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distal tibia

Stephen Matthew Quinnan
Obtaining optimal results in the treatment of extraarticular distal tibia fractures can be challenging. Plate and screw and intramedullary fixation have proven to be effective treatments, but are associated with significant complication rates when used for open fractures and patient with severe medical comorbidities. External fixation is a third alternative that is less often employed, but provides a very effective means of treatment. Circular external fixation offers great flexibility in obtaining anatomic alignment and stable fixation for even the most challenging distal tibia fractures...
November 2016: Journal of Orthopaedic Trauma
Daniel Torino, Samir Mehta
The role of fibular fixation in patients with distal tibia fractures is controversial. Although the stability of the fibula is critical in patients with syndesmotic instability or highly comminuted pilon fractures, fibular fixation in extraarticular distal tibia fractures or elementary intraarticular distal tibia fractures is more controversial. Biomechanical studies, as performed in sawbones or cadaveric models, denote advantages to fibular fixation with respect to specific uniplanar motion. However, the increased stability is susceptible to the fracture pattern of the tibia, fixation strategy for the tibia, fixation strategy for the fibula, and loading pattern of the entire construct...
November 2016: Journal of Orthopaedic Trauma
Richard S Yoon, Frank A Liporace
Intramedullary nail and plate combination techniques have been described mostly for use in the proximal tibia. However, the nail and plate combination technique can also be used in the distal tibia, to counteract the deforming forces that cause construct failure and nonunion. In this article, we review pertinent anatomy and biomechanics and offer case examples that highlight the indications and applications of the nail and plate combination technique for distal tibia fractures.
November 2016: Journal of Orthopaedic Trauma
John A Scolaro, Francis H Broghammer, Derek J Donegan
The optimal treatment strategy for distal tibia fractures, especially those with intraarticular extension, remains controversial. Although open reduction and internal fixation with a plate and screw device is commonly performed for these injuries, the risk of soft tissue complications using this approach is significant. Staged treatment protocols and alternative means of fixation have been proposed to address these undesired events. Although potentially more technically demanding than fixation of diaphyseal or extraarticular tibial fractures, intramedullary nail (IMN) fixation of simple intraarticular distal tibia fractures is a viable treatment alternative with unique advantages...
November 2016: Journal of Orthopaedic Trauma
Michael Talerico, Jaimo Ahn
The objective of this article is to highlight the salient points of preoperative planning, intraoperative considerations for fracture reduction methods, and implant fixation when treating distal diaphyseal or diametaphyseal tibia fractures with an intramedullary nail. Through review of the necessary preoperative considerations, techniques available to hold and maintain a reduction, and lastly how to maximize the selected implant of intramedullary nail, we hope to assist the treating surgeon in simplifying these sometimes complex fractures into manageable injuries that can be treated successfully with an intramedullary implant...
November 2016: Journal of Orthopaedic Trauma
Heather A Vallier
Displaced distal tibia shaft fractures are effectively treated with standard plates and intramedullary nails. Plate fixation performed with meticulous soft tissue handling results in minimal risks of infection and poor wound healing. Standard plates have high rates of primary union, whereas locking plates may delay union because of increased stiffness. Tibial healing may also be delayed after plating of the fibula, although fibula reduction and fixation may aid accuracy of reduction of the tibia. Malalignment occurs more often with infrapatellar intramedullary nailing versus plates, and early results of suprapatellar nailing appear promising in minimizing intraoperative malalignment...
November 2016: Journal of Orthopaedic Trauma
Daniel S Chan, Paul M Balthrop, Brian White, David Glassman, Roy W Sanders
OBJECTIVE: To determine whether multiple approaches pose an increased risk to fracture healing when compared to a standard single approach in the treatment of pilon (OTA 43C) fractures. DESIGN: Retrospective review of a prospective database. SETTING: Level I academic trauma center and level II community trauma center. METHODS: From January 1, 2005 to December 31, 2011, all records of patients treated for OTA 43C fractures of the distal tibia were reviewed...
