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1.
Medicine (Baltimore) ; 99(17): e19854, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332643

RESUMO

This study aimed to study the effects of surgical approaches and identify the morphological characteristics associated with the 1-year follow-up outcome of patients with posterolateral tibial plateau fractures after successful surgery.We followed 200 postoperative patients for 1 year. The modified Hospital for Special Knee Surgery score (HSS score) was used to evaluate the functional recovery of the knee. We supposed 4 morphological characteristics in CT images acting as possible risk factors, including the anteroposterior diameters of posterolateral broken bone fragments (fragment-diameter), the damage to the posterolateral cortex of the tibial head (cortex-damage), the combinational fracture of the proximal fibula (fibula-fracture) or fracture of the medial tibial condyle (medial-condyle-fracture). Multivariate regression models were used to analyze the effect of these factors on the HSS score after adjusting the 2 surgical approaches and other confounders.The average HSS score was 85.1 ±â€Š5.8 for all the patients. We treated 155 patients with the anterolateral approach and 45 patients with the posterolateral approach. The surgical approach, fragment-diameter, fibula-fracture, and medial-condyle-fracture were correlated with the HSS scores (P < .05). After adjusting for the above factors, the Schatzker type, age and gender, compared with anterolateral approach, the posterolateral approach could improve the HSS scores by an average of 3.7 points. The fragment-diameter <20 mm and posterolateral approach interacted on the HSS scores. Comparing posterolateral and anterolateral approaches, we found that the HSS scores of patients with fragment-diameter <20 mm increased by 6.1 points (95% CI: 4.1-8.2) in the posterolateral approach, while those with fragment-diameter ≥20 mm did not significantly improve the HSS scores.The surgical approach, fragment-diameter, fibula-fracture, and medial-condyle-fracture were independent risk factors associated with the follow-up outcome of patients with posterolateral tibial plateau fractures after successful surgery. The posterolateral approach could significantly improve the HSS score in the studied hospital.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas da Tíbia/patologia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Fatores de Risco , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/fisiopatologia , Adulto Jovem
2.
Br J Radiol ; 93(1106): 20190620, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573325

RESUMO

CT is a readily available imaging modality for cross-sectional characterization of acute musculoskeletal injuries in trauma. Dual-energy CT provides several additional benefits over conventional CT, namely assessment for bone marrow edema, metal artifact reduction, and enhanced assessment of ligamentous injuries. Winter sports such as skiing, snowboarding, and skating can result in high speed and high energy injury mechanisms; dual-energy CT is well suited for the characterization of those injuries.


Assuntos
Esportes na Neve/lesões , Tomografia Computadorizada por Raios X/métodos , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Lesões do Quadril/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/diagnóstico por imagem , Fraturas da Tíbia/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Adulto Jovem
3.
Ultraschall Med ; 41(1): 44-51, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30081395

RESUMO

PURPOSE: To assess the value of CEUS in the evaluation of tibial fracture perfusion and its ability to differentiate between physiologic and abnormal fracture healing. MATERIALS AND METHODS: From 2014 to 2017, 107 patients with tibial fractures or tibial non-unions underwent CEUS examination. CEUS was performed at the regular follow-up examination 26 weeks after osteosynthesis or before non-union surgery. Time-intensity curves (TICs) of the contrast enhancement in the fracture gap were generated, and volume parameters such as wash-in rate (WiR), peak enhancement (PE) and wash-in perfusion index (WiPI) were quantified. RESULTS: A total of 34 patients met the inclusion criteria of this study, including 14 consolidated fractures, 12 aseptic non-unions and 8 infected non-unions. WiR, PE and WiPI showed significantly lower values in aseptic non-unions compared to unions (p = 0.009, 0.009, 0.012, resp.). In contrast, infected non-unions showed higher values of WiR, PE and WiPI when compared to unions (p = 0.034, 0.056, 0.029, resp.). CONCLUSION: CEUS represents a feasible method in the assessment of tibial fracture perfusion. Perfusion differences between aseptic and infected tibial non-unions as well as healing tibial fractures could be detected. The deviation of physiologic fracture perfusion seems to be associated with disturbed osseous regeneration leading to non-union.


