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At least 793 records · Page 44Linked to original sources
PubMed1999

Introduction to adult posttraumatic osteomyelitis of the tibia.

The tibia is the most frequent site of an open fracture, and treatment of adult posttraumatic osteomyelitis of the tibia represents a significant clinical problem that has been recognized for centuries. Ancient modalities such as immobilization and debridement are still mainstays of therapy, and recent developments such as the use of antibiotics and muscle transfer have helped to improve outcome. Osteomyelitis is classified based on the Cierny-Mader system to provide prognostic and therapeutic information. Open fractures can be classified by the Gustilo system, again providing prognostic and therapeutic data. Gustilo Type III fractures have a high likelihood of having infection develop. Treatment principles include immobilization, thorough debridement, control of infection through antibiotic use, control of dead space, and soft tissue coverage.

Adult↗
PubMedDate not supplied

Use of Orthofix T-Garche fixator in late-onset tibia vara.

The treatment of late-onset tibia vara has not been well described. High tibial corticotomies and use of the Orthofix T-Garche fixator were performed on 11 children (14 knees) with late-onset tibia vara. The average age at surgery was 12 years, and follow-up was 2 years. Minimum follow-up was until completion of growth. Angular deformities were measured by using the tibiofemoral angle, metaphyseal-diaphyseal angle, and the mechanical axis both preoperatively and on removal of the fixation device. Union was accomplished in 7-12 weeks, and the total time with the appliance averaged 9 weeks. Complications included superficial pin-tract infections (two) and a transient nerve palsy (one). High tibial corticotomy followed by corrective gradual distraction osteosynthesis by using the Orthofix T-Garche fixator is effective in correcting angular deformity and alleviating knee pain. Advantages of this technique include ease of application, immediate weight bearing, and minimal discomfort with hardware removal. Disadvantages include difficulty in obtaining adequate radiographs with the anteriorly based fixation device, pin-tract infections, and the high degree of patient compliance needed.

Adolescent↗
PubMedDate not supplied

Ilizarov technique in the treatment of congenital pseudarthrosis of the tibia.

This study analyzes the risks and benefits of Ilizarov's technique in congenital pseudarthrosis of the tibia (CPT). This was a retrospective review of 14 patients treated between 1985 and 1993 for CPT, by using Ilizarov's technique. In 12 cases, this technique was used after failure of previous surgical treatment. Realignment, end-to-end compression, and leg lengthening were undertaken in all the cases, without excision of the pseudarthrosis site. The mean fixation duration was 7.8 months. Union was achieved with the initial treatment in seven cases. Bone grafting was used in six of the seven remaining cases and achieved bone healing in three of them. Refracture occurred in one case, and ended with nonunion. At 3.5-year average follow-up, the tibia was united in nine cases. We found that the best indications for Ilizarov's technique in CPT were the normotrophic and hypertrophic types of pseudarthrosis (Apoil II), after the age of 5 years. Secondary massive bone grafting is to be considered in some cases. The major disadvantage of this method is the lack of excision of the pseudarthrosis site. Even after healing is achieved, the bone remains dystrophic and fragile and necessitates a permanent protective orthosis, until the end of bone growth.

Adolescent↗
PubMedDate not supplied

Giant cell tumor of the proximal tibia: MR and CT appearance.

The magnetic resonance (MR) appearance of four cases of giant cell tumor (GCT) of the proximal tibia are described and the MR grading of these tumors is compared with CT and conventional radiography. Magnetic resonance showed the lesions to be well defined with respect to adjacent marrow and cortical bone. Homogeneous intermediate signal intensity or low signal within the tumors was seen on T1-weighted images. T2-weighted images showed mixed signal intensity with small "bright patches" of increased signal intensity in all four cases. No fluid levels were identified. Magnetic resonance was superior to CT and plain radiography in radiologic grading of the tumors. Computed tomography was superior in determining if cortical invasion was present. Intraarticular tumor extension was more accurately detected by MR and arthrotomography than CT. An MR manifestation of GCT of the proximal tibia is described which may be a common appearance of this tumor by this modality. Magnetic resonance is the procedure of choice in the radiologic grading of GCT.

Adult↗
PubMed1993

Late functional outcome in patients with tibia fractures covered with free muscle flaps.

