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1
Palanisami, Dhanasekararaja, Melvin J. George, Arif Mohammed Hussain, Chunchesh MD, Rajkumar Natesan, and Rajasekaran Shanmuganathan. "Tibial bowing and tibial component placement in primary total knee arthroplasty in valgus knees: Are we overlooking?" Journal of Orthopaedic Surgery 27, no. 3 (August 30, 2019): 230949901986700. http://dx.doi.org/10.1177/2309499019867006.
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Purpose: Tibial bowing in valgus knees with arthritis can lead to component malplacement during total knee arthroplasty (TKA). Incidence of valgus knees with medial tibial bowing, its effect on tibial component placement during primary TKA and methods to improve accuracy of the component placement were studied. Methods: Full-length weight-bearing alignment radiograph was taken in 117 patients (149 knees) with valgus deformity undergoing TKA. In these cases, the proximal tibial reference for extramedullary jig placement was planned preoperatively with reference to the tibial spines and classified as four zones. Results: The mean preoperative hip–knee–ankle (HKA) angle was 192.9° (180.3–234.5°). Bowing >3° was considered significant ( p < 0.001) and at this level of bowing, the proximal tibial reference was shifted from centre to medial. Tibial bowing <3° was considered straight and >3° as tibia valga. Tibia was bowed in 70 knees (46.97%). Severity of valgus deformity had strong positive correlation with the tibia valga ( p < 0.001). The post-operative medial proximal tibial angle (MPTA) and HKA angle were 91.63° (87.9–95.7°) and 182.6° (178.1–189.7°), respectively. The mean MPTA and post-operative HKA angle in bowed and straight tibiae were 90.35° versus 89.78° ( p = 0.547) and 181.5° versus 180.7° ( p = 0.5716), respectively, and the difference was not statistically significant. Conclusion: Medial tibial bowing is very common in valgus knees. Tibia valga has a strong positive correlation with the severity of valgus deformity. Accurate tibial component placement can be achieved with a medialized reference point for extramedullary tibial cutting jig in knees with significant tibia valga. The study has been registered in clinical trials registry – India (CTRI/2018/03/012283).
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Robbins, Craig A. "Deformity Reconstruction Surgery for Blount’s Disease." Children 8, no. 7 (June 30, 2021): 566. http://dx.doi.org/10.3390/children8070566.
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Blount’s disease is an idiopathic developmental abnormality affecting the medial proximal tibia physis resulting in a multi-planar deformity with pronounced tibia varus. A single cause is unknown, and it is currently thought to result from a multifactorial combination of hereditary, mechanical, and developmental factors. Relationships with vitamin D deficiency, early walking, and obesity have been documented. Regardless of the etiology, the clinical and radiographic findings are consistent within the two main groups. Early-onset Blount’s disease is often bilateral and affects children in the first few years of life. Late-onset Blount’s disease is often unilateral and can be sub-categorized as juvenile tibia vara (ages 4–10), and adolescent tibia vara (ages 11 and older). Early-onset Blount’s disease progresses to more severe deformities, including depression of the medial tibial plateau. Additional deformities in both groups include proximal tibial procurvatum, internal tibial torsion, and limb length discrepancy. Compensatory deformities in the distal femur and distal tibia may occur. When non-operative treatment fails the deformities progress through skeletal maturity and can result in pain, gait abnormalities, premature medial compartment knee arthritis, and limb length discrepancy. Surgical options depend on the patient’s age, weight, extent of physeal involvement, severity, and number of deformities. They include growth modulation procedures such as guided growth for gradual correction with hemi-epiphysiodesis and physeal closure to prevent recurrence and equalize limb lengths, physeal bar resection, physeal distraction, osteotomies with acute correction and stabilization, gradual correction with multi-planar dynamic external fixation, and various combinations of all modalities. The goals of surgery are to restore normal joint and limb alignment, equalize limb lengths at skeletal maturity, and prevent recurrence. The purpose of this literature review is to delineate basic concepts and reconstructive surgical treatment strategies for patients with Blount’s disease.
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Yassin, Mustafa, Avraham Garti, Muhammad Khatib, Moshe Weisbrot, Uzi Ashkenazi, Edward Ram, and Dror Robinson. "The Utility and Limitations of the Transfibular Approach in Ankle Trauma Surgery." Case Reports in Orthopedics 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/234369.
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The commonly used extensive approaches to the distal tibia include the posteromedial and anterolateral approaches. The current report describes several cases performed using this technique establishing a rationale and safe zone for performing a transfibular approach to the distal tibia. The advantages of such approach are the excellent visualization of the lateral tibia and the articular space. The utilization of this approach involves the risk of injury to the anterior tibial vessels and to the superficial peroneal nerve as well as a requirement for syndesmosis reconstruction. The recommendation is to utilize this approach in cases of severe comminution of the lateral tibia with a relatively intact medial tibia.
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Ho, Jade Pei Yuik, Azhar Mahmood Merican, Khairul Anwar Ayob, Shahrul-Hisham Sulaiman, and Muhammad Sufian Hashim. "Tibia vara in Asians: Myth or fact? Verification with three-dimensional computed tomography." Journal of Orthopaedic Surgery 29, no. 1 (January 1, 2021): 230949902199261. http://dx.doi.org/10.1177/2309499021992618.
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Background: There is a common perception among surgeons that Asian tibiae are significantly more varus compared to non-Asians, contributed both by an acute medial tibial proximal angle (MPTA) and diaphyseal bowing. Insight into the normative morphology of the tibia allows generation of knowledge towards disease processes and subsequently planning for corrective surgeries. Methods: Computed tomography (CT) scans of 100 normal adult knees, aged 18 years and above, were analysed using a 3-dimensional (3D) analysis software. All tibiae were first aligned to a standard frame of reference and then rotationally aligned to the tibial centroid axis (TCAx) and the transmalleolar axis (tmAx). MPTA was measured from best-fit planes on the surface of the proximal tibia for each rotational alignment. Diaphyseal bowing was assessed by dividing the shaft to three equal portions and establishing the angle between the proximal and distal segments. Results: The mean MPTA was 87.0° ± 2.2° (mean ± SD) when rotationally aligned to TCAx and 91.6° ± 2.7° when aligned to tmAx. The mean diaphyseal bowing was 0.1° ± 1.9° varus when rotationally aligned to TCAx and 0.3° ± 1.6° valgus when aligned to tmAx. The mean difference when the MPTA was measured with two different rotational alignments (TCAx and tmAx) was 4.6° ± 2.3°. No statistically significant differences were observed between males and females. Post hoc tests revealed statistically significant difference in MPTA between different ethnic sub-groups. Conclusion: The morphology of the proximal tibiae in the disease-free Asian knee is inherently varus but not more so than other reported populations. The varus profile is contributed by the MPTA, with negligible diaphyseal bowing. These implications are relevant to surgical planning and prosthesis design.
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Zhong, Hua, Sushuang Ma, Yibiao Cen, Limin Ma, Deqiang Li, Bo Liang, Jin Chen, and Yu Zhang. "A case report of early unilateral external fixation by 3D printing and computer-assisted and secondary bone graft internal fixation in pseudarthrosis of the tibia surgery." Journal of International Medical Research 48, no. 9 (September 2020): 030006052094551. http://dx.doi.org/10.1177/0300060520945518.
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Congenital pseudarthrosis of the tibia (CPT) is a rare congenital malformation. It is characterized by a tibial anterior bowing deformity or specific types of non-union, which typically result from abnormal development of the tibia, leading to the formation of local pseudarthrosis. The treatment of CPT is very challenging. The advent of 3D printing and computer-assisted techniques in recent years has provided a new ancillary technique for treatment planning and implementation. This case report describes the successful surgical treatment of a 14-year-old male that presented with a shortened limb deformity. Ahead of elective surgery, 3D printing and computer-assisted techniques were used to provide a 1:1 model of his left tibia, fibula and ankle joint to precisely determine the surgical procedure. The first surgery did not result in complete calcification of the tibial extension area, so a second proximal tibia iliac bone graft and internal fixation surgery was undertaken. Following regular follow-up and rehabilitation, by the 18-month follow-up, the proximal tibial bone graft had healed and the patient had resumed walking with a normal gait. This case report describes in detail the successful use of unilateral external fixation using the Ilizarov technique, 3D printing and computer-assisted orthopaedic surgery in the planning of treatment for CPT.
