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Sample records for tibial stress fractures

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

    DTIC Science & Technology

    2005-12-01

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

  2. Biomechanical Factors in Tibial Stress Fractures

    DTIC Science & Technology

    2005-08-01

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

  3. Bone stress in runners with tibial stress fracture.

    PubMed

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

    2015-11-01

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

  4. Tibial fractures.

    PubMed

    Seaman, Jeffrey A; Simpson, Amelia M

    2004-08-01

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

  5. Biomechanical Factors in Tibial Stress Fractures

    DTIC Science & Technology

    2004-08-01

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

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

    PubMed

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

    2007-07-01

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

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

    PubMed

    Ofluoglu, Demet; Ofluoglu, Onder; Akyuz, Gulseren

    2006-03-01

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

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

    DTIC Science & Technology

    2006-12-01

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

  10. Biomechanical Factors in the Etiology of Tibial Stress Fractures

    DTIC Science & Technology

    2002-08-01

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

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

    PubMed

    Yagi, Shigenori; Muneta, Takeshi; Sekiya, Ichiro

    2013-03-01

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

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

    PubMed

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

    1995-01-01

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

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

    PubMed

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

    2017-04-01

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

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

    PubMed

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

    2012-10-01

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

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

    PubMed Central

    Franklyn, Melanie; Field, Bruce

    2013-01-01

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

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

    PubMed

    Franklyn, Melanie; Field, Bruce

    2013-01-01

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

  17. [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.

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

    PubMed

    Couture, Christopher J; Karlson, Kristine A

    2002-06-01

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

  19. 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…

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

    DTIC Science & Technology

    2017-03-23

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

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

    PubMed

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

    2012-01-01

    Lower tibial bone fracture may easily cause bone delayed union or nonunion because of lacking of dynamic mechanical load. Research Group would design a new instrument as Rap System of Stress Stimulation (RSSS) to provide dynamic mechanical load which would promote lower tibial bone union postoperatively. This clinical research was conducted from January 2008 to December 2010, 92 patients(male 61/female 31, age 16-70 years, mean 36.3 years) who suffered lower tibial bone closed fracture were given intramedullary nail fixation and randomly averagely separated into experimental group and control group(according to the successively order when patients went for the admission procedure). Then researchers analysed the clinical healing time, full weight bearing time, VAS (Visual Analogue Scales) score and callus growth score of Lane-Sandhu in 3,6,12 months postoperatively. The delayed union and nonunion rates were compared at 6 and 12 months separately. All the 92 patients had been followed up (mean 14 months). Clinical bone healing time in experimental group was 88.78±8.80 days but control group was 107.91±9.03 days. Full weight bearing time in experimental group was 94.07±9.81 days but control group was 113.24±13.37 days respectively (P<0.05). The delayed union rate in 6 months was 4.3% in experimental group but 10.9% in control group(P<0.05). The nonunion rate in 12 months was 6.5% in experimental group but 19.6% in control group(P<0.05). In 3, 6, 12 months postoperatively, VAS score and Lane-Sandhu score in experimental group had more significantly difference than them in control group. RSSS can intermittently provide dynamic mechanical load and stimulate callus formation, promote lower tibial bone union, reduce bone delayed union or nonunion rate. It is an adjuvant therapy for promoting bone union after lower tibial bone fracture.

  2. Multiple Tibial Insufficiency Fractures in the Same Tibia

    PubMed Central

    Defoort, Saartje; Mertens, Peter

    2011-01-01

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

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

    PubMed

    Pamukoff, Derek N; Blackburn, J Troy

    2015-02-01

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

  4. 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.

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

    PubMed Central

    2017-01-01

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

  6. Calf muscle wasting after tibial shaft fracture

    PubMed Central

    Khalid, M; Brannigan, A; Burke, T

    2006-01-01

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

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

    PubMed

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

    2017-03-23

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

  8. Medial tibial stress syndrome: case report.

    PubMed

    Jovicić, Milica; Jovicić, Vladimir; Hrković, Marija; Lazović, Milica

    2014-01-01

    Although it can be difficult to differentiate pain in lower legs, it is important for clinicians to differentiate medial tibial stress syndrome, which is a rather benign condition, from acute compartment syndrome, which is an emergency, as well as from different types of stress fractures described in this region. The aim of this case report was to present medial tibial stress syndrome as a clinical diagnosis, possible dilemmas in differential diagnosis and the efficacy of rehabilitation treatment. A 25-year old male patient sought medical help complaining of the pain along the distal third of tibia. The pain was present on palpation of the distal two-thirds of the lateral and medial tibial border over the length of 9 cm and on muscle manual testing of foot flexors. The patient underwent physical and exercise treatment for three weeks. The recovery was monitored by visual analogue scale, which measured the lower leg pain, pain on palpation and manual muscle testing. In addition, the patient himself assessed his ability to resume sport activities on the 5-point Likert scale. The final evaluation and measurements showed his complete functional recovery. The results obtained in this case show the importance of accurate clinical diagnosis and rehabilitation for medial tibial stress syndrome.

  9. 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.

  10. [Retrograde nailing in a tibial fracture].

    PubMed

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

    2014-01-01

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

  11. Percutaneous plating of distal tibial fractures.

    PubMed

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

    2002-09-01

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

  12. 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

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

    PubMed Central

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

    2009-01-01

    We report the case of a polyethylene tibial post fracture in a 72-year-old woman 14 months after a Scorpio posterior-stabilized (PS) total knee arthroplasty. The polyethylene wear was found around the fracture site of the post, especially over the anterior aspect of the post base. The failure mechanism of the post fracture in the present case was anterior impingement with excessive wear over the base of the anterior aspect of the tibial post, which became a stress-riser of post and cam articulation. This is the first report of a polyethylene tibial post fracture of a Scorpio PS prosthesis. PMID:19885065

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

    PubMed

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

    2016-09-01

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

  15. Stress Fractures

    MedlinePlus

    Stress fractures Overview Stress fractures are tiny cracks in a bone. They're caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also arise from normal use of ...

  16. Tibial shaft fractures in football players.

    PubMed

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

    2007-06-13

    Football is officially the most popular sport in the world. In the UK, 10% of the adult population play football at least once a year. Despite this, there are few papers in the literature on tibial diaphyseal fractures in this sporting group. In addition, conflicting views on the nature of this injury exist. The purpose of this paper is to compare our experience of tibial shaft football fractures with the little available literature and identify any similarities and differences. A retrospective study of all tibial football fractures that presented to a teaching hospital was undertaken over a 5 year period from 1997 to 2001. There were 244 tibial fractures treated. 24 (9.8%) of these were football related. All patients were male with a mean age of 23 years (range 15 to 29) and shin guards were worn in 95.8% of cases. 11/24 (45.8%) were treated conservatively, 11/24 (45.8%) by Grosse Kemp intramedullary nail and 2/24 (8.3%) with plating. A difference in union times was noted, conservative 19 weeks compared to operative group 23.9 weeks (p < 0.05). Return to activity was also different in the two groups, conservative 27.6 weeks versus operative 23.3 weeks (p < 0.05). The most common fracture pattern was AO Type 42A3 in 14/24 (58.3%). A high number 19/24 (79.2%) were simple transverse or short oblique fractures. There was a low non-union rate 1/24 (4.2%) and absence of any open injury in our series. Our series compared similarly with the few reports available in the literature. However, a striking finding noted by the authors was a drop in the incidence of tibial shaft football fractures. It is likely that this is a reflection of recent compulsory FIFA regulations on shinguards as well as improvements in the design over the past decade since its introduction.

  17. Stress fractures in 51 runners.

    PubMed

    Sullivan, D; Warren, R F; Pavlov, H; Kelman, G

    1984-01-01

    A prospective study was initiated in 1976 to investigate runners who are at risk for incurring stress fractures and how these fractures can be prevented. Fifty-one runners incurred 57 stress fractures. Tibial fractures were most common (25), followed by fibula (12) and metatarsal (8). Seven runners had previously sustained stress fractures, and six developed two stress fractures simultaneously. Five women over 30 years old had pelvic stress fractures. Stress fracture development was positively correlated with the presence of pes planus, weekly training distances greater than 20 miles, hard training surfaces, and training regimen modifications. The incidence did not correlate with generalized musculoskeletal laxity or tightness. Forty-four of 51 patients had initially positive roentgenograms. Five of five bone scans were positive. The average duration of rest before running was resumed was 7.4 weeks.

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

    PubMed

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

    2017-07-01

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

  19. Current developments concerning medial tibial stress syndrome.

    PubMed

    Craig, Debbie I

    2009-12-01

    Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in athletes who run. Studies have reported MTSS to occur in 4% to 20% of this population. It can be defined as an overuse injury that creates pain over an area covering the distal to middle third of the posteriomedial tibial border, which occurs during exercise and creates cyclic loading. Differential diagnosis includes ischemic disorders and stress fractures. Although the pathology of this injury is understood, the etiology is less agreed upon. This makes it difficult for clinicians to diagnose and treat this common injury. The purpose of this article is to present health care practitioners with the most current information regarding MTSS so they can better diagnose and treat this common injury. To this end, a literature review was conducted, with the most current results presented. The areas of etiological theories, imaging techniques, and treatment options for MTSS were searched. Five of the most prevalent etiological theories are presented with supporting evidence. Of the imaging tools available to the clinician, magnetic resonance imaging (MRI) and bone scintigraphy have comparable specificity and sensitivity. Clinicians should first make the clinical diagnosis of MTSS, however, because of high percentages of positive MRI scans in asymptomatic patients. There have been few randomized controlled trials investigating treatment options for athletes with MTSS. Those that have been performed rendered no significant findings, leading researchers to conclude that rest is equal to or better than other treatment options. Given the evidence, treatment suggestions for practitioners caring for athletes with MTSS are provided.

  20. Stress Fractures.

    PubMed

    Goldberg, B; Pecora, C

    1994-03-01

    In brief We studied 3 years of stress fractures that occurred at a major university. We found an annual Incidence of 1.9% among athletes, but 67% of the injuries were in freshmen. In 86% of the cases, patients had abruptly changed their training-such as after summer break-and experienced symptoms an average of 4.5 weeks later. Students took, on average, another 3.5 weeks to seek medical care. These findings emphasize the need to carefully monitor freshman training regimens and to be alert for symptoms of stress fracture.

  1. Tibial stress injuries. An aetiological review for the purposes of guiding management.

    PubMed

    Beck, B R

    1998-10-01

    In the last 30 years, few advances have been made in the management of tibial stress injuries such as tibial stress fracture and medial tibial stress syndrome (MTSS). Tibial overuse injuries are a recognised complication of the chronic, intensive, weight-bearing training commonly practised by athletic and military populations. Generally, the most effective treatment is considered to be rest, often for prolonged periods. This is a course of action that will significantly disrupt an active lifestyle, and sometimes end activity-related careers entirely. There is now considerable knowledge of the nature of tibial stress injuries, such that presently accepted management practices can be critically evaluated and supplemented. Most recent investigations suggest that tibial stress injuries are a consequence of the repetitive tibial strain imposed by loading during chronic weight-bearing activity. Evidence is presented in this article for an association between repeated tibial bending and stress injury as a function of: (i) strain-related modelling (in the case of MTSS), and (ii) a strain-related positive feedback mechanism of remodelling (in the case of stress fracture). Factors that influence the bending response of the tibia to loading are reviewed. Finally, a guide for injury prevention and management based on research observations is presented.

  2. Stress fractures: diagnosis, treatment, and prevention.

    PubMed

    Patel, Deepak S; Roth, Matt; Kapil, Neha

    2011-01-01

    Stress fractures are common injuries in athletes and military recruits. These injuries occur more commonly in lower extremities than in upper extremities. Stress fractures should be considered in patients who present with tenderness or edema after a recent increase in activity or repeated activity with limited rest. The differential diagnosis varies based on location, but commonly includes tendinopathy, compartment syndrome, and nerve or artery entrapment syndrome. Medial tibial stress syndrome (shin splints) can be distinguished from tibial stress fractures by diffuse tenderness along the length of the posteromedial tibial shaft and a lack of edema. When stress fracture is suspected, plain radiography should be obtained initially and, if negative, may be repeated after two to three weeks for greater accuracy. If an urgent diagnosis is needed, triple-phase bone scintigraphy or magnetic resonance imaging should be considered. Both modalities have a similar sensitivity, but magnetic resonance imaging has greater specificity. Treatment of stress fractures consists of activity modification, including the use of nonweight-bearing crutches if needed for pain relief. Analgesics are appropriate to relieve pain, and pneumatic bracing can be used to facilitate healing. After the pain is resolved and the examination shows improvement, patients may gradually increase their level of activity. Surgical consultation may be appropriate for patients with stress fractures in high-risk locations, nonunion, or recurrent stress fractures. Prevention of stress fractures has been studied in military personnel, but more research is needed in other populations.

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

    PubMed

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

    2008-10-01

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

  4. Treatment of segmental tibial fractures with supercutaneous plating.

    PubMed

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

    2014-08-01

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

  5. Treatment strategy for tibial plateau fractures: an update

    PubMed Central

    Prat-Fabregat, Salvi; Camacho-Carrasco, Pilar

    2016-01-01

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

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

    PubMed

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

    2017-07-18

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

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

    PubMed

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

    2016-12-01

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

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

    PubMed Central

    Chen, Hongwei; Chang, Shimin; Pan, Jun

    2015-01-01

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

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

    PubMed

    Robertson, Greg A J; Wood, Alexander M

    2016-07-01

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

  10. High-resolution axial MR imaging of tibial stress injuries

    PubMed Central

    2012-01-01

    Purpose To evaluate the relative involvement of tibial stress injuries using high-resolution axial MR imaging and the correlation with MR and radiographic images. Methods A total of 33 patients with exercise-induced tibial pain were evaluated. All patients underwent radiograph and high-resolution axial MR imaging. Radiographs were taken at initial presentation and 4 weeks later. High-resolution MR axial images were obtained using a microscopy surface coil with 60 × 60 mm field of view on a 1.5T MR unit. All images were evaluated for abnormal signals of the periosteum, cortex and bone marrow. Results Nineteen patients showed no periosteal reaction at initial and follow-up radiographs. MR imaging showed abnormal signals in the periosteal tissue and partially abnormal signals in the bone marrow. In 7 patients, periosteal reaction was not seen at initial radiograph, but was detected at follow-up radiograph. MR imaging showed abnormal signals in the periosteal tissue and entire bone marrow. Abnormal signals in the cortex were found in 6 patients. The remaining 7 showed periosteal reactions at initial radiograph. MR imaging showed abnormal signals in the periosteal tissue in 6 patients. Abnormal signals were seen in the partial and entire bone marrow in 4 and 3 patients, respectively. Conclusions Bone marrow abnormalities in high-resolution axial MR imaging were related to periosteal reactions at follow-up radiograph. Bone marrow abnormalities might predict later periosteal reactions, suggesting shin splints or stress fractures. High-resolution axial MR imaging is useful in early discrimination of tibial stress injuries. PMID:22574840

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

    PubMed Central

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

    2017-01-01

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

  12. 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.

  13. Metatarsal stress fractures - aftercare

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000553.htm Metatarsal stress fractures - aftercare To use the sharing features on ... that connect your ankle to your toes. A stress fracture is a break in the bone that ...

  14. 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. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2012-12-01

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

  16. Tibial Bone Density in Athletes With Medial Tibial Stress Syndrome: A Controlled Study

    PubMed Central

    Özgürbüz, Cengizhan; Yüksel, Oğuz; Ergün, Metin; İşlegen, Çetin; Taskiran, Emin; Denerel, Nevzad; Karamizrak, Oğuz

    2011-01-01

    Medial tibial stress syndrome (MTSS) is a common overuse injury of the lower extremity predominantly observed in weight bearing activities. Knowledge about the pathological lesions and their pathophysiology is still limited. Only a single study was found to have investigated tibial bone density in the pain region, revealing lower density in athletes with long standing (range, 5-120 month) MTSS. In a follow-up study, bone density was determined to return to normal levels after recovery. The purpose of the present study was to investigate tibial bone density in athletes with shorter MTSS history (range, 3-10 weeks). A total of 11 athletes (7 males, 4 females) diagnosed with medial tibial stress syndrome were included in the study. The control group consisted of 11 regularly exercising individuals (7 males, 4 females). Tibial, femoral and vertebral bone densities were measured by dual energy x-ray absorptiometry. Total calcium intake was calculated by evaluating detailed nutrition history. No statistically significant differences were found in the tibial, femoral and vertebral bone densities between the groups. No statistically significant difference was found among groups, considering for calcium intake. Tibial bone densities were not lower in athletes with MTSS of 5.0 weeks mean duration (range, 3-10 weeks) compared to the healthy control group. Longitudinal studies with regular tibial bone density measurements in heavily trained athletes are necessary to investigate tibial density alterations in MTSS developing athletes during the course of the symptoms. Key points Tibial, femoral and vertebral bone densities were measured by dual energy x-ray absorptiometry. No differences were found between the MTSS group (MTSS history 3-10 weeks) and the healthy athletes group. PMID:24149568

  17. Contributing factors to medial tibial stress syndrome: a prospective investigation.

    PubMed

    Hubbard, Tricia J; Carpenter, Erica Mullis; Cordova, Mitchell L

    2009-03-01

    To conduct a prospective, multisite, cohort study investigating the possible risk factors for medial tibial stress syndrome (MTSS) in college athletes. One hundred and forty-six healthy, collegiate athletes from NCAA Division I and Division II institutions participated in the study. Subjects first completed a health history questionnaire to establish previous history of injury and underwent a physical examination to assess their ankle/foot strength, ankle/foot range of motion, tibial varum, and navicular drop before the start of their respective athletic season. Athletes were instructed to report to a certified athletic trainer if they developed pain on their tibia. If MTSS was present, subjects were then placed into the symptomatic group. Independent t-tests and chi-square analyses were used to determine whether differences existed between MTSS and healthy athletes for the continuous and the discrete dependent variables, respectively. The significant dependent variables were then used in the discriminant function analysis. Twenty-nine subjects developed MTSS during this study. Athletes that had been participating in athletic activity for fewer than 5 yr were significantly more likely to develop MTSS (P = 0.002). Additionally, athletes with a previous history of MTSS (P = 0.0001), a previous history of stress fracture (P = 0.039), and the use of orthotics (P = 0.031) were more likely to develop MTSS compared with those who did not develop MTSS. This study established that the factors most influencing MTSS development were previous history of MTSS and stress fracture, years of running experience, and orthotic use. These data demonstrate the importance of establishing a thorough history before the start of the season so that athletes who might be at risk for MTSS development can be identified.

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

    PubMed

    Ziran, Bruce H; Becher, Stephen John

    2013-11-01

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

  19. Medial tibial stress syndrome: conservative treatment options.

    PubMed

    Galbraith, R Michael; Lavallee, Mark E

    2009-10-07

    Medial tibial stress syndrome (MTSS), commonly known as "shin splints," is a frequent injury of the lower extremity and one of the most common causes of exertional leg pain in athletes (Willems T, Med Sci Sports Exerc 39(2):330-339, 2007; Korkola M, Amendola A, Phys Sportsmed 29(6):35-50, 2001; Hreljac A, Med Sci Sports Exerc 36(5):845-849, 2004). Although often not serious, it can be quite disabling and progress to more serious complications if not treated properly. Often, the cause of MTSS is multi-factorial and involves training errors and various biomechanical abnormalities. Few advances have been made in the treatment of MTSS over the last few decades. Current treatment options are mostly based on expert opinion and clinical experience. The purpose of this article is to review published literature regarding conservative treatment options for MTSS and provide recommendations for sports medicine clinicians for improved treatment and patient outcomes.

  20. 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.

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

    PubMed

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

    2001-06-01

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

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

    PubMed

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

    2008-01-01

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

  3. 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.

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

    PubMed

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

    2013-12-01

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

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

    PubMed

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

    2017-03-01

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

  6. 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)

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

    PubMed

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

    2018-01-01

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

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

    PubMed

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

    2016-09-01

    Alpine skiing and snowboarding share the hazards of accidents accounting for tibial fractures. The aim of this study was to evaluate the fracture patterns and mechanisms of injury of tibial fractures taking place in downhill skiing and snowboarding. All patients with tibial fracture due to alpine skiing or snowboarding accident treated in four trauma centers next to the largest ski resorts in Finland were analyzed between 2006 and 2012. The hospital records were retrospectively reviewed for data collection: equipment used (skis or snowboard), age, gender, and mechanism of injury. Fractures were classified according to AO-classification. There were 342 skiing and 30 snowboarding related tibial fractures in 363 patients. Tibial shaft fracture was the most common fracture among skiers (n = 215, 63%), followed by proximal tibial fractures (n = 92, 27%). Snowboarders were most likely to suffer from proximal tibial fracture (13, 43%) or tibial shaft fracture (11, 37%). Snowboarders were also more likely than skiers to suffer complex AO type C fractures (23% vs 9%, p < 0.05). Adult skiers had both wider variety of fractures and higher prevalence of proximal tibial fractures compared to children (49% vs 16%, p < 0.05). Skiers typically got injured due to falling down on the same level (70%) and snowboarders due to loss of control while jumping (46%). The most important finding was the relatively high number of the tibial plateau fractures among adult skiers. The fracture patterns between snowboarding and skiing were different; the most common fracture type in skiers was spiral tibial shaft fracture compared to proximal tibial fractures in snowboarders. Children had more simple fractures than adults. © The Finnish Surgical Society 2016.

  9. Forefoot flexibility and medial tibial stress syndrome.

    PubMed

    Kudo, Shintarou; Hatanaka, Yasuhiko

    2015-12-01

    To investigate the association between medial tibial stress syndrome (MTSS) and morphology and flexibility of the foot arches. 131 feet from 74 healthy subjects and 31 feet from 27 patients with MTSS were classified as normal feet (n=78 in 40 subjects), flat feet (n=53 in 34 subjects), or MTSS feet (n=31 in 27 patients). The medial longitudinal arch (MLA) ratio and the transverse arch length (TAL) were measured in both rearfoot and forefoot loading positions. The difference between the 2 positions indicated the flexibility of the MLA (diff-MLA ratio) and the transverse arch (diff- TAL). The MLA ratio was higher in normal feet than MTSS feet or flat feet (15.1% vs. 12.8% vs. 12.3%, p<0.001). The diff-TAL was lower in MTSS feet than normal feet or flat feet (0.4% vs. 0.8% vs. 0.9%, p<0.001]). The 3 groups were comparable in terms of the diff-MLA ratio and the TAL. Respectively for the MLA ratio and the diff-TAL, the cut-off value was 11.9% and 0.61% based on the Youden index. The sensitivity, specificity, and odds ratio of the cut-off value were 0.4, 0.9, and 4.8 for the MLA ratio, and 0.6, 0.7, and 9.8 for the diff-TAL, respectively. Decreased flexibility of the transverse arch and decreased MLA ratio are risk factors for MTSS. In contrast, the flexibility of the MLA and the height of the transverse arch were not risk factors for MTSS.

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

    PubMed

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

    2016-09-19

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

  11. -Lesser known stress fractures-.

    PubMed

    Wybier, M; Hamze, B; Champsaur, P; Parlier, C

    1997-01-01

    Stress fractures of the tibia may disclose a longitudinal orientation which is obvious at bone scanning; a mild periostosis may appear on plain films; CT demonstrates a radially-oriented fracture in one aspect of the diaphyseal cortex. A cortical dissection-like vertically oriented insufficiency fracture may involve the medial aspect of the femoral shaft underlying the lesser trochanter; the fracture is concentric to the femoral cortex at CT. Insufficiency fractures of the sacrum may be misdiagnosed on plain films; bone scanning displays a typical H-shaped increased uptake which is a specific pattern. Insufficiency fractures of the pubis may appear as tumoral bone destruction; however no soft tissue mass is present at CT which in addition demonstrates normal fat tissue abutting the osseous lesion.

  12. 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.

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

    PubMed

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

    2012-01-01

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

  14. Ultrasound-Diagnosed Tibia Stress Fracture: A Case Report

    PubMed Central

    Amoako, Adae; Abid, Ayesha; Shadiack, Anthony; Monaco, Robert

    2017-01-01

    Stress fractures are a frequent cause of lower extremity pain in athletes, and especially in runners. Plain imaging has a low sensitivity. Magnetic resonance imaging (MRI) or bone scan scintigraphy is the criterion standard, but expensive. We present the case of a young female distance runner with left shin pain. Plain radiography was unremarkable. Ultrasound showed focal hyperechoic elevation of the periosteum with irregularity over the distal tibia and increased flow on Doppler. These findings were consistent with a distal tibia stress fracture and confirmed by MRI. Examination of our case will highlight the utility of considering an ultrasound for diagnosis of tibial stress fracture. PMID:28469488

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

    PubMed

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

    2016-05-01

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

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

    PubMed

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

    2008-11-01

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

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

    PubMed

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

    2017-02-01

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

  18. Biomechanical Factors in Tibial Stress Fracture

    DTIC Science & Technology

    2001-08-01

    McClay, IS. Injury Patterns in Runners with Pes Cavus andPes Planus . Presented at the ACSM National Mtg in Indianapolis, IN, 6/00. Sahte, V, Ireland...Mass. Exercise Science EMPLOYMENT Director of Research, Joyner Sportsmedicine Institute, (6/97 - present) Development of research within the...Dimensional Kinetic Analysis of Running: Significance of Secondary Planes of Motion. Medicine and Science in Sports and Exercise 31(11)1629-1637

  19. Biomechanical Factors in Tibial Stress Fractures

    DTIC Science & Technology

    2003-08-01

    witii Pes Cavus andPes Planus . Presented at the ACSM National Mtg in Mdianapolis, IN, 6/00. Sahte, V, Ireland, ML, Ballantyne BT and McClay, IS. Acute...syndrome in competitive female runners". It will be submitted to Medicine and Science in Sport and Exercise by the end of 2003. Abstract Submission...Sports and Exercise , 35, S91. McClay Davis, I., Ferber, R., Hamill, J. & Pollard, CD. (2003). Rearfoot mechanics in competitive runners who had

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

    PubMed

    Janzing, H M; Broos, P L

    2001-06-01

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

  1. 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

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

    PubMed

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

    2016-01-01

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

  3. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system.

    PubMed

    Fredericson, M; Bergman, A G; Hoffman, K L; Dillingham, M S

    1995-01-01

    Medial tibial pain in runners has traditionally been diagnosed as either a shin splint syndrome or as a stress fracture. Our work using magnetic resonance imaging suggests that a progression of injury can be identified, starting with periosteal edema, then progressive marrow involvement, and ultimately frank cortical stress fracture. Fourteen runners, with a total of 18 symptomatic legs, were evaluated and, within 10 days, referred for radiographs, a technetium bone scan, and a magnetic resonance imaging scan. In 14 of the 18 symptomatic legs, magnetic resonance imaging findings correlated with an established technetium bone scan grading system and more precisely defined the anatomic location and extent of injury. We identified clinical symptoms, such as pain with daily ambulation and physical examination findings, including localized tibial tenderness and pain with direct or indirect percussion, that correlated with more severe tibial stress injuries. When clinically warranted, we recommend magnetic resonance imaging over bone scan for grading of tibial stress lesions in runners. Magnetic resonance imaging is more accurate in correlating the degree of bone involvement with clinical symptoms, allowing for more accurate recommendations for rehabilitation and return to impact activity. Additional advantages of magnetic resonance imaging include lack of exposure to ionizing radiation and significantly less imaging time than three-phase bone scintigraphy.

  4. Case report: comprehensive management of medial tibial stress syndrome.

    PubMed

    Krenner, Bernard John

    2002-01-01

    Activity or exercise-induced leg pain is a common complication among competitive and "weekend warrior" athletes. Shin splints is a term that has been used to describe all lower leg pain as a result of activity. There are many different causes of "shin splints," one of which is medial tibial stress syndrome, and the treating clinician must be aware of potentially serious causes of activity related leg pain. Restoring proper biomechanics to the entire kinetic chain and rehabilitation of the injured area should be the primary aim of treatment to optimize shock absorption. The role inflammation plays in medial tibial stress syndrome is controversial, but in this case, seemed to be a causative factor as symptomatology was dramatically decreased with the addition of proteolytic enzymes. Medial tibial stress syndrome can be quite difficult to treat and keeping athletes away from activities that will slow healing or aggravate the condition can be challenging. "Active" rest is the best way in which to allow proper healing while allowing the athlete to maintain their fitness.

  5. Outcome of surgical treatment of medial tibial stress syndrome.

    PubMed

    Yates, Ben; Allen, Mike J; Barnes, Mike R

    2003-10-01

    Medial tibial stress syndrome is a common chronic sports injury characterized by exercise-induced pain along the posteromedial border of the tibia. The reported outcomes of surgical treatment of this condition have varied. Of seventy-eight patients who underwent surgery for medial tibial stress syndrome, forty-six (thirty-one men and fifteen women) returned for follow-up. The outcomes of the surgery were determined by comparing preoperative and postoperative pain levels as indicated on a visual analog pain scale and ascertaining the ability of the athletes to return to presymptom levels of exercise. The mean duration of postoperative follow-up was thirty months (range, six to sixty-three months). Surgery significantly reduced pain levels (p < 0.001) by an average of 72% as indicated on the visual analog pain scale. An excellent result was achieved in 35% of the limbs; a good result, in 34%; a fair result, in 22%; and a poor result, in 9%. Despite the success with regard to pain reduction, for a variety of reasons only nineteen (41%) of the athletes fully returned to their presymptom sports activity. Surgery can significantly reduce the pain associated with medial tibial stress syndrome. Despite this reduction in pain, athletes should be counseled that a full uninhibited return to sports is not always achieved.

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

    PubMed Central

    Musiienko, Dharsh; Law, Samuel

    2017-01-01

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

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

    PubMed

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

    2017-12-01

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

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

    PubMed

    Schwandt, C S; Montavon, P M

    2005-01-01

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

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

    PubMed

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

    2013-08-20

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

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

    PubMed

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

    2018-01-01

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

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

    PubMed

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

    2017-10-01

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

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

    PubMed

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

    2014-03-01

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

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

    PubMed

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

    2017-11-21

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

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

    PubMed

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

    2010-06-01

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

  15. 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

  16. 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

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

    PubMed

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

    2013-01-01

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

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

    PubMed

    Giordano, Vincenzo; Schatzker, Joseph; Kfuri, Mauricio

    2017-07-01

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

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

    PubMed

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

    2013-11-01

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

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

    PubMed

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

    2013-08-01

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

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

    PubMed

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

    2007-03-01

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

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

    PubMed

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

    2015-09-01

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

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

    PubMed

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

    2012-03-07

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

  4. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits.

    PubMed

    Yates, Ben; White, Shaun

    2004-01-01

    To identify the incidence of medial tibial stress syndrome (MTSS) in a group of naval recruits undergoing a 10-week basic training period and to determine potential risk factors. One hundred and twenty-four recruits (84 men and 40 women) were followed prospectively during basic training. Anthropometric and lower limb biomechanical data were recorded at the start of the program along with injury history and previous sporting activity for the 3 months prior to enlisting. Recruits were monitored during training for development of medial tibial strees syndrome and were asked to complete an exit interview at the end of the program. Forty recruits (22 men and 18 women) developed medial tibial stress syndrome, giving an incidence of 35%. A significant relationship existed between gender and medial tibial stress syndrome (P =.012), with female recruits more likely to develop medial tibial stress syndrome than male recruits (53% vs 28%). A risk estimate revealed a relative risk of 2.03. The biomechanical results indicated a more pronated foot type (P =.002) in the medial tibial stress syndrome group when compared to the control group. A risk estimate established that recruits with a more pronated foot type had a relative risk of 1.70. Identifying a pronated foot type prior to training may help reduce the incidence of medial tibial stress syndrome by early intervention to control abnormal pronation. Findings of a higher incidence of medial tibial stress syndrome among female recruits require further investigation.

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

    PubMed

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

    2016-10-01

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

  6. [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.

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

    PubMed Central

    Nicetto, Tommaso; Longo, Federico

    2017-01-01

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

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

    PubMed

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

    2017-10-01

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

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

    PubMed

    Nicetto, Tommaso; Longo, Federico

    2017-06-01

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

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

    PubMed

    Kang, Jong Yeal; Lee, Yong Seuk

    2016-07-01

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

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

    PubMed

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

    2017-06-01

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

  12. 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

  13. 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

  14. 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. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    PubMed

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

    2018-01-31

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

  16. Risk factors and prognostic indicators for medial tibial stress syndrome.

    PubMed

    Moen, M H; Bongers, T; Bakker, E W; Zimmermann, W O; Weir, A; Tol, J L; Backx, F J G

    2012-02-01

    The objective of the study was to examine the risk factors and prognostic indicators for medial tibial stress syndrome (MTSS). In total, 35 subjects were included in the study. For the risk factor analysis, the following parameters were investigated: hip internal and external ranges of motion, knee flexion and extension, dorsal and plantar ankle flexion, hallux flexion and extension, subtalar eversion and inversion, maximal calf girth, lean calf girth, standing foot angle and navicular drop test. After multivariate regression decreased hip internal range of motion, increased ankle plantar flexion and positive navicular drop were associated with MTSS. A higher body mass index was associated with a longer duration to full recovery. For other prognostic indicators, no relationship was found. © 2010 John Wiley & Sons A/S.

  17. All-polyethylene tibial components generate higher stress and micromotions than metal-backed tibial components in total knee arthroplasty.

    PubMed

    Brihault, Jean; Navacchia, Alessandro; Pianigiani, Silvia; Labey, Luc; De Corte, Ronny; Pascale, Valerio; Innocenti, Bernardo

    2016-08-01

    Most total knee arthroplasty tibial components are metal-backed, but an alternative tibial component made entirely of polyethylene (all-polyethylene design) exists. While several clinical studies have shown that all-poly design performs similarly to the metal-backed, the objective of this study is to perform a biomechanical comparison. Loads, constraints and geometries during a squat activity at 120° of flexion were obtained from a validated musculoskeletal model and applied to a finite element model. Stresses in the tibia and micromotions at the bone-implant interface were evaluated for several implant configurations: (1) three different thicknesses of the cement penetration under the baseplate (2, 3 and 4 mm), (2) the presence or absence of a cement layer around the stem of the tibial tray and (3) three different bone conditions (physiological, osteopenic and osteoporotic bone). All-polyethylene tibial components resulted in significantly higher (p < 0.001) and more uneven stress distributions in the cancellous bone under the baseplate (peak difference: +128.4 %) and fivefold increased micromotions (p < 0.001). Performance of both implant designs worsened with poorer bone quality with peaks in stress and micromotion variations of +40.8 and +54.0 %, respectively (p < 0.001). Performance improvements when the stem was cemented were not statistically significant (n.s.). The metal-backed design showed better biomechanical performance during a squat activity at 120° of flexion compared to the all-polyethylene design. These results should be considered when selecting the appropriate tibial component for a patient, especially in the presence of osteoporotic bone or if intense physical activity is foreseen.

  18. Unusual presentation of a femoral stress fracture

    PubMed Central

    Ejnisman, Leandro; Wajnsztejn, Andre; Queiroz, Roberto Dantas; Ejnisman, Benno

    2013-01-01

    Stress fractures are common injuries in sports medicine. Among these fractures, femoral neck stress fractures frequently have a benign course, especially when it happens in the medial aspect of the neck. This case report describes a stress fracture of the medial aspect of the femoral neck that developed a complete fracture and underwent surgical fixation. PMID:23283621

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

    PubMed

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

    2018-02-14

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

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

    PubMed

    Guiot, Laurent P; Déjardin, Loïc M

    2011-02-01

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

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

    PubMed

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

    2004-09-01

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

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

    PubMed

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

    2016-06-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2017-07-18

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

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

    PubMed

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

    2015-08-01

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

  6. 3D printing-assisted osteotomy treatment for the malunion of lateral tibial plateau fracture.

    PubMed

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

    2016-12-01

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

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

    PubMed Central

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

    2017-01-01

    Abstract The aim of this study was to evaluate the clinical efficacy of external fixation, delayed open reduction, and internal fixation in treating tibial plateau fracture with dislocation. Clinical data of 34 patients diagnosed with tibial plateau fracture complicated with dislocation between January 2009 and May 2015 were retrospectively analyzed. Fifteen patients in group A underwent early calcaneus traction combined with open reduction and internal fixation and 19 in group B received early external fixation combined with delayed open reduction and internal fixation. Operation time, postoperative complication, bone healing time, knee joint range of motion, initial weight-bearing time, Rasmussen tibial plateau score, and knee function score (HSS) were statistically compared between 2 groups. The mean follow-up time was 18.6 months (range: 5–24 months). The mean operation time in group A was 96 minutes, significantly longer than 71 minutes in group B (P < .05). In group A, 5 cases had postoperative complications and 1 in group B (P < .05). The mean bone healing time in group A was 6.9 months (range: 5–9 months) and 6.0 months (range: 5–8 months) in group B (P > .05). In group A, initial weight-bearing time in group A was (14.0 ± 3.6) weeks, significantly differing from (12.9 ± 2.8) weeks in group B (P < 0.05). In group A, the mean knee joint range of motion was 122° (range: 95°–150°) and 135° (range: 100°–160°) in group B (P > 0.05). Rasmussen tibial plateau score in group A was slightly lower than that in group B (P > .05). The excellent rate of knee joint function in group A was 80% and 84.21% in group B (P > .05). External fixation combined with delayed open reduction and internal fixation is a safer and more efficacious therapy of tibial plateau fracture complicated with dislocation compared with early calcaneus traction and open reduction and internal fixation. PMID:29019890

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

    PubMed

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

    2017-10-01

    The aim of this study was to evaluate the clinical efficacy of external fixation, delayed open reduction, and internal fixation in treating tibial plateau fracture with dislocation.Clinical data of 34 patients diagnosed with tibial plateau fracture complicated with dislocation between January 2009 and May 2015 were retrospectively analyzed. Fifteen patients in group A underwent early calcaneus traction combined with open reduction and internal fixation and 19 in group B received early external fixation combined with delayed open reduction and internal fixation. Operation time, postoperative complication, bone healing time, knee joint range of motion, initial weight-bearing time, Rasmussen tibial plateau score, and knee function score (HSS) were statistically compared between 2 groups.The mean follow-up time was 18.6 months (range: 5-24 months). The mean operation time in group A was 96 minutes, significantly longer than 71 minutes in group B (P < .05). In group A, 5 cases had postoperative complications and 1 in group B (P < .05). The mean bone healing time in group A was 6.9 months (range: 5-9 months) and 6.0 months (range: 5-8 months) in group B (P > .05). In group A, initial weight-bearing time in group A was (14.0 ± 3.6) weeks, significantly differing from (12.9 ± 2.8) weeks in group B (P < 0.05). In group A, the mean knee joint range of motion was 122° (range: 95°-150°) and 135° (range: 100°-160°) in group B (P > 0.05). Rasmussen tibial plateau score in group A was slightly lower than that in group B (P > .05). The excellent rate of knee joint function in group A was 80% and 84.21% in group B (P > .05).External fixation combined with delayed open reduction and internal fixation is a safer and more efficacious therapy of tibial plateau fracture complicated with dislocation compared with early calcaneus traction and open reduction and internal fixation.

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

    PubMed Central

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

    2009-01-01

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

  10. [Dynamic investigation of tibial biomechanical property endured persistent intensive stress].

    PubMed

    Li, Cheng; Li, Guoping; Pei, Fuxing

    2007-04-01

    For investigating the changes in continuous biomechanical nature of bone bearing intensive stress in vivo, we adopted the animal model of persistent intensive stress. Thirty-seven rabbits were involved in the experiment; they were randomly divided into control group (5 rabbits) and trained group (32 rabbits). All animals were forced to jump and run about 300 times everyday in the electric stimulation cage so as to simulate the persistent intensive stress on tibias for different periods. Subsequently, all animals were sacrificed at different times (1-11 weeks), and all tibias of them were collected for biochemical investigation. By torsion destroy test, the experiment showed that the changes of biomechanical nature appeared obviously in a period of 6 weeks or so in the experiment. Furthermore, during the 2nd-3rd week of each period, the biomechanical indexes decreased strikingly; the abilities of deformation resistant dropped, the twisting rigidity decreased (69.7% lower than control, P< 0.01), the flexible index inereased (203.2% higher than control, P<0.05), the angle of twisting destroy increased (102.9% greater than control, P< 0.05). And the tibial mechanical strength declined too; the destroy torsion, energy absorption and energy absorb density decreased (most of them being 50% lower than control, even accounting for 34.5% of control; P< 0.05 or P< 0.01). We noticed that the biomechanical properties of bone endured persistent intensive stress presented periodicity and the period of change in bone biomechanical nature covered about 6 weeks in the experiment. Therefore, we have ground to conclude that a weakness period did exist when rabbit tibias endured 2-3 weeks persistent intensive stress, and such weakness did exist at the 2nd-3rd week of each training period.

