The Outcome of Corrective Transverse Osteotomy in Paediatric Tibia Vara.

Background: Tibia vara is a three-dimensional deformity of the proximal tibia, varus, internal tibial torsion and procurvatum. It is an uncommon deformity with the surgical management varied. This study describes the outcomes of tibia vara management using a corrective transverse osteotomy in one centre. Materials and methods: A retrospective cohort study was conducted involving eight patients with tibia vara (ten tibias). Consent was obtained for treatment using an acute corrective osteotomy. Measurements of Drennan's angle, the tibiofemoral angle (TFA) and the procurvatum angle were measured preoperatively and postoperatively both just after surgery and at 1 year. A validated questionnaire-the Knee Outcome Survey of Activity Daily Living (KOS-ADL)-was utilised to assess clinical function and outcome. Also recorded were the intraoperative and postoperative complications, the radiological lower limb alignments, the union rate and the recurrence of deformity. Results: There were eight patients involved in this study with a total of ten tibias (six with unilateral tibias and two with bilateral tibias). The mean age of the patients was 11.3 years old (ranging from 8 to 15 years old) with most males (five males and three females). The affected tibias were 6 right sided and 4 left sided. Measurements of Drennan's angle, the TFA and the procurvatum angle were used to determine lower limb alignment preoperatively, postoperatively (immediate post-surgery) and at 1-year follow-up. Functional parameters were measured using the KOS-ADL. A descriptive analysis between the preoperative and postoperative variables was done. The mean for Drennan's angle was 21.6 (±5.2) preoperatively, 3.6 (± 2.3) postoperatively and 4.9 (±2.8) at 1-year follow-up. The TFA was improved from 22.6 (±6.1) preoperatively to 3.5 (±2.8) postoperatively and 4.4 (±2.0) at 1-year follow-up. The procurvatum angle was improved preoperatively from 8.20 (±7.5) to 2.40 (±2.5) postoperatively and 2.20 (±2.5) at 1-year follow-up. At the latest follow-up, the ADLS mean score was 98.5 (±2.6) while the SAS mean score was 97.5 (±3.3). The mean length follow-up period was 2 years (ranging from 1 year to 3 years). None of the patients developed postoperative complications with all achieving union without deformity recurrence in the period of observation. Conclusion: This study revealed that acute correction via a corrective transverse osteotomy of the tibia is a safe and effective method in treating tibia vara. How to cite this article: Irwan MA, WH Chan, Anuar Ramdhan MI, et al. The Outcome of Corrective Transverse Osteotomy in Paediatric Tibia Vara. Strategies Trauma Limb Reconstr 2024;19(2):111-117.

Computationally derived endosteal strain and strain gradients correlate with increased bone formation in an axially loaded murine tibia model.

Osteoporosis is a common metabolic bone disorder characterized by low bone mass and microstructural degradation of bone tissue due to a derailed bone remodeling process. A deeper understanding of the mechanobiological phenomena that modulate the bone remodeling response to mechanical loading in a healthy bone is crucial to develop treatments. Rodent models have provided invaluable insight into the mechanobiological mechanisms regulating bone adaptation in response to dynamic mechanic stimuli. This study sheds light on these aspects by means of assessing the mechanical environment of the cortical and cancellous tissue to in vivo dynamic compressive loading within the mouse tibia using microCT-based finite element model in combination with diaphyseal strain gauge measures. Additionally, this work describes the relation between the mid-diaphyseal strains and strain gradients from the finite element analysis and bone formation measures from time-lapse in vivo tibial loading with a fluorochrome-derived histomorphometry analysis. The mouse tibial loading model demonstrated that cancellous strains were lower than those in the midshaft cortical bone. Sensitivity analyses demonstrated that the material property of cortical bone was the most significant model parameter. The computationally-modeled strains and strain gradients correlated significantly to the histologically-measured bone formation thickness at the mid-diaphyseal cross-section of the mouse tibia.

Solitary medial proximal tibial osteochondromas cause pes anserinus syndrome in adolescents.

