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At least 541 records · Page 30Linked to original sources

PubMed1999

[Mechanical evaluation of a ligament fixation system for ACL reconstruction at the tibia in a canine cadaver model].

OBJECT: Excellent fixation of an artificial ligament in bone is mandatory for initial stability. ACL reconstruction with the LARS artificial ligament may fail if anchorage to bone is inadequate. The weak metaphyseal bone of the proximal tibia is prone to inadequate fixation. This study evaluates the initial mechanical stability of two techniques with an interference screw on the tibial side of an ACL reconstruction with the LARS ligament. METHODS: Six left tibias were obtained from 1 to 3 year old mongrel dog weighing 20 to 26 kg. ACL straight line reconstruction according to the technique described by J.P. Laboureau was performed with a 4.5 mm drill. Two tunnels were created in the tibia, one oblique and one transverse, the latter 2 cm below the former. Reconstruction was done with a 30-fiber LARS ligament and a 5.2 mm x 15 mm conical titanium cannulated interference screw. Group I had an interference screw in the oblique tunnel and group II had an interference screw in the transverse tunnel. Pull-out tests were performed parallel to the oblique tunnel on an Instron 8521 machine at a speed of 5 mm per minute until failure. The oblique tunnel was tested first then the transverse tunnel. RESULTS: Group I (n = 6): sliding value = 238 +/- 115 N. Group II (n = 6): sliding value = 998 +/- 148 N. This is statistically significant (p < 0.001, student t-test). CONCLUSION: One interference screw in a transverse tibial tunnel for ACL reconstruction with the LARS ligament is 4 times more resistant on loading and impact than an oblique screw.

Animals↗

PubMed2000

[Tibia reconstruction using cross-leg pedicled fibular flaps: report of two cases].

The paper presents the results of treatment of two children with cross-leg pedicle fibular flaps. A boy (10 years old) was operated because of an extensive defect of the proximal tibial shaft (15 cm) and soft tissue deficit due to osteosarcoma. He had been previously operated several times: tumor resection with chemiotherapy, bone reconstruction using allografts and two other procedures because of inflammatory complications. The second case was a 9-year old girl who underwent an extensive excision of congenital pseudoarthrosis of the tibia due to neurofibroma and reconstruction of the further fragment of the tibia. Vascularized fibula was nailed deep into the tibial shaft, beyond the previously implanted metal elements. This allowed to maintain a correct axis of the limb, a firm stabilization of the transplant and probably evoked a quick periosteal reaction of the tibia. Plaster of Paris was used to immobilize the limb. Postoperative course showed no complications. The flap pedicle was cut off after 3-4 weeks. Progressive bone healing followed by bony hypertrophy was observed after 8 weeks. The children were able to fully load the operated extremities and ambulate without crutches (the boys 12 months post-surgery and the girl 6 months post-surgery).

Child↗

PubMed2002

[Comparison of long bone repair in tibia by vascularized fibular grafting of different sides].

OBJECTIVE: To evaluate the clinical effect of repair of massive bone defect in tibia by vascularized fibula grafting of either sides. METHODS: Twenty-four cases of massive bone defect in tibia, among which 14 case were repaired by vascularized fibula grafting of the other side and another 10 cases were repaired by those of the same side, from 1987 to 1997 were followed up for 3 to 13 years; the functions of the operated limbs were evaluated according to Enneking Score System, and the outcome of the fibula grafts were assessed by radiographic examination with reference to the standard established by International Symposium on Limb Salvage. RESULTS: The average recover rate of the operated limbs in those repaired by the other side grafting was 80.7%, and the average healing period of the fibula graft was 14 weeks with fracture of the graft in one case which made the operated lower limb shorten for about 2.5 cm; the fibula grafts were observed thickened in 43 weeks, on average, and the patients could walk independently without a crutch. While in those repaired by the same side grafting, the average recover rate of the operated limbs was 68.3%, the average healing period of the fibula graft was 17 weeks with fracture of the graft in 3 cases, in 2 of which the lower limbs were shortened for 2 cm and 4 cm respectively, and in the third one infection occurred and amputation was performed finally; the fibula grafts were observed thickened in 49 weeks, on average, which made it available for the patients to walk without a crutch. All of the data showed that there was a significant difference statistically between the differently treated cases. CONCLUSION: It's a good choice to repair massive bone defect in tibia by vascularized fibula grafting, and the vascularized fibula graft from the other side could promote the bone healing and accelerate the recover of the function of the operated lower limb.