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

    PubMed Central

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

    2008-01-01

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

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

    PubMed

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

    2017-12-01

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

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

    PubMed Central

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

    2017-01-01

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

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

    PubMed

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

    1999-10-01

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

  15. Lower limb stress fractures in sport: Optimising their management and outcome

    PubMed Central

    Robertson, Greg A J; Wood, Alexander M

    2017-01-01

    Stress fractures in sport are becoming increasing more common, comprising up to 10% of all of sporting injuries. Around 90% of such injuries are located in the lower limb. This articles aims to define the optimal management of lower limb stress fractures in the athlete, with a view to maximise return rates and minimise return times to sport. Treatment planning of this condition is specific to the location of the injury. However, there remains a clear division of stress fractures by “high” and “low” risk. “Low risk” stress fractures are those with a low probability of fracture propagation, delayed union, or non-union, and so can be managed reliably with rest and exercise limitation. These include stress fractures of the Postero-Medial Tibial Diaphysis, Metatarsal Shafts, Distal Fibula, Medial Femoral Neck, Femoral Shaft and Calcaneus. “High risk” stress fractures, in contrast, have increased rates of fracture propagation, displacement, delayed and non-union, and so require immediate cessation of activity, with orthopaedic referral, to assess the need for surgical intervention. These include stress fractures of the Anterior Tibial Diaphysis, Fifth Metatarsal Base, Medial Malleolus, Lateral Femoral Neck, Tarsal Navicular and Great Toe Sesamoids. In order to establish the optimal methods for managing these injuries, we present and review the current evidence which guides the treatment of stress fractures in athletes. From this, we note an increased role for surgical management of certain high risk stress fractures to improve return times and rates to sport. Following this, key recommendations are provided for the management of the common stress fracture types seen in the athlete. Five case reports are also presented to illustrate the application of sport-focussed lower limb stress fracture treatment in the clinical setting. PMID:28361017

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

    PubMed

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

    2015-04-01

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

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

    PubMed

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

    2017-01-01

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

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

    PubMed

    Yu, Liang; Fenglin, Zhong

    2015-04-01

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

  19. Identifying sex-specific risk factors for stress fractures in adolescent runners.

    PubMed

    Tenforde, Adam S; Sayres, Lauren C; McCurdy, Mary Liz; Sainani, Kristin L; Fredericson, Michael

    2013-10-01

    Adolescent females and males participating in running represent a population at high risk of stress fracture. Few investigators have evaluated risk factors for prospective stress fracture in this population. To better characterize risk factors for and incidence of stress fractures in this population, we collected baseline risk factor data on 748 competitive high school runners (442 girls and 306 boys) using an online survey. We then followed them prospectively for the development of stress fractures for a mean ± SD of 2.3 ± 1.2 total seasons of cross-country and track and field; follow-up data were available for 428 girls and 273 boys. We identified prospective stress fractures in 5.4% of girls (n = 23) and 4.0% of boys (n = 11). Tibial stress fractures were most common in girls, and the metatarsus was most frequently fractured in boys. Multivariate regression identified four independent risk factors for stress fractures in girls: prior fracture, body mass index < 19, late menarche (age menarche ≥15 yr), and previous participation in gymnastics or dance. For boys, prior fracture and increased number of seasons were associated with an increased rate of stress fractures, whereas prior participation in basketball was associated with a decreased risk of stress fractures. Prior fracture represents the most robust predictor of stress fractures in both sexes. Low body mass index, late menarche, and prior participation in gymnastics and dance are identifiable risk factors for stress fractures in girls. Participation in basketball appears protective in boys and may represent a modifiable risk factor for stress fractures. These findings may help guide future translational research and clinical care in the management and prevention of stress fractures in young runners.

  20. Sacral stress fractures in athletes.

    PubMed

    McFarland, E G; Giangarra, C

    1996-08-01

    Low back and buttock pain in runners can be a source of frustration for the athlete and a diagnostic dilemma for the physician. The authors reported on 3 cases of sacral stress fractures in women athletes, all of which initially presented as low back and/or buttock pain. Sacral stress fractures have been increasingly recognized as a potential cause of these symptoms, especially in young athletes. Because plain radiograph findings are typically normal, the diagnosis is best made with bone scintigraphy. Computed tomography is indicated if there is concern about neoplasm and to evaluate healing of the fracture. If treated with rest, most of these fractures heal and the athlete can return to previous sports activity. The treating physician should be suspicious of this injury among running athletes reporting sacral and buttock pain that does not respond to treatment.

  1. Dynamic midfoot kinematics in subjects with medial tibial stress syndrome.

    PubMed

    Rathleff, Michael S; Kelly, Luke A; Christensen, Finn B; Simonsen, Ole H; Kaalund, Søren; Laessoe, Uffe

    2012-01-01

    Medial tibial stress syndrome (MTSS) is a common diagnosis. Several studies have demonstrated that excessive static navicular drop (ND) is related to the diagnosis. However, no studies have yet investigated ND and the velocity of ND during dynamic conditions. The aim of this study was to evaluate ND characteristics in patients with MTSS in dynamic and static conditions. In a case-control study, 14 patients diagnosed as having MTSS were included from an orthopedic outpatient clinic. A control group consisting of 14 healthy participants was matched regarding age, sex, and typical sporting activity. Navicular drop was evaluated during treadmill walking by a two-dimensional video analysis. Static foot posture, static ND, dynamic ND (dND), and velocity of dND were compared. The two groups were comparable in relation to age, sex, height, weight, and foot size. No significant difference was found in static foot posture. Static ND showed a mean difference of 1.7 mm between the groups (P = .08). During treadmill walking, patients with MTSS had, on average, a 1.5-mm-larger dND (P =.004) and a 2.4-mm/sec-larger mean velocity of dND (P = .03). Patients with MTSS display a larger ND and a higher ND velocity during treadmill walking. Increased ND velocity may be important to this condition. Future studies should include velocity of dND to investigate the mechanisms of dND in relation to overuse injuries.

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

    PubMed

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

    2017-07-01

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

  3. The pathophysiology of stress fractures.

    PubMed

    Pepper, Michelle; Akuthota, Venu; McCarty, Eric C

    2006-01-01

    Stress fractures can occur in any active individual, from the weekend warrior to the elite athlete. As these injuries occur, it is important to understand how bones respond to the stresses placed on them. The understanding of potential intrinsic and extrinsic causes is important in treatment of these injuries. The proper identification and prevention of these stress injuries allows for athletes to return to activity expeditiously.

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

    PubMed

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

    2007-06-01

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

  5. Interaction among fractures and stress field computation of fracture systems

    NASA Astrophysics Data System (ADS)

    Zhang, Zhi-Li

    1994-12-01

    The interaction problem among fractures under the action of compressional stress is studied in this paper by using the finite element method and boundary element method respectively. The mechanical criteria which differentiate between the independent fractures and fracture systems and their computation methods are presented in this paper. The proportional conditions between length and spacing of fractures that exist interaction for several kinds of fracture groups of different geometric arrangement are given. The effect of interaction among fractures on the displacement field, stress field and strain energy distribution are computed. The relations between the fracture system of conjugate array and conjugate earthquakes are also discussed in this paper.

  6. 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.

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

    PubMed

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

    2015-03-01

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

  8. Medial tibial stress syndrome: evidence-based prevention.

    PubMed

    Craig, Debbie I

    2008-01-01

    Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc. 2002;34(1):32-40. Among physically active individuals, which medial tibial stress syndrome (MTSS) prevention methods are most effective to decrease injury rates? Studies were identified by searching MEDLINE (1966-2000), Current Contents (1996-2000), Biomedical Collection (1993-1999), and Dissertation Abstracts. Reference lists of identified studies were searched manually until no further studies were identified. Experts in the field were contacted, including first authors of randomized controlled trials addressing prevention of MTSS. The Cochrane Collaboration (early stage of Cochrane Database of Systematic Reviews) was contacted. Inclusion criteria included randomized controlled trials or clinical trials comparing different MTSS prevention methods with control groups. Excluded were studies that did not provide primary research data or that addressed treatment and rehabilitation rather than prevention of incident MTSS. A total of 199 citations were identified. Of these, 4 studies compared prevention methods for MTSS. Three reviewers independently scored the 4 studies. Reviewers were blinded to the authors' names and affiliations but not the results. Each study was evaluated independently for methodologic quality using a 100-point checklist. Final scores were averages of the 3 reviewers' scores. Prevention methods studied were shock-absorbent insoles, foam heel pads, Achilles tendon stretching, footwear, and graduated running programs. No statistically significant results were noted for any of the prevention methods. Median quality scores ranged from 29 to 47, revealing flaws in design, control for bias, and statistical methods. No current evidence supports any single prevention method for MTSS. The most promising outcomes support the use of shock-absorbing insoles. Well-designed and controlled trials are critically needed

  9. Medial Tibial Stress Syndrome: Evidence-Based Prevention

    PubMed Central

    Craig, Debbie I

    2008-01-01

    Reference: Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc. 2002;34(1):32–40. Clinical Question: Among physically active individuals, which medial tibial stress syndrome (MTSS) prevention methods are most effective to decrease injury rates? Data Sources: Studies were identified by searching MEDLINE (1966–2000), Current Contents (1996–2000), Biomedical Collection (1993–1999), and Dissertation Abstracts. Reference lists of identified studies were searched manually until no further studies were identified. Experts in the field were contacted, including first authors of randomized controlled trials addressing prevention of MTSS. The Cochrane Collaboration (early stage of Cochrane Database of Systematic Reviews) was contacted. Study Selection: Inclusion criteria included randomized controlled trials or clinical trials comparing different MTSS prevention methods with control groups. Excluded were studies that did not provide primary research data or that addressed treatment and rehabilitation rather than prevention of incident MTSS. Data Extraction: A total of 199 citations were identified. Of these, 4 studies compared prevention methods for MTSS. Three reviewers independently scored the 4 studies. Reviewers were blinded to the authors' names and affiliations but not the results. Each study was evaluated independently for methodologic quality using a 100-point checklist. Final scores were averages of the 3 reviewers' scores. Main Results: Prevention methods studied were shock-absorbent insoles, foam heel pads, Achilles tendon stretching, footwear, and graduated running programs. No statistically significant results were noted for any of the prevention methods. Median quality scores ranged from 29 to 47, revealing flaws in design, control for bias, and statistical methods. Conclusions: No current evidence supports any single prevention method for MTSS. The most

  10. 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.

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

    PubMed

    Boekhout, Christina; Cross, Alan

    2012-10-01

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

  12. Etiologic factors in the development of medial tibial stress syndrome: a review of the literature.

    PubMed

    Tweed, Jo L; Avil, Steven J; Campbell, Jackie A; Barnes, Mike R

    2008-01-01

    Medial tibial stress syndrome is a type of exercise-induced leg pain that is common in recreational and competitive athletes. Although various studies have attempted to find the exact pathogenesis of this common condition, it remains unknown. Various theories in literature from 1976 to 2006 were reviewed using key words. Until recently, inflammation of the periosteum due to excessive traction was thought to be the most likely cause of medial tibial stress syndrome. This periostitis has been hypothesized by some authors to be caused by the tearing away of the muscle fibers at the muscle-bone interface, although there are several suggestions as to which, if any, muscle is responsible. Recent studies have supported the view that medial tibial stress syndrome is not an inflammatory process of the periosteum but instead a stress reaction of bone that has become painful.

  13. Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners.

    PubMed

    Tweed, Jo L; Campbell, Jackie A; Avil, Steven J

    2008-01-01

    We investigated the relationship between functional and static foot posture and medial tibial stress syndrome in distance runners. Twenty-eight runners with a clinical diagnosis of medial tibial stress syndrome and 12 asymptomatic runners were assessed with the Foot Posture Index to measure static overpronation. Range of motion was measured at the talocrural joint, with the knee extended and flexed as was range of motion at the first metatarsophalangeal joint and the angular difference between the neutral and relaxed calcaneal stance positions. Each participant was then videotaped while running on a treadmill shod and unshod. This videotape was analyzed using freeze frame to identify abnormal or mistimed pronation at each phase of gait. The results were analyzed using logistic regression to give the probability that a runner is likely to experience medial tibial stress syndrome, predicted from the static measurements and dynamic observations. Variables identified as being significant predictors of medial tibial stress syndrome were the difference between the neutral and relaxed calcaneal stance positions, range of motion of the talocrural joint with the knee extended, early heel lift and abductory twist during gait, and apropulsive gait. Runners with suspected symptoms of medial tibial stress syndrome should be assessed dynamically and statically for abnormal or mistimed pronation.

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

    PubMed

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

    2016-12-01

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

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

    PubMed

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

    2009-03-01

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

  16. Treatment of medial tibial stress syndrome: a systematic review.

    PubMed

    Winters, Marinus; Eskes, Michel; Weir, Adam; Moen, Maarten H; Backx, Frank J G; Bakker, Eric W P

    2013-12-01

    Medial tibial stress syndrome (MTSS) is a common exercise-induced leg injury among athletes and military personnel. Several treatment options have been described in the literature, but it remains unclear which treatment is most effective. The objective of this systematic review was to assess the effectiveness of any intervention in the treatment of MTSS. Published or non-published studies, reporting randomized or non-randomized controlled trials of any treatment in subjects with MTSS were eligible for inclusion. Treatments were assessed for effects on pain, time to recovery or global perceived effect. Computerized bibliographic databases (MEDLINE, CENTRAL, EMBASE, CINAHL, PEDro and SPORTDiscus) and trial registries were searched for relevant reports, from their inception to 1 June 2012. Grey literature was searched for additional relevant reports. The Cochrane Risk of Bias Tool was used to appraise study quality of randomized clinical trials (RCTs) whereas the Newcastle Ottawa Scale was used to appraise non-randomized trials. The 'levels of evidence', according to the Oxford Centre for Evidence-Based Medicine, addressed the impact of the assessed trials. Two reviewers independently performed the search for articles, study selection, data extraction and appraised methodological quality. Eleven trials were included in this systematic review. All RCTs revealed a high risk of bias (Level 3 of evidence). Both non-randomized clinical trials were found to be of poor quality (Level 4 of evidence). RCTs, studying the effect of a lower leg brace versus no lower leg brace, and iontophoresis versus phonophoresis, were pooled using a fixed-effects model. No significant differences were found for lower leg braces (standardized mean difference [SMD] -0.06; 95 % CI -0.44 to 0.32, p = 0.76), or iontophoresis (SMD 0.09; 95 % CI -0.50 to 0.68, p = 0.76). Iontophoresis, phonophoresis, ice massage, ultrasound therapy, periosteal pecking and extracorporeal shockwave therapy (ESWT

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

    PubMed

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

    2009-02-01

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

  18. Differentiating Stress Fracture From Periostitis.

    PubMed

    Martire, J R

    1994-10-01

    In brief Even in the age of high-technology MRI and CT, the triple-phase bone scan (TPBS) remains an exceptionally useful and accurate tool in evaluating athletic injuries. This is perhaps best seen in active people with overuse injuries of the tibia, femur, or humerus when plain films are negative but bone pain persists. Differentiating periostitis from stress fracture requires analyzing distinctive TPBS appearances and patterns.

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

    PubMed

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

    2017-12-01

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

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

    PubMed

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

    2009-04-01

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

  1. 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

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

    PubMed

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

    2017-09-22

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

  3. Diagnosis and management of acute medial tibial stress syndrome in a 15 year old female surf life-saving competitor.

    PubMed

    Pietrzak, Max

    2014-08-01

    As the profound health and cost benefits of physical activity to society are established and participation guidelines implemented, health practitioners are increasingly expected to utilize efficacious and justified injury management and prevention strategies. The complex and multifactorial nature of sports injury makes elucidation of multiple risk factors and how they may subtly and variably interact, difficult. The purpose of this case report is to discuss the differential diagnosis, acute management and rehabilitation of a case of medial tibial stress syndrome (MTSS) in a surf life-saving athlete, in the context of sports injury prevention. The subject of this case study, a 15 year old female surf life-saving competitor, presented to the physiotherapist (PT) with recent onset, first episode, bilateral, diffuse posteromedial shin pain. Differential diagnosis, acute management, rehabilitation and preventative strategies for the subject are presented. Emerging injury surveillance research in surf life-saving suggests minor and major trauma as primary causative factors, however, the significance of high training volumes is likely underestimated. The influence of biomechanical, and subtle arthrokinematic dysfunctions on established risk factors for MTSS injury and prevention of re-injury for this subject, are also discussed. Furthermore, the concept of preventing tibial stress fracture (TSF) by successfully managing acute MTSS, is presented. Lastly, a critical analysis of reliability of clinical assessment methodologies utilised with the subject is provided. Level 5; Single case report.

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

    PubMed

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

    1999-06-01

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

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

    PubMed

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

    2014-04-01

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

  6. Treatment of Medial Tibial Stress Syndrome With Radial Soundwave Therapy in Elite Athletes: Current Evidence, Report on Two Cases, and Proposed Treatment Regimen.

    PubMed

    Saxena, Amol; Fullem, Brian; Gerdesmeyer, Ludger

    Two case reports of high-level athletes with medial tibial stress syndrome (MTSS), 1 an Olympian with an actual stress fracture, are presented. Successful treatment included radial soundwave therapy, pneumatic leg braces, relative rest using an antigravity treadmill, and temporary foot orthoses. Radial soundwave therapy has a high level of evidence for treatment of MTSS. We also present recent evidence of the value of vitamin D assessment. Both patients had a successful outcome with minimal downtime. Finally, a suggested treatment regimen for MTSS is presented. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Gait retraining and incidence of medial tibial stress syndrome in army recruits.

    PubMed

    Sharma, Jagannath; Weston, Matthew; Batterham, Alan M; Spears, Iain R

    2014-09-01

    Gait retraining, comprising biofeedback and/or an exercise intervention, might reduce the risk of musculoskeletal conditions. The purpose was to examine the effect of a gait-retraining program on medial tibial stress syndrome incidence during a 26-wk basic military training regimen. A total of 450 British Army recruits volunteered. On the basis of a baseline plantar pressure variable (mean foot balance during the first 10% of stance), participants classified as at risk of developing medial tibial stress syndrome (n = 166) were randomly allocated to an intervention (n = 83) or control (n = 83) group. The intervention involved supervised gait retraining, including exercises to increase neuromuscular control and flexibility (three sessions per week) and biofeedback enabling internalization of the foot balance variable (one session per week). Both groups continued with the usual military training regimen. Diagnoses of medial tibial stress syndrome over the 26-wk regimen were made by physicians blinded to the group assignment. Data were modeled in a survival analysis using Cox regression, adjusting for baseline foot balance and time to peak heel rotation. The intervention was associated with a substantially reduced instantaneous relative risk of medial tibial stress syndrome versus control, with an adjusted HR of 0.25 (95% confidence interval, 0.05-0.53). The number needed to treat to observe one additional injury-free recruit in intervention versus control at 20 wk was 14 (11 to 23) participants. Baseline foot balance was a nonspecific predictor of injury, with an HR per 2 SD increment of 5.2 (1.6 to 53.6). The intervention was effective in reducing incidence of medial tibial stress syndrome in an at-risk military sample.

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

    PubMed

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

    2017-12-01

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

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

    PubMed

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

    2016-03-01

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

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

    PubMed

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

    2013-09-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2013-11-01

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

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

    PubMed

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

    2016-03-01

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

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

    PubMed

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

    2012-02-01

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

  16. Female athlete triad and stress fractures.

    PubMed

    Feingold, David; Hame, Sharon L

    2006-10-01

    Stress fractures are a common occurrence in athletes, and the incidence of stress fractures in female Division 1 collegiate athletes is double that of men. Hormonal influences on bone and bone morphology may influence the risk for fracture. A high level of suspicion and special imaging procedures allow for accurate diagnosis of these fractures. In stress fractures that are associated with the female athlete triad, addressing the three aspects of the triad--eating disorders, amenorrhea, and osteoporosis--are critical for successful treatment. Preparticipation screening for the presence of signs of the female athlete triad by monitoring weight, energy level, menstrual cycles, and bone mineral density may help to prevent the occurrence of stress fractures in this population.

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

    PubMed Central

    2013-01-01

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

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

    PubMed

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

    2016-11-25

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

  19. Treatment of stress fractures: the fundamentals.

    PubMed

    Raasch, William Glenn; Hergan, David J

    2006-01-01

    This article is an introduction to the fundamentals of stress fracture management. Extrinsic and intrinsic factors, that may play a role in the development of stress fractures, are discussed and incorporated as possible treatment options. Different treatment modalities including ultrasound and electromagnetic fields are addressed, with an emphasis on literature support.

  20. [Stress reactions and stress fractures in the high performance athlete. Causes, diagnosis and therapy].

    PubMed

    Geyer, M; Sander-Beuermann, A; Wegner, U; Wirth, C J

    1993-02-01

    From 1987 until July 1991 70 athletes with stress reactions or stress fractures were treated in the orthopaedic department of the Hannover Medical School. The average age of the 42 male and 28 female athletes was 22.6 years. The number of athletes involved in track and field sports was 29 (41.4%), in gymnastics 9 (12.9%) and in soccer 5 (7.1%). The most common bone injured was the tibia in 29 (41.4%), followed by the tarsal navicular in 21 (30.0%), the midfoot in 17 (24.3%) and the fibula in 4 (5.7%) athletes. In three cases double stress fractures were found in adjacent locations; in one case a stress fracture of the opposite navicular occurred after the initial tarsal navicular stress fracture had healed, and in another case the tarsal navicular was found to be fractured again. Thirty-seven percent of the athletes claimed sudden increase in training intensity was the cause; 33% felt that the increased sprinting and jump activities were the reason for their complaints. In some athletes pain started after an ankle sprain. Standard diagnostic procedure consisted in X-rays in two planes and three-phase bone scanning. In tarsal navicular or tibial locations additional tomograms were performed. MRI and CT scans were reserved for unclear findings and to exclude the possibility of a tumorous or inflammatory process. A new grading system was introduced that covers all forms of stress reactions from periostitis to pseudarthrosis. Clinical symptoms, sport disabilities, radiological and bone scan findings were graded from A to D. Using a modified Wilson classification, all radiologically recognizable stress reactions could be classified.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Anatomic dissection of the tibialis posterior muscle and its correlation to medial tibial stress syndrome.

    PubMed

    Saxena, A; O'Brien, T; Bunce, D

    1990-01-01

    The authors attempt to redefine the anatomic origin of the tibialis posterior muscle, and correlate it with the location of medial tibial stress syndrome that occurs in the lower third of the tibia. Contrary to what is commonly described, the authors show on all ten dissected specimens, that the origin of the tibialis posterior does include a portion of the lower third of the tibia. The mean distance from tibialis posterior's origin to the medial malleolus was only 7.77 cm. In addition, to further explain lower leg pain, the authors investigated the crossing point of tibialis posterior and flexor digitorum longus; a mean distance for this to occur in the same ten specimens was 8.16 cm. proximal to the medial malleolus. These findings provide insight to anatomic reasons behind biomechanical factors responsible for medial tibial stress syndrome. This is also important to consider when performing surgery for a deep compartment syndrome.

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2016-03-01

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

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

    PubMed

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

    2016-08-01

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

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

    PubMed

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

    2018-02-06

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

  6. Biomechanical Factors in the Etiology of Tibial Stress Fractures

    DTIC Science & Technology

    2006-08-01

    Anterior Cruciate Ligament Injuries? Departments of Physical Therapy and Exercise and Sports Science, East Carolina University, Greenville, NC, October 16...IS. (2001) A Radiographic Analysis of the Relationship between the Size and Shape of the Intercondylar Notch and Anterior Cruciate Ligament Injury...Relationship between the Size and Shape of the Intercondylar Notch and Anterior Cruciate Ligament Injury Presented at the ACL Research Retreat

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

    PubMed

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

    2016-08-01

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

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

    PubMed

    Banerjee, Purnajyoti; McLean, Christopher

    2011-06-14

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

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

    PubMed Central

    Kulshrestha, Vikas

    2008-01-01

    Background: A major drawback of conventional fixator system is the penetration of fixator pins into the medullary canal. The pins create a direct link between the medullary cavity and outer environment, leading to higher infection rates on conversion to intramedullary nailing. This disadvantage is overcome by the AO pinless fixator, in which the trocar points are clamped onto the outer cortex without penetrating it. This study was designed to evaluate the role of AO pinless fixators in primary stabilization of open diaphyseal tibial fractures that received staged treatment because of delayed presentation or poor general condition. We also analyzed the rate of infection on early conversion to intramedullary nail. Materials and Methods: This study is a retrospective review of 30 open diaphyseal fractures of tibia, which were managed with primary stabilization with pinless fixator and early exchange nailing. Outcome was evaluated in terms of fracture union and rate of residual infection. The data were compared with that available in the literature. Results: All the cases were followed up for a period of 2 years. The study includes Gustilo type 1 (n=10), 14 Gustilo type 2 (n=14), and type3 (n=6) cases. 6 cases (20%) had clamp site infection, 2 cases (6.7%) had deep infection, and in 28 cases (93%) the fracture healed and consolidated well. Conclusion: This study has highlighted the valuable role of pinless external fixator in the management of open tibial fractures in terms of safety and ease of application as well as the advantage of early conversion to intramedullary implant without the risk of deep infection. PMID:19753227

  10. Transverse Stress Fracture of the Proximal Patella

    PubMed Central

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-01-01

    Abstract Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete. A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity. Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws. PMID:26871789

  11. Anterior tibial striations.

    PubMed

    Daffner, R H

    1984-09-01

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

  12. 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

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

    PubMed

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

    2012-05-01

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

  14. Spontaneous stress fractures of the femoral neck

    SciTech Connect

    Dorne, H.L.; Lander, P.H.

    1985-02-01

    The diagnosis of spontaneous stress fractures of the femoral neck, a form of insufficiency stress fracture, can be missed easily. Patients present with unremitting hip pain without a history of significant trauma or unusual increase in daily activity. The initial radiographic features include osteoporosis, minor alterations of trabecular alignment, minimal extracortical or endosteal reaction, and lucent fracture lines. Initial scintigraphic examinations performed in three of four patients showed focal increased radionuclide uptake in two and no focal abnormality in one. Emphasis is placed on the paucity of early findings. Evaluation of patients with persistent hip pain requires a high degree of clinical suspicion and close follow-up; the sequelae of undetected spontaneous fractures are subcapital fracture with displacement, angular deformity, and a vascular necrosis of the femoral head.

  15. Fractured pebbles—A new stress indicator

    NASA Astrophysics Data System (ADS)

    Eidelman, Amir; Reches, Ze'ev

    1992-04-01

    Well-organized patterns of tensile fractures were found in pebbles of young conglomerates in the Salton trough, California, and in the Dead Sea rift, Israel. The fractures are subparallel to each other in a single pebble and are within numerous pebbles in an outcrop. We show that intrapebble tension could develop due to the amplification of the stresses inside a competent pebble embedded within a compliant matrix; furthermore, tensile stresses may form in the pebbles, even under compressive tectonic stresses. The regional trends of the fractures are consistent in each of the study areas, and they appear to be excellent indicators of the tectonic stresses. The derived angles between σhmax (the largest horizontal compression) and the dominant local strike-slip fault is about 40° in the En Yahav region of the Dead Sea rift, and about 75° in the Indio Hills area of the Salton trough; these angles are in agreement with other stress data.

  16. Rare stress fracture: longitudinal fracture of the femur.

    PubMed

    Pérez González, M; Velázquez Fragua, P; López Miralles, E; Abad Moretón, M M

    2017-09-21

    42-year-old man with pain in the posterolateral region of the right knee that began while he was running. Initially, it was diagnosed by magnetic resonance (MR) as a possible aggressive process (osteosarcoma or Ewing's sarcoma) but with computed tomography it was noted a cortical hypodense linear longitudinal image with a continuous, homogeneous and solid periosteal reaction without clear soft tissue mass that in this patient suggest a longitudinal distal femoral fatigue stress fracture. This type of fracture at this location is very rare. Stress fractures are entities that can be confused with an agressive process. MR iscurrently the most sensitive and specific imaging method for its diagnosis. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Inverse relationship between the complexity of midfoot kinematics and muscle activation in patients with medial tibial stress syndrome.

    PubMed

    Rathleff, M S; Samani, A; Olesen, C G; Kersting, U G; Madeleine, P

    2011-08-01

    Medial tibial stress syndrome is a common overuse injury characterized by pain located on the medial side of the lower leg during weight bearing activities such as gait. The purpose of this study was to apply linear and nonlinear methods to compare the structure of variability of midfoot kinematics and surface electromyographic (SEMG) signals between patients with medial tibial stress syndrome and healthy controls during gait. Fourteen patients diagnosed with medial tibial stress syndrome and 11 healthy controls were included from an orthopaedic clinic. SEMG from tibialis anterior and the soleus muscles as well as midfoot kinematics were recorded during 20 consecutive gait cycles. Permuted sample entropy and permutation entropy were used as a measure of complexity from SEMG signals and kinematics. SEMG signals in patients with medial tibial stress syndrome were characterized by higher structural complexity compared with healthy controls (p<0.001) while it was the opposite for the midfoot kinematics (p=0.01). Assessing the complexity of midfoot kinematics and SEMG activation pattern enabled a precise characterization of gait in patients with medial tibial stress syndrome. The reported inverse relationship in foot kinematics and SEMG complexity most likely point towards separated control processes governing gait variability. Copyright © 2011 Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2015-11-01

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

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

    PubMed

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

    2017-01-01

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

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

    PubMed

    Halim, A S; Yusof, I

    2004-06-01

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

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

    PubMed

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

    2017-05-01

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

  2. Contact stress analysis of the tibial component of prosthetic knee implants.

    PubMed

    McGloughlin, T M; Monaghan, J M

    1997-01-01

    The engineering problems associated with implantation into the human body of prosthetic knee implants and some of the outstanding issues facing engineering designers in this growing sector of orthopaedic medicine are described. The contact behaviour of polymeric tibial components was modelled using a stainless steel indentor in contact with an Araldite CT200 block which contained embedded strain gauges. The block was subjected to normal and sliding loads and the stresses in the block were evaluated using the strain data; the results were compared with results obtained from finite element analysis. The results are considered in the light of recent experience with non-conforming knee implants.

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

    PubMed

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

    2018-01-08

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

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

    PubMed

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

    2017-04-01

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

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

    PubMed

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

    2015-02-01

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

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

    PubMed

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

    2018-03-01

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

  7. Stress fractures: definition, diagnosis and treatment.

    PubMed

    Astur, Diego Costa; Zanatta, Fernando; Arliani, Gustavo Gonçalves; Moraes, Eduardo Ramalho; Pochini, Alberto de Castro; Ejnisman, Benno

    2016-01-01

    Stress fractures were first described in Prussian soldiers by Breithaupt in 1855. They occur as the result of repeatedly making the same movement in a specific region, which can lead to fatigue and imbalance between osteoblast and osteoclast activity, thus favoring bone breakage. In addition, when a particular region of the body is used in the wrong way, a stress fracture can occur even without the occurrence of an excessive number of functional cycles. The objective of this study was to review the most relevant literature of recent years in order to add key information regarding this pathological condition, as an updating article on this topic.

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

    PubMed

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

    2014-03-01

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

  9. An isolated iliac wing stress fracture in a marathon runner.

    PubMed

    Amorosa, Louis F; Serota, Alana C; Berman, Nathaniel; Lorich, Dean G; Helfet, David L

    2014-02-01

    Iliac stress fractures are uncommon and are usually insufficiency fractures related to osteoporosis. Only 2 previous case reports of iliac stress fractures in runners that extended into the sacroiliac joint, and 1 previous case of an isolated iliac wing stress fracture not involving the sacroiliac joint were found in the English language literature. We report on a second case of an isolated stress fracture of the iliac wing in a female marathon runner and the associated diagnosis of the female athlete triad. Iliac stress fractures can be an occult cause of hip pain in athletes and should be included in the differential diagnosis of hip pain in a marathon runner.

  10. Dynamic Contact Stress Patterns on the Tibial Plateaus during Simulated Gait: A Novel Application of Normalized Cross Correlation

    PubMed Central

    Wang, Hongsheng; Chen, Tony; Torzilli, Peter; Warren, Russell; Maher, Suzanne

    2014-01-01

    The spatial distribution and pattern of local contact stresses within the knee joint during activities of daily living have not been fully investigated. The objective of this study was to determine if common contact stress patterns exist on the tibial plateaus of human knees during simulated gait. To test this hypothesis, we developed a novel normalized cross-correlation (NCC) algorithm and applied it to the contact stresses on the tibial plateaus of twelve human cadaveric knees subjected to multi-directional loads mimicking gait. The contact stress profiles at different locations on the tibial plateaus were compared, where regions with similar contact stress patterns were identified across specimens. Three consistent regional patterns were found, among them two most prominent contact stress patterns were shared by 9 to 12 of all the knees and the third pattern was shared by 6 to 8 knees. The first pattern was located at the posterior aspect of the medial tibial plateau and had a single peak stress that occurred during the early stance phase. The second pattern was located at the central-posterior aspects of the lateral plateau and consisted of two peak stresses coincident with the timing of peak axial force at early and late stance. The third pattern was found on the anterior aspect of cartilage-to-cartilage contact region on the medial plateau consisted of double peak stresses. The differences in the location and profile of the contact stress patterns suggest that the medial and lateral menisci function to carry load at different points in the gait cycle: with the posterior aspect of the medial meniscus consistently distributing load only during the early phase of stance, and the posterior aspect of the lateral meniscus consistently distributing load during both the early and late phases of stance. This novel approach can help identify abnormalities in knee contact mechanics and provide a better understanding of the mechanical pathways leading to post

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

    PubMed

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

    2015-06-13

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

  12. Fluid Production Induced Stress Analysis Surrounding an Elliptic Fracture

    NASA Astrophysics Data System (ADS)

    Pandit, Harshad Rajendra

    Hydraulic fracturing is an effective technique used in well stimulation to increase petroleum well production. A combination of multi-stage hydraulic fracturing and horizontal drilling has led to the recent boom in shale gas production which has changed the energy landscape of North America. During the fracking process, highly pressurized mixture of water and proppants (sand and chemicals) is injected into to a crack, which fractures the surrounding rock structure and proppants help in keeping the fracture open. Over a longer period, however, these fractures tend to close due to the difference between the compressive stress exerted by the reservoir on the fracture and the fluid pressure inside the fracture. During production, fluid pressure inside the fracture is reduced further which can accelerate the closure of a fracture. In this thesis, we study the stress distribution around a hydraulic fracture caused by fluid production. It is shown that fluid flow can induce a very high hoop stress near the fracture tip. As the pressure gradient increases stress concentration increases. If a fracture is very thin, the flow induced stress along the fracture decreases, but the stress concentration at the fracture tip increases and become unbounded for an infinitely thin fracture. The result from the present study can be used for studying the fracture closure problem, and ultimately this in turn can lead to the development of better proppants so that prolific well production can be sustained for a long period of time.

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

    PubMed

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

    2004-02-01

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

  14. Foot medial longitudinal-arch deformation during quiet standing and gait in subjects with medial tibial stress syndrome.

    PubMed

    Bandholm, Thomas; Boysen, Lisbeth; Haugaard, Stine; Zebis, Mette Kreutzfeldt; Bencke, Jesper

    2008-01-01

    The objective of this study was to investigate (1) if subjects with medial tibial stress syndrome demonstrate increased navicular drop and medial longitudinal-arch deformation during quiet standing and gait compared with healthy subjects, and (2) the relationship between medial longitudinal-arch deformation during quiet standing and gait. Thirty subjects aged 20 to 32 years were included (15 with medial tibial stress syndrome and 15 controls). Navicular drop and medial longitudinal-arch deformation were measured during quiet standing with neutral and loaded foot using a ruler and digital photography. Medial longitudinal-arch deformation was measured during walking gait using 3-dimensional gait analysis. Subjects with medial tibial stress syndrome demonstrated a significantly larger navicular drop (mean +/- 1 SD, 7.7 +/- 3.1 mm) and medial longitudinal-arch deformation (5.9 +/- 3.2 degrees) during quiet standing compared with controls (5.0 +/- 2.2 mm and 3.5 +/- 2.6 degrees, P < .05). Subjects with medial tibial stress syndrome also demonstrated significantly larger medial longitudinal-arch deformation (8.8 +/- 1.8 degrees) during gait compared with controls (7.1 +/- 1.7 degrees, P = .015). There was no correlation between medial longitudinal-arch deformation during quiet standing and gait in either of the 2 groups (r < 0.127, P > .653). The subjects with medial tibial stress syndrome in this study demonstrated increased navicular drop and medial longitudinal-arch deformation during quiet standing and increased medial longitudinal-arch deformation during gait compared to healthy subjects. Medial longitudinal-arch deformation during quiet standing did not correlate with medial longitudinal-arch deformation during gait in either of the 2 groups. ACFAS Level of Clinical Evidence: 5.

  15. Use of foot orthoses and calf stretching for individuals with medial tibial stress syndrome.

    PubMed

    Loudon, Janice K; Dolphino, Martin R

    2010-02-01

    Use of orthotics and calf stretching may alleviate symptoms in runners with medial tibial stress syndrome (MTSS). The objective of this study was to determine which patients with MTSS have a positive response to off-the-shelf foot orthoses and calf stretching based on selected clinical tests to establish a clinical prediction rule. This prospective cohort/predictive validity study enrolled 23 women and men aged 22 to 44 years with symptoms of MTSS. Interventions included off-the-shelf basic foot orthotics and calf stretching. Fifteen of the 23 runners had a 50% reduction of pain in 3 weeks of intervention. Duration was a significant factor that differentiated groups. Although an initial treatment for runners with MTSS may include off-the-shelf orthotics and calf stretching, this regimen should be only one component of an individualized rehabilitation program.

  16. Atrophy and Depigmentation After Pretibial Corticosteroid Injection for Medial Tibial Stress Syndrome: Two Case Reports.

    PubMed

    Loopik, Miette F; Winters, Marinus; Moen, Maarten H

    2016-12-01

    No reports have been published on the results of corticosteroid injections for medial tibial stress syndrome (MTSS). The authors present 2 cases of women with MTSS who showed atrophy and depigmentation of the skin after pretibial corticosteroid injections. Case 1 is an 18-y-old woman presenting with pain in her lower leg for 12 mo. No improvement was noticed after conservative treatment, so she received local injections with corticosteroids. Five months later physical examination showed tissue atrophy and depigmentation around the injection sites. Case 2 is a 22-y-old woman who presented with pain in both lower legs for 24 mo. Several conservative treatment options failed, so she received local injections with corticosteroids. Physical examination revealed tissue atrophy and depigmentation around the injection sites. No positive effect of injections with corticosteroids was found in 2 cases of MTSS. Furthermore, considerable tissue atrophy and hypopigmentation of the skin was observed.

  17. Shear Modulus of the Lower Leg Muscles in Patients with Medial Tibial Stress Syndrome.

    PubMed

    Akiyama, Kei; Akagi, Ryota; Hirayama, Kuniaki; Hirose, Norikazu; Takahashi, Hideyuki; Fukubayshi, Toru

    2016-08-01

    This study aimed to investigate the in vivo kinematics of shear modulus of the lower leg muscles in patients with medial tibial stress syndrome (MTSS). The study population included 46 limbs with MTSS and 40 healthy limbs. The shear modulus of the medial head of the gastrocnemius, lateral head of the gastrocnemius, soleus, peroneus longus and tibialis anterior muscles were measured using shear wave ultrasound elastography. As a result, the shear modulus of the lower leg muscles was significantly greater in patients with MTSS than in healthy patients (p < 0.01). Based on the differences in shear modulus of lower leg muscles between the patients with MTSS and healthy patients, the measurements obtained via shear wave ultrasound elastography could be used to evaluate risk factors of MTSS. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  18. Factors contributing to the development of medial tibial stress syndrome in high school runners.

