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Distal Tibial Fracture

Corinne E Metzger, Sammy Gong, Miriam Aceves, Susan A Bloomfield, Michelle A Hook
Profound bone loss occurs following spinal cord injury (SCI) resulting in a high incidence of fractures. While likely caused in part by loss of weight-bearing, there is greater bone loss following SCI when compared to that observed in other disuse animal models. Patients with SCI have a protracted inflammatory response, with elevated circulating levels of pro-inflammatory markers. This chronic inflammation could compound the bone loss attributed to disuse and the loss of neural signaling. To assess this, we examined inflammatory markers and bone turnover regulators in osteocytes from rats with a moderate spinal contusion injury (SCI) and intact controls (CON)...
December 11, 2018: Bone
Kingsley O Asiedu, Munira Ferdousi, Phuongnga T Ton, Stephen S Adler, Peter L Choyke, Noriko Sato
BACKGROUND: Bone fracture healing is dependent upon the rapid migration and engraftment of bone marrow (BM) progenitor and stem cells to the site of injury. Stromal cell-derived factor-1 plays a crucial role in recruiting BM cells expressing its receptor CXCR4. Recently, a CXCR4 antagonist, plerixafor, has been used to mobilize BM cells into the blood in efforts to enhance cell migration to sites of injury presumably improving healing. In this study, we employed zirconium-89 (89 Zr)-oxine-labeled BM cells imaged with positron emission tomography (PET)/computed tomography (CT) to visualize and quantitate BM cell trafficking following acute bone injury and to investigate the effect of plerixafor on BM cell homing...
December 13, 2018: EJNMMI Research
V Schütte, A Schmidt-Hebbel, A B Imhoff, A Achtnich
OBJECTIVE: Transosseous augmentation of patellar sleeve fractures (PSF) with suture tape in young athletes. INDICATIONS: Acute avulsions of the proximal or distal patellar pol with clinical relevant deficit of knee extension. CONTRAINDICATIONS: Local infections, severe soft tissue damage (relative contraindication), fractures of the patella or tibial tuberosity. SURGICAL TECHNIQUE: Direct longitudinal anterior approach to the patella...
December 11, 2018: Operative Orthopädie und Traumatologie
Hoon-Sang Sohn, Jong-Keon Oh, Ha Sol Yang, Hyeong Rang Kim
Background: The treatment of comminuted tibia plafond fractures remains clinically challenging due to the complexity of the articular fracture pattern despite using the anatomically precontoured locked plates. This study describes the morphologic characteristics of the anterolateral fragment and to evaluate the fixability of the anterolateral fragment with the anatomically precontoured locked plate in the pilon fracture. Materials and Methods: One hundred and twenty five cases of AO 43-B and C fracture were evaluated using the computed tomography (CT) scan...
November 2018: Indian Journal of Orthopaedics
Silvio Demitri, Giovanni Vicenti, Massimiliano Carrozzo, Davide Bizzoca, Dania De Franceschi, Biagio Moretti
The treatment of open distal tibia fractures remains challenging, particularly when the fracture involves severe soft tissue damage and segmental bone loss. We present the case of a 33-year-old woman who sustained an open distal tibia fracture type 43-A3.3, with segmental bone loss, and a closed bifocal fibular fracture. The fractures were initially fixed with a temporary external fixator. The open distal tibial fracture underwent an intramedullary nailing on day six post-trauma, while the segmental bone loss was refilled with a temporary cement spacer, in order to create a biologic chamber, according to the technique by Masquelet et al...
December 2018: Injury
Yuki Okazaki, Takayuki Furumatsu, Yuya Kodama, Yusuke Kamatsuki, Shin Masuda, Toshifumi Ozaki
The medial meniscus (MM) posterior root has an important role in the maintenance of knee kinematics and articular cartilage. Although transtibial pullout repair of the MM posterior root tear (MMPRT) has become the gold standard, it is associated with several suturing difficulties. The present technical note describes a simple fixation technique using two simple stiches under an expected initial tension. After the degree of knee flexion (20°) and an expected tension (30 N) are checked, tibial fixation is performed using a bioabsorbable interference screw with a spring tensioner...
November 29, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Sudipta Kumar Patra, Ajoy Prasad Shetty, Dheenadhayalan Jayaramaraju, S Rajasekaran
OBJECTIVES: To assess radiation exposure (RE) to the surgical team and fluoroscopy time (FT) during closed nailing of long bone fractures performed under fluoroscopic guidance with regard to surgeons experience. DESIGN: Prospective observational study SETTING:: Level-1 Trauma Centre PARTICIPANTS:: Surgical team, comprising surgeon, surgical assistant and scrub nurse, for closed nailings done in 202 consecutive closed tibial and femoral diaphyseal fractures. INTERVENTION: Dosimeter provided to each member of surgical team; Surgeon experience-level (Trainee, Senior registrar, Consultant) MAIN OUTCOME MEASUREMENTS:: RE (microsieverts) to the surgical team and FT (minutes) were recorded from the dosimeter and fluoroscopic unit respectively and correlated with surgeons experience...
October 8, 2018: Journal of Orthopaedic Trauma
M S Islam, M T Hossain, M N Uddin, M R Chowdhury, M S Hasan
We conducted a study to evaluate the reliability of the medial hemi-soleus muscle flap for wound coverage of infected open fracture of distal third of tibia. Wound coverage of exposed lower third tibia and ankle region remains a difficult task. Muscle flaps are preferred for infected wounds especially where there are exposed bone, joint and/or tendons. Soleus muscle is a good option for local reconstruction. Soleus being the prime ankle plantar flexor and stabilizer of the ankle in ambulation cannot be sacrificed without significant morbidity...
