Academic literature on the topic 'Diaphyseal tibial fractures'

Objectives: To evaluate the management of tibial diaphyseal fractures treated byPOP cast versus intramedullary nailing in terms of time of union. Design of study: Randomizedcontrolled trials. Setting: Department of Orthopaedic, Allied / DHQ Hospital, Faisalabad.Duration of Study: Six months (01-08-2013 to 31-01-2014). Materials and Methods: 80patients fulfilling the inclusion and exclusion criteria were included in the study. After laboratoryand radiological assessment, the patients in Group 1 were treated by long leg cast. The patientsin Group 2 were treated with intramedullary interlocking nail. The patients were followed on OPDbasis. Results: 80 patients divided into 2 groups. Each group had 40 patients. Mean age ofpatients was 30.99 ±8.092 years. There were total of 65% males and 35% females in this study.According to geometry of fractures simple transverse fractures were 47.5%, spiral fractureswere 17.5%, oblique fractures were 25% and segmental fractures were 10%. There were 71.25%closed fracture and 28.75% type l open fractures. Mean time of union was 23.86 ± 5.48 weeks ingroup 1 while in group 2, mean time of union was 18.35 ± 4.12 weeks. P-value was 0.001 whichis statistically significant. Conclusion: It is concluded that reamed intramedullary interlockingnailing is a good mode of internal fixation comparing with conservative management of closereduction and POP cast in both close and type I open fractures in terms of union.

Objective The main aim of this study was to evaluate a percutaneous method of bone alignment using a diaphyseal tibial fracture model. Materials and Methods Mid-shaft diaphyseal fractures were created in 12 large-breed canine tibiae. Interaction pins were inserted into the proximal and distal bone segments. Computed tomography scans of the fractured tibiae and pins were imported into three-dimensional (3D) modelling software and the fractures were virtually reduced. A multi-component 3D printed alignment jig was created that encompassed the pins in their aligned configuration. Orthogonal radiographs were taken after alignment jig application. Intact and post-alignment tibial lengths and joint angles were compared. Rotational alignment was subjectively evaluated. Results Post-alignment tibial lengths differed on the mediolateral and craniocaudal radiographs by an average of 1.55 and 1.43% respectively. Post-alignment mechanical medial proximal tibial angle, mechanical medial distal tibial angle and mechanical caudal proximal tibial angle had an average difference of 1.67°, 1.92° and 2.17° respectively. Differences in tibial length and joint angles were not significant (p > 0.05). Clinical Significance While in vivo evaluation is necessary, this technique to align diaphyseal fractures percutaneously using computer modelling and 3D printing is technically feasible and may facilitate the clinical use of minimally invasive osteosynthesis techniques.

Objective: To determine the outcome and consequences of close intramedullaryinterlocking nailing in diaphyseal tibial fractures and to observe the hospital stay & complicationsin this method of treatment. Place & Duration: The study was conducted in department oforthopaedic unit-I at Liaquat University Hospital Jamshoro/Hyderabad during Jan 2011 to June2012. Patients & Method: The present study constituted on 43 patients, 3 cases were droppedduring follow up and the rest 40 cases completed 1 year post operative follow up. After havingroutine laboratory investigations and necessary x – rays, the stable patients were operated forintramedullary interlocking nailing on routine operating days. The patients were assessedaccording to the criteria mentioned in follow up proforma from date and time of arrival to final visitin review clinic and results were tabulated. Results: Among 40 patients, 38 (95%) were males and02 (5%) females. The age ranges from 17 to 50 years with mean age of 32.23 years. There were 25close fractures (62.5%) 15 open fractures (37.5%), among these 13 (32.5%) were Gustilo type Iand 2 (5%) were of type II. The mode of injury in majority (75%) of cases was road traffic accident.Good union achieved in 39 cases (97.5%) in 17.53 weeks. But only 1 (2.5%) case unfortunatelywent in infected non union and was converted into Illizarove external Fixation. The maincomplication observed after surgery was loosening of screw in 3 (7.5%) cases. Deep infectionwas observed in the medullary cavity in 3(7.5%) cases (table-V). It has been observed inanalyzing the functional outcome of these patients that majority (80%) of cases was able to sit onbed in 12-24 hours and was able to stand in 24-48 hours. In next 24 hours after surgery 75% ofpatients were pain free. The mean hospital stay in these cases was 8.53 days and by the 48thweek all of cases were able to join their job except one case in which non union observed due toinfection. Conclusions: The data from the current study reveals that intramedullary interlockingnailing of closed and open grade I and II fractures is a safe technique. It combines a high rate ofunion with a low complication rate, less hospitalization and early return to job.

