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Distal Tibial Fracture

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
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
Elizabeth A Cody, James R Lachman, Elizabeth B Gausden, James A Nunley, Mark E Easley
BACKGROUND: The effect of bone mineral density (BMD) on outcomes from total ankle arthroplasty (TAA) has not been studied. BMD can be estimated by measuring Hounsfield units (HU) on standard computed tomography (CT), which is frequently performed prior to TAA. We aimed to identify whether tibial and talar HU measured from preoperative CT scans were associated with periprosthetic fracture or revision risk in patients undergoing TAA. METHODS: A prospectively collected database was used to retrospectively screen all patients undergoing primary TAA...
September 29, 2018: Foot & Ankle International
Delaram Shakoor, Greg M Osgood, Michael Brehler, Wojciech B Zbijewski, Cesar de Cesar Netto, Babar Shafiq, Jakrapong Orapin, Gaurav K Thawait, Lew C Shon, Shadpour Demehri
OBJECTIVE: To evaluate the influence of weight-bearing (WB) load in standard axial ankle syndesmotic measurements using cone beam CT (CBCT) examination of asymptomatic uninjured ankles. MATERIALS AND METHODS: In this IRB approved, prospective study, patients with previous unilateral ankle fractures were recruited. We simultaneously scanned the injured ankles and asymptomatic contralateral ankles of 27 patients in both WB and NWB modes. For this study, only asymptomatic contralateral ankles with normal plain radiographs were included...
September 21, 2018: Skeletal Radiology
Perry O Hooper, Patrick J Bevan, Christopher Silko, Lutul D Farrow
Background: The true prevalence of displaced tibial-sided avulsion injuries of the posterior cruciate ligament (PCL; Video 1) is unknown, and the majority of data regarding management has been published in areas other than the Western world, such as China and India (perhaps due to the higher prevalence of two-wheeler motorcycle accidents in these areas). Despite the rarity of data, a better understanding of the approach, fixation techniques, and outcomes is necessary to provide quality patient care...
March 28, 2018: JBJS Essential Surgical Techniques
David Wennergren, Carl Bergdahl, Jan Ekelund, Hans Juto, Mikael Sundfeldt, Michael Möller
INTRODUCTION: There is a lack of epidemiological studies of fractures in all segments of the tibia classified by orthopaedic surgeons according to the AO/OTA classification. Since 2011, the Swedish Fracture Register (SFR) has provided prospectively collected, population-based data on fractures of all types, treated both surgically and non-surgically. The aim of this study was to describe the epidemiology and incidence of fractures in all segments of the tibia in a cohort of consecutive tibia fractures over a period of five years at Sahlgrenska University Hospital, Gothenburg, Sweden...
September 7, 2018: Injury
Kyohei Takase, Sang Yang Lee, Takahiro Waki, Tomoaki Fukui, Keisuke Oe, Tomoyuki Matsumoto, Takehiko Matsushita, Kotaro Nishida, Ryosuke Kuroda, Takahiro Niikura
Rotational malreduction is a potential complication of intramedullary nailing for tibial shaft fractures. We experienced a symptomatic case of a 24° externally rotated malunion that we treated with minimally invasive corrective osteotomy. A 49-year-old man sustained a tibial shaft spiral fracture with a fibula fracture. He had been initially treated elsewhere with a reamed statically locked intramedullary nail. Bone union had been obtained, but he complained of asymmetry of his legs, difficulty walking and running, and the inability to ride a bicycle...
2018: Case Reports in Orthopedics
Sorawut Thamyongkit, Laura M Fayad, Lynne C Jones, Erik A Hasenboehler, Norachart Sirisreetreerux, Babar Shafiq
BACKGROUND: Limited data have been published regarding the typical coronal dimensions of the femur and tibia and how they relate to each other. This can be used to aid in judging optimal operative reduction of tibial plateau fractures. The purpose of the present study was to quantify the width of tibial plateau in relation to the distal femur. METHODS: We reviewed 3D computed tomography (CT) scans taken between 2013 and 2016 of 42 patients (84 knees). We measured positions of the lateral tibial condyle with respect to the lateral femoral condyle (dLC) and the medial tibial condyle with respect to the medial femoral condyle (dMC) in the coronal plane...
September 4, 2018: Journal of Orthopaedic Surgery and Research
Chang Ho Shin, Doo Jae Lee, Won Joon Yoo, In Ho Choi, Tae-Joon Cho
BACKGROUND: Interlocking telescopic rods for the management of osteogenesis imperfecta (OI)-related long bone fractures are a modification of the Sheffield rod. An interlocking pin anchors the obturator at the distal epiphysis, which spares the distal joint, while a T-piece anchors the sleeve at the proximal epiphysis. However, these devices are associated with some problems, including failure to elongate and difficulty with removal. A dual interlocking telescopic rod (D-ITR), in which the sleeve and the obturator are anchored with interlocking pins, was developed to address these problems...
