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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 -
The Orthopedic Clinics of North America Jan 2011Lambotte's 7 steps of fracture treatment have stood the test of time. Incision, preparation of the bone ends, reduction, temporary fixation, permanent fixation, closure,... (Review)
Review
Lambotte's 7 steps of fracture treatment have stood the test of time. Incision, preparation of the bone ends, reduction, temporary fixation, permanent fixation, closure, and dressing are modified to suit the needs of each fracture and each patient. One specific patient characteristic, obesity, has provided complex challenges in fracture care. This article reviews the challenges of obesity as they relate to the 7 steps of lower extremity periarticular fracture care. Specifically, helpful modifications to these 7 steps are provided for the treatment of tibial plateau fractures and tibial plafond fractures. As there is little published evidence with respect to the treatment of these injuries in the obese population, the suggestions that are provided are based on the extrapolation from published evidence of fracture care in other areas in patients with obesity, logic, and personal experience with fracture care in patients with obesity.
Topics: Ankle Joint; Fracture Fixation; Humans; Knee Joint; Obesity; Tibial Fractures; Treatment Outcome
PubMed: 21095433
DOI: 10.1016/j.ocl.2010.08.003 -
Current Medical Imaging 2022The clinical and imaging features of lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture are not clear.
BACKGROUND
The clinical and imaging features of lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture are not clear.
INTRODUCTION
This study was conducted to investigate these features for correct diagnosis, treatment and prevention of possible premature physeal arrest or angular deformation.
METHODS
Patients with lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture were enrolled, and the clinical, imaging, treatment and follow-up data were analyzed.
RESULTS
Five patients with lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture were found including four men and one woman with an age range of 12-15 years (mean 13.6). Injury to the distal tibial epiphysis was missed in the diagnosis in plain radiography reports, but careful reevaluation confirmed distal tibial epiphysis fracture in four cases including Salter-Harris type II in three cases and type III in one case. The remaining case had no apparent distal tibial epiphysis injury in the plain radiograph. CT scan revealed that all five patients had distal tibial triplane fracture of the lateral type including two fragments in three cases and three fragments in two cases. The fracture was divided into type I(within the articular weight-bearing line) in three cases, type II (outside the articular weight-bearing line) in two cases based on the involvement of the articular surface by the fracture line. For the lower tibial fracture, one patient was treated with closed reduction and fixation with an elastic nail, three patients had internal plate fixation, and the remaining patient had cast immobilization. Followed up for 3-11 months (mean 7), all the distal tibial fractures and the triplane fractures were healed without varus or valgus deformity in the ankle.
CONCLUSION
Distal tibial triplane fracture can be readily missed in plain radiography and should be suspected in patients with distal tibial spiral fracture which should be evaluated with a computed tomographic scan.
Topics: Adolescent; Child; Female; Fracture Fixation, Internal; Humans; Male; Radiography; Tibial Fractures; Tomography, X-Ray Computed
PubMed: 34279207
DOI: 10.2174/1573405617666210716170213 -
Injury Feb 2019The aim of this study was to determine how outcome is measured following adult tibial fracture in the modern era of functional outcome measurement and patient reported...
AIM
The aim of this study was to determine how outcome is measured following adult tibial fracture in the modern era of functional outcome measurement and patient reported outcomes.
METHODS
A systematic review of publications since 2009 was performed, looking specifically at acute, adult tibial shaft fractures. Ovid Medline, Embase, PubMed and PsycINFO databases were searched for relevant titles which were then screened by two authors with adjudication where necessary by a third. Relevant articles were reviewed in full and data was extracted concerning the study participants, study design and any measures that were used to quantify the results following fracture. The results were collated and patient reported outcome measures were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) standards.
RESULTS
A total of 943 titles and articles were reviewed, with 117 included for full analysis. A wide range of clinical and radiological "outcomes" were described, along with named clinician- and patient-reported outcome measures. There was considerable heterogeneity and lack of detail in the description of the simplest outcomes, such as union, infection or reoperation. Reported clinician and patient reported outcome measures are variably used. None of the identified patient reported outcome measures have been validated for use following tibial fracture.
CONCLUSION
We recommend definition of a core outcome set for use following tibial fracture. This will standardise outcome reporting following these injuries. Furthermore, there is need for a validated patient reported outcome measure to better assess patient important outcomes in this patient group.
Topics: Fracture Fixation, Intramedullary; Fracture Healing; Humans; Outcome Assessment, Health Care; Patient Reported Outcome Measures; Tibial Fractures; Treatment Outcome
PubMed: 30482409
DOI: 10.1016/j.injury.2018.11.025 -
Medicine Sep 2015A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. This case... (Review)
Review
A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. This case report describes the successful management of such a fracture pattern in a 45-year old male using an open reduction and lag screw fixation of the tuberosity with a minimally invasive reduction and plate fixation of the proximal tibial diaphyseal fracture. A literature search was done to determine the expected clinical outcome of this fracture pattern. This is the first reported adult case of an avulsion fractures of the tibial tuberosity associated with an open proximal tibial diaphyseal fracture successfully treated by an anatomical reduction and fixation of the avulsion fracture of the tibial tuberosity combined with minimally invasive percutaneous plate osteosynthesis of the proximal tibial diaphyseal fractures.