Assuntos
Meios de Contraste , Fraturas Mal-Unidas , Fraturas da Tíbia , Consolidação da Fratura , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , Perfusão , Fraturas da Tíbia/diagnóstico por imagem , Ultrassonografia/métodos
4.
J Pediatr Orthop ; 40(1): e1-e5, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30969196

RESUMO

BACKGROUND: The purpose of this study was to determine the frequency of concurrent ipsilateral distal tibial fractures with tibial shaft fractures in the pediatric population; to identify patient and fracture characteristics that increase the likelihood of a concurrent fracture; and determine if any of these concurrent distal tibial fractures were missed on initial radiographic examination. METHODS: Retrospective chart review was done to identify patients 5 to 17 years old who were treated for a tibial shaft fracture at a large, Level 1 free-standing children's hospital and an outpatient orthopaedic practice between 2008 and 2016. Patient and fracture characteristics were recorded. RESULTS: Of 517 fractures (515 patients), 22 (4.3%) had concurrent ipsilateral distal tibial fractures: 11 triplane, 5 medial malleolar, 3 bimalleolar, and 2 Tillaux (Salter-Harris III) ankle fractures, and 1 Salter-Harris II distal tibial fracture. Age was the only patient characteristic significantly associated with a second, more distal fracture: patients with both fractures were older (12.7 y) than those with an isolated tibial shaft fracture (11 y). There was no difference in the rate of distal tibial fractures between high-energy and low-energy mechanisms of injury and no differences in the rate of open injuries or the presence of a fibular fracture. Patients with a tibial shaft fracture at the junction of the middle and distal thirds were significantly more likely to have a concurrent distal tibial fracture; oblique and spiral fracture patterns were more frequent in the group with concurrent distal tibial fractures than in the isolated tibial shaft fracture group. CONCLUSIONS: In our series, 36% of the concurrent distal tibial fractures were not diagnosed until chart review for this study, which suggests the need for ankle-specific imaging in certain patients. We recommend ankle-specific imaging when an oblique or spiral tibial shaft fracture is located at the junction of the middle and distal thirds of the tibia or in patients in whom a distal tibial fracture is suspected because of pain, swelling, or bruising. LEVEL OF EVIDENCE: Level III-retrospective comparative study.


Assuntos
Fraturas do Tornozelo/complicações , Fraturas Múltiplas/complicações , Fraturas Múltiplas/diagnóstico por imagem , Diagnóstico Ausente , Fraturas da Tíbia/complicações , Fraturas da Tíbia/diagnóstico por imagem , Adolescente , Fatores Etários , Fraturas do Tornozelo/diagnóstico por imagem , Criança , Pré-Escolar , Diáfises/diagnóstico por imagem , Diáfises/lesões , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fraturas Salter-Harris/complicações , Fraturas Salter-Harris/diagnóstico por imagem
5.
J Pediatr Orthop ; 40(1): 48-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31815862

RESUMO

BACKGROUND: Evaluation of the union of osteotomies and fractures in patients with osteogenesis imperfecta (OI) is a critical component of patient care. Studies of the OI patient population have so far used varied criteria to evaluate bony union. The radiographic union score for tibial fractures (RUST), which was subsequently revised to the modified RUST, is an objective standardized method of evaluating fracture healing. We sought to evaluate the reliability of the modified RUST in the setting of the tibias of patients with OI. METHODS: Tibial radiographs of 30 patients with OI fractures, or osteotomies were scored by 3 observers on 2 separate occasions. Each of the 4 cortices was given a score (1=no callus, 2=callus present, 3=bridging callus, and 4=remodeled, fracture not visible) and the modified RUST is the sum of these scores (range, 4 to 16). The interobserver and intraobserver reliabilities were evaluated using intraclass coefficients (ICC) with 95% confidence intervals. RESULTS: The ICC representing the interobserver reliability for the first iteration of scores was 0.926 (0.864 to 0.962) and for the second series was 0.915 (0.845 to 0.957). The ICCs representing the intraobserver reliability for each of the 3 reviewers for the measurements in series 1 and 2 were 0.860 (0.707 to 0.934), 0.994 (0.986 to 0.997), and 0.974 (0.946 to 0.988). CONCLUSIONS: The modified RUST has excellent interobserver and intraobserver reliability in the setting of OI despite challenges related to the poor quality of the bone and its dysplastic nature. The application and routine use of the modified RUST in the OI population will help standardize our evaluation of osteotomy and fracture healing. LEVEL OF EVIDENCE: Level III-retrospective study of nonconsecutive patients.


