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1
Veaux, Philippe. "Traitement chirurgical à foyer fermé sous contrôle arthroscopique des fractures des plateaux tibiaux : à propos de 20 dossiers." Bordeaux 2, 1990. http://www.theses.fr/1990BOR25073.
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Ramirez, del Villar Stéphan. "Traitement par extension continue des fractures du pilon tibial de l'adulte : résultats à long terme." Bordeaux 2, 1992. http://www.theses.fr/1992BOR23094.
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FERRARINI, JEAN-MARC. "Fractures du pilon tibial : etude retrospective d'une serie de 55 patients." Toulouse 3, 1992. http://www.theses.fr/1992TOU31530.
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ABADIE, CATHALA NATHALIE. "Fractures du pilon tibial : a propos de 11 cas." Toulouse 3, 1992. http://www.theses.fr/1992TOU31095.
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RENAUD, CHRISTIAN. "Fractures des plateaux tibiaux recentes chez l'adulte : a propos de 124 cas." Amiens, 1990. http://www.theses.fr/1990AMIEM013.
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Greenfield, Julia. "Biomechanical assessment of distal tibia fracture reduction devices for supramalleolar corrective osteotomy fixation." Thesis, Lyon, 2019. http://www.theses.fr/2019LYSE1214.
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Introduction: Une procédure fréquente pour la prévention de l’arthrose de la cheville est une ostéotomie corrective du tibia distal (SMOT). Le Distal Tibia Nail (DTN ; Mizuho®), a été développé pour la réduction des fractures du tibia distal. L’objectif de ce projet était d’analyser la faisabilité du DTN pour des procédures SMOT effectuées avec une ouverture médiale (MWO). Méthodes : Au total 16 Sawbones® ont été instrumentés par un DTN ou une plaque (MDTP, Synthes®), suivi par la simulation d’une MWO. Quatre phases d’expérimentation étaient définies : Phase-0, Sawbones sans implant ni MWO ; Phase-1, échantillons avec un implant et MWO. Phase-2, les échantillons de la Phase-1 avec le cortex latéral fracturé ; Phase-3, simulation d’une fracture de type A3. La raideur et le mouvement inter-fragmentaire (IFM) étaient analysés. Des tomographies des échantillons ont été prises à Phases 0 et 1. Résultats : Jusqu’à 80% de différence était présente enter les Sawbones® de Phase-0 ; dans les Phases 1 et 2, des différences importantes se sont montrées entre des implants mais équivalent à <2 mm d’IFM. Le DTN a démontré une résistance très élevée aux charges appliquées en comparaison avec le MDTP pour la fixation des fractures A3. Des facteurs expérimentaux tels que la raideur initiale des Sawbones®, l’axe de chargement, et le positionnement de l’échantillon dans la machine d’essai, peuvent tous avoir une influence importante sur la raideur mesurée. Conclusion : Le DTN peut être considéré comme option pour la fixation des SMOT effectués avec un MWO. Des études futures doivent faire attention aux conditions limites ayant un effet sur des critères d’évaluation et des conclusions tiréesIntroduction: Supra-malleolar corrective osteotomies (SMOT) are a common surgical procedure for the prevention of early onset of ankle arthritis. The Distal Tibia Nail (DTN; Mizuho®), was previously developed for the reduction of distal tibia fractures. The aim of this project was to identify error sources in biomechanical testing, and to test the feasibility of the DTN for SMOT performed using the medial wedge opening (MWO) technique. Methods: A total of 16 Sawbones® were each implanted with either a DTN or medial distal tibia plate (MDTP; Synthes®), and a MWO simulated. Four testing phases were defined: Phase-0, testing of Sawbones® without implant/osteotomy; Phase-1, samples with MWO and implant; Phase-2, Phase-1 samples with lateral cortex fractured; Phase-3, samples with an A3 type fracture. Stiffness construct and interfragmentary movement (IFM) were analysed. CT scans were taken of the samples at Phases 0 and 1. Results: Up to 80% difference was noticed between Sawbones® samples in Phase-0; in Phases 1 and 2 significant differences were found between stiffness constructs of the implant groups but this amounted to <2 mm IFM. The DTN was significantly more resistant to compression and torsion when supporting an A3 fractures (Phase-3). Elements such as original Sawbones® stiffness construct, implant position, potting material, loading axis, and sample positioning can have a high influence on measured stiffness and bias the results. Conclusion: The DTN is a viable option for the fixation of SMOT performed with a MWO technique. Future studies should pay careful attention to boundary conditions affecting outcomes measures and drawn conclusions
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Farthouat, Philippe. "Les fractures des épines tibiales chez l'enfant : à propos de 27 cas." Bordeaux 2, 1989. http://www.theses.fr/1989BOR25131.
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LECLAIR, OLIVIER. "L'enclouage verrouille du femur et du tibia : a partir du materiel standard ao : notre experience a partir de 80 cas." Toulouse 3, 1988. http://www.theses.fr/1988TOU31277.
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Robb, Julie Lynn. "In vitro evaluation of veterinary and human suture anchors in metaphyseal bone of the canine tibia." Diss., Columbia, Mo. : University of Missouri-Columbia, 2006. http://hdl.handle.net/10355/5908.
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Thesis (M.S.)--University of Missouri-Columbia, 2006."August 2006" The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Vita. Includes bibliographical references.
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Watson, Hilary Joy. "Longitudinal study of recovery following diaphyseal fracture of the tibia or femur." Thesis, University of Edinburgh, 1988. http://hdl.handle.net/1842/19399.
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DEBEUGNY, PHILIPPE. "Fractures des epines tibiales de l'enfant : a propos de 22 observations." Lille 2, 1991. http://www.theses.fr/1991LIL2M351.
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TRIOMPHE, GENETY FRANCOISE. "Les fractures de fatigue du tibia chez le sportif : a propos de 16 cas ; revue de la litterature ; travail du centre de medecine du sport, service du professeur j.l. lerat." Lyon 1, 1989. http://www.theses.fr/1989LYO1M180.
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Gaugain, Claude. "Les fractures de contrainte par insuffisance osseuse du tiers inferieur du tibia." Nancy 1, 1988. http://www.theses.fr/1988NAN11300.
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Roberts, Anthony. "Computer analysis of acceleration and displacement data to monitor fracture repair of the tibia." Thesis, University of Salford, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.308291.
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GAUJOUX, GERARD. "Les troubles de croissance apres fracture de la metaphyse superieure du tibia chez l'enfant." Aix-Marseille 2, 1988. http://www.theses.fr/1988AIX20131.
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Reuter, Kimberly Marie. "A finite element model to study the torsional fracture strength of a composite tibia." Thesis, Wichita State University, 2009. http://hdl.handle.net/10057/2544.
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Screws are common orthopaedic hardware used to secure a fractured bone. After the
bone has healed, the screws may be removed, and the vacant screw holes introduce a potential
site for re-fracture, which is a known complication. The current study simulated a laboratory
torsional fracture test of a composite analogue tibia with vacant screw holes by using a finite
element (FE) model, and the results from the simulation were compared to those obtained
experimentally. Variations of the FE model were also analyzed to investigate the effects of
failure model, screw holes, element size, rotation direction, and simplification of the model's
geometry. This FE model was set up the same as the experimental torsion test, with a section
from the distal portion of the tibia. The proximal end of the section was subjected to an axial
load and rotated, while the distal end was fixed. The FE model contained 102,126 first order
tetrahedral elements and 24,817 nodes, and it utilized an isotropic linear elastic material law with
material properties obtained from the composite analogue manufacturer. Comparisons between
the FE model variations considered the fracture torque, fracture angle, torsional stiffness,
principal stress contour, and maximum shear stress contour. The results predicted a fracture
torque within the standard deviation of the experimental data, and the percent of strength
reduction caused by the screw holes agreed with experimental data.Thesis (M.S.)--Wichita State University, College of Engineering, Dept. of Mechanical Engineering
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Castiglia, Marcello Teixeira. "Complementação tomográfica da classificação de Schatzker para as fraturas do planalto tibial." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/17/17142/tde-23042018-171943/.
