-
Clinical and Applied... 2021To explore the correlation between the fracture line inferior plane and perioperative deep venous thrombosis (DVT) in patients with tibial fractures.
OBJECTIVE
To explore the correlation between the fracture line inferior plane and perioperative deep venous thrombosis (DVT) in patients with tibial fractures.
METHODS
Data was collected from the medical records of 536 consecutive patients with tibial fractures at Xi'an Honghui Hospital. The patients were divided into distal, shaft, and proximal segment groups according to the fracture line inferior plane on radiographs. Multivariate logistic regression models were used to identify the role of the inferior plane of the fracture line in perioperative DVT.
RESULTS
A total of 431 patients were included in the study and 226 patients had perioperative DVT in the lower extremities, including 11 proximal and 215 distal DVTs. Univariate regression analysis showed a significant correlation between the proximal segment and perioperative DVT; however, no correlation was found in the shaft segment group. Additionally, age, coronary heart disease, associated injuries, and time to operation ≥6 days were risk factors for perioperative DVT. However, fixation with intramedullary nails may be a protective factor for perioperative DVT compared with plates. After adjusting for potential confounding factors, the proximal segment group had an increased incidence of perioperative DVT compared to the distal segment group.
CONCLUSIONS
The proximal segment may be correlated with an increased incidence of perioperative DVT by 7.30-fold in patients with tibial fractures compared to that in the distal segment. In clinical practice, surgeons should be vigilant for DVT formation in these patients.
Topics: China; Female; Follow-Up Studies; Humans; Incidence; Lower Extremity; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Tibial Fractures; Ultrasonography; Venous Thrombosis
PubMed: 34939445
DOI: 10.1177/10760296211067258 -
European Journal of Trauma and... Apr 2022To investigate, if patients with complex proximal tibial fracture have realistic expectations on open reduction and internal fixation.
PURPOSE
To investigate, if patients with complex proximal tibial fracture have realistic expectations on open reduction and internal fixation.
METHODS
114 patients (mean 49 years, SD ± 13) with closed AO-type B and C proximal tibial fracture were grouped (group B, respectively C). Prior to surgery expectations concerning knee function, pain, return to work/sports, and the risk for osteoarthritis was assessed with the Hospital for Special Surgery-Knee Surgery Expectations Survey (HFSS-KSE) and a non-validated ten-item survey.
RESULTS
92% of patients expected at least an almost natural knee postoperatively. All items regarding restoring knee function were ranked to be at least important in both groups. 65% in group B and 47% in group C expected at most occasional pain. 83% in group B and 67% in group C expected full return to work without any limitations. Patients with low physical work intensity expected significantly shorter incapacity to work in both groups (7.8, respectively 8.9 weeks). 71% in group B and 60% in group C expected to return to sports with at most small limitations. 33% in group B and 22% in group C assumed risk for osteoarthritis will be prevented by surgery.
CONCLUSION
Expectations on surgery for complex proximal tibial fracture are high regardless of fracture type. The prognosis of many health and lifestyle domains was overestimated. The risk for osteoarthritis was underestimated. This study should sensitize surgeons to discuss realistic expectations. This may help to improve patient comprehension what leads to sensible expectations, resulting in improved patients´ satisfaction.
LEVEL OF EVIDENCE
IV.
TRIAL REGISTRATION NUMBER
14104, Date of registration: 06/2015.
Topics: Fracture Fixation, Internal; Humans; Osteoarthritis; Pain; Prognosis; Tibial Fractures; Treatment Outcome
PubMed: 33721052
DOI: 10.1007/s00068-021-01644-w -
Journal of Ayub Medical College,... 2022To determine the frequency of tibial diaphyseal fractures among patients presenting with motorcycle accidents. It was a cross-Sectional Study, conducted at Department of...
BACKGROUND
To determine the frequency of tibial diaphyseal fractures among patients presenting with motorcycle accidents. It was a cross-Sectional Study, conducted at Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi between May to December, 2020.
METHODS
All patients irrespective of gender, between ages 18-60 years who suffered from a motorcycle injury with a single bone involvement were eligible for the study. All patients who refused to take part in the study, had head injury, or had multiple fractures were excluded from the study. The data included patient's age, sex, associated bones involved and types of injury. The fractures were classified according to whether it was open or closed.
