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Injury Jun 2022Three-dimensional imaging has changed the understanding and management of tibial plateau fractures. In the 1970s, Schatzker proposed a classification for tibial plateau...
Three-dimensional imaging has changed the understanding and management of tibial plateau fractures. In the 1970s, Schatzker proposed a classification for tibial plateau fractures, which highlighted the morphology of the six principal types. More recently, this original classification was complimented by an extended one underscoring the importance of understanding where the split wedge fragment(s) is/are located in three dimensions. The extended classification introduced the split wedge fragment and the continuity of the rim as the determinants of joint stability and the critical role that this plays in the management of tibial plateau fractures. The current manuscript re-emphasizes contemporary concepts of tibial plateau stability and depicts key issues which must be considered when planning the definitive surgical fixation of tibial plateau fractures.
Topics: Humans; Imaging, Three-Dimensional; Retrospective Studies; Tibia; Tibial Fractures; Tomography, X-Ray Computed
PubMed: 35491279
DOI: 10.1016/j.injury.2022.04.006 -
Medicina (Kaunas, Lithuania) Mar 2022Background and Objectives: Tibial malunions are defined as tibial fractures that have healed in a clinically unacceptable position, resulting in deformity such as... (Review)
Review
Background and Objectives: Tibial malunions are defined as tibial fractures that have healed in a clinically unacceptable position, resulting in deformity such as shortening, lengthening, abnormal rotation, or angulation. These deformities can have adverse effects on patients, such as pain and gait disturbance, as well as long term development of post-traumatic arthritis. This paper seeks to highlight some of the options for surgical management of malunions and detail the strategies and approaches used to manage these complicated cases. Materials and Methods: An exhaustive search was conducted on PubMed using the key search terms “Tibial” OR “Tibia” AND “Malunion” to be included in the title. Exclusions to the search included any article with patients aged < 18 years, any nonhuman subjects, and any article not published or translated into English. Results: A systematic review of the literature revealed 26 articles encompassing 242 patients who had undergone surgical correction for tibia malunion. A total of 19 patients suffered from complications. Methods of treatment included osteotomies, with plate and screws, external fixator, angled blade plate, intramedullary nails, Ilizarov fixator, Taylor Spatial Frame, Precise nail, and total knee arthroplasty. Restoring alignment and the articular surface led to overwhelmingly positive patient outcomes. Conclusions: Tibial malunions take many forms, and as such, there are many approaches to correcting deformities. The literature supports the following radiological parameters to diagnose tibial malunion: 5−10 degrees angulation, 1−2 cm shortening, 10−15 degrees internal rotation, and 10−20 degrees external rotation. Surgical plans should be customized to each individual patient, as there are many approaches to tibial malunion that have been shown to be successful in delivering excellent clinical outcomes.
Topics: Adolescent; External Fixators; Fracture Fixation, Intramedullary; Humans; Osteotomy; Tibia; Tibial Fractures
PubMed: 35334565
DOI: 10.3390/medicina58030389 -
Journal of Orthopaedic Surgery and... Sep 2020The aim of this study is to assess the prevalence of nonunion in patients with tibia fracture and the association between influencing factors and tibia fracture nonunion. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this study is to assess the prevalence of nonunion in patients with tibia fracture and the association between influencing factors and tibia fracture nonunion.
METHOD
A database searches of PubMed, the Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), Weipu database, and Wanfang database from inception until June 2019 was conducted. The pooled prevalence, odds ratio (OR), and 95% confidence intervals (CI) were calculated with Stata software.
RESULTS
In this study, 111 studies involving 41,429 subjects were included. In the study of the relationship between influencing factors and tibia fracture nonunion, 15 factors significantly influenced the fracture union, including > 60 years old, male, tobacco smoker, body mass index > 40, diabetes, nonsteroidal anti-inflammatory drugs (NSAIDs) user, opioids user, fracture of middle and distal tibia, high-energy fracture, open fracture, Gustilo-Anderson grade IIIB or IIIC, Müller AO Classification of Fractures C, open reduction, fixation model, and infection.