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As fraturas do planalto tibial são lesões com um espectro muito variado de manifestação clínica. Diversos sistemas de classificação foram desenvolvidos para facilitar a compreensão e a tomada de decisões no tratamento dessas lesões. O presente estudo teve como objetivo primário avaliar o impacto da tomografia computadorizada na concordância inter e intraobservador da classificação de Schatzker. Além disso, procurou-se avaliar o impacto da tomografia computadorizada na tomada de decisões a respeito da via de acesso cirúrgico ao planalto tibial, utilizando para esta análise a classificação de Schatzker modificada por Kfuri. Um banco de dados com imagens de 70 pacientes, incluindo radiografias, tomografia computadorizada e reconstruções tridimensionais computadorizadas foi oferecido a um grupo de 10 observadores para análise. Como resultados, observou-se que a classificação de Schatzker apresentou coeficiente de concordância moderado, quando baseado no uso de radiografias (k=0,58), e substancial quando esta análise foi complementada por tomografia (k=0,62/0,64). A nova classificação de Schatzker modificada por Kfuri obteve nível moderado de concordância interobservador (k=0,53) e substancial intraobservador (k=0,63). A tomografia computadorizada, elemento básico da nova classificação, influenciou decisivamente os cirurgiões a mudarem a opção pela via de acesso cirúrgico, especialmente em fraturas com orientação no plano coronal. Como conclusão, verificou-se que a classificação de Schatzker modificada por Kfuri demonstrou substancial índice de concordância intraobservador e moderado índice de concordância intraobservador, e devem ser úteis para a prática clínica.Tibial plateau fractures are lesions with a varied spectrum of clinical presentation. Several classification systems have been developed to facilitate the understanding and decision making in the treatment of these injuries. The present study aimed to evaluate the impact of computerized tomography on the inter and intraobserver correlation of the Schatzker classification. In addition, we sought to evaluate the impact of the computed tomography in the decision making regarding the surgical approaches to the tibial plateau, using the Schatzker classification modified by Kfuri for this analysis. A database of 70 patient images, including radiographs, computerized tomography, and computerized three-dimensional reconstructions were offered to a group of 10 observers for analysis. As a result we observed that the Schatzker classification presents a moderate agreement when based on radiographs (k=0,58) and substantial when this analysis is complemented by tomography (k=0,62/0,64). The new Schatzker classification modified by Kfuri has a moderate level of interobserver agreement (k=0,53) and substantial intraobserver agreement (k=0,63). Computerized tomography, a basic element of the new classification, decisively influenced surgeons to change the option for surgical access, especially in fractures with orientation in the coronal plane. In conclusion, the Schatzker classification modified by Kfuri have a substantial intraobserver and moderate interobserver correlation, and should be useful for clinical practice.
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KHALFA, KHALED. "Les lipides libres du plasma apres l'enclouage centro-medullaire du femur et du tibia et dans les embolies graisseuses." Strasbourg 1, 1987. http://www.theses.fr/1987STR15005.
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Sauget, Jean-Baptiste. "L'enclouage centro-médullaire des fractures diaphysaires aux membres inférieurs : expérience du matériel de Russel-Taylor sur 6 ans : révision de 356 enclouages." Montpellier 1, 1995. http://www.theses.fr/1995MON11033.
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Delpuech, Benjamin. "Simulation de la résistance du tibia de souris avec et sans tumeur osseuse." Thesis, Lyon, 2019. http://www.theses.fr/2019LYSE1132.
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Le corps humain (adulte) est composé de 206 os (“Anatomy and Physiology | Simple Book Production” n.d.) qui sont des tissus denses et composent la majeure partie du squelette humain. Le squelette, étant hautement vascularisé, est l’endroit le plus communément affecté par le cancer métastatique (Coleman 1997). L’apparition de ces métastases osseuses fragilise l’os et peut provoquer des fractures pathologiques. Toutefois la prédiction de telles fractures est difficile et loin d’être automatique. Une possibilité pour créer un outil de diagnostic plus performant serait les simulations éléments finis (FEA en anglais pour « Finite Elements Analysis »). Des études ont montré que la FEA spécifique au patient était capable de surpasser l’expertise des cliniciens dans le cas d’étude ex vivo avec défauts osseux induits mécaniquement (dont Derikx et al. 2012). Les recherches portant sur le cancer osseux sont toutefois dur à mettre en place, les échantillons étant rare. De manière à contourner la difficulté de trouver des échantillons humains rarement disponibles, la souris a été utilisé comme modèle squelettique dans plusieurs cas, incluant la tenue mécanique d’os atteint de métastases ex vivo (Mann et al. 2008). Ainsi, de manière à pouvoir étudier l’implication du tissu métastatique dans la résistance globale de l’os sur échantillons réels, nous avons utilisé ce modèle animal pour créer des échantillons tumoraux.Notre but était double : premièrement, quantifier l’apport de la prise en compte des propriétés mécaniques de la métastase dans la résistance globale de l’os. Deuxièmement, statuer sur le fait qu’un modèle plus simple que celui proposé dans la littérature (reposant sur des propriétés purement élastiques plutôt qu’élasto-plastiques (Eggermont et al. 2018) pouvait permettre d’améliorer la prédiction de fractures pathologiques.Tout d’abord, les résultats obtenus avec nos modèles hétérogènes (ne prenant pas en compte la tumeur) ont montré une bonne consistance avec la littérature, la corrélation entre tous les modèles hétérogènes (n=43 pattes) quant à la fracture simulée et expérimentale étant du même ordre de grandeur que celles d’une étude analogue menée sur vertèbres de souris (Nyman et al. 2015). Ensuite, le modèle prenant en compte les propriétés des tumeurs n’as pas permis d’améliorer la prédiction de fracture, au contraire, la moyenne des différences de ces modèles étant de 30±21% (n=11 pattes tumorales) contre 12±9% (n=43 pattes). De plus le modèle spécifique (prenant en compte le module des tumeurs) étant plus difficile à obtenir que le modèle hétérogène (ne nécessitant pas de segmentation entre os et tumeur), le premier ne semble pas être judicieux dans la prédiction de fracture d’os long présentant des lyses osseuses. Enfin, un critère de détection reposant sur la différence entre valeurs de forces ultimes globale et locale a permis de détecter la majorité des instabilités mécaniques constatées dans cette étude (sensibilité de 85% et spécificité de 100%). Un autre critère, basé sur le ratio entre poids des individus et la force ultime locale prédite via FEA a permis de correctement diagnostiquer l’ensemble des cas (100% de sensibilité et de spécificité). Ce résultat pourrait s’avérer être d’une grande aide quant à la prise de décision d’intervention chirurgicale dans le cas d’os long atteints de métastases osseuses. Bien sûr, avant cela la route à parcourir reste longue, ce résultat devant d’abord être confirmé cliniquement (possiblement en ayant recours à l’étude d’un cohorte rétrospective, comme cela a déjà pu être fait dans d’autres études (Eggermont et al. 2018). Cette étude vient d’être initiée dans le cas du projet MEKANOS (étude multicentrique en France) porté par le Professeur Cyrille Confavreux (rhumatologue)The human body (adult) is composed of 206 bones ("Anatomy and Physiology | Simple Book Production" n.d.) that are dense tissues and make up the bulk of the human skeleton. The skeleton, being highly vascularized, is the most commonly affected site for metastatic cancer (Coleman 1997). The development of these bone metastases weakens the bone and can cause pathological fractures. However, the prediction of such fractures is difficult and far from automatic. One possibility for creating a more powerful diagnostic tool would be finite element simulations (FEA). Studies have shown that patient-specific FEA is able to surpass the expertise of clinicians in the case of ex vivo studies with mechanically induced bone defects (including Derikx et al., 2012). Research on bone cancer, however, is hard to put in place as samples are rare. In order to overcome the difficulty of finding human samples that are rarely available, the mouse has been used as a skeletal model in several cases, including the mechanical resistance of bones with ex vivo metastases (Mann et al., 2008). Thus, in order to study the involvement of metastatic tissue in the overall bone resistance of real samples, we used this animal model to create tumor samples. Our goal was twofold: first, to quantify the contribution of taking into account the mechanical properties of metastasis in the overall resistance of the bone. Secondly, to see if a simpler model than that proposed in the literature (based on purely elastic rather than elastoplastic properties (Eggermont et al., 2018) could improve the prediction of pathological fractures. First, the results obtained with our heterogeneous models (not taking tumor into account) showed a good consistency with the literature, the correlation between all the heterogeneous models (n = 43 legs) regarding the agreement of simulated and experimental fracture were of the same order of magnitude as a similar study conducted on mouse vertebrae (Nyman et al., 2015). Then, the model taking into account the properties of the tumors did not make it possible to improve the fracture prediction. The average of the differences of models taking tumor into account being of 30 ± 21% (n = 11 tumor limbs) against 12 ± 9% (n = 43 limbs). In addition, the specific model (taking into account the modulus of the tumors) being more difficult to obtain than the heterogeneous model (not requiring segmentation between bone and tumor), the first does not seem to be a wise choice in the prediction of long bone fracture presenting bone lysis. Finally, a detection criterion based on the difference between global and local ultimate force values made it possible to detect the majority of the mechanical instabilities observed in this study (sensitivity of 85% and specificity of 100%). Another criterion, based on the ratio between individual weights and the local ultimate force predicted via FEA, made it possible to correctly diagnose all cases (100% sensitivity and specificity). This result could prove to be of great help in making surgical decision making in the case of long bone with bone metastases. Of course, before that, the road ahead is long, this result having to be clinically confirmed first (possibly through the study of a retrospective cohort, as has already been done in other studies (Eggermont et al., 2018). This study has just been initiated in the case of the project MEKANOS (multicenter study in France) led by Professor Cyrille Confavreux (rheumatologist)
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Mirzadeh, Kousha. "TLD Measurements on Patients being treated with a Taylor Spatial Frame : Using Radiation from Na18F PET/CT Studies and from Naturally Occurring Radioisotopes." Thesis, Stockholms universitet, Fysikum, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-109361.
