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PubMed1987

Fracture of the tibia complicated by acute compartment syndrome.

A consecutive series of 32 patients with tibia fractures complicated by compartment syndrome was treated with fasciotomy. One group was also treated with closed reduction of the fracture and cast immobilization and compared with a comparable group treated with internal fixation without case immobilization after fasciotomy. All other patients were treated with fasciotomy and reduction followed with either external skeletal fixation, pins and plaster, or skeletal traction. Care of the open fasciotomy incisions, observation of the neurovascular status of the limb, and rehabilitation of the extremity were facilitated by internal fixation operations without subsequent external cast immobilization. The anatomic and functional results in this group were better than those treated with fasciotomy and cast immobilization. All fractures were united by 20 weeks. Complications in both groups were similar, although one deep infection, which was resolved with appropriate treatment, occurred in the group treated with internal fixation. Six open tibia fractures were treated with external skeletal fixation after fasciotomy; the results were less satisfactory, but the initial injuries were also more severe in this group. Patients with closed tibial fractures complicated by compartment syndromes should be treated expeditiously with fasciotomy, followed by stable internal fixation.

Acute Disease↗

PubMedDate not supplied

The Lottes nail in the closed treatment of tibia fractures.

The effectiveness of the Lottes nail was evaluated in 63 consecutive cases of tibia fractures treated by closed intramedullary fixation with image intensification. The procedure was offered to all adults except those with Gustillo and Anderson Type III open wounds and with fractures less than 10 cm from the knee or 5 cm from the ankle. The operations were generally performed within a few days in closed fractures and somewhat later in open fractures. Patellar-tendon-bearing casts were applied five to ten days after operation, and weight-bearing to tolerance was emphasized. All fractures united. Bridging callus was generally seen by seven or eight weeks. Complications not necessarily peculiar to the procedure included one each of delayed wound infection, peroneal neurapraxia, compartment syndrome, heel decubitus, and shortening of more than 2 cm. Technical failures included malunion of fracture, loss of fixation by the nail, backing out of the nail, and penetration into the ankle joint. Most of the complications and technical failures could be remedied and did not influence the ultimate result. The authors recommended the Lottes nail and closed intramedullary nail fixation as the preferred method of treatment of diaphyseal fractures of the tibia in adults.

Adolescent↗

PubMed1985

Growth disturbances following fractures of the femur and tibia in children.

We reviewed 160 diaphyseal and metaphyseal fractures of the femur and tibia in children treated between 1964 and 1980 at the Orthopaedic and Traumatological Clinic of the University of Rome. The initial documentation was complete in these cases and 96 presented for clinical and radiographic long-term follow-up. The analysis of this material showed that lengthening of the affected limb had occurred in 46% of cases. The amount of such lengthening, however, was only from 0.5 to 1.5 cm and never exceeded 2 cms. It was most frequent in children between the ages of 3 to 8 years with fractures of the tibia, particularly in the upper third of the bone.

Child↗

PubMed1982

[A contribution to the treatment of the proximal metaphyseal tibia fracture in children (author's transl)].

The proximal metaphyseal fracture of the tibia in children must be regarded as an important injury, which will be developing into a progressive crus valgum if it stays untreated. The cause of this misgrowth is the interposition of the Pes anserinus into the crack of the fracture. Initial the x-ray will show an exactly position of the tibia, so that the treatment seems to be conservative. The misgrowth only can be prevented by an operation with releasing the Pes anserinus out of the fracture. One case of this rare injury is demonstrated.

Child↗

PubMed1982

[The fibula-pro-tibia operation in infected defect pseudarthroses of the lower leg].

Surgery to effect synostosis between fibula and tibia is to be considered if it is not possible to bridge a relatively large gap at the tibia directly at the site of the defect by autologous (cortico)-spongiosaplasty because of inflammatory complications. Various modifications of the procedure are possible--they are described in the article--but the authors are of the opinion that preference should be given to synostosis which leaves the fibula at its physiological site. Technical details are given and the pros and cons discussed. This article is based on the experience collected during the treatment of eight patients.

Bone Plates↗

PubMed1982

[Tibio-fibular graft as a treatment of non-union of the tibia (author's transl)].

The authors have reviewed 47 cases of septic non-union of the tibia treated by tibio-fibular graft, Bone union was obtained in 31 cases, 2 limbs were amputated and 13 tibiae were united after another procedure. In 17 cases the grafts were performed in the presence of a discharging sinus. These cases did as well as any others. In cases of bone loss after diaphyseal resection, tibio-fibular grafting appeared to be a better procedure than Papineau's technique. Several cases of failure of this technique were cured successfully by tibio-fibular grafting when the bone loss was extensive, tibio-fibular grafting had to be completed by a supplementary tibial graft. The authors consider that grafting procedure should be done early in cases of extensive bone loss or in cases of severe compound comminuted fracture.

