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PubMed2006

Blocking wires facilitate freehand percutaneous plating of periarticular tibia fractures.

The authors describe the technique of blocking K-wires to facilitate the freehand percutaneous plating of periarticular tibia fractures. The blocking K-wires facilitate anatomic accuracy of plate placement, a limiting feature of percutaneous plating technique particularly in the absence of a plate-specific jig. The described technique is to be applied as part of a staged surgical protocol utilizing temporary external fixation and directed at the preservation of the periarticular soft-tissues of the tibia.

Bone Plates↗

PubMed1976

Entrapment of the tibialis anterior tendon as a cause of nonunion in fractures of the distal tibia.

Three cases of nonunion of a fracture of the distal third of the tibia are reported. The cause of the nonunion in all three cases was the entrapment of the tibialis anterior tendon between the bone ends. This has not been previously reported as a specific cause of nonunion of the distal shaft of the tibia. This paper draws attention to this occurrence as a possible cause of nonunion in this area especially if the fracture is of the oblique type with an anterior spike at the distal end of the proximal fracture, with the line of fracture running parallel to the line of the tendon of the tibialis anterior. We suggest that fractures of this type should be treated early by internal fixation in view of the complications that can occur, such as nonunion, atrophy, or even complete rupture of the tendon of tibialis anterior, leading to a residual equinus deformity.

Adult↗

PubMed1982

Bone grafting for nonunion of fractures of the tibia: a critical review.

This study concerns the results of treatment of 39 patients with 40 tibial fractures which had progressed to nonunion and which subsequently were treated by autogenous bone grafting and cast immobilization. Thirty-one fractures were initially open and nine of these became infected nonunions. Thirty-four fractures united after bone grafting, four other patients finally required amputations, and two tibiae healed after subsequent internal fixation. The functional results, especially as related to ankle and subtalar joints, the residual tibial deformities, shortening and cosmetic results, were less than optimal. The difficulty with correcting and maintaining correction of the initial deformity and long periods of joint immobilization contributed to these results. Each patient with a nonunion of the tibia should be assessed so that a recommendation as to the need for immobilization, its type, and the necessity for bone grafting or not can be made.

Adult↗

PubMed1988

Postocclusive transcutaneous oximetry in followup assessment of tibial nonunion and healed tibia fractures.

UNLABELLED: Transcutaneous oximetry measurements were performed on 25 limbs in 25 patients with clinical and radiographic nonunion, and compared with data obtained from patients with healed tibia fractures and a control group of nonfractured extremities. A technique of "stress testing" vascular inflow patterns by temporary occlusion of arterial inflow was utilized to accentuate differences in perfusion not apparent at rest between normal limbs and those with inflow impairment. Changes in postocclusive hyperemic response were monitored by changes in transcutaneous oxygen detected by sensors placed over the dorsum of the foot, at the fracture site, over the anterior compartment, and at the chest. No statistically significant differences were found between the control group and the group of united tibia fractures. Analysis of results using the unpaired Student's t-test demonstrated statistically significant differences between the control and nonunion groups at each limb site tested (p less than 0.05). The prolonged oxygen recovery time values found in more than half the limbs with nonunion are consistent with the presence of impaired oxygenation following physiologic stress. The impairment of oxygenation appears to be on a perfusion basis and reflects the limited capacity of many limbs with tibial nonunion to respond to experimental ischemia with immediate compensatory hyperemia. CLINICAL RELEVANCE: This technique is a feasible method for serially assessing the regional oxygenation of a limb, and substantiates ischemia as a possible factor in the genesis of tibial nonunion.

Adult↗

PubMed1991

Ipsilateral open fracture of the femur and tibia treated using the dynamic ASIF-BM tubular external fixator: case reports.

Two cases of ipsilateral open fracture of the femur and tibia treated using the dynamic ASIF-BM tubular external fixator are described. Results were very good, with short periods of occupational disability. These cases support primary stable osteosynthesis of these simultaneous fractures and the value of dynamic axial external fixation as a definitive treatment of open fractures of the femur and tibia shaft, either isolated or simultaneous.

Accidents, Occupational↗

PubMed1995

A comparison of reamed and unreamed nailing of the tibia.