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Background: In an ongoing study conducted at Karolinska Institutet & Karolinska University Hospital, Positron Emission Tomography (PET)/Computed Tomography (CT) scans are performed on patients with tibia fractures and deformations treated with Taylor Spatial Frames (TSFs) in order to monitor their bone remodeling progress. Each patients receive an administration of approximately 2 MBq/kg bodyweight of Na18F associated with PET scans on two sessions, six and twelve weeks after the attachment of the TSF. These PET/CT scans provide information about the progress of the healing bone and can be used to estimate the optimal time point for de-attachment of the TSF. The Standardized Uptake Value (SUV) is used as a measure of the rate of bone remodeling for these patients, however, there is a need for verification of this practice by a method independent of the PET scanner. Furthermore, information regarding the biodistribution of the Na18F throughout the body of these patients and the effects of the TSF on the CT scan X‑rays is required. Additionally, an investigation of alternative methods that have the potential to provide similar information with a lower absorbed dose to the patients is desirable. Materials and methods: Thermoluminescent Dosimeters (TLDs) were attached on the skin at the position of the heart, urinary bladder, femurs, fracture, and the contralateral tibia of twelve patients during the first one hour and five minutes after the administration of the Na18F. Additional TLD measurements were performed during the CT scan of two of these patients. From the PET scan images, SUVs at the fracture site of these patients were collected. An investigation of the possibility of exploiting the “naturally” occurring bone seeking radionuclide Strontium-90 (90Sr) in the human body to gain information about the fracture site was undertaken. Using a 90Sr source, three different detection techniques were evaluated and a practical methodology for in vivo measurements on the tibia fracture patients was developed. As it was concluded that TLD based measurements were the most suitable technique for this purpose, and it was tested on five patients with tibia fractures. Results: From the collected TLD data, it was concluded that for these patients the urinary bladder is the organ receiving the greatest amount of absorbed dose and the organ most affected as the administered activity exceeds 2 MBq/kg. On average, a three times higher surface dose was measured on the tibia fracture compared to the un-fractured tibia. A linear relationship between the surface dose and SUVmax was shown. A strong positive correlation between the activity concentration at the fracture site and the amount of injected activity was found, and it was demonstrated that this also affects the SUVs. For patients who were administered different amounts of Na18F for the two PET scans, maximum activity concentrationwas less affected than mean activity concentration. It was concluded that TSF’s effect on the scatter of the X-rays to organs higher up in the body is negligible. Regarding “naturally” occurring 90Sr in the human body, no higher activity at the fractured tibia compared to the non‑fractured tibia could be found. Conclusions: This project assessed the accumulation of Na18F in the fracture site of patients treated with TSF by a method independent of the PET scanner. The methodology of using SUVs as an indicator for bone remodeling was verified. It was shown that the uptake of Na18F by the fracture site is strongly correlated to the amount of injected activity. The importance of considering the amount of injected activity when evaluating and comparing SUVs was highlighted. In vivo measurements using LiF:Mn TLDs did not indicate any quantifiable higher concentration of 90Sr at the fracture in the tibia bone.
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Samsami, Shabnam [Verfasser], and Peter [Akademischer Betreuer] Müller. "Fracture fixation of complex tibial plateau fractures / Shabnam Samsami ; Betreuer: Peter Müller." München : Universitätsbibliothek der Ludwig-Maximilians-Universität, 2021. http://d-nb.info/1234389134/34.
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Skoglund, Björn. "Following the mevalonate pathway to bone heal alley /." Linköping : Department of Clinical and Experimental Medicine, Materials in Medicine, Section of Orthopaedics and Sports Medicine, Faculty of Health Sciences, Linköping University, 2007. http://www.bibl.liu.se/liupubl/disp/disp2007/med1033s.pdf.
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Hardy, John R. W. "Tibial diaphyseal fracture healing." Thesis, University of Leicester, 1996. http://hdl.handle.net/2381/34096.
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Verset, Michaël. "Ostéosynthèse d'une perte de substance médio-diaphysaire : étude biomécanique et histologique comparative de plaques vissées conventionnelles et verrouillées chez le mouton." Phd thesis, Toulouse 3, 2013. http://oatao.univ-toulouse.fr/9592/1/verset_9592.pdf.
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L’objectif de cette étude a été de déterminer l'effet du verrouillage des vis sur la cicatrisation osseuse et sur la stabilité de l’ostéosynthèse effectuée par plaque LCP® équipée soit de vis verrouillées soit de vis corticales standard. Pour cela, des tibias ovins, présentant une perte de substance de 5 mm, qui constitue un modèle de fracture comminutive, ont été utilisés. Les propriétés biomécaniques des tibias ex vivo (flexion, torsion et compression) ainsi que les propriétés radiographiques, biomécaniques, histologiques et histomorphométriques des tibias ovins in vivo au cours de la cicatrisation osseuse, ont été comparées entre les 2 groupes de vis.
Les différentes observations ont permis de conclure à un effet positif des vis verrouillées sur la vitesse et la qualité de la cicatrisation osseuse, par rapport aux vis standard. Il pourrait être lié à un environnement biomécanique et biologique plus favorable pour les montages verrouillés que pour les montages conventionnels.
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Gonzalez, Paula Cristina Sieczkowski. "Fixador esquelético externo circular para o tratamento de fraturas rádio e tíbia em cães." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/85403.
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O fixador esquelético externo circular foi desenvolvido durante a guerra fria na Rússia, pelo Professor Gavril Abramovich Ilizarov. Esse tipo de fixação ganhou espaço como alternativa à fixação interna, devido a sua versatilidade e às suas características biomecânicas que otimizam a formação do calo ósseo. O objetivo desse estudo foi avaliar o fixador esquelético externo circular como método de fixação para fraturas metafisárias de rádio e tíbia de cães atendidos no Hospital de Clínicas Veterinárias da UFRGS. Os resultados a respeito do tipo e frequência de complicações associados a essa técnica foram documentados. No total 16 animais cumpriram os critérios para entrar no estudo sendo sete fêmeas e nove machos. A idade média dos animais foi de 50,87 ± 57,01 meses com peso médio dos animais foi de 8,6 ± 6,95kg. Três (18%) animais apresentaram fratura de tíbia e fíbula e treze (82%) fraturas de rádio e ulna. O aparelho de fixação esquelética utilizado consistiu de um aro proximal 5/8 e dois aros distais inteiros, com dois fios em cada anel. Os fios foram colocados de maneira divergente o mais próximo possível de 90°. O aparelho pesou em média 128 ± 49g, representando em média 4,09 ± 3,22% do peso do animal. O tempo médio de cirurgia foi de 115 ± 32 minutos. O tempo médio de permanência com o aparelho de fixação esquelética externa circular foi de 81,69 ± 23,14 dias. Entre as complicações encontradas estão: tratos de drenagem ao redor dos fios (37,5%), miíase (6,25%), encurtamento dos músculos flexores do antebraço (6,25%), hemorragia associada ao local de passagens dos pinos (6,25%) e quebra do fio com deslocamento do fixador levando a necessidade de sua remoção (6,25%). Não houve diferença estatística entre os tempos cirúrgicos necessários para a osteossíntese de rádio e tíbia. Não houve correlação entre as variáveis: tempo decorrido do trauma até a cirurgia e tempo de duração da cirurgia; tempo decorrido do trauma até a cirurgia e tempo de permanência com o aparelho de fixação esquelética externa circular; peso do animal e duração da cirurgia; proporção do peso do circular em relação ao peso do animal e o tempo de permanecia com o circular. Houve correlação positiva estatisticamente significativa entre as variáveis: duração da cirurgia e tempo de permanência com o aparelho de fixação esquelética externa circular. Essa modalidade de tratamento representa uma opção cirúrgica atrativa para a correção de fraturas de rádio e tíbia em cães, entretanto, devido à possibilidade complicações e necessidade de cuidados pós-operatórios intensivos uma seleção acurada dos pacientes e proprietários deve ser realizada previamente à cirurgia.The circular external skeletal fixator was developed during the Cold War in Russia, by Professor Gavril Abramovich Ilizarov. This kind of fixation took place as an alternative to internal fixation, due to its versatility and its biomechanical characteristics that improves the formation of callus. The aim of this study was to evaluate the circular external skeletal fixator as a method of fixation for fractures of the radius and tibia of dogs treated at the Veterinary Teaching Hospital of UFRGS, corroborating the results, the type and frequency of complications associated with this technique. Sixteen animals met the criteria to participate on the study, seven females and nine males. The average age of the animals was 50.87 ± 57.01 months. The average weight of the animals was 8.6 ± 6.95 kg. Three (18%) animals showed fracture of tibia and fibula and thirteen (82%) fractures of the radius and ulna. The circular external skeletal fixation frame used consisted of a proximal ring ⅝ and two full distal rings, with two wires in each ring. The wires were placed divergently as close as possible to 90 °. The frame weighed on average 128 ± 49g, representing average 4.09 ± 3.22% of the weight of the animal. The mean time of the surgery was 115 ± 32 minutes. The average time spent with the circular was 81.69 ± 23.14 days. Among the complications found are drainage tracts around the pins (37.5%), myiasis (6.25%), shortening of the forearm flexors (6.25%), hemorrhage associated with the location of pins passages (6, 25%) and breakage of the device wire with displacement of the frame leading to its removal (6.25%). There was no statistical difference between the times required for the surgical fixation of the radius and tibia. There was no correlation between the variables: time elapsed from trauma to surgery and duration of surgery, time elapsed from trauma to surgery and time spent with the circular external skeletal fixation; animal weight and duration of surgery; the proportion of the circular weight in relation to the weight of the animal and the time remained with the circular. There was statistically significant positive correlation between the variables: duration of the surgery and the permanency with the circular external skeletal fixation. This treatment modality represents an attractive surgical option for fractures correction of the radius and tibia in dogs, however, due to possible complications and need for intensive post operative care accurate selection of patients and owners should be performed prior to surgery.