The functional outcome and work capacity of patients treated with a free muscle flap to cover open grade III tibial fractures was assessed. The conditions of patients, eight with grade IIIB and six with grade IIIC isolated open tibia fractures, treated with a free muscle flap transfer less than 3 months after their injury, were retrospectively reviewed. Flap survival was 86%. Twelve of the 14 were contacted, with follow-up time averaging 7 years. Four of the 14 eventually had below-knee amputations and one of the 10 patients with a successful limb salvage died of unrelated causes. All nine surviving patients with salvaged limbs had healed fractures in an average of 15 months (range, 8-23). Six were initially infected, but drainage had stopped an average of 13.5 months after flap coverage. No wounds were draining at last follow-up observation. Those tibias that were initially infected have been drainage free for an average of 78 months. The average total hospital cost of reconstruction was $48,996.40. The functional outcome in 12 patients was assessed. Eight of the nine patients whose limbs were salvaged returned to work, six to jobs with demands similar to their preinjury occupation. Three of the four patients with limb amputations were also able to return to jobs similar to their preinjury occupation. Patients must be made aware of the expected course of reconstruction and anticipated final outcome. Despite rarely achieving normal function, returning to work is a reasonable goal.

Adult↗
PubMed1994

Cortical bone blood flow in reamed and unreamed locked intramedullary nailing: a fractured tibia model in sheep.

We compared the effects of reamed versus unreamed locked intramedullary nailing on cortical bone blood flow in a fractured sheep tibia model. A standardized spiral fracture was created by three-point bending with torsion, and each tibia was stabilized by insertion of a locked intramedullary nail. Eleven animals were randomized into two groups: one that had reaming before nail insertion and one that did not. Blood flow was measured in real time using laser Doppler flowmetry. Cortical bone perfusion measurements were made at three locations (proximal diaphysis, fracture site, distal diaphysis) and at eight time intervals (prefracture, postfracture, postreaming, postnail insertion, postlocking, and at 2-, 6-, and 12-week follow-up). All animals were killed at 12 weeks postoperatively. After reamed nail insertion, cortical bone perfusion was significantly decreased (p < 0.0009). After unreamed nail insertion, perfusion was decreased less (p < 0.003). Insertion of locking screws did not affect blood flow. Cortical bone perfusion was greater in the unreamed group at completion of the procedure (p < 0.011), at 2-week follow-up (p < 0.006) and at 6-week follow-up (p < 0.027). The findings suggest that cortical revascularization had occurred by 6 weeks in the unreamed group but not until 12 weeks in the reamed group. The study demonstrates that cortical circulation is spared to a greater degree by unreamed nailing. This may be advantageous in severe open tibial fractures where blood supply is already significantly compromised.

Animals↗
PubMed1999

Safe extracapsular placement of proximal tibia transfixation pins.

OBJECTIVE: To identify the anatomic detail of the knee joint capsular insertion site on the proximal tibia, specifically as it relates to transfixation pins. DESIGN: Identification of capsular anatomy by anatomical dissection of cadaveric specimens, with radiography and arthroscopy of patients. SETTING: Cadaveric dissection. OUTCOME MEASURES: Anatomic observation of the capsular attachment site in relation to the tibial articular surface. RESULTS: The capsule inserts four to fourteen millimeters below the articular surface in a regular pattern. The anterior half of the circumference is close to the joint line (less than six millimeters). Posteromedially and posterolaterally, there are extensions distally to fourteen millimeters, occasionally communicating with the tibiofibular joint. CONCLUSION: Transfixing wires and half-pins can be placed in the proximal tibia without capsular penetration if kept more than fourteen millimeters from the subchondral line. If wire placement closer to the joint is required, wires should be placed in Zone 1 (the anterior half) and at least six millimeters from subchondral bone to avoid capsular penetration.

Arthroscopy↗
PubMed2004

Safe extracapsular placement of proximal tibia transfixation pins.

OBJECTIVE: To identify the anatomic detail of the knee joint capsular insertion site on the proximal tibia, specifically as it relates to transfixation pins. DESIGN: Identification of capsular anatomy by anatomical dissection of cadaveric specimens, with radiography and arthroscopy of patients. SETTING: Cadaveric dissection. OUTCOME MEASURES: Anatomic observation of the capsular attachment site in relation to the tibial articular surface. RESULTS: The capsule inserts four to fourteen millimeters below the articular surface in a regular pattern. The anterior half of the circumference is close to the joint line (less than six millimeters). Posteromedially and posterolaterally, there are extensions distally to fourteen millimeters, occasionally communicating with the tibiofibular joint. CONCLUSION: Transfixing wires and half-pins can be placed in the proximal tibia without capsular penetration if kept more than fourteen millimeters from the subchondral line. If wire placement closer to the joint is required, wires should be placed in Zone 1 (the anterior half) and at least six millimeters from subchondral bone to avoid capsular penetration.

