Tibial plafond fractures

2011 ◽  
Author(s):  
J.L. Marsh
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Preoperative Planning ◽  
Distal Tibia ◽  
Soft Tissue Envelope ◽  
Tibial Plafond ◽  
Tibial Plafond Fractures

♦ Tibial plafond fractures demand respect, largely due to the fragile soft tissue envelope that surrounds the distal tibia♦ Careful preoperative planning followed by meticulous operative handling of the soft tissues is required to avoid devastating complications.

scholarly journals Redefining Knee Balance in a Medially Stabilized Prosthesis: An In-Vitro Study

2017 ◽  
Vol 11 (1) ◽  
pp. 1165-1172
Author(s):  
Philippe Van Overschelde ◽  
Vera Pinskerova ◽  
Peter P. Koch ◽  
Christophe Fornasieri ◽  
Sandro Fucentese
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
In Vitro Study ◽  
Lateral Release ◽  
Soft Tissue Release ◽  
Iliotibial Band ◽  
Soft Tissue Envelope ◽  
Medial Side ◽  
Fresh Frozen

Background: To date, there is still no consensus on what soft tissues must be preserved and what structures can be safely released during total knee arthroplasty (TKA) with a medially stabilized implant. Objective: The aim of this study was to analyze the effect of a progressive selective release of the medial and lateral soft tissues in a knee implanted with a medially stabilized prosthesis. Method: Six cadaveric fresh-frozen full leg specimens were tested. In each case, kinematic pattern and mediolateral laxity were measured in three stages: firstly, prior to implantation; secondly, after the implantation of the trial components, but before any soft tissue release; and thirdly, progressively as soft tissue was released with the trial implant in place. The incremental impact of each selective release on knee balance was then analyzed. Results: In all cases sagittal stability was not affected by the progressive release of the lateral soft tissue envelope. It was possible to perform progressive lateral release provided the anterior one-third of the iliotibial band (ITB) remained intact. Progressive medial release could be performed on the medial side provided the anterior fibers of the superficial medial collateral ligament (sMCL) remained intact. Conclusion: The medially conforming implant remains stable provided the anterior fibers of sMCL and the anterior fibers of the ITB remain intact. The implant’s sagittal stability is mainly dependent on its medial ball-in-socket design.

Comprehensive Diagnosis and Planning for the Difficult Rhinoplasty Patient: Applications in Ultrasonography and Treatment of the Soft-Tissue Envelope

2017 ◽  
Vol 33 (05) ◽  
pp. 509-518 ◽  
Author(s):  
Aaron Kosins
Keyword(s):  
Soft Tissue ◽  
Preoperative Planning ◽  
Early History ◽  
Diagnosis And Treatment ◽  
Open Approach ◽  
Secondary Surgery ◽  
Soft Tissue Envelope ◽  
Comprehensive Diagnosis ◽  
History Of ◽  
Closed Approach

AbstractRhinoplasty is one of the most complicated operations that a plastic surgeon will encounter. In the early history of rhinoplasty, operations were done with a closed approach, and the structures were shrouded in mystery while surgeons relied on surface aesthetics for diagnosis and treatment. Finally, with the advent of the extended open approach, power tools, and piezosurgery, the whole bony pyramid can be directly visualized, shaped, and sculpted. Osteotomies can be done under direct vision with high precision. Using this approach, every part of the osseocartilaginous vault and nasal tip can now be directly observed, diagnosed, and surgically treated. However, this only occurs once the patient is in the operating room. This article will detail the diagnosis and treatment of the difficult soft-tissue envelope of the nose. It will also describe the use of ultrasonography for preoperative planning as well as postoperatively for diagnosis and treatment during the healing period and for planning possible revision and secondary surgery.