October 1, 2016: Journal of Orthopaedic Trauma
Byung Hoon Lee, Dong Ho Kum, Im Joo Rhyu, Youngjun Kim, Hyunchul Cho, Joon Ho Wang
PURPOSE: To evaluate the clinical advantages of a navigation system developed with an emphasis on attaining an appropriate femoral tunnel length and posterior wall margin with no posterior wall blowout, as well as having accurate tunnel positioning, in anatomical anterior cruciate ligament reconstruction (ACLR). METHODS: Ten freshly frozen human knees were transected at mid-femur and mid-tibia. Each knee specimen underwent arthroscopic single-bundle anterior cruciate ligament reconstruction using the outside-in technique, with two knees by manual ACLR (control group) and another eight knees by only the navigational ACLR without arthroscopic assistance (experimental group)...
October 19, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
John Arvesen, J Tracy Watson, Heidi Israel
OBJECTIVE: To determine the efficacy of a hexapod external fixator (TSF) and its ability to perform six-axis correction in restoring deformities associated with distal tibial nonunions. DESIGN: Consecutive retrospective case review. SETTING: St. Louis University Hospital. Level One Trauma Center. PATIENTS/PARTICIPANTS: 37 patients with distal tibial nonunion with greater than 5 degrees of deformity in any plane. Patients were excluded who were less than 18 years of age, had tibial deformities less than 5 degrees, had proximal or middle tibial deformities or had less than one year of follow up...
October 7, 2016: Journal of Orthopaedic Trauma
J A D van der Woude, S Spruijt, B T J van Ginneken, R J van Heerwaarden
Varus deformity can be localized in the tibia, in the femur or in both. If varus deformity is localized within the femur, it is mandatory to correct it in the femur. This report presents the technique and results of a consecutive case series of lateral uniplanar and biplanar closed-wedge valgus osteotomy of the distal femur for the treatment of varus deformity of the knee. Retrospectively, fifteen patients (sixteen knees) were identified. Indications for surgery varied from unloading an osteoarthritic medial compartment to reduction to symmetrical varus leg alignment...
October 14, 2016: Strategies in Trauma and Limb Reconstruction
William Colyn, Rintje Agricola, Nele Arnout, Jan A N Verhaar, Johan Bellemans
PURPOSE: The influence of type and intensity of sports during growth on knee alignment was investigated. The second aim was to ascertain whether the distal femur or proximal tibia contribute most to knee alignment. Also, the influence of field position and leg dominancy on knee alignment in soccer players was audited. METHODS: Standardized full-leg standing digital radiographs were obtained from 100 males and 100 females on which 8 different alignment parameters were measured...
October 14, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Richard L Jantz, Lee Meadows Jantz, Joanne L Devlin
Secular change in height has been extensively investigated, but size and shape of the postcranial skeleton much less so. The availability of large, documented collections of nineteenth- and twentieth-century skeletons makes it possible to examine changes in skeletal structure over the past 150 years. We examined secular changes in long bone lengths and proportions, their allometric relationship to stature, and crosssectional properties of long bone shafts. Bone measurements and stature were organized into 10-year birth cohorts, ranging from 1840 to 1989...
January 2016: Human Biology
Rachel M Frank, Anthony A Romeo, Matthew T Provencher
Anterior glenoid bone loss is present in nearly all cases of recurrent anterior glenohumeral instability. Treating glenoid bone loss in the setting of recurrent instability is challenging, and often, soft tissue stabilization procedures in isolation are inadequate. The nonanatomic, incongruous joint resulting from most bony augmentation procedures has motivated investigators to find an alternative solution. Recently, the use of fresh distal tibia allograft has been reported as an anatomic, osteoarticular reconstructive option for restoring the glenoid arc and maintaining glenohumeral congruency...
October 13, 2016: Orthopedics
S Farmer, V V Shanbhogue, S Hansen, C I Stahlberg, H Vestergaard, A P Hermann, H Frederiksen
: In this cross-sectional study of 45 patients with myeloproliferative neoplasms, we found no evidence of secondary osteoporosis. INTRODUCTION: Patients with essential thrombocythemia (ET) and polycythaemia vera (PV) are at increased risk of fractures but the underlying mechanisms have not been settled. We conducted a study to assess bone mineral density, microarchitecture, estimated bone strength and global bone turnover in 45 patients with ET or PV. METHODS: Patients were evaluated in a cross-sectional study with dual energy X-ray absorptiometry (DXA) at the hip and spine; high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius and distal tibia; and biochemical markers of bone turnover including pro-collagen type 1 N-terminal pro-peptide, osteocalcin, C-terminal cross-linking telopeptide of type 1 collagen and bone-specific alkaline phosphatase...
