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PubMed1999

[The causes for the worsening of treatment results in patients with infected pseudarthroses of the tibia in recent years].

Under analysis were results of treatment of 141 patients with infected pseudoarthroses of the tibia. Among them there were 10 women and 131 men aged from 18 to 62 years. The long-term results were followed-up during the period from 2 to 20 years. The analysis allowed a supposition that a combination of tibia segment resection and plasty with local tissues completed by suturing the wound, drainage and external fixation with the Ilizarov device leads to deterioration of the outcomes. A careful approach to treatment of such patients including the division of treatment into the stages of debridement and reconstruction seems to be more productive.

Adolescent↗

PubMed1999

Osteoid osteoma after a stress fracture of the tibia: a case report.

A 24-year-old man presented with a stress fracture over his left tibia following an infantry training 6 years ago. X-rays of his left tibia revealed a stress fracture and bone scan showed marked tracer uptake at the fracture. He was treated conservatively but his pain persisted since then. Five years later, X-rays and histological examination confirmed the diagnosis of osteoid osteoma. The stress fracture may act as a trigger for the formation of osteoid osteoma and caused a delay in diagnosis.

Adult↗

PubMed1999

Double-stress fracture of the tibia in a ten-year-old child.

A double-stress fracture of the tibia in a 10-year-old girl is described. Double-stress fracture of the tibia has previously been described in association with osteoarthritic varus deformity of the knee but not, to our knowledge, in a child. It is important to establish the diagnosis of stress fracture in childhood because the differential diagnosis, both clinically and on imaging, includes malignancy that must be excluded while avoiding unnecessary invasive investigations. The site of the lesions, their appearance on magnetic resonance imaging, the absence of any soft-tissue involvement, and the clinical history made the diagnosis possible. The characteristics of stress fracture shown on magnetic resonance imaging are described.

Bone Neoplasms↗

PubMed2001

Bone transport in the management of fractures of the tibia.

A review was carried out in 21 cases of bone transport in the tibia done between May 1995 and December 1997. These were done for the treatment of compound (Grade IIIB) fractures with extensive bone and soft tissue loss and in infective non-unions of the tibia using the Ilizarov technique and ring fixator. In 5 cases, 2 or 3 additional procedures were needed such as tendo achilles (TA) lengthening, bone grafting, revision of construct or revision of scar at the docking site. Average resection of infected bone was 5.2 cms in the infective non-union group and average bone and soft tissue loss was 8 cms in the compound Grade IIIB fracture group. The defect was bridged and regenerate bone occurred in all the cases except one. Union was achieved in all the cases although 10 needed bone grafting. Infection was eradicated in all the cases. Limb length discrepancy was corrected in all the cases except three. Mean duration of treatment was 12 months.

Adolescent↗

PubMedDate not supplied

The effectiveness of the circular external fixator in the treatment of post-traumatic of the tibia nonunion.

Authors report the results they obtained when the Ilizarov circular external fixator was used for the treatment of post-traumatic nonunion of the tibia. A total of 20 patients were treated. Of these 12 had been submitted to treatment elsewhere and using other methods; 9 presented with septic nonunion; 10 revealed radiographic findings of atrophic nonunion, and 10 were hypertrophic. There was axial deviation in 18 patients. The results of treatment were always: healing of the nonunion; functional recovery of the limb; correction of leg length discrepancy; recovery of the mechanical axis. The mean stabilization time (days between the application and the removal of the fixator) was 138 days. The Ilizarov method thus proved that it was effective in the treatment of post-traumatic nonunion of the tibia where other types of treatment had failed.

Adolescent↗

PubMedDate not supplied

Partial sleeve fractures of the tibia in children: an unusual fracture pattern.