Objectives: To determine the management of open diaphyseal fracture of tibia with plaster of Paris (pop) cast vs external fixator in orthopedic ward PUMHSW Hospital Nawabshah. Study Design: Cross-Sectional Comparative study. Setting: Orthopedic Department, Peoples University of Medical And Health Science Shaheed Benazirabad. Period: 18 months from January 2017 to June 2018. Material & Methods: The data was analyzed in SPSS Version 22.0. Results: Out of 50 patients with tibial diaphyseal fractures, there were 34 males compared to females 16 (2.1:1) (68% vs 32%) with an average age of 41 years. Patients with external fixator applied yielded decreased rates of infection; shorter duration of hospital stay and early union compared to patients with plaster of Paris (pop) cast application. However, the difference reached statistical significant value. Conclusion: Open Tibial diaphyseal fractures should be managed with external fixation that yields better results. A plaster cast is the initial treatment of modality in patients with open tibial diaphyseal fractures.

<p class="abstract"><strong>Background:</strong> The tibia, or shinbone, is the most commonly fractured long bone in the body. A tibial shaft fracture occurs along the length of the bone, below the knee and above the ankle. It typically takes a major force to cause this type of broken leg. Motor vehicle collisions, for example, are a common cause of tibial shaft fractures. In many tibia fractures, the smaller bone in the lower leg (fibula) is broken as well. The objective was to study fracture healing and union rates with closed intra-medullary interlocking nailing.</p><p class="abstract"><strong>Methods:</strong> Patients of both sexes belonging to adult age group presenting with fracture tibia to Orthopedic Department, Vydehi Institute of Medical Sciences, of are admitted from January 2015 to December 2015.<strong></strong></p><p class="abstract"><strong>Results:</strong> In the present study maximum number of patients belongs to 18 to 27 years age group (18 cases) followed by 28 to 37 years age group (15 cases), maximum number of patients sustained tibia fracture due to RTA (38 cases) followed by fall (12 cases), maximum number of patients sustained simple tibia fracture (32 cases), followed by type 2 compound tibia fracture (13 cases) and 36 patients had excellent functional results and 8 patients had good functional outcome, while only 4 patients had fair functional outcome.</p><p class="abstract"><strong>Conclusions:</strong> IM rods are secured within the bone by screws both above and below the fracture. The metal screws and the rod can be removed if they cause problems, but can also be left in place for life. Tibial rodding provides excellent fixation and alignment of the bones.</p>

Introduction: Tibial fractures accompanied by radius fractures at typical sites are the most common type of fractures. Objective: The study is aimed at using the examined sample to make an efficient and economically acceptable choice in the treatment of tibial diaphyseal fractures. Material and methods: The series comprises a retrospective and prospective study of the treatment of 131 fresh tibial fractures: 31 in women (23.66%) and 100 in men (76.34%) of the average age of 37.89. Nineteen patients (14.50%) were treated conservatively and 112 (85.50%) surgically: 22 (16.79%) with anti-rotation intramedullary nails, 74 (56.49%) with Mitkovic external fixator type M20, and 16 (12.21%) with locking compression plate. General anaesthesia was used in 46 patients (35.11%), while spinal anaesthesia was used in 85 of them (64.89%). Results: According to the Karlstrom-Olerud scoring system, the treatment results were as follows: for the 22 tibiae treated with anti-rotation intramedullary nails: in 15(68.18%) the results were excellent, in 3 (13.64%) they were good and in 4(18.18%) they were poor. As for the results for the 74 tibiae treated with Mitkovic external fixator type M20, they were as follows: in 62(83.78%) excellent, in 9(12.16%) good, and in 3(4.05%) they were poor. The results for the 16 patients treated with locking compression plate were excellent in 10(62.50%), good in 2(12.50%) and poor in 4 patients (25.00%). The treatment results for the 19 tibiae treated with plaster cast were excellent in 12 patients (63.16%), good in 2(10.53%) and poor in 5 (26.32%). The definite results for the 131 fractured tibiae treated with the aforementioned techniques were as follows: excellent in 99(75.57%), good in 17 (12.98%) and poor in 15 patients (11.45%). Discussion: There is a variety of controversial positions concerning the treatment of the tibial diaphysis. Conclusion: On the basis of the results of surgical treatment for the given series, the number of surgical interventions, the price of osteosynthetic material, my preferences in treating tibial diaphyseal fractures would be as follows: Mitkovic external fixator type M20, anti-rotation intramedullary nails and locking compression plate. Conservative treatment is indicated when the X-ray examination confirms that the fragments have a position acceptable for conservative treatment with plaster cast.