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Sindunata, Nyoman Aditya, Prettysia Suvarly, Rio Aditya, and John Butarbutar. "Knee Arthroplasty in Severe Varus Advanced Knee Osteoarthritis with Proximal Tibia Malunion: a case report." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl5 (May 1, 2020): 2325967120S0005. http://dx.doi.org/10.1177/2325967120s00054.
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Alignment is crucial for successful knee arthroplasty.1 Tibia malunion will make arthroplasty more challenging. In this case, we present advanced knee osteoarthritis with tibia vara due to malunion that needs corrective osteotomy during knee arthroplasty. Case Presentation: A 70 years old female presented to our office complaining pain in both knees markedly on the left, profoundly felt during walking. She has a history of being hit by motorcycle 15 months ago and left knee was more bent since then. Physical examination of the left knee showed severe varus, mild effusion, tenderness on medial tibial condyle, otherwise normal. Plain radiographs showed advanced bilateral knee osteoarthritis with left proximal tibia malunion. Patient underwent left knee arthroplasty with corrective tibia and fibula osteotomy. Solutions and Outcome: Patient underwent closed wedge tibial osteotomy together with fibula osteotomy followed by knee arthroplasty with posterior-stabilized implant and tibial stem extension in a single surgery. Tibial osteotomy was reinforced using plate and screws. Partial weight bearing was achieved in second postoperative day and discharged on the third day. Patient able to walk with painless left knee after 1 month. Discussion: Severe deformity that causes huge malalignment makes knee arthroplasty difficult. Some methods are available to correct malalignment.1 In this case, the surgeon chose to do closed wedge tibial osteotomy reinforced with plate and screws to correct the proximal tibia malunion. Arthroplasty was done using posterior-stabilized implant and tibial stem extension. Patient shows good result in alignment and function. Conclusion: Correcting the associated deformity is crucial in achieving good alignment in knee arthroplasty. Even in our case of severe genu varus due to proximal tibia malunion, correcting proximal tibia varus deformity prior to knee arthroplasty shows good alignment and function. References: Mullaji AB, Padmanabhan V, Jindal G. Total Knee Arthroplasty for Profound Varus Deformity. 2005;20(5):550–61.
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Hong, Yuhwan, Brent G. Parks, and Stuart D. Miller. "Biomechanical Analysis of Tibial Strength After Harvest of Unicortical Tibial Grafts from Two Different Sites." Foot & Ankle International 27, no. 3 (March 2006): 190–95. http://dx.doi.org/10.1177/107110070602700307.
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Background: Use of tibial strut grafts has several potential advantages over other donor sites and would be ideal as a harvest site for bone grafts if there are minimal or no resulting risks to tibial stability. Methods: Ten matched-pair cadaver tibiae were randomized to have a 1.5 × 4.0 cm cortical graft harvested from the tibial crest or 1 cm posterior to the tibial crest. Both locations were 6 cm distal to the tibial plateau. The grafts were removed using a high-speed oscillating saw, and each end of the tibia was mounted for testing and loaded onto a servohydraulic test frame. The samples were axially loaded with 720 N (162 lbs) of force, and an external rotational torque was applied at 5 degrees per second to failure. Failure torque for each tibia was recorded. A paired Student's t-test was used to determine whether any observed differences in failure torques were significant. Results: The torque to failure range for on-crest grafts was 11.65 to 81.76 Nm (average, 44.53 Nm; SD, 22.82 Nm). The torque to failure range for the tibiae with the graft 1 cm off-crest was 13.30 to 70.45 Nm (average, 41.64 Nm; SD, 17.83 Nm). All fractures were spiral, included the distalmost anterior corner of the donor site, and extended distally. There was no significant difference in torque to failure between the two donor sites ( p = 0.22). The grafts varied consistently in quality. Conclusion: Considering that there was no statistically significant difference in torque to failure between the two groups of tibiae, the site for tibial bone graft can be selected based on the shape of the cortical graft necessary for each specific surgery.
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Kamenaga, Tomoyuki, Takafumi Hiranaka, Yuichi Hida, Takaaki Fujishiro, and Koji Okamoto. "Morphometric analysis of medial and lateral tibia plateau and adaptability with Oxford partial knee replacement in a Japanese population." Journal of Orthopaedic Surgery 28, no. 2 (January 1, 2020): 230949902091930. http://dx.doi.org/10.1177/2309499020919309.
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Aims: In unicompartmental knee arthroplasty (UKA), tibial components must be correctly sized and positioned so that tibial cut surfaces are well covered without marked under- or overhang with impingement of the surrounding soft tissue. We used morphometric data of both medial and lateral tibial plateaus separately to plan UKA and evaluated the compatibility of the measurement data to the dimensions of six currently available tibial prostheses in a Japanese population. Materials and Methods: Using computed tomography, we preoperatively examined 60 patients (30 medial and 30 lateral osteoarthritis (OA)) scheduled for primary UKA at our hospital between 2013 and 2017. Each tibial cutting surface was measured in the transverse plane at 2 mm below the respective joint line. We used anteroposterior and mediolateral length to calculate the mediolateral length/anteroposterior ratio of both medial and lateral compartments. We then compared measurements across six current UKA systems: Oxford fixed tibia and fixed lateral tibia, Triathlon, TRIBRID, JOURNEY UNI, and HLS Uni Evolution. Results: We found no significant differences in morphometric data between the medial and the lateral OA. The cutting surface of lateral plateau, however, had smaller anteroposterior dimensions, greater mediolateral length, and higher mediolateral length/anteroposterior ratio than those of medial plateau. Therefore, in this Japanese population-based study, Oxford lateral tibia had good compatibility with the measurement data of lateral compartments. Conclusions: Lateral compartments had lower anteroposterior length, greater mediolateral length, and higher mediolateral length/anteroposterior ratio than those of medial compartments. We, therefore, strongly recommend using Oxford fixed lateral tibia for lateral OA over other current tibial prostheses because of superior coverage.
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Rodríguez-Collell, Juan Ramón, Damian Mifsut, Amparo Ruiz-Sauri, Luis Rodríguez-Pino, Eva María González-Soler, and Alfonso Amador Valverde-Navarro. "Improving the cementation of the tibial component in knee arthroplasty." Bone & Joint Research 10, no. 8 (August 1, 2021): 467–73. http://dx.doi.org/10.1302/2046-3758.108.bjr-2020-0524.r1.
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Aims The main objective of this study is to analyze the penetration of bone cement in four different full cementation techniques of the tibial tray. Methods In order to determine the best tibial tray cementation technique, we applied cement to 40 cryopreserved donor tibiae by four different techniques: 1) double-layer cementation of the tibial component and tibial bone with bone restrictor; 2) metallic cementation of the tibial component without bone restrictor; 3) bone cementation of the tibia with bone restrictor; and 4) superficial bone cementation of the tibia and metallic keel cementation of the tibial component without bone restrictor. We performed CT exams of all 40 subjects, and measured cement layer thickness at both levels of the resected surface of the epiphysis and the endomedular metaphyseal level. Results At the epiphyseal level, Technique 2 gave the greatest depth compared to the other investigated techniques. At the endomedular metaphyseal level, Technique 1 showed greater cement penetration than the other techniques. Conclusion The best metaphyseal cementation technique of the tibial component is bone cementation with cement restrictor. Additionally, if full tibial component cementation is to be done, the cement volume used should be about 40 g of cement, and not the usual 20 g. Cite this article: Bone Joint Res 2021;10(8):467–473.
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León-Muñoz, Vicente J., Alonso J. Lisón-Almagro, and Mirian López-López. "Planning on CT-Based 3D Virtual Models Can Accurately Predict the Component Size for Total Knee Arthroplasty." Journal of Knee Surgery 33, no. 11 (July 3, 2019): 1128–31. http://dx.doi.org/10.1055/s-0039-1692645.