Arthroscopy↗
PubMed1988

Unicameral bone cyst of the tibia complicated by genu valgum.

Progressive tibia valga occurred in an adolescent girl after curettage and allografting of a large unicameral bone cyst of the tibia. The valgus deformity was corrected by a closing-wedge osteotomy, which resulted in a good functional and cosmetic result. The progressive valgus deformity might have been caused by stimulation of overgrowth of the medial tibial metaphysis.

Bone Cysts↗
PubMed2002

A new knee arthroplasty versus Brown procedure in congenital total absence of the tibia: a preliminary report.

The rates of successful knee arthroplasties according, for example, to Brown in patients with congenital total absence of the tibia are disappointing. A new form of knee arthroplasty is demonstrated in a 15-month-old infant with a congenital total absence of the tibia. With the help of two crossed capsular flaps and a Z-plasty of the quadriceps tendon, the patella is transposed under the femoral condyles to function as a tibial plateau. The proximal fibula is fused centrally to the external, cortical surface of the patella. A mini-ringfixator construction is used to stabilize the components, although permitting mobilization of the knee arthroplasty in the immediate postoperative period. This new type of knee arthroplasty offers distinct advantages compared with the previously published procedures.

Arthroplasty, Replacement, Knee↗
PubMed2004

Intercalary femur and tibia segmental allografts provide an acceptable alternative in reconstructing tumor resections.

Intercalary femur and tibia segmental allografts were implanted in 59 consecutive patients after segmental resection-52 for malignant and seven for benign aggressive bone tumors. The patients were followed up for an average of 5 years. Allograft survival was determined with the Kaplan-Meier method. Infection, fracture, and nonunion rates were determined. The overall 5-year survivorship for the 59 intercalary allografts was 79%, and we found no significant differences between allograft survival in patients receiving or not receiving adjuvant chemotherapy. Infection and fracture rates were 5% and 7% respectively. From 118 host-donor junctions, 11 did not initially heal (9%). The nonunion rate (10 of 69 osteotomies) for diaphyseal junctions was higher than the rate (one of 49 osteotomies) for metaphyseal junctions. Although some patients required reoperations because of allograft complications, it seems that the use of intercalary allograft clearly has a place in the reconstruction of a segmental defect created by the resection of a tumor in the diaphyseal and /or metaphyseal portion of the femur or tibia.

Adolescent↗
PubMed2005

Reconstructed patellar tendon length after proximal tibia prosthetic replacement.

A common problem after proximal tibia prosthetic reconstruction is insufficient extensor mechanism or extensor lag. Maintaining the reconstructed patellar tendon length is an important way to minimize extensor lag. We measured the patellar tendon length and extensor lag serially. From 1994-2003, seven consecutive patients with malignant bone tumors of the proximal tibia had prosthetic reconstruction. The extensor mechanism was reconstructed by reattachment of the patellar tendon to the prosthesis with a synthetic material and augmented by a gastrocnemius flap. The patellar tendon length was measured according to the Insall-Salvati ratio. The ratios at 30 degrees knee flexion decreased immediately postoperatively, and reverted to almost the same preoperative values within 18 months. The mean ratios at 60 degrees knee flexion are significantly greater than 30 degrees at 6 months postoperatively. These findings indicate that the patellar tendon stretched, whereas the extensor lag improved continuously for 12 months postoperatively. In the revision at 22 months postoperatively, although the patellar tendon was not reattached to the replaced prosthesis, the ratio and the extensor lag had not worsened. These results show that providing strong continuity of the patellar tendon, gastrocnemius flap, and leg extensors can decrease the extensor lag, although the patellar tendon stretches.

Adolescent↗
PubMedDate not supplied

Residual shortening after Legg-Calve-Perthes disease, focusing on the response of the ipsilateral tibia.