Adult↗

PubMed1984

[Floating knee fracture (ipsilateral fracture of the femur and tibia)--treatment by closed Ender nailing].

Fourteen cases of ipsilateral fractures of the femur and tibia (floating knee fracture) were reviewed and patients were graded according to the type of fracture and the method of treatment. Using the criteria for assessment described by Karlström and Olerud, patients were graded as excellent, good, fair and poor. Excellent results were achieved in five patients, good in three and fair in six. When the fracture extended into the knee, it caused knee problem in three out of five. In ten cases the femoral shaft fractures were nailed and in five both bones were nailed. Nailing of both femur and tibia gave good or excellent result in all five cases. As the comminution is often severe in the cases of floating knee fracture, intramedullary nailing by Küntscher may be difficult. We have introduced a closed Ender nailing for femoral and tibial shaft fractures and we have found that this method is also useful for the floating knee fracture. It is advantageous for this type of fracture, because it is technically simple, it has wide indications and it results in rapid bone union without knee disturbance.

Adolescent↗

PubMed1984

Fractures of the intercondylar eminence of the tibia in childhood.

Fracture of the intercondylar eminence of the tibia occurs more frequently in children than in adults. This fracture may occur as an isolated injury without damage to the other structures of the knee joint. X-ray examination of the painful swollen knee of the child is necessary to determine the exact diagnosis. Type I and type II fractures of the intercondylar eminence of the tibia require only immobilisation in a plaster cast after anatomical reposition. Open reduction is often necessary following type III fractures and almost invariably following type IV fractures. Following anatomical reposition of the avulsed fragment the prognosis for complete recovery is excellent.

Adolescent↗

PubMed1980

Congenital pseudarthrosis of the tibia: treatment with vascularized autogenous fibular grafts. A preliminary report.

A review of the literature concerning the classification, etiology, histology and treatment of congenital pseudarthrosis of the tibia is presented. The authors describe two patients in whom resection of the lesion and reconstruction of the extermity with free vascularized fibular grafts were performed. Preliminary results after a short period of follow-up indicate that the technique may be an appropriate method for treatment of congenital pseudarthrosis of the tibia, since "the living graft" is not dependent upon the recipient bed for survival. Progressive hypertrophy of the graft without resorption is demonstrated.

Child, Preschool↗

PubMed1981

Open tibia fracture with compartment syndrome.

In a series of 104 open tibia fractures, six patients developed compartment syndromes involving all four compartments of the lower leg, four of which developed after initial debridement and reduction. The presence of an open tibia fracture with a displaced, comminuted, fibula fracture should suggest the possibility of a developing compartment syndrome. Clinical symptoms include: increasing muscle pain which can be exaggerated by stretching; loss of sensation; decrease in muscle strength; and palpably swollen compartments. Double fasciotomy incisions may lead to adequate decompression, but result in marked loss of soft tissue support for the fracture. To sustain stability, a single posterolateral incision is recommended for compartmental decompression.

Accidents, Traffic↗

PubMed1982

Treatment of congenital pseudarthrosis of the tibia with free vascularized bone graft.

Considering the often poor results obtained with conventional methods of bone grafting in the treatment of congenital pseudarthrosis of the tibia, the free vascularized bone graft may offer the best chance of cure to these unfortunate patients. A segment of rib or fibula may be harvested with its vascular supply and used as a graft to the involved segment of the tibia, using microvascular techniques to anastomose its vasculature to that of the affected leg. The advantages of this approach include a one stage procedure with minimal hospitalization, and a minimal donor defect especially when the rib is used. Although the procedure is time consuming the overall operative effort is far less than that of multiple procedures often needed with conventional methods of grafting. Although published reports are few, preliminary reports from microsurgeons using this technique indicate a high success rate, even after previous failures of conventional grafts. The increasing use of microvascular free bone transfers may eliminate the need for amputation in many of these children.

Bone Transplantation↗

PubMed1982

Amputation for congenital pseudarthrosis of the tibia. Indications and techniques.