Objective: Osteochondromas are common bone tumors with hyaline cartilage-covered heads, arising from cortical and medullary bone. Solitary medial proximal tibial osteochondromas (MPTOs) can cause pes anserinus syndrome via compression. However, the literature lacks comprehensive studies on MPTO-related pes anserinus syndrome and its surgical outcomes. Material and Method: The study reviewed 227 patients diagnosed with osteochondroma between January 2018 and January 2022, with 21 patients meeting inclusion criteria: under 19 years, MPTO, surgical excision, histological diagnosis, ≥1-year follow-up. Cases with irregular follow-ups and multiple hereditary exostoses were excluded. Different surgical techniques were employed based on lesion characteristics. Postoperative weight bearing was allowed, and follow-ups involved postoperative complications assessment, clinical data collection, imaging, and functional evaluations using the International Knee Documentation Committee (IKDC) and Hospital for Special Surgery Pediatric Functional Activity Brief Scale scoring systems. Results: The study involved 21 adolescents (15 ± 2 years). Lesion types were predominantly pedunculated (86%) and surgical interventions involved pes anserinus split (76%) or tenoplasty (24%). No significant correlations were observed between lesion dimensions and IKDC scores. Split intervention led to a significant improvement in IKDC scores (p < 0.01), while tenoplasty showed similar results (p < 0.05). Athlete status did not affect IKDC scores significantly, but both athletes and non-athletes demonstrated improvements (p < 0.05). Conclusion: The negative impact of MPTOs causing pes anserinus tendinitis on the patient's quality of life and activity can be completely corrected with surgical treatment. Complete pes anserinus tendon cutting and subsequent repair are recommended if they facilitate surgery. The study underscores the importance of surgical management for MPTO-related pes anserinus syndrome and provides insights into the effectiveness of different surgical techniques.

Survival and functional outcomes after hemiarthroplasty in children with proximal tibial osteosarcoma.

BACKGROUND: Treatment options for correcting limb-length discrepancy after limb-salvage reconstruction for proximal tibial osteosarcoma in children have several limitations. Therefore, we aimed to evaluate the feasibility, complications, prognosis, and clinical outcomes of reconstruction using hemiarthroplasty after tumor resection in pediatric patients with proximal tibial osteosarcoma. METHODS: We conducted a comprehensive retrospective analysis of the data of pediatric patients with osteosarcoma of the proximal tibia who underwent surgery between December 2008 and November 2018 at our center. We enrolled 49 consecutive patients who underwent hemiarthroplasty. The cruciate ligaments of all patients were reconstructed using special spacers, and the medial and lateral collateral ligaments of the knee and joint capsule were reconstructed using a mesh. Postoperatively, if the unequal length of both lower limbs exceeded 4 cm or knee instability occurred, a second-stage surgery was performed for limb lengthening and replacing the distal femoral prosthesis. We analyzed the oncological prognosis, complications of hemiarthroplasty, postoperative stability, and postoperative function. RESULTS: The follow-up period ranged between 11 and 159 months, with a median of 84 (62, 129) months. The overall 5-year survival rate was 83.2%. Thirty-nine patients survived at the end of the follow-up period with 34 prostheses (87.2%). The overall prosthesis survival rate was 87.4% after 5 years, indicating the long-term benefits of the procedure. Limb length was measured in 28 adult patients. The average limb-length discrepancy was 33 ± 15 mm with a median of 33 mm (21, 47); the femur and tibia caused a discrepancy of 8.5 ± 9.9 mm and 24.8 ± 15.5 mm, respectively. The patients had 30-135° of knee motion, with a mean of 82 ± 24°. The femoral tibial angle was greater on the affected side than on the healthy side, with a mean difference of 4.5°±3.6°. The Musculoskeletal Tumor Society (MSTS) score was 25 ± 3. Five patients underwent second-stage distal femoral prosthesis replacement, with mean MSTS scores of 24 ± 2 and 28 ± 1 before and after second-stage surgery, respectively. CONCLUSIONS: Hemiarthroplasty in children reduces limb-length discrepancy in adulthood by rebuilding cruciate ligaments, lateral collateral ligaments, and the joint capsule, thereby improving knee stability.

