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PubMed1993

Pilon fractures of the distal tibia.

Pilon fractures are relatively rare fractures of the distal metaphysis of the tibia resulting from axial and/or rotational forces. They involve varying degrees of metaphyseal disruption, articular damage, and malleolar displacement. When severe, these injuries represent a tremendous challenge to the orthopaedic trauma surgeon. Traditional treatment of high-grade pilon fractures by closed means has led to unsatisfactory results. Open reduction and internal fixation in accordance with AO/ASIF principles has greatly improved the outcome in these often disabling fractures. Surgical technique involves anatomic restoration of fibular length, reconstruction of the plafond, bond grafting of the metaphyseal defect, and buttress plating of the medial tibia. Thorough preoperative planning and meticulous surgical technique produce predictably good results in the majority of cases.

Ankle Injuries↗

PubMed1993

Double stress fracture of the tibia in the presence of arthritis of the knee.

Two cases of double stress fracture of the tibia are described. Both patients had severe medial compartment arthritis of the knee and some varus bowing of the tibia prior to the stress fractures. The deformities were corrected by tibial osteotomies. Total knee replacement was not required.

Biomechanical Phenomena↗

PubMed1993

Fat emboli syndrome in isolated fractures of the tibia and femur.

The fat emboli syndrome (FES) was studied in otherwise healthy young skiers with isolated fractures of the tibia and femur treated from 1980 until 1991. During the first year, 13 of 56 tibial and femoral fractures developed FES. The overall incidence of FES was 23%: 19% among fractured tibiae and 75% among fractured femora. Thirty-three percent of displaced transverse tibial fractures developed FES. During the next ten year, only those tibial or femoral fractures that developed FES were studied. There were 44 such cases. Symptoms included a mean PO2 of 45 mm Hg and a fever of 39 degrees. In addition, 40% of the patients had petechiae. The mean patient age was 26 years. None of the patients had other significant injuries or illnesses, 75% received oxygen, and 9% received steroids. None of the patients received mechanical ventilation. All cases had developed by the third day of hospitalization, and the duration of the syndrome was less than four days in 86% of the patients. The mortality rate was 0%. In 50% of the patients, hospitalization was prolonged because of FES; otherwise, there were no complications. This study of isolated femoral and tibial fractures in healthy young skiers demonstrates that FES occurs more commonly than previously thought, is not associated with mortality, and causes little morbidity. Treatment should consist of supportive care only, with specific care directed toward the underlying injury.

Adult↗

PubMed1977

[Comparison of the results of surgical and conservative treatment of fractures of the diaphysis of the tibia].

In this paper is treated the fundamental problematic of the fracture of the diaphysis of the tibia and the therapeutic results after the conservative and operative treatment are confronted. Among 518 patients with 433 open fractures and 35 with closed fractures of the diaphysis of the tibia, successful treatment of more 2/3 was obtained in the period from 1968 to 1972. Following our casuistics and literature, whose results are similar, we find out that the average total treatment of the osteosynthesis of the fracture of the diaphysis was shortened for 2,5 months depending upon the type and the localisation of the fracture. Apolied methods of the operative and conservative and conservative treatment in relation to the velocity of the medical cure as well as to the extreme anatomical-functional results are analised. We noticed that osteosynthesis, made by the intermedullary nail and the extension of the canals or by a small AO table, by the achieved stability makes conditions of immediate motions and an early rehabilitation. Because of that it gives the best functional results.

Adult↗

PubMed1996

[Fractures of the anterior rim of the distal part of the tibia. Apropos of a series of 38 cases].