Adolescent↗

PubMed1975

Effect of triiodothyronine (T3) thyroparathyroidectomy and mercaptoimidazole treatment on enchondral bone growth. II. Growth dynamics in the proximal growth organ of the tibia in young rats.

The 24 hour growth rate of the tibial proximal growth organ was investigated in triiodothyronine or mercaptoimidazole-treated, and in thyroidectomized male rats. Longitudinal growth of the tibia of the same period was also studied. After one week treatment, the 24 hour rate of growth in the triiodothyronine-treated rats was retarded as compared with the controls, whereas at the end of the 3rd and 5th weeks the growth rate of the treated animals exceeded that of the controls. The tibia was somewhat longer in the treated rats than in the untreated controls, though the difference was not significant. The growth rate in the growth organ of mercaptoimidazole-treated and thyroidectomized animals was generally higher than that measured in the controls. The length of the tibia was less than in the controls, but the difference was not significant. The phenomenon is attributed to the altered hormonal conditions.

Animals↗

PubMed2002

Deleterious effect of smoking on healing of open tibia-shaft fractures.

We retrospectively reviewed a prospectively followed cohort of 105 patients with 110 open tibia fractures treated with external fixator or intramedullary nail to determine whether smoking affects fracture healing. Severe open tibia-shaft fractures treated at a tertiary-care medical center were included. Patients with type II, IIIA, or IIIB tibia fractures were eligible. Treatment for all patients was similar, except that they were randomized to receive external fixator or intramedullary nail. Time to fracture healing was the main outcome measurement. Smokers had a union rate of 84% (52/62), and nonsmokers had a union rate of 94% (45/48), P = .10. For smokers in one arm of the study, time to union was significantly longer (P = .01), and there were more complications (P = .04). Smoking decreased unions, slowed healing, and increased complications.

Adolescent↗

PubMed1992

[Electrical stimulation in the treatment of osteoporosis in sciatic denervated rat tibia].

Osteoporosis in the sciatic-denervated rat tibia was reversed with a capacitively coupled electrical field. In the reversal of a previously established osteoporosis, a statistically significant enhancement of wet weight, dry weight, ashed weight, ultimate strength, cortical area, cortical thickness and a concomitant decrease in cortical porosity occurred in the stimulated, denervated tibiae of the experimental animals compared with the nonstimulated, denervated tibiae of the control animals. A 60 Hz symmetrical sinewave signal was effective in reversing osteoporosis at 10 V peak to peak. Reversal of a well-established osteoporosis in laboratory animals has not been reported previously.

Animals↗

PubMed2004

Do we get a "real" alignment of knee in the preoperative planning of high tibia osteotomy: a prospective study of reproducibility.

BACKGROUND: Precise preoperative measurement of knee alignment is needed to calculate the accurate angle of correction at proximal tibia osteotomy for medial gonarthrosis. METHODS: We performed a prospective study to compare the reproducibility of measuring the mechanical and anatomical axes. Thirty-two patients (32 knees) with medial compartment osteoarthritis to be treated with proximal tibia osteotomy were included in this study. Preoperatively, whole lower limb roentgenographs were obtained twice, and 2 independent radiologists measured the mechanical and anatomical axes from each roentgenograph. RESULTS: Measurement of mechanical and anatomical axes had a mean variability of 2.22 and 1.88 degrees, respectively, which was not statistically significant (p = 0.267) in the assessment of reproducibility. With the anatomic axis, however, we found 0.61 degree of variability to the roentgenographic procedures and 1.30 degree to the radiologists (p = 0.007). With the mechanical axis, the corresponding findings were 1.30 degree and 1.02 degree (p = 0.167). Despite the relative small number of patients in this series, errors in measurement of the anatomical axis seem mostly to originate from different radiologists, whereas errors in measurement of the mechanical axis seem to originate from both the radiologists and the procedures. The maximum variability in measuring both axes was 3 degrees, which is highly significant for a reliable calculation of the wedge when performing proximal tibia osteotomy. CONCLUSIONS: We suggest that, for accuracy and economy, measurement of the anatomical axis might be better. Furthermore, by measuring either mechanical or anatomical axis, the errors originating from roentgenographic measurement of knee alignment should be considered in preoperative planning.