RESULTS
A total of 174 patients were included in the study with a mean±SD age of 43.7±12.4. Tibial diaphyseal fracture was found to be in 111 (63.8%) patients as shown. Duration of fracture, gender, side of fracture, type of fracture was done with respect to Tibial diaphyseal fracture among patients. Insignificant difference was noted in age group (p=0.346), duration of fracture (p=0.087), gender (p=0.672), and type of fracture (p=0.063) whereas significant difference was found in side of fracture (p=0.0001).
CONCLUSION
We highlighted the importance of tibial diaphyseal fractures in middle aged men who use motorcycles as a means of transport in Karachi, Sindh which is a frequent finding among these patients. Efforts should be made at both the community and government levels to increase awareness regarding traffic rules and consequences of reckless driving.
Topics: Middle Aged; Male; Humans; Adolescent; Young Adult; Adult; Motorcycles; Incidence; Cross-Sectional Studies; Tibial Fractures; Accidents
PubMed: 36550657
DOI: 10.55519/JAMC-04-S4-10062 -
Chinese Journal of Traumatology =... Jan 2022Schatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane, consequent to valgus impaction caused by low velocity of...
Schatzkter type-I tibial plateau fracture is a split fracture of the lateral tibial plateau in sagittal plane, consequent to valgus impaction caused by low velocity of trauma. However, a deep understanding of the different columns of the tibial plateau and patho-mechanisms of the injury led to the unmasking of atypical fractures around the tibial plateau. We have encountered 2 cases with unusual fracture pattern of the lateral tibial condyle caused by road traffic accidents. The fracture pattern and severity of injury deviate from the original description of Schatzker type 1; in view of dual plane split, there is rotation of the posterolateral column fragment along its sagittal plane plus grade-III medial collateral ligament injury. The patients were initially treated with knee spanning external fixator and after a latency of 5 days, definitive fracture specific fixation was done, combined with repair of grade-III medial collateral ligament injury. At the 6 months follow-up both the patients achieved satisfactory knee functions (knee society score case 1: 100 and case 2: 92) and returned to their jobs. The severity of fracture pattern and displacement as described should prompt for examination of associated ligament injury. Because of timely diagnosis, early and appropriate care promised an excellent function outcome even in such a severe nature of knee injury. To prompt the description of injury pattern we coined the name "dual split and dislocation" of lateral tibial plateau, as a complex injury variant of split fracture of lateral tibial plateau fracture.
Topics: External Fixators; Fracture Fixation, Internal; Humans; Joint Dislocations; Knee Injuries; Tibial Fractures
PubMed: 34059441
DOI: 10.1016/j.cjtee.2021.04.001 -
BMC Musculoskeletal Disorders Dec 2022Tibial fractures are the most common fractures seen in adults and lead to the most nonunions. Osteogenesis imperfecta (OI) is characterized by increased bone fragility...
Incidence and nonunion rates of tibial fractures in adults with osteogenesis imperfecta: a retrospective cohort study of 402 patients with 42 fractures at an expert clinic.
BACKGROUND
Tibial fractures are the most common fractures seen in adults and lead to the most nonunions. Osteogenesis imperfecta (OI) is characterized by increased bone fragility and higher risk of fractures. No studies have been published on the incidence of tibial fractures and nonunions in adults with OI. This study aims to summarize the incidence of tibial fractures and nonunions in this population.
METHODS
A retrospective, descriptive study. All medical charts of adult patients in the OI database of our OI expert clinic were analyzed for tibial fractures between 2008 and 2020. Tibial fracture incidence, nonunion rate, treatment modality and potential risk factors were determined.
RESULTS
The database consisted of 402 patients, 34 of whom had suffered one or more tibial fractures, resulting in 42 fractures. The incidence of tibial fractures in adults with OI is 870 per 100,000 person-years. Two out of 42 fractures led to nonunion (5%). It was not possible to adjust for risk factors or type of treatment.
CONCLUSION
There is a higher incidence of tibial fractures in patients with OI, but a nonunion rate comparable to the general population. With only two nonunions it is not possible to draw conclusions on the influence of risk factors or treatment of tibial fractures on OI.