The indications for amputation with pseudarthrosis of the tibia are: failure of bony union after three surgical attempts; significant leg-length discrepancy; interference with growth distal to the pseudarthrosis; and a significant period under medical care, such that the patient suffers unduly. The primary problems related to amputating at the level of the pseudarthrosis are poor stump configuration, bony overgrowth, and poor skin coverage. A distal amputation at the ankle is recommended, using the technique for a cartilage-preserving Symes amputation. Methods for realigning the tibia at the time of amputation include the use of an intermedullary rod or a compression plate. The ultimate goal of treatment is always a functional limb.

Amputation, Surgical↗

PubMed1982

Nonunion of the tibia treated with Küntscher intramedullary nailing.

Nonunion of the tibia was treated by Küntscher intramedullary nailing un 48 patients. Thirty patients were treated with a completely closed intramedullary nailing and 18 required an open tibial osteotomy to realign the fracture. Bone grafting was not performed. The average time elapsed from injury to surgery was 15 months and the average healing time, as determined roentgenographically, was nine months following surgery. Three postoperative infections cleared with debridement and antibiotic therapy and subsequently united. There were two failures with persistent nonunion. Closed intramedullary nailing is an effective method of managing nonunion of the tibia in properly selected cases.

Adolescent↗

PubMed1982

Dynamic osteosynthesis with angled flexible nails in recent fractures of the diaphysis of the tibia.

Dynamic osteosynthesis with curved flexible nails was introduced by Burghele for the treatment of recent fractures of the diaphysis of the tibia. Our experience in sixty patients has shown that this method of treatment produces better results than rigid AO osteosynthesis and also than osteosynthesis with rigid Kuntscher nails. It can be used in both uni- and multifocal fractures. The technique is simple and atraumatic and can be used in fractures of the diaphysis of the tibia to within 8 cm of the ankle joint.

Bone Nails↗

PubMed1982

Closed osteosynthesis with stabilised Küntscher nail in comminuted diaphyseal fractures of the femur and the tibia.

Comminuted fractures of the femur and tibia often pose difficult problems of reduction and stable fixation. Closed endomedullary fixation in which the fixation device is anchored to the main fragments by screws enables these difficult problems to be solved in the majority of cases. Fourteen fractures of the femur and nine of the tibia were treated by this method in just over a year. In the author's opinion, the results confirm the validity of the method, which, although known for some time, has only recently been reintroduced by Kempf et al. (1978).

Adolescent↗

PubMed1981

Advanced tibia vara (Blount disease) in adolescent Nigerians.

Twenty-five cases of advanced tibia vara occurring in adolescent Nigerians treated at the University College Hospital, Ibadan, are reported. They were aged from 11 to 14 years. The severity of the condition was assessed by measuring the intercondylar distance of the knees, radiological appearance, and measurement of the femorotibial angles. The condition is characterized by failure of growth of the posteromedial part of the proximal part of tibial epiphysis, the deformity producing acute varus at the upper end of the tibia with medial torsion and ultimately with flexion of the diaphysis on epiphysis. The deformity leads to early degenerative changes in the knee.The decision to correct the deformity by tibial osteotomy was not only for cosmetic reasons but also to prevent knee osteoarthritis at a later date. The operation in experienced hands gives satisfactory cosmetic appearance with few complications except for the tendency of the scars to be keloidal, broad, and conspicuous.

Adolescent↗

PubMed1995

Follicular atrophoderma in association with congenital pseudarthrosis of the tibia.

Follicular atrophoderma has always been associated with other congenital malformations including, Conradi-Hünermann syndrome, Bazex's syndrome and keratosis palmaris et plantaris dissipata. Congenital pseudarthrosis of the tibia has usually been associated with neurofibromatosis. We report a case of follicular atrophoderma in association with congenital pseudarthrosis of the tibia: a previously unreported association with, in our case, a good outcome for the pseudarthrosis.

Adolescent↗

PubMed1995

Treatment of an adult with neglected congenital pseudoarthrosis of the tibia with acute fracture: a case report.

Treatment of congenital pseudoarthrosis of the tibia is very difficult. Numerous surgical procedures have been used including bone grafting, fixation, pulsed electromagnetic field, vascularized fibular bone grafting and lengthening devices. Previous studies, often reporting unsatisfactory results, are limited to children and adolescents. In adults, the following factors need to be considered: leg length discrepancy, leg deformity, soft tissue problems, lack of potential for growth and difficulties in healing. We reported a case of untreated congenital pseudoarthrosis of the tibia with fracture in a 32-year-old man. Conventional treatments used included excision of the pseudoarthrosis, correction of the deformity, intramedullary fixation, bone grafting and soft tissue transplantation for lengthening and coverage. These procedures led to good bony union and a satisfactory outcome.

Acute Disease↗