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PubMed2004

Percutaneous plate fixation of fractures of the distal tibia.

Minimally invasive plate osteosynthesis (MIPO) of the distal tibia offers several theoretical advantages compared to classic open reduction and internal fixation. A mechanically stable fracture-bridging osteosynthesis can be obtained without significant dissection and surgical trauma to the bone and surrounding soft tissues. In this retrospective study we looked at the results and complications in ten consecutive patients treated with percutaneous plating for fractures of the distal tibia and plafond with a minimum follow-up period of one year. No significant soft tissue problems occurred. The need for bone grafting should be carefully evaluated in every case as we encountered two delayed unions. All fractures healed within one year; there was no fracture malunion. The use of indirect reduction techniques and small incisions to insert hardware is technically more demanding and requires strict radioscopic control throughout the procedure, but it considerably decreases surgical trauma to the soft tissues.

Adult↗

PubMed2004

[Locked intramedullary nailing in treatment of femur and tibia delayed union and pseudoarthrosis].

Five patients treated operatively on account of tibia and femur shaft delayed union and pseudoarthrosis were re-operated by locked intramedullary nailing. The method permits stable bone fixation. Intramedullary canal reaming stimulates bone union, as it refreshes fracture site and is a source of bone graft. Intramedullary nail covers anatomical axis of bone and, in the case of femur, is close to its mechanical axis. It diminishes the risk of implant breakage. The method permits active and efficient rehabilitation. Some fractures stabilised with external fixator or operated by Zespol or Polfix method can be re-operated by close technic. It shortens time of operation and diminishes its aggressiveness. In our opinion locked intramedullary nailing is an efficient method in treatment of tibia and femur shaft delayed union and pseudoarthrosis.

Adult↗

PubMed2004

[Osteoporosis impairs fracture healing of tibia in a rat osteoporotic model].

OBJECTIVE: To evaluate the influence of osteoporosis on fracture healing. METHODS: Eighty-four 4 months old female Sprague-Dawley rats were randomly divided into osteoporosis (OP) group and sham operation (SO) group, 42 in each. Rats in OP group were performed ovariectomy operation while those in SO group with sham operation. When osteoporosis formed 10 weeks after ovariectomy, midshaft tibia fracture model was established. Tibias were harvested 2 weeks (2 rats per group), 4 weeks (9 rats per group), 6 weeks (9 rats per group), 12 weeks (9 rats per group) and 18 weeks (7 rats per group) after fracture for bone mineral density (BMD), histomorphological and biomechanical evaluation. RESULTS: Compared with the SO group: (1) Callus BMD was significantly lower about 12.8%, 18.0%, 17.0% in OP group 6, 12, 18 weeks after fracture, respectively (P < 0.05). (2) Callus failure load was significantly lower about 24.3%, 31.5%, 26.6%, 28.8% in OP group, and callus failure stress was also significantly lower about 23.9%, 33.6%, 19.1%, 24.9% in OP group 4, 6, 12, 18 weeks after fracture, respectively (P < 0.05). (3) In OP group, endochondral bone formation was delayed, more osteoclast cell could be seen around the trabecula, and the new bone trabecula arranged loosely and irregularly. CONCLUSION: Osteoporosis influences the middle and late periods of fracture healing in the rat osteoporostic model. The impairment is considered to be the result of the combined effects of the prolonged endochondral calcification, high activated osteoclast cell and the deceleration of the increase in bone mineral density.

Animals↗

PubMedDate not supplied

Distal diaphyseal fractures of the tibia treated by modified Grosse-Kempf nail.

Fractures of the distal fourth of tibia are difficult to treat because of the possible involvement of the joint, the comminution of the fragments, the local skin conditions and the surgical method required. There are many methods of osteosynthesis, and these range from external fixation to use of a plate to combined methods. Intramedullary nailing is generally not indicated in the treatment of such fractures, but if the correct technical procedure is used, indications may be widened, and the method may even be used in cases such as these. It is necessary to saw the tip of the nail so that the distal holes go beyond the fracture line. A total of 30 cases of fracture of the distal fourth of the tibia treated by Grosse-Kempf nailing sawed distally are reported.

Adult↗

PubMed2005

Tibiofibular synostosis procedure in the management of complex tibia fractures.