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Luna, Natalia Mariana Silva. "Análise isocinética do tornozelo e das forças de reação de solo em corredores de longa distância e triatletas." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-02022011-162751/.
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Introdução: A associação da fadiga muscular com o aumento da força vertical de reação do solo representa risco para a fratura por estresse de tíbia em esportes como a corrida de longa distância e o triatlo. Objetivos: analisar e comparar parâmetros do componente vertical das forças de reação do solo e parâmetros musculares isocinéticos da flexão-plantar (FP) e dorsiflexão (DF) do tornozelo entre corredores de longa distância, triatletas e indivíduos não-atletas. Materiais e Métodos: foram avaliados 75 indivíduos do sexo masculino, divididos em: Grupo Triatleta (GT) (n=26), Grupo Corredores de Longa Distância (GCL) (n=26) e Grupo Controle de não- atletas (GC) (n=23). Para avaliação da força vertical foi utilizada uma plataforma de força, onde os indivíduos realizaram passos de corrida em uma distância pré-determinada. Foram coletados dez passos (cinco com o membro direito e cinco com o esquerdo). A avaliação isocinética foi realizada no modo concêntrico/excêntrico e excêntrico/concêntrico da flexão-plantar (FP) e dorsiflexão (DF) do tornozelo direito e esquerdo. Foram feitas cinco repetições na velocidade de 60º/s e 30 repetições a 180º/s, com repouso de 10 segundos entre as séries. Resultados: O GC e o GT apresentaram forças verticais menores e maior tempo de contato com o solo e de aplicação da força na aceleração vertical máxima que o GCL. O tempo de aplicação de força foi maior no GC que o GT. A avaliação isocinética (180º/s) mostrou: maiores valores da DF excêntrica e FP concêntrica no GC e GT quando comparados com o GCL; maiores valores para DF concêntrica no GC comparado do GT e GCL e GT maior GCL; TA foi maior na DF excêntrica do GCL que GC; a maior relação agonista-antagonista FP e DF foi no modo concêntrico-excêntrico do GC quando comparado com GT e GCL. Na avaliação a 60º/s, maior PT durante a FP excêntrica e DF concêntrica no GC que GT e GCL e maior FP concêntrica no GT e GC. Conclusões: Os atletas mostraram menor força e resistência isocinéticas e maiores valores de impacto que os controles. Os triatletas tiveram menor impacto e melhor desempenho na variável de resistência muscular.Introduction: The association of fatigue with increasing vertical force of ground reaction represent a risk for Tibial stress fracture in sports like long distance running and triathlon. Objectives: To analyze and compare the parameters of the vertical component of ground reaction forces and the parameters of muscle isokinetic ankle flexion-plantar (PF) and dorsiflexion (DF) among long distance runners, triathletes and non-athletes. Materials and Methods: total of 75 males, divided into three groups: Triathletes (GT) (n=26), Long Distance Runners (GR) (n=23) and nonathletes Controls (GC) (n=26) participated in the study. The force platform were used to record vertical forces and the subjects were instructed to perform race steps for a predetermined distance and to complete ten practical experience (five with the right limb and five with the left), which consisted of consistent landing from one of his feet in the center of the platform. The isokinetic evaluation was performed in the concentric/eccentric and eccentric/concentric ankle plantar-flexion (PF) and dorsiflexion (DF) (60°/s and 180°/s). Results:The GC and GT showed lower vertical forces, increased total time ground support and time of application of force at maximum vertical acceleration than GR. In this last variable, the GC had a time of application of force even greater than GT. To isokinetic evaluation at 180 ° / s, GT and GC presented TW significantly higher than GR, during DF eccentric and PF concentric; in DF concentric, the GC was higher than GR and GT and GT higher than GR; GR presented TA significantly higher than GT and GC, during DF eccentric; GC presented agonist-antagonist ratio for PF and DF in the concentriceccentric mode, higher than GT and GCL. For evaluation at 60 °/s, the GC presented s PT significantly higher than GT and GR, during PF eccentric and DF concentric; FP concentric GC higher than GT. Conclusions: The athletes presented lower isokinetics strength and endurance and higher impact values than the controls. The triathletes had less impact and better performance in variable muscular endurance.
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Fourie, Jeanette Ann. "Stimulation of bone healing in new fractures of the tibial shaft using interferential currents." Master's thesis, University of Cape Town, 1994. http://hdl.handle.net/11427/27041.
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The aims . of this research were twofold, firstly to find out if interferential currents could reduce the healing time for fractures of the tibia and thereby prevent nonunion and secondly to develop a model which could predict nonunion, given the subject characteristics such as race, mechanism of injury, severity of fracture etc. Subjects, males only between the ages of 12 and 86, who had sustained fractures of the tibiae were entered into this double blind clinical trial on admission to the orthopaedic wards at Groote Schuur Hospital (between January 1989 and October 1991). According to strict inclusion and exclusion criteria, a final sample of 227 cases (208 subjects) were entered by block randomisation into three groups; an experimental group (n=41), placebo group (n=35) and control group (n= 151). lnterferential currents were applied to the experimental group via suction electrodes for, 30 minutes per day for 10 days, using a beat frequency of 10 - 25 Hz and a swing mode of 6 ϟ 6. The placebo group had the suction electrodes applied which produce a rhythmical massage effect. Subjects commented on pain relief which resulted in the addition of the control group as a check on the possible effect of suction, the control group received no intervention. The data were analysed firstly, by using the ANOV A with continuous covariates which resulted in a finding of no significant difference in the time taken to union for the three groups. The second statistical analysis using the same data set, were logistic regression models demonstrating risk factors for nonunion within 24, 32 and 40 weeks. These models were then validated, showing sensitivity and specificity for a variety of possible cutoffs. The conclusions reached about the validity of these models were that they could not be used to predict, accurately enough, those cases where surgical intervention would be necessary; however, for low cost non-invasive intervention they may have value.
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Zvietcovich, Cornejo César Guillermo. "Evaluación del tratamiento de las fracturas de meseta tibial : Hospital Nacional Hipólito Unanue enero 1998-diciembre 2000." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2002. https://hdl.handle.net/20.500.12672/2036.
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El presente trabajo se propone el determinar el perfil epidemiológico de las fracturas de meseta tibial tratadas en el Servicio de Traumatología del Hospital Nacional Hipólito Unanue, durante el periodo Comprendido entre enero de 1998 a diciembre del 2000. Analizando el seguimiento de los mismos con la recuperación funcional alcanzada, las secuelas generadas y las posibles complicaciones presentadas.
El presente trabajo de investigación servirá para valorar los resultados de las técnicas de tratamiento en las Fracturas de meseta tibial tratadas quirúrgicamente en el servicio de ortopedia y traumatología del Hospital Nacional Hipólito Unanue.