    PubMed

    Bennett, J E; Reinking, M F; Pluemer, B; Pentel, A; Seaton, M; Killian, C

    2001-09-01

    Predictive correlational study. To identify the incidence of medial tibial stress syndrome (MTSS) in a group of high school cross-country runners and to determine if a relationship exists between lower extremity structural measures and the incidence of MTSS. Medial tibial stress syndrome is an overuse injury that occurs in long-distance runners. Literature exists that implicates structural deformity as a contributor to MTSS, but no studies have developed a predictive model. We measured 125 high school cross-country runners for tibiofibular varum, resting calcaneal position during stance, and gastrocnemius length. Runners developing MTSS over an 8-week period were placed in the injured group (2 men, 13 women; age 15.3 years 1.0), and 21 randomly selected uninjured runners were placed in the uninjured group (13 men, 8 women; age 15.7 years +/-1.5). Navicular drop was measured for runners in both groups. Reliability of measures was determined using an intraclass correlation coefficient (ICC 3,1). Paired t tests were used to compare the injury and noninjury groups. A logistic regression analysis was used to establish if the descriptive data could accurately predict the development of MTSS. Paired t tests showed a significant difference in navicular drop test measures between the injured (6.8 mm 3.7) and noninjured (3.6 mm 3.3) groups. Logistic regression analysis revealed navicular drop test measurements and sex correctly identified athletes who developed MTSS with 76% accuracy. Our study supported the hypothesis that a pronatory foot type is related to MTSS. The combination of sex and navicular drop test measures provides an accurate prediction for the development of MTSS. Clinical measures that identify biomechanical risk factors for MTSS may allow prevention or early intervention.

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

    PubMed

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

    2013-12-01

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

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

    PubMed

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

    2015-07-01

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

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

    PubMed

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

    2006-01-01

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

  2. Low-energy extracorporeal shock wave therapy as a treatment for medial tibial stress syndrome.

    PubMed

    Rompe, Jan D; Cacchio, Angelo; Furia, John P; Maffulli, Nicola

    2010-01-01

    Medial tibial stress syndrome (MTSS) is a pain syndrome along the tibial origin of the tibialis posterior or soleus muscle. Extracorporeal shock wave therapy (SWT) is effective in numerous types of insertional pain syndromes. Shock wave therapy is an effective treatment for chronic MTSS. Cohort study; Level of evidence, 3. Forty-seven consecutive subjects with chronic recalcitrant MTSS underwent a standardized home training program, and received repetitive low-energy radial SWT (2000 shocks; 2.5 bars of pressure, which is equal to 0.1 mJ/mm(2); total energy flux density, 200 mJ/mm(2); no local anesthesia) (treatment group). Forty-seven subjects with chronic recalcitrant MTSS were not treated with SWT, but underwent a standardized home training program only (control group). Evaluation was by change in numeric rating scale. Degree of recovery was measured on a 6-point Likert scale (subjects with a rating of completely recovered or much improved were rated as treatment success). One month, 4 months, and 15 months from baseline, success rates for the control and treatment groups according to the Likert scale were 13% and 30% (P < .001), 30% and 64% (P < .001), and 37% and 76% (P < .001), respectively. One month, 4 months, and 15 months from baseline, the mean numeric rating scale for the control and treatment groups were 7.3 and 5.8 (P < .001), 6.9 and 3.8 (P < .001), and 5.3 and 2.7 (P < .001), respectively. At 15 months from baseline, 40 of the 47 subjects in the treatment group had been able to return to their preferred sport at their preinjury level, as had 22 of the 47 control subjects. Radial SWT as applied was an effective treatment for MTSS.

  3. Training, Muscle Fatigue and Stress Fractures.

    DTIC Science & Technology

    1992-07-29

    Altan 1984). While the stimulation of periosteal new bone formation (modeling) may make the immediate area "tender to the touch", it is certainly...Longitudinal normal and shear strains were calculated at each periosteal rosette site with respect to a local coordinate system aligned with its z-axis...exuberant periosteal new bone formation with which they were associated, presented a remarkably similar appearance to the stress fracture pathology observed

  4. Training, Muscle Fatigue, and Stress Fractures

    DTIC Science & Technology

    1988-07-15

    anesthesia (as above) and using aseptic technique, one gauge is sutured to the deep digital flexor tendon (DDFT), and one to either the lateral digital...research program is to study the etiology of the stress fracture lesion , and isolate any aspects of a physical regime which may exacerbate this...liquid metal strain gauges attached to tendon , surface and muscle embedded electrodes, heart and ventilation frequencies, blood lactate production

  5. Reduced ultrasound velocity in tibial bone of young ballet dancers.

    PubMed

    Foldes, A J; Danziger, A; Constantini, N; Popovtzer, M M

    1997-05-01

    Young ballet dancers are at risk both for osteopenia, due to low body weight, inadequate nutrition and gonadal dysfunction, as well as for lower limbs stress fractures. However, a direct relationship between stress fractures and bone mass in dancers could not be demonstrated, raising the possibility that qualitative aspects of bone, such as elasticity, may be adversely affected in the dancers. To test this hypothesis, speed of sound, a physical parameter that reflects both quantitative and qualitative properties of bone, was determined at the tibial bone of 27 dance students and 27 non-dance students. The results were compared to bone mineral density at the tibia and the lumbar spine, measured by dual-energy x-ray absorptiometry. All three bone measurements were lower in the dance group, but the difference was statistically significant only for the tibial speed of sound. The role of tibial speed of sound measurement in assessing bone status in athletes warrants further exploration.

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

    PubMed

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

    2016-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2017-07-01

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

  8. Stress Fractures of the Pelvis and Legs in Athletes

    PubMed Central

    Behrens, Steve B.; Deren, Matthew E.; Matson, Andrew; Fadale, Paul D.; Monchik, Keith O.

    2013-01-01

    Context: Stress fractures are common injuries in athletes, often difficult to diagnose. A stress fracture is a fatigue-induced fracture of bone caused by repeated applications of stress over time. Evidence Acquisition: PubMed articles published from 1974 to January 2012. Results: Intrinsic and extrinsic factors may predict the risk of stress fractures in athletes, including bone health, training, nutrition, and biomechanical factors. Based on their location, stress fractures may be categorized as low- or high-risk, depending on the likelihood of the injury developing into a complete fracture. Treatment for these injuries varies substantially and must account for the risk level of the fractured bone, the stage of fracture development, and the needs of the patient. High-risk fractures include the anterior tibia, lateral femoral neck, patella, medial malleolus, and femoral head. Low-risk fractures include the posteromedial tibia, fibula, medial femoral shaft, and pelvis. Magnetic resonance is the imaging test of choice for diagnosis. Conclusions: These injuries can lead to substantial lost time from participation. Treatment will vary by fracture location, but most stress fractures will heal with rest and modified weightbearing. Some may require more aggressive intervention, such as prolonged nonweightbearing movement or surgery. Contributing factors should also be addressed prior to return to sports. PMID:24427386

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

    PubMed

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

    2017-12-01

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

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

    PubMed Central

    Hu, Xin-Jia; Wang, Hua

    2017-01-01

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

  11. Bracing can partially limit tibial rotation during stressful activities after anterior crucial ligament reconstruction with a hamstring graft.

    PubMed

    Giotis, D; Paschos, N K; Zampeli, F; Pappas, E; Mitsionis, G; Georgoulis, A D

    2016-09-01

    Hamstring graft has substantial differences with BPTB graft regarding initial mechanical strength, healing sequence, and vascularization, which may imply that a different approach during rehabilitation period is required. The purpose of this study was to investigate the influence of knee bracing on tibial rotation in ACL-reconstructed patients with a hamstring autograft during high loading activities. The hypothesis was that there would be a decrease in tibial rotation in the ACL-reconstructed braced knee as compared to the unbraced knee. Twenty male patients having undergone unilateral ACL reconstruction with a semitendinosus/gracilis autograft were assessed. Kinematic data were collected with an eight-camera optoelectronic system during two stressful tasks: (1) descending from a stair and subsequent pivoting; and (2) landing from a platform and subsequent pivoting. In each patient, three different experimental conditions were evaluated: (A) wearing a prophylactic brace (braced condition); (B) wearing a patellofemoral brace (sleeved condition); (C) without brace (unbraced condition). The intact knee without brace served as a control. Tibial rotation was significantly lower in the intact knee compared to all three conditions of the ACL-reconstructed knee (P≤0.01 for both tasks). Presence of a brace or sleeve resulted in lower tibial rotation than in the unbraced condition (p=0.003 for descending/pivot and P=0.0004 for landing/pivot). The braced condition resulted in lower rotation than the sleeved condition for descending/pivoting (P=0.031) while no differences were found for landing/pivoting (P=0.230). Knee bracing limited the excessive tibial rotation during pivoting under high loading activities in ACL-reconstructed knees with a hamstring graft. This partial restoration of normal kinematics may have a potential beneficial effect in patients recovering from ACL reconstruction with a hamstring autograft. Level III, case-control therapeutic study. Copyright

  12. Sacral stress fracture in a female field hockey player.

    PubMed

    Slipman, Curtis W; Gilchrist, Russell V; Isaac, Zacharia; Lenrow, David A; Chou, Larry H

    2003-11-01

    We report a collegiate field hockey player who sustained a sacral fatigue-type stress fracture that manifested as persistent low back and leg pain. The diagnosis of sacral stress fracture was suggested by history and physical examination and confirmed by magnetic resonance imaging. Our patient experienced complete resolution of symptoms after a 3-mo interval of activity restriction. This article describes the first reported case of a sacral stress fracture in a field hockey player.

  13. Impact of Stress on Anomalous Transport in Fractured Rock

    NASA Astrophysics Data System (ADS)

    Kang, P. K.; Lei, Q.; Lee, S.; Dentz, M.; Juanes, R.

    2016-12-01

    Fluid flow and transport in fractured rock controls many natural and engineered processes in the subsurface. However, characterizing flow and transport through fractured media is challenging due to the large heterogeneity of fractured rock properties. In addition to these "static" challenges, geologic fractures are always under significant overburden stress, and changes in the stress state can lead to changes in the fracture's ability to conduct fluids. While confining stress has been shown to impact fluid flow through fractures in a fundamental way, the impact of confining stress on transport through fractured rock remains largely unexplored. The link between anomalous (non-Fickian) transport and confining stress has been shown only recently, at the level of a single rough fracture [1]. Here, we investigate the impact of confining stress on flow and transport through discrete fracture networks. We model geomechanical effects in 2D fractured rock by means of a finite-discrete element method (FEMDEM), which can capture the deformation of matrix blocks, reactivation and propagation of cracks. We implement a joint constitutive model within the FEMDEM framework to simulate the effect of fracture roughness. We apply the model to a fracture network extracted from the geological map of an actual outcrop to obtain the aperture field at different stress conditions (Figure 1). We then simulate fluid flow and particle transport through the stressed fracture networks. We observe that anomalous transport emerges in response to confining stress on the fracture networks, and show that this anomalous behavior can be linked to the stress state of the rock. Finally, we develop an effective transport model that captures the anomalous transport through stressed fractures. Our results point to a heretofore unrecognized link between geomechanics and anomalous transport in discrete fractured networks. [1] P. K. Kang, S. Brown, and R. Juanes, Emergence of anomalous transport in stressed

  14. Lower-leg Kinesio tape reduces rate of loading in participants with medial tibial stress syndrome.

    PubMed

    Griebert, Maggie C; Needle, Alan R; McConnell, Jennifer; Kaminski, Thomas W

    2016-03-01

    Medial tibial stress syndrome (MTSS) is an overuse injury occurring among the physically active. Linked to increased strain on the medial tendons of the ankle, studies emphasize controlling medial foot loading in the management of this condition. Kinesio taping (KT) has gained popularity for treating musculoskeletal pathologies; however, its effect on MTSS remains uninvestigated. This study aimed to determine if healthy participants and patients with current or previous history of MTSS differ in the rate of loading, and if KT affects plantar pressures in these participants. Twenty healthy participants and 20 participants with current or previous history of MTSS were recruited and walked across a plantar pressure mat prior to KT application, immediately after application, and after 24-h of continued use. Time-to-peak force was measured in 6 foot areas and compared across groups and conditions. ANOVA revealed a significant interaction between group, condition, and foot area (F = 1.990, p = 0.033). MTSS participants presented with lower medial midfoot time-to-peak force before tape application (95%CI: 0.014-0.160%, p = 0.021) that significantly increased following tape application (p < 0.05). These results suggest that KT decreases the rate of medial loading in MTSS patients. Future research might assess mechanisms by which this effect is achieved. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial.

    PubMed

    Moen, Maarten Hendrik; Holtslag, Leonoor; Bakker, Eric; Barten, Carl; Weir, Adam; Tol, Johannes L; Backx, Frank

    2012-03-30

    The only three randomized trials on the treatment of MTSS were all performed in military populations. The treatment options investigated in this study were not previously examined in athletes. This study investigated if functional outcome of three common treatment options for medial tibial stress syndrome (MTSS) in athletes in a non-military setting was the same. The study design was randomized and multi-centered. Physical therapists and sports physicians referred athletes with MTSS to the hospital for inclusion. 81 athletes were assessed for eligibility of which 74 athletes were included and randomized to three treatment groups. Group one performed a graded running program, group two performed a graded running program with additional stretching and strengthening exercises for the calves, while group three performed a graded running program with an additional sports compression stocking. The primary outcome measure was: time to complete a running program (able to run 18 minutes with high intensity) and secondary outcome was: general satisfaction with treatment. 74 Athletes were randomized and included of which 14 did not complete the study due a lack of progress (18.9%). The data was analyzed on an intention-to-treat basis. Time to complete a running program and general satisfaction with the treatment were not significantly different between the three treatment groups. This was the first randomized trial on the treatment of MTSS in athletes in a non-military setting. No differences were found between the groups for the time to complete a running program. CCMO; NL23471.098.08.

  16. Shockwave treatment for medial tibial stress syndrome in athletes; a prospective controlled study.

    PubMed

    Moen, M H; Rayer, S; Schipper, M; Schmikli, S; Weir, A; Tol, J L; Backx, F J G

    2012-03-01

    Objective The purpose of this study was to describe the results of two treatment regimens for medial tibial stress syndrome (MTSS); a graded running programme and the same running programme with additional shockwave therapy (extracorporeal shockwave therapy; ESWT). Design A prospective observational controlled trial. Setting Two different sports medicine departments. Participants 42 athletes with MTSS were included. Intervention Patients from one hospital were treated with a graded running programme, while patients from the other hospital were treated with the same graded running programme and focused ESWT (five sessions in 9 weeks). Main Outcome Measures Time to full recovery (the endpoint was being able to run 18 min consecutively without pain at a fixed intensity). Results The time to full recovery was significantly faster in the ESWT group compared with the patients who only performed a graded running programme, respectively 59.7±25.8 and 91.6±43.0 days (p=0.008). Conclusions This prospective observational study showed that MTSS patients may benefit from ESWT in addition to a graded running programme. ESWT as an additional treatment warrants further investigation in a prospective controlled trial with the addition of randomisation and double blinding.

  17. Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors.

    PubMed

    Plisky, Melody S; Rauh, Mitchell J; Heiderscheit, Bryan; Underwood, Frank B; Tank, Robert T

    2007-02-01

    Prospective cohort. To determine (1) the cumulative seasonal incidence and overall injury rate of medial tibial stress syndrome (MTSS) and (2) risk factors for MTSS with a primary focus on the relationship between navicular drop values and MTSS in high school cross-country runners. MTSS is a common injury among runners. However, few studies have reported the injury rate and risk factors for MTSS among adolescent runners. Data collected included measurement of bilateral navicular drop and foot length, and a baseline questionnaire regarding the runner's height, body mass, previous running injury, running experience, and orthotic or tape use. Runners were followed during the season to determine athletic exposures (AEs) and occurrence of MTSS. The overall injury rate for MTSS was 2.8/1000 AEs. Although not statistically different, girls had a higher rate (4.3/1000 AEs) than boys (1.7/1000 AEs) (P = .11). Logistic regression modeling indicated that only gender and body mass index (BMI) were significantly associated with the occurrence of MTSS. However, when controlled for orthotic use, only BMI was associated with risk of MTSS. No significant associations were found between MTSS and navicular drop or foot length. Our findings suggest that navicular drop may not be an appropriate measure to identify runners who may develop MTSS during a cross-country season; thus, additional studies are needed to identify appropriate preseason screening tools.

  18. Structural deformation of longitudinal arches during running in soccer players with medial tibial stress syndrome.

    PubMed

    Noh, Byungjoo; Masunari, Akihiko; Akiyama, Kei; Fukano, Mako; Fukubayashi, Toru; Miyakawa, Shumpei

    2015-01-01

    The purpose of this study was to compare angular change and translational motion from the medial longitudinal arch (MLA) and lateral longitudinal arch (LLA) during running between medial tibial stress syndrome (MTSS) and non-MTSS subjects. A total of 10 subjects volunteered, comprising 5 subjects with MTSS and 5 subjects without injury (non-MTSS) as the control group. All subjects performed the test movement that simulated running. Fluoroscopic imaging was used to investigate bone movement during landing in running. Sagittal motion was defined as the angular change and translational motion of the arch. A Mann-Whitney U-test was performed to determine the differences in the measured values between the MTSS and non-MTSS groups. The magnitude of angular change for the MLA and LLA was significantly greater for subjects with MTSS than for control subjects. Translational motion of the MLA and LLA of the MTSS group was also significantly greater than that of the non-MTSS group (all p < 0.05). Soccer players with MTSS have an abnormal structural deformation of foot during support (or stance) phase of running, with a large decrease in both the MLA and LLA. This abnormal motion could be a risk factor for the development of MTSS in these subjects.

  19. Fractures and stresses in Bone Spring sandstones

    SciTech Connect

    Warpinski, N.R.; Sattler, A.R.; Lorenz, J.C.; Northrop, D.A.

    1992-06-01

    This project was a collaboration between Sandia National Laboratories and the Harvey E. Yates Company (Heyco), Roswell, NM, conducted under the auspices of Department of Energy's Oil Recovery Technology Partnership. The project applied Sandia perspectives on the effects of natural fractures, stress, and sedimentology for the stimulation and production of low permeability gas reservoirs to low permeability oil reservoirs, such as those typified by the Bone Spring sandstones of the Delaware Basin, southeast New Mexico. This report details the results and analyses obtained in 1990 from core, logs, stress, and other data taken from three additional development wells. An overall summary gives results from all five wells studied in this project in 1989--1990. Most of the results presented are believed to be new information for the Bone Spring sandstones.

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

    PubMed

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

    2010-01-01

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

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

    PubMed

    Wang, Haosen; Hao, Zhixiu; Wen, Shizhu

    2017-01-01

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

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

    PubMed

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

    2016-11-01

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

  3. Stress fracture of ulna due to excessive push-ups

    PubMed Central

    Meena, Sanjay; Rastogi, Devarshi; Solanki, Bipin; Chowdhury, Buddhadev

    2014-01-01

    Stress fractures are most common in the weight-bearing bones of the lower extremities and spine, but are rarely found in non-weight-bearing bones of the body. Stress fracture of the ulna is extremely rare. We report a case of complete stress fracture of ulna caused due to excessive push ups in a young athlete. Conservative management was successful in healing of fracture and returning this patient back to his previous activity level. Physician should have high index of suspicion, whenever they encounter a young athlete complaining of forearm pain. PMID:24678236

  4. Stress fracture of ulna due to excessive push-ups.

    PubMed

    Meena, Sanjay; Rastogi, Devarshi; Solanki, Bipin; Chowdhury, Buddhadev

    2014-01-01

    Stress fractures are most common in the weight-bearing bones of the lower extremities and spine, but are rarely found in non-weight-bearing bones of the body. Stress fracture of the ulna is extremely rare. We report a case of complete stress fracture of ulna caused due to excessive push ups in a young athlete. Conservative management was successful in healing of fracture and returning this patient back to his previous activity level. Physician should have high index of suspicion, whenever they encounter a young athlete complaining of forearm pain.

  5. Could this unusual scaphoid fracture occurring in a badminton player be a stress fracture?

    PubMed

    Brutus, J P; Chahidi, N

    2004-02-01

    An unusual fracture of the scaphoid occurred in an otherwise healthy young badminton player, caused by a violent movement of extension/flexion of the wrist while performing a smash. There was no direct blow or fall on the wrist, nor history of wrist pain prior to the fracture. No underlying pathology was identified. Conservative treatment failed and surgical stabilization was required to achieve bone union. The diagnosis of stress fracture was suggested. The characteristics of these uncommon fractures are reviewed.

  6. Expedited patient-specific assessment of contact stress exposure in the ankle joint following definitive articular fracture reduction.

    PubMed

    Kern, Andrew M; Anderson, Donald D

    2015-09-18

    Acute injury severity, altered joint kinematics, and joint incongruity are three important mechanical factors linked to post-traumatic osteoarthritis (PTOA). Finite element analysis (FEA) was previously used to assess the influence of increased contact stress due to joint incongruity on PTOA development. While promising agreement with PTOA development was seen, the inherent complexities of contact FEA limited the numbers of subjects that could be analyzed. Discrete element analysis (DEA) is a simplified methodology for contact stress computation, which idealizes contact surfaces as a bed of independent linear springs. In this study, DEA was explored as an expedited alternative to FEA contact stress exposure computation. DEA was compared to FEA using results from a previously completed validation study of two cadaveric human ankles, as well as a previous study of post-operative contact stress exposure in 11 patients with tibial plafond fracture. DEA-computed maximum contact stresses were within 19% of those experimentally measured, with 90% of the contact area having computed contact stress values within 1MPa of those measured. In the 11 fractured ankles, maximum contact stress and contact area differences between DEA and FEA were 0.85 ± 0.64 MPa and 22.5 ± 11.5mm(2). As a predictive measure for PTOA development, both DEA and FEA had 100% concordance with presence of OA (KL grade ≥ 2) and >95% concordance with KL grade at 2 years. These results support DEA as a reasonable alternative to FEA for computing contact stress exposures following surgical reduction of a tibial plafond fracture. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Expedited Patient-Specific Assessment of Contact Stress Exposure in the Ankle Joint Following Definitive Articular Fracture Reduction

    PubMed Central

    Kern, Andrew M.; Anderson, Donald D.

    2015-01-01

    Acute injury severity, altered joint kinematics, and joint incongruity are three important mechanical factors linked to post-traumatic osteoarthritis (PTOA). Finite element analysis (FEA) was previously used to assess the influence of increased contact stress due to joint incongruity on PTOA development. While promising agreement with PTOA development was seen, the inherent complexities of contact FEA limited the numbers of subjects that could be analyzed. Discrete element analysis (DEA) is a simplified methodology for contact stress computation, which idealizes contact surfaces as a bed of independent linear springs. In this study, DEA was explored as an expedited alternative to FEA contact stress exposure computation. DEA was compared to FEA using results from a previously completed validation study of two cadaveric human ankles, as well as a previous study of post-operative contact stress exposure in 11 patients with tibial plafond fracture. DEA-computed maximum contact stresses were within 19% of those experimentally measured, with 90% of the contact area having computed contact stress values within 1 MPa of those measured. In the 11 fractured ankles, maximum contact stress and contact area differences between DEA and FEA were 0.85±0.64 MPa and 22.5±11.5 mm2. As a predictive measure for PTOA development, both DEA and FEA had 100% concordance with presence of OA (KL grade ≥ 2) and >95% concordance with KL grade at 2 years. These results support DEA as a reasonable alternative to FEA for computing contact stress exposures following surgical reduction of a tibial plafond fracture. PMID:26105660

  8. Shockwave treatment for medial tibial stress syndrome: A randomized double blind sham-controlled pilot trial.

    PubMed

    Newman, Phil; Waddington, Gordon; Adams, Roger

    2017-03-01

    Up to 35% of runners develop medial tibial stress syndrome (MTSS) which often results in lengthy disruption to training and sometimes affects daily activities. There is currently no high quality evidence to support any particular intervention for MTSS. This study aims to investigate the effect of shockwave therapy for MTSS. A randomized, sham-controlled, pilot trial in a university-based health clinic including 28 active adults with MTSS. Intervention included standard dose shockwave therapy for the experimental group versus sham dose for the control group, delivered during Week 1-3, 5 and 9. Main outcome measures were pain measured during bone and muscle pressure as well as during running using a numerical rating scale (0-10) and running was measured as pain-limited distance (m), at Week 1 (baseline) and Week 10 (post-intervention). Self-perception of change was measured using the Global Rating of Change Scale (-7 to +7) at Week 10 (post-intervention). Pain (palpation) was reduced in the experimental group by 1.1 out of 10.0 (95% CI -2.3 to 0.0) less than the control group. There were no other statistically significant differences between the groups. Standard dose shockwave therapy is not more effective than sham dose at improving pain or running distance in MTSS. However, the sham dose may have had a clinical effect. Further investigation including a no intervention control is warranted to evaluate the effect of shockwave therapy in the management of MTSS. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  9. The medial tibial stress syndrome score: a new patient-reported outcome measure.

    PubMed

    Winters, Marinus; Moen, Maarten H; Zimmermann, Wessel O; Lindeboom, Robert; Weir, Adam; Backx, Frank Jg; Bakker, Eric Wp

    2016-10-01

    At present, there is no validated patient-reported outcome measure (PROM) for patients with medial tibial stress syndrome (MTSS). Our aim was to select and validate previously generated items and create a valid, reliable and responsive PROM for patients with MTSS: the MTSS score. A prospective cohort study was performed in multiple sports medicine, physiotherapy and military facilities in the Netherlands. Participants with MTSS filled out the previously generated items for the MTSS score on 3 occasions. From previously generated items, we selected the best items. We assessed the MTSS score for its validity, reliability and responsiveness. The MTSS score was filled out by 133 participants with MTSS. Factor analysis showed the MTSS score to exhibit a single-factor structure with acceptable internal consistency (α=0.58) and good test-retest reliability (intraclass correlation coefficient=0.81). The MTSS score ranges from 0 to 10 points. The smallest detectable change in our sample was 0.69 at the group level and 4.80 at the individual level. Construct validity analysis showed significant moderate-to-large correlations (r=0.34-0.52, p<0.01). Responsiveness of the MTSS score was confirmed by a significant relation with the global perceived effect scale (β=-0.288, R(2)=0.21, p<0.001). The MTSS score is a valid, reliable and responsive PROM to measure the severity of MTSS. It is designed to evaluate treatment outcomes in clinical studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  10. Predicting individual risk for medial tibial stress syndrome in navy recruits.

    PubMed

    Garnock, Cameron; Witchalls, Jeremy; Newman, Phil

    2017-10-23

    Quantifying individual risk for medial tibial stress syndrome (MTSS) is valuable due to the high prevalence, substantial financial and service costs, and lengthy recovery time of the condition. Identification of those at risk is a key first step in prevention of the condition. This study aimed to test a suite of best evidence risk factors in a cohort of Navy recruits and to develop a predictive model for individuals at risk of MTSS. Prospective cohort study of Navy recruits undergoing initial training METHODS: A prospective cohort design, this study screened recruits by assessing gender, MTSS history, years of running experience, orthotic use, BMI, navicular drop, ankle plantarflexion and hip external rotation at the beginning of basic training. Follow-up was conducted at completion of training (11 weeks). Volunteers included 123 recruits (28 females and 95 males). Thirty developed MTSS (19 males and 11 females). Stepwise logistic regression of one half of the data produced a significant model (p<0.001), comprising female gender (OR 4.4, 95% CI 1.0, 18.9, p=0.05), MTSS history (OR 18.3, 95% CI 3.6, 91.5, p<0.01) and increased hip ER (OR 1.1 per degree, 95% CI 1.0, 1.202, p=0.05). Findings validated with the other half of the cohort and receiver operating characteristic curve analysis showed the model had 82% sensitivity and 84% specificity. This predictive model provides military institutions, clinicians and instructors with a strong and accurate calculator for predicting an individual recruit's risk of MTSS. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  11. Muscle stiffness of posterior lower leg in runners with a history of medial tibial stress syndrome.

    PubMed

    Saeki, J; Nakamura, M; Nakao, S; Fujita, K; Yanase, K; Ichihashi, N

    2018-01-01

    Previous history of medial tibial stress syndrome (MTSS) is a risk factor for MTSS relapse, which suggests that there might be some physical factors that are related to MTSS development in runners with a history of MTSS. The relationship between MTSS and muscle stiffness can be assessed in a cross-sectional study that measures muscle stiffness in subjects with a history of MTSS, who do not have pain at the time of measurement, and in those without a history of MTSS. The purpose of this study was to compare the shear elastic modulus, which is an index of muscle stiffness, of all posterior lower leg muscles of subjects with a history of MTSS and those with no history and investigate which muscles could be related to MTSS. Twenty-four male collegiate runners (age, 20.0±1.7 years; height, 172.7±4.8 cm; weight, 57.3±3.7 kg) participated in this study; 14 had a history of MTSS, and 10 did not. The shear elastic moduli of the lateral gastrocnemius, medial gastrocnemius, soleus, peroneus longus, peroneus brevis, flexor hallucis longus, flexor digitorum longus, and tibialis posterior were measured using shear wave elastography. The shear elastic moduli of the flexor digitorum longus and tibialis posterior were significantly higher in subjects with a history of MTSS than in those with no history. However, there was no significant difference in the shear elastic moduli of other muscles. The results of this study suggest that flexor digitorum longus and tibialis posterior stiffness could be related to MTSS. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Medial tibial stress syndrome can be diagnosed reliably using history and physical examination.

    PubMed

    Winters, M; Bakker, E W P; Moen, M H; Barten, C C; Teeuwen, R; Weir, A

    2017-02-08

    The majority of sporting injuries are clinically diagnosed using history and physical examination as the cornerstone. There are no studies supporting the reliability of making a clinical diagnosis of medial tibial stress syndrome (MTSS). Our aim was to assess if MTSS can be diagnosed reliably, using history and physical examination. We also investigated if clinicians were able to reliably identify concurrent lower leg injuries. A clinical reliability study was performed at multiple sports medicine sites in The Netherlands. Athletes with non-traumatic lower leg pain were assessed for having MTSS by two clinicians, who were blinded to each others' diagnoses. We calculated the prevalence, percentage of agreement, observed percentage of positive agreement (Ppos), observed percentage of negative agreement (Pneg) and Kappa-statistic with 95%CI. Forty-nine athletes participated in this study, of whom 46 completed both assessments. The prevalence of MTSS was 74%. The percentage of agreement was 96%, with Ppos and Pneg of 97% and 92%, respectively. The inter-rater reliability was almost perfect; k=0.89 (95% CI 0.74 to 1.00), p<0.000001. Of the 34 athletes with MTSS, 11 (32%) had a concurrent lower leg injury, which was reliably noted by our clinicians, k=0.73, 95% CI 0.48 to 0.98, p<0.0001. Our findings show that MTSS can be reliably diagnosed clinically using history and physical examination, in clinical practice and research settings. We also found that concurrent lower leg injuries are common in athletes with MTSS. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial

    PubMed Central

    2012-01-01

    Background The only three randomized trials on the treatment of MTSS were all performed in military populations. The treatment options investigated in this study were not previously examined in athletes. This study investigated if functional outcome of three common treatment options for medial tibial stress syndrome (MTSS) in athletes in a non-military setting was the same. Methods The study design was randomized and multi-centered. Physical therapists and sports physicians referred athletes with MTSS to the hospital for inclusion. 81 athletes were assessed for eligibility of which 74 athletes were included and randomized to three treatment groups. Group one performed a graded running program, group two performed a graded running program with additional stretching and strengthening exercises for the calves, while group three performed a graded running program with an additional sports compression stocking. The primary outcome measure was: time to complete a running program (able to run 18 minutes with high intensity) and secondary outcome was: general satisfaction with treatment. Results 74 Athletes were randomized and included of which 14 did not complete the study due a lack of progress (18.9%). The data was analyzed on an intention-to-treat basis. Time to complete a running program and general satisfaction with the treatment were not significantly different between the three treatment groups. Conclusion This was the first randomized trial on the treatment of MTSS in athletes in a non-military setting. No differences were found between the groups for the time to complete a running program. Trial registration CCMO; NL23471.098.08 PMID:22464032

  14. Bilateral stress fractures of the ulna in a young adolescent.

    PubMed

    Lin, Hsi-Hsien; Chang, Wei-Hsuan; Huang, Tung-Fu; Hung, Shih-Chieh; Ma, Hsiao-Li; Liu, Chien-Lin

    2012-11-01

    We present a case of bilateral ulnar stress fractures in a young male adolescent (15 years old) due to honour guard training and discuss the possible mechanism of this injury. In addition to acquisition of medical history, physical examination and plain radiography, we performed MRI to exclude pathological causes and confirm the plain radiographic findings, indicating stress reactions. Ulnar stress fractures are bone injuries caused by repetitive muscle pull and the reaction of supporting tissues. In honour guard training, the acceleration due to gravity and chronic torsional stress may also contribute to overloading. Thus, such fractures are best managed by avoiding overloading. In addition, we review the literature on stress fractures of the ulnar shaft to map this special kind of fracture. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

  15. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review

    PubMed Central

    Winkelmann, Zachary K.; Anderson, Dustin; Games, Kenneth E.; Eberman, Lindsey E.

    2016-01-01

    Reference/Citation: Hamstra-Wright KL, Bliven KC, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med. 2015;49(6):362–369. Clinical Question: What factors put physically active individuals at risk to develop medial tibial stress syndrome (MTSS)? Data Sources: The authors performed a literature search of CINAHL, the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE from each database's inception to July 2013. The following key words were used together or in combination: armed forces, athlete, conditioning, disorder predictor, exercise, medial tibial stress syndrome, militaries, MTSS, military, military personnel, physically active, predictor, recruit, risk, risk characteristic, risk factor, run, shin pain, shin splints, and vulnerability factor. Study Selection: Studies were included in this systematic review based on the following criteria: original research that (1) investigated risk factors associated with MTSS, (2) compared physically active individuals with and without MTSS, (3) was printed in English, and (4) was accessible in full text in peer-reviewed journals. Data Extraction: Two authors independently screened titles or abstracts (or both) of studies to identify inclusion criteria and quality. If the article met the inclusion criteria, the authors extracted demographic information, study design and duration, participant selection, MTSS diagnosis, investigated risk factors, mean difference, clinical importance, effect size, odds ratio, and any other data deemed relevant. After the data extraction was complete, the authors compared findings for accuracy and completeness. When the mean and standard deviation of a particular risk factor were reported 3 or more times, that risk factor was included in the meta-analysis. In addition, the methodologic quality was assessed with an adapted checklist developed by

  16. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review.

    PubMed

    Winkelmann, Zachary K; Anderson, Dustin; Games, Kenneth E; Eberman, Lindsey E

    2016-12-01

    Reference/Citation: Hamstra-Wright KL, Bliven KC, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med. 2015;49(6):362-369. What factors put physically active individuals at risk to develop medial tibial stress syndrome (MTSS)? The authors performed a literature search of CINAHL, the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE from each database's inception to July 2013. The following key words were used together or in combination: armed forces, athlete, conditioning, disorder predictor, exercise, medial tibial stress syndrome, militaries, MTSS, military, military personnel, physically active, predictor, recruit, risk, risk characteristic, risk factor, run, shin pain, shin splints, and vulnerability factor. Studies were included in this systematic review based on the following criteria: original research that (1) investigated risk factors associated with MTSS, (2) compared physically active individuals with and without MTSS, (3) was printed in English, and (4) was accessible in full text in peer-reviewed journals. Two authors independently screened titles or abstracts (or both) of studies to identify inclusion criteria and quality. If the article met the inclusion criteria, the authors extracted demographic information, study design and duration, participant selection, MTSS diagnosis, investigated risk factors, mean difference, clinical importance, effect size, odds ratio, and any other data deemed relevant. After the data extraction was complete, the authors compared findings for accuracy and completeness. When the mean and standard deviation of a particular risk factor were reported 3 or more times, that risk factor was included in the meta-analysis. In addition, the methodologic quality was assessed with an adapted checklist developed by previous researchers. The checklist contained 5 categories: study objective

  17. Bilateral femoral supracondylar stress fractures in a cross country runner.

    PubMed

    Ross, Kate; Fahey, Mark

    2008-08-01

    Several high-risk factors lead to stress fractures. They include excessive training in athletes leading to overuse injuries, nutritional deficiencies, and endocrine disorders. While stress fractures are common, bilateral stress fractures are rarely seen. Few cases have been reported of bilateral femoral stress fractures in young athletes. This article presents a case of a 14-year-old cross country runner with a bilateral femoral supracondylar stress fracture. He presented with bilateral supracondylar stress fractures from running. The patient followed a strict vegan diet, but his parents stated that, to their knowledge, he was getting adequate protein and calcium. Treatment consisted of decreased activity to pain-free levels with acetaminophen for pain. Low-impact conditioning such as swimming and bicycling was allowed. Hamstring and quadricep stretching was suggested. Nutritional consultation was obtained to ensure appropriate nutrition on a vegan diet. At 1-month follow-up, he was pain free and allowed to proceed with a gradual return to running activities. In this case, the onset of a new workout routine was intolerable for this patient's low bone density, causing insufficiency fractures. Appropriate vegan diets were not associated with stress fracture in our literature review. He may have had an inadequate diet prior to this injury. As in this case, full recovery can be made after this rest period, and the patient may return to his or her original activity safely. In young athletes, diet and nutrition must be kept in mind.

  18. High-Risk Stress Fractures: Diagnosis and Management.

    PubMed

    McInnis, Kelly C; Ramey, Lindsay N

    2016-03-01

    Stress fractures are common overuse injuries in athletes. They occur during periods of increased training without adequate rest, disrupting normal bone reparative mechanisms. There are a host of intrinsic and extrinsic factors, including biochemical and biomechanical, that put athletes at risk. In most stress fractures, the diagnosis is primarily clinical, with imaging indicated at times, and management focused on symptom-free relative rest with advancement of activity as tolerated. Overall, stress fractures in athletes have an excellent prognosis for return to sport, with little risk of complication. There is a subset of injuries that have a greater risk of fracture progression, delayed healing, and nonunion and are generally more challenging to treat with nonoperative care. Specific locations of high-risk stress fracture include the femoral neck (tension side), patella, anterior tibia, medial malleolus, talus, tarsal navicular, proximal fifth metatarsal, and great toe sesamoids. These sites share a characteristic region of high tensile load and low blood flow. High-risk stress fractures require a more aggressive approach to evaluation, with imaging often necessary, to confirm early and accurate diagnosis and initiate immediate treatment. Treatment consists of nonweight-bearing immobilization, often with a prolonged period away from sport, and a more methodic and careful reintroduction to athletic activity. These stress fractures may require surgical intervention. A high index of suspicion is essential to avoid delayed diagnosis and optimize outcomes in this subset of stress fractures. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  19. Surgical treatment of medial tibial stress syndrome (shin splint) by fasciotomy of the superficial posterior compartment of the leg.

    PubMed

    Holen, K J; Engebretsen, L; Grøntvedt, T; Rossvoll, I; Hammer, S; Stoltz, V

    1995-02-01

    From September 1988 to June 1990, 35 athletes were treated for medial tibial stress syndrome (shin splint) by fasciotomy of the superficial posterior compartment of the leg. Thirty-two patients were available for the follow-up, including self-assessment, clinical examination and activity scoring. The mean postoperative observation time was 16 months. Thirteen patients were performing sports at top international or top national level; 19 patients were competing at different lower levels. Twenty-three patients improved, 7 were unchanged and 2 had poor results.

  20. Patterns of fracture and tidal stresses due to nonsynchronous rotation - Implications for fracturing on Europa

    NASA Astrophysics Data System (ADS)

    Helfenstein, P.; Parmentier, E. M.

    1985-02-01

    This study considers the global patterns of fracture that would result from nonsynchronous rotation of a tidally distorted planetary body. The incremental horizontal stresses in a thin elastic or viscous shell due to a small displacement of the axis of maximum tidal elongation are derived, and the resulting stress distributions are applied to interpret the observed pattern of fracture lineaments on Europa. The observed pattern of lineaments can be explained by nonsynchronous rotation if these features formed by tension fracturing and dike emplacement. Tension fracturing can occur for a small displacement of the tidal axis, so that the resulting lineaments may be consistent with other evidence suggesting a young age for the surface.

  1. Mechanisms and Management of Stress Fractures in Physically Active Persons

    PubMed Central

    Romani, William A.; Gieck, Joe H.; Perrin, David H.; Saliba, Ethan N.; Kahler, David M.

    2002-01-01

    Objective: To describe the anatomy of bone and the physiology of bone remodeling as a basis for the proper management of stress fractures in physically active people. Data Sources: We searched PubMed for the years 1965 through 2000 using the key words stress fracture, bone remodeling, epidemiology, and rehabilitation. Data Synthesis: Bone undergoes a normal remodeling process in physically active persons. Increased stress leads to an acceleration of this remodeling process, a subsequent weakening of bone, and a higher susceptibility to stress fracture. When a stress fracture is suspected, appropriate management of the injury should begin immediately. Effective management includes a cyclic process of activity and rest that is based on the remodeling process of bone. Conclusions/Recommendations: Bone continuously remodels itself to withstand the stresses involved with physical activity. Stress fractures occur as the result of increased remodeling and a subsequent weakening of the outer surface ofthe bone. Once a stress fracture is suspected, a cyclic management program that incorporates the physiology of bone remodeling should be initiated. The cyclic program should allow the physically active person to remove the source of the stress to the bone, maintain fitness, promote a safe return to activity, and permit the bone to heal properly. PMID:16558676

  2. Family History Predicts Stress Fracture in Active Female Adolescents

    PubMed Central

    Loud, Keith J.; Micheli, Lyle J.; Bristol, Stephanie; Austin, S. Bryn; Gordon, Catherine M.

