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Chinese Journal of Traumatology =... Jul 2022Common peroneal nerve palsy is quite disabling and every effort should be made to prevent its injury during the treatment. (Review)
Review
PURPOSE
Common peroneal nerve palsy is quite disabling and every effort should be made to prevent its injury during the treatment.
METHODS
We retrospectively reviewed the prospectively collected data of 7 cases of tibial plateau fractures in association with proximal fibula fracture from January 2019 to September 2019 who presented to emergency room of our hospital.
RESULTS
In addition to fibular neck fracture, the first case had type 6 tibial plateau displaced fracture and the second case had displaced acetabular fracture with instability of knee with tibial tuberosity avulsion. common peroneal nerve palsy developed following application of distal tibial skeletal traction in both the cases. Other 6 such cases remained neurologically intact as traction was not applied to them.
CONCLUSION
Such iatrogenic complication could have been prevented if the injury pattern of "concomitant medial and lateral columns" of the proximal leg is kept in mind by the treating surgeon before applying skeletal traction.
Topics: Fibula; Humans; Iatrogenic Disease; Knee Injuries; Paralysis; Retrospective Studies; Tibial Fractures
PubMed: 34330596
DOI: 10.1016/j.cjtee.2021.06.005 -
Joint Diseases and Related Surgery 2020This study aims to investigate the effects of associated factors like age, fracture level, accompanying fibular fractures and wound condition on healing by determining...
OBJECTIVES
This study aims to investigate the effects of associated factors like age, fracture level, accompanying fibular fractures and wound condition on healing by determining and comparing union scores of pediatric tibial fractures (PTFs).
PATIENTS AND METHODS
Forty-five patients with 46 PTFs (32 males, 13 females; mean age 9.5 years; range 2 to 16 years) who were treated by closed reduction and casting or operated between January 2016 and January 2019 were retrospectively evaluated. The union scores were evaluated at the end of fourth, sixth and eighth weeks and compared to each other. Effects of the age, associated fibular fractures, wound condition, fracture level and treatment type to union score were analyzed.
RESULTS
Twenty-eight (60.9%) out of 46 PTFs had associated fibular fractures and 18 (39.1%) did not. Motor vehicle accident was the most frequent etiologic factor (47.8%). Thirty-four out of 46 fractures were closed tibial fractures (73.9%) and 12 had open wound (26.1%). There was a negative correlation between age and the union scores (p<0.001 for each week). No significant difference was observed between the union score of diaphyseal and metaphyseal fractures at the fourth, sixth, and eighth weeks. The union scores of each week were higher in the conservative group compared to operative group (p<0.001 for each week). Associated fibular fracture group had lower union scores compared to isolated tibial fracture group at fourth, sixth and eighth weeks. Likewise, the union scores of the open fracture group were lower than the closed fracture group (p<0.05 for each week).
CONCLUSION
Associated fibular fractures, open fractures and aging negatively affect union scores of PTFs. Attention should be paid, particularly in these conditions, during the selection of the operation type and the follow-up period of PTFs.
Topics: Age Factors; Child; Conservative Treatment; Female; Fractures, Closed; Fractures, Open; Humans; Male; Orthopedic Procedures; Patient Selection; Radiography; Retrospective Studies; Tibia; Tibial Fractures; Trauma Severity Indices; Turkey
PubMed: 32962586
DOI: 10.5606/ehc.2020.75764 -
Archives of Orthopaedic and Trauma... Dec 2022Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and...
INTRODUCTION
Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes.
MATERIALS AND METHODS
A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation.
PRIMARY OUTCOMES
limb salvage rate and infection eradication.
SECONDARY OUTCOMES
patient functional outcomes and satisfaction.
RESULTS
Patients in this series of chronically infected tibias had been operated upon 3.4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm (6-600) and 5.4 cm (1-23), respectively. A free flap was performed in 67.7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51.7% (15/31). Local flap failure rate was 30% (3/10), with 9.5% for free flaps (2/21). Limb salvage rate was 93.5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1.0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were "very satisfied" with the treatment outcome.
CONCLUSION
A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction.
Topics: Humans; Tibial Fractures; Limb Salvage; Retrospective Studies; Plastic Surgery Procedures; Free Tissue Flaps; Wound Infection; Treatment Outcome; Soft Tissue Injuries
PubMed: 34936017
DOI: 10.1007/s00402-021-04299-9 -
Journal of the American Academy of... Jul 2022Despite growing attention to healthcare disparities and interventions to improve inequalities, additional identification of disparities is needed, particularly in the...
