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Distal Tibial Fracture

Jeffery J Biskup, Joseph P Weigel, Peter K Liaw, Xie Xie
OBJECTIVE To assess the contribution of antirotational pins (ARPs) and an intact fibula to the compressive strength of 4 tibial plateau leveling osteotomy (TPLO) constructs (bone and implants). SAMPLE 20 hind limbs from 10 canine cadavers. PROCEDURES Each hind limb was assigned to 1 of 4 TPLO constructs (construct in which the ARP was removed, constructs in which 1 or 2 ARPs were left in place, and construct in which the ARP was removed and the fibula was cut). Following TPLO completion, all limbs underwent mechanical testing that included 10,000 cycles of cyclic axial compression followed by testing to failure at a displacement rate of 1 mm/s...
June 2018: American Journal of Veterinary Research
Rui Hu, Yi-Jun Ren, Li Yan, Xin-Cheng Yi, Fan Ding, Qiong Han, Wen-Jun Cheng
Background: Gustilo Anderson III B/C open tibial fractures are more difficult to manage than I, II, and III A fractures. These open tibial fractures are often associated with wound infection, soft tissue necrosis, bone nonunion, osteomyelitis or amputation. Staged treatment for this severe trauma is very necessary. Materials and Methods: 25 cases of Gustilo Anderson IIIB/C open tibial fractures with serious soft-tissue defects treated between January 2010 and January 2015 were included in this study...
July 2018: Indian Journal of Orthopaedics
André Lourenço Pereira, Ângelo Ribeiro Vaz de Faria, Túlio Vinícius de Oliveira Campos, Marco Antônio Percope de Andrade, Guilherme Moreira de Abreu E Silva
Avulsion of the tibial tubercle is an uncommon injury that occurs in the young athlete, resulting from an eccentric contraction of the extensor mechanism with the leg fixed to the ground. Concomitant injuries to the patellar tendon are very rare, with few cases reported in the literature. The authors present a case of a 15-year-old basketball player who suffered an avulsion of the tibial tubercle associated with complete distal rupture of the patellar tendon while training. It was treated with open reduction of the tibial fragment and reconstruction of the patellar tendon with mini-anchors and cannulated screws, as well as hamstring autograft tendon reinforcement...
July 2018: Revista Brasileira de Ortopedia
Christopher M McAndrew, William M Ricci, Anna N Miller, Matthew C Avery
Semiextended positioning can improve the surgeon's ability to obtain, maintain, and fluoroscopically evaluate a fracture reduction when performing fixation with an intramedullary nail, especially in fractures at the proximal and distal ends. Furthermore, this position allows for evaluation of instrument placement, including the start point, without moving the fluoroscopic unit into extremes of angulation or compromising the quality of the beam orientation. The intraarticular suprapatellar approach has been described as a soft tissue approach to maintain the leg in a position that would not complicate management of these fractures, especially those in the proximal third of the tibia...
August 2018: Journal of Orthopaedic Trauma
Tomas Liskutin, Mitchell Bernstein, William Lack, Michael Perry, Hobie Summers
INTRODUCTION: Peri- and intra-articular fractures about the knee are frequently managed with joint-spanning external fixation before definitive treatment. With a systematic approach, a near-anatomic reduction with respect to length, alignment, and rotation can be obtained. METHODS: This video highlights 2 clinical cases: a bicondylar tibial plateau fracture-dislocation and a distal femur fracture, both of which were treated with temporizing, knee-spanning external fixation...
August 2018: Journal of Orthopaedic Trauma
Kathleen D Rickert, Pooya Hosseinzadeh, Eric W Edmonds
BACKGROUND: Skeletal trauma is a primary tenet of pediatric orthopaedics. Many high-quality studies have been published over the last few years with substantial relevance to the clinical practice of pediatric orthopaedic trauma. Because of the volume of literature on the subject, this review excludes upper extremity trauma and focuses on the publications affecting the lower extremity. METHODS: An electronic search of the PubMed database was performed utilizing keywords for pediatric lower extremity trauma: pelvic injuries, femur fractures, tibial shaft fractures, femur fractures, ankle fractures, and foot fractures...
