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PubMedDate not supplied

Blount disease (idiopathic tibia vara).

Blount disease or idiopathic tibia vara is a developmental deformity of the proximal tibial medial physis that produces a varus deformity of the knee. It is classified by early or late onset. The etiology is not entirely clear but is presumed to be related to an abnormal compression on the medial aspect of the proximal tibial physis. Early diagnosis is important for a better prognosis. In general, the later the onset and the greater the progression of the deformity, the increased likelihood of articular changes. Orthotics are recommended as the first type of treatment. If progression occurs or onset is late, surgical intervention may be warranted. The nurse's role ranges from educating the family about the disease to helping them adapt to the varying treatments.

Bone Diseases, Developmental↗

PubMed1977

Free osteocutaneous flap from a rib to the tibia.

A large bony defect of the tibia, covered with thin unstable scar, was repaired successfully with a free osteocutaneous flap composed of 10 cm of the ninth rib with a 9 X 6 cm area of overlying muscle and skin. Microvascular anatomoses were done between the intercostal vessels in the transplant and the anterior tibial vessels in the recipient area.

Adult↗

PubMed1987

External longitudinal splitting of the tibialis anterior muscle for coverage of compound fractures of the middle third of the tibia.

In this modern era, compound fractures of the middle third of the tibia are relatively common. With the advent of external fixation, these fractures can be more rapidly and effectively dealt with, and attention can be directed to immediate coverage of the exposed bone. External longitudinal splitting of the anterior tibialis muscle offers a convenient and safe method for converting the open fracture to a closed one. The uniqueness of the tibialis anterior muscle is two-fold. It is circumpennate, and it has an internal axial tendon corresponding to almost its total length. Both these features impart to it considerable strength, and the muscle splitting herewith described does not appear to impair its function. Five treated limbs, each with loss of soft tissues overlying compound mid-third tibial fractures, are presented. Rapid healing and virtual absence of bone infection was observed in all cases.

Adult↗

PubMed1975

Congenital posterior angulation of tibia and fibula.

Congenital posterior angulation of the tibia occurs less frequently than congenital anterior bowing. Concomitant deformities of the foot and contractures of the soft tissue usually exist. A review of the literature indicates that nonoperative treatment is usually successful in correcting the deformity. Tibial growth is frequently less than normal and epiphysiodesis of the opposite extermity may be necessary. Three patients are presented who have been followed up for 17 years, two years, and over one year. Improvement is occurring with nonoperative treatment.

Adolescent↗

PubMed1975

Congenital pseudarthrosis of the tibia.

Congenital pseudarthrosis of the tibia is a rare and difficult problem. The cause is unknown, the treatment is nonstandardized, and the results are generally poor. One or two good attempts at union should be made, followed by amputation if union is not obtained or if deformity is worse than that produced by a prosthesis. Electrical stimulation of bone healing is not yet technically advanced enough for use in stimulating fractures to heal in humans, but it has been proven to promote healing in animals and holds considerable promise for the future.

Amputation, Surgical↗

PubMed2002

Concomitant focal fibrocartilaginous dysplasia of the tibia and eosinophilic granuloma of the jaw in a child.

This 2-year-old child presented with concomitant eosinophilic granuloma of the lower jaw and focal fibrocartilaginous dysplasia of the right tibia. Her eosinophilic granuloma was diagnosed on the basis of the clinical picture, imaging studies and the characteristic histologic appearance. Focal fibrocartilaginous dysplasia was revealed incidentally during the eosinophilic granuloma staging process. After chemotherapy, all signs of eosinophilic granuloma subsided, but focal fibrocartilaginous dysplasia remained without signs of clinical or radiographic progression. The importance of differentiating these two conditions is stressed in order to avoid ineffective and inappropriate treatment of focal fibrocartilaginous dysplasia.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2001

Micromelic dwarfism--humerus, femur and tibia type.

We report a baby with severe micromelic dwarfism characterized by severe shortening of the humeri, femora and tibiae with hypoplastic radii, ulnae and fibulae which are of normal shape. We suggest that this case is similar to the case reported by Baxova et al [(1993), Paediatr Radiol 23:446-449] confirming the identity of this new bone dysplasia.

Adult↗

PubMed2002

VATER--tibia aplasia association: report on two patients.

We report two patients with oesophageal atresia, tracheo-oesophageal fistula and unilateral tibial aplasia. The karyotype in both patients was normal and both cases were sporadic. The congenital defects of the children can be regarded as an uncommon variant of VA(C)TER(L) association. Recently Basel and Goldblatt [(2000) Clin Dysmorphol 9:205-208] reported a similar patient with a VATER-tibia aplasia association.

Abnormalities, Multiple↗

PubMed2003

Treatment of tibia vara by the Ilizarov method.