INTRODUCTION
Despite growing attention to healthcare disparities and interventions to improve inequalities, additional identification of disparities is needed, particularly in the pediatric population. We used state and nationwide databases to identify factors associated with the surgical treatment of pediatric forearm and tibial fractures.
METHODS
The Healthcare Cost and Utilization Project State Inpatient, Emergency Department, and Ambulatory Surgery and Services Databases from four US states and the Nationwide Emergency Department Sample database were quarried using International Classification of Diseases codes to identify patients from 2006 to 2015. Multivariable regression models were used to determine factors associated with surgical treatment.
RESULTS
State databases identified 130,006 forearm (1575 open) and 51,979 tibial fractures (1339 open). Surgical treatment was done in 2.6% of closed and 37.5% of open forearm fractures and 7.9% of closed and 60.5% of open tibial fractures. A national estimated total of 3,312,807 closed and 46,569 open forearm fractures were included, 59,024 (1.8%) of which were treated surgically. A total of 719,374 closed and 26,144 open tibial fractures were identified; 52,506 (7.0%) were treated surgically. Multivariable regression revealed that race and/or insurance status were independent predictors for the lower likelihood of surgery in 3 of 4 groups: Black patients were 43% and 35% less likely to have surgery after closed and open forearm fractures, respectively, and patients with Medicaid were less often treated surgically for open tibial fractures in state (17%) and nationwide (20%) databases.
CONCLUSIONS
Disparities in pediatric forearm and tibial fracture care persist, especially for Black patients and those with Medicaid; identification of influencing factors and interventions to address them are important in improving equality and value of care.
Topics: Child; Forearm; Forearm Injuries; Fractures, Open; Healthcare Disparities; Humans; Insurance Coverage; Medicaid; Tibial Fractures; United States
PubMed: 35908228
DOI: 10.5435/JAAOSGlobal-D-22-00126 -
European Journal of Orthopaedic Surgery... Jan 2021Approximately, 50 persons per 100,000 per year sustain a tibial fracture. There is, however, a lack of large cohort studies that describe the treatment and re-operation...
PURPOSE
Approximately, 50 persons per 100,000 per year sustain a tibial fracture. There is, however, a lack of large cohort studies that describe the treatment and re-operation frequencies of tibial fractures. The aim of this study was to describe the treatment and re-operation rates of tibial fractures in all segments of the tibia.
METHODS
Data related to all patients aged 16 and above treated for tibial fractures (ICD-10 S82.10-31) at Sahlgrenska University Hospital in 2011-2015 were extracted from the Swedish Fracture Register. To make sure all re-operations were included in the study, the operation planning system was checked for all patients included in the study.
RESULTS
The study comprised 1371 tibial fractures - 712 proximal, 417 diaphyseal and 242 distal tibial fractures. Among the proximal and distal tibial fractures, plate fixation was the most commonly used surgical method, whereas among tibial shaft fractures, an intramedullary nail was the most commonly used surgical method. Almost 30% (29.8%) of all surgically treated tibial fractures underwent re-operation. Among proximal tibial fractures, 24.0% underwent re-operation; tibial shaft fractures 37.0% and distal tibial fractures 26.8%. Re-operations due to infection were more or less equally common in all segments (3.9-5.4%).
CONCLUSION
This study describes the treatment and re-operation rates after tibial fractures in a cohort of 1371 tibial fractures at Sahlgrenska University Hospital during a period of 5 years. The study shows an overall re-operation rate of 29.8% for fractures in all segments of the tibia.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone Nails; Bone Plates; Fracture Fixation, Intramedullary; Humans; Middle Aged; Reoperation; Sweden; Tibial Fractures; Treatment Outcome; Young Adult
PubMed: 32743684
DOI: 10.1007/s00590-020-02751-x -
Chang Gung Medical Journal 2011Like other intra-articular fractures, the tibial plateau fracture is challenging for orthopedic surgeons because of its severity of trauma, associated soft tissue... (Review)
Review
Like other intra-articular fractures, the tibial plateau fracture is challenging for orthopedic surgeons because of its severity of trauma, associated soft tissue injuries. Open reduction incurs serious complications, especially wound healing after traditional dissections. Unsatisfactory results often occur in complex or bicondylar tibial plateau fractures. Traditional surgical methods achieved satisfactory results in 70-80% of cases. However, these methods have a high incidence of complications including loss of reduction, infection, and septic arthritis. The advantages of arthroscopy-assisted reduction and internal fixation include direct visualization of intra-articular fracture, accurate fracture reduction, and reduced morbidity. It is straightforward in the diagnosis and treatment of meniscal and ligamentous injuries, and removal of loose fragments. Good early to medium-term results of arthroscopically assisted osteosynthesis of tibial plateau fractures have been reported. The author reviews the current surgical principles, pitfalls, approaches, clinical results, and complications of arthroscopyassisted surgery for tibial plateau fractures.