Permitirá identificar los factores intrínsecos al paciente, a la lesión traumática como a la terapéutica misma, que afecte él pronostico de recuperación funcional de los pacientes evaluados. Con lo cual se podrá prevenir y tomar medidas correctivas ante la presencia de dichos factores en pacientes que posteriormente requieran dicho tratamiento.Tesis de segunda especialidad
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Topliss, Claire Joanne. "An investigation of the distal tibial pilon fracture." Thesis, University of Bristol, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.492599.
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This thesis summarises the history of the distal tibial pilon fracture and explores it with newly available techniques. It describes in detail exactly what a pilon fracture is and attempts to identify the mechanisms by which it occurs.
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Roussot, Mark. "Amputation rate following tibia fractures with associated popliteal artery injuries." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25507.
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Objectives: 1. Determine the amputation rate; and 2. identify risk factors in patients with tibia fractures and associated popliteal artery injuries. Intervention: Amputation or limb salvage. Design: Retrospective case-control study. Setting: Level 1 trauma center. Patients: Thirty popliteal artery injuries with ipsilateral tibial fractures. Outcome measures: Primary and delayed amputation rates were determined. Risk factors tested for significance (Fischer's Exact) included: mechanism of injury, signs of threatened viability, compartment syndrome, fracture pattern, surgical sequence, and time delay from injury or presentation to revascularization. Results: The study group consisted of 22 males and 8 females, with a mean age of 31 years. Motor vehicle accidents and gunshot wounds constituted the mechanism in 17 and 11 patients respectively. Twenty-one were polytrauma victims. Intra/extra16 articular metaphyseal fractures (OTA 41 A-C) were recorded in 19 and diaphyseal (OTA 42 A-C) in 7 patients. Primary amputation was performed in 7 and delayed in 10 patients (overall rate 57%). No individual risk factors were predictive of amputation; however, the "miserable triad" of a proximal tibia fracture (OTA 41) with signs of threatened viability, and delay to revascularization ≥ 6 hours from injury or ≥ 2 hours from presentation was predictive of amputation (p = 0,036 and p = 0,018 respectively). Conclusions: We should aim to intervene within 6 hours following injury or 2 hours following presentation to reduce the risk of amputation. This provides a target for trauma teams even with uncertain time of injury. Level of Evidence: III.
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Vijayakumar, Vinod. "Stress/strain environments in healing human tibial fractures." Thesis, University of Oxford, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275202.
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Torres, Geórgea Hermógenes Fernandes. "Associação de fraturas vertebrais moderadas e graves com menor densidade volumétrica trabecular na tíbia em mulheres idosas e menor densidade mineral óssea areal em fêmur em homens idosos da comunidade: São Paulo Ageing & Health study (SPAH)." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5166/tde-13022019-143204/.
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Introdução: A tomografia computadorizada periférica quantitativa de alta resolução (HR-pQCT) é um método diagnóstico que avalia microarquitetura óssea e estima resistência óssea por análise de elemento finito, facilitando a compreensão da fisiopatologia das fraturas. Objetivo: Avaliar associação de fraturas vertebrais moderadas e graves com parâmetros obtidos na HR-pQCT, escore trabecular ósseo (TBS) e densidade mineral óssea areal em idosos da comunidade. Métodos: Foram recrutados 276 idosos da coorte SPAH. Dados clínicos foram obtidos a partir de um questionário específico. A fratura vertebral (FV) foi avaliada por DXA-VFA utilizando-se o método semiquantitativo de Genant. HR-pQCT e DXA foram realizados no mesmo dia da coleta de sangue. O modelo de regressão logística foi realizado para verificar quais fatores foram associados de forma independente com a fratura vertebral moderada e grave. Resultados: Na tíbia, mulheres com FV moderada/grave apresentaram menor densidade mineral óssea volumétrica, menor número de trabéculas, menores valores dos parâmetros de resistência óssea e maior separação trabecular; e os homens apresentaram menor número de trabéculas, menor parâmetro de resistência óssea e maior separação trabecular. No rádio, as mulheres com FV moderada/grave tinham menor densidade mineral óssea volumétrica, espessura trabecular e cortical e menor valor do parâmetro de análise do elemento finito; e os homens tinham menor densidade mineral óssea volumétrica trabecular e menor valor de parâmetro de análise do elemento finito. Não foram observadas diferenças no TBS em ambos os sexos. A análise de regressão logística revelou que uma menor densidade mineral óssea volumétrica trabecular na tíbia em mulheres (OR: 0,980, 95% CI: 0,963-0,997, p = 0,022) e uma menor densidade mineral óssea areal do colo femoral e fêmur total em homens (OR: 0,002, IC 95%: 0-0,607, p = 0,033 e OR: 0,003, IC 95%: 0-0,623, p = 0,033) foram independentemente associados com FV moderada/grave. Conclusão: As imagens da HR-pQCT detectaram diferenças na microarquitetura óssea em mulheres idosas com FV moderada/grave independente de densidade mineral óssea areal e TBS por DXA; e HRpQCT pode ser uma ferramenta útil para avaliar o risco de fratura. Diferentemente, nos homens, a densidade mineral óssea areal do fêmur foi associada à FV moderada/grave; e a DXA continua sendo uma ferramenta importante para predizer a FVBackground: Many vertebral fractures (VF) occur in individuals classified by DXA as low risk for fragility fractures. Thus, the aim of this study was to verify the association between VF and peripheral bone microarchitecture and strength parameters using also high-resolution peripheral quantitative computed tomography (HR-pQCT) and axial bone microarchitecture by trabecular bone score (TBS). Study design: Cross-sectional study of 276 subjects aged >=65 years from SPAH cohort. Methods: Lateral scans of spine obtained from Vertebral Fracture Assessment by DXA were analyzed to assess VF. HR-pQCT was performed at radius and tibia. TBS was performed using DXA. Results: At tibia, women with Moderate/severe VF had lower volumetric bone density (vBMD), trabecular number (Tb.N), strength parameters and higher trabecular separation (Tb.Sp); and men had lower Tb.N, strength parameters and higher Tb.Sp. At radius, women with moderate/severe VF had lower v.BMD, trabecular and cortical thickness and strength parameters; and men had lower trabecular v.BMD and strength parameters. No differences were observed in TBS in both genders. Logistic regression analysis revealed that lower trabecular vBMD at tibia in women (OR: 0.980, 95%CI: 0.963-0.997, p = 0.022) and lower femoral neck aBMD and total hip in men (OR: 0.002, 95%CI: 0-0.607, p = 0.033 and OR: 0,003, IC 95%: 0-0,623, p = 0,033) were independently associated with VF. Conclusion: HR-pQCT images detected differences on bone microstructure in older women with moderate/severe VF independent of aBMD and TBS by DXA and HR-pQCT could be useful tool to assess fracture risk. Differently, in men femoral aBMD was associated with moderate/severe VF and DXA continue an important tool for predicting VF
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Findlay, Sharon Crawford. "Non-invasive measurement of bone following tibial shaft fracture." Thesis, University of Sheffield, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.401133.
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Ekenman, Ingrid. "Tibia stress fractures in athletes : an investigation of possible predisposing factors /." Stockholm, 1998. http://diss.kib.ki.se/search/diss.se.cfm?19980515eken.
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Moorcroft, Christopher Ian. "Control and monitoring of movement in fractures of the human tibia." Thesis, Staffordshire University, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299206.
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Llamoca, Sánchez José Martín. "Osteosíntesis con plaqueado minimamente invasivo en fracturas complejas de fémur y tibia." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2004. https://hdl.handle.net/20.500.12672/1911.
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La Osteosíntesis biológica no es un implante, sino un concepto que puede efectuarse con los elementos habituales de osteosíntesis. Pretende dar la estabilidad suficiente con reducción indirecta, sin pretender reducciones anatómicas de fragmentos que pueden dañar la vascularización de ellos y sin tocar el foco de fractura.
Se realizó un estudio descriptivo-retrospectivo en el cual se evaluaron los resultados de 15 pacientes con fracturas diafisiarias de fémur (05) y tibia (10) tratados mediante la técnica de Osteosíntesis con plaqueado minimamente invasivo; los cuales fueron tratados durante el periodo Enero 2001 y Diciembre 2002. La edad media fue de 50.2 y 32.5 años respectivamente.
Todas las fracturas femorales fueron cerradas, 08 fracturas fueron cerradas y 02 expuestas de I (según Gustillo) entre las fracturas tibiales. De acuerdo a la clasificación AO hubieron, 2 del tipo B2, 1 del tipo C1 y 2 del tipo C2 entre las fracturas de fémur y 3 del tipo B1, 3 del tipo B2, 2 del tipo C2, y 2 del tipo C3 entre las tibiales.