Residual shortening of the affected limb was measured at skeletal maturity by teleoroentgenograms in 68 patients with Legg-Calve-Perthes disease (LCPD); special attention was paid to the length of the ipsilateral tibia. Of these 68 patients, 38 were treated by abduction orthosis (AO) and 30 by femoral varus osteotomy (FVO). Residual shortening in AO group was significantly greater than that in FVO group. The femoral lengths in both of these groups were similar (12.5 mm in the AO group and 10.1 mm in the FVO group), but the tibial lengths were significantly different (2.5 mm shortening in the AO group and 0.9 mm lengthening in the FVO group). Residual shortening in the patients treated by FVO was less than that in patients treated by AO. The difference is speculated to be caused by the overgrowth of the ipsilateral tibia.

Bone Development↗
PubMedDate not supplied

Limb salvage treatment for congenital deficiency of the tibia.

Nine limb salvage treatments were performed in 7 patients with congenital deficiency of the tibia. All feet showed equinovarus deformity and were centralized in a slightly equinus position by placing the distal end of the fibula into the posterior facet of the calcaneus. Tibiofibular fusion was performed in 4 patients with partial deficiency, and fibular transfer (fibular centralization; Brown procedure) in 5 with complete deficiency of the tibia. Callus distraction lengthening was performed repeatedly for leg-length discrepancy on either the femur or the centralized fibula. Satisfactory functional and cosmetic results were obtained in all limbs with partial deficiency, whereas in limbs with completely deficiency, none of the 5 knees treated by fibular transfer achieved a satisfactory functional result because of insufficient quadriceps strength, progressive knee flexion contracture, and persistent ligamentous instability. Nevertheless, in these 5 cases, all patients were ultimately able to withstand weight-bearing.

Adolescent↗
PubMed2006

Comparison of patella lead with blood lead and tibia lead and their associations with neurobehavioral test scores.

OBJECTIVE: Lead exposure in adults is associated with worse cognitive function in cross-sectional and longitudinal studies. Previous studies have mainly examined relations with blood lead or cortical bone lead; few have examined trabecular bone lead. METHODS: We performed a cross-sectional analysis of the relations of patella lead and other lead biomarkers with measures of neurobehavioral and peripheral nervous system function in 652 lead workers. RESULTS: Patella lead was found to be associated with worse performance on seven of 19 tests of manual dexterity, sensory vibration threshold, and depressive symptoms. The associations of patella lead with cognitive function were essentially similar to those with blood lead or tibia lead but of somewhat lower magnitude. CONCLUSIONS: In this study, measurement of patella lead did not aid causal inference regarding cognitive effects when compared with blood lead and tibia lead.

Adult↗
PubMed2006

Elevation of medial tibial condyle for severe tibia vara.

Clinical and radiological evidence of knee instability was used as criteria for elevation of medial tibial condyle in severe tibia vara. Restoration of tension to the exposed medial collateral ligament was used as a guide for the required amount of elevation. A second-stage proximal tibial osteotomy was performed later for correction of the remaining varus deformity. External fixators were used in all instances. Elevation of the medial tibial condyle is indicated in severe tibia vara with arrest of the medial tibial physis, in which more than a 10 degrees difference exists between valgus and varus stress radiographs with the knee in extension as compared with an opposite normal knee.

Adolescent↗
PubMed1983

A biomechanical analysis of the etiology of tibia vara.

To elucidate the cause of tibia vara, finite element analysis of the proximal tibia was used to investigate the stresses occurring in the physeal plate during one-legged stance in 2- and 5-year-old children. A modification of the method of Kettlekamp and Chao was used to assign forces to the medial and lateral plateaus and lateral ligament. Stresses were calculated in the physeal plate for the two age groups as a function of degree of varus and body weight. Our results show that increasing varus resulted in increasing compressive stress in the medial tibial physis to a level seven times normal at 30 degrees of varus. Further, tensile stresses determined in the lateral tibial physis were increased above normal. Changes were more marked in the obese child and in the 5 year old. Using the data from Strobino et al. it appears that in the 2 year old 20 degrees of varus resulted in forces sufficient to retard growth. In the 5 year old, however, 10 degrees of varus resulted in borderline forces in a child of normal weight, but forces exceeding those necessary to retard physeal growth were calculated in the model of the obese child. Our data are consistent with the hypothesis that Blount's disease is primarily the result of the proximal tibial epiphysis responding to physical phenomena.

Biomechanical Phenomena↗