Topics: Humans; Osteogenesis Imperfecta; Retrospective Studies; Tibial Fractures
PubMed: 36482324
DOI: 10.1186/s12891-022-05966-7 -
Medicine Aug 2019Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported.... (Observational Study)
Observational Study
Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported. The purpose of this study was to evaluate any differences according to the mechanisms of injury in adolescents with tibial tubercle avulsion fracture.Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Seven patients (low-stress group) had a spontaneous fracture during running without definite trauma. Twenty-three patients (high-stress group) experienced pain during jumping and landing, or definite trauma. The mechanisms of injury, age, height, weight, body mass index (BMI), BMI percentile, fracture type, as well as any complication, such as limitation of motion and deformity related to the physeal arrest, were compared between groups.There was no definite difference in age, fracture type, and surgical outcomes between groups. There was no patient with significant early physeal arrest in both groups. The weight (P = .02), BMI (P = .03) and BMI percentile (P = .01) in low-stress group were higher than those in high-stress group. In low-stress group, 6 patients' BMIs were in the 97th percentile, and 1 patient's BMI was in the 5th percentile.Extreme BMI may be a risk factor for tibial tubercle avulsion fractures in adolescents during running without definite trauma. However, there was no difference in the final outcome according to injury mechanisms.
Topics: Adolescent; Athletic Injuries; Body Mass Index; Child; Female; Fracture Fixation, Internal; Fractures, Avulsion; Humans; Male; Radiography; Retrospective Studies; Risk Factors; Tibial Fractures
PubMed: 31393372
DOI: 10.1097/MD.0000000000016700 -
Journal of Orthopaedic Surgery and... Jun 2023To investigate the radiologic and prognostic outcomes after using arthroscopic-assisted reduction and internal fixation (ARIF) in complex tibial plateau fractures with...
BACKGROUND
To investigate the radiologic and prognostic outcomes after using arthroscopic-assisted reduction and internal fixation (ARIF) in complex tibial plateau fractures with mid- to long-term follow-up.
METHODS
This retrospective study reviewed complex tibial plateau fractures that underwent ARIF from 1999 to 2019. Radiologic outcomes, including tibial plateau angle (TPA), posterior slope angle (PSA), Kellgren-Lawrence classification and Rasmussen radiologic assessment, were measured and evaluated. The prognosis and complications were assessed by the Rasmussen clinical assessment with a minimum follow-up of 2 years.
RESULTS
Ninety-two consecutive patients (mean age: 46.9 years) with a mean follow-up of 74.8 months (24-180) were included in our series. Using AO classification, there were 20 type C1 fractures, 21 type C2 fractures, and 51 type C3 fractures. All the fractures achieved solid union. TPA was maintained well on average at the last follow-up and showed no significant difference compared to postoperatively (p = 0.208). In the sagittal plane, the mean PSA increased from 9.3 ± 2.9° to 9.6 ± 3.1° (p = 0.092). A statistically significant increase in PSA was also noted in the C3 group (p = 0.044). Superficial or deep infection was noted in 4 cases (4.3%), and total knee arthroplasty (TKA) was performed in 2 cases (2.2%) due to grade 4 osteoarthritis (OA). Ninety (97.8%) and 89 (96.7%) patients had good or excellent results in the Rasmussen radiologic assessment and Rasmussen clinical assessment, respectively.
CONCLUSIONS
The complex tibial plateau fracture could be treated successfully using arthroscopy-assisted reduction and internal fixation. Most patients achieve excellent and good clinical outcomes with low complication rates. In our experience, a higher incidence of increased slope was noted, especially in type C3 fractures. Reduction of the posterior fragment should be done cautiously during the operation.
LEVELS OF EVIDENCE
Level III.
Topics: Humans; Middle Aged; Follow-Up Studies; Retrospective Studies; Tibial Plateau Fractures; Tibial Fractures; Fracture Fixation, Internal; Treatment Outcome
PubMed: 37349746
DOI: 10.1186/s13018-023-03938-8 -
European Review For Medical and... Feb 2020To explore the effect of parathyroid hormone (PTH) on the expression of Jagged1 in the rabbit tibial fracture healing, and its function and mechanism in this process via...
OBJECTIVE
To explore the effect of parathyroid hormone (PTH) on the expression of Jagged1 in the rabbit tibial fracture healing, and its function and mechanism in this process via the Notch signaling pathway.
MATERIALS AND METHODS
A total of 60 New Zealand white rabbits were randomly divided into control group (n=30) and experimental group (n=30). Then, a rabbit tibial fracture model was established. After surgery, the rabbits in experimental group were given 10 μg/kg PTH (1-34) once a day for 5 days a week, while those in control group were given an equal volume of normal saline. Six rabbits were randomly selected from each group at 1, 2, 3, 4, and 6 weeks after surgery to collect right tibia specimens. Next, X-ray examination, bone mineral density (BMD) test, histological detection, and serum biochemical test were performed. Additionally, the messenger ribonucleic acid (mRNA) expression levels of Notch1 and Jagged1 in the Notch signaling pathway were measured via polymerase chain reaction (PCR) assay. Their protein levels were detected through Western blotting analysis.
