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Computational and Mathematical Methods... 2022To explore the risk factors and surgical strategies of knee traumatic arthritis after internal plate fixation in the treatment of tibial plateau fracture.
OBJECTIVE
To explore the risk factors and surgical strategies of knee traumatic arthritis after internal plate fixation in the treatment of tibial plateau fracture.
METHODS
A total of 300 patients with tibial plateau fractures treated with internal plate fixation in our hospital from January 2019 to April 2021 were retrospectively analyzed. According to whether secondary knee traumatic arthritis occurred after operation, they were divided into control group and research group. The control group was nonsecondary knee traumatic arthritis ( = 231), and the research group was secondary knee traumatic arthritis ( = 69). Univariate and multivariate logistic regression analysis was used in this research.
RESULTS
There were significant differences in fracture classification, injury method, osteoporosis, and the time from injury to operation between the two groups, and there are statistically significant differences between groups ( < 0.05). Fracture type, injury method, osteoporosis, and time from injury to operation were the influencing factors of tibial internal fixation, and there are statistically significant differences between groups ( < 0.05). Platform fracture was an independent risk factor for postoperative knee joint traumatic arthritis, and there are statistically significant differences between groups ( < 0.05). The HSS scores of both groups increased after operation, and there are statistically significant differences between groups ( < 0.05). No loosening of the prosthesis was found in all 69 patients with postoperative X-ray examination.
CONCLUSION
Fracture classification, injury mode, osteoporosis, and time from injury to operation are independent risk factors for knee traumatic arthritis in the treatment of tibial plateau fractures with internal plate fixation, incidence of knee trauma.
Topics: Humans; Knee Joint; Osteoarthritis; Osteoporosis; Retrospective Studies; Risk Factors; Tibial Fractures
PubMed: 36105245
DOI: 10.1155/2022/9146227 -
BMC Musculoskeletal Disorders Aug 2023The existence of a "bare area" at the anterior plateau has been observed in cases where anteromedial and/or anterolateral proximal tibial locking plates are used for...
BACKGROUND
The existence of a "bare area" at the anterior plateau has been observed in cases where anteromedial and/or anterolateral proximal tibial locking plates are used for fixation in the treatment of hyperextension tibial plateau fractures (HTPF). The objective of this study is to introduce the rim plate fixation technique and evaluate its clinical efficacy.
METHODS
A retrospective analysis was conducted on HTPF patients who underwent treatment with a combination of rim plate and proximal tibial locking plate at our hospital between April 2015 and December 2019. All patients were followed up for a minimum of one year. Open reduction and internal fixation were performed using anteromedial/posteromedial and/or anterolateral approaches for all cases. The surgical strategies employed for rim plate fixation were introduced, and both radiographic and clinical outcomes were assessed.
RESULTS
Thirteen patients were enrolled in the study, with an average follow-up time of 4.3 years. Satisfactory reduction was achieved and radiographically maintained in all cases. Additionally, all patients exhibited satisfactory clinical functions, as evidenced by a mean hospital for special surgery (HSS) knee score of 96.2 ± 2.0 (range: 90-98). Furthermore, no wound complications or implant breakage were observed in this series.
CONCLUSION
The combination of the rim plate and proximal tibial plate proved to be an effective fixation configuration, resulting in satisfactory clinical outcomes.
Topics: Humans; Retrospective Studies; Tibial Plateau Fractures; Tibial Fractures; Tibia; Fracture Fixation, Internal
PubMed: 37592278
DOI: 10.1186/s12891-023-06786-z -
Journal of Orthopaedic Surgery and... Jun 2019To report the diagnosis, injury mechanisms, and imaging characteristics of hyperextension bicondylar tibial plateau fractures and examine the indications and feasibility...
PURPOSE
To report the diagnosis, injury mechanisms, and imaging characteristics of hyperextension bicondylar tibial plateau fractures and examine the indications and feasibility of the modified anterior midline incision as a treatment strategy.
