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Tibial fractures

Najeeb Alqarni, Ran D Goldman
Question A 2-year-old boy presented to my office 2 days after he started limping. The history, physical examination, and radiology assessment revealed a toddler's fracture (TF). I understand that there is considerable variation in practice regarding management of TF. What is the best method to confirm the diagnosis? What method should be used to immobilize the affected limb and for how long? Is follow-up with a pediatric orthopedic surgeon needed? Answer Toddler's fracture, also called childhood accidental spiral tibial fracture or CAST fracture , is a fracture unique to ambulatory infants and young children...
October 2018: Canadian Family Physician Médecin de Famille Canadien
A Andreacchio, F Alberghina, L Marengo, F Canavese
The main objective of this paper is to review the current literature on treatment of tibial and femur fractures in children and adolescents guided by body weight in patients weighing 50 kg (110 lb) or more. A secondary aim of this mini-review was to determine, as per literature review, whether weight  > 50 kg (110 lb) is an identifiable factor associated with increased complication rate. A search of the PubMed/MEDLINE, EMBASE and Cochrane Database of Systematic Reviews databases from 1954 to September 2017 was performed to identify papers related to pediatric tibia and femur fractures in children weighing more than 50 kg (110 lb)...
October 11, 2018: Musculoskeletal Surgery
Omar M Albtoush, Marius Horger, Fabian Springer, Jan Fritz
The Segond fracture is a tibial avulsion injury of the insertion of the middle third of the lateral capsular ligament that is typically associated with anterior cruciate ligament and meniscal tears. The classically assigned mechanism of injury is a combination of internal rotation and varus stress. We report two cases of Segond fractures that presented with a variant pattern including osseous avulsion injuries of the medial collateral ligament at the femoral origin, anterior cruciate ligament tear, and pivot shift-type osseous contusion pattern, suggesting an alternative mechanism of injury that includes dominant valgus stress and external rotation components...
September 11, 2018: Clinical Imaging
Matt Blue, Christian Douthit, Joel Dennison, Cyrus Caroom, Mark Jenkins
A rare complication from computer-navigated total knee arthroplasty is a fracture through the insertion site of a tracking pin. These pins are inserted across the femoral and tibial shafts either bicortically, transcortically, or unicortically and have a reported fracture incidence of 1.38%, with all published cases occurring after bicortical pin placement. In this case, a 60-year-old female suffered a femoral shaft fracture through a unicortically inserted computer navigation tracking pin 6 weeks after total knee arthroplasty...
2018: Case Reports in Orthopedics
Robert C Spang, Frances A Tepolt, Nikolaos K Paschos, Lauren H Redler, Eric A Davis, Mininder S Kocher
OBJECTIVES: A variety of surgical options exist to treat the challenging problem of recurrent patellar instability in children and adolescents. The goal of the current study is to describe a novel combined reconstruction technique of both the medial patellofemoral ligament (MPFL) and the medial quadriceps tendon-femoral ligament (MQTFL) and report patient outcomes of a single-surgeon series. METHODS: All patients studied underwent simultaneous MPFL and MQTFL reconstruction for patellar instability using gracilis allograft...
October 8, 2018: Journal of Pediatric Orthopedics
Jonne Prins, Johanna C E Donders, Peter Kloen
Nonunion after a proximal tibia fracture is often associated with poor bone stock, (previous) infection, and compromised soft tissues. These conditions make revision internal fixation with double plating difficult. Combining a plate and contralateral 2-pin external fixator, coined composite fixation, can provide an alternative means of obtaining stability without further compromising soft tissues. Three patients with a proximal tibia nonunion precluding standard internal fixation with double plating were treated with composite fixation...
September 2018: American Journal of Orthopedics
M Křivohlávek, J Šrám, J Pazour, M Kloub
PURPOSE OF THE STUDY The locked nailing of diaphyseal fractures of the tibia currently represents a method of choice for treating the closed diaphyseal fractures, some of the tibial metaphyseal fractures and open tibial diaphyseal fractures classified as grade I and II according to Gustilo-Anderson (GA) classification. The suprapatellar (SP) approach is an alternative technique of insertion of the nail in semi-extension of the lower extremity with easier reduction, namely of multiple fractures and proximal diaphyseal fractures of the tibia in particular...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Dale L Robinson, Hongyuan Jiang, Qichun Song, Christopher Yates, Peter Vee Sin Lee, John D Wark
Fracture risk assessment using dual-energy X-ray absorptiometry (DXA) frequently fails to diagnose osteoporosis amongst individuals who later experience fragility fractures. Hence, more reliable techniques that improve the prediction of fracture risk are needed. In this study, we evaluated a finite element (FE) modelling framework based on clinical peripheral quantitative computed tomography (pQCT) imaging of the tibial epiphysis and diaphysis to predict the stiffness at these locations in compression, shear, torsion and bending...