Sleeve avulsion fractures of the patella are a well-recognized fracture pattern in children. Less appreciated is a similar fracture pattern involving the anterior metaphyseal area of the tibia. These metaphyseal sleeve fractures represent a fracture pattern characterized by the avulsion of a large area of periosteal attachment of the patellar tendon associated with small subchondral fragments of bone, encountered in skeletally immature children secondary to contraction of the quadriceps associated with forced knee flexion. Although an avulsion fracture of the tibial tubercle is the usual result of this type of trauma, partial sleeve avulsion fractures of the tibial apophysis and adjacent metaphysis occasionally occur and have not been adequately described. It was the authors' purpose to describe their experience with this fracture pattern. Since 1998, three boys have presented to a major pediatric trauma center with a partial sleeve fracture of the tibia. The average age was 13 years 6 months (range 10 years 3 months to 15 years 3 months). Follow-up ranged from 1 year 5 months to 2 years 3 months, with an average of 1 year 9 months. All three boys were treated with open reduction and internal fixation with small cancellous screws and postoperative plaster immobilization. At the time of most recent follow-up, each child showed full range of knee motion and had returned to all sports activities.

Adolescent↗

PubMed2002

Osseous integration of hydroxyapatite grafts in metaphyseal bone defects of the proximal tibia (CT-study).

PURPOSE OF THE STUDY: The purpose of the study was the examination of the osseous integration of hydroxyapatite grafts used for the filling of metaphyseal bone defects in tibia head fractures. MATERIAL: Four patients with lateral tibia plateau fractures AO-type B3 (12) were included in the study. Patients were treated by arthroscopically assisted reduction and percutaneous screw fixation. The metaphyseal bone defects were filled with prepared solid hydroxyapatite graft blocks (Endobon Fa. Merk Darmstadt, Germany). In all of the patients a CT study for the osseous integration of hydroxyapatite grafts used for the filling of metaphyseal bone defects in tibial head fractures was performed. Measurements of density were performed of the implant region, the periimplant region, the distant periimplant region and the fibula bone. Follow-up CT examinations of these specific regions were performed 6 and 12 months postoperative. RESULTS: In all cases an increase of density of the hydroxyapatite graft after 6 months and 12 months follow-up was detected. The periimplant region showed in all cases a decrease of density. A progressive decrease of the periimplant and the distant cancellous tibial bone region was also detectable after 6 and 12 months post-op. A similar decrease of density was visible in the region of the cancellous bone of the fibula. In the interface region a direct bone formation between the hydroxyapatite graft and the adjected cancellous bone was visible in all cases during follow-up. CONCLUSION: The increase of density of the hydroxyapatite grafts and the direct bone formation in the interface region between the hydroxyapatite graft and the adjacent cancellous bone are clear radiomorphological signs for an osteointegration of hydroxyapatite grafts in the metaphyseal region.

Adult↗

PubMedDate not supplied

External fixation and sequential nailing in the treatment of open diaphyseal fractures of the tibia.

Between September 1996 and April 1998 a total of 26 open fractures of the tibia (Gustilo Anderson grade I in 4 cases, grade II in 3, grade IIIA in 8, grade IIIB in 11) were treated by debridement and monoaxial external fixation followed by locked intramedullary nailing after healing of the soft tissues had been observed. Nailing by reamed Grosse Kempf nail was carried out in all of the cases. The mean duration of external fixation was 50 days (with a minimum of 18 days and a maximum of 6 months). Upon removal of the external fixator intramedullary osteosynthesis was performed during the same surgical session in 25 cases. Nailing was carried out 45 days after removal of the external fixator in 1 case. Healing was obtained in all of the patients an average of 6 months after trauma, and 3 and 1/2 months after the second operation. There were two cases of infection, one deep (3.8%) and the other superficial (3.8%). No cases of chronic osteomyelitis were ever observed. Poor consolidation with valgus equal to 10 degrees and 15 degrees was observed in 2 patients. This method of treatment, based on our experience, allows for healing in some open fractures of the tibia in a relatively short amount of time and with an acceptable risk of complications.