PURPOSE OF THE STUDY: Fracture of the anterior rim of the distal tibia is a rare injury. This fracture seems less serious than other pilon fractures but its treatment is often difficult and didn't give better results. The aim of this study was to describe problem we dealed with and to suggest solutions in order to improve long term results. MATERIAL: The study included 38 cases, treated in 5 Paris district trauma centers, with a minimal follow-up of 6 months. All patients were asked for clinical and radiological review between september 92 and march 93 ; otherwise, latest review datas were used. METHODS: Authors suggest a radiological classification based upon type, width and talus anterior displacement. Different surgical procedures were performed for 33 cases (screw, plate, external fixation) ; conservative treatment was used 5 times (non weight bearing plaster cast). Anatomical reconstruction was analysed. Functional results scoring system included pain, global abilities and ankle range of motion. Ankle arthritis was rated according to 1992 SOFCOT scoring system at 1 and 3 year follow-up. RESULTS: Follow-up ranges from 6 months to 11 years (average 28 months). 55 per cent of cases were lost for review with 1 year mean follow-up. 45 per cent of patients were recently tested with 4 year mean follow-up. Three ankles had joint fusion 6 to 18 months after trauma. Functional result was poor. For 35 ankles analysed 1 out of 4 remained totally painless (9 cases), 1 out of 2 had a good function (20 cases) and 1 out of 3 normal X-rays (12 cases). Arthritis was found for 2 ankles out of 3 after one year follow-up (16 cases out of 23). Loss of reduction or incomplete reconstruction seemed the most important point (13 cases out 38, 13 cases after 35 surgical procedures). DISCUSSION: Many patients didn't get a long term evaluation, and this study has no statistical value. Anyway, function loss was always early on a weight bearing joint. A perfect and stable reconstruction gives a higher rate of good result (11 out of 14). Analysis of cases with anatomic imperfection leads to recommendations: fixation of separation fracture, even undisplaced, bone grafting to correct impaction, appropriate use of external fixation for neutralization. CONCLUSION: Better results should come from a better analysis of the bone lesions : separation, impaction or mix fracture. This analysis leads to appropriate surgical procedure which give back a stable and anatomic distal tibia. External fixation can be usefull for immobilization ; this can't avoid open reduction and internal fixation of the fracture. Bone grafting can be useful for impaction fracture.

Adolescent↗

PubMed1997

Stress fracture of the tibia after arthrodesis of the ankle or the hindfoot.

We studied twelve patients who had a stress fracture of the tibia and one patient who had a stress fracture of the fibula after arthrodesis of the ankle or the foot. A second stress fracture subsequently developed in two patients. All but two patients were managed non-operatively, and the fractures healed uneventfully. One patient who was managed operatively had a below-the-knee amputation to treat a painful non-union of a tibial fracture, and the other had interlocking intramedullary nailing for a displaced fracture. All but one of the arthrodesis sites had fused before the stress fracture occurred. All of the stress fractures that occurred after arthrodesis of the ankle were in the middle and distal aspects or the distal aspect of the tibia, while those that occurred after triple arthrodesis were in the distal aspect of the fibula or the medial malleolus. Although six of the thirteen patients still had uncorrected alignment and deformity after the arthrodesis, optimum alignment after the arthrodesis did not preclude the occurrence of a stress fracture. We conclude that stress fracture must be considered in the differential diagnosis of pain months or even years after solid fusion at the site of an ankle or triple arthrodesis.

Adult↗

PubMed1997

[Post-traumatic epiphysiodesis of the distal end of the tibia in children].

PURPOSE OF THE STUDY: Thirteen distal traumatic epiphyseal closures of the lower end of the tibia are studied. A bony bridge resection was performed in nine cases. The aim of this study was to define the kind of injury that drives to epiphysiodesis in this localisation, and secondly to define the factors that may influence the results of de-epiphysiodesis. MATERIALS AND METHODS: One hundred and eighty-eight children were hospitalized between 1981 and 1995 for the treatment of a fracture of the lower end of the tibia. Six epiphysiodesis followed a Mac Farland lesion. Six epiphysiodesis followed a Salter and Harris Type-II injury. One epiphysiodesis followed a triplane fracture. The diagnostic of epiphysiodesis was performed at an average of 12 months after injury. The bony bridge interested less than 50 per cent of the growth plate in all cases. There was a varus deformation between 7 degrees and 20 degrees in six cases (average 13.8 per cent). Ten surgical procedures were performed: one fibular bi-focal epiphysiodesis and nine tibial de-epiphysiodesis including a resection of the bony bridge filled with acrylic cement. Two children were not operated because they were close to the end of growth and there was no varus deformation. One child was not reviewed. RESULTS: There was a significant correlation between the children age and the importance of the ankle varus deformation. The younger the children were and the more important the varus deformation was. Only three de-epiphysiodesis had a good clinical and radiological result. In five cases, a second surgical procedure was necessary. Fibular bi-focal epiphysiodesis gave a good clinical result. DISCUSSION: In this location, Harris and Salter type II fractures may have a poor prognosis for growth if the injury occurred with high energy. Varus deformation is a common way to discover epiphysiodesis in this location. There was no correlation between the children age and the result of the de-epiphysiodesis, and between the delay since injury and the de-epiphysiodesis result. There was a correlation between the result and the presence of a varus dexasation in the ankle. The more important the varus was and the poorer the result was. CONCLUSION: Mac Farland lesion and Salter and Harris type II lesion drive to epiphysiodesis more often than any other distal tibial fracture. Varus desaxation is more important in younger children and seems to determine de-epiphysiodesis results. But over all, de-epiphysiodesis has a poor prognosis in more than 60 per cent of cases.

