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PubMed2004

Ilizarov external fixation salvage of failed intramedullary fixation of tibia with nail retention.

Failure of intramedullary fixation of the tibia presents a unique problem, as improving fracture alignment is often difficult after nail placement. The purpose of this study was to demonstrate the effectiveness of the Ilizarov technique in obtaining anatomic union after failed intramedullary fixation of the tibia. We reviewed medical records and plain radiographs of 4 men who, at a tertiary-care facility, presented with failed intramedullary fixation of the tibia. Mean age was 28 years (range, 23-36 years). All 4 patients underwent reduction and external fixation by the llizarov technique with retention of the intramedullary nail. Anatomic union was attained in each case. Thin-wire circular-frame external fixation by the Ilizarov technique was a viable salvage option for failed intramedullary fixation of the tibia.

Adult↗

PubMed1992

The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov.

Circular external fixation using the Ilizarov apparatus combined with internal bone transport or compression-distraction techniques were used to treat 28 patients with infected nonunions or segmental bone loss of the tibia. There were 22 males and six females with an average age of 34 years (range, 17-58 years). Six of 28 patients had infected tibial nonunions associated with hemicircumferential bone loss. These tibiae were treated by anterior hemicircumferential corticotomy and partial bone fragment internal transport. Fifteen of the remaining 22 patients had an average of 4 cm of segmental bone loss (range, 2-7 cm). Seven patients without shortening or defect had infected nonunions associated with extensive diaphyseal sequestrae. These nonunions were treated by en bloc resection of the diaphyseal shaft and internal bone transport. All patients healed their infected extremities without the addition of cancellous bone graft, microvascular fibular, or soft-tissue grafting. Preoperative shortening was present in 13 of 28 patients. Regenerate new bone formation averaged 6 cm (range, 1.5-22 cm). Postoperative antibiotics were not administered in 21 of 28 patients. In seven patients, antibiotics were given for ten days after en bloc resection of the diaphyseal sequestrae. Equal limb length was maintained in 21 extremities, within 1 cm in five tibiae and less than 3 cm in two tibiae. Functional results were good to excellent in 21, fair in six, and poor in one. The application of Ilizarov techniques to diaphyseal infected nonunions and segmental defects is very encouraging. It may prove to be an excellent technique for future management of resistant diaphyseal infections of bone.

Adolescent↗

PubMed1986

The treatment of noninfected pseudarthrosis of the femur and tibia with locked intramedullary nailing.

Sixty-six cases of noninfected nonunions (27 femoral and 39 tibial) were treated with an interlocking nail. In these cases, 92.6% of the femurs and 94.8% of the tibias healed after the first operation in a mean time of 15.4 and 13.0 weeks, respectively. Deep infection complicated five nailings (7.5%, two femur and three tibia), which included three patients with reactivation of latent osteomyelitis. All cases healed after debridement and use of gentamicin PMMA beads. In one case the nail had to be removed and replaced by an external fixator. Residual angulation between 5 degrees and 10 degrees occurred in three femurs and seven tibias. Shortening occurred in all patients and averaged 0.9 cm in the femur and 0.5 cm in the tibia. Of the patients treated for femoral nonunion, 92.5% achieved full hip flexion and 77.8% full knee flexion on final follow-up examination. In patients with tibial nonunions treated with a locked nail, 92.3% had normal knee flexion and 84.6% obtained normal ankle function. Interlocking nailing offers unique advantages to patients with femoral or tibial shaft pseudarthrosis. The technique allows early weight-bearing, range of motion of adjacent joints, and reliable rates of consolidation of the nonunions.

Adolescent↗

PubMed1981

The treatment of unstable fractures of the tibia and fibula with flexible medullary wires. A review of two hundred and thirty-five fractures.

