Science.gov

Sample records for open tibial fractures

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

    PubMed Central

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

    2016-01-01

    Background: Traditionally, Gustilo Anderson grade IIIb open tibial fractures have been treated by initial wide wound debridement, stabilization of fracture with external fixation, and delayed wound closure. The purpose of this study is to evaluate the clinical and radiological results of staged treatment using negative pressure wound therapy (NPWT) for Gustilo Anderson grade IIIb open tibial fractures. Materials and Methods: 15 patients with Gustilo Anderson grade IIIb open tibial fractures, treated using staged protocol by a single surgeon between January 2007 and December 2011 were reviewed in this retrospective study. The clinical results were assessed using a Puno scoring system for severe open fractures of the tibia at the last followup. The range of motion (ROM) of the knee and ankle joints and postoperative complication were evaluated at the last followup. The radiographic results were assessed using time to bone union, coronal and sagittal angulations and a shortening at the last followup. Results: The mean score of Puno scoring system was 87.4 (range 67–94). The mean ROM of the knee and ankle joints was 121.3° (range 90°–130°) and 37.7° (range 15°–50°), respectively. Bone union developed in all patients and the mean time to union was 25.3 weeks (range 16–42 weeks). The mean coronal angulation was 2.1° (range 0–4°) and sagittal was 2.7° (range 1–4°). The mean shortening was 4.1 mm (range 0–8 mm). Three patients had partial flap necrosis and 1 patient had total flap necrosis. There was no superficial and deep wound infection. Conclusion: Staged treatment using NPWT decreased the risks of infection and requirement of flap surgeries in Gustilo Anderson grade IIIb open tibial fractures. Therefore, staged treatment using NPWT could be a useful treatment option for Gustilo Anderson grade IIIb open tibial fractures. PMID:27746498

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

    PubMed Central

    Stanisław, Bołtuć Witold; Bogusław, Golec Edward

    2008-01-01

    Background: The work presents the assessment of the results of treatment of open tibial shaft fractures in polytrauma patients. Materials and Methods: The study group comprised 28 patients who underwent surgical treatment of open fractures of the tibial shaft with locked intramedullary nailing. The mean age of the patients was 43 years (range from 19 to 64 years). The criterion for including the patients in the study was concomitant multiple trauma. For the assessment of open tibial fractures, Gustilo classification was used. The most common concomitant multiple trauma included craniocerebral injuries, which were diagnosed in 12 patients. In 14 patients, the surgery was performed within 24 h after the injury. In 14 patients, the surgery was delayed and was performed 8–10 days after the trauma. Results: The assessment of the results at 12 months after the surgery included the following features: time span between the trauma and the surgery and complications in the form of osteomyelitis and delayed union. The efficacy of gait, muscular atrophy, edema of the operated limb and possible disturbances of its axis were also taken under consideration. In patients operated emergently within 24 h after the injury, infected nonunion was observed in three (10.8%) males. These patients had grade III open fractures of the tibial shaft according to Gustilo classification. No infectious complications were observed in patients who underwent a delayed operation. Conclusion: Evaluation of patients with open fractures of the tibial shaft in multiple trauma showed that delayed intramedullary nailing performed 8–10 days after the trauma, resulted in good outcome and avoided development of delayed union and infected nonunion. This approach gives time for stabilization of general condition of the patient and identification of pathogens from wound culture. PMID:19753226

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

    PubMed Central

    Al-Sayyad, Mohammed J

    2008-01-01

    Background: The Taylor spatial frame (TSF) is a modern multiplanar external fixator that combines the ease of application and computer accuracy in the reduction of fractures. A retrospective review of our prospective TSF database for the use of this device for treating open tibial fractures in pediatric, adolescent, and adult patients was carried out to determine the effectiveness and complications of TSF in the treatment of these fractures. Materials and Methods: Nineteen male patients with open tibial fractures were included. Of these fractures, 10 were Gustilo Type II, five were Gustilo Type IIIA (two had delayed primary closure and three had split thickness skin grafting), and four were Gustilo Type IIIB (all had rotational flaps). Twelve of our patients presented immediately to the emergency room, and the remaining seven cases presented at a mean of 3 months (range, 2.2-4.5 months) after the initial injury. The fractures were located in proximal third (n=1), proximal/middle junction (n=2), middle third (n=3), middle/distal junction (n=8), distal third (n=3), and segmental fractures (n=2). Patients were of an average age of 26 years (range, 6-45years). Mean duration of follow-up was 3.5 years. Results: All fractures healed over a mean of 25 weeks (range, 9-46 weeks). All were able to participate in the activities of daily living without any difficulty and most were involved in sports during the last follow-up. Postoperative complications included pin tract infection in 12 patients. Conclusion: The TSF is an effective definitive method of open tibial fracture care with the advantage of early mobilization, ease of soft tissue management through gradual fracture reduction, and the ability to postoperatively manipulate the fracture into excellent alignment. PMID:19753231

  5. One-stage emergency treatment of open grade IIIB tibial shaft fractures with bone loss.

    PubMed

    Tropet, Y; Garbuio, P; Obert, L; Jeunet, L; Elias, B

    2001-02-01

    The purpose of this study was to report the authors' experience with emergency reconstruction of severe tibial shaft fractures. Five male patients were admitted to the emergency room with a grade IIIB open tibial shaft fracture with bone loss (average age, 33 years; age range, 18-65 years). Injuries were the result of motorcycle accidents (N = 2), pedestrian accidents (N = 1), gunshot wound (N = 1), and paragliding fall (N = 1). Primary emergent one-stage management for all patients consisted of administration of antibiotics, debridement, stabilization by locked intramedullary nailing, bone grafting from the iliac crest, and coverage using free muscle flaps (four latissimus dorsi and one gracilis). The average follow-up was 21 months (range, 8 months-3.5 years). Partial weight bearing with no immobilization was started at 3 months, and full weight bearing began 5 months after trauma. No angular complications and no nonunions were observed. There was one case of superficial infection without osteitis. All fractures healed within 6 months in 4 patients and within 10 months in 1 patient. At the last follow-up examination, ankle and knee motion was normal and no pain was noted, except for 1 patient who had associated lesions (ankle motion reduced by 50%). Aggressive emergency management of severe open tibial fractures provides good results. It improves end results markedly, not only by reducing tissue loss from infection, but also reducing healing and rehabilitation times.

  6. A Staged Surgical Treatment Outcome of Type 3 Open Tibial Fractures

    PubMed Central

    Uysal, Emin; Özmeriç, Ahmet

    2014-01-01

    Aim. In these case series which are about type 3 open tibial fractures formed with three different high energy trauma etiologies in different parts of tibia. We aimed to assess our three-stage treatment approach and discuss final results of our elective surgery management with three different fixation methods. Patients and Methods. We assessed 19 patients with type 3 open tibial fractures between 2009 and 2012. Our treatment protocol consisted of three stages. Early intervention in operating room, which including vascular repairs or soft tissue closure, was done if necessary. Definitive surgery was performed using internal or external fixation in the first 15 days. Patients were followed up for at least one year. Last conditions of all our cases were evaluated according to modified Johner and Wruhs criteria. Results. Nine cases were type 3A, seven cases were type 3B, and three cases were type 3C in terms of fracture typing. All patients were followed up for at least one year and mean follow up time was 15 months. In terms of functional and clinical outcome, six cases were evaluated as excellent, eight cases as good, two cases as fair, and three cases as poor. Discussion. Staged treatment option in type 3 open tibial fractures seems to be a good method in reducing complication and achieving the best result. We think that definitive staged treatment protocol including internal fixation with plating or intramedullary nailing (IMN) of the fractures is a reliable method, especially to avoid complications as a result of external fixator and to provide patient rapport. PMID:24967129

  7. Risk factors associated with infection in tibial open fractures.

    PubMed

    Almeida Matos, Marcos; Castro-Filho, Romulo Neves; Pinto da Silva, Bruno Vieira

    2013-01-01

    Introducción: El objetivo del tratamiento de las fracturas abiertas es prevenir las infecciones, estabilizar el hueso e restaurar la función. En relación a los objetivos mencionados, la prevención de infecciones tiene mayor destaque y es el punto mas importante a ser alcanzado. Objetivo: El objetivo de este trabajo es identificar los factores de riesgo asociados con la infección en un grupo de pacientes con fracturas abierta de la tibia. Paciente y métodos. Fue realizado un análisis retrospectivo con pacientes que tuvieron fractura abierta tibial que estaban en tratamiento en el Hospital Roberto Santos-Geral-HGRS, Salvador, Bahía, Brasil, de marzo a octubre de 2009. Fueron excluidos de este estudio todos los niños menores de 8 años con fracturas múltiples o que tenían alguna enfermedad sistémica o en los huesos. De acuerdo con los datos clínicos y demográficos, los pacientes fueron divididos en dos grupos: el grupo 1 estaba constituido por los que no tenían infección en las fracturas y el grupo 2 por los que tenían infección. En los dos grupos se investigo factores que podrían estar asociados a la infección. Resultados. De 50 pacientes estudiados la tasa de infección global fue de 14 (28%, IC95% = 15,5-40,5). El hecho de desenvolver infección fue asociado con el lugar del trauma (OR 3,78; IC 95% = 1,4-5,5, p = 0,02), y la demora en recibir tratamiento adecuado en tiempo superior a 24 horas (OR 3,4; IC95% 1.4-20.8 = p = 0,03). Las fracturas clasificadas como Gustilo I, II, IIIA tuvieron una menor chance de infección cuando comparadas como Gustilo IIIB y IIIC (OR 4.32; CI95%=1.3-19.1; p=0.01). Fracturas clasificadas como Tscherne III y IV tuvieron una mayor frecuencia de infección, lo que resulto ser el factor más importante e significativo (OR 8.07; CI95%=2.4-47.1; p p<0.00). Conclusión. En nuestros resultados observamos; una relación entre infección y la clasificación de Gustilo. También observamos asociación de infección cuando el

  8. 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

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

    PubMed

    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

    2016-11-01

    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

  10. Tibial fractures in children

    PubMed Central

    Palmu, Sauli A; Auro, Sampo; Lohman, Martina; Paukku, Reijo T; Peltonen, Jari I; Nietosvaara, Yrjänä

    2014-01-01

    Background Tibial fracture is the third most common long-bone fracture in children. Traditionally, most tibial fractures in children have been treated non-operatively, but there are no long-term results. Methods 94 children (64 boys) were treated for a tibial fracture in Aurora City Hospital during the period 1980–89 but 20 could not be included in the study. 58 of the remaining 74 patients returned a written questionnaire and 45 attended a follow-up examination at mean 27 (23–32) years after the fracture. Results 89 children had been treated by manipulation under anesthesia and cast-immobilization, 4 by skeletal traction, and 1 with pin fixation. 41 fractures had been re-manipulated. The mean length of hospital stay was 5 (1–26) days. Primary complications were recorded in 5 children. The childrens’ memories of treatment were positive in two-thirds of cases. The mean subjective VAS score (range 0–10) for function appearance was 9. Leg-length discrepancy (5–10 mm) was found clinically in 10 of 45 subjects and rotational deformities exceeding 20° in 4. None of the subjects walked with a limp. None had axial malalignment exceeding 10°. Osteoarthritis of the hip and/or knee was seen in radiographs from 2 subjects. Interpretation The long-term outcome of tibial fractures in children treated non-operatively is generally good. PMID:24786903

  11. 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.

  12. Outcome of application of primary versus secondary Illizarov’s fixator in open tibial shaft fractures

    PubMed Central

    Joshi, Anil; Singh, Saurabh; Jain, Sudeep; Rohilla, Narender; Trikha, Vivek; Yadav, Chandra

    2016-01-01

    BACKGROUND: The present study aimed to compare outcome of primary and secondary Illizarov’s fixator application as a treatment method for type III open tibial fractures in terms of non-union and wound infection. METHODS: This prospective study was done in a tertiary care center. Forty-eight type III tibial fractures were treated with Illizarov’s apparatus between 2008 and 2011. The patients were divided into two groups depending on the treatment protocol, timing of wound closure and Illizarov’s application, primary (n=28) and secondary (n=20). RESULTS: In the primary group, healing was achieved in all 28 patients. The median time to recovery was 24 weeks, and the median number of operations was 3. There were 6 patients with a bone defect. In the secondary group, complete recovery was achieved in 18 out of 20 patients. The median time to recovery was 30 weeks, and the median number of operations 5. There were 9 patients with a bone defect. The median time to recovery and the number of operations were significantly smaller in patients undergoing primary operation. Union was 100% in the primary group and more than 95% in the secondary group. Chronic osteomyelitis persisted in one patient and below amputation was done in one patient in the secondary group. CONCLUSION: Primary wound closure and Illizarov’s fixation required a smaller number of operations and shorter time to recovery than secondary wound closure and Illizarov’s fixation, mostly due to a significantly less number of patients with a bone defect in the primary group. PMID:27547283

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

    PubMed Central

    Ramasamy, P R

    2017-01-01

    Background: Open fractures of tibia have posed great difficulty in managing both the soft tissue and the skeletal components of the injured limb. Gustilo Anderson III B open tibial fractures are more difficult to manage than I, II, and III A fractures. Stable skeletal fixation with immediate soft tissue cover has been the key to the successful outcome in treating open tibial fractures, in particular, Gustilo Anderson III B types. If the length of the open wound is larger and if the exposed surface of tibial fracture and tibial shaft is greater, then the management becomes still more difficult. Materials and Methods: Thirty six Gustilo Anderson III B open tibial fractures managed between June 2002 and December 2013 with “fix and shift” technique were retrospectively reviewed. All the 36 patients managed by this technique had open wounds measuring >5 cm (post debridement). Under fix and shift technique, stable fixation involved primary external fixator application or primary intramedullary nailing of the tibial fracture and immediate soft tissue cover involved septocutaneous shift, i.e., shifting of fasciocutaneous segments based on septocutaneous perforators. Results: Primary fracture union rate was 50% and reoperation rate (bone stimulating procedures) was 50%. Overall fracture union rate was 100%. The rate of malunion was 14% and deep infection was 16%. Failure of septocutaneous shift was 2.7%. There was no incidence of amputation. Conclusion: Management of Gustilo Anderson III B open tibial fractures with “fix and shift” technique has resulted in better outcome in terms of skeletal factors (primary fracture union, overall union, and time for union and malunion) and soft tissue factors (wound healing, flap failure, access to secondary procedures, and esthetic appearance) when compared to standard methods adopted earlier. Hence, “fix and shift” could be recommended as one of the treatment modalities for open III B tibial fractures. PMID:28216752

  14. Fat embolism syndrome after nailing an isolated open tibial fracture in a stable patient: a case report

    PubMed Central

    2014-01-01

    Background Fat embolism syndrome is a potentially fatal complication of long bone fractures. It is usually seen in the context of polytrauma or a femoral fracture. There are few reports of fat embolism syndrome occurring after isolated long bone fractures other than those of the femur. Case presentation We describe a case of fat embolism syndrome in a 33-year-old Caucasian man. He was being seen for an isolated Gustilo’s grade II open tibial fracture. He was deemed clinically stable, so we proceeded to treat the fracture with intramedullary reamed nailing. He developed fat embolism syndrome intraoperatively and was treated successfully. Conclusion This case caused us to question the use of injury severity scoring for isolated long bone fractures. It suggests that parameters that have been described in the literature other than that the patient is apparently clinically stable should be used to establish the best time for nailing a long bone fracture, thereby improving patient safety. PMID:24731759

  15. TIBIAL SHAFT FRACTURES

    PubMed Central

    Kojima, Kodi Edson; Ferreira, Ramon Venzon

    2015-01-01

    The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical parameters and constant clinical monitoring. Once the diagnosis has been made, fasciotomy should be performed. It is always difficult to assess consolidation, but the RUST method may help in this. Radiography is assessed in two projections, and points are scored for the presence of the fracture line and a visible bone callus. Today, the dogma of six hours for cleaning the exposed fracture is under discussion. It is considered that an early start to intravenous antibiotic therapy and the lesion severity are very important. The question of early or late closure of the lesion in an exposed fracture has gone through several phases: sometimes early closure has been indicated and sometimes late closure. Currently, whenever possible, early closure of the lesion is recommended, since this diminishes the risk of infection. Milling of the canal when the intramedullary nail is introduced is still a controversial subject. Despite strong personal positions in favor of milling, studies have shown that there may be some advantage in relation to closed fractures, but not in exposed fractures. PMID:27026999

  16. TIBIAL SHAFT FRACTURES.

    PubMed

    Kojima, Kodi Edson; Ferreira, Ramon Venzon

    2011-01-01

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

  17. Surgical stabilization for open tibial fractures in children: External fixation or elastic stable intramedullary nail - which method is optimal?

    PubMed Central

    Ramasubbu, Rohan A; Ramasubbu, Benjamin M

    2016-01-01

    Background: Management of open tibial fractures is well documented in adults, with existing protocols outlining detailed treatment strategies. No clear guidelines exist for children. Surgical stabilization of tibial fractures in the pediatric population requires implants that do not disrupt the open epiphyses (growth plate). Both elastic stable intramedullary nails and external fixation can be used. The objective of this study was to identify the optimal method of surgical stabilization in the treatment of open tibial fractures in children. Materials and Methods: MEDLINE and Embase were searched from their inception to March 2014 using the following advanced search terms (Key words): “open tibia fracture,” “fracture fixation,” “external fixation,” “intramedullary,” and “bone nail.” Only studies in English and pertaining to children with open fractures treated with elastic stable intramedullary nails or external fixation between 1994 and 2014 were included. Twelve clinical studies were critically appraised. Results: Due to a paucity in the literature coupled with a nonsystematic presentation of results, it proved to be very difficult in extracting relevant results from the studies. This was further added by a variation in outcome measures. Consequently, the results we obtained were difficult to draw conclusions from. Conclusion: There is no conclusive evidence or best practice guidelines for their management. Thus, as is highlighted in this study, more research is needed to determine the optimum treatment strategy for this common pediatric injury. The existing literature is of poor quality; consisting mainly of retrospective reviews of patients’ medical records, charts, and radiographs. Carefully designed, high-quality prospective cohort studies utilizing a nationalized multi-hospital approach are needed to improve understanding before protocols and guidelines can be developed and implemented. PMID:27746486

  18. 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.

  19. Conversion of open tibial IIIb to IIIa fractures using intentional temporary deformation and the Taylor Spatial Frame.

    PubMed

    Sharma, H; Nunn, T

    2013-08-01

    The closure of small-to-moderate-sized soft tissue defects in open tibial fractures can be successfully achieved with acute bony shortening. In some instances, it may be possible to close soft tissue envelope defects by preserving length and intentionally creating a deformity of the limb. As the soft tissue is now able to close, this manoeuvre converts an open IIIb to IIIa fracture. This obviates the need for soft tissue reconstructive procedures such as flaps and grafts, which have the potential to cause donor-site morbidity and may fail. In this article, the authors demonstrate the technique for treating anterior medial soft tissue defects by deforming the bone at the fracture site, permitting temporary malalignment and closure of the wound. After healing of the envelope, the malalignment is gradually corrected with the use of the Taylor Spatial Frame. We present two such cases and discuss the technical indications and challenges of managing such cases.

  20. [Fractures of the tibial shaft].

    PubMed

    Märdian, S; Schwabe, P; Schaser, K-D

    2015-02-01

    The tibia shaft is the most often fractured long bone of human beings. Among others traffic accidents (37.5 %), falls (17.8 %), sport accidents (30.9 %) and assaults (4.5 %) are typical mechanisms. A brief clinical examination including the correct classification of the fracture pattern and even more important the degree of the soft tissue damage are the most crucial factors for the following therapeutic cascade. This follows a defined algorithm based on the degree of soft tissue damage. As biplanar X-ray diagnostics are obligatory, CT scans are subject to complex fracture patterns and accompanying intraarticular pathologies.The treatment of tibial shaft fractures is the preserve of operative stabilization, which should be done primarily depending on the degree of the soft tissue injury. Here intramedullary methods - especially intramedullary nailing - are the golden standard.The most serious complication of these fractures is the development of a compartment syndrome. This requires rapid diagnosis and an adequate surgical management in order to avoid extensive muscle necrosis with ischaemic contractures and irreversible neurovascular deficits. Apart from postoperative infections, which are the predominant complication especially in open injuries, non union provide typical and late complications which are partly difficult to treat. These should, depending on their type, follow a dedicated treatment algorithm.

  1. Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. A prospective, randomized study.

    PubMed

    Keating, J F; O'Brien, P J; Blachut, P A; Meek, R N; Broekhuyse, H M

    1997-03-01

    Ninety-one patients who had ninety-four open fractures of the tibial shaft were randomized into two treatment groups. Fifty fractures (nine type-I, eighteen type-II, sixteen type-IIIA, and seven type-IIIB fractures, according to the classification of Gustilo et al.) were treated with nailing after reaming, and forty-four fractures (five type-I, sixteen type-II, nineteen type-IIIA, and four type-IIIB fractures) were treated with nailing without reaming. The average diameter of the nail was 11.5 millimeters (range, nine to fourteen millimeters) in the group treated with reaming and 9.2 millimeters (range, eight to ten millimeters) in the group treated without reaming. Follow-up information was adequate for forty-five patients (forty-seven fractures) who had been managed with reaming and forty patients (forty-one fractures) who had been managed without reaming. No clinically important differences were found between the two groups with regard to the technical aspects of the procedure or the rate of early postoperative complications. The average time to union was thirty weeks (range, thirteen to seventy-two weeks) in the group treated with reaming and twenty-nine weeks (range, thirteen to fifty weeks) in the group treated without reaming. Four (9 per cent) of the fractures treated with reaming and five (12 per cent) of the fractures treated without reaming did not unite (p = 0.73). There were two infections in the group treated with reaming and one in the group treated without reaming. Significantly more screws broke in the group treated without reaming (twelve; 29 per cent) than in the group treated with reaming (four; 9 per cent) (p = 0.014). There was no difference between the two groups with regard to the frequency of broken nails (two nails that had been inserted after reaming broke, compared with one that had been inserted without reaming). The functional outcome, in terms of pain in the knee, range of motion, return to work, and recreational activity, did not

  2. Distal tibial physeal fractures in children that may require open reduction.

    PubMed

    Kling, T F; Bright, R W; Hensinger, R N

    1984-06-01

    Fractures of the distal end of the tibia in children often involve the physis. They are of particular importance because partial growth arrest can occur and result in angular deformity, limb-length discrepancy, or incongruity of the joint surface (or a combination of these). We evaluated the cases of thirty-two children who had a fracture leading to established partial growth arrest of the distal end of the tibia. Most of this group had had a Salter-Harris Type-III or Type-IV fracture. Twenty-eight of the fractures had been treated by gentle closed reduction and immobilization in a plaster cast. We also evaluated the cases of thirty-three children who were seen by us for treatment of an acute fracture; most of these were Salter-Harris Type-III or Type-IV fractures of the distal end of the tibia. Nineteen of the twenty acute Type-III or Type-IV fractures that were treated with accurate open reduction of the physis and internal fixation healed without growth disturbance, while five of the nine fractures that were treated by closed means formed a bone bridge, presaging a disturbance in growth. This study suggests that Salter-Harris Type-III and Type-IV, and perhaps Type-II, fractures of the distal end of the tibia commonly cause disturbance of growth in the tibia, and that anatomical reduction of the physis by closed or open means may decrease the incidence of these disturbances of growth, including shortening and varus angulation of the ankle.

  3. 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.

  4. [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.

  5. Open tibial fractures grade IIIC treated successfully with external fixation, negative-pressure wound therapy and recombinant human bone morphogenetic protein 7.

    PubMed

    Babiak, Ireneusz

    2014-10-01

    The aim of the therapy in open tibial fractures grade III was to cover the bone with soft tissue and achieve healed fracture without persistent infection. Open tibial fractures grade IIIC with massive soft tissue damage require combined orthopaedic, vascular and plastic-reconstructive procedures. Negative-pressure wound therapy (NPWT), used in two consecutive cases with open fracture grade IIIC of the tibia diaphysis, healed extensive soft tissue defect with exposure of the bone. NPWT eventually allowed for wound closure by split skin graft within 21-25 days. Ilizarov external fixator combined with application of recombinant human bone morphogenetic protein-7 at the site of delayed union enhanced definitive bone healing within 16-18 months.

  6. [Amputation or reconstruction of IIIB and IIIC open tibial fracture. Decision criteria in the acute phase and late functional outcome].

    PubMed

    Seekamp, A; Regel, G; Ruffert, S; Ziegler, M; Tscherne, H

    1998-05-01

    In IIIB and IIIC type open tibial fractures (according to Gustilo) the primary decision that has to be made regarding therapy is wether or not the limb can be salvaged. To standardize the criteria for amputation different salvage scores have been established in recent years. In this study the Hannover Fracture Scale (HFS), the Predictive Salvage Index (PSI), the Mangled Extremity Severity Score (MESS) and the NISSSA score were evaluated regarding their clinical relevance. When ROC Analysis was performed for all these scores in our patients the HFS revealed the highest sensitivity (0.91), but low specificity (0.71). The highest specificity was noted for the MESS (0.97), which in parallel showed the lowest sensitivity (0.59). In general it seems to be essential to make the right decision initially in order to avoid secondary amputation. All the scores mentioned here appear to be helpful in decision making. Salvaged limbs in IIIB and IIIC fractures presented a comparable good outcome, whereas salvaged IIIC injuries with a high score presented an outcome which was as bad as in secondary amputations. Secondary amputated patients required not only significant longer hospitalization but also resulted in poor outcome compared with the patients having received reconstruction or primary amputation.

  7. Metaphyseal locking plate as a definitive external fixator for treating open tibial fractures--clinical outcome and a finite element study.

    PubMed

    Ma, Ching-Hou; Wu, Chin-Hsien; Tu, Yuan-Kun; Lin, Ting-Sheng

    2013-08-01

    We evaluated both the outcome of using a locking plate as a definitive external fixator for treating open tibial fractures and, using finite element analysis, the biomechanical performance of external and internal metaphyseal locked plates in treating proximal tibial fractures. Eight open tibial patients were treated using a metaphyseal locked plate as a low-profile definitive external fixator. Then, finite element models of internal (IPF) as well as two different external plate fixations (EPFs) for proximal tibial fractures were reconstructed. The offset distances from the bone surface to the EPFs were 6 cm and 10 cm. Both axial stiffness and angular stiffness were calculated to evaluate the biomechanical performance of these three models. The mean follow-up period was 31 months (range, 18-43 months). All the fractures united and the mean bone healing time was 37.5 weeks (range, 20-52 weeks). All patients had excellent or good functional results and were walking freely at the final follow-up. The finite element finding revealed that axial stiffness and angular stiffness decreased as the offset distance from the bone surface increased. Compared to the IPF models, in the two EPF models, axial stiffness decreased by 84-94%, whereas the angular stiffness decreased by 12-21%. The locking plate used as a definitive external fixator provided a high rate of union. While the locking plate is not totally rigid, it is clinically stable and may be advisable for stiffness reduction of plating constructs, thus promoting fracture healing by callus formation. Our patients experienced a comfortable clinical course, excellent knee and ankle joint motion, satisfactory functional results and an acceptable complication rate.

  8. Total knee arthroplasty and fractures of the tibial plateau

    PubMed Central

    Softness, Kenneth A; Murray, Ryan S; Evans, Brian G

    2017-01-01

    Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation (ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty (TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed. PMID:28251061

  9. Compartment syndrome after tibial plateau fracture.

    PubMed

    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.

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

    PubMed

    Zelle, Boris A; Boni, Guilherme

    2015-01-01

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

  11. Anterior knee dislocation with ipsilateral open tibial shaft fracture: a 5-year clinical follow-up of a professional athlete.

    PubMed

    Aydın, Adem; Atmaca, Halil; Müezzinoğlu, Ümit Sefa

    2013-08-01

    Traumatic dislocation of the knee joint is an uncommon complex, multiple ligamentous injury resulting from a high-energy trauma. Significant lack of functions can be seen because of both early and late complications of these injuries such as popliteal artery disruption, peroneal nerve injury, persistent instability and posttraumatic arthritis. Therefore, the emergency surgery is necessary due to possibility of neurovascular compromise and limb loss. Controversies over operative versus closed immobilization of traumatic complex, multiple ligamentous knee injury are still debated. We report a case of traumatic anterior dislocation of the right knee with an ipsilateral tibial shaft fracture in association with right popliteal artery occlusion of a professional athlete who was returned to his sports activity by surgical treated tibia fracture and conservative treatment of the knee dislocation.

  12. Atypical tibial tuberosity fracture in an adolescent.

    PubMed

    Jalgaonkar, Azal A; Dachepalli, Sunil; Al-Wattar, Zaid; Rao, Sudhir; Kochhar, Tony

    2011-06-14

    Avulsion fractures of the tibial tuberosity are typically sustained by adolescent males during sporting activities. Tibial tuberosity avulsions with simultaneous proximal tibial epiphyseal fractures are rare injuries. We present an unusual case of Ogden type IIIA avulsion fracture of tibial tuberosity with a Salter Harris type IV posterior fracture of proximal tibial epiphysis in a 13-year-old boy. We believe that the patient sustained the tibial tuberosity avulsion during the take-off phase of a jump while playing basketball due to sudden violent contraction of the quadriceps as the knee was extending. This was then followed by the posterior Salter Harris type IV fracture of proximal tibial physis as he landed on his leg with enormous forces passing through the knee. Although standard radiographs were helpful in diagnosing the complex fracture pattern, precise configuration was only established by computed tomography (CT) scan. The scan also excluded well-recognized concomitant injuries including ligament and meniscal injuries. Unlike other reported cases, our patient did not have compartment syndrome. Anatomic reduction and stabilization with a partially threaded transepiphyseal cannulated screw and a metaphyseal screw followed by early mobilization ensured an excellent recovery by the patient.Our case highlights the importance of vigilance and a high index of suspicion for coexisting fractures or soft tissue injuries when treating avulsion fractures of tibial tuberosity. A CT scan is justified in such patients to recognize complex fracture configurations, and surgical treatment should be directed appropriately to both the fractures followed by early rehabilitation. Patients with such injuries warrant close monitoring for compartment syndrome during the perioperative period.

  13. Biomechanical Factors in Tibial Stress Fractures

    DTIC Science & Technology

    2003-08-01

    Gluteal strain/ tendinitis Greater trochanteritis TOTAL Groin sfrain/ tendinitis Hip/ groin injury other Pelvic sfress fracture 32 19 Thigh...Medial collateral sfrain 79 28 27 Medial plica syndrome 1 Patellar tendinitis 7 Patellofemoral pain syndrome 16 Pes Anserinus tendinitis 1...Knee other 24 Lower leg TOTAL 127 Achilles tendinitis 19 Acute fibular fracture 3 Acute tibial fracture 1 Anterior compartment syndrome 7

  14. A health economic analysis of the use of rhBMP-2 in Gustilo-Anderson grade III open tibial fractures for the UK, Germany, and France.

    PubMed

    Alt, Volker; Donell, Simon T; Chhabra, Amit; Bentley, Anthony; Eicher, Alexander; Schnettler, Reinhard

    2009-12-01

    The purpose of this study was to determine the cost savings from a societal perspective for recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) in grade III A and B open tibial fractures treated with a locked intramedullary nail and soft-tissue management in the UK, Germany, and France. Health care system costs (direct health care costs) and costs for productivity losses (indirect health care costs) were calculated using the raw data from the Bone Morphogenetic Protein Evaluation Group in Surgery for Tibial Trauma "BESTT study". Return-to-work time for estimation of productivity losses was assumed to correspond with the time of fracture healing. For calculation of secondary interventions costs and productivity losses the respective 2007/2008 national tariffs for surgical procedures and average national wages for the UK, Germany, and France were used. For a 1 year perspective, overall treatment costs per patient after the initial surgery of the control vs. the rhBMP-2 group were 44,757 euros vs. 36,847 euros for the UK, 50,197 euros vs. 40,927 euros for Germany and 48,766 euros vs. 39,474 euros for France in favour of rhBMP-2 with overall savings overall savings per case of rhBMP-2 treatment of 7911 euros for the UK, 9270 euros for Germany, and 9291 euros for France which was mainly due to reduced productivity losses by significant faster fracture healing in the rhBMP-2 group (p=0.01). These savings largely offset the upfront price of rhBMP-2 of 2266 euros (1790 pounds) in the UK, euros 2970 in Germany, and 2950 euros in France. Total net savings can be estimated to be 9.6 million euros for the UK, 14.5 million euros for Germany, and 11.4 million euros for France. The results depend on the methodology used particularly for calculation of productivity losses and return-to-work time which was assumed to correspond with fracture healing time. In summary, despite the apparent high direct cost of rhBMP-2 in grade III A and B open tibial fractures, at a national

  15. Biomechanical Factors in Tibial Stress Fractures

    DTIC Science & Technology

    2005-08-01

    that greater tibial varum would be associated with stress fractures (especially tibial) secondary to the increased bending moment on the leg. 26 9 8 -35...increased at the post- injury visit. These shear loading rates indicate the magnitude of bending loads that the lower extremity is subject to, in addition to...the compressive loading that occurs during initial weight acceptance in stance. It has been shown that anterior-posterior bending strength is related

  16. Outcomes of anterolateral thigh-free flaps and conversion from external to internal fixation with bone grafting in gustilo type IIIB open tibial fractures.

    PubMed

    Lee, Jae Hoon; Chung, Duke Whan; Han, Chung Soo

    2012-09-01

    The purpose of this study was to analyze the utility and the clinical outcomes of anterolateral thigh (ALT)-free flaps and conversion from external to internal fixation with plating and bone grafting in Gustilo type IIIB open tibial fractures. A total of 21 patients were analyzed retrospectively. The mean follow-up period was 18 months and the mean age was 46.7 years. There were 18 men and three women. The mean time from injury to flap coverage was 11.6 days. The mean size of flaps used was 15.3 × 8.2 cm. The mean size of bone defects was 2.26 cm. Segmental bone defects were observed in 5 five cases, for which bone transport or vascularized fibular graft were performed. When flaps were successful and the fracture sites did not have any evidence of infection, internal fixation with plates and bone grafting were performed. Flaps survived in 20 cases. In the 20 cases with successful flaps, two cases developed osteomyelitis, but the 20 cases achieved solid bone union at a mean of 8.6 months after the injury, salvaging the lower extremity in 100% of the cases. At the last follow-up, 9 nine cases were measured excellent or good; 6, fair; and 6, poor in the functional assessment based on the method developed by Puno et al. ALT- free flaps to cover soft tissue defects in Gustilo type IIIB open tibial fractures are considered as useful option for the treatment of composite defects. In addition, conversion to internal fixation and bone grafting can be an alternative method in order to reduce the risk of complications and inconvenience of external fixators.

  17. Recombinant human bone morphogenetic protein-2 for grade III open segmental tibial fractures from combat injuries in Iraq.

    PubMed

    Kuklo, T R; Groth, A T; Anderson, R C; Frisch, H M; Islinger, R B

    2008-08-01

    This is a retrospective consecutive case series of 138 Gustillo-Anderson type IIIB and IIIC segmental tibial fractures treated at Walter Reed Army Medical Center in soldiers injured in Iraq between March 2003 and March 2005. Five patients with a head injury and four who were lost to follow-up were excluded. The patients were treated definitively with either a ringed external fixator or a reamed intramedullary nail, evaluated in terms of supplementary bone grafting with either autogenous bone (group 1, 67 patients) or recombinant human bone morphogenetic protein-2 at 1.50 mg/ml applied to an absorbable collagen sponge (group 2, 62 patients). The mechanism of injury, defect size and classification, associated injuries, presence of infection, preliminary treatment/fixation, number of procedures before definitive management, time to and details of definitive management, subsequent infection, re-operation, smoking history and other complications were noted. Radiographs were assessed for union, delayed union or nonunion by an independent investigator. All the patients were male. Their mean age was 26.6 years (20 to 42) and the mean follow-up was for 15.6 months (12 to 32). Group 2 had a slightly higher profile of concomitant injuries and a slightly worse fracture classification, but these were not significant. The rate of union was 76% (51 of 67) for group 1 and 92% for group 2 (57 of 62; p = 0.015). There was also a higher rate of subsequent infection in group 1 (14.9%) compared with group 2 (3.2%; p = 0.001) and a higher rate of re-operation (28%) in group 1 (p = 0.003). There were no observed hypersensitivity reactions to the recombinant human bone morphogenetic protein-2 implant.

  18. 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.

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

    DTIC Science & Technology

    2006-12-01

    DAMD17-98-1-8519 TITLE: Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing PRINCIPAL INVESTIGATOR...2006 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing 5b. GRANT NUMBER...To determine the effect of capacitively coupled electric field stimulation on tibial stress fracture healing in men and women. Methods: A

  20. Intramedullary Tibial Nail Fixation of Simple Intraarticular Distal Tibia Fractures.

    PubMed

    Scolaro, John A; Broghammer, Francis H; Donegan, Derek J

    2016-11-01

    The optimal treatment strategy for distal tibia fractures, especially those with intraarticular extension, remains controversial. Although open reduction and internal fixation with a plate and screw device is commonly performed for these injuries, the risk of soft tissue complications using this approach is significant. Staged treatment protocols and alternative means of fixation have been proposed to address these undesired events. Although potentially more technically demanding than fixation of diaphyseal or extraarticular tibial fractures, intramedullary nail (IMN) fixation of simple intraarticular distal tibia fractures is a viable treatment alternative with unique advantages. This article presents a review of the literature and rationale for intramedullary tibial nail fixation of simple intraarticular distal tibia fractures and a surgical approach commonly utilized for successful implementation.

  1. 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

  2. Growth disturbances after distal tibial physeal fractures.

    PubMed

    Berson, L; Davidson, R S; Dormans, J P; Drummond, D S; Gregg, J R

    2000-01-01

    Twenty-four patients with distal tibial growth disturbance were reviewed. Disturbances were classified as physeal bar (prior to deformity), angular, linear or combined deformities. Treatment consisted of osteotomy in fourteen, epiphyseodesis in seven, excision of bony bar in two, and observation in one patient. Follow up was an average 36.6 months (range 4-129 months) after treatment of growth disturbance. The age at time of injury was 10.4 years of age average (range 3-15 years). There were 12 SH2, 2 SH3, 7 SH4, and 3 SH5 distal tibial physeal fractures. Thirteen of 15 fractures considered high energy and only 1 of 9 fractures considered low energy resulted in angular deformity. Angular and linear deformities presented an average 46 months (range 12-120 months) and physeal bars at an average 14 months (range 6-25 months) after injury. Patients with a delay in presentation of growth disturbance greater than 24 months had angular deformities in 92% compared with 33% in children presenting less than or at 24 months. Treatment based on type of deformity, age at time of injury, and growth remaining was considered successful in 83%. Patients with angular or linear deformities were more likely to present late, have high energy injuries, be male patients and have Salter-Harris types IV and V. Early diagnosis and treatment of growth disturbance can prevent severe deformity.

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

    PubMed Central

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

    2015-01-01

    Simultaneous bilateral avulsion fracture of the tibial tuberosity in teenagers is a rare lesion. We describe the first case in the literature, in a teenage girl who sustained a fall while jumping during a volleyball match. No predisposing factors were iden tified. The lesions were treated with open surgical reduction and internal fixation. The aim of the present study was to present a case of simultaneous bilateral avulsion fracture of the tibial tuberosity in a teenage girl and the therapy used. PMID:27042651

  4. [Results of treatment of tibial fractures in children].

    PubMed

    Antabak, Anko; Luetić, Tomislav; Cavar, Stanko; Davila, Slavko; Bogović, Marko; Batinica, Stipe

    2012-01-01

    Diaphyseal fractures of both lower leg bones are the most common fractures of lower extremities, and account for about 15% of all fractures of long bones in children. These fractures are usully unstabilae, difficult to reposition, and retention of the fragments, and the process of their treatment is not fully compliant. The paper analyzes the late results of treating 234 children with tibial fractures, depending on the method of treatment (surgical and conservative method). Twenty-three children had open fractures (9.8%). Nonsurgical method was used in the treatment of 194 children, and surgical in 40 children. The most frequent surgical method was closed reposition of the fragments, and percutaneous elastic stable intramedullary nailing with titanium wires. The success of the treatment was measured: residual angular deformities and difference in length between treated and healthy leg. Secondary displacement of fragments after primary conservative treatment was found in 32 children. Angular deformities of the treated tibia was seen in 80 children, 68 (35.0%) treated conservatively and 12 (30.0%) surgically. In 131 (67.5%) conservatively treated and 29 (72.5%) surgically treated children there were no differences in the length of sick and healthy leg. Results of treatment in our children confirmed that there were no statistically significant differences in late effects depending on treatment methods.

  5. Tibial plateau fracture following gracilis-semitendinosus anterior cruciate ligament reconstruction: The tibial tunnel stress-riser.

    PubMed

    Sundaram, R O; Cohen, D; Barton-Hanson, N

    2006-06-01

    Tibial plateau fractures following anterior cruciate ligament (ACL) reconstruction are extremely rare. This is the first reported case of a tibial plateau fracture following four-strand gracilis-semitendinosus autograft ACL reconstruction. The tibial tunnel alone may behave as a stress riser which can significantly reduce bone strength.

  6. Unusual Tibial Stress Fracture in a Basketball Player.

    PubMed

    Selesnick, H

    1990-09-01

    In brief Stress fractures of the proximal middle third of the tibia are common; those of the distal tibia are less common; and longitudinal stress fractures are rare. The basketball player in this case report had a rare longitudinal tibial pilon stress fracture, for which few diagnostic or treatment guidelines existed.

  7. Epithelialization Over a Scaffold of Antibiotic-Impregnated PMMA Beads: A Salvage Technique for Open Tibial Fractures with Bone and Soft Tissue Loss When all Else Fails

    PubMed Central

    Masrouha, Karim Z.; El-Bitar, Youssef; Najjar, Marc; Saghieh, Said

    2016-01-01

    The management of soft tissue defects in tibial fractures is essential for limb preservation. Current techniques are not without complications and may lead to poor functional outcomes. A salvage method is described using three illustrative cases whereby a combination of flaps and antibiotic-impregnated polymethylmethacrylate beads are employed to fill the bony defect, fight the infection, and provide a surface for epithelial regeneration and secondary wound closure. This was performed after the partial failure of all other options. All patients were fully ambulatory with no clinical, radiographic or laboratory sign of infection at their most recent follow-up. Although our findings are encouraging, this is the first report of epithelialization of the skin on a polymethylmethacrylate scaffold. Further studies investigating the use of this technique are warranted. PMID:27517073

  8. A Qualitative Study of Recovery from Type III-B and III-C Tibial Fractures

    PubMed Central

    Shauver, Melissa S.; Aravind, Maya S.; Chung, Kevin C.

    2011-01-01

    The literature has shown that long-term outcomes for both below-knee amputation and reconstruction following type III-B and III-C tibial fracture are poor. Yet, patients often report satisfaction with their treatment and/or outcomes. The aim of this study is to explore the relationship between patient outcomes and satisfaction after open tibial fractures via qualitative methodology. Twenty patients who were treated for open tibial fractures at one institution were selected using purposeful sampling and interviewed in-person in a semi-structured manner. Data were analyzed using grounded theory methodology. Despite reporting marked physical and psychosocial deficits, participants relayed high satisfaction. We hypothesize that the use adaptive coping techniques successfully reduces stress, which leads to an increase in coping self-efficacy that results in the further use of adaptive coping strategies, culminating in personal growth. This stress reduction and personal growth leads to satisfaction despite poor functional and emotional outcomes. PMID:20948418

  9. Fractures of the tibial plateau involve similar energies as the tibial pilon but greater articular surface involvement.

    PubMed

    Dibbern, Kevin; Kempton, Laurence B; Higgins, Thomas F; Morshed, Saam; McKinley, Todd O; Marsh, J Lawrence; Anderson, Donald D

    2017-03-01

    Patients with tibial pilon fractures have a higher incidence of post-traumatic osteoarthritis than those with fractures of the tibial plateau. This may indicate that pilon fractures present a greater mechanical insult to the joint than do plateau fractures. We tested the hypothesis that fracture energy and articular fracture edge length, two independent indicators of severity, are higher in pilon than plateau fractures. We also evaluated whether clinical fracture classification systems accurately reflect severity. Seventy-five tibial plateau fractures and 52 tibial pilon fractures from a multi-institutional study were selected to span the spectrum of severity. Fracture severity measures were calculated using objective CT-based image analysis methods. The ranges of fracture energies measured for tibial plateau and pilon fractures were 3.2-33.2 Joules (J) and 3.6-32.2 J, respectively, and articular fracture edge lengths were 68.0-493.0 mm and 56.1-288.6 mm, respectively. There were no differences in the fracture energies between the two fracture types, but plateau fractures had greater articular fracture edge lengths (p < 0.001). The clinical fracture classifications generally reflected severity, but there was substantial overlap of fracture severity measures between different classes. Similar fracture energies with different degrees of articular surface involvement suggest a possible explanation for dissimilar rates of post-traumatic osteoarthritis for fractures of the tibial plateau compared to the tibial pilon. The substantial overlap of severity measures between different fracture classes may well have confounded prior clinical studies relying on fracture classification as a surrogate for severity. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:618-624, 2017.

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

    PubMed

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

    2015-09-01

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

  11. Bone Transport for Limb Reconstruction Following Severe Tibial Fractures

    PubMed Central

    Fürmetz, Julian; Soo, Chris; Behrendt, Wolf; Thaller, Peter H.; Siekmann, Holger; Böhme, Jörg; Josten, Christoph

    2016-01-01

    A common treatment of tibial defects especially after infections is bone transport via external fixation. We compare complications and outcomes of 25 patients treated with a typical Ilizarov frame or a hybrid system for bone reconstruction of the tibia. Average follow up was 5.1 years. Particular interest was paid to the following criteria: injury type, comorbidities, development of osteitis and outcome of the different therapies. The reason for segmental resection was a second or third grade open tibia fractures in 24 cases and in one case an infection after plate osteosynthesis. Average age of the patients was 41 years (range 19 to 65 years) and average defect size 6.6 cm (range 3.0 to 13.4 cm). After a mean time of 113 days 23 tibial defects were reconstructed, so we calculated an average healing index of 44.2 days/cm. Two patients with major comorbidities needed a below knee amputation. The presence of osteitis led to a more complicated course of therapy. In the follow up patients with an Ilizarov frame had better results than patients with hybrid systems. Bone transport using external fixation is suitable for larger defect reconstruction. With significant comorbidities, however, a primary amputation or other methods must be considered. PMID:27114814

  12. Tibial nerve neuropathy following medial opening-wedge high tibial osteotomy-case report of a rare technical complication.

    PubMed

    Shin, Young-Soo; Sim, Hyun-Bo; Yoon, Jung-Ro

    2017-03-21

    A 63-year-old woman developed tibial nerve injury caused by an overlong K wire and 4.5-mm cortical lag screw through the first distal hole below the osteotomy during medial opening-wedge high tibial osteotomy (HTO), leading to a lack of sensation on the sole of the foot with no disturbances in motor functions. The temporary lag screw in the first distal hole below the osteotomy is often inserted by an excessive length in order to compress the potentially fractured opposite cortex. By doing so, posterior neurovascular structures including the tibial nerve and the popliteal vessels can be injured. To avoid this type of injury during medial opening-wedge HTO, proper knee position and appropriate Hohmann retractor position in combination with meticulous insertion of the K wire or screw under fluoroscopic control are essential. In addition, our study reinforces the fact that different presentations of injury to the tibial nerve should be carefully considered in the absence of common diagnostic features, including weakness of the toe flexors and posterior tibial muscle of the leg with intractable pain.

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

    PubMed Central

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

    2016-01-01

    Background Tibial plateau fractures can be successfully fixed utilizing 3.5 mm locking plates. However, there are some disadvantages to using these plates. Objectives 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. Materials and Methods 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. Results 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. Conclusions 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. PMID:27626010

  14. Biomechanical evaluation of tibial eminence fractures using suture fixation.

    PubMed

    Aoki, Stephen K; Curtis, Stuart H

    2011-12-06

    This study evaluates the initial fixation strength of tibial eminence fracture repair using 1, 2, 3, and 4 sutures to determine the optimal number of sutures required to adequately secure the avulsed fragment to the tibia. Sixteen skeletally immature porcine knees were stripped of all soft tissues, isolating the femur-anterior cruciate ligament (ACL)-tibia complex. Type III tibial eminence fractures were simulated in the specimens, and each specimen was randomly assigned to a repair group using 1, 2, 3, or 4 #2 FiberWire sutures (Arthrex, Inc, Naples, Florida). Initial fixation strength of the repair was measured by single cycle pull to failure testing using a materials testing machine (Instron, Norwood, Massachusetts). The mean ultimate failure force during anterior tibial translation was 389±128, 627±66, 703±77, and 802±29 N for 1, 2, 3, and 4 sutures, respectively. The lower limit of the 95% confidence interval was >500 N (estimated force of native ACL during activities of daily living) for each group with ≥2 sutures. In this study, at least 2 high-strength sutures were needed for tibial eminence fracture repairs to withstand potential forces seen across the ACL in the postoperative period. Suture fixation of tibial eminence fractures is a reproducible method requiring a minimum of 2 high-strength polyester sutures to resist forces seen during early rehabilitation.

  15. The radiographic union scale in tibial (RUST) fractures

    PubMed Central

    Clement, N. D.; Tawonsawatruk, T.; Simpson, C. J.; Simpson, A. H. R. W.

    2016-01-01

    Objectives The radiographic union score for tibial (RUST) fractures was developed by Whelan et al to assess the healing of tibial fractures following intramedullary nailing. In the current study, the repeatability and reliability of the RUST score was evaluated in an independent centre (a) using the original description, (b) after further interpretation of the description of the score, and (c) with the immediate post-operative radiograph available for comparison. Methods A total of 15 radiographs of tibial shaft fractures treated by intramedullary nailing (IM) were scored by three observers using the RUST system. Following discussion on how the criteria of the RUST system should be implemented, 45 sets (i.e. AP and lateral) of radiographs of IM nailed tibial fractures were scored by five observers. Finally, these 45 sets of radiographs were rescored with the baseline post-operative radiograph available for comparison. Results The initial intraclass correlation (ICC) on the first 15 sets of radiographs was 0.67 (95% CI 0.63 to 0.71). However, the original description was being interpreted in different ways. After agreeing on the interpretation, the ICC on the second cohort improved to 0.75. The ICC improved even further to 0.79, when the baseline post-operative radiographs were available for comparison. Conclusion This study demonstrates that the RUST scoring system is a reliable and repeatable outcome measure for assessing tibial fracture healing. Further improvement in the reliability of the scoring system can be obtained if the radiographs are compared with the baseline post-operative radiographs. Cite this article: Mr J.M. Leow. The radiographic union scale in tibial (RUST) fractures: Reliability of the outcome measure at an independent centre. Bone Joint Res 2016;5:116–121. DOI: 10.1302/2046-3758.54.2000628. PMID:27073210

  16. Treatment results of bicondylar tibial fractures using hybrid external fixator.

    PubMed

    Sales, Jafar Ganjpour; Soleymaopour, Jafar; Ansari, Maroof; Afaghi, Farhad; Goldust, Mohamad

    2013-05-15

    Tibial condyle fractures affect knee stability and motion. Treatment of bicondylar type of tibial plateau fracture is a challenging problem. This study aimed at evaluating the application of hybrid external fixators with minimum deformation in these patients and the resulted outcomes. In this descriptive analytical study, 28 patients with bicondylar tibial plateau fractures treated by HEF device were evaluated. The surgeon used a semicircular and one circular wire instead of the one or two loop of conventional HEF device for a better range of motion of the knee joint. Treatment outcomes including quality of walking, union condition, knee range of motion, complications and the final outcome according to the knee score (rusmussen) were checked. Twenty-eight male patients, with the mean age of 40.54 +/- 13.83 years were enrolled in the study. Complications occurred in 8 (28.6%) patients; 7 cases with superficial infection and 1 patient with deep vein thrombosis. All complications were managed medically with no significant consequences left. All the patients were able to walk with no aid except in one case. In 96.4% and 89.3% of the cases, the clinical and radiological outcomes were good to excellent, respectively according to the knee score. In 85.7% of the patients, the knee range of motion was in normal limits. Application of hybrid external fixator using one and half ring instead of one or two fixator rings in treating bicondylar tibial fractures was associated with desired clinical and radiological results.

  17. Bicondylar tibial plateau fractures managed with the Sheffield Hybrid Fixator. Biomechanical study and operative technique.

    PubMed

    Ali, A M; Yang, L; Hashmi, M; Saleh, M

    2001-12-01

    The two main challenges in the management of bicondylar tibial plateau fractures are: Firstly, the compromised skin and soft tissue envelope which invite a high rate of complications following attempted open reduction and dual plating. Secondly, poor bone quality and comminuted fracture patterns, which create difficulty in achieving stable fixation. Although dual plating is considered to be the best mechanical method of stabilizing these complex fractures, there remains concern regarding the high rate of complications associated with extensive soft tissue dissection, required for the insertion of these plates in an already compromised knee. The Sheffield Hybrid fixator (SHF) technique offers a solution to the two main problems of these difficult fractures by minimizing soft tissue dissection, since bone fragments are reduced and fixed percutaneously, and providing superior cancellous bone purchase with beam loading stabilization for comminuted fractures. Our biomechanical testing showed the SHF with four tensioned wires to be as strong as dual plating and able to provide adequate mechanical stability in the fixation of bicondylar tibial plateau fractures. This was confirmed clinically by a prospective review of the use of the SHF at our centre, for managing complex and high-energy tibial plateau fractures with a good final outcome and no cases of deep infection or septic arthritis.

  18. [Minimally invasive treatment of tibial plateau fracture under arthroscopy monitoring].

    PubMed

    Chen, Lixin; Ma, Shaoyun; Li, Xianpeng

    2014-05-01

    Twenty six patients with fracture of tibial plateau was under arthroscopy assisted reduction, the joint surface of bone graft, and USES the steel plate fixation treatment. Average surgery time was 65 min (70-120 min), average fracture healing time was 15 weeks (12-17 weeks), joint surface anatomical reattachment rate was 92.9%. Using break knee function criteria evaluation of curative effect: 18 cases great 6 cases wed, 2 cases ok, fine rate was 92.3%. No infection, deep venous thrombosis and small leg fascia chamber syndrome and other complications. Conclusion is that treatment of tibial plateau fractures under arthroscope has advantages of small trauma, check intuitively and reset accurately, functional recovery of patients are satisfied, the treatment has certain clinical application value.

  19. Expandable intramedullary nails for fixation of tibial shaft fractures.

    PubMed

    Ghafil, Dior; Ackerman, Pieter; Baillon, Renaud; Verdonk, Rene; Delince, Philippe

    2012-12-01

    Interlocking intramedullary nailing is currently the preferred treatment for most tibial fractures requiring operative treatment, with good results and a relatively low complication rate as reported in large clinical series. However, vascular and neurological complications caused by interlocking screws have been reported. In addition, insertion of distal interlocking screws can be technically demanding and may entail substantial exposure. We present the results with an expandable self-locking nail in the management of 52 AO type A and B tibial shaft fractures. The mean time to union was 15.8 weeks and the rate of union was 98%. The average surgical time was 60 minutes. Complications were those usually seen in diaphysis nailing and no complication was noted during nail expansion. Interlocking screws are not necessary, which reduces the risk of iatrogenic lesions. The expandable nail allows effective management of AO type A and B diaphyseal fractures of the tibia, a lower radiation exposure and shorter operative time.

  20. Arthroscopy-assisted operative management of tibial plateau fractures.

    PubMed

    Asik, Mehmet; Cetik, Ozgur; Talu, Ufuk; Sozen, Yunus V

    2002-11-01

    This retrospective review evaluated the results of arthroscopy-assisted surgery for tibial plateau fractures in 45 patients with closed tibial plateau fractures. The fracture involved articular depression in 27 patients in whom lifting and bone grafting with autogenous corticocancellous iliac bone graft was required. In 23 patients there were also meniscal lesions, which were treated by partial resection in 16 and repaired in 7. Internal fixation was performed using screws in 36 knees and plate in 10 knees. Radiological results were evaluated according to the Resnic-Niwoyama criteria; mean follow-up was 36 months (range 14-72). There was no intraoperative complication in the series, but postoperatively there were one infection and one loss of correction. Results were satisfactory in 89% of cases, according the Rasmussen criteria. Arthroscopy is thus an excellent and minimally invasive method for assessment and treatment of tibial plateau fractures. The advantages are complete and anatomical reduction in the fractured articular surface and evaluation of other concomitant intra-articular pathology and entails only little additional morbidity, especially compared to arthrotomy.

  1. Complications of Minimally Invasive Percutaneous Plating for Distal Tibial Fractures

    PubMed Central

    Muzaffar, Nasir; Bhat, Rafiq; Yasin, Mohammad

    2016-01-01

    Background The management of distal tibia fractures continues to remain a source of controversy and debate. Objectives The aim of this study was to evaluate the various complications of minimally invasive percutaneous plate osteosynthesis (MIPPO) using a locking plate for closed fractures of distal tibia in a retrospective study. Patients and Methods Twenty-five patients with distal tibial fractures, treated by minimally invasive percutaneous plate osteosynthesis, were evaluated in a retrospective study. We studied the rate, probable etiological factors and preventive and corrective measures of various complications associated with minimally invasive plating of distal tibia. Results Mean age of the patients was 41.16 years (range 22 - 65). There were 13 male and 12 female patients. All fractures united at an average duration of 16.8 weeks. There were two cases of superficial and two cases of deep infection, and deep infections required removal of hardware for cure. There were four cases of ankle stiffness, most of them occurring in intra-articular fractures, three cases of palpable implant, three cases of malunion, one case of loss of reduction and one patient required reoperation. The average AO foot and ankle score was 83.6. Conclusions We found MIPPO using locking plate to be a safe and effective method for the treatment of distal tibial fractures in properly selected patients yet can result in a variety of complications if proper precautions before, during and after surgery are not taken care of. PMID:28182170

  2. Do CT scans aid assessment of distal tibial physeal fractures?

    PubMed

    Cutler, L; Molloy, A; Dhukuram, V; Bass, A

    2004-03-01

    Distal tibial physeal fractures are the second most common growth plate injury and the most common cause of growth arrest and deformity. This study assesses the accuracy of pre-operative planning for placement of the screws in these fractures using either standard radiographs or CT scans. We studied 62 consecutive physeal fractures over a period of four years. An outline of a single cut of the CT scan was used for each patient. An ideal position for the screw was determined as being perpendicular to and at the midpoint of the fracture. The difference in entry point and direction of the screw between the ideal and the observers' assessments were compared using the paired Student's t-test. There was a statistically significant improvement (p < 0.0001) in the accuracy of the point of insertion and the direction of the screw on the pre-operative plan when CT scans were used rather than plain radiographs. We would, therefore, recommend that CT scans are routinely used in the pre-operative assessment and treatment of distal tibial physeal fractures.

