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PubMedDate not supplied

Gait analysis and muscle strength in children with congenital pseudarthrosis of the tibia: the effect of treatment.

Twelve patients with healed congenital pseudarthrosis of the tibia underwent gait analysis and muscle strength testing to determine the functional result of treatment. Six children younger than 4 years of age presented with pseudarthroses (early onset), and six children first fractured at older than 4 years of age (delayed onset). Four children with amputations as final treatment for congenital pseudarthrosis were studied for comparison. The early-onset group had undergone an average of 4.2 surgeries and all required transankle fixation. The delayed-onset group had undergone an average of 1.5 surgeries, with one child requiring fixation across the ankle. Lack of ankle push-off and foot drop occurred in the early-onset group. Terminal stance phase ankle power generation was greatly diminished in the early-onset group. Total mechanical work performed by the affected limb, when compared to the uninvolved contralateral limb, was symmetric in delayed-onset patients and reduced by 68% in early-onset patients and by 85% in amputees. Gastrocsoleus strength was reduced by 40%. Gait and muscle strength of patients with "healed" congenital pseudarthrosis of the tibia are markedly disturbed. Early onset of disease, early surgery, and transankle fixation lead to an inefficient gait comparable to that of amputees.

Age of Onset↗
PubMed1999

Algorithm for the surgical treatment of malignant lesions of the proximal tibia.

Complications are common among patients treated for malignant lesions of the proximal tibia and can be difficult to manage. This investigation was a retrospective review of 40 patients treated with total knee replacements after proximal tibial resections. Various reconstructive methods were used to fix the prosthetic stems, reestablish the extensor mechanism, and provide soft tissue coverage. Thirty-one patients had adequate followup to allow for review of prosthetic outcome (means, 78 months; range, 25-193 months). Seven patients died with less than 2 years followup, and two patients had postoperative acute infections treated by early amputation to allow chemotherapy to resume promptly. The overall 5-, 8-, and 12-year event free prostheses survival rates were 62%, 33%, and 16%, respectively. Prognostic factors for prosthetic survival were analyzed (age, gender, type of excision, type of prosthesis, type of fixation, and percent of bone resected). None were statistically significant. Patients with less than 40% of the tibia resected had better prosthetic survival at 5 years. The durability of uncemented stem fixation exceeded that of cemented stems. Expected survival of prostheses after revision was 52% at 8 years. The major cause of limb loss was infection. Failure to reconstruct soft tissues satisfactorily caused most failures. Aggressive multistage management of infection is needed. Prosthetic knee replacement is most suitable for patients with cancers that require chemotherapy and for those patients who have short potential survival.

Adolescent↗
PubMed2000

Neuromuscular plasticity in the locust after permanent removal of an excitatory motoneuron of the extensor tibiae muscle.

The capacity of the larval insect nervous system to compensate for the permanent loss of one of the two excitatory motoneurons innervating a leg muscle was investigated in the locust (Locusta migratoria). In the fourth instar, the fast extensor tibiae (FETi) motoneuron in the mesothoracic ganglion was permanently removed by photoinactivation with a helium-cadmium laser. Subsequently, the animals were allowed to develop into adulthood. When experimental animals were tested as adults after final ecdysis, fast-contracting fibers in the most proximal region of the corresponding extensor muscle, which are normally predominantly innervated by FETi only, uniformly responded to activity of the slow extensor tibiae (SETi) neuron. In adult operated animals, single pulses to SETi elicited large junctional responses in the fibers which resulted in twitch contractions of these fibers similar to the responses to FETi activity in control animals. The total number of muscle fibers, their properties as histochemically determined contractional types (fast and slow), and their distribution were not affected by photoinactivation of FETi. Possible mechanisms enabling the larval neuromuscular system to compensate for the loss of FETi through functionally similar innervation by a different motoneuron, i.e. SETi, are discussed.

Animals↗
PubMed1996

Vascularized bone grafts for congenital pseudarthrosis of the tibia.

