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Open tibia fractures

Young Woong Jang, DoHyung Lim, Hansol Seo, Myung Chul Lee, O-Sung Lee, Yong Seuk Lee
INTRODUCTION: Open-wedge high tibial osteotomy (OWHTO) is a well-established surgical option for medial compartment osteoarthritis of the varus knee. The initial strength of the fixation plate is critical for successful correction maintenance and healing of the osteotomy site. This study was conducted to verify if a newly designed anatomical plate (LCfit) improves the stability of both the medial implant and lateral hinge area, as well as to evaluate how the metal block contributes to both medial and lateral stability...
March 15, 2018: Archives of Orthopaedic and Trauma Surgery
Enrique Gómez-Barrena, Norma G Padilla-Eguiluz, Cristina Avendaño-Solá, Concepción Payares-Herrera, Ana Velasco-Iglesias, Ferran Torres, Philippe Rosset, Florian Gebhard, Nicola Baldini, Juan C Rubio-Suarez, Eduardo García-Rey, José Cordero-Ampuero, Javier Vaquero-Martin, Francisco Chana, Fernando Marco, Javier García-Coiradas, Pedro Caba-Dessoux, Pablo de la Cuadra, Philippe Hernigou, Charles-Henri Flouzat-Lachaniette, François Gouin, Didier Mainard, Jean Michel Laffosse, Miriam Kalbitz, Ingo Marzi, Norbert Südkamp, Ulrich Stöckle, Gabriela Ciapetti, Davide Maria Donati, Luigi Zagra, Ugo Pazzaglia, Guido Zarattini, Rodolfo Capanna, Fabio Catani
ORTHOUNION is a multicentre, open, comparative, three-arm, randomized clinical trial (EudraCT number 2015-000431-32) to compare the efficacy, at one and two years, of autologous human bone marrow-derived expanded mesenchymal stromal cell (hBM-MSC) treatments versus iliac crest autograft (ICA) to enhance bone healing in patients with diaphyseal and/or metaphysodiaphyseal fracture (femur, tibia, and humerus) status of atrophic or oligotrophic nonunion (more than 9 months after the acute fracture, including recalcitrant cases after failed treatments)...
2018: Stem Cells International
Lee James Beever, Kirsty Giles, Richard Lawrence Meeson
OBJECTIVES:  To quantify and evaluate risks of complications attributable to external skeletal fixator (ESF) usage in dogs. METHODS:  A retrospective review of medical records following ESF placement. RESULTS:  Case records of 97 dogs were reviewed; fixator-associated complications occurred in 79/97 dogs. Region of ESF placement was significantly associated with complication development ( p  = 0.005), not complication type ( p  = 0...
February 2018: Veterinary and Comparative Orthopaedics and Traumatology: V.C.O.T
Hakan Ömeroğlu
This review aims to summarize the basic treatment principles of fractures according to their types and general management principles of special conditions including physeal fractures, multiple fractures, open fractures, and pathologic fractures in children. Definition of the fracture is needed for better understanding the injury mechanism, planning a proper treatment strategy, and estimating the prognosis. As the healing process is less complicated, remodeling capacity is higher and non-union is rare, the fractures in children are commonly treated by non-surgical methods...
April 2018: Eklem Hastalıkları Ve Cerrahisi, Joint Diseases & related Surgery
Antti Stenroos, Jenni Jalkanen, Juha-Jaakko Sinikumpu, Sauli Palmu, Eeva Koskimies-Virta, Topi Laaksonen, Yrjänä Nietosvaara
BACKGROUND:  Surgical treatment of pediatric tibia shaft fractures has gained popularity despite closed reduction and cast-immobilization providing good long-term results. There is no consensus about optimal methods and satisfactory quality of treatment. MATERIALS AND METHODS:  During 2010 to 2014, 226 pediatric patients were treated under anesthesia for tibia shaft fractures in Finland's five university hospitals. A total of 164 (73%) patients had closed fractures of the tibia or both tibia and fibula without other injuries (62 tibia only and 102 both tibia and fibula)...
February 28, 2018: European Journal of Pediatric Surgery
Justin J Fleming
The reamed intramedullary (IM) technique has many benefits. However, open plating is the most commonly used technique. Previously, IM stabilization was reserved for fibular fractures, which were given lower priority, and generally associated with injuries to the distal tibia or instances in which the soft tissue envelope was unsuitable for an open approach. This article reviews the literature and the level of evidence, and presents case examples and operative technique.