  3. RADIOGRAPHIC ASSESSMENT OF THE OPENING WEDGE PROXIMAL TIBIAL OSTEOTOMY

    PubMed Central

    Silva, Carlos Francisco Bittencourt; Camara, Eduardo Kastrup Bittencourt; Vieira, Luiz Antonio; Adolphsson, Fernando; Rodarte, Rodrigo Ribeiro Pinho

    2015-01-01

    Objective: To radiographically evaluate individuals who underwent opening wedge proximal tibial osteotomy, with the aim of analyzing the proximal tibial slope in the frontal and sagittal planes, and the patellar height. Method: The study included 22 individuals who were operated at the National Traumatology and Orthopedics Institute (INTO) for correction of varus angular tibial deviation using the opening wedge osteotomy (OWO) technique with the Orthofix monolateral external fixator. Patients with OWO whose treatment was completed between January 2000 and December 2006 were analyzed. The measurement technique consisted of using anteroposterior radiographs with loading and lateral views with the operated knees flexed at 30°. Results: There were no statistically significant differences between the pre and postoperative tibial slope and patellar height values in the patients evaluated. Conclusion: Opening wedge proximal tibial osteotomy is a technique that avoids the problems presented by high proximal tibial osteotomy, since it is done without causing changes to the extensor mechanism, ligament imbalance or distortions in the proximal tibia. PMID:27022577

  4. Biomechanical Factors in Tibial Stress Fractures

    DTIC Science & Technology

    2004-08-01

    tendinitis 1 Greater trochanteritis 12 Groin strain/ tendinitis 6 Pelvic stress fracture 5 Hip/ groin injury other 32 Thigh TOTAL 52 Femoral stress...collateral strain 1 29 Medial plica syndrome 1 Patellar tendinitis 13 Patellofemoral pain syndrome 39 Osteoarthritis 1 Pes Anserinus tendinitis 1 Knee...3 Back strain 7 Back other 9 Hip/ groin TOTAL 92 Gluteal strain/ tendinitis 8 Greater trochaniteritis 7 Groin strain/ tendinitis 12 Hip/ groin injury

  5. Use of Both the Short Musculoskeletal Function Assessment Questionnaire and the Short Form-36 among Tibial Fracture Patients was Redundant

    PubMed Central

    2009-01-01

    Objective To compare the Short Musculoskeletal Function Assessment Dysfunction Index and the Short Form-36 Physical Component Summary scores among patients undergoing operative management of tibial fractures. Study Design and Setting Between July 2000 and September 2005, we enrolled 1319 skeletally mature patients with open or closed fractures of the tibial shaft that were managed with intramedullary nailing. Patients were asked to complete the Short Musculoskeletal Function Assessment and Short Form-36 at discharge and 3, 6, and 12 months post surgical fixation. Results Short Musculoskeletal Function Assessment Dysfunction Index and Short Form-36 Physical Component Summary scores were highly correlated at 3, 6, and 12 months post surgical fixation. The difference in mean standardized change scores for the Short Musculoskeletal Function Assessment Dysfunction Index and the Short Form-36 Physical Component Summary, from 3 to 12 months post-surgical fixation, was not statistically significant. Both the Short Musculoskeletal Function Assessment Dysfunction Index and Short Form-36 Physical Component Summary scores were able to discriminate between healed and non-healed tibial fractures at 3, 6, and 12 months post surgery. Conclusion In patients with tibial shaft fractures, the Short Musculoskeletal Function Assessment Dysfunction Index offered no important advantages over the Short Form-36 Physical Component Summary score. These results, along with the usefulness of the Short Form-36 for comparing populations, recommends the Short Form-36 for assessing physical function in studies of patients with tibial fractures. PMID:19364637

  6. 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.

  7. Bicondylar tibial plateau fractures treated with fine-wire circular external fixation.

    PubMed

    Ferreira, N; Marais, L C

    2014-04-01

    Bicondylar tibial plateau fractures are serious injuries to a major weight-bearing joint. These injuries are often associated with severe soft tissue injuries that complicate surgical management. We reviewed 54 consecutive patients who sustained bicondylar tibial plateau fractures that were treated with limited open reduction and cannulated screw fixation combined with fine-wire circular external fixation. Forty-six patients met the inclusion criteria of this retrospective review. Eight patients were excluded because they did not complete a minimum of 1-year follow-up. Thirty-six patients had Schatzker type-VI, and ten patients had Schatzker type-V fractures. All fractures were united without loss of reduction; there were no incidences of wound complications, osteomyelitis or septic arthritis. The average Knee Society Clinical Rating Score was 81.6, translating to good clinical results. Minor pin track infection was the most common complication encountered. This review concludes that fine-wire circular external fixation, combined with limited open reduction and cannulated screw fixation, consistently produces good functional results without serious complications.

  8. Remodeling of tibial fractures in children younger than 12 years.

    PubMed

    Dwyer, Amitabh Jitendra; John, Bobby; Krishen, Maharaj; Hora, Rajeev

    2007-05-01

    Forty-eight children with an average age of 7.2 years (range: 3-12 years) were examined clinically and radiographically at an average 4-year follow-up (range: 2-10 years), between 1989 and 2000 to analyze correction of deformities following tibial shaft fractures. An inconsistent alteration in the length of the fractured tibia was observed. Anterior angular deformity realigned maximally (52.7%) followed by varus (40.9%) and valgus (23.9%) deformities. Posterior deformity corrected the least (18.5%). In the sagittal plane, acceptable critical anterior and posterior angular deformities that corrected completely were 12 degrees and 6 degrees respectively. In the coronal plane, acceptable critical angular deformities were 10 degrees varus and 8 degrees valgus.

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

    PubMed

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

    2015-06-01

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

  10. Randomized Trial of Reamed and Unreamed Intramedullary Nailing of Tibial Shaft Fractures

    PubMed Central

    2008-01-01

    Background: There remains a compelling biological rationale for both reamed and unreamed intramedullary nailing for the treatment of tibial shaft fractures. Previous small trials have left the evidence for either approach inconclusive. We compared reamed and unreamed intramedullary nailing with regard to the rates of reoperations and complications in patients with tibial shaft fractures. Methods: We conducted a multicenter, blinded randomized trial of 1319 adults in whom a tibial shaft fracture was treated with either reamed or unreamed intramedullary nailing. Perioperative care was standardized, and reoperations for nonunion before six months were disallowed. The primary composite outcome measured at twelve months postoperatively included bone-grafting, implant exchange, and dynamization in patients with a fracture gap of <1 cm. Infection and fasciotomy were considered as part of the composite outcome, irrespective of the postoperative gap. Results: One thousand two hundred and twenty-six participants (93%) completed one year of follow-up. Of these, 622 patients were randomized to reamed nailing and 604 patients were randomized to unreamed nailing. Among all patients, fifty-seven (4.6%) required implant exchange or bone-grafting because of nonunion. Among all patients, 105 in the reamed nailing group and 114 in the unreamed nailing group experienced a primary outcome event (relative risk, 0.90; 95% confidence interval, 0.71 to 1.15). In patients with closed fractures, forty-five (11%) of 416 in the reamed nailing group and sixty-eight (17%) of 410 in the unreamed nailing group experienced a primary event (relative risk, 0.67; 95% confidence interval, 0.47 to 0.96; p = 0.03). This difference was largely due to differences in dynamization. In patients with open fractures, sixty of 206 in the reamed nailing group and forty-six of 194 in the unreamed nailing group experienced a primary event (relative risk, 1.27; 95% confidence interval, 0.91 to 1.78; p = 0

  11. Treatment of complex tibial fractures in children with the taylor spatial frame.

    PubMed

    Eidelman, Mark; Katzman, Alexander

    2008-10-01

    Most tibial shaft fractures in children can be treated with closed reduction and cast fixation, but some fractures need external or internal fixation. The Taylor spatial frame (Smith & Nephew, Memphis, Tennessee) is a relatively new external fixator that can correct 6-axis deformities with computer accuracy. This article reports our experience using the Taylor spatial frame as a rewarding treatment modality for complex tibial fractures in children and adolescents.

  12. Results of a modified posterolateral approach for the isolated posterolateral tibial plateau fracture

    PubMed Central

    Liu, Guan-Yi; Xiao, Bai-Ping; Luo, Cong-Feng; Zhuang, Yun-Qiang; Xu, Rong-Ming; Ma, Wei-Hu

    2016-01-01

    Background: There are few posterolateral approaches that do not require the common peroneal nerve (CPN) dissection. With the nerve exposure, it would pose a great challenge and sometimes iatrogenic damage over the surgical course. The purpose was to present a case series of patients with posterolateral tibial plateau fractures treated by direct exposure and plate fixation through a modified posterolateral approach without exposing the common peroneal nerve (CPN). Materials and Methods: 9 consecutive cases of isolated posterior fractures of the posterolateral tibial plateau were operated by open reduction and plate fixation through the modified posterolateral approach without exposing the CPN between June 2009 and January 2012. Articular reduction quality was assessment according to the immediate postoperative radiographs. At 24 month followup, all patients had radiographs and were asked to complete a validated outcome measure and the modified Hospital for Special Surgery (HSS) Knee Scale. Results: All patients were followedup, with a mean period of 29 months (range 25–40 months). Bony union was achieved in all patients. In six cases, the reduction was graded as best and in three cases the reduction was graded as middle according to the immediate postoperative radiographs by the rank order system. The average range of motion arc was 127° (range 110°–134°) and the mean postoperative HSS was 93 (range 85–97) at 24 months followup. None of the patients sustained neurovascular complication. Conclusions: The modified posterolateral approach through a long skin incision without exposing the CPN could help to expand the surgical options for an optimal treatment of this kind of fracture, and plating of posterolateral tibial plateau fractures would result in restoration and maintenance of alignment. This approach demands precise knowledge of the anatomic structures of this region. PMID:27053799

  13. Aging is Not a Risk Factor for Femoral and Tibial Fractures in Motor Vehicle Crashes

    PubMed Central

    Ryb, Gabriel; Dischinger, Patricia; Kleinberger, Michael; Burch, Cynthia; Ho, Shiu

    2008-01-01

    Objective To determine the effect of aging on the occurence of femoral and tibial fractures during vehicular crashes. Methods The Crash Injury Research and Engineering Network (CIREN), which includes occupants of a vehicle < 8 years old with at least one AIS ≥3 or two AIS ≥2 injuries in different body regions, comprised the study population. The occurrence of femoral and tibial fractures during vehicular crashes was analyzed in relation to age and other confounders [gender, BMI, stature, change in velocity (Δv), restraint use, occupant position (driver vs. passenger) and principal direction of force (PDOF)] using χ2, Mantel-Haenszel χ2 and student t test. Multiple logistic regression (MLR) models were built for the prediction of femoral and tibial fractures with age as the independent variable and possible confounders as co-variates. An α = 0.05 was used for all statistics. Results The incidence of femoral and tibial fractures in the study population (N=1,418) was 23% and 27%, respectively. Univariate analyses revealed a negative association between increasing age and femoral fractures and no association between age and tibial fractures. MLR models revealed no clear effect of increasing age on the occurrence of either femoral or tibial fractures. Obesity, frontal PDOF, and high Delta;v affected the occurrence of femoral fractures. Tibial fractures were influenced by occupant position (driver), frontal PDOF, high Δv and shorter stature. Conclusion Despite the known changes in bone composition and strength with aging, elderly vehicular occupants do not experience higher odds of incurring femoral and tibial fractures during crashes. PMID:19026239

  14. Anterior tibial stress fracture treated with intramedullary nailing: a case report.

    PubMed

    Plasschaert, V F; Johansson, C G; Micheli, L J

    1995-01-01

    This article describes the use of intramedullary rodding as a treatment for an anterior tibial stress fracture in a patient with high functional demands: a professional ballet dancer. In our patient, a year of conservative treatment and later tibial drilling was unsuccessful. After sustaining a complete fracture at the site of the stress fracture, he was treated with intramedullary rodding and was able to dance 21 weeks after surgery. The fracture went on to complete healing. The role of prophylactic intramedullary nailing in this difficult fracture is discussed.

  15. Fluid Lavage of Open Wounds (FLOW): A Multicenter, Blinded, Factorial Trial Comparing Alternative Irrigating Solutions and Pressures in Patients with Open Fractures

    DTIC Science & Technology

    2013-10-01

    serious adverse event SF-12: Short Form-12 questionnaire SPRINT: Study to Prospectively evaluate Reamed Intramedually Nails in Patients with Tibial ...models of a contaminated tibial shaft fracture, rat models of fracture healing, and cell culture models of bone nodule formation. Our experimental...Bhandari et al, 2002; Petrisor et al, 2008) to explore surgeons’ views regarding wound irrigation. Of 577 orthopaedic surgeons managing open tibial

  16. Elastic stable intramedullary nailing for severely displaced distal tibial fractures in children

    PubMed Central

    Shen, Kaiying; Cai, Haiqing; Wang, Zhigang; Xu, Yunlan

    2016-01-01

    Abstract Elastic stable intramedullary nailing (ESIN) has became a well-accepted method of osteosynthesis of diaphyseal fractures in the skeletally immature patient for many advantages, the purpose of this study is to evaluate the preliminary results of this minimally invasive treatment for severely displaced distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures. This study was carried out over a 6-year period. Twenty-one severely displaced DTDMJ fractures treated using ESIN were evaluated clinically and radiographically. Complications were assessed: the patients were evaluated with regard to nonunion, malunion, infection, growth arrest, leg length discrepancy, implant irritation, and joint function. Mean age at the time of surgery was 7.8 years (range between 5.3 and 14.8 years), mean body weight 34.1 kg, all fractures were transverse or mild oblique type, including 3 open fractures, 5 multifragmented fractures, and 4 fractures associated with polytrauma; 6 cases were treated with antegrade ESIN of tibia while 15 cases need combined retrograde fibula and antegrade tibia fixation treatments. Follow-ups were ranging from 11 to 36 months, 19 fractures showed both clinical and radiographic evidence of healing within 5 months; all cases had full range motion of knee and ankle with symmetrical foot progress angle. Nail removal was at a mean 7.1 months, at final follow-up, no growth arrest or disturbances occurred. Five patients had complications; leg length discrepancy had decreased yet affected 2 patients, 2 cases showed delayed union, and 1 case developed restricted dorsal extension at the metatarsophalangeal joint of the hallux. ESIN is the treatment of choice for pediatric severely displaced DTDMJ fractures that cannot be reduced by closed reduction or ones that cannot be casted. The advantages include faster fracture healing, excellent functional and cosmetic results, safe and reliable surgical technique, and lower severe complication rate. PMID

  17. Re-evaluation of low intensity pulsed ultrasound in treatment of tibial fractures (TRUST): randomized clinical trial

    PubMed Central

    Bhandari, Mohit; Einhorn, Thomas A; Schemitsch, Emil; Heckman, James D; Tornetta, Paul; Leung, Kwok-Sui; Heels-Ansdell, Diane; Makosso-Kallyth, Sun; Della Rocca, Gregory J; Jones, Clifford B; Guyatt, Gordon H

    2016-01-01

    Objective To determine whether low intensity pulsed ultrasound (LIPUS), compared with sham treatment, accelerates functional recovery and radiographic healing in patients with operatively managed tibial fractures. Design A concealed, randomized, blinded, sham controlled clinical trial with a parallel group design of 501 patients, enrolled between October 2008 and September 2012, and followed for one year. Setting 43 North American academic trauma centers. Participants Skeletally mature men or women with an open or closed tibial fracture amenable to intramedullary nail fixation. Exclusions comprised pilon fractures, tibial shaft fractures that extended into the joint and required reduction, pathological fractures, bilateral tibial fractures, segmental fractures, spiral fractures >7.5 cm in length, concomitant injuries that were likely to impair function for at least as long as the patient’s tibial fracture, and tibial fractures that showed <25% cortical contact and >1 cm gap after surgical fixation. 3105 consecutive patients who underwent intramedullary nailing for tibial fracture were assessed, 599 were eligible and 501 provided informed consent and were enrolled. Interventions Patients were allocated centrally to self administer daily LIPUS (n=250) or use a sham device (n=251) until their tibial fracture showed radiographic healing or until one year after intramedullary fixation. Main outcome measures Primary registry specified outcome was time to radiographic healing within one year of fixation; secondary outcome was rate of non-union. Additional protocol specified outcomes included short form-36 (SF-36) physical component summary (PCS) scores, return to work, return to household activities, return to ≥80% of function before injury, return to leisure activities, time to full weight bearing, scores on the health utilities index (mark 3), and adverse events related to the device. Results SF-36 PCS data were acquired from 481/501 (96%) patients, for whom

  18. The use of deep frozen and irradiated bone allografts in the reconstruction of tibial plateau fractures.

    PubMed

    Feng, Wei; Fu, Li; Liu, Jianguo; Li, Dongsong; Qi, Xin

    2013-09-01

    To investigate the clinical behavior of deep frozen and irradiated bone allografts in the treatment of depressed tibial plateau fractures. Twenty-two patients with a tibial plateau fracture were treated with cancellous bone allografts. The bone allograft preparation process included fresh-freezing at -70 °C for 4 weeks and gamma-irradiation at 25 kGy. All of the patients were followed for 1-2 years. The clinical effects were assessed using the Rasmussen score for tibial head fractures and X-rays. Postoperatively, the average excellent and fair Rasmussen scores were 88.9%. Only one patient developed an infection, with no integration between allograft and recipient bone observed. All of the other bone allografts were incorporated successfully, and no osteoporosis or sclerosis was observed. The frozen and gamma-irradiated bone allograft is a good alternative in the treatment of tibial plateau fractures, which we have shown can integrate with the surrounding host bone.

  19. Effect of Wedge Insertion Angle on Posterior Tibial Slope in Medial Opening Wedge High Tibial Osteotomy

    PubMed Central

    Ogawa, Hiroyasu; Matsumoto, Kazu; Ogawa, Takahiro; Takeuchi, Kentaro; Akiyama, Haruhiko

    2016-01-01

    Background: Medial opening wedge high tibial osteotomy (HTO) is a well-established surgery for medial compartment knee osteoarthritis (OA) wherein the lower extremity is realigned to shift the load distribution from the medial compartment of the knee to the lateral compartment. However, this surgery is known to affect the posterior tibial slope angle (PTSA), which could lead to abnormal knee kinematics and instability, and eventually to knee OA. Although PTSA control is as important as coronal realignment, few appropriate measurements for this parameter have been reported. The placement of a wedge spacer might have an effect on PTSA. Purpose: To elucidate the relationship between the PTSA and the direction of insertion of a wedge spacer. Study Design: Case series; Level of evidence, 4. Methods: This study assessed 43 knees from 34 patients who underwent medial opening wedge HTO for knee OA. Pre- and postoperative lateral radiographs of the knee as well as postoperative computed tomography scans were performed to evaluate the relationship among PTSA, wedge insertion angle (WIA), and opening gap ratio (distance of the anterior opening gap/distance of the posterior opening gap at the osteotomy site). Results: The PTSA significantly increased from 9.0° ± 2.8° preoperatively to 13.2° ± 4.1° postoperatively (P < .001), resulting in a mean ΔPTSA of 4.7° ± 4.5°. The mean opening gap ratio was 0.86 ± 0.11, and the mean WIA was 25.9° ± 8.4°. The WIA and opening gap ratio were both highly correlated with ΔPTSA (r = 0.71 and 0.72, respectively), implying that a smaller WIA or smaller gap ratio leads to less increase in posterior slope. Conclusion: The direction of wedge insertion is highly correlated with PTSA increase, which suggests that the PTSA can be controlled for by adjusting the direction of wedge insertion during surgery. Clinical Relevance: Study results suggest that it is possible to adjust the PTSA by controlling the WIA during surgery. Proper

  20. [Post-traumatic pseudoaneurysm of the anterior tibial artery secondary to tibial shaft fracture. Case report].

    PubMed

    Gómez-Salazar, J; Tovar-López, J; Hernández-Rodríguez, G; De la Concha-Ureta, H

    2016-01-01

    Arterial pseudoaneurysm of the lower limb is an infrequent entity, particularly in the infrapopliteal segment. It is commonly associated to vascular repairs or follows a localized arterial lesion, a fracture or a surgical procedure. There is little information in Mexico about this entity in cases involving the anterior tibial artery, and secondary to trauma and osteosynthesis. Given that sudden bleeding due to rupture of the pseudoaneurysm is a possible catastrophic outcome for the viability of the segment, it is important to timely detect and diagnose the pseudoaneurysm. Treatment indications contained in the international literature are controversial. Solution-oriented approaches may be either surgical or endovascular. Current reports show that the best treatment option is an autologous saphenous vein graft, which maintains blood flow and minimizes the risk of peripheral ischemia. The purpose of this paper is to report the case of a patient who sustained the above mentioned complication and provide a literature review. This topic should be further investigated, as this condition may go unnoticed in a large number of cases, given that its symptoms are silent.

  1. [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.

  2. An Innovative Intra-articular Osteotomy in the Treatment of Posterolateral Tibial Plateau Fracture Malunion.

    PubMed

    Wang, Yukai; Luo, Congfeng; Hu, Chengfang; Sun, Hui; Zhan, Yu

    2016-07-13

    Posterolateral tibial plateau fractures are not uncommon and the diagnosis can be easily missed. The treatment is technically demanding, which can easily lead to malunion of the posterolateral tibial plateau fracture. Here, we describe an innovative intra-articular osteotomy for the treatment of posterolateral tibial plateau fracture malunion. From 2010 through 2012, 13 patients with a posterolateral tibial plateau fracture malunion were treated in our trauma center. The patients were referred because of instability or knee pain. The instability was confirmed by physical examinations preoperatively. The depression malunion and lower limb alignment were evaluated on X-rays and computed tomography scans. All posterolateral tibial plateau fracture malunions were treated with an innovative intra-articular osteotomy via an extended anterolateral approach. The mean follow-up was 19.6 months (range, 14-28 months). The posterolateral osteotomy healed at an average of 15.1 weeks. The depression malunion was corrected in all patients, which was from 15.4 mm preoperatively to 3.3 mm at 12 months postoperatively. The average Lysholm, Knee Society Score, and visual analog scale scores were 91.7, 92.5, and 0.5, respectively. No loss of reduction, nonunion, or wound infection was observed. An innovative intra-articular osteotomy via an extended anterolateral approach is an effective treatment for posterolateral tibial plateau fracture malunion. The treatment achieved satisfactory functional results and knee stability restoration.

  3. 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.

  4. 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.

  5. Open Reduction and Internal Fixation of the Tibial Plateau Through the Anterolateral Approach.

    PubMed

    Hake, Mark E; Goulet, James A

    2016-08-01

    Fractures of the tibial plateau are challenging injuries to treat. The lateral tibial plateau is fractured more commonly than the medial plateau and the workhorse approach for these fractures is the anterolateral approach. This approach allows visualization of the lateral joint, metaphysis, and can be extensile if there is shaft extension. We present our technique for performing the anterolateral approach while treating a Schatzker III tibial plateau fracture. Special attention is given to performing a submeniscal arthrotomy to view the joint surface and judge the reduction. A femoral distractor is placed to assist with elevation the joint surface and visualization of the lateral plateau. A cortical window is created using a triple reamer from the sliding hip screw set. The reduction is performed and supported with cancellous bone chips. Finally, a lateral locking plate with rafting screws is placed. Knowledge of this approach and the strategies needed to address lateral and some bicondlar tibial plateau fractures are crucial to good patient outcomes.

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

    PubMed Central

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

    2016-01-01

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

  7. Cannulated screw and hexapodal fixator reconstruction for compound upper tibial fractures

    PubMed Central

    Uzun, Metin; Bilen, Fikri Erkal; Eralp, Levent

    2014-01-01

    Objectives: The aim of the treatment of tibial plateau fractures is to obtain a pain-free and fully functional knee with closed reduction, percutaneous cannulated screw fixation and hexapodal external fixator reconstruction for high energy compound upper tibial fractures. Methods: Patients with comminuted tibial plateau fractures underwent closed reduction, percutaneous fixation with cannulated screws, and reconstruction with hexapodal external fixator. The follow-up period was 24 months. Results: The clinical and radiological results were good or excellent. The average knee flexion was 125°. Conclusion: Our results are successful in the initial stage, however, it should be pointed out that during the long term follow-up osteoarthritis may develop leading to worsening of the condition. Level of Evidence IV, Case Series. PMID:24644420

  8. Micromotion in the fracture healing of closed distal metaphyseal tibial fractures: A multicentre prospective study.

    PubMed

    Vicenti, G; Pesce, V; Tartaglia, N; Abate, A; Mori, C M; Moretti, B

    2014-12-01

    The dynamic locking screw (DLS) in association with minimally invasive plate osteosynthesis (MIPO) in a bridging construct for simple metadiaphyseal long bone fractures enables modulation of the rigidity of the system and facilitates the development of early and triplanar bone callus. Twenty patients affected by distal tibial fracture were treated with MIPO bridging technique and DLS at the proximal side of the fracture. Time of consolidation, quality of the reduction, complications and American Orthopaedic Foot and Ankle Society (AOFAS) score were monitored and the results compared with those from a control group treated with only standard screws on both fracture sides. Student t-test for independent samples was used for the comparison of means between the two groups. Chi-square test was used for the comparison of proportions. A multiple logistic regression model was constructed to assess the possible confounding effects. Performance was considered significant for p<0.05. The mean healing time was 17.6 ± 2.8 weeks in the group treated with standard screws and 13.5 ± 1.8 weeks in the group treated with DLS (t=5.5, p<0.0001). The DLS was associated with early healing and triplanar bone callus.

  9. The functional results of tibial shaft fractures treated with intramedullary nail compressed by proximal tube.

    PubMed

    Karaarslan, Ahmet Adnan; Acar, Nihat; Aycan, Hakan; Sesli, Erhan

    2016-04-01

    Nailing of tibial shaft fractures is considered the gold standard surgical method by many surgeons. The aim of this retrospective study was to investigate and compare the clinical outcome of tibial shaft fractures treated with intramedullary nails compressed by proximal tube and conventional intramedullary interlocking nails. Fifty-seven patients with tibial shaft fractures, treated with intramedullary nails compressed by proximal tube (n = 32) and the conventional interlocking nails (n = 25), were reviewed. All fractures except for one were united without any additional surgical intervention in the proximal compression tube nail group, whereas in the conventional interlocking nail group, six patients needed dynamization surgery (p = 0.005) and three cases of nonunion were recorded. In the proximal compression tube nail group, faster union occurred in 20 ± 2 (16-24) weeks (mean ± SD; range) without failure of locking screws and proximal nail migration, whereas in the conventional interlocking nail group, union occurred in 22 ± 2.5 (17-27) weeks (p = 0.001) with two failures of locking screws and two proximal nail migration. The proximal compression tube nail system is safer than the conventional nailing methods for the treatment for transverse and oblique tibial shaft fractures with a less rate of nonunion, proximal locking screw failure and proximal nail migration.

  10. Tibial shaft stress fractures resulting from placement of navigation tracker pins.

    PubMed

    Hoke, David; Jafari, S Mehdi; Orozco, Fabio; Ong, Alvin

    2011-04-01

    The use of navigation during joint arthroplasty is believed to allow better placement of components. Gross fracture or stress fracture through navigation tracker pin placement is a complication reported in the literature. This case series presents details of stress fracture of tibial shaft through navigation pin track in 3 patients of 220 cases who underwent total knee arthroplasty at our institution. All the fractures eventually healed after a course of protected weight bearing. As a result, we use smaller-diameter self-tapping and self-drilling pins routinely and avoid placement of pins in the diaphysis and ensure that pins are inserted in different plains during insertion into metaphysis.

  11. Minimizing the complications of intramedullary nailing for distal third tibial shaft and metaphyseal fractures

    PubMed Central

    Yaligod, Vishwanath; Rudrappa, Girish H.; Nagendra, Srinivas; Shivanna, Umesh M.

    2013-01-01

    Background The complications of intramedullary nailing of distal third tibial shaft and metaphyseal fractures have a direct impact on ankle and hind foot function. Methods We retrospectively evaluated 28 patients. Unreamed nail was negotiated across the well reduced fracture till subchondral bone and fixed with 2 to 3 distal locking screws in different planes. Results Fracture union rate was 85%. Three out of 28 patients had malalignment. Mean ankle, hindfoot functional score was 85. Conclusion Complications can be minimized by impacting the unreamed nail till the subchondral bone while maintaining the fracture well reduced and by using multiple distal locking screws in different planes. PMID:24719527

  12. Study to prospectively evaluate reamed intramedually nails in patients with tibial fractures (S.P.R.I.N.T.): Study rationale and design

    PubMed Central

    2008-01-01

    Background Surgeons agree on the benefits of operative treatment of tibial fractures – the most common of long bone fractures – with an intramedullary rod or nail. Rates of re-operation remain high – between 23% and 60% in prior trials – and the two alternative nailing approaches, reamed or non-reamed, each have a compelling biological rationale and strong proponents, resulting in ongoing controversy regarding which is better. Methods/Design The objective of this trial was to assess the impact of reamed versus non-reamed intramedullary nailing on rates of re-operation in patients with open and closed fractures of the tibial shaft. The study to prospectively evaluate reamed intramedullary nails in tibial fractures (S.P.R.I.N.T) was a multi-center, randomized trial including 29 clinical sites in Canada, the United States and the Netherlands which enrolled 1200 skeletally mature patients with open (Gustilo Types I-IIIB) or closed (Tscherne Types 0–3) fractures of the tibial shaft amenable to surgical treatment with an intramedullary nail. Patients received a statically locked intramedullary nail with either reamed or non-reamed insertion. The first strategy involved fixation of the fracture with an intramedullary nail following reaming to enlarge the intramedullary canal (Reamed Group). The second treatment strategy involved fixation of the fracture with an intramedullary nail without prior reaming of the intramedullary canal (Non-Reamed Group). Patients, outcome assessors, and data analysts were blinded to treatment allocation. Peri-operative care was standardized, and re-operations before 6 months were proscribed. Patients were followed at discharge, 2 weeks post-discharge, and at 6 weeks, 3, 6, 9, and 12 months post surgery. A committee, blinded to allocation, adjudicated all outcomes. Discussion The primary outcome was re-operation to promote healing, treat infection, or preserve the limb (fasciotomy for compartment syndrome after nailing). The primary

  13. [Bilateral stress fracture of the mid-tibial shaft in a professional dancer].

    PubMed

    Tomčovčík, L; Tomčovčíková, A

    2011-01-01

    Stress fractures of the anterior cortex of the mid-tibial shaft in dancers are rare, with a 1.4 % incidence in injured eli- te dancers. Treatment can be difficult and long-lasting and can seriously influence the dancer's career. The authors pre- sent the case of a 26-year-old professional dancer of a folk dance ensemble who suffered rare simultaneous bilateral mid-tibial shaft stress fractures. A conservative method of treatment with avoiding exercise and dancing activities resulted in the resolution of symptoms and healing of the fractures after 6 months. The patient finished his dancing career because of the necessity of a prolonged therapy interfering with his dancing activities. Current options of the treatment are also presented.

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

    PubMed

    Giordano, Vincenzo; Schatzker, Joseph; Kfuri, Mauricio

    2016-09-29

    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.

  15. Biomechanical Factors in the Etiology of Tibial Stress Fractures

    DTIC Science & Technology

    2006-08-01

    to the increased bending moment on the leg. 0 1 2 3 4 5 6 7 8 9 Ti bi al v ar um (° ) CON PTSF -31% 4.46.4 Figure 16: Tibial varum in subjects...injury visit. These shear loading rates indicate the magnitude of bending loads that the lower extremity is subject to, in addition to the...compressive loading that occurs during initial weight acceptance in stance. It has been 28 shown that anterior-posterior bending strength is related to the

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

    PubMed

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

    2015-09-01

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

  17. Characteristics of unilateral tibial plateau fractures among adult patients hospitalized at an orthopaedic trauma centre in China

    PubMed Central

    Liu, Yong; Liao, Zhengwen; Shang, Lei; Huang, Wenhua; Zhang, Dawei; Pei, Guoxian

    2017-01-01

    The aim of this study was to investigate the characteristics of unilateral tibial plateau fractures among hospitalized adult patients in Xijing Hospital, to evaluate the accuracy of Schatzker classification system and AO/OTA classification system to tibial plateau fractures. We retrospectively analysed clinical data on 274 patients admitted to Xijing Hospital between September 2006 and August 2015. The patients’ demographic characteristics, admission periods and seasons, external causes and fracture types were recorded and summarized. Then the characteristics of tibial plateau fractures and the accuracy rate of these two classification systems were analysed. Schatzker type II fractures and AO/OTA type 41-B3 fractures were the most common types. The external causes differed between genders, types of employment, urban-rural residents and both two systems. In addition, some fractures were difficult to classify using Schatzker or AO/OTA classification system. Rural male physical labourers aged between 30–59 years-old were most likely to suffer from unilateral tibial plateau fractures, due to traffic accidents, falls and indoor activity injuries, or falls from height. We should pay more attention to the related people and professions, which contributed to the high occurrence of tibial plateau fractures. Besides that, further improvements are required for both Schatzker and AO/OTA classification systems. PMID:28074894

  18. Insertion of intramedullary nails from the suprapatellar pouch for proximal tibial shaft fractures. A technical note.

    PubMed

    Jakma, Tijs; Reynders-Frederix, Peter; Rajmohan, Rai

    2011-12-01

    Intramedullary nailing of proximal tibial fractures can be difficult when using the standard entry portal. We evaluated the suprapatellar portal, using a midline quadriceps tendon incision, to perform intramedullary nailing of the tibia. Seven patients were treated with this adaptation of the standard intramedullary nailing procedure. An arthroscopy was done before and after the nailing procedure. No special equipment was used to perform the intramedullary nailing. We evaluated the handling and necessary modifications of the standard intramedullary technique to introduce the locked tibial nail through the suprapatellar approach. We found this technique not necessarily more difficult than the standard intramedullary nailing of the tibia through the infrapatellar entry portal. Although the patients did not complain of patellofemoral discomfort after the suprapatellar nailing, definitive scuffing of the cartilage in the lower part of the femoral trochlea was visible. Introduction of a locked tibial nail via the suprapatellar approach was found to be possible and even advantageous for some complex upper tibial shaft fractures in compromised limbs. Some possible downsides of this approach need to be taken into account but, in some cases, they can be outweighed by the benefits.

  19. Inside out rafting K-wire technique for tibial plateau fractures.

    PubMed

    Yoon, Yong-Cheol; Oh, Jong-Keon; Oh, Chang-Wug; Sahu, Dipit; Hwang, Jin-Ho; Cho, Jae-Woo

    2012-02-01

    With the introduction of 3.5 anatomically pre-shaped plates, the rafting screw technique is gaining popularity in recent years for the management of lateral tibial plateau fractures with articular depression. To gain access to the depressed articular fragments, the split fragment is hinged open laterally. We elevate the depressed articular fragments to the normal level. The defect below is filled with bone graft or its substitutes. We then close the split fragment and apply rafting screws either through the screw holes of the plate or separately above the plate rather in a blind fashion. We therefore cannot be sure that the rafting screws are supporting the specific elevated fragments. For this reason some surgeons place the rafting screws from within and then close the lateral fragment over the screws. This so-called embedded rafting screw technique carries the risk of difficulty in removal, especially in case of an infection. Here we describe the inside out rafting technique to tackle this problem.

  20. Bone Healing by Using Ilizarov External Fixation Combined with Flexible Intramedullary Nailing versus Ilizarov External Fixation Alone in the Repair of Tibial Shaft Fractures: Experimental Study

    PubMed Central

    Popkov, A. V.; Kononovich, N. A.; Gorbach, E. N.; Tverdokhlebov, S. I.; Irianov, Y. M.; Popkov, D. A.

    2014-01-01

    Purpose. Our research was aimed at studying the radiographic and histological outcomes of using flexible intramedullary nailing (FIN) combined with Ilizarov external fixation (IEF) versus Ilizarov external fixation alone on a canine model of an open tibial shaft fracture. Materials and Methods. Transverse diaphyseal tibial fractures were modelled in twenty dogs. Fractures in the dogs of group 1 (n = 10) were stabilized with the Ilizarov apparatus while it was combined with FIN in group 2 (n = 10). Results. On day 14, a bone tissue envelope started developing round the FIN wires. Histologically, we revealed only endosteal bone union in group 1 while in group 2 the radiographs revealed complete bone union on day 28. At the same time-point, the areas of cancellous and mature lamellar bone tissues were observed in the intermediary area in group 2. The periosteal layers were formed of the trabeculae net of lamellar structure and united the bone fragments. The frame was removed at 30 days after the fracture in group 2 and after 45 days in group 1 according to bone regeneration. Conclusion. The combination of the Ilizarov apparatus and FIN accelerates bone repair and augments stabilization of tibial shaft fractures as compared with the use of the Ilizarov fixation alone. PMID:25379523

  1. Tibial plateau fracture after anterior cruciate ligament reconstruction: Role of the interference screw resorption in the stress riser effect.

    PubMed

    Thaunat, Mathieu; Nourissat, Geoffroy; Gaudin, Pascal; Beaufils, Philippe

    2006-06-01

    We report a case of tibial plateau fracture after previous anterior cruciate ligament (ACL) reconstruction using patellar tendon autograft and bioabsorbable screws 4 years previously. The fracture occurred through the tibial tunnel. The interference screw had undergone complete resorption and the tunnel widening had increased. The resorption of the interference screw did not simultaneously promote and foster the growth of surrounding bone tissue. Therefore, the area of reactive tissue left by the screw resorption in an enlarged bone tunnel may lead to vulnerability of the tibial plateau. Stress risers would occur following ACL reconstruction if either resorption is not complete or bony integration is not complete.

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

    PubMed Central

    Loriaut, Philippe; Moreau, Pierre-Emmanuel; Loriaut, Patrick; Boyer, Patrick

    2017-01-01

    Background: Avulsion fractures of the tibial intercondylar eminence are fairly common injuries requiring surgery for the optimal functional outcome. The purpose of this study was to assess the clinical and radiological outcomes of an arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory device. Material and Methods: Five patients with type 2 and 3 displaced tibial intercondylar eminence fractures who received an arthroscopically assisted fixation using a double button device were enrolled from 2011 to 2012. Clinical assessment included the patient demographics, cause of injury, the delay before surgery, time for surgery, time to return to work and sport, the International Knee Documentation Committee (IKDC) and Lysholm knee scores. Stability was measured with the KT-2000 arthrometer with a force of 134 N. A side to side difference on the KT-2000 examination superior to 3 mm was considered as a significant and abnormal increase in the anterior translation. Radiological examination consisted of anteroposterior and lateral radiographs, as well as computed tomography (CT) scan of the affected knee. Clinical and radiological followup was done at 1, 2, 3, 6, and 12 months postoperatively and at final followup. CT-scan was performed before surgery and at 3 months followup. Results: The median age of patients was 31 years. Mean followup was 27 ± 5.1 months. The average delay before surgery was 3 days. At final followup, the mean IKDC and Lysholm knee scores were, 93.9 and 94.5 respectively. All patients had a complete functional recovery and were able to return to work and to resume their sport activities. No secondary surgeries were required to remove hardware. No complication was noted. Bony union was achieved in all patients. Conclusion: The arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory system provided a satisfactory clinical and radiological outcome at a followup of 2 years.

  3. 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.

  4. Prevention of arthrofibrosis after arthroscopic screw fixation of tibial spine fracture in children and adolescents.

    PubMed

    Parikh, Shital N; Myer, David; Eismann, Emily A

    2014-01-01

    Arthrofibrosis is a major complication of tibial spine fracture treatment in children, potentially resulting in knee pain, quadriceps weakness, altered gait, decreased function, inability to return to sports, and long-term osteoarthritis. Thus, prevention rather than treatment of arthrofibrosis is desirable. The purpose of this study was to evaluate an aggressive postoperative rehabilitation and early intervention approach to prevent permanent arthrofibrosis after tibial spine fracture treatment and to compare epiphyseal and transphyseal screws for fixation. A consecutive series of 24 patients younger than age 18 with displaced type II and III tibial spine fractures who underwent arthroscopic reduction and screw fixation between 2006 and 2011 were retrospectively reviewed. Final range of motion was compared between patients with epiphyseal (n=12) and transphyseal (n=9) screws. One-third (4 of 12) of patients with epiphyseal screws underwent arthroscopic debridement and screw removal approximately 3 months postoperatively; 3 patients lacked 5° to 15° of extension, 1 experienced pain with extension, and 1 had radiographic evidence of screw pullout, loss of reduction, and resultant malunion. In the transphyseal screw group, 3 patients had 10° loss of extension, and all corrected after arthroscopic debridement and screw removal. The two groups did not significantly differ in time to hardware removal or return to sports or final range of motion. No growth disturbances were identified in patients after transphyseal screw removal. An aggressive approach of postoperative rehabilitation and early intervention after arthroscopic reduction and screw fixation of tibial spine fractures in children was successful in preventing permanent arthrofibrosis.

  5. A novel technique for reduction and immobilization of tibial shaft fractures: the hammock.

    PubMed

    Konda, Sanjit R; Jordan, Charles J; Davidovitch, Roy I; Egol, Kenneth A

    2011-06-01

    Standard techniques for immobilization of a tibia shaft fracture in the emergency department in a long-leg splint can be cumbersome, technically difficult, and often requires the use of an assistant. We have developed a novel technique for the reduction and splinting of tibial shaft fractures, which uses a "hammock" constructed of stockinette, which allows a single consulting orthopaedic physician to rapidly reduce and place a long-leg plaster splint or cast on a patient. This technique was performed on 12 consecutive patients with a total of 12 tibial shaft fractures. Translation, angulation, and shortening of the fracture were documented in anteroposterior and lateral views of the injured tibia and these parameters were compared against values measured after the hammock technique was used to reduce and splint the fracture. Pre-"hammock" average values for fracture displacement in the anteroposterior plane for translation, angulation, and shortening were 10.5 mm (53.1%), 12.0°, and 9.4 mm, respectively. Post-"hammock" average values for fracture displacement in the anteroposterior plane for the same parameters were 8.7 mm (44.4%), 4.2°, and 7.9 mm, respectively. Pre-"hammock" average values for fracture displacement in the lateral plane for translation and angulation were 4.9 mm and 8.7°. Post-"hammock" average values for fracture displacement in the lateral plane for the same parameters were 4.9 mm and 2.0°, respectively. These results show that this technique is able to achieve the goals of fracture reduction and immobilization in a rapid fashion when help is not available.

  6. Genu Recurvatum Deformity in a Child due to Salter Harris Type V Fracture of the Proximal Tibial Physis Treated with High Tibial Dome Osteotomy

    PubMed Central

    Beslikas, Theodoros; Christodoulou, Andreas; Chytas, Anastasios; Gigis, Ioannis; Christoforidis, John

    2012-01-01

    Salter-Harris type V fracture is a very rare injury in the immature skeleton. In most cases, it remains undiagnosed and untreated. We report a case of genu recurvatum deformity in a 15-year-old boy caused by a Salter-Harris type V fracture of the proximal tibial physis. The initial X-ray did not reveal fracture. One year after injury, genu recurvatum deformity was detected associated with significant restriction of knee flexion and limp length discrepancy (2 cm) as well as medial and posterior instability of the joint. Further imaging studies revealed anterior bone bridge of the proximal tibial physis. The deformity was treated with a high tibial dome osteotomy combined with a tibial tubercle osteotomy stabilized with malleolar screws and a cast. Two years after surgery, the patient gained functional knee mobility without clinical instability. Firstly, this case highlights the importance of early identification of this rare lesion (Salter-Harris type V fracture) and, secondly, provides an alternative method of treatment for genu recurvatum deformity. PMID:23259115

  7. 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

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

    PubMed Central

    Gwinner, Clemens; Hoburg, Arnd; Wilde, Sophie; Schatka, Imke; Krapohl, Björn Dirk; Jung, Tobias M.

    2016-01-01

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

  9. Ionising radiation exposure in patients with circular frame treatment of distal tibial fractures.

    PubMed

    Bryant, H; Dearden, P M C; Harwood, P J; Wood, T J; Sharma, H K

    2015-08-01

    Total radiation exposure accumulated during circular frame treatment of distal tibial fractures was quantified in 47 patients treated by a single surgeon from February 2007 until Oct 2010. The radiation exposures for all relevant radiology procedures for the distal tibial injury were included to estimate the radiation risk to the patient. The median time of treatment in the frame was 169 days (range 105-368 days). Patients underwent a median of 13 sets of plain radiographs; at least one intra operative exposure and 16 patients underwent CT scanning. The median total effective dose per patient from time of injury to discharge was 0.025mSv (interquartile range 0.013-0.162 and minimum to maximum 0.01-0.53). The only variable shown to be an independent predictor of cumulative radiation dose on multivariate analysis was the use of CT scanning. This was associated with a 13-fold increase in overall exposure. Radiation exposure during treatment of distal tibial fractures with a circular frame in this group was well within accepted safe limits. The fact that use of CT was the only significant predictor of overall exposure serves as a reminder to individually assess the risk and utility of radiological investigations on an individual basis. This is consistent with the UK legal requirements for justification of all X-ray imaging, as set out in the Ionising Radiation (Medical Exposure) Regulations 2000 [1].

  10. Growth Kinematics of Opening-Mode Fractures

    NASA Astrophysics Data System (ADS)

    Eichhubl, P.; Alzayer, Y.; Laubach, S.; Fall, A.

    2014-12-01

    Fracture aperture is a primary control on flow in fractured reservoirs of low matrix permeability including unconventional oil and gas reservoirs and most geothermal systems. Guided by principles of linear elastic fracture mechanics, fracture aperture is generally assumed to be a linear function of fracture length and elastic material properties. Natural opening-mode fractures with significant preserved aperture are observed in core and outcrop indicative of fracture opening strain accommodated by permanent solution-precipitation creep. Fracture opening may thus be decoupled from length growth if the material effectively weakens after initial elastic fracture growth by either non-elastic deformation processes or changes in elastic properties. To investigate the kinematics of fracture length and aperture growth, we reconstructed the opening history of three opening-mode fractures that are bridged by crack-seal quartz cement in Travis Peak Sandstone of the SFOT-1 well, East Texas. Similar crack-seal cement bridges had been interpreted to form by repeated incremental fracture opening and subsequent precipitation of quartz cement. We imaged crack-seal cement textures for bridges sampled at varying distance from the tips using scanning electron microscope cathodoluminescence, and determined the number and thickness of crack-seal cement increments as a function of position along the fracture length and height. Observed trends in increment number and thickness are consistent with an initial stage of fast fracture propagation relative to aperture growth, followed by a stage of slow propagation and pronounced aperture growth. Consistent with fluid inclusion observations indicative of fracture opening and propagation occurring over 30-40 m.y., we interpret the second phase of pronounced aperture growth to result from fracture opening strain accommodated by solution-precipitation creep and concurrent slow, possibly subcritical, fracture propagation. Similar deformation

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

    PubMed Central

    Durst, A; Clibbon, J; Davis, B

    2015-01-01

    The fibula free flap is ideal for complex jaw reconstructions, with low reported donor and flap morbidity. We discuss a distal tibial stress fracture two months following a vascularised fibula free flap procedure. Despite being an unrecognised complication, a literature review produced 13 previous cases; only two were reported in the reconstructive surgery literature, with the most recent claiming to be the first. The majority of these studies treated this fracture non-operatively; none reported their patient follow-up. Each case presented with ipsilateral leg pain, which has been cited as an early donor site morbidity in as many as 40% of fibula free flap cases. It is known that the fibula absorbs at least 15% of leg load on weight bearing. Studies have shown severe valgus deformities in up to 25% of patients with fibulectomies. We treated our patient operatively, first correcting his worsening valgus deformity with an external fixator, then reinforcing his healed fracture with a long distal tibial plate. We believe that this complication is underreported, unexpected and not mentioned during the consenting process. By highlighting the management of our case and the literature, we aim to increase awareness (and thus further reporting and appropriate management) of this debilitating complication. PMID:26274757

  12. Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

    PubMed Central

    2014-01-01

    Background Currently, antegrade intramedullary nailing and minimally invasive plate osteosynthesis (MIPO) represent the main surgical alternatives in distal tibial fractures. However, neither choice is optimal for all bony and soft tissue injuries. The Retrograde Tibial Nail (RTN) is a small-caliber prototype implant, which is introduced through a 2-cm-long incision at the tip of the medial malleolus with stab incisions sufficient for interlocking. During this project, we investigated the feasibility of retrograde tibial nailing in a cadaver model and conducted biomechanical testing. Methods Anatomical implantations of the RTN were carried out in AO/OTA 43 A1-3 fracture types in three cadaveric lower limbs. Biomechanical testing was conducted in an AO/OTA 43 A3 fracture model for extra-axial compression, torsion, and destructive extra-axial compression. Sixteen composite tibiae were used to compare the RTN against an angle-stable plate osteosynthesis (Medial Distal Tibial Plate, Synthes®). Statistical analysis was performed by Student's t test. Results Retrograde intramedullary nailing is feasible in simple fracture types by closed manual reduction and percutaneous reduction forceps, while in highly comminuted fractures, the use of a large distractor can aid the reduction. Biomechanical testing shows a statistically superior stability (p < 0.001) of the RTN during non-destructive axial loading and torsion. Destructive extra-axial compression testing resulted in failure of all plate constructs, while all RTN specimens survived the maximal load of 1,200 N. Conclusions The prototype retrograde tibial nail meets the requirements of maximum soft tissue protection by a minimally invasive surgical approach with the ability of secure fracture fixation by multiple locking options. Retrograde tibial nailing with the RTN is a promising concept in the treatment of distal tibia fractures. PMID:24886667

  13. Taylor Spatial Frame in the treatment of pediatric and adolescent tibial shaft fractures.

    PubMed

    Al-Sayyad, Mohammed J

    2006-01-01

    The Taylor Spatial Frame (TSF) is a modern multiplanar external fixator that combines ease of application plus computer accuracy in the reduction of fractures. A retrospective review of our experience in using this device for treating unstable tibia fractures in pediatric and adolescent patients was carried out to determine the effectiveness and complications of TSF in the treatment of these fractures. Ten tibia fractures were included. All patients were boys with an average age of 12 years (range 8-15 years). Mean duration of follow-up was 3.1 years. These fractures included 5 open fractures. All fractures healed over a mean of 18 weeks. All patients were doing well and involved in sports when last seen. Postoperative complications included pin tract infection in 5 patients. TSF is an effective definitive method of tibia fracture care with the advantage of early mobilization and ability to postoperatively manipulate fracture into excellent alignment.

  14. Landing on your own two feet: a case report of bilateral calcaneus and open pilon fractures.

    PubMed

    Tiedeken, Nathan C; Hampton, David; Shaffer, Gene

    2014-01-01

    High energy fractures of the distal tibial plafond and calcaneus have been associated with high functional morbidity and wound complications. Although both of these fractures result from a similar mechanism, they have rarely been reported to occur on an ipsilateral extremity. The combination of these 2 injuries on the same extremity would increase the likelihood of an adverse surgical or functional outcome. We present the case and management strategy of a 43-year-old male with bilateral open pilon fractures and closed calcaneal fractures after falling from a height. A staged protocol was used for the bilateral pilon fractures, with external fixation until operative fixation on day 9. Nonoperative management of the calcaneal fractures resulted in a successful functional outcome at 10 months of follow-up. Treatment of this fracture pattern must incorporate the condition of the soft tissues, an understanding of the fractures, and minimize patient risk factors to optimize the functional and surgical outcomes.

  15. Fracture of the polyethylene tibial post in a posterior stabilized knee prosthesis: A case report and review of literature.

    PubMed

    Kumar, Nishikant; Yadav, Chandrashekhar; Raj, Rishi; Yadav, Sanjay

    2015-09-01

    We report a case of fracture of tibial polyethylene post fracture from base in a 56 year old lady 10 years from posterior stabilized total knee arthroplasty following trivial trauma. There have been signs of wear at the base especially anteriorly. After revision of tibial polyethylene component patient developed complete relief of symptom.

  16. Timing of Operative Debridement in Open Fractures.

    PubMed

    Rozell, Joshua C; Connolly, Keith P; Mehta, Samir

    2017-01-01

    The optimal treatment of open fractures continues to be an area of debate in the orthopedic literature. Recent research has challenged the dictum that open fractures should be debrided within 6 hours of injury. However, the expedient administration of intravenous antibiotics remains of paramount importance in infection prevention. Multiple factors, including fracture severity, thoroughness of debridement, time to initial treatment, and antibiotic administration, among other variables, contribute to the incidence of infection and complicate identifying an optimal time to debridement.

  17. The Retrograde Tibial Nail: presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures.

    PubMed

    Kuhn, Sebastian; Appelmann, Philipp; Pairon, Philip; Mehler, Dorothea; Rommens, Pol M

    2014-01-01

    Displaced distal tibia fractures require stable fixation while minimizing secondary damage to the soft tissues by the surgical approach and implants. Antegrade intramedullary nailing has become an alternative to plate osteosynthesis for the treatment of distal metaphyseal fractures over the past two decades. While retrograde intramedullary nailing is a standard procedure in other long bone fractures, only few attempts have been made on retrograde nailing of tibial fractures. The main reasons are difficulties of finding an ideal entry portal and the lack of an ideal implant for retrograde insertion. The Retrograde Tibial Nail (RTN) is a prototype intramedullary implant developed by our group. The implant offers double proximal and triple distal interlocking with an end cap leading to an angle-stable screw-nail construct of the most distal interlocking screw. Its design meets the requirements of a minimally invasive surgical approach, with a stable fracture fixation by multiple locking options. The 8mm diameter curved nail, with a length of 120 mm, is introduced through an entry portal at the medial malleolus. We see possible indications for the RTN in far distal tibial shaft fractures, distal extraarticular metaphyseal tibial fractures and in distal tibia fractures with simple extension into the ankle joint when the nail is combined lag screw fixation. A biomechanical comparison of the current RTN prototype against antegrade nailing (Expert Tibial Nail, Synthes(®), ETN) was performed. Both implants were fixed with double proximal and triple distal interlocking. Seven biomechanical composite tibiae were treated with either osteosynthesis techniques. A 10mm defect osteotomy 40 mm proximal to the joint line served as an AO 43-A3 type distal tibial fracture model. The stiffness of the implant-bone constructs was measured under low and high extra-axial compression (350 and 600 N) and under torsional load (8 Nm). Results show a comparable stability during axial loading

  18. Arthroscopic-Assisted Fixation of Tibial Plateau Fractures: Patient-Reported Postoperative Activity Levels.

    PubMed

    Kampa, John; Dunlay, Ryan; Sikka, Robby; Swiontkowski, Marc

    2016-05-01

    Tibial plateau fractures may result in significant limitations postoperatively. Studies have described outcomes of arthroscopic-assisted percutaneous fixation (AAPF) of these injuries but have rarely reported postoperative activity levels. Between 2009 and 2013, patients who sustained a lateral split, split depression, or pure depression type tibial plateau fracture (Schatzker types I-III fractures) and underwent outpatient AAPF were eligible for the study. Outcomes were assessed using Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm score, and Marx activity score. Twenty-five consecutive patients were eligible for the study, and 22 (88%) were included in the final analysis, with average follow-up of 2.5 years (range, 1-5.2 years). Thirteen women and 9 men with an average age of 48.3 years (range, 23-65 years) comprised the study population. Average number of screws used for fixation was 2 (range, 1-4). The average depression was 8 mm preoperatively and 0.9 mm (range, 0-3 mm) postoperatively. Four patients (18%) had complications: 2 with hardware removal and 2 with postoperative deep venous thrombosis. Average postoperative Marx activity score was 5.7. Average postoperative KOOS Symptoms, Sports, and Quality of Life scores were 88 (range, 68-100), 85 (range, 45-100), and 77 (range, 50-100), respectively. Average IKDC and Lysholm scores were 81 (range, 55-97) and 87 (range, 54-100), respectively. The AAPF surgical technique, which was performed in an outpatient setting, facilitated excellent postoperative range of motion, outcomes, and activity scores with minimal complications. [Orthopedics. 2016; 39(3):e486-e491.].