Assuntos
Consolidação da Fratura , Osteogênese Imperfeita/fisiopatologia , Fraturas da Tíbia/diagnóstico por imagem , Adolescente , Pré-Escolar , Feminino , Humanos , Variações Dependentes do Observador , Osteogênese Imperfeita/complicações , Osteogênese Imperfeita/cirurgia , Osteotomia , Radiografia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fraturas da Tíbia/etiologia , Fraturas da Tíbia/cirurgia , Adulto Jovem
6.
Niger J Clin Pract ; 22(12): 1715-1721, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31793479

RESUMO

Aims: The aim of this study is to assess the functional and radiological outcomes of 52 surgically treated tibial plateau fractures and to determine the factors affecting functional outcomes. Subjects and Methods: A total of 52 patients who were operated between 2007 and 2014 due to tibial plateau fractures were retrospectively reviewed. The Knee Society Score (KSS) was used for the functional outcome assessment. The Kellgren-Lawrence radiological evaluation score was used for the relationship between postoperative trauma and osteoarthritis in the last follow-up. Results: Patients' mean age was 47.7 years (range, 14-84 years). The immobilization period was 4.2 weeks (range, 0-8 weeks), the full weightbearing time was 3.3 months (range, 1.5-5 months), and the follow-up time was 47 months (range, 17-102 months). Patients' mean KSS was 84.3 (range, 40-100). According to the Kellgren-Lawrence classification, 26 patients had grade 0, 11 patients had grade 1, 8 patients had grade 2, 5 patients had grade 3, and 2 patients had grade 4 postoperative osteoarthritis. Conclusion: Use of graft if there is collapse on joint surface, early knee motion, and early started full weightbearing after surgical fixation of tibial plateau fracture is essential for successful outcome. Findings of osteoarthritis on X-rays are not related to poor functional outcome at the mid- to long-term follow-up of surgical treated tibial plateau fractured patients.


Assuntos
Fixação Interna de Fraturas , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Tíbia/lesões , Fraturas da Tíbia/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
8.
J Am Podiatr Med Assoc ; 109(6): 477-481, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755767

RESUMO

Tillaux fracture is known to occur in adolescents once it happens during the transition period when the medial and central physis has finished closure, but the lateral physis is still opened. The trauma mechanism is typically external rotation ankle injury resulting in an avulsion fracture of the anterolateral tibial plafond. This fracture has rarely been reported in adults, especially associated with other injuries. We report a case of Tillaux fracture in an adult, associated with a Volkmann fracture and a Maisonneuve fracture, that were surgically treated with open reduction and internal fixation and had an excellent outcome. Recognizing and appropriately treating these injuries is key in the prevention of further degenerative arthritis and instability.


Assuntos
Traumatismos do Tornozelo/cirurgia , Fixação Interna de Fraturas/métodos , Ligamentos Articulares/lesões , Fraturas da Tíbia/cirurgia , Idoso , Traumatismos do Tornozelo/complicações , Feminino , Humanos , Radiografia , Tíbia/diagnóstico por imagem , Fraturas da Tíbia/complicações , Fraturas da Tíbia/diagnóstico por imagem
9.
J Am Podiatr Med Assoc ; 109(6): 459-462, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755769

RESUMO

We present a case of tibial pilon fracture where only the lateral part of the distal tibia was affected. The transfibular approach to the ankle was used for the surgical treatment of the fracture. After an initial nonweightbearing period of 3 weeks, full weightbearing was allowed 8 weeks after surgery. The second-year follow-up showed no evidence of degenerative signs, with full ankle range of motion.