Eight vascularized fibula grafts and two vascularized rib grafts were used for the treatment of 10 Boyd's Type II congenital pseudarthrosis of the tibia. All but one vascularized fibula graft united within 4 months. The two vascularized rib grafts did not unite until receiving a conventional bone graft. Nine spontaneous fractures were seen in four patients; all were subsequently treated successfully with cast or conventional bone graft. Corrective osteotomies were done in two patients. Follow-up averaged 8 years and 5 months (range, 5 years and 1 month to 14 years and 4 months). Average age at end of follow-up was 13 years and 6 months (range, 7 years and 10 months to 20 years and 4 months). After bony union was achieved, shortening of the affected leg averaged 3.8 centimeters, flexion deformity averaged 20 degrees, and valgus deformity averaged 24 degrees. In three patients, whose leg discrepancy averaged 4.9 centimeters, the leg was lengthened at an average patient age of 13 years and 9 months (age range, 11 years and 7 months to 15 years and 2 months). The resulting limb length discrepancy averaged 2.2 centimeters. Vascularized bone grafting is a reliable technique for achieving bony union in congenital pseudarthrosis of the tibia. Residual shortening may be corrected later by limb lengthening.

Adolescent↗
PubMed2005

Stress fracture of the distal tibia and fibula through heavy lifting.

BACKGROUND: Occupational stress fractures are reported among athletes, soldiers, ballet dancers, and in connection with shoveling. METHODS: A literature search on occupational stress fractures was performed. The biomechanical stress in association with special lifting tasks was estimated. RESULTS: A 59-year-old male welder presented with a stress fracture of the left distal tibia and fibula in connection with heavy lifting. The object was in front and lifted while he partly stood on one leg, which was rotated during the lifting. There was no considerable previous exposure to heavy lifting. CONCLUSION: It is likely, that this stress fracture was the result of strain on tibia and fibula through this composite lifting operation.

Fibula↗
PubMed1995

One-stage treatment of infected bone defects of the tibia with skin loss by free vascularized osteocutaneous grafts.

Twenty-six patients who had an infected nonunion or segmental defect of the tibia with skin loss were treated in one stage with debridement and a free vascularized osteocutaneous fibula or iliac graft. Successful control of infection, closure of skin defects, and incorporation of bone union were achieved in all patients except one. In an average follow-up of 39 months, no recurrence of infection was seen. There were four stress fractures of the grafted fibula; these healed within 2 months with cast immobilization. Graft hypertrophy was common in the fibula grafts, but it took 1 1/2 years for hypertrophy of the graft to be strong enough to remove external supports without stress fracture or an additional cancellous bone graft. The use of a one-stage free vascularized osteocutaneous graft for the management of infected bone defects of the tibia with skin loss is effective because extensive debridement can remove all devitalized and infected tissue and can increase vascularity in the region of infection and osseous defect to enhance antibiotic delivery.

Adult↗
PubMed1990

Case report 587: Adamantinoma of the tibia mimicking osteofibrous dysplasia.

This case emphasized that the differential diagnosis of osteofibrous dysplasia and adamantinoma of the tibia can be difficult on roentgengrams as well as on histological studies. A radiological and histological diagnosis of osteofibrous dysplasia of the tibia in a young adult should always raise the consideration of the possibility of an adamantinoma, and in the correlation of the radiological features with the biopsy findings it is very important to gain representative tissue material for establishing the correct diagnosis of adamantinoma.

Adolescent↗
PubMed1984

The floating knee. 40 cases of ipsilateral fractures of the femur and the tibia.

"Floating knee" is the term used to describe simultaneous fractures of the femur and tibia in the same limb. Thirty nine patients, with 40 such injuries, are presented with a follow up interval of six months to five years. The final functional result was poor if the femoral fracture was situated in the condylar flare and the results were comparatively better in those cases treated by cast bracing or when the fracture of the femur was stabilised internally. In all cases the fracture of the tibia was treated conservatively.

Adolescent↗
PubMed1977

[The intraarticular fracture of the distal end of the tibia as a prognostic criterion (author's transl)].

Ankle fractures with injuries of the distal articular surface of the tibia have particularly unfavourable results. A follow-up of 103 cases shows, that even small marginal fragments of the lip of tibia produce posttraumatic athrosis. Results become statistically worse when the fragment is about 1/5 of the joint surface. Further there is a clear relationship between the number of the single injuries and the incidence of posttraumatic arthrosis. Thus the prognosis of ankle fractures is better described by the genetic classification of Lauge-Hansen than by the classification of Weber,

Ankle Injuries↗
PubMed1991

Sports-related two-plane fractures of the distal tibia. Report of two cases.

Two cases of sports-related two-plane fractures of the distal tibia, their operative treatment and the result of therapy after hardware removal are reported. The incidence and mechanism of this type of fracture in adolescents are shown as well as the indication for surgical reconstruction depending on the gap in the joint surface of the distal tibia.

