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PubMed2000

Insufficiency fractures of the distal tibiae.

We describe two patients with uncommon types of insufficiency fractures that occurred at the distal tibiae. In case 1, a 71-year-old man with secondary osteoporosis due to hypogonadism fracture of his left distal tibia was overlooked because initial radiographs had seemed normal. However, bone scintigram obtained 2 months prior to the onset of fracture had already demonstrated abnormally high uptake at the site. In case 2, a 62-year-old woman with postmenopausal osteoporosis sustained an insufficiency fracture of the left distal tibia. Good clinical results were obtained with nonsurgical treatment. Based on the clinical course of case 1, we believe that bone scintigrams may be useful not only for the early diagnosis of insufficiency fracture but also for predicting such fractures.

Aged↗

PubMed1980

A retrospective review of the healing of fractures of the shaft of the tibia with special reference to the mechanism of injury.

A retrospective review of 500 fractures of the tibia was undertaken. In 316 adults we assessed the influence of various forms of violence on the rate of healing and the incidence of complications in fractures of the shaft of the tibia. Other factors pertinent to fracture healing in the shaft of the tibia were also investigated and their relative importance was assessed.

Accidents, Traffic↗

PubMed1985

External fixation of ipsilateral fractures of the femur and tibia.

In five patients with ipsilateral femoral and tibial shaft fractures the Hoffmann apparatus was used to stabilize the fractures of both the femur and tibia. The patients walked early and there were no disturbances of fracture healing. The pin track became infected in three patients. It is suggested that in patients with ipsilateral fractures of the femur and tibia external fixation is indicated for the tibia and that the fracture of the femur should be stabilized by closed medullary nailing. If the patient is critically ill or if there is gross comminution of the femur external fixation is indicated for this fracture as well.

Adolescent↗

PubMed2004

Fractures of the distal tibia: minimally invasive plate osteosynthesis.

Unstable fractures of the distal tibia that are not suitable for intramedullary nailing are commonly treated by open reduction and internal fixation and/or external fixation, or treated non-operatively. Treatment of these injuries using minimally invasive plate osteosynthesis (MIPO) techniques may minimise soft tissue injury and damage to the vascular integrity of the fracture fragments. We report the results of 20 patients treated by MIPO for closed fractures of the distal tibia. Their mean age was 38.3 years (range: 17-71 years). Fractures were classified according to the AO system, and intra-articular extensions according to Rüedi and Allgöwer. The mean time to full weight-bearing was 12 weeks (range: 8-20 weeks) and to union was 23 weeks (range: 18-29 weeks), without need for further surgery. There was one malunion, no deep infections and no failures of fixation. MIPO is an effective treatment for closed, unstable fractures of the distal tibia, avoiding the complications associated with more traditional methods of internal fixation and/or external fixation.

Adolescent↗

PubMed2005

Treatment of infected defect pseudoarthrosis of the tibia by in situ fibular transfer in children.

The aim of this study was to determine the effectiveness of in situ fibular transfer in the treatment of infected defect pseudoarthrosis in childhood. Four cases with infected defect pseudoarthrosis of the tibia were treated with debridement, sequestrectomy and two-staged ipsilateral fibular transfer. The mean age of the patients was 7.5 (2-11) years. Mean follow-up period was 9.5 (6-13) years. In all cases infection was resolved and tibia-fibular synostosis was achieved. The diameter of the transferred fibula increased significantly with regard to the unaffected fibula. None of the patients had limitation of joint motion or shortening more than 1cm. This technique is a good method for treatment of infected defect pseudoarthrosis of the tibia.

Child↗

PubMed2006

Minimally invasive locking plate osteosynthesis for fractures of the distal tibia--results in 20 patients.

AIMS: We report our experiences with minimally invasive locking plate osteosynthesis (MILPO), for distal tibia fractures, with specific reference to fracture union and complications encountered. PATIENTS AND METHODS: Twenty patients underwent MILPO for open and closed distal tibia fractures between March 2003 and December 2004. Fractures were classified according to the AO system. Open fractures were graded using the Gustilo and Anderson classification and closed fractures via the Tscherne classification system. RESULTS: There were 16 males and 4 females of mean age 44.7 years (range 19-69 years). Thirteen patients had temporary external fixation, prior to definitive fracture fixation. Minimum follow-up was 12 months and average time to full weight bearing in the closed fracture group (12 patients) was 18.1 weeks (range 8-32 weeks) and 19.3 weeks in the open fracture group (8 patients, range 8-44 weeks). Fracture healing was defined as radiological evidence of bridging mature callus combined with pain-free full weight bearing. In the open fracture group, four fractures united within 6 months, one within 6-12 months and one united 12 months after surgery; there were two cases of non-union. In the closed fracture group, seven fractures united within 6 months, three fractures between 6 and 12 months and two after 12 months from surgery. Two of the 20 patients required additional procedures to aid bone healing in the post-operative period. Three of the 20 patients required metalwork removal, for delayed wound breakdown in two cases and wound infection in one case. An uneventful recovery was made following this, in all three cases. There was one case of implant failure due to plate breakage at 32 weeks post-op. The fracture site was opened and re-plated at 32 weeks with a DCP. There were no complications following this. CONCLUSION: MILPO was used for definitive fixation of high energy, open and closed, peri-articular distal tibia fractures. This approach aims to preserve bone biology and minimise surgical soft tissue trauma. This surgical approach may provide an answer to treating a challenging group of fractures and further research is warranted.