METHODS
We performed a retrospective analysis of 11 cases of hyperextension bicondylar tibial plateau fractures who were treated with open reduction and internal fixation, predominantly via an anterolateral and posteromedialdouble incision or a modified anterior midline incision. Radiological and functional evaluations were performed.
RESULTS
Eleven patients were followed-up for a mean period of 11.5 months (range 3-24 months). The mean time to radiographic bony union was 12.5 weeks (range 10-26 weeks). At final follow-up, the average Rasmussen functional score was 26.8 (range 24 - 29); five patients had an excellent rating, and six a good rating. The average range of motion of the affected knees was 3.4-130° postoperatively. Fixation failure was not observed in any of the treated fractures.
CONCLUSION
Hyperextension bicondylar tibial plateau fractures show a special Tiankeng-like collapse characteristic, while the changes in posterior tibial slope angle are easy to overlook. The modified anterior midline incision is a safe and effective approach for treatment of hyperextension bicondylar tibial plateau fractures with less rear displacement. Open reduction and double plating for the treatment of hyperextension bicondylar tibial plateau fractures provides excellent results.
Topics: Adult; Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Open Fracture Reduction; Radiography; Retrospective Studies; Tibia; Tibial Fractures; Tomography, X-Ray Computed; Young Adult
PubMed: 31238968
DOI: 10.1186/s13018-019-1220-z -
Journal of Cerebral Blood Flow and... Aug 2015Multitrauma is a common medical problem worldwide, and often involves concurrent traumatic brain injury (TBI) and bone fracture. Despite the high incidence of combined...
Multitrauma is a common medical problem worldwide, and often involves concurrent traumatic brain injury (TBI) and bone fracture. Despite the high incidence of combined TBI and fracture, preclinical TBI research commonly employs independent injury models that fail to incorporate the pathophysiologic interactions occurring in multitrauma. Here, we developed a novel mouse model of multitrauma, and investigated whether bone fracture worsened TBI outcomes. Male mice were assigned into four groups: sham-TBI+sham-fracture (SHAM); sham-TBI+fracture (FX); TBI+sham-fracture (TBI); and TBI+fracture (MULTI). The injury methods included a closed-skull weight-drop TBI model and a closed tibial fracture. After a 35-day recovery, mice underwent behavioral testing and magnetic resonance imaging (MRI). MULTI mice displayed abnormal behaviors in the open-field compared with all other groups. On MRI, MULTI mice had enlarged ventricles and diffusion abnormalities compared with all other groups. These changes occurred in the presence of heightened neuroinflammation in MULTI mice at 24 hours and 35 days after injury, and elevated edema and blood-brain barrier disruption at 24 hours after injury. Together, these findings indicate that tibial fracture worsens TBI outcomes, and that exacerbated neuroinflammation may be an important factor that contributes to these effects, which warrants further investigation.
Topics: Animals; Blood-Brain Barrier; Brain Injuries; Disease Models, Animal; Magnetic Resonance Imaging; Male; Mice; Multiple Trauma; Radiography; Tibial Fractures
PubMed: 25853909
DOI: 10.1038/jcbfm.2015.56 -
European Journal of Trauma and... Apr 2023Multiple authors have highlighted the increased incidence of occult posterior malleolar fractures (PMFs) with spiral tibial shaft fractures, although other reported...
Prediction of distal tibial articular extension in tibial shaft fractures: both posterior malleolar fracture and non posterior malleolar fracture intra-articular extension.
BACKGROUND
Multiple authors have highlighted the increased incidence of occult posterior malleolar fractures (PMFs) with spiral tibial shaft fractures, although other reported associated risks of intra-articular extension have been limited. The aim of our study is to investigate both PMFs and non-PMFs intra-articular extensions associated with tibial diaphyseal fractures to try to determine any predictive factors.
METHODS
We undertook a retrospective review of a prospectively collected database. The inclusion criteria for this study were any patient who had sustained a diaphyseal tibial fracture, who had undergone surgery during the study period and who had also undergone a CT scan in addition to plain radiographs. The study time period for this study was between 01/01/2013 and 9/11/2021.