Complex tibia nonunions and defects caused by tumor, trauma, and congenital abnormality are difficult to treat. The tibiofibular synostosis procedure is a treatment option. Fifteen patients with complex diaphyseal tibia fractures (4 segmental, 11 comminuted; 10 open, 5 closed) were managed with this procedure. Mean time between injury and procedure was 20.3 weeks. Mean healing time was 16 weeks (acceptable); 14 of 15 cases showed healing by final follow-up (36 months). At final follow-up, each patient's knee range of motion (ROM) and ankle ROM were acceptable. Knee ROM varied from full extension to 150 degrees of flexion for 13 patients and from full extension to 120 degrees of flexion for 2 patients. Ankle dorsiflexion ranged from 0 degrees to 40 degrees for 10 patients, from 0 degrees to 30 degrees for 3 patients, and from 0 degrees to 20 degrees for 2 patients. There were no radiographic arthritic changes in any case. The tibiofibular synostosis procedure is effective in treating complex nonunions and defects.

Adult↗

PubMed2005

[Early results of treatment with expandable intramedullary nails in tibia shaft fractures].

OBJECTIVES: We evaluated the use of expandable intramedullary nails, their efficacy, and short-term results in the treatment of tibia shaft fractures. METHODS: The study included 19 patients (8 females, 11 males; mean age 38 years; range 17 to 65 years) who were treated with expandable intramedullary nails (Fixion) for tibia shaft fractures. All the fractures were closed. Four patients had associated injuries. According to the AO classification, the fractures were type 42-A, B, or C. The mean duration from injury to surgery was 2.8 days (range 6 hours to 14 days). The results were evaluated using the Johner-Wruhs criteria. The mean follow-up was 23 months (range 9 to 39 months). RESULTS: The mean operation time was 47 minutes (range 25 to 53 min). Union was achieved in all the patients in a mean of 11.5 weeks (range 8 to 18 weeks). According to the Johner-Wruhs criteria, the results were excellent in 17 patients (89.5%) and good in two patients (10.5%). Treatment of fragmented-oblique fractures of the distal metadiaphysis (42-B2) resulted in a valgus angulation of 5 degrees in two patients, and extremity shortening of 5 mm in one patient, both of whom had good results. Complications such as delayed union, early or late infections, or bone necrosis did not occur. The range of motion of the knee and ankle reached that of the contralateral side in all the patients. CONCLUSION: Expandable intramedullary nails offer advantages in terms of ease of application and are less invasive than static nails and reamed applications. However, they may not provide adequate stability in fractures with fragments greater than 50%.

Adolescent↗

PubMed1991

[Malalignment following injuries of the distal tibia and epiphysis of the fibula].

If the correct treatment is applied, growth disturbances following epiphyseal fractures of the distal tibia are rare. Even if the prognosis is good after the correct treatment of epiphyseal fractures of the distal tibia, the parents and child may have to be informed about growth disturbances. Most frequent is a varus deformity after asymmetric closure of the medial growth plate. If at least 2 years of growth can be expected, a callus resection according to Langenskjöld is indicated. If this procedure fails, the ideal timing for a correction is the end of the growth. Imminent contractures can be an indication for early correction even if a recurrent deformity can be expected. An open-wedge osteotomy permits all three procedures to be carried out: callus resection, axis correction and leg-length correction. If an incongruence of the joint is present, the closed wedge technique using an external fixator is indicated; correction of the leg length can be postponed. Joint incongruence reacts well to axis alignment. The pre-arthrotic joint can remain free of symptoms for years. We never encountered epiphyseal fractures of the distal fibula, but we did see one case of deformity of the ankle joint as a result of closure of the proximal fibular growth plate.

Adolescent↗

PubMed1991

The dynamic axial fixator in fractures of the tibia and femur. A retrospective study in 98 patients.

In a retrospective study involving 98 patients the results achieved with the dynamic axial fixator (Orthofix) in closed or open fractures of the tibia or femur treated in two district hospitals in the southwest of England during the period 1986-1988 were evaluated. Fifteen patients were vacationers and, as a result, were lost to followup. The operation and subsequent management was performed by more than 15 different members of the staff, of different levels of seniority and experience. The present survey in this group of surgeons has demonstrated that the dynamic axial fixator is a reliable means of treating open fractures of the tibia following an initial good reduction. It does, however, highlight the importance of the strict adherence to simple guidelines for application, pin care and dynamization if best results are to be obtained.