July 2, 2018: Journal of Pediatric Orthopedics
R Schimpf, H Siekmann, C Bauer, F Radetzki
There are many cases in the literature that describe atypical femur fractures under antiresorptive therapy. Other localizations of fractures of this genesis, especially if occurring bilaterally, are rare. This case reports about the diagnosis, treatment and process of a 76-year old patient, who within a 4‑month period suffered from bilateral distal tibial shaft fractures, after years of treatment with bisphosphonates, strontium ranelate and denosumab.
July 4, 2018: Der Orthopäde
Sarah Townsend, Daniel D Lewis
The Minimally Invasive Reduction Instrumentation System (MIRIS) was utilized to facilitate minimally invasive plate osteosynthesis (MIPO) of distal limb diaphyseal comminuted fractures (2 crural, 1 antebrachial) in three dogs. The MIRIS facilitated efficient MIPO in all three fractures. Radial and tibial lengths were restored within 2% of the length of the intact bone and postoperative frontal and sagittal plane angulation were within 3° of the normal contralateral limb for each of the fractures. Fixation failed in one of the tibial fractures when the plates bent a week following surgery...
2018: Case reports in veterinary medicine
Dirk Stengel, Wolf Mutschler
No abstract text is available yet for this article.
July 2018: Der Unfallchirurg
K N Manjunath, M S Venkatesh, Ashwini Shivaprasad
Background: Reconstruction of the popliteal region has limited option in terms of muscle flaps or myocutaneous flaps. Gastrocnemius muscle or the myocutaneous flaps are the option for majority of cases. However, reach of Gastrocnemius is limited if the wound is on the distal one-third thigh or the lateral aspect of knee region. Similarly, if the wound injures the muscle, then coverage becomes all the more difficult. Although inferiorly based fasciocutaneous flaps can cover the wound in case of bony injuries, muscle flaps are beneficial as they help in fracture healing...
January 2018: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Matthew J Hadad, Brian T Sullivan, Paul D Sponseller
BACKGROUND: Triplane ankle fractures are complex transitional fractures that often necessitate surgical treatment. Axial fracture lines determine optimal screw trajectories for fixation. The purpose of our study was to identify fracture patterns in triplane fractures by illustrating fracture lines in the axial plane of the distal tibial metaphysis and epiphysis. METHODS: We retrospectively reviewed records of children presenting with ankle fractures at 1 center from January 2007 through June 2017...
June 20, 2018: Journal of Bone and Joint Surgery. American Volume
C J Manning, M A Bari
No abstract text is available yet for this article.
June 18, 2018: Annals of the Royal College of Surgeons of England
Patrick B Horrigan, Monica J Coughlan, Malcolm DeBaun, Blake Schultz, Julius A Bishop, Michael J Gardner
Use of percutaneous clamps are often helpful tools to aid reduction and intramedullary nailing of distal tibial spiral diaphyseal fractures. However, the anterior and posterior neurovascular bundles are at risk without careful clamp placement. We describe our preferred technique of percutaneous clamp reduction for distal spiral tibial fractures with a distal posterolateral fracture spike, with care to protect the adjacent neurovascular structures. We also investigated the relationship between these neurovascular structures and the site of common percutaneous clamp placement...
June 4, 2018: Journal of Orthopaedic Trauma
George L Vestermark, Susan M Odum, Bryan D Springer
Background: Periprosthetic fracture following total knee arthroplasty (TKA) is usually associated with a traumatic event and typically treated with fracture fixation techniques. However, we report on a series of patients with early atraumatic condyle fractures that occurred as a result of insufficiency of the unloaded preoperative femoral condyle treated with delayed reconstruction. Methods: We retrospectively reviewed a series of 7 patients who sustained femoral condyle fractures following TKA and evaluated risk factors for insufficiency...