RESULTS
Out of 764 diaphyseal fractures identified, 442 met the inclusion criteria. A total of 107 patients had PMF extensions (24.21%), and a further 128 patients (28.96%) had intra-articular extensions that were not PMF's. On multivariate analysis, spiral tibial fracture subtypes of the AO/OTA classification (OR 4.18, p < 0.001) and medial direction of tibial spiral from proximal to distal (OR 4.38, p < 0.001) were both significantly associated with PMF. Regarding intra-articular fractures, multivariate analysis showed significant associations with non-spiral (OR 4.83, p < 0.001) and distal (OR 15.32, p < 0.001) tibial fractures and fibular fractures that were oblique (OR 2.01, p = 0.019) and at the same level as tibia fracture (OR 1.83, p = 0.045) or no fracture of the fibular (OR 7.02, p < 0.001).
CONCLUSION
In our study, distal tibial articular extension occurs in almost half of tibial shaft fractures. There are very few fracture patterns that are not associated with some type of intra-articular extension, and therefore, a low threshold for preoperative CT should be maintained.
Topics: Humans; Tibia; Tibial Fractures; Ankle Fractures; Radiography; Tomography, X-Ray Computed; Retrospective Studies; Fracture Fixation, Internal
PubMed: 36515704
DOI: 10.1007/s00068-022-02156-x -
Journal of Orthopaedic Surgery and... Sep 2022The occurrence of nonunion after tibial fracture surgery is mainly related to insufficient blood supply. Therefore, anatomical study of the internal and external tibial...
BACKGROUND
The occurrence of nonunion after tibial fracture surgery is mainly related to insufficient blood supply. Therefore, anatomical study of the internal and external tibial artery is very important, but there is no good method for displaying the intraosseous artery clearly and intuitively. This hinders the protection and reconstruction of it by surgeons, as well as the development of new instruments and techniques by researchers.
OBJECTIVE
To develop a transparent specimen that could clearly display the intraosseous artery of the tibia.
METHODS
In 10 isolated pig calves with popliteal vessels, the popliteal artery was exposed and a tube was placed. A casting agent was then injected at constant pressure, and the tissue around the blood vessel was preliminarily removed after solidification. The perivascular tissue and periosteum were further removed via alkali corrosion, and the tibia was fixed with an external fixator to protect the non-corrosive areas at both ends. Alternate acid corrosion and flushing were then applied until the intraosseous artery was completely exposed. The distribution and branches of intraosseous nutrient arteries were observed with the naked eye and via microscopy. Three-dimensional (3D) scanning and 3D printing filling techniques were used to make transparent tibia specimens with preservation of intraosseous arteries.
RESULTS
A cast specimen of the intraosseous artery of porcine tibia was successfully generated via epoxy resin perfusion combined with acid-alkali etching, and the intraosseous artery was clearly visible. The 3D printing and filling technique successfully produced a transparent tibia specimen with preservation of internal bone arteries, and accurately restored the external shape of the tibia. The foramen of the nutrient artery appeared near the middle upper third of the lateral edge of the tibia. After entering the tibia, the nutrient artery proceeded forward, medial, and downward for a certain distance, twisted and turned near the midpoint of the medullary cavity, and divided into the ascending and descending branches. After going in the opposite direction for a distance, the ascending trunk sent out 2-3 branches, and the descending trunk sent out 2-3 branches.
CONCLUSION
The cast specimen of pig intraosseous artery generated via the above-described perfusion corrosion method provides methodological guidance for the study of anatomical characteristics of the intraosseous artery, and a theoretical basis for the study of new methods of internal fixation and reconstruction of the blood supply of the lower tibia.