August 30, 2018: Clinical Orthopaedics and related Research
Kempland C Walley, Evan P Roush, Christopher M Stauch, Allen R Kunselman, Kaitlin L Saloky, Jesse L King, Gregory S Lewis, Michael C Aynardi
BACKGROUND: The pathophysiology of adult-acquired flatfoot deformity (AAFD) is not fully explained by degeneration of the posterior tibial tendon alone. While a shortened or dysplastic lateral column has been implicated in flatfoot deformity in pediatrics, there is no study that has quantified the degree of dysplasia in adults with a stage IIb flatfoot deformity, or if any exists at all. METHODS: An institutional radiology database was queried for patients with posterior tibial tendon dysfunction (PTTD) who had computed tomography (CT) performed...
August 31, 2018: Foot & Ankle Specialist
Adam Phillip Schumaier, Frank Roman Avilucea, Brendan Ryan Southam, Preetha Sinha, Theodore Toan Le, John Dwight Wyrick, Michael Thomas Archdeacon
PURPOSE: The purpose of this study is to characterize the distal anatomic end-point of a tibial intramedullary nail placed using modern surgical techniques. The goal is to improve reduction of distal tibia fractures. METHODS: An intramedullary nail was placed in 14 skeletally mature legs. This included 8 patients with mid-shaft tibial fractures and 6 intact cadaveric legs. Each nail was a titanium cannulated tibial nail, size 10- or 11-mm. The nails were placed using a suprapatellar or transpatellar approach with an ideal starting point...
August 22, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Erwin A Kruger, Oded Ben-Amotz, Shaun D Mendenhall, L Scott Levin
Objective: The descending genicular artery provides the dominant pedicle for the medial femoral condyle and medial femoral trochlear free flaps. Variations of the flap include using a skin paddle for monitoring, a vastus medialis muscle component, and the medial superior geniculate artery for the pedicle. We present a case of a 49-year-old man with a distal tibial fracture from a motor vehicle accident complicated by chronic osteomyelitis, poor soft tissue envelope, and tibial nonunion. Methods: The composite lower extremity defect was reconstructed with a chimeric myo-osseous variant of the medial femoral condyle free flap since no perforator was available to the skin and there was a large amount of dead space...
2018: Eplasty
Enrico Vaienti, Paolo Schiavi, Francesco Ceccarelli, Francesco Pogliacomi
PURPOSE: The aim of this study is to compare clinical and radiological outcome of intramedullary nailing (IMN) and locked plate (LP) in patients affected by fracture of the distal tibia (DTF). We performed also an analysis to identify predictive factors of unfavourable outcome. METHODS: Data about patients with DTF treated at our first level trauma centre between 2008 and 2017 were collected. Patients were divided in group 1 (IMN) and group 2 (LP). The inclusion criteria were age at least 18 years at the time of diagnosis and unilateral DTF (closed or Gustilo 1)...
August 22, 2018: International Orthopaedics
Stephen A Kottmeier, Randall Drew Madison, Nicholas Divaris
Fractures of the distal tibial plafond (ie, pilon) comprise a broad range of injury mechanisms, patient demographics, and soft-tissue and osseous lesions. Patients often present with considerably comminuted fracture patterns and notable soft-tissue compromise. Surgical intervention must be performed with respect for the exceedingly vulnerable soft-tissue envelope and with a properly executed technique. Even with proper timing, favorable host factors, and expert surgical technique, restoration of function and avoidance of complications are not always achievable...
September 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
Lea R Mehrkens, Caleb C Hudson, Grayson L Cole
OBJECTIVE: To determine factors contributing to tibial tuberosity fracture (TTF) after tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Retrospective case-control study. ANIMALS: Dogs (n = 2490) with cranial cruciate ligament rupture that underwent 3000 TPLO surgeries. METHODS: Radiographs of 3000 stifles from dogs that underwent TPLO were reviewed for evidence of TTF. Two ratios were generated: (1) the height of the tuberosity over the width of the tibia at the most distal extent of the osteotomy (TW) and (2) the width of the narrowest point of the tuberosity over TW...
July 2018: Veterinary Surgery: VS
Michael J Gardner
No abstract text is available yet for this article.
August 15, 2018: Journal of Bone and Joint Surgery. American Volume
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
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