Soft Tissue Thickness Variations of the Nose: A Radiological Study

2020 ◽  
Vol 40 (7) ◽  
pp. 711-718
Author(s):  
Melekber Çavuş Özkan ◽  
Fatma Yeşil ◽  
İnci Bayramiçli ◽  
Mehmet Bayramiçli
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Soft Tissue Coverage ◽  
Limited Information ◽  
Tissue Thickness ◽  
Level Of Evidence ◽  
Age And Gender ◽  
Soft Tissue Envelope ◽  
Soft Tissue Thickness ◽  
And Gender

Abstract Background Soft tissue thickness (STT) is a major factor affecting the outcome in rhinoplasty. However, limited information is found in the literature on the age- and gender-related variations of the nasal STT. Objectives The purpose of this study was to measure STT at various landmarks over the nasal framework and compare the age- and gender-related differences. Methods STT measurements were made at 11 landmarks in 325 patients by employing magnetic resonance imaging. Patients were divided into subgroups to compare the STT differences between female and male and between the age groups as young, middle age, and elderly. Results Soft tissue was thickest at the nasion and thinnest at the rhinion. The soft tissue coverage was significantly thicker in the male population at the supratip, tip, nasal bones, upper lateral cartilages, and alar lobules, whereas it is thicker in females at the rhinion. Average thickness of the soft tissues over the entire nasal framework increases with age except the rhinion. Conclusions The STT is variable over different parts of the osteocartilaginous framework. Gender and age influence the STT. The soft tissue is thicker at the distal half of the nose in male patients, and these areas become gradually thicker with age, whereas the soft tissue over the midvault becomes thinner. Increasing age presents a particular challenge to achieve predictable results in rhinoplasty, and an understanding of the soft tissue envelope allows for improved aesthetic outcome. Level of Evidence 2

Complications and Soft Tissue Coverage Following Complete Articular, Open Tibial Plafond Fractures

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jeffrey J. Olson ◽  
Krishna Anand ◽  
John G. Esposito ◽  
Arvind G. von Keudell ◽  
Edward K. Rodriguez ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Coverage ◽  
Tibial Plafond ◽  
Tibial Plafond Fractures

1343 Post-Operative Outcomes of Circular External Fixation in The Treatment of Tibial Plafond Fractures: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Legg ◽  
Y Ibrahim ◽  
K Malik-Tabassum
Keyword(s):  
Systematic Review ◽  
Soft Tissue ◽  
External Fixation ◽  
Complication Rate ◽  
Risk Of Bias ◽  
Tibial Plafond ◽  
Anatomic Reduction ◽  
Outcome Scores ◽  
Tibial Plafond Fractures ◽  
Mean Time

Abstract Introduction Tibial plafond fractures (TPF) are uncommon but potentially devastating injuries to the ankle. Meticulous care of the associated soft tissue injury is imperative in managing these fractures. The reported benefits of circular external fixation (CEF) include the ability to affect fracture reduction and create stable fixation, while limiting further soft tissue insult. This article provides the systematic review of the clinical and functional outcomes of TPF treated definitively with CEF. Method A literature search from inception to 13th November 2020 was performed. Quality and risk of bias was assessed using standardised scoring tools. Results 16 studies were included. 303 patients were analysed. Mean follow-up was 35 months. The mean time in CEF was 18 weeks and mean time to union was 21 weeks. Non-union and malunion occurred in 3.2% and 12.4% respectively. The overall complication rate was 12.3%. The rate of deep infection was 4.8%. No amputations were reported. Minor soft tissue infection (including pin site infections) accounted for 56.7% of complications. Almost two-thirds achieved good-to-anatomic reduction radiologically. Mean range of motion assessments were 11.8 and 24.8 degrees in dorsiflexion and plantarflexion, respectively. Approximately one-third reported excellent functional outcome scores. Quality of the studies was deemed satisfactory. A moderate risk of bias was acknowledged. Conclusions This systematic review provides an evidence-based summary, which highlights CEF as an acceptable treatment option with comparable complication rate and outcome scores to that of internal fixation. However, we acknowledge that high quality evidence is still lacking.

scholarly journals The effect of muscle contusion on cortical bone and muscle perfusion following reamed, intramedullary nailing: a novel canine tibia fracture model