Deep infections after low-velocity ballistic tibia fractures are frequently polymicrobial and recalcitrant.

Objectives: To identify risk factors for developing a fracture-related infection in operatively treated ballistic tibia fractures and to report the microbiologic results of intraoperative cultures. Design: Retrospective review. Setting: Level 1 trauma center. Patients/Participants: One hundred thirty-three adults with operatively treated low-velocity ballistic tibia fractures, from 2011 to 2021. Intervention: One dose of prophylactic cefazolin or equivalent as well as perioperative prophylaxis. Main Outcome Measurements: Deep infection rate. Results: The deep infection rate was 12% (16/134) with no significant difference in injury characteristics, index surgical characteristics, or time to antibiotics between the groups (P > 0.05). Patients who were slightly older (35.5 vs. 27 median years, P = 0.005) and with higher median body mass indexes (BMIs) (30.09 vs. 24.51, P = 0.021) developed a deep infection. 56.3% of patients presented with signs of infection within the first 100 days after injury. Nine patients had polymicrobial infections. There were 29 isolated organisms, 69% were uncovered by first-generation cephalosporin prophylaxis (anaerobes, gram-negative rods, Enterococcus, methicillin resistant Staphylococcus Aureus [MRSA]), and 50% of patients developed recalcitrant infection and required a second reoperation where 6 organisms were isolated, half of which were not covered by first-generation prophylaxis (Enterococcus, Staphylococcus Aureus MRSA). Conclusions: We found a deep infection rate of 12% among ballistic tibia fractures receiving standard-of-care antibiotic prophylaxis. Increased age and body mass index were associated with deep infections. Half became recalcitrant requiring a second reoperation. 66.7% of isolated organisms were not covered by first-generation cephalosporin prophylaxis. Consideration should be given to treatment options such as broader prophylaxis or local antibiotic treatment. Level of Evidence: IV.

Brodie's Abscess of the Ankle Presenting as a Tumor: A Summary of Five Cases.

Introduction: A Brodie's abscess is a form of subacute osteomyelitis that is often considered in the differential diagnosis of other benign and malignant bone lesions. The authors summarize the findings of five cases of Brodie's abscesses in the distal tibia initially thought to be tumors by the referring physicians. Case Report: All five cases were presented to the referring physicians with a chief complaint of ankle pain. All patients complained of chronic ankle pain and swelling that was aggravated by activity without constitutional symptoms. On physical examination, all patients presented with point tenderness over the distal tibia/malleolar regions. Three out of the five cases had a full range of ankle motion; the other two had limited dorsiflexion secondary to pain. All inflammatory laboratory values were within normal limits or only slightly elevated. All initial radiographs of the cases described demonstrated a well-defined radiolucent lesion within the distal tibia. In all cases, patients were treated with curetting, with or without bone graft. Bacterial and fungal cultures were negative in all five patients and no long-term post-operative antibiotics were administered. Conclusion: In this report, we discuss the clinical, radiographic, and pathologic features of this relatively rare condition in the distal tibia. The distinct clinicopathologic features of the disease process are presented to distinguish Brodie's abscess from a bone tumor.

DVT with Pulmonary Embolism in Patient with Grade 2 Compound Tibia Shaft Fracture- Treated with Thrombolysis and Use of Prophylactic IVC Filter: Case Report.

