scholarly journals Distal Tibia Delayed Union with Fibular Shortening Causing Syndesmotic Instability and Anterolateral Impingement

2019 ◽  
Vol 1 (1) ◽  
pp. 31-34
Author(s):  
Austin J Cantrell ◽  
Joshua A Wilson ◽  
Amgad Haleem ◽  
Seth Boydstun
Keyword(s):  
Distal Tibia ◽  
Delayed Union ◽  
Anterolateral Impingement

scholarly journals Management of Fractures of Distal third Tibia by Interlock Nailing

2016 ◽  
Vol 3 (1) ◽  
pp. 15-22
Keyword(s):  
Tissue Injury ◽  
Distal Tibia ◽  
Soft Tissue Injury ◽  
Skin Condition ◽  
Delayed Union ◽  
Fracture Site ◽  
Tibia Fracture ◽  
Asia Pacific ◽  
Fracture Geometry ◽  
Fibula Fracture

ABSTRACT Introduction Most of the distal third tibia is subcutaneous and has precarious blood supply. Fractures of the distal third tibia have comminution at the fracture site, as it is metaphyseal cancellous bone with a thin shell of cortex, and have associated significant soft tissue injury. Generally, skin condition is not satisfactory due to ecchymosis, blebs, swellings, wounds, etc. All these factors contribute to delayed union, nonunion, and malunion. The present study is about the ability to maintain a mechanically stable reduction in the distal third tibia with intramedullary nail, when lower 4 cm of tibia not fractured. If associated with fibula fracture (in lower 10 cm), it is always fixed as a rule to give stability to syndesmosis and stability to same-level tibia fracture. Materials and methods From January 2013 to March 2015, 60 patients of distal tibia fracture admitted to Government Medical College and Hospital, Latur, were operated and followed up prospectively. Results Mean age of patients was 35 years (25–50). Fracture union was seen radiologically within 3 to 4 months, depending on fracture geometry. Conclusion We conclude that results of fractures of distal third tibia not extending into lower 4 cm of tibia treated with interlock nailing were found satisfactory. Meticulous planning and placement of nail at the center of a wide metaphysis in the anteroposterior and lateral is mandatory to avoid varus, valgus, and posterior tilt. Polar screw or temporary K-wire during surgery is very helpful. Same-level fibula fracture fixation with a plate or square nail is very effective for stability of reduction. How to cite this article Gawali SR, Kukale SB, Nirvane PV, Toshniwal RO. Management of Fractures of Distal third Tibia by Interlock Nailing. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):15-22.

scholarly journals Evaluation of results of minimally invasive plating osteosynthesis (MIPO) technique in the treatment of fractures of distal tibia

2016 ◽  
Vol 3 (1) ◽  
pp. 7
Author(s):  
Waseem Akram ◽  
Ajay Kumar Mahto ◽  
Masroor Alam
Keyword(s):  
Minimally Invasive ◽  
Distal Tibia ◽  
Operation Time ◽  
Delayed Union ◽  
Locking Compression Plate ◽  
Tibia Fracture ◽  
Distal Tibia Fracture ◽  
Alternative Treatment Option ◽  
Compression Plate ◽  
Minimally Invasive Plating