June 2018: Arthroplasty Today
Iulia Tevanov, Dan Mircea Enescu, Madalina Carp, Andrei Dusca, Alin Ladaru, Alexandru Ulici
Open fractures of the leg with large loss of tissue require extensive reconstructive methods that can injure the donor area. The use of negative pressure wound therapy (NPWT) may minimise the impact of these reconstructive methods because of its capacity to create granulation tissue that will form a wound bed for the skin graft, thus reducing the volume of soft tissue defect and saving the donor region. This case study describes the effectiveness of NPWT in the treatment and reconstruction of an open fracture of the leg, with massive loss of soft tissue, associated with elastic intramedullary nailing in a 10-year-old female patient, who was a victim of a car accident...
June 1, 2018: Journal of Wound Care
John S Hwang, Michael S Sirkin, Zachary Gala, Mark Adams, Mark C Reilly
An association exists between tibial shaft fractures and ankle injuries. In addition, although uncommon, an association between tibial shaft fractures and proximal tibiofibular dislocations has also been established. A review of the previous literature resulted in one case report of a complete proximal and distal tibiofibular joint dislocation without fracture of the tibia or fibula. Here, we discuss a case of a complete proximal and distal tibiofibular syndesmotic complex dislocation associated with a tibial shaft fracture...
August 1, 2018: Journal of the American Academy of Orthopaedic Surgeons
Magnus Bernhardsson, Per Aspenberg
Background and purpose - Fracture healing in the shaft is usually described as a sequence of events, starting with inflammation, which triggers mesenchymal tissue formation in successive steps. Most clinical fractures engage cancellous bone. We here describe fracture healing in cancellous bone, focusing on the timing of inflammatory and mesenchymal cell type appearance at the site of injury Material and methods - Rats received a proximal tibial drill hole. A subgroup received clodronate-containing liposomes before or after surgery...
August 2018: Acta Orthopaedica
Giovanni Lovisetti, Alexander Kirienko, Charles Myerson, Ettore Vulcano
BACKGROUND: Nonunions of the distal tibia in close proximity to the ankle joint can be a challenge to treat. The purpose of this study was to evaluate radiographic and clinical outcomes of patients who underwent ankle-sparing bone transport for periarticular distal tibial nonunions. METHODS: Twenty-one patients underwent ankle-sparing bone transport between January 2006 and July 2016. The mean age of the patients was 48.6 years, and 71% (15/21) were male. Patients were followed for an average of 14...
June 1, 2018: Foot & Ankle International
Kazuhiko Udagawa, Yasuo Niki, Kengo Harato, Shu Kobayashi, So Nomoto
Retrograde intramedullary nailing (RIMN) has been used for periprosthetic fracture of the distal femur after total knee arthroplasty (TKA), yielding good fracture union rates and satisfactory outcomes. However, RIMN for posterior-stabilized- (PS-) TKA risks malpositioning the entry point and disturbing the post of the tibial insert, and the surgeon therefore usually requires knee joint arthrotomy. We report a case of a 79-year-old male who was involved in bicycle accident resulting in periprosthetic fracture of the distal femur after PS-TKA...
2018: Case Reports in Orthopedics
S Rammelt, E Manke
BACKGROUND: Injuries to the distal tibiofibular syndesmosis are frequent and continue to generate controversy due to an extensive range of diagnostic techniques and therapeutic options. OBJECTIVE: The aim of this review is to summarize the current knowledge on syndesmotic instability and to present some recommendations for the clinical practice for acute an chronic injuries. MATERIAL AND METHODS: Analysis of the current literature concerning the anatomy, etiology, diagnostics and treatment of syndesmosis injuries...
May 29, 2018: Der Unfallchirurg
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