April 2018: Clinics in Podiatric Medicine and Surgery
Ted C Lai, Justin J Fleming
Surgical treatment of distal tibia fractures can present as a difficult task. Intramedullary nailing (IMN), external fixation, and open reduction internal fixation (ORIF) have displayed various complications ranging from a high rate of knee morbidity with IMN to wound complications and infection with ORIF. Minimally invasive plate osteosynthesis (MIPO) has been used to decrease development of these complications. MIPO respects the soft tissue envelope along with maintaining the biological environment needed for proper osseous healing...
April 2018: Clinics in Podiatric Medicine and Surgery
Shambhu Sah, Bikash Kc, Sailoj Jung Dangi, Rem Kumar Rai, Roshan Yadav
INTRODUCTION: The management of distal tibia fracture is challenging because of the limited soft tissue coverage and poor vascularity around the bone in that area. Minimally invasive percutaneous plate osteosynthesis is a novel technique in this regard but needs fluoroscopy. In unavailability of fluoroscopy or its technical malfunction, limited open reduction percutaneous plate osteosynthesis becomes useful. The aim of this study is to compare the outcomes of distal tibia fractures treated by LORPPO and MIPPO techniques in terms of duration of hospital stay, full weight bearing, union time and complications...
October 2017: JNMA; Journal of the Nepal Medical Association
J Hu, X Feng, M Valdearcos, D Lutrin, Y Uchida, S K Koliwad, M Maze
BACKGROUND: Perioperative neurocognitive disorders (PND) result in long-term morbidity and mortality with no effective interventions available. Because interleukin-6 (IL-6), a pro-inflammatory cytokine, is consistently up-regulated by trauma, including after surgery, we determined whether IL-6 is a putative therapeutic target for PND in a mouse model. METHODS: Following institutional approval, adult (12-14 weeks) male C57/Bl6 mice were pretreated with the IL-6 receptor (IL6R) blocking antibody tocilizumab prior to open tibia fracture with internal fixation under isoflurane anaesthesia...
March 2018: British Journal of Anaesthesia
Benjamin T Miller, Andrew H Lin, Susan C Clark, Andrew P Cap, Joseph J Dubose
BACKGROUND: The U.S. Navy's casualty-receiving ships provide remote damage control resuscitation (RDCR) platforms to treat injured combatants deployed afloat and ashore. We report a significant mass casualty incident aboard the USS Bataan, and the most warm fresh whole blood (WFWB) transfused at sea for traumatic hemorrhagic shock since the Vietnam War. METHODS: Casualty-receiving ships have robust medical capabilities, including a frozen blood bank with packed red blood cells (pRBC) and fresh frozen plasma (FFP)...
February 13, 2018: Journal of Trauma and Acute Care Surgery
Robert M Corey, Nathan K Park, Lisa K Cannada
OBJECTIVES: To determine the most commonly associated injuries, complications, and healing rates of patients sustaining segmental tibial shaft fractures. DESIGN: Retrospective review. SETTING: Two Level I trauma centers. PATIENTS: One hundred and eight patients with segmental tibial shaft fractures were identified between 2005-2013. INTERVENTION: None. MAIN OUTCOME MEASURES: Demographics, injury characteristics, treatments, and complications...
January 24, 2018: Journal of Orthopaedic Trauma
Michael Schlumberger, Raul Mayr, Christian Koidl, Martin Eichinger, Tobias Roth
INTRODUCTION: Nonunion after open fracture of the lower leg is a frequent complication with a prevalence of up to 40%. In cases with major bone defects, revision of the osteosynthesis with bone grafting is commonly performed. Until today, there is no report on treatment of a tibial nonunion with transplantation of a heterotopic ossification. PRESENTATION OF CASE: We present a case of a 27-year-old male patient, who suffered from a paragliding accident with major injuries...
February 9, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Christian David Weber, Frank Hildebrand, Philipp Kobbe, Rolf Lefering, Richard M Sellei, Hans-Christoph Pape
BACKGROUND: Open tibia fractures usually occur in high-energy mechanisms and are commonly associated with multiple traumas. The purposes of this study were to define the epidemiology of open tibia fractures in severely injured patients and to evaluate risk factors for major complications. METHODS: A cohort from a nationwide population-based prospective database was analyzed (TraumaRegister DGU®). Inclusion criteria were: (1) open or closed tibia fracture, (2) Injury Severity Score (ISS) ≥ 16 points, (3) age ≥ 16 years, and (4) survival until primary admission...