<p class="abstract"><strong>Background:</strong> The limited soft tissue, subcutaneous location of large portion of tibia and precarious blood supply renders the treatment of distal tibial fracture very challenging. The main treatment of this type of fracture is reinstatement of the normal alignment and articular congruity. Conventional osteosynthesis is not suitable because distal tibia is subcutaneous bone with poor vascularity. Closed Reduction and MIPO with locking compression plate (LCP) has emerged as an alternative treatment option because it respects biology of distal tibia, maintains fracture haematoma and provides biomechanically stable construct, early mobilization, less complications and relatively higher rates of union<span lang="EN-IN">.</span>The aim of this study was to evaluate the functional and clinical outcomes of distal tibia fracture of patients, treated by internal fixation by minimally invasive plating osteosynthesis (MIPO) technique with locking compression plate (LCP).</p><p class="abstract"><strong>Methods:</strong> Sixty patients with distal tibia fracture with or without intra articular extension were treated in our department, Katihar Medical College and Hospital, Katihar with MIPO with LCP and were prospectively followed for average duration of 16 months (6-24 months).<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 60 patients in the study including 48 males and 12 female of mean age 43 years. The mean follow up period of our patients varied ranging from 6 months to 24 months (average– 16 months). All fractures united at an average of 16 weeks (range- 12 to 20 weeks) except two cases of delayed union(&gt;20 weeks) in patients with Gustilo – Anderson type III A fracture. There were five superficial wound infections which were treated with oral antibiotics and progressed to union and there were no failures of implants. There were two cases of delayed union and malalignment<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Minimally invasive plating osteosynthesis (MIPO) is an effective method of treatment for distal tibial fractures. The use of indirect reduction techniques and small incision is technically demanding as it is effective, minimally invasive, optimises the operation time, promotes early healing and reduces the incidence of infections.</span></p>

scholarly journals Role of tibia interlocking nail in treating distal tibial metadiaphyseal fractures: study of 46 cases

2017 ◽  
Vol 4 (1) ◽  
pp. 65
Author(s):  
Neetin P. Mahajan ◽  
Eknath D. Pawar ◽  
Amit C. Supe ◽  
Hitesh J. Mangukiya
Keyword(s):  
Storage System ◽  
Distal Tibia ◽  
Delayed Union ◽  
P Value ◽  
Non Union ◽  
Interlocking Nail ◽  
Screw Breakage ◽  
Diaphyseal Fractures

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Distal tibial diaphyseal fractures are </span><span lang="EN-IN">known for its various challenges that orthopaedicians face while treating. While performing surgery, many principles of fixations are needed to be properly addressed. This study was undertaken to know the efficiency of closed reduction, polar screws and tibia interlocking nail fixation at our Institute.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The data, which were collected from the medical records and Department digitalised storage system and from the HMIS patient filing system, included age, sex, date of admission, type of admission (elective versus emergency), and AO classification of distal tibial fracture admitted in Orthopaedics Department from 2007 to 2013. Analyses of 46 cases, 34 males and 12 females, were made to find out the functional, radiological outcome, associated complications in treating distal tibia with ILN. During Analysis, association of the single event with the variables was estimated using Relative Risk, with a 95% confidence interval and P value of &lt;0.05 was considered significant</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The average time to union of the closed fracture was 15.4 weeks (range: 12–28 weeks). The healing times for the primarily nailed compound Grade I averaged 17.8 weeks (range: 15-34 weeks). Complications of delayed union occurred in 3 cases, and two cases of non-union. Infection in 6 cases (5 superficial, 1 deep), screw breakage in 4 cases and 3 cases of significant malalignment. The final functional outcome of 33 patients had excellent results, 11 had good results and 2 had fair results as determined by criteria of Johner and Wruh</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The dynamic osteosynthesis of distal tibia by interlocking nail and judicious use of poller screws is an effective alternative for the treatment of distal metaphyseal tibial fractures</span><span lang="EN-IN">.</span></p><p class="abstract"> </p>

Distal Intra Articular Tibial Fracture Treated by Ilizarov with Ligamentotaxis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mahmoud Mohamed Fayd ◽  
Mohamed Ahmad Al-Kersh ◽  
Elia Saad Fakhry Bishay
Keyword(s):  
Systematic Review ◽  
External Fixator ◽  
Observational Studies ◽  
Tibial Fracture ◽  
Articular Surface ◽  
Meta Analysis ◽  
Distal Tibia ◽  
Delayed Union ◽  
Ilizarov External Fixator ◽  
Major Infection