Adult↗

PubMed2006

Glucocorticoid inhibition of vascular abnormalities in a tibia fracture rat model of complex regional pain syndrome type I.

Tibia fracture in rats evokes chronic hindpaw warmth, spontaneous extravasation, edema, allodynia, and periarticular bone loss, a syndrome resembling complex regional pain syndrome type I (CRPS I). Glucocorticoids such as methylprednisolone (MP) are probably effective analgesic and anti-edematous agents in patients suffering from CRPS and this study examined the effects of chronic MP treatment in the rat CRPS I model. Bilateral hindpaw thickness, temperature, and nociceptive thresholds were determined, and the hindlimb bone density was measured using dual-energy X-ray absorptiometry (DXA). Spontaneous cutaneous extravasation and substance P infusion evoked extravasation were determined using an Evans blue vascular permeability assay. After baseline testing, the distal tibia was fractured and the hindlimb casted for 4 weeks. At 2 weeks post-fracture MP infusion was started (1 mg/kg/day for 28 days). The rats were retested at 4, 6, and 8 weeks post-fracture. Hindpaw edema and warmth after fracture were reversed by MP infusion and these effects persisted after discontinuing treatment. Furthermore, there was an increase in spontaneous protein extravasation and an enhanced substance P evoked extravasation and edema response in the hindpaw at 4 weeks that was inhibited by MP infusion. Glucocorticoid treatment had no effect on the allodynia, hindpaw unweighting, or the periarticular bone loss observed after tibia fracture. We postulate that post-junctional facilitation of substance P signaling contributes to the hindpaw warmth, edema, and the enhanced spontaneous protein extravasation observed in this CRPS I model, and that the anti-edematous effects of glucocorticoid treatment are due to inhibition of post-junctional neuropeptide signaling.

Absorptiometry, Photon↗

PubMed1996

Arthroscopic internal fixation of fractures of the intercondylar eminence of the tibia.

We treated a 53-year-old man with a fracture of intercondylar eminence of the tibia. He had a nondisplaced (type I) fracture at the first examination and was treated by long leg cast. However, 4 weeks later, it was found that the fracture was displaced, which suggests that nondisplaced fracture of intercondylar eminence may displace later. We recommend primary arthroscopic fixation for type I fractures of the intercendolar eminence of the tibia, because it is difficult to reduce the fragment arthroscopically once it is displaced. This report describes a new technique of arthroscopic reduction and internal fixation for the fractures intercondylar eminence of the tibia.

Adolescent↗

PubMed1998

Prior anterior cruciate ligament reconstruction complicating intramedullary nailing of a tibia fracture.

As the number of patients with anterior cruciate ligament reconstructions continues to grow, a subpopulation of patients with displaced tibia-fibula fractures will emerge who have had prior anterior cruciate ligament reconstructions. Previous cruciate ligament surgery can complicate the operative treatment of tibia-fibula fractures by intramedullary nailing. Technical complications arise because the tibial tunnel-graft-screw is in the path of insertion of the intramedullary implant. We present a case in which we traced the path of the patellar tendon autograft, adjusted our entry point for the tibial intramedullary canal, and removed the interference screw to facilitate the fracture surgery. This technical note provides an approach to planning intramedullary nailing of the tibia in patients with prior anterior cruciate ligament surgery.

Adult↗

PubMed2004

Histological analysis of bone/heteroplastic implant interfaces in dog tibia.

This work presents histological analysis of interfaces between bone and heteroplastic implants in dog tibias. The study was performed in four tibias (of four mongrel dogs) into which cylindrical implants were inserted. One ceramic (titania) implant and three grit-blasted titanium implants (with sandblasted and acid-corroded surfaces) were chosen for histological analysis of the implant surface/bone tissue interface. The implants remained in the tibias for eight months and none were loaded during this period. The animals were subsequently sacrificed and the samples were processed for analysis. Light microscope analysis revealed a large amount of osteoid tissue and proximity of osteoblasts and osteocytes to the implant surfaces. In addition, little or no fibrous tissue was observed between the bone and implant surfaces. The titanium implants presented better osseointegration than did the ceramic implant.