  19. Opening-wedge high tibial osteotomy: a seven - to twelve-year study

    PubMed Central

    PIPINO, GENNARO; INDELLI, PIER FRANCESCO; TIGANI, DOMENICO; MAFFEI, GIUSEPPE; VACCARISI, DAVIDE

    2016-01-01

    Purpose medial opening-wedge osteotomy is a widely performed procedure used to treat moderate isolated medial knee osteoarthritis. Historically, the literature has contained reports showing satisfactory mid-term results when accurate patient selection and precise surgical techniques were applied. This study was conducted to investigate the clinical and radiographic seven- to twelve-year results of opening-wedge high tibial osteotomy in a consecutive series of patients affected by varus knee malalignment with isolated medial compartment degenerative joint disease. Methods we reviewed a case series of 147 medial opening-wedge high tibial osteotomies at an average follow-up of 9.5 years. Endpoints for evaluation included the reporting of adverse effects, radiographic evidence of bone union, radiographic changes in the correction angle during union, and clinical and functional final outcomes. Results good or excellent results were obtained in 94% of the cases: the patients reported no major complications related to the opening-wedge high tibial osteotomy surgical technique, bone graft resorption, implant choice or postoperative rehabilitation protocol. At final follow-up, the average hip-knee angle was 4° of valgus without major loss of correction during the healing process. A statistically significant change in the patellar height was detected postoperatively, with a trend towards patella infera. Conclusions medial opening-wedge high tibial osteotomy is still a reliable method for correcting varus deformity while producing stable fixation, thus allowing satisfactory stability, adequate bone healing and satisfactory mid- to long-term results. Level of evidence Level IV, therapeutic cases series. PMID:27386441

  20. Comparison of outcome of tibial plafond fractures managed by hybrid external fixation versus two-stage management with final plate fixation

    PubMed Central

    Cisneros, Luis Natera; Gómez, Mireia; Alvarez, Carlos; Millán, Angélica; De Caso, Julio; Soria, Laura

    2016-01-01

    Background: Tibial platfond fractures are usually associated with massive swelling of the foot and ankle, as well as with open wounds. This swelling may cause significant decrease of the blood flow, so the state of the soft tissue is determinant for the surgical indication and the type of implant. This retrospective study compares the union times in cases of tibial plafond fractures managed with a hybrid external fixation as a definitive procedure versus those managed with a two stage strategy with final plate fixation. Materials and Methods: A retrospective study in a polytrauma referral hospital was performed between 2005 and 2011. Patients with a tibial plafond fracture, managed with a hybrid external fixation as a definitive procedure or managed with a two stage strategy with the final plate fixation were included in the study. Postoperative radiographs were evaluated by two senior surgeons. Fracture healing was defined as callus bridging of one cortex, seen on both lateral and anteroposterior X-ray. The clinical outcome was evaluated by means of 11 points Numerical Rating Scale for pain and The American Orthopedic Foot and Ankle Society ankle score, assessed at the last followup visit. Thirteen patients had been managed with a hybrid external fixation and 18 with a two-stage strategy with the final plate fixation. There were 14 males and 17 females with a mean age of 48 years (range 19–82 years). The mean followup was 24 months (range 24–70 months). Results: The mean time from surgery to weight bearing was 7 ± 6.36 days for the hybrid fixation group and 57.43 ± 15.46 days for the plate fixation group (P < 0.0001); and the mean time from fracture to radiological union was 133.82 ± 37.83) and 152.8 ± 72.33 days respectively (P = 0.560). Conclusion: Besides the differences between groups regarding the baseline characteristics of patients, the results of this study suggest that in cases of tibial plafond fractures, the management with a hybrid external

  1. Myogenic progenitors contribute to open but not closed fracture repair

    PubMed Central

    2011-01-01

    Background Bone repair is dependent on the presence of osteocompetent progenitors that are able to differentiate and generate new bone. Muscle is found in close association with orthopaedic injury, however its capacity to make a cellular contribution to bone repair remains ambiguous. We hypothesized that myogenic cells of the MyoD-lineage are able to contribute to bone repair. Methods We employed a MyoD-Cre+:Z/AP+ conditional reporter mouse in which all cells of the MyoD-lineage are permanently labeled with a human alkaline phosphatase (hAP) reporter. We tracked the contribution of MyoD-lineage cells in mouse models of tibial bone healing. Results In the absence of musculoskeletal trauma, MyoD-expressing cells are limited to skeletal muscle and the presence of reporter-positive cells in non-muscle tissues is negligible. In a closed tibial fracture model, there was no significant contribution of hAP+ cells to the healing callus. In contrast, open tibial fractures featuring periosteal stripping and muscle fenestration had up to 50% of hAP+ cells detected in the open fracture callus. At early stages of repair, many hAP+ cells exhibited a chondrocyte morphology, with lesser numbers of osteoblast-like hAP+ cells present at the later stages. Serial sections stained for hAP and type II and type I collagen showed that MyoD-lineage cells were surrounded by cartilaginous or bony matrix, suggestive of a functional role in the repair process. To exclude the prospect that osteoprogenitors spontaneously express MyoD during bone repair, we created a metaphyseal drill hole defect in the tibia. No hAP+ staining was observed in this model suggesting that the expression of MyoD is not a normal event for endogenous osteoprogenitors. Conclusions These data document for the first time that muscle cells can play a significant secondary role in bone repair and this knowledge may lead to important translational applications in orthopaedic surgery. Please see related article: http

  2. A pneumatic leg brace for the treatment of tibial stress fractures.

    PubMed

    Whitelaw, G P; Wetzler, M J; Levy, A S; Segal, D; Bissonnette, K

    1991-09-01

    Forty-two competitive athletes with posterior medial pain in the lower one-half of the tibia were evaluated by plain roentgenograms and bone scans. Twenty stress fractures were diagnosed in 17 patients by plain roentgenograms or bone scans or both. The remaining 25 patients were diagnosed as having shin splints. All 42 patients subsequently had a pneumatic leg brace applied to the affected limb or limbs. The 17 patients with stress fractures were able to ambulate without pain and were allowed to resume light training in an average of one week. Their injuries were nontender to palpation. The patients were allowed to resume intensive training at an average of 3.7 weeks postinjury. Patients returned to competition at the preinjury level in an average of 5.3 weeks after application of the brace. The pneumatic leg brace allowed the athletes with tibial stress fractures to begin pain-free ambulation and rehabilitation, thus facilitating the maintenance of their cardiovascular fitness and permitting an early return to competition.

  3. A meta-analysis of reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures.

    PubMed

    Xia, Liheng; Zhou, Jian; Zhang, Yongtao; Mei, Gang; Jin, Dan

    2014-04-01

    Controversy exists regarding the clinical outcomes of reamed vs unreamed intramedullary nailing in the treatment of closed tibial fractures. This study assessed the effects of reamed vs unreamed intramedullary nailing for closed tibial fractures. The authors searched PubMed, EMBASE, BIOSIS, and the Cochrane Controlled Trials Register for randomized and quasi-randomized controlled clinical trials from January 1980 to June 2012 comparing reamed with unreamed intramedullary nailing for closed tibial fracture in adults. Primary outcomes were nonunion, delayed union, malunion, secondary procedure, failure of implants, compartment syndrome, infection, and knee pain. Eight randomized and 1 quasi-randomized clinical trials (1229 fractures) were included. No statistically significant differences were found between reamed and unreamed nailing groups in delayed union (P=.20), malunion (P=.28), infection (P=.36), compartment syndrome (P=.36), and knee pain (P=.93). The unreamed group had a higher rate of fracture nonunion than the reamed group (P=.02). The subgroup analysis of implant failures (broken screws vs broken nails) indicated that reamed nailing significantly reduced the risk of screw breakage (P<.001); however, there was no significant difference between reamed and unreamed intramedullary nailing in nail breakage (P=.94). The subgroup analysis of a secondary procedure showed that the reamed intramedullary nailing resulted in significantly lower risks of implant exchange (P=.01) and dynamization (P=.04); however, there was no significant difference in bone grafting rate (P=.73). Evidence comparing reamed with unreamed intramedullary nailing for closed tibial fractures indicates that reamed intramedullary nailing may lead to significantly lower risks of nonunion, screw failure, implant exchange, and dynamization without increasing operative complications.

  4. Use of bone graft substitutes in the management of tibial plateau fractures.

    PubMed

    Goff, Thomas; Kanakaris, Nikolaos K; Giannoudis, Peter V

    2013-01-01

    The current available evidence for the use of bone graft substitutes in the management of subchondral bone defects associated with tibial plateau fractures as to their efficiency and safety has been collected following a literature review of the Ovid MEDLINE (1948-Present) and EMBASE (1980-Present). Nineteen studies were analysed reporting on 672 patients (674 fractures), with a mean age of 50.35 years (range 15-89), and a gender ratio of 3/2 males/females. The graft substitutes evaluated in the included studies were calcium phosphate cement, hydroxyapatite granules, calcium sulphate, bioactive glass, tricalcium phosphate, demineralised bone matrix, allografts, and xenograft. Fracture healing was uneventful in over 90% of the cases over a variant period of time. Besides two studies reporting on injectable calcium phosphate cement excellent incorporation was reported within 6 to 36 months post-surgery. No correlation was made by any of the authors between poor incorporation/resorption and adverse functional or radiological outcome. Secondary collapse of the knee joint surface ≥ 2 mm was reported in 8.6% in the biological substitutes (allograft, DBM, and xenograft), 5.4% in the hydroxyapatite, 3.7% in the calcium phosphate cement, and 11.1% in the calcium sulphate cases. The recorded incidence of primary surgical site and donor site infection (3.6%) was not statistically significant different, however donor site-related pain was reported up to 12 months following autologous iliac bone graft (AIBG) harvest. Shorter total operative time, greater tolerance of early weight bearing, improved early functional outcomes within the first year post-surgery was also recorded in the studies reporting on the use of injectable calcium phosphate cement (Norian SRS). Despite a lack of good quality randomised control trials, there is arguably sufficient evidence supporting the use of bone graft substitutes at the clinical setting of depressed plateau fractures.

  5. How Vein Sealing Boosts Fracture Opening

    NASA Astrophysics Data System (ADS)

    Nüchter, Jens-Alexander

    2015-04-01

    Veins from from cracks. As such, a stage of brittle failure and fracturing is to be set apart from a stage of opening and sealing. The process of fracture opening requires distortion of the host rocks to create space for the evolving vein. To keep a crack arrested and, at the same time, to widen or stabilize the cavity, the stress intensity factor K_I=(P-S3)(πa) must remain below the fracture toughness K_IC of the host rock, and P-S3 >0 (P and S3 denote pore fluid pressure and absolute minimum principal stress, respectively and 'a' refers to the half-length of the fracture). For purely elastic distortion of the host rocks, maximum aperture W0=K_IC (1-ν^2)/(E(π/8)^1/2))(2a)^1/2 depends on on K_IC, Poisson's ratio ν, and Young's modulus E of the host rocks. Owing to the low values for rock K_IC typically ranging between 0.1 and 1 MPa m^1/2, veins formed by purely elastic distortion of the host rocks are restricted to high aspect ratios 2a/W. In metamorphic rocks, veins with low aspect ratios are common; inelastic deformation and viscous creep in the host rocks must have contributed to final vein shapes. In the present study, I use finite element models to simulate fracture opening and cavity formation supported by viscous creep distributed in the host rock. Simulations are carried out on 2D plate models containing elliptical fractures. The walls of the fractures are coated by thin layers simulating incipient sealing; a residual cavity prevails in the centre of the model veins. Constant displacement is applied to the plate boundaries oriented normal to the cracks. I run a series of models with various viscosity contrasts between the rocks and the sealing. The results of these models indicate the following. (1) Fracture opening is most effective when the viscosity of the sealing ηs exceeds the viscosity of the host rocks ηr (2) The rate of fracture opening increases with increasing values for ηs/ηr . (3) An increase in the thickness of the sealing layer causes

  6. 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

  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.

  8. PROXIMAL TIBIAL OSTEOTOMY: STABILIZATION OF THE MEDIAL OPENING WITH A TRICORTICAL ILIAC BONE GRAFT

    PubMed Central

    da Cunha Luciano, Roberto; de Moura Souza, Getúlio Danival; Rispoli, Juliano; Cardoso, Rodrigo Galvão; do Nascimento, Marcus Vinícius Martins; Domingos, Gustavo Gontijo; Luciano, Dyego Vilela

    2015-01-01

    Objective: Radiographic assessment of lower limb alignment, in the frontal and sagittal planes, after high tibial osteotomy. To stabilize the osteotomy, a tricortical iliac graft was used, along with a positioning screw. Methods: Prospective study on 46 patients with ages ranging from 17 to 61 years. Among them, 42 patients presented genu varum secondary to knee osteoarthritis and four from other causes. Teleradiography was performed for surgical planning, using the Frank Noyes method, as modified by Fugizawa. A conventional surgical access of 3 cm was made to harvest a tricortical iliac graft. Osteotomy was performed under radioscopic control, by means of an anteromedial incision of 3 cm with release of the superficial portion of the medial collateral ligament. The graft was placed in the posterior portion of the osteotomy, to maintain an unaltered tibial slope. The screw crossed the osteotomy orthogonally to protect the lateral cortex. Pre and postoperative radiographic criteria were established to assess the results. Results: There was consolidation in 100% of the cases and maintenance of the mechanical axis, obtained intraoperatively, in 94% of the cases. The posterior slope of the tibial plateau in the sagittal plane ranged from 7° to 12°. Joint mobility was restored in all the patients. Eleven patients presented temporary pain at the site of graft harvesting, but none had paresthesia. The incidence of complications was 8% (infection, loss of correction and joint fracture). Conclusion: The technique was shown to be reproducible, simple, biological, accurate and low-cost, and it may be an alternative to the existing techniques. PMID:27026961

  9. 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.

  10. A Novel 'Transfibular Approach' for the Nonunion of a Tibial Shaft Fracture with Poor Anteromedial Soft Tissue Cover.

    PubMed

    Vaishya, Raju; Agarwal, Amit Kumar; Singh, Harsh; Vijay, Vipul

    2015-09-03

    The need for an ideal approach for the nonunion of the tibial shaft with anteromedial soft tissue scarring has long baffled surgeons. Many different approaches have been suggested in the past, but all those approaches were haggled by a multitude of problems. We have described a novel 'transfibular approach' for this selective situation. An appropriate patient with a mid-shaft tibial non-union was selected. After preoperative workup, the patient underwent an open reduction internal fixation (ORIF) with lateral tibial plating, bone grafting, and partial fibulectomy. In this new approach, the plane between tibialis anterior and extensor hallucis longus was used combined with a conventional posterolateral approach using the same incision. Subsequently, the patient was followed up for adequacy of the fixation and wound-related problems with a convincing outcome.

  11. ACL injury while jumping rope in a patient with an unintended increase in the tibial slope after an opening wedge high tibial osteotomy.

    PubMed

    Jung, Kwang Am; Lee, Su Chan; Hwang, Seung Hyun; Song, Moon Bok

    2009-08-01

    High tibial osteotomy (HTO) is an accepted surgical technique for the treatment of medial compartmental arthrosis of the knee in younger patients. Compared to total knee arthroplasty, HTO may be a good choice in patients who wish to continue with heavy labor and/or impact sports. Based on the rehabilitation protocol after HTO, impact sports, such as running, jumping rope, and full sports activities, are generally permitted 6 months postoperatively. Jumping rope is an excellent form of aerobic exercise, and when done properly, jumping rope can lead to a dramatic improvement in rehabilitation and full sports activities. However, an adequate evaluation should be performed prior to initiating impact sports. We present the case of a ruptured anterior cruciate ligament that occurred in a patient with an unintended increase in the tibial slope after an opening wedge HTO who was jumping rope.

  12. Patient-specific finite element analysis of chronic contact stress exposure after intraarticular fracture of the tibial plafond.

    PubMed

    Li, Wendy; Anderson, Donald D; Goldsworthy, Jane K; Marsh, J Lawrence; Brown, Thomas D

    2008-08-01

    The role of altered contact mechanics in the pathogenesis of posttraumatic osteoarthritis (PTOA) following intraarticular fracture remains poorly understood. One proposed etiology is that residual incongruities lead to altered joint contact stresses that, over time, predispose to PTOA. Prevailing joint contact stresses following surgical fracture reduction were quantified in this study using patient-specific contact finite element (FE) analysis. FE models were created for 11 ankle pairs from tibial plafond fracture patients. Both (reduced) fractured ankles and their intact contralaterals were modeled. A sequence of 13 loading instances was used to simulate the stance phase of gait. Contact stresses were summed across loadings in the simulation, weighted by resident time in the gait cycle. This chronic exposure measure, a metric of degeneration propensity, was then compared between intact and fractured ankle pairs. Intact ankles had lower peak contact stress exposures that were more uniform and centrally located. The series-average peak contact stress elevation for fractured ankles was 38% (p = 0.0015; peak elevation was 82%). Fractured ankles had less area with low contact stress exposure than intact ankles and a greater area with high exposure. Chronic contact stress overexposures (stresses exceeding a damage threshold) ranged from near zero to a high of 18 times the matched intact value. The patient-specific FE models represent substantial progress toward elucidating the relationship between altered contact stresses and the outcome of patients treated for intraarticular fractures.

  13. Pseudoaneurysm of anterior tibial artery following a diaphyseal fracture of the tibia mimicking a malignant bone tumor.

    PubMed

    Sautet, Pierre; Choufani, Elie; Petit, Philippe; Launay, Franck; Jouve, Jean-Luc; Pesenti, Sébastien

    2016-09-01

    Pseudoaneurysms of the lower limb are rare and frequently iatrogenics complications. Closed traumas are likely to generate lesions of the arterial wall, which generally become symptomatic at a later stage. The diagnosis of such vascular lesion is difficult because the symptomatology and the onset can be delayed. We herein report the case of a 15-year-old patient in whom the diagnosis of pseudoaneurysm of the anterior tibial artery was made 5 months after a non-displaced closed fracture of the tibial shaft. The radiographs were evocative of a malignant bone tumor. The study of vessels by a contrast-enhanced CT-scan enabled us to diagnose the pseudoaneurysm. Before the occurrence of late onset swelling, a history of trauma must be sought, even old.

  14. 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.

  15. Modified biplanar open-wedge high tibial osteotomy with rigid locking plate to treat varus knee*

    PubMed Central

    Zhang, Hai-ning; Zhang, Jie; Lv, Cheng-yu; Leng, Ping; Wang, Ying-zhen; Wang, Xiang-da; Wang, Chang-yao

    2009-01-01

    Objective: To introduce and characterize the modified biplanar opening high tibial osteotomy with rigid fixation to treat varus knee in young and active patients. Methods: Between June 2001 to July 2008, 18 patients with monocompartmental degeneration of the knee combined with a varus malalignment of the leg had the modified biplanar opening high tibial osteotomy and the osteotomy was fixed with the locking plates (Locking Compression Plate System). The mean varus deformity before operation was 11.5° (5°~19°) and no degenerative changes were found in other departments. Stability of the knee was normal in 15 patients, but ruptures in anterior cruciate ligaments or lateral collateral ligament were presented in the remaining 3 patients. Preoperative symptom was mainly limited in the pain of medial compartment. The preoperative and follow-up data for the range of motion and Lysholm score were determined. Subjective satisfactory examination was also applied to the patients for the operation they selected. Results: All of the patients were followed up with an average of 32.5 months (12~82 months). There was no ununion or delayed union in this group during the follow-up period. No complications like broken plate, nerve injury, or blood vessel injury occurred. The postoperative average corrected degree was 9.5° (5.5°~18°). No degenerations developed in the three departments of the knee. The Lysholm scores before and after surgery were 42.5 and 77.5, respectively (P<0.01). The overall fineness rate was 83.3%. The subjective satisfactory survey demonstrated that about 83.3% patients showed satisfactory on the operation. There was no obvious difference in the range of motion before and after operation, but significant changes were found in the Lysholm score and varus degree from preoperative to follow-up. Conclusion: Proximal opening high tibial osteotomy performed in conjunction with the special rigid locking plate yielded good results for symptomatic genu varum. This

  16. Trial to re-evaluate ultrasound in the treatment of tibial fractures (TRUST): a multicenter randomized pilot study

    PubMed Central

    2014-01-01

    Background The role of low-intensity pulsed ultrasound (LIPUS) in the management of fractures remains controversial. The purpose of this study was to assess the feasibility of a definitive trial to determine the effect of LIPUS on functional and clinical outcomes in tibial fractures managed operatively. Methods We conducted a multicenter, concealed, blinded randomized trial of 51 skeletally mature adults with operatively managed tibial fractures who were treated with either LIPUS or a sham device. All participating centers were located in Canada and site investigators were orthopedic surgeons specializing in trauma surgery. The goals of our pilot study were to determine recruitment rates in individual centers, investigators’ ability to adhere to study protocol and data collection procedures, our ability to achieve close to 100% follow-up rates, and the degree to which patients were compliant with treatment. Patients were followed for one year and a committee (blinded to allocation) adjudicated all outcomes. The committee adjudicators were experienced (10 or more years in practice) orthopedic surgeons with formal research training, specializing in trauma surgery. Results Our overall rate of recruitment was approximately 0.8 patients per center per month and site investigators successfully adhered to the study protocol and procedures. Our rate of follow-up at one year was 84%. Patient compliance, measured by an internal timer in the study devices, revealed that 39 (76%) of the patients were fully compliant and 12 (24%) demonstrated a greater than 50% compliance. Based on patient feedback regarding excessive questionnaire burden, we conducted an analysis using data from another tibial fracture trial that revealed the Short Musculoskeletal Function Assessment (SMFA) dysfunction index offered no important advantages over the SF-36 Physical Component Summary (PCS) score. No device-related adverse events were reported. Conclusions Our pilot study identified key issues

  17. Comparison study of therapeutic results of closed tibial shaft fracture with intramedullary nails inserted with and without reaming.

    PubMed

    Sadighi, Ali; Elmi, Asghar; Jafari, Mohamad Ali; Sadeghifard, Vahid; Goldust, Mohamad

    2011-10-15

    Tibia fractures are the most common type of long bone fractures in US. This study aimed at comparing the therapeutic results of closed tibial shaft fracture with intramedullary nails inserted with and without reaming. In this randomized clinical trial study, 60 patients with a fracture of the tibia were examined. The patients were randomly divided into two groups. Thirty patients treated through inserting intramedullary nail with reaming technique (group A). The other 30 patients treated through inserting intramedullary nail without reaming technique (group B). After operation physical examination and control radiography were taken up to 6 month and results were compared. Sixty patients suffering from closed tibial diaphysis fractures were studied. Mean age of the group A and B were 40.24 +/- 12.32 and 38.42 +/- 14.28, respectively. Group A consisted of 24 (80%) males and 6 (20%) females while group B consisted of 24% females and 76% males. Considering fracture based on OTA criteria (p = 0.4) and severity of soft tissue damage based on Tscherne classification (p = 0.6), there was no statistically meaningful difference between groups A and B. The study demonstrated that degree of horizontal displacement, mean time of surgery, post-operation infection, organ shortness at the end of the follow-up period, organ deviation in patients of the group A was significantly more than that of the group B. Time required for callus formation (mean time of union), mean time of full weight bearing time and mean time of return to normal activities in group B was significantly more than that of the group A.

  18. Treatment of distal intraarticular tibial fractures: A biomechanical evaluation of intramedullary nailing vs. angle-stable plate osteosynthesis.

    PubMed

    Kuhn, Sebastian; Greenfield, Julia; Arand, Charlotte; Jarmolaew, Andrey; Appelmann, Philipp; Mehler, Dorothea; Rommens, Pol M

    2015-10-01

    In factures of the distal tibia with simple articular extension, the optimal surgical treatment remains debatable. In clinical practice, minimally invasive plate osteosynthesis and intramedullary nailing are both routinely performed. Comparative biomechanical studies of different types of osteosynthesis of intraarticular distal tibial fractures are missing due to the lack of an established model. The goal of this study was first to establish a biomechanical model and second to investigate, which are the biomechanical advantages of angle-stable plate osteosynthesis and intramedullary nailing of distal intraarticular tibial fractures. Seven 4(th) generation biomechanical composite tibiae featuring an AO 43-C2 type fracture were implanted with either osteosynthesis technique. After primary lag screw fixation, 4-hole Medial Distal Tibial Plate (MDTP) with triple proximal and quadruple distal screws or intramedullary nailing with double proximal and triple 4.0mm distal interlocking were implanted. The stiffness of the implant-bone constructs and interfragmentary movement were measured under non-destructive axial compression (350 and 600 N) and torsion (1.5 and 3Nm). Destructive axial compression testing was conducted with a maximal load of up to 1,200 N. No overall superior biomechanical results can be proclaimed for either implant type. Intramedullary nailing displays statistically superior results for axial loading in comparison to the MDTP. Torsional loading resulted in non-statistically significant differences for the two-implant types with higher stability in the MDTP group. From a biomechanical view, the load sharing intramedullary nail might be more forgiving and allow for earlier weight bearing in patients with limited compliance.

  19. [Midterm Results for Quality of Life After Surgical Treatment of Moore Type V Fractures of the Tibial Plateau].

    PubMed

    Wirbel, R; Weber, A; Heinzmann, J; Meyer, C; Pohlemann, T

    2016-10-01

    Background: Dislocation fractures of the tibial plateau often lead to functional restrictions and subjective complaints from the patients. Besides functional and radiological results, criteria to determine the quality of life are of increasing importance. Intermediate term restriction in quality of life was evaluated and correlated with objective radiological results in patients with Moore type V dislocation fracture of the tibial plateau. Patients and Methods: From 2003 to 2012, a multicentre retrospective cohort study in three hospitals was used to register 36 patients with 38 Moore type V dislocation fractures of the tibial plateau. The injury mechanism, the surgical treatment (one step or two step surgery, single or double plate fixation) the complication rate, the radiological result (Kellgren/Lawrence osteoarthritis score, loss of reduction, secondary deviation of the axis) after a mean follow-up of 37 months, and the quality of life (pain and function by NRS, IKDC form, EQ 5D score) after a mean follow-up of 68 months (range, 15-128 months), were analysed. Results: The mean age of the 27 men and the 9 women was 50.8 years. There were 30 cases of high impact injury. An external fixator was used for primary fracture stabilisation in 24 knees; definitive internal fixation was performed in a second step. Internal fixation using a single plate was used in 12 knees, and double plate fixation in 25 knees; one patient was treated definitively with an external fixator. Early complications (3 × infection, 2 × compartment syndrome, 4 × implant failure) were seen in 21.1 % of patients; all could be cured surgically. The function of the affected knee joint gave a mean NRS of 4.53; the IKDC score was 50.46, and the EQ 5D 7.47. Only two patients (5 %) were free of pain, 27 (75 %) reported mild to moderate pain, and 7 patients (20 %) reported severe pain. Four patients are retired or have applied for a pension. Altogether, the quality of life was calculated

  20. Open Pelvic Fractures: Review of 30 Cases

    PubMed Central

    Giordano, Vincenzo; Koch, Hilton Augusto; Gasparini, Savino; Serrão de Souza, Felipe; Labronici, Pedro José; do Amaral, Ney Pecegueiro

    2016-01-01

    Background: Open pelvic fractures are rare but usually associated with a high incidence of complications and increased mortality rates. The aim of this study was to retrospectively evaluate all consecutive open pelvic fractures in patients treated at a single Level-1 Trauma Center during a 10-year interval. Patients and Methods: In a 10-year interval, 30 patients with a diagnosis of open pelvic fracture were admitted at a Level-1 Trauma Center. A retrospective analysis was conducted on data obtained from the medical records, which included patient’s age, sex, mechanism of injury, classification of the pelvic lesion, Injury Severity Score (ISS), emergency interventions, surgical interventions, length of hospital and Intensive Care Unit stay, and complications, including perioperative complications and death. The Jones classification was used to characterize the energy of the pelvic trauma and the Faringer classification to define the location of the open wound. Among the survivors, the results were assessed in the last outpatient visit using the EuroQol EQ-5D and the Blake questionnaires. It was established the relationship between the mortality and morbidity and these classification systems by using the Mann-Whitney non-parametric test, with a level of significance of 5%. Results: Twelve (40%) patients died either from the pelvic lesion or related injuries. All of them had an ISS superior to 35. The Jones classification showed a direct relationship to the mortality rate in those patients (p = 0.012). In the 18 (60%) other patients evaluated, the mean follow-up was 16.3 months, ranging from 24 to 112 months. Eleven (61%) patients had a satisfactory outcome. The Jones classification showed a statistically significant relationship both to the objective and subjective outcomes (p < 5%). The Faringer classification showed a statistically significant relationship to the subjective, but not to the objective outcome. In addition, among the 18 patients evaluated at the

  1. Open Wedge High Tibial Osteotomy and Combined Arthroscopic Surgery in Severe Medial Osteoarthritis and Varus Malalignment: Minimum 5-Year Results

    PubMed Central

    Yoo, Moon-Jib; Shin, Yong-Eun

    2016-01-01

    Purpose To evaluate the radiologic and functional outcomes of medial open wedge high tibial osteotomy (HTO) combined with arthroscopic procedure in patients with medial osteoarthritis. Materials and Methods From June 1996 to March 2010, 26 patients (32 knees) who underwent medial open wedge osteotomy and arthroscopic operation for medial osteoarthritis were retrospectively reviewed. Measurements included hip-knee-ankle (HKA) angle, femorotibial angle, medial proximal tibial angle, posterior tibial slope angle, and Kellgren-Lawrence grade. Clinical evaluation was performed using Lysholm knee scoring scale and knee and function score of the American Knee Society. Results Differences between the mean preoperative and postoperative measurements were significant in all angles including the HKA angle (−5.7° and +5.5°), femorotibial angle (−1.9° and +9.8°), and medial proximal tibial angle (82.9° and 90.5°) (p<0.05). Mean Lysholm knee scoring scale was 63.6 preoperatively and 88.7 at the last follow-up, mean Knee Society knee score was 61.2 and 86.6, and mean function score was 59.3 and 87.2, respectively. All differences were significant (p<0.05). Conclusions Medial open wedge HTO in combination with arthroscopic procedure is an effective treatment method for medial osteoarthritis to treat varus deformity and an intra-articular lesion. PMID:27894173

  2. 3D Surgical Printing Cutting Guides for Open-Wedge High Tibial Osteotomy: Do It Yourself.

    PubMed

    Pérez-Mañanes, Rubén; Burró, Juan Arnal; Manaute, Jose Rojo; Rodriguez, Francisco Chana; Martín, Javier Vaquero

    2016-11-01

    Opening wedge osteotomy has recently gained popularity, thanks to the recent implementation of locking plates, which have shown equivalent stability with greater reproducibility, accuracy, and longevity than the closing wedge techniques and a lower prosthetic conversion rate. We present a new "do-it-yourself" cutting guides system for tibial opening osteotomy. Using a conventional computed tomography digital image, a positioning guide and wedge spacers were printed in three dimensions (3D) for implementing the osteotomy and obtaining the planned correction. The surgeon makes the whole process in a do-it-yourself style. This new technique was used in eight cases. Previous opening osteotomies with the standard technique were used as control (20 cases). Surgical time, fluoroscopic time, and accuracy of the axial correction were measured. The use of a custom positioning guide reduced the surgical (31 minutes less) and fluoroscopic times (6.9 times less) while achieving a high-axis correction accuracy compared with the standard technique. Digitally planned and executed osteotomies under 3D printed osteotomy positioning guides help the surgeon to minimize human error while reducing surgical time. The reproducibility of this technique is very robust, allowing a transfer of the steps planned in a virtual environment to the operating table.

  3. Open Galeazzi fracture with ipsilateral elbow dislocation.

    PubMed

    Adanır, Oktay; Yüksel, Serdar; Beytemur, Ozan; Güleç, M Akif

    2016-08-01

    Combination of the Galeazzi fracture and dislocation of the elbow joint in same extremity is very rare. In this article, we report a 26-year-old male patient with a posterolateral dislocation of the elbow and ipsilateral volar type Galeazzi fracture. We performed closed reduction for the elbow dislocation during admission to the emergency department. Patient was taken to the operating room in the sixth hour of his application to emergency department and open wound on the ulnovolar region of the wrist was closed primarily after irrigation and debridement. We performed open reduction and internal fixation of the radial fracture with a dynamic compression plate. After fixation, we evaluated the stability of the elbow joint and distal radioulnar joint. Distal radioulnar joint was unstable under fluoroscopic examination and fixed with one 1.8 mm Kirschner wire in a pronated position. Then, elbow joint was stable. One year after surgery, patient had no pain or sings of instability. At the last follow-up, range of motion of the elbow was 10°-135° and forearm pronation and supination were 70°.

  4. Comminuted intraarticular fractures of the tibial plateau lead to posttraumatic osteoarthritis of the knee: Current treatment review.

    PubMed

    Aurich, Matthias; Koenig, Veit; Hofmann, Gunther

    2017-01-25

    Posttraumatic osteoarthritis (PTOA) of the knee is a common complication after intra- and extra-articular fractures. Moreover, PTOA may also be a result of isolated cartilage defects, meniscus resections, and ligament injuries. There are various methods of treatment of knee joint fractures. However, in the final stage of a PTOA, when nonoperative treatment fails, endoprosthetic joint replacement is the method of choice. Primary total knee replacement (TKR) for the treatment for a fracture of the knee joint is a rare indication, even at major treatment centers. It is performed in elderly patients with the inability to be mobilized with partial- or non-weight bearing; in cases with considerable bone destruction; in cases with symptomatic osteoarthritis (OA) in the elderly; and, it is often associated with the primary use of a modular implant. However, TKR in the acute situation should always be an individual decision. Secondary TKR after knee joint fracture shows overall good functional results. However, the results are inferior when compared with TKR for primary OA. In addition, the complication rates of TKR for PTOA are much higher. Problems with the extensor mechanism after tibial plateau fractures are common. There are also problems caused by preexisting scars, nonunion (possibly due to a low grade infection), malalignment, restricted movement, or instability.

  5. Novel management of distal tibial and fibular fractures with Acumed fibular nail and minimally invasive plating osteosynthesis technique

    PubMed Central

    Wang, Tie-Jun; Ju, Wei-Na; Qi, Bao-Chang

    2017-01-01

    Abstract Rationale: Anatomical characteristics, such as subcutaneous position and minimal muscle cover, contribute to the complexity of fractures of the distal third of the tibia and fibula. Severe damage to soft tissue and instability ensure high risk of delayed bone union and wound complications such as nonunion, infection, and necrosis. Patient concerns: This case report discusses management in a 54-year-old woman who sustained fractures of the distal third of the left tibia and fibula, with damage to overlying soft tissue (swelling and blisters). Plating is accepted as the first choice for this type of fracture as it ensures accurate reduction and rigid fixation, but it increases the risk of complications. Diagnosis: Closed fracture of the distal third of the left tibia and fibula (AO: 43-A3). Interventions: After the swelling was alleviated, the patient underwent closed reduction and fixation with an Acumed fibular nail and minimally invasive plating osteosynthesis (MIPO), ensuring a smaller incision and minimal soft-tissue dissection. Outcomes: At the 1-year follow-up, the patient had recovered well and had regained satisfactory function in the treated limb. The Kofoed score of the left ankle was 95. Lessons: Based on the experience from this case, the operation can be undertaken safely when the swelling has been alleviated. The minimal invasive technique represents the best approach. Considering the merits and good outcome in this case, we recommend the Acumed fibular nail and MIPO technique for treatment of distal tibial and fibular fractures. PMID:28328865

  6. Closed head experimental traumatic brain injury increases size and bone volume of callus in mice with concomitant tibial fracture

    PubMed Central

    Brady, Rhys D; Grills, Brian L; Church, Jarrod E; Walsh, Nicole C; McDonald, Aaron C; Agoston, Denes V; Sun, Mujun; O’Brien, Terence J; Shultz, Sandy R; McDonald, Stuart J

    2016-01-01

    Concomitant traumatic brain injury (TBI) and long bone fracture are commonly observed in multitrauma and polytrauma. Despite clinical observations of enhanced bone healing in patients with TBI, the relationship between TBI and fracture healing remains poorly understood, with clinical data limited by the presence of several confounding variables. Here we developed a novel trauma model featuring closed-skull weight-drop TBI and concomitant tibial fracture in order to investigate the effect of TBI on fracture healing. Male mice were assigned into Fracture + Sham TBI (FX) or Fracture + TBI (MULTI) groups and sacrificed at 21 and 35 days post-injury for analysis of healing fractures by micro computed tomography (μCT) and histomorphometry. μCT analysis revealed calluses from MULTI mice had a greater bone and total tissue volume, and displayed higher mean polar moment of inertia when compared to calluses from FX mice at 21 days post-injury. Histomorphometric results demonstrated an increased amount of trabecular bone in MULTI calluses at 21 days post-injury. These findings indicate that closed head TBI results in calluses that are larger in size and have an increased bone volume, which is consistent with the notion that TBI induces the formation of a more robust callus. PMID:27682431

  7. Biomechanical comparison of gourd-shaped LCP versus LCP for fixation of comminuted tibial shaft fracture.

    PubMed

    Xu, Guo-hui; Liu, Bo; Zhang, Qi; Wang, Juan; Chen, Wei; Liu, Yue-ju; Peng, A-qin; Zhang, Ying-ze

    2013-04-01

    The purpose of this study was to compare monotonic biomechanical properties of gourd-shaped LCP fixation with LCP fixation of human tibial shaft in gap fracture mode. Twenty paired fresh cadaveric human tibias were randomly divided into 4 groups (5 pairs each): (1) axial loading single cycle to failure testing, (2) torsion single cycle to failure testing, (3) 4-point bending single cycle to failure testing, and (4) dynamic 4-point bending testing. A 7-hole 4.5 mm gourd-shaped LCP was secured on the anteromedial surface of 1 randomly selected bone from each pair, respectively, using 6 locking screws in the 1st, 2nd, 3rd, 5th, 6th and 7th hole with the middle hole unfilled and just located at the mid-diaphysis of the tibia. A 7-hole 4.5 mm LCP was secured on the other bone with the same method. Standard AO/ASIF techniques were used. After fixation finished, a 10 mm gap in the mid-diaphysis of tibia was created, centrally located at the unfilled hole. The axial, torsional, and bending stiffness and failure strengths were calculated from the collected data in static testings and statistically compared using paired Student's t-test. The 4-point bending fatigue lives of the two constructs were calculated from the dynamic testing data and also statistically compared using paired Student's t-test. Failure modes were recorded and visually analyzed. P<0.05 was considered significant. Results showed that the axial, torsional and bending stiffness of gourd-shaped LCP construct was greater (4%, 19%, 12%, respectively, P<0.05) than that of the LCP construct, and the axial, torsional and bending failure strengths of gourd-shaped LCP construct were stronger (10%, 46%, 29%, respectively, P<0.05) than those of the LCP construct. Both constructs failed as a result of plate plastic torsional deformation. After axial loading and 4-point bending testings, LCP failed in term of an obvious deformation of bent apex just at the unfilled plate hole, while the gourd-shaped LCP failed in term

  8. 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.

  9. The SPECT/CT Evaluation of Compartmental Changes after Open Wedge High Tibial Osteotomy

    PubMed Central

    Kim, Tae Won; Kim, Byung Kag; Kim, Dong Whan; Sim, Jae Ang; Lee, Beom Koo; Lee, Yong Seuk

    2016-01-01

    Purpose The purpose of this study was to evaluate compartmental changes using combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT) after open wedge high tibial osteotomy (OWHTO) for providing clinical guidance for proper correction. Materials and Methods Analysis was performed using SPECT/CT from around 1 year after surgery on 22 patients who underwent OWHTO. Postoperative mechanical axis was measured and classified into 3 groups: group I (varus), group II (0°–3° valgus), and group III (>3° valgus). Patella location was evaluated using Blackburne-Peel (BP) ratio. On SPECT/CT, the knee joint was divided into medial, lateral, and patellofemoral compartments and the brighter signal was marked as a positive signal. Results Increased signal activity in the medial compartment was observed in 12 cases. No correlation was observed between postoperative mechanical axis and medial signal increase. Lateral increased signal activity was observed in 3 cases, and as valgus degree increased, lateral compartment’s signal activity increased. Increased signal activity of the patellofemoral joint was observed in 7 cases, and significant correlation was observed between changes in BP ratio and increased signal activity. Conclusions For the treatment of medial osteoarthritis, OWHTO requires overcorrection that does not exceed 3 valgus. In addition, the possibility of a patellofemoral joint problem after OWHTO should be kept in mind. PMID:27894172

  10. The orthopedic and social outcome of open tibia fractures in children.

    PubMed

    Levy, A S; Wetzler, M; Lewars, M; Bromberg, J; Spoo, J; Whitelaw, G P

    1997-07-01

    To determine whether the accepted principles of management of open tibia fractures apply to children, 40 consecutive open fractures of the tibial shaft in skeletally immature patients were retrospectively reviewed. Attempts were made to evaluate the functional and social impact of open tibia fractures in children. All open fractures were initially treated by rapid irrigation and debridement which was repeated every 48 hours until soft tissues stabilized. The average age was 10.1 years and average follow up was 26 months (range: 18 to 84). There were 16 grade I, 10 grade II, and 14 grade III open fractures. The grade III fractures were further subdivided into 6 grade IIIA, 7 grade IIIB, and 1 grade IIIC. The average time to union was 7.5 and 11.0 weeks in the grade I and II fractures respectively, with no infections and no delayed unions. In grade III fractures, the average time to union was 15 weeks, with 1 infection and 3 delayed unions. Bone grafting using autogenous iliac crest was performed on 2 patients. The children surveyed missed an average of 4.1 months of school and 33% had to repeat a year. Twenty-five percent of the children complained of nightmares involving the events of the accident. Chronic pain despite solid union was found in 30% of patients. Forty percent of those surveyed (7 grade III fractures) complained of a limp. The low incidence of soft tissue complications and infections in the study population supports applying in children the same basic soft tissue management principles of open fracture treatment as used in adults. While bone stabilization options are limited in children, the rate of successful union without adjunctive bone grafting is much higher than that of adults treated under similar protocols. Routine early iliac crest bone grafting is unnecessary. The prevalence of gait abnormality despite fracture union should be taken into account during the patient's rehabilitation. The extensive time missed from school and resulting

  11. Evaluation of Patellar Position before and After Medial Opening Wedge High Tibial Osteotomy: Radiographic and Computed Tomography Findings

    PubMed Central

    Moghtadaei, Mehdi; Otoukesh, Babak; Bodduhi, Bahram; Ahmadi, Keyvan; Yeganeh, Ali

    2016-01-01

    Introduction: Genovarum is a common orthopedic problem. Its optimal prompt treatment is an issue of importance. Aim: This study was conducted to determine the radiographic changes in patella bone before and after open wedge high tibial osteotomy. Material and Methods: In this quasi-experimental study, 43 patients were enrolled and underwent open wedge high tibial osteotomy and the radiographic and CT-scan indices including Q-Angle, Congruence Angle, Insall-Salvati index, and TTTG were measured and compared before and after surgery. Results: The result revealed that all indices including Q-Angle, Congruence Angle, Insull-Salvati index, and TTTG were not significantly differed across the study (P > 0.05). There was no difference between DLFA values before and after the operation (P> 0.05), while MPTA values were significantly different before and after operation (p <0.001). Conclusions: Totally it may be concluded that imaging indices are not differed after open wedge high tibial osteotomy and monitoring for them is not necessary and they would have no prognostic role. PMID:27703292

  12. A Rare Combination Open Fracture Dislocation of Elbow with Open Fracture both Bones Forearm with Radial Nerve Palsy

    PubMed Central

    Shivanna, Deepak; Aski, Bahubali; Manjunath, Dayanand; Bhatnagar, Abhinav

    2014-01-01

    Introduction: The injury pattern of open fracture dislocation of elbow with fracture both bones forearm with radial nerve injury is very rare. Very few reports are there in literature related to this kind of injury. However this combination is first of its kind. This rare injury needs special attention by early intervention and biological fixation to achieve good results. Case Report: A 22 year old female presented to us with history of road traffic accident. On evaluation patient had combination of open fracture dislocation of elbow with open diaphyseal fracture of both forearm bones with radial nerve palsy. The patient was treated in emergency and followed for 2 years. Conclusion: Open fracture dislocation of elbow is a rare entity. Our case additionally had open fracture both the bones forearm with radial nerve palsy. Early intervention and biological fixation with minimal invasion gives good results in terms of range of movements and patient satisfaction. PMID:27298951

  13. The management of tibial fracture non-union using the Taylor Spatial Frame.

    PubMed

    Khunda, A; Al-Maiyah, M; Eardley, W G P; Montgomery, R

    2016-12-01

    We reviewed 40 complex tibial non-unions treated with Taylor Spatial Frames. 39 healed successfully. Using the ASAMI scoring, we obtained 33 excellent, 5 good, 1 fair and 1 poor bone results. The functional results were excellent in 29 patients, good in 8, fair in two and poor in one. Mean patient satisfaction score was 95%. All but one patient would have the same treatment again. 28 of the 36 patients in work when injured, returned to work at the time of their final review. Four patients had an adverse event requiring significant intervention. Average treatment cost was approximately £26,000/patient.

  14. Improvement of the knee center of rotation during walking after opening wedge high tibial osteotomy.

    PubMed

    Kim, Kyungsoo; Feng, Jun; Nha, Kyung Wook; Park, Won Man; Kim, Yoon Hyuk

    2015-06-01

    Accurate measurement of the center of rotation of the knee joint is indispensable for prediction of joint kinematics and kinetics in musculoskeletal models. However, no study has yet identified the knee center of rotations during several daily activities before and after high tibial osteotomy surgery, which is one surgical option for treating knee osteoarthritis. In this study, an estimation method for determining the knee joint center of rotation was developed by applying the optimal common shape technique and symmetrical axis of rotation approach techniques to motion-capture data and validated for typical activities (walking, squatting, climbing up stairs, walking down stairs) of 10 normal subjects. The locations of knee joint center of rotations for injured and contralateral knees of eight subjects with osteoarthritis, both before and after high tibial osteotomy surgery, were then calculated during walking. It was shown that high tibial osteotomy surgery improved the knee joint center of rotation since the center of rotations for the injured knee after high tibial osteotomy surgery were significantly closer to those of the normal healthy population. The difference between the injured and contralateral knees was also generally reduced after surgery, demonstrating increased symmetry. These results indicate that symmetry in both knees can be recovered in many cases after high tibial osteotomy surgery. Moreover, the recovery of center of rotation in the injured knee was prior to that of symmetry. This study has the potential to provide fundamental information that can be applied to understand abnormal kinematics in patients, diagnose knee joint disease, and design a novel implants for knee joint surgeries.

  15. Synkinematic quartz cementation in partially open fractures in sandstones

    NASA Astrophysics Data System (ADS)

    Ukar, Estibalitz; Laubach, Stephen E.; Fall, Andras; Eichhubl, Peter

    2014-05-01

    Faults and networks of naturally open fractures can provide open conduits for fluid flow, and may play a significant role in hydrocarbon recovery, hydrogeology, and CO2 sequestration. However, sandstone fracture systems are commonly infilled, at least to some degree, by quartz cement, which can stiffen and occlude fractures. Such cement deposits can systematically reduce the overall permeability enhancement due to open fractures (by reducing open fracture length) and result in permeability anisotropies. Thus, it is important to identify the factors that control the precipitation of quartz in fractures in order to identify potential fluid conduits under the present-day stress field. In many sandstones, quartz nucleates syntaxially on quartz grain or cement substrate of the fracture wall, and extends between fracture walls only locally, forming pillars or bridges. Scanning electron microscope cathodoluminescence (SEM-CL) images reveal that the core of these bridges are made up of bands of broken and resealed cement containing wall-parallel fluid inclusion planes. The fluid inclusion-rich core is usually surrounded by a layer of inclusion-poor clear quartz that comprises the lateral cement. Such crack-seal textures indicate that this phase was precipitating while the fractures were actively opening (synkinematic growth). Rapid quartz accumulation is generally believed to require temperatures of 80°C or more. Fluid inclusion thermometry and Raman spectroscopy of two-phase aqueous fluid-inclusions trapped in crack-seal bands may be used to track the P-T-X evolution of pore fluids during fracture opening and crack-seal cementation of quartz. Quartz cement bridges across opening mode fractures in the Cretaceous Travis Peak Formation of the tectonically quiescent East Texas Basin indicate individual fractures opened over a 48 m.y. time span at rates of 16-23 µm/m.y. Similarly, the Upper Cretaceous Mesaverde Group in the Piceance Basin, Colorado contains fractures that

  16. Malocclusion after open reduction of midfacial fracture: a case report

    PubMed Central

    2017-01-01

    Malocclusion is a serious complication of open reduction surgery for facial fractures. It is often caused by the lack of adequate consideration for the occlusal relationship before the trauma and intermaxillary fixation during the operation. This is a case report of postoperative malocclusion that occurred in a patient with a midfacial complex fracture. PMID:28280712

  17. A biomechanical comparison of the antegrade inserted universal femoral nail with the retrograde inserted universal tibial nail for use in femoral shaft fractures.

    PubMed

    Frankle, M; Cordey, J; Sanders, R W; Koval, K; Perren, S M

    1999-01-01

    Femoral shaft fractures with and without bony contact were simulated in cadaver specimens fixed with one of two different types of intramedullary locked nail systems; conventional antegrade nail fixation of the femur with the universal AO femoral nail or retrograde insertion in the femur with the universal tibial nail (a smaller diameter slotted nail) were utilized. Mechanical testing simulated one leg stance, and resultant deformation was measured in bending, torsion, and shortening. In stable fractures, fracture stability was similar to both devices, while in unstable fractures, the larger femoral nail was more stable. Furthermore, the simulation of single leg stance led to a coupled deformation of varus bending, axial shortening, and external rotation, which was dependent on bone geometry.

  18. Elastic suture (shoelace technique) for fasciotomy closure after treatment of compartmental syndrome associated to tibial fracture.

    PubMed

    Branco, Paulo Sergio Martins Castelo; Cardoso Junior, Mauricio; Rotbande, Isaac; Ciraudo, José Antonio Fraga; Silva, Celso Ricardo Correa de Melo; Leal, Paulo Cesar Dos Santos

    2017-01-01

    This article reports the use of elastic suture as an adjuvant in surgical wound closure caused by decompressive fasciotomy after compartment syndrome associated with a compound fracture of the tibia. Widely used in other medico-surgical specialties, this technique is unusual in orthopedics surgery, but the simplicity of the procedure and the successful outcome observed in this case allows for its consideration as indicated for situations similar to that presented in this study.

  19. Complications and Short-Term Outcomes of Medial Opening Wedge High Tibial Osteotomy Using a Locking Plate for Medial Osteoarthritis of the Knee

    PubMed Central

    Seo, Seung-Suk; Kim, Ok-Gul; Seo, Jin-Hyeok; Kim, Do-Hoon; Kim, Youn-Gu; Lee, In-Seung

    2016-01-01

    Purpose The purpose of this study was to investigate complications and radiologic and clinical outcomes of medial opening wedge high tibial osteotomy (MOWHTO) using a locking plate. Materials and Methods This study reviewed 167 patients who were treated with MOWHTO using a locking plate from May 2012 to June 2014. Patients without complications were classified into group 1 and those with complications into group 2. Medical records, operative notes, and radiographs were retrospectively reviewed to identify complications. Clinically, Oxford Knee score and Knee Injury and Osteoarthritis Outcome score (KOOS) were evaluated. Results Overall, complications were observed in 49 patients (29.3%). Minor complications included lateral cortex fracture (15.6%), neuropathy (3.6%), correction loss (2.4%), hematoma (2.4%), delayed union (2.4%), delayed wound healing (2.4%), postoperative stiffness (1.2%), hardware irritation (1.2%), tendinitis (1.2%), and hardware failure without associated symptoms (0.6%). Major complications included hardware failure with associated symptoms (0.6%), deep infection (0.6%), and nonunion (0.6%). At the first-year follow-up, there were no significant differences in radiologic measurements between groups 1 and 2. There were no significant differences in knee scores except for the KOOS pain score. Conclusions Our data showed that almost all complications of the treatment were minor and the patients recovered without any problems. Most complications did not have a significant impact on radiologic and clinical outcomes. PMID:27894176

  20. PCL rupture tibial avulsion in a contact athlete teen with open physis. One case presentation and literature review

    PubMed Central

    Larrain, Mario; Rocco, Eduardo Di; Riatti, Patricio; Ferreyra, Facundo; Cianciosi, Juan Sebastián

    2017-01-01

    Introduction: Given the infrequency and lack of consensus in the treatment of children and adolescents with these injuries, we decided to write this report with the aim of present a case of PCL tibial avulsion in a contact athlete teen with open physis and a review of the literature published. Materials and Methods: RF.male, 13 years, rugby, suffers French tackle and fall on knees flexed. 3 months post-trauma consultation with left knee pain, joint fluid and sport limitation. Whidout instability but "not feeling well". The posterior drawer test + + / ++++, gravitational test +. Rx posterior drawer: 8mm difference between the two nenes. MRI: tibial avulsion PCL. We interpreted as symptomatic PCL injury in athletes, surgery (arthroscopy + posterior approach) is decided reintegration of chondral fragment in 1 time P.OP: no load 4 Weeks . plaster wedge extension 6 weeks, then 3 months and passive immobilizer progressive mobility. Results: 0-90 mobility achieving in 8th week. The 3rd month drawer rx 4mm. MRI posterior translation of the 4th month reintegration of LCP with anchor . 6ª month later minimally elongated drawer with stop net. 11th month continuous strengthening recrearional and sports activities. Discussion and Conclusion: Most avulsion of PCL in patients with open physis probably be for greater strength and endurance ligament compared with the phisis and bone at this age. We suspected in patients with vague knee pain, with or without instability, history of trauma and normal Rx a correct examination and MRI to be essential for diagnosis. We beleave that athletes with open physis, because of the risk of joint degeneration, surgery is justified to restore kinematics, prevent osteoarthritis and resume activity prior to the injury.

  1. Comparison of theoretical fixation stability of three devices employed in medial opening wedge high tibial osteotomy: a finite element analysis

    PubMed Central

    2014-01-01

    Background Medial open wedge high tibial osteotomy is a well-established procedure for the treatment of unicompartmental osteoarthritis and symptomatic varus malalignment. We hypothesized that different fixation devices generate different fixation stability profiles for the various wedge sizes in a finite element (FE) analysis. Methods Four types of fixation were compared: 1) first and 2) second generation Puddu plates, and 3) TomoFix plate with and 4) without bone graft. Cortical and cancellous bone was modelled and five different opening wedge sizes were studied for each model. Outcome measures included: 1) stresses in bone, 2) relative displacement of the proximal and distal tibial fragments, 3) stresses in the plates, 4) stresses on the upper and lower screw surfaces in the screw channels. Results The highest load for all fixation types occurred in the plate axis. For the vast majority of the wedge sizes and fixation types the shear stress (von Mises stress) was dominating in the bone independent of fixation type. The relative displacements of the tibial fragments were low (in μm range). With an increasing wedge size this displacement tended to increase for both Puddu plates and the TomoFix plate with bone graft. For the TomoFix plate without bone graft a rather opposite trend was observed. For all fixation types the occurring stresses at the screw-bone contact areas pulled at the screws and exceeded the allowable threshold of 1.2 MPa for at least one screw surface. Of the six screw surfaces that were studied, the TomoFix plate with bone graft showed a stress excess of one out of twelve and without bone graft, five out of twelve. With the Puddu plates, an excess stress occurred in the majority of screw surfaces. Conclusions The different fixation devices generate different fixation stability profiles for different opening wedge sizes. Based on the computational simulations, none of the studied osteosynthesis fixation types warranted an intransigent full

  2. Pediatric open elbow dislocation without fracture: A case report

    PubMed Central

    Polat, Gökhan; Karademir, Gökhan; Akgül, Turgut; Ceylan, Hasan Hüseyin

    2014-01-01

    INTRODUCTION Elbow dislocations in children are rare injuries. These injuries are often in the form of complex injuries that is accompanied by the median nerve damage and medial epicondyle fracture in the pediatric age group. Open elbow dislocation without fracture in the pediatric age group has been reported very rarely in the literature. PRESENTATION OF CASE The purpose of this study is to present an 8-year-old patient who has open elbow dislocation without fracture accompanying with brachial artery injury. In the clinical examination of the patient, there was an open wound in the transverse antecubital region. After repair of brachial artery injury, open reduction was performed under general anesthesia. In the postoperative clinical examination at 6 months, left elbow flexion was 140°, extension was full and there were no deficit in the supination and pronation of the forearm. DISCUSSION Elbow dislocation without fracture in pediatric patients is a very rare injury. Usually the trauma mechanism of elbow dislocation is falling on outstretched hand with elbow in approximately 30° of flexion. However our patient had fallen on outstretched hand with elbow in full extension. Although this type of trauma mechanism is typical for supracondylar humerus fractures in pediatric age group, in our patient an open posterior elbow dislocation without fracture had occurred. CONCLUSION Pediatric elbow dislocations are rare injuries and the management of these injuries can be technically demanding due to concurrent neurovascular injuries. An open dislocation without fracture is very rare and it should be treated with immediate intervention, an effective teamwork and good rehabilitation. PMID:25460475

  3. Opening-wedge osteotomy, allografting with dual buttress plate fixation for severe genu recurvatum caused by partial growth arrest of the proximal tibial physis: a case report.

    PubMed

    Chen, Liang-Chin; Chan, Yi-Sheng; Wang, Ching-Jen

    2004-07-01

    Injuries to the proximal tibial physis are among the least common epiphyseal injuries. We present a case of severe genu recurvatum deformity (45 degrees) with leg length discrepancy (4 cm) following a neglected proximal tibial physeal injury incurred 6 years previously. The 16-year-old patient was successfully treated by open-wedge osteotomy, allograft reconstruction, and dual buttress plate fixation. At 3 years' follow-up, the patient was asymptomatic, fully active with a full range of motion (0 - 140 degrees) of the leg, and equal leg lengths. There were no signs of genu recurvatum clinically.