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AbstractThe ability to predict accurate sizing of the implant components for total knee arthroplasty surgery can have several benefits in the operating room, in terms of simplifying the workflow and reducing the number of required instrument trays. Planning on a three-dimensional (3D) virtual model can be used to predict size. The aim of this study was to quantify the accuracy of the surgeon-validated plan prediction on a computed tomography (CT)-based system. The clinical records of 336 cases (267 patients), operated using a CT-based patient-specific instrumentation, have been reviewed for the size of implanted components. Preoperative default planning (according to the preferences of the surgeon) and approved planning have been compared with the size of implanted components for both the femur and tibia. The prosthesis size, preplanned by the manufacturers, was modified by the surgeon during the validation process in 0.9% of cases for the femoral component and in 2.7% of cases for the tibial component. The prosthesis size, preplanned by the surgeon after the validation process, was used in 95.8% for the femur and 92.6% for the tibia. Concordance on the size of the surgeon-validated plan and the finally implanted size was perfect for both, the femoral (κ = 0.951; 95% confidence interval [CI]: 0.92–0.98) and the tibial component (κ = 0.902; 95% CI: 0.86–0.94). The most frequent change of size (51%) was an increase by one size of the planned tibial component. Planning of knee arthroplasty surgery on a 3D virtual, CT-based model is useful to surgeons to help predict the size of the implants to be used in surgery. The system we have used can accurately predict the component size for both the femur and tibia. This study reflects a study of level III evidence.
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Nagamine, Ryuji, Makoto Kawasaki, Kang-Il Kim, Akinori Sakai, and Toru Suguro. "The posterior tibial slope is mainly created by the posterior rotation of the tibial condyles." Journal of Orthopaedic Surgery 28, no. 3 (May 1, 2020): 230949902097558. http://dx.doi.org/10.1177/2309499020975580.
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Purpose: Constitutional varus in the coronal plane is formed based on the Hueter-Volkmann’s law. The varus deformity occurs at the proximal metaphysis of the tibia and the tibial condyle rotates medially. In the sagittal plane, we hypothesized that the posterior slope angle of the tibial articular surface may also occur at the proximal metaphysis and the tibial condyle rotates posteriorly. The purpose of this study was to verify the hypothesis. Methods: A total of 208 patients who underwent TKA had lateral view proximal tibia digital radiograph on which seven parameters were analyzed. The posterior slope angle of the tibial articular surface relative to the anterior wall of the tibial condyle and that relative to the anterior cortex of the tibial shaft were assessed. Correlation between the position of the tibial condyle and the posterior slope angle of the articular surface were assessed. Results: The proximal tibial condyle itself did not have a posterior slope in the 86.5% of the participants. Posterior rotation of the tibial condyle created posterior slope of the tibial articular surface relative to the anterior cortex of the tibial shaft. The more tibial condyle was posteriorly rotated, the more the tibial articular surface shifted posteriorly. Conclusion: Study findings showed that the posterior tibial slope occurs at the proximal metaphysis of the tibia, and the tibial condyle rotates posteriorly. The posterior tibial slope involves the posterior shift of the tibial articular surface. The posterior tibial slope is mainly created by the posterior rotation of the tibial condyle.
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Dalal, Rakesh B., Rajesh Rachha, and Hari Kovilazhikathu Sugathan. "Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery." Journal of Foot and Ankle Surgery (Asia Pacific) 2, no. 1 (2015): 27–30. http://dx.doi.org/10.5005/jp-journals-10040-1024.
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ABSTRACT Cancellous bone graft harvesting from proximal tibia is usually by a lateral approach. We describe our technique and results in harvesting proximal tibia bone graft by a medial approach in foot and ankle surgery. Our results confirm that medial proximal tibial bone graft harvesting is a relatively safe and easy procedure to obtain adequate amount of autogenous cancellous bone graft. Donor site morbidity was found to be very low and fusion rate was found to be excellent in a variety of foot and ankle surgeries. How to cite this article Dalal R, Sugathan HK, Rachha R. Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery. J Foot Ankle Surg (Asia-Pacific) 2015;2(1):27-30.
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Rachha, Rajesh, Hari Kovilazhikathu Sugathan, and Rakesh Dalal. "Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery." Journal of Foot and Ankle Surgery (Asia Pacific) 3, no. 1 (2016): 6–9. http://dx.doi.org/10.5005/jp-journals-10040-1041.
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ABSTRACT Cancellous bone graft harvesting from proximal tibia is usually by a lateral approach. We describe our technique and results in harvesting proximal tibia bone graft by a medial approach in foot and ankle surgery. Our results confirm that medial proximal tibial bone graft harvesting is a relatively safe and easy procedure to obtain adequate amount of autogenous cancellous bone graft. Donor site morbidity was found to be very low and fusion rate was found to be excellent in a variety of foot and ankle surgeries. How to cite this article Dalal R, Sugathan HK, Rachha R. Proximal Medial Tibial Bone Graft Harvesting in Foot and Ankle Surgery. J Foot Ankle Surg (Asia-Pacific) 2016;3(1):6-9.
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Noonan, Timothy, Michael Pinzur, Odysseas Paxinos, Robert Havey, and Avinash Patwardhin. "Tibiotalocalcaneal Arthrodesis With a Retrograde Intramedullary Nail: A Biomechanical Analysis of the Effect of Nail Length." Foot & Ankle International 26, no. 4 (April 2005): 304–8. http://dx.doi.org/10.1177/107110070502600406.
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Background: Fatigue fractures of the tibia have been observed at the level of the proximal end of the nail after successful tibiocalcaneal arthrodesis with a retrograde intramedullary device. Materials: To study the effect of nail length, five matched pairs of cadaver tibiae were instrumented with strain gauges and potted in methyl-methacrylate from a level 3 cm proximal to the distal medial malleolus to simulate a successful tibiocalcaneal arthrodesis. A standard length (15 cm) ankle arthrodesis nail and an identical longer device terminating in the proximal tibial metaphysis were inserted in each paired tibia using appropriate technique. The strain of the posterior cortex of the tibia was recorded under bending moments of up to 50 Nm for each intact specimen after nail insertion and after proximal locking of the nail. The nails were then exchanged between the specimens of the same pairs and the experiment was repeated to insure uniformity. Results: The standard length locked nail increased the principal strain of the posterior cortex of the tibia at the level of the proximal screw holes 5.3 times more than the locked long nail (353 and 67 microstrains), respectively. This stress concentration was not observed when the proximal extent of the nail terminated within the proximal tibial metaphysis. Conclusion: A successful tibiocalcaneal arthrodesis with a standard length locked intramedullary nail creates stress concentration around the proximal screw holes that may be responsible for the fractures observed clinically. This study supports the use of a “long” retrograde locked intramedullary nail for tibiocalcaneal arthrodesis in patients with systemic or localized osteopenia.
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Cai, Wenquan, Yuxi Su, and Guoxin Nan. "Novel method for the treatment of congenital pseudarthrosis of the tibia using the gastrocnemius flap: A preliminary study." Journal of Children's Orthopaedics 16, no. 3 (June 2022): 167–73. http://dx.doi.org/10.1177/18632521221097525.
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Purpose: Congenital pseudarthrosis of the tibia is a rare disease that is particularly difficult to treat; the most difficult complications include nonunion of the tibia, refracture, and failed surgery. This study aimed to evaluate the efficiency of transposing gastrocnemius flaps for the treatment of congenital pseudarthrosis of the tibia. Methods: Nine patients (aged 6.2 ± 3.6 years) diagnosed with congenital pseudarthrosis of the tibia in our hospital between March 2013 and March 2018 were enrolled. The tibial pseudarthrosis and thickened periosteum were completely removed, and intramedullary nails were used to fix the tibia. Bone harvest from the iliac, mixed with allogenic bone, was filled in the gap created by excision of the pseudarthrosis site and the surrounding periosteum; the gastrocnemius flap was then used to wrap the pseudoarthrosis site. The plaster cast was fixed postoperatively. The tibial union was evaluated via radiograph, and the plaster cast was removed after 12–24 weeks. Patients began walking approximately 12–14 weeks postoperatively. Results: Anatomical reduction was achieved in all the patients; the mean bone healing time was 10.1 ± 2.1 months. Bone nonunion was observed in one patient, and no neurovascular injury or wound infection occurred. Limb length discrepancy was in the range 3.2 ± 1.8 cm at 1 year and 4.7 ± 2.7 cm at 2 years after surgery. Two patients underwent replacement of the intramedullary nail, and eight patients exhibited good functional and radiographic outcomes. Conclusion: This preliminary study proved that using the gastrocnemius muscle flap to cover the pseudarthrosis site was an effective method to promote the tibial union and treat congenital pseudarthrosis of the tibia.
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DeOrio, James K., and Anthony W. Ware. "Salvage Technique for Treatment of Periplafond Tibial Fractures: The Modified Fibula-Pro-Tibia Procedure." Foot & Ankle International 24, no. 3 (March 2003): 228–32. http://dx.doi.org/10.1177/107110070302400305.