Adolescent↗

PubMed1997

Congenital pseudarthrosis of the tibia treated with free vascularized fibular graft.

Management of patients with deformities due to congenital pseudarthrosis of the tibia continues to be controversial. The use of free vascularized fibular grafts in the reconstruction of these deformities appears to be successful in this patient population but is not without potential for significant complications. Long-term evaluation, at least to skeletal maturity, is necessary to judge the success of any procedure done for any pediatric patient. This case illustrates the natural history of the vascularized free fibular graft for congenital pseudarthrosis of the tibia in a young child. Complications of this treatment modality did occur, including probable recurrence and fracture at almost 11 years post-index procedure. However, stable reconstruction leading to fracture union was achieved, and the patient has resumed full activities with little residual deformity.

Adolescent↗

PubMed1997

Multiple stress fractures of the tibia in a healthy adult.

Multiple stress fractures in the same bone are a rare occurrence. This paper presents an unusual case of a 19-year-old, healthy man who sustained a pathologic fracture of the proximal tibia through a stress-fracture site. The radiographic examination of the tibia also revealed multiple stress fractures inferior to the pathologic fracture. Magnetic resonance imaging can be used to rule out neoplasm and to confirm the stress-fracture diagnosis. Multiple stress fractures in the same bone can be treated with cast immobilization.

Adult↗

PubMed1997

[Value of the surgical approach through the patellar tendon for intramedullary nailing of the tibia and the femur].

The goal of this study was to propose a new approach of the upper tibia for intramedullary nailing. Since two years, the authors performed a transversal skin incision superior to the distal end of the patella. The patellar tendon is dissociated and the tibia is perforated through the anterior intercondylar area. The advantages of this approach versus classical techniques are discussed. This approach allows isolated tibial or femoral nailing but also both nailings during the same procedure.

Bone Nails↗

PubMed1997

[Flexible locked centromedullary osteosynthesis. Results of 125 cases of unstable cortical bone fractures of the tibia].

We present a series of 125 cases of centromedullary fixation with a flexible locked nail of unstable cortical bone fractures of the tibia in which we studied healing conditions in order to identify parameters which would predict the rate of consolidation. One hundred ten fractures followed more than 6 months were included in the statistical analysis. For 94 fractures, primary consolidation was achieved in a mean 11 weeks. Fractures situated in the lower portion of the tibia healed the fastest (10 weeks). However, opening the fracture site and comminutive fractures did not affect the rate of healing except for proximal fractures and for fractures with a gap exceeding 10 cm. These two parameters, width of the bone gap (whether trauma induced or iatrogenic) and proximal localization of the fracture were the cause of the cases with long periods of non-consolidation (14.5%). The speed of peripheral osteogenesis is considered to be accelerated with the flexible nail as seen in our 94 cases where no conversion was necessary. This method provides a mean 1 month gain over consolidation times compared with locked nailing where the distal locking probably increases the rigidity of the system.

Bone Nails↗

PubMed2003

Quantitative ultrasound of the tibia and radius in prepubertal and early-pubertal female athletes.