  4. Treatment of Pediatric Open Supracondylar Humerus Fractures: Case Report

    PubMed Central

    Al-Sadek, Tabet A.; Niklev, Desislav; Al-Sadek, Ahmed

    2016-01-01

    BACKGROUND: Open supracondylar fractures of the humerus are rare in children, and the treatment strategy for these fractures is yet to be standardised. AIM: We present the case of a 7-year-old boy with open supracondylar humerus fracture that was managed with an external wrist fixator. CASE PRESENTATION: A 7-year-boy was brought to our department with pain in the right arm after a fall from a height about 3 hours before admission. On examination, the elbow was found to be markedly swollen with restriction of movement of the right arm. A 4-cm-wide wound was also observed on the flexural aspect of the elbow, indicating severe contamination of the fractured site. Neurological examination revealed restriction of hand movement and decreased sensations, which suggested the possibility of nerve injuries. CONCLUSION: A good clinical outcome was achieved in this case, without the development of any complications over a 6-month follow-up period. PMID:28028413

  5. Management of Osteoarthritis Knee by Graduated Open Wedge High Tibial Osteotomy in 40-60 Years Age Group Using Limb Reconstruction System: A Clinical Study

    PubMed Central

    Sharma, Pawan Kumar; Chugh, Ankush; Singh, Randhir

    2015-01-01

    Background With i ncrease in elderly population, osteoarthritis has become major concern nowadays. Knee joint is most commonly affected joint. A number of methods have been developed in the last few years which help in treating the osteoarthritis knee, which includes non pharmacological, pharmacological and surgical methods. Among the most promising techniques with renewed interest for osteoarthritis knee with deformity is the use of high tibial osteotomy. Uni-compartmental osteoarthritis knee with deformity especially in relatively younger age group (less than 60 years) constitutes the main indication. Aim The aim of present study was to evaluate management of osteoarthritis knee by graduated open wedge high tibial osteotomy in 40-60 years age group using limb reconstruction system. Materials and Methods Medial Opening Wedge High Tibial Osteotomy leaving the lateral cortex intact which acts as a hinge, was done in 30 patients and stabilized by Limb Reconstruction System. Distraction was started at 7th day at the rate of 1 mm/day and continued till proper alignment was achieved. Results Medial Opening Wedge High Tibial Osteotomy stabilized by unilateral external fixator is a good method for unicompartmental osteoarthritis knee with deformity as it gives precise control over final limb alignment and its ability to perform a residual correction. Deformity correction can be quantified at the time of correction as it is not acute correction. Gradual deformity correction can be done over time by distraction histogenesis with the help of unilateral external fixator. It is also a good method in young patients requiring large correction. Conclusion Medial Opening Wedge High Tibial Osteotomy is having many benefits over closed wedge osteotomy and stabilization by unilateral external fixator also has its added benefits. It is less invasive, no internal hardware present and safer in terms of neurovascular complications. PMID:26557580

  6. 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

  7. Unusual Foreign Bone Fragment in Femoral Open Fracture

    PubMed Central

    Sadoni, Hanon; Arti, Hamidreza

    2016-01-01

    Introduction: Femoral shaft fracture is one of the typical bone fractures due to high energy trauma and may occur as an open fracture. Some foreign materials may enter the fracture site such as sand, cloth particles and so on. Case Presentation: A 28-year-old motorcycle riding military member and his collaborator were received in the hospital because of multiple traumas due to a fall in a hollow during a surveillance mission. His collaborator died because of head trauma and multiple severe open fractures. When fixing the patients femoral fracture, a large femoral butterfly fragment was removed from the patient’s thigh as a foreign segment. The patient’s femur was fixed with a plate and screws. No femoral defect was detected during surgery or post-operative X-rays and CT scan. The removed segment was not a part of the patient’s femur. Conclusions: Surgical and post-surgical findings showed that this segment was not related to the patient’s femur. The foreign segment may have belonged to the other victim of this trauma. PMID:27218050

  8. [The mathematical modeling of the injurious impact on the tibial bone for the evaluation of the conditions leading to its fracture].

    PubMed

    Leonov, S V; Pinchuk, P V; Krupin, K N; Panfilov, D A

    2017-01-01

    We have undertaken the mathematical modeling of the process associated with the destruction of the diaphyseal and proximal epiphyseal parts of the tibial bone by means of the finite element analysis. The main emphasis was laid on the elucidation of the topography of force stresses in the model bone. It was shown that loading the upper third of the bone either along its axis or perpendicular to the surface (i.e. in the region formed largely by the cancellous tissue) results in the depressed fracture at the site of the impact. Loading of the mid-third region of the bone (characterized by the predominance of the compact tissue) under the same conditions led to the transverse fracture originating from the side opposite to the impact application site.

  9. Complications of open reduction and internal fixation of ankle fractures.

    PubMed

    Leyes, Manuel; Torres, Raúl; Guillén, Pedro

    2003-03-01

    This article discusses the complications after open reduction and internal fixation of ankle fractures. Complications are classified as perioperative (malreduction, inadequate fixation, and intra-articular penetration of hardware), early postoperative (wound edge dehiscence, necrosis, infection and compartment syndrome), and late (stiffness, distal tibiofibular synostosis, degenerative osteoarthritis, and hardware related complications). Emphasis is placed on preventive measures to avoid such complications.

  10. 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.

  11. Results of a fracture liaison service on hip fracture patients in an open healthcare system.

    PubMed

    Cosman, Felicia; Nicpon, Kathleen; Nieves, Jeri W

    2017-04-01

    We assessed osteoporosis management in patients admitted for rehabilitation of acute hip fracture to an open system community hospital before and after institution of a fracture liaison service (FLS). Pre-FLS, we surveyed 60 patients 4-6 months after hip fracture. Subsequently, the FLS program performed routine consultations, and recommended lab, bone density testing (BMD) and osteoporosis medication. FLS program outcomes were assessed by survey in 75 patients after hip fracture. In the pre-FLS population, after hip fracture, 55 % changed calcium intake, 48 % changed vitamin D intake, and 35 % obtained a BMD. Osteoporosis medication was taken by 38 % before and 33 % after hip fracture. Post-FLS, 56 % changed calcium intake, 68 % changed vitamin D intake and 65 % obtained a BMD. Post-FLS, osteoporosis medication was taken by 21 % of patients before and 19 % after hip fracture. Our FLS program in hip fracture patients improved non-pharmacologic measures, but not the use of osteoporosis medication.

  12. The effect of the association of NIR laser therapy BMPs, and guided bone regeneration on tibial fractures treated with wire osteosynthesis: Raman spectroscopy study.

    PubMed

    Lopes, C B; Pacheco, M T T; Silveira, L; Duarte, J; Cangussú, M C T; Pinheiro, A L B

    2007-12-14

    Bone fractures are lesions of different etiology; may be associated or not to bone losses; and have different options for treatment, such as the use of biomaterials, guided bone regeneration, techniques considered effective on improving bone repair. Laser therapy has also been shown to improve bone healing on several models. The association of these three techniques has been well documented by our group using different models. This study aimed to assess, through Raman spectroscopy, the incorporation of calcium hydroxyapatite (CHA approximately 958 cm(-1)) on the repair of complete tibial fractures in rabbits treated with wire osteosynthesis (WO); treated or not with laser therapy; and associated or not with the use of BMPs and/or Guided Bone Regeneration. Complete tibial fractures were created in 12 animals that were divided into four groups: WO; WO+BMPs; WO+laser therapy; and WO+BMPs+laser therapy. Irradiation started immediately after surgery; was repeated at every other day during 2 weeks; and was carried out with lambda 790 nm laser light (4 J/cm(2) per point, 40 mW, phi approximately 0.5 cm(2), 16J per session). Animal death occurred after 30 days. Raman spectroscopy was performed at both the surface and the depth of the fracture site. Statistical analysis showed significant difference on the concentrations of CHA between surface and depth. The analysis in each of the areas showed at the depth of the fracture significant differences between all treatment groups (p<0.0001). Significant differences were also seen between WO+BMPs+laser therapy and WO (p<0.001) and WO+laser therapy (p<0.001). At the surface, significant difference was seen only between the treatment groups and the non-fractured subjects (p=0.0001). However, no significant difference was seen between the treatment groups (p=0.14). It is concluded that the use of NIR laser therapy associated to BMPs and GBR was effective in improving bone healing on the fractured bones as a result of the increasing

  13. Locking versus Non-locking Neutralization Plates with Limited Excision and Internal Fixation for Treatment of Extra-articular Type a Distal Tibial Fractures

    PubMed Central

    Zhou, Kai-hua; Chen, Nong

    2017-01-01

    Purpose: This study aimed to compare the clinical, radiologic, and cost-effectiveness results between locking and non-locking plates for the treatment of extra-articular type A distal tibial fractures. Methods: We performed a retrospective review of AO/OTA 42-A1, A2 distal tibial fractures treated by plates from January 2011 to June 2013. Patients were divided to the locking plate group or the non-locking plate group. Clinical outcomes, radiographic outcomes, and hospitalization fee were compared between the two plates groups. Results: 28 patients were treated with a locking plate and 23 patients were treated with a non-locking plate. The mean follow-up was 18.8 months (12-23 months). There were no significant differences between the groups in surgical time, bleeding, bone union time, or AOFAS scores. The cost of the locking plate was ¥24,648.41 ± 6,812.95 and the cost of the non-locking plate was ¥11,642 ± 3,162.57, p < 0.001. Each group had one patient that experienced superficial infection these wounds were readily healed by oral antibiotics and dressing changes. To date, five patients in the locking group and ten patients in the non-locking group had sensations of metal stimulation or other discomfort (X2 = 3.99, p < 0.05) Until the last follow-up, 14 patients in the locking plate group and 18 patients in the non-locking plate group had their plates removed or wanted to remove their plates (X2 = 4.31, p < 0.05). Conclusion: The use of locking or non-locking plates provides a similar outcome in the treatment of distal fractures. However the locking plate is much more expensive than the non-locking plate.

  14. 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

  15. Does the Zone of Injury in Combat-Related Type III Open Tibia Fractures Preclude the Use of Local Soft Tissue Coverage?

    DTIC Science & Technology

    2010-11-01

    procedure. J Bone Joint Surg Am. 2001;83:239 246. 6. Burgess AR, Poka A, Brumback RJ , et al. Management of open grade III tibial fractures. Orthop Clin...extremities with failed free flaps: a single institution’s experience over 25 years. Ann Plast Surg. 2007;59:18 21. 19. Fix RJ , Vasconez LO...of lower extremity defects: anatomic considerations. Surg Clin North Am. 1974;54:1337 1354. 22. Shepherd LE, Costigan WM, Gardocki RJ , et al. Local or

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

    DTIC Science & Technology

    2007-08-15

    Escherichia coli 2 1 Stenotrophomonas maltophilia 1 0 Unknown 1 0 Gram-positive Coagulase-negative staphylococci 3 7 Enterococcus species 3 0 MSSA 2b 5...aeruginosa (6) Amputation (9)c 8 25 (M, IIIb) CoNS ( Escherichia coli and En- terobacter species recovered from broth) (30) Imipenem-cilastatin (2...nonunion wound; this organisim was a methicillin- resistant Staphylococcus aureus strain that was inadvertently not treated. Five of 35 patients

  17. 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.

  18. Utilizing reamer irrigator aspirator (RIA) autograft for opening wedge high tibial osteotomy: A new surgical technique and report of three cases☆

    PubMed Central

    Seagrave, Richard A.; Sojka, John; Goodyear, Adam; Munns, Stephen W.

    2013-01-01

    INTRODUCTION The lateral closing wedge high tibial osteotomy (HTO) was popularized by Coventry in the 1960s. In the 1990s the medial opening wedge osteotomy gained popularity because it could achieve greater valgus correction and it did not require dissociation of the fibula from the tibia, an important consideration when treating varus knees with lateral and posterolateral ligament deficiencies (Noyes’ double-varus and triple-varus knees). However, it has the disadvantage of requiring bone graft to fill bony defects. Recently, the reamer-irrigator-aspirator (RIA; Synthes, Paoli, PA) system was developed, and as a result of this procedure, a large amount of usable autogenous bone graft can be collected safely for use. To our knowledge, there is no published series combining opening wedge HTO with the use of RIA obtained autogenous bone graft. PRESENTATION OF CASE We present a novel technique in which a series of three patients underwent opening wedge HTO using ipsilateral, retrograde femur RIA graft to fill the bone defect. All patients had satisfactory clinical and radiologic outcomes following the new technique at latest follow up. DISCUSSION Opening wedge high tibial osteotomy is a well-documented and accepted orthopedic procedure, however, has the disadvantage of requiring varying amounts of bone graft. Traditionally, iliac crest or tricortical allograft have been the grafting modalities of choice, however both have inherent drawbacks to their use. In our series, the use of RIA autograft is a safe and reliable harvest technique for high tibial osteotomy, providing abundant and quality autogenous bone graft. CONCLUSION All three of our patients achieved radiographic union with high clinical patient satisfaction without any major complications. We feel this novel technique is a safe and acceptable operative solution grafting opening wedge osteotomies about the knee. PMID:24412805

  19. [Arterial injuries combined with open fractures--management and therapy].

    PubMed

    Gäbel, G; Pyrc, J; Hinterseher, I; Zwipp, H; Saeger, H-D; Bergert, H

    2009-08-01

    Vascular injuries are an uncommon finding. In times of peace vascular injuries occur in approximately 1-4 % during traffic accidents. Especially challenging is the treatment of open fractures combined with arterial lesions. These fractures are usually accompanied with severe soft tissue damage and injuries to neurological structures. The overall prognosis of these trauma patients is dependent on fast and sufficient diagnostics and therapy. In particular, for unstable patients time-consuming diagnostics can be dispensed and a primarily operative therapy should be targeted. Vascular reconstruction by direct suture is sometimes only possible with interposition and should be the primary goal. Interposition should be performed with autologous vein material because of the high risk of infection. Here we demonstrate on the basis of our patients the interdisciplinary -management of such trauma patients in our hospital.

  20. Reconstruction and anticipatory Langenskiöld procedure in traumatic defect of tibial medial malleolus with type 6 physeal fracture.

    PubMed

    Abbo, Olivier; Accadbled, Frank; Laffosse, Jean-Michel; De Gauzy, Jérome Sales

    2012-09-01

    Traumatic osteoarticular or ligament defect of the tibial medial malleolus is a rare entity in children. Associated lesions may include soft tissue and joint defect, subsequent instability of the ankle, and growth arrest. We report here, the case of an 11-year-old boy, a victim of a severe trauma to the ankle, managed by an original technique. It combined a reconstruction by a composite iliac crest and gluteal fascia graft, an anticipatory Langenskiold procedure, and a serratus anterior muscle flap. This original technique proved to be a suitable alternative in this type of trauma.

  1. Rupture traumatique du tendon tibial postérieur survenue lors d'une fracture fermée de la cheville: à propos d'un cas

    PubMed Central

    Karabila, Mohamed Amine; Azouz, Mohamed; Mhamdi, Younes; Hmouri, Ismail; Kharmaz, Mohamed; Bardouni, Ahmed; Lahlou, Abdou; Mahfoud, Mustapha; Berrada, Mohamed Saleh

    2015-01-01

    Nous rapportons le cas d'une rupture post-traumatique du tendon tibial postérieur survenue lors d'une fracture bimalléolaire de la cheville. Le diagnostic a été posé lors de l'intervention chirurgicale. La réparation du tendon, non dégénératif, a été réalisée en même temps que l'ostéosynthèse. Bien que rare, cette possibilité de lésion tendineuse lors des fractures de la cheville ne doit pas êtreoubliée. Des douleurs résiduelles, un déficit de l'inversion active du pied, une modification de l'arche médiane du pied et à terme une évolution vers un pied plat valgus doivent faire évoquer rétrospectivement le diagnostic. PMID:27022431

  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. 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.

  4. Outcomes Following Operative Treatment of open Fractures of the Distal Radius: A Case Control Study

    PubMed Central

    MacKay, Brendan J; Montero, Nicole; Paksima, Nader; Egol, Kenneth A

    2013-01-01

    Purpose To report radiographic, clinical, and patient-based functional outcomes following contemporary operative treatment of patients who sustained an open distal radius fracture and compare them to a similar group of patients treated operatively for closed distal radius fractures. Methods Over five years, 601 patients with a distal radius fracture presented to our academic medical center, including one Level 1 trauma hospital, and were prospectively enrolled in an upper extremity trauma database. Patients with open distal radius fractures underwent irrigation, debridement, and operative fixation within 24 hours of presentation. Closed distal radius fractures requiring operative fixation were treated electively. Retrospective review of the database identified eighteen open fractures of the distal radius (11 type I, 6 type II, 1 type IIIa). The open fracture patients were individually matched with eighteen closed distal radius fracture patients who underwent surgical fixation based on age, sex, injury to dominant extremity, fracture pattern, and method of fracture fixation. Clinical, radiographic, patient- based functional outcomes, and complications were recorded at routine postoperative intervals. Results Follow-up was greater than 77% in both groups at all time points. The open and closed groups were similar in regards to age, gender, BMI, race, tobacco use, income, employment status, hand dominance, injury to dominant extremity, mechanism of injury, fracture classification, method of fracture fixation, and presence of concomitant injury. Postoperative complications and reoperation rates were similar between the open and closed groups. Union rates and radiographic alignment one year postoperatively were similar between the open and closed fracture groups. At final follow-up, range of motion parameters, grip strengths, DASH indices, and subjective pain scores were similar between both groups. Discussion Open distal radius fractures treated with early debridement

  5. Comparison of clinical and radiological outcomes between opening-wedge and closing-wedge high tibial osteotomy: A comprehensive meta-analysis

    PubMed Central

    Wu, Lingfeng; Lin, Jun; Jin, Zhicheng; Cai, Xiaobin; Gao, Weiyang

    2017-01-01

    High tibial osteotomy (HTO) has been widely used for clinical treatment of osteoarthritis of the medial compartment of the knee, and both opening-wedge and closing-wedge HTO are the most commonly used methods. However, it remains unclear which technique has better clinical and radiological outcomes in practice. To systematically evaluate this issue, we conducted a comprehensive meta-analysis by pooling all available data for the opening-wedge HTO and closing-wedge HTO techniques from the electronic databases including PubMed, Embase, Wed of Science and Cochrane Library. A total of 22 studies encompassing 2582 cases were finally enrolled in the meta-analysis. There was no significant difference regarding surgery time, duration of hospitalization, knee pain VAS, Lysholm score and HSS knee score (clinical outcomes) between the opening-wedge and closing-wedge HTO groups (P > 0.05). However, the opening-wedge HTO group showed wider range of motion than the closing-wedge HTO group (P = 0.003). Moreover, as for Hip-Knee-Ankle angle and mean angle of correction, no significant difference was observed between the opening-wedge and closing-wedge HTO groups (P > 0.05), while the opening-wedge HTO group showed greater posterior tibial slope angle (P < 0.001) and lesser patellar height than the closing-wedge HTO group (P < 0.001). On light of the above analysis, we believe that individualized surgical approach should be introduced based on the clinical characteristics of each patient. PMID:28182736

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

    PubMed Central

    Patil, Mahantesh Yellangouda; Gupta, Srinath Myadam; Agarwal, Saumya; Chandarana, Vishal

    2016-01-01

    Introduction 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. Aim To determine the efficacy of Limb Reconstruction System for treatment of compound tibia fractures. Materials and Methods 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. Results 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. Conclusion LRS is an easy, simple and definitive surgical procedure that allows immediate full weight bearing walking. It reduces hospital stay, is cost effective with

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

    PubMed

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

    2011-12-01

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

  8. 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 ...

  9. Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation: A retrospective analysis of 15 cases

    PubMed Central

    Sharma, Naveen; Singh, Varun; Agrawal, Ashish; Bhargava, Rakesh

    2015-01-01

    Background: Proximal tibia fractures with compartment syndrome present a challenge for orthopedic surgeons. More often than not these patients are subjected to multiple surgeries and are complicated by infection osteomyelitis and poor rehabilitation. There is no consensus in the management of these fractures. Most common mode is to do early fasciotomy with external fixation, followed by second stage definitive fixation. We performed a retrospective study of proximal tibia fractures with impending compartment syndrome treated by single stage fasciotomy and internal fixation. Results in terms of early fracture union, minimum complications and early patient mobilization were very good. Materials and Methods: Fifteen patients who were operated between July 2011 and June 2012 were selected for the study. All documents from their admission until the last followup in December 2013 were reviewed, data regarding complications collected and results were evaluated using Oxford Knee scoring system. Results: At the final outcome, there was anatomical or near anatomical alignment with no postoperative problems with range of motion of near complete flexion (>120) in all patients within 3 months. 13 patients started full weight bearing walking at 3 months. Delayed union in two patients and skin necrosis in one patient was observed. Conclusions: Since the results are encouraging and the rehabilitation time is much less when compared to conventional approaches, it is recommended using this protocol to perform early fasciotomy with the definitive internal fixation as single stage surgery to obtain excellent followup results and to reduce rehabilitation time, secondary trauma, expense of treatment and infection rate. PMID:26538755

  10. 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.

  11. Clinical efficacy and prognosis factors of open calcaneal fracture: a retrospective study

    PubMed Central

    Zhang, Xuebin; Liu, Yueju; Peng, Aqin; Wang, Haili; Zhang, Yingze

    2015-01-01

    Background: Treatment of open calcaneal fractures remains to be a challenge for orthopaedic surgeons. The aim of this study is to assess factors affecting the treatment results of open calcaneal fractures. Methods: A total of 98 patients who have 101 open calcaneal fractures were recruited in our hospital, they were all treated with a standard protocol based on the appearance of the traumatic wound. Data on mechanism of injury, location and size of wound, classification, fixation methods and subsequent soft-tissue complications were collected and evaluated. AOFAS Ankle-Hindfoot Survey and physical examinations were performed to access outcomes. Results: No statistical difference was found in complication and AOFAS score in open calcaneal fractures treated with different fixation, and no statistical difference was found in AOFAS between gustilo I and II type open calcaneal fractures (P > 0.05). There was significant difference between gustilo I and III type or gustilo II and III type fractures (P < 0.05). The more serious soft tissue injury of open calcaneal fracture lead to the worse outcome and higher incidence of complications obtained. Conclusion: Open calcaneal fractures have a high propensity for soft-tissue complications no matter which fixation method was chose. There was no significant difference between patients who had been treated with different fixations in complication rates. Soft-tissue injury played an important role in outcomes of open calcaneal fractures. Deep infections and osteomyelitis were rare by means of emergency debridement and following repeated debridement. PMID:26064282

  12. Is it possible to predict limb viability in complex Gustilo IIIB and IIIC tibial fractures? A comparison of two predictive indices.

    PubMed

    O'Sullivan, S T; O'Sullivan, M; Pasha, N; O'Shaughnessy, M; O'Connor, T P

    1997-01-01

    The patient with severe lower limb trauma presents a management dilemma; whether to amputate primarily or to attempt limb salvage. In recent years, many predictive indices have been published which purport to identify limbs which are non-viable. We retrospectively applied two recently described indices, the Mangled Extremity Severity Score (MESS) and the Limb Salvage Index (LSI), to 54 limbs in 50 patients with either Gustilo IIIB or IIIC complex tibial fractures. There were 22 amputations (40.7 per cent) in the series. The mean MESS score in the limb salvage group was 3.8 (range 2-10), and the mean MESS score in the amputation group was 7.7 (range 4-13) (P < 0.0001). The mean LSI score in the limb salvage group was 3.6 (range 3-8), and the mean LSI score in the amputation group was 6.9 (P < 0.01). However, in the group with MESS scores > 7 (which recommends amputation), there were three limbs which were salvaged with acceptable functional outcome. Similarly, in those with LSI scores > 6 (which recommends amputation), there were seven limbs successfully salvaged. A MESS > 7 offered a greater relative risk of amputation (9.2) than a LSI score > 6 (5.3). We found both indices of use in predicting limb salvage and functional outcome. However, neither is sufficiently accurate to be considered absolutely reliable in clinical practice.

  13. Use of autologous platelet-rich plasma for a delayed consolidation of a tibial fracture in a young donkey

    PubMed Central

    FAILLACE, Vanessa; TAMBELLA, Adolfo Maria; FRATINI, Margherita; PAGGI, Emanuele; DINI, Fabrizio; LAUS, Fulvio

    2017-01-01

    A 9-month-old filly donkey was referred for a comminuted diaphyseal fracture of the right tibia. Surgical osteosynthesis, with multiple lag screws and a neutralization plate, was performed for anatomical reconstruction. Despite a good gait condition, delayed bone consolidation and a bone gap were evident on follow up radiographic evaluations. Due to delayed healing, autologous platelet-rich plasma (PRP) was injected on the surface of the tibia. Increased bone consolidation was evident on radiographs one month after the PRP injection. Progressive filling of both the fracture lines and bone gap continued during the six-month follow up. Clinical outcome was excellent. Autologous PRP should be considered as a practical adjuvant therapy in bone healing process in donkeys. PMID:28190827

  14. [Operative treatment of pediatric open fractures of the lower limb using the Taylor spatial frame fixator].

    PubMed

    Gessmann, J; Baecker, H; Graf, M; Ozokyay, L; Muhr, G; Seybold, D

    2010-05-01

    The operative management of open fractures of the lower limb requires a consistent treatment to avoid soft tissue complications. Acute angular shortening of the fracture enabling primary soft tissue closure is still an uncommon operative technique because of difficulties in correcting the secondary deformity. The case of a pediatric open fracture of the lower limb (Gustilo type IIIa) is described, which was treated with acute angular shortening followed by gradual correction using the Taylor spatial frame (TSF).

  15. 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.

  16. The treatment of condylar fractures: to open or not to open? A critical review of this controversy

    PubMed Central

    VALIATI, Renato; IBRAHIM, Danilo; ABREU, Marcelo Emir Requia; HEITZ, Claiton; de OLIVEIRA, Rogério Belle; PAGNONCELLI, Rogério Miranda; SILVA, Daniela Nascimento

    2008-01-01

    The treatment of condylar process fractures has generated a great deal of discussion and controversy in oral and maxillofacial trauma and there are many different methods to treat this injury. For each type of condylar fracture, the techniques must be chosen taking into consideration the presence of teeth, fracture height, patient's adaptation, patient's masticatory system, disturbance of occlusal function, deviation of the mandible, internal derangements of the temporomandibular Joint (TMJ) and ankylosis of the joint with resultant inability to move the jaw, all of which are sequelae of this injury. Many surgeons seem to favor closed treatment with maxillomandibular fixation (MMF), but in recent years, open treatment of condylar fractures with rigid internal fixation (RIF) has become more common. The objective of this review was to evaluate the main variables that determine the choice of method for treatment of condylar fractures: open or closed, pointing out their indications, contra-indications, advantages and disadvantages. PMID:18974859

  17. 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 Central

    2014-01-01

    Background 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)). Methods/Design 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. Discussion 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

  18. Ipsilateral distal femoral and proximal tibial epiphyseal growth plate injury: a case report

    PubMed Central

    2013-01-01

    Introduction Both the isolated distal femoral epiphysiolysis and the isolated proximal tibial epiphysiolysis are the least common epiphyseal injuries. Even though they are uncommon, they have a high incidence rate of complications. Case presentation We present a case with Gustilo-Anderson grade 3b open and Salter-Harris type 1 epiphysiolysis of the distal femur and proximal tibia caused by a farm machinery accident. The patient was a 10-year-old boy, treated by open reduction and internal fixation. Conclusion Although distal femoral and proximal tibial growth plate injuries are rarely seen benign fractures, their management requires meticulous care. Anatomic reduction is important, especially to minimize the risk of growth arrest and the development of degenerative arthritis. However, there is a high incidence of growth arrest and neurovascular injury with these type of fractures. PMID:23724954

  19. 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

  20. A trial of measuring the displacement of tibial fragments with pinless external fixator.

    PubMed

    Wu, Jian; Ye, Datian; Wang, Guangzhi; Ding, Haishu

    2005-01-01

    Currently, the mechanical performances of pinless external fixator are primarily evaluated for application to long bone fractures. A new method that detecting the relative displacement changes of the tibial fragments with the pinless external fixator by the three dimensional measurement system was introduced to evaluate the performance of the pinless external fixator. And such testing item was taken as the complement for the mechanical performances of the pinless external fixator. In this paper, a high precision optical 3D measurement system was used to detect the displacement change in the anterior and posterior fracture part of the tibial bones which was fixed by a clamp pattern pinless external fixator in open tibial fractures. Furthermore, the relative displacement change and relative angle rotation were analyzed after obtaining the trajectory of the markers which fixed on the tibial fragments, the results were used to evaluate the stability of the pinless external fixator, and taken as the reference for revising the design of the pinless external fixator as well.

  1. 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

  2. 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

  3. Antegrade Unreamed Locked Intramedullary Nailing in Open Fractures of Shaft of Humerus

    PubMed Central

    Singh, Jasbir; Lal, Mukand; Chandel, Desh Raj

    2016-01-01

    Introduction Open fractures of shaft of humerus have been treated conservatively as well as operatively. Plate osteosynthesis has been considered as the gold standard treatment. Intramedullary nailing also has same success rate in closed fractures. The results of 30 open fractures of shaft humerus fixed with locked unreamed antegrade intramedullary nailing were evaluated. Aim The purpose of the study was to evaluate the role of locked intramedullary nailing in open fractures of shaft humerus in terms of bone union, secondary procedure required, complication, shoulder dysfunction and infection. Materials and Methods Of consecutive 365 humeral shaft fractures, 63 fractures were open. Thirty-two patients were operated with plate osteosynthesis, while 31 patients who were treated with locked unreamed intramedullary nails fulfilling the inclusion criteria entered the study. Results Twenty eight of thirty patients united in mean duration of 10.5 weeks. There were two non-unions both of them united with bone grafting and plate osteosynthesis. Seven patients had superficial infection which healed with antibiotic course, while two patients had deep infection, which healed with repeat debridement. Eleven patients had preoperative radial nerve palsy, nine of which healed completely in average of six months. Twenty eight patients had excellent functional outcome at final follow-up while two patients had good outcome. Conclusion Antegrade nailing is associated with good union rates and low infection rates and is a good option in open fractures and in polytrauma patients. PMID:27790533

  4. Opening-mode fracture in siliceous mudstone at high homologous temperature—effect of surface forces

    NASA Astrophysics Data System (ADS)

    Eichhubl, Peter; Aydin, Atilla; Lore, Jason

    In analogy to high-temperature sintering of ceramics and metal powder compacts, the formation of opening-mode fractures in siliceous mudstone during natural in-situ combustion of hydrocarbons is attributed to contractile surface forces between mineral grains and an interstitial melt phase. A comparison between bulk density increase during sintering and created fracture space indicates that fracturing resulted from contraction of the rock matrix due to porosity reduction, grain-scale mass transfer, and high-temperature mineral formation. It is suggested that contractile surface forces between mineral grains and between mineral grains and pore fluid contribute to subcritical fracture formation under a wide range of subsurface conditions.

  5. The Ilizarov method for the treatment of complex tibial fractures and non-unions in a mass casualty setting: the 2005 earthquake in Pakistan.

    PubMed

    Tilkeridis, Konstantinos; Chari, Basavraj; Cheema, Nusrat; Tryfonidis, Marios; Khaleel, Arshad

    2015-04-01

    We report our experience in treating victims of the recent earthquake disaster in Pakistan. Our experience was based on two humanitarian missions to Islamabad: one in October 2005, 10 days after the earthquake, and the second in January 2006. The mission consisted of a team of orthopaedic surgeons and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov external fixators. We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad. During the first visit, we treated 12 injured limbs in 11 patients. Four of these patients were children. All cases consisted of complex multifragmentary fractures associated with severe crush injuries. All fractures involved the tibia, which were treated with Ilizarov external fixators. Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening. During a second visit, we reviewed all patients treated during our first mission. In addition, we treated 13 new patients with complex non-unions. Eight of these patients were deemed to be infected. All patients had previous treatment with monolateral fixators as well as soft tissue coverage procedures, except one patient who had had an IEF applied by another team. All these patients had revision surgery with circular frames. All patients from both groups were allowed to fully weight-bear post-operatively, after a short period of elevation to allow the flaps to take. Overall, all fractures united except one case who eventually had an amputation. Four patients had a corticotomy and lengthening, and three of them had a successful restoration of limb length. The fourth patient was the one with the eventual amputation.

  6. Primary ankle arthrodesis for neglected open Weber B ankle fracture dislocation.

    PubMed

    Thomason, Katherine; Ramesh, Ashwanth; McGoldrick, Niall; Cove, Richard; Walsh, James C; Stephens, Michael M

    2014-01-01

    Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described.

  7. Single-incision open reduction and internal fixation of comminuted trapezium fractures with distal radius cancellous autograft.

    PubMed

    Matzon, Jonas L; Reb, Christopher W; Danowski, Ryan M; Lutsky, Kevin

    2015-03-01

    Trapezium fractures comprise approximately 3% to 5% of all hand fractures. Although operative management of intra-articular trapezium fractures can result in good functional outcomes, there is very little literature addressing specific operative techniques. We describe a technique for open reduction and internal fixation of severely comminuted, intra-articular trapezium fractures, utilizing autogenous cancellous bone graft from the distal radius.

  8. Is it safe to place a tibial intramedullary nail through a traumatic knee arthrotomy?

    PubMed

    Bauer, Jennifer M; Bible, Jesse E; Mir, Hassan R

    2014-03-01

    We conducted a study to compare postoperative infection and nonunion rates in tibial intramedullary nails (IMNs) placed through either uninjured knees or traumatic knee arthrotomies (KAs). We reviewed all adult tibial diaphyseal fractures (n = 1378) treated with an IMN between 1998 and 2010. Fourteen of these nails were placed through a traumatic KA. Each patient in the study group was assigned 4 separate matched controls for comparison. Controls were matched on age, sex, diabetes, smoking, and fracture classification (closed or open with Gustilo-Anderson). There were no postoperative infections (knee or fracture site) in the traumatic KA group and 2 (3.5%) in the control group (P = .473). One nonunion (7.1%) was noted in the traumatic KA group, and 9 (16%) were noted in the control group (P = .6694). To our knowledge, this is the first study to report outcomes of placing tibial IMNs through traumatic KAs. In our sample, the practice presented no increased risk either for infection (at the knee or the fracture site) or for nonunion with appropriate surgical debridement.

  9. Management of an Open Acetabular Fracture in a Skeletally Immature Patient

    PubMed Central

    Clutter, Sarah Y; Morgan, Steven J; Erickson, Mark; Smith, Wade R; Stahel, Philip F

    2007-01-01

    Background: Open acetabular fractures in children are rare, but potentially devastating injuries. Secondary to the low incidence, there is an apparent lack of reports on appropriate management strategies for open pediatric acetabular fractures in the literature. Methods: Description of a case study. Results: A 3 years and ten months-old girl was ejected as a passenger from an all terrain vehicle. She sustained a displaced, grade IIIA open left anterior column acetabular fracture. The injury was treated by extending the open wound to a formal first window of the ilioinguinal approach. After surgical debridement, the anterior column was reduced anatomically and fixed by two lag screws which avoided the tri-radiate cartilage. A vaginal laceration was debrided and repaired. The patient was treated in a spica cast without weight bearing on the left lower extremity for 8 weeks. No perioperative complications occurred. The acetabular fracture healed in an anatomic position within 8 weeks. To avoid premature closure of the tri-radiate cartilage, the patient underwent a physeal bar resection at one year after injury. At two-year follow up, she was walking and running without pain and had a free range of motion of her left hip. Conclusions: Operative management should represent the therapy of choice for open, displaced pediatric acetabular fractures. After fracture healing, a scheduled physeal bar resection may be required for injuries which involve the tri-radiate cartilage. PMID:19461903

  10. Tibial osteonecrosis.

    PubMed

    Lonner, J H; Lotke, P A

    2001-01-01

    Spontaneous osteonecrosis of the tibial plateau involves a continuum of change observed in the subchondral zone that is commonly associated with early and mid stages of osteoarthritis. The typical patient is an elderly woman who experiences a sudden onset of pain in the medial aspect of the knee. The diagnosis of this under-appreciated clinical entity may be difficult, but careful examination and judicious use of imaging studies, as well as a high index of suspicion, may facilitate the accurate diagnosis. Although the radiographs may initially be normal (with the exception of mild arthrosis), radionuclide scans and MRI can be of great value. The MRI studies usually show a decreased signal intensity on a T1-weighted image, but may be normal in the early course of the disease. The T2-weighted images and fat suppression views are helpful in establishing a diagnosis and determining the extent of involvement. Recognition of this problem may help to avoid unnecessary intra-articular surgery. Many of these patients have complete or partial resolution of symptoms by 1 year, after a period of protected weight bearing. Nonetheless, surgery may be necessary for more advanced lesions and in those patients with progressive arthrosis.

  11. Modified Iliac Crest Reconstruction with Bone Cement for Reduction of Donor Site Pain and Morbidity after Open Wedge High Tibial Osteotomy: A Prospective Study

    PubMed Central

    Lee, Jong Seong; Park, Yong Jee; Wang, Lih; Chang, Yong Suk; Shetty, Gautam M.; Nha, Kyung Wook

    2016-01-01

    Purpose This study was to determine the efficacy of iliac crest reconstruction using bone cement in reducing pain and morbidity at the donor site in patients undergoing open wedge high tibial osteotomy (OWHTO) with tricortical iliac crest autologous graft. Materials and Methods Thirty-three patients who underwent iliac crest reconstruction using polymethyl methacrylate (PMMA) bone cement (group A) and thirty patients who had no iliac crest reconstruction (group B) were enrolled in this study. All patients were evaluated for pain and functional disability related to graft harvesting using the pain and functional visual analogue scale (VAS) score during hospital stay and at 6 weeks, 3 months, and 6 months postoperatively. Results There was significant difference between the two groups in terms of pain and function. The pain VAS score was significantly lower in group A than group B during the first 2 weeks postoperatively (p=0.04) and the functional VAS score was also significantly lower in group A during the first 2 weeks postoperatively (p<0.001) in terms of breathing, sitting up from the supine position, and standing up with crutches from the sitting position. Conclusions Iliac crest donor site reconstruction using PMMA bone cement in patients undergoing OWHTO significantly decreased pain and improved function during the first 2 weeks postoperatively when compared to patients who underwent OWHTO without iliac crest reconstruction. PMID:27894174

  12. Open physeal fracture of the distal phalanx of the hallux: Case study, diagnosis and management.

    PubMed

    Morris, Brandon; Mullen, Scott; Schroeppel, Paul; Vopat, Bryan

    2017-02-06

    Open physeal fractures of the distal phalanx of the hallux are the lesser described counterpart to the same fracture of the finger, known by its eponym as a "Seymour fracture". Displaced Salter-Harris phalangeal fractures present with a concomitant nailbed or soft tissue injury. Often these fractures occur in the summer months when open-toe footwear can be worn, however, they may occur indoors as well. Frequently, the injury results from direct axial load of the toe, or "stubbing", which causes the fracture and associated soft tissue injury. Prompt diagnosis and appropriate treatment is necessary to prevent negative sequelae such as osteomyelitis, malunion, nonunion, or premature growth arrest. In this article, we present a 12year-old male who sustained an open physeal fracture of the distal phalanx when he "stubbed" his great toe on a bed post. His injury was initially misdiagnosed at an urgent care facility, thereby delaying appropriate intervention and necessitating an operative surgical procedure. Additionally, we review the existing literature discussing these infrequently reported injuries, as well as present key points as they pertain to the diagnosis and management of this injury in the emergency department.

  13. 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.

  14. 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.

  15. A Descriptive Study of Open Fractures Contaminated by Seawater: Infection, Pathogens, and Antibiotic Resistance

    PubMed Central

    Zhu, Hongyi

    2017-01-01

    Aims. In this work, the main objectives were to investigate the clinical characteristics and bacterial spectrum present in open fractures contaminated by seawater. Methods. We conducted a retrospective cohort study and included all patients with open fractures from 1st January, 2012, to 31st December, 2015, in our hospital. Patients were grouped based on the presence of seawater contamination in wounds. We compared the infection rate, bacterial spectrum, and antibiotic resistance between the two groups. Results. We totally included 1337 cases of open fracture. Wounds from 107 cases (8.0%) were contaminated by seawater. The wound infection rate of seawater-contaminated group was significantly higher in patients with Gustilo-Anderson Type II and Type III open fractures. The bacterial spectrum from seawater-contaminated wounds was remarkably different from that of the remaining. Antibiotic sensitivity tests revealed that more than 90% of infecting pathogens in seawater-contaminated wounds were sensitive to levofloxacin and ciprofloxacin. Conclusion. Cephalosporin in combination with quinolone was recommended in the early-stage management of open fractures contaminated by seawater. PMID:28303249

  16. A Descriptive Study of Open Fractures Contaminated by Seawater: Infection, Pathogens, and Antibiotic Resistance.

    PubMed

    Zhu, Hongyi; Li, Xingwei; Zheng, Xianyou

    2017-01-01

    Aims. In this work, the main objectives were to investigate the clinical characteristics and bacterial spectrum present in open fractures contaminated by seawater. Methods. We conducted a retrospective cohort study and included all patients with open fractures from 1st January, 2012, to 31st December, 2015, in our hospital. Patients were grouped based on the presence of seawater contamination in wounds. We compared the infection rate, bacterial spectrum, and antibiotic resistance between the two groups. Results. We totally included 1337 cases of open fracture. Wounds from 107 cases (8.0%) were contaminated by seawater. The wound infection rate of seawater-contaminated group was significantly higher in patients with Gustilo-Anderson Type II and Type III open fractures. The bacterial spectrum from seawater-contaminated wounds was remarkably different from that of the remaining. Antibiotic sensitivity tests revealed that more than 90% of infecting pathogens in seawater-contaminated wounds were sensitive to levofloxacin and ciprofloxacin. Conclusion. Cephalosporin in combination with quinolone was recommended in the early-stage management of open fractures contaminated by seawater.

  17. Pilon fracture: a case report of a 45-year-old dental technician.

    PubMed

    Mafi, Pouya; Stanley, James; Hindocha, Sandip; Mafi, Reza

    2014-01-01

    Pilon fractures are complex and difficult-to-treat fractures of the lower extremity that account for about 1% of all lower extremity fractures and up to 10% of tibial fractures. The injury is caused by high energy axial load either from motor vehicle accidents or a fall from height. The treatment of these fractures has caused controversy among surgeons due to mixed outcomes. Here we report a case of pilon fracture in a 45 year old male patient who has sustained the injury as a result of a fall from a height of approximately 12 feet. We describe why it is absolutely crucial that the patient is treated with external fixation initially and evaluate its merits and drawbacks as well as ways to minimize the complications associated with external fixation of open intra-articular distal tibial fractures.

  18. IMF Screw: An Ideal Intermaxillary Fixation Device During Open Reduction of Mandibular Fracture.

    PubMed

    Sahoo, N K; Mohan, Ritu

    2010-06-01

    Intermaxillary fixation (IMF) is conventionally used for treatment of fractures involving maxillomandibular complex both for closed reduction and as an adjuvant to open reduction. To overcome the cumbersome procedure of tooth borne appliances cortical bone screws were introduced in the year of 1989 to achieve IMF which is essentially a bone borne appliance. In our institution we treated 45 cases of mandibular fracture both single and multiple fractures by open reduction over a period of 24 months. IMF screws were used to achieve dental occlusion in all the cases. Various advantages, disadvantages and complications are discussed. In our institutional experience we found that the IMF screws are an ideal device for temporary intermaxillary fixation for the cases having only mandibular fracture.

  19. Sword-Like Trauma to the Shoulder with Open Head-Splitting Fracture of the Head

    PubMed Central

    Pantazis, Konstantinos; Iliopoulos, Ilias; Seferlis, Ioannis; Kokkalis, Zinon

    2016-01-01

    Head-splitting fractures occur as a result of violent compression of the head against the glenoid; the head splits and the tuberosities may remain attached to the fragments or split and separate. Isolated humeral head-splitting fractures are rare injuries. Favorable results with osteosynthesis can be difficult to achieve because of the very proximal location of the head fracture and associated poor vascularity. We present a case of a 67-year-old man who sustained a severe, sword-like trauma to his left shoulder after a road traffic accident with associated isolated open Gustilo-Anderson IIIA humeral head-splitting fracture. Bony union was achieved with minimal internal fixation but the clinical outcome deteriorated due to accompanying axillary nerve apraxia. To our knowledge, this type of sword-like injury with associated humeral head-split fracture has not previously been reported. PMID:27478665

  20. Proximal Tibial Bone Graft

    MedlinePlus

    ... All Site Content AOFAS / FootCareMD / Treatments Proximal Tibial Bone Graft Page Content What is a bone graft? Bone grafts may be needed for various ... the proximal tibia. What is a proximal tibial bone graft? Proximal tibial bone graft (PTBG) is a ...

  1. Silver Dressings Augment the Ability of Negative Pressure Wound Therapy to Reduce Bacteria in a Contaminated Open Fracture Model

    DTIC Science & Technology

    2011-07-01

    ORIGINAL ARTICLE Silver Dressings Augment the Ability of Negative Pressure Wound Therapy to Reduce Bacteria in a Contaminated Open Fracture Model...contaminated by S. aureus. Key Words: Contamination, Infection, Open fracture , Negative pressure, Silver dressing. (J Trauma. 2011;71: S147–S150...is commonly used in the treatment of large wounds and acute open fractures , and has even been applied to surgical incisions in an effort to minimize

  2. Manuel Rocha Medal Recipient Wave interaction with underground openings in fractured rock

    NASA Astrophysics Data System (ADS)

    Hildyard, M. W.

    2007-12-01

    The objective of this work is to lead to improved models of seismic wave propagation around underground openings by studying the interaction of the waves with the fractured rock surrounding these openings. It demonstrates that seismic models can help in stability problems such as rockbursting in deep-level mining, or in the interpretation of micro-fracturing at waste storage sites. A significant emphasis is placed on comparing the models with observations from controlled experiments. These comparisons demonstrate that the wave propagation can be reliably and accurately modelled, and in so doing it motivates their application to the larger rock engineering problems. Seismic wave models are first applied to laboratory experiments on multiple fractures. Simulation through multiple displacement discontinuities yields strikingly similar waveforms to the experiments, while also identifying the need to build stress dependence into the fracture models, such as stress dependent fracture stiffness. The wave-fracture modelling is extended to in situ fractures in rock at the surface of a deep tunnel, using data collected during an acoustic emission experiment at the URL Mine-by tunnel. Waveforms from the velocity scans are compared against those from elastic models and various models of fracture, such as random assemblies of small open fractures (cracks) and larger fractures with fracture stiffness. Results indicate that it is possible to account for the wave-speeds and amplitudes using models with fractures. A generic method is then proposed for calculating the frequency variation of wave-speed and amplitude for any collection of cracks. The models of fracture are then applied to the rockburst problem, to investigate how the excavation affects the amplitude and the distribution of ground motion. The results provide important insights into the causes of the apparent amplification observed by researchers in this field. The thesis also covers the theory of the models used

  3. [Drill wire osteosynthesis in subcapital humerus fractures: percutaneous or open procedure?].

    PubMed

    Imhoff, M; Sadr, I; Lehner, J H; Hasse, F M; Gahr, R H

    1992-04-01

    Between 1978 and mid-1990, 135 patients suffering from dislocated, non-luxated fracture of the humerus at the anatomical neck (fractura colli anatomici) were treated by means of open or closed percutaneous drill wire osteosynthesis. Follow-up examination after an average of 9 months did not show any significant differences between the two surgical approaches in 117 patients, independent of the shape of the fracture. However, in about 30% of the cases it was impossible to employ the percutaneous approach due to the presence of an obstacle to reduction, so that open reduction and fixation was the only choice. A great majority of the functional results must be considered as good, fractures of the tubercles having the most unfavourable prognosis independent of the surgical technique. It is, therefore, recommended to first try closed reduction with percutaneous drill wire osteosynthesis. If there are any obstacles to reduction, open reduction should be restored to during the surgery session.

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

    PubMed Central

    Olufemi, Olukemi Temiloluwa; Adeyeye, Adeolu Ikechukwu

    2017-01-01

    Introduction: 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. Methods: 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. Results: 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). Conclusions: 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. PMID:28134091

  5. Tibiofibula Transposition in High-Energy Fractures

    PubMed Central

    Gledhill, Rebecca A.; Evans, Nick

    2016-01-01

    We report two cases of failed attempts at closed reduction of high-energy tibial fractures with an associated fibula fracture. The first case was a 39-year-old male involved in high-speed motorbike collision, while the second was a 14-year-old male who injured his leg following a fall of three metres. Emergency medical services at the scenes of the accidents reported a 90-degree valgus deformity of the injured limb and both limbs were realigned on scene and stabilized. Adequate alignment of the tibia could not be achieved by manipulation under sedation or anaesthesia. Open reduction and exposure of the fracture sites revealed that the distal fibula fragment was “transposed” and entrapped in the medulla of the proximal tibial fragment. Reduction required simulation of the mechanism of injury in order to disengage the fragments and allow reduction. Tibiofibula transposition is a rare complication of high-energy lower limb fractures which has not previously been reported and may prevent adequate closed reduction. Impaction of the distal fibula within the tibial medulla occurs as the limb is realigned by paramedic staff before transfer to hospital. We recommend that when this complication is identified the patient is transferred to the operating room for open reduction and stabilization of the fracture. PMID:27807487

  6. A Cost-Utility Analysis of Amputation versus Salvage for Gustilo IIIB and IIIC Open Tibial Fractures

    PubMed Central

    Chung, Kevin C.; Saddawi-Konefka, Daniel; Haase, Steven C.; Kaul, Gautam

    2009-01-01

    Background: Lower extremity trauma is common. Despite an abundance of literature on severe injuries that can be treated with salvage or amputation, the appropriate management of these injuries remains uncertain. In this situation, a cost-utility analysis is an important tool in providing evidence-based practice an approach to guide treatment decisions. Methods: Costs following amputation and salvage were derived from data presented in a study that emerged from the Lower Extremity Assessment Project. We extracted relevant data on projected lifetime costs and analyzed them to include discounting and sensitivity analysis for consider patient age. The utilities for the various health states (amputation or salvage, including possible complications) were previously measured using the standard gamble method and a decision tree simulation to determine quality-adjusted life years (QALYs). Results: Amputation is more expensive than salvage independent of varied ongoing prosthesis needs, discount rate, and patient age at presentation. Moreover, amputation yields fewer QALYs than salvage. Salvage is deemed the dominant, cost-saving strategy. Conclusions: Unless the injury is so severe that salvage is not a possibility, based on this economic model, surgeons should consider limb salvage, which will yield lower costs and higher utility when compared to amputation. PMID:19952652

  7. Non-universal aperture-length scaling of opening mode fractures

    NASA Astrophysics Data System (ADS)

    Mayrhofer, Franziska; Schöpfer, Martin P. J.; Grasemann, Bernhard

    2014-05-01

    Opening-mode fractures, such as joints, veins and dykes, typically exhibit a power-law aperture-length scaling with a power-law exponent of about 0.5. The fracture aperture is hence proportional to the square root of fracture length, a relation which is in fact predicted by linear elastic fracture mechanics (LEFM) for an isolated Mode I fracture subjected to remote tension. The existence of such a 'universal scaling law' is however a highly debated topic. High quality outcrop data illustrate that fracture aperture-length scaling may be 'non-universal' and indicate that below a certain length-scale scaling is super-linear (power-law exponent > 1). We use a numerical model comprised of a square lattice of breakable elastic beams to investigate the aperture-length scaling that emerges in thin plates subjected to remote tension. Strength heterogeneity is introduced in the regular lattice by randomly assigning beam strengths from a Weibull probability distribution. The model fracture system evolution is characterised by two stages which are separated by the strain at which peak-stress occurs. During the pre-peak stress stage fracture aperture-length scaling is universal with a power-law exponent of about 0.5 as expected from LEFM. Shortly after the material has attained its maximum load bearing capacity, aperture-length scaling becomes non-universal, so that the average aperture-length relation plotted on a log-log graph exhibits a distinct kink. Fractures with a length less than this critical length scale exhibit super-linear aperture-length scaling, whereas fractures with a greater length exhibit sub-linear scaling. The models illustrate that the emergence of non-universal aperture-length scaling is a result of fracture clustering, which occurs after peak-stress in the form of a localised fracture zone. Given that fracture clustering is a common phenomenon in natural fracture systems, we argue that a universal scaling law may be the exception rather than the rule.

  8. An animal model for open femur fracture and osteomyelitis: Part I.

    PubMed

    Lindsey, Brock A; Clovis, Nina B; Smith, E Suzanne; Salihu, Sydha; Hubbard, David F

    2010-01-01

    Infection is an everyday problem in orthopaedics and is quite common in open fracture management. To study this process and provide a basis to prevent infection, we developed a model that includes trauma (blunt fracture in the fashion of Bonnarens and Einhorn), surgical stabilization (standardized intramedullary K-wire fixation), and infection (Staphylococcus aureus inoculum). In this two-part study, we found that 10(2) colony-forming units of inoculum produced an optimal infection rate of 90-100%, which substantially challenged the immune system without overwhelming sepsis. We hypothesized that, in traumatic fractures, there is a specific immunological response that may lead to an increased rate of infection. In Part 2, we demonstrated immunosuppression (decreased Interleukin-12 levels) at days 6, 10, and 12 after fracture fixation versus nonfractured control groups (p < 0.05). This study describes a rat model of femur factures with osteomyelitis that allows investigation of posttraumatic immunosuppression.

  9. Grade 3C open femur fractures with vascular repair in adults.

    PubMed

    Balci, Halil I; Saglam, Yavuz; Tunali, Onur; Akgul, Turgut; Aksoy, Murat; Dikici, Fatih

    2015-06-01

    Grade 3C open femur fractures are challenging injuries with higher rates of complications. This is a retrospective review of grade 3C open femur fractures with vascular repair between 2002 and 2012. Outcomes included initial MESS score, additional injuries, duration of operation, complications, secondary operations or amputations, and social life implications. Thirty-one of 39 total patients were selected for revascularization and fracture fixation based on soft tissue injury and MESS score. The intra-operative approach included temporary arterial shunt replacement, orthopedic fixation, arterial reconstruction venous and/or nerve repair and routine fasciotomies. An external fixation and reverse saphenous vein graft was used in a majority of the patients (respectively; 93.5%, 90.3%). The mean follow up was 5.4 years (range 2.2-10). The decision to amputate versus salvage should be left up to patients and their care teams after discussing options and future possibilities rather than using a scoring system.

  10. [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.

  11. External fixators for open fractures of tibia and fibula in patients with haemophilia A.

    PubMed

    Lin, J; Liu, H; Liu, P; Yang, H

    2015-01-01

    To evaluate the efficacy of external fixators(EFs) for management of open fractures of tibia and fibula in patients with haemophilia A. EFs are commonly used in the clinical management of infected or open fractures when internal fixation is contraindicated and plaster immobilization is inadequate. However, EFs have not been frequently used for these indications in haemophilic patients for fear of pin tract infection and bleeding. This is a retrospective therapeutic study. We describe the use of EF (Orthofix uniplanar fixators) in five patients (mean age: 31.4 years; range: 10-52) with haemophilia A suffering from open fracture of tibia and fibula (Gustilo classification ranging from II to IIIA). The average time to union was 23 weeks (range: 18-30 weeks). Much lower levels were subsequently maintained till wound healing. The average total factor consumption was 358.30 IU kg(-1) (range: 272-421 IU kg(-1) ), administered over a period of 14.2 days (range 9-21). There were no major complications related to EF. In summary, EFs can be used safely and effectively in management of open fractures of tibia and fibula in patients with haemophilia A.

  12. The choice of antibiotic in open fractures in a teaching hospital in a developing country.

    PubMed

    Alonge, T O; Salawu, S A; Adebisi, A T; Fashina, A N

    2002-06-01

    Open fracture wounds may be contaminated, and the use of an appropriate antibiotic in the early stages of management reduces the risk of osteomyelitis developing. Environmental factors influence both the type of micro-organisms that are isolated from these wounds and the antibiotics that are chosen to manage the wounds. Before this study, the choice of antibiotic in the management of open fractures in our hospital was based on tradition and 'best guess' antibiotics. In a prospective study of 52 open fractures seen in the accident and emergency unit of University College Hospital, Ibadan, between January and June 2000, the positive bacterial culture yield was more than 70%. Staphylococcus aureus was the commonest microbial isolate, accounting for 37.5% of total isolates. The antibiotic sensitivity pattern revealed high efficacies for pefloxacin, ciprofloxacin and ceftriaxone against the isolated micro-organisms. In comparative costs, these antibiotics are cheaper than the combination of the 'best guess' antibiotics that were used previously. On the strength of this finding, we have suggested a change in the antibiotic policy of the hospital with regard to the antibiotic regimen to be used to complement the surgical management of open fractures.

  13. Ustilago echinata: Infection in a Mixed Martial Artist Following an Open Fracture.

    PubMed

    Stewart, Ethan; Waldman, Sarah; Sutton, Deanna A; Sanders, Carmita; Lindner, Jonathan; Fan, Hongxin; Wiederhold, Nathan P; Thompson, George R

    2016-04-01

    Ustilago, a common fungal parasite of grains, is infrequently isolated as a pathogen in humans. We describe a case of Ustilago echinata infection following an open distal tibia fracture, review the current literature of this genus as a cause of invasive fungal infection in humans, and discuss management issues.

  14. Antibiotic Impregnated Bone Cement for the Treatment of Osteomelitis and Severe Open Fractures: Expanded Options for Surgeons

    DTIC Science & Technology

    2008-06-01

    Impregnated Bone Cement for the treatment of Osteomelitis and Severe Open Fractures: Expanded Options for Surgeons PRINCIPAL INVESTIGATOR: CDR...34Antibiotic Impregnated Bone Cement for the treatment of Osteomelitis 5b. GRANT NUMBER W81XWH-07-1-0221 and Severe Open Fractures: Expanded Options for

  15. Assessing an open-well aquifer test in fractured crystalline rock

    USGS Publications Warehouse

    Tiedeman, C.R.; Hsieh, P.A.