Topics: Bone Plates; Bone Screws; Femoral Fractures; Fracture Fixation, Internal; Fractures, Open; Humans; Male; Middle Aged; Tibial Fractures
PubMed: 26426669
DOI: 10.1097/MD.0000000000001684 -
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 -
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 -
Veterinary Surgery : VS May 2019To report tibial fracture repairs with I-Loc angle-stable interlocking nails (AS-ILN) in 2 calves.
OBJECTIVE
To report tibial fracture repairs with I-Loc angle-stable interlocking nails (AS-ILN) in 2 calves.
STUDY DESIGN
Clinical case reports.
ANIMALS
One 5-day-old Holstein calf and one 3-month-old beefalo calf.
METHODS
In a 50-kg Holstein calf, a proximal juxtametaphyseal comminuted tibial fracture with tibial tuberosity slab fracture was repaired with an 8-160-mm I-Loc nail and 2 cortical lag screws. In an 89-kg beefalo calf, a long oblique middiaphyseal tibial fracture was repaired with an 8-185-mm I-Loc nail and 5 double loop cerclage wires. In each case, an I-Loc AS-ILN was selected because unique biomechanical challenges precluded treatment with traditional osteosynthesis methods, such as external coaptation or plate fixation.
RESULTS
No complications were diagnosed, and clinical union was documented 4 weeks after surgery in both cases. Axial growth continued in both calves, with no evidence of angular limb deformity at 7- and 6-month follow-up.
CONCLUSION
This is the first report describing the use of the I-Loc nail in a bovine species. This application led to uncomplicated healing of tibial fractures and continued growth in both young calves described here.
CLINICAL SIGNIFICANCE
Interlocking nailing may provide an effective and safe alternative for osteosynthesis of tibial fractures in young calves. Insertion of the AS-ILN across the center of the proximal tibial physis of a rapidly growing calf does not seem to alter its growth potential.
Topics: Animals; Bone Nails; Bone Plates; Cattle; Female; Fracture Fixation, Internal; Humans; Male; Tibia; Tibial Fractures
PubMed: 30682236
DOI: 10.1111/vsu.13167 -
The Bone & Joint Journal Oct 2022A fracture of the medial tibial plateau is a serious complication of Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). The risk of these fractures is...
AIMS
A fracture of the medial tibial plateau is a serious complication of Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). The risk of these fractures is reportedly lower when using components with a longer keel-cortex distance (KCDs). The aim of this study was to examine how slight varus placement of the tibial component might affect the KCDs, and the rate of tibial plateau fracture, in a clinical setting.
METHODS
This retrospective study included 255 patients who underwent 305 OUKAs with cementless tibial components. There were 52 males and 203 females. Their mean age was 73.1 years (47 to 91), and the mean follow-up was 1.9 years (1.0 to 2.0). In 217 knees in 187 patients in the conventional group, tibial cuts were made orthogonally to the tibial axis. The varus group included 88 knees in 68 patients, and tibial cuts were made slightly varus using a new osteotomy guide. Anterior and posterior KCDs and the origins of fracture lines were assessed using 3D CT scans one week postoperatively. The KCDs and rate of fracture were compared between the two groups.
RESULTS
Medial tibial fractures occurred after surgery in 15 patients (15 OUKAs) in the conventional group, but only one patient (one OUKA) had a tibial fracture after surgery in the varus group. This difference was significant (6.9% vs 1.1%; p = 0.029). The mean posterior KCD was significantly shorter in the conventional group (5.0 mm (SD 1.7)) than in the varus group (6.1 mm (SD 2.1); p = 0.002).
CONCLUSION
In OUKA, the distance between the keel and posterior tibial cortex was longer in our patients with slight varus alignment of the tibial component, which seems to decrease the risk of postoperative tibial fracture.Cite this article: 2022;104-B(10):1118-1125.
Topics: Aged; Arthroplasty, Replacement, Knee; Female; Humans; Knee Joint; Knee Prosthesis; Male; Osteoarthritis, Knee; Retrospective Studies; Tibia; Tibial Fractures
PubMed: 36177640
DOI: 10.1302/0301-620X.104B10.BJJ-2021-1508.R2 -
Clinical Techniques in Small Animal... Aug 2004Tibial fractures are common in small animal practice. As with other appendicular fractures, the patient's age, fracture location, and fracture type must be considered... (Review)
Review
Tibial fractures are common in small animal practice. As with other appendicular fractures, the patient's age, fracture location, and fracture type must be considered thoroughly. While methods for tibial fracture repair are similar to those used for appendicular fractures elsewhere, there are some unique considerations, both anatomically and functionally, that must be contemplated before repair. The following article will review the incidence of tibial fractures, tibial fracture types, and options for tibial fracture management and treatment. The use of external fixators, orthopedic bone plates, open reduction with internal fixation (ORIF), and external coaptation will be discussed. An emphasis will be placed on the most common types of tibial fractures, as well as those best suited for repair by general practitioners of veterinary medicine. Three case based examples will follow the overview.
Topics: Animals; Bandages; Casts, Surgical; Cats; Dogs; External Fixators; Female; Fracture Fixation; Male; Radiography; Tibial Fractures
PubMed: 15712461
DOI: 10.1053/j.ctsap.2004.09.007