Adolescent↗

PubMedDate not supplied

Conservative treatment of eminentia intercondylaris fractures of the tibia in children.

Seventeen patients (16 children, 1 adolescent) were reviewed 31 months to 71 months after sustaining the common childhood fracture of the eminentia intercondylaris of the tibia. The aim was to assess long-term results and prognosis by clinical and radiological examination and to discover whether conservative treatment was adequate for type I and type II fractures according to Meyers and McKeever. Early improvement occurred in all patients after conservative treatment, but long-term results were not satisfactory in displaced fractures,which were treated with closed reduction and immobilization in extension. Therefore, anatomic reduction and rigid fixation should be obtained for displaced fractures of the eminentia intercondylaris of the tibia.

Accidents, Traffic↗

PubMed2001

[Autogenous bone marrow graft for the management of nonunion of tibia].

OBJECTIVE: To investigate the effect of percutaneous bone marrow graft for the management of nonunion of tibia. METHODS: From March 1996 to June 2000, 56 cases with nonunion of tibia were treated by autogenous bone marrow graft. Among them, there were 38 males and 18 females, aged from 19 to 72 years. A marrow needle was inserted into the site of the nonunion under the X-ray, the autogenous bone marrow was injected into the site of nonunion. Compression bandage and appropriate immobilization material were applied after operation. This procedure was repeated every month, 2 or 3 times was needed. RESULTS: 56 patients were followed-up for 4 months to 4 years and 2 months, averaged 2.8 years. Fracture healed in 53 cases and X-ray displayed fracture line disappeared and a great deal of continuous callus formed, and nonunion in 3 cases. CONCLUSION: Percutaneous autogenous bone marrow graft can play a role in osteogenesis at the site of nonunion. It is easy to aspirate bone marrow and the operation is simple. It has clinical application value for the satisfactory effect.

Adult↗

PubMed2002

Use of a stockinette in closed reduction of distal extra-articular tibia fractures.

Tibia fractures are common orthopaedic injuries. One of the most difficult tibia fractures that physicians encounter is the extra-articular distal third fracture. Operative fixation has certain risks depending on the procedure. Intramedullary nails fail to obtain adequate distal locking, and plate fixation increases the risk of soft tissue complications. Therefore, when indicated, closed reduction should be attempted. We have devised a method of applying in-line traction while performing closed reduction and casting with the use of a stockinette. This method avoids many of the problems encountered with other techniques such as calcaneal traction pins and hair splints. With the use of in-line traction through the stockinette, we are able to apply traction throughout casting without assistance, and the procedure is noninvasive.

Child↗

PubMed2002

[Interlocking intramedullary nail with reaming of bone marrow cavity in treatment of tibia and femur pseudarthrosis].

The aim of this paper was to assess the results of treatment of pesudoarthrosis of the tibia and femur with reamed interlocked intramedullary nailing. A group of 17 patients with pseudoarthrosis of long bones were treated. Pseudoarthrosis were located in 10 cases in the tibia and in 7 cases in the femur. In the analysed group there were 14 male and 3 female patients (average age: 48 years). All patients were treated by locked intramedullary nailing. Complete bone union was observed in 15 cases, 1 case is still under observation (radiological signs of bone union are already evident) and in 1 case treatment failed to resolve the pseudoarthrosis. Intramedullary interlocking nailing in the treatment of long bone pseudoarthrosis give very good stability and creates very good conditions for blood vessel penetration between the bone fragments. The reaming procedure yields biologically active material that accelerates the bone union process.

Adolescent↗

PubMed1992

[External torsion fractures of the tibia combined with ankle joint fractures].