El promedio de tiempo de apoyo total para las fracturas de fémur fue de 16.6 semanas y 14 semanas para las de tibia; mientras el promedio de tiempo de unión por radiografía fue de 18.8 semanas y 15.6 semanas respectivamente.
Se presentó un caso de infección superficial, un caso de perdida de fijación de fractura y no se presentaron casos de fallas de material de osteosíntesis.
Una fractura consolidó con un alineamiento en varo de 10° y recurvatum de 15° y una fractura con recurvatum de 15°, estas pertenecientes al grupo de las fracturas tibiales.
Los resultados del tratamiento para fracturas diafisiarias de fémur y tibia obtenidos con ésta técnica compara favorablemente con otras series usando técnicas diferentes sin la morbilidad asociada de grandes abordajes y autoinjerto óseo.
Sin embargo la técnica quirúrgica demanda un cuidado especial para restaurar el alineamiento axial.Tesis de segunda especialidad
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Carrera, Fernandez Ion. "Investigación de la biomecánica y mecanobiología de las fracturas de la meseta tibial mediante un modelo de elementos finitos." Doctoral thesis, Universitat Autònoma de Barcelona, 2017. http://hdl.handle.net/10803/456315.
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Las fracturas de la meseta tibial afectan a una gran articulación de carga como es la rodilla y son lesiones graves que conducen frecuentemente a anomalías funcionales. Para preservar la función normal de la rodilla, se debe mantener la congruencia articular, conservar el eje mecánico normal, asegurar la estabilidad de la fractura y recuperar el rango de movilidad completo. Alcanzar estos objetivos presenta dificultades por la importante afectación de tejidos blandos, los distintos tipos de calidad ósea y, en ocasiones, la presencia de comorbilidades de los pacientes. El mecanismo de lesión principal que da lugar a las fracturas de la meseta tibial es una tensión en varo o valgo con una carga axial asociada. La meseta lateral resulta afectada en el 55%-70% de los casos, mientras que la medial se ve afectada en el 10%-30%.
Todavía no existe una práctica totalmente estandarizada en las fracturas de la meseta tibial debido a la falta de estudios biomecánicos concluyentes, y coexisten diferentes técnicas usadas para el tratamiento de estas fracturas.
Tener un mejor conocimiento biomecánico de las fracturas de la meseta tibial y comparar los tratamientos más utilizados ha sido uno de los objetivos principales de esta investigación para intentar dar respuesta a la pregunta de cuál es el mejor método para tratarlas.
La base de esta investigación ha sido el uso del método de elementos finitos (EF) para el estudio de las fracturas de meseta tibial y sus tratamientos. Este método consiste en subdividir geometrías complejas en un ensamblado discreto de elementos de geometría sencilla en los que los desplazamientos relativos de puntos pueden ser fácilmente calculados en función de las cargas que se ejercen sobre el elemento. Según la dimensión del problema, estos elementos podrán ser líneas (1D), triángulos o cuadrados (2D), o tetraedros o hexaedros (3D). Los desplazamientos relativos de puntos calculados dentro de los elementos están asociados a valores de tensiones vía la introducción de ecuaciones de comportamiento para el material del elemento virtualmente constituido.
El objetivo del primer trabajo (Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration) fue evaluar con cálculos de EF si la carga inmediata de peso sería posible tras la estabilización quirúrgica, ya sea con tornillos canulados o con una placa bloqueada en una fractura de la meseta tibial lateral.
El segundo trabajo (An intact fibula may contribute to allow early weight-bearing in surgically treated tibial plateau fractures) intenta dar respuesta a la estabilidad que el peroné proximal aporta en las fracturas de la meseta tibial lateral.
Se realizó un modelo de geometría tridimensional mediante elementos finitos a partir de la base de datos VAKHUM (http://www.ulb.ac.be/project/vakhum) y se creó una reconstrucción del modelo a partir de las imágenes de tomografía computarizada. Posteriormente se simuló una fractura tipo de meseta tibial lateral usando datos geométricos a partir de imágenes radiológicas y de TC. Se simularon los sistemas de tratamiento, con y sin peroné, la placa bloqueada Polyax® (Biomet Inc, IN, USA) y un set de tornillos canulados de 6,5 mm (Biomet Inc, IN, USA).
Las fracturas de la meseta tibial lateral, fijadas ya sea con placa bloqueadas o con tornillos canulados, no mostraron movimientos interfragmentarios clínicamente relevantes en un modelo de EF. La fijación de la fractura con una placa bloqueada mostró una mayor estabilidad mecánica que la fijación con tornillos canulados. La placa bloqueada podría también permitir una capacidad de carga completa o al menos parcial bajo postura estática. Este modelo de EF mostró que un peroné intacto podría contribuir a la estabilidad mecánica de las fracturas de la meseta tibial lateral, y combinado con placa, la integridad mecánica que aporta el peroné puede permitir una capacidad de carga temprana y sin movimientos interfragmentarios significativos.Tibial plateau fractures affect to the knee joint and they are injuries that often cause functional impairment. To preserve the normal function of the knee, articular congruence must be achieved, stable fixation must be obtained as well as physiological knee aligment in order to recover full range of motion. This goals are often difficult to be achieved due to the soft tissue damage, bone quality and patient comorbidities. The most frecuent injury mechanism is an axial load of the knee combined with and excessive valgus or varus force. Lateral plateau is affected on 55%-70% of the cases and medial plateau on 10%-30%. There is not yet a totally standardized technique to approach all tibial plateau fractures due to the little number of biomechanic studies, therefore there are diferent techniques to treat the same fractures. The aim of this study was to have a better biomechanic understanding of tibial plateau fractures and to compare the most common treatments to asses what is the best way to treat these injuries. This investigation was conducted using finite elements (FE). FE method consists on subdividing complex geometries in a less complex geometry element assemblement. Therefore relative movements in the geometry can be easily measured and accurate calculations can be obtained. Depending on the dimension of the geometry studied the elements can be linear (1D), triangles or squares (2D)or tetrahedrons or hexahedrons (3D). Relative displacements of calculated points inside the elements are associated to tension values with behavioral equations for virtually simulated material and geometry. The purpose of the first study (Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration) was to assess, with finite element (FE) calculations, whether immediate weight bearing would be possible after surgical stabilization either with cannulated screws or with a locking plate in a split fracture of the lateral tibial plateau (LTP). The purpose of the second study ( An intact fibula may contribute to allow early weight-bearing in surgically treated tibial plateau fractures ) was to assess differences in interfragmentary movement (IFM) in a split fracture of lateral tibial plateau, with and without intact fibula. It was hypothesized that an intact fibula could positively contribute to the mechanical stabilization of surgically reduced lateral tibial plateau fractures. A split fracture of the LTP was recreated in a FE model of a human tibia. A three-dimensional FE model geometry of a human femur-tibia system was obtained from the VAKHUM project database, and was built from CT images from a subject with normal bone morphologies and normal alignment. The mesh of the tibia was reconverted into a geometry of NURBS surfaces. A split fracture of the lateral tibial plateau was reproduced by using geometrical data from patient radiographs. A locking screw plate (LP) and a cannulated screw (CS) systems were modelled to virtually reduce the fracture and 80 kg static body-weight was simulated with and without fibula. While the simulated body-weight led to clinically acceptable interfragmentary motion, possible traumatic bone shear stresses were predicted nearby the cannulated screws. With a maximum estimation of about 1.7 MPa maximum bone shear stresses, the Polyax system might ensure more reasonable safety margins. Split fractures of the LTP fixed either with locking screw plate or cannulated screws showed no clinically relevant IFM in a FE model. The locking screw plate showed higher mechanical stability than cannulated screw fixation. The locking screw plate might also allow full or at least partial weight bearing under static posture at time zero. This FE model showed that an intact fibula contributes to the mechanical stability of the lateral tibial plateau. In combination with a locking plate fixation, early weight bearing may be allowed without significant IFM, contributing to an early clinical and functional recovery of the patient.
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Clasper, Jonathan Charles. "Secondary intramedullary nailing of the tibia in an animal model of an external fixator pin track infection." Thesis, University of Southampton, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268414.
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Cersso, Bendezú César Augusto. "Enclavado endomedular bloqueado como tratamiento para fracturas tibiales : experiencia en el Hospital Daniel Alcides Carrión, enero 2008 - diciembre 2010." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2011. https://hdl.handle.net/20.500.12672/12802.