The availability of unreamed interlocked nails for fixation of tibia fractures has raised the issue of what effect reaming the intramedullary canal has on the clinical outcome after tibial nailing. A retrospective review was performed of all tibial fractures treated with interlocking nailing at the authors' institution over the past 5 years in order to compare reamed and unreamed nailing. Forty-five nailings were identified of which 38 had adequate follow-up information to be considered healed or non-united at 1 year. Thirteen reamed and 23 unreamed tibial nailings were followed to healing; there were 6 nonunions. The unreamed nailings had lower average operative times and lower average estimated blood loss, although the results did not reach statistically significant levels. There was a statistically significant difference in healing times, with unreamed nailings taking an average of 242 days to heal while reamed nailings took 158. This difference held for subgroups such as isolated tibia fractures, closed tibial fractures, and high-energy tibial fractures. Six non-unions occurred, one in a reamed nailing and five in unreamed nailings. Malunions occurred in four reamed nailings and six unreamed nailings, most often in distal third fractures, interlocked on only one side of the fracture. Patellofemoral complications were more common in unreamed nailings. Although this study is limited by retrospective, nonrandom design, it raises questions about the routine use of unreamed nailing with regard to healing potential and other postoperative complications. Further study is warranted.

Adolescent↗

PubMed1999

Treatment of fractures of femur and tibia with the telescopic locking nail: design of a new implant and the first clinical results.

BACKGROUND: This study was carried out to evaluate the first clinical experiences with the telescopic locking nail (TLN). The TLN is a newly developed universal locking nail system for both femur and tibia that permits cyclic dynamic loading at the fracture site while weightbearing. The nail can also be used for static interlocking or for compression of the fracture elements. The nail is strong enough to permit immediate weightbearing, and the diameter of 9 mm allows unreamed introduction in many cases. MATERIALS: Seventy-one consecutive patients were treated with the TLN, 24 patients with femoral and 47 patients with tibial fracture or nonunion. RESULTS: Functional outcome, complication rate, and union rate were comparable to other interlocking nail systems. CONCLUSION: Its distinctive biomechanical properties and its universal application in both femur and tibia make the TLN a sophisticated, yet in practice simple, new asset in the practice of intramedullary nailing.

Adolescent↗

PubMed1981

Use of the soleus muscle flap to cover part of the distal tibia.

A method for covering soft-tissue defects overlying the distal tibia with a proximally based soleus muscle flap is described. The flap can be used to cover a portion of the distal tibia by extending the distal reach of the soleus muscle. The muscle is extended by several relaxing incisions in the epimysium. This simple procedure enables the soleus muscle to be advanced distally, extending its application for coverage of the distal lower leg. The method has been used successfully clinically, eliminating the need for more time-consuming or difficult procedures.

Adult↗

PubMed2003

Residual challenges after healing of congenital pseudarthrosis in the tibia.

The purpose of the current study was to evaluate the clinical results of the Ilizarov bone transport method in the treatment of congenital pseudarthrosis in the tibia. In seven patients operated on between 2.6 and 7.8 years of age, primary healing of the pseudarthrosis was achieved in all patients (after additional bone grafting in two patients). Within a followup of 6 to 8 years, major complications occurred in all patients. Five refractures occurred, and in one patient the refracture did not heal. At the last followup, axial deformities and an abnormal malalignment test with lateral mechanical axis deviation of 10 mm or greater was found in all patients. Three patients had leg length inequality of 20 mm or more. The Ilizarov bone transport method is useful in achieving primary healing in congenital pseudarthrosis of the tibia, but residual challenges with secondary reconstructive surgery caused by refracture and postoperative deformities must be expected.

Bone Transplantation↗

PubMed2005

The treatment of chronic open osteomyelitis of the tibia in adults.

UNLABELLED: The treatment of 30 consecutive adult patients with chronic draining osteomyelitis of the tibia was reviewed. There were four treatment patterns. Eight patients had local debridement with or without soft tissue coverage procedures or bone graft. Three patients had radical debridement and bone transport using a circular frame. Eight patients were treated by the Papineau grafting technique after debridement. Eleven patients had debridement and circular frame fixation to correct associated nonunion, malunion, or shortening. All patients received long-term antibiotic therapy. At an average of 6 years' followup (minimum, 2 years), two patients had persistent drainage and one patient had an aseptic nonunion. This experience affirms the value of the circular frame, of the Papineau graft, of bone transport, and of long-term antibiotics for treatment of chronic osteomyelitis of the tibia. There was successful limb salvage in all of the patients and successful treatment (fracture healing without drainage) in 27 of 30 patients. LEVEL OF EVIDENCE: Therapeutic study, Level III-1 (case-control study). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗

PubMed2005

Provisional plating of Type III open tibia fractures prior to intramedullary nailing.

