settled by routine x-rays (for type, extent and site of lesions, bones affected), clinical features of patient, histopathology and other systemic or pre-existing conditions. PMID:27298900

  19. Repeated Stress Fractures in an Amenorrheic Marathoner: A Case Conference.

    ERIC Educational Resources Information Center

    Sutton, John R.; Nilson, Karen L.

    1989-01-01

    Presents a case conference by 2 experts on the relationship between a 26-year-old marathoner's amenorrhea and her sustained unusual stress fractures in 4 ribs (plus previous similar fractures of the calcaneal, navicular, metatarsal, and tibial bones). The experts conclude that she suffers many manifestations of overtraining. (SM)

  20. Assessing Tibial Tray Rotation in TKA: A Cadaveric Study.

    PubMed

    Hakki, Sam; El-Othmani, Mouhanad M; Gabriel, Christian; Mihalko, William M; Saleh, Khaled J

    2016-05-01

    Tibial anatomical landmarks for transverse plane rotation of the tibial tray have not been validated. The current authors propose aligning the tibial tray with both the anterior tibial center point of rotation (ATCPR) and the femoral trochlear groove (FTG) to establish the ideal tibial tray rotation in total knee arthroplasty (TKA). When the tibial tray centerline was aligned with ATCPR and FTG lines, the mean range of motion (ROM) was 144.3° (preoperatively 145°) and tibial rotation range was 22.8 mm (preoperatively, 24.9 mm). When the tibial component was rotated 5 mm medially to the ATCPR, the knee ROM decreased in flexion with patellar subluxation, while it decreased in extension when rotated 5 mm laterally. This method identifies the ideal tibial tray rotation in TKA, at which maximal range of tibial rotation and knee ROM are achieved without obvious overriding of components. [Orthopedics, 2016; 39(3):S67-S71.]. Copyright 2016, SLACK Incorporated.