Adolescent↗
PubMed2006

Ipsilateral fractures of tibia and femur or floating knee.

Ipsilateral fractures of the femur and the tibia are relatively uncommon lesions, with critical consequences to the knee. We report a series of 18 ipsilateral fractures of the femur and the tibia treated at the Department of orthopaedics, CHU Hassan II of Fez, over an eight-year period (1996-2004). Various surgical procedures were used, in particular, intramedullary nailing. After an average follow-up of 2.5 years, we re-examined the 18 patients. The functional results were evaluated using the Schiedts' criteria, and we had seven excellent results (38.9%), six good (33.4%), and five bad (27.8%). There was one major lesion of the popliteal artery that led to an emergency amputation, two cases of osteitis, one septic non-union, one case of late deep sepsis, one insignificant shortening of 2 cm, two cases of varus, three cases of stiffness, and one ankylosis of the knee. Through this work we will try to show the repercussions of this type of fracture of the knee and to evaluate our therapeutic choices.

Adult↗
PubMed2006

Surgical outcomes after treatment of fractures in femur and tibia in pycnodysostosis.

Pycnodysostosis is a rare hereditary disease, characterized by systemic bone sclerosis. The most important orthopedic problem in this condition is the recurrent pathological fracture of long bones. In this paper, the surgical results for fractures of six limbs (three femurs and three tibias) in five cases of pycnodysostosis are reported. Five limbs achieved fracture union and union is developing in one tibia after intramedullary nail (IM) nailing or Ilizarov external fixation (IEF), although fracture line tends to persist for longer periods of time. One femoral fracture was treated by IM nailing, and one femoral and one tibial fracture were treated by IEF leading to final bone union. One femoral and one tibial fracture were initially treated by IEF, and were treated by IM nailing after re-fracture. One tibial fracture was initially treated by IEF leading to a failure of union, and was converted to IM nailing. All cases are able to walk; one case requires a single crutch. Infection was noted in two limbs after IM nailing following IEF. Fixation with IM nail was effective in preventing re-fracture as well as in alignment correction. Although the surgical technique is more difficult, IM nailing in the initial surgery may be a better choice for achieving successful union while reducing the risk of re-fracture or infection.

Adult↗
PubMed2003

Biomechanical analysis for stress fractures of the anterior middle third of the tibia in athletes: nonlinear analysis using a three-dimensional finite element method.

We evaluated stresses in the anterior middle third of the tibia that have been reported to predict a poor prognosis for tibial stress fractures compared to other predominant sites (posteromedial regions of the distal third and proximal third). The effect of two different loads (bending-compression load and torsional load) on three sites was investigated using a three-dimensional finite element method. The model was constructed using the tibia, fibula, proximal tibiofibular joint, interosseous membrane, and tibiofibular ligament based on computed tomography scans obtained at 4-mm intervals of the lower leg of a 20-year-old woman who exhibited no abnormal findings on roentgenograms. First, a normal model was constructed using normal material properties, and then the model was modified to produce fracture models by varying the mechanical properties of each predominant site and expanding the area in three gradual phases on the assumption that the fracture advanced in three phases. Each model was tested against the same two loads, and stresses at the nodal points on the border of the fracture area and normal area were compared in each cross section to determine the effect of the load on fracture advancement. In response to torsional load, both the normal model and fracture models tended to show higher values for the posteromedial distal third than the anterior middle third. By examining the bending-compression load it could be seen that the mean peak value significantly decreased between the first and second phases in fracture models of the anterior middle third. This finding was inconsistent with our previous belief that the bending-compression load would have more serious consequences than the torsional load. In contrast, when the area of fracture was expanded into the third phase, maximum values were significantly higher than during the second phase. No similar finding was observed for the posteromedial distal third, suggesting that the anterior middle third may have the same stable biomechanical conditions as the posteromedial distal third at an earlier stage and thus have little influence on fractures. When the fracture is more advanced, however, the conditions change suddenly, and a bending-compression load may adversely affect the mechanical conditions in this area and thereby cause complete fracture.

Adult↗
PubMed2002

Low-velocity gunshot fractures of the tibia.

A gunshot-related fracture is a unique type of open fracture. Bullet-induced fractures of the tibia may be encountered in any urban or rural setting as a result of hunting or cleaning mishaps or, perhaps more frequently, of criminal activity. For surgeons with limited experience, there is a bewildering range of apparently contradictory advice concerning their management. This article reports a case of a 53-year-old man with a highly comminuted bullet-induced shaft fracture of the tibia received during hunting activity. The patient was treated with a unilateral external fixator and vascularized flap for skin reconstruction. Six months after surgery, the external fixator was removed at clinical and radiological evidence of healing. At 1 year follow-up, the patient obtained complete healing and returned to normal activity.

