Lower tibial shaft spiral fracture concurrent with distal tibial triplane fracture

2021 ◽  
Vol 17 ◽  
Author(s):  
Lei Cao ◽  
Shu-Man Han ◽  
Hui-Zhao Wu ◽  
Jin-Xu Wen ◽  
Zhe Guo ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Plain Radiograph ◽  
Plain Radiography ◽  
Type I ◽  
Imaging Features ◽  
Type Ii ◽  
Tibial Shaft ◽  
Spiral Fracture ◽  
Tibial Epiphysis ◽  
Triplane Fracture

Background: The clinical and imaging features of lower tibial shaft spiral fracture, concurrent with distal tibial triplane fracture, are not clear. Introduction: Consequently, this study was aimed to investigate these features for correct diagnosis, treatment, and prevention of possible premature physeal arrest or angular deformation. Method: 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. Result: 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 that were 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. Having 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.

scholarly journals Imaging features of hemangioma in long tubular bones

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lei Cao ◽  
Jin-Xu Wen ◽  
Shu-Man Han ◽  
Hui-Zhao Wu ◽  
Zhi-Gang Peng ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Plain Radiograph ◽  
Ground Glass Opacity ◽  
Plain Radiography ◽  
Long Bone ◽  
Imaging Features ◽  
Mri Imaging ◽  
Soft Tissue Density ◽  
Tissue Density ◽  
Hyperintense Signal

Abstract Background To investigate the imaging features of hemangiomas in long tabular bones for better diagnosis. Methods Twenty-four patients with long bone hemangiomas confirmed by pathology were enrolled. Nineteen patients had plain radiography, fourteen patients had computed tomography (CT) and eleven had magnetic resonance imaging (MRI). The hemangioma was divided into medullary [13], periosteal [6] and intracortical type [5]. Results Among 19 patients with plain radiography, eleven patients were medullary, three periosteal, and five intracortical. In the medullary type, the lesion was primarily osteolytic, including five cases with irregular and unclear rims and one lesion having osteosclerotic and unclear rims. In three patients with the periosteal type, the lesion had clear rims with involvement of the cortical bone in the form of bone defect, including two cases with local thickened bone periosteum and one case having expansile periosteum. Five intracortical hemangiomas had intracortical osteolytic lesions with clear margins. Among 14 patients with CT imaging, 8 cases were medullary, three periosteal, and three intracortical. Among 8 medullary hemangiomas, one had ground glass opacity, and seven had osteolytic, expansile lesions like soft tissue density with no calcification. In three periosteal cases, the lesion was osteolytic with thickened periosteum and narrowed medullary cavity. In three intracortical hemangiomas, the lesion was of even soft tissue density with no calcification. Among 11 patients with MRI imaging, seven were medullary, two periosteal, and two intracortical. Among 7 medullary lesions, six were of hypointense signal on T1WI and hyperintensesignal on T2 WI. In two periosteal cases, the periosteum was thickened, with one case being of equal signal, and the other having no signal. Two intracortical hemangiomas were both of slightly low signal on T1WI but hyperintense signal on T2WI. Conclusions The long bone hemangiomas had characteristic cystic honeycomb-like presentations in plain radiograph. CT and MRI imagings are helpful for diagnosis of hemangiomas in long bone.

The Effects of Non-Weight Bearing on Skeletal Muscle in Older Rats: an Interrupted Bout versus an Uninterrupted Bout

2004 ◽  
Vol 5 (3) ◽  
pp. 195-202 ◽  
Author(s):  
Alissa Guildner Gehrke ◽  
Margaret Sheie Krull ◽  
Robin Shotwell McDonald ◽  
Tracy Sparby ◽  
Jessica Thoele ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Fiber Type ◽  
Weight Bearing ◽  
Cross Sectional Area ◽  
Type I ◽  
Type Ii ◽  
Sectional Area ◽  
Cross Sectional ◽  
Age Related ◽  
Type Ii Fibers