    2011-01-01

    OBJECTIVE Increased physical activity and menstrual irregularity have been associated with increased risk for stress fracture among adult women active in athletics. The purposes of this study were to determine whether menstrual irregularity is also a risk factor for stress fracture in active female adolescents and to estimate the quantity of exercise associated with an increased risk for this injury. PATIENTS AND METHODS A case-control study was conducted of 13- to 22-year-old females diagnosed with their first stress fracture, each matched prospectively on age and self-reported ethnicity with 2 controls. Patients with chronic illnesses or use of medications known to affect bone mineral density were excluded, including use of hormonal preparations that could alter menstrual cycles. The primary outcome, stress fracture in any extremity or the spine, was confirmed radiographically. Girls with stress fracture had bone mineral density measured at the lumbar spine by dual-energy x-ray absorptiometry. RESULTS The mean ± SD age of the 168 participants was 15.9 ± 2.1 years; 91.7% were postmenarchal, with a mean age at menarche of 13.1 ± 1.1 years. The prevalence of menstrual irregularity was similar among cases and controls. There was no significant difference in the mean hours per week of total physical activity between girls in this sample with stress fracture (8.2 hours/week) and those without (7.4 hours/week). In multivariate models, case subjects had nearly 3 times the odds of having a family member with osteoporosis or osteopenia. In secondary analyses, participants with stress fracture had a low mean spinal bone mineral density for their age. CONCLUSIONS Among highly active female adolescents, only family history was independently associated with stress fracture. The magnitude of this association suggests that further investigations of inheritable skeletal factors are warranted in this population, along with evaluation of bone mineral density in girls with stress

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

    PubMed

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

    2015-12-01

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

  4. Inversion/Eversion Strength Dysbalance in Patients With Medial Tibial Stress Syndrome

    PubMed Central

    Yüksel, Oguz; Özgürbüz, Cengizhan; Ergün, Metin; Işlegen, Çetin; Taskiran, Emin; Denerel, Nevzad; Ertat, Ahmet

    2011-01-01

    The main purpose of the study is to investigate the inversion/eversion muscle strength balance of the ankle in patients with medial tibial stress syndrome (MTSS). A dysbalance of these muscles may play a role in the pathophysiology of MTSS. Another aim is to measure the medial longitudinal arch and navicular drop in patients with MTSS. A total of 11 patients diagnosed with MTSS in the outpatient clinic of Ege University School of Medicine Sports Medicine Department were enrolled in this study. The control group consisted of 11 regularly exercising individuals. The mean age of the patient group and the control group was 21. 0 ± 1.9 years (18-23 years) and 23.2 ± 2.9 years (18-27 years), respectively. A detailed exercise questionnaire was administered to all subjects. Isokinetic muscle strength testing was performed at 30°/sec and 120°/sec to assess invertor and evertor muscle strength of the ankle. Photographs of the weight bearing and non-weight bearing foot were taken to measure the medial longitudinal arch deformation and the navicular drop. At 30°/sec, the average eversion concentric strength was significantly higher in the patient group, and the inversion/eversion strength ratio was significantly higher in the control group (p < 0.05). At 120°/sec velocity, average concentric eversion strength was significantly higher in the patient group (p < 0.05). The measurements of pronation indicators did not reveal any statistically significant differences between the two groups (p > 0.05). MTSS may occur without an increase of pronation indicators like medial longitudinal arch deformation or navicular drop. In such cases, one of the predisposing factors may be the strength dysbalance of the invertor/evertor muscles in favour of the evertor muscles. This observation may be of additional value in the prevention and therapy of MTSS. Key points At 30°/sec, the average eversion concentric strength was significantly higher in the MTSS group, and the inversion

  5. Inversion/Eversion strength dysbalance in patients with medial tibial stress syndrome.

    PubMed

    Yüksel, Oguz; Ozgürbüz, Cengizhan; Ergün, Metin; Işlegen, Cetin; Taskiran, Emin; Denerel, Nevzad; Ertat, Ahmet

    2011-01-01

    The main purpose of the study is to investigate the inversion/eversion muscle strength balance of the ankle in patients with medial tibial stress syndrome (MTSS). A dysbalance of these muscles may play a role in the pathophysiology of MTSS. Another aim is to measure the medial longitudinal arch and navicular drop in patients with MTSS. A total of 11 patients diagnosed with MTSS in the outpatient clinic of Ege University School of Medicine Sports Medicine Department were enrolled in this study. The control group consisted of 11 regularly exercising individuals. The mean age of the patient group and the control group was 21. 0 ± 1.9 years (18-23 years) and 23.2 ± 2.9 years (18-27 years), respectively. A detailed exercise questionnaire was administered to all subjects. Isokinetic muscle strength testing was performed at 30°/sec and 120°/sec to assess invertor and evertor muscle strength of the ankle. Photographs of the weight bearing and non-weight bearing foot were taken to measure the medial longitudinal arch deformation and the navicular drop. At 30°/sec, the average eversion concentric strength was significantly higher in the patient group, and the inversion/eversion strength ratio was significantly higher in the control group (p < 0.05). At 120°/sec velocity, average concentric eversion strength was significantly higher in the patient group (p < 0.05). The measurements of pronation indicators did not reveal any statistically significant differences between the two groups (p > 0.05). MTSS may occur without an increase of pronation indicators like medial longitudinal arch deformation or navicular drop. In such cases, one of the predisposing factors may be the strength dysbalance of the invertor/evertor muscles in favour of the evertor muscles. This observation may be of additional value in the prevention and therapy of MTSS. Key pointsAt 30°/sec, the average eversion concentric strength was significantly higher in the MTSS group, and the inversion

  6. Biomechanical Factors Associated With Achilles Tendinopathy and Medial Tibial Stress Syndrome in Runners.

    PubMed

    Becker, James; James, Stanley; Wayner, Robert; Osternig, Louis; Chou, Li-Shan

    2017-09-01

    There is disagreement in the literature regarding whether the excessive excursion or velocity of rearfoot eversion is related to the development of 2 common running injuries: Achilles tendinopathy (AT) and medial tibial stress syndrome (MTSS). An alternative hypothesis suggests that the duration of rearfoot eversion may be an important factor. However, the duration of eversion has received relatively little attention in the biomechanics literature. Runners with AT or MTSS will demonstrate a longer duration of eversion but not greater excursion or velocity of eversion compared with healthy controls. Controlled laboratory study. Forty-two runners participated in this study (13 with AT, 8 with MTSS, and 21 matched controls). Participants were evaluated for lower extremity alignment and flexibility, after which a 3-dimensional kinematic and kinetic running gait analysis was performed. Differences between the 2 injuries and between injured and control participants were evaluated for flexibility and alignment, rearfoot kinematics, and 3 ground-reaction force metrics. Binary logistic regression was used to evaluate which variables best predicted membership in the injured group. Injured participants, compared with controls, demonstrated higher standing tibia varus angles (8.67° ± 1.79° vs 6.76° ± 1.75°, respectively; P = .002), reduced static dorsiflexion range of motion (6.14° ± 5.04° vs 11.19° ± 5.10°, respectively; P = .002), more rearfoot eversion at heel-off (-6.47° ± 5.58° vs 1.07° ± 2.26°, respectively; P < .001), and a longer duration of eversion (86.02% ± 15.65% stance vs 59.12% ± 16.50% stance, respectively; P < .001). There were no differences in the excursion or velocity of eversion. The logistic regression (χ2 = 20.84, P < .001) revealed that every 1% increase in the duration of eversion during the stance phase increased the odds of being in the injured group by 1.08 (95% CI, 1.023-1.141; P = .006). Compared with healthy controls, runners

  7. Measurements of residual stress in fracture mechanics coupons

    SciTech Connect

    Prime, Michael B; Hill, Michael R; Nav Dalen, John E

    2010-01-01

    This paper describes measurements of residual stress in coupons used for fracture mechanics testing. The primary objective of the measurements is to quantify the distribution of residual stress acting to open (and/or close) the crack across the crack plane. The slitting method and the contour method are two destructive residual stress measurement methods particularly capable of addressing that objective, and these were applied to measure residual stress in a set of identically prepared compact tension (C(T)) coupons. Comparison of the results of the two measurement methods provides some useful observations. Results from fracture mechanics tests of residual stress bearing coupons and fracture analysis, based on linear superposition of applied and residual stresses, show consistent behavior of coupons having various levels of residual stress.

  8. Quantification of Fracture Interaction Using Stress Intensity Factor Variation Maps

    NASA Astrophysics Data System (ADS)

    Thomas, Robin N.; Paluszny, Adriana; Zimmerman, Robert W.

    2017-10-01

    Accurate and flexible models of fracture interaction are sought after in the fields of mechanics and geology. Stress intensity factors (SIFs) quantify the energy concentrated at the fracture tips and are perturbed from their isolated values when two fractures are close to one another. Using a three-dimensional finite element fracture mechanics code to simulate static fractures in tension and compression, interaction effects are examined. SIF perturbations are characterized by introducing three interaction measures: the circumferential and maximum SIF perturbation provide the "magnitude" of the effect of interaction, and the amplification to shielding ratio quantifies the balance between increased and decreased SIFs along the tip. These measures are used to demonstrate the change in interaction with fracture separation and to find the separation at which interaction becomes negligible. Interaction maps are constructed by plotting the values of the interaction measures for a static fracture as a second fracture is moved around it. These maps are presented for several common fracture orientations in tension. They explore interaction by highlighting regions in which growth is more likely to occur and where fractures will grow into nonplanar geometries. Interaction maps can be applied to fracture networks with multiple discontinuities to analyze the effect of geometric variations on fracture interaction.

  9. Stress Fractures of the Foot and Ankle in Athletes

    PubMed Central

    Mayer, Stephanie W.; Joyner, Patrick W.; Almekinders, Louis C.; Parekh, Selene G.

    2014-01-01

    Context: Stress fractures of the foot and ankle are a common problem encountered by athletes of all levels and ages. These injuries can be difficult to diagnose and may be initially evaluated by all levels of medical personnel. Clinical suspicion should be raised with certain history and physical examination findings. Evidence Acquisition: Scientific and review articles were searched through PubMed (1930-2012) with search terms including stress fractures and 1 of the following: foot ankle, medial malleolus, lateral malleolus, calcaneus, talus, metatarsal, cuboid, cuneiform, sesamoid, or athlete. Study Design: Clinical review. Level of Evidence: Level 5. Results: Stress fractures of the foot and ankle can be divided into low and high risk based upon their propensity to heal without complication. A wide variety of nonoperative strategies are employed based on the duration of symptoms, type of fracture, and patient factors, such as activity type, desire to return to sport, and compliance. Operative management has proven superior in several high-risk types of stress fractures. Evidence on pharmacotherapy and physiologic therapy such as bone stimulators is evolving. Conclusion: A high index of suspicion for stress fractures is appropriate in many high-risk groups of athletes with lower extremity pain. Proper and timely work-up and treatment is successful in returning these athletes to sport in many cases. Low-risk stress fracture generally requires only activity modification while high-risk stress fracture necessitates more aggressive intervention. The specific treatment of these injuries varies with the location of the stress fracture and the goals of the patient. PMID:25364480

  10. Post-Cam Design and Contact Stress on Tibial Posts in Posterior-Stabilized Total Knee Prostheses: Comparison Between a Rounded and a Squared Design.

    PubMed

    Watanabe, Toshifumi; Koga, Hideyuki; Horie, Masafumi; Katagiri, Hiroki; Sekiya, Ichiro; Muneta, Takeshi

    2017-12-01

    The post-cam mechanism in posterior stabilized (PS) prostheses plays an important role in total knee arthroplasty (TKA). The purpose of this study is to clarify the difference of the contact stress on the tibial post between a rounded post-cam design and a squared design during deep knee flexion and at hyperextension using the three-dimensional (3D) finite element models. We created 2 types of 3D, finite element models of PS prostheses (types A and B), whose surfaces were identical except for the post-cam geometries: type A has a rounded post-cam design, while type B has a squared design. Both types have a similar curved-shape intercondylar notch of the femoral component. Stress distributions, peak contact stresses, and contact areas on the tibial posts at 90°, 120°, and 150° flexion with/without 10° tibial internal rotation and at 10° hyperextension were compared between the 2 models. Type B demonstrated more concentrated stress distribution compared to type A. The peak contact stresses were similar in both groups during neutral flexion; however, the stresses were much higher in type B during flexion with 10° rotation and at hyperextension. The higher peak contact stresses corresponded to the smaller contact areas in the tibial post. A rounded post-cam design demonstrated less stress concentration during flexion with rotation and at hyperextension compared with a squared design. The results would be useful for development of implant designs and prediction of the contact stress on the tibial post in PS total knee arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Transverse Stress Fracture of the Proximal Patella: A Case Report.

    PubMed

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-02-01

    Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete.A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity.Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws.

  12. 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

  13. Stress Fractures: Etiology, Epidemiology, Diagnosis, Treatment, and Prevention.

    PubMed

    Knapik, Joseph J; Reynolds, Katy; Hoedebecke, Kyle L

    Stress fractures are part of a continuum of changes in healthy bones in response to repeated mechanical deformation from physical activity. If the activity produces excessive repetitive stress, osteoclastic processes in the bone may proceed at a faster pace than osteoblastic processes, thus weakening the bone and augmenting susceptibility to stress fractures. Overall stress fracture incidence is about three cases per 1,000 in active duty Servicemembers, but it is much higher among Army basic trainees: 19 per 1,000 for men and 80 per 1,000 for women. Well-documented risk factors include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, cigarette smoking, and inadequate intake of vitamin D and/or calcium. Individuals with stress fractures present with focal tenderness and local pain that is aggravated by physical activity and reduced by rest. A sudden increase in the volume of physical activity along with other risk factors is often reported. Simple clinical tests can assist in diagnosis, but more definitive imaging tests will eventually need to be conducted if a stress fracture is suspected. Plain radiographs are recommended as the initial imaging test, but magnetic resonance imaging has higher sensitivity and is more likely to detect the injury sooner. Treatment involves first determining if the stress fracture is of higher or lower risk; these are distinguished by anatomical location and whether the bone is loaded in tension (high risk) or compression (lower risk). Lowerrisk stress fractures can be initially treated by reducing loading on the injured bone through a reduction in activity or by substituting other activities. Higher-risk stress fractures should be referred to an orthopedist. Investigated prevention strategies include modifications to physical training programs, use of shock absorbing insoles, vitamin D and calcium supplementation

  14. Stress Rupture Fracture Model and Microstructure Evolution for Waspaloy

    NASA Astrophysics Data System (ADS)

    Yao, Zhihao; Zhang, Maicang; Dong, Jianxin

    2013-07-01

    Stress rupture behavior and microstructure evolution of nickel-based superalloy Waspaloy specimens from tenon teeth of an as-received 60,000-hour service-exposed gas turbine disk were studied between 923 K and 1088 K (650 °C and 815 °C) under initial applied stresses varying from 150 to 840 MPa. Good microstructure stability and performance were verified for this turbine disk prior to stress rupture testing. Microstructure instability, such as the coarsening and dissolution of γ' precipitates at the varying test conditions, was observed to be increased with temperature and reduced stress. Little microstructure variation was observed at 923 K (650 °C). Only secondary γ' instability occurred at 973 K (700 °C). Four fracture mechanisms were obtained. Transgranular creep fracture was exhibited up to 923 K (650 °C) and at high stress. A mixed mode of transgranular and intergranular creep fracture occurred with reduced stress as a transition to intergranular creep fracture (ICF) at low stress. ICF was dominated by grain boundary sliding at low temperature and by the nucleation and growth of grain boundary cavities due to microstructure instability at high temperature. The fracture mechanism map and microstructure-related fracture model were constructed. Residual lifetime was also evaluated by the Larson-Miller parameter method.

  15. 3-D description of fracture surfaces and stress-sensitivity analysis for naturally fractured reservoirs

    SciTech Connect

    Zhang, S.Q.; Jioa, D.; Meng, Y.F.; Fan, Y.

    1997-08-01

    Three kinds of reservoir cores (limestone, sandstone, and shale with natural fractures) were used to study the effect of morphology of fracture surfaces on stress sensitivity. The cores, obtained from the reservoirs with depths of 2170 to 2300 m, have fractures which are mated on a large scale, but unmated on a fine scale. A specially designed photoelectric scanner with a computer was used to describe the topography of the fracture surfaces. Then, theoretical analysis of the fracture closure was carried out based on the fracture topography generated. The scanning results show that the asperity has almost normal distributions for all three types of samples. For the tested samples, the fracture closure predicted by the elastic-contact theory is different from the laboratory measurements because plastic deformation of the aspirates plays an important role under the testing range of normal stresses. In this work, the traditionally used elastic-contact theory has been modified to better predict the stress sensitivity of reservoir fractures. Analysis shows that the standard deviation of the probability density function of asperity distribution has a great effect on the fracture closure rate.

  16. Lower thoracic rib stress fractures in baseball pitchers.

    PubMed

    Gerrie, Brayden J; Harris, Joshua D; Lintner, David M; McCulloch, Patrick C

    2016-01-01

    Stress fractures of the first rib on the dominant throwing side are well-described in baseball pitchers; however, lower thoracic rib fractures are not commonly recognized. While common in other sports such as rowing, there is scant literature on these injuries in baseball. Intercostal muscle strains are commonly diagnosed in baseball pitchers and have a nearly identical presentation but also a highly variable healing time. The diagnosis of a rib stress fracture can predict a more protracted recovery. This case series presents two collegiate baseball pitchers on one team during the same season who were originally diagnosed with intercostal muscle strains, which following magnetic resonance imaging (MRI) were found to have actually sustained lower thoracic rib stress fractures. The first sustained a stress fracture of the posterior aspect of the right 8th rib on the dominant arm side, while the second presented with a left-sided 10th rib stress fracture on the nondominant arm side. In both cases, MRI was used to visualize the fractures as plain radiographs are insensitive and commonly negative early in patient presentation. Patients were treated with activity modification, and symptomatic management for 4-6 weeks with a graduated return to throwing and competition by 8-10 weeks. The repetitive high stresses incurred by pitching may cause either dominant or nondominant rib stress fractures and this should be included in the differential diagnosis of thoracic injuries in throwers. It is especially important that athletic trainers and team physicians consider this diagnosis, as rib fractures may have a protracted course and delayed return to play. Additionally, using the appropriate imaging techniques to establish an accurate diagnosis can help inform return-to-play decisions, which have important practical applications in baseball, such as roster management and eligibility.

  17. Stress fracture development classified by bone scintigraphy

    SciTech Connect

    Zwas, S.T.; Elkanovich, R.; Frank, G.

    1985-05-01

    There is no consensus on classifying stress fractures (SF) appearing on bone scans. The authors present a system of classification based on grading the severity and development of bone lesions by visual inspection, according to three main scintigraphic criteria: focality and size, intensity of uptake compare to adjacent bone, and local medular extension. Four grades of development (I-IV) were ranked, ranging from ill defined slightly increased cortical uptake to well defined regions with markedly increased uptake extending transversely bicortically. 310 male subjects aged 19-2, suffering several weeks from leg pains occurring during intensive physical training underwent bone scans of themore » pelvis and lower extremities using Tc-99-m-MDP. 76% of the scans were positive with 354 lesions, of which 88% were in th4e mild (I-II) grades and 12% in the moderate (III) and severe (IV) grades. Post-treatment scans were obtained in 65 cases having 78 lesions during 1- to 6-month intervals. Complete resolution was found after 1-2 months in 36% of the mild lesions but in only 12% of the moderate and severe ones, and after 3-6 months in 55% of the mild lesions and 15% of the severe ones. 75% of the moderate and severe lesions showed residual uptake in various stages throughout the follow-up period. Early recognition and treatment of mild SF lesions in this study prevented protracted disability and progression of the lesions and facilitated complete healing.« less

  18. [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.

  19. Stress fractures of the proximal tibia in runners

    SciTech Connect

    Daffner, R.H.; Martinez, S.; Gehweiler, J.A.

    1982-01-01

    Stress fractures developed along the popliteal-solean line of the posteromedial surface of the tibia in 4 patients as the result of running. Radionuclide bone scans may be useful in early diagnosis of such injuries.

  20. Genetic predisposition for femoral neck stress fractures in military conscripts.

    PubMed

    Korvala, Johanna; Hartikka, Heini; Pihlajamäki, Harri; Solovieva, Svetlana; Ruohola, Juha-Petri; Sahi, Timo; Barral, Sandra; Ott, Jürg; Ala-Kokko, Leena; Männikkö, Minna

    2010-10-21

    Stress fractures are a significant problem among athletes and soldiers and may result in devastating complications or even permanent handicap. Genetic factors may increase the risk, but no major susceptibility genes have been identified. The purpose of this study was to search for possible genetic factors predisposing military conscripts to femoral neck stress fractures. Eight genes involved in bone metabolism or pathology (COL1A1, COL1A2, OPG, ESR1, VDR, CTR, LRP5, IL-6) were examined in 72 military conscripts with a femoral neck stress fracture and 120 controls. The risk of femoral neck stress fracture was significantly higher in subjects with low weight and body mass index (BMI). An interaction between the CTR (rs1801197) minor allele C and the VDR C-A haplotype was observed, and subjects lacking the C allele in CTR and/or the C-A haplotype in VDR had a 3-fold higher risk of stress fracture than subjects carrying both (OR = 3.22, 95% CI 1.38-7.49, p = 0.007). In addition, the LRP5 haplotype A-G-G-C alone and in combination with the VDR haplotype C-A was associated with stress fractures through reduced body weight and BMI. Our findings suggest that genetic factors play a role in the development of stress fractures in individuals subjected to heavy exercise and mechanical loading. The present results can be applied to the design of future studies that will further elucidate the genetics of stress fractures.

  1. Stress fractures of the ribs in amateur golf players.

    PubMed

    Lin, H C; Chou, C S; Hsu, T C

    1994-07-01

    Stress fractures of the ribs are sometimes seen at the Outpatient Department in patients with a history of playing golf enthusiastically. Many are diagnosed as "muscle strain" or "myofascial pain" and patients are simply advised to take some rest or are treated with analgesics and local injection. This case study investigated 11 amateur golfers whose chief complaint was anterior, posterior or lateral chest pain. After X-ray and bone scan evaluation, "stress fracture of the ribs" was diagnosed. A questionnaire presented to them trying to find the possible mechanisms of these stress fractures. Biomechanical analysis showed that the bending force of the ribs was located at posterolateral segments where fractures tend to occur. Overuse, poor technique and inadequate stretch in beginners are postulated as causes for apparent increased susceptibility to these skeletal injuries. Questionnaires inquired about (1) warm-up time, (2) number of strikes, (3) fracture sites, (4) pain patterns, (5) combined injuries. All 11 patients were beginners with right side hand dominance who had begun to play golf within the year. Right side ribs fracture occurred in six cases; left side ribs fracture occurred in eight cases including three patients with two fracture sites. Localized pain was reported in six cases and there were five cases with radiating pain along costal margins. All the golfers had spent no more than 10 minutes in warm up them. Seven patients suffered from multiple injuries after they had played. Five were diagnosed by X-ray and six showed positive finding after Tc-99m MDP bone scan. All lesions were located at the posterolateral segments of the ribs. Stress fractures of the ribs in amateur golfers are certainly not uncommon. Predominant muscle forces are generated by forced coupling of scapular retraction and protraction, acting through the serratus anterior. With early diagnosis and relative rest for four to eight weeks, the pain will improve. Overuse, poor technique

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

    PubMed

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

    2015-02-01

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

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

    PubMed Central

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

    2015-01-01

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

  4. Characterization of fractures subjected to normal and shear stress

    NASA Astrophysics Data System (ADS)

    Choi, Min-Kwang

    Results from a series of laboratory experiments to determine fracture specific stiffness, for a fracture subjected to shear and normal stress, are presented and analyzed. The experimental work focuses on the determination of relations between normal and shear fracture specific stiffness and between spatial distribution of fracture specific stiffness and fluid flow through the fracture The ratio of shear to normal fracture specific stiffness is experimentally investigated on a fracture subjected to shear as well as normal stress. Synthetic fractures made of gypsum and lucite were prepared with different fracture surface conditions: either well-mated or non-mated. For well-mated fracture surfaces, asperities were created by casting gypsum against sandpaper. A block of gypsum was cast against the sandpaper and then a second block was cast against the first block such that the two contact surfaces were well-mated. The surface roughness was controlled by using the sandpapers with different average grit size. Non-mated fracture surfaces were fabricated with two lucite blocks that were polished (lucite PL) or sand-blasted (lucite SB) along their contact surface. In the experiments, each specimen was subjected to normal and shear loading while the fracture was probed with transmitted and reflected compressional and shear waves. Shear and normal fracture specific stiffnesses were calculated using the displacement discontinuity theory. For non-mated fractures, the stiffness ratio was not sensitive to the application of shear stress and, as normal stress increased, approached a theoretical ratio which was determined assuming that the transmission of compressional and shear waves was equal. The stiffness ratio obtained from well-mated fractures ranged from 0.5 to 1.4, which deviated from the conventional assumption that shear and normal fracture specific stiffness are equal. The stiffness ratio increased with increasing surface roughness and with increasing shear stress. For

  5. Multi-Phase Fracture-Matrix Interactions Under Stress Changes

    SciTech Connect

    A.S. Grader; D. Elsworth; P.M. Halleck; F. Alvarao; A. Alajmi; Z. Karpyn; N. Mohammed; S. Al-Enezi

    2005-12-07

    The main objectives of this project are to quantify the changes in fracture porosity and multi-phase transport properties as a function of confining stress. These changes will be integrated into conceptual and numerical models that will improve our ability to predict and optimize fluid transport in fractured system. This report details our progress on: (a) developing the direct experimental measurements of fracture aperture and topology and fluid occupancy using high-resolution x-ray micro-tomography, (b) counter-current fluid transport between the matrix and the fracture, (c) studying the effect of confining stress on the distribution of fracture aperture and two-phase flow, and (d) characterization of shear fractures and their impact on multi-phase flow. The three-dimensional surface that describes the large-scale structure of the fracture in the porous medium can be determined using x-ray micro-tomography with significant accuracy. Several fractures have been scanned and the fracture aperture maps have been extracted. The success of the mapping of fracture aperture was followed by measuring the occupancy of the fracture by two immiscible phases, water and decane, and water and kerosene. The distribution of fracture aperture depends on the effective confining stress, on the nature of the rock, and the type and distribution of the asperities that keep the fracture open. Fracture apertures at different confining stresses were obtained by micro-tomography covering a range of about two thousand psig. Initial analysis of the data shows a significant aperture closure with increase in effective confining stress. Visual and detailed descriptions of the process are shown in the report. Both extensional and shear fractures have been considered. A series of water imbibition tests were conducted in which water was injected into a fracture and its migration into the matrix was monitored with CT and DR x-ray techniques. The objective was to understand the impact of the

  6. Studying the Relation Between Medial Tibial Stress Syndrome and Anatomic and Anthropometric Characteristics of Military Male Personnel.

    PubMed

    Sobhani, Vahid; Shakibaee, Abolfazl; Khatibi Aghda, Amidoddin; Emami Meybodi, Mohammad Kazem; Delavari, Abbasali; Jahandideh, Dariush

    2015-06-01

    Medial Tibial Stress Syndrome (MTSS) is common among military recruits and to our knowledge; the factors that might put the military recruits at higher risk of incidence of MTSS are not well known. This study was done to investigate the association between some anthropometric and anatomical factors and the prevalence of MTSS among military recruits. One hundred and eighty one randomly selected military recruits were included in this cross sectional study. Using history taking and physical examinations they were tested for MTSS. Accordingly the subjects were assigned to the case (those with MTSS) and control groups (normal healthy subjects). Using standard guidelines, the anthropometric and anatomical criteria of the subjects were measured. The correlation between the measurements and the prevalence of MTSS was tested using statistical analysis. Data of all the 181 subjects with the mean age of 30.7 ± 4.68 years were Included in the final analysis. The prevalence of MTSS was found to be 16.6% (30 people). Internal and external rotation range of motion, iliospinale height, the score of navicular drop test, and the trochanteric tibial lateral length were significantly different between healthy subjects and patients with MTSS (P < 0.05). The prevalence of MTSS was relatively lower in this study comparing to other studies on military personnel. It was not probably due to type of military shoes or exercise area surface (none of them were standardized); it could be due to low intensity trainings and the long intervals between training sessions.

  7. Sacral Stress Fracture in an Amateur Badminton Player.

    PubMed

    Yuasa, Yusuke; Miyakoshi, Naohisa; Hongo, Michio; Ebata, Kunio; Tomioka, Tatsuru; Shimada, Yoichi

    2017-01-01

    Sacral stress fractures are rare among athletes but have been reported most frequently in long distance runners. We report herein the first case of a sacral stress fracture in an amateur badminton player. A 16-year-old, left-handed adolescent girl, who had just started to play badminton 3 months previously, complained of acute left buttock pain when she received a shuttlecock. Magnetic resonance imaging revealed a linear lesion of the left sacrum with low signal intensity on T1- and high signal intensity on T2-weighted images, which was consistent with a stress fracture. Conservative treatment with rest relieved her symptoms. Her fracture was considered to have occurred due to repetition of an exercise that caused excessive vertical power.

  8. Permeability evolution of stressed fractures permeated by reactive fluids

    NASA Astrophysics Data System (ADS)

    McGuire, Thomas P.

    Understanding the dynamic response of stressed fractures during the flow of reactive fluids is an important contemporary research topic. Specifically, understanding the response of stressed fractures in carbonate is important for both energy (petroleum) production and sequestration of the products of energy use (carbon dioxide). We conduct tightly constrained experiments on artificial fractures with repeatable initial roughness and permeability to measure permeability response and rates of mineral dissolution during the flow of reactive fluids. These experiments are supplemented by detailed numerical modeling to better understand relevant mechanisms; namely pressure solution, stress corrosion cracking enhanced diffusion, precipitation, and free-face dissolution, that lead to permeability evolution of these fractures and to accurately quantify their relative rates. Experimental measurements are conducted on various lengths of 2.5 cm diameter cylindrical samples of tight, vuggy, Capitan Massive limestone. A single rough artificial fracture with repeatable initial permeability is created in the samples by making a single longitudinal saw cut prior to roughening the surface with either 60 grit (rough) or 150 grit (smooth) ceramic abrasive. The effective permeability-inferred hydraulic aperture of these fractures is monitored throughout each experiment by the mass balance of the percolating reactive fluid maintained at a fixed hydraulic gradient. Relative rates of pressure solution, stress corrosion cracking enhanced diffusion, precipitation, and free-face dissolution lead to either net fracture gaping or compaction. Dissolved mineral mass balance in the pore fluid provides an independent means of quantifying fracture closure or gaping, depending on the relative strength of each mechanism. To decipher these mixed effects numerical models are developed. Lumped parameter models of stress corrosion cracking enhanced diffusion and free-face dissolution provide adequate

  9. Influence of fracture extension on in-situ stress in tight reservoir

    NASA Astrophysics Data System (ADS)

    Zhang, Yongping; Wei, Xu; Zhang, Ye; Xing, Libo; Xu, Jianjun

    2018-01-01

    Currently, hydraulic fracturing is an important way to develop low permeability reservoirs. The fractures produced during the fracturing process are the main influencing factors of changing in-situ stress. In this paper, the influence of fracture extension on in-situ stress is studied by establishing a mathematical model to describe the relationship between fracture length and in-situ stress. The results show that the growth rate gradually decreases after the fracture reaches a certain length with the increase of fracturing time; the continuous extension of the fracture is the main factor to change the in-situ stress. In order to reduce the impact on the subsequent fracture extension due to the changing of in-situ stress, controlling fracturing time and fracture length without affecting the stimulated reservoir effect is an important way. The results presented in this study can effectively reduce the impact of changing of in-situ stress on subsequent fracturing construction.

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

    PubMed

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

    2017-03-01

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

  11. The comprehensive description of stress fractures: a new classification system.

    PubMed

    Kaeding, Christopher C; Miller, Timothy

    2013-07-03

    Stress fractures represent a fatigue failure of bone, occurring with a spectrum of severity of structural injury, and healing potential varies by location. There is no comprehensive classification system for stress fractures incorporating both clinical and radiographic characteristics of the injury that is applicable to all bones. We introduce a system that is reproducible, generalizable, easy to use, and clinically relevant, with three descriptors: fracture grade, fracture location, and imaging modality. After a review of current classification systems, a five-tier system was proposed to determine fracture grade: Grade I indicated asymptomatic stress reaction on imaging, Grade II indicated pain with no fracture line, Grade III indicated non-displaced fracture, Grade IV indicated displaced fracture, and Grade V indicated nonunion. Example cases of each grade with clinical vignettes and images were prepared to test the interobserver and intraobserver reliability of the system by the test and retest evaluation among fifteen clinicians. A questionnaire and recall test assessed the ease of use, clinical applicability, and recall accuracy. Test and retest analysis showed that the system had almost perfect agreement in intraobserver reliability with a kappa value of 0.81. The overall intraobserver reliability showed almost perfect agreement with a kappa value of 0.81. Almost perfect agreement with a kappa value of 0.83 was also produced when these responses were compared with our assessment. The overall interobserver reliability had substantial agreement with a kappa value of 0.78. The reliability of the group compared with that of the answer key was almost perfect with a kappa value of 0.83. The recall test showed an overall accuracy of 97.3%. Of the fifteen evaluators who completed questionnaires, fourteen (93.3%) said that the system would be easily remembered, would facilitate communication among colleagues, and would be useful in clinical practice. The proposed

  12. Crack propagation and fracture in engineered stress profile glass

    NASA Astrophysics Data System (ADS)

    Abrams, Matthew B.

    Ion exchange procedures have been developed for soda lime silicate and soda alumina silicate glasses that produce a maximum compressive stress below the surface of the material. These glasses can form stable surface cracks under applied tensile stress, resulting in rising apparent R-curve behavior and reduced strength variability as a function of flaw size in the material. Glass exhibiting this behavior has been termed engineered stress profile (ESP) glass. In this work, eight ion exchange procedures and three surface preparation methods were used to produce a range of ESP glasses. An experimental stress measurement method utilizing iterated optical retardation and progressive etching was developed to determine the stress profile in the glass surfaces. Based on the measured stress profiles, a weight function approach was used to predict stress intensity factors as a function of crack geometry, and thus determine crack propagation paths as a function of initial flaw size, residual and applied stresses, and material fracture toughness. These calculations were used to predict fracture strength distribution, crack stability, and the potential for multiple surface cracking. Predicted values were compared to experimental observations of crack growth and fracture behavior, and with measured fracture strength distributions.

  13. Taking a holistic approach to managing difficult stress fractures.

    PubMed

    Miller, Timothy L; Best, Thomas M

    2016-09-09

    Stress fractures and other bony stress injuries occur along a spectrum of severity which can impact treatment and prognosis. When treating these injuries, it should be borne in mind that no two stress fractures behave exactly alike. Given that they are not a consistent injury, standardized treatment protocols can be challenging to develop. Treatment should be individualized to the patient or athlete, the causative activity, the anatomical site, and the severity of the injury. A holistic approach to the treatment of the most difficult stress fractures should be taken by orthopedists and sports medicine specialists. This approach is necessary to obtain optimal outcomes, minimize loss of fitness and time away from sports participation, and decrease the risk of recurrence.

  14. Fracture toughness and the effects of stress state on fracture of nickel aluminides

    NASA Technical Reports Server (NTRS)

    Lewandowski, John J.; Michal, Gary M.; Locci, Ivan; Rigney, Joseph D.

    1991-01-01

    The effects of stress state on the fracture behavior of Ni3Al, Ni3Al + B, and NiAl were determined using either notched or fatigue-precracked bend bars tested to failure at room temperature, in addition to testing specimens in tension under superposed hydrostatic pressure. Although Ni3Al is observed to fail in a macroscopically brittle intergranular manner in tension tests conducted at room temperature, the fracture toughnesses presently obtained on Ni3Al exceeded 20 MPam, and R-curve behavior was exhibited. In situ monitoring of the fracture experiments was utilized to aid in interpreting the source(s) of the high toughness in Ni3Al, while SEM fractography was utilized to determine the operative fracture modes. The superposition by hydrostatic pressure during tensile testing of NiAl specimens was observed to produce increased ductility without changing the fracture mode.

  15. Adhesive fracture mechanics. [stress analysis for bond line interface

    NASA Technical Reports Server (NTRS)

    Bennett, S. J.; Devries, K. L.; Williams, M. L.

    1974-01-01

    In studies of fracture mechanics the adhesive fracture energy is regarded as a fundamental property of the adhesive system. It is pointed out that the value of the adhesive fracture energy depends on surface preparation, curing conditions, and absorbed monolayers. A test method reported makes use of a disk whose peripheral part is bonded to a substrate material. Pressure is injected into the unbonded central part of the disk. At a certain critical pressure value adhesive failure can be observed. A numerical stress analysis involving arbitrary geometries is conducted.

  16. Stress fracture in acetabular roof due to motocross: case report.

    PubMed

    de Paiva Luciano, Alexandre; Filho, Nelson Franco

    2016-01-01

    One of the first steps to be taken in order to reduce sports injuries such as stress fractures is to have in-depth knowledge of the nature and extent of these pathological conditions. We present a case report of a stress fracture of the acetabular roof caused through motocross. This type of case is considered rare in the literature. The description of the clinical case is as follows. The patient was a 27-year-old male who started to have medical follow-up because of uncharacteristic pain in his left hip, which was concentrated mainly in the inguinal region of the left hip during motocross practice. After clinical investigation and complementary tests, he was diagnosed with a stress fracture of the acetabular roof.

  17. Characteristics of stress fractures in young athletes under 20 years.

    PubMed

    Ohta-Fukushima, M; Mutoh, Y; Takasugi, S; Iwata, H; Ishii, S

    2002-06-01

    With the popularization of organized sports among adolescents and children, the clinical cases of stress fractures in young athletes have increased. This study was carried out to investigate the characteristics of stress fractures in young athletes. During the 18-month period between January 1996 and June 1997, new clinical cases of stress fracture due to sports activities were collected from 39 hospitals in Japan. We analyzed 222 stress fractures in 208 athletes under 20 years of age (108 males: 14.4+/-2.2 years, 100 females: 15.2+/-1.5 years). Among these cases, the peak age of occurrence was 16. The most common sport causing stress fracture was basketball. The tibia was the most common location. About 70% of the patients participated in the respective sport for 6 or 7 days per week. High school students trained significantly more often than the primary and junior high school students (p<0.0001). There was a statistically significant difference in the return time to the sport between the cases who visited a hospital within 3 weeks and those who waited for more than 3 weeks after the onset of symptoms (return time, 10.4 vs 18.4 wks). Several cases visited a hospital beyond 8 weeks after the onset of symptoms regardless of the continuous pain of stress fracture, and their recovery was prolonged. It is important to educate young athletes that continuous pain lasting over 3 weeks is a warning signal to the body, and that early diagnosis leads to early recovery.

  18. Studying the Relation Between Medial Tibial Stress Syndrome and Anatomic and Anthropometric Characteristics of Military Male Personnel

    PubMed Central

    Sobhani, Vahid; Shakibaee, Abolfazl; Khatibi Aghda, Amidoddin; Emami Meybodi, Mohammad Kazem; Delavari, Abbasali; Jahandideh, Dariush

    2015-01-01

    Background: Medial Tibial Stress Syndrome (MTSS) is common among military recruits and to our knowledge; the factors that might put the military recruits at higher risk of incidence of MTSS are not well known. Objectives: This study was done to investigate the association between some anthropometric and anatomical factors and the prevalence of MTSS among military recruits. Patients and Methods: One hundred and eighty one randomly selected military recruits were included in this cross sectional study. Using history taking and physical examinations they were tested for MTSS. Accordingly the subjects were assigned to the case (those with MTSS) and control groups (normal healthy subjects). Using standard guidelines, the anthropometric and anatomical criteria of the subjects were measured. The correlation between the measurements and the prevalence of MTSS was tested using statistical analysis. Results: Data of all the 181 subjects with the mean age of 30.7 ± 4.68 years were Included in the final analysis. The prevalence of MTSS was found to be 16.6% (30 people). Internal and external rotation range of motion, iliospinale height, the score of navicular drop test, and the trochanteric tibial lateral length were significantly different between healthy subjects and patients with MTSS (P < 0.05). Discussion: The prevalence of MTSS was relatively lower in this study comparing to other studies on military personnel. It was not probably due to type of military shoes or exercise area surface (none of them were standardized); it could be due to low intensity trainings and the long intervals between training sessions. PMID:26448835

  19. Stress Related Fracturing in Dimension Stone Quarries

    NASA Astrophysics Data System (ADS)

    Hamdi Deliormanli, Ahmet; Maerz, Norbert H.