October 2018: Mymensingh Medical Journal: MMJ
Ayesha Ropri, Zain Badar, Asad Khan, Hamza Murtaza, Sankarsh Jetty, Jason Chu, Arthur Yegorov
Salter-Harris type I fractures of the distal tibia are commonly seen in paediatrics and management of such fractures follows an algorithm established in the literature. Despite this, osteonecrosis of the distal tibia can subsequently develop. Osteonecrosis or avascular necrosis is cell death that occurs secondary to trauma, metabolic disturbances, sickle cell disease, or medication side effect. It most frequently affects the femur, talus, or humerus, and rarely the tibia. Radiographs and MRI are pivotal in making a timely diagnosis in order to minimize patient discomfort...
July 2018: Journal of Ayub Medical College, Abbottabad: JAMC
Osama Gamal, Ahmed Shams
INTRODUCTION: This prospective case series study aimed to assess the value of the Less Invasive Stabilization System (LISS) to treat closed Segmental Tibial Fractures (STFs) using a proposed surgical technique. MATERIALS AND METHODS: Between August 2010 and January 2014, 21 consecutive recently (within 1 week) closed STFs that matched the inclusion criteria were enrolled. Patients were treated with the 13-hole LISS plate. All patients were followed up every 2 weeks for the first 2 months, then every month for the rest of the first 6 months and then every 6 months thereafter...
2018: SICOT-J
Mohamed Sameer, Keerthy Chandra Bassetty, V Singaravadivelu
Distal tibia fractures are complex injuries with high complication rates. Limited soft tissue, poor vascularity and complexity of fracture pattern impose limitations for traditional plating techniques. Better understanding of fracture patterns using 3D-CT reconstruction, optimum pre-op planning and availability of anatomical locking plates have certainly improved the outcome in these fractures. We report the functional and radiological outcome in 12 patients of complex tibial pilon fractures, who were treated on the basis of the novel column concept...
December 2017: Acta Orthopaedica Belgica
Michael M Hadeed, Cody L Evans, Brian C Werner, Wendy M Novicoff, David B Weiss
INTRODUCTION: Tibial pilon fractures are often treated with initial external fixation followed by delayed definitive fixation. It has been postulated that the external fixator pin site may correlate with infection risk. The purpose of this study was to determine whether external fixator pin-site distance from definitive implants impacts the risk of deep infection in pilon fractures. MATERIALS AND METHODS: A retrospective cohort study was completed at a single level 1 trauma center...
November 1, 2018: Injury
M C Liebensteiner, B Henninger, C Kittl, R Attal, J M Giesinger, C Kranewitter
PURPOSE: To assess the visibility of both the anterolateral ligament (ALL) and the deep structures of the iliotibial tract (ITT) by means of MRI in paediatric patients. To determine reproducibility for such measurements. METHODS: Knee MRI data from patients aged <18a without lesions of the capsule or ligaments, fractures, bone edemas, foreign material or motion artifacts were analyzed by two musculoskeletal radiologists separately and twice. The visibility of the different parts of the ALL was determined (femoral, meniscal, tibial parts)...
October 29, 2018: Injury
J Hendrych, T Pešl, P Havránek
PURPOSE OF THE STUDY The triplane fracture of the distal tibial epiphysis is characterised by the fracture line in typical three planes which can, however, differ case by case. The authors use the CT imaging as the perfect examination method to determine the nature of the fracture to plan the osteosynthesis. MATERIAL AND METHODS In the five-year retrospective study of a group of patients treated at their own department in the period 2011-2015 the authors assess a total of 55 patients with a triplane fracture...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Zhong-Xin Liu, Wei Wang, Xin Zhang, Jun Yang
OBJECTIVE: To establish finite element models of anterior inferior tibiofibular syndesmosis injuries (AITSI), screw fixation and Tight-rope(TR) fixation, and to compare its force and displacement, so as provide evidence for clinical diagnosis and treatment. METHODS: A three-dimensional model of a healthy ankle complex was developed by computed tomography (CT) images, and anterior inferior tibiofibular syndesmosis injuries(AITSI) model also established, then a screw was inserted into AITSI model to obtain a screw fixation model, and a Tight-rope system was put into AITSI model to obtain a TR model...
October 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Alex A Johnson, Elizabeth L Wolfe, Douglas N Mintz, Shadpour Demehri, Beth E Shubin Stein, Andrew J Cosgarea
Background: Tibial tuberosity osteotomy (TTO) is a versatile procedure commonly used to treat patellar instability as well as to unload cartilage lesions. TTO with concomitant distalization (TTO-d) may be performed in patients with patella alta to stabilize the patella by helping it to engage in the trochlea earlier during flexion. Purpose: To identify and compare perioperative complications in patients who underwent TTO and those who underwent TTO-d and to analyze risk factors associated with these complications...
October 2018: Orthopaedic Journal of Sports Medicine
Garret L Sobol, M Kareem Shaath, Mark C Reilly, Mark R Adams, Michael S Sirkin
OBJECTIVES: To investigate the incidence of concomitant posterior malleolar fractures (PMFs) 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 ninety-three consecutive, skeletally mature patients with operatively treated fractures of the distal-third, tibial shaft and metaphysis...
November 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
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