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Objetivo: Describir la experiencia del enclavado endomedular bloqueado como tratamiento para fracturas tibiales en el Hospital Daniel Alcides Carrión entre enero del 2008 a diciembre del 2010
Métodos: Estudio de tipo observacional, descriptivo, transversal y retrospectivo. Se incluyó a toda la población de pacientes atendidos en el servicio de Traumatología con fracturas tibiales y sometidos a tratamiento con clavo endomedular bloqueado entre enero 2008 a diciembre 2010 del Hospital Nacional Daniel Alcides Carrión. Se pesquisaron los reportes operatorios de sala de operaciones y las historias clínicas de cada paciente en el archivo del hospital. La investigación fue aprobada por el Comité Ético y Metodológico del Hospital Nacional Daniel Alcides Carrión.
Resultados: En el periodo de estudio se trataron 33 fracturas tibiales con clavo endomedular bloqueado. La media de edad fue 35,9 ±14,4 años. 28 casos (84,8%) fueron por accidente automovilístico. El rango del tiempo de enfermedad fue de 3 a 24 días, con una media de 10 ±4 días. Al comparar según el frezado de canal endomedular, no se encontraron diferencias significativas en la duración del acto quirúrgico, estancia postoperatoria y la consolidación de la fractura. En relación al bloqueo proximal, el paciente no presentó falla en el implante, mientras que en el bloqueo distal, se encontró 7 pacientes en los que no se realizó bloqueo completo, de los cuales 3 presentaron falla en el implante, siendo la asociación significativa entre bloqueo distal incompleto en el intraoperatorio con falla en el implante postoperatorio (p<0,000).
Conclusiones: El tratamiento con clavo endomedular bloqueado resulta una técnica eficaz y eficiente para lograr la resolución clínica del paciente, 9 de cada 10 pacientes evolucionaron sin problemas. El bloqueo distal incompleto es una condición que pone en riesgo la evolución favorable del paciente.
Recomendaciones: Se debe tener en cuenta que los pacientes con bloqueo distal incompleto, se encuentran en mayor riego de evolución desfavorable, por lo cual se debe brindar un soporte especial y multidisciplinario que le permita llevar mejor su evolución clínica.Trabajo académico
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Ubidia, Anicama Gerson Paul. "Fractura diafisiaria de tibia: resultados y complicaciones con clavo endomedular no fresado, Hospital Alberto Sabogal Sologuren de agosto del 2004 a diciembre del 2010." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2013. https://hdl.handle.net/20.500.12672/13978.
Full textAbstract:
Publicación a texto completo no autorizada por el autorDescribe la experiencia del enclavado endomedular bloqueado no fresado como tratamiento para fracturas tibiales en el Hospital Alberto Sabogal Sologuren entre agosto del 2004 a diciembre del 2010. Estudio de tipo observacional, descriptivo, transversal y retrospectivo. Se incluyó a toda la población de pacientes atendidos en el Servicio de Traumatología por fracturas tibiales y sometidos a tratamiento con clavo endomedular bloqueado no fresado entre agosto 2004 a diciembre 2010 del Hospital Alberto Sabogal Sologuren. Se revisó las historias clínicas y los reportes operatorios de todos los pacientes. La investigación fue aprobada por el Comité Ético y Metodológico del Hospital Alberto Sabogal Sologuren. En el periodo de estudio se trataron 30 fracturas tibiales con clavo endomedular bloqueado sin fresado. La media de edad fue de 35.9 ± 13.9 años. El mecanismo de lesión principal fue la caída en 50% de los casos. Se encontró diferencias significativas entre la clasificación de la fractura (AO y Tscherne y Gotzen), y el tiempo de consolidación, así como el tiempo transcurrido hasta el retorno laboral (p<0.001). La principal complicación fue el dolor articular en rodilla. El tratamiento con clavo endomedular bloqueado resulta una técnica eficiente para lograr la resolución clínica del paciente. Se debe tener en cuenta que los pacientes con clasificaciones de la fractura que impliquen severidad, se encuentran en mayor riesgo de presentar consolidación tardía y mayor tiempo sin actividad laboral, por lo cual se debe brindar un soporte especial y multidisciplinario que le permita llevar mejor su evolución clínica.
Trabajo académico
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Arevalo, Lozano Luis Orlando. "Resultados del tratamiento quirúrgico de las fracturas diafisiarias de tibia: Hospital San Juan Bautista de Huaral." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2015. https://hdl.handle.net/20.500.12672/9227.
Full textAbstract:
El documento digital no refiere un asesorPublicación a texto completo no autorizada por el autor
Muestra los resultados del tratamiento quirúrgico de las fracturas diafisiarias de tibia en el Hospital San Juan Bautista de Huaral entre el 2008 al 2010. Un total de 40 pacientes cumplen con los criterios de inclusión. Este estudio es de tipo descriptivo y de enfoque cuantitativo con un diseño transversal y correlacional, se utiliza la prueba de Chi cuadrado y ANOVA. Se exige un nivel de significación de p< 0,05. La principal causa son los accidentes de tránsito (55%). El tipo más frecuente de fractura corresponde al 42A2 de la AO (22.5%). En fracturas expuestas, el más frecuente es de tipo IIIA según Gustillo (25%). En el tratamiento quirúrgico predomina la osteosíntesis con fijación externa (45%). La complicación inmediata más frecuente es celulitis (15%) y la mediata es pseudoartrosis (20%). El tiempo de consolidación de fractura más frecuente es después de las 18 semanas (50%). Concluye que existen diversas formas de tratamiento de fracturas de tibia, las principales complicaciones son en aquellos pacientes con fracturas expuestas y que son sometidos a fijación externa.
Trabajo académico
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Demko, Jennifer Lynn. "Axial pull-out strength of 3.5 cortical and 4.0 cancellous bone screws placed in canine proximal tibias using manual and power tapping." Master's thesis, Mississippi State : Mississippi State University, 2008. http://library.msstate.edu/etd/show.asp?etd=etd-03312008-205137.
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Miranda, Huancahuari Mirko. "Manejo y resultados en las fracturas de platillo tibial : Hospital Dos de Mayo enero 2007 a diciembre 2008." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2010. https://hdl.handle.net/20.500.12672/13349.
Full textAbstract:
El documento digital no refiere asesorSe realizo un estudio de enero del 2007 a diciembre del 2008, con un número de 22 pacientes, que ingresaron al servicio de Ortopedia y Traumatología con el diagnóstico de fractura de platillo tibial, siendo intervenidos quirúrgicamente 20 pacientes y dos pacientes recibieron tratamiento conservador en el Hospital Nacional Dos de Mayo-Lima-Perú- La edad media fue de 43.2 años (25-73 años), con predominio del sexo masculino, la rodilla mas afectada fue el lado derecho en el 63,3%; en cuanto a la clasificación de la fractura el tipo 2 y 3 de Schaztker fueron del 54.2%. El promedio de espera quirúrgica fue de 23,9 días, el tiempo promedio de la cirugía 156 minutos asimismo la reducción cruenta mas fijación interna con placas y tornillos 19 (95%) fue la mas utilizada por el servicio contra la fijación externa 01 (5%) el tiempo de seguimiento de pacientes fue a dos a años encontrándose en la escala de función de la sociedad americana de rodilla con una de 85 puntos (bueno). Se obtuvieron buenos resultados, todas las fracturas consolidaron, en 2 (10%) pacientes se encontró infección de herida operatoria que fue solucionada con antibiótico terapia oral y curaciones diarias.
Trabajo académico
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Franco, Cortéz Carlos Modesto. "Fracturas diafisiarias de tibia cerradas y expuestas de primer y segundo grado tratadas con fijador externo descartable en el Hospital Sergio E. Bernales : enero 1998 a diciembre del 2002." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2005. https://hdl.handle.net/20.500.12672/1811.
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Las fracturas diafisiarias de tibia, son de las lesiones mas frecuentes en traumatología, siendo una de sus principales causas los accidentes de transito: choques, atropellos; violencia física caídas, accidentes deportivos entre otras causas.
Se revisaron todas las Historias Clínicas de pacientes que ingresaron al Hospital Sergio E. Bernales con el Diagnostico de fracturas diafisiarias de tibia, un total de 76 Historias Clínicas, de las cuales 42 fueron seleccionadas para el presente trabajo por tener los criterios de inclusión, información completa y que fueron sometidos a intervención quirúrgica con el Sistema de Fijación Externa Descartable.
La fijación externa es una opción mas, entre tantas otras posibilidades quirúrgicas, es ampliamente aceptada para fracturas expuestas como la primera opción, sin embargo para fracturas cerradas la bibliografía menciona otras posibilidades quirúrgicas como son el Clavo Intramedular, placas y tornillos según sea el caso.
