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tibial fractures in children

Rohan A Ramasubbu, Benjamin M Ramasubbu
BACKGROUND: Management of open tibial fractures is well documented in adults, with existing protocols outlining detailed treatment strategies. No clear guidelines exist for children. Surgical stabilization of tibial fractures in the pediatric population requires implants that do not disrupt the open epiphyses (growth plate). Both elastic stable intramedullary nails and external fixation can be used. The objective of this study was to identify the optimal method of surgical stabilization in the treatment of open tibial fractures in children...
September 2016: Indian Journal of Orthopaedics
Kaiying Shen, Haiqing Cai, Zhigang Wang, Yunlan Xu
Elastic stable intramedullary nailing (ESIN) has became a well-accepted method of osteosynthesis of diaphyseal fractures in the skeletally immature patient for many advantages, the purpose of this study is to evaluate the preliminary results of this minimally invasive treatment for severely displaced distal tibial diaphyseal metaphyseal junction (DTDMJ) fractures.This study was carried out over a 6-year period. Twenty-one severely displaced DTDMJ fractures treated using ESIN were evaluated clinically and radiographically...
September 2016: Medicine (Baltimore)
Timo Rantalainen, Benjamin K Weeks, Rossana C Nogueira, Belinda R Beck
Skeletal robustness (cross-section size relative to length) is associated with stress fractures in adults, and appears to explain the high incidence of distal radius fractures in adolescents. However, little is known about the ontogeny of long bone robustness during the first three decades of life. Therefore, we explored the ontogeny of tibial, fibular, ulnar and radial robustness in a cross-sectional sample of 5 to 29year-old volunteers of both sexes. Peripheral quantitative computed tomography (pQCT) was used to evaluate cross-sections of the leg (4%, 14%, 38% and 66%), and forearm (4%, and 66%) in N=432 individuals...
September 17, 2016: Bone
Rhianna M Little, Matthew D Milewski
While some fractures may be managed similarly in adults and children, physeal fractures are uniquely limited to the pediatric population and require special consideration. Although physeal fractures about the knee are relatively rare, they are occurring more frequently due to increasing youth participation in sports and high-energy recreational activities. The evaluation and management of distal femoral and proximal tibial physeal fractures are similar to one another, but fractures of the tibial spine and tibial tubercle are approached somewhat differently...
September 7, 2016: Current Reviews in Musculoskeletal Medicine
Yen-Nien Chen, Pei-Yuan Lee, Chih-Han Chang, Chih-Wei Chang, Yi-Hung Ho, Chun-Ting Li, Yao-Te Peng
INTRODUCTION: Elastic stable intramedullary nailing (ESIN) is a treatment strategy for the management of diaphyseal long-bone fractures in adolescents and children, but few studies have investigated the mechanical stability of tibial diaphyseal fractures treated with various degrees of prebending of the elastic nails. Therefore, the aim of this study was to compare the mechanical stability, including the gap deformation and nail dropping, of a tibia fracture with various fracture sites and fixed with various degrees of prebending of the elastic nails by the finite element method...
July 7, 2016: Injury
Julio J Masquijo, Gregory B Firth, Dalia Sepúlveda
Growth modulation with tension band plates (TBP) has been shown to be a very useful method for the treatment of angular deformities in growing children. Recently, we have observed cases of failure where the epiphyseal screw was drawn through the physis into the metaphysis. This study describes a series of children who developed this complication. Patients who developed TBP failure after operative treatment of lower limb angular deformities were identified from the databases at four institutions over a 5-year period...
July 8, 2016: Journal of Pediatric Orthopedics. Part B
Khalid A Azzam, Eric T Rush, Bridget R Burke, Aleisha M Nabower, Paul W Esposito
BACKGROUND: Patients with osteogenesis imperfecta (OI) have significant burden of both fractures and bony deformities. The present approach to care in this disorder is a combination of surgical care with intramedullary rod fixation, cyclic bisphosphonate therapy, and rehabilitation with goal of maximizing patient function and quality of life. METHODS: Retrospective chart review identified 58 children with OI who had realignment osteotomies with Fassier-Duval (FD) intramedullary nailing of the lower extremity by a single surgeon...
