Expert Tibial Nails for Treating Distal Tibial Fractures With Soft Tissue Damage: A Patient Series

A cohort of patients presented to Queen Victoria Hospital, UK, with iatrogenic toe ischaemia following application of a different, newly available post-procedure dressing with different properties to those usually used. This resulted in ischaemia with extensive skin and soft tissue damage, requiring debridement surgery and, in some cases, skin grafting. We aim to highlight the risk of morbidity from dressing application to the digits. This is a key learning skill for anyone who may either perform dressings or evaluate dressings on digits in the community and across multiple specialties in hospital. This article follows a thorough root cause analysis and addresses other possible causes of an acutely painful erythematous toe post-Zadek's procedure.

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200 A Scoring System for Equine Dental Health

Journal of Animal Science ◽

10.1093/jas/skab235.194 ◽

2021 ◽

Vol 99 (Supplement_3) ◽

pp. 107-107

Author(s):

Jesse Fenton ◽

Mary Beth Gordon ◽

Erin B Perry ◽

Zach Dombek ◽

Micheal Jerina ◽

...

Keyword(s):

Soft Tissue ◽

Tissue Damage ◽

Scoring System ◽

Dental Health ◽

Soft Tissue Damage ◽

Kappa Statistics ◽

Joint Movement ◽

Dental Abnormalities ◽

Nutrition Research ◽

Chewing Ability

Abstract Scoring systems have been implemented in veterinary practice to indicate the severity of pathologies, such as lameness and gastric ulceration. The need for a scoring system of equine dentition in relation to digestive health has been identified. A scoring system would allow veterinarians, owners, and researchers to more accurately assess dental health and the resulting impact it may have on chewing ability. A proposed system, the Equine Dental Scoring System (EDSS), was developed via collaboration of a team of veterinarians and equine nutritionists familiar with equine dental abnormalities. The EDSS was designed to assign higher scores corresponding to increasing severity of dental abnormalities that would impede proper chewing. The proposed scoring system ranges from 0 to 5 as follows: 0) no sharp enamel points, soft tissue damage, or malocclusion, (1) sharp enamel points, but no soft tissue damage or malocclusion, (2) sharp enamel points and soft tissue damage, but no malocclusion, (3) mild malocclusion with all aligned teeth meeting level (ex. ramps, hooks), (4) moderate malocclusion with all teeth meeting but not level (ex. wave, smile, diagonal, frown), (5) major malocclusion with one or more teeth not meeting or inhibited temporomandibular joint movement (ex. step, shear, retained cap), and/or infection, and/or pain while chewing. The EDSS was validated by assessing agreement via the Cohen’s kappa statistic between four trained professionals scoring ten images of horse dentition. Both the weighted (к = 0.62) and unweighted (к = 0.73) kappa statistics indicated substantial agreement between scorers, signifying reliable repeatability of the EDSS. Presenting dental health in the form of a score would indicate severity of dental pathologies and allow for quantitative and statistical evaluation of dental health in nutrition research and veterinary medicine.

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External Articular Transfixation for Joint Injuries with Severe Soft Tissue Damage

Fractures with Soft Tissue Injuries ◽

10.1007/978-3-642-69499-8_7 ◽

1984 ◽

pp. 103-117 ◽

Cited By ~ 1

Author(s):

D. Rogge

Keyword(s):

Soft Tissue ◽

Tissue Damage ◽

Soft Tissue Damage ◽

Joint Injuries ◽

Severe Soft Tissue

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A STUDY ON OUTCOME OF MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) IN EXTRA ARTICULAR FRACTURE OF DISTAL 1/3RD TIBIA.

10.36106/gjra/1911590 ◽

2021 ◽

pp. 106-111

Author(s):

Vaibhav Vaibhav

Keyword(s):