CONCLUSION
The prevalence of nonunion in patients with tibia fracture was 0.068 and 15 potential factors were associated with the prevalence. Closed reduction and minimally invasive percutaneous plate osteosynthesis (MIPPO) have the low risks of nonunion for the treatment of tibial fractures.
Topics: Adolescent; Adult; Age Factors; Aged; Anti-Inflammatory Agents, Non-Steroidal; Body Mass Index; Closed Fracture Reduction; Female; Fracture Fixation, Internal; Fractures, Ununited; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Opioid-Related Disorders; Prevalence; Risk Factors; Sex Factors; Tibial Fractures; Tobacco Smoking; Young Adult
PubMed: 32883313
DOI: 10.1186/s13018-020-01904-2 -
Injury Dec 2020Grade III open fractures of the lower extremity are serious injuries and are difficult to reconstruct. The optimal treatment for such injuries is unclear. We aimed to... (Review)
Review
BACKGROUND
Grade III open fractures of the lower extremity are serious injuries and are difficult to reconstruct. The optimal treatment for such injuries is unclear. We aimed to determine the safety and efficacy of orthoplastic reconstruction, using a primary free anterolateral thigh flap combined with the Masquelet technique and internal fixation for Gustilo grade IIIB/C open tibial fractures.
METHODS
From April 2018 to April 2019, 15 patients, ranging from 19 to 72 years old, with Gustilo grade IIIB/C open fractures were treated using a primary free anterolateral thigh flap combined with the Masquelet technique and internal fixation. This involved wound debridement and removal of free bone fragments, followed by bone cement packing of the defect, external fixation, and vacuum sealing drainage treatment. The final stage involved switching from external to internal fixation and wound repair using a free anterolateral thigh flap. Repair time ranged from 2 to 7 days. Flap size ranged from 25 × 15 cm to 13 × 7cm. Hospital stay ranged from 11 to 50 days (mean, approximately 33.3 days). Bone cement was removed after 6-19 weeks and replaced with autogenic cancellous bone.
RESULTS
All flaps survived without incident. One patient experienced a wound infection, but there were no deep infections. For all patients, bone union was achieved after 4 to 7 months.
CONCLUSION
The use of a primary free anterolateral thigh flap combined with the Masquelet technique and internal fixation is a safe and effective procedure for reconstruction of Gustilo grade IIIB/C open fractures.
Topics: Adult; Aged; Debridement; Fracture Fixation; Fracture Fixation, Internal; Fractures, Open; Humans; Middle Aged; Plastic Surgery Procedures; Soft Tissue Injuries; Tibia; Tibial Fractures; Treatment Outcome; Young Adult
PubMed: 33097199
DOI: 10.1016/j.injury.2020.10.039 -
International Orthopaedics Sep 2022The injury mechanisms and classifications of tibial plateau fractures (TPFs) are still controversial. The aim of this study is to show 3D fracture mapping of different...
PURPOSE
The injury mechanisms and classifications of tibial plateau fractures (TPFs) are still controversial. The aim of this study is to show 3D fracture mapping of different types of tibial plateau fractures. Moreover, combined with Schatzker and ten-segment classification, we aimed to analyze the injury frequency and characteristics of different segments.
METHODS
In total, 346 patients with TPFs treated at level I trauma centres from 2017 to 2021 were reviewed. The CT files of the included cases were typed and categorized. 3D reconstruction of TPFs patients' CT files were performed using software. All fracture lines were superimposed on the standard model by the software to create TPFs 3D fracture mapping.
RESULTS
This study included 204 male and 142 female patients (average age, 47 years [range, 18 to 83 years]) with a tibial plateau fracture. Using the Schatzker classification, we found 39 type I (11.27%), 103 type II (29.77%), nine type III (2.60%), 71 type IV (20.52%), 52 type V (15.03%), 59 type VI (17.05%) fractures, and 13 others (3.76%). The density areas of fracture lines are mainly located in the ALC and PLC segments (74.3%, 69.1%). In different views, fracture lines of different Schatzker types showed distinct distribution characteristics.
CONCLUSIONS
Schatzker classification combined with 3D fracture mapping provides a new presentation of tibial plateau fracture morphology. According to the 3D fracture mapping, different types of TPFs have distinctly different distribution characteristics of fracture lines. There are significant differences between different types of fracture injury segments.