A retrospective study was done of the treatment of closed and open unstable fractures of the tibia and fibula with flexible intramedullary wires in 223 patients with 235 fractures. The surgical procedure is relatively atraumatic to the tibia, can be learned easily by the surgeon, and does not require complicated or expensive instrumentation. The flexible intramedullary wires permit stabilization of the fractures in a functional position. External support by a long cast in the initial phase of treatment is necessary, but full weight-bearing is usually allowed during the third to fourth week. This has proved to be a beneficial method of treatment for bilateral fracture of the tibia and fibula and for combined femoral and ipsilateral tibiofibular fractures. Of the 235 fractures, fifty-seven (24.3 per cent) were closed and 178 (75.7 per cent) were open. Primary healing of soft tissue and bone occurred in fifty-three (92.9 per cent) of the closed fractures and in 117 (65.7 per cent) of the open fractures. The complication rate in closed fractures was 7.1 per cent, primarily due to delayed bone union. There was a 34.3 per cent complication rate in the open fractures, of which thirty-one (17.4 per cent) showed delayed soft-tissue healing, ten (5.6 per cent) had delayed bone union, and eight (4.4 per cent) resulted in deep infection with osteomyelitis. There were eight non-unions in the open, uninfected fractures, five of which healed after bone-grafting. Flexible intramedullary wiring of the tibia should be considered as an alternate method of treatment in the presence of an unstable fracture.

Adolescent↗

PubMed1995

[Interlocking nailing of the tibia].

Centromedullary nailing is a well-established method of treatment for diaphyseal long bone fractures. The indications have been broadened greatly since the introduction in 1974 of interlocking centromedullary nailing. The purpose of this paper is to review our first results with locked intramedullary nailing of the tibia. We report our experience with the first 19 cases of interlocking tibia nails (15 fractures, 1 delayed union, 2 pseudarthrosis, 1 osteotomy). On the extension table, the insertion of the nail and the placement of the interlocking screws did not cause any problem. In 3 cases, a proximal screw had to be removed within two weeks because of spontaneous displacement. Complications have been noticed in three patients (15.8%) (pulmonary embolism on day 1, and compartment syndrome two days later in one case, sciatic nerve neuroapraxia in the other two). The other patients have been mobilized 24 to 48 hours after surgery. 94% of the fractures were consolidated 4 months post-operatively, with no major deformation. Interlocking tibia nailing seems to be an attractive method in the treatment of certain fractures of the tibia. Early mobilisation and weight-bearing are provided. The indications, the technical aspects as well as the dangers of the method must be carefully respected in order to avoid complications and poor results.

Bone Nails↗

PubMed1994

[Intramedullary pressure in intramedullary nailing of the femur and tibia].

Intramedullary nailing of shaft fractures of the femur and tibia is a recognized operative procedure and its use has even been enlarged by the introduction of the so-called interlocking technique. In recent years case reports have been published describing peroperative pulmonary embolism during reamed femoral nailing, suggesting either an unfavorable effect of the reaming or the pressure increase in the medullary cavity while reaming and nailing. In an in vitro study on explanted human femora and tibiae we investigated the intramedullary pressure increase in reamed and unreamed nailing procedures of both bones. A lower pressure increase was noted in unreamed nailing compared to reamed nailing in the femur (289/496 mm Hg) and in the tibia (128/>833 mm Hg). The unreamed tibial nailing displayed significantly less pressure increase than the unreamed femoral nailing (p = 0.01). Opening of the medullary cavity with the so-called cheese cutter (cannulated cutter over a centering pin) showed significantly greater pressure increase in the femur than in the tibia (p = 0.01). Pressure increase seems to be dependent of the mode of insertion of the unreamed nail (ram-blows versus manual insertion), although the difference in the tibial unreamed nailing is statistically not significant.

Biomechanical Phenomena↗

PubMed1997

Histologic evidence: growth hormone completely prevents reduction in cortical bone gain and partially prevents cancellous osteopenia in the tibia of hypophysectomized rats.

