SEARCH · PubMed Health

Results for “Tibia”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 361 records · Page 20Linked to original sources

PubMed2006

Three-year results of proximal tibia fractures treated with the LISS.

UNLABELLED: Proximal tibia fractures present a difficult treatment challenge with historically high complication rates. In a prospective study, we asked whether the Less Invasive Stabilization System (LISS) plate can adequately treat extraarticular and complex intraarticular proximal tibia fractures and provide low complication rates and acceptable long-term functional outcomes. We prospectively observed 25 patients with 26 proximal tibia fractures (AO type A2, A3, C1, C2, or C3) treated with the LISS. Consecutive 3-year followup included radiographs and clinical examinations using Knee Society scores and Hospital for Special Surgery scores for extraarticular and intraarticular fractures. No loss of reduction occurred in patients with extraarticular fractures, whereas varus malalignment occurred in one patient with an intraarticular fracture. Two patients with AO 41 C 3.3 fractures had severe knee arthrosis develop and had total knee replacements. The mean Knee Society scores and final average Hospital for Special Surgery scores were similar for extraarticular and intraarticular fractures. Complications related to the surgery included one delayed union and implant removal in two patients. The LISS provided stable fixation of extraarticular and intraarticular proximal tibia fractures and good functional outcomes with a low complication rate. In complex articular fractures additional screws should be used. LEVEL OF EVIDENCE: Therapeutic study, Level II (lesser quality randomized controlled trial [eg, < 80% followup, no blinding, or improper randomization]).

Adult↗

PubMed2006

The Ponseti method for treatment of congenital club foot.

PURPOSE OF REVIEW: This review of the Ponseti technique for the treatment of congenital club foot covers a topic of recently renewed interest. Pediatric orthopedists and parents have become increasingly enthusiastic about the success of this technique, which has been practiced continuously at the University of Iowa since 1948 but only recently become widely utilized. RECENT FINDINGS: Current literature has emphasized the reproducibility of these excellent results among multiple centers throughout the world. In addition, the role of the Internet, and accessibility of medical information have been central elements in the development of this phenomenon. SUMMARY: The current research should convince physicians that all children should be managed by the Ponseti technique at the outset. This research should also reassure physicians and parents that the overwhelming majority of children with club feet can be successfully managed, without the need for major reconstructive surgery.

Braces↗

PubMed2006

Continuous compartment pressure monitoring for tibia fractures: does it influence outcome?

BACKGROUND: Compartment syndrome is common in acute fractures of the tibia. Early diagnosis is important, as delayed treatment leads to significant complications. Continuous compartment pressure monitoring has been recommended to prevent late diagnosis of compartment syndrome associated with tibia fractures. In this study, we aim to examine the effect of continuous compartment pressure monitoring on outcome in acute tibia fractures. METHODS: We randomized 200 consecutive acute extra-articular tibia fractures into monitored and nonmonitored groups. The monitored group received continuous compartment pressure for 36 hours and the nonmonitored group received usual postoperative observations. In alert patients, the diagnosis of compartment syndrome was made clinically. In unconscious patients, a difference between compartment pressure and diastolic blood pressure (DeltaP) of less than 30 mm Hg was the criteria for fasciotomy. Patients were assessed for late sequelae of compartment syndrome (sensory loss, muscle weakness, contracture, and toe clawing) at 6 months. RESULTS: Eighty-nine percent of patients were followed up for a minimum of 6 months or to fracture union. There were five cases of compartment syndrome in the nonmonitored group and none in the monitored group. At 6 months, the complication rates and late sequelae in both groups were not significantly different. In the monitored group, there were 18 patients with DeltaP less than 30 mm Hg, none of whom developed compartment syndrome or late sequelae. In both groups, patients with high energy or open fractures had significantly more late sequelae. CONCLUSIONS: Continuous compartment pressure monitoring is not indicated in alert patients who are adequately observed.

Adolescent↗

PubMedDate not supplied

Effects of three intramedullary pinning techniques on proximal pin location and articular damage in the canine tibia.