The aim of this retrospective study is to emphasize on combined fractures of the tibia with lesions of the ankle joint. The report bases on 820 fractures of the lower leg. 123 cases showed external rotation fractures of the tibia, which were combined with lesions of the ankle joint in 88 cases. 25 patients were operated on the ankle joint. Because of the combination of external rotation fractures with lesions of the ankle joint, which accounted to 65% of the posterior tibial margin, to 17% of the lateral malleolus and to 3% of the syndesmosis, it is important to investigate the ankle joint radiologically and clinically.

Ankle Injuries↗

PubMed1992

Compartment pressures of the leg following intramedullary fixation of the tibia.

A prospective study was performed to determine whether compartment pressures of the leg were affected by intramedullary fixation of the tibia. Ten of the 11 patients studied had surgery for acute diaphyseal fractures and 1 for tibial nonunion. Compartment pressures were measured immediately prior to the procedure and at 12 hours after the procedure. There was no difference between the preoperative and postoperative compartment pressures. Our data suggest that intramedullary stabilization of the tibia does not predictably increase compartment pressures.

Adolescent↗

PubMedDate not supplied

The Fixion expansion nail in the surgical treatment of diaphyseal fractures of the humerus and tibia. Our experience.

The authors present their experience in the application of a Fixion expansion intramedullary nail for the treatment of diaphyseal fractures of the humerus and tibia, in a total of 40 surgeries. The features of the nail are: stability and flexibility of the instrumentation, speed of surgery, minimal exposure to radiation. The results obtained up to now are encouraging; there are no significant problems either during or after surgery, and mean consolidation time is 3 months for fractures of the humerus, and 4 months for those of the tibia. The Fixion nail is a versatile type of instrumentation that is easy to use.

Adult↗

PubMed2003

Arthroplasty in treating knee osteoarthritis and proximal tibia stress fracture.

The authors describe two cases of severely angulated tibial non-unions after proximal tibia stress fractures associated with ipsilateral osteoarthritis treated with modular knee endoprosthesis with a long tibial stem to stabilize non-union fragments. During the procedure, no additional osteosynthesis or bone grafting was added. Both non-unions healed after 6 months with no post-operative complications. The authors suggest implantation of modular knee endoprosthesis, as a single procedure, in treatment of proximal tibia non-union after a stress fracture as a result of severe varus/valgus deformity. It provides a solution for osteoarthritis treatment, axis correction and non-union osteosynthesis.

Aged↗

PubMed2003

[The value of laser Doppler examination of differential diagnosis of the Sudeck syndrome with local osteoporosis after tibia fracture].

The fractures of the shaft of the tibia were analyzed in 120 cases. The level of the osteoporosis in the radiological examination was assessed in comparison to the healthy limb. Osteoporosis was recorded in 60.6% of the cases. The clinical symptoms of the Sudeck syndrome was recorded in 11.25% of the cases. The Laser-Doppler examination was carried out in 120 cases. A standard 3 points measurement was employed: the apex of the toe, the flexion-dorsal part of the foot, and the medial part of the mid tibia length. The examination was done comparatively on both limbs. The pressure used in the occlusion, was 100 mm Hg higher than the pressure on the humeral artery. A faster and higher amplitude post-occlusion circulation reaction in the affected limb, among the patients with an early stage of the clinically diagnosed Sudeck syndrome had been recorded. The outcome is significant statistically. The Laser-Doppler measurement of the microcirculation is a new method and definite conclusions must be draw with caution. However, these results encourage further research.

Diagnosis, Differential↗

PubMed2004

Periprosthetic fractures of the tibia and patella in total knee arthroplasty.

Periprosthetic fractures of the tibia and patella associated with total knee arthroplasty are less common than periprosthetic fractures of the distal femur and therefore have been less frequently reported in the literature. Because more total knee replacements are now being performed and implant and patient survival has improved, periprosthetic fractures of the tibia and patella may be recognized more frequently in association with both primary and revision total knee replacement. Several risk factors associated with both types of fractures have been identified, and addressing patient factors, surgical techniques, and implant designs that may contribute to increased risk is an important aspect of management.

Algorithms↗