Risk of total knee replacement after proximal tibia fracture: a register-based study of 7,841 patients

Background and purpose — Post-traumatic knee osteoarthritis following proximal tibia fracture (PTF) is a common complication that may lead to total knee replacement as secondary treatment (TKRS). We determined the risk of TKRS following PTF, whether treated nonoperatively or operatively, and compared the results with a 38-fold control group without prior PTF. Patients and methods — We identified all patients over 18 years of age in Finland with PTF treated during the period 2009–2018 from the Finnish Hospital Discharge Register (FHDR) and Finnish Arthroplasty Register (FAR). Age, sex, treatment method, follow-up time, and possible TKRS were recorded. Results — 7,701 patients were treated for PTF during the period 2009–2018. Over the 5.1-year (SD 3.1) follow-up, TKRS was performed in 340 (4.3%) patients with a prior PTF after a mean of 2.1 (SD 2.0) years post-fracture. TKRS was needed in 138 (3.7%, HR 1.8) patients in the nonoperatively treated group and in 202 (5.0%, HR 3.2) patients in the operatively treated group. Operative treatment, female sex, and high age were identified as risk factors for TKRS. The incidence of TKRS was highest during the first 2 years after fracture and remained elevated throughout the follow-up. Interpretation — Patients with a prior PTF had a 1.8- to 3.2-fold higher risk of TKRS compared with controls during the first 5 years post-fracture. Risk of TKRS was associated with an operatively treated PTF, female sex, and high age. The patients in the operative group likely sustained more complex fractures, while female sex and age may be explained by more osteoporotic bone quality.

Comparison of Effects of Two Drugs (Pregabalin & Celecoxib) on 24 hours Post-Operative Pain Intensity in Patients Undergoing Tibia Fracture Surgery

Background: Celecoxib is widely used in post-operative cases because of its ability to reduce postoperative opioid drug use. Currently, the use of this drug is common in post-operative cases. In various studies, pregabalin was used for the management of pain after spinal surgery to reduce the need for opioids. Objectives: Since the treatment of tibia fractures and surgery is painful and has a long-term recovery, this study aimed to compare the effect of two drugs (pregabalin and celecoxib) on pain severity at 24 h postoperatively in patients having tibia fracture surgery. This would mark significant progress in taking the proper drug. Methods: In this probability clinical experiment, the sample consisted of 50 patients scheduled for tibia fractures, who were selected from the table of random numbers. Then, the patients were assigned into two groups: celecoxib (Group C) and pregabalin (Group P). In the first group, celecoxib was administered to patients at 1 h pre-operatively at a dose of 200 mg and 1 h post-operatively at a dose of 200 mg. In the second treatment group, patients received pregabalin at 1 h pre-operatively at a dose of 200 mg and 1 h post-operatively at a dose of 200 mg orally. Then VAS (visual analog scale) scores were recorded at 6, 12, and 24 h after surgery. Finally, using SPSS software, qualitative variables were compared according to their percentage by the Chi-square test. For quantitative analysis of variables, the mean value of each group was calculated. The comparison of means was made by t-test. Results: The VAS score was considerably lower at 24 hours after surgery in the pregabalin group than in the celecoxib-treated group. However, after 6 and 12 h of surgery, no statistically meaningful difference was observed. A less analgesic effect was observed in the group treated with celecoxib than pregabalin, which was statistically significant. Conclusion: Pregabalin improves postoperative pain, and it has more analgesic effects than celecoxib.

Biomechanical Performance of BoneHelix® Compared with Elastic Stable Intramedullary Nailing (ESIN) in a Pediatric Tibia Fracture Model

Tibial shaft fractures are common injuries in the pediatric and adolescent populations. Elastic stable intramedullary nailing (ESIN) is the treatment of choice for cases that require surgical stabilization. A new intramedullary device, BoneHelix® (BH), may be an alternative for use with fractures that cannot be satisfactorily stabilized with ESIN. This study aimed to assess the biomechanical performance of BH compared with ESIN in a porcine tibia fracture model, observing cyclic fatigue and load to failure. Computed tomography was used to monitor the implant position and to rule out unintended damage. No implant or bone failure occurred during the fatigue testing. An increase in the cumulative plastic displacement was observed in both test groups over the loading cycles applied. Both implant–bone constructs displayed a trend toward closure of the osteotomy gap. During the load-to-failure test, the average loads at failure in specimens instrumented with ESIN and BH were 5364 N (±723) and 4350 N (±893), respectively, which were not statistically significant (p = 0.11). The values of both groups were two to three times higher than the estimated maximal load (2000 N) during physiological weight bearing. The biomechanical results thus indicate equivalent performance and stability by the implants tested.