Age-related changes in skeletal muscle, in combination with bed rest, may result in a poorer rehabilitation potential for an elderly patient. The purpose of this study was to determine the effects of non-weight bearing (hind limb unweighting [HU]) on the soleus and extensor digitorum longus (EDL) in older rats. Two non-weight bearing conditions were used: an uninterrupted bout of HU and an interrupted bout of HU. Twenty-one rats were randomly placed into 1 of 3 groups: control, interrupted HU (2 phases of 7 days of HU, separated by a 4-day weight-bearing phase) and an uninterrupted HU (18 uninterrupted days of HU). Following non-weight bearing, the soleus and EDL muscles were removed. Fiber type identification was performed by myofibrillar ATPase and cross-sectional area was determined. The findings suggest that any period of non-weight bearing leads to a decrease in muscle wet weight (19%-45%). Both type I and type II fibers of the soleus showed atrophy (decrease in cross-sectional area, 35%-44%) with an uninterrupted bout of non-weight bearing. Only the type II fibers of the soleus showed recovery with an interrupted bout of weight bearing. In the EDL, type II fibers were more affected by an uninterrupted bout of non-weight bearing (15% decrease in fiber size) compared to the type I fibers. EDL type II fibers showed more atrophy with interrupted bouts of non-weight bearing than with a single bout (a 40% compared to a 15% decrease). This study shows that initial weight bearing after an episode of non-weight bearing may be damaging to type II fibers of the EDL.

scholarly journals Assessment of esophagogastric junction morphology by dynamic real-time MRI: comparison of imaging features to high-resolution manometry

2021 ◽  
Author(s):  
Lorenz Biggemann ◽  
Johannes Uhlig ◽  
Nina Gliem ◽  
Omar Al-Bourini ◽  
Edris Wedi ◽  
...  
Keyword(s):  
High Resolution ◽  
Real Time ◽  
Hiatal Hernia ◽  
Esophagogastric Junction ◽  
Valsalva Maneuver ◽  
Type I ◽  
Imaging Features ◽  
Type Ii ◽  
High Resolution Manometry ◽  
Type Iii

Abstract Purpose To assess the esophagogastric junction (EGJ) on real-time MRI and compare imaging parameters to EGJ morphology on high-resolution manometry (HRM). Methods A total of 105 of 117 eligible patients who underwent real-time MRI and high-resolution manometry for GERD-like symptoms between 2015 and 2018 at a single center were retrospectively evaluated (male n = 57; female n = 48; mean age 52.5 ± 15.4 years). Real-time MRI was performed at a median investigation time of 15 min (1 frame/40 ms). On HRM, EGJ morphology was assessed according to the Chicago classification of esophageal motility disorders. Real-time MRI was performed at 3 T using highly undersampled radial fast low-angle shot acquisitions with NLINV image reconstruction. A 10 mL pineapple juice bolus served as oral contrast agent at supine position. Real-time MRI films of the EGJ were acquired during swallowing events and during Valsalva maneuver. Anatomic and functional MRI parameters were compared to EGJ morphology on HRM. Results On HRM, n = 42 patients presented with EGJ type I (40.0%), n = 33 with EGJ type II (31.4%), and n = 30 with EGJ type III (28.6%). On real-time MRI, hiatal hernia was more common in patients with EGJ type III (66.7%) than in patients with EGJ type I (26.2%) and EGJ type II (30.3%; p < 0.001). Sliding hiatal hernia was more frequent in patients with EGJ type II (33.3%) than in patients with EGJ type III (16.7%) and EGJ type I (7.1%; p = 0.017). The mean esophagus–fundus angle of patients was 85 ± 31° at rest and increased to 101 ± 36° during Valsalva maneuver. Conclusion Real-time MRI is a non-invasive imaging method for assessment of the esophagogastric junction. Real-time MRI can visualize dynamic changes of the EGJ during swallowing events.

scholarly journals EXTERNAL FIXATOR;

2013 ◽  
Vol 20 (04) ◽  
pp. 600-605
Author(s):  
ROOHULLAH JAN ◽  
ZAHID ASKAR ◽  
JAVED IQBAL
Keyword(s):  
Body Weight ◽  
External Fixation ◽  
External Fixator ◽  
Weight Bearing ◽  
Functional Results ◽  
Type Ii ◽  
Tibial Shaft ◽  
Shaft Fractures ◽  
Tibial Shaft Fractures ◽  
Full Body