Abstract Background The thin soft tissue and muscles envelope that surrounds the distal tibia makes treatment of these fractures difficult. These fractures are often referred to as ―pilon‖ fractures or ―plafond‖ fractures‖. If the articular surface of the tibia is involved; in such cases an anatomic realignment of the involved articular fracture in conjunction with a stable fixation is crucial. Objectives The aim of this paper is to conduct a systematic review of literature about functional and radiological outcomes in patients with distal intra articular tibial fracture treated by external fixator with ligamentotaxis. Materials and Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) statement. MOOSE is a reporting checklist for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists Results Over all, five studies reported the time to union. The overall effect estimates showed that the time to union after Ilizarov external fixator was 12.83 weeks. Three studies reported the rate of union. The overall effect estimates showed that the rate of union after Ilizarov external fixator was 88.4%. Over all, eight studies reported the good-excellent AOFS score. The overall effect estimates showed that the rate of good-excellent AOFS score after Ilizarov external fixator was 69.4%. Nine studies reported the rate of malunion. The overall effect estimates showed that the rate of malunion after Ilizarov external fixator was 10.2%. Over all, seven studies reported the rate of delayed union. The overall effect estimates showed that the rate of delayed union after Ilizarov external fixator was 6.3%. All studies reported the rate of pin infection. The overall effect estimates showed that the rate of pin infection after Ilizarov external fixator was 33.7%. Ten studies reported the rate of major infection. The overall effect estimates showed that the rate of major infection after Ilizarov external fixator was 3.4. Conclusion External fixation and ligamentotaxis by either ilizarov or any external fixator is a good and easy method for fixation of distal intraarticulat tibial fracture with few serious complications. due to easy to apply it, less rate of infection, no risk of bleeding since no opening the fracture site, good aligment of the joint, no streaping of the periosteomy that lead to later on good and rapid healing of the fracture.

Treatment of Delayed Union and Septic Osteomyelitis of Metacarpus III/IV in a Calf Using Gentamicin-impregnated Collagen Sponges and Minimal External Coaptation

1998 ◽  
Vol 11 (01) ◽  
pp. 19-22 ◽  
Author(s):  
A. Steiner ◽  
Gaby Hirsbrunner
Keyword(s):  
Standard Treatment ◽  
Delayed Union ◽  
Surgical Debridement ◽  
Rigid Fixation ◽  
Skin Defect ◽  
Long Time ◽  
Metaphyseal Fracture ◽  
External Stabilization ◽  
Long Acting ◽  
Local Antibiotic

SummaryA newborn calf was admitted for evaluation of a primarily closed comminuted metaphyseal fracture of metacarpus III/IV. Closed reduction and application of transfixation pins and a fibreglass cast were performed. Ten days after pin removal, radiographs revealed that the initially healed fracture had collapsed, and osteomyelitis was diagnosed. Bacteriological culture from the deep draining tract yielded Actinomyces pyogenes and Staphylococcus aureus. Standard treatment of delayed union or nonunion caused by septic osteomyelitis consists of surgical debridement, rigid fixation, and long-time administration of antibiotics. In this case, we used surgical debridement, administration of a new long-acting local antibiotic (gentamicin- impregnated collagen sponges), and minimal external stabilization. At day 27 after initiation of this treatment, the skin defect had healed, and the fracture was stable on manual palpation.Standard treatment of delayed union or nonunion caused by septic osteomyelitis consists of surgical debridement, rigid fixation and prolonged administration of antibiotics. In the case described, we used surgical debridement, administration of a long-acting local antibiotic (gentamicin-impregnated collagen sponges), and minimal external stabilization. The promising outcome of this case and the good results in human surgery warrant further investigation in the use of gentamicin-impregnated collagen sponges in veterinary orthopaedics.