Assuntos
Fíbula/cirurgia , Fixação Interna de Fraturas/métodos , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Adulto , Feminino , Humanos , Tíbia/lesões , Fraturas da Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
10.
Bone Joint J ; 101-B(11): 1416-1422, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31674252

RESUMO

AIMS: In this randomized study, we aimed to compare quality of regenerate in monolateral versus circular frame fixation in 30 patients with infected nonunion of tibia. PATIENTS AND METHODS: Both groups were comparable in demographic and injury characteristics. A phantom (aluminium step wedge of increasing thickness) was designed to compare the density of regenerate on radiographs. A CT scan was performed at three and six months postoperatively to assess regenerate density. A total of 30 patients (29 male, one female; mean age 32.54 years (18 to 60)) with an infected nonunion of a tibial fracture presenting to our tertiary institute between June 2011 and April 2016 were included in the study. RESULTS: The regenerate mineralization on radiographs was comparable in both groups at two, four, six, and ten months' follow-up but the rail fixator group had statistically significant higher grades of mineralization when compared with the circular frame group at eight and 12 months' follow-up. The regenerate mineralization was also higher in the rail fixator group than in the circular frame group on CT at three and six months, although this difference was not statistically significant. CONCLUSION: Overall, the regenerate mineralization was higher in the monolateral than the circular frame group. A monolateral fixator may be preferred in patients with infected nonunion of the tibia with bone defects up to 7 cm. Cite this article: Bone Joint J 2019;101-B:1416-1422.


Assuntos
Fraturas não Consolidadas/cirurgia , Osteogênese por Distração/métodos , Fraturas da Tíbia/cirurgia , Infecção dos Ferimentos/cirurgia , Adolescente , Adulto , Densidade Óssea/fisiologia , Desenho de Equipamento , Fixadores Externos , Feminino , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese por Distração/instrumentação , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Radiografia , Fraturas da Tíbia/diagnóstico por imagem , Infecção dos Ferimentos/diagnóstico por imagem , Adulto Jovem
11.
Medicine (Baltimore) ; 98(42): e17338, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626090

RESUMO

RATIONALE: Unicompartmental knee arthroplasty (UKA) is an effective method to treat single compartment disease of the knee joint. Report about the complications of UKA, especially tibial plateau fractures, is rare. Given its rarity, its pathogenesis is not well described, and a standard of treatment is still not established. Therefore, relevant studies and analysis of this complication have a significant effect on helping physicians avoid risks and guide clinical diagnosis and treatment. PATIENT CONCERNS: The 1st case corresponds to a 70-year-old male patient who complained of knee pain, difficulty walking, nocturnal rest pain, and elevated skin temperature at 3 weeks after the left knee arthroplasty. The second case is a 72-year-old female patient who complained of left knee pain and swelling during movement at 2 weeks after the left knee arthroplasty. DIAGNOSIS: The 1st case showed a fracture of the medial malleolus of the left knee and a secondary depression of the medial tibial plateau in X-rays and the second case showed a fracture of the medial malleolus of the left knee in computed tomography (CT) and X-rays. INTERVENTIONS: The 1st case was treated with plate and screw fixation and the second case was treated conservatively and immobilized using brace and remained nonweight bearing for 6 weeks. OUTCOMES: After 1 year, both patients have good joint activity, and there was no pain or loosening of the prosthesis and fragment displacement. LESSONS: The incidence of tibial plateau fractures (TPF) related to UKA might be low, but fatal and difficult to treat. Its pathogenesis determines procedure-related factors; when fracture develops, treatment should be based on the degree of displacement, stability of implant fixation, etc.


Assuntos
Artroplastia do Joelho/efeitos adversos , Tratamento Conservador/métodos , Fixação Interna de Fraturas/métodos , Complicações Pós-Operatórias/terapia , Fraturas da Tíbia/terapia , Idoso , Idoso de 80 Anos ou mais , Braquetes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
J Pediatr Orthop ; 39(9): e668-e673, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503222