The effects of three different techniques of intramedullary (IM) pin placement on pin location and incidence of stifle joint injury were evaluated using 70 cadaver canine tibiae after mid-disphyseal osteotomy. In 50 tibiae, pins were placed retrograde in either a nondirected (group A) or a craniomedially directed fashion (group B) with 25 tibiae in each group. Pins were driven normograde (group N) in 20 tibiae. All the stifles were dissected to qualitatively evaluate pin interference with different joint structures. End-on radiographs of the tibial plateaus were used to quantitatively evaluate pin location. Interference with the caudal cruciate ligament, medial meniscus, lateral meniscus, or meniscal ligaments was not observed in any group. There was a significant association between pinning technique and incidence of involvement of the cranial cruciate ligament (P < .005), patella (P < .001), patellar ligament (P < .005), and femoral condyle (P < .01). Pin location for group A was significantly different from either other group in a cranial-caudal direction (P = .003), and was significantly different from group N in a medial-lateral direction (P = .005). No significant difference was observed between pin location for groups B and N in either plane. It was concluded that although nondirected retrograde pinning cannot be recommended, retrograde pins directed craniomedially may be an acceptable technique for the repair of proximal to mid-diaphyseal tibial fractures if care is taken to properly seat the pins.

Animals↗

PubMed1995

Nonspiking local interneurons in insect leg motor control. I. Common layout and species-specific response properties of femur-tibia joint control pathways in stick insect and locust.

1. Locusts (Locusta migratoria) and stick insects (Carausius morosus) exhibit different strategies for predator avoidance. Locusts rely primarily on walking and jumping to evade predators, whereas stick insects become cataleptic, catalepsy forming a major component of the twig mimesis exhibited by this species. The neuronal networks that control postural leg movements in locusts and stick insects are tuned differently to their specific behavioral tasks. An important prerequisite for the production of catalepsy in the stick insect is the marked velocity dependency of the control network, which appears to be generated at the level of nonspiking local interneurons. We examined interneuronal pathways in the network controlling the femur-tibia joint of the locust middle leg and compared its properties with those described for the stick insect middle leg. It was our aim to identify possible neural correlates of the species-specific behavior with regard to postural leg motor control. 2. We obtained evidence that the neuronal networks that control the femur-tibia joints in the two species consist of morphologically and physiologically similar--and thus probably homologous--interneurons. Qualitatively, these interneurons receive the same input from the femoral chordotonal organ receptors and they drive the same pools of leg motoneurons in both species. 3. Pathways that contribute to the control of the femur-tibia joint include interneurons that support both "resisting" and "assisting" responses with respect to the motoneuron activity that is actually elicited during reflex movements. Signal processing via parallel, antagonistic pathways therefore appears to be a common principle in insect leg motor control. 4. Differences between the two insect species were found with regard to the processing of velocity information provided by the femoral chordotonal organ. Interneuronal pathways are sensitive to stimulus velocity in both species. However, in the locust there is no marked velocity dependency of the interneuronal responses, whereas in the same interneurons of the stick insect it is pronounced. This characteristic was maintained at the level of the motoneurons controlling the femur-tibia joint. Pathways for postural leg motor control in the locust thus lack an important prerequisite for the generation of catalepsy, that is, a marked velocity dependency.

Animals↗

PubMedDate not supplied

Nonunions of stress fractures of the tibia.

Stress fractures of the tibia commonly occur in the proximal metaphysis and heal readily with rest. Fractures of the middle third of the tibia, on the other hand, are uncommon. We encountered six stress fractures of the middle third of the tibia over a 5 year period. None of these fractures healed with simple immobilization. One was treated with electromagnetic stimulation and failed to unite 2 years after presentation. One patient underwent a biopsy of the lesion without bone grafting and it had not healed when he was last seen. One patient sustained two acute complete fractures, and the stress fracture finally healed after the second acute fracture was openly reduced and internally fixed. The other three lesions were excised and grafted because of failure to unite. They all healed promptly. Stress fractures of the middle third of the tibia are unusual lesions. However, care must be taken in treating them. The patient must protect the extremity until the fracture has completely healed. Surgical excision and bone grafting of the lesion may be required if the fracture does not heal with plaster immobilization.

Adolescent↗

PubMed1996

A study of intrinsic factors in patients with stress fractures of the tibia.

We aimed to study intrinsic factors in 29 consecutive patients with well-documented unilateral stress fractures of the tibia. Anthropometry, range of motion, isokinetic plantar flexor muscle performance, and gait pattern were analyzed. The uninjured leg served as the control. A reference group of 30 uninjured subjects was compared regarding gait pattern. Anterior stress fractures of the tibia (N = 10) were localized in the push-off/ landing leg in 9/10 athletes, but were similarly distributed between legs in posteromedial injuries (N = 19). Ten (30%) of the stress fracture subjects had bilateral high foot arches, similar to those found in the reference group. There were no other systematic differences in anthropometry, range of motion, gait pattern, or isokinetic plantar flexor muscle peak torque and endurance between injured and uninjured legs. No other differences were found between anterior and posteromedial stress fractures. We conclude that anterior stress fractures of the tibia occur mainly in the push-off/landing leg in athletes. Within the limitations of our protocol, no registered intrinsic factor was found to be directly associated with the occurrence of a stress fracture of the tibia.