2021 ◽  
Author(s):  
Henry Koo ◽  
Thomas Hupel ◽  
Rad Zdero ◽  
Alexei Tov ◽  
Emil H. Schemitsch
Keyword(s):  
Soft Tissue ◽  
Cortical Bone ◽  
Intramedullary Nailing ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Fixation Method ◽  
Doppler Flowmetry ◽  
Muscle Perfusion ◽  
Soft Tissue Envelope

Background Management of tibial fractures associated with soft tissue injury remains controversial. Previous studies have assessed perfusion of the fractured tibia and surrounding soft tissues in the setting of a normal soft tissue envelope. The purpose of this study was to determine the effects of muscle contusion on blood flow to the tibial cortex and muscle during reamed, intramedullary nailing of a tibial fracture. Methods Eleven adult canines were distributed into two groups, Contusion or No-Contusion. The left tibia of each canine underwent segmental osteotomy followed by limited reaming and locked intramedullary nailing. Six of the 11 canines had the anterior muscle compartment contused in a standardized fashion. Laser doppler flowmetry was used to measure cortical bone and muscle perfusion during the index procedure and at 11 weeks post-operatively. Results Following a standardized contusion, muscle perfusion in the Contusion group was higher compared to the No-Contusion group at post-osteotomy and post-reaming (p < 0.05). Bone perfusion decreased to a larger extent in the Contusion group compared to the No-Contusion group following osteotomy (p < 0.05), and the difference in bone perfusion between the two groups remained significant throughout the entire procedure (p < 0.05). At 11 weeks, muscle perfusion was similar in both groups (p > 0.05). There was a sustained decrease in overall bone perfusion in the Contusion group at 11 weeks, compared to the No-Contusion group (p < 0.05). Conclusions Injury to the soft tissue envelope may have some deleterious effects on intraosseous circulation. This could have some influence on the fixation method for tibia fractures linked with significant soft tissue injury.

scholarly journals PO 18069 - Management of soft-tissue injuries in lower extremity fractures

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 7S
Author(s):  
Rafael Da Rocha Macedo ◽  
João Paulo Gonçalves dos Santos ◽  
Dario Putini ◽  
Luciano Miller Reis Rodrigues
Keyword(s):  
Soft Tissue ◽  
Literature Review ◽  
Lower Extremity ◽  
Soft Tissue Injuries ◽  
Tibial Plafond ◽  
Management Protocol ◽  
Definitive Surgery ◽  
Tibial Plafond Fractures ◽  
Treatment Alternatives ◽  
Severe Soft Tissue

Introduction: Patients with lower extremity fractures have a high incidence of peri- and postoperative complications, such as extensive swelling, blisters, surgical wound infection, slow wound healing, persistent wound drainage and suture dehiscence. In calcaneal and tibial plafond fractures and ankle fractures/dislocations, especially in patients older than 50 years and those with diabetes, these complications are associated with a longer hospital stay and increased treatment costs and morbidity and mortality rates. The objective of this study is to perform a literature review of the management of blisters in lower extremity fractures and, based on the findings, to develop a management protocol for these lesions.  Methods: Literature review of the state of the art in international databases. Articles published in indexed journals from 1995 to 2014 addressing soft-tissue management in ankle, calcaneal and tibial plafond fractures were selected. Results: Various treatment methods have been described in the literature: observation without intervention, application of sterile dressing, content aspiration, removal of the blister roof and application of an antibiotic ointment or topical treatment alone; all have similar outcomes regarding the delay in definitive surgery and the incidence of mild and severe soft-tissue complications. No large studies comparing these treatment alternatives are available. Conclusion: There is no consensus in the literature on the proper management of blisters. Further studies should be performed to define a protocol for the management of these lesions.

scholarly journals The effect of muscle contusion on cortical bone and muscle perfusion following reamed, intramedullary nailing: a novel canine tibia fracture model

2021 ◽  
Author(s):  
Henry Koo ◽  
Thomas Hupel ◽  
Rad Zdero ◽  
Alexei Tov ◽  
Emil H. Schemitsch
Keyword(s):  
Soft Tissue ◽  
Cortical Bone ◽  
Intramedullary Nailing ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Fixation Method ◽  
Doppler Flowmetry ◽  
Muscle Perfusion ◽  
Soft Tissue Envelope