Introduction: Major orthopedic procedures place patients at risk for Deep venous thrombosis (DVT) and pulmonary embolism (PE). DVT has a 10-40% incidence after isolated fractures of the tibia and distal bones of the lower extremity. Diagnostic techniques are venous compression ultrasonography, venography, and pulmonary angiography. Prevention methods for venous thromboembolism (VTE) include mechanical prophylaxis and pharmacological prophylaxis. Inferior vena cava filter (IVCF) intercepts thrombus in inferior vena cava and prevents it from reaching the pulmonary artery. Case Report: A 39-year-old female having compound Type 2 mid-shaft tibia fracture and operated with intramedullary nailing at a corporate hospital, Navi Mumbai in January 2024. Despite giving DVT prophylaxis, she developed shortness of breath on 3rd day. 2D echocardiogram (ECHO) showed dilated right atrium and right ventricular and computed tomography pulmonary angiography (CTPA) showed saddle embolism at the junction of pulmonary artery division. The cardiologist immediately advised intravenous (IV) thrombolysis (injection tenecteplase 30 mg stat) followed by IV anticoagulants (injection low molecular weight heparin 0.6) and oral (rivaroxaban 20 mg) for 15 days. However, she complained of high-grade fever, right leg persistent swelling, and per vaginal (PV) bleeding. Venous Doppler showed persistent thrombi. Hence oral rivaroxaban was stopped, and IVCF was inserted in February 2024 to prevent further embolization. After observing her menstrual cycles, she was resumed on oral rivaroxaban after 1 month. Follow-up after 3 months of surgery (April 2024) showed signs of healing of shaft tibia fracture. Follow-up after 3 months of IVCF placement (May 2024) showed no persistent thrombi in bilateral lower limb venous Doppler. Hence decision of F removal was made at 3 months. Conclusion: Clinical evaluation of patients is important for the detection of DVT-PE. Complain of breathlessness on exertion suggested the diagnosis of PE, confirmed by 2D ECHO and CTPA, and immediately treated by the cardiac team with thrombolytics and anticoagulants. Since the patient developed bleeding PV, the insertion of an IVCF is the best option for treatment and prophylaxis of future VTE episodes.

A Scoping Review on the Management of Open Fractures in African Trauma and Orthopaedics Centres.

An open fracture is when the fractured part of a bone is exposed to the external environment by breaching the overlying soft tissue and skin. Open fractures often arise from high-energy injuries, and the risk of microbial contamination is high. There is a need to understand the management of open fractures in Africa by assessing the overall prevalence of open fractures, the mechanisms of injury, management approaches and outcomes. A literature search was conducted using PubMed, African Journal Online, and Google Scholar regarding open fracture management in Africa from inception till date. Thirty-nine (39) studies were included in this review. Road traffic accidents represented the majority of all mechanisms of open fractures, with the Tibia being the most affected bone. 320 cases were classified as Gustilo Anderson Type 1, with 487 classified as Type 2. Type 3 was divided into 3A (330), 3B (248), and 3C (34). Most studies recorded the immediate administration of intravenous antibiotics, but tetanus prophylaxis was only given in 13 studies, while initial debridement and washout were done in 35 studies. External fixators and Kirschner wires were most used for initial fixation. Follow-up for patients was between six weeks to 50 months. There were 645 cases of malunion, 83 cases of non-union, and 88 patients who had delayed union. There were 147 cases of wound infection and 119 cases of pin tract infections. Our findings emphasize the need for standardized protocols and robust emergency services to manage open fractures within Africa.

Significance of prothrombin, activated partial thromboplastin, and thrombin times in early rehabilitation after tibial fracture surgery.

OBJECTIVE: To assess the role of prothrombin time (PT), activated partial thromboplastin time (APTT), and thrombin time (TT) in guiding early rehabilitation following tibial fracture surgery. METHODS: A retrospective analysis was conducted on 168 patients treated for tibial fractures from May 2020 to May 2022. Patients were divided into good and poor rehabilitation groups based on treatment outcomes. Data on age, gender, BMI, Schatzker classification, operation time, blood loss, PT, APTT, and TT were collected for univariate analysis. ROC curve analysis determined optimal cut-off values, followed by multivariable logistic regression to identify independent risk factors. A nomogram prediction model was then constructed. RESULTS: Independent risk factors for early recovery included age ≥45 years, Schatzker type III, operation time ≥99.5 minutes, APTT≥28.5 seconds, and TT≥13.5 seconds. The nomogram model demonstrated high prediction accuracy with a C-index of 0.980. CONCLUSION: Prolonged APTT, extended TT, longer operation time, and higher Schatzker classification were identified as independent risk factors influencing early recovery post-surgery. A logistic regression-based prediction model was developed, facilitating the design of personalized rehabilitation training programs to improve patient outcomes.