Background: Tibia is the most commonly fractured bone because of itsstructure and position. Tibial fractures are increasing with time to time and hence the morbidityand mortality are increasing despite proper public health efforts. There is a lack of nationalepidemiological data on the characteristics of patients with tibial shaft fractures. Therefore,epidemiological assessment is crucial for fracture. The purpose of this study was to provide upto-date information about patients baseline demographics, distribution of fracture classification,trauma mechanism and to formulate the preventive measures. Study Design: Retrospectivestudy. Setting: Emergency or OPD at Orthopaedics and Spine Centre, Ghurki Trust TeachingHospital, Lahore. Period: 1st January 2011 to 31st December 2015. Material and methods:Any type of diaphyseal tibial fracture. The data were taken from hospital database and includeclinical, epidemiological and radiological records. The results were analyzed using SPSS 20.Results: A total of 2120 patients were included in the study. 1980(93.4%) were male and 140(6.6%) were females. Male to females ratio were 14.14:1 with mean age of 33.28 ± 21.02.Between 0-20 years, 519(24.5%) of patients were admitted, 1021(48.2%) of patients werebetween 21-40 years, 467(22.0%) were between 41-60 years and only 113(5.33%) were above60 years. Type A2 in 444(20.9%) were the most common pattern of fracture found. The traumaswere most common in months of May, June and July and Motorbike accidents were the maincause. The mid shaft of tibia is the most commonly fractured i-e 1038 (49.0%) followed bydistal part i-e 611(28.8%) and the least is the proximal i-e 471(22.22%). Conclusion: Thisstudy shows AO-type 4A2 was the most common fracture type, representing 20.9% of all tibialshaft fractures. The individuals between 21-40 years were mostly affected and the motorbikeaccidents were found the main cause for such traumas.

Background: Tibial shaft fractures are the commonest long bone fractures in adults, most commonly managed by intramedullary interlocking nailing. However, several meta-analysis show that locking plate osteosynthesis is equally effective in managing tibial diaphyseal fractures and are associated with less number of complications. Aim: To compare the results of fixation of tibial fractures followingplating and nailing in terms of union, patient satisfaction and complications. Materials and Methods: Khwaja Yunus Ali Medical College and Hospital based non randomized clinical trial was performed from September 2014 to August 2017 where closed or open diaphyseal or metaphyseo- diaphyseal fractures of the tibia (closed or open Gustilo Anderson type 1 through 3B) were included. Simple sequential allocation was used for allotting the patients to two groups, one for interlocking nailing and other for plating. The patients were followed up for clinical, radiographic and functional results. Results: Forty patients with 41 involved limbs completed followup for one year. in our study was 19.55±0.69 weeks in case of interlocking nailing and 20.38±1.39 weeks in case of plating and there was no statistically significant difference between the two. Conclusion: There was no difference between the twomodalities in terms of fracture union. Complications were lesser but more serious in case of plating. Patient satisfaction was more with plating. KYAMC Journal Vol. 10, No.-2, July 2019, Page 99-105