    2016-10-01

    In Missouri, the horizontal stresses (pressures) in the near surface rock are uncommonly high. While the vertical stresses in rock are simply a function of the weight of the overlying rock, near surface stresses can be many times higher. The near surface horizontal stresses can be in excess of 5 times greater than the vertical stresses. In this research, Flatjack method was used to measure horizontal stress in Red Granite Quarry in Missouri. The flat jack method is an approved method of measuring ground stresses. A saw cut is used to “relax” the stress in the ground by allowing the rock to deform inwards the cut. A hydraulic flat jack is used to inflate the slot; to push the rock back to its stressed position, as measured by a strain gauge on either side of the slot. The pressure in the jack, when the rock is exactly back to its original position, is equal to the ground stress before the saw cut was made. According to the results, present production direction for each pit is not good because the maximum stress direction is perpendicular with production direction. This case causes unintentional breakage results in the loss rock. The results show that production direction should be changed.

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

    PubMed

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

    2009-01-01

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

  1. Hygrothermomechanical fracture stress criteria for fiber composites with sense-parity

    NASA Technical Reports Server (NTRS)

    Chamis, C. C.; Ginty, C. A.

    1983-01-01

    Hygrothermomechanical fracture stress criteria are developed and evaluated for unidirectional composites (plies) with sense-parity. These criteria explicity quantify the individual contributions of applied, hygral and thermal stresses as well as couplings among these stresses. The criteria are for maximum stress, maximum strain, internal friction, work-to-fracture and combined-stress fracture. Predicted results obtained indicate that first ply failure will occur at stress levels lower than those predicted using criteria currently available in the literature. Also, the contribution of the various stress couplings (predictable only by fracture criteria with sense-parity) is significant to first ply failure and attendant fracture modes.

  2. The relationship between lower extremity alignment and Medial Tibial Stress Syndrome among non-professional athletes

    PubMed Central

    Raissi, Golam Reza D; Cherati, Afsaneh D Safar; Mansoori, Kourosh D; Razi, Mohammad D

    2009-01-01

    Objective To determine the relationship between lower extremity alignment and MTSS amongst non-professional athletes Design In a prospective Study, sixty six subjects were evaluated. Bilateral navicular drop test, Q angle, Achilles angle, tibial angle, intermalleolar and intercondylar distance were measured. In addition, runner's height, body mass, history of previous running injury, running experience was recorded. Runners were followed for 17 weeks to determine occurrence of MTSS. Results The overall injury rate for MTSS was 19.7%. The MTSS injury rate in girls (22%) was not significantly different from the rate in boys (14.3%). Most MTSS injuries were induced after 60 hours of exercise, which did not differ between boys and girls. There was a significant difference in right and left navicular drop (ND) in athletes with MTSS. MTSS had no significant correlation with other variables including Quadriceps, Tibia and Achilles angles, intercondylar and intermaleolar lengths and lower extremity lengths. Limitation All measurements performed in this study were uniplanar and static. The small sample size deemed our main limitation. The accurate assessment of participants with previous history of anterior leg pain for MTSS was another limitation. Conclusion Although a significant relationship between navicular drop and MTSS was found in this study; there was not any significant relationship between lower extremity alignment and MTSS in our sample study. PMID:19519909

  3. Fiber networks below the isostatic point: Fracture without stress concentration

    NASA Astrophysics Data System (ADS)

    Zhang, Leyou; Rocklin, D. Zeb; Sander, Leonard M.; Mao, Xiaoming

    2017-10-01

    Crack nucleation, in which a crack is propagated via the concentration of stress at its tip, is a ubiquitous phenomenon. Here, we show via simulations and theory that in systems such as fiber networks that are below the point of mechanical stability, continuous nonlinear alignments lead to a steady state in which new load-bearing fiber chains emerge to replace those lost to fracture, preventing stress concentration and leading to the accumulation of distributed damage over a divergent length scale. In contrast to linear models that display diverging length scales at a critical point, this phenomenon occurs over a large parameter range, and is expected to be observed in biopolymer networks and porous artificial materials. This mixture of fiber alignment and fracture leads to massively greater energy dissipation and to fracture avalanche statistics distinct from those present in linear models.

  4. Massage treatment and medial tibial stress syndrome; A commentary to provoke thought about the way massage therapy is used in the treatment of MTSS.

    PubMed

    Fogarty, Sarah

    2015-07-01

    As students and practitioners we are taught about the treatment and causative factors of medial shin pain, in particular' shin splints' or the more recent term; medial tibial stress syndrome (MTSS). During the years there have been many theories, conjecture and misunderstandings about the mechanisms of 'shin splints/medial tibial stress syndrome' however the ramifications of these mechanisms on how massage treatment is delivered have not being discussed. The evidence for the treatment of MTSS is largely clinical with little evidence of any treatment being proven to be effective in treating MTSS. The aim of this article is to present a summary of the mechanisms of MTSS and a commentary to provoke thought about the way massage therapy is used in the treatment of MTSS based on these mechanisms. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    PubMed

    Guthrie, J W; Kalff, S

    2017-12-12

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

  6. SCAPHOID STRESS FRACTURE IN GYMNASTICS ATHLETE: A CASE REPORT.

    PubMed

    Nakamoto, João Carlos; Saito, Mateus; Cunha, Ana Paula; Luques, Isabela Ugo

    2009-01-01

    We present a case report of an 18 year-old gymnast who was diagnosed with a scaphoid stress fracture associated with a distal radial epiphysiolysis, reporting the treatment of choice. After a brief literature review about this rare association, the authors ask for attention concerning the importance of physical and image examination in making right diagnosis and finding associated injuries.

  7. All-Polyethylene Tibial Components: An Analysis of Long-Term Outcomes and Infection.

    PubMed

    Houdek, Matthew T; Wagner, Eric R; Wyles, Cody C; Watts, Chad D; Cass, Joseph R; Trousdale, Robert T

    2016-07-01

    There is debate regarding tibial component modularity and composition in total knee arthroplasty (TKA). Biomechanical studies have suggested improved stress distribution in metal-backed tibias; however, these results have not translated clinically. The purpose of this study was to analyze the outcomes of all-polyethylene components and to compare the results to those with metal-backed components. We reviewed 31,939 patients undergoing a primary TKA over a 43-year period (1970-2013). There were 28,224 (88%) metal-backed and 3715 (12%) all-polyethylene tibial components. The metal-backed and all-polyethylene groups had comparable demographics with respect to gender, age and body mass index (BMI). Mean follow-up was 7 years. The mean survival for all primary TKAs at the 5-, 10-, 20- and 30-year time points was 95%, 89%, 73%, and 57%, respectively. All-polyethylene tibial components were found to have a significantly improved (P < .0001) survivorship when compared with their metal-backed counterparts. All-polyethylene tibial components were also found to have a significantly lower rate of infection, instability, tibial component loosening, and periprosthetic fracture. The all-polyethylene group had improved survival rates in all age groups, except in patients 85 years old or greater, where there was no significant difference. All-polyethylene tibial components had improved survival for all BMI groups except in the morbidly obese (BMI ≥ 40) where there was no significant difference. All-polyethylene tibial components had significantly improved implant survival, reduced rates of postoperative infection, fracture, and tibial component loosening. All polyethylene should be considered for most of the patients, regardless of age and BMI. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Dispersion of solids in fracturing flows of yield stress fluids

    NASA Astrophysics Data System (ADS)

    Hormozi, Sarah; Frigaard, Ian

    2016-11-01

    Solids dispersion is an important part of hydraulic fracturing. Whereas many frac fluids are low-viscous others transport solids through increased viscosity. In this context, one method for influencing both dispersion and solids carrying capacity is to use a yield stress fluid as the frac fluid. We propose a model framework for this scenario and analyse one of the simplifications. A key effect of including a yield stress is to focus high shear rates near the fracture walls. In typical fracturing flows this results in a large variation in shear rates across the fracture. In using shear-thinning viscous frac fluids, flows may vary significantly on the particle scale, from Stokesian behaviour to inertial behaviour across the width of the fracture. Equally, according to the flow rates, Hele-Shaw style models give way at higher Reynolds number to those in which inertia must be considered. We develop a model framework able to include this range of flows and make estimates of the streamwise dispersion in various relevant scenarios. Schlumberger Oilfield Services, NSF and ACS PRF.

  9. Recurrent metatarsal stress fractures in a college football lineman.

    PubMed

    Moul, J L; Massey, A N

    1995-03-01

    Stress fractures are common overuse injuries of bone attributed to repetitive trauma, training errors, and/or structural abnormalities. A 21-year-old, 252-lb football lineman participating in spring conditioning drills complained of right foot pain following a plantar flexion, inversion injury that occurred while cutting. Pain was concentrated over the dorsum of the foot in both weight bearing and at rest. X-ray evaluation indicated an acute stress fracture of the fourth metatarsal and two nonunions of the second and third metatarsals. Additionally, x-rays revealed metatarsus adductus, a congenital anatomic deformity. The athlete demonstrated compensatory hyperpronation in the right hind foot during a follow-up biomechanical evaluation. He was removed from weightbearing activities, treated symptomatically for pain and swelling, and placed in a rigid orthotic. He has returned to full activity without further incident. This case report emphasizes the important role that biomechanical factors may have in osseous stress injuries.

  10. A comparison of the effect of shoes on human tibial axial strains recorded during dynamic loading.

    PubMed

    Milgrom, C; Burr, D; Fyhrie, D; Hoshaw, S; Finestone, A; Nyska, M; Davidson, R; Mendelson, S; Giladi, M; Liebergall, M; Lehnert, B; Voloshin, A; Simkin, A

    1998-02-01

    Percutaneous axial extensometers were mounted on the medial cortex of the midtibial diaphysis in seven male volunteers and the effect of three different shoes on in vivo peak-to-peak axial compression-tension strains measured during dynamic loading. Zohar shoes had lower axial strains and strain rates during treadmill walking than Nike Air Max running shoes or Israeli infantry boots. During running on a running track, there was no statistically significant difference between the axial strains or strain rates between the shoes tested. Shoe gear can modify tibial strains and strain rates that contribute to the development of tibial stress fractures.

  11. Composite fracture using the normal stress ratio theory

    NASA Technical Reports Server (NTRS)

    Beuth, J. L., Jr.; Gurdal, Z.; Herakovich, C. T.

    1989-01-01

    Experiments were performed on center-notched specimens of unidirectional AS4/3501-6 graphite-epoxy subjected to varied far-field loading conditions. Specimens tested include on-axis and off-axis tensile coupons and Iosipescu shear specimens, allowing the study of normal, shear, and combined far-field loading conditions. From the tests, the direction of initial crack extension and the far-field stresses at crack initiation and fracture are obtained. The normal stress ratio theory is subsequently applied within a macroscopic-level homogeneous anisotropic stress solution to predict the direction of crack extension, critical stresses, and other crack growth behavior for the experiments. Comparison between experimental results and theoretical predictions indicates that application of the normal stress ratio theory within a macroscopic-level stress analysis has significant potential as an approach to modeling composite crack growth.

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

    PubMed

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

    2016-10-01

    To evaluate the development in patient-reported quality of life (QOL) and muscle strength in the period from surgery to 12 months postoperatively after intramedullary nailing of a tibial shaft fracture. The design was a prospective, follow-up cohort study. QOL was measured with the questionnaire Eq5D-5L and compared to norm data from a reference population. Recordings of pain and contralateral muscle strength (isometric maximal voluntary contraction (MVC) for knee flexion and extension were collected at 6 weeks, 3, 6, and 12 months postoperatively. Ipsilateral MVCs were recorded at 6 and 12 months. Forty-nine patients were included. The mean age at the time of fracture was 43.1 years (18-79 years). Twelve months postoperatively, the mean Eq5D-5L index was 0.792 (95 % CI 0.747-0.837). Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Six and 12 months after surgery patients demonstrated decreased muscle strength in the injured leg compared to the non-injured leg for knee extension and flexion (P < 0.001). Twelve months postoperatively, increasing relative difference in muscle strength during knee extension show a fair correlation to worse QOL (R = 0.541, P < 0.001). Throughout the 12 months postoperatively, patients reported worse QOL compared to the reference population. Muscle strength in the non-injured leg improved over time and was higher after 6 and 12 months compared with the injured leg.

  13. Treatment of Medial Tibial Stress Syndrome according to the Fascial Distortion Model: A Prospective Case Control Study

    PubMed Central

    Finze, Susanne; Lison, Andreas

    2014-01-01

    Medial tibial stress syndrome (MTSS) is a common problem among athletes and soldiers. There is no proven theory that could explain the pathophysiology of shin splints. The therapies described so far are time-consuming and involve a high risk of relapse. The method according to the fascial distortion model (FDM) addresses local changes in the area of the lower leg fascia. It is suited to reduce pain and functional impairments associated with this symptom complex by applying targeted manual techniques. 32 patients (male: 30; female: 2) participated in this study. Visual analogue scale (VAS) was used for the quantification of pain. Scores were also given to rate the maximum painless exercise tolerance of the patients. Subsequently treatment of the crural fascia was performed. Patients retested ability of running and jumping. Therapy was continued until full exercise tolerance or painlessness was reached. A significant reduction of the VAS pain score from 5.2 to 1.1 could be achieved (P < 0.001). The impairment of exercise tolerance could be reduced from 7 to 2 points (P < 0.001). The duration of treatment was 6.3 (SD: 4.3) days on average. The FDM therapy is a potential effective method for acute treatment of MTSS. PMID:25379543

  14. Treatment of medial tibial stress syndrome according to the fascial distortion model: a prospective case control study.

    PubMed

    Schulze, Christoph; Finze, Susanne; Bader, Rainer; Lison, Andreas

    2014-01-01

    Medial tibial stress syndrome (MTSS) is a common problem among athletes and soldiers. There is no proven theory that could explain the pathophysiology of shin splints. The therapies described so far are time-consuming and involve a high risk of relapse. The method according to the fascial distortion model (FDM) addresses local changes in the area of the lower leg fascia. It is suited to reduce pain and functional impairments associated with this symptom complex by applying targeted manual techniques. 32 patients (male: 30; female: 2) participated in this study. Visual analogue scale (VAS) was used for the quantification of pain. Scores were also given to rate the maximum painless exercise tolerance of the patients. Subsequently treatment of the crural fascia was performed. Patients retested ability of running and jumping. Therapy was continued until full exercise tolerance or painlessness was reached. A significant reduction of the VAS pain score from 5.2 to 1.1 could be achieved (P < 0.001). The impairment of exercise tolerance could be reduced from 7 to 2 points (P < 0.001). The duration of treatment was 6.3 (SD: 4.3) days on average. The FDM therapy is a potential effective method for acute treatment of MTSS.

  15. Gender differences of muscle and crural fascia origins in relation to the occurrence of medial tibial stress syndrome.

    PubMed

    Edama, M; Onishi, H; Kubo, M; Takabayashi, T; Yokoyama, E; Inai, T; Watanabe, H; Nashimoto, S; Koga, Y; Kageyama, I

    2017-02-01

    Although women reportedly have a higher prevalence of medial tibial stress syndrome (MTSS) than men, the possible role of gender-based anatomical differences has not been investigated. The aim of the present study was to investigate the presence of gender-based differences in the range of muscle attachments along the entire medial tibia, the proportion of muscle attachment at the middle and distal thirds of the medial margin of the tibia, the structure of the crural fascia, and chiasm position. The specimens were 100 legs of 55 Japanese cadavers. Statistical analysis was carried out using a chi-square test to compare anatomical features between the sexes. The flexor digitorum longus (FDL) had a higher proportion of attachment to the middle and distal thirds of the medial margin of the tibia than the soleus (SOL; P < 0.001). The proportion of the SOL attachment to the middle and distal thirds of the medial margin of the tibia was 33.3% in men and 72.5% in women (P < 0.001). The soleal aponeurosis was not observed in any specimen. In all specimens the FDL formed the top layer of both chiasms. These results suggest that the higher prevalence of MTSS reported among women may be the result of gender-based anatomical differences. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors

    PubMed Central

    Reinking, Mark F.; Austin, Tricia M.; Richter, Randy R.; Krieger, Mary M.

    2016-01-01

    Context: Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia. Objective: To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors. Data Sources: Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015. Study Selection: Inclusion criteria were determined a priori and included original research with participants’ pain diffuse, located in the posterior medial tibial region, and activity related. Study Design: Systematic review with meta-analysis. Level of evidence: Level 4. Data Extraction: Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I2 index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality. Results: Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity

  17. Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors.

    PubMed

    Reinking, Mark F; Austin, Tricia M; Richter, Randy R; Krieger, Mary M

    Medial tibial stress syndrome (MTSS) is a common condition in active individuals and presents as diffuse pain along the posteromedial border of the tibia. To use cross-sectional, case-control, and cohort studies to identify significant MTSS risk factors. Bibliographic databases (PubMed, Scopus, CINAHL, SPORTDiscus, EMBASE, EBM Reviews, PEDRo), grey literature, electronic search of full text of journals, manual review of reference lists, and automatically executed PubMed MTSS searches were utilized. All searches were conducted between 2011 and 2015. Inclusion criteria were determined a priori and included original research with participants' pain diffuse, located in the posterior medial tibial region, and activity related. Systematic review with meta-analysis. Level 4. Titles and abstracts were reviewed to eliminate citations that did not meet the criteria for inclusion. Study characteristics identified a priori were extracted for data analysis. Statistical heterogeneity was examined using the I 2 index and Cochran Q test, and a random-effects model was used to calculate the meta-analysis when 2 or more studies examined a risk factor. Two authors independently assessed study quality. Eighty-three articles met the inclusion criteria, and 22 articles included risk factor data. Of the 27 risk factors that were in 2 or more studies, 5 risk factors showed a significant pooled effect and low statistical heterogeneity, including female sex (odds ratio [OR], 2.35; CI, 1.58-3.50), increased weight (standardized mean difference [SMD], 0.24; CI, 0.03-0.45), higher navicular drop (SMD, 0.44; CI, 0.21-0.67), previous running injury (OR, 2.18; CI, 1.00-4.72), and greater hip external rotation with the hip in flexion (SMD, 0.44; CI, 0.23-0.65). The remaining risk factors had a nonsignificant pooled effect or significant pooled effect with high statistical heterogeneity. Female sex, increased weight, higher navicular drop, previous running injury, and greater hip external rotation

  18. Ductile fracture in pure silver under high-triaxial stresses

    SciTech Connect

    Tolle, M.C. . Dept. of Mechanical Engineering); Kassner, M.E. . Dept. of Mechanical Engineering Lawrence Livermore National Lab., CA )

    1994-09-01

    The purpose of this study was to determine the mechanism of ductile fracture in pure silver subjected to a triaxial stress state. This was accomplished by preparing mechanical-testing specimens of thin, constrained, silver interlayers. The general objective of this research was to determine the (perhaps common) mechanism for ductile fracture in materials subjected to a variety of triaxial stress states. The approach consisted of three tasks: first, the authors compared the Huang et al. numerically determined instability criterion for an axisymmetric principal stress state with the experimentally observed [sigma][sub m]/[sigma][sub y] values for simple, tensile-loaded, high-purity, silver interlayers at failure. This would determine whether the unstable cavity growth mechanisms can apply to the important case of low strain ductile failures in thin constrained interlayers loaded in tension. Second, they would experimentally examine (ductile) fractures under other triaxial stress states, such as axisymmetric and non-axisymmetric stress-states, apparently outside the HHT predicted limits of unstable cavity growth in elastic-perfectly plastic solids with [sigma][sub 2]/[sigma][sub 1] < 0.75 (for [sigma][sub y]/E [approx equal] 0.003). This would be followed by an analysis of the failure, particularly for the case of small macroscopic plastic strains to failure. This would include comparing the observed stress states associated with ductile failure in biaxially loaded interlayers with FEM predictions of the stress levels required for unstable cavity growth using identical stress states (i.e., [sigma][sub 1], [sigma][sub 2], and [sigma][sub 3] of the same ratios).

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

    PubMed

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

    2012-01-01

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

  20. Stress fracture injury in young military men and women.

    PubMed

    Armstrong, David W; Rue, John-Paul H; Wilckens, John H; Frassica, Frank J

    2004-09-01

    Approximately 5% of all military recruits incur stress fracture injuries during intense physical training, predominately in the lower extremity. We compared young men and women with stress fracture injury (subjects) to a matched group of uninjured volunteers (controls) during a summer training program at the United States Naval Academy to identify possible risk factors for stress fracture injury. The subject group was composed of 13 female and 18 male plebes with training-induced stress fracture injury verified by plain radiographs and/or nuclear bone scan. The control group was composed of 13 female and 18 male plebes who remained without injury during plebe summer training but who were matched with the 31 injured plebes for the Initial Strength Test (1-mi run time, means: women, 7.9 min; men, 6.4 min) and body mass index (means: women, 23.4; men, 23.8). We found that the subjects lost significant body weight (mean, 2.63 +/- 0.54 kg) between Day 1 and the date of their diagnosis of a stress fracture (mean, Day 35) and that they continued to lose weight until the date of their DEXA scan (mean, Day 49). Among female plebes, there was no evidence of the female athlete triad (eating disorders, menstrual dysfunction, or low bone density). Thigh girth was significantly smaller in female subjects than in female controls and trended to be lower in male subjects than in male controls. Total body bone mineral content was significantly lower in the male subjects than in male controls. Bone mineral density of the distal tibia and femoral neck were not significantly different between the groups. DEXA-derived structural geometric properties were not different between subjects and controls. Because, on average, tibias were significantly longer in male subjects than in male controls, the mean bone strength index in male subjects was significantly lower than that of male controls. We conclude that significant, acute weight loss combined with regular daily physical training among

  1. Dietary intake and stress fractures among elite male combat recruits

    PubMed Central

    2012-01-01

    Background Appropriate and sufficient dietary intake is one of the main requirements for maintaining fitness and health. Inadequate energy intake may have a negative impact on physical performance which may result in injuries among physically active populations. The purpose of this research was to evaluate a possible relationship between dietary intake and stress fracture occurrence among combat recruits during basic training (BT). Methods Data was collected from 74 combat recruits (18.2 ± 0.6 yrs) in the Israeli Defense Forces. Data analyses included changes in anthropometric measures, dietary intake, blood iron and calcium levels. Measurements were taken on entry to 4-month BT and at the end of BT. The occurrence of stress reaction injury was followed prospectively during the entire 6-month training period. Results Twelve recruits were diagnosed with stress fracture in the tibia or femur (SF group). Sixty two recruits completed BT without stress fractures (NSF). Calcium and vitamin D intakes reported on induction day were lower in the SF group compared to the NSF group-38.9% for calcium (589 ± 92 and 964 ± 373 mg·d-1, respectively, p < 0.001), and-25.1% for vitamin D (117.9 ± 34.3 and 157.4 ± 93.3 IU·d-1, respectively, p < 0.001). During BT calcium and vitamin D intake continued to be at the same low values for the SF group but decreased for the NSF group and no significant differences were found between these two groups. Conclusions The development of stress fractures in young recruits during combat BT was associated with dietary deficiency before induction and during BT of mainly vitamin D and calcium. For the purpose of intervention, the fact that the main deficiency is before induction will need special consideration. PMID:22413851

  2. Laboratory investigation on the effect of in situ stresses on hydraulic fracture containment

    SciTech Connect

    Warpinski, N. R.; Clark, J. A.; Schmidt, R. A.; Huddle, C. W.

    1981-01-01

    Laboratory experiments have been conducted to determine the effect of in situ stress variations on hydraulic fracture containment. Fractures were initiated in layered rock samples with prescribed stress variations, and fracture growth characteristics were determined as a function of stress levels. Stress contrasts of 2-3 MPa were found to be sufficient to restrict fracture growth in laboratory samples of Nevada tuff and Tennessee and Nugget sandstones. The required stress level was found not to depend on mechanical rock properties. However, permeability and the resultant pore pressure effects were found to be important. Tests conducted at bimaterial interfaces between Nugget and Tennessee sandstone show that the resultant stresses set up near the interface due to the applied overburden stress affect the fracture behavior in the same way as the applied confining stresses. These results provide a guideline for determining the in situ stress contrast necessary to contain a fracture in a field treatment.

  3. Stress- and Chemistry-Mediated Permeability Enhancement/Degradation in Stimulated Critically-Stressed Fractures

    SciTech Connect

    Derek Elsworth; Abraham S. Grader; Chris Marone; Phillip Halleck; Peter Rose; Igor Faoro; Joshua Taron; André Niemeijer; Hideaki Yasuhara

    2009-03-30

    This work has investigated the interactions between stress and chemistry in controlling the evolution of permeability in stimulated fractured reservoirs through an integrated program of experimentation and modeling. Flow-through experiments on natural and artificial fractures in Coso diorite have examined the evolution of permeability under paths of mean and deviatoric stresses, including the role of dissolution and precipitation. Models accommodating these behaviors have examined the importance of incorporating the complex couplings between stress and chemistry in examining the evolution of permeability in EGS reservoirs. This document reports the findings of experiment [1,2] and analysis [3,4], in four sequential chapters.

  4. Fracture and Stress Evolution on Europa: New Insights Into Fracture Interpretation and Ice Thickness Estimates Using Fracture Mechanics Analyses

    NASA Technical Reports Server (NTRS)

    Kattenhorn, Simon

    2004-01-01

    The work completed during the funding period has provided many important insights into fracturing behavior in Europa's ice shell. It has been determined that fracturing through time is likely to have been controlled by the effects of nonsynchronous rotation stresses and that as much as 720 deg of said rotation may have occurred during the visible geologic history. It has been determined that there are at least two distinct styles of strike-slip faulting and that their mutual evolutionary styles are likely to have been different, with one involving a significant dilational component during shear motion. It has been determined that secondary fracturing in perturbed stress fields adjacent to older structures such as faults is a prevalent process on Europa. It has been determined that cycloidal ridges are likely to experience shear stresses along the existing segment portions as they propagate, which affects propagation direction and ultimately induces tailcracking at the segment tip than then initiates a new cycle of cycloid segment growth. Finally, it has been established that mechanical methods (e.g., flexure analysis) can be used to determine the elastic thickness of the ice shell, which, although probably only several km thick, is likely to be spatially variable, being thinner under bands but thicker under ridged plains terrain.

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

    PubMed

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

    2014-03-08

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

  6. RANK/RANKL/OPG pathway: genetic associations with stress fracture period prevalence in elite athletes.

    PubMed

    Varley, Ian; Hughes, David C; Greeves, Julie P; Stellingwerff, Trent; Ranson, Craig; Fraser, William D; Sale, Craig

    2015-02-01

    The RANK/RANKL/OPG signalling pathway is important in the regulation of bone turnover, with single nucleotide polymorphisms (SNPs) in genes within this pathway associated with bone phenotypic adaptations. To determine whether four SNPs associated with genes in the RANK/RANKL/OPG signalling pathway were associated with stress fracture injury in elite athletes. Radiologically confirmed stress fracture history was reported in 518 elite athletes, forming the Stress Fracture Elite Athlete (SFEA) cohort. Data were analysed for the whole group and were sub-stratified into male and cases of multiple stress fracture groups. Genotypes were determined using proprietary fluorescence-based competitive allele-specific PCR assays. SNPs rs3018362 (RANK) and rs1021188 (RANKL) were associated with stress fracture injury (P<0.05). 8.1% of the stress fracture group and 2.8% of the non-stress fracture group were homozygote for the rare allele of rs1021188. Allele frequency, heterozygotes and homozygotes for the rare allele of rs3018362 were associated with stress fracture period prevalence (P<0.05). Analysis of the male only group showed 8.2% of rs1021188 rare allele homozygotes had suffered a stress fracture whilst 2.5% of the non-stress fracture group were homozygous. In cases of multiple stress fractures, homozygotes for the rare allele of rs1021188 and individuals possessing at least one copy of the rare allele of rs4355801 (OPG) were shown to be associated with stress fracture injury (P<0.05). The data support an association between SNPs in the RANK/RANKL/OPG signalling pathway and the development of stress fracture injury. The association of rs3018362 (RANK) and rs1021188 (RANKL) with stress fracture injury susceptibility supports their role in the maintenance of bone health and offers potential targets for therapeutic interventions. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Expected Time to Return to Athletic Participation After Stress Fracture in Division I Collegiate Athletes.

    PubMed

    Miller, Timothy L; Jamieson, Marissa; Everson, Sonsecharae; Siegel, Courtney

    2017-12-01

    Few studies have documented expected time to return to athletic participation after stress fractures in elite athletes. Time to return to athletic participation after stress fractures would vary by site and severity of stress fracture. Retrospective cohort study. Level 3. All stress fractures diagnosed in a single Division I collegiate men's and women's track and field/cross-country team were recorded over a 3-year period. Site and severity of injury were graded based on Kaeding-Miller classification system for stress fractures. Time to return to full unrestricted athletic participation was recorded for each athlete and correlated with patient sex and site and severity grade of injury. Fifty-seven stress fractures were diagnosed in 38 athletes (mean age, 20.48 years; range, 18-23 years). Ten athletes sustained recurrent or multiple stress fractures. Thirty-seven injuries occurred in women and 20 in men. Thirty-three stress fractures occurred in the tibia, 10 occurred in the second through fourth metatarsals, 3 occurred in the fifth metatarsal, 6 in the tarsal bones (2 navicular), 2 in the femur, and 5 in the pelvis. There were 31 grade II stress fractures, 11 grade III stress fractures, and 2 grade V stress fractures (in the same patient). Mean time to return to unrestricted sport participation was 12.9 ± 5.2 weeks (range, 6-27 weeks). No significant differences in time to return were noted based on injury location or whether stress fracture was grade II or III. The expected time to return to full unrestricted athletic participation after diagnosis of a stress fracture is 12 to 13 weeks for all injury sites. Athletes with grade V (nonunion) stress fractures may require more time to return to sport.

  8. Anisotropy effect on the stress-based fracture forming limit diagram using a modified Lou-Huh ductile fracture criterion

    NASA Astrophysics Data System (ADS)

    Park, Namsu; Huh, Hoon

    2013-12-01

    This paper is concerned with the anisotropy effect on the stress-based fracture forming limit diagram using a modified Lou-Huh ductile fracture criterion. In sheet metal forming process, a usage of advanced high-strength steels (AHSSs) has been remarkably increasing for the lightweight car body and good formability. It is, however, unable to evaluate the formability of AHSS with the conventional forming limit diagram during complex forming processes since it is obtained by assuming the proportional loading path and AHSS shows sudden fracture involving little amount of necking. The stress-based fracture forming limit diagram was constructed using a modified Lou-Huh ductile fracture criterion in order to evaluate the formability of AHSS accurately. The anisotropy effect on the fracture strain is also evaluated to reflect the material behavior of sheet metals in constructing the criterion for the prediction of onset of the fracture. The constructed stress-based fracture forming limit diagrams deal with the stress state ranging from pure shear to equi-biaxial tension with the variation of orientation of sheet metals. It is clearly observed that the stress-based fracture forming limit diagrams are varied with the change of orientation of sheet metals.

  9. Repetition of an unusual stress fracture in an anorexic man: a case report.

    PubMed

    Myers, S; Bell, D; Gorman, J; Best, J; Rooney, J

    2002-12-01

    Stress fractures of the fibula commonly occur distally in runners, whereas stress fractures of the proximal fibula are uncommon and typically occur in jumpers. Furthermore, it is rare for a stress fracture to be repeated in the same bone. We report a case of a repeated stress fracture of the proximal fibula in a male runner with abnormal gait that primarily involved excessive pronation. Unusual risk factors in this case were anorexia nervosa and use of an inhaled corticosteroid. The patient was treated conservatively, and healing of the fracture was completed at 12 weeks.

  10. Shockwave treatment for medial tibial stress syndrome in military cadets: A single-blind randomized controlled trial.

    PubMed

    Gomez Garcia, Santiago; Ramon Rona, Silvia; Gomez Tinoco, Martha Claudia; Benet Rodriguez, Mikhail; Chaustre Ruiz, Diego Mauricio; Cardenas Letrado, Francia Piedad; Lopez-Illescas Ruiz, África; Alarcon Garcia, Juan Maria

    2017-10-01

    Medial tibial stress syndrome (MTSS) is a common injury in athletes and soldiers. Several studies have demonstrated the effectiveness of extracorporeal shockwave treatment (ESWT) in athletes with MTSS. To assess whether one session of focused ESWT is effective in the treatment of military cadets with MTSS. A randomized, prospective, controlled, single-blind, parallel-group clinical study. Ib. Military School of Cadets of the Colombian Army. Forty-two military cadets with unilateral chronic MTSS were randomly assigned to either one session of focused electromagnetic ESWT (1500 pulses at 0.20 mJ/mm2) plus a specific exercise programme (muscle stretching and strengthening exercises) or the exercise programme alone. The primary endpoint was change in asymptomatic running test (RT) duration at four weeks from baseline. Secondary endpoints were changes in the visual analogue scale (VAS) after running and modified Roles and Maudsley (RM) score also at four weeks from baseline. ESWT patients were able to run longer. Mean RT after four weeks was 17 min 33 s (SE: 2.36) compared to 4 min 48 s (SE: 1.03) in the exercise-only group (p = 0.000). Mean VAS after running was 2.17 (SE: 0.44) in the ESWT group versus 4.26 (SE: 0.36) in the exercise-only group (p = 0.001). The ESWT group had a significantly higher RM score, with excellent or good results for 82.6% of patients vs. 36.8% in the exercise-only group (p = 0.002). No significant adverse effects of ESWT were observed. A single application of focused shockwave treatment in combination with a specific exercise programme accelerates clinical and functional recovery in military cadets with MTSS. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Two simple clinical tests for predicting onset of medial tibial stress syndrome: shin palpation test and shin oedema test.

    PubMed

    Newman, Phil; Adams, Roger; Waddington, Gordon

    2012-09-01

    To examine the relationship between two clinical test results and future diagnosis of (Medial Tibial Stress Syndrome) MTSS in personnel at a military trainee establishment. Data from a preparticipation musculoskeletal screening test performed on 384 Australian Defence Force Academy Officer Cadets were compared against 693 injuries reported by 326 of the Officer Cadets in the following 16 months. Data were held in an Injury Surveillance database and analysed using χ² and Fisher's Exact tests, and Receiver Operating Characteristic Curve analysis. Diagnosis of MTSS, confirmed by an independent blinded health practitioner. Both the palpation and oedema clinical tests were each found to be significant predictors for later onset of MTSS. Specifically: Shin palpation test OR 4.63, 95% CI 2.5 to 8.5, Positive Likelihood Ratio 3.38, Negative Likelihood Ratio 0.732, Pearson χ² p<0.001; Shin oedema test OR 76.1 95% CI 9.6 to 602.7, Positive Likelihood Ratio 7.26, Negative Likelihood Ratio 0.095, Fisher's Exact p<0.001; Combined Shin Palpation Test and Shin Oedema Test Positive Likelihood Ratio 7.94, Negative Likelihood Ratio <0.001, Fisher's Exact p<0.001. Female gender was found to be an independent risk factor (OR 2.97, 95% CI 1.66 to 5.31, Positive Likelihood Ratio 2.09, Negative Likelihood Ratio 0.703, Pearson χ² p<0.001) for developing MTSS. The tests for MTSS employed here are components of a normal clinical examination used to diagnose MTSS. This paper confirms that these tests and female gender can also be confidently applied in predicting those in an asymptomatic population who are at greater risk of developing MTSS symptoms with activity at some point in the future.

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

    PubMed

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

    2016-06-01

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

  13. On the strength of oceanic fracture zones and their influence on the intraplate stress field

    SciTech Connect

    Bergman, E.A.; Solomon, S.C. )

    1992-10-01

    We use the locations and source mechanisms of oceanic intraplate earthquakes to test the hypothesis that the strength of oceanic fracture zones is less than that of normal oceanic lithosphere. The 77 earthquakes selected for the study have well-determined focal mechanisms and epicenters in regions where fracture zones are well mapped. We have search for dependence of faulting style, fault orientation, or principal stress direction on the distance from the nearest fracture zone. If fracture zones were generally weaker than the surrounding lithosphere, one of the principal horizontal stresses would be oriented nearly perpendicular to the fracture zone; we find no evidence that principal stresses near fracture zones are oriented preferentially in this manner. There is a slight tendency for earthquakes to occur near fracture zones, and patterns of fault orientation and sense of slip support the view that differential cooling and horizontal contraction on fracture zones may contribute seismogenic stress. 56 refs.

  14. The soleus syndrome. A cause of medial tibial stress (shin splints).

    PubMed

    Michael, R H; Holder, L E

    1985-01-01

    Radionuclide bone scans have demonstrated linear uptake along the posterior medial border of the tibia in patients with shin splints. This area was investigated by anatomical dissection (14 human cadavers), electromyographic (EMG) and muscle stimulation studies (10 patients), and open biopsy (1 patient). Histologically, the increased metabolic activity manifested on the radionuclide scan is due to a periostitis with new bone formation. The soleus muscle and its investing fascia are anatomically and biomechanically implicated in the production of these stress changes, particularly when the heel is in the pronated position. The soleus muscle and fascia form a tough "soleus bridge" over the deep compartment which is thought to be important in patients requiring surgical decompression.

  15. Stress analysis of fracture of atherosclerotic plaques: crack propagation modeling.

    PubMed

    Rezvani-Sharif, Alireza; Tafazzoli-Shadpour, Mohammad; Kazemi-Saleh, Davood; Sotoudeh-Anvari, Maryam

    2017-08-01

    Traditionally, the degree of luminal obstruction has been used to assess the vulnerability of atherosclerotic plaques. However, recent studies have revealed that other factors such as plaque morphology, material properties of lesion components and blood pressure may contribute to the fracture of atherosclerotic plaques. The aim of this study was to investigate the mechanism of fracture of atherosclerotic plaques based on the mechanical stress distribution and fatigue analysis by means of numerical simulation. Realistic models of type V plaques were reconstructed based on histological images. Finite element method was used to determine mechanical stress distribution within the plaque. Assuming that crack propagation initiated at the sites of stress concentration, crack propagation due to pulsatile blood pressure was modeled. Results showed that crack propagation considerably changed the stress field within the plaque and in some cases led to initiation of secondary cracks. The lipid pool stiffness affected the location of crack formation and the rate and direction of crack propagation. Moreover, increasing the mean or pulse pressure decreased the number of cycles to rupture. It is suggested that crack propagation analysis can lead to a better recognition of factors involved in plaque rupture and more accurate determination of vulnerable plaques.

  16. 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

  17. Stress fracture of the ulna in an elite ice dancer.

    PubMed

    Tornese, Davide; Curci, Domenico; Nardo, Alice; Cuccia, Alessandra; Pozzi, Grazia

    2015-03-01

    Stress fracture of the ulna is a rare overuse injury often arising from repetitive excessive forearm rotation. Here we report the first case of ulnar stress fracture in a female ice dancer. Diagnosis was made by history and physical examination, with the aid of imaging studies (plain x-ray, computed tomography, and magnetic resonance imaging), and biomechanical analysis of forearm pronation and supination. Following identification and modification of the causal technical element, the ice dancer was able to continue training and competing without cessation of activity. Treatment was with a 30-day course of capacitively coupled bone stimulation to promote fracture healing, confirmed on radiography and magnetic resonance imaging. Such injuries to ice dancers may be prevented at the planning stage of technical elements in the dance program if coaches place more attention on the potentially deleterious effects of difficult positions the lifted dancer must sustain to reward points on the technical elements score. Key pointsThe technical elements in ice dancing can overload joints and bones due to the positions held by the skaters.To project a competition program as much as possible safe regarding overuse injury prevention an accurate knowledge of physiological parameters of the ice dancer and of ISU rules is necessary.