Topics: Arthroscopy; Humans; Postoperative Complications; Radiography; Tibial Fractures
PubMed: 21733353
DOI: No ID Found -
Archives of Orthopaedic and Trauma... Jul 2022ACL injury is one of the most common injuries of the knee joint in sports. As accompanying osseous injuries of the ACL rupture a femoral impression the so-called lateral...
INTRODUCTION
ACL injury is one of the most common injuries of the knee joint in sports. As accompanying osseous injuries of the ACL rupture a femoral impression the so-called lateral femoral notch sign and a posterolateral fracture of the tibial plateau are described. However, frequency, concomitant ligament injuries and when and how to treat these combined injuries are not clear. There is still a lack of understanding with which ligamentous concomitant injuries besides the anterior cruciate ligament injury these bony injuries are associated.
MATERIALS AND METHODS
One hundred fifteen MRI scans with proven anterior cruciate ligament rupture performed at our center were retrospectively evaluated for the presence of a meniscus, collateral ligament injury, a femoral impression, or a posterolateral impression fracture. Femoral impressions were described according to their local appearance and posterolateral tibial plateau fractures were described using the classification of Menzdorf et al. RESULTS: In 29 cases a significant impression in the lateral femoral condyle was detected. There was a significantly increased number of lateral meniscal (41.4% vs. 18.6% p = 0.023) and medial ligament (41.4% vs. 22.1%; p = 0.040) injuries in the group with a lateral femoral notch sign. 104 patients showed a posterolateral bone bruise or fracture of the tibial plateau. Seven of these required an intervention according to Menzdorf et al. In the group of anterior cruciate ligament injuries with posterolateral tibial plateau fracture significantly more lateral meniscus injuries were seen (p = 0.039).
CONCLUSION
In the preoperative planning of ACL rupture accompanied with a positive femoral notch sign, attention should be paid to possible medial collateral ligament and lateral meniscus injuries. As these are more likely to occur together. A posterolateral impression fracture of the tibial plateau is associated with an increased likelihood of the presence of a lateral meniscal injury. This must be considered in surgical therapy and planning and may be the indication for necessary early surgical treatment.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Epiphyses; Humans; Knee Injuries; Magnetic Resonance Imaging; Retrospective Studies; Rupture; Tibial Fractures
PubMed: 34341852
DOI: 10.1007/s00402-021-04105-6 -
Orthopaedics & Traumatology, Surgery &... May 2020Periprosthetic tibial fracture after total knee arthroplasty (TKA) is rare, but jeopardizes implant survival. The main objective of the present study was to assess...
INTRODUCTION
Periprosthetic tibial fracture after total knee arthroplasty (TKA) is rare, but jeopardizes implant survival. The main objective of the present study was to assess treatment efficacy, on the hypothesis that surgery provides good long-term results.
MATERIAL AND METHODS
A two-center retrospective study included 15 patients (6 male, 9 female: mean age, 71.8±10.2 years), managed between 1997 and 2017 for isolated tibial fracture after TKA. Patients were assessed clinically (IKS, inverted Oxford, Parker and SF-12 scores) and radiologically. Complications and revision surgeries were collated. Fractures were classified on the SoFCOT classification: 9 stable implants (4 type B1, 5 type C1), 4 periprosthetic osteolyses (1 type A3, 2 type B3, 1 type C3), and 2 loosenings (type A2). Treatments comprised: non-operative treatment (1 bed-ridden patient), 11 osteosyntheses for fracture on stable implant (2 standard plates, 7 locking plates, 2 intramedullary nailings), and 3 implant replacements by cemented long stem models for loosening.
RESULTS
Mean follow-up was 28 months (range, 12-120 months). Consolidation was achieved in 13 cases, at a mean 15 weeks. Complications comprised: 4 infections, 2 cases of secondary displacement, and 2 of non-union. Surgical revision was required in 8 cases, including 2 secondary implant revision procedures. Functional results were good in 10 cases. At last follow-up, mean Parker score was 7 (range, 4-8.5), Oxford score 32 (range, 16-39), and IKS score 150 (range, 85-167) with knee and function scores respectively 78 (range, 55-86) and 75 (range, 30-85).
