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1.
Article in Spanish | LILACS, BINACIS | ID: biblio-1556246

ABSTRACT

Introducción: Las epifisiólisis de la tuberosidad anterior de la tibia en adolescentes representan el 1% de las lesiones fisarias y el 3% de las fracturas de la tibia proximal, y pueden comprometer la fisis; por lo tanto, ameritan un diagnóstico y un tratamiento correctos para evitar complicaciones. El objetivo de este artículo es comunicar un caso clínico, compararlo con casos similares publicados, analizar las diferencias y, sobre la base de la experiencia, llegar a una conclusión para su resolución. Presentamos a un varón de 13 años que consultó tras sufrir un traumatismo directo en la rodilla derecha, durante la carrera en la práctica deportiva, un mes atrás. La radiografía mostró epifisiólisis por avulsión de la tuberosidad anterior de la tibia (Ogden IIIA, Jones III), por lo que fue sometido a reducción abierta y fijación. Como la recuperación y el retorno a la actividad habitual fueron rápidos, se tomaron un par radiográfico para el diagnóstico y una tomografía para la planificación quirúrgica. Conclusión: Si bien no hay un consenso sobre el diagnóstico y el tratamiento por la baja cantidad de casos publicados, es conveniente sospechar este cuadro en pacientes jóvenes que sufren un traumatismo en la rodilla que limita la extensión. Nivel de Evidencia: IV


Epiphysiolysis of the anterior tibial tubercle in adolescents accounts for 1% of physeal injuries and 3% of proximal tibial fractures, and it may involve the physis, necessitating diagnosis and treatment to prevent complications. Objective: To present a case, compare it existing literature, analyze differences, and propose resolutions based on our experience. A 13-year-old male consulted after suffering direct trauma to his right knee while running in sports practice one month earlier. Radiography revealed epiphysiolysis due to avulsion of the anterior tibial tubercle (Odgen IIIA and Jones III), prompting open reduction and internal fixation with two partially-threaded cannulated screws and washers. After six weeks of cast immobilization, he began rehabilitation. Given his swift recovery, AP and lateral radiographs were obtained for diagnosis and a CT scan for surgery planning, leading to a second surgery involving open reduction and internal fixation with two cannulated screws surrounding the physis, although the patellar tendon was explored first to mitigate the risk of invagination within the fracture line. Conclusion: Despite the scarcity of reported cases, a rising trend due to increased youth sports participation underscores the importance of considering this injury in young patients presenting with knee trauma and restricted extension. Level of Evidence: IV


Subject(s)
Child , Tibial Fractures , Fractures, Avulsion , Knee Injuries
2.
Article in Spanish | LILACS, BINACIS | ID: biblio-1552154

ABSTRACT

Introducción: Las fracturas de tibia por estrés son un cuadro muy frecuente en el personal militar recién incorporado. Nuestro objetivo fue demostrar que existe una asociación entre fracturas por estrés y otros hallazgos patológicos. materiales y métodos: Se evaluaron retrospectivamente 42 fracturas por estrés en 34 pacientes, entre noviembre de 2012 y septiembre de 2014. Todos se habían incorporado recientemente al Ejército Argentino y consultaron por cuadros dolorosos en la tibia. Se realizó el diagnóstico clínico y centellográfico de fractura por estrés. Se documentaron datos filiatorios, hallazgos patológicos asociados y factores de riesgo. Los criterios de inclusión fueron: reciente incorporación, mismo entrenamiento, edad 16-23 años. Se excluyó a pacientes con traumatismos, enfermedad tumoral o centellograma negativo, y a los simuladores. Resultados: Se evaluaron 42 fracturas por estrés en 34 pacientes (14 hombres y 20 mujeres). La edad promedio era de 20 años. No hubo diferencias significativas en el número de lesiones respecto al miembro afectado. El 64,7% tenía hallazgos patológicos asociados (mujeres 73%, hombres 27%). El 80% de las mujeres y el 43% de los hombres tenían un hallazgo patológico asociado. Se detectaron diversos hallazgos patológicos asociados con desejes de miembros inferiores en varo y en valgo, los primeros fueron los que más se asociaron con fracturas. Conclusiones: La tasa de asociación con hallazgos patológicos en los miembros inferiores fue alta, con predominio de los desejes en varo. Las mujeres con fracturas por estrés tenían más hallazgos patológicos asociados que los hombres. Nivel de Evidencia: IV


Introduction: Tibial stress fractures are a very common condition in military recruits. Our objective is to demonstrate that stress fractures are associated with other pathologies. materials and methods: 42 stress fractures in 34 patients were retrospectively evaluated. Every patient had recently joined the Argentine Army and consulted for painful symptoms in the tibia. A clinical and scintigraphic diagnosis of stress fracture was made. Patient data, associated pathologies, and risk factors were documented. Inclusion criteria: recent incorporation, same training, age between 16 and 23 years. Trauma, simulators, tumoral pathology, and cases with negative scintigraphy were excluded. Results: We studied 42 stress fractures in 34 patients, 14 were men and 20 were women. The average age was 20 years. There were no significant differences in the number of injuries regarding the affected limb. 64.7% had associated pathologies, 73% in women and 27 % in men. Among the women with stress fractures, 80% had associated pathologies, compared to 43% for men. Different pathologies were found with lower limb varus and valgus imbalances. Varus was the most associated with fractures. Conclusions: A high rate of associated pathologies was found in patients with tibial stress fractures with a predominance of lower limb varus imbalances. Associated pathologies were more likely to be found in women with stress fractures than in men. Level of Evidence: IV


Subject(s)
Adolescent , Adult , Tibial Fractures , Fractures, Stress , Leg Injuries , Military Personnel
3.
Article in Spanish | LILACS, BINACIS | ID: biblio-1552156

ABSTRACT

La fijación elástica en las lesiones de la sindesmosis es un procedimiento que se realiza ampliamente y brinda buenos resultados. Presentamos un caso de una fractura de tibia como complicación de la fijación elástica de la sindesmosis, su tratamiento y una revisión bibliográfica en la cual no hemos encontrado reportes sobre esta complicación. Nivel de Evidencia: IV


Elastic fixation in syndesmosis injuries is a widely performed procedure with good outcomes. We report a case of a tibial fracture as a complication of the elastic fixation of the syndesmosis, its treatment, and a literature review, in which we have not found reports of this complication. Level of Evidence: IV


Subject(s)
Middle Aged , Tibial Fractures , Ankle Injuries , Fracture Fixation, Internal , Ankle Joint
4.
Article in Chinese | WPRIM | ID: wpr-1009117