Algorithms↗

PubMed2004

[Knee replacement of the treatment of malignant tumor of the proximal tibia and early follow-up].

OBJECTIVE: To discuss the clinical effects of using rotating hinge prosthesis in treating primary malignant tumor of the proximal tibia. METHODS: After the malignant tumor of the proximal tibia was extensively resected or radically resected, rotating hinge prosthesis replacement was performed for reconstruction, while neoadjuvant chemotherapy was used in treating the osteosarcoma. RESULTS: The average follow-up period was 4.2 years. There was no local recurrence and metastasis in 22 patients, though there was recurrence in 8 patients. The MSTS functional scores of all different items 4 years after the operations were above 3, which showed the clinical results were satisfactory. CONCLUSIONS: It is an efficacious method for the treatment of malignant tumor of the proximal tibia by using rotating hinge prosthesis. It has the advantage of early recovery of joint function.

Adolescent↗

PubMedDate not supplied

Proximal tibia bone harvest: review of technique, complications, and use in maxillofacial surgery.

Autologous bone grafts for alveolar ridge augmentation are the gold standard for restoring atrophic residual ridges in preprosthetic surgery. Many indications, donor sites, and techniques have been reported. The purpose of this article is to review the anatomy, surgical technique, and potential complications associated with proximal tibia bone harvest. A consecutive series of 44 patients who underwent proximal tibia bone graft harvest between 2000 and 2003 was studied by retrospective chart review. Five major and 7 minor complications were observed; overall morbidity was low. A significant amount of corticocancellous bone may be harvested from the proximal tibia with minimal morbidity.

Adult↗

PubMed1992

Elevation of the medical plateau of the tibia in the treatment of Blount disease.

Seven children, between ten and thirteen years old, had elevation of the medial plateau of the tibia for correction of severe varus deformity secondary to Blount disease. The deformity was severe (grade V or VI according to the system of Langenskiöld and Riska) in all patients; the average preoperative varus deformity, determined by the angle formed by the femoral shaft and the tibial shaft, was 25 degrees. The goal of the operation was restoration of a more normal configuration of the articular surface of the proximal end of the tibia. This was accomplished by direct elevation of the depressed medial tibial plateau. All patients had an osteotomy to correct the alignment of the tibia. The osteotomy was performed concomitant with the elevation of the plateau in three patients, before the elevation in three, and after the elevation in one patient. Four patients had a concomitant osteotomy of the femur to align the knee joint parallel to the floor. The results were good in five patients and fair in two.

Child↗

PubMed2005

Composite B-cell and T-cell non-Hodgkin lymphoma of the tibia.