October 13, 2016: Osteoporosis International
A Ireland, R F Capozza, G R Cointry, L Nocciolino, J L Ferretti, J Rittweger
: Fibula response to disuse is unknown; we assessed fibula bone in spinal cord injury (SCI) patients and able-bodied counterparts. Group differences were smaller than in the neighbouring tibia which could not be explained by bone geometry. Differential adaptation of the shank bones may indicate previously unknown mechanoadaptive behaviours of bone. INTRODUCTION: The fibula supports only a small and highly variable proportion of shank compressive load (-8 to +19 %), and little is known about other kinds of stresses...
October 12, 2016: Osteoporosis International
Jessica Pepe, Emmanuel Biver, Nicolas Bonnet, François R Herrmann, René Rizzoli, Thierry Chevalley, Serge Livio Ferrari
CONTEXT: The maternal heritability of bone microarchitecture according to the sex of the offspring is not known. OBJECTIVE: To explore gender difference and influence of mother menopausal status on the heritability of bone microarchitecture between mothers and their offspring. SUBJECTS AND METHODS: In 102 mother-daughter and 161 mother-son pairs, volumetric BMD and bone microarchitecture were measured at distal radius and tibia by high-resolution peripheral quantitative computed tomography (HR-pQCT)...
October 12, 2016: Journal of Clinical Endocrinology and Metabolism
Kristin L Popp, William McDermott, Julie M Hughes, Stephanie A Baxter, Steven D Stovitz, Moira A Petit
PURPOSE: To determine differences in bone geometry, estimates of bone strength, muscle size and bone strength relative to load, in women runners with and without a history of stress fracture. METHODS: We recruited 32 competitive distance runners aged 18-35, with (SFX, n=16) or without (NSFX, n=16) a history of stress fracture for this case-control study. Peripheral quantitative computed tomography (pQCT) was used to assess volumetric bone mineral density (vBMD, mg/mm(3)), total (ToA) and cortical (CtA) bone areas (mm(2)), and estimated compressive bone strength (bone strength index; BSI, mg/mm(4)) at the distal tibia...
October 10, 2016: Bone
Murong You, Juehua Jing, Dasheng Tian, Jun Qian, Guangrong Yu
Dioscin has been shown to play important roles in suppression of osteoclast maturation. It is proposed as a potential natural product for the treatment of osteoclast-related diseases. We hypothesized in this study that treatment of dioscin on bone marrow mesenchymal stem cells (BMSCs) could increase the osteo-chondrogenic differentiation of BMSCs and promote endochondral ossification of BMSCs in bone fracture environment. BMSCs were extracted from femur and tibia of male C57b mice. Stemness of BMSCs was studied by performing proliferation assay and multilineage differentiation...
2016: American Journal of Translational Research
Oui Sik Yoo, Yong Seuk Lee, Myung Chul Lee, Jae Hong Park, Jae Won Kim, Doo Hoon Sun
BACKGROUND: After open wedge high tibial osteotomy (OWHTO), the proximal fragment resembles the anatomy of the proximal tibia that is aligned in the anterior-posterior direction and the distal fragment resembles the anatomy of the mid shaft that is aligned in the proximal-distal direction. In addition, the medial portion of the proximal fragment becomes aligned medially and the medial portion of the distal fragment, laterally, depending on the magnitude of the posterior opening gap. Therefore, there would be a mismatch between the post-correction bony surface and the previous pre-contoured plate geometry...
October 10, 2016: BMC Musculoskeletal Disorders
Richard J Sulston, Brian S Learman, Bofeng Zhang, Erica L Scheller, Sebastian D Parlee, Becky R Simon, Hiroyuki Mori, Adam J Bree, Robert J Wallace, Venkatesh Krishnan, Ormond A MacDougald, William P Cawthorn
BACKGROUND: Bone marrow adipose tissue (MAT) contributes to increased circulating adiponectin, an insulin-sensitizing hormone, during caloric restriction (CR), but whether this occurs in other contexts remains unknown. The antidiabetic thiazolidinediones (TZDs) also promote MAT expansion and hyperadiponectinemia, even without increasing adiponectin expression in white adipose tissue (WAT). OBJECTIVES: To test the hypothesis that MAT expansion contributes to TZD-associated hyperadiponectinemia, we investigated the effects of rosiglitazone, a prototypical TZD, in wild-type (WT) or Ocn-Wnt10b mice...
2016: Frontiers in Endocrinology
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