ABSTRACT

OBJECTIVE@#To review the biomechanical research progress of internal fixation of tibial plateau fracture in recent years and provide a reference for the selection of internal fixation in clinic.@*METHODS@#The literature related to the biomechanical research of internal fixation of tibial plateau fracture at home and abroad was extensively reviewed, and the biomechanical characteristics of the internal fixation mode and position as well as the biomechanical characteristics of different internal fixators, such as screws, plates, and intramedullary nails were summarized and analyzed.@*RESULTS@#Tibial plateau fracture is one of the common types of knee fractures. The conventional surgical treatment for tibial plateau fracture is open or closed reduction and internal fixation, which requires anatomical reduction and strong fixation. Anatomical reduction can restore the normal shape of the knee joint; strong fixation provides good biomechanical stability, so that the patient can have early functional exercise, restore knee mobility as early as possible, and avoid knee stiffness. Different internal fixators have their own biomechanical strengths and characteristics. The screw fixation has the advantage of being minimally invasive, but the fixation strength is limited, and it is mostly applied to Schatzker typeⅠfracture. For Schatzker Ⅰ-Ⅳ fracture, unilateral plate fixation can be used; for Schatzker Ⅴand Ⅵ fracture, bilateral plates fixation can be used to provide stronger fixation strength and avoid the stress concentration. The intramedullary nails fixation has the advantages of less trauma and less influence on the blood flow of the fracture end, but the fixation strength of the medial and lateral plateau is limited; so it is more suitable for tibial plateau fracture that involves only the metaphysis. Choosing the most appropriate internal fixation according to the patient's condition is still a major difficulty in the surgical treatment of tibial plateau fractures.@*CONCLUSION@#Each internal fixator has good fixation effect on tibial plateau fracture within the applicable range, and it is an important research direction to improve and innovate the existing internal fixator from various aspects, such as manufacturing process, material, and morphology.


Subject(s)
Humans , Biomechanical Phenomena , Bone Plates , Fracture Fixation, Internal , Fracture Fixation, Intramedullary , Tibial Fractures/surgery , Tibial Plateau Fractures
5.
Article in Chinese | WPRIM | ID: wpr-1009107

ABSTRACT

OBJECTIVE@#To explore the effectiveness of Nice knot technique for wound closure in Gustilo type ⅢA and ⅢB open tibial fractures.@*METHODS@#A retrospective study was performed on 22 patients with Gustilo type ⅢA and ⅢB open tibial fractures, who underwent wound closure using the Nice knot technique and were admitted between June 2021 and June 2022. There were 15 males and 7 females. The age ranged from 18 to 67 years, with an average of 41.9 years. The causes of injury included traffic accident in 11 cases, falling from height in 7 cases, and heavy object injuries in 4 cases. Fractures were located on the left side in 9 cases and on the right side in 13 cases. And 9 cases were type ⅢA fractures and 13 were type ⅢB fractures according to Gustilo classification. All patients had extensive soft tissue injuries, and no vascular or neurological damage was observed. The time from injury to debridement was 3-8 hours (mean, 6.5 hours). The sizes of wounds before operation and at 2 weeks after operation were measured and wound healing rate at 2 weeks after operation were calculated. The wound healing time and wound healing grading were recorded. The Vancouver Scar Scale (VSS) score was used to assess the wound scar after wound healed and the excellent and good rate was calculated.@*RESULTS@#The wound area was 21.0-180.0 cm 2 (mean, 57.82 cm 2) before operation, and it was 1.2-27.0 cm 2 (mean, 6.57 cm 2) at 2 weeks after operation. The wound healing rate at 2 weeks after operation was 76%-98% (mean, 88.6%). After operation, 2 cases needed to adjust Nice knot due to skin cutting and 1 case occurred soft tissue infection on the wound. The other patient's wounds healed. The average wound healing time was 27.8 days (range, 18-44 days). And the wound healing were grade A in 13 cases and grade B in 9 cases. VSS score was 2-9, with an average of 4.1; 10 cases were rated as excellent, 10 as good, and 2 as poor, with an excellent and good rate of 90.9%. All patients were followed up 9-24 months (mean, 14.6 months). During follow-up, no deep infection or osteomyelitis occurred. Two cases experienced fracture non-union, and were treated with compression fixation and bone grafting. The fractures of the other patients all healed, with a healing time of 85-190 days (mean, 148.2 days).@*CONCLUSION@#Nice knot technique can be used in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures effectively, which is easy to operate.


Subject(s)
Male , Female , Humans , Adolescent , Young Adult , Adult , Middle Aged , Aged , Cicatrix , Retrospective Studies , Treatment Outcome , Tibial Fractures/surgery , Wound Healing , Fracture Fixation, Internal/methods , Fractures, Open/surgery
6.
Rev. bras. ortop ; 58(5): 808-812, Sept.-Oct. 2023. graf
Article in English | LILACS | ID: biblio-1529944

ABSTRACT

Abstract The present study reports a rare case of avulsion fracture of the tibial tuberosity in an adolescent. A 14-year-old male patient sprained his left knee during a soccer match. At the first emergency-room visit, he presented pain in his left knee, 2 +/4+ edema, and inability to walk and flex the affected knee, but no neurovascular changes or signs of compartment syndrome. Radiographs revealed a physeal fracture at the left proximal tibia, classified by Ogden, Tross and Murphy, and modified by Ryu and Debenham, as type IV, and complemented by Aerts et al. as type IV-B. Immobilization was performed with a plaster cast from the inguinal to malleolar regions, followed by analgesia. The patient was operated on the next day, when open reduction and internal fixation using 4.5-mm cannulated screws were performed. The patient was discharged one day after surgery, with plaster cast immobilization and load restraint for four weeks, and bone consolidation was radiologically confirmed three months after the procedure. The patient evolved with a range of motion similar to that of the contralateral limb, no length discrepancy in the lower limbs, and no complaints after one year of follow-up.


Resumo O presente estudo tem como objetivo relatar um caso raro de fratura por avulsão da tuberosidade da tíbia em adolescente. Um paciente de 14 anos, do sexo masculino, sofreu entorse de joelho esquerdo durante partida de futebol. No primeiro atendimento em pronto-socorro, ele apresentava dor no joelho esquerdo, edema 2 +/4 + , incapacidade de deambulação e de flexo-extensão do joelho acometido, sem alterações neurovasculares ou sinais de síndrome compartimental. Nas radiografias, identificou-se fratura fisária na tíbia proximal esquerda, classificada por Ogden, Tross e Murphy, com modificação por Ryu e Debenham, como tipo IV, e complementada por Aerts et al. como tipo IV-B. Foi realizada imobilização com tala gessada inguino-maleolar e analgesia, e o paciente submetido a cirurgia no dia seguinte, com redução aberta e fixação interna utilizando parafusos canulados 4,5 mm. O paciente recebeu alta no dia seguinte à cirurgia, sendo mantida a imobilização com tala gessada e a restrição de carga por quatro semanas, e apresentou consolidação óssea confirmada por radiografia com três meses do pós-operatório. O paciente evoluiu sem discrepância de comprimento dos membros inferiores, arco de movimento igual ao do membro contralateral, e sem queixas no seguimento de um ano.