We report a unique case of de novo composite lymphoma in the tibia of a 35-year-old man who presented with increasingly frequent and intense pain in the right upper leg. He was otherwise healthy without significant medical history. A plain radiograph of the right leg showed a permeative lesion with alternating areas of radiolucency and radiodensity in the upper third of the tibia. Magnetic resonance imaging showed a large, heterogeneous enhancing lesion involving the medullary and cortical bone of the proximal tibia with cortical disruption and extension into the adjacent soft tissue. A biopsy showed sheets and clusters of large cells, punctuated by clusters of small, irregular lymphocytes. Flow cytometry and immunohistochemical analysis showed composite lymphoma: diffuse large B-cell lymphoma (DLBCL) and peripheral T-cell non-Hodgkin lymphoma with predominantly small cell morphologic features. The DLBCL expressed CD19, CD20, CD79a, CD5, CD10, CD23, CD38, CD117, bcl-2, and bcl-6, with monotypic expression of immunoglobulin kappa light chain. The T cells expressed CD2, CD3, CD5, CD7, and CD8, with partial loss of CD4. Clonal rearrangement of T-cell receptor gamma chain gene was found. Neither the large B cells nor the small T cells expressed Epstein-Barr virus-encoded RNA. Physical examination and radiologic studies showed no evidence of lymphadenopathy, organomegaly, or other mass lesions in the body. No peripheral lymphocytosis or bone marrow involvement was present.

Adult↗

PubMed2005

[Fixation of proximal tibia medial opening wedge osteotomy using plates with wedges].

OBJECTIVES: The indications, surgical technique, and the results of fixation using plates with metal wedges were assessed in proximal tibia medial opening wedge osteotomy. METHODS: Forty knees in 38 consecutive patients (5 men, 33 women; mean age 51 years; range 36 to 65 years) with medial compartment osteoarthritis of the knee were treated with proximal tibia medial opening wedge osteotomy using plates with wedges. Following arthroscopic debridement, medial proximal tibial osteotomy was performed laterally and proximally on an oblique line and 3-4 cm distal to the medial joint space. Disruption of the lateral cortex was avoided. Fixation of the osteotomy was performed using plates with wedges. The plates which were designed by the author were either rectangular in shape with two or four holes or had an inverse "L" shape with four holes, bearing metal wedges at varying heights from 5 to 15 mm. The plates were fixed with screws. Tricortical (n=8) or bicortical (n=25) iliac bone autografts and allografts (n=7) were used. Clinical and functional evaluations were made using the HSS scoring system. The mean follow-up was 17 months (range 9 to 36 months). RESULTS: The mean preoperative and postoperative tibiofemoral angles were 4.3 degrees varus (0 degrees -10 degrees ) and 5.8 degrees valgus (3 degrees -11 degrees ), respectively. The mean HSS score increased from 59 (range 52 to 75) preoperatively to 90 (range 79 to 96) on final evaluations. During surgery, lateral tibial plateau fissures and lateral cortex fractures occurred in three (7.5%) and 11 (27.5%) knees, respectively. Delayed healing and delayed union and breakdown of a distal screw were encountered in one patient (2.5%). CONCLUSION: Fixation of proximal tibia medial opening wedge osteotomy using plates with wedges provides adequate stabilization to maintain the desired correction and to allow early functional rehabilitation in the treatment of medial osteoarthritis of the knee.

Adult↗

PubMed2005

Prophylactic surgical correction of Crawford's type II anterolateral bowing of the tibia using Ilizarov's method.

The treatment of anterolateral bowing with an intact tibia is directed toward prevention of the fracture and subsequent pseudoarthrosis. Patients with anterolateral bowing of the tibia are usually treated with an ankle-foot orthosis until the deformity is improved. There is no documentation that an orthosis can prevent the fracture or correct the deformity, and if the deformity is not corrected, it will result in different mechanical problems. In this study, 6 legs in 6 patients with anterolateral bowing of the tibia with a narrow sclerotic medullary canal (Crawford type II) were treated using Ilizarov's method. The average age was 6.8 years. All patients underwent correction of the anterolateral bowing by excision of the affected part. If the gap was less than 4 cm, acute shortening followed by bone lengthening was done. If the gap was more than 4 cm, bone transport was preferred. The mean duration of follow-up was 3.2 years. The anterolateral bowing was corrected in all patients. Complications such as pin track infection, premature consolidation and delayed union at the docking site were encountered. We believe that Ilizarov's method offers a more efficient solution for this type of deformity than prophylactic orthotic treatment or prophylactic bypass bone graft.

Adolescent↗

PubMed2006

[Preservation of the foot in a five-year-old child with bilateral congenital deficiency of the tibia].