Topics: Animals; Cattle; External Fixators; Periosteum; Swine; Tibia; Tibial Arteries; Tibial Fractures
PubMed: 36064419
DOI: 10.1186/s13018-022-03302-2 -
Acta Ortopedica Mexicana 2022tibial plateau fractures affect functionality of a large load bearing joint such as the knee, due to its multiple compromises, not only articular but also the ones... (Observational Study)
Observational Study
INTRODUCTION
tibial plateau fractures affect functionality of a large load bearing joint such as the knee, due to its multiple compromises, not only articular but also the ones including soft tissues. This study aims to evaluate the stability, function, alignment, associated injuries and complications of the knee after surgery and tibial plateau fractures rehabilitation.
MATERIAL AND METHODS
a descriptive prospective observational study was carried out where patients with a tibial plateau fracture who had undergone surgery, that accomplish the inclusion criteria were included, in the period from April 2018 to June 2019. Analysis of variables was performed with t tests for independent samples.
RESULTS
from a total of 92 patients with tibial plateau fracture, 66 (71%) were able to achieve the minimum six months follow-up. The most common fracture according to Schatzker classification was type II with 33.3%, and the most common according to Luo classification was the medial, lateral and posterior three column with 39.4%. More than 70% of patients who underwent surgery due to tibial plateau fractures developed soft tissue injury, therefore knee instability, specially with a higher rate of anterior cruciate ligament injuries or anterior instability.
CONCLUSION
an important proportion of patients who underwent surgery for tibial plateau fractures have knee ligament injuries.
Topics: Humans; Tibia; Tibial Fractures; Knee Injuries; Anterior Cruciate Ligament Injuries; Fracture Fixation, Internal; Retrospective Studies
PubMed: 37402493
DOI: No ID Found -
The British Journal of Radiology Jun 2020This study explored the morphological differences between posterior Pilon fracture and posterior malleolus fracture from radiographs and CT to provide detail for... (Comparative Study)
Comparative Study
OBJECTIVES
This study explored the morphological differences between posterior Pilon fracture and posterior malleolus fracture from radiographs and CT to provide detail for diagnosis and treatment of them.
METHODS
Radiographs and CT imaging data of 174 patients with distal posterior tibial fractures who were treated from January 2013 to January 2019 were retrospectively analyzed. Based on the operation and imaging examination, the fractures were classified into posterior Pilon fractures and posterior malleolus fractures. Radiographic parameters including the width, height, depth, α angle, β angle, γ angle, fragment area ratio 1 (FAR1), δ angle and fragment area ratio 2 (FAR2) of ankle mortise were measured.
RESULTS
There were 96 posterior Pilon fractures (Type I: 30, Type II: 22 and Type III: 44) and 78 posterior malleolus fractures (Type I: 40 and Type II: 38). The ankle depth, α angle, γ angle, FAR1 and FAR2 of posterior Pilon fractures were larger than these of posterior malleolus fractures ( < 0.05). In addition, FAR1 and FAR2 of Type II and Type III posterior Pilon fractures were significantly larger than these of Type I ( < 0.05). FAR1 and FAR2 of Type I posterior malleolus fractures were significantly smaller than these of Type II ( < 0.05).
CONCLUSION
Radiographs combined with CT analysis is an effective method to accurately distinguish morphological features between posterior Pilon fracture and posterior malleolus fracture.
ADVANCES IN KNOWLEDGE
Radiographs combined with CT distinguished the fracture of posterior malleolus and posterior Pilon rapidly and accurately, instead of operation.
Topics: Adult; Aged; Aged, 80 and over; Ankle Fractures; Diagnosis, Differential; Female; Fracture Dislocation; Humans; Male; Middle Aged; Radiography; Retrospective Studies; Tibial Fractures; Tomography, X-Ray Computed; Young Adult
PubMed: 32233930
DOI: 10.1259/bjr.20191030 -
Clinical Orthopaedics and Related... Feb 2022Open tibial fracture research has traditionally focused on surgical techniques; however, despite technological advances, outcomes from these injuries remain poor, with...
BACKGROUND
Open tibial fracture research has traditionally focused on surgical techniques; however, despite technological advances, outcomes from these injuries remain poor, with patients facing a sustained reduced quality of life. Research has rarely asked patients what is important to them after an open tibial fracture, and this question could potentially offer great insight into how to support patients. A qualitative study may assist in our understanding of this subject.