Subject(s)
Humans , Male , Adolescent , Tibial Fractures , Fractures, Avulsion , Knee Injuries
7.
Rev. venez. cir. ortop. traumatol ; 55(1): 74-80, jun. 2023. ilus, tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1513225

ABSTRACT

Las fracturas triplanares de tibia distal, son fracturas complejas caracterizadas por afectación multiplanar, clasificándose como Salter Harris tipo IV, en el periodo de cierre fisiario. Son poco frecuentes, representando el 5-15% de las fracturas pediátricas. El mecanismo de lesión que ocurre con mayor frecuencia, consiste en supinación y rotación externa. La tomografía computarizada es actualmente el Gold Standard para el diagnóstico de este tipo de fractura, nos permite evaluar todos los planos, siendo la radiografía simple insuficiente para el diagnóstico ya que puede pasar desapercibida. Paciente de 14 años de edad con fractura triplanar en 2 partes de tibia distal, con resolución quirúrgica. Nuestro caso es un ejemplo de una fractura triplanar de tibia distal, la cual es de baja frecuencia, difícil diagnostico e interpretación. Presentamos imágenes preoperatorias, intraoperatorias y postoperatorias del manejo de esta lesión, obteniendo resultados satisfactorios clínicos, funcionales y en estudios de imágenes. Es indispensable lograr una reducción anatómica de la superficie articular para lograr una evolución satisfactoria. Se recomienda una tomografía computarizada para diagnosticar y manejar esta lesión de manera adecuada. El seguimiento postoperatorio es crucial para el manejo de este paciente, ya que se espera una discrepancia en la longitud de las extremidades y/o deformidad(AU)


Triplane fractures of the distal tibia are complex fractures characterized by multiplane effects. They are classified in the Salter-Harris system as type IV in the period of physeal closure. These fractures are rare and represent 5-15% of pediatric fractures. The most common mechanism of injury is supination and external rotation. Computed tomography is currently the Gold Standard for the diagnosis of this type of fracture since it allows us to evaluate all planes, while plain radiography is insufficient because the fracture can go unnoticed. The objective is to report the clinical case of a 14-year-old patient with triplanar fracture in 2 parts of the distal tibia with surgical resolution. This case is an example of a triplanar fracture of the distal tibia, which is of low frequency, and difficult to diagnose and interpret. Preoperative, intraoperative and postoperative images of the management of this lesion are presented, obtaining satisfactory clinical, functional and imaging study results. It is essential to achieve an anatomical reduction of the joint surface to achieve a satisfactory evolution. A CT scan is recommended to properly diagnose and manage this injury. Postoperative follow-up is crucial for the management of this patient, as a limb length discrepancy and/or deformity is expected(AU)


Subject(s)
Humans , Male , Adolescent , Rotation , Tibial Fractures/surgery , Supination
8.
Rev. bras. ortop ; 58(2): 313-319, Mar.-Apr. 2023. tab, graf
Article in English | LILACS | ID: biblio-1449792

ABSTRACT

Abstract Objectives To describe a series of cases of tibial fractures surgically treated using the posterior approach as described by Carlson, focusing on evaluating its functional results and complication rate. Methods Eleven patients with tibial plateau fractures, who underwent surgical treatment using the Carlson approach from July to December 2019, were followed-up. The minimum follow-up period was defined as 6 months. The American Knee Society Score (AKSS), American Knee Society Score/Function (AKSS/Function) and the Lysholm score were used to check treatment results at 6 months after the fracture. The patients underwent standard anteroposterior and lateral radiographs to assess fracture healing, and clinical healing was determined by the absence of pain during full weight-bearing. Results The mean follow-up period was 12 months (9-16 months). The primary mechanism of trauma was motorcycle accident, and the most prevalent side of fracture was the right side. Eight participants were male. The mean age of the patients was 28 years. All fractures healed, and none of the patients presented complications. The AKSS was excellent in 11 patients, with a mean AKSS/Function of 99.1±3, and Lysholm scores with a median of 95.0±5.6. Conclusions The Carlson approach for posterior fractures of the tibial plateau can be considered safe, presenting a low complication rate and satisfactory functional results.


Resumo Objetivos O objetivo deste trabalho é descrever uma série de casos de fraturas de tíbia submetidas ao tratamento cirúrgico pela via posterior de Carlson para avaliação de resultados funcionais e frequência de complicações. Métodos Onze pacientes com fraturas do platô tibial foram submetidos a tratamento cirúrgico pela via de Carlson de julho a dezembro de 2019 e acompanhados por um período mínimo de 6 meses. As pontuações American Knee Society Score (AKSS), American Knee Society Score/Function (AKSS/Função) e de Lysholm verificaram os resultados do tratamento 6 meses após a fratura. Os pacientes foram submetidos a radiografias comuns em incidência anteroposterior e de perfil para avaliação da consolidação da fratura e a cicatrização clínica foi determinada pela ausência de dor à descarga total de peso. Resultados O período médio de acompanhamento foi de 12 meses (9 a 16 meses). O principal mecanismo de trauma foi acidente motociclístico e a fratura foi mais prevalente no lado direito. Oito pacientes eram do sexo masculino. A média de idade dos pacientes foi de 28 anos. Todas as fraturas cicatrizaram e nenhum paciente apresentou complicações. A AKSS foi excelente em 11 pacientes, com AKSS/Função média de 99,1 ±3, e a mediana das pontuações de Lysholm foi de 95,0 ±5,6. Conclusões Nas fraturas posteriores do platô tibial, a abordagem de Carlson pode ser considerada segura, apresentando baixo índice de complicações e resultados funcionais satisfatórios.