BACKGROUND: In previous studies we found that the cause of bone loss in young hypophysectomized (HX) animals was due primarily to an inhibition in growth-dependent bone gain and a decrease in bone turnover. The aim of this study was to determine whether growth hormone, which has stimulatory effects on bone growth and turnover, can prevent HX-induced skeletal alterations in rats. METHODS: Female Sprague-Dawley rats were divided into baseline control (BASAL), age-matched control (CON), HX, HX plus low-dose GH (1.5 mg/kg/d, subcutaneously), and HX plus high-dose GH (4.5 mg/kg/d) groups. The BASAL group was sacrificed at 2 months of age and the remaining groups were sacrificed after 6 weeks of treatment. Cancellous and cortical bone histomorphometry was performed on double-fluorescent-labeled 40 microm-thick sections of the proximal tibia and tibial shaft. RESULTS: Both low- and high-dose GH prevented the HX-induced decrease of IGF-I serum levels. High-dose GH also significantly increased the body weight and the wet weight of the gastrocnemius muscle when compared to the CON groups. In the tibial shaft, the periosteal labeled surface, mineral apposition rate and bone formation rate were higher in both of the GH-treated groups than in the HX group (P < 0.05). The tissue area and cortical bone area of the high-dose GH-treated rats were greater than those of the HX rats, but did not differ from those of the CON rats. In the proximal tibia, both low- and high-dose GH prevented an HX-induced decrease in the longitudinal growth rate and growth plate width, and increased surface-based bone formation compared to the HX and CON. Cancellous bone volume, tissue-based bone formation rate, and eroded surface in both of the GH-treated groups were higher than those of the HX group, but lower than those of the BASAL and CON groups (P < 0.05). Bone architecture of the HX rats was also improved after GH treatment. CONCLUSIONS: This study clearly demonstrates that GH replacement at the dosage of 4.5 mg/kg/d can completely prevent the HX-induced reduction in cortical bone gain in the tibial shaft, but can only partially prevent cancellous osteopenia in the proximal tibia after six weeks.

Animals↗

PubMed1997

Early bone formation around calcium-ion-implanted titanium inserted into rat tibia.

Rat tibia tissue into which calcium ion (Ca2+)-implanted titanium was surgically placed was histologically analyzed to investigate the performance of the Ca(2+)-implanted titanium as a biomaterial. Calcium ions were implanted into only one side of titanium plates at 10(17) ions/cm2 and the Ca(2+)-treated titanium was surgically implanted into rat tibia for 2, 8, and 18 days. Tetracycline and calcein were used as hard-tissue labels. After excision of the tibia, the tissues were fixed, stained, embedded in polymethyl methacrylate, and sliced. The specimens were observed using a fluorescence microscope. A larger amount of new bone was formed on the Ca(2+)-treated side than on the untreated side, even at 2 days after surgery. In addition, part of the bone made contact with the Ca2(+)-treated surface. On the other hand, bone formation on the untreated side was delayed and the bone did not make contact with the surface. Mature bone with bone marrow formed in 8 days. Neither macrophage nor inflammatory cell infiltration was observed. The results indicated that Ca(2+)-implanted titanium is superior to titanium alone for bone conduction.

Animals↗

PubMed1998

X-ray diffraction and polarizing optical microscopy investigation of the structural organization of rabbit tibia.

X-ray diffraction and polarized optical microscopy investigations were carried out on thin sections of rabbit tibia in order to study the morphological organization of the structural components of this tissue, which often is utilized to test bone response to implants. In the optical microscope, the lateral face as well as the lateral portion of the caudal face exhibit a lamellar structure with an alternation of dark and bright lamellae running parallel to the long axis of the tibia. In contrast, both in the medial face and in the medial portion of the caudal face there are numerous osteonic structures. In spite of the complexity of this morphological organization, the results of small- and high-angle X-ray diffraction analyses indicate that the structural relationship between collagen fibrils and inorganic crystals is quite similar to that observed in single osteons and allows evaluation of the orientation of the two main structural components. Both collagen fibrils and apatitic crystallites are preferentially oriented parallel to the long axis of the tibia. The degree of orientation is greater in the thickness than in the plane of the lamellae, suggesting that collagen fibrils and inorganic crystallites lie preferentially in the plane of the lamellae, where they follow an oblique course. The degree of orientation of the apatitic crystallites is higher in the lateral face than in the medial and caudal faces, in agreement with the optical microscopic images. The results provide information that must be taken into account when evaluating the structural modifications of bone due to the insertion of a prosthetic device.

Animals↗

PubMed2001

Associations of tibia lead, DMSA-chelatable lead, and blood lead with measures of peripheral nervous system function in former organolead manufacturing workers.