Introduction: Open tibia fractures are some of the most common types of Orthopedics injuries in low- and middle-income countries (LMICs). In Tanzania, open tibia fractures are treated either conservatively by prolonged cast or surgically by external fixation (EF) or intramedullary nail (IMN) when available. The cost of treatment and amount of time patients spend away from work are major economic concerns with prolonged casting and EF. The goal of this study was to determine the cost effectiveness of IMN versus EF in the treatment of open diaphyseal tibia fractures at Muhimbili Orthopaedic Institute (Dar es Salaam, Tanzania). Methods: This is a prospective randomized control study conducted of patients with a closeable AO/OTA 42 open diaphyseal tibia fracture. The patients underwent surgical fixation with either IMN or EF at Muhimbili Orthopaedic Institute (MOI), and were followed up at 2, 6, and 12 weeks postoperatively. A micro-costing method was used to estimate the fixed and variable costs of IMN and EF of the open diaphyseal tibial fracture. Results: The mean total cost per patient was lower for the IMN group ($425.8 ± 38.4) compared to the EF group ($559.6 ± 70.5, p < 0.001), with savings of $133.80 per patient for the IMN group. The mean hospital stay was 2.72 ± 1.40 days for the IMN group and 2.44 ± 1.47 days for the EF group (p = 0.5). Quality-adjusted life years (QALYs) were 0.26 per patient for the IMN group and 0.24 in the EF group at 12 weeks (p = 0.8). Ninety-two percent of patients in the IMN group achieved fracture union versus 60% in the EF group at three months postoperatively (p = 0.03). Conclusion: IM nailing of a closeable open diaphyseal tibial fracture is more cost effective than EF. In addition, IM nailing has better union rates at three months compared to EF.

The dachshund, a chondrodystrophic dog breed, presents a unique challenge in the treatment of tibial fractures by having short and curvaceous tibiae, leading to high implant failure risk. In this study, intramedullary pins with full cerclage wires as an option in the treatment of oblique diaphyseal tibial fractures was studied in vitro. This fixation technique was biomechanically compared with the current gold standard in internal stabilization, namely bone plates and screws. Twenty tibiae recovered from adult dachshund cadavers were randomly allocated into two groups of ten bones each. Oblique fractures running in a proximo-cranial-disto-caudal direction in the middle third of the tibial diaphysis were simulated by osteotomy and each bone repaired by using one of the following methods:

• Pre-bent intramedullary pin, filling 40% to 60% of the medullary cavity at its narrowest point, inserted normograde and combined with a set of three full cerclage wires (group 1).
• Lag screw at the osteotomy site, combined with a six hole 2.7 mm contoured dynamic compression plate and cortical screws in neutral mode (group 2).

Each test specimen was subjected to a two point single cycle axial compression test by applying a standardized, increasing compression load to the point of fixation failure or bone collapse. A stress-strain graph for each test specimen was drawn from the raw data. Radiographs and digital photographs were made pre-osteotomy, post-osteotomy, post-repair and post-test, and modes of failure noted for each test specimen. Stress (applied load) and strain (deformation) at yield, ultimate strength, and at failure were determined for each test specimen from the stress-strain graphs and the mean values statistically compared between the groups using the ANCOVA method. Significance levels of p < 0.05 were used, while p < 0.1 and p < 0.01 were also indicated. In group 1, 50% specimens failed due to unraveling or slippage with displacement of the cerclage wires, 30% due to bone fracture at a cerclage wire, and 20% due to bone fracture elsewhere. In group 2, 80% specimens failed due to bone fracture at one or more of the screw holes, whereas 20% failed due to bone fracture not directly associated with implants. No bone plate or screw underwent plastic (permanent) deformation, whereas 80% of the intramedullary pins and 30% of the cerclage wires underwent plastic deformation. Mean stress at the yield point in groups 1 and 2 were 0.323 MPa and 0.403 MPa respectively, at the point of ultimate strength 0.383 MPa and 0.431 MPa respectively, and at the failure point 0.345 MPa and 0.403 MPa respectively. Mean strain at the yield point in groups 1 and 2 were 0.296% and 0.362% respectively, at the point of ultimate strength 0.412% and 0.472% respectively, and at the failure point 0.713% and 0.838% respectively. Clinically, there was an indication that plates and screws were more resistant to deformation by the loads applied than intramedullary pins and cerclage wires. However, statistically, there were no significant differences in stress at yield (p = 0.299), ultimate strength (p = 0.275), or failure (p = 0.137) between the two groups. Similarly, there were no significant differences in strain at yield (p = 0.684), ultimate strength (p = 0.778), or failure (p = 0.505) between the two groups. Main limitations of the study were the relatively small number of specimens tested, the smoothness of the osteotomy cuts which limited interdigitation between the fragments, and that only three of the five recognized loads acting on bones in vivo, were tested in vitro. In conclusion, this study did not show enough evidence to prove a significant difference between the two methods of fixation. Therefore, it is suggested that intramedullary pins and full cerclage wires be used as an acceptable alternative to bone plates and screws in the treatment of oblique mid-diaphyseal tibial fractures in chondrodystrophic dog breeds.
Die dachshund, ‘n chondrodistrofiese honderas, bied ‘n unieke uitdaging in die behandeling van frakture van die tibia, deurdat hulle tibias kort en krom is, wat lei tot ‘n hoë risiko van inplantaat mislukking. In hierdie studie is intramedullêre penne met vol sirkeldrade as ‘n keuse in die behandeling van skuins frakture van die tibiale skag in vitro bestudeer. Hierdie tegniek van herstel is vergelyk met die huidige goue standaard in interne stabilisering, naamlik beenplate en skroewe. Twintig tibias wat van volwasse dachshund kadawers herwin is, is lukraak aan twee groepe van tien bene elk toegewys. Skuins frakture in ‘n proksimo-kranio-disto-koudale rigting in die middelste derde van die tibiale skag is nageboots deur ‘n osteotomie, waarna elke been herstel is deur die gebruik van een van die volgende metodes:

• Vooraf gebuigde intramedullêre pen, wat 40% tot 60% van die murgholte by die dunste punt vul, normograad geplaas en gekombineer met ‘n stel van drie vol sirkeldrade (groep 1).
• Trekskroef by die osteotomie area, gekombineer met ‘n ses-gat 2.7 mm gekontoerde dinamiese drukplaat en kortikale skroewe geplaas op neutrale wyse (groep 2).

Elke toetsmonster is onderwerp aan ‘n twee-punt enkel siklus aksiale druktoets deur die toepassing van ‘n gestandardiseerde, verhogende druklading tot by die punt van fiksasie breuk of kollaps van die been. ‘n Druk-spanning grafiek vir elke toetsmonster is vanaf die rou data saamgestel. X-straalfoto’s en digitale foto’s van elke been is pre-osteotomie, post-osteotomie, post-herstel and post-toets geneem en die maniere van faal vir elke toetsmonster aangeteken. Druk (toegepaste lading) en spanning (vervorming) by meegee (“yield”), treksterkte (“ultimate strength”) en faal (“failure”) is vir elke toetsmonster bepaal vanaf die druk-spanning grafieke en die gemiddelde waardes statisties vergelyk tussen die groepe deur gebruik te maak van die ANCOVA metode. Beduidenis vlakke van p < 0.05 is gebruik, terwyl p < 0.1 en p < 0.01 ook aangedui is. In groep 1 het 50% toetsmonsters gefaal as gevolg van losgaan of gly van die sirkeldrade met verplasing, 30% as gevolg van beenfrakture by ‘n sirkeldraad, en 20% as gevolg van beenfrakture elders. In groep 2 het 80% toetsmonsters gefaal as gevolg van beenfrakture by een of meer skroefgate, terwyl 20% gefaal het as gevolg van beenfrakture wat nie direk met die inplantate geassosieer is nie. Geen beenplaat of skroef het plastiese (permanente) vervorming ondergaan nie, terwyl 80% van die IM penne en 30% van die sirkeldrade plastiese vervorming ondergaan het. Gemiddelde druk by die meegeepunt in groepe 1 en 2 was 0.323 MPa en 0.403 MPa onderskeidelik, by die punt van treksterkte 0.383 MPa en 0.431 MPa onderskeidelik, en by die faalpunt 0.345 MPa en 0.403 MPa onderskeidelik. Gemiddelde spanning by die meegeepunt in groepe 1 en 2 was 0.296% en 0.362% onderskeidelik, by die punt van treksterkte 0.412% en 0.472% onderskeidelik, en by die faalpunt 0.713% en 0.838% onderskeidelik. Klinies was daar ‘n indikasie dat plate en skroewe meer weerstandbiedend was teen vervorming deur die toegepaste ladings as intramedullêre penne en sirkeldrade. Statisties was die druk wat die toetsmonster laat meegee (p = 0.299), en die druk by die treksterkte- (p = 0.275) en faalpunte (p = 0.137) egter nie beduidend verskillend tussen die twee groepe nie. Net so was die spanning by die meegee- (p = 0.684), treksterkte- (p = 0.778) en faalpunte (p = 0.505) nie beduidend verskillend tussen die twee groepe nie. Hoof beperkings van die studie was die relatief klein getal monsters wat getoets is, die gladheid van die osteotomie-snitte wat interdigitasie tussen die fragmente beperk het, en dat slegs drie van die vyf erkende ladings wat op bene in vivo inwerk, in vitro getoets kon word. Laastens het hierdie studie nie genoeg getuienis opgelewer om ‘n beduidende verskil te bewys trussen die twee metodes van herstel nie. Derhalwe word voorgestel dat IM-penne en vol sirkeldrade gebruik word as aanvarbare alternatief tot beenplate en skroewe in die behandeling van skuins midskag tibia frakture in chondrodistrofiese honderasse.
Dissertation (MSc)--University of Pretoria, 2012.
Companion Animal Clinical Studies
unrestricted