Subject(s)
Humans , Male , Female , Outcome and Process Assessment, Health Care , Tibial Fractures/surgery , Tibial Fractures/complications
9.
Rev. bras. ortop ; 58(6): 939-943, 2023. tab, graf
Article in English | LILACS | ID: biblio-1535613

ABSTRACT

Abstract Objective To review knee magnetic resonance imaging (MRI) scans for the analysis of the location of neurovascular structures (NVSs), and to define the risk of bicortical fixation. Methods Distances between the posterior cortex and the popliteal NVSs were measured on the MRI scans of 45 adolescents (50 knees) at 3 levels (C1: center of the proximal tibial epiphysis; C2: 10 mm distal to the physis; and C3: 20 mm distal to the physis). The NVSs located between 5 mm and 10 mm from the incision were considered in a zone of moderate risk for damage, while those less than 5 mm from the incision were considered in a zone of high risk for damage, and those more than 10 mm from the incision were considered to be in a zone of low risk for damage. The independent Student t-test was used for the comparison of the NVS distance 0with gender, skeletal maturity, and the tibial tubercle-trochlear groove (TT-TG) distance. Values of p < 0.05 were regarded as statistically significant. Results The path of the C1 screw posed an increased risk of damage to the popliteal artery and vein compared with other screw paths (p < 0.001). The popliteal artery has a high risk of damage at the level of C1 (4.2 ± 2.2mm), and a moderate risk at C2 (9.6 ± 2.4mm), and the popliteal vein has a moderate risk at C1 (6.0 ± 2.7 mm), and a low risk at C2 and C3 (10.8 ± 3.1mm, and 12.05 ± 3.1mm respectively). The C3 position presented the lowest risk of damage to these structures (p < 0.001). The distance between the posterior tibial cortex and the posterior tibial nerve was < 15 mm at the 3 levels analyzed (C1: 11.0 ± 3.7 mm; C2:13.1 ± 3.8 mm; and C3:13 ± 3.9 mm). Conclusions The present study clarifies that the popliteal vessels are at risk of injury during tibial tubercle screw fixation, particularly when drilling the proximal tibial epiphysis. Monocortical drilling and screw fixation are recommended for the surgical treatment of tibial tubercle fractures. Level of Evidence III Diagnostic study.


Resumo Objetivo Revisar estudos de ressonância magnética (RM) do joelho para análise da localização das estruturas neurovasculares (ENVs) e definição do risco de fixação bicortical. Métodos As distâncias entre o córtex posterior e as ENVs poplíteas foram medidas nas RMs de 45 adolescentes (50 joelhos) em 3 níveis (C1: centro da epífise proximal da tíbia; C2:10 mm distalmente à fise e C3: 20 mm distalmente à fise). Considerou-se que as ENVs entre 5mme10mmda incisão estavam na zona de risco moderado de lesão, as ENVs a menos de 5 mm da incisão, na zona de alto risco de lesão, e as ENVs a mais de 10 mm da incisão, na zona de baixo risco de lesão. O teste t de Student independente foi usado para comparar a distância até as ENVs com o gênero, a maturidade esquelética e a distância entre a tuberosidade tibial e a garganta (fundo) da tróclea (TT-GT). Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados A trajetória do parafuso em C1 apresentou maior risco de lesão à artéria e à veia poplítea em comparação com outras trajetórias (p < 0,001). A artéria poplítea apresenta risco de lesão alto em C1 (4,2 ± 2,2 mm) e moderado em C2 (9,6 ± 2,4 mm), e a veia poplítea tem risco moderado em C1 (6,0±2,7 mm) e baixo em C2 e C3 (10,8±3,1 mm e 12,05±3,1mm, respectivamente). A posição C3 apresentou o menor risco de lesão dessas estruturas (p < 0,001). A distância entre o córtex tibial posterior e o nervo tibial posterior foi inferior a 15 mm nos 3 níveis analisados (C1: 11,0±3,7mm; C2: 13,1±3,8 mm; e C3: 13±3,9mm). Conclusões Este estudo esclarece que os vasos poplíteos correm risco de lesão durante a fixação do parafuso na tuberosidade tibial, principalmente durante a perfuração da epífise proximal da tíbia. A perfuração monocortical e a fixação com parafusos são recomendadas para o tratamento cirúrgico das fraturas da tuberosidade tibial. Nível de Evidência III Estudo diagnóstico.


Subject(s)
Humans , Child, Preschool , Child , Tibial Fractures , Fracture Fixation, Internal
10.
Article in Spanish | LILACS, BINACIS | ID: biblio-1415759

ABSTRACT

Introducción: La fractura de la región anterolateral de la epífisis distal de la tibia, o tubérculo de Tillaux-Chaput, es conocida como fractura de Tillaux. Se trata de una fractura extremadamente rara en los adultos, pero tiene una importancia fundamental, porque compromete la superficie articular tibio-astragalina, la estabilidad de la sindesmosis y, en algunos casos, la incisura peronea. Se presenta el caso de una mujer de 45 años con un traumatismo rotatorio del tobillo izquierdo e impotencia funcional y dolor en la región anterolateral del tobillo. Las radiografías generaron la sospecha de un trazo de fractura correspondiente al tubérculo de Tillaux-Chaput. Por lo tanto, se realizó una tomografía computarizada que confirmó una fractura de Tillaux, que tenía un desplazamiento >2 mm y compromiso de la incisura peronea. La paciente fue sometida a reducción abierta y fijación interna. La fractura consolidó a los 3 meses. Al año de la cirugía, su estado clínico y funcional es excelente. Conclusión: La sospecha diagnóstica que surge de una completa anamnesis y un meticuloso examen físico, y la confirmación mediante estudios por imágenes son esenciales para abordar correctamente patrones de fracturas raros, como la fractura de Tillaux. Nivel de Evidencia: IV


Introduction: The fracture of the anterolateral region of the distal tibial epiphysis, or Tillaux-Chaput tubercle, is known as Tillaux fracture. It is an exceptional entity in adults, but it has significant importance because it affects the tibiotalar joint surface, the stability of the syndesmosis, and, in some cases, the fibular notch. We present the case of a 45-year-old woman treated in the Emergency Service due to rotational trauma to the left ankle and functional impairment and pain in the anterolateral region of the ankle. The radiographs led to the suspicion of a fracture line corresponding to the Tillaux-Chaput tubercle. Therefore, a CT scan was performed, which confirmed a Tillaux fracture with a >2 mm displacement and involvement of the fibular notch. The patient underwent open reduction and internal fixation. The fracture consolidated after 3 months. One year after surgery, her clinical and functional status was excellent. Conclusion:Diagnostic suspicion through meticulous physical examination and anamnesis and confirmation by imaging studies are essential for the proper management of rare fracture patterns, such as Tillaux fractures. Level of Evidence: IV


Subject(s)
Adult , Tibial Fractures , Ankle Injuries , Fracture Fixation, Internal
11.
Article in Spanish | LILACS, BINACIS | ID: biblio-1523933