  18. Stress Fracture of the Ulna in an Elite Ice Dancer

    PubMed Central

    Tornese, Davide; Curci, Domenico; Nardo, Alice; Cuccia, Alessandra; Pozzi, Grazia

    2015-01-01

    Stress fracture of the ulna is a rare overuse injury often arising from repetitive excessive forearm rotation. Here we report the first case of ulnar stress fracture in a female ice dancer. Diagnosis was made by history and physical examination, with the aid of imaging studies (plain x-ray, computed tomography, and magnetic resonance imaging), and biomechanical analysis of forearm pronation and supination. Following identification and modification of the causal technical element, the ice dancer was able to continue training and competing without cessation of activity. Treatment was with a 30-day course of capacitively coupled bone stimulation to promote fracture healing, confirmed on radiography and magnetic resonance imaging. Such injuries to ice dancers may be prevented at the planning stage of technical elements in the dance program if coaches place more attention on the potentially deleterious effects of difficult positions the lifted dancer must sustain to reward points on the technical elements score. Key points The technical elements in ice dancing can overload joints and bones due to the positions held by the skaters. To project a competition program as much as possible safe regarding overuse injury prevention an accurate knowledge of physiological parameters of the ice dancer and of ISU rules is necessary. PMID:25729287

  19. Prediction of fatigue failure of a total knee replacement tibial plateau using finite element analysis.

    PubMed

    Paganelli, J V; Skinner, H B; Mote, C D

    1988-08-01

    Recent reports of total knee prosthesis fractures have raised concerns over the long-term structural integrity of metal-backed tibial components. Both the development of a fibrous tissue membrane under the tibial plateau of a total knee prosthesis and loading conditions may seriously alter the fatigue life of the metal tibial tray. The effects of the cement and fibrous tissue at the bone-prosthesis interface were studied. Using the method of three-dimensional finite element analysis, peak loads of normal gait were simulated at several locations on the plateau of a generic, single-stemmed, porous-coated, CoCrMo tibial component model, providing information on the effect of abnormal loading patterns. According to the analysis, stresses below the material endurance limit are predicted throughout the prosthesis prior to the development of the fibrous membrane. However, stresses exceeding the yield strength of the material are predicted in a prosthesis that is supported by a fully developed 1 mm membrane, meaning that it has a markedly increased risk of low-cycle fatigue failure. Lateral displacement of the loading is detrimental to prosthesis life because maximum stress increases 100% while posterior displacement of the loading increases maximum stress by only 30%. Anterior loading creates stresses similar to those created by central loading. Because of their susceptibility to low-cycle fatigue failure, simple, single-stemmed prostheses are not recommended in cases of questionable bone stock unless modified. Several design alternatives are proposed.

  20. Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners.

    PubMed

    Kahanov, Leamor; Eberman, Lindsey E; Games, Kenneth E; Wasik, Mitch

    2015-01-01

    Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management. Accurate diagnosis for stress fractures is dependent on the anatomical area. Anatomical regions such as the pelvis, sacrum, and metatarsals offer challenges due to difficulty differentiating pathologies with common symptoms. Special tests and treatment regimes, however, are similar among most stress fractures with resolution between 4 weeks to a year. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize recurrence.

  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. Modified maximum tangential stress criterion for fracture behavior of zirconia/veneer interfaces.

    PubMed

    Mirsayar, M M; Park, P

    2016-06-01

    The veneering porcelain sintered on zirconia is widely used in dental prostheses, but repeated mechanical loadings may cause a fracture such as edge chipping or delamination. In order to predict the crack initiation angle and fracture toughness of zirconia/veneer bi-layered components subjected to mixed mode loadings, the accuracy of a new and traditional fracture criteria are investigated. A modified maximum tangential stress criterion considering the effect of T-stress and critical distance theory is introduced, and compared to three traditional fracture criteria. Comparisons to the recently published fracture test data show that the traditional fracture criteria are not able to properly predict the fracture initiation conditions in zirconia/veneer bi-material joints. The modified maximum tangential stress criterion provides more accurate predictions of the experimental results than the traditional fracture criteria. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Is in situ stress important to groundwater flow in shallow fractured rock aquifers?

    NASA Astrophysics Data System (ADS)

    Mortimer, L.; Aydin, A.; Simmons, C. T.; Love, A. J.

    2011-03-01

    SummaryIn situ stress affects the permeability tensor of fractured rock masses at depth but its effect on shallow to near-surface fractured rock aquifers has received little attention. This is partly because stress-related effects on groundwater flow at shallow depths are difficult to identify and characterise due to the complex interactions between all of the inherent properties of a fractured rock aquifer. These properties include the factors that dominantly control groundwater flow: fracture network density, geometry, connectivity and infill. Furthermore, surface processes such as weathering, erosion and unloading alter the original hydraulic nature (connectivity, transmissivity) of fractured rock masses resulting in higher degrees of spatial heterogeneity within shallow flow systems. These processes and interactions often mask the influence of in situ stress fields on fracture network permeability and groundwater flow. In this study, an integrated analysis of local area fracture networks, borehole geophysical logs, borehole groundwater yields and hydromechanical models demonstrate that in situ stress does affect groundwater flow in shallow (<200 m) fractured rock aquifers by altering fracture hydraulic aperture distributions, fracture network connectivity and groundwater flow rates via fracture deformation processes. In particular, a comparison between representative models of deformed (stressed state) and undeformed (zero stress state) fracture networks showed that below 100 m depth, groundwater flow rates could decrease several fold under the influence of the contemporary stress field. This prediction was highly consistent with the field observations. In contrast, groundwater flow modelling of shallow fractured rock aquifers is typically conducted under the assumption that permeability is independent of the state of stress. A key finding of this study is that in situ stress may be a more important control on both local and regional scale shallow groundwater

  4. Recurrent Metatarsal Stress Fractures in a College Football Lineman

    PubMed Central

    Moul, Jamie L.; Massey, Andrew N.

    1995-01-01

    Stress fractures are common overuse injuries of bone attributed to repetitive trauma, training errors, and/or structural abnormalities. A 21-year-old, 252-lb football lineman participating in spring conditioning drills complained of right foot pain following a plantar flexion, inversion injury that occurred while cutting. Pain was concentrated over the dorsum of the foot in both weight bearing and at rest. X-ray evaluation indicated an acute stress fracture of the fourth metatarsal and two nonunions of the second and third metatarsals. Additionally, x-rays revealed metatarsus adductus, a congenital anatomic deformity. The athlete demonstrated compensatory hyperpronation in the right hind foot during a follow-up biomechanical evaluation. He was removed from weightbearing activities, treated symptomatically for pain and swelling, and placed in a rigid orthotic. He has returned to full activity without further incident. This case report emphasizes the important role that biomechanical factors may have in osseous stress injuries. ImagesFig 1.Fig 2.Fig 3.Fig 4.Fig 5. PMID:16558316

  5. Risk Stratification of Stress Fractures and Prediction of Return to Duty

    DTIC Science & Technology

    2015-12-01

    1 AD_________________ Award Number: W81XWH-15-C-0024 TITLE: Risk Stratification of Stress Fractures and Prediction of Return-to-Duty PRINCIPAL...Nov 2014 - 14 Nov 2015 4. TITLE AND SUBTITLE Risk Stratification of Stress Fractures and Prediction of Return-to-Duty 5a. CONTRACT NUMBER W81XWH-15...enrollment. In study Task 1 we aim to determine the sex- and race-ethnicity-specific bone traits that may contribute to stress fracture risk in military

  6. Risk Factors for Osteoporosis are Associated with Stress Fracture in Young Women

    DTIC Science & Technology

    1989-08-01

    E) Form 1473 flj (is not) enclosed. Title Risk Factors for Osteoporosis are Associated with Stress Fracture in Young Women. Author(s) KE Friedl, JA...2 figures RISK FACTORS FOR OSTEOPOROSIS ARE ASSOCIATED WITH STRESS FRACTURE IN YOUNG WOMEN * Karl E. Friedl, PhD Jennifer A. Nuovo, MD Troy H...sampling studies; stress fracture; menstrual status; amenorrhea; ethnic; smoking--complications; family characteristics; osteoporosis ; age factors; body

  7. Clinical analysis of the rap stress stimulator applied for crus fracture after skeletal external fixation.

    PubMed

    Zhuang, Ping; Hong, Jiayuan; Chen, Wei; Wu, Jin; Ding, Zhenqi

    2015-06-19

    Open crus fracture is still difficult in clinical treatment because of the delayed fracture union and high rate of nonunion after the operation. A consensus has been reached that mechanical stress can promote fracture healing. We independently developed a stress stimulator, which can provide longitudinal pressure for the fixed fracture end of the lower legs to promote fracture healing. The purpose of this study is to explore the advantages and clinical effect of the rap stress stimulator applied for open crus fracture after skeletal external fixation. One hundred and sixty-five patients (183 limbs) who suffered from open tibia and fibula fracture received skeletal external fixation, of which 108 limbs were treated with the rap stress stimulator after external fixation and 75 limbs were treated with regular functional exercises of muscle contraction and joint activity only. Then the fracture healing time and rate of nonunion were compared between the two groups. The mean fracture healing time and rate of nonunion in the group treated with the rap stress stimulator were 138.27 ±4.45 days and 3.70% respectively, compared to 153.43 ±4.89 days and 10.67% in the group treated without the stimulator. The rap stress stimulator significantly shortened the fracture healing time and reduced the rate of nonunion for treating open tibia and fibula fractures.

  8. In-situ stress from hydraulic fracture measurements in G Tunnel, Nevada Test Site

    SciTech Connect

    Smith, C.; Vollendorf, W. C.; Warren, W. E.

    1981-04-01

    Hydraulic fracture work in G Tunnel, Nevada Test Site, performed to obtain the in-situ stress state is discussed. Field equipment and procedures are described; analysis is developed to relate the hydraulic fracture pressures to the in-situ stress state. Pressure data are analyzed to provide estimates of the stress state at a number of locations in the tunnel complex. A unique feature of the work is the mineback - a mining process in which the rock is cut away to reveal the actual plane of the fracture. Advantages, limitations, and problem areas associated with extracting in-situ stress fields from hydraulic fracture pressure records are discussed in detail.

  9. Analysis of stress fractures in athletes based on our clinical experience

    PubMed Central

    Iwamoto, Jun; Sato, Yoshihiro; Takeda, Tsuyoshi; Matsumoto, Hideo

    2011-01-01

    AIM: To analyze stress fractures in athletes based on experience from our sports medicine clinic. METHODS: We investigated the association between stress fractures and age, sex, sports level, sports activity, and skeletal site in athletes seen at our sports medicine clinic between September 1991 and April 2009. Stress fractures of the pars interarticularis were excluded from this analysis. RESULTS: During this period (18 years and 8 mo), 14276 patients (9215 males and 5061 females) consulted our clinic because of sports-related injuries, and 263 patients (1.8%) [171 males (1.9%) and 92 females (1.8%)] sustained stress fractures. The average age of the patients with stress fractures was 20.2 years (range 10-46 years); 112 patients (42.6%) were 15-19 years of age and 90 (34.2%) were 20-24 years of age. Altogether, 90 patients (34.2%) were active at a high recreational level and 173 (65.8%) at a competitive level. The highest proportion of stress fractures was seen in basketball athletes (21.3%), followed by baseball (13.7%), track and field (11.4%), rowing (9.5%), soccer (8.4%), aerobics (5.3%), and classical ballet (4.9%). The most common sites of stress fractures in these patients were the tibia (44.1%), followed by the rib (14.1%), metatarsal bone (12.9%), ulnar olecranon (8.7%) and pelvis (8.4%). The sites of the stress fractures varied from sport to sport. The ulnar olecranon was the most common stress fracture site in baseball players, and the rib was the most common in rowers. Basketball and classical ballet athletes predominantly sustained stress fractures of the tibia and metatarsal bone. Track and field and soccer athletes predominantly sustained stress fractures of the tibia and pubic bone. Aerobics athletes predominantly sustained stress fractures of the tibia. Middle and long distance female runners who sustained multiple stress fractures had the female athlete triad. CONCLUSION: The results of this analysis showed that stress fractures were seen in high

  10. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis

    PubMed Central

    Newman, Phil; Witchalls, Jeremy; Waddington, Gordon; Adams, Roger

    2013-01-01

    Background Medial tibial stress syndrome (MTSS) affects 5%–35% of runners. Research over the last 40 years investigating a range of interventions has not established any clearly effective management for MTSS that is better than prolonged rest. At the present time, understanding of the risk factors and potential causative factors for MTSS is inconclusive. The purpose of this review is to evaluate studies that have investigated various risk factors and their association with the development of MTSS in runners. Methods Medical research databases were searched for relevant literature, using the terms “MTSS AND prevention OR risk OR prediction OR incidence”. Results A systematic review of the literature identified ten papers suitable for inclusion in a meta-analysis. Measures with sufficient data for meta-analysis included dichotomous and continuous variables of body mass index (BMI), ankle dorsiflexion range of motion, navicular drop, orthotic use, foot type, previous history of MTSS, female gender, hip range of motion, and years of running experience. The following factors were found to have a statistically significant association with MTSS: increased hip external rotation in males (standard mean difference [SMD] 0.67, 95% confidence interval [CI] 0.29–1.04, P<0.001); prior use of orthotics (risk ratio [RR] 2.31, 95% CI 1.56–3.43, P<0.001); fewer years of running experience (SMD −0.74, 95% CI −1.26 to −0.23, P=0.005); female gender (RR 1.71, 95% CI 1.15–2.54, P=0.008); previous history of MTSS (RR 3.74, 95% CI 1.17–11.91, P=0.03); increased body mass index (SMD 0.24, 95% CI 0.08–0.41, P=0.003); navicular drop (SMD 0.26, 95% CI 0.02–0.50, P=0.03); and navicular drop >10 mm (RR 1.99, 95% CI 1.00–3.96, P=0.05). Conclusion Female gender, previous history of MTSS, fewer years of running experience, orthotic use, increased body mass index, increased navicular drop, and increased external rotation hip range of motion in males are all significantly

  11. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis.

    PubMed

    Newman, Phil; Witchalls, Jeremy; Waddington, Gordon; Adams, Roger

    2013-11-13

    Medial tibial stress syndrome (MTSS) affects 5%-35% of runners. Research over the last 40 years investigating a range of interventions has not established any clearly effective management for MTSS that is better than prolonged rest. At the present time, understanding of the risk factors and potential causative factors for MTSS is inconclusive. The purpose of this review is to evaluate studies that have investigated various risk factors and their association with the development of MTSS in runners. Medical research databases were searched for relevant literature, using the terms "MTSS AND prevention OR risk OR prediction OR incidence". A systematic review of the literature identified ten papers suitable for inclusion in a meta-analysis. Measures with sufficient data for meta-analysis included dichotomous and continuous variables of body mass index (BMI), ankle dorsiflexion range of motion, navicular drop, orthotic use, foot type, previous history of MTSS, female gender, hip range of motion, and years of running experience. The following factors were found to have a statistically significant association with MTSS: increased hip external rotation in males (standard mean difference [SMD] 0.67, 95% confidence interval [CI] 0.29-1.04, P<0.001); prior use of orthotics (risk ratio [RR] 2.31, 95% CI 1.56-3.43, P<0.001); fewer years of running experience (SMD -0.74, 95% CI -1.26 to -0.23, P=0.005); female gender (RR 1.71, 95% CI 1.15-2.54, P=0.008); previous history of MTSS (RR 3.74, 95% CI 1.17-11.91, P=0.03); increased body mass index (SMD 0.24, 95% CI 0.08-0.41, P=0.003); navicular drop (SMD 0.26, 95% CI 0.02-0.50, P=0.03); and navicular drop >10 mm (RR 1.99, 95% CI 1.00-3.96, P=0.05). Female gender, previous history of MTSS, fewer years of running experience, orthotic use, increased body mass index, increased navicular drop, and increased external rotation hip range of motion in males are all significantly associated with an increased risk of developing MTSS. Future

  12. Stress fracture of the ulna associated with bisphosphonate therapy and use of walking aid.

    PubMed

    Chiang, G S H; Grace, C S H; Koh, K W B; Kelvin, K W B; Chong, T W; Wei, C T; Tan, B Y; Yeow, T B

    2014-08-01

    We report a case of a stress fracture of the ulna secondary to long-term bisphosphonate therapy and walking cane. Physicians need to have a high index of suspicion of stress fractures occurring in patients complaining of chronic upper limb pain if they are on bisphosphonate therapy and are using walking aids. Stress fractures of the upper extremities are rare and are usually associated with athletes; however, a few recent case reports have shown an association between stress fractures of the upper extremities and the use of walking aids. The association between increased incidence of upper extremity stress fractures and the use of both bisphosphonates and walking aids in patients has not been well studied, with only one previously reported case. Here, we report a case of a complete stress fracture of the ulna in a 77-year-old female, premorbidly ambulant with walking cane, on long-term bisphosphonates without any pre-existing medical conditions which could result in secondary causes of bone loss. Investigations did not reveal any causes of pathological fracture. This fracture is attributed to the use of long-term bisphosphonate therapy in conjunction with the use of a walking cane. This case highlights the importance of entertaining the possibility of such fractures occurring in any patient who is on bisphosphonate therapy presenting with stress fractures of the upper extremity.

  13. Dynamic fracture of tantalum under extreme tensile stress

    SciTech Connect

    Albertazzi, Bruno; Ozaki, Norimasa; Zhakhovsky, Vasily; Faenov, Anatoly; Habara, Hideaki; Harmand, Marion; Hartley, Nicholas; Ilnitsky, Denis; Inogamov, Nail; Inubushi, Yuichi; Ishikawa, Tetsuya; Katayama, Tetsuo; Koyama, Takahisa; Koenig, Michel; Krygier, Andrew; Matsuoka, Takeshi; Matsuyama, Satoshi; McBride, Emma; Migdal, Kirill Petrovich; Morard, Guillaume; Ohashi, Haruhiko; Okuchi, Takuo; Pikuz, Tatiana; Purevjav, Narangoo; Sakata, Osami; Sano, Yasuhisa; Sato, Tomoko; Sekine, Toshimori; Seto, Yusuke; Takahashi, Kenjiro; Tanaka, Kazuo; Tange, Yoshinori; Togashi, Tadashi; Tono, Kensuke; Umeda, Yuhei; Vinci, Tommaso; Yabashi, Makina; Yabuuchi, Toshinori; Yamauchi, Kazuto; Yumoto, Hirokatsu; Kodama, Ryosuke

    2017-06-02

    The understanding of fracture phenomena of a material at extremely high strain rates is a key issue for a wide variety of scientific research ranging from applied science and technological developments to fundamental science such as laser-matter interaction and geology. Despite its interest, its study relies on a fine multiscale description, in between the atomic scale and macroscopic processes, so far only achievable by large-scale atomic simulations. Direct ultrafast real-time monitoring of dynamic fracture (spallation) at the atomic lattice scale with picosecond time resolution was beyond the reach of experimental techniques. We show that the coupling between a high-power optical laser pump pulse and a femtosecond x-ray probe pulse generated by an x-ray free electron laser allows detection of the lattice dynamics in a tantalum foil at an ultrahigh strain rate of Embedded Image ~2 × 108 to 3.5 × 108 s-1. A maximal density drop of 8 to 10%, associated with the onset of spallation at a spall strength of ~17 GPa, was directly measured using x-ray diffraction. The experimental results of density evolution agree well with large-scale atomistic simulations of shock wave propagation and fracture of the sample. Our experimental technique opens a new pathway to the investigation of ultrahigh strain-rate phenomena in materials at the atomic scale, including high-speed crack dynamics and stress-induced solid-solid phase transitions.

  14. Dynamic fracture of tantalum under extreme tensile stress

    SciTech Connect

    Albertazzi, Bruno; Ozaki, Norimasa; Zhakhovsky, Vasily

    2017-06-02

    The understanding of fracture phenomena of a material at extremely high strain rates is a key issue for a wide variety of scientific research ranging from applied science and technological developments to fundamental science such as laser-matter interaction and geology. Despite its interest, its study relies on a fine multiscale description, in between the atomic scale and macroscopic processes, so far only achievable by large-scale atomic simulations. Direct ultrafast real-time monitoring of dynamic fracture (spallation) at the atomic lattice scale with picosecond time resolution was beyond the reach of experimental techniques. We show that the coupling between a high-power opticalmore » laser pump pulse and a femtosecond x-ray probe pulse generated by an x-ray free electron laser allows detection of the lattice dynamics in a tantalum foil at an ultrahigh strain rate of Embedded Image ~2 × 10 8 to 3.5 × 10 8 s -1. A maximal density drop of 8 to 10%, associated with the onset of spallation at a spall strength of ~17 GPa, was directly measured using x-ray diffraction. The experimental results of density evolution agree well with large-scale atomistic simulations of shock wave propagation and fracture of the sample. Our experimental technique opens a new pathway to the investigation of ultrahigh strain-rate phenomena in materials at the atomic scale, including high-speed crack dynamics and stress-induced solid-solid phase transitions.« less

  15. Fractures and stresses in Bone Spring sandstones. Final report

    SciTech Connect

    Warpinski, N.R.; Sattler, A.R.; Lorenz, J.C.; Northrop, D.A.

    1992-06-01

    This project was a collaboration between Sandia National Laboratories and the Harvey E. Yates Company (Heyco), Roswell, NM, conducted under the auspices of Department of Energy`s Oil Recovery Technology Partnership. The project applied Sandia perspectives on the effects of natural fractures, stress, and sedimentology for the stimulation and production of low permeability gas reservoirs to low permeability oil reservoirs, such as those typified by the Bone Spring sandstones of the Delaware Basin, southeast New Mexico. This report details the results and analyses obtained in 1990 from core, logs, stress, and other data taken from three additional development wells. An overall summary gives results from all five wells studied in this project in 1989--1990. Most of the results presented are believed to be new information for the Bone Spring sandstones.

  16. Imaging of upper extremity stress fractures in the athlete.

    PubMed

    Anderson, Mark W

    2006-07-01

    Although it is much less common than injuries in the lower extremities, an upper extremity stress injury can have a significant impact on an athlete. If an accurate and timely diagnosis is to be made, the clinician must have a high index of suspicion of a stress fracture in any athlete who is involved in a throwing, weightlifting, or upper extremity weight-bearing sport and presents with chronic pain in the upper extremity. Imaging should play an integral role in the work-up of these patients; if initial radiographs are unrevealing, further cross-sectional imaging should be strongly considered. Although a three-phase bone scan is highly sensitive in this regard, MRI has become the study of choice at most centers.

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

    PubMed

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

    2015-02-01

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

  18. Chronic wrist pain in a goalkeeper; bilateral scaphoid stress fracture: A case report

    PubMed Central

    Saglam, Fevzi; Gulabi, Deniz; Baysal, Özgür; Bekler, Halil İbrahim; Tasdemir, Zeki; Elmali, Nurzat

    2014-01-01

    Introduction Bilateral scaphoid stress fractures are uncommon, and rarely presented with chronic wrist pain. Most fractures of the scaphoid heal with immobilization. Presentation of case The case presented here is of a bilateral stress fractures of the carpal scaphoid in a 19-year-old male.The patient had been playing as a goalkeeper and presented with a 4-year history of chronic pain in both wrists. We had a successful result in the treatment of these stress fractures with long- arm thumb plaster cast.Discussion Most fractures of the scaphoid in the immature skeleton heal with immobilization. Approximately 88–95% of acute scaphoid fractures are said to heal with conservative treatment using cast immobilisation. Non-surgical treatment is successful for scaphoid fractures in children and for those fractures which are non-displaced, stable, and where there is no damage to other bones or ligaments. In stable fractures, union is achieved within 8–12 weeks.Conclusion Bilateral stress fractures of the scaphoid can be considered for the wrist pain, especially for the patients that had repetitive minor wrist trauma, and in spite of developments in surgical techniques and materials used, treatment by plaster casting should still be considered initially for non-displaced, stable scaphoid stress fractures. PMID:25562597

  19. An Isolated Gluteus Minimus Tendon Tear with Stress Fracture of the Iliac Wing in a Marathon Runner: A case report.

    PubMed

    Rivera Rosado, Emanuel; Santaella Sante, Borja; Corderob, Priscila M; Rivera, Juan J; Otero Lopez, Francisco

    2016-01-01

    Stress fractures and muscle strains are common in marathon runners. Most stress fractures occur in lower extremities and tibia stress fractures comprise almost half. Iliac wing stress fractures are not commonly found in runners and are usually related to osteoporosis. There have been 4 previous reports of iliac stress fractures in marathon runners none reported an associated isolated gluteus minimus tendon tears. We will report a case of a female marathon runner with iliac wing stress fracture with associated isolated gluteus minimus tendon tear.

  20. Vitamin D, Calcium, and Dairy Intakes and Stress Fractures Among Female Adolescents

    PubMed Central

    Sonneville, Kendrin R.; Gordon, Catherine M.; Kocher, Mininder S.; Pierce, Laura M.; Ramappa, Arun; Field, Alison E.

    2013-01-01

    Objective To identify whether calcium, vitamin D, and/or dairy intake are prospectively associated with stress fracture risk among female adolescents. Design Prospective cohort study. Setting Adolescent girls living throughout the United States. Participants A total of 6712 girls ages 9 to 15 years at baseline in the Growing Up Today Study, an ongoing prospective cohort study. Main Exposure Dairy, calcium, and vitamin D intake assessed by food frequency questionnaire every 12-24 months between 1996 and 2001. Main Outcome Measures Incident stress fracture that occurred between 1997 and 2004, as reported by mother’s of the participants in 2004. Cox proportional hazards models were used to examine associations. Results During 7 years of follow-up, 3.9% of females developed a stress fracture. Dairy and calcium intake were unrelated to risk of developing a stress fracture. However, vitamin D intake was inversely related to stress fracture risk. The multivariable-adjusted hazard ratio (HR) of stress fracture for the highest versus the lowest quintile of vitamin D was 0.49 (95% CI=0.24-1.01; ptrend=0.07). We conducted a stratified analysis to estimate the association between vitamin D intake and stress fracture risk among girls participating in ≥1 hour/day of high-impact activity, among whom 90% of the stress fractures occurred, and found that higher vitamin D intake predicted significantly lower risk of stress fracture (ptrend=0.04) Conclusions Vitamin D intake is associated with lower stress fracture risk among adolescent girls who engage in high levels of high-impact activity. Neither calcium nor dairy intake were prospectively associated with stress fracture risk. PMID:22393172

  1. Quantitative ultrasound: use in screening for susceptibility to stress fractures in female army recruits.

    PubMed

    Lappe, Joan; Davies, Kennard; Recker, Robert; Heaney, Robert

    2005-04-01

    QUS measurements were made on 4139 female Army recruits at the beginning of basic training (BT). QUS predicted stress fracture in female recruits as well as it predicts hip fracture in elderly women. Recruits with low QUS values and a history of smoking and not exercising had an extremely high risk of stress fracture. Stress fractures during basic military training (BT) cause morbidity for the recruits and expense for the Military Services. Females have a higher incidence than males. If recruits at high risk for stress fracture could be accurately identified before they began BT, the military might find it advantageous to provide adaptive training programs for them. Currently no accurate methods of risk identification are available. We measured quantitative ultrasound (QUS) in a population sample of female Army recruits to determine if QUS is a useful tool for determining soldiers at high risk of stress fracture during BT. We recruited 93% of the population of female recruits entering BT at Fort Leonard Wood, MO, during a 10-month period. We measured calcaneal QUS and administered a risk factor questionnaire at baseline and ascertained stress fractures during the 8 weeks of BT. Logistic regression was used to calculate relative risk (RR) of stress fracture. The area under the receiver-operating characteristic (ROC) curve was also analyzed to determine the sensitivity and specificity of speed of sound (SOS) in predicting stress fracture. The incidence of stress fracture was 4.7%. SOS was significantly related to the risk of stress fracture. (p < 0.000) The area under the ROC curve was 0.70. The relative risk (RR) of fracture of those in the lowest quintile (Q1) of SOS was 6.7. The highest risk of stress fracture was found in the subgroup of white women in Q1 of SOS who smoked and didn't exercise (RR, 14.4). Over 16% of the fractures occurred in this subgroup, which indicates that about six of these women would need to be assigned to an alternate BT regimen to

  2. Visualization of stress fractures of the foot using PET-MRI: a feasibility study.

    PubMed

    Crönlein, Moritz; Rauscher, Isabel; Beer, Ambros J; Schwaiger, Markus; Schäffeler, Christoph; Beirer, Marc; Huber, Stephan; Sandmann, Gunther H; Biberthaler, Peter; Eiber, Matthias; Kirchhoff, Chlodwig

    2015-12-23

    Diagnosis and treatment of stress fractures still remains to be a clinical and radiological challenge. Therapeutic options vary from conservative treatment to surgical treatment without a clear treatment concept. Recently the combination of PET and MRI has been introduced, aiming a superior diagnostic accuracy in clinical practice. Therefore the aim of our study was to analyse whether PET-MRI would be a feasible technique to recognize stress fractures of the foot and to analyse if our conservative treatment plan leads to a good clinical outcome. Therefore, 20 patients with suspected stress fractures of the foot and ankle underwent plain radiography and (18)F-Fluoride PET-MRI. Two blinded readers assessed in consensus both imaging techniques for the presence of stress fracture, stress reaction or osteoarthritis. Patients with stress fractures or stress reactions in the foot and ankle area underwent our conservative treatment plan, with immobilization in a VACO®ped cast for 6 weeks under partial weight bearing on forearm crutches. The benefit of our conservative therapeutic concept was evaluated by the patients on the basis of VAS and FAOS scoring systems before and after treatment. 8 out of 20 patients underwent conservative treatment after diagnosis of either a stress fracture or a stress reaction of the foot and ankle area. PET-MRI identified four stress fractures and seven stress reactions. In all cases, no pathological findings were present on plain X-ray. FAOS and VAS significantly improved according to the patients' records. PET-MRI seems to be a useful modality to diagnose stress fractures and stress reactions of the foot and ankle area, especially when conventional modalities, such as plain radiographs fail. Conservative management is a promising therapeutic option for the treatment of stress fractures. To rule out the benefits compared to a surgical treatment plan, further studies are needed.

  3. Stress Fractures of the First Rib Related to Swinging of a Baseball Bat: Two Case Reports.

    PubMed

    Kawashima, Kenji; Terabayashi, Nobuo; Miyagawa, Takaki; Tanaka, Ryo; Ogawa, Hiroyasu; Takigami, Iori; Matsumoto, Kazu; Akiyama, Haruhiko

    2016-11-01

    Stress fractures of the first rib are uncommon, and few reports have described the occurrence of this injury in overhead-throwing athletes. Furthermore, although there have been a few reports of first rib stress fractures on the throwing side in baseball players, fractures on the nonthrowing side are very rare. Here, we report 2 cases of first rib stress fractures on the nonthrowing side related to swinging of a baseball bat. The cause of the fractures in the present cases may have been repetitive traction and shear force on the first rib resulting from muscle exertion while swinging a bat. Conservative treatment that considered the mechanism of stress fractures resulted in a symptom-free and complication-free return to baseball. The patient's background should be considered for an accurate understanding of the injury mechanism, adequate conservative therapeutic plan, and a successful return to baseball.

  4. Sacral Stress Fracture Mimicking Lumbar Radiculopathy in a Mounted Police Officer: Case Report and Literature Review

    PubMed Central

    Bednar, Drew A.; Almansoori, Khaled

    2015-01-01

    Study Design Case report and review of the literature. Objective To present a unique case of L5 radiculopathy caused by a sacral stress fracture without neurologic compression. Methods We present our case and its clinical evolution and review the available literature on similar pathologies. Results Relief of the unusual mechanical loading causing sacral stress fracture led to rapid resolution of radiculopathy. Conclusion L5 radiculopathy can be caused by a sacral stress fracture and can be relieved by simple mechanical treatment of the fracture. PMID:26430605

  5. Polyaxial stress-dependent permeability of a three-dimensional fractured rock layer

    NASA Astrophysics Data System (ADS)

    Lei, Qinghua; Wang, Xiaoguang; Xiang, Jiansheng; Latham, John-Paul

    2017-12-01

    A study about the influence of polyaxial (true-triaxial) stresses on the permeability of a three-dimensional (3D) fractured rock layer is presented. The 3D fracture system is constructed by extruding a two-dimensional (2D) outcrop pattern of a limestone bed that exhibits a ladder structure consisting of a "through-going" joint set abutted by later-stage short fractures. Geomechanical behaviour of the 3D fractured rock in response to in-situ stresses is modelled by the finite-discrete element method, which can capture the deformation of matrix blocks, variation of stress fields, reactivation of pre-existing rough fractures and propagation of new cracks. A series of numerical simulations is designed to load the fractured rock using various polyaxial in-situ stresses and the stress-dependent flow properties are further calculated. The fractured layer tends to exhibit stronger flow localisation and higher equivalent permeability as the far-field stress ratio is increased and the stress field is rotated such that fractures are preferentially oriented for shearing. The shear dilation of pre-existing fractures has dominant effects on flow localisation in the system, while the propagation of new fractures has minor impacts. The role of the overburden stress suggests that the conventional 2D analysis that neglects the effect of the out-of-plane stress (perpendicular to the bedding interface) may provide indicative approximations but not fully capture the polyaxial stress-dependent fracture network behaviour. The results of this study have important implications for understanding the heterogeneous flow of geological fluids (e.g. groundwater, petroleum) in subsurface and upscaling permeability for large-scale assessments.

  6. Compression Fracture of CFRP Laminates Containing Stress Intensifications

    PubMed Central

    Schütt, Martin; Philipkowski, Timo; Kürten, Jonas; Schulte, Karl

    2017-01-01

    For brittle fracture behaviour of carbon fibre reinforced plastics (CFRP) under compression, several approaches exist, which describe different mechanisms during failure, especially at stress intensifications. The failure process is not only initiated by the buckling fibres, but a shear driven fibre compressive failure beneficiaries or initiates the formation of fibres into a kink-band. Starting from this kink-band further damage can be detected, which leads to the final failure. The subject of this work is an experimental investigation on the influence of ply thickness and stacking sequence in quasi-isotropic CFRP laminates containing stress intensifications under compression loading. Different effects that influence the compression failure and the role the stacking sequence has on damage development and the resulting compressive strength are identified and discussed. The influence of stress intensifications is investigated in detail at a hole in open hole compression (OHC) tests. A proposed interrupted test approach allows identifying the mechanisms of damage initiation and propagation from the free edge of the hole by causing a distinct damage state and examine it at a precise instant of time during fracture process. Compression after impact (CAI) tests are executed in order to compare the OHC results to a different type of stress intensifications. Unnotched compression tests are carried out for comparison as a reference. With this approach, a more detailed description of the failure mechanisms during the sudden compression failure of CFRP is achieved. By microscopic examination of single plies from various specimens, the different effects that influence the compression failure are identified. First damage of fibres occurs always in 0°-ply. Fibre shear failure leads to local microbuckling and the formation and growth of a kink-band as final failure mechanisms. The formation of a kink-band and finally steady state kinking is shifted to higher compressive strains

  7. Compression Fracture of CFRP Laminates Containing Stress Intensifications.

    PubMed

    Leopold, Christian; Schütt, Martin; Liebig, Wilfried V; Philipkowski, Timo; Kürten, Jonas; Schulte, Karl; Fiedler, Bodo

    2017-09-05

    For brittle fracture behaviour of carbon fibre reinforced plastics (CFRP) under compression, several approaches exist, which describe different mechanisms during failure, especially at stress intensifications. The failure process is not only initiated by the buckling fibres, but a shear driven fibre compressive failure beneficiaries or initiates the formation of fibres into a kink-band. Starting from this kink-band further damage can be detected, which leads to the final failure. The subject of this work is an experimental investigation on the influence of ply thickness and stacking sequence in quasi-isotropic CFRP laminates containing stress intensifications under compression loading. Different effects that influence the compression failure and the role the stacking sequence has on damage development and the resulting compressive strength are identified and discussed. The influence of stress intensifications is investigated in detail at a hole in open hole compression (OHC) tests. A proposed interrupted test approach allows identifying the mechanisms of damage initiation and propagation from the free edge of the hole by causing a distinct damage state and examine it at a precise instant of time during fracture process. Compression after impact (CAI) tests are executed in order to compare the OHC results to a different type of stress intensifications. Unnotched compression tests are carried out for comparison as a reference. With this approach, a more detailed description of the failure mechanisms during the sudden compression failure of CFRP is achieved. By microscopic examination of single plies from various specimens, the different effects that influence the compression failure are identified. First damage of fibres occurs always in 0°-ply. Fibre shear failure leads to local microbuckling and the formation and growth of a kink-band as final failure mechanisms. The formation of a kink-band and finally steady state kinking is shifted to higher compressive strains

  8. Hydraulic fracturing and associated stress modeling for the Eastern Gas Shales Project. Final report

    SciTech Connect

    Advani, S.H.

    1980-12-01

    Frac fluid flow, structure, and fracture mechanics simulations are developed for predicting and optimizing fracture dimensions and fluid leak-offs. Roles of in situ stress and material properties for possible vertical migration of fractures from the pay zone are discussed. Rationale for foam and dendritic fracturing experiments is presented along with numerical experiments for examining the phenomena of spalling of the fracture faces and conditions for secondary fracture initiation. Assignment of conventional, foam, cyrogenic, dendritic, and explosive fracturing treatments for specific reservoir properties is considered. Variables include fracture density and extent, shale thickness, in-situ stress gradients, energy assist mechanisms, well clean-up, shale-frac fluid interaction, proppant selection, and fracture height control. The analysis suggests that correlation with prevailing in situ stress gradients are promising diagnostic indicators for fracture treatment selection and design. In conclusion, the comprehensive development of an economical strategy requires extensive and controlled field testing with supporting predictive analyses of reservoir responses. Finite element modeling of reservoir in situ stress trajectories and the flow and fracture responses in the reservoir is recommended.

  9. Bilateral stress fractures of the distal fibula in a woman with osteoporosis: a case report.

    PubMed

    Kazimoglu, Cemal; Karapinar, Hasan; Sener, Muhittin; Bozkurt, Attila

    2009-01-01

    Bilateral stress fractures of the fibula are very rare. We present an unusual case report of a 54-year-old osteoporotic woman with bilateral stress fractures involving the distal fibula. After conservative treatment, she made a good recovery with full motion and was free of pain.

  10. Stress Wave Source Characterization: Impact, Fracture, and Sliding Friction

    NASA Astrophysics Data System (ADS)

    McLaskey, Gregory Christofer

    Rapidly varying forces, such as those associated with impact, rapid crack propagation, and fault rupture, are sources of stress waves which propagate through a solid body. This dissertation investigates how properties of a stress wave source can be identified or constrained using measurements recorded at an array of sensor sites located far from the source. This methodology is often called the method of acoustic emission and is useful for structural health monitoring and the noninvasive study of material behavior such as friction and fracture. In this dissertation, laboratory measurements of 1--300 mm wavelength stress waves are obtained by means of piezoelectric sensors which detect high frequency (10 kHz--3MHz) motions of a specimen's surface, picometers to nanometers in amplitude. Then, stress wave source characterization techniques are used to study ball impact, drying shrinkage cracking in concrete, and the micromechanics of stick-slip friction of Poly(methyl methacrylate) (PMMA) and rock/rock interfaces. In order to quantitatively relate recorded signals obtained with an array of sensors to a particular stress wave source, wave propagation effects and sensor distortions must be accounted for. This is achieved by modeling the physics of wave propagation and transduction as linear transfer functions. Wave propagation effects are precisely modeled by an elastodynamic Green's function, sensor distortion is characterized by an instrument response function, and the stress wave source is represented with a force moment tensor. These transfer function models are verified though calibration experiments which employ two different mechanical calibration sources: ball impact and glass capillary fracture. The suitability of the ball impact source model, based on Hertzian contact theory, is experimentally validated for small (˜1 mm) balls impacting massive plates composed of four different materials: aluminum, steel, glass, and PMMA. Using this transfer function approach

  11. The role of adaptive bone formation in the etiology of stress fracture

    PubMed Central

    Popp, Kristin L; Yanovich, Ran; Bouxsein, Mary L; Matheny, Ronald W

    2016-01-01

    Stress fractures are common injuries with load-bearing activities. Stress fractures have been reported in the scientific literature for over a century; however, the etiology continues to be investigated with important distinctions made between the contributions of the tissue-level processes of bone remodeling and modeling. In response to novel repetitive loading, increased bone remodeling may serve to replace fatigue-damaged bone while at the same time creating temporary porosity. Much attention has been given to the role of remodeling in the etiology of stress fracture; however, the role of bone modeling has received less attention. Modest increases in modeling, via bone formation on the periosteal surface of long bones in response to mechanical loading, greatly increases the fatigue resistance of bone. Thus, enhancing this adaptive bone formation is a promising target for stress fracture prevention, and a focus on adaptive bone formation may reveal novel risk factors for stress fracture. PMID:27496801

  12. The Influence of Sample Set Up on Compressive Fracture Stress of Frozen Specimen

    NASA Astrophysics Data System (ADS)

    Tang, Cun Qi; Mihori, Tomoo; Watanabe, Hisahiko

    Improvement of sample set up which influences over fracture stress of frozen specimen was examined at temperatures betwen-20°C and -196°C. Filling cold water into the void between a bearing block and the end of specimen, when it was frozen, improved the close contact between them, and resulted in increased fracture stress of the frozen specimen. Fracture stress of pure water ice was constant over the whole range between -20°C and -196°C. On the other hand, the fracture stress of surimi and soybean curd increased as the temperature decreased until it reached a characteristic temperature; below temperature the fracture stress of surimi and soybean curd remained constant.