Adolescent↗

PubMed1976

Inconsistency of the tibia test for estimating growth hormone in crude pituitary extracts.

The complement fixation immunoassay (CFIA) was used for quantitating growth hormone (GH) in crude anterior pituitary extracts from rats subjected to thyroidectomy with or without cortisol and exogenous GH administration. The results obtained from this study were compared with pertinent bioassay (tibia test) results or correlated with the pituitary acidophil cell counts. Whereas it has been reported that pituitary GH levels are normal by the tibia test at 2 weeks after thyroidectomy, the highly specific CFIA method showed an actual 87% decrement which correlated well with the reduction in acidophilis. In addition, the apparently normal content of GH after cortisol administration to thyroidectomized rats, as measured by the tibia test, was contradictory to the very low acidophil population and to the marked reduction in pituitary GH content as measured by the CFIA. Furthermore, theoretical tibia responses illustrate the inconsistency of the bioassay in different experimental conditions. If, as previously suggested, the content of thyrotrophin (TSH) in the crude pituitary extracts renders the bioassay of GH a dubious procedure, then the superiority of immunoassay is obvious.

Animals↗

PubMed2004

Use of an intramedullary rod for treatment of congenital pseudarthrosis of the tibia. A long-term follow-up study.

BACKGROUND: The treatment of congenital pseudarthrosis of the tibia remains difficult and controversial. The purpose of this study was to evaluate the long-term results of a technique consisting of excision of the pseudarthrosis, autologous bone-grafting, and insertion of a Williams intramedullary rod into the tibia. METHODS: Twenty-one consecutive patients with congenital pseudarthrosis of the tibia were managed with this technique between 1978 and 1999, and the results were retrospectively reviewed. The mean age of the patients at the time of the latest follow-up was 17.2 years (range, seven to twenty-five years), and the mean duration of postoperative follow-up was 14.2 years (range, three to twenty years). RESULTS: Initial consolidation occurred in eighteen of the twenty-one patients. Refracture occurred in twelve patients; five fractures healed with closed treatment, five healed after an additional surgical procedure, and two ultimately required amputation. Ten patients had an ankle valgus deformity after tibial union. Eleven patients had a residual limb-length discrepancy of >2 cm; six required a contralateral distal femoral and/or proximal tibial epiphyseodesis, two had a tibial lengthening, and one used a shoe-lift. Five patients had an amputation: two, because of a recalcitrant fracture; two, because of a limb-length discrepancy (6 and 9 cm); and one, because of a chronic lower-extremity deformity. CONCLUSIONS: This technique produced a satisfactory long-term functional outcome in sixteen of twenty-one patients and should be considered for the management of congenital pseudarthrosis of the tibia.

Adolescent↗

PubMed2005

Use of an intramedullary rod for the treatment of congenital pseudarthrosis of the tibia. Surgical technique.

Bone Nails↗

PubMed2000

Single-incision technique for internal fixation of distal tibia and fibula fractures.

Open reduction and internal fixation of distal tibia and fibula fractures generally involves two separate incisions: an anteromedial incision to approach the tibia and a lateral incision to approach the fibula. Exposing the distal tibia from the medial side is associated with the risk of wound dehiscence, infection, and discomfort to the patient since the hardware is directly beneath the skin. By using a single incision from the anterolateral side, the fibular fracture can be fixed and the lateral aspect of the distal tibia can be safely approached for internal fixation, thus eliminating the need for two separate incisions.

Female↗

PubMed2006

Surgical treatment of nonarticular distal tibia fractures.