Introduction: Open Tibial shaft fractures are one of the most common fractures of long bones. External fixation is methodof choice for the treatment of open tibial shaft fractures. The subcutaneous location of tibia makes it suitable for the application of externalfixator. Patients and Methods: This study was done on 50 patients at Orthopaedics and Trauma unit “B” at Khyber Teaching Hospital,Peshawar, from Jan 2008 to Feb. 2009 to determine functional outcome of A.O. external fixator in open tibial fractures in terms of knee andankle mobility, pain and gait on full body weight bearing. The data of all patients was entered in standardized proforma and analyzed onSPSS 10. Results: There were 43 (86%) males and 7 (14%) females. There were 17 (34%) type-II and 20 (40%) type IIIA and 13 (26%)type III B fractures. Knee mobility was full (100%) in 49 (98%) cases, 75% in 1(2%). 43 (86%) cases retained 100% ankle joint mobilitywhile it was 75% in 4 (8%), 50 % in 2 (4%) cases and 25 % in 1(2%) cases. On full body weight bearing, 42(84%) patients were pain free,and moderate pain was in 4(8%) cases. In 42(84%) cases the gait was completely normal on full body weight bearing while 3(6%) casesshowed significant limping. Conclusion: The excellent functional results in our series show that external fixation of tibia is safe andeffective in terms of restoring functions of tibia.

scholarly journals Inactivity, age, and exercise: single-muscle fiber power generation

2013 ◽  
Vol 114 (1) ◽  
pp. 90-98 ◽  
Author(s):  
Jong-Hee Kim ◽  
LaDora V. Thompson
Keyword(s):  
Young Adult ◽  
Peak Power ◽  
Weight Bearing ◽  
Type I ◽  
Type Ii ◽  
Middle Aged ◽  
Adult Rats ◽  
Maximal Force ◽  
Old Rats ◽  
Type I Fibers

We examined the effects of mild therapeutic exercise during a period of inactivity on size and contractile functions of myosin heavy chain (MHC) type I ( n = 204) and type II ( n = 419) single fibers from the medial gastrocnemius in three age groups. Young adult (5–12 mo), middle-aged (24–31 mo), and old (32–37 mo) F344BNF1 rats were assigned to one of three groups: weight-bearing control, non-weight bearing (NWB), and NWB plus exercise (NWBX). Fourteen days of hindlimb suspension were applied in NWB rats. The NWBX rats exercised on the treadmill for 15 min, four times a day, during the period of NWB. The NWBX did not improve peak power, but increased normalized power of MHC type I fibers in young adult rats. In MHC type II fibers, NWBX did not change peak power, isometric maximal force, Vmax, and fiber size from young adult and middle-aged rats. NWBX did not improve peak power and isometric maximal force and showed a dramatic decline in Vmax and normalized power in the old rats. Collectively, mild treadmill exercise during a period of inactivity does not improve peak power of MHC type I or type II fiber from the gastrocnemius in young, middle-aged, and old rats. However, NWBX is beneficial in enhancing normalized power of MHC type I fibers in young adult rats, most likely due to the stimulus intensity and the ability of the individual fibers to adapt to the stimulus. In contrast, several factors, such as impaired adaptation potential, inappropriate exercise intensity, or increased susceptibility to muscle damage, may contribute to the lack of improvement in the older rats.

Magnetic resonance imaging abnormalities in the resection region correlate with histopathological type, gliosis extent, and postoperative outcome in pediatric cortical dysplasia

2014 ◽  
Vol 14 (1) ◽  
pp. 68-80 ◽  
Author(s):  
James L. Leach ◽  
Lili Miles ◽  
David M. Henkel ◽  
Hansel M. Greiner ◽  
Marcia K. Kukreja ◽  
...  
Keyword(s):  
Intractable Epilepsy ◽  
Postoperative Outcome ◽  
Cortical Dysplasia ◽  
Type I ◽  
Imaging Features ◽  
Type Ii ◽  
Mri Findings ◽  
Site Specific ◽  
Mri Score ◽  
Specific Evaluation