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We describe a technique of fixation for treatment of distal tibia periplafond fractures and nonunions that uses a modification of the principle of the fibula-pro-tibia procedure (fusing the tibia and fibula together to create a one-bone lower leg). The fibula is plated, and the screws are brought across to the medial tibial cortex. The procedure is accomplished with or without a tibial buttress plate and always includes iliac crest bone grafting of the nonunion site and synostosis. We have used this technique in five patients with satisfaction.
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Borade, Amrut, and Gitkumar Hajgude. "Lateral distal tibial locking compression plate fixation through single lateral incision technique is biologically superior and mechanically equivalent alternative to medial plate fixation for lower third tibia-fibula fractures." International Journal of Research in Orthopaedics 7, no. 6 (October 26, 2021): 1206. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20214189.
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<p><strong>Background:</strong> A number of surgical options for management of distal tibia fractures makes scenario confusing and available techniques are associated with complications. Recently lateral plating of tibia has shown good promise. To compare results between medial and lateral distal tibial locking compression plate for treatment of distal third tibia fractures</p><p><strong>Methods:</strong> Prospective clinical study was carried out among 24 patients presenting with distal third tibia fractures. Patients were randomized into two groups of 12 each. One group was allocated into medial distal tibial LCP and second group was allocated into lateral distal tibial LCP. In first group, approach taken was medial or anteromedial while in second group, approach taken was lateral. Follow up was done for six months after surgery.</p><p><strong>Results:</strong> There were 10 cases in medical group and eight cases in lateral group which had fracture due to road traffic accidents. All cases in medical group had concomitant fibula fracture while such cases were 10 in lateral group. One case in each group developed infection after surgery. There was one case of superficial skin dehiscence and one case of hardware problem in medial group compared to none in lateral group. Two cases from medial group required removal of implant compared to none from medial group.</p><p><strong>Conclusions:</strong> Lateral distal tibial LCP seems to provide biological advantage than medial distal tibial LCP without difference in biomechanical properties of implants. Single lateral incision technique is an ingenious, biologically sound, and cosmetically superior for fixation of both lower third tibia & fibula fractures together.</p>
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Atherton, Matthew J., and Gareth Arthurs. "Osteosarcoma of the Tibia 6 Years After Tibial Plateau Leveling Osteotomy." Journal of the American Animal Hospital Association 48, no. 3 (May 1, 2012): 188–93. http://dx.doi.org/10.5326/jaaha-ms-5730.
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A 7 yr old spayed female mastiff presented for examination of a left pelvic limb lameness of 3 mo duration. Six years previously, the dog had undergone tibial plateau leveling osteotomy (TPLO) surgery of the left pelvic limb for the treatment of cranial cruciate disease. On presentation, the dog had a painful and swollen proximal tibia. Following investigation, a diagnosis of osteosarcoma of the proximal left tibia at the site of the previous TPLO surgery was made. This is the first reported case of osteosarcoma following TPLO using an implant other than the Slocum plate.
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Kawasaki, Makoto, Ryuji Nagamine, Weijia Chen, Yuan Ma, Akinori Sakai, and Toru Suguro. "Proximal tibia vara involves the medial shift of the tibial articular surface." Journal of Orthopaedic Surgery 28, no. 1 (January 1, 2020): 230949902090259. http://dx.doi.org/10.1177/2309499020902592.
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Purpose: According to the concept of the constitutional varus, the tibial articular surface (TAS) has varus inclination. On the other hand, it has been reported that proximal tibia vara involved medial shift of the TAS. However, it has not been assessed whether varus inclination of the TAS has a correlation with the medial shift. We investigated whether varus inclination of the TAS has a correlation with the medial shift. If there is a correlation between two parameters, the influence of the medial shift of the TAS on the value of the hip–knee–ankle (HKA) angle and the femorotibial angle should be considered. Methods: A total of 112 patients who underwent total knee arthroplasty had anteroposterior view tibia digital radiograph on which five parameters were analyzed. Varus angle of the TAS, the distance between the mechanical axis and the anatomical axis on the articular surface, and the width of the articular surface were measured. Results: The more the proximal tibia had varus deformity, the more the TAS shift medially would be. Therefore, the mechanical axis does not match the anatomical axis. Because the HKA angle was assessed based on the concept that the mechanical and anatomical axes match on the tibia, this angle may not express the true alignment of the lower extremity in knees with proximal tibia vara. Conclusion: In varus knees, the proximal tibia has a medial shift of the TAS that may influence the value of the HKA angle.
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Chuzhak, A. V. "The use of the combined stable-elastic fixation for unstable injuries of the ankle joint in trans-syndesmotic fractures of the tibia." TRAUMA 22, no. 3 (July 19, 2021): 43–47. http://dx.doi.org/10.22141/1608-1706.3.22.2021.236323.
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The problem of complications and the frequency of poor outcomes in the surgical treatment of ankle fractures with ti-biofibular syndesmosis (TFS) rupture (4.8–36.8 % of cases) remains significant. It was interesting from a scientific and practical point of view to conduct a clinical study to determine the effectiveness of the newly developed method of metal osteosynthesis for tibial fractures with TFS rupture, which would combine stability of tibial fixation and not limit the elastic qualities of TFS. The aim of the study: to determine the effectiveness of combined stable-elastic fixation for unstable injuries of the ankle joint in trans-syndesmotic fractures of the tibia. Materials and methods. On the basis of own clinical researches and data of literature sources, the method of the combined stable-elastic fixation for unstable injuries of the ankle joint in trans-syndesmotic fractures of the tibia is developed. The effectiveness of the proposed technique was evaluated 6 months after surgery on the Kitaoka scale. We have examined 12 patients with tibial fractures type 44 B1, B2 and B3 according to the AO classification, who underwent surgery using our methods. Results. The high efficiency of using the technique of combined stable-elastic fixation for unstable injuries of the ankle joint due to trans-syndesmotic fractures of the tibia has been determined. Good and excellent treatment results 6 months after surgery were observed in all 12 people (100 %), with excellent outcomes observed in 75 % of cases. There were no satisfactory and unsatisfactory treatment results. Conclusions. The study proves the high efficiency of the proposed method for combined stable-elastic fixation of ankle injuries in unstable trans-syndesmotic fractures of the tibia with TFS damage. There were 75 % excellent and 25 % good results within 6 months after surgery. A wider introduction of this technique into the practice of traumatologists of Ukraine is proposed.
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Tomic, Slavko, Aleksandar Lesic, V. Bumbasirevic, O. Krajcinovic, Nemanja Slavkovic, and Marko Bumbasirevic. "Treatment of gigantocellular tumor of the tibia metaphysis by means of the Ilizarov method: A case study." Acta chirurgica Iugoslavica 52, no. 2 (2005): 131–35. http://dx.doi.org/10.2298/aci0502131t.
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The authors show a 36-year old female patient with a gigantocellular tumor of the distal metaphysis of the left tibia (stage III by Campanacci). A 7.6 cm long distal articular defect of the tibia has been formed by radical segmentary resection. The defect was compensated by the extension of the rest of the tibia; whereas the support function of the limb was provided through tibio-talar arthrodesis. 5.5 years after the surgery, there are no signs of local relapses; the patient walks without any orthopedic aids and works at the same job as prior to the operation.
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Miceli, Ana Lucia Carpi, Livia Costa Pereira, Thiago da Silva Torres, MônicaDiuana Calasans-Maia, and Rafael Seabra Louro. "Mandibular Reconstruction with Lateral Tibial Bone Graft: An Excellent Option for Oral and Maxillofacial Surgery." Craniomaxillofacial Trauma & Reconstruction 10, no. 4 (December 2017): 292–98. http://dx.doi.org/10.1055/s-0036-1593475.
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Autogenous bone grafts are the gold standard for reconstruction of atrophic jaws, pseudoarthroses, alveolar clefts, orthognathic surgery, mandibular discontinuity, and augmentation of sinus maxillary. Bone graft can be harvested from iliac bone, calvarium, tibial bone, rib, and intraoral bone. Proximal tibia is a common donor site with few reported problems compared with other sites. The aim of this study was to evaluate the use of proximal tibia as a donor area for maxillofacial reconstructions, focusing on quantifying the volume of cancellous graft harvested by a lateral approach and to assess the complications of this technique. In a retrospective study, we collected data from 31 patients, 18 women and 13 men (mean age: 36 years, range: 19–64), who were referred to the Department of Oral and Maxillofacial Surgery at the Servidores do Estado Federal Hospital. Patients were treated for sequelae of orthognathic surgery, jaw fracture, nonunion, malunion, pathology, and augmentation of bone volume to oral implant. The technique of choice was lateral access of proximal tibia metaphysis for graft removal from Gerdy tubercle under general anesthesia. The mean volume of bone harvested was 13.0 ± 3.7 mL (ranged: 8–23 mL). Only five patients (16%) had minor complications, which included superficial infection, pain, suture dehiscence, and unwanted scar. However, none of these complications decreases the result and resolved completely. We conclude that proximal tibia metaphysis for harvesting cancellous bone graft provides sufficient volume for procedures in oral and maxillofacial surgery with minimal postoperative morbidity.