July 2, 2016: Journal of Pediatric Orthopedics
Lior Koren, Yaniv Keren, Mark Eidelman
BACKGROUND: Taylor Spatial Frame (TSF) is a modern circular external fixator that, using a virtual hinge, is able to correct six axis deformities simultaneously. Despite the growing popularity of this method, few reports exist about its use in children and adolescents. To evaluate the effectiveness of TSF in correcting multiplanar deformities in patients with open physis, we reviewed the results of treatment in children who had at least two planes deformities of lower limbs. METHODS: Over a period of 8 years, we treated 51 patients, 40 boys, 11 girls, with a mean age of 12...
2016: Open Orthopaedics Journal
Mostafa Abdelkhalek, Barakat El-Alfy, Ayman M Ali
The aim of this study was to compare the results of treatment of segmental tibial defects in the pediatric age group using an Ilizarov external fixator versus a nonvascularized fibular bone graft. This study included 24 patients (age range from 5.5 to 15 years) with tibial bone defects: 13 patients were treated with bone transport (BT) and 11 patients were treated with a nonvascularized fibular graft (FG). The outcome parameters were bone results (union, deformity, infection, leg-length discrepancy) and functional results: external fixation index and external fixation time...
November 2016: Journal of Pediatric Orthopedics. Part B
Matthias J Feucht, Peter U Brucker, Carlo Camathias, Karl-Heinz Frosch, Michael T Hirschmann, Stephan Lorenz, Hermann O Mayr, Philipp Minzlaff, Wolf Petersen, Tim Saier, Dorien Schneidmüller, Amelie Stoehr, Daniel Wagner, Norbert P Südkamp, Philipp Niemeyer
PURPOSE: To prospectively evaluate the prevalence and characteristics of meniscal injuries in children and adolescents undergoing surgical treatment for tibial eminence fractures and to test for possible relationships between associated meniscal lesions and patient demographics or injury characteristics. METHODS: A prospective multicenter study was conducted to arthroscopically assess the prevalence and characteristics of meniscal injuries in children and adolescents undergoing surgical treatment for tibial eminence fractures between 04/2014 and 10/2015...
May 27, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Fátima Baptista, Lurdes M Rebocho, Graça Cardadeiro, Vera Zymbal, Nicoletta Rosati
Boys usually have higher values of bone mineral density measured by dual-energy X-ray absorptiometry than girls, but contradictorily also have a greater incidence of fractures during growth. The purpose of this study was to investigate sex- and maturity-related differences in bone speed of sound (SoS) at the radius and tibia in a sample of 625 healthy children aged 10-14 y and to analyze the contributions of physical activity (PA) to possible dissimilarities. Radial and tibial SoS was evaluated by quantitative ultrasound, maturity was estimated as the years of distance from the peak height velocity age, and PA was assessed by accelerometry...
September 2016: Ultrasound in Medicine & Biology
Justin J Mitchell, Meredith H Mayo, Derek P Axibal, Anthony R Kasch, Ryan R Fader, Vivek Chadayammuri, E Bailey Terhune, Gaia Georgopoulos, Jason T Rhodes, Armando F Vidal
BACKGROUND: Avulsion fractures of the anterior tibial spine in young athletes are injuries similar to anterior cruciate ligament (ACL) injuries in adults. Sparse data exist on the association between anterior tibial spine fractures (ATSFs) and later ligamentous laxity or injuries leading to ACL reconstruction. PURPOSE: To better delineate the incidence of delayed instability or ACL ruptures requiring delayed ACL reconstruction in young patients with prior fractures of the tibial eminence...
August 2016: American Journal of Sports Medicine
Andrea Kelly, Joan Schall, Virginia A Stallings, Babette S Zemel
Osteopenia and increased fracture rates are well-recognized in adults with CF, but neither the specific contributions of cortical and trabecular bone deficits to bone fragility nor their presence in youth with CF are well-characterized. This study sought to characterize cortical and trabecular volumetric bone mineral density (vBMD), geometry, and biomechanical competence in children with CF and determine their relationship to growth, body composition, and disease severity. Peripheral quantitative computerized tomography (pQCT) measures of total, cortical, and trabecular vBMD, cortical, muscle, and fat cross-sectional areas (CSA), periosteal and endosteal circumferences, and the polar unweighted section modulus (Zp) of the tibia were converted to age- and tibial length-adjusted Z-scores in 97 CF and 199 healthy children (aged 8-21y)...