RESUMO

BACKGROUND: Anterior tibial spine fractures (ATSF) in the skeletally immature parallel anterior cruciate ligament (ACL) tears in adult patients, yet these injuries are generally regarded as mutually exclusive. Biomechanical analysis suggests that intrinsic ACL damage occurs during ATSF, and long-term clinical studies demonstrate residual anteroposterior knee laxity following ATSF. We aim to describe prevalence, demographics, and characteristics of pediatric patients who sustained ATSF with concomitant ACL injury. METHODS: We included 129 patients with ATSF over a 16-year period. Age, sex, injury mechanism, ATSF type, magnetic resonance imaging (MRI) evaluation, treatment modality, ACL injury, and concomitant meniscal/chondral injuries were analyzed. Concurrent ACL injury was confirmed either from MRI or intraoperatively. RESULTS: Nineteen percent (n=25) of ATSF patients had concomitant ACL injury, with ACL injury significantly more likely in type II or type III ATSF compared with type I ATSF (P=0.03). Patients with combined ATSF/ACL injury were significantly older (P=0.02) and more likely to be male (P=0.01). Mechanism of ATSF injury was not associated with ACL injury (P=0.83). Preoperative MRI had low sensitivity (0.09) for recognizing ACL injury at the time of ATSF relative to intraoperative assessment. Half of ATSF/ACL-injured patients had additional meniscal or chondral injury, with meniscal repair or debridement required in 37.5% of the type II ATSF/ACL injury. CONCLUSIONS: There are demographic characteristics, such as age (older) and sex (male), associated with a higher risk of concomitant ACL injury at the time of ATSF. Type II and type III ATSF patterns had a higher prevalence of ACL injury. MRI failed to correctly identify ACL injury at the time of ATSF. Concomitant ACL injury at the time of ATSF is highly prevalent in the skeletally immature, occurring in 19.4% of patients with ATSF. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Lesões do Ligamento Cruzado Anterior/complicações , Fraturas da Tíbia/complicações , Adolescente , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/epidemiologia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Criança , Estudos de Coortes , Colorado/epidemiologia , Desbridamento , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Prevalência , Estudos Retrospectivos , Tíbia/cirurgia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/epidemiologia , Lesões do Menisco Tibial/complicações
13.
Pan Afr Med J ; 33: 40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384355

RESUMO

Triplane fractures of the proximal tibia are less well known than the distal extremity. The diagnosis is based on a good analysis of X-rays and possibly CT images to better plan the management. The authors reports a triplane fracture of the proximal tibial in a 12 year old boy treated by closed reduction and internal fixation. To our knowledge, only a dozen cases have been reported in the literature with generally a good evolution of the fracture.


Assuntos
Fixação Interna de Fraturas/métodos , Radiografia/métodos , Fraturas da Tíbia/diagnóstico por imagem , Criança , Humanos , Masculino , Fraturas da Tíbia/cirurgia
14.
Medicine (Baltimore) ; 98(32): e16700, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393372

RESUMO

Tibial tubercle avulsion fracture caused by knee extensor is very rare; furthermore, non-traumatic fractures during running or bilateral fractures have been reported. The purpose of this study was to evaluate any differences according to the mechanisms of injury in adolescents with tibial tubercle avulsion fracture.Thirty patients with tibial tubercle avulsion fractures were reviewed and the average age was 13 years 1 month. Seven patients (low-stress group) had a spontaneous fracture during running without definite trauma. Twenty-three patients (high-stress group) experienced pain during jumping and landing, or definite trauma. The mechanisms of injury, age, height, weight, body mass index (BMI), BMI percentile, fracture type, as well as any complication, such as limitation of motion and deformity related to the physeal arrest, were compared between groups.There was no definite difference in age, fracture type, and surgical outcomes between groups. There was no patient with significant early physeal arrest in both groups. The weight (P = .02), BMI (P = .03) and BMI percentile (P = .01) in low-stress group were higher than those in high-stress group. In low-stress group, 6 patients' BMIs were in the 97th percentile, and 1 patient's BMI was in the 5th percentile.Extreme BMI may be a risk factor for tibial tubercle avulsion fractures in adolescents during running without definite trauma. However, there was no difference in the final outcome according to injury mechanisms.