QUESTIONS/PURPOSES
We asked: (1) What common themes did patients who have experienced open tibial fractures share? (2) What stresses and coping strategies did those patients articulate? (3) What sources for acquiring coping strategies did patients say they benefited from?
METHODS
Semistructured interviews were conducted with patients who had sustained an open tibial fracture between January 1, 2016 and January 1, 2019. All participants were recruited from a Level 1 trauma center in England, and 26 participants were included. The mean age was 44 ± 17 years, and 77% (20 of 26) were men. The patients' injuries ranged in severity, and they had a range of treatments and complications. Transcripts were analyzed using framework analysis, with codes subsequently organized into themes and subthemes.
RESULTS
Four themes were identified, which included recouping physical mobility, values around treatment, fears about poor recovery, and coping strategies to reduce psychological burden. Coping strategies were important in mitigating the psychological burden of injury. Task-focused coping strategies were preferred by patients and perceived as taking a proactive approach to recovery. Healthcare practitioners, and others with lived experience were able to educate patients on coping, but such resources were scant and therefore probably less accessible to those with the greatest need.
CONCLUSION
Most individuals fail to return to previous activities, and it is unlikely that improvements in surgical techniques will make major improvements in patient outcomes in the near future. Investment in psychosocial support could potentially improve patient experience and outcomes. Digital information platforms and group rehabilitation clinics were identified as potential avenues for development that could offer individuals better psychosocial support with minimal additional burden for surgeons.
LEVEL OF EVIDENCE
Level IV, therapeutic study.
Topics: Adaptation, Psychological; Adult; Female; Fractures, Open; Humans; Male; Middle Aged; Qualitative Research; Quality of Life; Tibial Fractures
PubMed: 34779791
DOI: 10.1097/CORR.0000000000002031 -
Physical Therapy May 2021The purpose of this study was to characterize outpatient physical therapy (OPT) use following tibial fractures and examine the variability of OPT attendance, time of...
OBJECTIVE
The purpose of this study was to characterize outpatient physical therapy (OPT) use following tibial fractures and examine the variability of OPT attendance, time of initiation, number of visits, and length of care by patient, injury, and treatment factors. In the absence of clinical guidelines, results will guide future efforts to optimize OPT following tibial fractures.
METHODS
This study used 2016 to 2017 claims from the IBM MarketScan Commercial Claims Research Database. The cohort included 9079 patients with International Classification of Diseases: Tenth Revision (ICD-10) diagnosis codes for tibial fractures. Use in the year following initial fracture management was determined using Current Procedural Terminology codes. Differences in use were examined using χ2 tests, t tests, and Kruskal-Wallace tests.
RESULTS
Sixty-seven percent of patients received OPT the year following fracture. OPT attendance was higher in female patients, in patients with 1 or no major comorbidity, and in the western United States. Attendance was higher in patients with upper tibial fractures, moderate-severity injuries, and treatment with external fixation and in patients discharged to an inpatient rehabilitation facility. Patients started OPT on average [SD] 50 [52.6] days after fracture and attended 18 [16.1] visits over the course of 101 [86.4] days. The timing of OPT, the number of visits attended, and the length of OPT care varied by patient, injury, and treatment-level factors.
CONCLUSIONS
One-third of insured patients do not receive OPT following tibial fracture. The timing of OPT initiation, the length of OPT care, and the number of visits attended by patients with tibial fractures were highly variable. Further research is needed to standardize referral and prescription practices for OPT following tibial fractures.
IMPACT
OPT use varies based on patient, injury, and treatment-level factors following tibial fractures. Results from this study can be used to inform future efforts to optimize rehabilitation care for patients with tibial fractures.
Topics: Adolescent; Adult; Ambulatory Care; Female; Humans; Insurance Claim Review; Male; Middle Aged; Physical Therapy Modalities; Retrospective Studies; Tibial Fractures; Young Adult
PubMed: 33522593
DOI: 10.1093/ptj/pzab034