October 6, 2018: Biomechanics and Modeling in Mechanobiology
Sung-Sahn Lee, Haluk Celik, Dae-Hee Lee
PURPOSE: To compare the accuracy of plain radiography and computed tomography (CT) in detecting lateral hinge fractures and to identify predictive factors of the lateral hinge fractures after open wedge high tibial osteotomy (HTO). METHODS: This study included patients who underwent isolated primary open wedge HTO for medial compartment degenerative arthritis from 2015 to 2016 and were evaluated by postoperative CT scans and followed for a minimum of 1 year. This study involved 48 patients (48 knees) undergoing open wedge HTO for primary medial osteoarthritis...
October 3, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Jean-Louis Prudhon, Régis Verdier, Jacques H Caton
INTRODUCTION: Using a cementless fixation for total knee arthroplasty (TKA) is controversial. We hypothesized that cementless tibial base plate with a monoblock long stem (MLS) would provide secure tibial alignment and stable fixation when bone conditions were considered as poor for a cementless fixation. The purpose of this study was to compare the mean eight year survivorship of cementless standard keels (SK) vs cementless MLS. MATERIAL METHODS: We report a matched series of 98 cases of SK and 98 cases of MLS in patients with poor bone conditions...
October 3, 2018: International Orthopaedics
Philostratos Klidaras, Jacqueline Severt, Deborah Aggers, Jason Payne, Paul D Miller, Steven W Ing
Infants and children with hypophosphatasia (HPP) treated with asfotase alfa show improvement in bone mineralization and motor function, but it is unclear whether the medication can affect fracture healing in adult HPP patients. We present the course of fracture healing in two adults with HPP on enzyme replacement. Case 1 is a 41-year-old female with infantile-onset HPP who was wheelchair-bound due to a nonhealing tibial fragility fracture sustained 3 years before and also had nonhealing femoral pseudofracture sustained 17 years before starting asfotase alfa therapy in December 2015...
September 2018: JBMR Plus
Nicholas M Brown, Gerard Engh, Kevin Fricka
Partial knee arthroplasty is a procedure with long-term successful outcomes. However, there are several potential complications including retained cement fragments, bearing dislocation, infection, component loosening, medial collateral ligament injury, and overcorrection, leading to progressive arthritis. Periprosthetic fracture is an uncommon complication, with multiple reports showing an incidence of less than 1%. Hence, there are no established algorithms to guide treatment. A consecutive series of 2,464 patients who underwent partial knee arthroplasty between January 2009 and April 2017 was reviewed...
October 3, 2018: Journal of Knee Surgery
Mario Ronga, Mario Cherubino, Katia Corona, Alessandro Fagetti, Barbara Bertani, Luigi Valdatta, Redento Mora, Paolo Cherubino
PURPOSE: Management of acute open tibial fractures with critical bone defect remains a challenge in trauma surgery. Few and heterogeneous cases have been reported about the treatment with the induced membrane technique. METHODS: We prospectively evaluated three patients treated with the induced membrane technique for acute Gustilo IIIB tibial fractures with critical bone defect. Success treatment was defined by bone union with patient pain free. Clinical and radiological evaluations were performed regularly until healing, then annually and with a minimum follow-up of five years...
October 2, 2018: International Orthopaedics
Logan F Hanson, Cameron G Hanson, Kyle L Barner
Charcot arthropathy is an infrequent condition that primarily involves the foot and ankle; rarely, it has been reported to affect the knee. Risk factors for Charcot arthropathy are well described with diabetes being the most common cause. Idiopathic Charcot arthropathy without a secondary etiology is extremely rare, with only a few cases described involving the foot and shoulder. Clinically, idiopathic Charcot arthropathy presents a notable challenge because delayed diagnosis can lead to surgical complications and advancement of joint destruction...