En el presente estudio, de 42 pacientes, 36 fueron hombres (85.71%), el promedio de edad de 20 – 29 años con 15 pacientes con un 35.71 % , el mecanismo de acción (atropello) 26 pacientes (61.9%), la tibia derecha se afecto en 27 pacientes (64.28%), fracturas cerradas 24 pacientes (57.14%), las fracturas tipo II de Aybar 15 pacientes (35.71%)fueron las mas frecuentes, se realizaron fasciotomia en 11 pacientes (26.19%), osteosintesis mínima en 15 pacientes (35.51%), el tiempo de consolidación vario de 6 – 15 meses, las tipo I de Aybar consolido en 8.57 meses.Tesis de segunda especialidad
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Boriani, Filippo <1977>. "The "Orthoplastic" combined surgical approach to open tibia fractures: a multicentric prospective outcome study." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2015. http://amsdottorato.unibo.it/6754/.
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Introduction:
Open fractures of the leg represent a severe trauma. The combined approach, shared between plastic and orthopaedic surgeons, is considered to be important, although this multidisciplinary treatment is not routinely performed. Aim of this study was to verify whether the orthoplastic treatment is of any advantage over the traditional simply orthopedic treatment, through a multicentric inclusion of these unfrequent injuries into a prospective study.
Material and methods:
The following trauma centres were involved: Rizzoli Orthopaedic Institute/University of Bologna (leading centre) and Maggiore Hospital (Bologna, Italy), Frenchay Hospital (Bristol, United Kingdom), Jinnah Hospital (Lahore, Pakistan). All patients consecutively hospitalized in the mentioned centres between January 2012 and December 2013 due to tibial open fractures were included in the study and prospectively followed up to December 2014. Demographics and other clinical features were recorded, including the type of treatment (orthopaedic or orthoplastic). The considered outcome measures included duration of hospitalization, time for bone union and soft tissue closure, Enneking score at 3, 6 and 12 months, the incidence of osteomyelitis and other complications.
Results:
A total of 164 patients were included in the study. Out of them 68% were treated with an orthoplastic approach, whereas 32% received a purely orthopedic treatment. All considered outcome measures showed to be improved by the orthoplastic approach, compared to the orthopaedic one: time for soft tissue closure (2 versus 25 weeks), duration of hospital stay (22 versus 55 days), time for bone union (6 versus 8.5 months) , number of additional operations (0.6 versus 1.2) and functional recovery of the limb at 12 months (27 versus 19, Enneking’s score). All results were statistically significant.
Conclusion:
The combined orthoplastic approach to the treatment of open tibia fractures, in particular for high grade injuries (Gustilo 3B), is proven to improve the outcome of these severe injuries.
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Salem, Khaled Hamed [Verfasser]. "Analysis of delayed fracture healing following unreamed tibial nailing / Khaled Hamed Salem." Ulm : Universität Ulm. Medizinische Fakultät, 2004. http://d-nb.info/1015471188/34.
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Sloan, Andrew. "Inhibition of the fracture healing process in smokers : deregulation of cellular and molecular milieu in tibial fracture micro-environment." Thesis, University of Lincoln, 2013. http://eprints.lincoln.ac.uk/14680/.
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Introduction: Tobacco smoking has been shown to have a detrimental impact on fracture healing and is often implicated in the non- and delayed-union of bone. Whilst numerous studies have concentrated on the demographic and clinical manifestations of fracture healing and smoking, very little analyses have been undertaken at the biochemical level. Aims: This research project will assess the impact of smoking on the cellular and molecular mechanisms of bone healing by analysing human tibial fracture haematomas using a variety of laboratory techniques. Materials and methods: Cell culture: Fracture haematomas (~2 mL) were collected from anaesthetised patients (n=48), who had sustained a fracture of the tibia. The semisolid material was explanted into 25 cm2 non-coated tissue culture flasks and allowed to clot. Complete culture media was prepared and pipetted into the vessels, which were then placed in an incubator (37˚C; humidified 5% CO2). After characterisation via immunocytochemistry (using antigen-specific markers to CD29, CD44, CD73, CD105, CD166 and CD34), isolated cells were counted using flow cytometry and proliferation rates were compared between non-smokers and smokers. Cigarette smoke extract (CSE) was manufactured based on the methods of Bernhard et al. (2004), in order to synthesise an in vitro smoking environment. Cells harvested from non-smokers (n=10) were cultured and infused with the CSE (2.5%) and proliferation and cell recovery rates were compared between the treated and untreated groups. Cellular nitric oxide levels and necrosis rates (using propidium iodide for the latter) were also compared in a similar way. An MTT assay was conducted to assess response to various concentrations of BMP-2 (10, 100 and 500 ng mL-1) infusion in cell xvi cultures. Molecular assays: Serum was extracted from the haematomas and resolved on 16% acrylamide gels before staining with either Coomassie blue or silver nitrate. The resolved gels were photographed using a Kodak gel imaging system and unknown bands were identified using MALDI-TOF. Intracellular TGF- and IL-6 were probed using antibodies, which were then analysed via flow cytometry in order to confirm the presence of these acute-phase proteins. In additional experiments, the ELISA was undertaken to quantify and compare the amounts of VEGF and IL-6 in haematoma serum and lysed fracture cells respectively. Biochemical testing on serum for b-ALP, albumin and total protein amounts in fracture serum was carried out, comparing smoker (n=10) and non-smoker (n=10) levels. Results: Cell culture: Spindle-shaped, fibroblast-like cells were visible in the primary culture, which were expanded through at least 10 further passages. The immunostaining of cells suggested a mesenchymal stem cell (MSC) lineage (CD29+, CD44+, CD73+, CD105+, CD166+, CD34-). Absolute cell counting using flow cytometry revealed marked proliferation of cells after 3 passages of culture. There was a reduction in the rate of proliferation of MSCs in smokers over 2 passages compared with non-smokers (-20%). A 5-day proliferation study in the CSE-treated vs. untreated cells showed a reduction in the rate of doubling in the treated group (-40% p<0.05). Cells showed a recovery response after CSE was withdrawn from culture, but was not significant. Cell necrosis analysis of CSE-treated vs. untreated cells showed that the CSE-treated cultures had a higher rate of necrosis than the untreated cells (CSE-treated 14.37% vs. untreated 7.98% p<0.05). Nitric oxide levels were lower in the CSE-treated cells (CSE-treated 3.0 M vs. untreated 3.6 M; p<0.05). MTT assay; BMP-2 infusions all improved cell viability compared to the non-infused cells, xvii with a BMP-2 concentration of 10 ng mL-1 increasing cell viability the most, though not significantly (+23%; p>0.05). Molecular assay: After staining, SDS-PAGE gels showed numerous bands of serum proteins and the haematoma serum lanes displayed unknown proteins which were later found to be haptoglobin (~20 kDa) and haemoglobin (~14 kDa) chains via mass spectrometry (MALDI-TOF). Cells were strongly positive (>96%) for the intracellular protein markers TGF- and IL-6. The VEGF-A (serum) and IL-6 (cells) preliminary data from the ELISA revealed a reduction of these acute-phase proteins in patients who were smokers (VEGF-A -10%; IL-6 -15%). In the biochemical assays, albumin was reduced in smokers’ serum (-13%, p<0.05), whereas b-ALP was raised (+20%; p>0.05 n.s.) and total protein lowered (-12%; p<0.01). Conclusions: The haematoma cultures produced colonies of adherent fibroblast-like cells that were of a MSC lineage. With the exception of a residual haemolysis-derived haptoglobin band, SDS-PAGE did not appear to show an over-expression of acute phase proteins, although it was useful for the characterisation of the fracture milieu, in that it was suggestive of a consistently haemolysed haematoma. The effect of smoking on bone fracture healing, therefore, appears to contribute to the inhibition of MSC proliferation, angiogenesis and the acute phase stress response. Cigarette smoke was also shown to cause excessive necrosis and reduce the amount of NO in those MSC cultures treated with CSE, which may indicate reduced vasodilatation to the fracture site. Bone alkaline phosphatase (b-ALP) was raised in the fracture serum of smokers, suggesting abnormally-high bone turnover, whilst the reduction of total protein and serum albumin likely indicates a lowered capacity for acute-phase protein synthesis and calcium transport in these patients. Exogenous BMP may be indicated for rectification of malunion in smokers.
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Ortiz, Agapito Fernando, and Ortiz Carlos Joel Gonzalez. "“Tratamiento de Fracturas Articulares de Tibia Proximal. Evaluación de Resultados y Complicaciones Asociadas”." Tesis de Licenciatura, Medicina-Quimica, 2014. http://ri.uaemex.mx/handle/123456789/14730.
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Crowell, Harrison Philip. "Gait retraining for the reduction of lower extremity loading." Access to citation, abstract and download form provided by ProQuest Information and Learning Company; downloadable PDF file, 142 p, 2009. http://proquest.umi.com/pqdweb?did=1694575271&sid=7&Fmt=2&clientId=8331&RQT=309&VName=PQD.
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