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Kumar, Ramesh, Chandrashekhar M. Badole, Girish Mote, and Gajanan D. Chintawar. "Bone hydatid disease of distal femur and diaphysis of tibia: report of two cases with review of literature." International Journal of Research in Medical Sciences 5, no. 3 (February 20, 2017): 1126. http://dx.doi.org/10.18203/2320-6012.ijrms20170675.
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Cystic echinococcus or hydatidosis is a parasitic infection of humans and animals. In this we are reporting 2 cases. one is hydatid disease at distal femur left side and other patient having hydatid disease at shaft tibia rt side. both cases investigated and definitive surgery was done as arthrodesis with long tibio-femoral nail for distal femoral hydatidosis and curettage for tibial hydatidosis. Both patient given albendazole and followed up. in recent follow-up both cases do not have signs of recurrence. hence case report of these two cases is discussed along with review of literature.
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Zhang, Shaodong, Xiaotao Wu, Lei Liu, and Chen Wang. "Removal of interlocking intramedullary nail for relieve of knee pain after tibial fracture repair." Journal of Orthopaedic Surgery 25, no. 1 (January 1, 2017): 230949901668474. http://dx.doi.org/10.1177/2309499016684748.
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Objective: To investigate the effects of intramedullary nail removal after tibial fracture repair. Methods: Sixty patients at our hospital were enrolled in a prospective study and divided into moderate/severe knee pain (visual analog scale (VAS) ≥ 4) and mild/no knee pain (VAS < 4) groups after interlocking intramedullary nailing. Variables studied included the distance from the tip of the nail to the tibial plateau and the front of the tibia on a normalized lateral X-ray, the VAS score of knee and ankle pain, the range of motion of the knee and ankle, and Johner–Wruhs criteria before, 6 weeks after operation, and at the last follow-up. Results: Fifty-seven patients were followed for a mean of 8.4 (2–17) months. In patients with moderate or severe knee pain intramedullary nail removal led to significant pain reductions ( p < 0.05). A significantly shorter distance from the tip of the nail to the tibial plateau (<10 mm) and the anterior border of tibia (<6 mm) was found in the 24 patients with moderate or severe knee pain. Knee pain VAS scores significantly lowered 6 weeks postoperatively and at the last follow-up, compared to before the operation ( p < 0.05). However, no significant changes occurred with respect to ankle pain VAS scores, range of motion, and Johner–Wruhs criteria ( p > 0.05). Conclusion: For patients complaining knee pain after interlocking intramedullary nailing of tibial fractures, especially with a short distance from the tip of the nail tail to the tibial plateau (<10 mm) and the anterior border of the tibia (<6 mm) removal of the intramedullary nails relieved the pain significantly.
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Kononovich, N. A., E. R. Mingazov, E. N. Gorbach, and D. A. Popkov. "Impact of telescopic intramedullary rodding on the growing tibia: an experimental study." Genij Ortopedii 28, no. 6 (December 2022): 817–22. http://dx.doi.org/10.18019/1028-4427-2022-28-6-817-822.
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Introduction Telescopic intramedullary osteosynthesis (TIO) is used in children with osteogenesis imperfecta and other diseases accompanied by frequent fractures and deformities of long bones due to pathological bone tissue featuring reduced strength properties. Purpose In an animal experiment to study the growth characteristics of an intact tibia under conditions of intramedullary reinforcement with a telescopic rod. Material and methods A non‑randomized controlled study was conducted on 4 animals (puppies, littermates) that underwent TIO of the right limb tibia with a telescopic titanium rod (outer diameter of 4.2 mm) at the age of 5 months. X-ray parameters (length of the tibia, angles of inclination of the articular surfaces, telescoping magnitude) were studied before surgery, on the day of rod placement, and after the end of spontaneous growth of the segment (7 months after surgery). The contralateral left tibia served as a control, and its X-ray parameters were studied at the same time-points. Results Transphyseal reinforcement with a telescopic rod caused growth retardation with loss of length in only one case out of four (8 mm or 4.8 % of residual growth). In other cases, no difference in the length of the tibias of the right and left lower extremities was found. Eccentric insertion of the transphyseal rods into the posterior third of the distal epiphysis (due to the natural anatomy of the canine tibial shaft) formed an angular deformity during growth: a significant increase in the distal anterior and lateral tibial angles of the operated limb compared to the intact limb. The amount of divergenceof the parts of the rods was, on average, 11.3 mm. There were no cases of migration of intramedullary rods or loss of fixation of threaded sections in the epiphyses. Conclusion Under experimental conditions, the slowing down of longitudinal bone growth is not a constantly observed effect. Titanium telescopic rods are not prone to blocking during the limb growth or to losing the position of the threaded parts in the epiphyses. The eccentric passage of the rods through the growth zones causes angular deformities in the course of growth of the segment.
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Tapasvi, Sachin, Anshu Shekhar, Shantanu Patil, and Hemant Pandit. "Limb position influences component orientation in Oxford mobile bearing unicompartmental knee arthroplasty." Bone & Joint Research 9, no. 6 (June 2020): 272–78. http://dx.doi.org/10.1302/2046-3758.96.bjr-2019-0258.r1.
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Aims The mobile bearing Oxford unicompartmental knee arthroplasty (OUKA) is recommended to be performed with the leg in the hanging leg (HL) position, and the thigh placed in a stirrup. This comparative cadaveric study assesses implant positioning and intraoperative kinematics of OUKA implanted either in the HL position or in the supine leg (SL) position. Methods A total of 16 fresh-frozen knees in eight human cadavers, without macroscopic anatomical defects, were selected. The knees from each cadaver were randomized to have the OUKA implanted in the HL or SL position. Results Tibial base plate rotation was significantly more variable in the SL group with 75% of tibiae mal-rotated. Multivariate analysis of navigation data found no difference based on all kinematic parameters across the range of motion (ROM). However, area under the curve analysis showed that knees placed in the HL position had much smaller differences between the pre- and post-surgery conditions for kinematics mean values across the entire ROM. Conclusion The sagittal tibia cut, not dependent on standard instrumentation, determines the tibial component rotation. The HL position improves accuracy of this step compared to the SL position, probably due to better visuospatial orientation of the hip and knee to the surgeon. The HL position is better for replicating native kinematics of the knee as shown by the area under the curve analysis. In the supine knee position, care must be taken during the sagittal tibia cut, while checking flexion balance and when sizing the tibial component.
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Stefanello, Damiano, Stefano Romussi, Paola Signorelli, Mario Caniatti, Mauro DiGiancamillo, Paola Roccabianca, and Giancarlo Avallone. "Primary Osseous Melanoma in the Tibia of a Dog." Journal of the American Animal Hospital Association 44, no. 3 (May 1, 2008): 139–43. http://dx.doi.org/10.5326/0440139.
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An 18-month-old, female Cane Corso dog was presented with a suspected primary tumor of the tibia. Plain radiographs and computed tomography (CT) of the tibia were highly suggestive of a primary bone neoplasm. A diagnosis of malignant melanoma was made by cytology. Total body survey radiographs, CT scan of the thorax, and abdominal ultrasound excluded the presence of neoplastic lesions other than in the tibia. Limb amputation was performed. Histology and immunohistochemical analysis of the tibial neoplasm confirmed the diagnosis of a melanoma with secondary metastasis to the popliteal lymph node. The dog was alive and in good physical condition 43 months after surgery.
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Ebraheim, Nabil A., Jike Lu, Hua Yang, and Jim Rollins. "The Fibular Incisure of the Tibia on CT Scan: A Cadaver Study." Foot & Ankle International 19, no. 5 (May 1998): 318–21. http://dx.doi.org/10.1177/107110079801900509.