Animals↗

PubMed1999

Heritability of tibia fluctuating asymmetry and developmental instability in the winter moth (Operophtera brumata L.) (Lepidoptera, geometridae)

Broad-sense heritability of fluctuating asymmetry and developmental instability in the winter moth were analysed in a full-sib breeding experiment. Effects of both genetic background and common environment on both tibia FA (measured for the three pairs of legs) and body size were studied. As body size has previously been shown to be a reliable indicator of larval feeding success and expected fitness, the relationship between FA and body size was investigated as well. This relationship is of interest because it has been argued that the low heritability of FA results from a strong relationship between FA and fitness. Broad-sense h2 of body size equalled zero whereas the effect of common environment was strong. The heritability of FA was low and not statistically significant for separate tibias. For FA based on the average of the three tibias h2 equalled 0.07 and differed significantly from zero. The heritability of developmental instability equalled 0.09. Thus the use of the hypothetical repeatability to translate the h2 of FA to h2 of developmental instability did not result in a strong increase in this species. Individual asymmetry was not correlated with fitness (as estimated by body size), indicating that the low heritabilities of FA are not a consequence of a strong correlation with fitness. Between-trait correlations in the unsigned FA were significant. However, these correlations are not necessarily indicative of an individual asymmetry parameter as the signed FA values were positively correlated as well, suggesting interdependent development of the three pairs of legs. Further research is necessary to investigate what the effects of interdependent development are on patterns in FA.

Journal Article↗

PubMed1999

Use of a reversed-flow vascularized pedicle fibular graft for treatment of nonunion of the tibia.

Ten patients with nonunion of the lower tibia were treated with a vascularized ipsilateral fibular graft, that was transferred distally and based on retrograde peroneal vessel flow. Eight patients were treated for congenital pseudarthrosis of the tibia; one had a nonunion subsequent to infection, and another patient had bone and skin loss due to infection. A posterior approach was used to expose the tibia and to harvest the fibula. Bone union and full weight-bearing were achieved in all cases by 9 months. The patients were followed-up for a mean of 1.8 years (range: 1.5 to 3 years).

Adult↗

PubMed2001

Tibia fracture after fibula resection for distal peroneal bypass.

The lateral approach to the distal peroneal artery has been used by vascular surgeons for 25 years. No complications specifically related to this approach have previously been reported. We reviewed 18 cases of peroneal bypass for limb salvage using the lateral approach with fibula resection and found that two of these cases had ipsilateral tibia fractures within 1 year of the bypass. Eight out of 18 cases were women, and two of these eight had tibia fracture. Both women suffered from osteoporosis. We conclude that tibia fracture is a possible complication of this approach, especially in elderly women with osteoporosis.

Aged↗

PubMed2005

Effects of an experimental phytase on performance, egg quality, tibia ash content and phosphorus bioavailability in laying hens fed on maize- or barley-based diets.

A 24-week performance trial was conducted to evaluate the efficacy of an experimental phytase on performance, egg quality, tibia ash content and phosphorus excretion in laying hens fed on either a maize- or a barley-based diet. At the end of the trial, an ileal absorption assay was conducted in order to determine the influence of phytase supplementation on the apparent absorption of calcium and total phosphorus (P). Each experimental diet was formulated either as a positive control containing 3.2 g/kg non-phytate phosphorus (NPP), with the addition of dicalcium phosphate (DCP), or as a low P one, without DCP addition. Both low P diets (containing 1.3 or 1.1 g/kg NPP) were supplemented with microbial phytase at 0, 150, 300 and 450 U/kg. The birds were housed in cages, allocating two hens per cage as the experimental unit. Each of 10 dietary treatments was assigned to 16 replicates. Low dietary NPP (below 1.3 g/kg) was not able to support optimum performance of hens during the laying cycle (from 22 to 46 weeks of age), either in maize or barley diets. Rate of lay, daily egg mass output, feed consumption, tibia ash percentage and weight gain were reduced in hens fed low NPP diets. The adverse effects of a low P diet were more severe in hens on a maize diet than in those on a barley diet. Low dietary NPP reduced egg production, weight gain, feed consumption and tibia ash content and microbial phytase supplementation improved these parameters. Hens given low NPP diets supplemented with phytase performed as well as the hens on positive control diets containing 3.2 g/kg of NPP. A 49% reduction of excreta P content was achieved by feeding hens on low NPP diets supplemented with phytase, without compromising performance. Phytase addition to low NPP diets increased total phosphorus absorption at the ileal level, from 0.25 to 0.51 in the maize diet and from 0.34 to 0.58 in the barley diet. Phosphorus absorption increased linearly with increasing levels of dietary phytase. Mean phosphorus absorption was higher in barley diets than in maize diets (0.49 vs 0.39).