CONCLUSION
Radiologic and clinical results were encouraging, but with impaired quality of life and a high rate of complications.
LEVEL OF EVIDENCE
IV, retrospective cohort study.
Topics: Aged; Arthroplasty, Replacement, Knee; Female; Femoral Fractures; Follow-Up Studies; Fracture Fixation, Internal; Humans; Male; Middle Aged; Periprosthetic Fractures; Quality of Life; Reoperation; Retrospective Studies; Tibial Fractures; Treatment Outcome
PubMed: 32184065
DOI: 10.1016/j.otsr.2020.01.008 -
Clinical Biomechanics (Bristol, Avon) Mar 2020Periprosthetic tibial fracture after unicompartmental knee replacement is a challenging post-operative complication. Patients have an increased risk of mortality after...
BACKGROUND
Periprosthetic tibial fracture after unicompartmental knee replacement is a challenging post-operative complication. Patients have an increased risk of mortality after fracture, the majority undergo further surgery, and the revision operations are less successful. Inappropriate surgical technique increases the risk of fracture, but it is unclear which technical aspects of the surgery are most problematic and no research has been performed on how surgical factors interact.
METHODS
Firstly, this study quantified the typical variance in surgical cuts made during unicompartmental knee replacement (determined from bones prepared by surgeons during an instructional course). Secondly, these measured distributions were used to create a probabilistic finite element model of the tibia after replacement. A thousand finite element models were created using the Monte Carlo method, representing 1000 virtual operations, and the risk of tibial fracture was assessed.
FINDINGS
Multivariate linear regression of the results showed that excessive resection depth and making the vertical cut too deep posteriorly increased the risk of fracture. These two parameters also had high variability in the prepared synthetic bones. The regression equation calculated the risk of fracture from three cut parameters (resection depth, vertical and horizonal posterior cuts) and fit the model results with 90% correlation.
INTERPRETATION
This study introduces for the first time the application of a probabilistic approach to predict the aetiology of fracture after unicompartmental knee replacement, providing unique insight into the relative importance of surgical saw cut variations. Targeted changes to operative technique can now be considered to seek to reduce the risk of periprosthetic fracture.
Topics: Arthroplasty, Replacement, Knee; Female; Finite Element Analysis; Humans; Knee Prosthesis; Male; Middle Aged; Postoperative Complications; Probability; Rotation; Tibial Fractures
PubMed: 31935599
DOI: 10.1016/j.clinbiomech.2019.12.014 -
Journal of Bone and Mineral Research :... Nov 2023Bone fractures are among the most prevalent musculoskeletal injuries, and pain management is an essential part of fracture treatment. Fractures heal through an early...
Bone fractures are among the most prevalent musculoskeletal injuries, and pain management is an essential part of fracture treatment. Fractures heal through an early inflammatory phase, followed by repair and remodeling. Nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended for fracture pain control as they potently inhibit the inflammatory phase and, thus, impair the healing. Opioids do not provide a better alternative for several reasons, including abuse potential. Accordingly, there is an unmet clinical need for analgesics that effectively ameliorate postfracture pain without impeding the healing. Here, we investigated the analgesic efficacy of two nonpsychotropic cannabinoids, cannabidiol (CBD) and cannabigerol (CBG), in a mouse model for tibial fracture. Mice with fractured tibiae exhibited increased sensitivity to mechanical, cold, and hot stimuli. Both CBD and CBG normalized pain sensitivity to all tested stimuli, and their analgesic effects were comparable to those of the NSAIDs. Interestingly, CBD and CBG promoted bone healing via multiple mechanisms during the early and late phases. During the early inflammatory phase, both cannabinoids increased the abundance of periosteal bone progenitors in the healing hematoma and promoted the osteogenic commitment of these progenitors. During the later phases of healing, CBD and CBG accelerated the fibrocartilaginous callus mineralization and enhanced the viability and proliferation of bone and bone-marrow cells. These effects culminated in higher bone volume fraction, higher bone mineral density, and improved mechanical quality of the newly formed bone. Together, our data suggest CBD and CBG as therapeutic agents that can replace NSAIDs in managing postfracture pain as both cannabinoids exert potent analgesic effects and, at the same time, promote bone healing. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Topics: Mice; Animals; Cannabidiol; Cannabinoids; Bony Callus; Pain; Anti-Inflammatory Agents, Non-Steroidal; Tibial Fractures; Minerals; Fracture Healing
PubMed: 37597163
DOI: 10.1002/jbmr.4902