Soft Tissue ◽

Average Duration ◽

Tibial Fractures ◽

Categorical Variables ◽

Minimal Risk ◽

Distal Tibial Fractures ◽

Non Union ◽

Articular Fractures ◽

Number Of Patients ◽

Duration Of Surgery

BACKGROUND: Fractures of the distal tibia can be challenging to treat because of the limited soft tissue, the subcutaneous location, and poor vascularity. There is a considerable debate regarding the best method for treating distal tibial fractures. In present study we have treated distal tibial fractures using MIPPO technique OBJECTIVES: To evaluate the functional outcome following use of MIPO technique in lower 1/3rd fractures of tibia. MATERIAL AND METHODS: This is a longitudinal follow up study. In this study a total of 30 patients with fracture distal 1/3rd tibia admitted to CMRI hospital will be selected for treatment with MIPO technique according to inclusion and exclusion criteria. All patients were reviewed in CMRI Hospital and radiographs (Tibia AP and lateral views) obtained after surgery and then at 1 month, 3 months and nally at 6 months. From 5 weeks onwards symptoms and functions will be assessed using the scoring system of Olerud and Molander(1984). Statistical analysis of categorical variables was expressed as number of patients and percentage of patients and continuous variables are expressed as descriptive statistics. The statistical software SPSS version 20 has been used for the analysis. RESULTS: The age of patients ranged from 22-65 years. Fracture was most common in 4th and 5th decade of life. Average mean age was 44.03±10.74yrs. In this study majority of 17(56.7%) patients were male and there were 13(43.3%) were female. Road Trafc accident (RTA) was the main cause to produce lower end tibia fractures (83.3%) in our study. In this study right side (60%) was involved more than left (40%). In this study only 3 (10%) patients had open grade 1 injury. Majority of patients 27 (90%) had closed injury. In our study 66.67% (20) of patients had associated injuries and 33.33% patients had no associated injury. Average injury operation interval in this study was 3.27±1.53 days. Average no. of plate holes were 10.50±1.72. Average duration of hospital stay in this study was 10.07±2.75 days. Average duration of surgery in this study was 88.03±16.36 minutes. In this study 26 patients (86.7%) had no early post-op complications and 4 (13.3%) had complications. 3 patients (10%) had delayed wound healing and 1patient (3.3%) had supercial infection of suture lines. There was 1 non-union and majority of patients 21(70%) took 20-25 weeks for union. 7(23.4%) patients took less than 20 weeks and 1(3.33%) patient took more than 25 weeks. Average time of union in this study was 21.17±2.17 weeks. Average time of weight bearing was 17.72±1.91 weeks in this study. Most frequent late complication seen was swelling with frequency of 7 followed by stiffness and pain. 1 patient had malunion and 1 patient had non-union. In this study there were 28(93.3%) patients which showed union, 1 (3.3%) patient showed coronal malunion and 1(3.3%) had non-union. There were 21 patients (70 %) with excellent result, 7 patients (23.3%) with good result and 2 patients (6.7%) with fair result in our cases of study. Average clinical Olerud & Molander score was 81.17±16.07 in this study. CONCLUSION: The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in peri-articular fractures. Biological xation of complex fractures gives stable as well as optimal internal xation and complete recovery of limb function at an early stage with minimal risk of complications.

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Soft-tissue penetration of the oscillating saw during tibial resection in total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.102b10.bjj-2019-1602.r2 ◽

2020 ◽

Vol 102-B (10) ◽

pp. 1324-1330

Author(s):

Stijn Herregodts ◽

Mathijs Verhaeghe ◽

Rico Paridaens ◽

Jan Herregodts ◽

Hannes Vermue ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Soft Tissue ◽

Knee Arthroplasty ◽

Tissue Damage ◽

Soft Tissue Damage ◽

Iliotibial Band ◽

Collateral Ligament ◽

Tibial Resection ◽

Total Knee ◽

Oscillating Saw

Aims Inadvertent soft tissue damage caused by the oscillating saw during total knee arthroplasty (TKA) occurs when the sawblade passes beyond the bony boundaries into the soft tissue. The primary objective of this study is to assess the risk of inadvertent soft tissue damage during jig-based TKA by evaluating the excursion of the oscillating saw past the bony boundaries. The second objective is the investigation of the relation between this excursion and the surgeon’s experience level. Methods A conventional jig-based TKA procedure with medial parapatellar approach was performed on 12 cadaveric knees by three experienced surgeons and three residents. During the proximal tibial resection, the motion of the oscillating saw with respect to the tibia was recorded. The distance of the outer point of this cutting portion to the edge of the bone was defined as the excursion of the oscillating saw. The excursion of the sawblade was evaluated in six zones containing the following structures: medial collateral ligament (MCL), posteromedial corner (PMC), iliotibial band (ITB), lateral collateral ligament (LCL), popliteus tendon (PopT), and neurovascular bundle (NVB). Results The mean 75th percentile value of the excursion of all cases was mean 2.8 mm (SD 2.9) for the MCL zone, mean 4.8 mm (SD 5.9) for the PMC zone, mean 3.4 mm (SD 2.0) for the ITB zone, mean 6.3 mm (SD 4.8) for the LCL zone, mean 4.9 mm (SD 5.7) for the PopT zone, and mean 6.1 mm (SD 3.9) for the NVB zone. Experienced surgeons had a significantly lower excursion than residents. Conclusion This study showed that the oscillating saw significantly passes the edge of the bone during the tibial resection in TKA, even in experienced hands. While reported neurovascular complications in TKA are rare, direct injury to the capsule and stabilizing structures around the knee is a consequence of the use of a hand-held oscillating saw when making the tibial cut. Cite this article: Bone Joint J 2020;102-B(10):1324–1330.

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