BACKGROUND: The goals of the present study were to compare and contrast associations of blood lead, DMSA-chelatable lead, current tibia lead, and back-extrapolated "peak" tibia lead with four peripheral nervous system (PNS) sensory and motor function measures in older males with past exposure to organic and inorganic lead. METHODS: Data were collected from former organolead manufacturing workers with an average of 16 years since last occupational lead exposure. Current tibia lead levels were measured by (109)Cd x-ray fluorescence. Sensory pressure thresholds (index and pinky fingers) and pinch and grip strength were measured with the Pressure-Specified Sensory Device (PSSD). RESULTS: In adjusted analyses, none of the four lead biomarkers was associated with sensory pressure threshold of the index finger or pinch or grip strength. In contrast, all four biomarkers were associated (P < or = 0.10) with pressure threshold of the pinky finger. The final linear regression models accounted for a small proportion of the variance in the sensory (1-3%) and motor measures (10-21%). CONCLUSIONS: This study found no strong association between lead biomarkers and selected PNS sensory or motor function measures among former organolead manufacturing workers with no recent occupational exposure to lead. Previously reported CNS findings in this cohort suggest that the PNS may be less sensitive to the chronic toxic effects of lead in this dose range among adults. It is also possible that the PNS has a greater capacity for repair than does the CNS, or that the PNS measures were less sensitive for detection of lead-related health outcomes than were the CNS measures.

Adult↗

PubMed2001

Long-term measurement of bone strain in vivo: the rat tibia.

Despite the importance of strain in regulating bone metabolism, knowledge of strains induced in bone in vivo during normal activities is limited to short-term studies. Biodegeneration of the bond between gauge and bone is the principle cause of this limitation. To overcome the problem of bond degeneration, a unique calcium phosphate ceramic (CPC) coating has been developed that permits long-term attachment of microminiature strain gauges to bone. Using this technique, we report the first long-term measurements of bone strain in the rat tibia. Gauges, mounted on the tibia, achieved peak or near peak bonding at 7 weeks. Measurements were made between 7-10 weeks. Using ambulation on a treadmill, the pattern and magnitude of strain measured in the tibia remained relatively constant between 7-10 weeks post implantation. That strain levels were similar at 7 and 10 weeks suggests that gauge bonding is stable. These data demonstrate that CPC-coated strain gauges can be used to accurately measure bone strain for extended periods, and provide an in vivo assessment of tibial strain levels during normal ambulation in the rat.

Animals↗

PubMed2005

Agenesis of tibia with bifid femur, congenital heart disease, and cleft lip with cleft palate or tracheoesophageal fistula: possible variants of Gollop-Wolfgang complex.

Two patients with bifurcation of one femur, ipsilateral absence of tibia and one partially formed tibia, or bilateral absent tibiae, club feet with normal or nearly normal digits, congenital heart disease and, in one case, tracheoesophageal fistula; in the second, cleft lip and cleft palate and enlarged head with increased fluid and lissencephaly, are described. These appear to be unique combinations of defects but overlap with the Gollop-Wolfgang complex is present, particularly with the case of possible Gollop-Wolfgang described by Raas-Rothschild et al.

Abnormalities, Multiple↗

PubMed1983

Cross-sectional geometry of Pecos Pueblo femora and tibiae--a biomechanical investigation: II. Sex, age, side differences.

Intra-populational variation in cross-sectional geometric properties of the femur and tibia are investigated in the Pecos Pueblo skeletal sample. Sex differences in geometric parameters suggest that male lower limb bones are more adapted for A-P bending, females for M-L bending. Proposed explanations for this finding include sexual dimorphism in pelvic structure and culturally prescribed sex-related activities at Pecos. With aging, both males and females undergo endosteal resorption and cortical thinning, greater among females. Both sexes also demonstrate an increase with age in subperiosteal area and second moments of area, supporting results reported in some studies of modern population samples. Sex and site-specific remodeling of the femur and tibia with aging also occur. These localized remodeling changes appear to selectively conserve more compact cortical bone in areas of high mechanical stress. Side differences in cross-sectional geometric properties indicate that left lower limb bones are generally larger than right lower limb bones, with asymmetry greater among females. In particular, left femora and tibiae are relatively stronger in A-P bending, again more so in females.