6-Phytase↗

PubMed1988

Effects of ionizing radiation on the metabolism and longitudinal growth of cartilaginous embryonic chick tibiae in vitro.

The effect of ionizing radiation on the metabolism and longitudinal growth of cartilaginous tibiae of 6.5-day-old chick embryos was studied in vitro over a 3-day period. Before being cultured, tibiae received absorbed doses of 2 to 200 Gy. Of each pair, the counterpart served as control. Compared to the strong inhibition of [3H]thymidine incorporation, already 50 percent at 10 Gy, the effects of ionizing radiation on [3H]uridine and [3H]proline incorporation were limited: 20 and 40 percent respectively at 150 Gy. Metabolism of the cartilage cells in our organ culture was almost completely arrested at 200 Gy. Light and electron microscopy showed no morphological differences between irradiated and sham-irradiated tibiae until 150 Gy. At 200 Gy necrosis of most of the cells was observed. No differences in form and arrangement of extracellular fibers were noticed. The results of the metabolic studies and the morphological observations were correlated with the effects of ionizing radiation on the longitudinal growth. In contrast to DNA synthesis, RNA transcription and synthesis of collagen fibres were radioresistant processes.

Animals↗

PubMed2003

Salvage of distal tibia metaphyseal nonunions with the 90 degrees cannulated blade plate.

Nonunion of distal tibia metaphyseal fractures after trauma is a major problem. Treating these nonunions is made more challenging by the presence of symptomatic ipsilateral tibiotalar arthrosis. The current study examined the use of the 90 degrees cannulated blade plate as an alternative method of stable internal fixation for 13 distal tibia metaphyseal nonunions and simultaneous fusion of three arthritic tibiotalar joints in 13 patients (seven males and six females) with an average age of 42.4 years (range, 21-73 years). Each patient had an average of three prior procedures (range, 2-6). Patients were followed up for an average of 34.2 months (range, 24-55 months). All 13 patients achieved radiographic and clinical union an average of 15.6 weeks (range, 12-20 weeks) from the date of the definitive procedure. There were two broken screws, but no secondary procedures were required to obtain fusion. All patients were ambulatory without support at the last followup. The implant proved effective for stable internal fixation of distal tibia metaphyseal nonunions alone or with simultaneous fusion of the tibiotalar joint.

Adult↗

PubMed1990

Fractures of the ipsilateral femur and tibia: emphasis on intra-articular and soft tissue injury.

Twenty-one patients with fractures of the ipsilateral femur and tibia were treated at Boston City Hospital from 1982 through 1987. Fourteen (67%) of the 21 patients sustained a total of 17 open fractures (76% of which were grade II or III wounds). Over 50% of the patients suffered concomitant ipsilateral knee injuries. Associated injuries required 37 nonorthopaedic procedures; 30 orthopaedic procedures were required to stabilize the axial skeleton and the other three extremities. Five patients ultimately required amputation, reflecting the magnitude of the initial high-energy trauma. Superior results were achieved when early rigid intramedullary fixation of the femur and rigid stabilization of the tibia with either an intramedullary nail or an external fixator was undertaken. Patients that underwent initial rigid intramedullary fixation of both the femur and tibia required fewer secondary operative procedures than those treated with primary external fixation. Rigid internal fixation allowed for thorough evaluation and treatment of the ligamentous structures of the knee and facilitated management of the soft tissue trauma.

Adolescent↗

PubMed1994

Intramedullary nailing of the tibia without a fracture table: the transfixion pin distractor technique.

A series of 44 fractures of the tibia requiring operative stabilization were treated using an intraoperative external transfixion pin frame to correct angular deformity and maintain length in preparation for intramedullary (IM) nailing, eliminating the need for a fracture table. The technique requires a radiolucent operating room table; the injured extremity is draped free. A transfixion pin is inserted in the os calcis. Rotational deformity is manually corrected. Using fluoroscopic control, a second transfixion pin is inserted at a location just distal and parallel to the proximal tibial articular surface, paralleling the horizontal plane of the first pin. The transfixion pins are connected with carbon fiber rods, creating a rectangular frame. Manual fracture reduction is followed by "fine tuning" with compressor/distractor clamps as needed. Alternatively, for added reduction force, the carbon fiber rod on the concave side of the angular deformity may be replaced with the AO/ASIF universal distractor. IM nailing is then performed in the usual fashion. In this series, an acceptable reduction was obtained in all cases. This technique shortens setup time, provides complete access to the distal part of the tibia, and allows free manipulation of the limb, thereby facilitating nail insertion and placement of distal locking screws. Use of medial and lateral bars prevents the angular deformity often created or exacerbated with the use of the universal distractor alone. This technique is recommended for IM nailing of all fractures of the tibia that would otherwise require use of the fracture table or universal distractor.

Adolescent↗