Object The authors conducted a study to correlate histopathological features, MRI findings, and postsurgical outcomes in children with cortical dysplasia (CD) by performing a novel resection site–specific evaluation. Methods The study cohort comprised 43 children with intractable epilepsy and CD. The MR image review was blinded to pathology but with knowledge of the resection location. An MRI score (range 0–7) was calculated for each resection region based on the number of imaging features of CD and was classified as “lesional” or “nonlesional” according to all imaging features. Outcome was determined using the International League Against Epilepsy (ILAE) scale. The determination of pathological CD type was based on the ILAE 2011 consensus classification system, and the cortical gliosis pattern was assessed on GFAP staining. Results There were 89 resection regions (50 ILAE Type I, 29 Type IIa, and 10 Type IIb). Eleven (25.6%) of 43 children had more than one type of CD. The authors observed MRI abnormalities in 63% of patients, characteristic enough to direct resection (lesional) in 42%. Most MRI features, MRI score ≥ 3, and lesional abnormalities were more common in patients with Type II CD. Increased cortical signal was more common in those with Type IIb (70%) rather than Type IIa (17.2%) CD (p = 0.004). A good outcome was demonstrated in 39% of children with Type I CD and 72% of those with Type II CD (61% in Type IIa and 100% in Type IIb) (p = 0.03). A lesional MRI abnormality and an MRI score greater than 3 correlated with good outcome in 78% and 90% of patients, respectively (p < 0.03). Diffuse cortical gliosis was more prevalent in Type II CD and in resection regions exhibiting MRI abnormalities. Complete surgical exclusion of the MRI abnormality was associated with a better postoperative outcome. Conclusions This study provides a detailed correlation of MRI findings, neuropathological features, and outcomes in children with intractable epilepsy by using a novel resection site–specific evaluation. Because 25% of the patients had multiple CD subtypes, a regional analysis approach was mandated. Those children with lesional MRI abnormalities, Type II CD, and surgical exclusion of the MRI abnormality had better outcomes. Type II CD is more detectable by MRI than other types, partly because of the greater extent of associated gliosis in Type II. Although MRI findings were correlated with the pathological CD type and outcome in this study, the majority of patients (58%) did not have MRI findings that could direct surgical therapy, underscoring the need for improved MRI techniques for detection and for the continued use of multimodal evaluation methods in patient selection.

Histochemical and contractile responses of rat medial gastrocnemius to 2 weeks of complete disuse

1992 ◽  
Vol 70 (8) ◽  
pp. 1075-1081 ◽  
Author(s):  
Phillip F. Gardiner ◽  
Michèle Favron ◽  
Pierre Corriveau
Keyword(s):  
Succinate Dehydrogenase ◽  
Weight Bearing ◽  
Medial Gastrocnemius ◽  
Hindlimb Suspension ◽  
Muscle Fibres ◽  
Type I ◽  
Type Ii ◽  
Disuse Atrophy ◽  
Tetanic Force

We studied the histochemical and in situ contractile changes in a rat ankle extensor, medial gastrocnemius, in which activation of muscle fibres by motoneurones was blocked for 14 days, using the sodium channel blocker tetrodotoxin applied to the sciatic nerve. Muscles were atrophied and showed slower twitch responses, greater fusion at subtetanic frequencies of stimulation, and higher twitch/tetanic ratios. Tetanic force/mm2 of fibre area and fatiguability were unchanged. Type II fibres were more atrophied and showed greater decreases in mitochondrial succinate dehydrogenase activity than type I fibres. The contractile changes resulting from complete disuse do not occur in models in which weight-bearing alone has been removed (space flight, hindlimb suspension), suggesting that the residual motoneurone activity reported in models of weightlessness is sufficient to prevent these responses. Similarly, the finding of a greater type II fibre susceptibility to complete disuse, which differs from the pattern seen in models of weightlessness, suggests that this residual motoneurone activity in the latter influences atrophic responses in a manner that is variable among motor unit types, to produce the reported preferential type I atrophy characteristic of removal of weight-bearing.Key words: disuse, atrophy, fibre types, succinate dehydrogenase, contractile properties.

Treatment of tibial shaft fractures in sheep using interlocking nails, Schanz screws and type I external fixators

2012 ◽  
Vol 15 (4) ◽  
pp. 651-659 ◽  
Author(s):  
A. Piórek ◽  
Z. Adamiak ◽  
Y. Zhalniarovich ◽  
M. Jaskólska
Keyword(s):  
Weight Bearing ◽  
External Fixators ◽  
Type I ◽  
Tibial Osteotomy ◽  
Tibial Shaft ◽  
Clinical Tests ◽  
Shaft Fractures ◽  
Bone Callus ◽  
Tibial Shaft Fractures ◽  
Observation Period