    2001-01-01

    Use of open wells to conduct aquifer tests in fractured crystalline rock aquifers is potentially problematic, because open wells can hydraulically connect highly permeable fracture zones at different depths within the rock. Because of this effect, it is questionable whether estimates of the hydraulic properties of the rock obtained from analysis of an open-well aquifer test in fractured crystalline rock are representative of the true rock properties. To address this issue, rock properties estimated from such a test are compared with rock properties estimated from an aquifer test at the same location in which packers were installed in wells to restrict vertical fluid movement along the wellbores. Results indicate that when the open-hole test is analyzed with a numerical model that accurately represents the three-dimensional heterogeneity structure in the wellfield, the open-hole test estimates of the rock hydraulic properties are similar to the packer-isolated test estimates. When the open-well test is analyzed using a model having an oversimplified representation of the rock heterogeneity, the estimates of rock transmissivity are similar to the transmissivity estimates from the packer-isolated test, but the storativity estimates are larger than the storativity estimates from the packer-isolated test. These results indicate the importance of accurately representing the rock heterogeneity structure when analyzing an open-hole aquifer test in fractured crystalline rock.Use of open wells to conduct aquifer tests in fractured crystalline rock aquifers is potentially problematic, because open wells can hydraulically connect highly permeable fracture zones at different depths within the rock. Because of this effect, it is questionable whether estimates of the hydraulic properties of the rock obtained from analysis of an open-well aquifer test in fractured crystalline rock are representative of the true rock properties. To address this issue, rock properties estimated from

  16. Open fractures and the incidence of infection in the surgical debridement 6 hours after trauma

    PubMed Central

    Fernandes, Miguel de Castro; Peres, Luciano Rodrigo; de Queiroz, Aristóteles Correia; Lima, José Queiroz; Turíbio, Flávio Moral; Matsumoto, Marcelo Hide

    2015-01-01

    Objectives: To determine whether a time delay greater than 6h from injury to surgical debridement influences the infection rate in open fractures. Methods: During a period of 18 months, from October 2010 to March 2012, 151 open fractures were available for study in 142 patients in our hospital. The data were collected prospectively and the patients were followed up for 6 weeks. The patients were divided into two groups regarding the time delay from injury to surgical debridement (more or less than 6 hours). Results: Surgical debridement was carried out in less than 6h from injury in 90 (59.6%) fractures and after 6 hours from injury in 61 (40.4%) fractures. Infection rates were 12.22% and 13.24%, respectively. The global infection rate was 13.24%. Conclusion: A significantly increased infection rate was not observed in patients whose surgical debridement occurred more than 6h after injury. However, in the fractures of high-energy trauma, a statistically significant increase of the rate of infection was observed in those operated 6 hours after trauma. Level of Evidence II, Study Type Comparative and Prospective. PMID:26327794

  17. Open Reduction and Internal Fixation of Displaced Calcaneum, Intra-Articular Fractures by Locking Calcaneal Plate

    PubMed Central

    Santosha; Singh, Arambam Mahendra; Waikhom, Sanjib; Pakhrin, Vishal; Mukherjee, Sagnik; Debbarma, Rajkumar; Prashant, Prabhu Shrinivas

    2016-01-01

    Introduction Calcaneal fractures constitute the most common fractures in hindfoot. Lots of controversies exist in the management of calcaneal fractures but now-a-days, it is preferable to perform open reduction and internal fixation and early mobilizatation. Aim To evaluate the functional outcome after open reduction and internal fixation of displaced intra-articular fractures of the calcaneum by locking calcaneal plate. Materials and Methods The study was conducted in the Department of Orthopaedic Surgery from September 2013 to April 2016. Thirty intra-articular fractures of the calcaneum were treated by locking calcaneal plate. Patients were followed up for a period of 24 months. Bohler’s angle was measured in preoperative, immediate Post-operative period and after 2 years, follow-up was compared. Results were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) Score. Results After 24 months of follow-up, all 24 patients were available for evaluation. Radiological union was achieved in a mean time of 12.5 weeks. Mean duration of hospital stay was 21 days. Bohler’s angle was significantly higher after 2 years of follow-up when compared with preoperative x-ray. According to the AOFAS, Ankle–Hind foot Scale outcome score results were excellent in 43.3% of the patients, good in 33.3%, fair in 10%, and poor in 13.3% of patients. The mean AOFAS score was 79.9 (Range 49-96). Conclusion Open reduction and internal fixation of intra-articular fractures of the calcaneum with locking calcaneal plate gives good results. Maintenance of calcaneal height and Bohler’s angle helps to decrease the incidence of subtalar arthritis. PMID:28208957

  18. Management of complications of open reduction and internal fixation of ankle fractures.

    PubMed

    Ng, Alan; Barnes, Esther S

    2009-01-01

    The management of complications resulting from the open reduction and internal fixation of ankle fractures is discussed in detail. The initial radiographic findings of the most common postsurgical complications of ankle fracture reduction are briefly discussed, namely lateral, medial, and posterior malleolar malunion or nonunion, syndesmotic widening, degenerative changes, and septic arthritis with or without concomitant osteomyelitis. Emphasis is placed on the management of these complications, with a review of the treatment options proposed in the literature, a detailed discussion of the authors' recommendations, and an inclusion of different case presentations.

  19. Optimizing femorotibial alignment in high tibial osteotomy

    PubMed Central

    Rudan, John; Harrison, Mark; Simurda, Michael A

    Objective To study factors that affect femorotibial (F-T) alignment after valgus closing wedge tibial osteotomy. Study design A review of standardized standing radiographs. Femorotibial alignment was measured 1 year postoperatively for over- and under-correction. Changes in F–T alignment and in tibial plateau angle were measured. Setting An urban hospital and orthopedic clinic. Patients Eighty-two patients with osteoarthritis and varus femorotibial alignment underwent valgus closing wedge tibial osteotomy. Patients having a diagnosis of inflammatory arthritis or a prior osteotomy about the knee were excluded. Results A 1° wedge removed from the tibia resulted in an average correction of F–T alignment of 1.2°. A knee that had increased valgus orientation of the distal femur had a greater degree of correction, averaging 1.46° in F–T alignment per degree of tibial wedge. This resulted in excessive postoperative valgus alignment for some patients who had increased valgus tilt of the distal femur. Optimal F–T alignment of 6° to 14° of valgus occurred when the postoperative tibial inclination was 4° to 8° of valgus. Conclusions There was a trend for knees with increased valgus orientation of the distal femur to have greater correction in F–T alignment after tibial osteotomy, likely because of a greater opening up of the medial joint space during stance. Surgeons need to account for this in their preoperative planning. PMID:10526522

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

    PubMed Central

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

    2016-01-01

    Purpose 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). Materials and Methods 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. Results 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. Conclusions In HTO, correction based on the Miniaci method using a PACS was more accurate than correction using the cable method. PMID:27894175

  1. A Versatile Model of Open-fracture Infection: a Contaminated Segmental Rat Femur Defect

    DTIC Science & Technology

    2014-06-01

    relevance of antibiotics . Animals inoculated with 105 CFU of bacteria, and then surgically treated at six hours, had an infection rate of approximately 50...treat- ments that work harmoniously with antibiotics to be Table I. Quantification of bacteria recovered from animals 14 days after inoculation with...numbers of patients need to be recruited, but it can take many years to report their findings.3 Alter- natively, animal models of open fractures offer the

  2. Emergency Soft Tissue Reconstruction Algorithm in Patients With Open Tibia Fractures

    PubMed Central

    Ivanov, P.A.; Shibaev, E.U.; Nevedrov, A.V.; Vlasov, A.P.; Lasarev, M.P.

    2016-01-01

    Introduction: Tactic of emergency closing of soft tissue defect allows to significantly improve the treatment results concerning patients with severe open fractures. However, a number of certain factors make the implementation of this tactic rather difficult. Injured people’s unstable conditions are mong these crucial factors which include, polytrauma in lots of cases, absence of exact recommendations for recovery terms, choice of definite tissue flaps and a type of circulation. The Aim of Study: is to develop exact, usable and in practice algorithm of emergency reconstruction of leg soft tissues in patients with severe open tibia fractures, based on the usage of the most foolproof and simple methods. Data (Patients) and Methods: 85 patients with open tibia fractures complicated by soft tissue defects were included in our study. Patients were divided into two groups. The control group consisted of 56 patients. Soft tissue reconstruction in this group was provided without an exact algorithm, after continuous attempts on local healing. After analyzing the treatment process and the treatment results we have developed the algorithm of emergency soft tissue reconstruction. It was used in 29 patients (the study group). This algorithm allows choosing optimal timing for tissue reconstruction and appropriate method to be applied, depending on the patient’s condition, the mechanism of soft tissue defect formation, and its square and localization. Results: We observed a statistical decrease in deep wound infection frequency, partial tibia necrosis frequency, chronic osteomyelitis frequency, duration of hospitalization in patients with severe open tibia fractures because of using our algorithm. PMID:27583057

  3. 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.

  4. 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

  5. Tibial Bowing and Pseudarthrosis in Neurofibromatosis Type 1

    DTIC Science & Technology

    2013-04-01

    observed in 5% of children with neurofibromatosis type 1 ( NF1 ), typically identified in infancy. The majority of NF1 individuals with tibial bowing...will sustain a fracture that will not heal (i.e. pseudarthrosis) resulting in multiple surgeries, poor limb function, and amputation. Some NF1 ...pseudarthrosis and better understand its pathophysiology. We have begun recruitment and assessed many individuals with NF1 with and with tibial bowing. QUS

  6. The Intramedullary Nailing of Adult Femoral Shaft Fracture by the Way of Open Reduction is a Disadvantage or Not?

    PubMed

    Burç, Halil; Atay, Tolga; Demirci, Demir; Baykal, Y Barbaros; Kirdemir, Vecihi; Yorgancigil, Hüseyin

    2015-12-01

    The purpose of this study is that to evaluate superiority and results of open technique in the treatment of femoral shaft fracture with interlocking intramedullary nailing. The retrospective study is designed to evaluate results of our technique. In this study, the patients that were admitted to the Orthopedics and Traumatology Department of University Hospital that is third level of trauma center. We claim that open technique is not a disadvantage during union process over closed technique in treatment of femoral shaft fracture with interlocking nailing. In this study, 44 patients that were consulted for adult femoral shaft fracture between January 2008 to July 2010 were included. Patients with open fractures, gunshot wounds, neurovascular injuries, and patients that did not have isolated femoral diaphysis fractures were excluded from the study. Clinical and radiological results of the patients were checked periodically. The open interlocking intramedullary nailing was used in treatment. Complete union rate was 90.9 % in 40 patients who were treated with open interlocking intramedullary nailing for adult femoral shaft fracture, and nonunion rate was 9.1 % in four patients. Mean union time was 18.3 weeks (12-36 weeks). Evaluation of 44 patients according to Thoresen criteria was excellent in 22 patients, good in 6 patients, and bad in 4 patients. We think that open technique is an acceptable technique because all results of our study were similar to results of closed intramedullary nailing technique in literature and some advantages of open technique over closed technique.

  7. Fibular Strut Graft Augmentation for Open Reduction and Internal Fixation of Proximal Humerus Fractures

    PubMed Central

    Saltzman, Bryan M.; Erickson, Brandon J.; Harris, Joshua D.; Gupta, Anil K.; Mighell, Mark; Romeo, Anthony A.

    2016-01-01

    Background: Proximal humerus fractures are common problems plaguing the elderly population. Purpose: The purposes of this study were to determine the outcomes of fibular strut allografts in treatment of proximal humerus fractures with open reduction internal fixation (ORIF) and to present the authors’ preferred surgical technique. The hypothesis was that the use of fibular strut allografts in treating proximal humerus fractures with ORIF will provide low reoperation rates with acceptable outcomes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was registered with PROSPERO and performed with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines using 3 publicly available free databases. Therapeutic clinical outcome investigations reporting arthroscopic elbow outcomes with levels of evidence 1 through 4 were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using Student t tests, 1-way analysis of variance, chi-square tests, and 2-proportion Z tests. Results: Four studies met the inclusion criteria. While there is great heterogeneity existing in the literature surrounding use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures, current evidence shows a humeral head screw penetration rate of 3.7% with acceptable functional outcome scores, with a reoperation rate of 4.4% at a weighted mean 80.78 weeks (1.55 years) of postoperative follow-up. Conclusion: There is great heterogeneity that exists in the literature surrounding the use of a fibular strut allograft as an adjunct to ORIF of proximal humerus fractures. Current evidence shows a screw penetration rate of 3.7% with acceptable functional outcome scores, demonstrating fibular strut allograft is a viable option for treating proximal humerus fractures. PMID:27504463

  8. Computational comparison of reamed versus unreamed intramedullary tibial nails.

    PubMed

    Gómez-Benito, María José; Fornells, Pere; García-Aznar, José Manuel; Seral, Belén; Seral-Iñnigo, Fernando; Doblaré, Manuel

    2007-02-01

    We compared, via a computational model, the biomechanical performance of reamed versus unreamed intramedullary tibial nails to treat fractures in three different locations: proximal, mid-diaphyseal, and distal. Two finite element models were analyzed for the two nail types and the three kinds of fractures. Several biomechanical variables were determined: interfragmentary strains in the fracture site, von Mises stresses in nails and bolts, and strain distributions in the tibia and fibula. Although good mechanical stabilization was achieved in all the simulated fractures, the best results were obtained in the proximal fracture for the unreamed nail and in the mid-diaphyseal and distal fractures for the reamed nail. The interlocking bolts, in general, were subjected to higher stresses in the unreamed tibial nail than in the reamed one; thus the former stabilization technique is more likely to fail due to fatigue.

  9. Tibial nerve dysfunction

    MedlinePlus

    ... Tibial nerve dysfunction is an unusual form of peripheral neuropathy . It occurs when there is damage to the ... PA: Elsevier Saunders; 2012:chap 76. Shy ME. Peripheral neuropathies. In: Goldman L, Schafer AI, eds. Goldman-Cecil ...

  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. Effectiveness of Chitosan Films Impregnated With Ciprofloxacin for the Prophylaxis of Osteomyelitis in Open Fractures: An Experimental Study in Rats

    PubMed Central

    Paiva Costa, Lincoln; Moreira Teixeira, Luiz Eduardo; Maranhão Lima, Gustavo Silame; Mendes Ferreira, Marcelo; de Andrade, Mateus Antunes; Teixeira Vidigal, Paula Vieira; Gomes Faraco, André Augusto; Temponi, Eduardo Frois; de Araújo, Ivana Duval

    2016-01-01

    Background The systemic antimicrobial prophylaxis is the standard treatment in the prevention of osteomyelitis after open fractures, with topical application of antimicrobials as an alternative due to their high concentrations at the site of the fracture, low systemic concentrations and fewer side effects. Objectives This study aimed to evaluate the effectiveness of prophylaxis of osteomyelitis through experimental model of open fractures with the use of chitosan films, whether or not impregnated with ciprofloxacin. Materials and Methods In this experimental study, 24 Holtzman rats were distributed into 4 groups of 6 rats each. The CT (control of treatment) group: an open fracture model treated with systemic antimicrobial; the IC (infection control) group: an open fracture untreated model; the C (chitosan) group: an open fracture model treated using a chitosan film; and the CA (chitosan with antimicrobial) group: an open fracture model treated using a chitosan film impregnated with antimicrobial. After 3 weeks the animals were killed by an overdose of anesthetic, and a fragment osseous was removed for histological and microbiological analysis. The comparisons between the groups considered significant values of P ≤ 0.05. Results In cultures of the CT group, there was less bacterial growth compared to the results of the cultures of the IC (P = 0.005), C (P = 0.005) and CA (P = 0.009) groups. The inflammation was lower in the CT group compared to the IC (P = 0.014), C (P = 0.001) and CA (P = 0.007) groups. Conclusions In this experimental model of open fracture, the chitosan film pure or impregnated with ciprofloxacin was not effective in the prophylaxis of osteomyelitis. PMID:27800468

  12. 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.

  13. Control of motion of tibial fractures with use of a functional brace or an external fixator. A study of cadavera with use of a magnetic motion sensor.

    PubMed

    McKellop, H; Hoffmann, R; Sarmiento, A; Ebramzadeh, E

    1993-07-01

    A computer-linked magnetic motion transducer was used to monitor and record the six components of motion of the bone fragments in eight cadaveric tibiae in which a simulated, oblique fracture of the middle of the shaft had been stabilized with a functional brace. The limbs were mounted in a servo-hydraulic testing frame, and a cyclic load of 150 newtons was applied along the axis of the tibia. Motion sensors, attached to each side of the fracture, measured and displayed the values of the three translations (axial, anterior-posterior, and medial-lateral), the axial rotation, and the two angulations (anterior-posterior and varus-valgus) as they occurred. Although only an axial load was applied, the off-axis motions were comparable in magnitude with the motion along the axis. The elastic (recoverable) translations of the fragments ranged from 0.5 to 1.9 millimeters, about four to ten times larger than the corresponding motions that were recorded in an earlier study of such fractures that had been stabilized with two types of external fixators. The recoverable rotation and angulations of the fragments of the limbs in the functional brace ranged from 0.7 to 1.2 degrees, about ten times those recorded when the external fixators were used.

  14. 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.

  15. 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.

  16. [Meaning of living with external fixation for grade III open fracture of lower limbs: patient view].

    PubMed

    Lopez, Catia Cristina Gomes; Gamba, Mônica Antar; Matheus, Maria Clara Cassuli

    2013-06-01

    The present study is aimed to understand the meaning of living with an external fixation device for grade III open fractures of the lower limbs from the perspective of the patient. The data were collected with six young adults who were undergoing outpatient orthopedic treatment in a public hospital in the city of São Paulo, through semi-structured interviews with open questions, between June and August 2010. Seeking to understand the meaning of this experience, we have maintained a phenomenological attitude during the analysis, which made it possible to reveal the phenomenon "try to live in spite of feeling trapped in a cage." Patients said that their personal desire and support from others helped them reorganize their lives, despite the several challenges they had to overcome to adapt to the fastener attached to their body and the fear of the future and doubts about the success of treatment.

  17. Retrograde tibial nail: anatomical implantation and surgical feasibility study.

    PubMed

    Kuhn, S; Appelmann, P; Pairon, P; Gruszka, D; Rommens, P M

    2015-01-01

    PURPOSE OF THE STUDY The treatment of distal tibial fractures requires a stable fixation while minimizing the secondary trauma to the soft tissues by the surgical approach and implant. The experimental Retrograde Tibial Nail is currently investigated as a minimally invasive alternative to plating and antegrade nailing. The purpose of this study was to evaluate the surgical feasibility in a cadaver model for all distal tibial fracture types generally considered treatable by nailing. MATERIAL AND METHODS Five different fracture types (AO/OTA 43-A1/A2/A3 and 43-C1/C2) were created on separate cadaveric limbs. In simple fractures (AO/OTA 43-A1/A2/A3) primary nailing was performed. In intraarticular fractures (AO/OTA 43-C1/2) reduction of the articular block and lag screw fixation was performed before nailing. Intraoperative complications, quality of reduction, fluoroscopy duration and operative time were evaluated. RESULTS Retrograde intramedullary nailing is feasible in simple fracture types by closed manual reduction and percutaneous reduction forceps. Retrograde nailing is possible in fractures with simple intraarticular involvement after primary lag screw fixation. The duration of surgery averaged 51.8 minutes (range 40-62 min). No major complications occurred during nailing. CONCLUSIONS The minimally invasive retrograde nail combines a minimally invasive local osteosynthesis with the ability to adequately fix extraarticular and simple intraarticular distal tibial fractures. The results suggests that retrograde tibia nailing is a promising new concept for the treatment of distal tibia fractures. Key words: minimally invasive surgery, tibia, metaphyseal fractures, intramedullary nailing, retrograde nailing.

  18. 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.

  19. Heterotopic Ossification around the Knee after Internal Fixation of a Complex Tibial Plateau Fracture Combined with the Use of Demineralized Bone Matrix (DBM): A Case Report

    PubMed Central

    Nota, Sjoerd P.F.T.; Kloen, Peter

    2014-01-01

    Demineralized bone matrix has been successfully commercialized as an alternative bone graft material that not only can function as filler but also as an osteoinductive graft. Numerous studies have confirmed its beneficial use in clinical practice. Heterotopic ossification after internal fixation combined with the use of demineralized bone matrix has not been widely reported. In this paper we describe a 39 year old male who sustained a complex articular fracture that developed clinically significant heterotopic ossification after internal fixation with added demineralized bone matrix. Although we cannot be sure that there is a cause-and-effect relation between demineralized bone matrix and the excessive heterotopic ossification seen in our patient, it seems that some caution in using demineralised bone matrix in similar cases is warranted. Also, given the known inter- and intraproduct variability, the risks and benefits of these products should be carefully weighed. PMID:25692153

  20. Muscle-bone Interactions During Fracture Healing

    DTIC Science & Technology

    2015-03-01

    equal vascu- larization in healed bone and non-unions in animal studies as well as in human patients20,24-26. In a murine open tibial fracture model...the periosteum is intact, repair occurs largely through endochondral ossification driven by a periosteal supply of cells10,47-50. Indeed, in open...activated to serve as a secondary supply of cells when the periosteal supply becomes compro- mised52,53. These recent findings of muscle’s ability to

  1. Clavicle fractures in 2010: sling/swathe or open reduction and internal fixation?

    PubMed

    McKee, Michael D

    2010-04-01

    Clavicle fractures are common, and they comprise close to 3% of all fractures seen in fracture clinics. Midshaft fractures account for approximately 80% of all clavicle fractures and are the focus of this article. In carefully selected cases primary plate fixation of displaced midshaft clavicle fractures improves outcome, results in earlier return to function, and reduces the nonunion and symptomatic malunion rate significantly compared with nonoperative treatment.

  2. [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.

  3. Open glenohumeral dislocation: skeletonization of the proximal humerus without associated fracture.

    PubMed

    Maroney, Samuel S; Devinney, D Scott

    2011-11-09

    Shoulder dislocations are common injuries. In the realm of high-energy trauma, enough force can be dissipated to violate the entire soft tissue envelope surrounding the shoulder girdle, generating an open injury. This article presents a case of a young man involved in a motorcycle accident in which he sustained an open glenohumeral dislocation with complete skeletonization of the proximal humerus. There were no associated fractures with his injury. Our patient underwent staged irrigation and debridement of his shoulder with delayed tendoligamentous reconstruction of the skeletonized proximal humerus. After reconstruction, he was immobilized for 3 weeks and then began a progressive shoulder rehabilitation protocol. He healed with no evidence of infection, residual instability, or avascular necrosis at his 4-month follow-up examination. At that point, he had regained functional use of his shoulder for activities of daily living and had no pain. His range of active motion was limited to 90° of flexion and abduction, 0° of external rotation, and internal rotation to the L4. He had complete resolution of a sensory and motor axillary neuropraxia that resulted from his initial injury. It was felt that the patient had potential for continued gains in range of motion and strength.Our patient is only the second description of an open glenohumeral dislocation with no associated fractures of the proximal humerus. This skeletonization of the proximal humerus represents a complex soft tissue injury that severely compromises the functional capacity of the shoulder. Understanding the nature of the injury and the involved structures and maintaining a sound treatment algorithm allow orthopedic surgeons to maximize the patient's functional outcome.

  4. Comparison of Fracture Characteristics of Open-Hole-Notch Carbon-Fiber-Reinforced Composites Subjected to Tensile and Compressive Loadings

    NASA Astrophysics Data System (ADS)

    Saeed, M.-U.; Chen, Z. F.; Chen, Z. H.; Li, B. B.

    2017-01-01

    Open-hole tension (OHT) and open-hole compression (OHC) tests were carried out on hot-pressed carbon-fiberreinforced composite samples with a singular open hole. The fracture surfaces of the OHT- and OHC-tested specimens were examined by using scanning electron microscopy (SEM). SEM micrographs showed significant features on the surface of carbon fiber, matrix, and especially in the fiber/matrix interface. Interpretation of these micrographs revealed the possible failure mechanism of composite samples with an open hole under tensile and compressive loadings. Furthermore, a comparative study of these micrographs also pointed to certain specific differences between the fracture characteristics of open-hole composite samples failed under tension and compression. This information is useful in the post-failure analysis of a composite structure.

  5. Leg Muscle Usage on Tibial Elasticity During Running

    DTIC Science & Technology

    2005-01-01

    Tibial stress fractures (TSFs) are a substantial problem for military recruits, elite athletes, and adults transitioning from a sedentary lifestyle to...were being taken by the co-investigators to minimize the Greater than Minimal Risk assigned to the transition from a sedentary lifestyle to moderate-to

  6. Mandibular pathological fracture during treatment with a dynamic mouth opening device: A clinical report.

    PubMed

    Marunick, Mark T; Garcia-Gazaui, Sabrina; Hildebrand, Joseph M

    2016-10-01

    Trismus is a well-known complication of head and neck cancer treatment. It is defined as a progressive tonic contraction of the muscles of mastication that results in decreased mouth opening. This condition can lead to impairment of speech and eating, malnutrition, poor oral hygiene, and difficulty with dental treatment. Its prevalence in patients with head and neck cancer ranges from 5% to 38%. Different treatments are available to improve muscle length and function. Mouth opening devices along with exercising of the mandible immediately after surgery and/or radiation therapy have been found to be effective in reducing the trismus induced by cancer therapy. Presently, only limited defined guidelines are available for initiating or monitoring trismus therapy in this patient population. This clinical report presents a patient with head and neck cancer and a history of progressive recurrent trismus as a sequela of extensive surgery and chemoradiation, who experienced a pathological fracture of the mandible during treatment with a mouth opening device.

  7. Spontaneous Bone Regeneration in an Open Segmental Fracture of the Forearm with Extruded Middle Segment

    PubMed Central

    Rai, Bibek K; Vaishya, Raju

    2016-01-01

    Open segmental fractures of both bones of the forearm with the loss of the middle segment of the radius is a rare injury in children. An eight-year-old boy presented to our clinic four days following a road traffic accident. The child’s mother was carrying a 12-cm long extruded and soiled segment of the radius bone. The extruded bone segment seemed necrotic, and we decided not to use it for replantation. The wound over the forearm fracture was infected. It was debrided and regularly dressed until it became healthy. We planned to use a fibular graft for the gap and to fix the graft with a Kirschner wire (K-wire). The operation was delayed due to the poor wound condition. At the four-week follow-up, we noticed unexpected signs of bone regeneration in the bone defect of the radius. After eight weeks, a complete spontaneous reconstruction of the bone was noted. This case highlights the excellent healing potential of the bones in children, where even if a long segment of the bone is lost, we can expect spontaneous complete regeneration of the bone if the periosteum is intact and continuous. PMID:27738571

  8. [Open posterior dislocation of the elbow with fractures of the radial head and coronoid process and multiple diaphyseal fractures of the ulna].

    PubMed

    Visna, P; Kalvach, J; Beitl, E; Pilný, J; Cizmár, I

    2008-03-01

    A healthy, right-handed 34-year-old man was injured by repeated direct blows delivered to his left upper arm with a baseball bat. These blows led to a posterior dislocation of the elbow joint, associated with fractures of the radial head and the coronoid process. There was bone loss on the fractured joint surface of the olecranon, with simultaneous ipsilateral trauma to the ulna. The correct surgical approach in the case of such fractures is still the subject of some controversy. The treatment can have serious complications. The results of treatment are often poor, especially because of persisting instability and stiffness of the elbow following a long period of immobilisation. Few studies have been concentrated on this topic up to now. We report on the functional and radiological results 24 months after the treatment of this rare, open "shock triad in the elbow."

  9. External Fixation Versus Open Reduction With Locked Volar Plating for Geriatric Distal Radius Fractures

    PubMed Central

    Lee, Daniel J.

    2014-01-01

    The optimal management of displaced dorsal radius fractures (DRFs) in older patients remains an issue of debate. Bridging external fixation is a well-accepted treatment modality for severely comminuted DRFs, while open reduction and internal fixation with locked volar plating has emerged as a promising alternative in recent years. The current body of randomized trials supports the trend toward locked volar plating, as it allows for quicker improvement in subjective and functional outcomes. There is no clear evidence to suggest that one technique carries significantly less complications than the other. Locked volar plating should be considered in patients for whom an accelerated functional recovery would be advantageous. Otherwise, both external fixation and locked volar plating provide good long-term clinical outcomes. PMID:25360346

  10. An animal model for open femur fracture and osteomyelitis--Part II: Immunomodulation with systemic IL-12.

    PubMed

    Lindsey, Brock A; Clovis, Nina B; Smith, E Suzanne; Salihu, Sydha; Hubbard, David F

    2010-01-01

    Infection resulting from open fracture is a common problem in orthopedics. The purpose of this project was to study the effect of Interleukin-12 (IL-12) systemic therapy on a previously established open fracture model. One hundred seven male Sprague-Dawley rats were assigned to five groups: (1) normal (baseline), (2) control (controlled for anesthesia), (3) fracture, (4) staph, and (5) staph and IL-12 (SIL). Each group was divided into four time periods: 6, 10, 14, and 21 days after injury and fixation. The operative groups had a standardized femur fracture and fixation using a Kirschner wire as an intramedullary device. The two infection groups (staph and SIL) were inoculated with Staphylococcus aureus following fracture and fixed with an identical technique. The SIL group was treated with systemic IL-12 for a total of 10 doses over 10 days. Significantly decreased serum IL-12 levels were noted at day 10 in the operative groups compared to the normal and control groups. The SIL group showed significantly higher macrophage activation levels and total platelet counts at day 21 compared to all the other groups. The overall infection rate was not changed by IL-12 supplementation; however, bacterial qualitative growth scores were significantly lower in the SIL group at day 10, which corresponded to the lowest level of systemic IL-12 in the fracture group.

  11. Spacing and aperture of opening-mode fractures in layered materials

    NASA Astrophysics Data System (ADS)

    Bai, Taixu

    This dissertation investigates the mechanical control on spacing and aperture of equally-spaced fractures in layered materials using the Finite Element Method, based on the theories of elasticity and linear fracture mechanics. It also investigates the effects of fracture spacing and aperture on fluid flow through the equally-spaced fractures. The results show that under a remote extension in the direction perpendicular to the fractures the normal stress acting in this direction between adjacent fractures changes from tensile to compressive as the fracture spacing to layer thickness ratio changes from greater than to less than a critical value. This stress transition precludes further infilling of fractures unless they are driven by mechanisms other than an extension, or there are significant flaws between the fractures. Hence, it defines the condition of saturation for fractures formed under extension in flawless layered materials. When flaws are present, further infilling of fractures is possible depending upon the size and locations of the flaws. The aspect ratio of equally-spaced fractures is linearly related to the average strain, the overburden stress, and the internal fluid pressure. The aspect ratio increases nonlinearly with increasing fracture spacing to layer thickness ratio because of the mechanical interaction between adjacent fractures. The interaction becomes insignificant when the spacing to layer thickness ratio is greater than about 6.0. The aspect ratio also depends on the ratio of Young's modulus of the fractured layer to that of the neighboring layers. This dependence is significant when the fracture spacing to layer thickness ratio is less than 1.3, otherwise it is negligibe. The aspect ratio is insensitive to variations in Poisson's ratios. Fluid flow rate through equally-spaced fractures does not always increases with increasing fracture density, i.e., with decreasing spacing to layer thickness ratio. There is an optimum value for the ratio

  12. Fractures in Shale: a Study on the Roughness of the Vein-Rock Interface vs. Open Fractures

    NASA Astrophysics Data System (ADS)

    Pluymakers, A. M. H.

    2015-12-01

    Gas recovery from methane-bearing shale rocks receives currently a lot of attention. The permeability of these rocks is controlled by induced and/or pre-existing fractures, where flow and thus gas recovery is partly controlled by the roughness of fracture walls. In this study, we determine fracture roughness and geometry both of veins and decompression fractures of the Pomeronian shale from Poland, recovered from ~4 km depth. Since vein formation occurs at depth, the topography of the vein-rock interface is preserved even when samples are extracted from the subsurface. Here, we have imaged a series of shale sample in 3D using X-ray microtomography performed on a laboratory tomograph and on the beamline ID19 at the European Synchrotron Radiation Facility. Several voxel spatial sizes were used, in the range 0.2 to 20 micrometers, allowing a multi-scale analysis of these rocks. We also compare fracture and veins roughness values from tomography scans to results obtained using white light interferometry, where these different measurements provides us with information on how scale, resolution and method affect roughness values. The low resolution CT scans show a small but clear difference between the roughness of the vein-rock interface and decompression fractures, implying fracture origin is important in controlling final roughness. The first results on scans made at different resolution furthermore indicate that higher resolution shows higher roughness values, which implies that low resolution tomography alone cannot capture the complexity of these fine-grained rocks. The results from this study provide input for (reactive) flow models, to study how efficient gas recovery can be.

  13. Mycobacterium chelonae and Mycobacterium fortuitum infection following open fracture: a case report and review of the literature.

    PubMed

    Kwan, K; Ho, S T

    2010-01-01

    We report a case of dual nontuberculous mycobacterial infections complicating an open distal radius and ulna fracture after polytrauma in a 35-year-old man. There was persistent wound discharge after definitive fixation of this fracture, but microbiological cultures did not yield any organism. The patient underwent multiple debridement, and subsequent tissue grew Mycobacterium chelonae and Mycobacterium fortuitum. Despite appropriate chemotherapy and surgical debridement the infection persisted until radical bone excision and tissue debridement were done. This case indicates that nontuberculous mycobacterial infections should be considered when conventional microbiological assays fail to identify the infecting agent in suspected osteomyelitis following open fracture. A combination of radical debridement, including removal of infected bone, and prolonged antimicrobial therapy are required to eradicate the infection completely.

  14. Removal of a bent tibial intramedullary nail: a rare case report and review of the literature.

    PubMed

    Aggerwal, Sameer; Soni, Ashwani; Saini, Uttam-C; Gahlot, Nitesh

    2011-04-01

    Intramedullary interlocking nailing is a gold standard for treatment of tibial shaft fractures. Bending of a nail secondary to trauma is a rare complication, which may be encountered in healed or unhealed tibial shaft fractures. Removal of such bent nail is always a challenge. We reported this case to discuss various techniques for removal of bent nails and to share our experience in removing a bent tibial intramedullary nail in a 30-year-old man, who was admitted in our department with re-fracture of the right tibial shaft due to a roadside accident two years after the initial surgical treatment. The intramedullary nail, bent by 30 degrees and visible on anterioposterior as well as on lateral radiographs, was firstly weakened by partially cutting the convex wall, then straightened by applying external force, and finally removed by using the standard nail removal method.

  15. A viscoelastic Unitary Crack-Opening strain tensor for crack width assessment in fractured concrete structures

    NASA Astrophysics Data System (ADS)

    Sciumè, Giuseppe; Benboudjema, Farid

    2016-09-01

    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). The presented method is an extension to viscoelasticity of the approach proposed by Matallah et al. (Int. J. Numer. Anal. Methods Geomech. 34(15):1615-1633, 2010) for a purely elastic damage model. The viscoelastic Unitary Crack-Opening (UCO) strain tensor is computed accounting for evolution with time of surplus of stress related to damage; this stress is obtained from decomposition of the effective stress tensor. From UCO the normal crack width is then derived accounting for finite element characteristic length in the direction orthogonal to crack. This extension is quite natural and allows for accounting of creep impact on opening/closing of cracks in time dependent problems. A graphical interpretation of the viscoelastic UCO using Mohr's circles is proposed and application cases together with a theoretical validation are presented to show physical consistency of computed viscoelastic UCO.

  16. Bilateral tibial hemimelia I.

    PubMed

    Suganthy, J; Rassau, Marina; Koshi, Rachel; Battacharjee, Suranjan

    2007-05-01

    Congenital absence of tibia is a rare anomaly. We report a case of bilateral tibial hemimelia born to phenotypically normal parents. The two amputated legs with tibial dysplasia obtained from a 3-year-old boy were studied by radiography and anatomical dissection. The radiological evaluation revealed a normal hip joint. The lower end of femur was normal without any bifurcation, shortening or bowing. Fibula was present on both legs and there was no sign of bowing or doubling. Both right and left tibiae were absent. In addition, on the right side, five tarsal bones, two metatarsals and the corresponding digital rays were absent. On the left side, three tarsal bones were absent. Dissection of the amputated segments showed the presence of extensor digitorum longus, peroneus tertius, peroneus longus and brevis, gastrocnemius, and soleus. Following bilateral knee disarticulation the patient was fitted with prosthesis and is doing well.

  17. Monte Carlo based NMR simulations of open fractures in porous media

    NASA Astrophysics Data System (ADS)

    Lukács, Tamás; Balázs, László

    2014-05-01

    According to the basic principles of nuclear magnetic resonance (NMR), a measurement's free induction decay curve has an exponential characteristic and its parameter is the transversal relaxation time, T2, given by the Bloch equations in rotating frame. In our simulations we are observing that particular case when the bulk's volume is neglectable to the whole system, the vertical movement is basically zero, hence the diffusion part of the T2 relation can be editted out. This small-apertured situations are common in sedimentary layers, and the smallness of the observed volume enable us to calculate with just the bulk relaxation and the surface relaxation. The simulation uses the Monte-Carlo method, so it is based on a random-walk generator which provides the brownian motions of the particles by uniformly distributed, pseudorandom generated numbers. An attached differential equation assures the bulk relaxation, the initial and the iterated conditions guarantee the simulation's replicability and enable having consistent estimations. We generate an initial geometry of a plain segment with known height, with given number of particles, the spatial distribution is set to equal to each simulation, and the surface-volume ratio remains at a constant value. It follows that to the given thickness of the open fracture, from the fitted curve's parameter, the surface relaxivity is determinable. The calculated T2 distribution curves are also indicating the inconstancy in the observed fracture situations. The effect of varying the height of the lamina at a constant diffusion coefficient also produces characteristic anomaly and for comparison we have run the simulation with the same initial volume, number of particles and conditions in spherical bulks, their profiles are clear and easily to understand. The surface relaxation enables us to estimate the interaction beetwen the materials of boundary with this two geometrically well-defined bulks, therefore the distribution takes as a

  18. Delayed Open Reduction and K-Wire Fixation of Widely Displaced Supracondylar Fractures of Humerus in Children using Medial Approach

    PubMed Central

    Waikhom, Sanjib; Ibomcha, Irom; Digendra, Akoijam; Sohkhlet, Handboy R

    2016-01-01

    Introduction Supracondylar fractures of humerus in children are usually treated with percutaneous pinning on emergency basis. When the operating time is delayed, percutaneous pinning is difficult due to massive swelling. Late presentation is common in developing countries. Aim To assess the outcome of open reduction and internal fixation with K-wire of widely displaced supracondylar fracture when operated later than 2 days after the injury. Materials and Methods A total of 52 children (aged 3-12 years) with widely displaced supracondylar fracture of humerus (Gartland type-III) who presented later than 2 days after injury were treated with open reduction through medial approach and fixation with cross K-wires. Results were assessed with Flynn’s criteria. Result: A total of 40 patients completed follow-up. Mean age of all (n=52) patients was 4.8 years (range 3-12 years). Mean delay of presentation was 7.5 days (range 2-14 days). Hundred percent patients had satisfactory results according to Flynn’s criteria. Two patients had pin infections. Conclusion Open reduction through medial approach and fixation with two cross K-wires is a reliable method of treatment for supracondylar fractures of humerus in children when the operation is delayed. PMID:27656516

  19. Open Reduction and Volar Plate Fixation of Dorsally Displaced Distal Radius Fractures: A Prospective Study of Functional and Radiological Outcomes

    PubMed Central

    Sadasivan, Anand Kumar; Hegde, Anoop; Shetty, Ashwin

    2016-01-01

    Introduction The fractures of the distal radius have always posed a unique challenge to the orthopaedic fraternity. The complex ligamentous and bony anatomy offers a wide variety of fractures to be dealt with around this zone. Over the years these injuries have become common especially in the elderly age group as well as the implants and surgical techniques have improved. Aim To assess the radiological and functional outcome after fixation of intra-articular dorsally displaced distal radius fractures with open reduction and volar Locking Compression Plate fixation (LCP). To study the complications occurring with this technique. Materials and Methods A prospective study was conducted in the Department of Orthopaedics at ARS Hospital, Tirupur, Tamil Nadu, from June 2015 to June 2016. A total of 20 skeletally mature patients with Lidstrom class 2D and 2E fresh closed distal radius fractures were enrolled in the study. All the patients underwent open reduction with locking compression plating with titanium LCPs using the volar approach. The patients were reviewed regularly at three, six, 12 and 24 weeks. Final assessment of radiographic fracture union was done and scored as per the ‘Radiographic Scoring System to Evaluate Union of Distal Radius Fractures {Radius Union Scoring System (RUSS)}’ and the functional assessment of the wrist was done using the Mayo wrist score. The final results were tabulated and calculated statistically using ‘frequency and proportions’ and ‘Chi-square tests’ were used to assess the test of association. Results Of the 20 patients reviewed, one patient had excellent Mayo wrist score, five had good scores, 12 had satisfactory and two patients had poor results. Seven patients had a RUSS score less than five points and four patients had RUSS score of five points, four patients had six points, two patients had seven points and three patients had eight points. One patient was noted to have dorsal collapse of the fracture during the

  20. Lower limb fractures associated with multiligament knee injury

    PubMed Central

    Stagnaro, Joaquin; Yacuzzi, Carlos; Barla, Jorge; Zicaro, Juan Pablo; Costa-Paz, Matias

    2017-01-01

    Objectives: Knee ligament injuries related to lower limb fractures are common and frequently unnoticed. Management of acute polytrauma is usually focused in the bone lesion and a complete physical examination might be really difficult. The purpose of this study was to analyze a series of patients who suffered multiligament knee injuries associated to a lower limb fracture. Hypothesis: The use of magnetic resonance imaging (MRI) during the initial management can lead to an early diagnosis of ligament injuries. Methods: A retrospective search was conducted from our hospital´s electronic database. We evaluated the initial diagnosis and acute surgical treatment, and management and functional outcomes after the ligament lesion was diagnosed. Results: Seven patients who presented a knee multiligament injury associated with a lower limb fracture were evaluated. The average age was 29 years. Primary diagnoses were: four tibial plateau fractures; one open fracture-dislocation of the knee; one open leg fracture and ipsilateral hip dislocation; and one bifocal femur fracture. Only three patients had an MRI during the initial management of trauma. Six out of seven patients had to be operated on for the multiligament knee injury. The period between the resolution of the fracture and the ligamentous repair was from 3 to 24 months. Conclusion: Poor functional outcomes are reported in patients with multiligament knee injuries associated with high-energy lower limb fractures. We consider an MRI during the initial management can lead to better outcomes. A trauma surgeon working alongside an arthroscopic surgeon might optimize the results for these lesions.

  1. [Surgical treatment of bicondylar tibial fractures].

    PubMed

    Gilev, M V; Volokitina, E A; Antoniadi, Yu V; Zverev, F N; Chernitsyn, D N; Zhiryakov, D L

    2017-01-01

    Цель работы — усовершенствовать тактику хирургического лечения двухмыщелковых переломов большеберцовой кости. Материал и методы. Проанализированы результаты лечения 69 пострадавших. Приведены группы сравнения для оценки эффективности предлагаемых авторами методик (двухэтапность хирургической коррекции, погружной остеосинтез в условиях дистракции сустава, применение комбинации новых L-образного наружного и L-образного внутреннего доступов, остеопластика b-трикальцийфосфатом, углеродным наноструктурным имплантатом и ксенопластическим материалом Остеоматрикс). Вывод. Эффективность лечения в основной группе превалировала над аналогичным показателем в группе контроля (50 и 27,6% соответственно), что показывает высокую эффективность предлагаемых методик.

  2. Biomechanical Factors in Tibial Stress Fracture

    DTIC Science & Technology

    2001-08-01

    entry only. Back Injury: Hip /Groin Injury; Thigh Injury: Knee Injury: I none none none ~3 (none Lower Leg Injury: pone Ankle Injury Foot...eumenorrhoeic and had two separate DEXA bone density scans over the past two years that demonstrated normal bone density. Area moments of inertia were...Ankle, Knee , and Hip ) Angle, Moment, Power, and Ground Reaction Force Data Ankle AngleX-axis Ankle Angle Y axis Ankle Angle Z axis Figure 1. Ankle

  3. Evaluation of local MCP-1 and IL-12 nanocoatings for infection prevention in open fractures.

    PubMed

    Li, Bingyun; Jiang, Bingbing; Dietz, Matthew J; Smith, E Suzanne; Clovis, Nina B; Rao, K Murali Krishna

    2010-01-01

    The increasing incidence of bacterial infection and the appearance of Staphylococcus aureus (S. aureus) strains that are resistant to commonly used antibiotics has made it important to develop non-antibiotic approaches for infection prevention. The aim of this study was to develop local monocyte chemoattractant protein-1 (MCP-1) and interleukin-12 p70 (IL-12 p70) therapies to prevent S. aureus infection by enhancing the recruitment and activation of macrophages, which are believed to play an important role in infection prevention as the first line of defense against invading pathogens. Nanocoating systems for MCP-1 and IL-12 p70 deliveries were prepared, and their release characteristics desirable for infection prevention in open fractures were explored. Local MCP-1 therapy reduced S. aureus infection and influenced white blood cell populations, and local IL-12 p70 treatment had a more profound effect on preventing S. aureus infection. No synergistic relationship in decreasing S. aureus infection was observed when MCP-1 and IL-12 p70 treatments were combined. This reported new approach may reduce antibiotic use and antibiotic resistance.

  4. Rate of Improvement following Volar Plate Open Reduction and Internal Fixation of Distal Radius Fractures

    PubMed Central

    Dillingham, Chris; Horodyski, MaryBeth; Struk, Aimee M.; Wright, Thomas

    2011-01-01

    Purpose. To determine recovery timeline of unstable distal radius fractures treated by open reduction and internal fixation with a locking volar plate. Methods. Data was collected prospectively on a consecutive series of twenty-seven patients during routine post-operative visits at 2 and 6 weeks, and 3, 6, 12 and 24 months. Range of motion measures and grip strength for both wrists were recorded. Results. Greatest gains were made within the first 3 months after surgery. Supination and pronation returned more quickly than flexion or extension, with supination and pronation both at 92% of the uninjured wrist at 3 months. Only flexion improved significantly between 3 and 6 months. All wrist motions showed some improvement until 1 year. Grip strength returned to 94% of the uninjured wrist by 12 months. Conclusions. Range of motion improvement will be greatest between 2 weeks and 3 months, with improvement continuing until 12 months. Grip strength should return to near normal by one year. Function and pain will improve, but not return to normal by the end of 12 months. Clinical Relevance. These results provide the surgeon with information that can be shared with patients on the anticipated timeline for normal recovery of function and strength. PMID:21991417

  5. Tibial hypoplasia with a bifid tibia: an unclassified tibial hemimelia.

    PubMed

    Shah, Krupa; Shah, Hitesh

    2016-08-16

    Tibial hemimelia is a rare congenital limb deficiency which is characterised by a hypoplastic/aplastic tibia. It actually represents a spectrum of anomalies, ranging from mild hypoplasia of the tibia to total absence of the tibia. Several classifications based on radiological description exist in the literature. The tibial hemimelia is usually described with preaxial mirror polydactyly, split hand/foot syndrome-ectrodactyly, polydactyly-triphalangeal thumb syndrome (Werner syndrome) and micromelia-trigonal brachycephaly syndrome. We describe a child with unclassified tibial hemimelia. The child had right incomplete tibial hemimelia with bifid tibia, left complete tibial hemimelia, bilateral split hands and left split foot. This is the first report of the bifid tibia in the literature.

  6. The effects of glass ionomer and flowable composite liners on the fracture resistance of open-sandwich class II restorations.

    PubMed

    Güray Efes, Begüm; Yaman, Batu Can; Gümüştaş, Burak; Tıryakı, Murat

    2013-01-01

    This in vitro study aimed to investigate the effects of glass-ionomer and flowable composite liners on the fracture resistance of Class II amalgam and composite restorations. Group 1 cavities were restored with amalgam and Group 4 cavities with nanofill composite after the application of a dentin-bonding agent. For the remaining groups, light-cured-glass-ionomer liner was used in a gingival floor proximal box (Groups 2, 5) or flowable composite was used as a liner (Groups 3, 6), the remainder of the cavity was restored with amalgam (Groups 2, 3) or composite (Groups 5, 6). The restorations were loaded in compression to failure. The data was analyzed using Tukey's multiple comparison test. The fracture resistance was significantly higher (p<0.05) in Group 3 than in all other groups, except Group 2 (p>0.05). Flowable composite, glass-ionomer liners increased the fracture resistance of open-sandwich Class II amalgam restorations.

  7. Extended analysis of constant-height hydraulic fractures for the estimation of in-situ crack-opening modulus from bottomhole pressure records

    SciTech Connect

    Wijesinghe, A.M.

    1987-03-01

    Hydraulic fractures created in oil and gas bearing rock formations can be made to propagate for a limited time at approximately constant height if favorable stress, deformation modulus or fracture toughness barriers to height growth exist and if the fracture design is suitably optimized to exploit these favorable conditions and reduce height growth. In this report, a unified theoretical formulation for the Perkins-Kern-Nordgren (PKN) and Christianovitch-Geertsma-De Klerk-Daneshy (CGDD) constant height fracture models is first presented. For a fracture fluid injection rate that varies as an arbitrary power of time, growth laws for fracturing fluid pressure, fracture width, and flow rate are rigorously derived for PKN and CGDD types of fractures. These similarity solutions account for non-Newtonian power-law fluid flow, transient fluid storage and generalized power-law fluid leak-off to the rock formation. They include and extend the results currently available in the literature for PKN and CGDD fractures. The results for PKN and CGDD fractures are then generalized to obtain an approximate hybrid CGDD-PKN fracture model that can be applied to constant height fractures of arbitrary length/height aspect ratio and arbitrary cross-sectional shape. Characteristic times for fracture extension are identified and estimates are given for the transition times when the fracture evolves from a CGDD-type fracture at small aspect ratio to a PKN-type fracture at large aspect ratio. These results are useful for interpreting fracturing data and for designing fractures for crack-opening modulus measurements.

  8. Adamantinoma of tibial shaft.

    PubMed

    A, Joshi; Kc, B R; Basnet, S B; Panth, R; Shrestha, R L; Chand, P; Thapa, B B

    2009-01-01

    Adamantinoma is an extremely rare primary bony neoplasm. Because of its malignant nature, accurate and early diagnosis is very important. On the other hand adamantinoma mimics many benign conditions, so it is doubly important to establish correct tissue diagnosis to avoid radical surgery with morbidities. Because of its rarity, diagnosing adamantinoma still remains difficult, even if when it occurs in classical sites. We report a case of adamantinoma of tibial shaft diaphysis in a 23 year male. In this case, because of classic clinic-radiological features, we were suspecting adamantinoma from very beginning but final diagnosis was delayed for nine months.

  9. Open reduction internal fixation for proximal humerus fractures indications, techniques, and pitfalls.

    PubMed

    Shulman, Brandon S; Egol, Kenneth A

    2013-01-01

    Proximal humerus fractures account for approximately 5% of all fractures. It is estimated that due to our aging population, orthopaedic surgeons will see a three-fold increase in proximal humerus fractures over the next 30 years. Internal fixation with locked plating is the current mainstay of treatment for functionally active patients who desire minimal loss of function. A thorough understanding of the indications, techniques, and drawbacks of treatment with internal fixation is essential to achieve the highest quality of patient care.

  10. Minimally-invasive open reduction of intracapsular condylar fractures with preoperative simulation using computer-aided design.

    PubMed

    Yang, Ming-liang; Zhang, Bin; Zhou, Qing; Gao, Xiao-bo; Liu, Qiang; Lu, Li

    2013-04-01

    Reduction of intracapsular condylar fractures is difficult, so we have based our technique on preoperative simulation using computer-aided design (CAD), which has proved useful in other surgical specialties. We have treated 11 patients with intracapsular condylar fractures. Before the operation the procedure was shown on the computer using a three-dimensional simulation system. The relation between the stump and the fragment of the condyle, and assessment of the position and the size of the screw, were made preoperatively to obtain a perfect fit. The displaced fragment was reduced by elevators, and fixed with a bicortical screw through a minimised preauricular incision under general anaesthesia. The fragments and the location of the screws were similar on the preoperative simulation and on the postoperative computed tomographic (CT) scan. The reduction and fixation of the fracture showed a perfect fit on the same view in the preoperative CAD simulation in the Mimics 10.01 software and postoperatively. Postoperative clinical examinations showed good occlusion and satisfactory mouth opening. Two patients had temporary paralysis of the occipitofrontalis muscle that recovered within 3 months. All patients regained normal mandibular movements and had short and invisible scars at 6 months' follow up. The technique of CAD simulation could help to improve the accuracy during open treatment for intracapsular condylar fractures.

  11. Case 24: Stress Fracture of the Tibia

    DTIC Science & Technology

    2008-03-01

    strengthening was started. At six-week follow up, periosteal involvement was subsiding and a healing sclerotic band was seen across the tibial shaft on...stress fracture. Fig. 2: Axial CT showing the periosteal reaction. Female athletes have the greater tendency of acquiring tibial stress...extremity to include the vertebral body, femoral neck, tibial diaphysis, metatarsal shaft and calcaneous are most commonly affected. If the offending

  12. Experimental study of stable imbibition displacements in a model open fracture. I. Local avalanche dynamics.

    PubMed

    Clotet, Xavier; Ortín, Jordi; Santucci, Stéphane

    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 different constant flow rates v. In this first part of the study we have focused on the local dynamics at a scale below the size of the quenched disorder. Changing μ and v independently, we have found that the dynamics is not simply controlled by the capillary number Ca∼μv. Specifically, we have found that the wide statistical distributions of local front velocities, and their large spatial correlations along the front, are indeed controlled by the capillary number Ca. However, local velocities exhibit also very large temporal correlations, and these correlations depend more strongly on the mean imposed velocity v than on the viscosity μ of the invading fluid. Correlations between local velocities lead to a burstlike dynamics. Avalanches, defined as clusters of large local velocities, follow power-law distributions-both in size and duration-with exponential cutoffs that diverge as Ca→0, the pinning-depinning transition of stable imbibition displacements. Large data sets have led to reliable statistics, from which we have derived accurate values of critical exponents of the relevant power-law distributions. We have investigated also the dependence of their cutoffs on μ and v and related them to the autocorrelations of local velocities in space and time.

  13. Experimental study of stable imbibition displacements in a model open fracture. I. Local avalanche dynamics

    NASA Astrophysics Data System (ADS)

    Clotet, Xavier; Ortín, Jordi; Santucci, Stéphane

    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 different constant flow rates v . In this first part of the study we have focused on the local dynamics at a scale below the size of the quenched disorder. Changing μ and v independently, we have found that the dynamics is not simply controlled by the capillary number Ca˜μ v . Specifically, we have found that the wide statistical distributions of local front velocities, and their large spatial correlations along the front, are indeed controlled by the capillary number Ca. However, local velocities exhibit also very large temporal correlations, and these correlations depend more strongly on the mean imposed velocity v than on the viscosity μ of the invading fluid. Correlations between local velocities lead to a burstlike dynamics. Avalanches, defined as clusters of large local velocities, follow power-law distributions—both in size and duration—with exponential cutoffs that diverge as Ca→0 , the pinning-depinning transition of stable imbibition displacements. Large data sets have led to reliable statistics, from which we have derived accurate values of critical exponents of the relevant power-law distributions. We have investigated also the dependence of their cutoffs on μ and v and related them to the autocorrelations of local velocities in space and time.

  14. [Complications of open reduction and internal fixation versus external fixation for unstable distal radius fractures: a meta-analysis].

    PubMed

    Yang, Z; Yuan, Z Z; Ma, J X; Ma, X L

    2016-12-20

    Objective: To make a systematic assessment of the complications of open reduction and internal fixation versus external fixation for unstable distal radius fractures. Method: A computer-based online search of PubMed, ScienceDirect, EMBASE, BIOSIS, Springer and Cochrane Library were performed.The randomized and controlled trials of open reduction and internal fixation versus external fixation for unstable distal radius fractures were collected.The included trials were screened out strictly based on the criterion of inclusion and exclusion.The quality of included trials was evaluated.RevMan 5.0 was used for data analysis. Result: A total of 17 studies involving 1 402 patients were included.There were 687 patients with open reduction and internal fixation and 715 with external fixation.The results of Meta-analysis indicated that there were statistically significant differences with regard to the postoperatively total complications, infection, malunion, tendon rupture (I(2)=8%, RR=0.77(95%CI 0.65-0.91, Z=3.10, P<0.05). There were no statistically significant differences observed between two approaches with respect to nounion, re-operation, complex regional pain syndrome, carpal tunnel syndrome, neurapraxia, tendonitis, painful hardware, scar(P>0.05). Conclusion: Postoperative complications are present in both open reduction and internal fixation and external fixation.Compared with external fixation, open reduction and internal fixation is lower in total complications postoperatively, infection and malunion, but external fixation has lower tendon rupture incidence.

  15. A Modified Levering Technique for Removing a Broken Solid Intramedullary Tibial Nail: A Technical Tip.

    PubMed

    Pullen, W Michael; Erdle, Nicholas J; Crickard, Colin; Smith, Christopher S

    Intramedullary tibial fixation is a commonly used and highly successfully treatment in acute fractures, nonunion settings, and correctional procedures. In the setting of a nonunion, removal of a failed implant can add to operative time and surgeon frustration while further compromising bone in an area already at risk for failure. Here we present a technique, using readily accessible equipment, for removing a distal solid tibial nail fragment in a manner that preserves bone.

  16. 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

  17. Evaluation of Biodegradable Cefazolin Sodium Microspheres for the Prevention of Infection in Rabbits with Experimental Open Tibial Fractures Stabilized with Internal Fixation

    DTIC Science & Technology

    1993-05-01

    ES) 8. PERFORMING ORGANIZATION REPORT NUMBER United States Army Institute of Dental Research Walter Reed Army Medical Center Washington, D.C. 20307 9...t:Michael T. Fallon, fJames F McNeill, Jr., and *George S. Siderys Microbiology Branch, United States Army Institute of Dental Research, Washington DC...surprising, in light of the fact that and in five (83%) of the six animals in group B. In many commonly used orthopaedic implant materials contrast, of

  18. Tibial Bowing and Pseudarthrosis in Neurofibromatosis Type 1

    DTIC Science & Technology

    2014-04-01

    bowed tibia. We have extracted DNA from peripheral blood of all individuals with tibial bowing and will continue to monitor them for development of...to improve bone quality prior to fracture in a non-invasive and age specific manner • DNA extraction from peripheral blood for somatic mutation...Johnson B, Rauen KA. Peripheral muscle weakness in RASopathies. Oral presentation at the Western Society for Pediatric Research, Carmel, California

  19. 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.