Sixty-nine lower extremities of 45 patients (mean age, 10 years 8 months) with tibia vara were treated with the Ilizarov circular external fixator and distraction osteogenesis. Twenty-four of the patients had bilateral involvement, six of whom had simultaneous surgery and the remaining 18 had staged operations 8 to 12 months apart. In 11 limbs with femoral valgus deformity greater than 10 degrees simultaneous corrections were done. Active movements of the joints of the extremity were encouraged the day after surgery and partial weightbearing began 2 days later. All patients were followed up 27 to 178 months (mean, 80 months) after surgery. No neurovascular complications, delayed union, or nonunions were observed. The mean 28.6 degrees varus tibiofemoral angle preoperatively (range, 15 degrees -45 degrees ) improved to 7.5 degrees valgus (range, 0 degrees -18 degrees ) postoperatively. The preoperative internal torsion angle also improved from 20.7 degrees (range, 0 degrees -48 degrees ) to 3.5 degrees external torsion (range, 0 degrees -9 degrees ) postoperatively. Residual deformity was seen in six patients, and they had successful revision surgery using the same technique. The Ilizarov method allows early weightbearing and motion and allows all components of the deformity to be corrected.

Adolescent↗

PubMed2005

Preoperative tibiofemoral angle predicts survival of proximal tibia osteotomy.

A prospective group study was done to clarify whether perioperative variables such as preoperative and postoperative tibiofemoral angles influence the survivorship of proximal tibia osteotomy as measured by conversion to arthroplasty and patient dissatisfaction. The results of 93 proximal tibial osteotomies in 82 consecutive patients with medial compartment osteoarthrosis were followed up for a mean of 10.9 years. All data were analyzed by the Kaplan-Meier survivorship method and the multivariate Cox proportional hazards model. Only the preoperative tibiofemoral angle was a predictor of conversion to arthroplasty and patient dissatisfaction. The ideal prognostic cutoff angle was 9 degrees or less varus. Increasing the preoperative varus alignment 1 degrees would result in a 1.2 (95% confidence intervals, 1.02-1.50) times higher risk of conversion to a total knee arthroplasty and a 1.5 (95% confidence intervals, 1.27-1.76) times higher chance of patient dissatisfaction. Factors such as age, gender, body mass index, Ahlback's classification, and postoperative tibiofemoral angle were not significant. We think that proximal tibial osteotomy should be considered for patients with medial compartment osteoarthrosis and a preoperative varus alignment of 9 degrees or less, whereas arthroplasty is a more suitable alternative for patients with preoperative varus alignment greater than 9 degrees.

Adult↗

PubMedDate not supplied

Treatment of congenital pseudarthrosis of the tibia: a multicenter study in Japan.

Treatment of congenital pseudarthrosis of the tibia (CPT) remains a challenge. To clarify the current situation in treatment, a multicenter study was carried out to obtain information on the results of CPT treatment. The objective of this study was to propose appropriate treatment guidelines for CPT. Records of 73 patients with CPT who underwent surgical treatment were collected from 32 hospitals. The modality of the treatment was 26 with Ilizarov technique, 25 with free vascularized fibular graft, 7 with a combination of the two techniques, 6 with intramedullary nailing with free bone grafting, 5 plating with free bone grafting, and 4 with other treatments. Fifty-four procedures resulted in union, 7 resulted in delayed union, 7 were left un-united, 1 underwent amputation, and the results were unknown in 4. According to the results of this study, the most acceptable methods of treatment of CPT are the Ilizarov method and the vascularized fibular graft.

Adolescent↗

PubMed2003

Bone formation around titanium implants in the rat tibia: role of insulin.

BACKGROUND AND PURPOSE: Clinical and experimental studies show, with few exceptions, that type 1 diabetes mellitus is associated with a delay in bone repair around endosseous implants. The effect of insulin in bone repair/remodeling is not completely understood. The aim of this study was to investigate the course of histological and ultrastructural changes of the osseointegration process under the influence of insulin. MATERIALS AND METHODS: Titanium implants were inserted into the tibiae of male Wistar rats. Animals were divided into three groups: 1) rats with alloxan-induced diabetes; 2) diabetic rats treated with isophane insulin (2 IU/day); and 3) matching controls. Histological and histomorphometric analysis of bone-implant sections were performed 10 and 21 days after implant placement. RESULTS: Relative to control values, rats with alloxan-induced diabetes exhibited a 50% reduction in the area of formed bone (P < 0.001) and in the surface of contact between bone and implant (P < 0.01) 21 days after implant placement. There were no significant differences between groups 10 days after surgery. Values returned to normal levels in diabetic rats after insulin treatment. Presence of chondrocyte-like cells surrounded by a cartilaginouslike matrix in diabetic rats suggests a delay in the process of bone repair. Ultrastructural characteristics of bone-implant interface in diabetic rats treated with insulin resembled those observed in controls. CONCLUSION: The data presented suggest that bone repair around endosseous implants is regulated, at least in part, by insulin. The results imply that the control of the metabolic status of the diabetic patient is essential for a successful osseointegration.

Alloxan↗

PubMed2003

Medial gastrocnemius muscle flap in limb-sparing surgery of malignant bone tumors of the proximal tibia: mid-term results in 25 patients.