ABSTRACT

Objetivo: Validar la clasificación de Leonetti y Tigani con evaluadores de diferentes niveles de experiencia. materiales y métodos: Se evaluó a 54 pacientes (54 fracturas del pilón tibial) en forma retrospectiva. Se tomaron radiografías de tibia distal, de frente y perfil, y una tomografía computarizada con cortes axiales, sagitales, coronales y reconstrucción 3D. Se incluyeron todos los subtipos de la clasificación de Leonetti y Tigani. Los evaluadores tenían diferentes niveles de entrenamientos: dos eran fellows en pie y tobillo, y dos, residentes del último año de formación. Para determinar la concordancia interobservador, cada caso fue clasificado en tipo I, II, III o IV, según Leonetti y Tigani. Para evaluar la concordancia intraobservador el mismo evaluador analizó los casos a las 6 semanas. Se utilizó el coeficiente kappa para determinar el grado de concordancia entre evaluadores y ese valor fue expresado con un intervalo de confianza del 95%. Resultados: La concordancia intraobservador fue moderada y muy buena para cada fellow, y buena y muy buena para los residentes, entre la primera y segunda evaluación. La concordancia interobservador arrojó un coeficiente kappa global de 0,7156 (IC95% 0,60-0,83), un valor bueno cuando se consideraron todas las fracturas por todos los evaluadores. Conclusiones: El sistema de clasificación de fracturas del pilón tibial alcanza concordancias superiores a las de estudios previos de otras clasificaciones. Dichas concordancias se lograron con médicos con diferentes niveles de experiencia y conocimiento. Nuestros hallazgos contribuyen a la validación externa e independiente de este nuevo sistema de clasificación. Nivel de Evidencia: IV


Objective: To validate the classification of Leonetti and Tigani with evaluators of different levels of expertise. Materials and methods: 54 patients with 54 tibial pilon fractures were evaluated retrospectively. Patients were studied using AP and lateral radiography of the distal tibia, as well as CT scans (axial, coronal, and sagittal images with reconstruction). All subtypes of the Leonetti classification were included. The evaluators presented different levels of training: two Foot and Ankle fellows and two residents in their last year of training. To determine the interobserver agreement, each case was classified into types I, II, III and IV according to Leonetti. To determine the intraobserver agreement, the cases were analyzed by the same evaluator after 6 weeks. The kappa coefficient (k) was used to determine the degree of agreement between the evaluators, that value was expressed with a 95% confidence interval. Results: The intraobserver agreement between the first and second evaluation for fellows was moderate and very good. For the residents, it was good and very good. The interobserver agreement for the classification of tibial pilon fractures presented an overall kappa of 0.7156 (95%CI: 0.60 to 0.83), which is a good value when all fractures are considered by all evaluators. Conclusion:This tibial pilon fracture classification system surpasses previous studies of other classifications in terms of agreement. These agreements were reached with physicians with varying levels of expertise. Our findings contribute to the external and independent validation of this new classification system. Level of Evidence: IV


Subject(s)
Tibial Fractures/classification , Observer Variation , Reproducibility of Results , Ankle Injuries
12.
Article in Spanish | LILACS, BINACIS | ID: biblio-1523934

ABSTRACT

Introducción: El Hospital Militar Central cuenta con un grupo especial para la atención de pacientes con trauma de guerra que incluye una evaluación inicial y manejo urgente de las lesiones que amenacen la vida, mediante un enfoque de control de daños que busca preservar la vida del paciente, salvar la extremidad y conservar su función. Materiales y Métodos: Estudio observacional, descriptivo, transversal de pacientes de las fuerzas militares de Colombia, que sufrieron fracturas de fémur o tibia por trauma de guerra entre 2012 y 2020; y tratados mediante fijación externa en este Hospital. Objetivos: Describir las complicaciones del trauma de guerra tras un año de manejo de pacientes con fracturas de fémur o tibia utilizando un protocolo de control de daños en el Hospital Militar Central, centro de referencia para este tipo de trauma en el país. Resultados: Se realizó una revisión retrospectiva de pacientes con fracturas femorales o tibiales por traumas de guerra entre 2012 y 2020, manejados con un protocolo de control de daños. Se seleccionaron 72 soldados, el 96% de las fracturas eran abiertas, el 91% (66 casos) sufrió alguna complicación, como lesión nerviosa, lesión vascular, defecto de cobertura, infección, falta de consolidación. Conclusiones: El trauma de guerra continúa representando una de las etiologías de politraumatismo en pacientes jóvenes de nuestro país que, a su vez, sigue teniendo grandes implicaciones clínicas y económicas. Las lesiones óseas de las extremidades requieren un manejo por etapas basado en la fijación externa según los principios de control de daños. Nivel de Evidencia: IV


Introduction: The Central Military Hospital of Bogotá, Colombia has a specialized team for treating war trauma patients. They conduct an initial assessment of patients and promptly manage potentially fatal injuries using a damage control approach that aims to save the patient's life, save the limb, and preserve its function. Materials and Methods: An observational, descriptive, cross-sectional study was conducted on patients from the Colombian armed forces who, between 2012 and 2020, had femur or tibia fractures as a result of war trauma; these patients were treated using external fixation by the orthopedics and traumatology service of the Central Military Hospital in Bogotá, Colombia. Objectives: To describe the complications associated with war trauma following a year of treatment for femur and/or tibia fractures under a damage control protocol at the Central Military Hospital, the nation's reference facility for this kind of trauma. Results:A retrospective review of war trauma patients between 2012 and 2020 with femoral or tibial fractures treated with DCO was performed. Fisher's Exact tests were used for comparisons. Seventy-two soldiers were selected, 96% of fractures were open, 91% (66 cases) had some type of complication such as nerve injury, vascular injury, coverage defect, infection, and nonunion. Conclusions: In our country, war trauma persists as one of the causes of polytrauma in young patients, which has significant clinical and financial implications. Bone injuries of severely affected extremities require staged management based on external fixation according to damage control principles. Level of Evidence: IV


Subject(s)
Adult , Tibial Fractures , External Fixators , Femoral Fractures , War-Related Injuries , Fractures, Open , Leg Injuries
13.
Rev. med. Urug ; 39(1): e401, 2023.
Article in Spanish | LILACS, BNUY | ID: biblio-1431903