RESULTS
The healing and BMD in experimental group were better than those in control group since cortical and medullary bridging was observed in the rabbits of experimental group at the 6th week after surgery. Plasma level of alkaline phosphatase (ALP), P content, and the product of Ca and P significantly increased (p<0.05) in experimental group. The pathological morphology of the calluses stained with hematoxylin-eosin (HE) in experimental group was overtly superior to that in control group. The PCR results revealed that both mRNA and protein levels of Notch1 and Jagged1 were lower in control group than those in experimental group (p<0.05).
CONCLUSIONS
PTH (1-34) promotes the rabbit tibial fracture healing by regulating Jagged1 ligand molecules in the Notch signaling pathway.
Topics: Animals; Fracture Healing; Jagged-1 Protein; Parathyroid Hormone; Rabbits; Receptors, Notch; Signal Transduction; Tibia; Tibial Fractures
PubMed: 32141528
DOI: 10.26355/eurrev_202002_20336 -
Danish Medical Journal Mar 2014Tibial eminentia avulsion fracture is the paediatric equivalent to a midsubstance anterior cruciate ligament injury. It is most common between the ages of 8 and 19 years... (Review)
Review
INTRODUCTION
Tibial eminentia avulsion fracture is the paediatric equivalent to a midsubstance anterior cruciate ligament injury. It is most common between the ages of 8 and 19 years of age. The incidence is three per 100,000 per year. We explored the clinical evaluation and classification of the fracture, indications for and methods of surgery and the possible sequelae.
METHODS
We performed a systematic search in the PubMed database and retrieved 127 articles. A total of 16 articles met the defined inclusion criteria and were reviewed. Only studies on adolescents were included.
RESULTS
No prospective studies were found. The Meyers & McKeever and Zaricznyj classifications were commonly used, also when evaluating fractures for surgery. X-ray in three views is often sufficient to establish a diagnosis, but computed topographies can be necessary to further evaluate the type of fracture. There is disagreement as to whether a type II-fracture needs surgery. The method of fixation varies greatly between different kinds of suture techniques and screw fixations, but arthroscopic surgery is preferred in the most recent literature. Whether to cross the physis when fixating the fracture is also a matter of dis-agreement, but there is a lack of literature on the subject. All authors describe low rates of subjective sequelae.
CONCLUSION
Arthroscopic surgery is less invasive and allows for earlier mobilisation than other techniques. Pull-out suture seems to be a recommendable technique. There is a lack of literature on transphyseal fixation and a need for prospective studies evaluating the many different surgical techniques described and the indications for surgery.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arthroscopy; Female; Humans; Male; Middle Aged; Suture Techniques; Tibial Fractures; Young Adult
PubMed: 24814913
DOI: No ID Found -
Medicine Sep 2018Tibial tuberosity fractures most often occur in the adolescents. Fracture of tibial tuberosity in adults is extremely rare with only 5 reported cases till date. Tibial... (Review)
Review
RATIONALE
Tibial tuberosity fractures most often occur in the adolescents. Fracture of tibial tuberosity in adults is extremely rare with only 5 reported cases till date. Tibial plateau fractures combined with tibial tubercle fractures are not common.
PATIENT CONCERNS
We report here a type B3 tibial plateau fracture (AO classification) with a concomitant fracture of tibial tuberosity.
DIAGNOSES
Anteroposterior and lateral knee view radiographs revealed a complex comminuted fracture of the right tibial plateau (AO Type B3; Schatzker Type IV) with tibial tubercle fracture. Three-dimensional computed tomography (CT) showed that the tibial media plateau was split into 2 pieces in the sagittal plane, along with the isolated tibial tubercle.
INTERVENTIONS
The open procedure was performed first and a standard posteromedial approach for medial and posteromedial tibial plateau fracture was used with double locking plate fixation. The tibial tuberosity was fixed with a cortical screw.
OUTCOMES
The patient showed full range of motion in right knee after 8 weeks. The patient was allowed full weight bearing at 4 months. Eight months after operation, he was asymptomatic, showed a full range of motion and good strength. He had returned to work with no limitations.
LESSONS
Fractures of the partial tibial plateau combined with tibial tubercle are present and should not be ignored. Accurate diagnosis and proper treatment will help achieve favorable outcomes in these patients.
Topics: Adult; Humans; Male; Tibia; Tibial Fractures
PubMed: 30200081
DOI: 10.1097/MD.0000000000012015