Intramedullary nailing of tibial shaft fractures is the preferred treatment of most displaced, unstable tibial shaft fractures. In open tibia fractures, direct exposure of the fracture segments for irrigation and debridement is required prior to fracture stabilization. We propose a method of provisional stabilization using commonly available implants placed through the associated traumatic open wound prior to intramedullary nailing. This technique, particularly helpful to surgeons operating with limited assistance, employs a temporarily applied 3.5-mm dynamic compression plate or limited contact dynamic compression plate implant secured with unicortical screws, allowing reaming and intramedullary nailing of a reduced, stabilized tibia fracture.

Adolescent↗

PubMedDate not supplied

Salter-Harris I and II fractures of the distal tibia: does mechanism of injury relate to premature physeal closure?

INTRODUCTION: The distal tibial physis is the second most commonly injured physis in long bones. Recent reports demonstrate a high rate of premature physeal closure (PPC) in Salter-Harris (SH) type I or II fractures of the distal tibia. METHODS: At our institution, 137 distal tibial SH type I or II fractures were treated from 1994 to 2002. Reviews were performed on all patients and 91 fractures met inclusion criteria. Patients were categorized according to treatment. RESULTS: We report a PPC rate of 39.6% in SH type I or II fractures of the distal tibial physis. We found a difference in PPC based on injury mechanism. The rate of PPC in patients with a supination-external-rotation-type injury was 35%, whereas patients with pronation-abduction-type injuries developed PPC in 54% of cases. Type of treatment may prevent PPC in some fractures. The most important determinant of PPC is the fracture displacement following reduction. DISCUSSION AND CONCLUSION: PPC is a common problem following SH type I or II fractures of the distal tibia. Operative treatment may decrease the frequency of PPC in some fractures. Regardless of treatment method, we recommend anatomic reduction to decrease the risk of PPC.

Ankle Injuries↗

PubMed2003

The tibialis anterior used as a local muscle flap over the tibia after soft tissue loss.

BACKGROUND: A series of 12 extremities among 11 patients with open wounds exposing the tibia were treated using a local tibialis anterior muscle flap. There was an associated tibial shaft fracture in 11 of the 12 extremities, which were managed by external fixation or intramedullary nailing. The wounds, ranging from 1 to 15 cm in length, were located anteriorly over the middle and distal thirds of the tibia. METHODS: A retrospective chart review included patients whose open anterior tibial wounds were managed with an anterior tibialis rotational flap. These patients had been treated at the Medical College of Ohio between 1995 and 1999. No patients were excluded, and all the patients had at least 1 year of follow-up evaluation. RESULTS: Complete coverage was obtained in all cases. All the wounds healed without complication. All the associated tibial shaft fractures had a delayed union or nonunion, with 10 of the 11 requiring bone graft or an exchange intramedullary nail. CONCLUSION: The anterior tibialis is a relatively easy flap to use for covering anterior tibial open wounds. The high rate of nonunion seems related more to the injury than to the coverage technique.

Adult↗

PubMed2003

Outcomes in open tibia fractures: relationship between delay in treatment and infection.

BACKGROUND: Emergent irrigation and debridement has been accepted as a mainstay of open fracture treatment. The purpose of this study was to evaluate the infectious outcome of open tibia fractures relative to the time from injury to operative irrigation and debridement. METHODS: One hundred seventy-eight patients with 191 consecutive fractures were retrospectively reviewed. Of these, 103 patients with 106 fractures were available for this study, with an average follow-up of 10.23 months. RESULTS: Results revealed 21.7% type I fractures, 43.4% type II fractures, 16.0% type IIIa fractures, 11.3% type IIIb fractures, and 7.5% type IIIc fractures. Of all fracture types, 22.6% became infected and 5.7% went on to have osteomyelitis. The average time to treatment was not significantly different in infected versus noninfected fractures across fracture types. No infection occurred when the time to surgery was within 2 hours; however, no significant increase in infection was discovered with respect to patients treated after 6 hours compared with those treated within 6 hours. CONCLUSION: The results support the Gustilo grading system of open fractures as a significant prognostic indicator for infectious complication. We continue to support the emergent treatment of open tibia fractures.