Topics: Female; Fracture Fixation, Internal; Humans; Male; Middle Aged; Retrospective Studies; Software; Tibial Fractures; Tomography, X-Ray Computed; Trauma Centers
PubMed: 35579696
DOI: 10.1007/s00264-022-05434-w -
Equine Veterinary Journal Mar 2023Equine tibial fractures are relatively infrequent in racing and non-racing sport horses, but limitations in successful treatment of tibial fractures in adult horses... (Review)
Review
Equine tibial fractures are relatively infrequent in racing and non-racing sport horses, but limitations in successful treatment of tibial fractures in adult horses result in relatively high mortality compared with other musculoskeletal injuries. The aetiology of tibial fracture can be classified into two general categories: traumatic impact or fatigue failure. Tibial stress fractures, also known as fatigue fractures, are often rated as the second most common stress fracture in racing Thoroughbreds; young age, early stage in race training, and initiation of training after a period of rest are the reported risk factors. Both impact and fatigue fracture propagation are dependent on the magnitude of force applied and on the local composition/alignment of mineralised collagen in the tibial lamella. Extensive research has characterised the pattern of strain distribution and stress remodelling within the equine tibia, but in vivo measurement of load and angular moments are currently not feasible. Further research is warranted to correlate biomechanical theory of tibia fatigue fracture propagation with current histopathological data. Preventative measures for fatigue fractures aim to optimise diagnostic efficiency, reduce the interval between injury and diagnosis and modify racing and training conditions to reduce non-specific fracture risk. Treatment options for complete tibial fractures in adult horses are limited, but with careful case selection, successful outcomes have been reported after open reduction and internal fixation. On the other hand, tibial stress fractures and minimally displaced incomplete fractures are typically treated conservatively and have good prognosis for athletic recovery. This review aims to describe the current literature regarding tibial fracture aetiology, prevalence, risk factors, fracture biomechanics, treatment, prognosis and prevention.
Topics: Horses; Animals; Fractures, Stress; Physical Conditioning, Animal; Tibial Fractures; Sports; Prognosis; Horse Diseases
PubMed: 35569040
DOI: 10.1111/evj.13599 -
Journal of Orthopaedic Surgery and... Feb 2022Tibial plateau fractures are traumatic injuries with severities ranging from nondisplaced to complicated fractures. This study describes the epidemiological...
BACKGROUND
Tibial plateau fractures are traumatic injuries with severities ranging from nondisplaced to complicated fractures. This study describes the epidemiological characteristics of patients with tibial plateau fractures treated in five trauma clinics.
METHODS
This retrospective, cross-sectional study included 1165 patients with tibial plateau fractures treated between December 2015 and May 2017. Subjects were selected from the medical records of five institutions based on the inclusion and exclusion criteria. Age, sex, laterality, fracture type, trauma mechanism, vehicle type, classification, and associated injuries were assessed via univariate and bivariate analyses.
RESULTS
In total, 23.3% of patients with tibial fractures treated during the study period had tibial plateau fractures. Of those affected, 73% were men and 50% were younger than 40 years. Furthermore, 95.7% of fractures were caused by traffic accidents, 82.6% of which involved motorcycles. Fractures were closed in 93.1% of cases, and 78% of subjects had associated injuries. The most common fractures, according to Schatzker classification, were type VI (23%) and V (19.1%) fractures.
CONCLUSIONS
Tibial plateau fractures are frequent injuries in our setting and mostly occur in men in their 30 s and 40 s. These fractures are typically caused by motorcycle traffic accidents.
LEVEL OF EVIDENCE
IV.