Distal tibia metaphyseal fractures can be difficult to manage. Treatment selection is influenced by the proximity of the fracture to the plafond, fracture displacement, comminution, and injury to the soft-tissue envelope. Nonsurgical management is possible for stable fractures with minimal shortening. Indications for intramedullary nailing have expanded to include distal metaphyseal tibia fractures. Intramedullary nailing allows atraumatic, closed stabilization while preserving the vascularity of the fracture site and integrity of the soft-tissue envelope. Intramedullary canal anatomy at this level prevents intimate contact between the nail and endosteum, however, and concerns have been raised regarding the biomechanical stability of fixation and risk of malunion. Plate fixation is effective in stabilizing distal tibia fractures. Conventional techniques involve extensive dissection and periosteal stripping, which increase the risk of soft-tissue complications. Percutaneous plating techniques use indirect reduction methods and allow stabilization of distal tibia fractures while preserving vascularity of the soft-tissue envelope. External fixation is effective in the setting of contaminated wounds or extensive soft-tissue injury. Careful preoperative planning with consideration for fracture pattern and soft-tissue condition helps guide implant selection and minimize postoperative complications.

Bone Nails↗

PubMed2001

Stress fracture of the proximal tibia after total knee arthroplasty: a case report.

Stress fracture of the proximal tibia after total knee arthroplasty (TKA) is very rare. We found only 16 cases in a review of the literature. We report the case of a 76-year-old obese woman who sustained a stress fracture of the right proximal tibia without trauma 18 months after TKA. Pain developed in the proximal medial aspect of the tibia during walking. Physical examination showed tenderness of the proximal medial aspect of the tibia and varus deformity of 15 degrees during stress test of the knee. Roentgenography 4 weeks after symptom onset showed an obvious stress fracture line. Treatment with bed rest and above-the-knee plaster cast immobilization for 8 weeks was successful. The causes of this rare complication may include increased level of activity after TKA, generalized osteoporosis, and varus deformity of the knee.

Aged↗

PubMed1975

The transarticular graft for infantile pseudarthrosis of the tibia. A new technique.

Fourteen cases of pseudarthrosis of the tibia in childhood presented at a hospital in Burma over a period of eight years. The ages of the patients ranged from one month to seventeen years. Nine were treated by a pointed graft driven into the medullary cavity of the distal tibia, and usually across the ankle joint into the body of the talus, before fixation to the proximal tibia. In six of the nine union was secured, but one case required a second grafting. Transarticular segments of graft showed a marked tendency to undergo absorption. No significant deformity was observed to follow central penetration of the growth plate and epiphysis of the lower tibia.

Adolescent↗

PubMed2002

[Unilateral external fixator combined with simple internal fixation for severe open tibia-fibular fracture].

OBJECTIVE: To improve the treatment for severe open tibia-fibular fracture. METHODS: From 1994 to 2000, 146 patients with severe open tibia-fibular fracture were treated. According to Gustilo classification, all patients were of type III. Among them, 96 patients belonged to III A, 36 III B, and 18 III C. One hundred and eight patients were male and 38 female, aged from 11 to 68 years, with an average of 31. All patients were treated with unilateral external fixator combined with simple internal fixation (general screw or Kirschner wire). Thirty patients were treated with secondary flap operation. Among them, 19 patients received pedicle gastrocnemius muscle flaps, 9 free vastus lateralis muscle flaps, and 2 free latissimus dorsi muscle flaps. RESULTS: Three patients of type IIIB were subjected to amputation because of advanced age and associated cerebral or thoraco-abdominal injury. Five patients of type III C had amputation because of insufficient postoperative blood supply and necrosis. The rupture of other 138 patients was well reduced, and firmly fixed. They were followed up for 6 months-6 years, with an average of 2.5 years. The average time of fracture-union was 27 weeks, and the average time for removal of fixtors was 28 weeks. The motion of knee joint ranged from 0 to 120 degree in 110 patients; from 0 to 100 degrees in 25, and from 0 to 90 degrees. The motion of ankle joint was approximately normal. CONCLUSIONS: For patients with severe open tibia-fibular fracture, comprehensive analysis should be made for preservation of the wounded limb or amputation as for elderly patients with vessel-nerve injury or with cerebral- thoracoabdominal injury, emergency amputation should be done. Unilateral external fixator combined with simple internal fixation (general screw or Kirschner wire) for severe open tibia-fibular fracture is advantageous for a simple and reliable fixation. It is less traumatic.

Adolescent↗

PubMed2003

Management of open tibia fracture--Anderson and Hutchins technique re-visited.