  20. Early Definitive Fixation of an Open Periprosthetic Femur Fracture in the Polytraumatized Patient: A Case Report and Review of the Literature

    PubMed Central

    Aleem, Ilyas S; Bhandari, Mohit; Elizalde, Sebastian Rodriguez

    2016-01-01

    Introduction: Periprosthetic fractures of the femur after total hip arthroplasty are increasing in frequency. In the polytraumatized patient with long-bone fracture, an ongoing debate exists regarding early definitive stabilization versus initial damage control orthopaedics, followed by delayed fixation. It remains to be seen whether this rationale applies to the polytraumatized patient with periprosthetic fracture. Case presentation: We present the case of a 73-years old Caucasian woman who sustained bilateral Gustillo-Anderson grade III open femur fractures; the fracture on the right was a Vancouver C open periprosthetic fracture after cemented total hip arthroplasty. After massive fluid resuscitation in the trauma bay she was taken to the intensive care unit in a hemodynamically unstable condition. She was subsequently operated and underwent early definitive fixation of both femurs with the rationale of potentially reducing pulmonary complications and promoting early mobilization. Conclusion: Early definitive stabilization versus delayed fixation in the polytraumatized patient with an open periprosthetic femur fracture is reviewed. Although several treatment algorithms based on fracture classification and implant stability exist, further study is required to delineate the preferred method and timeline of fixation for this growing cohort of patients. PMID:27299122

  1. A comparison of MRI, radiographic and clinical findings of the position of the TMJ articular disc following open treatment of condylar neck fractures.

    PubMed

    Schneider, Alexander; Zahnert, Diana; Klengel, Steffen; Loukota, Richard; Eckelt, Uwe

    2007-10-01

    We examined the position and function of the articular disc after open treatment of condylar fractures by comparing magnetic resonance images (MRI) and radiographs with clinical data. MRI and radiographs were taken after treatment of 28 patients with 33 fractures of the mandibular condyles. In all cases, the disc was located in the fossa after open reduction and internal fixation (ORIF). The MRI, radiographic and clinical findings did not correlate, and damage to the temporomandibular joint (TMJ) could be seen more clearly on MRI than on clinical or radiographic examination. Damage to soft tissues seen on MRI after treatment was more pronounced in dislocated than in displaced fractures.

  2. 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.

  3. [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.

  4. 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.

  5. Effect of a transpositional muscle flap on VEGF mRNA expression in a canine fracture model.

    PubMed

    Khodaparast, Omeed; Coberly, Dana M; Mathey, Jonathon; Rohrich, Rod J; Levin, L Scott; Brown, Spencer A

    2003-07-01

    The effect of sepsis on neovascularization in fractures that follows open fractures is important to the understanding of bone and soft-tissue healing. An animal model was designed that mimics the open fracture and the clinical repair of the human, high-energy open fracture. Vascular endothelial growth factor (VEGF) mRNA levels in canine bone samples were determined in samples from days 0 and 7. Canine right tibiae were fractured with a penetrating, captive-bolt device and then repaired in a standard clinical fashion using an interlocking intramedullary nail. Animals were subject to one of the following experimental protocols: tibial fracture (group I, n = 3); tibial fracture and Staphylococcus aureus inoculation at the fracture site (group II, n = 3); and tibial fracture and S. aureus inoculation with a rotational gastrocnemius muscle flap (group III, n = 3). Bone samples were harvested on days 0 and 7 and prepared for reverse transcriptase polymerase chain reaction assay. Primers for VEGF were commercially prepared and assay products were sequenced. The assay products were associated with Genebank VEGF mRNA sequences. VEGF mRNA levels increased significantly in the fracture-alone group from day 0 to day 7 (n = 3, p < 0.05). In the fracture and S. aureus group (group I), VEGF mRNA expression decreased 79 percent (p < 0.05). In animals with fractures inoculated with S. aureus and a transpositional muscle flap (group III), VEGF mRNA expression was increased 38 percent from day 0 to day 7 (p < 0.05) and was similar to the increase observed in the fracture-alone group. These results demonstrate that S. aureus decreased the normal increase of VEGF mRNA expression during bone wound healing. Use of the transpositional muscle flap in the presence of S. aureus increased VEGF mRNA expression over time to the expression pattern observed in the fracture-alone group. This experimental model demonstrates that specific biological signals and cellular pathways are influenced by

  6. Protocol for a randomised controlled trial of standard wound management versus negative pressure wound therapy in the treatment of adult patients with an open fracture of the lower limb: UK Wound management of Open Lower Limb Fractures (UK WOLFF)

    PubMed Central

    Achten, Juul; Parsons, Nick R; Bruce, Julie; Petrou, Stavros; Tutton, Elizabeth; Willett, Keith; Lamb, Sarah E; Costa, Matthew L

    2015-01-01

    Introduction Patients who sustain open lower limb fractures have reported infection risks as high as 27%. The type of dressing applied after initial debridement could potentially affect this risk. In this trial, standard dressings will be compared with a new emerging treatment, negative pressure wound therapy, for patients with open lower limb fractures. Methods and analysis All adult patients presenting with an open lower limb fracture, with a Gustilo and Anderson (G&A) grade 2/3, will be considered for inclusion. 460 consented patients will provide 90% power to detect a difference of eight points in the Disability Rating Index (DRI) score at 12 months, at the 5% level. A randomisation sequence, stratified by trial centre and G&A grade, will be produced and administered by a secure web-based service. A qualitative substudy will assess patients’ experience of giving consent for the trial, and acceptability of trial procedures to patients and staff. Patients will have clinical follow-up in a fracture clinic up to a minimum of 12 months as per standard National Health Service (NHS) practice. Functional and quality of life outcome data will be collected using the DRI, SF12 and EQ-5D questionnaires at 3, 6, 9 and 12 months postoperatively. In addition, information will be requested with regards to resource use and any late complications or surgical interventions related to their injury. The main analysis will investigate differences in the DRI score at 1 year after injury, between the two treatment groups on an intention-to-treat basis. Tests will be two sided and considered to provide evidence for a significant difference if p values are less than 0.05. Ethics and dissemination Ethical approval was given by NRES Committee West Midlands—Coventry & Warwickshire on 6/2/2012 (ref: 12/WM/0001). The results of the trial will be disseminated via peer-reviewed publications and presentations at relevant conferences. Trial registration number ISRCTN33756652. PMID

  7. 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.

  8. 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.

  9. Staged protocol for the treatment of chronic tibial shaft osteomyelitis with Ilizarov's technique followed by the application of intramedullary locked nail.

    PubMed

    Lin, Chun-Cheng; Chen, Chuan-Mu; Chiu, Fang-Yao; Su, Yu-Pin; Liu, Chien-Lin; Chen, Tain-Hsiung

    2012-12-01

    Open tibial shaft fractures are the most common open fractures, and many complications can occur. During the treatment period, infection leading to osteomyelitis was the most common complication. However, no consensus exists regarding the ideal management for such cases in the literature.The purposes of this retrospective study were to review the treatment of patients with chronic tibial shaft osteomyelitis over the past 14 years who were referred to the authors' institution and to provide a staged protocol for spontaneous wound healing. The staged protocol included: (1) radical debridement for infected bone and soft tissue; (2) immediate application of Ilizarov's apparatus for all patients except those needing delayed application; (3) osteotomy in healthy bone; (4) simultaneous distraction-compression osteogenesis and histogenesis; (5) additional docking-site bone grafting; and (6) shifting the external fixator to a locked nail when callus formation was visible at the distraction site. Union was achieved in 15 of 16 patients, with an average external fixation time of 4.5 months (range, 3-6 months). No deformity or leg-length discrepancy greater than 1 cm occurred.In the treatment of chronic osteomyelitis, this staged protocol was safe and successful and allowed for union, realignment, reorientation, and leg-length restoration. Regarding the soft tissues, this technique provides a unique type of reconstructive closure for infected wounds. It is suggested that the staged protocol is reliable in providing successful simultaneous reconstruction for bone and soft tissue defects without flap coverage.

  10. Partial Heel Pad Avulsion with Open Calcaneal Tuberosity Fracture with Tendo-achilles Rupture: A Case Report

    PubMed Central

    Ahmed, Shameem; Ifthekar, Syed; Ahmed Khan, R Pathan Rameez; Ranjan, Rahul

    2016-01-01

    Introduction: The management of heel pad avulsion injuries has been challenging because of the precarious blood supply. The difficulties get compounded when it is associated with tendo-achilles rupture and calcaneal fracture. Here, it is a description of a case with the above features managed with a unique technique. Case Report: A 63-year-old woman presented to casualty with injury to right ankle after a road traffic accident. On clinical and radiological examination, there was avulsion of heel pad with calcaneal tuberosity fracture and tendo-achilles rupture. It was managed with debridement of the wound, repair of tendo-achilles, and fixation of calcaneal tuberosity and heel pad. The functional outcome was assessed in terms of the ability of the patient to return to painless barefoot weight bearing. The uniqueness of this method is the combined use of suture material (Ethibond) and stainless steel (cannulated cancellous screws [CCS]), by tying the Ethibond from tendo-achilles to the head of CCS rather than bone. When the CCS were tightened, two things were achieved; one being the reduction of the fracture and the second to bring a good apposition of tendo-achilles with the calcaneum. As this method worked on tension band principle and Ethibond was used instead of stainless steel wire, if no objections, this technique can be called as “soft tension band technique.” Conclusion: This case report illustrates a method of preserving heel pad when it is viable along with definitive treatment of associated soft tissue and bony injuries by a simple technique. This method has described the fixation of open fracture of calcaneal tuberosity with tendo-achilles rupture with heel pad avulsion in one sitting with excellent clinical results. PMID:27299125

  11. Comparison of Surgical Outcomes Between Short-Segment Open and Percutaneous Pedicle Screw Fixation Techniques for Thoracolumbar Fractures

    PubMed Central

    Fu, Zhiguo; Zhang, Xi; Shi, Yaohua; Dong, Qirong

    2016-01-01

    Background This study aimed to compare the surgical outcomes between open pedicle screw fixation (OPSF) and percutaneous pedicle screw fixation (PPSF) for the treatment of thoracolumbar fractures, which has received scant research attention to date. Material/Methods Eight-four patients with acute and subacute thoracolumbar fractures who were treated with SSPSF from January 2013 to June 2014 at the Changzhou Hospital of Traditional Chinese Medicine (Changzhou, China) were retrospectively reviewed. The patients were divided into 4 groups: the OPSF with 4 basic screws (OPSF-4) group, the OPSF with 4 basic and 2 additional screws (OPSF-6) group, the PPSF with 4 basic screws (PPSF-4) group, and the PPSF with 4 basic and 2 additional screws (PPSF-6) group. The intraoperative, immediate postoperative, and over 1-year follow-up outcomes were evaluated and compared among these groups. Results Blood loss in the PPSF-4 group and the PPSF-6 group was significantly less than in the OPSF-4 group and the OPSF-6 group (P<0.05). The OPSF-6 group exhibited significantly higher immediate postoperative correction percentage of anterior column height of fractured vertebra than the other 3 groups (P<0.05), and higher correction of sagittal regional Cobb angle and kyphotic angle of injured vertebra than in the PPSF-4 and -6 groups (P<0.05). In addition, there was no significant difference in the correction loss of percentage of anterior column height, and loss of sagittal Cobb angle and kyphotic angle of fractured vertebrae at final follow-up among the 4 groups (P>0.05). Conclusions OPSF with 6 screws had an advantage in the correction of injured vertebral height and kyphosis, and PPSF reduced the intraoperative blood loss of patients. PMID:27602557

  12. Static and Dynamic Differences in Fixation Stability between a Spacer Plate and a Small Stature Plate Fixator Used for High Tibial Osteotomies: A Biomechanical Bone Composite Study

    PubMed Central

    Maas, Stefan; Dueck, Klaus; Pape, Dietrich

    2013-01-01

    Background. The objective of the present study was to compare mechanical strength and stability of the newly designed spacer plate with the gold standard plate for the treatment of medial knee joint osteoarthritis. Materials and Methods. Ten fourth-generation tibial bone composites underwent a medial open-wedge high tibial osteotomy (HTO) according to standard techniques, using five TomoFix plates and five Contour Lock plates. Static compression load to failure and load-controlled cyclical fatigue failure tests were performed. Forces and horizontal displacements were measured; plastic deformations and dynamic stiffness were determined. Results and Discussion. In all samples, rotation of the tibial head and fracture of the opposite cortex were observed. Behaviors of the specimens under static loading were comparable between groups. Cyclic testing revealed lateral significant higher stiffness until failure for the Contour Lock compared to the TomoFix plate. No visible implant failure was observed in any group. Conclusion. Considering the static analysis, both plates offered sufficient stability under physiologic loads of up to 3000 N. The Contour Lock plate-fixated specimens showed a higher stability during the cyclic testing, supposedly due to the wider distance between the fixation screws. PMID:24959357

  13. Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius

    PubMed Central

    Kumar, Pawan; Manjhi, Lal Bahadur; Rajak, Ramesh Lal

    2013-01-01

    Extruded middle segment of radius with open segmental fracture both bone forearm and dislocation of ipsilateral elbow is a rare injury. A 12-year-old child presented to us within 4 hours following fall from tree. The child's mother was carrying a 12-cm-long extruded soiled segment of radius. The extruded bone was thoroughly washed. The medullary cavity was properly syringed with antiseptic solution. The bone was autoclaved and put in the muscle plane of the distal forearm after debridement of the wound. After 5 days, a 2.5-mm K-wire was introduced by retrograde method into the proximal radius by passing through the extruded segment. Another 2.5-mm K-wire was passed in ulna. The limb was evaluated clinicoradiologically every 2 weeks. The wound was healed by primary intention. At 4 months, the reposed bone appeared less dense radiologically and K-wire seemed to be out of the bone. In the subsequent months, the roentgenograms show remodeling of the extruded fragment. After 20 weeks, the K-wires were removed (first ulnar and then radial). Complete union was achieved with full range of movement except loss of few degrees of extension of elbow and thumb. This case is reported to show a good outcome following successful incorporation of an extruded segment of radius in an open fracture. PMID:23798764

  14. Open segmental fracture of both bone forearm and dislocation of ipsilateral elbow with extruded middle segment radius.

    PubMed

    Kumar, Pawan; Manjhi, Lal Bahadur; Rajak, Ramesh Lal

    2013-05-01

    Extruded middle segment of radius with open segmental fracture both bone forearm and dislocation of ipsilateral elbow is a rare injury. A 12-year-old child presented to us within 4 hours following fall from tree. The child's mother was carrying a 12-cm-long extruded soiled segment of radius. The extruded bone was thoroughly washed. The medullary cavity was properly syringed with antiseptic solution. The bone was autoclaved and put in the muscle plane of the distal forearm after debridement of the wound. After 5 days, a 2.5-mm K-wire was introduced by retrograde method into the proximal radius by passing through the extruded segment. Another 2.5-mm K-wire was passed in ulna. The limb was evaluated clinicoradiologically every 2 weeks. The wound was healed by primary intention. At 4 months, the reposed bone appeared less dense radiologically and K-wire seemed to be out of the bone. In the subsequent months, the roentgenograms show remodeling of the extruded fragment. After 20 weeks, the K-wires were removed (first ulnar and then radial). Complete union was achieved with full range of movement except loss of few degrees of extension of elbow and thumb. This case is reported to show a good outcome following successful incorporation of an extruded segment of radius in an open fracture.

  15. The impact of a dedicated orthoplastic operating list on time to soft tissue coverage of open lower limb fractures

    PubMed Central

    Fernandez, MA; Wallis, K; Venus, M; Skillman, J; Young, J; Costa, ML

    2015-01-01

    An observational study was conducted of 105 patients presenting with an open fracture of the tibia or ankle to determine the impact of a dedicated orthoplastic operating list on our management of these injuries over the time period January 2012 to July 2014. There were 51 patients before and 54 after the introduction of the orthoplastic list. Significant improvements were noted in our ability to deliver a service in line with national guidelines across all Gustilo–Anderson grades of injury. Among patients with the most severe grades of injury (Gustilo types IIIB and IIIC), there was a trend towards an improved time to first skeletal stabilisation (29.5 vs 14.2 hours, p=0.068), an improvement in time to soft tissue coverage (173.6 vs 88.1 hours, p=0.009) and a trend towards a reduced length of inpatient stay (32.6 vs 23.2 days, p=0.138). Where the 72-hour target had been breached, there was a significant improvement in the proportion of patients covered within 7 days of injury (48.2% vs 83.3%, p=0.017). Our compliance with national management standards increased significantly to reflect these improvements in care. These results support the implementation of dedicated orthoplastic operating sessions to meet the growing burden of patients presenting with open fractures at specialist centres. PMID:26274740

  16. Asisstance Arthroscopy in Juvenile Tillaux Fractures

    PubMed Central

    Mañero, Luciano Martin; Arroquy, Damian; Barrios, Juan Manuel; Botta, Juan Martin; Caceres, Carlos Alberto

    2017-01-01

    Introduction: Juvenile Tillaux Fracture is an isolated fracture of the lateral portion of the distal tibial epiphysis, considered SALTER-HARRIS fracture type 3, wherein the fragment is moved by the anterolateral ligament anterior inferior tibiofibular. They occur at the beginning of the 2nd decade of life and are caused by a force external rotation. The pattern of injury is considered a result of the closing sequence of the distal tibial physis, which usually closes around 15 years of age in girls and 17 in boys, this process usually takes about 18 months, occurring first in the central area of the physis, extending medially and finally to side, being this epiphyseal portion which is open at the time of the vulnerable to fracture injury in this age group. The curriculum includes RX, and TAC, being more sensitive to detect fragments of 2 or more mm of travel, but may overestimate the true displacement. The non-displaced fracture can be treated with cast immobilization and displaced with closed reduction (plantar flexion external rotation in the pronated foot and direct pressure on the anterolateral epiphysis). An equal displacement or > 2 mm of the articular surface is indication of open reduction and percutaneous fixation, because it may increase the risk of osteoarthritis in the future. Objective: Presentation of a case Juvenile Tillaux Fractures with surgical resolution under arthroscopic assistance. Methods: Male patient 14 years old who suffered indirect trauma left ankle during practice sports (rugby) in September 2015, 48 hours of evolution. After performing X-rays and scans one left Salter Harris type III at the level of distal tibial epiphysis (Tillaux fracture) ankle fracture was diagnosed. It had a greater than 2 mm displacement. As a reduction treatment and percutaneous osteosynthesis with more osteodesis screw with arthroscopic assistance and fluoroscopy was performed. After surgery a long leg cast was placed for three weeks, continuing with three other

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

    PubMed

    Squires, Judy H; Emery, Kathleen H; Johnson, Neil; Sorger, Joel

    2014-04-01

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

  18. Early complications after high tibial osteotomy: a comparison of two techniques.

    PubMed

    van den Bekerom, Michel P J; Patt, Thomas W; Kleinhout, Miriam Y; van der Vis, Harm M; Albers, G H Rob

    2008-01-01

    This prospective cohort study compared opening wedge high tibial osteotomy with use of the Puddu plate and the Vitoss synthetic cancellous bone versus closing wedge high tibial osteotomy with use of the AO/ASIF L-plate, focusing on complications (nonunions, infections, loss of correction, reoperations) and patient satisfaction (visual linear analog scale). During a 10-month period, we performed high tibial osteotomy for 40 patients experiencing medial knee osteoarthritis and a varus deformity. The average follow-up was 11 months. The complication rate in patients treated with the opening wedge technique was significantly higher regarding tibial nonunion, loss of correction, and material failure. Patients in the closing wedge group were more satisfied with the postoperative result. This study found that the Puddu plate, despite 6 weeks of non-weight bearing facilitating the osseous consolidation with Vitoss cement, was not able to maintain the correction during the time required for bone healing.

  19. 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.

  20. 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.

  1. 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.

    2016-12-01

    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.

  2. A Protocol for Percutaneous Transarticular Fixation of Sanders Type II and III Calcaneal Fractures With or Without an Added Mini-Open Approach.

    PubMed

    Gamal, Osama; Shams, Ahmed; El-Sayed Semaya, Ahmad

    Intra-articular fracture of the calcaneus is one of the most displeasing fractures if not properly managed. Open reduction and internal fixation have been associated with a high incidence of postoperative soft tissue complications. Closed reduction and percutaneous fixation have resulted in a greater incidence of postoperative subtalar osteoarthritis with improper reduction of the articular surface. In the present study, a mini-open approach was used in cases of failure of articular surface restoration with closed reduction. A total of 64 feet in 57 consecutive patients with an intra-articular calcaneal fracture underwent the proposed minimally invasive surgical protocol. Of the 57 patients, 7 (12.3%) had bilateral fractures. According to Sanders classification, 33 (51.6%) fractures were type II and 31 (48.4%) were type III. Seven (12.3%) patients had wedge fractures of the dorsolumbar spine without neurologic manifestations. The postoperative evaluation included radiographs and completion of the Maryland Foot Score and visual analog scale for pain. The mean follow-up period was 16 (range 12 to 36) months. The mean operative time was 42 (range 35 to 60) minutes. The mean period until union of the fracture was 12 (range 10 to 16) weeks. The clinical results according to the Maryland Foot Score revealed 52 (81%) with satisfactory (27 excellent and 25 good) and 12 (19%) with unsatisfactory (10 fair and 2 poor) results. The mean visual analog scale score was 1.5 ± 0.3 when radiographic fracture healing was observed. Six patients (9.4%) developed superficial pin tract infections that responded to local care and parenteral antibiotic therapy and resolved completely after removal of the Kirschner wires. In conclusion, the presented surgical protocol combining closed reduction with or without an added mini-open approach and percutaneous fixation improves the functional outcome and minimizes the incidence of complications.

  3. Return-to-Work Following Open Reduction and Internal Fixation of Proximal Humerus Fractures

    PubMed Central

    Dietrich, Michael; Wasmer, Mathias; Platz, Andreas; Spross, Christian

    2014-01-01

    Objectives : Shoulder disorders have an important impact on a patient’s capacity to work. We investigated whether there is a relationship between subjective or objective outcome measures and the ability and time for returning to work (RTW) after a proximal humerus fracture (PHF). Design : Retrospective single-centre study from March 2003 to June 2008. Setting : City hospital, trauma level one centre. Intervention : All PHF stabilized with a PHILOS®. Main Outcome Measurements : Routine follow-up examinations (X-ray, Constant-Murley Score (CMS), Short-Form 36 (SF-36)) were performed prospectively after 1.5, 3, 6 and 12 months or until RTW. Primary interest was the comparison of the outcome scores with the time needed for RTW. Results : 72 patients (52 years (22-64), 37 (51%) women) fulfilled the inclusion criteria. We distinguished “office-workers” (OW) (n = 49, 68%) from patients who worked at a physically demanding job (PW) (n = 23, 32%). Although time for RTW was fundamentally different (42 (OW) vs 118 days (PW), p<0.001), CMS (64.7 vs 64.1) and SF-36 (66.8 vs 69.9) at time of RTW were almost identical. At follow-up, CMS and SF-36 were always lower in the PW group. Conclusion : Jobs which require higher physical demands were likely to influence and to delay RTW. This study identifies cut off values for CMS and SF-36 at which a patient feels capable or willing to RTW after PHF. These values show the importance and impact of a patient’s occupation or demands on RTW. We were able to show, that besides age, sex and fracture, the type of occupation might alter the scores in postoperative outcomes. PMID:25246994

  4. Spontaneous Reduction of a Chronic Radial Head Subluxation after open Reduction and Percutaneous Pin Fixation of a Radial Neck Fracture: A Case Report and Review of the Literature

    PubMed Central

    Illingworth, Kenneth David; Thompson, Kirk; Lovell, Matthew; McGinty, Jasmin

    2013-01-01

    Background Fractures of the radial neck in children have shown to account for 5-10% of traumatic elbow injuries in the pediatric population. Chronic dislocation of the radial head with concomitant fracture has been shown to result in progressive deformity and unacceptable loss of motion. Methods In this case report, we describe a patient who sustained a type 2 radial neck fracture with 100% displacement. The patient’s clinical and surgical management will be discussed and a review of the literature is provided as it relates to this particular case. Results The patient underwent open reduction and percutaneous pin fixation of her displaced, dislocated left radial neck fracture in the operating room after multiple failed attempts at closed reduction due to interposition of the annular ligament. Three months after her operation radiographs revealed a well-healed radial neck with no signs of avascular necrosis with an anterior dislocation of her radial head, which was a new finding from her previous radiographs. Fourteen months after her initial injury and operation, radiographs taken at this visit revealed a radial neck fracture that was completely remodeled and had spontaneous relocated and was now aligned with the capitellum without any reduction attempt. Conclusion Closed reduction of displaced radial neck fractures may be unsuccessful and open reduction may be warranted. Excess callus formation post-operatively may have resulted in the radial head subluxation; however there was spontaneous reduction with conservative treatment without a reduction attempt, most likely related to remodeling of the excel callus formation. PMID:24027488

  5. Displaced Intra-Articular Fractures of the Distal Radius: Open Reduction With Internal Fixation Versus Bridging External Fixation

    PubMed Central

    Fakoor, Mohammad; Fakoor, Morteza; Mohammadhoseini, Payam

    2015-01-01

    Background: Distal radius fracture is common in all ages. Mobility and wrist function is important. The choice of treatment should aim for optimal function with minimal complications. Objectives: In this study we compared two surgical approaches, open reduction and internal fixation (ORIF) and closed reduction with external fixation (CR + EF), for treatment of intra-articular distal radius fractures. Patients and Methods: Ninety-four patients with distal radius fracture (type 3, 4 and 5 Fernandez classification) were treated with two surgical methods (ORIF and CR + EF); 55 were treated with CR + EF and 39 were treated with ORIF by different surgeons. All patients were assessed at the end of the first, third and sixth week; and then after the third, sixth and 12th month. At the end of the follow-up, all patients completed the Michigan hand outcome questionnaire (MHOQ). We compared radiological parameters of distal radius, range of motion (ROM) of the wrist, duration of rehabilitation, complication and patient satisfaction of the methods. Results: In our study, radiological findings for the ORIF group were radial inclination (RI): 19.35, radial length (RL): 10.35, radial tilt (RT): 8.92, and ulnar variance (UV): 1.64, while for the CR + EF group these were RI: 15.13, RL: 8, RT: 4.78, and UV: 0.27. The ROM for ORIF were flexion/extension (F/E): 137, Radial/Ulnar deviation (R/U): 52, and Supination/Pronation (S/P): 141, while for the CR + EF group these were F/E: 117, R/U: 40 and S/P: 116. Michigan hand outcome score for ORIF was 75% and for Ext. fix was 60%. The rate of complication with the ORIF method was 58% and in Ext. fix this was 69%. The patients in CR + EF had more than the ORIF course of physiotherapy and rehabilitation. Conclusions: In comparison of ORIF and CR + EF, all results including functional score, clinical and radiologic criteria were in favor of the ORIF method while there were less complications with this method. We believe that ORIF is a better

  6. A systematic review of open reduction and internal fixation of periprosthetic femur fractures with or without allograft strut, cerclage, and locked plates.

    PubMed

    Moore, Ryan E; Baldwin, Keith; Austin, Matthew S; Mehta, Samir

    2014-05-01

    Few comparative studies exist for open reduction and internal fixation of Vancouver B1 and C fractures. We therefore performed a systematic review of fractures treated with or without an allograft strut, and using various fixation techniques. Thirty-seven manuscripts including 682 fractures were identified between 1992 and 2012. Percent union was similar for Vancouver B1 fractures treated with or without an allograft strut (90.7% vs. 91.5%). Time to union (4.4 vs. 6.6 months) and deep infection (3.8% vs. 8.3%) were increased with use of allograft struts. Percent union and time to union were unaffected by plate type or use of cerclage. We conclude that due to increased infection and time to union, allograft struts should be used cautiously during operative treatment of Vancouver B1 factures.

  7. Fatigue load of current tibial intramedullary nail designs: a simulated study.

    PubMed

    Wagner, Mark; Liu, Qi; Ellis, Thomas J

    2011-06-14

    Comminuted tibial shaft fractures are traditionally treated with statically locked intramedullary nailing and protected weight bearing until fracture callous is evident. The purpose of this study was to demonstrate that a simulation of immediate full weight bearing following intramedullary nailing of these fractures does not result in implant failure.A comminuted fracture model was created using 2 pieces of polyvinyl chloride (PVC) pipe. Ten-millimeter-diameter tibial nails (Synthes, Paoli, Pennsylvania; Styker, Mahwah, New Jersey; Zimmer, Warsaw, Indiana; Smith & Nephew, Memphis, Tennessee) were inserted within the PVC pipe and secured proximally and distally with 2 or 3 locking bolts. The constructs were cycled in axial compression for 500,000 cycles or until implant failure. The tests were conducted using a modified staircase method (200 N per step), and the fatigue strength was identified for each of the tibial nail designs. When 2 interlocking bolts were placed proximally and distally, the fatigue strength was between 900 and 1100 N for the Stryker nail, 1100 and 1300 N for the Zimmer nail, 1200 and 1400 N for the Synthes nail, and 1400 and 1600 N for the Smith & Nephew nail. Adding a third interlocking bolt proximally and distally to the Smith & Nephew nail increased the fatigue strength by 13% to between 1700 and 1900 N. In all cases, implant failures occurred through the proximal or distal interlocking bolts.Biomechanical tests suggest that current tibial nail designs may permit immediate full weight bearing of comminuted tibial shaft fractures with minimal risk of implant failure. This may facilitate mobilization in the early postoperative period, especially in the multiply injured patient.

  8. The "not so simple" ankle fracture: avoiding problems and pitfalls to improve patient outcomes.

    PubMed

    Hak, David J; Egol, Kenneth A; Gardner, Michael J; Haskell, Andrew

    2011-01-01

    Ankle fractures are among the most common injuries managed by orthopaedic surgeons. Many ankle fractures are simple, with straightforward management leading to successful outcomes. Some fractures, however, are challenging, and debate arises regarding the best treatment to achieve an optimal outcome. Some patients have medical comorbidities that increase the risk for complications or may require modifications to standard surgical techniques and fixation methods. Several recent investigations have highlighted the pitfalls in accurately reducing syndesmotic injuries. Controversy remains regarding the number and diameter of screws, the duration of weight-bearing limitations, and the need or timing of screw removal. Open reduction may allow more accurate reduction than standard closed methods. Direct fixation of associated posterior malleolus fractures may provide improved syndesmotic stability. Posterior malleolus fractures vary in size and can be classified based on the orientation of the fracture line. As the size of the posterior malleolus fracture fragment increases, the load pattern in the ankle is altered. Direct or indirect reduction and surgical fixation may be required to prevent posterior talar subluxation and restore articular congruency. The supination-adduction fracture pattern is also important to recognize. Articular depression of the medial tibial plafond may require reduction and bone grafting. Optimal fixation requires directing screws parallel to the ankle joint or using a buttress plate. Identifying ankle fractures that may present additional treatment challenges is essential to achieving a successful outcome. A careful review of radiographs and CT scans, a thorough patient assessment, and detailed preoperative planning are needed to improve patient outcomes.

  9. [Atlas fractures].

    PubMed

    Schären, S; Jeanneret, B

    1999-05-01

    Fractures of the atlas account for 1-2% of all vertebral fractures. We divide atlas fractures into 5 groups: isolated fractures of the anterior arch of the atlas, isolated fractures of the posterior arch, combined fractures of the anterior and posterior arch (so-called Jefferson fractures), isolated fractures of the lateral mass and fractures of the transverse process. Isolated fractures of the anterior or posterior arch are benign and are treated conservatively with a soft collar until the neck pain has disappeared. Jefferson fractures are divided into stable and unstable fracture depending on the integrity of the transverse ligament. Stable Jefferson fractures are treated conservatively with good outcome while unstable Jefferson fractures are probably best treated operatively with a posterior atlanto-axial or occipito-axial stabilization and fusion. The authors preferred treatment modality is the immediate open reduction of the dislocated lateral masses combined with a stabilization in the reduced position using a transarticular screw fixation C1/C2 according to Magerl. This has the advantage of saving the atlanto-occipital joints and offering an immediate stability which makes immobilization in an halo or Minerva cast superfluous. In late instabilities C1/2 with incongruency of the lateral masses occurring after primary conservative treatment, an occipito-cervical fusion is indicated. Isolated fractures of the lateral masses are very rare and may, if the lateral mass is totally destroyed, be a reason for an occipito-cervical fusion. Fractures of the transverse processes may be the cause for a thrombosis of the vertebral artery. No treatment is necessary for the fracture itself.

  10. Long-term Results, Functional Outcomes and Complications after Open Reduction and Internal Fixation of Neglected and Displaced Greater Tuberosity of Humerus Fractures

    PubMed Central

    Amroodi, Morteza Nakhaei; Behshad, Vahid; Motaghi, Paniz

    2016-01-01

    Background: Humerus fractures include 5% to 8% of total fractures. Non-union and delayed union of GT (GT) fractures is uncommon; however they present a challenge to the orthopedic surgeons. Significant controversy surrounds optimal treatment of neglected fractures. The purpose of this article was to perform a comparative study to evaluate the outcomes of open reduction and internal fixation (ORIF) of neglected GT fractures. Methods: We retrospectively evaluated the results of surgical intervention in 12 patients with displaced nonunion of GT fractures who were referred to our center. Before and minimally 25 months after surgery ROM, muscle forces, Constant Shoulder Score (Constant-Murley score) (CSS), Visual Analogue Scale (VAS), Activities of Daily Living (ADL) Score and American Shoulder and Elbow Surgeons (ASES) Score were all recorded. Additionally, the results were compared with undamaged shoulder. Results: Between March 2006 and January 2013, 12 patients underwent surgical intervention and followed for 36.2 months in average. All fractures healed. Anatomic reduction achieved only in 6 cases with no report of avascular necrosis or infection. All ROMs and muscle forces increased significantly (Mean Forward Flexion: 49.16 to 153.3, Mean Internal Rotation: 3 to 9, Mean External Rotation: -5 to 27.5) (P value<0.0001). All functional scores including CSS, VAS, ADL and ASES score improved significantly (Mean VAS: 6.5 to 1.3, Mean CSS: 29.83 to 86, Mean ADL: 6.6 to 27.1,: Mean ASES: 28.6 to 88.9) (P value<0.0001). Conclusion: ORIF for neglected and displaced GT fractures has satisfactory functional outcomes, despite of non-anatomical reduction of the fracture. PMID:27847845

  11. Distal tibial derotational osteotomy with external fixation to treat torsional deformities: a review of 71 cases.

    PubMed

    Erschbamer, Matthias; Gerhard, Pascal; Klima, Harry; Ellenrieder, Birte; Zdenek-Lehnen, Katja; Giesinger, Karlmeinrad

    2017-03-01

    We retrospectively reviewed the safety and efficacy of operative treatment of torsional malalignment of the tibia in 44 children, on whom we performed 71 derotational osteotomies of the distal tibia to treat tibial torsion. We placed four pins using an alignment jig, performed a percutaneous osteotomy, and applied an external fixator after derotation. Postoperative radiographs showed accurate tibial derotation and pin placement in all patients. Nine patients developed superficial pin-tract infections that resolved with antibiotic treatment. Two developed fractures after removal of the external fixator, which healed in a plaster cast. Operative treatment of these cases with an external fixator is safe, effective, and well tolerated.

  12. Posterior Tibial Tendoscopy: Endoscopic Synovectomy and Assessment of the Spring (Calcaneonavicular) Ligament.

    PubMed

    Lui, Tun Hing

    2015-12-01

    A tear of the spring ligament is frequently associated with posterior tibial tendon dysfunction. Repair of the damaged spring ligament is an important component of surgical reconstruction in the treatment of posterior tibial tendon dysfunction because it is a major anatomic contributor to the integrity of the medial longitudinal arch, particularly if the dynamic support of the posterior tibial tendon is compromised. Extensive dissection is required for exposure and repair of the ligament because it is a deep-seated structure. It is beneficial to confirm the presence of ligament tears before surgical exploration to avoid unnecessary dissection. Preoperative magnetic resonance imaging and ultrasound studies have moderate sensitivity in the detection of these tears. We report an arthroscopic technique for assessment of the integrity of the spring ligament during endoscopic or open reconstruction of the posterior tibial tendon. This allows the surgeon to confirm the presence of a ligament tear before additional dissection to explore and repair the ligament.

  13. Open reduction and internal fixation of extracapsular mandibular condyle fractures: a long-term clinical and radiological follow-up of 25 patients

    PubMed Central

    2014-01-01

    Background During the last 2 decades, many studies on the treatment of mandibular condyle fracture have been published. The incidence of mandibular condyle fractures is variable, ranging from 17.5% to 52% of all mandibular fractures. This retrospective study evaluated the long-term clinical and radiological outcomes after surgical treatment of 25 patients with a total of 26 extracapsular condyle fractures. Methods We used 2 types of surgical approaches, the retromandibular retroparotid or preauricular approach. Three kinds of rigid internal fixation plates were used—single plate, double plate, and trapezoidal plate. The following post-operative clinical parameters were evaluated: dental occlusion, facial nerve functionality, skin scarring, and temporomandibular joint functionality. All patients underwent post-operative orthopanoramic radiography and computed tomography. The patients were also monitored for complications such as Frey’s syndrome, infection, salivary fistula, plate fracture, and permanent paralysis of the facial nerve; the patient’s satisfaction was also recorded. Results Of the 25 patients, 80% showed occlusion recovery, 88% had no facial nerve injury, and 88% presented good surgical skin scarring. The patients showed early complete recovery of temporomandibular joint functionality and 72% of them were found to be asymptomatic. The postoperative radiographs of all patients indicated good recovery of the anatomical condylar region, and 80% of them had no postoperative complications. The average degree of patient satisfaction was 8.32 out of 10. Our results confirm that the technique of open reduction and internal fixation in association with postoperative functional rehabilitation therapy should be considered for treating patients with extracapsular condylar fractures. Conclusion The topic of condylar injury has generated more discussion and controversy than any other topic in the field of maxillofacial trauma. We confirm that open reduction and

  14. Gustilo IIIC fractures in the lower limb: our 15-year experience.

    PubMed

    Soni, A; Tzafetta, K; Knight, S; Giannoudis, P V

    2012-05-01

    Controversy continues to surround the management of patients with an open fracture of the lower limb and an associated vascular injury (Gustilo type IIIC). This study reports our 15-year experience with these fractures and their outcome in 18 patients (15 male and three female). Their mean age was 30.7 years (8 to 54) and mean Mangled Extremity Severity Score (MESS) at presentation was 6.9 (3 to 10). A total of 15 lower limbs were salvaged and three underwent amputation (two immediate and one delayed). Four patients underwent stabilisation of the fracture by external fixation and 12 with an internal device. A total of 11 patients had damage to multiple arteries and eight had a vein graft. Wound cover was achieved with a pedicled flap in three and a free flap in six. Seven patients developed a wound infection and four developed nonunion requiring further surgery. At a mean follow-up of five years (4.1 to 6.6) the mean visual analogue scale for pain was 64 (10 to 90). Depression and anxiety were common. Activities were limited mainly because of pain, and the MESS was a valid predictor of the functional outcome. Distal tibial fractures had an increased rate of nonunion when associated with posterior tibial artery damage, and seven patients (39%) were not able to return to their previous occupation.

  15. High tibial osteotomy in varus knees: indications and limits

    PubMed Central

    LOIA, MARCO CORGIAT; VANNI, STEFANIA; ROSSO, FEDERICA; BONASIA, DAVIDE EDOARDO; BRUZZONE, MATTEO; DETTONI, FEDERICO; ROSSI, ROBERTO

    2016-01-01

    Opening wedge high tibial osteotomy (OWHTO) is a surgical procedure that aims to correct the weight-bearing axis of the knee, moving the loads laterally from the medial compartment. Conventional indications for OWHTO are medial compartment osteoarthritis and varus malalignment of the knee; recently OWHTO has been used successfully in the treatment of double and triple varus. OWHTO, in contrast to closing wedge high tibial osteotomy, does not require fibular osteotomy or peroneal nerve dissection, or lead to disruption of the proximal tibiofibular joint and bone stock loss. For these reasons, interest in this procedure has grown in recent years. The aim of this study is to review the literature on OWHTO, considering indications and prognostic factors (body mass index, grade of osteoarthritis, instability, range of movement and age), outcomes at mid-term follow-up, and limits of the procedure (slope modifications, patellar height changes and difficulties in conversion to a total knee arthroplasty). PMID:27602350

  16. Severe open fractures of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score (MESS)

    PubMed

    McNamara, M G; Heckman, J D; Corley, F G

    1994-01-01

    Recent reports using the Mangled Extremity Severity Score (MESS) suggest that a score of > or = 7 is 100% accurate in predicting the need for amputation of severely injured lower extremities. To further evaluate the value of the MESS in predicting amputation, specifically with respect to type IIIB and type IIIC (Gustilo and Anderson) open fractures of the tibia, we retrospectively evaluated 24 patients with these injuries. A significant difference (p = 0.001) between MESS values of 13 salvaged (6.36 +/- 0.35 SEM) and 11 amputated limbs (6.36 +/- 0.54 SEM) was found. A MESS value of > or = 4 was most sensitive (100%); a MESS value of > or = 7 was most specific, and a MESS value of > or = 7 was found to have a positive predictive value of 100%. Subsequently, we addressed recent criticisms of the MESS by including nerve injury in the scoring system and by separating soft-tissue and skeletal injury components of the MESS. We modified the MESS with a score called the NISSSA and applied it retrospectively to our cases. After careful statistical comparison we found both the MESS and NISSSA to be highly accurate (p < 0.005) in predicting amputation. The NISSSA was found to be more sensitive (81.8% versus 63.6%) and more specific (92.3 versus 69.2%).

  17. 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.

  18. Length of stay, wait time to surgery and 30-day mortality for patients with hip fractures after the opening of a dedicated orthopedic weekend trauma room

    PubMed Central

    Taylor, Michel; Hopman, Wilma; Yach, Jeff

    2016-01-01

    Background In September 2011, Kingston General Hospital (KGH) opened a dedicated orthopedic weekend trauma room. Previously, 1 weekend operating room (OR) was used by all surgical services. We assessed the impact this dedicated weekend trauma room had on hospital length of stay (LOS), time to surgery and 30-day mortality for patients with hip fractures. Methods Patients admitted between Oct. 1, 2009, and Sept. 30, 2012, were identified through our trauma registry, representing the 2 years before and 1 year after the opening of the orthopedic weekend trauma room. We documented type of fracture, mode of fixation, age, sex, American Society of Anesthesiologists (ASA) score, time to OR, LOS, discharge disposition and 30-day mortality. We excluded patients with multiple fractures, open fractures and those requiring trauma team activation. Results Our study included 609 patients (405 pre- and 204 post–trauma room opening). Mean LOS decreased from 11.6 to 9.4 days (p = 0.005) and there was a decreasing trend in mean time to OR from 31.5 to 28.5 hours (p = 0.16). There was no difference in 30-day mortality (p = 0.24). The LOS decreased by an average of 2 days following opening of the weekend trauma room (p = 0.031) and by an average of 2.2 additional days if the patient was admitted on the weekend versus during the week (p = 0.024). Conclusion The weekend trauma OR at KGH significantly decreased the LOS and appears to have decreased wait times to surgery. Further analysis is needed to assess the cost-effectiveness of the current strategy, the long-term outcome of this patient population and the impact the additional orthopedic weekend trauma room has had on other surgical services (i.e., general surgery) and their patients. PMID:27668332

  19. 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.

  20. Porous tantalum tibial component prevents periprosthetic loss of bone mineral density after total knee arthroplasty for five years-a matched cohort study.

    PubMed

    Minoda, Yukihide; Kobayashi, Akio; Ikebuchi, Mitsuhiko; Iwaki, Hiroyoshi; Inori, Fumiaki; Nakamura, Hiroaki

    2013-12-01

    In 21 knees receiving porous tantalum tibial component and 21 knees receiving a cemented cobalt-chromium tibial component, dual x-ray absorptiometry scans were performed for five years post-operatively. The postoperative decrease in the bone mineral density in the lateral aspect of the tibia was significantly less in knees with porous tantalum tibial components (11.6%) than in knees with cemented cobalt-chromium tibial components (29.6%) at five years (p < 0.05). No prosthetic migration or periprosthetic fracture was detected in either group. The present study is one of the studies with the longest follow-up period on bone mineral density after total knee arthroplasty. Porous tantalum tibial component has a favorable effect on the bone mineral density of the proximal tibia after total knee arthroplasty up to five years.

  1. Iliotibial band avulsion fracture: a case report with differential diagnosis.

    PubMed

    Fay, Kristin; Mannem, Rajeev; Baynes, Keith; Sarin, Dhruv; DuBois, Melissa

    2016-02-01

    Avulsion injuries of the knee are common sequelae of significant trauma given the number of ligamentous and tendinous insertions around the joint. Commonly discussed avulsion fractures of the lateral knee include the Segond fracture of the lateral tibial plateau and the arcuate complex avulsion fracture of the fibular styloid process. A less common avulsion fracture is the iliotibial (IT) band avulsion fracture involving the anterolateral corner of the tibia (Gerdy's tubercle). It is crucial to identify IT band avulsion fractures because of the frequent associated internal derangements of the knee. This case report describes the imaging of an acute IT band avulsion fracture and compares these findings with other lateral knee avulsion fractures.

  2. 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

  3. Anti-DKK1 antibody promotes bone fracture healing through activation of β-catenin signaling.

    PubMed

    Jin, Hongting; Wang, Baoli; Li, Jia; Xie, Wanqing; Mao, Qiang; Li, Shan; Dong, Fuqiang; Sun, Yan; Ke, Hua-Zhu; Babij, Philip; Tong, Peijian; Chen, Di

    2015-02-01

    In this study we investigated if Wnt/β-catenin signaling in mesenchymal progenitor cells plays a role in bone fracture repair and if DKK1-Ab promotes fracture healing through activation of β-catenin signaling. Unilateral open transverse tibial fractures were created in CD1 mice and in β-catenin(Prx1ER) conditional knockout (KO) and Cre-negative control mice (C57BL/6 background). Bone fracture callus tissues were collected and analyzed by radiography, micro-CT (μCT), histology, biomechanical testing and gene expression analysis. The results demonstrated that treatment with DKK1-Ab promoted bone callus formation and increased mechanical strength during the fracture healing process in CD1 mice. DKK1-Ab enhanced fracture repair by activation of endochondral ossification. The normal rate of bone repair was delayed when the β-catenin gene was conditionally deleted in mesenchymal progenitor cells during the early stages of fracture healing. DKK1-Ab appeared to act through β-catenin signaling to enhance bone repair since the beneficial effect of DKK1-Ab was abrogated in β-catenin(Prx1ER) conditional KO mice. Further understanding of the signaling mechanism of DKK1-Ab in bone formation and bone regeneration may facilitate the clinical translation of this anabolic agent into therapeutic intervention.

  4. In vivo effect of quaternized chitosan-loaded polymethylmethacrylate bone cement on methicillin-resistant Staphylococcus epidermidis infection of the tibial metaphysis in a rabbit model.

    PubMed

    Tan, Hong-Lue; Ao, Hai-Yong; Ma, Rui; Lin, Wen-Tao; Tang, Ting-Ting

    2014-10-01

    Infection of open tibial fractures with contamination remains a challenge for orthopedic surgeons. Local use of antibiotic-impregnated polymethylmethacrylate (PMMA) beads and blocks is a widely used procedure to reduce the risk of infection. However, the development of antibiotic-resistant organisms make the management of infection more difficult. Our in vitro study demonstrated that quaternized chitosan (hydroxypropyltrimethyl ammonium chloride chitosan [HACC])-loaded PMMA bone cement exhibits strong antibacterial activity toward antibiotic-resistant bacteria. Therefore, the present study aimed to investigate the in vivo antibacterial activity of quaternized chitosan-loaded PMMA. Twenty-four adult female New Zealand White rabbits were used in this study. The right proximal tibial metaphyseal cavity was prepared, 10(7) CFU of methicillin-resistant Staphylococcus epidermidis was inoculated, and PMMA-only, gentamicin-loaded PMMA (PMMA-G), chitosan-loaded PMMA (PMMA-C), or HACC-loaded PMMA (PMMA-H) bone cement cylinders were inserted. During the follow-up period, the infections were evaluated using X rays on days 21 and 42 and histopathological and microbiological analyses on day 42 after surgery. Radiographic indications of bone infections, including bone lysis, periosteal reactions, cyst formation, and sequestral bone formation, were evident in the PMMA, PMMA-G, and PMMA-C groups but not in the PMMA-H group. The radiographic scores and gross bone pathological and histopathological scores were significantly lower in the PMMA-H group than in the PMMA, PMMA-G, and PMMA-C groups (P < 0.05). Explant cultures also indicated significantly less bacterial growth in the PMMA-H group than in the PMMA, PMMA-G, and PMMA-C groups (P < 0.01). We concluded that PMMA-H bone cement can inhibit the development of bone infections in this animal model inoculated with antibiotic-resistant bacteria, thereby demonstrating its potential application for treatment of local infections in open

  5. Treatment of fractures of the tibia and radius-ulna by external coaptation.

    PubMed

    Adams, S B; Fessler, J F

    1996-03-01

    External coaptation of radial-ulnar and tibial fractures with casts or modified Thomas splint-cast combinations is a useful treatment. The economics of therapy make this method of treatment feasible for commercial animals. Current estimates for the cost of treatment of tibial fractures with Thomas splint-cast combinations are $225.00 for calves and $410.00 for cattle if the metal splints are reused. Casts have similar costs. The availability of external coaptation techniques to all veterinarians and the success of treatment make external coaptation a good method for the treatment of many tibial and radial-ulnar fractures in cattle.

  6. Bilateral double level tibial lengthening in dwarfism☆

    PubMed Central

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

    2015-01-01

    Purpose Outcome assessment after double level tibial lengthening in patients with dwarfism. Methods Fourteen patients with dwarfism were analyzed after bilateral simultaneous double level tibial lengthening. Results Average age was 15.1 years. Average lengthening was 13.5 cm. The two levels were lengthened by an average of 7.5 cm proximally and 6.0 cm distally. Concomitant deformities were also addressed during lengthening. External fixation treatment time averaged 8.8 months. Healing index averaged 0.7 months/cm. Conclusion Bilateral tibial lengthening for dwarfism is difficult, but the results are usually quite gratifying. PMID:26566326

  7. Distal realignment (tibial tuberosity transfer).

    PubMed

    Feller, Julian Ashley

    2012-09-01

    Although tibial tuberosity (TT) transfer has for many years been the basis of many protocols for the management of patellar instability, the role of pure medial transfer in particular appears to be declining. In contrast, the greater recognition of the importance of patella alta as a predisposing factor to recurrent patellar dislocation has resulted in a resurgence in the popularity of distal TT transfer. When TT transfer is performed, the direction and amount of transfer is based on the patellar height and the lateralization of the TT relative to the trochlear groove. Patellar height is best assessed on a lateral radiograph with the knee in flexion using a ratio that uses the articular surface of the patella in relation to the height above the tibia. Assessment of lateralization of the TT relative to the trochlear groove can be made using either computed tomography or magnetic resonance imaging scans.

  8. Internal tibial torsion correction study. [measurements of strain for corrective rotation of stressed tibia

    NASA Technical Reports Server (NTRS)

    Cantu, J. M.; Madigan, C. M.

    1974-01-01

    A quantitative study of internal torsion in the entire tibial bone was performed by using strain gauges to measure the amount of deformation occuring at different locations. Comparison of strain measurements with physical dimensions of the bone produced the modulus of rigidity and its behavior under increased torque. Computerized analysis of the stress distribution shows that more strain occurs near the torqued ends of the bones where also most of the twisting and fracturing takes place.

  9. Computed tomography of stress fracture

    SciTech Connect

    Murcia, M.; Brennan, R.E.; Edeiken, J.

    1982-06-01

    An athletic young female developed gradual onset of pain in the right leg. Plain radiographs demonstrated solid periosteal reaction in the tibia compatible with stress fracture. She stopped sport activites but her pain continued. Follow-up radiographs of the tibia revealed changes suspicious for osteoid osteoma. Computed tomography (CT) scan demonstrated periosteal reaction, but in addition, lucent fracture lines in the tibial cortex were evident. CT obviated the need for more invasive diagnostic procedures in this patient. In selected cases CT may be useful to confirm the diagnosis of stress fracture when plain radiographic or routine tomographic studies are not diagnostic.

  10. Osteoporotic fracture in an elite male Kenyan athlete.

    PubMed

    Pollock, N; Hamilton, B

    2008-12-01

    An elite Kenyan runner presented with a tibial fracture sustained during an international cross-country race. There was no clear history of symptoms suggestive of preceding overload and no radiological features of stress fracture. He was found to have sustained an osteoporotic, insufficiency fracture. There are no previous case reports of an osteoporotic fracture in a male athlete. Possible aetiologies and directions for future investigation are presented.

  11. Proximal Tibial Epiphysis Injury (Flexion Type, Salter–Harris Type 1)

    PubMed Central

    Israni, Pratik; Panat, Mangesh

    2016-01-01

    Introduction: Fractures of the proximal tibial epiphysis rare. It has been estimated that fractures of the upper tibial epiphysis account for 0.5-3.1% of all epiphyseal injuries. Who had no neurovascular deficit, with fixed extension deformity at the left knee was treated early with closed reduction techniques. Case Report: We present a case of a 16-year-old boy who while playing cricket on the road was hit by a car. The patient presented in emergency room with extremely swollen knee and soft tissue swelling (hemarthrosis), he was unable to lift his leg actively due to severe pain because of hamstrings spasm, and he had no wound over his left knee and had no other associated injuries. Plain radiographs were taken which revealed, separated proximal tibial epiphysis (salter harris Type 1 injury) The epiphysis was anteriorly displaced fracture line extending beyond growth plate through metaphysis and tibial tuberosity also displaced anteriorly, the proximal fibular epiphysis fragment was displaced anteriorly with no injury to femoral epiphysis and no patellar fracture, radiograph also revealed no intra-articular fracture as joint appears congruent. Under spinal anesthesia, under all aseptic precautions traction was applied for few minutes, the fracture was reduced closed as the hamstring spasm gave way, reduction was confirmed under image intensifier in both AP and lateral planes, and joint congruity was examined. Proximal fibular epiphysis also snapped back in place. Post-operative patient was immobilized with nil weight bearing for 4 weeks, check X-rays taken, he was mobilized in wheelchair. After 4 weeks slab was removed, K-wires were removed, and partial weight bearing was started with rehabilitation for full range of motion of the left knee. At 6 weeks, both the knee joints appeared symmetrical with no abnormalities or limb length discrepancy or instability with knee from 0° to 140°, with full weight bearing. Conclusion: Although less commonly seen, Salter

  12. Intermittent foot claudication caused by a dynamic compression of the posterior tibial artery.

    PubMed

    Kaczynski, Jakub; Topliss, Claire; Fligelstone, Louis

    2016-07-14

    A young adult presented with an atypical intermittent foot claudication caused by a dynamic compression of the posterior tibial artery by a ganglion. This case highlights the diagnostic challenges when dealing with an entrapment syndrome. Subsequent open surgical treatment was successful, and the patient has made a good recovery.

  13. Experimental study of stable imbibition displacements in a model open fracture. II. Scale-dependent avalanche dynamics.

    PubMed

    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 V_{ℓ}, 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 V_{ℓ}(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 V_{ℓ}(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 N_{eff}=ℓ/ℓ_{c} (the ratio of the lateral size of the measuring window ℓ to the correlation length ℓ_{c}∼1/sqrt[μv]). The large correlated excursions of V_{ℓ}(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 ξ_{S} and maximum durations ξ_{T} of global avalanches are not controlled by the same mechanism. While ξ_{S} are also

  14. Analysis of Knee Joint Line Obliquity after High Tibial Osteotomy.

    PubMed

    Oh, Kwang-Jun; Ko, Young Bong; Bae, Ji Hoon; Yoon, Suk Tae; Kim, Jae Gyoon

    2016-11-01

    The aim of this study was to evaluate which lower extremity alignment (knee and ankle joint) parameters affect knee joint line obliquity (KJLO) in the coronal plane after open wedge high tibial osteotomy (OWHTO). Overall, 69 knees of patients that underwent OWHTO were evaluated using radiographs obtained preoperatively and from 6 weeks to 3 months postoperatively. We measured multiple parameters of knee and ankle joint alignment (hip-knee-ankle angle [HKA], joint line height [JLH], posterior tibial slope [PS], femoral condyle-tibial plateau angle [FCTP], medial proximal tibial angle [MPTA], mechanical lateral distal femoral angle [mLDFA], KJLO, talar tilt angle [TTA], ankle joint obliquity [AJO], and the lateral distal tibial ground surface angle [LDTGA]; preoperative [-pre], postoperative [-post], and the difference between -pre and -post values [-Δ]). We categorized patients into two groups according to the KJLO-post value (the normal group [within ± 4 degrees, 56 knees] and the abnormal group [greater than ± 4 degrees, 13 knees]), and compared their -pre parameters. Multiple logistic regression analysis was used to examine the contribution of the -pre parameters to abnormal KJLO-post. The mean HKA-Δ (-9.4 ± 4.7 degrees) was larger than the mean KJLO-Δ (-2.1 ± 3.2 degrees). The knee joint alignment parameters (the HKA-pre, FCTP-pre) differed significantly between the two groups (p < 0.05). In addition, the HKA-pre (odds ratio [OR] = 1.27, p = 0.006) and FCTP-pre (OR = 2.13, p = 0.006) were significant predictors of abnormal KJLO-post. However, -pre ankle joint parameters (TTA, AJO, and LDTGA) did not differ significantly between the two groups and were not significantly associated with the abnormal KJLO-post. The -pre knee joint alignment and knee joint convergence angle evaluated by HKA-pre and FCTP-pre angle, respectively, were significant predictors of abnormal KJLO after OWHTO. However, -pre ankle joint parameters

  15. 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

    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.

  16. 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

  17. [Results of the surgical treatment of ankle fractures in children and adolescents].

    PubMed

    Kowalczyk, Bartłomiej; Lejman, Tadeusz

    2007-01-01

    We present results of treatment in 36 cases of distal tibial epiphyseolysis in 34 patients treated between 1999 and 2005 with a minimal follow up of 12 months (average 28,5, range 13-84 months). The mean age at injury was 12 years (range from 7 to 16). There were 22 cases of type II injury according to the Salter-Harris classification, 5 cases of type VII, 3 of type IV, 2 of type I and two cases of triplane fracture, one case of retrospectively recognised type V and one of type III. 12 children required open reduction and K-wire fixation, the rest of 22 children underwent closed reduction followed by percutaneus fixation in 12 cases. Concomitant fibular fracture occured in 30 cases and required open reduction and fixation in 4. There were 18 good, 14 fair and 3 bad results according to Gleizes. The mean AOFAS scale result was 92.7. One child underwent 2 weeks of intravenous antybiotic therapy to recover from superficial skin infection around percutaneus K-wires. Four cases of physeal bar formation were noted. In two of them distal tibial osteotomy to correct ankle varus was necessary and one underwent bony bridge removal followed by fatty tissue interposition. The remaining physeal bar resulted in 10 degree of ankle valgus without functional dispairement.