ABSTRACT

Objetivo: comparar si existe diferencia en resultados clínicos, radiológicos y funcionales con el uso de diferentes tipos de injertos óseos o sustitutos sintéticos, así como tiempo quirúrgico y consolidación para el tratamiento de fracturas de platillo tibial con hundimiento articular en pacientes mayores de 18 años. Material y método: se realizó una búsqueda sistematizada en bases de datos de literatura médica, PubMed, Lilacs, Scielo, Cochrane y portal Timbó. Se utilizaron términos "tibial plateau fracture", "bone grafting", "bone substitutes". Se incluyeron estudios comparativos en seres humanos, pacientes mayores de 18 años, fracturas de platillo tibial que asociaron hundimiento articular, en los cuales se realizó aporte de injerto óseo o material sintético. Artículos en español, inglés, portugués. Publicaciones enero 1980 y diciembre 2021. Se obtuvieron 10 artículos. Resultados: los tipos de injertos y sustitutos óseos encontrados fueron 10. Las muestras en sumatoria total 524 pacientes. La edad promedio fue 49 años. El promedio de seguimiento fue de 12 meses. Se dividieron los estudios en tres grupos: comparación entre injerto autólogo (IOA) e injerto alogénico, IOA con sustitutos sintéticos, y los que comparan sustitutos sintéticos entre sí. El aloinjerto y los sustitutos sintéticos demostraron no ser inferiores en resultados clínicos, funcionales e imagenológicos, mejorando los tiempos intraoperatorios y disminuyendo complicaciones en el sitio donante con respecto al IOA. Conclusiones: el IOA continúa siendo el gold standard a pesar de sus posibles complicaciones vinculadas al sitio donante. El aloinjerto y los sustitutos sintéticos representan una opción válida para tratar estas lesiones.


Objective: to find out whether there are clinical, radiological and functional differences when using different types of bone grafts or synthetic substitutes, as well as surgical times and consolidation to treat depressed tibial-plateau fractures in patients older than 18 years old. Method: a systematized search was conducted in medical literature, PubMed, Lilacs, Scielo, Cochrane and Timbó portal databases using the following terms: "tibial plateau fracture", "bone grafting", "bone substitutes". The study included comparative studies in human patients older than 18 years old with depressed tibial-plateau fractures who were treated with bone grafts or synthetic materials. Publications in Spanish, English and Portuguese, between January, 1980 and December, 2021 were included in the search, what resulted in 10 articles found. Results: there were 10 kinds of bone grafts and bone substitutes found. Samples added up to 524 patients. Average age was 49 years old. Average follow up was 12 months. Studies were divided into 3 groups: comparison between autologous bone grafts and allogenic bone grafts, comparison between autologous grafts and synthetic substitutes and studies comparing synthetic substitutes with one another. Allogenic grafts and synthetic grafts proved at least equivalent in terms of clinical, functional and imaging studies results, improving intraoperative times and reducing complications in donor site when compared to autologous grafts. Conclusions: autologous grafts continue to be the gold standard despite possible complications associated to the donor site, and allogenic grafts and synthetic substitutes constitute a valid option to treat these lesions.


Objetivo: comparar os resultados clínicos, radiológicos e funcionais com o uso de diferentes tipos de enxertos ósseos ou substitutos sintéticos, bem como tempo cirúrgico e consolidação para o tratamento de fraturas do platô tibial com colapso articular em pacientes com mais de 18 anos. Material e método: foi realizada busca sistemática nas bases de dados da literatura médica, PubMed, Lilacs, SciELO, Cochrane e portal Timbó. Utilizaram-se os termos "tibial plateau fracture", "bone grafting", "bone substitutes". Foram incluídos estudos comparativos incluindo seres humanos maiores de 18 anos e fraturas do platô tibial associadas a colapso articular, nas quais foi realizado enxerto ósseo ou sintético, publicados entre janeiro de 1980 e dezembro de 2021 em espanhol, inglês e português. Foram obtidos 10 artigos. Resultados: foram identificados 10 tipos de enxertos e substitutos ósseos. 524 pacientes com idade média de 49 anos foram estudados. O seguimento médio foi de 12 meses. Os estudos foram divididos em 3 grupos: comparação entre enxerto autólogo (IOA) e enxerto alogênico, IOA com substitutos sintéticos e substitutos sintéticos entre si. O aloenxerto e os substitutos sintéticos mostraram-se não inferiores nos resultados clínicos, funcionais e de imagem, melhorando os tempos intraoperatórios e reduzindo as complicações da área doadora em relação à IOA. Conclusões: o IOA continua a ser o padrão ouro apesar de suas possíveis complicações relacionadas ao local doador; tanto o aloenxerto como os substitutos sintéticos representam uma opção válida para tratar essas lesões.


Subject(s)
Tibial Fractures/surgery , Bone Substitutes , Tibial Plateau Fractures/surgery
14.
Artrosc. (B. Aires) ; 30(2): 83-87, 2023.
Article in Spanish | LILACS, BINACIS | ID: biblio-1451225

ABSTRACT

Las fracturas de platillos tibiales son lesiones frecuentes. Una de sus complicaciones postoperatorias es la pérdida de reducción con desviación de los ejes en los planos coronal, sagital y axial. La depresión ósea genera incongruencia articular con pérdida de tensión de estructuras ligamentarias indemnes, causando una pseudo-laxitud con inestabilidad. Esto requiere de una corrección ósea para aumentar la tensión de dichas estructuras ligamentarias y lograr así recuperar la congruencia y estabilidad articular en todo el rango de movilidad. El objetivo del presente trabajo es reportar un caso de inestabilidad medial en un paciente joven, quien, tras una fractura de platillo tibial medial mal consolidada, requirió una osteotomía selectiva biplanar e intraarticular para corregir dicha deformidad


Tibial plateau fractures are frequent. Loss of reduction with axis deviation in the coronal, sagittal and axial planes is one of the postoperative complications.Bone depression generates joint incongruity with loss of tension in undamaged ligament structures resulting in pseudo-laxity with instability. This requires a bone correction to increase the tension of ligament structures, hence achieving the recovery of joint congruence and stability throughout the range of mobility.The objective of the current paper is to report a case of medial instability in a young patient, who suffered a medial tibial plateau fracture with poor bone consolidation, with consequent laxity and pain in the medial compartment, which required a selective biplanar and intra-articular osteotomy to correct such deformity.