Fractures, Comminuted↗
PubMed1985

Management of infected fractures of the tibia with associated soft tissue loss: experience with external fixation, bone grafting and soft tissue reconstruction using pedicle muscle flaps or microvascular composite tissue grafts.

The aim of this study was to assess the results of treatment given by a team of orthopaedic and plastic surgeons in a series of infected unhealed fractures of the tibia associated with loss of adjacent soft tissues. Twenty-five lower leg fractures, treated during a 10 year period, entered the study and were grouped according to the principles of treatment followed. In the earlier Group A (nine patients), the osteosynthesis implants were retained or changed to more stable internal fixation devices, the soft tissue defects were closed by conventional muscle or musculocutaneous flaps and bone grafting procedures were performed late in the treatment scheme. In the later Group B (16 patients) the implants were removed and the fracture stabilised by external fixation; the defects were covered with pedicle muscle flaps or with microvascular composite tissue grafts and cancellous bone grafting was performed at the same operation. Twenty-three fractures healed. One fracture developed non-union and in one patient infection necessitated below-knee amputation. The time of union after surgical reconstruction was significantly shorter in Group B (24 +/- 3 weeks) than in Group A (47 +/- 11 weeks). The results suggested that: in severe infected fractures of the tibia surgical implants used previously for fracture treatment should be removed and replaced with an external frame using firm axial compression, microvascular composite grafts seem to improve greatly the rate of healing, early bone grafting should be included in the reconstruction and late infections can be largely avoided even after extensive one-stage reconstructive procedures.

Adolescent↗
PubMed1990

Embryonic development of the innervation of the locust extensor tibiae muscle by identified neurons: formation and elimination of inappropriate axon branches.

Intracellular dye fills have been used to reveal the pattern of embryonic growth of each of the four neurons which innervate the extensor tibiae muscle (ETi) of the hind leg of the locust. The growth cone of the slow extensor tibiae motoneuron (SETi), the first of the four neurons to leave the central nervous system, pioneers nerve 3 (N3). The fast extensor motoneuron (FETi), the next neuron to grow out, follows earlier outgrowing motoneurons into the periphery in nerve 5 (N5) and then rejoins SETi in N3. As it transfers from N5 to N3, it is transiently dye-coupled to the Tr1 pioneer neuron which spans the gap between the two nerves. It then follows SETi onto the ETi muscle in the femur. The common inhibitory neuron and the dorsal unpaired median neuron (DUMETi) follow SETi and FETi in nerves 3B2 and 5B1, respectively. SETi's growth cone requires almost twice as long to reach ETi as those of the three later motoneurons, all of which follow preexisting neural pathways. At least three of the four developing motoneurons form one or more axon branches not found in the adult. These branches may occur (1) at segmental boundaries; (2) where the nerve, which the growth cone is following, itself branches or the growth cone encounters another nerve; or (3) when the axon continues to grow beyond its target muscle. These findings contrast with the apparent absence of inappropriate axon branches in another developing locust neuromuscular system and during the innervation of zebrafish myotomes, but resemble in some ways the transient production of inappropriate axonal branches reported for embryonic leech motoneurons.

Animals↗
PubMed1982

Fractures of the shaft of the tibia treated with AO-compression osteosynthesis.

Ninety-six displaced fractures of the shaft of the tibia in a series of 162 consecutive fractures were treated by AO internal fixation. Forty per cent were open fractures, of which 93 per cent received prophylactic treatment with antibiotics at the time of admission. The average time between the accident and the operation was 10 hours in closed fractures and 5 hours in open fractures. All cases were operated on by senior surgeons. The infection rate was 5.3 per cent in closed fractures, and 0 in open fractures. The average stay in hospital was 13 days. More than 90 per cent returned to work within 6 months after the accident. No case of pseudarthrosis or re-fracture was seen. The median time to final review was 36 months. Rigid internal fixation is advocated for all displaced fractures of the shaft of the tibia and is advocated as an urgent procedure especially in open fractures, and should be performed by experienced surgeons only. Rigid internal fixation appears to provide effective prophylaxis against secondary soft-tissue damage and limits the consequences of the initial soft-tissue damage.

Adult↗