  18. Nose fracture

    MedlinePlus

    Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It ... with other fractures of the face. Sometimes a blunt injury can ...

  19. Crushing injuries of the foot and ankle, with complex open fractures: result of a prospective study with a 3 year follow-up.

    PubMed

    DA, Edelstein; I, Florescu

    2016-01-01

    The objective of this study was to determine the compared results of both the reconstruction surgery and the amputation in severe crushing of the foot, which led to open fractures. The type of study. Prospective. Background. Two major trauma hospitals (Floreasca Clinical Emergency Hospital and "Bagdasar Arseni" Clinical Emergency Hospital) from the university center in Bucharest. Patients. 21 patients, who sustained crushing of the foot with resulting Gustilo type III open fractures, were involved. The exclusion criteria were represented by open fractures that had very gross destructions of the neurovascular bundle, for which the amputation was the only solution, with no modality to reconstruct whatsoever. Treatment. An immediate amputation (at 24, 48 hours after a thorough debridement, proper patient resuscitation, and detailed imaging investigation - the technique of delayed emergency) and reconstruction surgery were performed. Methods of evaluation. Three variables were used: the Sickness Impact Profile (SIP) score, the Visual Analogue Scale (VAS) for the residual pain and the number of rehospitalizations for secondary surgical procedures. Results. When comparing the two lots of patients, first in which the amputation patients were included and second in which the reconstruction patients were included, it was noticed that there was a less favorable prognostic in the second lot for a three-year follow up period. Conclusions. The patients with a mangled foot, in which reconstruction surgery of the bone and soft tissue envelope was performed, had a worse prognostic than those who had an amputation as a first intention. Abbreviations: SIP = Sickness Impact Profile, VAS = Visual Analogue Scale, MVA = Motor Vehicle Accident, STSG = Split Thickness Skin Graft.

  20. The effect of muscle fatigue on in vivo tibial strains.

    PubMed

    Milgrom, Charles; Radeva-Petrova, Denitsa R; Finestone, Aharon; Nyska, Meir; Mendelson, Stephen; Benjuya, Nisim; Simkin, Ariel; Burr, David

    2007-01-01

    Stress fracture is a common musculoskeletal problem affecting athletes and soldiers. Repetitive high bone strains and strain rates are considered to be its etiology. The strain level necessary to cause fatigue failure of bone ex vivo is higher than the strains recorded in humans during vigorous physical activity. We hypothesized that during fatiguing exercises, bone strains may increase and reach levels exceeding those measured in the non-fatigued state. To test this hypothesis, we measured in vivo tibial strains, the maximum gastrocnemius isokinetic torque and ground reaction forces in four subjects before and after two fatiguing levels of exercise: a 2km run and a 30km desert march. Strains were measured using strain-gauged staples inserted percutaneously in the medial aspect of their mid-tibial diaphysis. There was a decrease in the peak gastrocnemius isokinetic torque of all four subjects' post-march as compared to pre-run (p=0.0001), indicating the presence of gastrocnemius muscle fatigue. Tension strains increased 26% post-run (p=0.002, 95 % confidence interval (CI) and 29% post-march (p=0.0002, 95% CI) as compared to the pre-run phase. Tension strain rates increased 13% post-run (p=0.001, 95% CI) and 11% post-march (p=0.009, 95% CI) and the compression strain rates increased 9% post-run (p=0.0004, 95% CI) and 17% post-march (p=0.0001, 95% CI). The fatigue state increases bone strains well above those recorded in rested individuals and may be a major factor in the stress fracture etiology.

  1. 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)

  2. 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.

  3. The effects of tibia profile, distraction angle, and knee load on wedge instability and hinge fracture: A finite element study.

    PubMed

    Weng, Pei-Wei; Chen, Chia-Hsien; Luo, Chu-An; Sun, Jui-Sheng; Tsuang, Yang-Hwei; Cheng, Cheng-Kung; Lin, Shang-Chih

    2017-04-01

    Several plate systems for high tibial osteotomy (HTO) have been developed to stabilize the opening wedge of an osteotomized tibia. Among them, the TomoFix system, having a quasi-straight and T-shaped design, has been widely adopted in the literature. However, this system is implemented by inserting a lag (i.e., cortical) screw through the proximal combi-hole, to deform the plate and pull the distal tibia toward the plate. This process potentially induces plate springback and creates an elastic preload on the osteotomized tibia, especially at the lateral hinge of the distracted wedge. Using the finite-element method, this study aims to investigate the contoured effect of lag-screw application on the biomechanical behavior of the tibia-plate construct. Two tibial profiles (normal and more concave), three distraction angles (6°, 9°, and 12°), and three knee loads (intraoperative: contouring plate; postoperative: weight and nonweight bearing) are systematically varied in this study. The wedge instability and fracture risk at the lateral hinge are chosen as the comparison indices. The results show the necessity of preoperative planning for a precontoured procedure, rather than elastic deformation using a lag screw. Within the intraoperative period, a more concave tibial profile and/or reduced distraction angle (i.e., 6° or 9°) necessitate a higher compressive load to elastically deform the plate, thereby deteriorating the lateral-hinge fracture risk. A precontoured plate is recommended in the case that the proximal tibia is highly concave and the distraction angle is insufficient to stretch the tibial profile.

  4. 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

  5. Open reduction and internal fixation of OTA type C2-C4 fractures of the calcaneus with a triple-plate technique.

    PubMed

    Brunner, Alexander; Müller, Jochen; Regazzoni, Pietro; Babst, Reto

    2012-01-01

    The purpose of this study was to present a surgical technique of open reduction and internal fixation of displaced intra-articular calcaneal fractures with 3 AO mini-fragment plates and to evaluate the clinical and radiological outcome of a consecutive group of patients after a mean follow-up of 41.7 months. A series of 54 patients (16 women and 38 men) with 62 calcaneal fractures were treated over a period of 6.5 years. Forty-five patients with 50 calcaneal fractures were completely clinically and radiologically followed up. Clinical follow-up included assessment of range of motion, pain according to a visual analogue scale, the American Orthopaedic Foot and Ankle Society hindfoot score, and the short-form 36 health survey. Radiological follow-up included plain axial and lateral radiographs and measurement of the Böhler's angle and Gissane's angle. Independent Student's t test and paired Student's t test were used alongside the chi-square test to compare clinical and radiological data and score values between different groups of patients. Eleven patients showed breakage of the osteosynthesis material during the healing process and 2 patients sustained deep wound infection requiring revision surgery. At the final follow-up all fractures had healed. The average range of motion was supination 26.4° (range 0° to 50°; SD 11.6°), pronation 15.4° (range 0° to 30°; SD 6.4°), dorsal extension 14.3° (range -10° to 30°; SD 8.0°), and plantarflexion 39.6° (range 20° to 65°; SD 11.7°). Patients with OTA type C4 fractures achieved significantly lower supination (p < .01) and plantarflexion (p < .01) compared with other fracture types. The mean visual analog scale pain score was 3.6 (range 0 to 8; SD 2.3) points, average American Orthopaedic Foot and Ankle Society hindfoot score was 70.8 (range 33 to 100; SD 17.1) points, and the mean short-form 36 score was 60.98 (range 22.9 to 93.0; SD 18.4) points. The mean postoperative Böhler's angle was 28.9° (range 8

  6. Topography of human ankle joint: focused on posterior tibial artery and tibial nerve

    PubMed Central

    Kim, Deog-Im; Kim, Yi-Suk

    2015-01-01

    Most of foot pain occurs by the entrapment of the tibial nerve and its branches. Some studies have reported the location of the tibial nerve; however, textbooks and researches have not described the posterior tibial artery and the relationship between the tibal nerve and the posterior tibial artery in detail. The purpose of this study was to analyze the location of neurovascular structures and bifurcations of the nerve and artery in the ankle region based on the anatomical landmarks. Ninety feet of embalmed human cadavers were examined. All measurements were evaluated based on a reference line. Neurovascular structures were classified based on the relationship between the tibial nerve and the posterior tibial artery. The bifurcation of arteries and nerves were expressed by X- and Y-coordinates. Based on the reference line, 9 measurements were examined. The most common type I (55.6%), was the posterior tibial artery located medial to the tibial nerve. Neurovascular structures were located less than 50% of the distance between M and C from M at the reference line. The bifurcation of the posterior tibial artery was 41% in X-coordinate, -38% in Y-coordinate, and that of the tibial nerve was 48%, and -10%, respectively. Thirteen measurements and classification showed statistically significant differences between both sexes (P<0.05). It is determined the average position of neurovascular structures in the human ankle region and recorded the differences between the sexes and amongst the populations. These results would be helpful for the diagnosis and treatment of foot pain. PMID:26140224

  7. Percutaneous Reduction and Fixation with Kirschner Wires versus Open Reduction Internal Fixation for the Management of Calcaneal Fractures: A Meta-Analysis

    PubMed Central

    Wu, Jianbin; Zhou, Feiya; Yang, Lei; Tan, Jun

    2016-01-01

    The aim of our meta-analysis was to compare outcomes for two surgical treatments of calcaneal fractures, percutaneous reduction and fixation with Kirschner wires (PRFK) and open reduction internal fixation (ORIF), with the intent of evaluating the quality of evidence to inform practice. Search of MEDLINE, Cochrane and CNKI databases to identify randomized controlled trials (RCTs) comparing PRKF and ORIF on the following outcomes: post-operative function, complications and quality of the reduction. Odd ratios (OR) and weighted mean differences were pooled using either a fixed-effects or random-effects model, depending on the heterogeneity of the trials included in the analysis. Eighteen RCTs provided the data from 1407 patients. PRFK was associated with a lower risk of surgical wound complications, and ORIF with better post-operative function, angle of Gissane, calcaneal height, and calcaneal width. There were no statistically significant differences between the techniques with regards to post-operative Böhler’s angle. PRFK does not provide a substantive advantage over ORIF for the treatment of calcaneal fractures in adults. PRFK may, however, yield comparable functional outcomes to ORIF for closed Sanders type II calcaneal fractures but with less complication related to surgical wound healing. PMID:27457262

  8. Fatigue strength of common tibial intramedullary nail distal locking screws

    PubMed Central

    Griffin, Lanny V; Harris, Robert M; Zubak, Joseph J

    2009-01-01

    Background Premature failure of either the nail and/or locking screws with unstable fracture patterns may lead to angulation, shortening, malunion, and IM nail migration. Up to thirty percent of all unreamed nail locking screws can break after initial weight bearing is allowed at 8–10 weeks if union has not occurred. The primary problem this presents is hardware removal during revision surgery. The purposes of our study was to evaluate the relative fatigue resistance of distal locking screws and bolts from representative manufacturers of tibial IM nail systems, and develop a relative risk assessment of screws and materials used. Evaluations included quantitative and qualitative measures of the relative performance of these screws. Methods Fatigue tests were conducted to simulate a comminuted fracture that was treated by IM nailing assuming that all load was carried by the screws. Each screw type was tested ten times in a single screw configuration. One screw type was tested an additional ten times in a two-screw parallel configuration. Fatigue tests were performed using a servohydraulic materials testing system and custom fixturing that simulated screws placed in the distal region of an appropriately sized tibial IM nail. Fatigue loads were estimated based on a seventy-five kilogram individual at full weight bearing. The test duration was one million cycles (roughly one year), or screw fracture, whichever occurred first. Failure analysis of a representative sample of titanium alloy and stainless steel screws included scanning electron microscopy (SEM) and quantitative metallography. Results The average fatigue life of a single screw with a diameter of 4.0 mm was 1200 cycles, which would correspond roughly to half a day of full weight bearing. Single screws with a diameter of 4.5 mm or larger have approximately a 50 percent probability of withstanding a week of weight bearing, whereas a single 5.0 mm diameter screw has greater than 90 percent probability of

  9. Fixation orientation in ankle fractures with syndesmosis injury.

    PubMed

    Nimick, Craig J; Collman, David R; Lagaay, Pieter

    2013-01-01

    Accurate reduction of the syndesmosis has been shown to be an important prognostic factor for functional outcome in ankle injuries that disrupt the syndesmosis. The purpose of the present case series was to assess the fixation orientation and the position of the fibula within the tibial incisura after open reduction and internal fixation of ankle fractures with syndesmosis injury. Computed tomography was used to assess the accuracy of the reduction. Twelve patients were included in the present case series. A ratio representing the relationship between the tibia and fibula and the orientation of the syndesmotic fixation was measured preoperatively and postoperatively and compared with the uninjured contralateral ankle, representing the patient's normal anatomy. The measurements were accomplished electronically to one tenth of 1 mm using Stentor Intelligent Informatics, I-site, version 3.3.1 (Phillips Electronics; Andover, MA). Posteriorly oriented syndesmotic fixation caused posterior translation of the fibula with respect to the tibia and anteriorly oriented syndesmotic fixation caused anterior translation.

  10. Biomechanical Factors in the Etiology of Tibial Stress Fractures

    DTIC Science & Technology

    2002-08-01

    I, Laughton, C and Hughes, M. Can a dual function orthosis control rearfoot motion and attenuate shock? (in review) Foot and Ankle 31 Wills, J...McCrory, JL, Quick, NE, Ballantyne, BT & McClay, IS. Effect of a Resistive Dynamic Knee Orthosis on Muscle Activations During the Lateral Step Up...Morin, G., Clarkson, P. M., Andres, R. O. Exercise moderation of foot function during walking with a re-usable semirigid ankle orthosis . Clinical

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

    DTIC Science & Technology

    2005-12-01

    Triathlon 24 Stanford University 11 Female 21 Running 38 Stanford University 12 Male 45 Running 30 Stanford University 13 Male 22 Ultimate Frisbee 22...Running 6 Griffith University 6 22 Male 33 Triathlon 17 Griffith University 23 Male 25 Running 8 Griffith University 24 Male 25 Running 8...Griffith University 25 Female 34 Triathlon 17 Griffith University 26 Female 23 Step aerobics 19 Griffith University 27 Female 32 Running 17 Griffith

  12. Osteochondritis of the Distal Tibial Epiphysis

    PubMed Central

    EL Hajj, Firass; Sebaaly, Amer; Kharrat, Khalil; Ghanem, Ismat

    2012-01-01

    Osteochondritis of the distal tibial epiphysis is a very rare entity. 9 cases have been described in 7 articles and 8 other cases have been mentioned in textbooks. This paper describes the 10th case of osteochondritis of the distal tibial epiphysis and summarizes the clinical and radiological presentations of the 9 other cases. The etiology of this entity is well debated in the literature. We believe that it results from a vascular abnormality in the distal tibial epiphysis associated with a mechanical stress (trauma, excessive overload, etc.). Since it is a self-limited disease, the prognosis is good and the younger the patient is the better the prognosis will be. In general, this entity responds well to conservative treatment. PMID:23193412

  13. The importance of tibial alignment: finite element analysis of tibial malalignment.

    PubMed

    Perillo-Marcone, A; Barrett, D S; Taylor, M

    2000-12-01

    The influence of the tibial plateau orientation on cancellous bone stress was examined by finite element analysis for a cemented device. The objectives of the study were i) to examine the effect of the plateau-ankle angle on the cancellous bone stress, ii) to analyze the significance of the anteroposterior angles of the tibial component on these stresses, and iii) to compare the finite element predictions with clinical data. In general, positioning the tibial plateau in valgus resulted in lower cancellous bone stresses. These results support previous clinical studies, which suggest that overall alignment in valgus results in lower migration rates and lower incidence of loosening.

  14. Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kim, Sang Bum; Lim, Jin Woo; Seo, Jeong Gook

    2016-01-01

    Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case. PMID:26929808

  15. Management of metacarpal fractures.

    PubMed

    McNemar, Thomas B; Howell, Julianne Wright; Chang, Eric

    2003-01-01

    Fractures of the hand are the most common fractures of the human skeleton. Metacarpal fractures account for 30% to 50% of all of hand fractures. The mechanisms of these injuries vary from axial loading forces to direct blows to the dorsal hand. Resulting deformities include malrotation, angulation, and shortening. Treatment modalities vary from nonoperative reduction to open reduction and internal fixation. The treatment algorithm is guided by the location of the fracture, the stability of the fracture, and the resultant deformity. Operative procedures, although they may lead to excellent radiographic reduction of fractures, often lead to debilitating stiffness from the inflammatory reaction of the surgical procedure. Operative fixation must be employed judiciously and offered only when confident that non-operative therapy can be improved on with operative intervention. This article reviews the various types of metacarpal fractures, with the treatment options available for each fracture. The indications for each treatment modality, postoperative care, and rehabilitation are presented.

  16. Chondrocyte BMP2 signaling plays an essential role in bone fracture healing.

    PubMed

    Mi, Meng; Jin, Hongting; Wang, Baoli; Yukata, Kiminori; Sheu, Tzong-Jen; Ke, Qiao Han; Tong, Peijian; Im, Hee-Jeong; Xiao, Guozhi; Chen, Di

    2013-01-10

    The specific role of endogenous Bmp2 gene in chondrocytes and in osteoblasts in fracture healing was investigated by generation and analysis of chondrocyte- and osteoblast-specific Bmp2 conditional knockout (cKO) mice. The unilateral open transverse tibial fractures were created in these Bmp2 cKO mice. Bone fracture callus samples were collected and analyzed by X-ray, micro-CT, histology analyses, biomechanical testing and gene expression assays. The results demonstrated that the lack of Bmp2 expression in chondrocytes leads to a prolonged cartilage callus formation and a delayed osteogenesis initiation and progression into mineralization phase with lower biomechanical properties. In contrast, when the Bmp2 gene was deleted in osteoblasts, the mice showed no significant difference in the fracture healing process compared to control mice. These findings suggest that endogenous BMP2 expression in chondrocytes may play an essential role in cartilage callus maturation at an early stage of fracture healing. Our studies may provide important information for clinical application of BMP2.

  17. Hardware Removal Due to Infection after Open Reduction and Internal Fixation: Trends and Predictors

    PubMed Central

    Rasouli, Mohammad R.; Viola, Jessica; Maltenfort, Mitchell G.; Shahi, Alisina; Parvizi, Javad; Krieg, James C.

    2015-01-01

    Background: Little is known about trends and predictors of hardware related infection following open reduction and internal fixation (ORIF) of extremity fractures, one of the major causes of failure following ORIF. The present study was designed and conducted to determine trends and predictors of infection-related hardware removal following ORIF of extremities using a nationally representative database. Methods: We used Nationwide Inpatient Sample data from 2002 to 2011 to identify cases of ORIF following upper and lower extremity fractures, as well as cases that underwent infection-related hardware removal following ORIF. Multivariate analysis was performed to identify independent predictors of infection-related hardware removal, controlling for patient demographics and comorbidities, hospital characteristics, site of fracture, and year. Results: For all ORIF procedures, the highest rate of hardware removal related to infection was observed in tarsal fractures (5.56%), followed by tibial (3.65%) and carpal (3.37%) fractures. Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Tarsal fractures(odds ratio (OR)=1.06, 95% confidence interval (CI): 1.04-1.09, P<0.001), tibial fractures (OR=1.04, 95% CI: 1.03-1.06, P<0.001) and those patients with diabetes mellitus (OR=2.64, 95% CI: 2.46-2.84, P<0.001), liver disease (OR=2.04, 95% CI: 1.84- 2.26, P<0.001), and rheumatoid arthritis (OR=2.06, 95% CI: 1.88-2.25 P<0.001) were the main predictors of infection-related removals; females were less likely to undergo removal due to infection (OR= 0.61, 95% CI: 0.59-0.63 P<0.001). Conclusions: Hardware removal rates due to infection increased in all fractures except radial/ulnar fractures. Diabetes, liver disease, and rheumatoid arthritis were important predictors of infection-related hardware removal. The study identified some risk factors for hardwarerelated infection following ORIF, such as diabetes, liver disease, and rheumatoid

  18. Effect of step width manipulation on tibial stress during running.

    PubMed

    Meardon, Stacey A; Derrick, Timothy R

    2014-08-22

    Narrow step width has been linked to variables associated with tibial stress fracture. The purpose of this study was to evaluate the effect of step width on bone stresses using a standardized model of the tibia. 15 runners ran at their preferred 5k running velocity in three running conditions, preferred step width (PSW) and PSW±5% of leg length. 10 successful trials of force and 3-D motion data were collected. A combination of inverse dynamics, musculoskeletal modeling and beam theory was used to estimate stresses applied to the tibia using subject-specific anthropometrics and motion data. The tibia was modeled as a hollow ellipse. Multivariate analysis revealed that tibial stresses at the distal 1/3 of the tibia differed with step width manipulation (p=0.002). Compression on the posterior and medial aspect of the tibia was inversely related to step width such that as step width increased, compression on the surface of tibia decreased (linear trend p=0.036 and 0.003). Similarly, tension on the anterior surface of the tibia decreased as step width increased (linear trend p=0.029). Widening step width linearly reduced shear stress at all 4 sites (p<0.001 for all). The data from this study suggests that stresses experienced by the tibia during running were influenced by step width when using a standardized model of the tibia. Wider step widths were generally associated with reduced loading of the tibia and may benefit runners at risk of or experiencing stress injury at the tibia, especially if they present with a crossover running style.

  19. Dorsal fracture-dislocation of the proximal interphalangeal joint: a comparative study of percutaneous Kirschner wire fixation versus open reduction and internal fixation.

    PubMed

    Aladin, A; Davis, T R C

    2005-05-01

    Nineteen patients with a dorsal fracture-dislocation of the proximal interphalangeal joint of a finger were treated with either closed reduction and transarticular Kirschner wire fixation (eight cases) or open reduction and internal fixation, using either one or two lag screws (six cases) or a cerclage wire (five cases). At a mean follow-up of 7 (range 6-9) years, most patients reported satisfactory finger function, even though some of the injuries healed with proximal interphalangeal joint incongruency (seven cases) or subluxation (four cases). Those treated by open reduction complained of more "loss of feeling" in the affected finger and those specifically treated by cerclage wire fixation reported more cold intolerance and had a significantly larger fixed flexion deformity (median, 30 degrees : range 18-38 degrees ) and a smaller arc of motion (median, 48 degrees : range 45-60 degrees ) at the proximal interphalangeal joint, despite having the best radiological outcomes. Closed reduction and transarticular Kirschner wire fixation produced satisfactory results, with none of the eight patients experiencing significant persistent symptoms despite a reduced arc of proximal interphalangeal joint flexion (median=75 degrees ; range 60-108 degrees ). The results of this relatively simple treatment appear at least as satisfactory as those obtained by the two techniques of open reduction and internal fixation, both of which were technically demanding.

  20. Stress fracture of the pelvis and lower limbs including atypical femoral fractures-a review.

    PubMed

    Tins, Bernhard J; Garton, Mark; Cassar-Pullicino, Victor N; Tyrrell, Prudencia N M; Lalam, Radhesh; Singh, Jaspreet

    2015-02-01

    Stress fractures, that is fatigue and insufficiency fractures, of the pelvis and lower limb come in many guises. Most doctors are familiar with typical sacral, tibial or metatarsal stress fractures. However, even common and typical presentations can pose diagnostic difficulties especially early after the onset of clinical symptoms. This article reviews the aetiology and pathophysiology of stress fractures and their reflection in the imaging appearances. The role of varying imaging modalities is laid out and typical findings are demonstrated. Emphasis is given to sometimes less well-appreciated fractures, which might be missed and can have devastating consequences for longer term patient outcomes. In particular, atypical femoral shaft fractures and their relationship to bisphosphonates are discussed. Migrating bone marrow oedema syndrome, transient osteoporosis and spontaneous osteonecrosis are reviewed as manifestations of stress fractures. Radiotherapy-related stress fractures are examined in more detail. An overview of typical sites of stress fractures in the pelvis and lower limbs and their particular clinical relevance concludes this review. Teaching Points • Stress fractures indicate bone fatigue or insufficiency or a combination of these. • Radiographic visibility of stress fractures is delayed by 2 to 3 weeks. • MRI is the most sensitive and specific modality for stress fractures. • Stress fractures are often multiple; the underlying cause should be evaluated. • Infratrochanteric lateral femoral fractures suggest an atypical femoral fracture (AFF); endocrinologist referral is advisable.

  1. 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.

  2. Collagen fibre arrangement in the tibial plateau articular cartilage of man and other mammalian species

    PubMed Central

    KÄÄB, M. J.; AP GWYNN, I.; NÖTZLI, H. P.

    1998-01-01

    Experimental animal models are frequently used to study articular cartilage, but the relevance to man remains problematic. In this study animal models were compared by examination of the collagen fibre arrangement in the medial tibial plateau of human, cow, pig, dog, sheep, rabbit and rat specimens. 24 cartilage samples from each species were prepared and maximum cartilage thickness in the central tibial plateau measured. Samples were fixed, dehydrated, freeze-fractured and imaged by scanning electron microscopy (SEM). At low magnification, 2 different arrangements of collagen fibres were observed: leaf-like (human, pig, dog) and columnar (cow, sheep, rabbit, rat). The porcine collagen structure was the most similar to that of man. This arrangement was consistent from the radial to the upper zones. Under higher magnification at the surface of the leaves, the collagen was more randomly oriented, whereas the columns consisted of parallel collagen fibrils. The maximum thickness of cartilage did not correlate with the type of collagen arrangement but was correlated with the body weight of the species (r=0.785). When using animal models for investigating human articular cartilage function or pathology, the differences in arrangement of collagen fibres in tibial plateau cartilage between laboratory animals should be considered especially if morphological evaluation is planned. PMID:9758134

  3. Intraneural ganglion cyst of the tibial nerve.

    PubMed

    Adn, M; Hamlat, A; Morandi, X; Guegan, Y

    2006-08-01

    Intraneural ganglion cyst of the tibial nerve is very rare. To date, only 5 cases of this entity in the popliteal fossa have been reported. We report a new case and review the previously reported cases. A 40-year-old man experienced a mild vague pain in the medial half of his right foot for 3 years. Magnetic resonance imaging scan demonstrated a soft-tissue mass along the right tibial nerve. At surgery, an intraneural ganglion cyst was evacuated. After 12 months, the patient was pain-free with no signs of recurrence. Trauma might be a contributing factor to the development of intraneural ganglion cysts. Application of microsurgical techniques is encouraged.

  4. [Nasal fractures in adults].

    PubMed

    Sjöstedt, Sannia; Larsen, Christian Grønhøj; Bilde, Anders; von Buchwald, Christian

    2016-03-07

    The risk of complications warrants treatment of most dislocated nasal fractures. Other injuries including other facial fractures and septal haematoma must be treated if present at the initial presentation. The usual treatment for a simple nasal fracture is closed reduction in local anaesthesia after five to seven days. Complicated cases require open reduction in general anaesthesia. Later revision of the deviated nose may become necessary in patients suffering from complications such as persistent nasal stenosis and/or deformity.

  5. The functional outcome of lower-extremity fractures with vascular injury.

    PubMed

    Lin, C H; Wei, F C; Levin, L S; Su, J I; Yeh, W L

    1997-09-01

    Salvage of lower-extremity Gustilo type IIIC fractures is difficult, time-consuming for the patients and physicians, and not universally successful because of poor functional outcomes. Even if successful with limb salvage, the functional result may be unsatisfactory because of mutilating injuries to muscle and nerve, bone loss, and the presence of chronic infection. From July 1991 until July 1994, revascularizations of open IIIC fractures were attempted for wounds with Mangled Extremity Severity Score (MESS) < or = 10. The functional results were evaluated at 2 years after injury. Thirty-six lower-extremity revascularizations were performed on 34 patients, including 1 patient with bilateral distal tibial IIIC fractures and a child with IIIC femoral fracture accompanied by ipsilateral distal tibial amputation. Excluded were patients with below-ankle IIIC fractures as well as patients who underwent immediate amputation at admission. After the revascularization, seven patients with IIIC fractures (7 of 36, 19.4%) underwent secondary amputation within 1 week. At the 2-year follow-up, the overall secondary amputation rate was 25% (9 of 36) and the salvage rate was 75% (27 of 36). Those were no deaths. Of the 29 salvaged limbs among these 27 patients, 23 limbs (23 of 29, 79.3%) required secondary coverage procedures that included 12 free flap transfers (12 of 29, 41.4%). Every patient needed subsequent reconstructive surgery to achieve an acceptable functional result. In this series, MESS was able to predict the secondary amputation rate and the functional result. Sixteen of the 17 limb-salvaged patients with MESS < or = 7 were able to achieve minimal functional requirements, whereas 3 of the 10 patients with MESS = 8 to 10 failed to achieve minimal functional requirements at the 2-year follow-up. Using statistical analysis, we found that the salvaged limbs with MESS < or = 9 exhibited a significant difference in achieving adequate function compared with limbs with MESS

  6. Bilateral Simultaneous Avulsion Fractures of the Proximal Tibia in a 14-Year-Old Athlete with Vitamin-D Deficiency

    PubMed Central

    Harb, Ziad; Malhi, Arfan

    2015-01-01

    Fractures involving the proximal tibial epiphysis are rare and form 0.5% of all epiphyseal injuries. The specific anatomical and developmental features of the proximal tibial epiphysis make it vulnerable to unique patterns of fractures. Vitamin-D plays a vital role in bone homeostasis and its deficiency has an impact on fracture risk and healing. We present the first ever reported case of simultaneous bilateral proximal tibial physeal fractures in an athlete with vitamin-D deficiency. Treatment consisted of plaster immobilisation, and the patient made a full recovery and returned to preinjury level of activities. We report this case for its uniqueness and as an educational review of the importance of the developmental anatomy of the proximal tibia. We review the literature and discuss how the stages of the growing physis determine the type of fracture sustained. PMID:26425381

  7. Influence of nail prominence and insertion point on anterior knee pain after tibial intramedullary nailing.

    PubMed

    Chen, Chun-Yu; Lin, Kai-Cheng; Yang, Shan-Wei; Tarng, Yih-Wen; Hsu, Chien-Jen; Renn, Jenn-Huei

    2014-03-01

    Chronic anterior knee pain is the most common complication after tibial nail insertion. Its etiology remains unknown, and multifactorial sources have been suggested. The authors believe that nail prominence and the insertion point of the nail are important in the development of anterior knee pain. The purpose of this retrospective study was to evaluate the roles of the insertion point and nail prominence in anterior knee pain after tibial intramedullary nailing using a transtendinous approach and a common nail type. A total of 108 patients with tibial shaft fractures underwent reamed intramedullary nailing using a transtendinous approach between 2006 and 2009. Mean follow-up was 26.8±5.0 months. A visual analog scale (0-100) was used to estimate anterior knee pain severity while patients performed 7 activities retrospectively. Radiographic assessments, including nail prominence and insertion point, were performed. Sixty (55.6%) patients experienced knee pain (group P) and 48 (44.4%) did not (group N). Significant differences were not found between the groups with respect to demographics, nail diameters, or fracture classifications. Less superior and more anterior nail prominences in radiographic assessments were significantly associated with anterior knee pain. When the insertion point was over the bottom half of the anterior cortex, the influence of anterior nail prominence was more obvious. Nail removal resulted in diminished pain during the 7 assessed activities. Nail insertion should be over the bottom half of the anterior cortex, with minimal anterior nail prominence. If anterior knee pain occurs, removal of the nail should be considered.

  8. Mode of opening of an oceanic pull-apart: The 20°N Basin along the Owen Fracture Zone (NW Indian Ocean)

    NASA Astrophysics Data System (ADS)

    Rodriguez, Mathieu; Chamot-Rooke, Nicolas; Fournier, Marc; Huchon, Philippe; Delescluse, Matthias

    2013-09-01

    basins are common features observed at releasing bends along major strike-slip faults. The formation and structural evolution of such basins have mostly been investigated in the continental domain and by sandbox laboratory experiments or numerical models. Here we present recently acquired multibeam bathymetry, 3.5 kHz echo sounder, and seismic profiles across the 20°N pull-apart Basin along the India-Arabia transform boundary, known as the Owen Fracture Zone (OFZ). Using nearby oceanic drilling (Deep Sea Drilling Project 222), we constrain the structural evolution of the basin since opening some 3 Myr ago. The 20°N Basin is large (90 km long and 35 km wide) despite limited transcurrent motion (~10 km). The first stage involved the formation of a step over along the OFZ and the subsequent isolation of a subsiding half graben. Extension and subsidence were further partitioned over three distinct subbasins separated by complex sets of transverse faults. The size of the basin was enhanced by gravity-driven collapse. The 20°N Basin has been a catchment for Indus turbidites since its opening, which provide a good record of syn-sedimentary deformation. The deformation related to the subsidence of the half graben mimics rollover structures commonly encountered in salt tectonics, suggesting that subsidence was accommodated by one or several décollement layers at depth. Despite a different rheological context, the subsurface structure of the nascent oceanic 20°N Basin is very similar to the more mature continental Dead Sea Basin along the Levant Fault, which also displays subbasins separated by transverse faults.

  9. Genu recurvatum caused by partial growth arrest of the proximal tibial physis: simultaneous correction and lengthening with physeal distraction. A report of two cases.

    PubMed

    Olerud, C; Danckwardt-Lillieström, G; Olerud, S

    1986-01-01

    Two cases of genu recurvatum deformity and leg length discrepancy after partial growth arrest of the proximal tibial physis are described. The patients are both boys thirteen and fifteen years old respectively. The etiology of the deformity is considered to be local pressure on the tibial tuberosity, in the first case after treatment with plaster cast after correction of an angular deformity in a tibial fracture and in the second case after prolonged treatment with patellar tendon bearing brace. The boys were treated with physeal distraction which corrected both the leg length discrepancy and the angular deformity. The technique is recommended because the correction is done at the site of the deformity and knee motion is possible during the entire treatment period.

  10. Automated fit quantification of tibial nail designs during the insertion using computer three-dimensional modelling.

    PubMed

    Amarathunga, Jayani P; Schuetz, Michael A; Yarlagadda, Prasad Kvd; Schmutz, Beat

    2014-12-01

    Intramedullary nailing is the standard fixation method for displaced diaphyseal fractures of the tibia. An optimal nail design should both facilitate insertion and anatomically fit the bone geometry at its final position in order to reduce the risk of stress fractures and malalignments. Due to the nonexistence of suitable commercial software, we developed a software tool for the automated fit assessment of nail designs. Furthermore, we demonstrated that an optimised nail, which fits better at the final position, is also easier to insert. Three-dimensional models of two nail designs and 20 tibiae were used. The fitting was quantified in terms of surface area, maximum distance, sum of surface areas and sum of maximum distances by which the nail was protruding into the cortex. The software was programmed to insert the nail into the bone model and to quantify the fit at defined increment levels. On average, the misfit during the insertion in terms of the four fitting parameters was smaller for the Expert Tibial Nail Proximal bend (476.3 mm(2), 1.5 mm, 2029.8 mm(2), 6.5 mm) than the Expert Tibial Nail (736.7 mm(2), 2.2 mm, 2491.4 mm(2), 8.0 mm). The differences were statistically significant (p ≤ 0.05). The software could be used by nail implant manufacturers for the purpose of implant design validation.

  11. External Fixation combined with Limited Internal Fixation versus Open Reduction Internal Fixation for Treating Ruedi-Allgower Type III Pilon Fractures

    PubMed Central

    Guo, Yongzhi; Tong, Liangyong; Li, Shaoguang; Liu, Zhi

    2015-01-01

    Background The optimal treatment of type III pilon fractures remains controversial. Hence, we performed this study to investigate whether open reduction and internal fixation (ORIF) is superior to external fixations combined with limited internal fixations (EFLIF). Material/Methods From January 2012 to October 2013, a total of 78 patients were included. Twenty-six patients underwent EFLIF and 52 patients underwent ORIF. All subjects were followed up at 1, 3, 6, and 12 months postoperatively. All outcomes and complications were recorded. Results No statistical differences were observed in Mazur score or ROM between the 2 groups. There were significant differences between the 2 groups in hospital stay (P<0.001), reduction results (P=0.019), screw loosening (P=0.025), and traumatic arthritis (P=0.037). Conclusions Similar functional outcomes were achieved in EFLIF and ORIF groups. Due to several limitations of this study, a well-designed randomized controlled trial involving more patients and long-term follow-up is needed to find an optimal treatment protocol. PMID:26050786

  12. Rock fracture processes in chemically reactive environments

    NASA Astrophysics Data System (ADS)

    Eichhubl, P.

    2015-12-01

    Rock fracture is traditionally viewed as a brittle process involving damage nucleation and growth in a zone ahead of a larger fracture, resulting in fracture propagation once a threshold loading stress is exceeded. It is now increasingly recognized that coupled chemical-mechanical processes influence fracture growth in wide range of subsurface conditions that include igneous, metamorphic, and geothermal systems, and diagenetically reactive sedimentary systems with possible applications to hydrocarbon extraction and CO2 sequestration. Fracture processes aided or driven by chemical change can affect the onset of fracture, fracture shape and branching characteristics, and fracture network geometry, thus influencing mechanical strength and flow properties of rock systems. We are investigating two fundamental modes of chemical-mechanical interactions associated with fracture growth: 1. Fracture propagation may be aided by chemical dissolution or hydration reactions at the fracture tip allowing fracture propagation under subcritical stress loading conditions. We are evaluating effects of environmental conditions on critical (fracture toughness KIc) and subcritical (subcritical index) fracture properties using double torsion fracture mechanics tests on shale and sandstone. Depending on rock composition, the presence of reactive aqueous fluids can increase or decrease KIc and/or subcritical index. 2. Fracture may be concurrent with distributed dissolution-precipitation reactions in the hostrock beyond the immediate vicinity of the fracture tip. Reconstructing the fracture opening history recorded in crack-seal fracture cement of deeply buried sandstone we find that fracture length growth and fracture opening can be decoupled, with a phase of initial length growth followed by a phase of dominant fracture opening. This suggests that mechanical crack-tip failure processes, possibly aided by chemical crack-tip weakening, and distributed

  13. [Pycnodysostosis: a rare disease with frequent fractures].

    PubMed

    Sánchez Lázaro, J A; Linares Álvarez, L

    2014-04-01

    Pycnodysostosis is a rare disease caused by a dysfunction of the osteoclasts due to a mutation in the cathepsin K gene. We present a case of a young adult patient with the above mentioned syndrome, who suffered an atypical fracture of the tibia after a low energy fall. Some bone changes that could have predisposed the fracture were observed when examined in the Emergency Department. Not long afterwards he suffered the same type of fracture in another tibia. Due to the conditions typical of the pycnodysostosis, the above mentioned fracture required an unconventional approach for this mid-shaft tibial fracture (osteosynthesis plate), combined with a longer consolidation time. The case was finally resolved satisfactorily.

  14. Bone Geometry as a Predictor of Tissue Fragility and Stress Fracture Risk

    DTIC Science & Technology

    2005-10-01

    S, Casagrande D, Jepsen KJ. The relationship between continued periosteal apposition and bone fragility. Poster presentation at the American Society...al. Stress fractures and tibial bone width. A risk factor. J Bone Jt Surg Br, 69:326- 329, 1987. Jepsen, KJ, Pennington, DE, Lee, Y-L, Warman, M...medial- lateral (ML) widths were determined for tibial diaphyses from 17 male donors 17–46 years of age. A slen- derness index was defined as the

  15. Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures

    PubMed Central

    Burke, Neil G; Cosgrave, Ciaran H; O'Neill, Barry James; Kelly, Eamonn P

    2014-01-01

    Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well. PMID:24686808

  16. Medial tibial stress syndrome: a critical review.

    PubMed

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

    2009-01-01

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

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

    PubMed

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

    1976-04-01

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

  18. Tibial Bowing and Pseudarthrosis in Neurofibromatosis Type 1

    DTIC Science & Technology

    2015-01-01

    Oxendine I, Sant DW, Song MH, Stevenson DA, Viskochil DH, Wise CA, Kim HKW, Rios JJ. Neurofibromin Deficiency -Associated Transcriptional Dysregulation...HKW, Rios JJ. Neurofibromin Deficiency -Associated Transcriptional Dysregulation Suggests a Novel Therapy for Tibial Pseudoarthrosis in NF1. J Bone...Manuscript (Paria et al. Neurofibromin Deficiency -Associated Transcriptional Dysregulation Suggests a Novel Therapy for Tibial Pseudoarthrosis in NF1

  19. Fat emboli syndrome in isolated fractures of the tibia and femur.

    PubMed

    Ganong, R B

    1993-06-01

    The fat emboli syndrome (FES) was studied in otherwise healthy young skiers with isolated fractures of the tibia and femur treated from 1980 until 1991. During the first year, 13 of 56 tibial and femoral fractures developed FES. The overall incidence of FES was 23%: 19% among fractured tibiae and 75% among fractured femora. Thirty-three percent of displaced transverse tibial fractures developed FES. During the next ten year, only those tibial or femoral fractures that developed FES were studied. There were 44 such cases. Symptoms included a mean PO2 of 45 mm Hg and a fever of 39 degrees. In addition, 40% of the patients had petechiae. The mean patient age was 26 years. None of the patients had other significant injuries or illnesses, 75% received oxygen, and 9% received steroids. None of the patients received mechanical ventilation. All cases had developed by the third day of hospitalization, and the duration of the syndrome was less than four days in 86% of the patients. The mortality rate was 0%. In 50% of the patients, hospitalization was prolonged because of FES; otherwise, there were no complications. This study of isolated femoral and tibial fractures in healthy young skiers demonstrates that FES occurs more commonly than previously thought, is not associated with mortality, and causes little morbidity. Treatment should consist of supportive care only, with specific care directed toward the underlying injury.

  20. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments.

    PubMed

    Franklyn, Melanie; Oakes, Barry

    2015-09-18

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis

  1. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments

    PubMed Central

    Franklyn, Melanie; Oakes, Barry

    2015-01-01

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient’s history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis

  2. Tibial lengthening over humeral and tibial intramedullary nails in patients with sequelae of poliomyelitis: a comparative study.

    PubMed

    Chen, Daoyun; Chen, Jianmin; Jiang, Yao; Liu, Fanggang

    2011-06-01

    Leg discrepancy is common after poliomyelitis. Tibial lengthening is an effective way to solve this problem. It is believed lengthening over a tibial intramedullary nail can provide a more comfortable lengthening process than by the conventional technique. However, patients with sequelae of poliomyelitis typically have narrow intramedullary canals allowing limited space for inserting a tibial intramedullary nail and Kirschner wires. To overcome this problem, we tried using humeral nails instead of tibial nails in the lengthening procedure. In this study, we used humeral nails in 20 tibial lengthening procedures and compared the results with another group of patients who were treated with tibial lengthening over tibial intramedullary nails. The mean consolidation index, percentage of increase and external fixation index did not show significant differences between the two groups. However, less blood loss and shorter operating time were noted in the humeral nail group. More patients encountered difficulty with the inserted intramedullary nail in the tibial nail group procedure. The complications did not show a statistically significant difference between the two techniques on follow-up. In conclusion, we found the humeral nail lengthening technique was more suitable in leg discrepancy patients with sequelae of poliomyelitis.

  3. Analysis of zygomatic fractures.

    PubMed

    Hwang, Kun; Kim, Dong Hyun

    2011-07-01

    The purpose of this study was to evaluate the natural history of zygomatic fractures in 469 cases over 14 years. The medical records of patients seeking treatment for zygomatic fractures were reviewed. The zygomatic fractures were classified as monopod, dipod, or tripod fractures for most patients. The monopod fractures included (1) zygomaticofrontal, (2) zygomaticomaxillary, and (3) zygomatic arch fractures. The dipod fractures were subclassified into 3 types according to combination of the previously mentioned 3 sites, which were 1 and 2, 1 and 3, and 2 and 3. Tripod fracture included all 1, 2, and 3. Among 469 cases of zygomatic fractures, tripod fractures (n = 238, 50.7%), zygomaticomaxillary fracture (n = 121, 25.8%), and isolated fracture of the zygomatic arch (n = 98 20.9%) formed most of the cases (n = 457, 97.4%). About one-half cases were tripod fractures (n = 238, 50.7%), and another half cases were monopod fractures (n = 220, 46.9%). Only 11 cases (2.4%) were dipod fractures. Most of the monopod fractures were zygomaticomaxillary (n = 121, 25.8%) and zygomatic arch fractures (n = 98, 20.9%). Among the dipod fractures, no cases of zygomaticofrontal and zygomatic arch fractures were reported. An open reduction was performed in 73.8% (346 cases), closed reduction in 24.5% (115 cases), and conservative treatment in only 1.7%. In tripod fracture (n = 238), an open reduction and internal fixation was performed for most of the cases (n = 225, 94.5%), and closed reduction was performed in only 11 cases (4.6%). In monopod zygomaticomaxillary fracture (n = 121), internal fixation was performed for most of the cases (n = 108, 89.3%), and closed reduction was performed in only 9 cases (7.7%). However, in monopod fracture of the zygomatic arch (n = 98), most of the cases (n = 95, 96.9%) were treated with closed reduction; open reduction was performed in only 1 case (1.0%). At zygomaticofrontal area (n = 241), internal fixation was performed in most of the cases (n

  4. Tibia-based referencing for standard proximal tibial radiographs during intramedullary nailing.

    PubMed

    Bible, Jesse E; Choxi, Ankeet A; Dhulipala, Sravan C; Evans, Jason M; Mir, Hassan R

    2013-11-01

    Limited information exists to define standard tibial radiographs. The purpose of this study was to define new landmarks on the proximal tibia for standard anteroposterior and lateral radiographs. In 10 cadaveric knees, fibular head bisection was considered the anteroposterior image, and femoral condyle overlap the lateral image. In another 10 knees, a "twin peaks" anteroposterior view, showing the sharpest profile of the tibial spines, was used. The "flat plateau" lateral image was obtained by aligning the femoral condyles then applying a varus adjustment with overlap of the tibial plateaus. Medial peritendinous approaches were performed, and an entry reamer used to open the medullary canal. A priori analysis showed good to excellent intra-/inter-observer reliability with the new technique (intra-class correlation coefficient ICC 0.61-0.90). The "twin peaks" anteroposterior radiograph was externally rotated 2.7±2.1° compared to the standard radiograph with fibular head bisection. Portal position and incidence of damage to intra-articular structures did not significantly differ between groups (P>.05). The "twin peaks" anteroposterior view and "flat plateau" lateral view can safely be used for nail entry portal creation in the anatomic safe zone. Tibia-based radiographic referencing is useful for intramedullary nailing cases in which knee or proximal tibiofibular joint anatomy is altered.

  5. Recent Advances and Developments in Knee Surgery: Principles of Periprosthetic Knee Fracture Management

    PubMed Central

    Chimutengwende-Gordon, Mukai; Khan, Wasim; Johnstone, David

    2012-01-01

    The management of distal femoral, tibial and patellar fractures after total knee arthroplasty can be complex. The incidence of these fractures is increasing as the number of total knee arthroplasties being performed and patient longevity is increasing. There is a wide range of treatment options including revision arthroplasty for loose implants. This review article discusses the epidemiology, risk factors, classification and treatment of these fractures. PMID:22888380

  6. Tibial Lengthening Using a Fixator-Assisted Lengthening Plate: A New Technique

    PubMed Central

    Tosun, Haci Bayram; Agir, Ismail; Gumustas, Seyitali; Serbest, Sancar; Uludag, Abuzer; Celik, Suat

    2016-01-01

    Background There are many techniques that are used for limb lengthening. Lengthening a limb over a plate is an alternative choice used in children or when using an intramedullary nail is difficult. Objectives In this study, we presented a new technique for tibial lengthening using a monolateral external fixator over a lengthening plate. Materials and Methods For tibial lengthening, a monolateral external fixator was attached to the composite bone model medially. After a corticotomy was performed, the lengthening plate was placed laterally. Three locking screws were inserted proximally, and two cortical screws were inserted into a lengthening hole that was 1 cm below the osteotomy site. We avoided contact between the screws of the lengthening plate and the pins of the external fixator. During bone lengthening with the monolateral external fixator, the screws at the lengthening hole were able to slide distally with the distal segment of the tibia to allow for tibial elongation. Two locking screws were fixed at the distal locking holes of the plate when the bone elongation was complete. The external fixator was then removed. Results The fixator-assisted lengthening plate allowed bone lengthening without malalignment. There were no mechanical problems associated with the external fixator during the lengthening process. Plate osteosynthesis was stable after the fixator was removed. There was no contact between the screws of plate and the Schanz pins of the external fixator under C-arm fluoroscopy. Conclusions The fixator-assisted lengthening plate technique helps to maintain the stability and alignment at both sides of an osteotomy during tibial elongation. It allows the early removal of the external fixator immediately after lengthening is completed. This technique can be applied in children with open physes and in patients with a narrow medullary canal who are unsuitable for limb lengthening over an intramedullary nail. PMID:28184364

  7. Chopart fractures.

    PubMed

    Klaue, Kaj

    2004-09-01

    The Chopart articular space was described by François Chopart (1743-1795) as a practical space for amputations in cases of distal foot necrosis. It corresponds to the limit between the anatomical hind-foot and the mid-foot. The bones involved are the talus and the calcaneus proximally, and the navicular and the cuboid distally. This space thus holds two functionally distinct entities, the anterior part of the coxa pedis (an essential functional joint) and the calcaneo-cuboidal joint,which can be considered to be an "adaptive joint" within a normal foot. Trauma to this region may cause fractures and/or dislocations and, in high energy trauma,compartment syndromes. Principles of treatment are immediate reduction of dislocations and realignment of the medial and lateral column of the foot in length and orientation. Open reduction and internal fixation of talus and navicular fractures are often indicated to restore the "coxa pedis". Open reconstruction or fusion in correct length of the calcaneo-cuboidal joint is occasionally indicated. Salvage procedures in malunions include navicular osteotomies and calcaneo-cuboidal bone block fusions. Treatment of joint destructions, especially involving the talo-navicular joint, include triple arthrodesis.

  8. Full versus surface tibial baseplate cementation in total knee arthroplasty.

    PubMed

    Galasso, Olimpio; Jenny, Jean-Yves; Saragaglia, Dominique; Miehlke, Rolf K

    2013-02-01

    The use of a keel in the tibial component during modern primary total knee arthroplasty (TKA) has become common, and its cementation may affect the future performance of the prosthesis. Although proponents of cementing the entire tibial component argue that this technique provides better initial fixation and may prevent aseptic loosening, reasons exist to apply cement only to the tibial baseplate. In this study, 232 patients who underwent TKA using full or surface cementation of the tibial baseplate were evaluated at an average 5.6-year follow-up to assess survivorship and clinical results. The cumulative survival rate at 8 years was 97.1%. With revision of either component for any reason considered the endpoint, no significant difference was noted between full and surface cemented groups. Knee Society Score, range of motion, and femoro-tibial mechanical angle significantly increased postoperatively. Multivariate analysis revealed that good preoperative range of motion and Knee Society Scores were related to good postoperative range of motion and Knee Society Scores. Follow-up length was a negative predictor of postoperative Knee Society Score. The use of full or surface cementation of the baseplate was unrelated to the postoperative clinical outcomes. Clinical outcomes did not differ according to the tibial component cementation technique. The results of this study suggest that cementing the keel of the tibial component during primary TKA has no advantage for patients. Longer-term follow-up and proper patient randomization are required to confirm these findings.

  9. Trabecular metal tibial knee component still stable at 10 years.

    PubMed

    Henricson, Anders; Nilsson, Kjell G

    2016-10-01

    Background and purpose - Total knee replacement (TKR) in younger patients using cemented components has shown inferior results, mainly due to aseptic loosening. Excellent clinical results have been reported with components made of trabecular metal (TM). In a previous report, we have shown stabilization of the TM tibial implants for up to 5 years. In this study, we compared the clinical and RSA results of these uncemented implants with those of cemented implants. Patients and methods - 41 patients (47 knees) aged ≤ 60 years underwent TKR. 22 patients (26 knees) received an uncemented monoblock cruciate-retaining (CR) tibial component (TM) and 19 patients (21 knees) received a cemented NexGen Option CR tibial component. Follow-up examination was done at 10 years, and 16 patients (19 knees) with TM tibial components and 17 patients (18 knees) with cemented tibial components remained for analysis. Results - 1 of 19 TM implants was revised for infection, 2 of 18 cemented components were revised for knee instability, and no revisions were done for loosening. Both types of tibial components migrated in the first 3 months, the TM group to a greater extent than the cemented group. After 3 months, both groups were stable during the next 10 years. Interpretation - The patterns of migration for uncemented TM implants and cemented tibial implants over the first 10 years indicate that they have a good long-term prognosis regarding fixation.

  10. Trabecular metal tibial knee component still stable at 10 years

    PubMed Central

    Henricson, Anders; Nilsson, Kjell G

    2016-01-01

    Background and purpose Total knee replacement (TKR) in younger patients using cemented components has shown inferior results, mainly due to aseptic loosening. Excellent clinical results have been reported with components made of trabecular metal (TM). In a previous report, we have shown stabilization of the TM tibial implants for up to 5 years. In this study, we compared the clinical and RSA results of these uncemented implants with those of cemented implants. Patients and methods 41 patients (47 knees) aged ≤ 60 years underwent TKR. 22 patients (26 knees) received an uncemented monoblock cruciate-retaining (CR) tibial component (TM) and 19 patients (21 knees) received a cemented NexGen Option CR tibial component. Follow-up examination was done at 10 years, and 16 patients (19 knees) with TM tibial components and 17 patients (18 knees) with cemented tibial components remained for analysis. Results 1 of 19 TM implants was revised for infection, 2 of 18 cemented components were revised for knee instability, and no revisions were done for loosening. Both types of tibial components migrated in the first 3 months, the TM group to a greater extent than the cemented group. After 3 months, both groups were stable during the next 10 years. Interpretation The patterns of migration for uncemented TM implants and cemented tibial implants over the first 10 years indicate that they have a good long-term prognosis regarding fixation PMID:27357222

  11. Stress fractures: pathophysiology, clinical presentation, imaging features, and treatment options.

    PubMed

    Matcuk, George R; Mahanty, Scott R; Skalski, Matthew R; Patel, Dakshesh B; White, Eric A; Gottsegen, Christopher J

    2016-08-01

    Stress fracture, in its most inclusive description, includes both fatigue and insufficiency fracture. Fatigue fractures, sometimes equated with the term "stress fractures," are most common in runners and other athletes and typically occur in the lower extremities. These fractures are the result of abnormal, cyclical loading on normal bone leading to local cortical resorption and fracture. Insufficiency fractures are common in elderly populations, secondary to osteoporosis, and are typically located in and around the pelvis. They are a result of normal or traumatic loading on abnormal bone. Subchondral insufficiency fractures of the hip or knee may cause acute pain that may present in the emergency setting. Medial tibial stress syndrome is a type of stress injury of the tibia related to activity and is a clinical syndrome encompassing a range of injuries from stress edema to frank-displaced fracture. Atypical subtrochanteric femoral fracture associated with long-term bisphosphonate therapy is also a recently discovered entity that needs early recognition to prevent progression to a complete fracture. Imaging recommendations for evaluation of stress fractures include initial plain radiographs followed, if necessary, by magnetic resonance imaging (MRI), which is preferred over computed tomography (CT) and bone scintigraphy. Radiographs are the first-line modality and may reveal linear sclerosis and periosteal reaction prior to the development of a frank fracture. MRI is highly sensitive with findings ranging from periosteal edema to bone marrow and intracortical signal abnormality. Additionally, a brief description of relevant clinical management of stress fractures is included.

  12. [Tibial abscess caused by histoplasma capsulatum].

    PubMed

    de Fernández, M I; Negroni, R; Arechavala, A

    2001-01-01

    Disseminated histoplasmosis is the most serious form of the disease produced by the fungus Histoplasma capsulatum. Histoplasmosis was first described by Darling in 1906, and it is endemic in certain areas of Central and Southeastern regions of USA, and most Latin America countries, including the Pampa húmeda and Mesopotamia regions in Argentina, but in other continents it has a limited regional distribution. Lung involvement predominates in 90% of cases, but H. capsulatum may involve bone and soft tissues. Bone lesions without other signs of infection are very rare, and are often misdiagnosed as cancer. We report a case of disseminated histoplasmosis in a man with a myelodysplasia who presented a left tibial abscess, without any clinical evidence of pulmonary involvement. The patient was successfully treated with itraconazole.

  13. Posterior tibial nerve lesions in ankle arthroscopy.

    PubMed

    Cugat, Ramon; Ares, Oscar; Cuscó, Xavier; Garcia, Montserrat; Samitier, Gonzalo; Seijas, Roberto

    2008-05-01

    Ankle arthroscopy provides a minimally invasive approach to the diagnosis and treatment of certain ankle disorders. Neurological complications resulting from ankle arthroscopy have been well documented in orthopaedic and podiatric literature. Owing to the superficial location of the ankle joint and the abundance of overlying periarticular neurovascular structures, complications reported in ankle arthroscopy are greater than those reported for other joints. In particular, all reported neurovascular injuries following ankle arthroscopy have been the direct result of distractor pin or portal placement. The standard posteromedial portal has recognized risks because of the proximity of the posterior neurovascular structures. There can be considerable variability in the course of these portals and their proximity to the neurovascular structures. We found one report of intra-articular damage to the posterior tibial nerve as a result of ankle arthroscopy in the English-language literature and we report this paper as a second case described in the literature.

  14. Shoulder Fractures

    MedlinePlus

    ... Journal of Hand Surgery (JHS) Home Anatomy Shoulder Fractures Email to a friend * required fields From * To * ... create difficulty with its function. Types of Shoulder Fractures The type of fracture varies by age. Most ...

  15. Stress Fractures

    MedlinePlus

    Stress fractures Overview By Mayo Clinic Staff Stress fractures are tiny cracks in a bone. They're caused by ... up and down or running long distances. Stress fractures can also arise from normal use of a ...