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Twenty cadaver lower limbs were used for CT assessment of the fibular incisure of the tibia. The length of the syndesmotic facet is shorter in the anterior (11.20 ± 1.90 mm) than in the posterior (14.89 ± 2.72 mm) ( P < 0.001). The angle between anterior and posterior facets is 135.18 ± 9.27°. The depth of the fibular incisure of the tibia is 4.29 ± 1.26 mm. The vertical distance of tibiofibular overlapping is 7.81 ± 1.93 mm. The distance between anterior margin of the tibia and anterior margin of the fibula is 17.40 ± 3.61 mm. The distance between the medial fibular border and the lateral border of the posterior tibia is 2.01 ± 0.49 mm. The syndesmotic notch could be divided into two groups: significant concave surface and shallow concave surface. The position of the fibula in the incisural notch may depend on the depth of the fibular incisure of the tibia during traumatic forces applied on the syndesmosis. CT can display the tibial tubercles and clearly demonstrates the fibular incisure of the tibia and the interior of the tibiofibular space.
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Chandrakant, Kawalkar Abhijit, and Badole Chandrashekher Martand. "Distal Tibia Metaphyseal Fractures: Which is Better, Intra-medullary Nailing or Minimally Invasive Plate Osteosynthesis?" Journal of Orthopaedics, Trauma and Rehabilitation 24, no. 1 (June 2018): 66–71. http://dx.doi.org/10.1016/j.jotr.2017.09.004.
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Introduction Tibia fractures are the most common long bone fractures encountered by the orthopedic surgeons and distal tibia fractures have the second highest incidence of all tibia fractures after the middle third of tibia the distal tibial fractures are unique and are considered as most challenging fractures to treat due to its proximity to the ankle joint and its superficial nature. The objective of this study is to compare two osteosynthesis systems developed for surgical treatment of distal tibia fractures: the intramedullary nailing and the MIPPO technique. Methods The study was conducted between Jan 2011 to Dec 2012. 63 patients with extra-articular distal tibia fracture treated with intramedullary nailing and MIPPO technique were reviewed retrospectively and clinical outcome was evaluated according to American Orthopaedic Foot and Ankle Score. Results 31 patients were treated with intramedullary nail & 32 with MIPPO technique. Fibular fixation was done in cases where fibular fracture was at or below the level of tibial fractures. We found no difference in terms of time for fracture union, mal-union, non-union, duration of surgery and amount of blood loss. But there was significant difference in terms of infection and duration of hospital stay. Also weight bearing was possible much earlier in intramedullary group as compared to the MIPPO group. Conclusion Thus we conclude that intramedullary nailing is better choice of implant in patients with extra- articular distal tibia fractures & helps in early weight bearing and ambulation of patient with fewer complications.
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Harnroongroj, Thos, Lauren G. Volpert, Scott J. Ellis, Carolyn M. Sofka, Jonathan T. Deland, and Constantine A. Demetracopoulos. "Comparison of Tibial and Talar Bone Density in Patients Undergoing Total Ankle Replacement vs Non–Ankle Arthritis Matched Controls." Foot & Ankle International 40, no. 12 (August 17, 2019): 1408–15. http://dx.doi.org/10.1177/1071100719868496.
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Background: Bone quality in the distal tibia and talus is an important factor contributing to initial component stability in total ankle replacement (TAR). However, the effect of ankle arthritis on bone density in the tibia and talus remains unclear. The objective of this study was to compare bone density of tibia and talus in arthritic and nonarthritic ankles as a function of distance from ankle joint. Methods: We retrospectively reviewed 93 end-stage ankle arthritis patients who had preoperative nonweightbearing ankle computed tomography (CT) and identified a cohort of 83 nonarthritic ankle patients as a demographic-matched control group. A region of interest tool was used to calculate Hounsfield unit (HU) values in the cancellous region of the tibia and talus. Measurements were obtained on axial cut CTs from 6 to 12 mm above the tibial plafond, and 1 to 4 mm below the talar dome. HU measurements between groups and the decrease of HU at the relative level in each group were compared. Results: Arthritic ankles demonstrated significantly greater mean bone density than nonarthritic ankles at between 6 and 10 mm above the joint in the tibia ( P < .05). No significant difference in bone density between 10 and 12 mm from the joint in the tibia nor at any level of the talus was found between groups. In both groups, bone density decreased significantly at each successive level away from the ankle joint. Conclusion: Ankle arthritis patients demonstrated greater or equal bone density in both the tibia and talus compared to demographic-matched controls. In both groups, bone density decreased with increasing distance away from the articular surface. In TAR, tibial bone resection between 6 and 8 mm may provide improved initial implant stability. Level of Evidence: Level III, comparative study.
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Goyal, Tarun, Mukesh Singla, and Souvik Paul. "Anatomy of posterior cruciate ligament retained in a posterior cruciate ligament retaining total knee replacement: a cadaveric study." SICOT-J 4 (2018): 40. http://dx.doi.org/10.1051/sicotj/2018013.
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Background: Recent evidence has highlighted a risk that the majority of posterior cruciate ligament (PCL) is removed while making bone cuts in tibia and femur during total knee replacement surgery. Aim of this cadaveric study is to calculate how much PCL footprint is retained in a PCL retaining prosthesis after routine tibial and femoral cuts are made. Methods: Twelve paired formalin-fixed Indian cadaveric knees were studied. Knees were disarticulated and all soft tissues were circumferentially removed from the tibia and femur. Footprints of antero-lateral and postero-medial bundles were marked on tibia and femur. Proximal tibial and distal femoral cuts were made using standard cutting jigs (Zimmer NexGen LPS). Digital photographs were taken with a magnification marker attached on the bone before and after making the cuts. Area of PCL insertion before and after the bone cuts was measured using software ImageJ (National Institute of Health). Results: Footprint on tibial side was reduced by 9.1%, and on femoral side by 21.8%. Footprint of AL bundle was reduced by 24.3% on the tibial side and by 15.3% on the femoral side. Footprint of PM bundle on tibia was not affected by the bone cut but was reduced by 18.5% on the femoral side. Conclusion: Tibial and femoral insertions of PCL are relatively well preserved after bone cuts are made in a posterior cruciate retaining TKR. There is differential sectioning of antero-lateral and postero-medial bundles of PCL on tibial and femoral sides.
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Hintermann, Beat, Christian Sommer, and Benno M. Nigg. "Influence of Ligament Transection on Tibial and Calcaneal Rotation with Loading and Dorsi-Plantarflexion." Foot & Ankle International 16, no. 9 (September 1995): 567–71. http://dx.doi.org/10.1177/107110079501600910.
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The purpose of this study was to quantify the effect of sequential ligament transection (anterior talofibular, calcaneofibular, posterior talofibular, deltoid, and subtalar interosseous ligaments) on the rotational movement of the tibia and the calcaneus as associated with axial loading and dorsi-plantarflexing the foot. Eight cadaver foot-leg specimens were investigated using a unconstrained testing apparatus. As the ankle complex was axially loaded, almost the same internal rotation of the tibia and the same calcaneus eversion was found with and without the various degrees of lateral and medial ligament release; additional sectioning of the subtalar interosseous ligament tremendously increased the resulting tibial and calcaneal rotation. While tibial and calcaneal rotation from foot dorsi-plantarflexing did not alter significantly with transection of the lateral ligaments, almost no tibial and calcaneal rotation occurred after additional sectioning of the deltoid and subtalar interosseous ligament. These results indicate that, after release of the lateral ligaments, the foot becomes partially mechanically disconnected from the tibia by additional transection of the medial ligaments and even further disconnected after transection of the subtalar interosseous ligament.
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Obringer, Olivia, Bradley Coolman, and Jason Crawford. "Spontaneous Regression and Reoccurrence of Osteosarcoma in a Canine Tibia." VCOT Open 04, no. 02 (July 2021): e86-e91. http://dx.doi.org/10.1055/s-0041-1735844.