Assuntos
Índice de Massa Corporal , Fratura Avulsão/classificação , Fraturas da Tíbia/classificação , Adolescente , Traumatismos em Atletas/classificação , Criança , Feminino , Fixação Interna de Fraturas , Fratura Avulsão/diagnóstico por imagem , Fratura Avulsão/cirurgia , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Fatores de Risco , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia
15.
J Orthop Surg Res ; 14(1): 267, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443667

RESUMO

BACKGROUND: Tibial plateau fractures remain a clinical challenge due to the complexity of the fracture patterns which have been repeatedly categorized by many researchers. However, limitations do exist in some respects. So we aimed to reclassify tibial plateau fractures based on injury mechanism and morphological characteristics. METHODS: Five hundred fourteen cases of tibial plateau fractures were enrolled. The X-rays and CT scans were analyzed. RESULTS: According to our observation and analysis, tibial plateau fractures can be categorized into the following six types: (1) Lateral condylar fractures (axial force applied while knee extending in valgus position). Two hundred fifty-one cases were included (48.83%). (2) Fracture dislocation (multiple forces especially rotational stress while knee extending). Fifty-five out of 514 cases belong to this pattern (10.70%). Correction of the subluxation remains primary and crucial during surgical procedures. (3) Simple medial condylar fractures (axial force applied while knee extending in varus position). One third of which were associated with an avulsion fracture of fibular head. Fifteen cases were included (2.92%). (4) Bicondylar fractures (axial forces applied while knee extending). One hundred twelve cases were included (21.79%). Surgical algorithm greatly depends on soft tissue conditions. (5) Posterior condylar fractures (axial stress applied while knee flexing). Sixty-five cases were seen in our study (12.65%), most of which were associated with an avulsion fracture of the intercondylar eminence (49/65, 75.38%). The fracture of posteromedial part, posterolateral part, and intercondylar eminence forms a unique pattern of injury defined as "Posterior Condylar Triad." (6) Anterior condylar compression fractures (axial, varus, or valgus forces applied while knee overextending). Posterior structural complexes, crucial ligaments, or even popliteal arteries are prone to be damaged. Sixteen cases were identified (3.11%). CONCLUSION: Our classification system has instructive significance in overall preoperative evaluation of fracture features and soft tissue problems as well as guiding clinical management for better functional outcomes.


Assuntos
Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/epidemiologia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação Interna de Fraturas/tendências , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/epidemiologia , Luxações Articulares/cirurgia , Traumatismos do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Tíbia/cirurgia , Adulto Jovem
16.
Orthop Surg ; 11(4): 560-568, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31456325

RESUMO

OBJECTIVE: To compare short-term treatment effects of internal and external fixation in the treatment of complicated tibial plateau fractures by preoperative planning with 3D printing. METHODS: Sixty-nine patients with tibial plateau fractures were examined. 3D printing was used to establish the model in all patients before the operation. Thirty-four patients were treated with an external fixator (9-Schatzker Type V, 25-Schatzker Type VI) and 35 patients were treated with internal fixation (12-Schatzker Type V, 23-Schatzker Type VI). The time span of the study was 2 years after the operation. All patients were followed up in the clinic of the attending physician who recorded patient follow-up information at the same time. Finally, the Rasmussen functional score, radiographic parameters, complication rates, hospital days and operative parameters of the two groups were analyzed. RESULTS: The short-term (within 2 years) Rasmussen score in the external fixation group was close to that of the internal fixation group; the differences were not significant (P > 0.05). The fractures were reduced adequately using both forms of surgical treatment. There is no significant difference between internal and external fixation in terms of radiographic parameters after 2 years (Mann-Whitney U-tests, P > 0.05). Thrombosis was detected in 7 cases (2 external fixation, 5 internal fixation). Superficial infection was detected in 3 cases (1 external fixation, 2 internal fixation). Deep infection was detected in 3 cases (0 external fixation, 3 internal fixation). Knee stiffness was detected in 4 cases (2 external fixation, 2 internal fixation); 1 (2.7%) case of screw pullout occurred in the internal fixation group. The external fixation group had shorter operation times (172.94 ± 50.00 min vs 253.86 ± 64.59 min), less bleeding volume (395.88 ± 121.10 mL vs 864.29 ± 238.12 mL), and fewer days (17.03 ± 5.03 days vs 30.17 ± 8.64 days) of hospitalization compared to the internal fixation (t-test, P = 0.00); subgroup analysis of all patients with complex tibial plateau fractures revealed that for patients with tibial plateau fracture type VI, the functional score of external fixation (26.79 ± 2.04) is better than that (25.54 ± 1.69) of internal fixation (t- test, P = 0.026) and the overall infection rate of external fixation is lower than that of internal fixation (χ2 - test, P = 0.047). CONCLUSION: Using 3D printed models in combination with external fixation has more advantages for short-term treatment of complex tibial plateau fractures. In particular, relatively better functional recovery and lower rates of infection can be achieved for Schatzker type VI fractures. The external fixation treatment was preferred in cases of Schatzker VI tibial plateau fractures.