Abstract This paper presents the results of a study of the treatment of transverse tibial shaft fractures in six sheep with the use of interlocking nails and type I extemal fixators. During surgery, tibial osteotomy was performed to induce an experimental fracture which was stabilized using a type I extemal fixator. Osteosynthesis was monitored for nine weeks by performing clinical tests, observing the degree of lameness and subjecting the patients to weekly radiological examinations. After nine weeks, the animals were euthanized, and samples of bone callus were sampled for histopathological analyses. Weight bearing on the fractured limb began on day 2 to 4 after treatment. Limb function was fully restored around five weeks after surgery. Radiograms taken during the observation period revealed gradual hyperplasia and progressing mineralization of bone callus at different stages of healing. The histopathological picture of the bone callus was characteristic of the phase of bone turnover and remodeling.

scholarly journals Primary interlocking nailing for open fractures of tibial shaft: a clinical study

2019 ◽  
Vol 5 (5) ◽  
pp. 811
Author(s):  
Talluri V. G. Krishna
Keyword(s):  
Intramedullary Nailing ◽  
Open Fractures ◽  
Type I ◽  
Type Ii ◽  
Tibial Shaft ◽  
Non Union ◽  
Interlocking Nailing ◽  
Type Iiia ◽  
Open Injury ◽  
Closed Intramedullary Nailing

<p class="abstract"><strong>Background:</strong> The excellent method for treating fractures of the tibial shaft was the closed intramedullary nailing technique. But because of limited references related to the results, incidence of infection, non-union of open injury. Hence, it was decided to analyse open tibial fractures treatment by primary interlocking nailing.</p><p class="abstract"><strong>Methods:</strong> 50 Patients with open fractures of the tibial shaft which were treated with primary interlocking nail were studied in the period of 14 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> In present study 18 (36%) type I, 22 (44%) type II and 10 (20%) type IIIA Gustilo open fractures were treated. The average duration of time between injury and nailing was 3.5 hours (range was 1.5 hours to 4 hours). After reaming, 40 (80%) fractures were fixed, without reaming, 10 (20%) of fractures were fixed. The average time to union was 27 weeks for type I fractures, 30 weeks for type II fractures and 33 weeks for type IIIA fractures. There was 1 non-union. There were 4 deep infections.</p><p class="abstract"><strong>Conclusions:</strong> The best mode of therapy was primary interlocking intramedullary nailing for open fractures.</p>

scholarly journals The Role of Lunate Morphology in the Severity of Kienböck Disease: A Retrospective Study

2019 ◽  
Vol 6 (4) ◽  
pp. 13-18
Author(s):  
Hooman Shariatzadeh ◽  
◽  
Farid Najd Mazhar ◽  
Hanon Sadony ◽  
Nima Bagheri ◽  
...  
Keyword(s):  
Plain Radiograph ◽  
Disease Stage ◽  
Type I ◽  
Type Ii ◽  
Stage Iiia ◽  
Number Of Patients ◽  
Kienböck Disease ◽  
The Mean ◽  
The Relationship

Background: Lunate morphology has been associated with several wrist pathologies. In this study, we aimed to find how lunate morphology (absence or presence of hamate facet) affects the severity of Kienböck disease. Objectives: Evaluation of the relationship between lunate morphology and kienbocks disease. Methods: A total of 106 patients with stage IIIA or IIIB of Kienböck disease at initial presentation were included in this study. Modified Litchman classification system and standardized lateral radiographs were used for staging the Kienböck disease. Lunate morphology was investigated on plain radiograph and computed tomography scan or magnetic resonance imaging and was classified into type I (absence of hamate facet) and type II (presence of hamate facet). Results: The mean±SD age of the patients was 33.5±9.2 years. Kienböck disease stage IIIA and IIIB were identified in 68 (64.2%) and 38 (35.8%), respectively. Hamate facet was present in 65 (61.3%) patients and absent 41 (38.7%) patients. A significant association was found between lunate morphology and stage of disease so that the number of patients with lunate type I was significantly more in stage IIIB and number of patients with lunate type II was significantly more in stage IIIA (p<0.001). Conclusion: Lunate morphology is associated with the severity of Kienböck disease in patients initially presented with stage IIIA or IIIB. These associations could be implicated to prevent disease progression as well as to optimize the outcome of treatment.

Sign in / Sign up

Export Citation Format

Share Document