Background Management of tibial fractures associated with soft tissue injury remains controversial. Previous studies have assessed perfusion of the fractured tibia and surrounding soft tissues in the setting of a normal soft tissue envelope. The purpose of this study was to determine the effects of muscle contusion on blood flow to the tibial cortex and muscle during reamed, intramedullary nailing of a tibial fracture. Methods Eleven adult canines were distributed into two groups, Contusion or No-Contusion. The left tibia of each canine underwent segmental osteotomy followed by limited reaming and locked intramedullary nailing. Six of the 11 canines had the anterior muscle compartment contused in a standardized fashion. Laser doppler flowmetry was used to measure cortical bone and muscle perfusion during the index procedure and at 11 weeks post-operatively. Results Following a standardized contusion, muscle perfusion in the Contusion group was higher compared to the No-Contusion group at post-osteotomy and post-reaming (p < 0.05). Bone perfusion decreased to a larger extent in the Contusion group compared to the No-Contusion group following osteotomy (p < 0.05), and the difference in bone perfusion between the two groups remained significant throughout the entire procedure (p < 0.05). At 11 weeks, muscle perfusion was similar in both groups (p > 0.05). There was a sustained decrease in overall bone perfusion in the Contusion group at 11 weeks, compared to the No-Contusion group (p < 0.05). Conclusions Injury to the soft tissue envelope may have some deleterious effects on intraosseous circulation. This could have some influence on the fixation method for tibia fractures linked with significant soft tissue injury.

Principles of monolateral external fixation

2011 ◽  
Author(s):  
F. Lavini ◽  
C. Dall’Oca ◽  
L. Renzi Brivio
Keyword(s):  
Soft Tissue ◽  
External Fixation ◽  
Simple Structure ◽  
Preoperative Planning ◽  
External Fixators ◽  
Insertion Point ◽  
Soft Tissue Envelope ◽  
External Frame ◽  
Neurovascular Structures ◽  
Bone Anchorage

Monolateral external fixation is a system for the stabilization, reduction, and manipulation of bone segments by means of bone anchorage consisting of pins fastened to an external frame. Monolateral external fixators in their various forms have the advantage that they allow the use of half-pins (bicortical pins that do not penetrate both sides of the soft tissue envelope), thereby avoiding major damage to the neurovascular structures contralateral to the insertion point. The simple structure of monolateral systems permits rapid application and simplified preoperative planning, both of which are features particularly appreciated in traumatology.

Outcomes and Complications With Treatment of Open Tibial Plafond Fractures With Circular External Fixator

2021 ◽  
pp. 107110072097997
Author(s):  
Ahmed M. Thabet ◽  
Christopher Gerzina ◽  
Francesco Sala ◽  
Soyoung Jeon ◽  
Giovanni Lovisetti ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Case Series ◽  
Deep Infection ◽  
External Fixators ◽  
Union Rate ◽  
Tibial Plafond ◽  
Radiographic Measurements ◽  
Tibial Plafond Fractures

Background: Open tibial plafond fractures (Orthopaedic Trauma Association and AO Foundation [OTA/AO] 43) are associated with severe complications, including deep infection (closed fractures, 20%; open fractures, 30%), amputation (3%-14%), and nonunion (up to 25%). Circular external fixators (CEFs) can minimize soft tissue injury. This study aimed to report the rate of union and occurrence of severe complications in patients with open tibial plafond fractures treated with CEFs. Methods: A retrospective review of case series was conducted at 3 level I trauma centers. The study included patients older than 18 years with open tibial plafond fractures treated with CEFs. The reported outcomes included union rate, deep infection, operative complications, and limb alignment. The radiographic measurements of anatomic alignment were obtained. Fifty-two patients were included in the study. Results: The primary union rate was 79%. No deep infection occurred in the majority (92%) of patients. No patient required amputation of the affected limb or free flap coverage. Conclusion: Definitive fixation of open tibial plafond fractures with CEFs avoided severe soft tissue complications but resulted in variation in final radiographic alignment. Level of Evidence: Level IV, case series.

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