Comparison Between Conventional and Variable-Angle Locking Compression Plates in Complex Proximal Tibia Fractures.

BACKGROUND: Proximal tibial fractures, particularly those involving the tibial plateau, are complex injuries that require careful management to restore knee function and prevent long-term disability. Recent advancements have introduced variable-angle locking compression plates (VALCP) as a potential alternative to the widely used fixed-angle locking plating techniques. These plates allow for more precise screw placement, potentially improving fixation and clinical outcomes. The goal of this study was to find out how well conventional locking plates and VALCP treat Schatzker's type I, II, and III tibial plateau fractures in terms of clinical, functional, and radiological outcomes. We evaluated the outcomes using the Rasmussen functional and radiological grading systems, as well as the Oxford Knee Score (OKS). METHODS: This prospective study was undertaken by a tertiary care medical institute from January 2020 to August 2021. The study included a total of 60 patients with Schatzker's type I, II, and III tibial plateau fractures. These patients were randomly assigned to two groups, with each group consisting of 30 patients. Conventional locking compression plates (CLCP) treated one group, while VALCP treated the other. Clinical, functional, and radiological outcomes of patients were evaluated using the OKS, Rasmussen's functional grading system, and Rasmussen's radiological grading system. Additionally, the study documented and examined the duration of the surgical procedure, the stability of the fixation, and any complications that occurred in the postoperative phase over a span of six months. RESULTS: The study included 52 males and eight females, aged 19 to 65 years. The mean age was 42.66 years for the conventional LCP group and 35.6 years for the VALCP group. Road traffic accidents were the most common cause of injury, with 86.67% in the VALCP group and 70% in the conventional group. In both groups, the majority of fractures were Schatzker type II. At the six-month follow-up, 60% of VALCP patients had excellent functional outcomes compared to 50% in the conventional group. Radiologically, 80% of VALCP patients had excellent results versus 73.33% in the conventional group. The OKS showed that 86.67% of VALCP patients had excellent results, compared to 73.33% in the conventional group. While VALCP showed slightly better outcomes, the differences were not statistically significant. Complications were minimal, with 90% of VALCP and 86.67% of conventional LCP patients experiencing no complications. CONCLUSION: The small number of patients, short-term study, and heterogeneity of fractures constitute a limitation of this study. VALCP plating in tibial plateau fractures is a good treatment modality because it seems to improve fixation, provides early mobilization, and has excellent to good functional and radiological outcomes. However, no significant difference in functional and radiological outcomes was found between the conventional and VALCP groups.

An Evaluation of Intra-articular Pathologies Accompanying Tibial Plateau Fractures Postoperatively.

INTRODUCTION AND AIM: Tibial plateau fractures are one of the most complex and common intra-articular fractures encountered in trauma surgery. This study aims to evaluate the MRI intra-articular findings of patients with tibial plateau fractures treated surgically and the functional and radiological changes after surgical treatment. MATERIALS AND METHODS: A total of 91 patients admitted to our clinic between 2010 and 2019 and operated for tibial plateau fracture were identified from the hospital information system. Patients were excluded from the study if aged <18 years, if the radiographs and MRIs were not suitable for the measurements, or if they could not be contacted by telephone. The study was completed with 49 operated knees and 49 healthy knees of 49 patients. The patients were evaluated with respect to demographic characteristics, Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), Knee Injury and Osteoarthritis Outcome Score (KOOS) functional and clinical scores, Rasmussen, Kellgren-Lawrence, and Whole-Organ Magnetic Resonance Imaging Score (WORMS) radiological scoring, and meniscus and ligament pathologies examined on the follow-up MR images. RESULTS: The patients comprised 39 males and 10 females with a mean age of 45.9±11.89 years, and a mean follow-up of 58.2±30.7 months. The fractures were seen to be 49% (n=24)in the lateral plateau, 6.1% (n=4) in the medial plateau, and 42.9% (n=21) were bicondylar fractures involving both plateaux. The KSKS knee score was satisfactory in 85.7% of the patients, the KSFS functional score in 89.7%, and the Rassmussen radiological score in 93.8%. In the KOOS subjective questionnaire, the mean points obtained were 430.7, and the mean total WORMS points were 34.2. According to the Kellgren-Lawrence grades, severe osteoarthritis (grade 3-4) developed in 18.3% (n=9) of the patients. CONCLUSION: Meniscus injuries that are overlooked at the time of the first injury or which may develop in the subsequent process were not found to seriously affect the functional outcomes of tibial plateau fractures. It can be considered that even if a ligament injury is seen to be accompanying the fracture at the time of the first trauma, the effect is not great in terms of prognosis, and the treatment can remain conservative, especially for collateral ligament injuries.