BACKGROUND: Physical exercise during childhood has been shown to enhance bone mineral density, thus reducing the risk of osteoporosis. OBJECTIVE: To examine bone properties, as measured by quantitative ultrasound, in prepubertal and early-pubertal female athletes engaged in impact and nonimpact sports. DESIGN: Survey. SETTING: General community. PARTICIPANTS: Twenty-five acrobatic gymnasts, 21 swimmers, and 21 control subjects. Athletes had been training for at least 1(1/2) years. MAIN OUTCOME MEASURE: Bone speed of sound (bilateral) at the distal radius and the midtibia. RESULTS: Gymnasts were significantly shorter and lighter than swimmers and control girls (P<.001) but had a body mass index similar to that of swimmers. Adiposity was lower in athletes than in controls. Speed of sound did not correlate with measures of body size. Higher mean +/- SD radial speed of sound values (nondominant side) were observed in gymnasts (3764 +/- 104 m/s; P =.045) than in swimmers and control girls (3732 +/- 99 and 3721 +/- 83 m/s, respectively). Mean +/- SD tibial speed of sound values (nondominant side) were similar in gymnasts and swimmers (3629 +/- 87 and 3619 +/- 78 m/s, respectively) and higher in the athletic groups than in the control group (3516 +/- 127 m/s; P<.001). In all 3 groups, no differences were observed between dominant and nondominant sides in the radii or tibias. CONCLUSIONS: Physical exercise, impact and nonimpact, is related to enhanced bone properties, as measured by quantitative ultrasound. Longitudinal studies using various modes of bone evaluation are necessary to determine the long-term effect of various types of exercise on bone properties.

Anthropometry↗

PubMed1996

Light and electron microscopic studies of bone-titanium interface in the tibiae of young and mature rats.

Bone-titanium contact was examined in young and mature rats on various days after insertion of pure titanium into the tibia. Under light microscopy, on the 14th day, lamellar mature bone was initially formed, and was seen to make direct contact with the titanium in both groups. In young rats on the 28th day, bone-titanium contact was greater than that in mature animals. On 1-micron sections, an amorphous zone 0.5-1.0 micron thick was found around the titanium, and a slender cell layer lay parallel to the implant, forming the superficial layer of the amorphous zone. Ultrastructurally, these slender cells were identified as osteoblastlike cells and made direct contact with the implant via a 20-50-nm thin amorphous zone. Below this cell layer, a collagen-containing, poorly mineralized zone was present and bordered by lamellar bone with a lamina limitans-like structure. However, this cell layer was absent in places, and therefore the thick amorphous zone without slender cell layer consisted ultrastructurally of a 20-50-nm thin amorphous zone and a poorly mineralized zone bordered by the lamellar bone. Sometimes this poorly mineralized zone was absent, and in such cases, the lamellar bone contacted the titanium by the thin amorphous zone formed on the lamina limitans-like structure. Thus, although bone was seen to make contact with the titanium implant, ultrastructurally a 20-50-nm thin amorphous zone, a slender cell layer, and/or a poorly mineralized zone were interposed between the bone and titanium.

Animals↗

PubMed1997

Effects of aging on titanium implants inserted into the tibiae of female rats using light microscopy, SEM, and image processing.

We examined the influence of aging on the implant-bone interface of titanium implants inserted transcortically and extending into the medullary canal of rat tibiae, and quantitatively assessed the differences in bone reaction using an image processing system. Three groups of 15 female rats, aged 6 weeks (young group), 22 weeks (adult group), and 80 weeks (old group) were used in this experiment. The animals were sacrificed 28 days after implant placement. Toluidine blue stained undecalcified sections were prepared for histological observation and image analysis, and the implant socket was observed by SEM. There was no difference in the degree of maturation of newly formed bone between the young and adult groups. Titanium implants inserted in the young and adult groups were surrounded with a bone layer. In the old group, however, there was little mature bone tissue around the implants. Quantitative evaluation indicated that the young group showed the highest, the adult group showed a slightly lower, and the old group showed the lowest percent bone contact, thickness of bone contact, and area of bone surrounding the implant.

Aging↗

PubMed1997

Positional stability of polylactide pins with various surface textures in sheep tibia.

Resorbable pins with a smooth or textured surface were produced from poly(L-lactide) P(L)LA poly(L/D-lactide) 95/5% P(L/D)LA, and poly(L/DL-lactide) 95/5% P(L/DL)LA by injection molding. The pins were implanted in sheep tibiae to establish whether the pin surface geometry and the polymer composition used for the pin preparation affect their positional stability in bone; i.e., can the pin design and its ability to swell in body fluids protect against loosening. Three of the 32 P(L)LA pins with a smooth surface loosened but none of the P(L/D)LA and P(L/DL)LA pins with a smooth surface did. This may indicate that expansion of the pin upon swelling protects against loosening, even if the pin's surface geometry is not optimal. None of the pins with a textured surface were loose, independent of the polymer used for the pin preparation. The textured surface of these pins allowed the ongrowth of new bone and hence, implant anchoring, secured the positional stability of the implant in the bone.