Twenty-five patients in whom the medial head of the gastrocnemius muscle was transposed to cover defects in limb-sparing surgery of malignant bone tumors in the proximal tibia were evaluated prospectively in a tumor register. Surgical technique and mid-term clinical-functional results after a mean follow-up of 4 years 6 months are presented in this study. Twenty-four of the 25 gastrocnemius muscle flaps survived without complications. In 1 patient, infection and necrosis of the transposed muscle developed 10 days after surgery, requiring revisional muscle transposition. The total revision rate after primary tumor surgery was high (48%), but this had no impact on the viability of the transposed muscle flap. The mean Musculoskeletal Tumor Society score at follow-up was 75.1% (range, 20-97%) and the mean postoperative range of motion in the operated knee was 60 deg (range, 30-100 deg). Because of its easy, safe, and quick preparation, the medial gastrocnemius muscle flap is exceptionally valuable as a means of covering defects arising during the course of this extensive tumor surgery. It guarantees a high survival rate of the transposed muscle and supports vascularity of the skin flaps, helps to reestablish joint function and mobility by stabilization and reinforcement of the extensor mechanism, and provides protection against infection.

Bone Neoplasms↗

PubMedDate not supplied

Rotational osteotomy of the distal tibia and fibula.

A surgical technique for distal transverse osteotomy of the tibia and fibula to correct torsional malalignment of the leg is described. Thirty-two derotation osteotomies have been performed on 19 patients, whose average age at the time of surgery was 12 years; average follow-up was 2 years. Average torsional change following surgery was 38 degrees. Ninety-four percent of the patients available for follow-up (16 or 17) had a successful outcome. The two small incisions required in this procedure are cosmetically acceptable, and the location of the osteotomy in metaphyseal bone provides stability. We conclude that this osteotomy is a simple, safe, and effective procedure for correction of torsional malalignment in carefully selected patients.

Adolescent↗

PubMedDate not supplied

Late-onset tibia vara.

Fifteen children with late-onset tibia vara were studied. There were seven unilateral and eight bilateral cases. Eleven children were male, four were female and 13 were black; 14 were obese. All had a history of gradually progressive genu varus (average onset 11 years); 12 had preoperative knee pain. The average age at surgery was 12 years, with a preoperative tibiofemoral angle of 14 degree varus. The average follow-up was 4 years 4 months. The average tibiofemoral angle at follow-up was 0 degrees. There were 15 good, two fair, and six poor final results.

Adolescent↗

PubMedDate not supplied

Fibular transfer for congenital absence of the tibia.

Twelve patients (13 extremities) who had complete congenital absence of the tibia were treated between 1963 and 1989. Three patients (three extremities) had a knee disarticulation performed as the primary procedure because they had no quadriceps function. Nine patients (10 extremities) underwent centralization of fibula under the femoral condyles (Brown procedure). Four of these 10 extremities developed a severe flexion contracture of the knee (> 25 degrees) and underwent subsequent knee disarticulation. One patient with a short stump secondary to an ipsilateral proximal femoral focal deficiency had a femorofibular arthrodesis. Five of these 10 extremities had a satisfactory result when reviewed at an average follow-up of 18 years. The patients were evaluated in reference to gait, range of motion (ROM) of the knee, quadriceps strength, prosthetic needs, and peer group sports activities. A strong quadriceps (> grade 4) was noted in all five patients who had a satisfactory result. Flexion contracture of the knee, when < 25 degrees, did not compromise the result.

Female↗

PubMedDate not supplied

Langenskiöld classification of tibia vara: an assessment of interobserver variability.

Six pediatric orthopaedic specialists and six senior orthopaedic residents independently classified 60 radiographs of infantile tibia vara according to the six-stage Langenskiöld classification. Correlation coefficients and percentage agreement were similar in both groups. Interobserver agreement was good for early and late stages, but was poor for intermediate stages. We caution clinicians that small but frequent discrepancies in radiographic staging impart a dubious prognostic value to the Langenskiöld classification.

Bone Diseases, Developmental↗

PubMedDate not supplied

The role of fibular osteotomy in rotational osteotomy of the distal tibia.

A randomized prospective study was undertaken to assess the role of fibular osteotomy in distal tibial derotational osteotomies. Thirty-five patients were randomized to "intact fibula" and "osteotomized fibula" groups. There were no statistically significant differences in the amount of intraoperative derotation, time to weight bear, time to healing, and the amount of correction retained at follow-up between the two groups. Complications in the intact fibula group included one delayed union and one recurrence. In the osteotomized fibula group, there were two cases of loss of fixation, two pin-tract infections, one delayed union of tibia, one pressure sore in the cast, one distal tibial physeal arrest, and one recurrence. Although the difference in the complication rate between the two groups did not reach statistical significance, our results suggest that in distal tibial derotational osteotomies, fixed with cross pins, it might be advantageous to leave the fibula intact.

Adolescent↗