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AbstractA 32-month-old female Labrador Retriever mix-breed presented for right pelvic limb lameness with firm swelling on the lateral aspect of the stifle. Radiographs revealed a mass with periosteal elevation along the lateral cortex of the proximal tibia. Histology on a core biopsy sample was diagnostic for osteosarcoma. Surgical treatment was declined. Eight months post diagnosis, the patient was re-evaluated by the primary care veterinarian and had no lameness, pain, or tibial swelling. Sixty-three months later (5.2 years), the patient presented for cranial cruciate ligament ruptures. Radiographs revealed a smooth bony protuberance on the lateral aspect of the right proximal tibia in the area of the previous osteosarcoma. The patient underwent bilateral tibial plateau levelling osteotomies. The surgical recovery was uneventful with normal healing. Twenty-seven months following surgery, the patient returned for painful swelling around the right proximolateral tibia. Radiographs revealed an 8 × 9 cm osteoproliferative and osteolytic lesion of the proximal tibia. Osteosarcoma was confirmed via core biopsy. The bone tumour grew rapidly, and the patient was euthanatized 3 months thereafter. This case report demonstrates the unusual occurrence of an osteosarcoma in a young dog which spontaneously regressed. Ninety months (7.5 years) after clinical resolution of the initial tumour, osteosarcoma formed again in the same location. Lifetime patient monitoring with repeated clinical exams, serial radiographs, and multiple biopsies by the same surgeon, pathologists, and radiologist are unique features of this case report.
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Akhtyamov, I. F., I. Sh Gilmutdinov, and E. R. Khasanov. "New option of tibial plateau plasty in total knee arthroplasty." Genij Ortopedii 27, no. 5 (October 2021): 592–96. http://dx.doi.org/10.18019/1028-4427-2021-27-5-592-596.
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Abstract. Introduction There are several options of fixation and plasty for tibial defects. Screw and cement augmentation of the tibia is an alternative to conventional bone autograft and allograft. Although use of metal and cement augments provides reliable support for the tibial plateau and facilitates early weight-bearing on the operated limb the technique fails to maintain enough bone stock for future revisions. The purpose was to present an option of cement and metal augmentation of the tibial component in total knee arthroplasty (TKA). Material and methods The technique consists of cement and screw augmentation using three screws placed vertically as a regular triangle and being perpendicular to the tibial plateau. We describe the technique and a clinical instance of type 2A defect of the proximal tibia using the author's method. Outcome measures were goniometry and radiography. Results Goniometry examination showed positive dynamics in the first week after surgery with flexion of 110.0 degrees, extension 175.0 degrees; at 12 months with flexion of 90.0 degrees and extension of 180.0 degrees. Radiographic examination demonstrated no instability and micromobility of the cement mantle. Discussion The author's technique of screw and cement augmentation of the tibial component was practical for type 2A defects of the proximal tibia with a shortage of materials of bone autografts. This is a pilot study that requires further investigations.
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Khojasteh, Arash, Mohamadreza Baghaban Eslaminejad, Hamid Nazarian, Golnaz Morad, Seyyedeh Ghazaleh Dashti, Hossein Behnia, and Mark Stevens. "Vertical Bone Augmentation With Simultaneous Implant Placement Using Particulate Mineralized Bone and Mesenchymal Stem Cells: A Preliminary Study in Rabbit." Journal of Oral Implantology 39, no. 1 (February 1, 2013): 3–13. http://dx.doi.org/10.1563/aaid-joi-d-10-00206.
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This study aimed to assess vertical bone augmentation with simultaneous implant placement in rabbit tibiae using particulate mineralized bone/fibrin glue/mesenchymal stem cell. Bone marrow was aspirated from tibiae of five 10-week-old New Zealand White male rabbits. Right and left tibiae of each rabbit were prepared, and a 3-mm protruding implant from tibial bone was placed in each side. Particulate allogenic bone/fibrin glue/mesenchymal stem cell combination was placed around test implants and particulate bone graft/fibrin glue around controls. Two months postoperatively, the animals were euthanized, and sections were prepared for histological analysis. The mean amount of vertical bone length was higher in the experimental group than the control group (2.09 mm vs 1.03 mm; P < .05). New supracrestal trabecular bone formation was also significantly higher in the test group (28.5 ± 4.5% vs 4.3 ±1.8%; P < .05). Mesenchymal stem cell/particulate allograft/fibrin glue appears to be a promising combination for vertical bone augmentation around simultaneously inserted implants in rabbit tibia.
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Agarwal, Sanjeev, Sarah Choi, Rakesh Kumar, and Rhidian Morgan-Jonnes. "Extra-articular tibial deformity management in total knee replacement." Acta Orthopaedica Belgica 87, no. 4 (December 2021): 659–64. http://dx.doi.org/10.52628/87.4.11.
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Background : Presence of an extra-articular deformity in the femur or tibia poses a challenge to the surgeon undertaking knee replacement procedure. The conundrum is whether to correct the deformity beforehand, or accept the deformity and compensate for this through placement of the implant. Material and Methods : This is a retro-spective study comprising six patients who had a knee replacement in the presence of an extra-articular deformity of the tibia treated at our centre. All six had the knee replacement without correction of deformity. The data evaluated included clinical outcome, mechanical axis correction, type of implant, and the use of any software / computer guidance. The deformity was managed through planning of tibial resection without the need for pre-operative deformity correction. Results : Mean age was 66.5 years. Mean coronal plane deformity in the tibia was 8.6 degrees. The hip- knee-ankle improved from a mean 12.6 degrees to 4 degrees. Mean Oxford knee score improved from a mean of 19 to 33.6. Conclusion : Planning the tibial resection on the basis of mechanical axis of tibia allows correction of alignment without the need for preoperative correction. Correction of the deformity may not be needed if the maximum tibial resection is less than 15 mm.
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Hsu, Wei-Kuo, Yi-Chuan Chou, Chang-Han Chuang, Chia-Lung Li, and Po-Ting Wu. "Aeromonas hydrophilia-infected nonunion of a closed tibial fracture in a healthy adolescent: A case report." Journal of Orthopaedic Surgery 29, no. 2 (May 1, 2021): 230949902110015. http://dx.doi.org/10.1177/23094990211001587.
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Aeromonas hydrophilia can cause soft tissue infection in both immunocompromised and healthy persons. A healthy 15-year-old adolescent fell into a ditch after a scooter accident and sustained a right distal tibial shaft closed fracture, a right femoral shaft closed fracture, and a dirty laceration over the medial aspect of the distal thigh above the right knee. After empiric antibiotics and radical debridement of the contaminated wound, a femoral interlocking nail and tibial external fixator were applied. However, acute osteomyelitis later presented in his femur and tibia, and Aeromonas hydrophilia grew in cultures from the knee wound and the fracture sites. During the follow-up, his tibia became an infected nonunion, and was successfully treated with the induced membrane technique. In an otherwise healthy patient with a closed fracture, Aeromonas hydrophilia can cause acute osteomyelitis and necrotizing fasciitis by spreading from a nearby contaminated wound. Exposure to water is a risk factor for Aeromonas hydrophilia infection.
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Rahman, Md Asjadur, Md Shahidullah Kaiser, SM Roknuzzaman, and Nadim Ahmed. "Comparative Study between Intra-medullary Nailing and Minimally Invasive Plate Osteosynthesis (MIPO) in Closed Distal Tibia Fracture in a District Hospital in Bangladesh." Journal of Shaheed Suhrawardy Medical College 12, no. 1 (January 24, 2021): 33–37. http://dx.doi.org/10.3329/jssmc.v12i1.51616.
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Introduction: Tibia fractures are the most common long bone fractures encountered by the orthopedic surgeons and distal tibia fractures have the second highest incidence of all tibia fractures after the middle third of tibia the distal tibial fractures are unique and are considered as most challenging fractures to treat due to its proximity to the ankle joint and its superficial nature. The objective of this study is to compare two osteosynthesis systems developed for surgical treatment of distal tibia fractures: the intramedullary nailing and the MIPO technique.
Methods: The study was conducted between Jan 2018 to Dec 2019. 30 patients with extraarticular distal tibia fracture treated with intramedullary nailing and MIPO technique were reviewed retrospectively and clinical outcome was evaluated according to American Orthopaedic Foot and Ankle Score.
Results: 15 patients were treated with intramedullary nail and 15 with MIPO technique. Fibular fixation was done in cases where fibular fracture was at or below the level of tibial fractures. We found no difference in terms of time for fracture union, mal-union, non-union, duration of surgery and amount of blood loss. But there was significant difference in terms of infection and duration of hospital stay. Also weight bearing was possible much earlier in intramedullary group as compared to the MIPO group.
Conclusion: Thus we conclude that intramedullary nailing is better choice of implant in patients with extra- articular distal tibia fractures and helps in early weight bearing and ambulation of patient with fewer complications.
J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 33-37
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Shelton, Trevor J., Stephen M. Howell, and Maury L. Hull. "A Total Knee Arthroplasty Is Stiffer When the Intraoperative Tibial Force Is Greater than the Native Knee." Journal of Knee Surgery 32, no. 10 (November 9, 2018): 1008–14. http://dx.doi.org/10.1055/s-0038-1675421.