  13. 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.

  14. 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.

  15. Dry fracture method for simultaneous measurement of in-situ stress state and material properties

    SciTech Connect

    Serata, S.; Oka, S.; Kikuchi, S.

    1996-04-01

    Based on the dry fracture principle, a computerized borehole probe has been developed to measure stress state and material properties, simultaneously. The probe is designed to obtain a series of measurements in a continuing sequence along a borehole length, without any interruptive measures, such as resetting packers, taking indentation of borehole wall, overcoming, etc. The new dry fracture probe for the single fracture method is designed to overcome the difficulties posed by its ancestor which was based on the double fracture method. The accuracy of the single fracture method is confirmed by a close agreement with the theory, FE modeling and laboratory testing.

  16. Dynamic Response in Transient Stress-Field Behavior Induced by Hydraulic Fracturing

    NASA Astrophysics Data System (ADS)

    Jenkins, Andrew

    Hydraulic fracturing is a technique which is used to exploit geologic features and subsurface properties in an effort to increase production in low-permeability formations. The process of hydraulic fracturing provides a greater surface contact area between the producing formation and the wellbore and thus increases the amount of recoverable hydrocarbons from within the reservoir. The use of this stimulation technique has brought on massive applause from the industry due to its widespread success and effectiveness, however the dynamic processes that take part in the development of hydraulic fractures is a relatively new area of research with respect to the massive scale operations that are seen today. The process of hydraulic fracturing relies upon understanding and exploiting the in-situ stress distribution throughout the area of study. These in-situ stress conditions are responsible for directing fracture orientation and propagation paths throughout the period of injection. The relative magnitude of these principle stresses is key in developing a successful stimulation plan. In horizontal well plan development the interpretation of stress within the reservoir is required for determining the azimuth of the horizontal well path. These horizontal laterals are typically oriented in a manner such that the well path lies parallel to the minimum horizontal stress. This allows for vertical fractures to develop transversely to the wellbore, or normal to the least principle stress without the theoretical possibility of fractures overlapping, creating the most efficient use of the fluid energy during injection. The orientation and magnitude of these in-situ stress fields however can be dynamic, controlled by the subsequent fracture propagation and redistribution of the surrounding stresses. That is, that as the fracture propagates throughout the reservoir, the relative stress fields surrounding the fractures may see a shift and deviate from their original direction or

  17. Fracture mechanics. A comparison study of torsional stress on bone.

    PubMed

    VanCourt, R B; Byron, S E; Ali, S J; Caldwell, B D

    2000-04-01

    Fractures that result from torsional loading of shafts in mechanical systems of nonbiologic materials generate a fracture line that forms a 45 degrees angle to an axis that is perpendicular to the direction of torsional loading on the shaft. As tension and compression are applied to these isotropic substances, the angle of fracture increases and decreases, respectively. Understanding how these forces, particularly compressive forces, generate elongation of a spiral fracture increases the ability to predict the extent of injury to bone. Fibular and metatarsal fractures are of primary importance to the podiatric physician, but any spiral fracture may be subject to torsional loading. Thus the principles stated here apply to the entire skeletal system. The purpose of this article is to provide a better understanding of the mechanics behind the causes and characteristics of fractures and to explore whether these same factors apply to the fracture mechanics of bone.

  18. Upper extremity stress fractures in athletes: clinical features of 44 cases.

    PubMed

    Sinha, A K; Kaeding, C C; Wadley, G M

    1999-10-01

    To review the clinical features of a large series of active patients with a stress fracture in a non-weight-bearing location of the upper extremity or ribs. Multicenter cross-sectional study. Multiple academic medical centers. 44 patients with a diagnosis of upper extremity or rib stress fracture. Clinical features according to anatomic location, primary sport, and subdivided according to the nature of the sport-specific skills involved. A diagnosis of stress fracture was made in 44 patients based on history and physical examination, and confirmed by radiography, scintigraphy, magnetic resonance imaging (MRI), computed tomography (CT), or a combination of imaging techniques. Patients were subjectively divided into four categories based on the predominant type of upper extremity activity required for participation in their sport: 1) weight lifter (e.g., football, weight lifting, wrestling); 2) upper extremity weight bearer (e.g., gymnastics, diving, cheerleading); 3) thrower (e.g., pitcher, soccer goalie, javelin); or 4) swinger (e.g., golf, tennis). We noted that all fractures in the weight bearers occurred distal to the elbow, whereas in the throwers most fractures affected the shoulder girdle. Lower rib stress fractures predominated in the swingers group, whereas weight lifters had fractures located throughout the upper extremity. Stress fracture should be considered in the differential diagnosis of athletes presenting with upper extremity or rib pain of bony origin that is of insidious onset. Further study of the sport-specific patterns of injury described here may improve our ability to treat and prevent these injuries.

  19. Mechanisms Underlying Stress Fracture and the Influence of Sex and Race/Ethnicity

    DTIC Science & Technology

    2017-10-01

    AWARD NUMBER: W81XWH-16-1-0652 TITLE: Mechanisms Underlying Stress Fracture and the Influence of Sex and Race/Ethnicity PRINCIPAL INVESTIGATOR...5a. CONTRACT NUMBER W81XWH-16-1-0652 Mechanisms Underlying Stress Fracture and the Influence of Sex and Race/Ethnicity 5b. GRANT NUMBER W81XWH...features according to sex and race/ethnic-origin that may contribute or protect from stress fracture. To date, we have enrolled 21 subjects in Study 1

  20. The Young's Modulus, Fracture Stress, and Fracture Strain of Gellan Hydrogels Filled with Whey Protein Microparticles.

    PubMed

    Lam, Cherry Wing Yu; Ikeda, Shinya

    2017-05-01

    Texture modifying abilities of whey protein microparticles are expected to be dependent on pH during heat-induced aggregation of whey protein in the microparticulation process. Therefore, whey protein microparticles were prepared at either pH 5.5 or 6.8 and their effects on small and large deformation properties of gellan gels containing whey protein microparticles as fillers were investigated. The majority of whey protein microparticles had diameters around 2 μm. Atomic force microscopy images showed that whey protein microparticles prepared at pH 6.8 partially collapsed and flatted by air-drying, while those prepared at pH 5.5 did not. The Young's modulus of filled gels adjusted to pH 5.5 decreased by the addition of whey protein microparticles, while those of filled gels adjusted to pH 6.8 increased with increasing volume fraction of filler particles. These results suggest that filler particles were weakly bonded to gel matrices at pH 5.5 but strongly at pH 6.8. Whey protein microparticles prepared at pH 5.5 showed more enhanced increases in the Young's modulus than those prepared at pH 6.8 at volume fractions between 0.2 and 0.4, indicating that microparticles prepared at pH 5.5 were mechanically stronger. The fracture stress of filled gels showed trends somewhat similar to those of the Young's modulus, while their fracture strains decreased by the addition of whey protein microparticles in all examined conditions, indicating that the primary effect of these filler particles was to enhance the brittleness of filled gels. © 2017 Institute of Food Technologists®.

  1. Greater Polar Moment of Inertia at the Tibia in Athletes Who Develop Stress Fractures.

    PubMed

    Weidauer, Lee A; Binkley, Teresa; Vukovich, Matt; Specker, Bonny

    2014-07-01

    Several previous investigations have determined potential risk factors for stress fractures in athletes and military personnel. To determine factors associated with the development of stress fractures in female athletes. Case-control study; Level of evidence, 3. A total of 88 female athletes (cross-country, n = 29; soccer, n = 15; swimming, n = 9; track and field, n = 14; volleyball, n = 12; and basketball, n = 9) aged 18 to 24 years were recruited to participate in a longitudinal bone study and had their left distal tibia at the 4%, 20%, and 66% sites scanned by peripheral quantitative computed tomography (pQCT). Patients included 23 athletes who developed stress fractures during the following year (cases). Whole body, hip, and spine scans were obtained using dual-energy x-ray absorptiometry (DXA). Analysis of covariance was used to determine differences in bone parameters between cases and controls after adjusting for height, lower leg length, lean mass, fat mass, and sport. No differences were observed between cases and controls in any of the DXA measurements. Cases had significantly greater unadjusted trabecular bone mineral content (BMC), greater polar moment of inertia (PMI) at the 20% site, and greater cortical BMC at the 66% site; however, after adjusting for covariates, the differences became nonsignificant. When analyses were repeated using all individuals who had ever had a stress fracture as cases (n = 31) and after controlling for covariates, periosteal circumference was greater in the cases than the controls (71.1 ± 0.7 vs 69.4 ± 0.5 mm, respectively; P = .04). A history of stress fractures is associated with larger bones. These findings are important because larger bones were previously reported to be protective against fractures and stress fractures, but study findings indicate that may not always be true. One explanation could be that individuals who sustain stress fractures have greater loading that results in greater periosteal circumference

  2. Stress fracture of the supracondylar process of the humerus in a professional tennis player.

    PubMed

    Pedret, Carles; Balius, Ramon; Alomar, Xavier; Vilaró, Jaume; Ruiz-Cotorro, Angel; Minoves, Montserrat

    2015-01-01

    The supracondylar process of the humerus is an anatomic variant present in 1% of the population associated with a fibrous band, the ligament of Struthers that attaches it to the medial epicondyle, and may serve as a proximal origin of a fascicle of the pronator teres. Fractures of the supracondylar process of the humerus are extremely rare. To the best of our knowledge, this is the first report of a stress fracture of the supracondylar process. We present the case of a professional tennis player with a stress fracture of the supracondylar process who underwent surgery to avoid possible displacement and neurovascular complications. Clinicians should consider the diagnosis of a supracondylar process fracture with or without neurovascular compression when examining athletes with otherwise unexplained arm or elbow pain. Stress fracture of the supracondylar process may be secondary to the excessive traction of the pronator teres.

  3. Bilateral femoral neck stress fractures in military recruits with unilateral hip pain.

    PubMed

    Moo, Ing How; Lee, Y H D; Lim, K K; Mehta, K V

    2016-10-01

    Femoral neck stress fractures are rare and can be easily missed and failure to diagnose these injuries early can lead to avascular necrosis, malunion and osteoarthritis. It is important to have a high index of suspicion for femoral neck stress fractures in military recruits. We present three cases of bilateral femoral neck fractures in military recruits, all presenting with unilateral hip symptoms and signs. All the asymptomatic contralateral hips had femoral neck stress fractures diagnosed by screening MRI. Tension type and displaced femoral neck fractures were treated surgically. All the fractures managed healing without complications. Military recruits with unilateral groin pain should have an early referral for MRI hip to rule out femoral neck stress fractures and those military personnel with ipsilateral femoral neck fracture should have MRI of the contralateral hip. Two of the patients had vitamin D deficiency, of which one had elevated parathyroid hormones and low bone mineral density. Our case series highlights the significance of vitamin D deficiency among military recruits. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Stress analysis of implant-bone fixation at different fracture angle

    NASA Astrophysics Data System (ADS)

    Izzawati, B.; Daud, R.; Afendi, M.; Majid, MS Abdul; Zain, N. A. M.; Bajuri, Y.

    2017-10-01

    Internal fixation is a mechanism purposed to maintain and protect the reduction of a fracture. Understanding of the fixation stability is necessary to determine parameters influence the mechanical stability and the risk of implant failure. A static structural analysis on a bone fracture fixation was developed to simulate and analyse the biomechanics of a diaphysis shaft fracture with a compression plate and conventional screws. This study aims to determine a critical area of the implant to be fractured based on different implant material and angle of fracture (i.e. 0°, 30° and 45°). Several factors were shown to influence stability to implant after surgical. The stainless steel, (S. S) and Titanium, (Ti) screws experienced the highest stress at 30° fracture angle. The fracture angle had a most significant effect on the conventional screw as compared to the compression plate. The stress was significantly higher in S.S material as compared to Ti material, with concentrated on the 4th screw for all range of fracture angle. It was also noted that the screws closest to the intense concentration stress areas on the compression plate experienced increasing amounts of stress. The highest was observed at the screw thread-head junction.

  5. Bilateral Simultaneous Femoral Neck Stress Fracture Despite Clinical Recovery from Anorexia Nervosa: A Case Report.

    PubMed

    Hernigou, Jacques; Koulischer, Simon; Maes, Renaud

    2017-01-01

    A 38-year-old woman who had returned to sports activity (running) after having clinically recovered from anorexia nervosa presented with a bilateral femoral neck stress fracture that was treated with bilateral hip osteosynthesis. Although exercise is usually considered to be beneficial for health, heavy exercise (such as running) after recovery from anorexia nervosa may be associated with an increased risk of fracture.

  6. Hydraulic Fracturing In Situ Stress Estimations in a Potential Geothermal Site, Seokmo Island, South Korea

    NASA Astrophysics Data System (ADS)

    Chang, Chandong; Jo, Yeonguk; Oh, Yangkyun; Lee, Tae Jong; Kim, Kwang-Yeom

    2014-09-01

    We conducted hydraulic fracturing (HF) in situ stress measurements in Seokmo Island, South Korea, to understand the stress state necessary to characterize a potential geothermal reservoir. The minimum horizontal principal stress was determined from shut-in pressures. In order to calculate the maximum horizontal principal stress ( S Hmax) using the classical Hubbert-Willis equation, we carried out hollow cylinder tensile strength tests and Brazilian tests in recovered cores at depths of HF tests. Both tests show a strong pressure rate dependency in tensile strengths, from which we derived a general empirical equation that can be used to convert laboratory determined tensile strength to that suitable for in situ. The determined stress regime (reverse-faulting) and S Hmax direction (ENE-WSW) at depths below ~300 m agrees with the first order tectonic stress. However the stress direction above ~300 m (NE-SW) appears to be interfered by topography effect due to a nearby ridge. The state of stress in Seokmo Island is in frictional equilibrium constrained by optimally oriented natural fractures and faults. However, a severe fluctuation in determined S Hmax values suggests that natural fractures with different frictional coefficients seem to control stress condition quite locally, such that S Hmax is relatively low at depths where natural fractures with low frictional coefficients are abundant, while S Hmax is relatively high at depths where natural fractures with low frictional coefficients are scarce.

  7. Risk Stratification of Stress Fractures and Prediction of Return-to-Duty

    DTIC Science & Technology

    2016-12-01

    determine the sex - and race-ethnicity-specific bone traits that may contribute to stress fracture risk in military recruits. We are ahead of schedule...with recent stress fracture enrolled. 15. SUBJECT TERMS bone microarchitecture, HRpQCT, race, gender, sex , bone mineral density, vBMD, bone geometry...cross sectional study aimed at identifying the bone properties that may be related to the well-known sex and race/ethnicity differences in risk for

  8. FEM analysis of deformation localization mechanisms in a 3-D fractured medium under rotating compressive stress orientations

    NASA Astrophysics Data System (ADS)

    Strijker, Geertje; Beekman, Fred; Bertotti, Giovanni; Luthi, Stefan M.

    2013-05-01

    Stress distributions and deformation patterns in a medium with a pre-existing fracture set are analyzed as a function of the remote compressive stress orientation (σH) using finite element models with increasingly complex fracture configurations. Slip along the fractures causes deformation localization at the tips as wing cracks or shear zones. The deformation intensity is proportional to the amount of slip, attaining a peak value for α = 45° (α: angle between the fracture strike and σH) and slip is linearly proportional with fracture length. Wing cracks develop for high deformation intensities for 30° < α < 60°, whereas primary plastic shear zones develop for low deformation intensities. Additionally, two types of secondary shear zones develop for α < 30° and α > 60°, with constant angles of 135° and - 60° with σH, respectively. Mechanical interaction between fractures in a fracture zone, quantified as change in slip compared to an isolated fracture, decreases with increasing fracture separation. Fracture underlap elongates the fracture length and therefore increases the amount of slip, while fracture overlap exhibits the opposite effect. Fracture slip decreases with an increasing amount of directly adjacent fractures. Mechanical interaction becomes negligible for fracture configurations with spacing-to-length and spacing-to-overlap ratios exceeding 0.5 and that in this case fractures are decoupled. Independent of the pre-existing fracture configuration, the development of a secondary systematic fracture set driven by a remote stress rotation is dominated by σH; development of wing cracks or shear zones is restricted to the fracture tips. Blocks with tapered geometries are present in models with a variable fracture strike, where the maximum principal stress (σ1, applying the geological convention that compressive stresses are positive) trajectories consistently deviate from σH; the presence of two systematic σ1 trajectory orientations suggests

  9. Identification of natural fractures and in situ stress at Rantau Dedap geothermal field

    NASA Astrophysics Data System (ADS)

    Artyanto, Andika; Sapiie, Benyamin; Idham Abdullah, Chalid; Permana Sidik, Ridwan

    2017-12-01

    Rantau Dedap Area is a geothermal field which is located in Great Sumatra Fault (GSF). The fault and fracture are main factor in the permeability of the geothermal system. However, not all faults and fractures have capability of to flow the fluids. Borehole image log is depiction of the borehole conditions, it is used to identify the natural fractures and drilling induced fracture. Both of them are used to identify the direction of the fracture, direction of maximum horizontal stress (SHmax), and geomechanics parameters. The natural fractures are the results of responses to stress on a rock and permeability which controlling factor in research area. Breakouts is found in this field as a trace of drilling induced fracture due to in situ stress work. Natural fractures are strongly clustered with true strike trending which first, second, and third major direction are N170°E – N180°E (N-S), N60°E – N70°E (NE-SW), and N310°E – N320°E (NW-SE), while the dominant dip is 80° –90°. Based on borehole breakout analysis, maximum horizontal stress orientation is identified in N162°E – N204°E (N-S) and N242°E (NE-SW) direction. It’s constantly similar with regional stress which is affected by GSF. Several parameters have been identified and analyzed are SHmax, SHmin, and Sy. It can be concluded that Rantau Dedap Geothermal Field is affected by strike-slip regime. The determination of in situ stress and natural fractures are important to study the pattern of permeability which is related to the fault in reservoir of this field.

  10. SUPERPOSE-An excel visual basic program for fracture modeling based on the stress superposition method

    NASA Astrophysics Data System (ADS)

    Ismail Ozkaya, Sait

    2014-03-01

    An Excel Visual Basic program, SUPERPOSE, is presented to predict the distribution, relative size and strike of tensile and shear fractures on anticlinal structures. The program is based on the concept of stress superposition; addition of curvature-related local tensile stress and regional far-field stress. The method accurately predicts fractures on many Middle East Oil Fields that were formed under a strike slip regime as duplexes, flower structures or inverted structures. The program operates on the Excel platform. The program reads the parameters and structural grid data from an Excel template and writes the results to the same template. The program has two routines to import structural grid data in the Eclipse and Zmap formats. The platform of SUPERPOSE is a single layer structural grid of a given cell size (e.g. 50×50 m). In the final output, a single tensile or two conjugate shear fractures are placed in each cell if fracturing criteria are satisfied; otherwise the cell is left blank. Strike of the representative fracture(s) is calculated and exact, but the length is an index of fracture porosity (fracture density×length×aperture) within that cell.

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

    PubMed

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

    2013-09-01

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

  12. kISMET: Stress and fracture characterization in a deep mine

    NASA Astrophysics Data System (ADS)

    Oldenburg, C. M.; Dobson, P. F.; Daley, T. M.; Birkholzer, J. T.; Cook, P. J.; Ajo Franklin, J. B.; Rutqvist, J.; Siler, D.; Kneafsey, T. J.; Nakagawa, S.; Wu, Y.; Guglielmi, Y.; Ulrich, C.; Marchesini, P.; Wang, H. F.; Haimson, B. C.; Sone, H.; Vigilante, P.; Roggenthen, W.; Doe, T.; Lee, M.; Mattson, E.; Huang, H.; Johnson, T. C.; Morris, J.; White, J. A.; Johnson, P. A.; Coblentz, D. D.; Heise, J.

    2016-12-01

    We are developing a community facility called kISMET (permeability (k) and Induced Seismicity Management for Energy Technologies) at the Sanford Underground Research Facility (SURF) in Lead, SD. The purpose of kISMET is to investigate stress and the effects of rock fabric on hydraulic fracturing. Although findings from kISMET may have broad applications that inform stress and fracturing in anisotropic rock, results will be most applicable to improving control of hydraulic fracturing for enhanced geothermal systems (EGS) in crystalline rock. At the kISMET site on the 4850 ft (1480 m depth) level of SURF, we have drilled and cored an array of nearly vertical boreholes in Precambrian phyllite. The array consists of four 50-m deep monitoring boreholes surrounding one 100-m deep borehole forming a 6 m-wide five-spot pattern at a depth of 1530 m. Previous investigations of the stress field at SURF suggest that the principal stress s1 is nearly vertical. By aligning the kISMET boreholes approximately with σ1, fractures created in the center borehole should in theory be perpendicular to σ3, the least principal horizontal stress. But the phyllite at kISMET has a strong fabric (foliation) that could influence fracturing. Stress measurements and stimulation using hydraulic fracturing will be carried out in the center borehole using a straddle packer and high-pressure pump. We will use an impression packer and image logs after stress testing and stimulation to determine fracture orientation and extent at the center borehole. In order to study the control of stress, rock fabric, and stimulation approach on size, aperture, and orientation of hydraulic fractures, we will carefully monitor the stress measurements and stimulation. For example, we will use continuous active source seismic (CASSM) in two of the monitoring boreholes to measure changes in seismic-wave velocity as water fills the fracture. Second, near real-time electrical resistance tomography (ERT) will be used in

  13. Effects of Bone Marrow Mesenchymal Stem Cells-Conditioned Medium on Tibial Partial Osteotomy Model of Fracture Healing in Hypothyroidism Rats

    PubMed

    Sefati, Niloofar; Norouzian, Mohsen; Abbaszadeh, Hojjat-Allah; Abdollahifar, Mohammad-Amin; Amini, Abdollah; Bagheri, Mohammad; Aryan, Arefeh; Fadaei Fathabady, Fatemeh

    2018-03-01

    Hypothyroidism is associated with dysfunction of the bone turnover with reduced osteoblastic bone formation and osteoclastic bone resorption. Mesenchyme stem cells (MSCs) secrete various factors and cytokines that may stimulate bone regeneration. The aim of this study was to determine the effects of MSCs-conditioned medium (CM) in hypothyroidism male rats after inducing bone defect. : In this study, 24 male rats were randomly assigned to three groups: (I) hypothyroidism+bone defect (HYPO), (II) hypothyroidism+bone defect+CM (HYPO+CM), and (III) no hypothyroidism+bone defect (control). Four weeks after surgery, the right tibia was removed, and immediately, biomechanical and histological examinations were performed. The results showed a significant reduction in bending stiffness (32.64±3.99), maximum force (14.63±1.89), high stress load (7.59±2.31), and energy absorption (12.68±2.12) at the osteotomy site in hypothyroidism rats in comparison to the control and hypothyroidism+condition medium groups (P<0.05). There was also a significant decrease in the trabecular bone volume (3.86±3.88) and the number of osteocytes (5800±859.8) at the osteotomy site in hypothyroidism rats compared to the control and hypothyroidism+condition medium groups (P<0.01 and P<0.02, respectively). The present study suggests that the use of the CM can improve the fracture regeneration and accelerates bone healing at the osteotomy site in hypothyroidism rats.

  14. Elastic stress transmission and transformation (ESTT) by confined liquid: A new mechanics for fracture in elastic lithosphere of the earth

    USGS Publications Warehouse

    Xu, Xing-Wang; Peters, Stephen; Liang, Guang-He; Zhang, Bao-Lin

    2016-01-01

    Tectonic stress alters local stress fields in the surrounding country rocks and therefore synchronously varies the local effective tensile tangential stress and the nature and geometry of the liquid-driven fractures.

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

    PubMed

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

    2015-08-01

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

  16. Evaluation of Oxidative Stress Levels and Antioxidant Enzyme Activities in Burst Fractures

    PubMed Central

    Kuyumcu, Fetullah; Aycan, Abdurrahman

    2018-01-01

    Background Spinal burst fractures are pathologies that occur in spinal injuries and cause significant mortality and morbidity as a result. Burst fractures in spinal cord injuries can result in rapid and significant oxidative stress. In addition to the primary injury in severe spinal cord injuries, subsequent secondary lesions are mainly due to inflammatory cascade activation and excessive production of free radicals. This study evaluated oxidative stress and antioxidant enzyme levels in burst fractures. Material/Methods Twenty patients with burst fractures were diagnosed and underwent surgery and 20 healthy control subjects were included in the study. Neurological status was evaluated using the American Spine Injury Association Impairment Scale (ASIA) before and after surgery. Neurological function was scored as ASIA A: complete deficits, ASIA B–D: incomplete deficits, and ASIA E: neurologically intact. Spectrophotometry was performed to measure malondialdehyde (MDA) and low glutathione (GSH), glutathione peroxidase (GPx) levels, which represent lipid peroxide content. Evaluations were performed within 2 days after injury in the patients. Results MDA levels were higher in the burst fracture group (p<0.001), whereas GSH and SOD activities were higher in the control group (both p<0.001). There was no statistically significant difference in GPx levels between the groups (p=0.482). Conclusions Oxidative stress appears to be related to burst fractures. Considering the importance of burst fractures in spinal cord injuries, a better understanding of these mechanisms may help in defining the role of oxidative stress after burst fractures. Prospective, randomized, controlled trials may reveal new therapeutic approaches that include antioxidants for explosive fractures focusing on oxidative stress. PMID:29324724

  17. Evaluation of Oxidative Stress Levels and Antioxidant Enzyme Activities in Burst Fractures.

    PubMed

    Kuyumcu, Fetullah; Aycan, Abdurrahman

    2018-01-11

    BACKGROUND Spinal burst fractures are pathologies that occur in spinal injuries and cause significant mortality and morbidity as a result. Burst fractures in spinal cord injuries can result in rapid and significant oxidative stress. In addition to the primary injury in severe spinal cord injuries, subsequent secondary lesions are mainly due to inflammatory cascade activation and excessive production of free radicals. This study evaluated oxidative stress and antioxidant enzyme levels in burst fractures. MATERIAL AND METHODS Twenty patients with burst fractures were diagnosed and underwent surgery and 20 healthy control subjects were included in the study. Neurological status was evaluated using the American Spine Injury Association Impairment Scale (ASIA) before and after surgery. Neurological function was scored as ASIA A: complete deficits, ASIA B-D: incomplete deficits, and ASIA E: neurologically intact. Spectrophotometry was performed to measure malondialdehyde (MDA) and low glutathione (GSH), glutathione peroxidase (GPx) levels, which represent lipid peroxide content. Evaluations were performed within 2 days after injury in the patients. RESULTS MDA levels were higher in the burst fracture group (p<0.001), whereas GSH and SOD activities were higher in the control group (both p<0.001). There was no statistically significant difference in GPx levels between the groups (p=0.482). CONCLUSIONS Oxidative stress appears to be related to burst fractures. Considering the importance of burst fractures in spinal cord injuries, a better understanding of these mechanisms may help in defining the role of oxidative stress after burst fractures. Prospective, randomized, controlled trials may reveal new therapeutic approaches that include antioxidants for explosive fractures focusing on oxidative stress.

  18. In situ stress and fracture permeability along the Stillwater fault zone, Dixie Valley Nevada

    USGS Publications Warehouse

    Hickman, S.H.; Barton, C.A.; Zoback, M.D.; Morin, R.; Sass, J.; Benoit, R.

    1997-01-01

    Borehole televiewer and hydrologic logging and hydraulic fracturing stress measurements were carried out in a 2.7-km-deep geothermal production well (73B-7) drilled into the Stillwater fault zone. Precision temperature and spinner flowmeter logs were also acquired in well 73B-7, with and without simultaneously injecting water into the well. Localized perturbations to well-bore temperature and flow were used to identify hydraulically conductive fractures. Comparison of these data with fracture orientations from the televiewer log indicates that permeable fractures within and adjacent to the Stillwater fault zone are critically stressed, potentially active shear planes in the current west-northwest extensional stress regime at Dixie Valley.

  19. First-rib stress fracture in two adolescent swimmers: a case report.

    PubMed

    Low, Sara; Kern, Michael; Atanda, Alfred

    2016-01-01

    First-rib stress fractures have been described in adolescent athletes in various sports, with only one prior case report of first-rib stress fractures in an adolescent female swimmer. There is a need for research on the cause, management, and prevention of these injuries as they lead to significant morbidity and critical time away from sport for these aspiring athletes. We aimed to describe first-rib stress fractures as a potential cause for non-specific atraumatic chronic shoulder pain in adolescent swimmers and to discuss the different presentations, unique risk factors, treatment, and potential injury prevention strategies of such fractures. We discussed two such cases which were successfully treated with activity modification with restriction of all overhead activity, gradually progressive physical therapy and a return to swimming protocol. First-rib stress fractures can vary in presentation and should be in the differential diagnosis in adolescent swimmers with chronic shoulder pain. These injuries can be successfully managed with rest from overhead activities and physical therapy. Gradual return to competitive swimming can be achieved even with non-union of a first-rib stress fracture. Emphasis on balanced strength training in different muscle groups and proper swimming technique is essential to prevent these injuries.

  20. Evaluation of tarsal navicular stress fracture fixation using intraoperative O-arm computed tomography.

    PubMed

    Hsu, Andrew R; Lee, Simon

    2014-12-01

    Stress fractures of the tarsal navicular are high-risk injuries that can result in displacement, avascular necrosis, malunion, and nonunion. Delayed diagnosis and improper treatment can lead to long-term functional impairments and poor clinical outcomes. Increased shear stress and decreased vascularity in the central third of the navicular can complicate bony healing with often unpredictable return times to activity using conservative management in a non-weight-bearing cast. There recently has been increasing debate regarding the effectiveness of treatment options with a trend toward surgical management to anatomically reduce and stabilize navicular stress fractures in athletes. However, anatomic reduction and fixation of the navicular can be difficult despite direct visualization and intraoperative fluoroscopy. We report a case of a chronic navicular stress fracture in a high-level teenage athlete treated with open reduction internal fixation (ORIF) and calcaneus autograft using intraoperative computed tomography (CT) (O-arm®, Medtronic, Minneapolis, MN) for real-time evaluation of fracture reduction and fixation. Intraoperative CT was fast, reliable, and allowed for confirmation of guide wire orientation, alignment, and length across the fracture site. Anatomic fixation of navicular stress fractures can be challenging, and it is important for surgeons to be aware of the potential advantages of using intraoperative CT when treating these injuries. Therapeutic, Level IV: Case Report. © 2014 The Author(s).

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

    PubMed

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

    2014-12-01

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

  2. Stress dependence of permeability of intact and fractured shale cores.

    NASA Astrophysics Data System (ADS)

    van Noort, Reinier; Yarushina, Viktoriya

    2016-04-01

    Whether a shale acts as a caprock, source rock, or reservoir, understanding fluid flow through shale is of major importance for understanding fluid flow in geological systems. Because of the low permeability of shale, flow is thought to be largely confined to fractures and similar features. In fracking operations, fractures are induced specifically to allow for hydrocarbon exploration. We have constructed an experimental setup to measure core permeabilities, using constant flow or a transient pulse. In this setup, we have measured the permeability of intact and fractured shale core samples, using either water or supercritical CO2 as the transporting fluid. Our measurements show decreasing permeability with increasing confining pressure, mainly due to time-dependent creep. Furthermore, our measurements show that for a simple splitting fracture, time-dependent creep will also eliminate any significant effect of this fracture on permeability. This effect of confinement on fracture permeability can have important implications regarding the effects of fracturing on shale permeability, and hence for operations depending on that.

  3. Stress fracture and premenstrual syndrome in Japanese adolescent athletes: a cross-sectional study.

    PubMed

    Takeda, Takashi; Imoto, Yoko; Nagasawa, Hiroyo; Takeshita, Atsuko; Shiina, Masami

    2016-10-18

    To investigate the relationship between the occurrence of stress fracture and premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) in Japanese adolescent athletes. Cross-sectional study. Osaka, Japan. A school-based survey on menstruation and school life was conducted using a sample of 1818 Japanese female students who belonged to two public high schools in Japan. Among them, we recruited 394 athletes who had regular menstrual cycles (25-38 days) and completed a questionnaire about their premenstrual symptoms and their competitive career. Premenstrual symptoms and the occurrence of stress fracture. The prevalences of moderate-to-severe PMS and PMDD were 8.9% and 1.3%, respectively, which were the same as in collegiate athletes in a previous study. Premenstrual symptoms disturbed 'Work efficiency or productivity, home responsibilities', 'Relationships with coworkers or family' and 'Athletic performance in training or competition' more severely than menstrual pain (p=0.031, p=0.004 and p<0.001, respectively). 66 athletes (16.8%) reported having experienced a stress fracture. The severity of 'Overeating or food cravings', 'Physical symptoms' and 'Performance in training or competition' in athletes with previous stress fractures were much higher than in those without a history of stress fractures (p=0.015, p=0.008 and p=0.006, respectively). In terms of premenstrual symptoms, 'Physical symptoms' was associated with an increased risk of stress fractures in athletes (OR 1.66, 95% CI 1.06 to 2.62). The results from this study indicated that premenstrual symptoms may affect athletic performance and has the risk of stress fractures in adolescent athletes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. Stress fracture and premenstrual syndrome in Japanese adolescent athletes: a cross-sectional study

    PubMed Central

    Imoto, Yoko; Nagasawa, Hiroyo; Takeshita, Atsuko; Shiina, Masami

    2016-01-01

    Objectives To investigate the relationship between the occurrence of stress fracture and premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) in Japanese adolescent athletes. Design Cross-sectional study. Setting Osaka, Japan. Participants A school-based survey on menstruation and school life was conducted using a sample of 1818 Japanese female students who belonged to two public high schools in Japan. Among them, we recruited 394 athletes who had regular menstrual cycles (25–38 days) and completed a questionnaire about their premenstrual symptoms and their competitive career. Main outcome measure Premenstrual symptoms and the occurrence of stress fracture. Results The prevalences of moderate-to-severe PMS and PMDD were 8.9% and 1.3%, respectively, which were the same as in collegiate athletes in a previous study. Premenstrual symptoms disturbed ‘Work efficiency or productivity, home responsibilities’, ‘Relationships with coworkers or family’ and ‘Athletic performance in training or competition’ more severely than menstrual pain (p=0.031, p=0.004 and p<0.001, respectively). 66 athletes (16.8%) reported having experienced a stress fracture. The severity of ‘Overeating or food cravings’, ‘Physical symptoms’ and ‘Performance in training or competition’ in athletes with previous stress fractures were much higher than in those without a history of stress fractures (p=0.015, p=0.008 and p=0.006, respectively). In terms of premenstrual symptoms, ‘Physical symptoms’ was associated with an increased risk of stress fractures in athletes (OR 1.66, 95% CI 1.06 to 2.62). Conclusions The results from this study indicated that premenstrual symptoms may affect athletic performance and has the risk of stress fractures in adolescent athletes. PMID:27798029

  5. Thermoelastic stresses induced by non-isothermal fluid injection into fractured rock

    NASA Astrophysics Data System (ADS)

    Mossop, A.; Matthai, S. K.

    2003-04-01

    The injection of cold water into hot fractured rock occurs in a number of industrial scenarios, most commonly in the recharge of geothermal reservoirs and during waterflood operations in hydrocarbon reservoirs. The cold water cools the rock local to the fracture flow pathways, the cooled rock contracts, causing localised stress perturbations. Essentially analogous physical processes are involved in the injection of hot fluids into cooler rock such as occur in steam flood operations in viscous oil recovery. In this study we investigate such thermoelastic stresses induced by non-isothermal injection into a three dimensional fractured rock mass. The starting point of our analysis is an idealized model of injection into a single, uniform, horizontal fracture. For this case we have previously found semi-analytic solutions and analytic estimates of the stress perturbation and these are in turn used for cross-verification of an isoparametric, quadratic, finite element model of the system. In the numerical model the fractures are treated as discrete conductive channels within the matrix and an additional feature is that the matrix itself can be assigned a non-zero permeability. As the numerical simulator follows a fundamentally different methodology for solving these thermoelastic problems, the results help to validate some of the scaling relationships and non-intuitive behaviour deduced from the analytic estimates (e.g. for a broad range of flow rates, fracture normal stress perturbations decrease with increasing injection rates). The finite element model is then used to explore progressively more complex fracture geometries and networks. Finally we investigate the validity of a continuum limit as fracture densities increase to the point that fracture separation length scales are comparable with thermal diffusion length scales.

  6. Stress fracture of the scaphoid combined with the distal radial epiphysiolysis.

    PubMed Central

    Inagaki, H; Inoue, G

    1997-01-01

    A stress fracture of the scaphoid combined with distal radial epiphysiolysis occurred in a 16 year old badminton player. Repeated shearing and torsional forces by excessive wrist movement from hitting a shuttle probably cause stress injuries in both the scaphoid and the distal radius. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:9298566

  7. Fracture resistance and stress distribution of simulated immature teeth after apexification with mineral trioxide aggregate.

    PubMed

    Brito-Júnior, M; Pereira, R D; Veríssimo, C; Soares, C J; Faria-e-Silva, A L; Camilo, C C; Sousa-Neto, M D

    2014-10-01

    To evaluate the effect of adhesive restorations on fracture resistance and stress distribution in teeth with simulated immature apices and apical plugs of mineral trioxide aggregate (MTA). Sixty bovine incisors were sectioned 8 mm above and 12 mm below the cemento-enamel junction (CEJ). The root canal was enlarged using a diamond bur, resulting in remaining root canal walls with 0.1-0.2 mm of thickness. A 5-mm apical plug of MTA was placed and the teeth were restored according to the following groups: GP--the root canal was filled with gutta-percha and endodontic sealer; CR--the root canal was filled with light-cured composite resin inserted incrementally; FP--a fibre post was cemented into the root canal; and RFP--the fibre post was relined with composite resin prior to the cementation into the root canal. A load was applied on the crown of all teeth at 135° to their long axis until fracture. Data was analysed by one-way anova and SNK tests (α = 0.05), whilst the fracture pattern was evaluated according to the position of the fracture. Stress distributions in the restored teeth were verified by finite element analysis. Teeth restored with fibre posts and relined fibre posts were associated with the highest fracture resistance, whilst the GP group had the lowest values. GP and RC groups had similar fracture resistance values (P = 0.109). All fractures types involved the cervical and middle thirds of roots. The GP model had high levels of stress concentration in the cervical and middle thirds of roots. No difference was found amongst the stress concentration in the RC, FP and RFP models. Restorative protocols alter the fracture resistance and stress distribution of immature teeth after placement of MTA apical plugs. © 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd.

  8. Information on stress conditions in the oceanic crust from oval fractures in a deep borehole

    USGS Publications Warehouse

    Morin, R.H.