Prior to September 1995, most open tibia fractures seen at the University College Hospital, Ibadan had hitherto been managed by the application of plaster-of-Paris after limited wound debridement. The outcome of this form of treatment was found, from the outpatient clinic follow-up records, to be associated with a high rate of complications including chronic osteomyelitis and joint stiffness. In most hospitals in the developed and developing countries, majority of these injuries are best managed by the use of various types of external fixators. However, these external fixator devices are by no means cheap and often times most patients in our environment are unable to afford them since the country operates a health care system where the patients are solely responsible for their health care needs. In this study, the Anderson and Hutchins technique (Steinmann's pins threaded through bone and incorporated in plaster-of-Paris) was used in the management of thirty-four open tibia fractures between September 1995 and August 1999. Seventy-nine percent of these were severe or Type III open fractures. The time to radiological union was 21 weeks and pin tract infection occurred in 15 percent of the patients, mainly in the proximal (tibia) pins. The use of a single stout proximal (tibia) transfixing Steinmann's pin was found to offer a stable fixation.

Adolescent↗

PubMed2004

[Fractures of the intercondylar eminence of the tibia].

PURPOSE OF THE STUDY: We analyzed a group of patients surgically treated for fractures of the intercondylar eminence of the tibia in the Department of Orthopedics in Pilsen between 1992 and 2002, and evaluated the results of this treatment on the basis of objective examination and comparison with the relevant literature data. We describe indications for surgical treatment and the surgical methods used, including different fixation materials. MATERIAL: In the period from 1992 to 2002, 27 patients underwent surgery for a fracture of the intercondylar eminence of the tibia in our Department. The group included 19 men and 8 women aged between 8 and 49 years; the average age was 16.2 years. METHODS: Surgery was indicated in type II and type III fractures of the intercondylar eminence of the tibia, as classified according to the Meyers and McKeveer system. Medial arthrotomy was used in 16 patients, nine of whom had undergone diagnostic arthroscopy. Arthroscopic surgery from the classical, either anterolateral or anteromedial, approach was performed in 11 patients. After arthroscope insertion, the knee joint was irrigated and inspected. The meniscus or transversal ligament, if interpositioned, were released and, subsequently, a dislocated fragment was reduced and fixed. Fixation was carried out with a Kirschner's wire, cannulated screw, wire loop or absorbable suture. RESULTS: The patients were examined in 2003, after a follow-up ranging from 1 to 10 years. A total of 17 patients turned up. The outcome of treatment was evaluated on the basis of X-ray and clinical findings. Union of the eminence in an appropriate position was found on X-ray films in all patients. Clinical evaluation included the range of motion and knee joint stability. Restricted motion was found in three patients. No positive anterior drawer or Lachman's tests were recorded. DISCUSSION: No failure of osteosynthesis was recorded in our patients although different fixation materials were used. This is in agreement with the results of other authors who did not report any failure of osteosynthesis due to insufficient stability provided by different fixation materials. The outcomes of surgical treatment in comparable patient groups were also similar. CONCLUSIONS: Arthroscopy is considered the most suitable technique for the treatment of fractures of the intercondylar eminence of the tibia, because it is minimally invasive and provides a good view of the operative field. The outcome of surgery is not dependent on the fixation material used. However, metal implants, in contrast to absorbable materials, have to be removed in an additional surgical procedure.

Adolescent↗

PubMed1992

Intramedullary fixation for congenital pseudarthrosis of the tibia.

Eighteen consecutively seen patients who had a congenital pseudarthrosis of the tibia were treated operatively. The mean age when the patients were first seen was four years. Seventeen previous procedures had failed: six patients had had one previous procedure; three, two previous procedures; and one, five previous procedures. At an average follow-up interval of ten years (range, three to nineteen years), healing with re-formation of the medullary canal was seen in thirteen of the eighteen tibiae, including one tibia that had united after a Boyd amputation. Five patients did not have healing of the tibia: four of them had a below-the-knee amputation, and one declined additional treatment. The average residual angulation was 12 degrees in the sagittal plane and 5 degrees in the coronal plane. Union occurred in ten of the thirteen patients who had been managed with intramedullary fixation. Of these thirteen, eight had been managed with intramedullary fixation, bone-grafting, and implantation of an electrical stimulator, and seven of them had union. Five of the thirteen patients had been managed with intramedullary fixation and bone-grafting, and three of them had union. Union occurred in one of two patients who had been managed with vascularized free fibular transfer, one who had been managed with delayed bone-grafting, and one who had been managed with a Boyd amputation. Four of the five patients who did not have union were subsequently managed with a below-the-knee amputation, and one patient refused additional treatment.

Adolescent↗