Adolescent↗

PubMed1990

[Fatigue fracture of the tibia following osteosynthesis. An interesting case].

Stress-fractures most often affect healthy bones, in the majority of cases the tibia. We report a case of a young man who had a stress-fracture 18 months after osteosynthesis of a lower leg-fracture. Under biomechanical aspects an oscillation-fracture is mostly probable because the angle of the fracture is exactly 45 degrees to the longitudinal axis of the tibia.

Adult↗

PubMed1991

Plating of the fibula. Its potential value as an adjunct to external fixation of the tibia.

There is added stability when plate fixation of the fibula supplements the external fixator used in treating tibial fractures associated with a segmental defect. An anatomic specimen model of a Grade III open fracture of the tibia with an associated fibular fracture was used in this study. Fibular internal fixation using an AO standard plate was performed on one of each of five matched pairs of legs. These were then subjected to identical loads in compression and torsion. The numeric values obtained during loading in all modes were converted to ratios between each of the tested pair to directly compare the effect of stabilization of the fibula. The final results showed that in each case, the preparation with fibular plating had improved resistance to deformation in axial loading. On average, the plated specimens were 2.2 times stiffer. In torsion, plating the fibula did not appear to affect the resistance of the construct to the applied load. Supplemental plate fixation of the fibula in fractures of the tibia with segmental defects may improve subsequent morbidity. The increased rigidity of the system may be sufficient to allow partial to full weight bearing immediately after surgery. This may have significant value in the management of the polytraumatized patient.

Biomechanical Phenomena↗

PubMed1990

Influence of carbonated drinking water on tibia strength of domestic cockerels reared in hot environments.

To determine the effects of heat stress and drinking water treatments on physical characteristics of skeletal tissue, tibias of cockerels ranging in age from 4 to 11 weeks were tested for breaking strength. Birds were subjected to either a thermoneutral environment (21 +/- 2 C) or a hot environment (37 +/- 2 C) and supplied with either tap or carbonated drinking water. Breaking strength of tibias was reduced in the hot environment; however, consumption of carbonated drinking water in the hot environment resulted in bone strength comparable with that associated with thermoneutral environment (both types of water). Also, bones from birds of the carbonated water-37 C treatment group had less phase breaks and tended to separate with a single break. Results indicate that hot environment and carbonated drinking water not only affect the previously reported morphologic and chemical characteristics of developing bone, but also their physical attributes.

Animals↗

PubMed1990

The role of bone grafting in the treatment of delayed unions and nonunions of the tibia.

From 1972 to 1984, 53 delayed unions or non-unions of the tibia were successfully treated by either posterolateral or local bone grafting techniques. There were 40 initially open fractures, 19 of which became infected nonunions. The average time from injury to surgery was 10.9 months. Clinical union was achieved in 5.6 months in the posterolateral bone graft group and in 5.4 months in the local bone graft group. There were no refractures or amputations and only one patient continued to drain following bony union. The combination of these surgical techniques allows for an approach to bone grafting of the entire tibia and remains the most effective and reliable form of treatment of the tibial delayed union or nonunion.

Adolescent↗

PubMed1990

The association of two or more surgical methods in the tibia.

The authors propose the association of two or more surgical methods in the treatment of aseptic pseudarthrosis of the tibia with the object of increasing the probability of union and reducing the period of disability. Based on the anatomo-pathological features of the pseudarthrosis, methods aimed at obtaining mechanical stability (fibula pro tibia, Küntscher) and methods which stimulate biological repair (decortication, transplants) are associated. The results obtained confirm the theoretical presuppositions, revealing a relatively short amount of time required for healing.

Adult↗

PubMed1990

Delayed intramedullary nailing after failed external fixation of the tibia.