Functional Outcome of Solid Interlocking Nail in Open Tibial Fracture at a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: There is a high incidence of open fractures accounting 23% of all tibial fractures. The minimal soft tissue and precarious blood supply of the shaft of tibia make these fractures vulnerable to complications. The treatment should be decided through thoughtful analysis for personality of injuries and the status of the soft tissue. Intramedullary nailing allows stable fixation with minimal soft tissues dissection and preserve the soft tissue and allows early joint motion with higher rate of union. The purpose of our study was to find the outcome of open tibial fractures lower than Gustilo type IIIb, that were treated by unreamed solid interlocking intramedullary nails. METHODS: A descriptive cross-ectional study was conducted from December 2021 to June 2023 after taking approval from ethical committee. All 34 patients treated with solid interlocking intramedullary nail, without reaming for open tibial fracture during 18 months period were included in the study. Final follow up was done at one year and the outcome was assessed by Modified Ketenjian's criteria. RESULTS: The mean time of union rate was 15.82±3.95 weeks. Complications were: superficial infections in 4 (11.76%) patients and deep infection in 1 (2.94%) patient. Using Modified Ketenjian's Criteria, 26 (76.47%) patients had an excellent result followed by good in 7 (20.59%), fair in 1 (2.94%) and there was no case with  poor outcome. CONCLUSIONS: Solid intramedullary interlocking nail is an effective treatment with minimal soft tissue dissection for open tibia fracture less than GA III B as it provides stable fixation with early mobilization and provides a high rate of union, less complication and early return to function.

Transverse tibial bone transport for non-healing heel wound: A case report.

INTRODUCTION: Treatment of diabetic foot ulcer is complex and expensive, and frequently results in amputation. Transverse Tibia Transport is a new strategy for diabetic foot ulcers, which is based on the techniques of distraction histogenesis. PRESENTATION OF CASE: We present a 32-year-old male with longstanding insulin-dependent diabetes mellitus and many medical comorbidities with a non-healing heel ulcer of greater than 1 year. Following diagnosis of his diabetic foot ulcer complicated by osteomyelitis, he underwent a series of vascular and local wound interventions unsuccessfully. Transverse tibia transport was successful in healing the ulcer after 4 months. No complications were observed during follow up. DISCUSSION: Distraction histogenesis mechanically stimulates regeneration of soft tissues such as muscles, tendons, and blood vessels by sustained tension. Inducing vascular regeneration at a targeted site has broad potential value for treating various disorders such as atrophic union and osteomyelitis. CONCLUSION: For patients with refractory diabetic foot ulcers, transverse tibia transport may be considered as a treatment option.

What influences post-operative opioid requirements for tibial fractures?