COMPARATIVE ANALYSIS OF CLOSED REDUCTION AND EXPERT TIBIA NAILING WITH OPEN REDUCTION AND PLATE & SCREW FIXATION IN THE TREATMENT OF PROXIMAL TIBIA EXTRAARTICULAR FRACTURES

2018 ◽  
Author(s):  
Anil Pandey ◽  
Setul Shah ◽  
Deepak S Maravi ◽  
S Uikey
Keyword(s):  
Intramedullary Nailing ◽  
Closed Reduction ◽  
Proximal Tibia ◽  
Plate Fixation ◽  
Surgical Site Infections ◽  
Delayed Union ◽  
Large Sample Size ◽  
Multicentric Study ◽  
Group A ◽  
Group B

Introduction:- Extra-articular proximal tibial fractures account for 5–10 % of all tibial shaft fractures and it result from high-velocity trauma. Closed reduction with minimally invasive plating and locked intramedullary  nailing have been widely used for treatment of proximal tibia extraarticular fractures. Our pupose is to compare the pros and cons of these two methods. Materials and methods:- 22 patients were included in this study for a period of 2 years. Patients treated with IMN were kept in group A patients treated with percutaneus plating were kept in group B. Standard approach of nailing and plating were used and proper follow up were taken for next upcoming 1 year. Results:- Combined average age was 38years. Male were more commonly affected than female (13:8). Majority of fracture were of type A33. Operative time was < 2 hours in both groups. Less blood loss occurred during intramedullary nailing as compared to locking plate fixation. Surgical site infections (SSIs) were seen in two patients in the PTP group. Delayed union occurred in two patients in the IMN group. The average range of motion was 119.7(range 90-150, SD= 19.18) in group A and 115.2(range 80-150, SD = 17.28) in group B. Conclusion:- in treatment of proximal tibia extra articular fracture use of IMN and PTLCP gives comparable results. To validate this issue further a large sample size multicentric study is recommended   Key words: intramedullary nailing (IMN), Extraarticular tibialn fracture, Surgical site infection.

Growth arrest and its risk factors after physeal fracture of the distal tibia in children and adolescents

Injury ◽  
2021 ◽  
Author(s):  
Hyon Soo Jung ◽  
Moon Seok Park ◽  
Kyoung Min Lee ◽  
Kug Jin Choi ◽  
Woo Young Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Children And Adolescents ◽  
Distal Tibia ◽  
Growth Arrest ◽  
Physeal Fracture

scholarly journals High Cortico-Trabecular Transitional Zone Porosity and Reduced Trabecular Density in Men and Women with Stress Fractures

2021 ◽  
Vol 10 (5) ◽  
pp. 1123
Author(s):  
Afrodite Zendeli ◽  
Minh Bui ◽  
Lukas Fischer ◽  
Ali Ghasem-Zadeh ◽  
Wolfgang Schima ◽  
...  
Keyword(s):  
Lower Limb ◽  
Quantitative Computed Tomography ◽  
Distal Tibia ◽  
Transitional Zone ◽  
Peripheral Quantitative Computed Tomography ◽  
Stress Fractures ◽  
Cross Sectional ◽  
Men And Women ◽  
Trabecular Microstructure ◽  
Trabecular Density

To determine whether stress fractures are associated with bone microstructural deterioration we quantified distal radial and the unfractured distal tibia using high resolution peripheral quantitative computed tomography in 26 cases with lower limb stress fractures (15 males, 11 females; mean age 37.1 ± 3.1 years) and 62 age-matched healthy controls (24 males, 38 females; mean age 35.0 ± 1.6 years). Relative to controls, in men, at the distal radius, cases had smaller cortical cross sectional area (CSA) (p = 0.012), higher porosity of the outer transitional zone (OTZ) (p = 0.006), inner transitional zone (ITZ) (p = 0.043) and the compact-appearing cortex (CC) (p = 0.023) while trabecular vBMD was lower (p = 0.002). At the distal tibia, cases also had a smaller cortical CSA (p = 0.008). Cortical porosity was not higher, but trabecular vBMD was lower (p = 0.001). Relative to controls, in women, cases had higher distal radial porosity of the OTZ (p = 0.028), ITZ (p = 0.030) not CC (p = 0.054). Trabecular vBMD was lower (p = 0.041). Distal tibial porosity was higher in the OTZ (p = 0.035), ITZ (p = 0.009), not CC. Stress fractures are associated with compromised cortical and trabecular microstructure.

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