Animals↗

PubMed1998

An immunoelectron microscopic localization of noncollagenous bone proteins (osteocalcin and osteopontin) at the bone-titanium interface of rat tibiae.

This study was designed to investigate by postembedding immunogold method the localization and distribution of osteocalcin (Ocl) and osteopontin (Opn) at the bone-titanium interface in rat tibiae 14 and 28 days postimplantation to determine which bone proteins are present at this interface. Both proteins were widely distributed on the newly formed bone and accumulated predominantly in the region of bone close to the titanium, in electron-dense patches in the bone, and at the osteocytic lacunae. Collagenous osteoid showed little or no labeling for either Ocl or Opn. An amorphous zone (20-50 nm) was interposed between the titanium and interfacial slender cells, osteoid, or bone, and was labeled strongly for Ocl but only weakly for Opn. Furthermore, a second electron-dense layer, the lamina limitans, which faces the titanium, was labeled strongly for Opn but weakly for Ocl. Ocl as a marker protein of osteoblasts was sometimes found in the granules and vesicles of the interfacial cells and extracellularly in their intercellular spaces, close to the titanium. However, Opn was not detected in any granules. This is the first report to show that the amorphous zone contains large amounts of Ocl and small amounts of Opn, and that bone contacts titanium through this Ocl-rich amorphous zone. Furthermore, it is suggested that the interfacial cells seem to be osteoblasts, and that Ocl in the amorphous zone is produced and secreted by these cells and functions with Opn as a regulator of the mineralization front close to the titanium, and as a mediator of cell-matrix and matrix-matrix/mineral adhesion along the titanium.

Animals↗

PubMed1998

Analysis of differential gene expression in rat tibia after an osteogenic stimulus in vivo: mechanical loading regulates osteopontin and myeloperoxidase.

The skeleton has the ability to alter its mass, geometry, and strength in response to mechanical stress. In order to elucidate the molecular mechanisms underlying this phenomenon, differential display reverse transcriptase-polymerase chain reaction (DDRT-PCR) was used to analyze gene expression in endocortical bone of mature female rats. Female Sprague-Dawley rats, approximately 8 months old, received either a sham or bending load using a four-point loading apparatus on the right tibia. RNA was collected at 1 h and 24 h after load was applied, reverse-transcribed into cDNA, and used in DDRT-PCR. Parallel display of samples from sham and loaded bones on a sequencing gel showed several regulated bands. Further analysis of seven of these bands allowed us to isolate two genes that are regulated in response to a loading stimulus. Nucleotide analysis showed that one of the differentially expressed bands shares 99% sequence identity with rat osteopontin (OPN), a noncollagenous bone matrix protein. Northern blot analysis confirms that OPN mRNA expression is increased by nearly 4-fold, at 6 h and 24 h after loading. The second band shares 90% homology with mouse myeloperoxidase (MPO), a bactericidal enzyme found primarily in neutrophils and monocytes. Semiquantitative PCR confirms that MPO expression is decreased 4- to 10-fold, at 1 h and 24 h after loading. Tissue distribution analysis confirmed MPO expression in bone but not in other tissues examined. In vitro analysis showed that MPO expression was not detectable in total RNA from UMR 106 osteoblastic cells or in confluent primary cultures of osteoblasts derived from either rat primary spongiosa or diaphyseal marrow. Database analysis suggests that MPO is expressed by osteocytes. These findings reinforce the association of OPN expression to bone turnover and describes for the first time, decreased expression of MPO during load-induced bone formation. These results suggest a role for both OPN and MPO expression in bone cell function.

Animals↗

PubMed2000

New mesomelic dysplasia with absent fibulae and triangular tibiae.

We report on two unrelated, sporadic cases of a mesomelic dysplasia characterized by absence of fibulae and severely hypoplastic, triangular-shaped tibiae. Moderate mesomelic shortness was present in the upper limbs with proximal widening of the ulnae. There was also axial skeletal involvement in both cases, characterized radiographically by an abnormal pelvis and marked bilateral glenoid hypoplasia. These cases appear to represent a new form of mesomelic dysplasia distinct from those previously delineated.

Bone Diseases, Developmental↗