Subject(s)
Middle Aged , Osteotomy , Postoperative Complications , Tibial Fractures , Range of Motion, Articular , Joint Instability , Knee Joint
15.
Chinese Journal of Traumatology ; (6): 106-110, 2023.
Article in English | WPRIM | ID: wpr-970982

ABSTRACT

A cruciate ligament avulsion is a much less common form of injury than a cruciate ligament tear. Simultaneous tibial avulsion fractures of both cruciate ligaments occur even more rarely. Over the last decades, many studies have described arthroscopic fixation of acute cruciate tibial avulsion fractures, but arthroscopic treatment in a late presenting patient has not been reported in the literature. This case report presents a 32-year-old female with a chronic tibial avulsion fracture of both anterior cruciate ligament and posterior cruciate ligament. Simultaneous fixation of both fractures was performed arthroscopically at week four post-injury. At one year of follow-up, the patient had demonstrated full knee range of motion and stable knee with no complaints, and achieved excellent clinical outcomes. Radiographs showed union of both fractures, and the patient had resumed high-impact exercises.


Subject(s)
Female , Humans , Adult , Fractures, Avulsion/surgery , Arthroscopy , Knee Joint/surgery , Tibia/surgery , Tibial Fractures/surgery , Suture Techniques , Treatment Outcome
16.
Article in Chinese | WPRIM | ID: wpr-1009210

ABSTRACT

OBJECTIVE@#To explore clinical effect of attaching locking plate with bone grafting based on retaining the original intramedullary nail in treating non-union after intramedullary nail fixation of long shaft fractures of lower limbs.@*METHODS@#A retrospective study was conducted on 20 patients treated with non-union fractures after intramedullary nailing of long shaft fractures of lower limbs from June 2015 to June 2020. All patients were treated with the original intramedullary nailing and bone grafting from the iliac bone, and were underwent open reduction plate internal fixation and bone grafting for old fractures. Among them, 14 were males and 6 were females, aged from 35 to 56 years old with an average of (42.2±9.6) years old. Nine patients were femoral shaft fracture and 11 patients were tibial shaft fracture. According to characteristics of fracture end nonunion, 6 patients were stable/atrophic, 9 patients were unstable/large, and 5 patients were unstable/atrophic. The nonunion time ranged from 8 to 12 months with an average of(9.8±2.0) months after the initial surgery. Visual analogue scale (VAS), knee range of motion, bone healing time, complications and fracture-end healing were recorded before and at the latest follow-up.@*RESULTS@#All patients were followed up for 18 to 48 months with an average of (36.3±10.5) months. The incision of all patients were healed at stageⅠwithout complications such as infection or internal fixation ruptur. Healing time of femur and tibia was (8.5±2.6) months and (9.5±2.2) months. Knee joint motion increased from preoperative (101.05±8.98) ° to postoperative (139.35±8.78) ° at the latest follow-up (t=-12.845, P<0.001). VAS decreased from preoperative (5.15±1.72) to postoperative (0.75±0.96) at the latest follow-up (t=11.186, P<0.001).@*CONCLUSION@#On the basis of retaining the original intramedullary nail, the addition of locking plate internal fixation and autogenous iliac bone grafting have advantages of simple operation, less trauma, fewer complications and high fracture healing rate. It is one of the effective surgical schemes for the treatment of nonunion after intramedullary nail fixation of long bone fracture of lower extremity.


Subject(s)
Male , Female , Humans , Adult , Middle Aged , Bone Transplantation , Retrospective Studies , Bone Plates , Fracture Fixation, Intramedullary/adverse effects , Femoral Fractures/complications , Lower Extremity , Fractures, Ununited/surgery , Fracture Healing , Tibial Fractures/complications , Bone Nails , Treatment Outcome
17.
Article in Chinese | WPRIM | ID: wpr-1009206

ABSTRACT

OBJECTIVE@#To explore effects of isopsoralen (ISO) with different doses on fracture and vascular healing in mice.@*METHODS@#Sixty 2-month-old male C57BL/6 mices with body mass of (20±2) g were selected and divided into 4 groups by random number table method:model group (model), low dose group (isopsoralen-low dose, ISO-L), medium dose group (isopsoralen-medium dose, ISO-M) and high dose group (isopsoralen-high dose, ISO-H), with 15 animals in each group. The right tibial fracture model was established. After operation, ISO-L group, ISO-M group and ISO-H group were given ISO concentration of 10 mg·kg-1, 20 mg·kg-1 and 40 mg·kg-1, respectively. Model group was given same volume of normal saline once a day for 28 days. Weighed once a week. X-ray was performed on 7, 14, 21 and 28 days, respectively, and modified I.R. Garrett scoring method was used to evaluate callus growth. After 28 days, the main organs were stripped and weighed, and organ coefficients were calculated. Hematoxylin eosin staining (HE staining) was performed on the organs to observe whether there were pathological structural changes. Micro-computed tomography (Micro-CT) was used to scan fracture area and conduct three-dimensional reconstruction to obtain the effect map, and quantify bone volume fraction (bone volume/total volume, BV/TV). After decalcification, the tibia was embedded in paraffin wax and sectioned. The healing and shape of fracture end were observed by HE staining and ferruxin solid green staining. The right tibia was removed and decalcified after intravascular infusion of Microfil contrast agent. Micro-CT was used to scan the callus microvessels in the fracture area, and the vascular volume fraction and vessel diameter were quantified.@*RESULTS@#After 28 days of administration, there was no significant difference in body mass and organ coefficient among all groups (P>0.05), and no significant pathological changes were found in HE staining of organs. The results of X-ray and improved I.R. Garrett score showed that ISO-M group was higher than that of Model group at 28 days (P<0.05). Scores of ISO-H group at 14, 21 and 28 days were higher than those of the other 3 groups (P<0.05). Micro-CT results showed intracavitary callus in ISO-M group was significantly reduced, which was lower than that in Model group (P<0.05), most of the callus in ISO-H group were subsided, and BV/TV in ISO-H group was lower than that in the other 3 groups (P<0.05). The results of HE staining and ferrubens solid green staining showed fracture area of ISO-H group was closed, continuous laminar bone had appeared, and the fracture healing process was higher than that of other groups. Angiographic results showed vascular volume fraction in ISO-H and ISO-M groups was higher than that in Model and ISO-L groups (P<0.05), and the vascular diameter in ISO-H and ISO-M groups was higher than that in Model and ISO-L groups (P<0.05).@*CONCLUSION@#In the concentration range of 10-40 mg·kg-1, ISO has no obvious toxic and side effects, and could improve bone microstructure, promote formation of callus microvessels, and accelerate healing of fracture ends in a concentration-dependent manner.