Congenital tibial deficiency is a rare anomaly causing shortening and varus deformity of the lower extremity. Recent limb lengthening and foot repositioning techniques enable functional results with preservation of the foot. We present a five-year-old boy with bilateral congenital tibial deficiency of type 2 according to the Jones classification, who was treated with tibia-fibular fusion without Syme amputation. His ambulation depended on crawling. Radiographic examination showed a normally developed fibula with thickening in the distal portion, and only proximal tibia with absence of the distal part. He also had bilateral stiff equinovarus deformity. In a series of operations, he underwent bilateral tibia-fibular fusion and fibular osteotomy, subtalar arthrodesis and metatarsal osteotomy in the right foot, and subtalar arthrodesis in the left foot. At the end of a six-year treatment and follow-up, walking was achieved despite some degree of limping.

Child↗

PubMed1991

The effect of simulated fracture-angulations of the tibia on cartilage pressures in the knee joint.

The effects of angular deformities of the tibia on the contact areas and pressures on cartilage in the knee were measured with use of pressure-sensitive film. Six cadaver knees were mounted in a test-frame, such that the offset and tilt of the knee relative to the load-axis simulated that due to angular deformities of the tibia of 5, 10, 15, or 20 degrees of varus or valgus at the levels of the proximal, middle, and distal thirds. Angulation had little effect on the contact area. The change in pressure was least for fractures of the distal third and greatest for fractures of the proximal third. For example, a 20-degree angulation of the distal third increased the maximum contact pressure by an average of 26 per cent in the compartment toward the load-axis and reduced it by 32 per cent in the opposite compartment. With an angulation of 20 degrees at the level of the proximal third of the tibia, the increase in pressure averaged 106 per cent and the decrease averaged 89 per cent. The changes in pressure with fractures at the middle third were between these extremes.

Biomechanical Phenomena↗

PubMed1990

Vascularized fibular grafts in the treatment of congenital pseudarthrosis of the tibia.

Free vascularized fibular bone grafts were used in nineteen children, seen consecutively, who had congenital pseudarthrosis of the tibia. The average age was 5.1 years (range, 1.4 to 11.4 years). Sixteen of the patients had been treated with electrical stimulation for at least one year, and the tibia had not united. All but four patients had had at least one previous operative procedure. At an average follow-up of 6.3 years (range, 2.0 to 11.0 years), eighteen (95 per cent) of the nineteen pseudarthroses had healed. The leg-length discrepancy averaged 1.6 centimeters (range, 0 to 4.0 centimeters), but ten tibiae had residual or progressive valgus or anteroposterior malalignment despite bracing. There was minimum morbidity at the donor site.

Bone Transplantation↗

PubMed1989

Congenital pseudarthrosis of the tibia. An overview.

Congenital pseudarthrosis of the tibia was perhaps described almost 300 years ago, yet it remains one of the most difficult conditions to treat in orthopedic surgery. Recent advances in surgical techniques have given much more encouraging results. Coleman has played a significant role in this progress with his concept of complete correction of the tibial and fibular deformities and fixation with strong and long intramedullary rods. To this technique have been added autologous cancellous bone grafting and electrical stimulation. These advances have increased the rate of successful union of the pseudarthrosis of the tibia. More recently, transfer of a vascularized fibular graft with correction at the same time of the leg-length discrepancy has offered even greater hope for achieving successful bony union of the tibia. This treatment involves surgery on the normal leg. Long-term results of this method of management are eagerly awaited.

Humans↗

PubMed1989

[Biometry of the tibia].

This study investigates the relations between 67 tibia parameters. For this investigation, 30 human tibia of unknown sex and age were examined from the bone collection of the Department of Anatomy of the University of Alcalá de Henares (Madrid). Many tibia parameter relationship were established, which were correlated through statistical analysis. 3 groups of parameters correlations were established: antero-posterior diameters of the diaphysis; perimeters of the diaphysis and width of the proximal extremity of the bone. The authors present the statistical values of all the measurements, which are of great anthropological interest.

Biometry↗