Adolescent↗

PubMed2004

Exchange reamed nailing for aseptic nonunion of the tibia.

BACKGROUND: Exchange reamed nailing of the tibia is a common procedure in the treatment of an aseptic tibial nonunion. However, reports in the literature supporting this technique are limited. METHODS: Forty patients with a tibial nonunion after initial unreamed intramedullary nailing were retrospectively assessed after an exchange reamed nailing. The main outcome measurements included radiographic and clinical union as well as time from exchange reamed nailing to union. RESULTS: Thirty-eight patients achieved union of their fracture (95%). The average time from exchange nailing to union was 29 +/- 21 weeks. Complications included one deep vein thrombosis (2.5%) and two hardware failures (5%). CONCLUSION: Exchange reamed nailing for nonunions of the tibia results in a high union rate and is associated with a low complication rate. This technique is recommended as a standard procedure for aseptic tibial nonunions after initial unreamed intramedullary nailing.

Adolescent↗

PubMed1996

Treatment of congenital pseudarthrosis of tibia with the circular frame technique.

We treated nine patients with congenital pseudarthrosis of the tibia consecutively by a modification of the Ilizarov (circular frame) technique. Seven patients had had several previous operations, and two patients had had none. After resecting of the pseudarthrosis and the surrounding pathologic periosteum, we performed acute shortening and compression at the level of resection, together with simultaneous lengthening of the proximal tibia. Union was achieved in all cases. With this technique, not only the mechanical but also the biologic problems are addressed. As compared with other methods, the circular frame technique also offers the possibility of correcting angulation and limb length discrepancy.

Adolescent↗

PubMed2000

Congenital pseudarthrosis of the tibia: history, etiology, classification, and epidemiologic data.

Congenital pseudarthrosis of the tibia is a rare disease with a variable history. The pseudarthrosis is usually not present at birth (and therefore is not truly congenital) but occurs during the first decade of life. Paget in 1891 was the first to describe a case. The etiology is unknown. Neurofibromatosis plays a role in approximately 50% of patients. In the others, hereditary and mechanical factors are debated. Various (morphologic) classification systems have been proposed (Andersen, Boyd, Crawford). Because the appearance changes during the course of the disease, all classification systems have limited value: the determining factor is the stage of the disease at which it was classified. Because of the rarity of the disease and the variability of its history, the European Pediatric Orthopaedic Society decided to carry out a multicenter study on this disease. This paper presents the epidemiologic data on the patients involved. Data have been gathered on 340 patients from 13 countries. Two hundred patients were male (58.8%), 140 were female (41.2%). The right side was affected in 165 patients (48.5%) and the left side in 172 (50.6%); 3 patients had bilateral disease. Symptoms of neurofibromatosis were present in 54.7%. Histologic examinations in 192 patients showed a nonspecific appearance in 45.3%; in 15.6% the ultrastructure resembled fibrous dysplasia, and in 39% there was histologic evidence of neurofibromatosis. Most of the lesions were initially localized in the middle or distal third of the tibia. In 29% the localization changed during the course of the disease.

Child↗

PubMed2000

Management of congenital pseudarthrosis of the tibia by excision of the pseudarthrosis, onlay grafting, and intramedullary nailing.

Fourteen skeletally immature children with congenital pseudarthrosis of the tibia were treated by excision of the pseudarthrosis, double onlay autogenous cortical bone grafting, and intramedullary nailing. Union was achieved in 12 patients, and no refractures occurred at the site of the original pseudarthrosis. In three patients, a fresh pseudarthrosis developed at a different site; these united after repeat onlay grafting. Five skeletally mature patients were treated by excision of the pseudarthrosis, compression at the site, and limb lengthening by callotasis. Union was achieved in three. Gain in tibial length ranged from 6 to 13 cm, with no significant complications during lengthening. The authors conclude that union can be achieved and refractures prevented in a significant proportion of skeletally immature children with congenital pseudarthrosis of the tibia by excision of the pseudarthrosis, dual onlay bone grafting, and intramedullary nailing. Any residual shortening of the limb can be treated at skeletal maturity.

Adolescent↗