博士
國立成功大學
生物醫學工程學系
105
Elastic stable intramedullary nailing (ESIN) is a treatment strategy for the management of diaphyseal long-bone fractures in adolescents and children, but few studies have investigated the mechanical stability and the stability mechanism of tibial diaphyseal fractures treated with various degrees of prebending of the elastic nails. Therefore, the aim of this study was to compare the mechanical stability, including the gap deformation and nail dropping, of a tibia fracture with various fracture sites and fixed with various degrees of prebending of the elastic nails. The stability mechanism of prebent nails was examined through nail deformation during implantation into the intramedullary canal. Furthermore, the contribution of end caps to stability was taken into consideration in the simulation. A tibia model based on the CT images of a healthy subject was developed with a transverse fracture at the proximal, middle and distal parts of the diaphysis, and fixed with three degrees of prebending of elastic nails, including those equal to, two times and three times the diameter of the intramedullary canal. The outer diameter of the nail used in the computation was 3.5 mm, and the fractured tibia was fixed with two elastic double C-type nails. Furthermore, the proximal end of each nail was set to free or being tied to the surrounding bone by a constraint equation to simulate with or without using end caps. The results indicated that using end caps can prevent the fracture gap from collapsing by stopping the ends of the nails from dropping back in all prebending conditions and fracture patterns, and increasing the prebending of the nails to a degree three times the diameter of the canal reduced the gap shortening and the dropping distance of the nail end in those without using end caps under axial compression and bending. Insufficient prebending of the nails and not using end caps caused the gap to collapse and the nail to drop back at the entry point under loading. Using end caps or increasing the prebending of the nails to three times the diameter of the canal is suggested to stop the nail from dropping back and thus produce a more stable structure, with less gap deformation and less nail dropping, in the management of a simulated tibial diapyhseal fracture by using titanium elastic nails with a double C-shape.

♦ After forearm and digital injuries, tibial and ankle fractures are the commonest fractures in the immature skeleton and the majority of these involve the diaphysis or ankle♦ Compared to the morbidity seen in adults these are relatively forgiving injuries in children as the healing rate of bone and soft tissues is rapid and remodelling will occur♦ It is wise, however, to guard against overconfidence in the remodelling potential of certain injuries; for example, angulated mid-diaphyseal fractures, rotational malalignment, and metaphyseal fractures within 2 years of skeletal maturity♦ Children will tolerate manipulative/cast treatment better than adults as the duration of treatment is usually shorter and rapid rehabilitation is almost the norm with or without physiotherapy♦ Postfracture overgrowth does occur but is less than that following femoral fractures and seldom clinically significant (over 10mm)♦ Isolated fibular fractures are of minor importance but need to be taken into account in managing complex injuries involving the distal tibia♦ It is convenient to discuss injuries according to three anatomical sections: proximal, diaphyseal, and distal.