Topics: Accidents, Traffic; Adult; Aged; Colombia; Cross-Sectional Studies; Female; Functional Laterality; Humans; Male; Middle Aged; Retrospective Studies; Tibial Fractures; Tomography, X-Ray Computed
PubMed: 35183211
DOI: 10.1186/s13018-022-02988-8 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Extra- and intra-articular proximal tibia malunion is not uncommon. Functional impact is variable but may lead to almost total impotence. The present study aimed to... (Review)
Review
Extra- and intra-articular proximal tibia malunion is not uncommon. Functional impact is variable but may lead to almost total impotence. The present study aimed to provide a review on malunion, answering 5 questions: (1) How should malunion be classified, and with what pathogenicity? Malunion results from reduction defect and/or secondary displacement in tibial plateau fracture (A2, A3, B, C on the AO classification), but also from previous epiphysiodesis or osteotomy (valgization or varization). (2) How should malunion be assessed? Pre-treatment work-up comprises standard X-ray (AP, lateral, full-length), but also 2D and 3D CT-scan to assess the severity and type of residual depression in old fracture. (3) What conservative treatments are available, and for whom? In under-50 year-olds, correction osteotomy is recommended: intra- or extra-articular or combined. In extra-articular malunion, especially in the absence of osteoarthritis, realignment osteotomy may be indicated even in elderly subjects. (4) What implants are suited to what malunion, and for whom? In over-50 year-olds with intra-or extra-articular or combined malunion, partial or total replacement is recommended, isolated or associated to realignment osteotomy. The open questions concern material removal, surgical approach and type of implant, bearing in mind that these implants raise technical difficulties. (5) What are the complications, and the results? Results with osteotomy and partial prostheses are generally satisfactory. Results in total replacement are poorer than for primary implants in osteoarthritis of the knee, with much more frequent complications. LEVEL OF EVIDENCE: V, expert opinion.
Topics: Fracture Fixation; Fractures, Malunited; Humans; Knee Joint; Osteotomy; Radiography; Plastic Surgery Procedures; Tibia; Tibial Fractures
PubMed: 31208930
DOI: 10.1016/j.otsr.2019.03.018 -
Journal of Healthcare Engineering 2021Few studies exist on the predictive factors of tibial fractures with hidden posterior ankle fractures.
BACKGROUND
Few studies exist on the predictive factors of tibial fractures with hidden posterior ankle fractures.
OBJECTIVE
To study the incidence and predictive factors of tibial fractures with occult posterior ankle fractures.
METHODS
Tibial fracture patients were prospectively selected who were admitted to our hospital from January 2016 to May 2021 and their general clinical data, X-ray images, CT images, and other imaging data were collected and then divided them into posterior malleolus fracture group and nonposterior malleolus fracture group according to the presence or absence of posterior malleolus fractures. Multivariate regression analysis and receiver operating curves (ROC) were performed to analyze the influencing factors of tibial fracture with occult posterior ankle fracture.
RESULTS
CT showed that 25 (13.44%) patients had occult posterior ankle fractures among 186 patients with tibial fracture. There was no significant difference in gender, age, and locations of tibial fracture between the two groups ( > 0.05). There were statistical differences in the types, locations, and lengths of patients with tibial fracture but without posterior malleolus fractures. The length of the tibia fracture group was significantly lower than the tibia with posterior ankle fracture group ( < 0.05). Logistics regression analysis showed that tibial fracture with occult posterior ankle fracture was not significantly correlated with gender, age, and location of tibial fracture ( > 0.05), but was significantly correlated with tibial fracture type, location, and length (HR = 1.830, =0.035; HR = 5.161, =0.004; HR = 1.126, =0.030). The ROC curve showed that the AUC of length of tibial fracture with occult posterior ankle fracture was 0.599. The YD index suggested that the best cut point for the prediction of tibial fracture with occult posterior ankle fracture was above 13.18%. The sensitivity and specificity of spiral tibial fracture and distal 1/3 tibial fracture for prediction were 88.00% and 63.35%, 92.00%, and 58.39%, respectively, which was significantly higher than that of tibial fracture length ( < 0.05).
CONCLUSION
Patients with tibial fractures have a higher incidence of occult posterior ankle fractures. Spiral tibial fractures and distal 1/3 tibial fractures have a higher predictive value for tibial fracture with occult posterior ankle fractures and can help clinical detection as soon as possible, which is a more accurate and appropriate treatment.
Topics: Ankle Fractures; Ankle Joint; Humans; Incidence; Retrospective Studies; Tibial Fractures
PubMed: 34925733
DOI: 10.1155/2021/4392595 -
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