Assuntos
Fixadores Externos , Fixação de Fratura/métodos , Fixadores Internos , Impressão Tridimensional , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Adulto , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
J Orthop Surg Res ; 14(1): 236, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340818

RESUMO

INTRODUCTION: The aim of this study was to evaluate the intraoperative revision rate and reasons for revision following 3D imaging in the management of dislocated articular tibial plateau fractures based on a large patient sample. METHODS: This retrospective cohort study included all patients who underwent open reduction and internal fixation due type B or C tibial plateau fracture according to the AO/OTA classification between August 2001 and December 2017 using intraoperative cone beam CT (3D imaging) for the analysis of fracture reduction and implant placement. The findings of the 3D scan were categorized regarding the amount and type of revision. Furthermore, demographic data was examined. RESULTS: Five hundred and fifty-nine consecutive fractures were included in the study. Evaluation of the image data records revealed an intraoperative revision due to the usage of 3D imaging in 148 out of 559 cases (26.5%). The most common reasons for an intraoperative revision were insufficient fracture reduction (114 cases) and screw length (21 cases). CONCLUSION: This study reveals indications for a limited analysis of fracture reduction and implant placement during the operative treatment of dislocated articular tibial plateau fractures using conventional fluoroscopy. In view of the high revision rate during open reduction and internal fixation of tibial plateau fractures due to 3D imaging the usage of intraoperative cone beam, CT may be considered. If this is not possible, a postoperative computed tomography may therefore be reasonable.


Assuntos
Fixação Interna de Fraturas/métodos , Imageamento Tridimensional/métodos , Monitorização Intraoperatória/métodos , Reoperação/métodos , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Gerenciamento Clínico , Feminino , Fluoroscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
18.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340943

RESUMO

A 35-year-old man with juvenile idiopathic arthritis since childhood presented with bilateral atypical tibial fractures, followed by a later, single atypical fracture of the femur. The fractures were associated with 6 years of oral alendronate treatment immediately followed by subcutaneous denosumab therapy and later teriparatide therapy for osteoporosis. Atypical fractures are known to occur in the femur following bisphosphonate therapy; however, there are only a few documented cases of atypical fractures in the tibia. Our case highlights a rare but serious complication of a commonly prescribed antiresorptive agent. It also shows that teriparatide, while helpful in increasing bone mass, does not fully prevent the development of atypical fractures. Careful investigation should be considered in patients on long-term antiresorptive therapy presenting with bony tenderness to exclude an atypical fracture.


Assuntos
Alendronato/efeitos adversos , Denosumab/efeitos adversos , Fraturas Espontâneas/induzido quimicamente , Osteoporose/tratamento farmacológico , Teriparatida/efeitos adversos , Absorciometria de Fóton/métodos , Adulto , Alendronato/uso terapêutico , Densidade Óssea/fisiologia , Denosumab/uso terapêutico , Relação Dose-Resposta a Droga , Esquema de Medicação , Fraturas do Fêmur/induzido quimicamente , Fraturas do Fêmur/diagnóstico por imagem , Seguimentos , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Masculino , Osteoporose/diagnóstico por imagem , Medição de Risco , Teriparatida/uso terapêutico , Fraturas da Tíbia/induzido quimicamente , Fraturas da Tíbia/diagnóstico por imagem
19.
Acta Orthop ; 90(6): 610-613, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31328600