    1990-01-01

    Oval images etched into the wall of a deep borehole were detected in DSDP Hole 504B, eastern equatorial Pacific Ocean, from analysis of an acoustic televiewer log. A systematic inspection of these ovals has identified intriguing consistencies in appearance that cannot be explained satisfactorily by a random, coincidental distribution of pillow lavas. As an alternative hypothesis, Mohr-Coulomb failure criterion is used to account for the generation and orientation of similarly curved, stress-induced fractures. Consequently, these oval features can be interpreted as fractures and related directly to stress conditions in the oceanic crust at this site. The azimuth of the oval center corresponds to the orientation of maximum horizontal principal stress (SH), and the oval width, which spans approximately 180?? of the borehole, is aligned with the azimuth of minimum horizontal principal stress (Sh). The oval height is controlled by the fracture angle and thus is a function of the coefficient of internal friction of the rock. -from Author

  9. Preventive osteopathic manipulative treatment and stress fracture incidence among collegiate cross-country athletes.

    PubMed

    Brumm, Lynn F; Janiski, Carrie; Balawender, Jenifer L; Feinstein, Adam

    2013-12-01

    Stress fractures are common among athletes, particularly distance runners, with many theories regarding the etiologic process of stress fractures and various studies identifying risk factors or suggesting preventive techniques. To our knowledge, no previous studies have discussed the possible causative effects of somatic dysfunction or the preventive capabilities of osteopathic manipulative treatment (OMT). To apply a preventive OMT protocol for cross-country athletes to reduce the incidence of stress fractures. Cohort study. Examinations of cross-country athletes at an NCAA (National Collegiate Athletic Association) Division I university were performed by supervising physician-examiners and first- and second-year osteopathic medical students during several consecutive academic years. Athletes re-enrolled in the study each year they continued to be eligible. The intervention included osteopathic structural examination and OMT that focused on somatic dysfunction identified in the pelvis, sacrum, and lower extremities. More than 1800 participant examinations were performed on 124 male and female participants by 3 supervising physician-examiners and 141 osteopathic medical students over the course of 5 consecutive academic years (2004-2005 to 2008-2009). Data from these academic years were compared with data from the previous 8 academic years (1996-1997 to 2003-2004). An average of 20 new participants enrolled yearly. The number of annual stress fractures per team ranged from 0 to 6 for male participants and 1 to 6 for female participants. The cumulative annual incidence of stress fractures for male participants demonstrated a statistically significant decrease from 13.9% (20 of 144) before intervention to 1.0% (1 of 105) after intervention, resulting in a 98.7% relative reduction in stress-fracture diagnosis (P=.019). The cumulative annual incidence for female participants showed a minimal decrease from 12.9% (23 of 178) before intervention to 12.0% (17 of 142) after

  10. Femoral Neck Stress Fracture: Can MRI Grade Help Predict Return-to-Running Time?

    PubMed

    Ramey, Lindsay N; McInnis, Kelly C; Palmer, William E

    2016-08-01

    Limited research is available regarding return-to-running (RTR) time after femoral neck stress fractures. While studies have shown the prognostic value of image-based grading scales for stress fractures at other sites, few have included femoral neck stress fractures. To determine if the grade of femoral neck stress fractures based on magnetic resonance imaging (MRI) characteristics correlates with RTR time. Cohort study; Level of evidence, 3. This study included 24 patients (mean age, 32.9 years; range, 18-51 years) who were diagnosed with 27 femoral neck stress fractures by MRI from 2009 to 2015 at a single sports medicine clinic. All fractures were compression sided and were treated nonoperatively. Charts were reviewed for patient demographics and RTR time. Images were graded from 1 to 4 using the Arendt stress fracture severity scale. Statistical analysis was performed using survival analysis and Cox proportional hazard model to compare the RTR time between grades. Cox regression was repeated, adjusted for age, bone mineral density (BMD), and body mass index (BMI). The mean (±standard error of the mean) RTR time in weeks for patients with fractures graded 1 to 4 was 7.4 ± 2.7 (range, 4-11), 13.8 ± 3.8 (range, 6-21), 14.7 ± 3.5 (range, 8.5-24), and 17.5 ± 3.4 (range, 10-32), respectively. Survival analysis indicated that there was a statistically significant effect of fracture grade on RTR time (P = .0065). The Cox model indicated a statistically significant difference in RTR time between grades 1 and 2 (P = .036), 1 and 3 (P = .014), and 1 and 4 (P = .002). The unadjusted hazard ratio was significant (P = .037). There were no statistically significant differences between the remaining grades (P = .82 for grades 2 and 3, P = .37 for grades 2 and 4, and P = .31 for grades 3 and 4). Age (P = .71) and BMD (P = .81) did not have an effect on RTR time. The hazard ratio remained significant (P = .05) after adjusting for age and BMD. BMI tended to have an effect on

  11. Skeletal Self-Repair: Stress Fracture Healing by Rapid Formation and Densification of Woven Bone

    PubMed Central

    Uthgenannt, Brian A.; Kramer, Michael H.; Hwu, Joyce A.; Wopenka, Brigitte; Silva, Matthew J.

    2013-01-01

    Stress fractures of varying severity were created using a rat model of skeletal fatigue loading. Periosteal woven bone formed in proportion to the level of bone damage, resulting in the rapid recovery of whole-bone strength independent of stress fracture severity. Introduction A hard periosteal callus is a hallmark of stress fracture healing. The factors that regulate the formation of this woven bone callus are poorly understood. Our objective was to produce stress fractures of varying severity and to assess the woven bone response and recovery of bone strength. Materials and Methods We used the forelimb compression model to create stress fractures of varying severity in 192 adult rats. Forelimbs were loaded in fatigue until the displacement reached 30, 45, 65 or 85% of fracture. The osteogenic responses of loaded and contralateral control ulnae were assessed 7 and 14 days after loading using pQCT, microCT, mechanical testing, histomorphometry, and Raman spectroscopy. Results Loading stimulated the formation of periosteal woven bone that was maximal near the ulnar mid-shaft and transitioned to lamellar bone away from the mid-shaft. Woven bone area increased in a dose-response manner with increasing fatigue displacement. Whole-bone strength was partially recovered at 7 days and fully recovered at 14 days, regardless of initial stress fracture severity. The density of the woven bone increased by 80% from 7 to 14 days, due in part to a 30% increase in the mineral:collagen ratio of the woven bone tissue. Conclusion Functional healing of a stress fracture, as evidenced by recovery of whole-bone strength, occurred within 2 weeks, regardless of stress fracture severity. Partial recovery of strength in the first week was attributed to the rapid formation of a collar of woven bone that was localized to the site of bone damage and whose size depended on the level of initial damage. Complete recovery of strength in the second week was due to woven bone densification. For the

  12. Greater Polar Moment of Inertia at the Tibia in Athletes Who Develop Stress Fractures

    PubMed Central

    Weidauer, Lee A.; Binkley, Teresa; Vukovich, Matt; Specker, Bonny

    2014-01-01

    Background: Several previous investigations have determined potential risk factors for stress fractures in athletes and military personnel. Purpose: To determine factors associated with the development of stress fractures in female athletes. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 88 female athletes (cross-country, n = 29; soccer, n = 15; swimming, n = 9; track and field, n = 14; volleyball, n = 12; and basketball, n = 9) aged 18 to 24 years were recruited to participate in a longitudinal bone study and had their left distal tibia at the 4%, 20%, and 66% sites scanned by peripheral quantitative computed tomography (pQCT). Patients included 23 athletes who developed stress fractures during the following year (cases). Whole body, hip, and spine scans were obtained using dual-energy x-ray absorptiometry (DXA). Analysis of covariance was used to determine differences in bone parameters between cases and controls after adjusting for height, lower leg length, lean mass, fat mass, and sport. Results: No differences were observed between cases and controls in any of the DXA measurements. Cases had significantly greater unadjusted trabecular bone mineral content (BMC), greater polar moment of inertia (PMI) at the 20% site, and greater cortical BMC at the 66% site; however, after adjusting for covariates, the differences became nonsignificant. When analyses were repeated using all individuals who had ever had a stress fracture as cases (n = 31) and after controlling for covariates, periosteal circumference was greater in the cases than the controls (71.1 ± 0.7 vs 69.4 ± 0.5 mm, respectively; P = .04). Conclusion: A history of stress fractures is associated with larger bones. These findings are important because larger bones were previously reported to be protective against fractures and stress fractures, but study findings indicate that may not always be true. One explanation could be that individuals who sustain stress fractures have

  13. Stress fractures around the knee in elderly patients. A cause of acute pain in the knee.

    PubMed

    Satku, K; Kumar, V P; Chacha, P B

    1990-07-01

    A review of the cases of sixteen elderly patients who had eighteen stress fractures around the knee revealed that thirteen fractures had been misdiagnosed, which led to inappropriate management of six. The most frequent factor contributing to misdiagnosis was the presence of other abnormalities of the knee for which the patient had previously consulted the physician. Conservative treatment with rest, walking aids, and, for some patients, splinting of the extremity resulted in relief of pain and healing of the fracture. A careful clinical assessment that includes new radiographs and, if necessary, bone scans is essential for early diagnosis in patients who have acute, incapacitating pain in the knee.

  14. Patterns of fracture and tidal stresses on Europa

    NASA Astrophysics Data System (ADS)

    Helfenstein, P.; Parmentier, E. M.

    1983-03-01

    A comparison of dark band, triple band, and cuspate ridge orientations with the fracture patterns predicted for tidal distortion due to orbital recession and eccentricity is undertaken, to test the hypothesized identification of Europa's lineaments as tidal distortion and planetary volume change fractures. Short, reticule dark bands near the anti-Jove point could be tension cracks caused by orbital eccentricity. Long, arcuate dark bands and triple bands peripheral to the anti-Jove point may be strike-slip faults due to orbital recession. The orientation and distribution of cuspate ridges, if they are compressional, suggests their formation in response to a combination of orbital recession and planetary volume decrease. If surface fracturing is due to tidal deformation, important constraints are exerted by it on Europa's orbital evolution.

  15. Stress-induced, time-dependent fracture closure at hydrothermal conditions

    USGS Publications Warehouse

    Beeler, N.M.; Hickman, S.H.

    2004-01-01

    Time-dependent closure of fractures in quartz was measured in situ at 22-530??C temperature and 0.1-150 MPa water pressure. Unlike previous crack healing and rock permeability studies, in this study, fracture aperture is monitored directly and continuously using a windowed pressure vessel, a long-working-distance microscope, and reflected-light interferometry. Thus the fracture volume and geometry can be measured as a function of time, temperature, and water pressure. Relatively uniform closure occurs rapidly at temperatures and pressures where quartz becomes significantly soluble in water. During closure the aperture is reduced by as much as 80% in a few hours. We infer that this closure results from the dissolution of small particles or asperities that prop the fracture open. The driving force for closure via dissolution of the prop is the sum of three chemical potential terms: (1) the dissolution potential, proportional to the logarithm of the degree of undersaturation of the solution; (2) the coarsening potential, proportional to the radius of curvature of the prop; and (3) the pressure solution potential, proportional to the effective normal stress at the contact between propping particles and the fracture wall. Our observations suggest that closure is controlled by a pressure solution-like process. The aperture of dilatant fractures and microcracks in the Earth that are similar to those in our experiments, such as ones generated from thermal stressing or brittle failure during earthquake rupture and slip, will decrease rapidly with time, especially if the macroscopic stress is nonhydrostatic.

  16. Elastic and Viscoelastic Modeling of Stresses Induced by Hydraulic Fracturing in Shale Gas Reservoir

    NASA Astrophysics Data System (ADS)

    Trzeciak, Maciej; Sone, Hiroki; Dabrowski, Marcin; Jarosinski, Marek

    2017-04-01

    Hydraulic fracturing is one of the most important engineering tasks in the development of an unconventional gas or oil play. Further exploitation of the reservoir is strongly influenced by the effectiveness of this process. Knowledge about the in situ stress state, and its changes is critical for successful fracturing of a reservoir. Hydraulic fracturing is usually carried out in several stages. The previous stages influence the later ones, because the induced and reactivated fractures, and the corresponding strain tend to increase the minimum horizontal stress (Shmin). This phenomena may lead to changes in the stress regime. The stress state, and fracture network changes result also in consecutive scattering of the microseismic events related to each of the stages. The goal of the present work was to investigate what happens to the stress state after each of the hydraulic fracturing stages, and how it may affect the success of whole operation. Our investigation was divided in two major parts: first we characterized the rheological behavior of the shale rocks from prospective reservoir in northern Poland, and later we incorporated the constitutive models obtained in the laboratory into numerical models of the reservoir. Laboratory testing consisted of fourteen 72-hours-long triaxial creep tests, with ultrasonic acquisition (P, S1 and S2 waves) on cylindrical rock samples from different depths of one borehole. This procedure allowed us to construct a reliable vertical profile of rheological parameters. We did not only focus on the prospective intervals, but we also collected data for the interbedded marl or limestone layers. Numerical modeling was performed with different rheological settings: we started with a simple one layer isotropic elastic material, and then we increased the complexity in steps. Finally we arrived at layered anisotropic viscoelastic material with several fracturing stages which were superimposed on each other.

  17. Fractured rock stress-permeability relationships from in situ data and effects of temperature and chemical-mechanical couplings

    SciTech Connect

    Rutqvist, J.

    2014-09-19

    The purpose of this paper is to (i) review field data on stress-induced permeability changes in fractured rock; (ii) describe estimation of fractured rock stress-permeability relationships through model calibration against such field data; and (iii) discuss observations of temperature and chemically mediated fracture closure and its effect on fractured rock permeability. The field data that are reviewed include in situ block experiments, excavation-induced changes in permeability around tunnels, borehole injection experiments, depth (and stress) dependent permeability, and permeability changes associated with a large-scale rock-mass heating experiment. Data show how the stress-permeability relationship of fractured rock very much depends on localmore » in situ conditions, such as fracture shear offset and fracture infilling by mineral precipitation. Field and laboratory experiments involving temperature have shown significant temperature-driven fracture closure even under constant stress. Such temperature-driven fracture closure has been described as thermal overclosure and relates to better fitting of opposing fracture surfaces at high temperatures, or is attributed to chemically mediated fracture closure related to pressure solution (and compaction) of stressed fracture surface asperities. Back-calculated stress-permeability relationships from field data may implicitly account for such effects, but the relative contribution of purely thermal-mechanical and chemically mediated changes is difficult to isolate. Therefore, it is concluded that further laboratory and in situ experiments are needed to increase the knowledge of the true mechanisms behind thermally driven fracture closure, and to further assess the importance of chemical-mechanical coupling for the long-term evolution of fractured rock permeability.« less

  18. Bilateral stress fracture of the fibulae and periostitis of the tibiae.

    PubMed

    Tsuchie, Hiroyuki; Okada, Kyoji; Nagasawa, Hiroyuki; Chida, Shuichi; Shimada, Yoichi

    2010-01-01

    This study describes a unique case of bilateral stress fractures of the fibulae and provides a literature review. A 16-year-old female badminton player presented with pain around the bilateral distal lateral legs. She had mild bilateral varus deformity at the knee joint, and the bilateral ankles showed valgus deformity in standing posture. Radiographs and computed tomography showed periosteal reactions on the bilateral distal fibulae. Technetium-99m bone scintigraphy demonstrated increased uptake in the bilateral distal fibulae and the bilateral middle third of the tibiae. A diagnosis of bilateral distal fibular stress fractures was made. She was advised to stop playing badminton until the symptoms disappeared. Varus deformity of the knee and valgus deformity of the ankle may have influenced the mechanism underlying bilateral symmetric stress fractures. Copyright © 2010 S. Karger AG, Basel.

  19. Effective-stress-law behavior of Austin chalk rocks for deformation and fracture conductivity

    SciTech Connect

    Warpinski, N.R.; Teufel, L.W.

    1994-08-01

    Austin chalk core has been tested to determine the effective law for deformation of the matrix material and the stress-sensitive conductivity of the natural fractures. For deformation behavior, two samples provided data on the variations of the poroelastic parameter, {alpha}, for Austin chalk, giving values around 0.4. The effective-stress-law behavior of a Saratoga limestone sample was also measured for the purpose of obtaining a comparison with a somewhat more porous carbonate rock. {alpha} for this rock was found to be near 0.9. The low {alpha} for the Austin chalk suggests that stresses in the reservoir, or around the wellbore, willmore » not change much with changes in pore pressure, as the contribution of the fluid pressure is small. Three natural fractures from the Austin chalk were tested, but two of the fractures were very tight and probably do not contribute much to production. The third sample was highly conductive and showed some stress sensitivity with a factor of three reduction in conductivity over a net stress increase of 3000 psi. Natural fractures also showed a propensity for permanent damage when net stressed exceeded about 3000 psi. This damage was irreversible and significantly affected conductivity. {alpha} was difficult to determine and most tests were inconclusive, although the results from one sample suggested that {alpha} was near unity.« less

  20. Rockfall triggering by cyclic thermal stressing of exfoliation fractures

    USGS Publications Warehouse

    Collins, Brian D.; Stock, Greg M.

    2016-01-01

    Exfoliation of rock deteriorates cliffs through the formation and subsequent opening of fractures, which in turn can lead to potentially hazardous rockfalls. Although a number of mechanisms are known to trigger rockfalls, many rockfalls occur during periods when likely triggers such as precipitation, seismic activity and freezing conditions are absent. It has been suggested that these enigmatic rockfalls may occur due to solar heating of rock surfaces, which can cause outward expansion. Here we use data from 3.5 years of field monitoring of an exfoliating granite cliff in Yosemite National Park in California, USA, to assess the magnitude and temporal pattern of thermally induced rock deformation. From a thermodynamic analysis, we find that daily, seasonal and annual temperature variations are sufficient to drive cyclic and cumulative opening of fractures. Application of fracture theory suggests that these changes can lead to further fracture propagation and the consequent detachment of rock. Our data indicate that the warmest times of the day and year are particularly conducive to triggering rockfalls, and that cyclic thermal forcing may enhance the efficacy of other, more typical rockfall triggers.

  1. Acoustic Emission Based Surveillance System for Prediction of Stress Fractures

    DTIC Science & Technology

    2007-09-01

    aging are susceptible to such fractures in contexts of osteoporosis, diabetes, cerebral palsy, fibrous dysplasia and osteogenesis imperfecta . This...CONTRACTING ORGANIZATION: Purdue University West Lafayette IN, 47907 REPORT DATE: September 2007 TYPE OF REPORT: Final PREPARED FOR...directions and a conference abstract was submitted to the American Society of Mechanical Engineers – Summer Bioengineering Conference (Appendix III

  2. The incidence and distribution of stress fractures in elite tennis players

    PubMed Central

    Maquirriain, J; Ghisi, J P

    2006-01-01

    Background Modern professional tennis involves powerful movements repeatedly subjecting the musculoskeletal system to heavy mechanical load. Thus tennis players are exposed to high risk of overuse injuries including stress fractures. Objective To determine the incidence and distribution of stress fractures in elite tennis players. Study design Retrospective cohort study. Methods The cohort study population consisted of 139 elite players (mean (SD) age, 20.0 (5.0) years; 48 female, 91 male). Stress fractures were identified and confirmed radiologically from medical records during a two year period. Injuries were analysed according to age, sex, site, severity, delay in diagnosis, and time needed to return to sports. Results 15 players sustained 18 stress fractures, corresponding to an overall case incidence of 12.9% (95% confidence interval (CI), 8.1 to 20.0). The tarsal navicular was most affected (n = 5; 27%), followed by the pars interarticularis (n = 3; 16%), the metatarsals (n = 3; 16%), the tibia (n = 2; 11%) and the lunate (n = 2; 11%). Magnetic resonance imaging showed a greater incidence of “high grade” lesions (94.4%). Stress fracture incidence was significantly higher in juniors (20.3% (95% CI, 11.4 to 33.2)) than in professional players (7.5% (2.8 to 15.6)) (p = 0.045). Conclusions There was a high absolute risk (12.9%) of stress fractures in elite tennis players over a two year period. Junior players were at highest risk. The lesions are a major cause of disruption both of training and of competition. Risk factors should therefore be identified and prevention emphasised. PMID:16632579

  3. Predicting Fluid Flow in Stressed Fractures: A Quantitative Evaluation of Methods

    NASA Astrophysics Data System (ADS)

    Weihmann, S. A.; Healy, D.

    2015-12-01

    Reliable estimation of fracture stability in the subsurface is crucial to the success of exploration and production in the petroleum industry, and also for wider applications to earthquake mechanics, hydrogeology and waste disposal. Previous work suggests that fracture stability is related to fluid flow in crystalline basement rocks through shear or tensile instabilities of fractures. Our preliminary scoping analysis compares the fracture stability of 60 partly open (apertures 1.5-3 cm) and electrically conductive (low acoustic amplitudes relative to matrix) fractures from a 16 m section of a producing zone in a basement well in Bayoot field, Yemen, to a non-producing zone in the same well (also 16 m). We determine the Critically Stressed Fractures (CSF; Barton et al., 1995) and dilatation tendency (Td; Ferrill et al., 1999). We find that: 1. CSF (Fig. 1) is a poor predictor of high fluid flow in the inflow zone; 88% of the fractures are predicted to be NOT critically stressed and yet they all occur within a zone of high fluid flow rate 2. Td (Fig. 2) is also a poor predictor of high fluid flow in the inflow zone; 67% of the fractures have a LOW Td(< 0.6) 3. For the non-producing zone CSF is a very reliable predictor (100% are not critically stressed) whereas the values of Tdare consistent with their location in non-producing interval (81% are < 0.6) (Fig. 3 & 4). In summary, neither method correlates well with the observed abundance of hydraulically conductive fractures within the producing zone. Within the non-producing zone CSF and Td make reasonably accurate predictions. Fractures may be filled or partially filled with drilling mud or a lower density and electrically conductive fill such as clay in the producing zone and therefore appear (partly) open. In situ stress, fluid pressure, rock properties (friction, strength) and fracture orientation data used as inputs for the CSF and Td calculations are all subject to uncertainty. Our results suggest that scope

  4. An integrated workflow for stress and flow modelling using outcrop-derived discrete fracture networks

    NASA Astrophysics Data System (ADS)

    Bisdom, K.; Nick, H. M.; Bertotti, G.

    2017-06-01

    Fluid flow in naturally fractured reservoirs is often controlled by subseismic-scale fracture networks. Although the fracture network can be partly sampled in the direct vicinity of wells, the inter-well scale network is poorly constrained in fractured reservoir models. Outcrop analogues can provide data for populating domains of the reservoir model where no direct measurements are available. However, extracting relevant statistics from large outcrops representative of inter-well scale fracture networks remains challenging. Recent advances in outcrop imaging provide high-resolution datasets that can cover areas of several hundred by several hundred meters, i.e. the domain between adjacent wells, but even then, data from the high-resolution models is often upscaled to reservoir flow grids, resulting in loss of accuracy. We present a workflow that uses photorealistic georeferenced outcrop models to construct geomechanical and fluid flow models containing thousands of discrete fractures covering sufficiently large areas, that does not require upscaling to model permeability. This workflow seamlessly integrates geomechanical Finite Element models with flow models that take into account stress-sensitive fracture permeability and matrix flow to determine the full permeability tensor. The applicability of this workflow is illustrated using an outcropping carbonate pavement in the Potiguar basin in Brazil, from which 1082 fractures are digitised. The permeability tensor for a range of matrix permeabilities shows that conventional upscaling to effective grid properties leads to potential underestimation of the true permeability and the orientation of principal permeabilities. The presented workflow yields the full permeability tensor model of discrete fracture networks with stress-induced apertures, instead of relying on effective properties as most conventional flow models do.

  5. Stress fracture of the acetabulum in a ballet dancer. A case report.

    PubMed

    Thienpont, Emmanuel; Simon, Jean-Pierre

    2005-12-01

    The authors report the case of a 26-year old professional ballet dancer with chronic dysmenorrhea and a Body Mass Index of 17, who presented with right hip pain related with a stress fracture of the acetabulum. Plain radiographs were unremarkable and the diagnosis was made with magnetic resonance imaging. Conservative treatment including partial weight bearing with crutches for six weeks resulted in immediate resolution of symptoms. The authors discuss the specific risk factors for stress fractures encountered in professional ballet dancers, such as hypogonadism and eating disorders.

  6. Stress fracture and military medical readiness: bridging basic and applied research.

    PubMed

    Friedl, Karl E; Evans, Rachel K; Moran, Daniel S

    2008-11-01

    Military recruits and distance runners share a special risk of stress fracture injury. Recent efforts by US and Israeli military-sponsored researchers have uncovered important mechanisms and practical low-cost interventions. This article summarizes key findings relevant to prevention of stress fracture, including simple strategies to identify and to mitigate risk. Published research supported through the Bone Health and Military Medical Readiness research program and related military bone research was analyzed for contributions to preventing stress fracture in military recruits and optimizing bone health. Thousands of military recruits helped test hypotheses about predictors of risk, safer exercise regimens, and rest, nutrition, gait training, and technology interventions to reduce stress fracture risk. Concurrent cellular, animal, and human laboratory studies were used to systematically investigate mechanisms of mechanical forces acting on bone and interactions through muscle, hormonal and genetic influences, and metabolism. The iterative and sometimes simultaneous process of basic discovery and field testing produced new knowledge that will provide safer science-based physical training. Human training studies evaluating effects on bone require special commitment from investigators and funders due to volunteer compliance and attrition challenges. The findings from multiple studies indicate that measures of bone elasticity, fragility, and geometry are as important as bone mineral density in predicting fracture risk, with applications for new measurement technologies. Risk may be reduced by high intakes of calcium, vitamin D, and possibly protein (e.g., milk products). Prostaglandin E2, insulin-like growth factor 1, and estrogens are important mediators of osteogenesis, indicating reasons to limit the use of certain drugs (e.g., ibuprofen), to avoid excessive food restriction, and to treat hypogonadism. Abnormal gait may be a correctable risk factor. Brief daily

  7. Minimally Invasive Screw Fixation of Inferior Pubic Ramus Stress Fracture Nonunion in a Runner: A Case Report.

    PubMed

    Okike, Kanu; Moritz, Burt E

    2016-04-13

    A fifty-one-year-old female runner developed a stress fracture of the inferior pubic ramus. Nonoperative treatment was initiated, but the symptoms persisted and she was diagnosed with a nonunion. After eleven months of symptoms and ten months of nonoperative treatment, including four months of complete avoidance of running, percutaneous screw fixation was performed, with radiographic and clinical healing of the fracture. While inferior pubic ramus stress fractures are usually successfully treated nonoperatively, instances of nonunion and delayed union have been described. In the present report, we describe the case of a patient in whom an inferior pubic ramus stress fracture nonunion was successfully treated with minimally invasive screw fixation.

  8. Quantitative Stress Determination by Wire-line Hydraulic Fracturing Tests in the ANDRILL South McMurdo Sound Drillhole

    NASA Astrophysics Data System (ADS)

    Schmitt, D. R.; Wilson, T. J.; Pierdominici, S.; Jarrard, R. D.; Paulsen, T. S.; Wonik, T.; Handwerger, D.

    2008-12-01

    In general, knowledge of the state of stress within the Antarctic lithosphere remains largely unconstrained due in part to Antarctica's inaccessibility and because of the paucity of seismic focal mechanism solutions. As such, an important component of the ANDRILL project was to acquire new information on the stress directions and magnitudes within the upper crust. Extensive fracture mapping of the core and oriented ultrasonic televiewer logging, as presented in a related contribution, provided strong constraints on both stress orientations and the faulting regime. The first hydraulic fracturing stress determinations in Antarctica were also carried out to provide complimentary stress magnitudes. These measurements were accomplished using a wireline transported hydraulic fracturing system consisting, essentially, of two synthetic polymer packers that were inflated to isolate the 1-m long pressurization interval. The tests were conducted at the end of the drilling and logging in a ~130-m section specially drilled below 1000 mbsf for hydraulic fractures. This zone was drilled primarily through competent, dense, and low permeability diamicts. The core fracture and televiewer logging information was used to site twenty separate measurements. Classic hydraulic fracturing pressurization records with unambiguous breakdown and fracture closure pressures were obtained in about half of the measurements. The remaining tests provided fracture propagation and closure pressures that are consistent with the classic breakdown curves, but they did not include a clear breakdown pressure and are indicative of the reopening of either natural or drilling induced fractures in the wellbore wall. Comparison of the televiewer images obtained before and after the hydraulic fracturing tests highlighted the existence of at least one artificial hydraulic fracture; more could not be obtained because blockage of the wellbore did not allow the lowest sections to be logged a second time. The

  9. The additional value of a pneumatic leg brace in the treatment of recruits with medial tibial stress syndrome; a randomized study.

    PubMed

    Moen, M H; Bongers, T; Bakker, E W P; Weir, A; Zimmermann, W O; van der Werve, M; Backx, F J G

    2010-12-01

    To study the additional effect of a pneumatic leg brace with standard rehabilitation for the treatment of medial tibial stress syndrome (MTSS) in recruits. In a single blinded randomized study, 15 recruits (age 17-22) followed a rehabilitation programme consisting of leg exercises and a graded running programme. Recruits performed daily exercises and ran three times a week. The running programme consisted of 6 consecutive phases. One group was, after randomization, additionally provided with a pneumatic leg brace. Follow-up was provided every other week. Days to completing the running programme was the primary outcome measure, the Sports Activity Rating Scale (SARS) score and satisfaction with the treatment were secondary outcome measures. In total 14 recruits completed the rehabilitation programme. No differences were found in the number of days until phase six of the running schedule was finished between the brace and the control group (Brace 58.8 +/- 27.7 (mean +/- SD) vs Non-Brace 57.9 +/- 26.2 (mean +/- SD, p = 0.57). Also no differences were found in the SARS scores between the groups. Overall satisfaction with the treatment was 6.4 +/- 1.1 (mean +/- SD) on a 1-10 scale for the brace group and 7.1 +/- 0.7 (mean +/- SD) for the control group (p = 0.06). Comfort of the brace was assessed as 4.8 +/- 1.3 (mean +/- SD) on a 1-10 scale. No additional large effect of the pneumatic leg brace could be found in recruits and wearing of the brace was not feasible, since the wearing comfort was low.

  10. Tibial Tray Thickness Significantly Increases Medial Tibial Bone Resorption in Cobalt-Chromium Total Knee Arthroplasty Implants.

    PubMed

    Martin, J Ryan; Watts, Chad D; Levy, Daniel L; Miner, Todd M; Springer, Bryan D; Kim, Raymond H

    2017-01-01

    Stress shielding is an uncommon complication associated with primary total knee arthroplasty. Patients are frequently identified radiographically with minimal clinical symptoms. Very few studies have evaluated risk factors for postoperative medial tibial bone loss. We hypothesized that thicker cobalt-chromium tibial trays are associated with increased bone loss. We performed a retrospective review of 100 posterior stabilized, fixed-bearing total knee arthroplasty where 50 patients had a 4-mm-thick tibial tray (thick tray cohort) and 50 patients had a 2.7-mm-thick tibial tray (thin tray cohort). A clinical evaluation and a radiographic assessment of medial tibial bone loss were performed on both cohorts at a minimum of 2 years postoperatively. Mean medial tibial bone loss was significantly higher in the thick tray cohort (1.07 vs 0.16 mm; P = .0001). In addition, there were significantly more patients with medial tibial bone loss in the thick tray group compared with the thin tray group (44% vs 10%, P = .0002). Despite these differences, there were no statistically significant differences in range of motion, knee society score, complications, or revision surgeries performed. A thicker cobalt-chromium tray was associated with significantly more medial tibial bone loss. Despite these radiographic findings, we found no discernable differences in clinical outcomes in our patient cohort. Further study and longer follow-up are needed to understand the effects and clinical significance of medial tibial bone loss. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Analysis of the in situ stress contrast impact on a planar hydraulic fracture propagation using the fully coupled poroelastic model

    NASA Astrophysics Data System (ADS)

    Baykin, A. N.; Golovin, S. V.

    2017-10-01

    In this paper, we use a fully coupled model for 3D planar fracture propagation within a poroelastic reservoir in order to analysis the non-symmetry of the fracture as it develops in a 3-layer reservoir with different compressive stresses in each layer. We demonstrate that the fracture predominantly develops in the layer with the lower compressive stress until it gets arrested due to the equality of the total leakoff to the volume of pumped fluid.

  12. Stress fracture of the hamate body and fourth metacarpal base following military style push-ups: an unusual trauma mechanism.

    PubMed

    Busche, Marc N; Knobloch, Karsten; Rosenthal, Herbert; Vogt, Peter M

    2008-12-01

    We report the case of a 19-year-old male soldier, who sustained stress fractures of the hamate body and fourth metacarpal base due to his daily knuckle push-up routine in the military. We introduce repetitive microtrauma due to daily knuckle push-ups as an unusual, but potential trauma mechanism for metacarpal and carpal stress fractures.

  13. Excess Stress Fractures, Musculoskeletal Injuries, and Health Care Utilization Among Unfit and Overweight Female Army Trainees.

    PubMed

    Krauss, Margot R; Garvin, Nadia U; Boivin, Michael R; Cowan, David N

    2017-02-01

    Musculoskeletal injuries are prevalent among military trainees and certain occupations. Fitness and body mass index (BMI) have been associated with musculoskeletal conditions, including stress fractures. The incidence of, and excess health care utilization for, stress fracture and non-stress fracture overuse musculoskeletal injuries during the first 6 months of service is higher among unfit female recruits. Those who exceeded body fat limits are at a greater risk of incident stress fractures, injuries, or health care utilization compared with weight-qualified recruits. Cohort study; Level of evidence, 3. All applicants to the United States Army were required to take a preaccession fitness test during the study period (February 2005-September 2006). The test included a 5-minute step test scored as pass or fail. BMI was recorded at application. There were 2 distinct comparisons made in this study: (1) between weight-qualified physically fit and unfit women and (2) between weight-qualified physically fit women and those who exceeded body fat limits. We compared the incidence of, and excess health care utilization for, musculoskeletal injuries, including stress fractures and physical therapy visits, during the first 183 days of military service. Among the weight-qualified women, unfit participants had a higher non-stress fracture injury incidence and related excess health care utilization rate compared with fit women, with rate ratios of 1.32 (95% CI, 1.14-1.53) and 1.18 (95% CI, 1.10-1.27), respectively. Among fit women, compared with the weight-qualified participants, those exceeding body fat limits had higher rate ratios for non-stress fracture injury incidence and related excess health care utilization of 1.27 (95% CI, 1.07-1.50) and 1.20 (95% CI, 1.11-1.31), respectively. Weight-qualified women who were unfit had a higher incidence of stress fractures and related excess health care utilization compared with fit women, with rate ratios of 1.62 (95% CI, 1

  14. Effective Stress Approximation using Geomechanical Formulation of Fracturing Technology (GFFT) in Petroleum Reservoirs

    NASA Astrophysics Data System (ADS)

    Haghi, A.; Asef, M.; Kharrat, R.

    2010-12-01

    Recently, rock mechanics and geophysics contribution in petroleum industry has been significantly increased. Wellbore stability analysis in horizontal wells, sand production problem while extracting hydrocarbon from sandstone reservoirs, land subsidence due to production induced reservoir compaction, reservoir management, casing shearing are samples of these contributions. In this context, determination of the magnitude and orientation of the in-situ stresses is an essential parameter. This paper is presenting new method to estimate the magnitude of in-situ stresses based on fracturing technology data. Accordingly, kirsch equations for the circular cavities and fracturing technology models in permeable formations have been used to develop an innovative Geomechanical Formulation (GFFT). GFFT introduces a direct reasonable relation between the reservoir stresses and the breakdown pressure of fracture, while the concept of effective stress was employed. Thus, this complex formula contains functions of some rock mechanic parameters such as poison ratio, Biot’s coefficient, Young’s modulus, rock tensile strength, depth of reservoir and breakdown/reservoir pressure difference. Hence, this approach yields a direct method to estimate maximum and minimum effective/insitu stresses in an oil field and improves minimum in-situ stress estimation compared to previous studies. In case of hydraulic fracturing; a new stress analysis method is developed based on well known Darcy equations for fluid flow in porous media which improves in-situ stress estimation using reservoir parameters such as permeability, and injection flow rate. The accuracy of the method would be verified using reservoir data of a case history. The concepts discussed in this research would eventually suggest an alternative methodology with sufficient accuracy to derive in-situ stresses in hydrocarbon reservoirs, while no extra experimental work is accomplished for this purpose.

  15. Simulating the hydraulic stimulation of multiple fractures in an anisotropic stress field applying the discrete element method

    NASA Astrophysics Data System (ADS)

    Zeeb, Conny; Frühwirt, Thomas; Konietzky, Heinz

    2015-04-01

    Key to a successful exploitation of deep geothermal reservoirs in a petrothermal environment is the hydraulic stimulation of the host rock to increase permeability. The presented research investigates the fracture propagation and interaction during hydraulic stimulation of multiple fractures in a highly anisotropic stress field. The presented work was conducted within the framework of the OPTIRISS project, which is a cooperation of industry partners and universities in Thuringia and Saxony (Federal States of Germany) and was funded by the European Fond for Regional Development. One objective was the design optimization of the subsurface geothermal heat exchanger (SGHE) by means of numerical simulations. The presented simulations were conducted applying 3DEC (Itasca™), a software tool based on the discrete element method. The simulation results indicate that the main direction of fracture propagation is towards lower stresses and thus towards the biosphere. Therefore, barriers might be necessary to limit fracture propagation to the designated geological formation. Moreover, the hydraulic stimulation significantly alters the stresses in the vicinity of newly created fractures. Especially the change of the minimum stress component affects the hydraulic stimulation of subsequent fractures, which are deflected away from the previously stimulated fractures. This fracture deflection can render it impossible to connect all fractures with a second borehole for the later production. The results of continuative simulations indicate that a fracture deflection cannot be avoided completely. Therefore, the stage alignment was modified to minimize fracture deflection by varying (1) the pauses between stages, (2) the spacing's between adjacent stages, and (3) the angle between stimulation borehole and minimum stress component. An optimum SGHE design, which implies that all stimulated fractures are connected to the production borehole, can be achieved by aligning the stimulation

  16. Extremely Low-Stress Triaxiality Tests in Calibration of Fracture Models in Metal-Cutting Simulation

    NASA Astrophysics Data System (ADS)

    Šebek, František; Kubík, Petr; Petruška, Jindřich; Hůlka, Jiří

    2016-11-01

    The cutting process is now combined with machining, milling, or drilling as one of the widespread manufacturing operations. It is used across various fields of engineering. From an economical point of view, it is desirable to maintain the process in the most effective way in terms of the fracture surface quality or minimizing the burr. It is not possible to manage this experimentally in mass production. Therefore, it is convenient to use numerical computation. To include the crack initiation and propagation in the computations, it is necessary to implement a suitable ductile fracture criterion. Uncoupled ductile fracture models need to be calibrated first from fracture tests when the test selection is crucial. In the present article, there were selected widespread uncoupled ductile fracture models calibrated with, among others, an extremely low-stress triaxiality test realized through the compression of a cylinder with a specific recess. The whole experimental program together with the cutting process experiment were carried out on AISI 1045 carbon steel. After the fracture models were calibrated and the cutting process was simulated with their use, fracture surfaces and force responses from computations were compared with those experimentally obtained and concluding remarks were made.

  17. Pore Pressure and Stress Distributions Around a Hydraulic Fracture in Heterogeneous Rock

    NASA Astrophysics Data System (ADS)

    Gao, Qian; Ghassemi, Ahmad

    2017-12-01

    One of the most significant characteristics of unconventional petroleum bearing formations is their heterogeneity, which affects the stress distribution, hydraulic fracture propagation and also fluid flow. This study focuses on the stress and pore pressure redistributions during hydraulic stimulation in a heterogeneous poroelastic rock. Lognormal random distributions of Young's modulus and permeability are generated to simulate the heterogeneous distributions of material properties. A 3D fully coupled poroelastic model based on the finite element method is presented utilizing a displacement-pressure formulation. In order to verify the model, numerical results are compared with analytical solutions showing excellent agreements. The effects of heterogeneities on stress and pore pressure distributions around a penny-shaped fracture in poroelastic rock are then analyzed. Results indicate that the stress and pore pressure distributions are more complex in a heterogeneous reservoir than in a homogeneous one. The spatial extent of stress reorientation during hydraulic stimulations is a function of time and is continuously changing due to the diffusion of pore pressure in the heterogeneous system. In contrast to the stress distributions in homogeneous media, irregular distributions of stresses and pore pressure are observed. Due to the change of material properties, shear stresses and nonuniform deformations are generated. The induced shear stresses in heterogeneous rock cause the initial horizontal principal stresses to rotate out of horizontal planes.

  18. A nonlinear thermoviscoelastic stress and fracture analysis of an adhesive bond

    NASA Astrophysics Data System (ADS)

    Duong, Cong Nghiep

    The evolution of residual stresses resulting from cooling an adhesive bond configuration on its lateral surfaces at a constant rate through the glass transition of the polymer are considered. A nonlinear, viscoelastic (free-volume) model serves for the thermoviscoelastic characterization of the polymer. Both an infinite (one-dimensional) and a finite (two dimensional) domain are studied. A 'critical' cooling time exists, in the present case on the order of a few seconds, which separates the control of the solidification process according to whether the relaxation or thermal diffusion time scale governs. The short time 'quenching process,' i.e., when the time scale is governed by thermal diffusion, leads to essentially constant residual stresses. Slower cooling increasingly invokes the time and rate sensitive properties of the polymer and leads to monotically decreasing residual stresses with longer cooling times. To reduce residual stresses by a factor of two from their maximal values requires cooling times on the order of one or two days. Apart from singular behavior of the stress components in the two-dimensionally finite domain 'quenching' has the effect of producing significantly different stress distributions (including stress 'spikes') than slow or thermoelastic analyses would suggest. Implications of these results for systems possessing geometric and material differences subjected to various thermal cooling ranges are also discussed. In the second part of the thesis the effect of the residual stresses on fracture behavior of an adhesive bond are addressed within the context of linear fracture mechanics for dissimilar materials. The crack faces are found to be in contact at the fractured end during the (residually stress) unloading process. A significantly error results if this contact zone is not taken into account. The combined effect of the mechanical loads and the residual stresses on the energy release rate is also studied. The total energy release rate

  19. 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...related to age, sex, and race. Mil Med 148:666–667. 8. Bennell K, Matheson G, Meeuwisse W, Brukner P 1999 Risk factors for stress fractures. Sports Med... Sports Med 19:647–652. 11. Giladi M, Milgrom C, Simkin A, Stein M, Kashtan H, Margu- lies J, Rand N, Chisin R, Steinberg R, Aharonson Z 1987 Stress