Adult↗

PubMed1985

Effects of age and sex on the amount and distribution of mineral in Eskimo tibiae.

The bone mineral content (BMC), bone width, and cross-sectional moment of inertia (CSMI) of 141 Alaskan Eskimo tibias were measured using photon absorptiometry. The effects of age and sex on the bones' structural properties were studied. It was found that in women, BMC decreased by 50% between the third and sixth decades, but that of the males did not decline significantly with age. This was true of the CSMI as well, for bending in both the anteroposterior (AP) and mediolateral (ML) planes. This result is different than that in some other prehistoric native American populations, where tibia CSMI increases with age in both sexes. The CSMI values were significantly higher in men than in women. Also, in men the AP CSMI was 55% larger than the ML CSMI; in women this difference was only 25%, and declined with age. Since the tibia is preferentially loaded in the AP plane by locomotor activities, the platycnemic differences between the sexes may reflect sex-related differences in activity which become more pronounced with age. The non-destructive method for obtaining data on the cross-sectional geometry of dry bones which is described here may be useful in studying other archaeological collections.

Adult↗

PubMed1985

Relative tibia long bone growth in the Libben and Bt-5 prehistoric skeletal populations.

Patterns of tibia long bone growth were examined for the Libben Late Woodland and Bt-5 Late Archaic hunter-gatherer skeletal groups. Subadults included in the analyses ranged in age from birth to 10 years. The primary goals were to identify potential differences in relative tibia growth and evaluate the extent to which such differences were concordant with demographic and epidemiological characteristics of the two groups. Methods used were designed to minimize the shortcomings of unknown age and sex of the skeleton, small sample sizes, and population differences in adult size attained. Results showed that Bt-5 preadolescent growth performance and health status in general were superior to those of the Libben group. Modifications in the rate and timing of Libben tibia growth occurred early and were primarily restricted to the weaning period. It is suggested that high levels of infectious disease experienced in the first years of life at Libben played a substantial role in the etiology of early long bone growth retardation, a greater prevalence of iron deficiency anemia in the childhood years, and elevated levels of subadult morbidity and mortality compared to Bt-5. Paleodemographic, paleoepidemiological, and modern comparative population data that support these inferences are discussed. No evidence of chronic malnutrition owing to dietary inadequacy was observed for either group. Alternatively, higher population density and greater degree of sedentism alone may have been responsible for elevated disease loads at Libben compared to low levels that were observed for the seasonally mobile semisedentary Bt-5 hunter-gatherers.

Adolescent↗

PubMed1995

Postcranial estimates of body weight in Proconsul, with a note on a distal tibia of P. major from Napak, Uganda.

A distal tibia of Proconsul major from Napak, Uganda, is described. It is morphologically similar to other Proconsul tibiae, only much larger in size. This specimen and others are used to estimate the body weight of P. major from postcrania for the first time. Body weight is predicted from articular and diaphyseal dimensions using regression equations derived from a modern comparative sample of catarrhine primates. The estimated body weight of P. major based on the Napak tibia is 86.7 kg, whereas two other P. major specimens are smaller, giving a total range of 63.4-86.7 kg and an average of 75.1 kg. The regression equations are also used to predict the body weight of specimens from Rusinga/Mfangano belonging to P. nyanzae and P. heseloni. As the body weight estimates generated here are consistent with previous postcranial-based estimates for Proconsul species, the two sets of estimates are pooled to give means of 10.9 kg for P. heseloni (n = 6) and 35.6 kg for P. nyanzae (n = 12). These findings support the traditional assignment of two species at Rusinga/Mfangano. The postcranial body weight estimates for the three species of Proconsul are compared to body weights estimated from M1 area in order to investigate possible differences in scaling between the teeth and limbs in these species. Despite being based on a smaller sample size, the postcranial estimates clearly differentiate the three taxa, whereas the dental estimates form a more continuous distribution. Molar area overestimates body weight in P. heseloni, indicating that it is megadont compared to a large sample of modern anthropoid primates. In contrast, molar area underestimates body weight in P. Nyanzae and especially P. major, suggesting relative microdonty in these taxa.