RESUMO

Background and purpose - Unnecessary radiographic and clinical follow-ups are common in treatment of pediatric fractures. We hypothesized that follow-up radiographs are unnecessary to monitor union of physeal fractures of the distal tibia.Patients and methods - All 224 (147 boys) children under 16 years old treated for a physeal fracture of the distal tibia during a 5-year period (2010-14) in Helsinki Children's Hospital were included in this study. Peterson type II fractures comprised 55% and transitional fractures (Tillaux and Triplane) 20% of all injuries. Fracture displacement and alignment was measured. Type and place of treatment was recorded. Number of follow-up radiographs and outpatient visits was calculated and their clinical significance was assessed.Results - 109 children had fractures with < 2 mm displacement and no angulation. The other 115 children's mean fracture displacement was 6 mm (2-28). 54% of all children were treated by casting in situ in the emergency room, 20% with manipulation under anesthesia and 26% with surgery (internal 57, external fixation 2). Median 3 (1-7) follow-up appointments and median 3 (0-6) radiographs were taken. Follow-up radiographs at or before cast removal did not alter treatment in any of the patients. 223 patients' fractures healed within 4-9 weeks in good alignment (≤ 5° angulation).Interpretation - Routine radiographic follow-up is unnecessary to monitor alignment and union of physeal fractures of the distal tibia.


Assuntos
Continuidade da Assistência ao Paciente , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/terapia , Procedimentos Desnecessários , Adolescente , Moldes Cirúrgicos , Criança , Pré-Escolar , Diáfises/diagnóstico por imagem , Diáfises/lesões , Diáfises/cirurgia , Epífises/diagnóstico por imagem , Epífises/lesões , Epífises/cirurgia , Feminino , Finlândia , Fixação de Fratura , Consolidação da Fratura , Humanos , Lactente , Masculino , Manipulação Ortopédica , Visita a Consultório Médico/estatística & dados numéricos , Radiografia , Fraturas da Tíbia/classificação
20.
J Bone Joint Surg Am ; 101(13): 1193-1202, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31274721

RESUMO

BACKGROUND: Quantitative outcomes assessment remains a persistent challenge in orthopaedic trauma. Although patient-reported outcome measures (PROMs) and radiographic assessments such as Radiographic Union Scale for Tibial Fractures (RUST) scores are frequently used, very little evidence has been presented to support their validity for measuring structural bone formation or biomechanical integrity. METHODS: In this pilot study, a sequential cohort of patients with a tibial shaft fracture were prospectively recruited for observation following standard reamed intramedullary nailing in a level-I trauma center. Follow-up at 6, 12, 18, and 24 weeks included radiographs and completion of PROMs (EuroQol 5-Dimension [EQ-5D] and pain scores). Low-dose computed tomography (CT) scans were also performed at 12 weeks. Scans were reconstructed in 3 dimensions (3D) and subjected to virtual mechanical testing via the finite element method to assess torsional rigidity in the fractured limb relative to that in the intact bone. RESULTS: Patients reported progressive longitudinal improvement in mobility, self-care, activity, and health over time, but the PROMs were not correlated with structural bone healing. RUST scoring showed moderate intrarater agreement (intraclass coefficient [ICC] = 0.727), but the scores at 12 weeks were not correlated with the time to union (R = 0.104, p = 0.193) and were only moderately correlated with callus structural integrity (R = 0.347, p = 0.010). In contrast, patient-specific virtual torsional rigidity (VTR) was significantly correlated with the time to union (R = 0.383, p = 0.005) and clearly differentiated 1 case of delayed union (VTR = 10%, union at 36 weeks) from the cases in the normally healing cohort (VTR > 60%; median union time, 19 weeks) on the basis of CT data alone. CONCLUSIONS: PROMs provide insight into the natural history of the patient experience after tibial fracture but have limited utility as a measure of structural bone healing. RUST scoring, although reproducible, may not reliably predict time to union. In contrast, virtual mechanical testing with low-dose CT scans provides a quantitative and objective structural callus assessment that reliably predicts time to union and may enable early diagnosis of compromised healing. LEVEL OF EVIDENCE: Therapeutic Level IV. Please see Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fixação Intramedular de Fraturas , Consolidação da Fratura , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adulto , Fenômenos Biomecânicos , Feminino , Análise de Elementos Finitos , Humanos , Imageamento Tridimensional , Masculino , Medidas de Resultados Relatados pelo Paciente , Projetos Piloto , Estudos Prospectivos , Fatores de Tempo
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