Introduction: Currently there are few opioid prescribing guidelines for orthopaedic fractures. Long-term post-surgical analgesia requirements, understandably, vary between orthopaedic cases. Our study aims to provide detailed information to clinicians and policy makers, on the opioid requirement associations for patients sustaining tibial fractures. Methods: This study reviewed all patients sustaining an isolated tibial fracture at a major trauma centre that were operated on within 1 month of injury, from 2015 to 2022. The total opioid dosage used each month in morphine milligrams equivalents (MME) and the number of days opioids were used each month, within the first-year post-surgery were collected, representing the strength and coverage of opioid analgesia in the post-operative stage, respectively. We compared opioid strength and coverage requirements with types of definitive fracture fixations, location, fracture type and concurrent patient medical comorbidities to assess for any trends. Results: A total of 1814 patients sustaining a combined of 1970 fractures were included in the study. Tibial plateau fractures had the highest opioid strength and coverage requirements in each month and the entire year (p < .05). Across all fracture locations, Ex Fix frame showed higher opioid strength and coverage requirements compared to both IM nailing and plate ORIF. With regard to opioid coverage in the presence of specific comorbidities, only chronic kidney disease (quotient: 1.37, 95% Confidence interval [95%CI] = 1.19-1.55, p = .002) and hypertension (quotient: 1.34, 95%CI = 1.14-1.53, p = .009) showed significance at the 1-year overall level. For opioid strength, Chronic Kidney Disease (quotient: 1.72, 95%CI = 1.41-2.03 p = .005) and COPD (quotient: 1.90, 95%CI = 1.44-2.36, p = .014), show significance at the 1-year overall level. Conclusion: Our study details opioid requirements post-surgery amongst tibial fractures with subgroup analysis assessing opioid needs amongst specific fracture locations, types, surgical techniques and medical comorbidities. This framework aids clinicians in anticipating rehabilitation and assists in risk stratifying patients at injury onset.

Plateau and Patella: A Framework for Ipsilateral Injury Fixation.

Ipsilateral patella and tibial plateau fractures represent an extremely rare injury pattern. They are seldom discussed in literature, with no frameworks for management being reported that we were able to find. We report our experience and management of such an injury, suffered by a 57-year-old female patient with good premorbid functional status, by direct trauma to the right knee. Preoperatively, she was managed in a knee splint to aid elevation and help control her pain. We undertook fixation of both the patella and tibia through a midline incision. Postoperatively, we used a hinged knee brace, initially locked in extension, to allow gradual flexion at two weekly follow-ups. She has suffered no postoperative complications thus far at three months. We hope to highlight a novel management plan for this rare and complex fracture pattern, for which no prior published management evidence exists. As such, we submit the key principles from which our operative plan was derived to aid in the management of such injuries in the future.

A novel model of autologous tooth transplantation for the study of nerve recruitment.

BACKGROUND: Limited treatment options exist for damaged nerves and despite impressive advances in tissue engineering, scientists and clinicians have yet to fully replicate nerve development and recruitment. Innervation is a critical feature for normal organ function. While most organs are innervated prior to birth, a rare example of postnatal nerve recruitment occurs in the natural development of secondary teeth during adolescence. Many animals undergo postnatal shedding of deciduous teeth with development and eruption of secondary teeth, a process requiring recruitment of nerve and vasculature to each tooth pulp for viability. Here, the investigators created a novel model for the study of postnatal innervation by exploiting the natural phenomenon of tooth-driven nerve recruitment. METHODS: The investigators theorized that developing teeth possess a special capacity to induce innervation which could be harnessed in a clinical setting for nerve regeneration, and hyptothesized that a transplant model could be created to capture this phenomenon. In this descriptive study, a rat model of autologous tooth transplantation and de novo nerve recruitment was developed by surgically transferring whole developing molars to the autologous tibia. RESULTS: Downstream histological analysis performed 6 to 14 weeks after surgery demonstrated integration of molar into tibia in 81% of postoperative rats, with progressive pulpal expression of nerve marker ß-tubulin III suggestive of neuronal recruitment. CONCLUSIONS: These findings provide a novel model for the study of organ transplantation and support the theory that developing dental tissues may retain nerve-inductive properties postnatally.

Finite element analysis and optimization studies on tibia implant of SS 316L steel and Ti6Al4V alloy.