September 2016: Bone
H Najdi, C Thévenin-Lemoine, J Sales de Gauzy, F Accadbled
INTRODUCTION: Tibial intercondylar eminence fracture rarely occurs in childhood. Its treatment requires anatomic reduction to provide knee stability and a rigid fixation to minimize postoperative immobilization time. HYPOTHESIS: Arthroscopy combined with fluoroscopy with intra-epiphyseal ASNIS screw fixation can meet the requirements of this treatment. MATERIAL AND METHODS: The series comprised 24 patients (mean age: 11 years) with Meyers and McKeever type II tibial intercondylar eminence fractures (n=15) or type III (n=9), operated on between 2011 and 2013...
June 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Matthias Erschbamer, Pascal Gerhard, Harry Klima, Birte Ellenrieder, Katja Zdenek-Lehnen, Karlmeinrad Giesinger
We retrospectively reviewed the safety and efficacy of operative treatment of torsional malalignment of the tibia in 44 children, on whom we performed 71 derotational osteotomies of the distal tibia to treat tibial torsion. We placed four pins using an alignment jig, performed a percutaneous osteotomy, and applied an external fixator after derotation. Postoperative radiographs showed accurate tibial derotation and pin placement in all patients. Nine patients developed superficial pin-tract infections that resolved with antibiotic treatment...
March 18, 2016: Journal of Pediatric Orthopedics. Part B
Rashida F Vasanwala, Anish Sanghrajka, Nicholas J Bishop, Wolfgang Högler
Long-term bisphosphonate (BP) therapy in adults with osteoporosis is associated with atypical femoral fractures, caused by increased material bone density and prolonged suppression of bone remodeling which may reduce fracture toughness. In children with osteogenesis imperfecta (OI), long-term intravenous BP therapy improves bone structure and mass without further increasing the already hypermineralized bone matrix, and is generally regarded as safe. Here we report a teenage girl with OI type IV, who was started on cyclical intravenous pamidronate therapy at age 6 years because of recurrent fractures...
July 2016: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
T Slongo, L Audigé, J B Hunter, S M Berger
BACKGROUND: Elastic stable intramedullary nailing (ESIN) may be complicated by the loss of reduction following push out of the nails at the entry site in unstable femoral and tibial fractures, especially in older and heavier children and following technical failures. An end cap system addressing this complication was evaluated clinically. METHODS: In a retrospective case series, 49 femoral and five tibial fractures in 54 pediatric patients treated by ESIN and end caps were documented in two European tertiary centers...
June 2011: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Giuseppe Rosario Schirò, Sergio Sessa, Andrea Piccioli, Giulio Maccauro
BACKGROUND: In the last decades a lot of new reconstructive techniques were developed for the treatment of mangled lower extremity. However failed attempt to limb salvage is related to high risk of mortality for the patient. Several scores were developed to establish guidelines for the decision to amputate or not, however in literature there is no consensus about the reliability of this scores. METHODS: The authors focused their attention on the most used score system to provide guidance of the management of a mangled lower limb...
2015: BMC Musculoskeletal Disorders
Matthew T Stepanovich, Joseph B Slakey
Traumatic extensor dysfunction of the knee in children is a rare injury, with the majority resulting from tibial tubercle avulsion fracture or patellar sleeve fracture. We report a rare case of combined patellar avulsion fracture and tibial tubercle fracture. With open anatomic reduction, both injuries were successfully treated. While many variations of tibial tubercle fracture have been reported, the authors believe this to be the first report in the English-language literature of this particular combined injury to the knee extensor mechanism in an adolescent...
January 2016: American Journal of Orthopedics
Pooya Hosseinzadeh, Vishwas R Talwalkar
Compartment syndrome (CS) can present differently in children than in adults. Increased need for analgesics is the first sign of evolving CS in children. Children with supracondylar humeral fractures, floating elbow injuries, operatively treated forearm fractures, and tibial fractures are at high risk for CS. Elbow flexion beyond 90° in supracondylar humeral fractures and closed treatment of forearm fractures in floating elbow injuries are associated with increased risk for CS. Prompt diagnosis and treatment with fasciotomy in children result in excellent long-term outcomes...
January 2016: American Journal of Orthopedics
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