Animals↗

PubMed1995

Subperiosteal implantation of octacalcium phosphate (OCP) stimulates both chondrogenesis and osteogenesis in the tibia, but only osteogenesis in the parietal bone of a rat.

BACKGROUND: It is not known whether long bones and calvaria have distinct biological characteristics. Octacalcium phosphate (OCP), which is a precursor phase of the hydroxyapatite, has been reported to stimulate bone formation if implanted in the subperiosteal region of mouse calvaria. The present study was designed to investigate how the long bone and the calvarium respond to OCP implantation and to compare their biological characteristics. METHODS: The synthetic OCP was implanted into the subperiosteal region of rat tibiae and parietal bones being mixed with bovine type I collagen treated by pepsin (Atelocollagen). The biological response was examined histologically and immunohistochemically for collagen matrix phenotypes of types I and II to identify bone and cartilage formation. RESULTS: Both chondrogenesis and osteogenesis were initiated in the tibia 1 week after implantation of OCP and most of the cartilage was replaced by bone at week 2. However, the parietal bone did not show osteogenesis responding to OCP implantation until week 3, and no cartilage formation was associated with the osteogenesis. CONCLUSIONS: The present study demonstrated the distinct characteristics of biological response to OCP implantation between the long bone and the calvarium in terms of whether or not cartilage formation is involved in the stimulated osteogenesis by OCP, and in terms of timing of the stimulated chondrogenesis and/or osteogenesis, i.e., the parietal bone takes more time to respond to OCP implantation than the tibia.

Animals↗

PubMed1994

Effects of tiludronate on bone mass, structure, and turnover at the epiphyseal, primary, and secondary spongiosa in the proximal tibia of growing rats after sciatic neurectomy.

To evaluate the effects of tiludronate on the mass, structure, and turnover of cancellous bone regions in immobilized rat tibiae, we performed a 4 week dosing experiment. The right hindlimbs of 84 Sprague-Dawley rats (5 weeks old) wee neurectomized or sham operated. Animals were assigned to seven groups (n = 12 each); group 1 was sham operated, and groups 2-7 were neurectomized. Groups 1 and 2 were given vehicle only (distilled water), and groups 3, 4, and 5 were given tiludronate orally at doses of 25, 50, and 100 mg/kg body weight (BW)/day, respectively, throughout the experimental period. Group 6 was given 100 mg/kg BW/day of the agent for the first 2 weeks only, and group 7 received vehicle only for the first 2 weeks and then 100 mg/kg BW/day of the agent for the last 2 weeks. After tetracycline labeling was performed, the right tibiae were removed from the animals and processed to yield undecalcified sections. Histomorphometry was performed in the epiphyseal, primary, and secondary spongiosa of the proximal tibia. In group 2, trabecular bone volume (BV/TV) and trabecular number (Tb.N) were significantly decreased in the primary and secondary spongiosae, but this did not occur in the epiphyseal spongiosa. Osteoid surface (OS/BS) was decreased and osteoclast surface (Oc.S/BS) was increased in the secondary spongiosa. Tiludronate increased BV/TV and Tb.N in the primary spongiosa by reducing the values for the parameters of osteoclast surface (Oc.S/BS) and osteoclast number (Oc.N/BS). Osteoid surface in this region was not decreased by the agent. In groups 4 and 5, tiludronate prevented bone loss in the secondary spongiosa by reducing both OS/BS and Oc.S/BS. In group 6, BV/TV in the primary spongiosa was maintained at the level of group 1, but Oc.S/BS and Oc.N/BS were elevated. In the secondary spongiosa, bone mass was preserved and the reduction in these parameters was maintained. In group 7, however, BV/TV was increased in the primary spongiosa as a result of a reduction in osteoclastic resorption; in the secondary spongiosa, however, BV/TV was decreased and trabecular turnover was not reduced at the end of the experiment in these growing animals. Mineral apposition rates were not reduced by tiludronate. This study clearly demonstrated that this agent prevented immobilization bone loss by inhibiting resorption.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