February 2, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Rene Burchard, Denise Katerla, Marina Hammer, Anke Pahlkötter, Christian Soost, Gerhard Dietrich, Arne Ohrndorf, Wolfgang Richter, Markus Lengsfeld, Hans-Jürgen Christ, Jan Adriaan Graw, Claus-Peter Fritzen
PURPOSE: Opening wedge high tibial osteotomy (HTO) as a treatment in unicompartimental osteoarthritis of the knee can significantly relieve pain and prevent or at least delay an early joint replacement. The fixation of the osteotomy has undergone development and refinements during the last years. The angle-stable plate fixator is currently one of the most commonly used plates in HTOs. The angular stable fixation between screws and the plate offers a high primary stability to retain the correction with early weight-bearing protocols...
February 1, 2018: International Orthopaedics
Mihail-Lazar Mioc, Radu Prejbeanu, Bogdan Deleanu, Bogdan Anglitoiu, Horia Haragus, Marius Niculescu
Distal tibia fractures are reported to have a high complication rate pre-operatively as well as post-operatively, which can include open fractures, soft tissue damage, infection, malalignment, pseudarthrosis and ankle arthrosis. The operative treatment for the extra-articular distal tibia fractures is a controversial topic in the orthopaedic literature. Some of these fractures are proximal enough to be treated with an intramedullary nail while others are too distal for that. The aim of our study was to compare the results we have had with intramedullary nail (IMN) and minimally invasive plate osteosynthesis (MIPO) in distal metaphyseal (extra-articular) tibia fractures...
January 22, 2018: International Orthopaedics
Chester J Donnally, Charles M Lawrie, Jonathan I Sheu, Meredith A Gunder, Stephen M Quinnan
BACKGROUND: Although gunshot-induced extremity fractures are typically not considered open fractures, there is controversy regarding wound management in the setting of operative fixation to limit infection complications. Previous studies have evaluated the need for a formal irrigation and debridement (I&D) prior to intra-medullary nailing (IMN) of gunshot-induced femur fractures but none have specifically evaluated tibias. By comparing primary IMN for tibial shaft fractures caused by low-velocity firearms additionally treated with a formal operative I&D (group 1) with those without an I&D (group 2), we sought to identify whether there are: differences in treatment group infection rates; particular fracture patterns more prone to infection; and patient characteristics more prone to infections...
January 17, 2018: Surgical Infections
Yun-Nan Lin, Chieh-Han Chuang, Shih-Hao Huang, Shu-Hung Huang, Tsai-Ming Lin, I-Wen Lin, Sin-Daw Lin, Yur-Ren Kuo
RATIONALE: Although numerous reconstruction protocols have been reported for lower leg trauma, those for distal leg trauma remain few. We present the case of a woman with an implant exposure wound, who was successfully treated through fat grafting, without major flap surgery. PATIENT CONCERNS: An 83-year-old woman with an exposed implant in lower extremity received reconstruction surgery once and the surgery failed. She refused additional major surgery and negative pressure wound therapy...
December 2017: Medicine (Baltimore)
Markus Rupp, Christoph Biehl, Matthäus Budak, Ulrich Thormann, Christian Heiss, Volker Alt
The intention of the current article is to review the epidemiology with related socioeconomic costs, pathophysiology, and treatment options for diaphyseal long bone delayed unions and nonunions. Diaphyseal nonunions in the tibia and in the femur are estimated to occur 4.6-8% after modern intramedullary nailing of closed fractures with an even much higher risk in open fractures. There is a high socioeconomic burden for long bone nonunions mainly driven by indirect costs, such as productivity losses due to long treatment duration...
December 22, 2017: International Orthopaedics
Stephen R Rossman, M Kareem Shaath, Kenneth W Graf
Introduction: Open femoral fractures are relatively uncommon occurrences, with few reports addressing their management. They are caused by high-energy mechanisms, and bone loss is a possible, but infrequent occurrence. We present a case in which two friends, 20- and 21-year-old males, were involved in a motorcycle collision. A large piece of bone was ejected from one patient's femur as a bony projectile and impaled the other patient's tibia, resulting in an open tibial plateau fracture...
September 2017: Journal of Orthopaedic Case Reports
Maike Reul, Harm Hoekstra
Background The posterior tibial plateau is often affected in intra-articular tibial fractures. Moreover, treating these posterior fractures is recognised as an important prognostic factor. Open reduction and internal fixation of lateral and posterior two column tibial plateau fractures can be achieved via a combined reversed L-shape approach and an anterolateral approach in the floating position without intraoperative repositioning of the patient. Material and Methods The operative procedure starts in the posterior position with visualisation of the posterior column after lateral retraction of the medial head of the M...
December 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
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