Thirteen patients (11 males, two females) with 16 tibia fractures (three segmental) were initially treated with external fixation and secondarily had delayed intramedullary nailing after fixator removal. There were six closed injuries and two Grade I, five Grade II, one Grade IIIA, and two Grade IIIB open soft-tissue injuries. The average patient age was 40 years (range, 19-84 years). The external fixator was removed at an average of 12 weeks (range, three to 25 weeks) for malreductions in six case, atrophic segmental fractures in two, and atrophic/unstable fracture patterns in five. Intramedullary nailing was performed at an average of 13 days (range, five to 30 days) after fixator removal. There were 12 reamed nails and one self-broaching nail. Preoperative antibiotics averaged eight days, and postoperative averaged 11 days. All patients healed with bridging callus; full weight bearing occurred at an average of 2.7 months. Follow-up evaluation averaged 22.5 months. Weight bearing began within the first three weeks in 12 of 13 patients. Results were rated as excellent in eight and good in five. There were no complications related to infection or non-union. Delayed intramedullary nailing, after excluding potential high-risk patients, is an option for the treatment of tibia fractures that have failed treatment with external fixation. However, it is not recommended as a routine procedure.

Adult↗

PubMed1990

Lower infection rate after interlocking nailing in open fractures of femur and tibia.

Between 1975 and 1987 91 patients with Types I and II open lower extremity fractures (66 tibia and 25 femur) have been treated surgically with interlocking nailing at the I University Clinic of Traumatology, and the Trauma Department of Wilhelminenspital, Vienna. Our infection rate of 1.2% was found to be lower than figures cited in the literature. Conscientious indication of the interlocking nail in these circumstances cannot claim all the credit for these results, the appropriate preoperative management with preventive antibiotics together with excellent operative technique have to be taken into consideration as well. Reviewing these results, we have adopted the opinion that the interlocking nail, when selectively used in the hands of an expert, can be recommended not only in closed fractures but also in Types I and II open fractures of the femur and tibia, provided that the special principles of treatment in a particular case are not neglected.

Adolescent↗

PubMed1990

Medial external fixation with lateral plate internal fixation in metaphyseal tibia fractures. A report of eight cases associated with severe soft-tissue injury.

Eight patients with unstable fractures involving the articular surface and metaphyseal-diaphyseal bone of the proximal or distal tibia associated with severe soft-tissue injury or compounding wound were treated with irrigation, debridement, tetanus inoculation, antibiotic prophylaxis, and combined internal fixation with one-half frame external skeletal fixation for neutralization. All patients were followed to complete healing and functional restoration of the extremity. All fractures healed, but one superficial and one deep infection occurred. All patients achieved at least 110 degrees of knee motion. This method should be considered in unstable metaphyseal and articular tibia fractures not adequately stabilized with a lateral plate in which use of an additional medial plate is required for stability, but contraindicated because of the status of the soft tissues or extensive comminution of the bone.

Accidents, Traffic↗

PubMed1989

[A new general orthopedic universal intramedullary nail for the tibia. Clinical development and experiences].

The new AO-Universal-Nail was developed through intensive cooperation between fundamental research, technicians and clinical application. We are now able to transfer the concept of a Universal-Nail (initially for the femur) to the tibia as well. The existing technique of the medullary nail was maintained as far as possible. Special features to be highlighted: The new AO-bend obtains better impact behavior and a more anatomical stabilization of the bone cavity. The tapered tip eases the gliding of the tip of the nail along the inner wall of the dorsal corticalis and past the fracture. Proximal locking is obtained through three transverse extending holes. They offer many choices for optimal placement of the locking bolts. Interlocking from anterior to posterior has been logically abandoned, due to danger for nerves and vessels. Distal looking offers a large selection for stabilization through one a.p.-hole and two transverse holes for the locking bolts. The design from anterior to posterior entables the protection of the soft tissue. The Universal-nail can either be inserted with or without interlocking. A free decision is possible during the operation. The new AO-Universal-Nail for the tibia (as for the femur) maintained reliable aspects and was consequently converted to meet new demands and findings. The basic fundamentals of the AO, namely the observance and application of biomechanical principles and safe operation procedure were attained through simple instrumentation and have been proved successful for clinical application.

Fracture Fixation, Intramedullary↗

PubMed1988

[Stable metal osteosynthesis in ununited fractures and pseudarthroses of the tibia].

The plunge nailing osteosynthesis with the Küntscher nail through the tibia tuberosity and with the Bogdanov nail through the medial malleolus provide stable fixation of the fragments. When combined with decortication of the bone diaphysis and autoplasty with translocated bone transplants the method gives consolidation in ununited fractures and false joints of the tibia within 17-21 weeks. The method was used in operations of 20 patients. The follow-up observation of 18 patients lasted longer than a year. All of them resumed their working capacity.

Adult↗