Subject(s)
Mice , Male , Animals , X-Ray Microtomography , Mice, Inbred C57BL , Bony Callus , Fracture Healing , Tibial Fractures/surgery
18.
Article in Chinese | WPRIM | ID: wpr-1009193

ABSTRACT

OBJECTIVE@#To investigate the effect of intramedullary nail fixation (IMN) and minimally invasive percutaneous plate internal fixation (MIPPO) techniques on tibiofibular fractures and their effect on platelet activation and serum transforming growth factor-β1 (TGF-β1) and bone morphogenetic protein-2 (BMP-2).@*METHODS@#Total of 105 patients with tibiofibular fractures from February 2019 to February 2020 were selected and divided into 53 cases in the MIPPO group and 52 cases in the IMN group. There were 29 males and 24 females with an average age of (41.74±6.05) years old in MIPPO group;in IMN group, 31 males and 21 females with an average age of (40.59±5.26) years old. The perioperative surgical indexes, postoperative complications, ankle function recovery at 12 months postoperatively, platelet activation indexes at 3 and 7 days preoperatively and postoperatively, and serum TGF-β1 and BMP-2 levels at 4 and 8 weeks preoperatively and postoperatively were compared between the two groups.@*RESULTS@#The operating time and fracture healing time in the MIPPO group were shorter than those in the IMN group(P<0.05); Compared with the preoperative period, the levels of GMP-140, PAC-1, CD63, and CD61 increased in both groups at 3 and 7 days after surgery, but were lower in the MIPPO group than in the IMN group(P<0.05);the levels of serum TGF-β1 and BMP-2 increased in both groups at 4 and 8 weeks after surgery compared with the preoperative period, and the postoperative complication rate in the MIPPO group was lower than that in the IMN group(P<0.05);the difference was not statistically significant in the excellent rate of ankle function recovery at 12 months follow-up after surgery between two groups(P>0.05).@*CONCLUSION@#Both intramedullary nail fixation and MIPO technique for treatment of tibia and fibula fractures can improve ankle joint function, but the latter has the advantages of short operation time, fast fracture healing, fewer complications, and light platelet activation. Serum TGF-β1, BMP-2 level improves quickly.


Subject(s)
Male , Female , Humans , Adult , Middle Aged , Tibia/injuries , Transforming Growth Factor beta1 , Fracture Fixation, Intramedullary/methods , Tibial Fractures/surgery , Fracture Fixation, Internal/methods , Bone Plates , Fracture Healing , Postoperative Complications , Fractures, Multiple , Treatment Outcome , Bone Morphogenetic Proteins , Minimally Invasive Surgical Procedures/methods , Retrospective Studies
19.
Article in Chinese | WPRIM | ID: wpr-981752

ABSTRACT

OBJECTIVE@#To explore the effect of a modified three-point bending fracture device for establishing a rabbit model of closed tibial fracture.@*METHODS@#The model of closed tibial fracture was established in 40 6-month-old male New Zealand white rabbits with a body weight of 2.5 to 3.0 kg, and the model was verified at 6 weeks after operation. Five rabbits underwent pre modeling without temporary external fixation before modeling, and then were fractured with a modified three-point bending fracture device;35 rabbits underwent formal modeling. Before modeling, needles were inserted, and splints were fixed externally, and then the fracture was performed with a modified three-point bending fracture device. The fracture model and healing process were evaluated by imaging and histopathology at 2 hours, 4 weeks, and 6 weeks after operation.@*RESULTS@#Two hours after modeling, the prefabricated module showed oblique fracture in varying degrees and the broken end shifted significantly;Except for 1 comminuted fracture, 2 curved butterfly fractures and 2 without obvious fracture line, the rest were simple transverse and oblique fractures without obvious displacement in formal modeling group. According to the judgment criteria, the success rate of the model was 85.71%. Four weeks after modeling, the fixed needle and splint of the experimental rabbits were in good position, the fracture alignment was good, the fracture line was blurred, many continuous callus growths could be seen around the fracture end, and the callus density was high. Six weeks after modeling, many thick new bone trabeculae at the fracture, marginal osteoblasts attached, and a small number of macrophages were seen under the microscope. The intramembrane osteogenesis area was in the preparation bone stage, the medullary cavity at the fracture had been partially reopened, the callus was in the absorption plastic stage, and many osteoclasts were visible. The X-ray showed that the fracture line almost disappeared, part of the medullary cavity had been opened, the external callus was reduced around, the callus was in the plastic stage, and the bone cortex was continuous. It suggests that the fracture model showed secondary healing.@*CONCLUSION@#The improved three-point bending fracture device can establish a stable rabbit model of closed tibial fracture, and the operation is simple, which meets the requirements of closed fracture model in basic research related to fracture healing.


Subject(s)
Rabbits , Male , Animals , Bony Callus , Fracture Healing , Tibial Fractures/surgery , Osteogenesis , Radiography
20.
Article in Chinese | WPRIM | ID: wpr-981734

ABSTRACT

OBJECTIVE@#To develop a reduction device for the arthroscopy-assisted treatment of tibial plateau fracture and explore its clinical efficacy.@*METHODS@#From May 2018 to September 2019, 21 patients with tibial plateau fracture were treated, including 17 males and 4 females. Their ages ranged from 18 to 55 years old with an average of (38.6±8.7) years old. There were 5 cases of Schatzker typeⅡand 16 cases of Schatzker type Ⅲ. The self-designed reductor combined with arthroscope was used for auxiliary reduction and fixation(minimally invasive percutaneous plate osteosynthesis). The efficacy was analyzed by observing the operation time, blood loss, fracture healing time and knee function(HSS and IKDC scoring criteria).@*RESULTS@#All the 21 patients were followed up for 8 to 24 with an average of(14.0±3.1) months. The operative time ranged from 70 to 95 min with an average of(81.7±7.6)min, incision length ranged from 4 to 7 cm with an average of(5.3±0.9) cm, intraoperative blood loss ranged from 20 to 50 ml with an average of(35.3±5.2) ml, postoperative weight-bearing time ranged from 30 to 50 d with an average of(35.1±9.2) d, fracture healing time ranged from 65 to 90 d with an average of(75.0±4.4) d, and complications were 0 cases, respectively. The fracture was well healed and no screw plate fracture was observed. The knee function scores of HSS and IKDC 18 months after operation were significantly higher than those before operation(P<0.05).@*CONCLUSION@#The custom-made reduction tool for the arthroscopic management of tibial plateau fracture is reasonable in design and simple in operation. The specific reduction tool could effectively reduce the fracture, and shorten the fixation time with minimally invasive procedure.


Subject(s)
Male , Female , Humans , Adolescent , Young Adult , Adult , Middle Aged , Tibial Plateau Fractures , Tibial Fractures/surgery , Fracture Fixation, Internal/methods , Treatment Outcome , Bone Plates , Retrospective Studies
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