Tibial fractures account for approximately 15% of all fractures, typically resulting from high-energy trauma. A critical surgical approach to treat these fractures involves the fixation of the tibia using a plate with minimally invasive osteosynthesis. The selection and fixation of the implant plate are vital for stabilizing the fracture. This selection is highly dependent on the plate's stability, which is influenced by factors like the stresses generated in the plate due to the load on the bone, as well as the plate's length, thickness, and number of screw holes. Minimizing these stresses is essential to reduce the risk of implant failure, ensuring optimal stress distribution and promoting faster, more effective bone healing. In the present work, the finite element and statistical approach was used to optimize the geometrical parameters of the implant plate made of SS 316L steel and Ti6Al4V alloy. A 3D finite element model was developed for analyzing the stresses and deformation, and implant plates were manufactured to validate the results with the help of an experiment conducted on the universal testing machine. A strong correlation was observed between the experimental and predicted results, with an average error of 8.6% and 8.55% for SS316L and Ti6Al4V alloy, respectively. Further, using the signal-to-noise ratio for the minimum stress condition was applied to identify the optimum parameters of the plate. Finally, regression models were developed to predict the stresses generated in SS316L and Ti6Al4V alloy plates with different input conditions. The statistical model helps us to develop the relation between different geometrical parameters of the Tibia implant plate. As determined by the present work, the parameter most influencing is implant plate length. This outcome will be used to select the implant for a specific patient, resulting in a reduction in implant failure post-surgery.

Surgical Options and Clinical Outcomes Following a Failed Latarjet Procedure: A Systematic Review.

BACKGROUND: A failed prior Latarjet procedure can be a challenging situation for both patients and surgeons. The purpose of this study was to report on the techniques and outcomes of patients undergoing revision surgery for the treatment of recurrent anterior shoulder instability after a failed Latarjet procedure. METHODS: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies which reported on surgical techniques for a failed Latarjet procedure with reporting of clinical outcomes. The search terms used were: Latarjet failed. Patients were evaluated based on revision method, patient-reported outcome measures (PROMs), reoperation rates, recurrent instability, overall satisfaction, and return to sports and work. RESULTS: Thirteen studies (all Level IV evidence) met inclusion criteria, including a total of 293 shoulders with a mean age of 28.3 years (range, 16-55 years) at the time of surgery. The mean follow-up time was 50.4 months (range, 14.0-208.0 months) and males accounted for 78.6% of all patients. Revision procedures included open and arthroscopic Eden-Hybinette, distal tibial allograft, iliac crest autograft, osteochondral glenoid allograft, and Bankart repair and/or capsular plication. These may all be viable techniques for revision surgery for a failed Latarjet procedure. All revision procedures showed improvements in PROMs including the VAS (Visual analogue scale), Constant score, subjective shoulder value (SSV), Walch-Duplay, and Rowe scores. Return to sports ranged from 46.1% to 94%. Recurrent instability rates ranged from 0% to 43.8%. Reoperation rates ranged from 0% to 31.3%. Overall satisfaction following a revision procedure ranged from 80% to 100%. CONCLUSION: A failed Latarjet procedure can be treated with various revision procedures such as open and arthroscopic Eden-Hybinette, distal tibial allograft, iliac crest autograft, osteochondral glenoid allograft, and Bankart repair and/or capsular plication. Overall, surgical management of the failed Latarjet results in improvements in PROMs, pain, return to sports, and decreased recurrent instability with a moderate complication rate.

[Lateral open wedge tibial osteotomy for posttraumatic deformity]. / Tibiale laterale Open-wedge-Osteotomie bei posttraumatischer Deformität.

OBJECTIVE: Correction of pseudoinstability and tibial malalignment by re-establishment of the pretraumatic tibial axis. INDICATIONS: Posttraumatic valgus malalignment accompanied by pseudoinstability. CONTRAINDICATIONS: Infections, significant inhibition of movement and multidirectional ligament instability. SURGICAL TECHNIQUE: Standard anterolateral approach to the proximal tibial head. Lateral open wedge high tibial osteotomy above (supra) the tibiofibular joint and opening until the pseudoinstability of the lateral collateral ligament is levelled. POSTOPERATIVE MANAGEMENT: Partial weight bearing for 4 weeks, after radiological control full body weight loading is allowed. Implant removal after full bony consolidation. RESULTS: There is limited evidence in the current literature but the available results show good results in 70% of the cases in long-term follow-up.