July 2018: Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
Garret L Sobol, Mohamad K Shaath, Mark C Reilly, Mark R Adams, Michael S Sirkin
OBJECTIVES: To investigate the incidence of concomitant posterior malleolar fractures in operative, distal-third, spiral tibia fractures. DESIGN: Prospective protocol with retrospective review of data SETTING:: Single, level 1 trauma center PATIENTS/PARTICIPANTS:: One hundred and ninety-three consecutive, skeletally mature patients with operatively treated fractures of the distal-third, tibial shaft and metaphysis. Pilon fractures were excluded. INTERVENTION: Computed tomography (CT) scans were obtained in all distal-third, spiral fractures of the tibia to determine fracture morphology and presence of a posterior malleolar fracture...
September 10, 2018: Journal of Orthopaedic Trauma
David N Kugelman, Abdullah M Qatu, Eric J Strauss, Sanjit R Konda, Kenneth A Egol
OBJECTIVES: What patient characteristics and injury factors predict decreased knee range of motion (ROM) following operative management of tibial plateau fractures? DESIGN: Prospective cohort study. SETTING: Academic medical center. PATIENTS: Over 11 years, tibial plateau fractures at a single academic institution were prospectively followed. A total of 266 patients were included in this study. INTERVENTION: Surgical repair of tibial plateau fractures and secondary interventions due to arthrofibrosis...
September 10, 2018: Journal of Orthopaedic Trauma
Sancar Serbest, Uğur TiftiKçi, Mehmet Çoban, Meriç Çirpar, Bülent Dağlar
OBJECTIVES: To evaluate the effects of intramedullar nailing of the tibia using a suprapatellar approach with respect to pain and function of the knee. DESIGN: Prospective clinical investigation SETTING:: Academic level I trauma center PATIENTS/PARTICIPANTS:: Twenty-one patients with tibial shaft fractures (OTA 42A-B-C) with a minimum of twelve months follow up. INTERVENTION: Locked intramedullary nailing using a suprapatellar approach MAIN OUTCOME MEASUREMENTS:: Radiographic evaluation for nail position proximally, tibial shaft alignment and union, anterior knee pain using the Visual Analog Scale (VAS), and knee function evaluation using the Lysholm and SF-36 scores...
September 10, 2018: Journal of Orthopaedic Trauma
A O Usoro, A Bhashyam, A Mohamadi, G S Dyer, L Zirkle, A von Keudell
OBJECTIVES: This study is a systematic review and meta-analysis of the clinical outcomes and pooled complication rate of femoral, tibial, and humeral fracture fixation using SIGN nails. We aimed to compare the pooled rate of adverse events based on the country of study origin, acute versus delayed fracture fixation, and length of follow up. METHODS: We searched PubMed/MEDLINE/Cochrane databases from 2000-2016 for English language studies. There was substantial heterogeneity among included studies...
September 10, 2018: Journal of Orthopaedic Trauma
Takumi Matsumoto, Song Ho Chang, Ryutaro Takeda, Sakae Tanaka, Takuo Juji
Adult-acquired flatfoot deformity is a progressive flattening of the arch of the foot that results from posterior tibial tendon insufficiency with a predilection for middle-aged women. A lateralized force vector associated with hindfoot valgus in adult-acquired flatfoot produces lateral ankle pain due to impingement at the lateral hindfoot, which can even lead to stress fractures of the distal fibula. Here, we present the rare case of a 73-year-old woman who presented with stress fractures of the bilateral taluses and unilateral distal fibula accompanied by severe adult-acquired flatfoot deformities...
2018: Case Reports in Orthopedics
Xiang Yao, Yong Xu, Jishan Yuan, Bin Lv, Xingli Fu, Lei Wang, Shengquan Yang, Sheng Meng
PURPOSE: The existing classification systems of tibial plateau fracture (TPF) are suboptimal for clinical use and academic communication. A more comprehensive and universal classification system with the capability to analyze all patterns of TPF is urgently required to guide the clinical practice. This study aimed to analyze the incidence and fracture characteristics of TPF using a computed tomography-based "four-column and nine-segment" classification. METHODS: According to the differentiated morphological characteristics, tibial plateau and proximal fibula were divided into four columns, which were subdivided into nine segments...
September 20, 2018: Injury
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