  16. Greenstick Fractures

    MedlinePlus

    Greenstick fractures Overview By Mayo Clinic Staff A greenstick fracture occurs when a bone bends and cracks, instead of breaking completely into separate pieces. The fracture looks similar to what happens when you try ...

  17. Interlocking Intramedullary Nails in Fracture Treatment.

    PubMed

    Ouyang, Xiao; Wang, Jing Rong; Hong, Shi Dong; Xin, Feng; Wang, Lin; Yang, Xiao Wei; Wang, Jian

    2015-09-01

    The aim of this study is to evaluate interlocking intramedullary nails in the treatment of fractures. We retrospectively reviewed 68 adult patients (for a total of 95 fractures) with isolated long-bone fractures who were treated with interlocking intramedullary nails between January 2010 and January 2012. The patients were followed for 18 months to observe the healing of the fracture, time, and the occurrence of complications in the shoulder, knee, and hip joint functions. After about a follow-up period of 26.2 months (range 18-39 months), all cases obtained bony union. The mean time to fracture union was 5.2 months. Cases of knees and hip joint functions of the femoral or tibial fracture and shoulder functions of the humeral fractures were observed. The interlocking intramedullary nails may be considered as an alternative method for isolated diaphyseal fractures of the extremities. The advantages of this method include small operative scars, reliable fixations, better fracture healings, and fewer complications.

  18. Minimally invasive (sinus tarsi) approach for open reduction and internal fixation of intra-articular calcaneus fractures in children: surgical technique and case report of two patients.

    PubMed

    Abdelgawad, Amr A; Kanlic, Enes

    2015-01-01

    Calcaneus fractures in children differ from those in adults. Most calcaneus fractures in children can be managed nonoperatively, with good long-term results expected. The width and height of the calcaneus can remodel with time in children. Recently, there has been a trend toward operative treatment of displaced intra-articular fractures of the calcaneus in children to correct the articular deformity. Studies of calcaneal fracture fixation in children used an extended lateral approach, with its possible complications. In the present report, we describe the operative treatment of 2 children (12 and 13 years old), who had a displaced intra-articular fracture of the calcaneus, using a minimally invasive sinus tarsi approach. Adequate reduction was obtained in both cases with no soft tissue complications or implant discomfort. Fixation was obtained using 3.5-mm cortical screws. Anatomic joint alignment was restored. The children were followed up until they had both resumed their full activities with no complications. We recommend this approach for operative treatment of displaced intra-articular fractures of the calcaneus, because it addresses the intra-articular displacement, which is the most important element of the deformity in children.

  19. Effects of recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) in grade III open tibia fractures treated with unreamed nails-A clinical and health-economic analysis.

    PubMed

    Alt, Volker; Borgman, Benny; Eicher, Alexander; Heiss, Christian; Kanakaris, Nikolaos K; Giannoudis, Peter V; Song, Fujian

    2015-11-01

    Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) is licensed in Europe for open tibia fractures treated with unreamed nails. However, there is limited data available on the specific use of rhBMP-2 in combination with unreamed nails for open tibia fractures. The intention of the current study was to evaluate the medical and health-economic effects of rhBMP-2 in Gustilo-Anderson grade III open tibia fractures treated with unreamed nails based on individual patient data from two previously published studies. Linear regression analysis was performed on raw data of 90 patients that were either treated by standard of care with soft tissue management and unreamed nailing (SOC group) (n=50) or with rhBMP-2 in addition to soft tissue management and unreamed nailing (rhBMP-2 group) (n=40). For all types of revision, a significant lower percentage of patients (27.5%) of the rhBMP-2 group had to be revised compared to 48% of the patients of the SOC group (p=0.04). When only invasive secondary interventions such as bone grafting and nail exchange were considered, there was also a statistically significant reduction in the rhBMP-2 group with a revision rate of 10.0% (4 of 40 patients) compared to the SOC group with a revision rate of 28.0% (14 of 50 patients) (p=0.01). Mean fracture healing time of 228 days in the rhBMP-2 compared to 266 days in the SOC group was not statistically significant (p=0.24). Health-economic analysis based on a societal perspective with calculation of overall treatment costs after initial surgery and including productivity losses revealed savings of €6,239 per patient for Germany and €4,752 for the UK in favour of rhBMP-2 which was mainly driven by reduction of productivity losses. In conclusion, rhBMP-2 reduces secondary interventions in patients with grade III open tibia fractures treated with an unreamed nail and its use leads to financial savings for Germany and the UK from a societal perspective.

  20. A Surgical Opinion in a 36-Week Pregnant with Tibia Fracture: Intramedullary Nailing

    PubMed Central

    Sarikaya, Baran

    2016-01-01

    The operative treatment of tibial fractures in late pregnancy is a controversial issue that is rarely discussed in the literature. Here we present a case of a tibial diaphyseal fracture in a woman that was 36 weeks pregnant, which was treated with intramedullary nails under noninvasive foetal monitoring with cardiotocography. The patient underwent a successful surgery, and no harm or adverse events to either the mother or the foetus were reported during or after the procedure. Following surgery, the mother had a comfortable pregnancy and a normal spontaneous vaginal delivery with a healthy newborn. PMID:28070433

  1. Phalangeal fractures: displaced/nondisplaced.

    PubMed

    Gaston, R Glenn; Chadderdon, Christopher

    2012-08-01

    Nonsurgical management is the preferred treatment of stable, extra-articular fractures of the proximal and middle phalanx, most distal phalanx fractures, and, rarely, nondisplaced intraarticular fractures in elite athletes. Techniques that afford maximal strength with minimal dissection, thus allowing earlier return to play, are ideal. Open reduction with internal fixation with plate fixation is most often chosen for unstable phalangeal shaft fractures in high-demand athletes to provide rigid internal fixation and allow immediate range of motion and more rapid return to sport. It is our practice to routinely treat unicondylar fractures with surgery with percutaneous headless compression screws in elite athletes.

  2. Tibial tubercle osteotomy for patello-femoral joint disorders.

    PubMed

    Hall, Matthew J; Mandalia, Vipul I

    2016-03-01

    Tibial tubercle osteotomy has a long history in the management of patella instability and patello-femoral arthritis. This review aims to provide a comprehensive review of the literature describing the biomechanics of the patello-femoral joint and the rationale behind the use of the tibial tubercle osteotomy in modern day practice. Several different tibial tubercle osteotomies are available and we aim to detail the concepts behind their use and the subsequent clinical results. With continued developments of chondrocyte implantation techniques, the potential to fill defects on the chondral surface of either the patella or trochlea in conjunction with a tibial tubercle osteotomy may well become more commonplace in a group that is commonly young and difficult to manage. Level of evidence III.

  3. Multi-Elemental Profiling of Tibial and Maxillary Trabecular Bone in Ovariectomised Rats

    PubMed Central

    Han, Pingping; Lu, Shifeier; Zhou, Yinghong; Moromizato, Karine; Du, Zhibin; Friis, Thor; Xiao, Yin

    2016-01-01

    Atomic minerals are the smallest components of bone and the content of Ca, being the most abundant mineral in bone, correlates strongly with the risk of osteoporosis. Postmenopausal women have a far greater risk of suffering from OP due to low Ca concentrations in their bones and this is associated with low bone mass and higher bone fracture rates. However, bone strength is determined not only by Ca level, but also a number of metallic and non-metallic elements in bone. Thus, in this study, the difference of metallic and non-metallic elements in ovariectomy-induced osteoporosis tibial and maxillary trabecular bone was investigated in comparison with sham operated normal bone by laser ablation inductively-coupled plasma mass spectrometry using a rat model. The results demonstrated that the average concentrations of 25Mg, 28Si, 39K, 47Ti, 56Fe, 59Co, 77Se, 88Sr, 137Ba, and 208Pb were generally higher in tibia than those in maxilla. Compared with the sham group, Ovariectomy induced more significant changes of these elements in tibia than maxilla, indicating tibial trabecular bones are more sensitive to changes of circulating estrogen. In addition, the concentrations of 28Si, 77Se, 208Pb, and Ca/P ratios were higher in tibia and maxilla in ovariectomised rats than those in normal bone at all time-points. The present study indicates that ovariectomy could significantly impact the element distribution and concentrations between tibia and maxilla. PMID:27338361

  4. Nail position has an influence on anterior knee pain after tibial intramedullary nailing.

    PubMed

    Darabos, Nikica; Bajs, Ivana Dovzak; Rutić, Zeljko; Darabos, Anela; Poljak, Damir; Dobsa, Jasminka

    2011-09-01

    Our aim was to determine the possible relationship between anterior knee pain (AKP) and nail position marked as a distance from tip of nail to tibial plateau (NP) and to the tuberositas tibiae (NT). Nail position has an influence on anterior knee pain after tibial intramedullary nailing. We evaluated postoperative outcome results of 50 patients in the last 3 years with healed fractures initially treated with intramedullary (IM) reamed nails with 2 or 3 interlocking screws on both parts of the nail and with the use of medial paratendinous incision for nail entry portal. Patients marked a point on the visual analog scale (VAS) that corresponded to the level of postoperative AKP felt. Two groups of patients were formed on the basis of AKP (pain level was neglected): groups A and B, with and without pain, respectively. The difference between the two groups concerning NP measurements was statistically significant (p < 0.05), but not concerning NT measurements at the p < 0.05 level. Patients were classified by pain with high accuracy (98%) according to a classification tree. Symptoms of AKP did not appear if the tip of the nail position was more than 6.0 mm from the NP and more than 2.6 mm from the NT. However, for better evaluation of these results it will be necessary to examine a larger number of postoperative patients with AKP.

  5. Endoscopic Resection of Avulsed Fragment of Tibial Tuberosity and Endoscopic-Assisted Repair of Patellar Tendon.

    PubMed

    Lui, Tun Hing

    2015-12-01

    An avulsion fracture of part of the tibial tuberosity can occur as a result of a tophaceous tuberosity or Osgood-Schlatter disease. We describe an endoscopic technique of debridement, bone fragment resection, and tendon repair. This technique has the potential advantage of fewer wound complications. It is performed through proximal and distal portals on the sides of the patellar tendon. The working space is deep to the tendon. After debridement of the tendon and resection of the bone fragment, the tendon gap is assessed. Endoscopic-assisted side-by-side repair is performed to close the gap if the gap is less than 30% of the width of the tendon. If the gap is more than 30% of the width of the tendon, the proximal stump of the avulsed tendon can be retrieved through the proximal portal. Krackow suture with stay stitches is applied to the proximal stump. The stump is put back and sutured to the tibial insertion through a bone tunnel or suture anchor. This is augmented by side-by-side suturing of the avulsed tendon with the adjacent normal tendon.

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

    PubMed

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

    1982-01-01

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

  7. Tibial stress reaction presenting as bilateral shin pain in a man taking denosumab for giant cell tumor of the bone.

    PubMed

    Lim, Sian Yik; Rastalsky, Naina; Choy, Edwin; Bolster, Marcy B

    2015-12-01

    Prolonged bisphosphonate use has been associated with increased risk of atypical femoral fractures. Very few cases of atypical femoral fractures have been reported with denosumab. We report a case of bilateral tibial stress reactions in a 60-year-old man with no history of osteoporosis who was on prolonged high-dose denosumab for the treatment of giant cell tumor of bone. He presented with a 3-month history of pain in his bilateral shins worsening with activity and improving with rest. Although initial radiographs were unremarkable, he was found to have changes consistent with a stress reaction on magnetic resonance imaging of the distal tibia. To our knowledge, bilateral tibial stress reactions have not been previously reported with anti-resorptive therapies (neither bisphosphonates nor denosumab). Our case is intriguing in terms of the development of stress reactions as a precursor to stress fractures which may also relate to atypical fractures. Our case suggests a possible association between denosumab use and stress reactions. Of note the indication for denosumab in our case was for the treatment of giant cell tumor of bone where the Food and Drug Administration (FDA) approved dose is substantially higher than the FDA approved dose for osteoporosis treatment. Although rare, clinicians should consider the possibility of stress fractures in patients on anti-resorptive medications such as denosumab, especially when a patient presents with new onset thigh pain, hip pain or pain over an area affecting the long bones. Evaluation by imaging of affected areas should be pursued to enable early detection and intervention, as well as prevention of morbidity and associated ongoing risk to the patient.

  8. Accumulation of irrigation fluid in the calf as a complication during high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament reconstruction.

    PubMed

    Marti, C B; Jakob, R P

    1999-01-01

    Extravasation of irrigation fluid during arthroscopy is a well-known complication. We report a case of accumulation of fluid into the calf during open wedge high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament (ACL) reconstruction. The main cause for fluid extravasation was the drilling of the tibial tunnel, which allowed the fluid to cross the osteotomy gap and invade the flexor compartments. Although an elevation of the intracompartmental pressure was measured, there was no clinical evidence of compartment syndrome. A subcutaneous release of the flexor compartment of the leg was performed. The patient suffered no further sequelae. High tibial osteotomy combined with simultaneous arthroscopic ACL reconstruction has to be performed carefully, and potential complications must be detected immediately to prevent compartment syndrome.

  9. Effects of fracture reactivation and diagenesis on fracture network evolution: Cambrian Eriboll Formation, NW Scotland

    NASA Astrophysics Data System (ADS)

    Hooker, J. N.; Eichhubl, P.; Xu, G.; Ahn, H.; Fall, A.; Hargrove, P.; Laubach, S.; Ukar, E.

    2011-12-01

    The Cambrian Eriboll Formation quartzarenites contain abundant fractures with varying degrees of quartz cement infill. Fractures exist that are entirely sealed; are locally sealed by bridging cements but preserve pore space among bridges; are mostly open but lined with veneers of cement; or are devoid of cement. Fracture propagation in the Eriboll Formation is highly sensitive to the presence of pre-existing fractures. Fracture reactivation occurs in opening mode as individual fractures repeatedly open and are filled or bridged by syn-kinematic cements. As well, reactivation occurs in shear as opening of one fracture orientation coincides with shear displacement along pre-existing fractures of different orientations. The tendency for pre-existing fractures to slip varies in part by the extent of cement infill, yet we observe shear and opening-mode reactivation even among sealed fractures. Paleotemperature analysis of fluid inclusions within fracture cements suggests some fractures now in outcrop formed deep in the subsurface. Fractures within the Eriboll Formation may therefore affect later fracture propagation throughout geologic time. With progressive strain, fault zones develop within fracture networks by a sequence of opening-mode fracture formation, fracture reactivation and linkage, fragmentation, cataclasis, and the formation of slip surfaces. Cataclasite within fault zones is commonly more thoroughly cemented than fractures in the damage zone or outside the fault zone. This variance of cement abundance is likely the result of (1) continued exposure of freshly broken quartz surfaces within cataclasite, promoting quartz precipitation, and (2) possibly more interconnected pathways for mass transfer within the fault zone. Enhanced cementation of cataclasite results in strengthening or diagenetic strain hardening of the evolving fault zone. Further slip is accommodated by shear localization along discrete slip surfaces. With further linkage of fault segments

  10. Cartilage Strain Distributions Are Different Under the Same Load in the Central and Peripheral Tibial Plateau Regions

    PubMed Central

    Briant, Paul; Bevill, Scott; Andriacchi, Thomas

    2015-01-01

    There is increasing evidence that the regional spatial variations in the biological and mechanical properties of articular cartilage are an important consideration in the pathogenesis of knee osteoarthritis (OA) following kinematic changes at the knee due to joint destabilizing events (such as an anterior cruciate ligament (ACL) injury). Thus, given the sensitivity of chondrocytes to the mechanical environment, understanding the internal mechanical strains in knee articular cartilage under macroscopic loads is an important element in understanding knee OA. The purpose of this study was to test the hypothesis that cartilage from the central and peripheral regions of the tibial plateau has different internal strain distributions under the same applied load. The internal matrix strain distribution for each specimen was measured on osteochondral blocks from the tibial plateau of mature ovine stifle joints. Each specimen was loaded cyclically for 20 min, after which the specimen was cryofixed in its deformed position and freeze fractured. The internal matrix was viewed in a scanning electron microscope (SEM) and internal strains were measured by quantifying the deformation of the collagen fiber network. The peak surface tensile strain, maximum principal strain, and maximum shear strain were compared between the regions. The results demonstrated significantly different internal mechanical strain distributions between the central and peripheral regions of tibial plateau articular cartilage under both the same applied load and same applied nominal strain. These differences in the above strain measures were due to differences in the deformation patterns of the collagen network between the central and peripheral regions. Taken together with previous studies demonstrating differences in the biochemical response of chondrocytes from the central and peripheral regions of the tibial plateau to mechanical load, the differences in collagen network deformation observed in this

  11. Tibial osteotomy for the varus osteoarthritic knee.

    PubMed

    Aglietti, P; Rinonapoli, E; Stringa, G; Taviani, A

    1983-06-01

    High tibial osteotomy is a reliable method for relieving pain in the varus osteoarthritic knee. In a review of 139 osteotomies, excellent and good results were noted in 64% of the knees after a follow-up period of at least ten years. The ideal candidate for this operation has Grade I or II osteoarthritis; less than 10 degrees of varus deformity, as measured by a single leg standing roentgenogram; no lateral subluxation; and no instability. The lateral closed wedge osteotomy without internal fixation is the preferred technique, and correction beyond the normal anatomic position, to 5 degrees of valgus, is advised. Protected weight-bearing after the second postoperative day is allowed. Complications have been infrequent and minor. Forty-seven knees were managed in this manner, and 88% had an excellent or good result at a four-year follow-up evaluation. In the majority of the well corrected knees, the alignment did not change with time, and the osteoarthritis did not progress. No failures in this series were attributable to the associated patellofemoral osteoarthritis; the reaction of the patellofemoral joint to osteotomy is obscure.

  12. Shape optimization of tibial prosthesis components

    NASA Technical Reports Server (NTRS)

    Saravanos, D. A.; Mraz, P. J.; Davy, D. T.

    1993-01-01

    NASA technology and optimal design methodologies originally developed for the optimization of composite structures (engine blades) are adapted and applied to the optimization of orthopaedic knee implants. A method is developed enabling the shape tailoring of the tibial components of a total knee replacement implant for optimal interaction within the environment of the tibia. The shape of the implant components are optimized such that the stresses in the bone are favorably controlled to minimize bone degradation, to improve the mechanical integrity of the implant/interface/bone system, and to prevent failures of the implant components. A pilot tailoring system is developed and the feasibility of the concept is demonstrated and evaluated. The methodology and evolution of the existing aerospace technology from which this pilot optimization code was developed is also presented and discussed. Both symmetric and unsymmetric in-plane loading conditions are investigated. The results of the optimization process indicate a trend toward wider and tapered posts as well as thicker backing trays. Unique component geometries were obtained for the different load cases.

  13. Open reduction and palmar plate-osteosynthesis in combination with a nanocrystalline hydroxyapatite spacer in the treatment of comminuted fractures of the distal radius.

    PubMed

    Huber, F-X; Hillmeier, J; Herzog, L; McArthur, N; Kock, H-J; Meeder, P J

    2006-06-01

    In a prospective study, we used the nanocrystalline hydroxyapatite paste Ostim (Osartis, Obernburg, Germany) in combination with a palmar plate to treat comminuted radius fractures with a metaphyseal and articular component in order to examine the clinical use of Ostim as a bone substitute. Twenty-one patients with 22 radius fractures of AO types C2 and C3 were included in the study. The measurements, taken 10.2+/-1.3 months after the initial treatment, revealed a dorsopalmar tilt of 8.8+/-3.7 degrees , a radioulnar inclination of 18.8+/-2.8 degrees and an ulnar variance of 0.8+/-1.8mm. According to the Gartland and Werley evaluation, eight of the treated fractures attained an excellent, 11 a good and the remaining three a fair result. The study demonstrates that Ostim, in combination with angularly stable osteosynthesis, can be used as an acceptable bone substitute for the treatment of type C2 and C3 radial fractures.

  14. Stress fractures of the ankle and forefoot in patients with inflammatory arthritides.

    PubMed

    Mäenpää, Heikki; Lehto, Matti U K; Belt, Eero A

    2002-09-01

    Twenty-four stress fractures occurring in the metatarsal bones and ankle region were examined in 17 patients with inflammatory arthritides. There were 16 metatarsal, four distal fibular, two distal tibial, and two calcaneus fractures. Radiographic analyses were performed to determine the presence of possible predisposing factors for stress fractures. Metatarsal and ankle region stress fractures were analyzed separately. Stress fractures occurred most frequently in the second and third metatarsals. In metatarsal fractures, there was a trend for varus alignment of the ankle to cause fractures of the lateral metatarsal bones and valgus alignment of the medial metatarsal bones. Valgus deformity of the ankle was present in patients with distal fibular fractures in the ankle region group. Calcaneus fractures showed neutral ankle alignment. Malalignment of the ankle and hindfoot is often present in distal tibial, fibular, and metatarsal stress fractures. Additionally, patients tend to have long disease histories with diverse medication, reconstructive surgery and osteoporosis. If such patients experience sudden pain, tenderness, or swelling in the ankle region, stress fractures should be suspected and necessary examinations performed.

  15. Is obesity protective against wound healing complications in pilon surgery? Soft tissue envelope and pilon fractures in the obese.

    PubMed

    Graves, Matthew L; Porter, Scott E; Fagan, Bryan C; Brien, Glenn A; Lewis, Matthew W; Biggers, Marcus D; Woodall, James R; Russell, George V

    2010-08-11

    Open treatment of pilon fractures is associated with wound healing complications. A traumatized, limited soft tissue envelope contributes to wound healing complications. Obese patients have larger soft tissue envelopes around the ankle, theoretically providing a greater area for energy distribution and more accommodation to implants. This led us to test 2 hypotheses: (1) ankle dimensions in obese patients are larger than in lean patients, and (2) the increased soft tissue envelope volume translates into fewer wound complications. A consecutive series of 176 pilon fractures treated from March 2002 to December 2007 were retrospectively reviewed. Inclusion criteria were adults who received a preoperative computed tomography (CT) scan and were treated with a staged protocol including plating. Patients with body mass index (BMI) >30 were compared to those with BMI <30 for CT-derived ankle dimensions and wound complications. Comorbidities were evaluated for their role as potential confounders. Thirty-one fractures in obese patients were compared to 83 in lean patients. The average ratio of bone area to soft tissue area at the tibial plafond was 0.35 for the obese group and 0.38 for the lean group (P=.012). There were 8 major wound-healing complications. Four occurred in the obese group (incidence 13%), and 4 in the lean group (incidence 5%) (P=.252). Ankle dimensions in clinically obese patients are larger than in lean patients. Obesity does not appear to be protective of wound-healing complications, but rather there is a trend toward the opposite.

  16. One-stage long-stem total knee arthroplasty for arthritic knees with stress fractures.

    PubMed

    Mittal, Amber; Bhosale, Pradeep B; Suryawanshi, Ashish V; Purohit, Shaligram

    2013-08-01

    PURPOSE. To evaluate the outcome of one-stage long-stem total knee arthroplasty (TKA) for patients with arthritic knees and tibiofemoral stress fractures. METHODS. Records of 11 men and 18 women aged 47 to 78 (mean, 66) years who underwent fixed-bearing posterior-stabilised TKA for osteoarthritis or rheumatoid arthritis of the knee with tibial (n=31) and femoral (n=3) stress fractures were reviewed. All the tibial fractures involved the proximal half. There were 7 associated fibular stress fractures. Of the 31 knees with tibial stress fractures, 26 and 5 manifested varus and valgus deformity, respectively. RESULTS. The mean follow-up period was 51 (range, 24-96) months. The mean tibiofemoral angle improved from 23.2 to 1.9 degrees varus. The mean Knee Society knee score improved from 38.5 (range, 15- 63) to 89.6 (range, 80-95) [p<0.05]. The mean Knee Society functional score improved from 25.5 (range, 0-40) to 86.5 (range, 60-100) [p<0.05]. All fractures were united at the last follow-up. No complications were encountered. CONCLUSION. One-stage long-stem TKA restores limb alignment and facilitates fracture healing, with excellent outcome.

  17. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis.

    PubMed

    Mandell, Jacob C; Khurana, Bharti; Smith, Stacy E

    2017-03-25

    Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.

  18. Adaptations in tibial cortical thickness and total volumetric bone density in postmenopausal South Asian women with small bone size.

    PubMed

    Darling, Andrea L; Hakim, Ohood A; Horton, Khim; Gibbs, Michelle A; Cui, Liang; Berry, Jacqueline L; Lanham-New, Susan A; Hart, Kathryn H

    2013-07-01

    There is some evidence that South Asian women may have an increased risk of osteoporosis compared with Caucasian women, although whether South Asians are at increased risk of fracture is not clear. It is unknown whether older South Asian women differ from Caucasian women in bone geometry. This is the first study, to the authors' knowledge, to use peripheral Quantitative Computed Tomography (pQCT) to measure radial and tibial bone geometry in postmenopausal South Asian women. In comparison to Caucasian women, Asian women had smaller bone size at the 4% (-18% p<0.001) and 66% radius (-15% p=0.04) as well as increased total density at the 4% (+13% p=0.01) radius. For the tibia, they had a smaller bone size at the 4% (-16% p=0.005) and 14% (-38% p=0.002) sites. Also, Asians had increased cortical thickness (-17% p=0.04) at the 38% tibia, (in proportion to bone size (-30% p=0.003)). Furthermore, at the 4% and 14% tibia there were increased total densities (+12% to +29% p<0.01) and at the 14% tibia there was increased cortical density (+5% p=0.005) in Asians. These differences at the 14% and 38% (but not 4%) remained statistically significant after adjustment for Body Mass Index (BMI). These adaptations are similar to those seen previously in Chinese women. Asian women had reduced strength at the radius and tibia, evidenced by the 20-40% reduction in both polar Strength Strain Index (SSIp) and fracture load (under bending). Overall, the smaller bone size in South Asians is likely to be detrimental to bone strength, despite some adaptations in tibial cortical thickness and tibial and radial density which may partially compensate for this.

  19. Bone Regeneration of Rat Tibial Defect by Zinc-Tricalcium Phosphate (Zn-TCP) Synthesized from Porous Foraminifera Carbonate Macrospheres

    PubMed Central

    Chou, Joshua; Hao, Jia; Kuroda, Shinji; Bishop, David; Ben-Nissan, Besim; Milthorpe, Bruce; Otsuka, Makoto

    2013-01-01

    Foraminifera carbonate exoskeleton was hydrothermally converted to biocompatible and biodegradable zinc-tricalcium phosphate (Zn-TCP) as an alternative biomimetic material for bone fracture repair. Zn-TCP samples implanted in a rat tibial defect model for eight weeks were compared with unfilled defect and beta-tricalcium phosphate showing accelerated bone regeneration compared with the control groups, with statistically significant bone mineral density and bone mineral content growth. CT images of the defect showed restoration of cancellous bone in Zn-TCP and only minimal growth in control group. Histological slices reveal bone in-growth within the pores and porous chamber of the material detailing good bone-material integration with the presence of blood vessels. These results exhibit the future potential of biomimetic Zn-TCP as bone grafts for bone fracture repair. PMID:24351911

  20. Indium-111 leukocyte scanning and fracture healing

    SciTech Connect

    Mead, L.P.; Scott, A.C.; Bondurant, F.J.; Browner, B.D. )

    1990-01-01

    This study was undertaken to determine the specificity of indium-111 leukocyte scans for osteomyelitis when fractures are present. Midshaft tibial osteotomies were performed in 14 New Zealand white rabbits, seven of which were infected postoperatively with Staphylococcus aureus per Norden's protocol. All 14 rabbits were scanned following injection with 75 microCi of indium 111 at 72 h after osteotomy and at weekly intervals for 4 weeks. Before the rabbits were killed, the fracture sites were cultured to document the presence or absence of infection. The results of all infected osteotomy sites were positive, whereas no positive scans were found in the noninfected osteotomies. We concluded from this study that uncomplicated fracture healing does not result in a positive indium-111 leukocyte scan.

  1. Properties of the tibial component regarding impact load.

    PubMed

    Yoshino, Kazunori; Koga, Yoshio; Segawa, Hiroyuki; Ueno, Yuichi; Tanabe, Yuji; Endo, Naoto; Omori, Go

    2004-06-01

    Load transmission through knee prostheses was examined to clarify how the tibial component behaves under dynamic loading conditions. We did Genesis II total knee arthroplasty using sawbones and measured impact load transmission ratios using the split-Hopkinson pressure bar technique. We also measured the polyethylene strain when an impact load was applied using a strain gauge bonded to the anterior surface of the polyethylene. The impact load transmission ratios of metal-backed and all-polyethylene tibial components were less than 4%. Greater load transmission was observed with metal-backed components, which suggests that some of the applied dynamic load is transferred directly to the tibial cortical bone. Increasing polyethylene thickness decreased impact load transmission ratios in both components, which might lower the cancellous bone stresses beneath tibial implants. Greater strain in the tibial component was observed in all-polyethylene components. Increased polyethylene thickness did not significantly decrease the polyethylene strain, probably because of the nonlinear elastic behavior of the polyethylene material. The distant positioning of the strain gauge may, however, have prevented the detection of local contact strains. Recent clinical studies did not confirm our theoretical predictions, suggesting that other factors contribute more significantly to the clinical outcome in current total knee arthroplasty.

  2. Numerical Modeling of Fracture Propagation in Naturally Fractured Formations

    NASA Astrophysics Data System (ADS)

    Wang, W.; Prodanovic, M.; Olson, J. E.; Schultz, R.

    2015-12-01

    Hydraulic fracturing consists of injecting fluid at high pressure and high flowrate to the wellbore for the purpose of enhancing production by generating a complex fracture network. Both tensile failure and shear failure occur during the hydraulic fracturing treatment. The shear event can be caused by slip on existing weak planes such as faults or natural fractures. From core observation, partially cemented and fully cemented opening mode natural fractures, often with considerable thickness are widely present. Hydraulic fractures can propagate either within the natural fracture (tensile failure) or along the interface between the natural fracture and the rock matrix (tensile/shear failure), depending on the relative strength of cement and rock matrix materials, the bonding strength of interface, as well as the presence of any heterogeneities. In this study, we evaluate the fracture propagation both experimentally and numerically. We embed one or multiple inclusions of different mechanical properties within synthetic hydrostone samples in order to mimic cemented natural fractures and rock. A semi-circular bending test is performed for each set of properties. A finite element model built with ABAQUS is used to mimic the semi-circular bending test and study the fracture propagation path, as well as the matrix-inclusion bonding interface status. Mechanical properties required for the numerical model are measured experimentally. The results indicate that the match between experiment and modeling fracture path are extremely sensitive to the chosen interface (bonding) model and related parameters. The semi-circular bending test is dry and easily conducted, providing a good platform for validating numerical approaches. A validated numerical model will enable us to add pressurized fluid within the crack and simulate hydraulic fracture-natural fracture interaction in the reservoir conditions, ultimately providing insights into the extent of the fracture network.

  3. Measurement properties of radial and tibial speed of sound for screening bone fragility in 10- to 12-year-old boys and girls.

    PubMed

    Rebocho, Lurdes M; Cardadeiro, Graça; Zymbal, Vera; Gonçalves, Ezequiel M; Sardinha, Luís B; Baptista, Fátima

    2014-01-01

    The objective of this study was to analyze measurement properties of the radial and tibial speed of sound (SoS) evaluated by quantitative ultrasound (QUS) for screening bone fragility. Bone fragility was defined as low whole body less head bone mineral density (WBLH BMD) measured by DXA (first tertile, 95% CI -1.1 to -0.9) and as past fractures evaluated by questionnaire. The sample included 319 nonobese boys and girls, ages 10-12 yr. All bone variables were standardized. The results revealed concordance coefficient correlations between WBLH BMD and radial and tibial SoS of 0.129 and 0.038, respectively. The regression lines between DXA and QUS variables were different from the identity lines. Cross-classification analysis by Kappa statistic showed that only 34% and 36% of the 113 participants categorized in the first tertile of WBLH BMD were also categorized in the first tertile of tibial and radial SoS, correspondingly. Logistic regression with gender and maturity adjustments demonstrates that radial SoS was the single significant variable in predicting OR for identifying participants with past fractures. In conclusion, the radial QUS revealed itself to be a valuable tool for screening bone fragility in youth of 10-12 yr, despite the absence of agreement with DXA WBLH BMD.

  4. Retrograde nail for tibiotalocalcaneal arthrodesis as a limb salvage procedure for open distal tibia and talus fractures with severe bone loss.

    PubMed

    Ochman, Sabine; Evers, Julia; Raschke, Michael J; Vordemvenne, Thomas

    2012-01-01

    The treatment of complex fractures of the distal tibia, ankle, and talus with soft tissue damage, bone loss, and nonreconstructable joints for which the optimal timing for reduction and fixation has been missed is challenging. In such cases primary arthrodesis might be a treatment option. We report a series of multi-injured patients with severe soft tissue damage and bone loss, who were treated with a retrograde tibiotalocalcaneal arthrodesis nail as a minimally invasive treatment option for limb salvage. After a median follow-up of 5.4 years, all patients returned to their former profession. The ankle and bone fusion was complete, with moderate functional results and quality of life. Calcaneotibial arthrodesis using a retrograde nail is a good treatment option for nonreconstructable fractures of the ankle joint with severe bone loss and poor soft tissue quality in selected patients with multiple injuries, in particular, those involving both lower extremities, as a salvage procedure.

  5. Diagnosing segmental wedge fracture of the tibia before performing intramedullary nailing.

    PubMed

    Gutowski, Christina; Abrams, Jeffrey S; Gutowski, W T

    2013-08-01

    Tibial shaft fractures with a wedge butterfly segment are often repaired with intramedullary fixation. At the time of presentation, the fragment may appear benign on radiographs as a portion of the cortical bone in an acceptable position. However, a segment that includes the entire circumference of the tibial cortex can be a problem during surgical stabilization. This ring effect will demand cannulation of the butterfly segment with the guide wire before rod insertion. Since computed tomography is not always necessary for minimally displaced fractures, this issue may not be discovered until surgery. Lack of cannulation may lead to painful nonunion. Preoperative recognition of this fracture pattern and intraoperative butterfly cannulation will improve the postoperative stability of this fracture.

  6. Lateral foot pain following open reduction and internal fixation of the fracture of the fifth metatarsal tubercle: treated by arthroscopic arthrolysis and endoscopic tenolysis.

    PubMed

    Lui, Tun Hing

    2014-04-17

    We report a case of fracture of the tuberosity of the fifth metatarsal which was managed by tension band wiring and bone grafting. It was complicated by symptomatic fibrosis of the operated site involving the cubometatarsal joint, peroneus brevis tendon, peroneus tertius tendon and the long extensor tendon to the fifth toe. This was successfully managed by arthroscopic lysis of the involved joint and tendons.

  7. Skull fracture

    MedlinePlus

    ... compress the underlying brain tissue (subdural or epidural hematoma). A simple fracture is a break in the bone without damage ... Causes of skull fracture can include: Head trauma Falls, automobile accidents, physical assault, and sports

  8. Rib Fractures

    MedlinePlus

    ... From Brain Injury Additional Content Medical News Rib Fractures By Thomas G. Weiser, MD, MPH, Department of ... Hemothorax Injury to the Aorta Pulmonary Contusion Rib Fractures Tension Pneumothorax Traumatic Pneumothorax (See also Introduction to ...

  9. Hand Fractures

    MedlinePlus

    ... Thumb Arthritis Thumb Sprains Trigger Finger Tumors Wrist Fracture Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety ... Tunnel Ganglion Cysts Thumb Arthritis Trigger Finger Wrist Fracture Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety ...

  10. Entablature: fracture types and mechanisms

    NASA Astrophysics Data System (ADS)

    Forbes, A. E. S.; Blake, S.; Tuffen, H.

    2014-05-01

    Entablature is the term used to describe zones or tiers of irregular jointing in basaltic lava flows. It is thought to form when water from rivers dammed by the lava inundates the lava flow surface, and during lava-meltwater interaction in subglacial settings. A number of different fracture types are described in entablature outcrops from the Búrfell lava and older lava flows in Þjórsárdalur, southwest Iceland. These are: striae-bearing, column-bounding fractures and pseudopillow fracture systems that themselves consist of two different fracture types—master fractures with dimpled surface textures and subsidiary fractures with curved striae. The interaction of pseudopillow fracture systems and columnar jointing in the entablature produces the chevron fracture patterns that are commonly observed in entablature. Cube-jointing is a more densely fractured version of entablature, which likely forms when more coolant enters the hot lava. The entablature tiers display closely spaced striae and dendritic crystal shapes which indicate rapid cooling. Master fracture surfaces show a thin band with an evolved composition at the fracture surface; mineral textures in this band also show evidence of quenching of this material. This is interpreted as gas-driven filter pressing of late-stage residual melt that is drawn into an area of low pressure immediately preceding or during master fracture formation by ductile extensional fracture of hot, partially crystallised lava. This melt is then quenched by an influx of water and/or steam when the master fracture fully opens. Our findings suggest that master fractures are the main conduit for coolant entering the lava flow during entablature formation.

  11. Iatrogenic pseudoaneurysm of the popliteal artery following corrective tibial osteotomy.

    PubMed

    Szyber, P; Skóra, J; Rybak, W; Pupka, A

    2011-09-01

    Due to its anatomical location the popliteal artery is exposed to injury during surgical procedures in the region of the knee joint, in particular during high-level corrective osteotomies of the proximal tibial epiphysis. Nevertheless, posttraumatic (iatrogenic) pseudoaneurysm constitutes a very rare complication of the procedure. Only few reports of such complication have been published and they were usually connected with lateral tibial osteotomy - the accidents after medial osteotomy are seldom. The complication we report was observed in a 52-year-old female patient after corrective osteotomy of the medial portion of the proximal tibial epiphysis. The complication was diagnosed 7 days after surgery on US-examination and subsequently confirmed by emergently performed angio-CT. The patient was referred for urgent reconstructive surgery. No significant complications were observed, neither postoperatively nor during follow-up visits.

  12. Computer-Assisted Navigation in High Tibial Osteotomy

    PubMed Central

    Song, Sang Jun

    2016-01-01

    Computer-assisted navigation is used to improve the accuracy and precision of correction angles during high tibial osteotomy. Most studies have reported that this technique reduces the outliers of coronal alignment and unintended changes in the tibial posterior slope angle. However, more sophisticated studies are necessary to determine whether the technique will improve the clinical results and long-term survival rates. Knowledge of the navigation technology, surgical techniques and potential pitfalls, the clinical results of previous studies, and understanding of the advantages and limitations of the computer-assisted navigation are crucial to successful application of this new technique in high tibial osteotomy. Herein, we review the evidence concerning this technique from previous studies. PMID:27904715

  13. [Anatomical quantification of the tibial part of the plantar aponeurosis].

    PubMed

    Hiramoto, Y

    1983-03-01

    The metrical analysis of the anatomical characteristics is important because of its objectiveness. As it is concerned with the organs belonging to the locomotor system, the metrical method of the bones has already been systematized by Martin (1928), whereas the same kind of method for use on other organs remains undeveloped. The author aims to establish the metrical method of the plantar aponeurosis. The method for measuring the tibial part of the aponeurosis developed in this paper is sufficiently applicable for obtaining its principal anatomical characteristics. The results show that the tibial portion of the plantar aponeurosis becomes statistically significantly wider and thinner in its anterior part, and that the thickness of the tibial portion of the aponeurosis in the anterior part is larger on the right side than on the left side.

  14. Facial fractures.

    PubMed Central

    Carr, M. M.; Freiberg, A.; Martin, R. D.

    1994-01-01

    Emergency room physicians frequently see facial fractures that can have serious consequences for patients if mismanaged. This article reviews the signs, symptoms, imaging techniques, and general modes of treatment of common facial fractures. It focuses on fractures of the mandible, zygomaticomaxillary region, orbital floor, and nose. Images p520-a p522-a PMID:8199509

  15. Periprosthetic tibial bone mineral density changes after total knee arthroplasty

    PubMed Central

    Jaroma, Antti; Soininvaara, Tarja; Kröger, Heikki

    2016-01-01

    Background and purpose Total knee arthroplasty (TKA) may cause postoperative periprosthetic bone loss due to stress shielding. Bone also adapts to mechanical alterations such as correction of malalignment. We investigated medium-term changes in bone mineral density (BMD) in tibial periprosthetic bone after TKA. Patients and methods 86 TKA patients were prospectively measured with dual-energy X-ray absorptiometry (DXA), the baseline measurement being within 1 week after TKA and the follow-up measurements being at 3 and 6 months, and at 1, 2, 4, and 7 years postoperatively. Long standing radiographs were taken and clinical evaluation was done with the American Knee Society (AKS) score. Results The baseline BMD of the medial tibial metaphyseal region of interest (ROI) was higher in the varus aligned knees (25%; p < 0.001). Medial metaphyseal BMD decreased in subjects with preoperatively varus aligned knees (13%, p < 0.001) and in those with preoperatively valgus aligned knees (12%, p = 0.02) between the baseline and 7-year measurements. No statistically significant changes in BMD were detected in lateral metaphyseal ROIs. No implant failures or revision surgery due to tibial problems occurred. Interpretation Tibial metaphyseal periprosthetic bone is remodeled after TKA due to mechanical axis correction, resulting in more balanced bone stock below the tibial tray. The diaphyseal BMD remains unchanged after the initial drop, within 3–6 months. This remodeling process was related to good component survival, as there were no implant failures or revision operations due to tibial problems in this medium-term follow-up. PMID:27120266

  16. Does the Taylor Spatial Frame Accurately Correct Tibial Deformities?

    PubMed Central

    Segal, Kira; Ilizarov, Svetlana; Fragomen, Austin T.; Ilizarov, Gabriel

    2009-01-01

    Background Optimal leg alignment is the goal of tibial osteotomy. The Taylor Spatial Frame (TSF) and the Ilizarov method enable gradual realignment of angulation and translation in the coronal, sagittal, and axial planes, therefore, the term six-axis correction. Questions/purposes We asked whether this approach would allow precise correction of tibial deformities. Methods We retrospectively reviewed 102 patients (122 tibiae) with tibial deformities treated with percutaneous osteotomy and gradual correction with the TSF. The proximal osteotomy group was subdivided into two subgroups to distinguish those with an intentional overcorrection of the mechanical axis deviation (MAD). The minimum followup after frame removal was 10 months (average, 48 months; range, 10–98 months). Results In the proximal osteotomy group, patients with varus and valgus deformities for whom the goal of alignment was neutral or overcorrection experienced accurate correction of MAD. In the proximal tibia, the medial proximal tibial angle improved from 80° to 89° in patients with a varus deformity and from 96° to 85° in patients with a valgus deformity. In the middle osteotomy group, all patients had less than 5° coronal plane deformity and 15 of 17 patients had less that 5° sagittal plane deformity. In the distal osteotomy group, the lateral distal tibial angle improved from 77° to 86° in patients with a valgus deformity and from 101° to 90° for patients with a varus deformity. Conclusions Gradual correction of all tibial deformities with the TSF was accurate and with few complications. Level of Evidence Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:19911244

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

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  18. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  19. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  20. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  1. On fracture toughness evaluation for semi-brittle fracture

    NASA Technical Reports Server (NTRS)

    Eftis, J.; Liebowitz, H.

    1975-01-01

    The existing methods of assessing the fracture toughness of materials exhibiting semi-brittle fracture are critically reviewed. The methods concern the Crack Growth Resistance (R-curve), the Crack Opening Displacement (COD), and the J-integral. An analysis of the shortcomings of the methods described makes it possible to formulate a new definition of fracture toughness appropriate to semi-brittle fracture. An improved simple experimental method for measuring fracture toughness for semi-brittle fracture is proposed which takes into account both crack growth and plastic nonlinear effects at crack front. The proposed method is shown to be free of the theoretical and experimental discrepancies encountered in the R-curve, COD, and J-integral methods.

  2. Posterior tibial vein aneurysm presenting as tarsal tunnel syndrome.

    PubMed

    Ayad, Micheal; Whisenhunt, Anumeha; Hong, EnYaw; Heller, Josh; Salvatore, Dawn; Abai, Babak; DiMuzio, Paul J

    2015-06-01

    Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve within the tarsal tunnel. Its etiology varies, including space occupying lesions, trauma, inflammation, anatomic deformity, iatrogenic injury, and idiopathic and systemic causes. Herein, we describe a 46-year-old man who presented with left foot pain. Work up revealed a venous aneurysm impinging on the posterior tibial nerve. Following resection of the aneurysm and lysis of the nerve, his symptoms were alleviated. Review of the literature reveals an association between venous disease and tarsal tunnel syndrome; however, this report represents the first case of venous aneurysm causing symptomatic compression of the nerve.

  3. Extra Corporeal Fixation of Fractured Mandibular Condyle

    PubMed Central

    Shenoy K, Vandana; Kengagsubbiah, Srivatsa; V, Sathyabhama; Priya, Vishnu

    2014-01-01

    Condylar fracture is the second most common site in the mandibular fractures. Motor vehicle accident and fall are the major causes of such fractures. Because of the anatomical weakness of the condyle and the shape of the condylar head the antero-medial dislocation of the condyle is common. Open reduction and closed reduction is always debatable. The open reduction will bring back the normal function much earlier than closed reduction. Medially dislocated condylar fracture fragments are always managed with open method. In superior or high condylar fractures,exact reduction with conventional open reduction can be difficult due to the limited surgical and visual fields. In such cases extracorporeal fixation of condyle using vertical ramus osteotomy may be better choice to achieve perfect alignment and absolute maintaince of vertical height of the ramus and facial symmetry. We here present a case of extracorporeal fixation of unilateral left high condylar fracture. PMID:25386546

  4. Biomechanical Analysis of a Novel Wedge Locking Plate in a Porcine Tibial Model

    PubMed Central

    Ha, Jeong-Ku; Yeom, Chul Hyun; Jang, Ho Su; Song, Han Eui; Lee, Sung Jae; Kim, Kang Hee; Chung, Kyu Sung; Bhat, Mahendar Gururaj

    2016-01-01

    Background The purpose of this study was to analyze biomechanical properties of a novel wedge locking plate in medial open wedge high tibial osteotomy (OWHTO) in a porcine tibial model. Methods A uniform 8-mm OWHTO was performed in 12 porcine tibiae. Six of them were subsequently fixed with the plate without a wedge, whereas the other 6 were additionally reinforced with a metal wedge of 8 mm. Biomechanical properties (stiffness, displacement of the osteotomy gap, and failure load) were evaluated under axial load. The different modes of failure were also investigated. Results The plate showed an axial stiffness of 2,457 ± 450 N/mm with a wedge and 1,969 ± 874 N/mm without a wedge. The maximum failure load was 5,380 ± 952 N with a wedge and 4,354 ± 607 N without a wedge. The plate with a wedge had a significantly greater failure load and significantly less displacement of medial gap at failure than that without a wedge (p = 0.041 and p = 0.002, respectively). The axial stiffness was not different between the two types of fixation. Most failures were caused by lateral cortex breakage and there was no implant failure. Conclusions The novel wedge locking plate showed excellent biomechanical properties and an additional wedge provided significant improvement. This plate can be a good fixation method for OWHTO. PMID:27904718

  5. Tarsomere and distal tibial glands: structure and potential roles in termites (Isoptera: Rhinotermitidae, Termitidae).

    PubMed

    Costa-Leonardo, Ana Maria; Soares, Helena Xavier; Haifig, Ives; Laranjo, Lara Teixeira

    2015-09-01

    Social insects have numerous exocrine glands, but these organs are understudied in termites compared to hymenopterans. The tarsomere and distal tibial glands of the termites Heterotermes tenuis, Coptotermes gestroi and Silvestritermes euamignathus were investigated by scanning and transmission electron microscopy. Pore plates are visible in scanning micrographs on the distal tibial surfaces and on the ventral surface of the first and second tarsomeres of workers of H. tenuis and C. gestroi. In contrast, workers of S. euamignathus have isolated pores spread throughout the ventral surfaces of the first, second, and third tarsomeres and the distal tibia. In all three species each pore corresponds to the opening of a class-3 secretory unit, composed of one secretory and one canal cell. Clusters of class-3 glandular cells are arranged side by side underneath the cuticle. The main characteristics of these exocrine glands include their presence on all the legs and the electron-lucent secretion in the secretory cells. Possible functions of these glands are discussed.

  6. Modeling fracture porosity evolution in dolostone

    NASA Astrophysics Data System (ADS)

    Gale, Julia F. W.; Lander, Robert H.; Reed, Robert M.; Laubach, Stephen E.

    2010-09-01

    Opening-mode fractures in dolostones buried to depths of ˜1-5 km contain synkinematic dolomite cement, the amount and internal structure of which has a systematic relationship to fracture size. Narrow fractures (<0.01 mm) typically seal completely with either massive cement or cement with a crack-seal texture that indicates multiple incremental openings. Wider fractures can preserve considerable effective porosity, but anomalously thick dolomite cement bridges are commonly present in fractures that are otherwise lined with a thin veneer of cement. Dolomite bridges resemble quartz bridges that are common in fractured sandstones. We developed a geometric crystal growth model for synkinematic dolomite fracture fill in fractured dolostones, where periodic incremental fracture-opening events are introduced with concurrent cement growth. We assumed constant temperature and supersaturation with respect to dolomite. A key assumption in the model is that rapid dolomite accumulation within bridges is governed by high cement-growth rates on repeatedly broken grain surfaces during the process of crack seal. Slower cement-growth rates occur on euhedral crystals. This assumption is made on the basis of a comparison with quartz cement growth in fractured sandstones. Simulations with different fracture-opening rates mimic bridge and lining cement morphologies, including characteristic rhombic shapes of dolomite bridges.

  7. Managing scaphoid fractures. How we do it?

    PubMed Central

    Gupta, Vikas; Rijal, Laxman; Jawed, Akram

    2013-01-01

    The scaphoid is the common carpal bone to be fractured. Proper clinical and radiological evaluation is required to establish it's diagnosis. The management of acute fractures includes conservative treatment with cast in minimally displaced to open reduction and internal fixation in case of displaced ones. The established nonunion requires open reduction, bone grafting and internal fixation. PMID:26403769

  8. Changes in the radiological measurements of the tibiofibular syndesmal area in patients with Weber C ankle fractures who were treated with open reduction, internal fixation, and transyndesmal screw.

    PubMed

    Jasqui-Remba, S; Torres-Gómez, A; Salas-Morales, G A; Hernández-Martínez, A

    2015-01-01

    The tibiofibular syndesmosis provides stability to the ankle mortise. The ankle syndesmosis is compromised in all Weber C type injuries. The radiographic method described by Merle DAubigné considers the bony relationships as a measure of syndesmotic widening. We sought to investigate whether the patients with a C type ankle fracture treated with ORIF and placement of a transyndesmal screw have an increment of the tibiofibular space and decrease of the tibiofibular overlap after the transyndesmal screw is removed. Our sample included 52 patients with Weber C ankle fractures treated by ORIF and transyndesmal screw at a level II trauma center. We measured the tibiofibular clear space and tibiofibular overlap in each phase of the treatment. The transyndesmal screw was removed at day 55.56 (± 21.83). We found an increase of the tibiofibular overlap of 0.20 mm (± 2.29, p = 0.532); and 0.21 mm (± 0.97, p = 0.146) in the tibiofibular clear space. The changes of 2.38% in the tibiofibular overlap and 5.29% in the tibiofibular clear space between the postoperative and post-removal periods were not statistically significant. After removal of the syndesmal screw, there is a slight radiographic broadening of the syndesmosis; however, it is small and statistically not significant.

  9. Distal forearm fractures in children. Complications and surgical indications.

    PubMed

    Dicke, T E; Nunley, J A

    1993-04-01

    Appropriate indications for operative management of pediatric distal forearm fractures include: 1. Compartment syndrome for fasciotomy. 2. Open fractures for irrigation and debridement. 3. Soft tissue/nerve entrapment. 4. Displaced intra-articular physeal fractures. 5. Displaced or angulated fractures when the patient is close to skeletal maturity. 6. Correction of physeal arrest with malalignment or malrotation. 7. Gross displacement with cosmetic deformity.

  10. Stemmed knee replacement in a patient with an irremovable tibial nail.

    PubMed

    Ward, William G; Cooper, Joshua M

    2013-01-01

    A patient with a cemented centrally located intramedullary tibial nail that occluded the proximal tibial canal underwent knee reconstruction with a total knee design utilizing a custom hollow tibial stem. In this oncology case, a rotating-hinge knee design was used that incorporates an intra-articular inverted post-in-channel central rotational post design. This design allowed for a rather straightforward reconstruction that functioned well for 3 years. Although rarely encountered, utilization of a hollow-stemmed tibial total knee component may allow salvage of an extremity with central occlusion of the proximal tibial canal.

  11. High tibial osteotomy with a dynamic axial fixator: precision in achieving alignment.

    PubMed

    Bachhal, V; Sankhala, S S; Jindal, N; Dhillon, M S

    2011-07-01

    We report the outcome of 32 patients (37 knees) who underwent hemicallostasis with a dynamic external fixator for osteoarthritis of the medial compartment of the knee. There were 16 men (19 knees) and 16 women (18 knees) with a mean age at operation of 54.6 years (27 to 72). The aim was to achieve a valgus overcorrection of 2° to 8° or mechanical axis at 62.5% (± 12.5%). At a mean follow-up of 62.8 months (51 to 81) there was no change in the mean range of movement, and no statistically significant difference in the Insall-Salvati index or tibial slope (p = 0.11 and p = 0.15, respectively). The mean hip-knee-ankle angle changed from 190.6 (183° to 197°) to 176.0° (171° to 181°), with a mean final position of the mechanical axis of 58.5% (35.1% to 71.2%). The desired alignment was attained in 31 of 37 (84%) knees. There were 21 excellent, 13 good, two fair and one poor result according to the Oxford knee score with no correlation between age and final score. This score was at its best at one year with a statistically significant deterioration at two years (p = 0.001) followed by a small but not statistically significant deterioration until the final follow-up (p = 0.17). All the knees with Ahlback grade 1 osteoarthritis had excellent or good results. Complications included pin tract infections involving 16.4% of all pins used, delayed union in two, knee stiffness in four, fracture of the lateral cortex in one and ring sequestrum in one. In conclusion, hemicallostasis provides precision in attaining the desired alignment without interfering with tibial slope or patellar height, and is relatively free of serious complications.

  12. Tibial bone geometry in chronic stroke patients: influence of gender, cardiovascular health, and muscle mass

    PubMed Central

    Pang, Marco Y.C.; Ashe, Maureen C.; Eng, Janice J.

    2011-01-01

    Introduction Individuals with chronic stroke sustain a high risk of bone fractures, partly due to the stroke-induced bone loss and geometric changes. This study aimed to examine the geometry of the tibia in ambulatory, chronic stroke survivors. Materials and Methods Fifty-five ambulatory individuals with chronic stroke were included in the study. Peripheral quantitative computed tomography (pQCT) was used to obtain a cross-sectional scan of the tibia at the 30% site on both the paretic and non-paretic sides. Leg lean mass was derived from a total body scan using dual-energy X-ray absorptiometry. Each subject was also evaluated for peak oxygen consumption rate, spasticity, and functional mobility. Paired t-tests were used to compare the pQCT parameters between the two sides. The degree of association between tibial bone strength index (BSI) and other variables was determined by Pearson’s correlation coefficients and Spearman’s rho. Multiple linear regression analysis was used to identify the significant determinants of tibial BSI. Results In men, marrow cavity area on the paretic side was significantly greater than the non-paretic side (p=0.011) while the total bone area showed no significant side-to-side difference (p=0.252). In women, total bone area on the paretic side was significantly smaller than the non-paretic side (p=0.003) while the marrow cavity area had no side-to-side difference (p=0.367). Peak oxygen consumption (R2=0.739, F5,49=22.693, p<0.001) and paretic leg lean mass (R2=0.802, F6,48=32.475, p<0.001) remained independently associated with tibial BSI, after controlling for age, gender, body mass index, years since stroke onset, and physical activity level. Conclusions The geometry of the tibia in stroke patients showed gender-specific side-to-side differences. The results suggested that while endosteal resorption was apparent in men, periosteal resorption was more predominant in women. The results also highlight the potential importance of

  13. Changes in serum protein profiles of chickens with tibial dyschondroplasia

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Differences in serum protein profiles were analyzed to identify biomarkers associated with a poultry leg problem named tibial dyschondroplasia (TD) that can cause lameness. We used a bead-based affinity matrix containing a combinatorial library of hexapeptides (ProteoMinerTM) to deplete high abundan...

  14. Tibial dyschondroplasia associated proteomic changes in chicken growth plate cartilage

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Tibial dyschondroplasia (TD) is a poultry leg problem that affects the proximal growth plate of tibia preventing its transition to bone. To understand the disease-induced proteomic changes we compared the protein extracts of cartilage from normal and TD- affected growth plates. TD was induced by fe...

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

    PubMed Central

    Todo, Mitsugu

    2014-01-01

    One of the most common errors of total knee arthroplasty procedure is a malrotation of tibial component. The stress on tibial insert is closely related to polyethylene failure. The objective of this study is to analyze the effect of malrotation of tibial component for the stress on tibial insert during high flexion using a finite element analysis. We used Stryker NRG PS for analysis. Three different initial conditions of tibial component including normal, 15° internal malrotation, and 15° external malrotation were analyzed. The tibial insert made from ultra-high-molecular-weight polyethylene was assumed to be elastic-plastic while femoral and tibial metal components were assumed to be rigid. Four nonlinear springs attached to tibial component represented soft tissues around the knee. Vertical load was applied to femoral component which rotated from 0° to 135° while horizontal load along the anterior posterior axis was applied to tibial component during flexion. Maximum equivalent stresses on the surface were analyzed. Internal malrotation caused the highest stress which arose up to 160% of normal position. External malrotation also caused higher stress. Implanting prosthesis in correct position is important for reducing the risk of abnormal wear and failure. PMID:24895658

  16. MRI Based Comparison of Tibial Bone Coverage by Five Knee Prosthesis: Anthropometric Study in Indians.

    PubMed

    Shah, Sourabh; Agarwal, Naresh; Jain, Anuj; Srivastav, Shekhar; Thomas, Simon; Agarwal, Shekhar

    2015-09-01

    This MRI based study evaluates morphological differences of proximal