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AbstractWe hypothesized that a total knee arthroplasty (TKA) with an intraoperative tibial force greater than the tibial force of the native knee has signs of stiffness as measured by loss of extension and flexion, and anterior translation of the tibia. Intraoperative forces in the medial and lateral tibial compartments were measured during passive motion in 71 patients treated with calipered kinematically aligned TKA. Maximum extension, flexion, and the anterior–posterior position of the tibia with respect to the distal femur at 90 degrees of flexion were measured. Measurements were repeated after exchanging to a 2 mm thicker insert. The sum of the average of the medial and lateral compartment forces at 0, 45, and 90 degrees of flexion represented the tibial force through a 90-degree motion arc. For the implanted insert, the tibial force averaged 28 ± 17 lb, which is comparable to the 20 ± 7 lb reported for the native knee. At 6 months, patients reported an average 40 point Oxford Knee and 15 point Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score. For the 2 mm thicker insert, the tibial force averaged 50 ± 28 lb. A 30 lb tibial force greater than native generated a 3-degree loss of extension, a 3-degree loss of flexion, and 3-mm anterior translation of the tibia. Because a TKA with a tibial force greater than native has signs of stiffness, a strategy for lowering this risk is to match the tibial force of the native knee when balancing a TKA as this restored high function.
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Enguídanos, Celia, Elena Sáez, Francisco Torrecillas, and Lucía Cucó. "Fracturas de pilón tibial: Qué son, clasificaciones y manejo quirúrgico." Journal of Orthopaedic Surgery and Traumatology 5, Number 5 (November 30, 2022): 1–14. http://dx.doi.org/10.36438/jost2022008.
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A single Tibial pylon fractures are articular injuries of the distal tibia. They are fractures caused by a high-energy mechanism, and in most cases involve the fibula. The most accepted classification is that of the AO/OTA. There are constant articular fragments that can have differents sizes and comminution: anterolateral, posterolateral and medial. They are best visualized by computed tomography (CT), so this study is essential before surgery. Soft tissue involvement, fracture pattern, patient profile and surgeon experience guide treatment. Therefore, understanding the fracture pattern and the forces that have caused the tibial failure is necessary to perform surgical approach.
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Chong, David Y., and Dror Paley. "Deformity Reconstruction Surgery for Tibial Hemimelia." Children 8, no. 6 (May 31, 2021): 461. http://dx.doi.org/10.3390/children8060461.
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Tibial hemimelia is a rare congenital deficiency with a wide spectrum of pathology and deformity. This paper aims to give a comprehensive review of tibial hemimelia, with a concise summary of the history, pathology, and clinical findings of tibial hemimelia, while providing treatment recommendations and a review of the current literature. Classifications and surgical treatments are discussed, including amputation, limb reconstruction, and lengthening. Type-specific treatments are also discussed, including staged distraction correction of joint contractures of knee and ankle, Weber patelloplasty, fibular centralization, knee and ankle arthrodesis, implantable articulated distractors, and the role of femoral shortening. Amputation is a simpler and easier solution for many patients; however, reconstruction options continue to evolve, improve, and provide better functional outcomes in many cases. Factors favoring surgical reconstruction include the presence of a knee joint/proximal tibia, and the presence of a patella and quadriceps mechanism.
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Karpenko, V. Yu, A. L. Karasev, A. F. Kolondaev, K. A. Antonov, and N. A. Lyubeznov. "Subtotal proximal resection and tibial reconstruction with a modular endoprosthesis complemented with custom-made short distal stem (a case report)." Genij Ortopedii 28, no. 2 (April 29, 2022): 261–67. http://dx.doi.org/10.18019/1028-4427-2022-28-2-261-267.
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Introduction Malignant tumors are frequently localized in the long bones. Radical resection and reconstruction with megaprostheses is the gold standard of surgery in this group of patients. Unfortunately, the use of standard modular components is not possible in subtotal resection or is associated with a high risk of instability. Development of personalized shortened components of endoprostheses based on 3D computer modeling expands the possibilities of limb salvage surgical treatment. Materials and methods We describe a case of surgical treatment of a patient with extensive tibial fibrosarcoma. Pre-operative diagnosis based on CT, MRI, PET-CT and biopsy was low-grade fibrosarcoma, post-operative diagnosis was the same. Radical subtotal proximal resection of the tibia was performed, and modular knee megaprosthesis based on 3D-modelling custommade distal short tibial component of hybrid fixation was used for reconstruction. Rehabilitation after surgery included wearing knee and ankle orthoses. Results No tumor recurrence or metastases were revealed one year after surgery, functional and radiological results were excellent. Patient walked without support, her gate was correct, and MSTS score was 83 %. Discussion In recent years, custom-made short components of oncological endoprostheses using 3D computer modeling have been developed. The short custom-made tibial component used by us in the report is a combination of a short cemented stem locked with two extraosseous plates with a rough surface. It simultaneously ensures the strength of the implant and increases the contact with the distal tibia. Excellent radiological and functional results obtained one year after the operation allow us to hope for a positive outcome in the medium term and to delay extirpation of the tibia. Conclusion Radical bone resections and megaprosthetic reconstruction in malignant tumors provide the best functional results. Implementation of based on 3D-modelling custom-made prosthetic components in extensive resections is a perspective trend in limb-salvage surgery.
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Mittelstaedt, Daniel, David Kahn, and Yang Xia. "Detection of early osteoarthritis in canine knee joints 3 weeks post ACL transection by microscopic MRI and biomechanical measurement." Journal of Orthopaedic Surgery 26, no. 2 (May 1, 2018): 230949901877835. http://dx.doi.org/10.1177/2309499018778357.
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Purpose: To detect early osteoarthritis (OA) in a canine Pond–Nuki model 3 weeks after anterior cruciate ligament (ACL) transection surgery, both topographically over the medial tibial surface and depth-dependently over the cartilage thickness. Methods: Four topographical locations on each OA and contralateral medial tibia were imaged individually by magnetic resonance imaging (MRI) at 17.6 µm transverse resolution. The quantitative MRI T2 relaxation data were correlated with the biomechanical stress-relaxation measurements from adjacent locations. Results: OA cartilage was thinner than the contralateral tissue and had a lower modulus compared to the contralateral cartilage for the exterior, interior, and central medial tibia locations. Depth-dependent and topographical variations were detected in OA cartilage by a number of parameters (compressive modulus, glycosaminoglycan concentration, bulk and zonal thicknesses, T2 at 0° and 55° specimen orientations in the magnet). T2 demonstrated significant differences at varying depths between OA and contralateral cartilage. Conclusion: ACL transection caused a number of changes in the tibial cartilage at 3 weeks after the surgery. The characteristics of these changes, which are topographic and depth-dependent, likely reflect the complex degradation in this canine model of OA at the early developmental stage.
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Saw, Aik, Zi Hao Phang, Mohammed Khalid Alrasheed, Roshan Gunalan, Mohammed Ziyad Albaker, and Rukmanikanthan Shanmugam. "Gradual correction of proximal tibia deformity for Blount disease in adolescent and young adults." Journal of Orthopaedic Surgery 27, no. 3 (September 1, 2019): 230949901987398. http://dx.doi.org/10.1177/2309499019873987.
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Purpose: Management of Blount disease in adolescents and young adults is complex and associated with high risk of morbidities. Gradual correction with external fixator can minimize soft tissue injury and allow subsequent adjustment in degree of correction. This study investigates the surgical outcome and complication rate of gradual correction of neglected Blount disease through single-level extra-articular corticotomy. Methods: Patients treated for Blount disease using external fixator from 2002 to 2016 were recruited for the study. We used Ilizarov and Taylor Spatial Frame (TSF) external fixator to perform simultaneous correction of all the metaphyseal deformities without elevating the tibia plateau. Surgical outcome was evaluated using mechanical axis deviation (MAD), tibial femoral angle (TFA), and femoral condyle tibial shaft angle (FCTSA). Results: A total of 22 patients with 32 tibias have been recruited for the study. The mean MAD improved from 95 ± 51.4 mm to 9.0 ± 37.7 mm (medial to midpoint of the knee), mean TFA improved from 31 ± 15° varus to 2 ± 14° valgus, and mean FCTSA improved from 53 ± 14° to 86 ± 14°. Mean duration of frame application is 9.4 months. Two patients developed pathological fractures over the distracted bones, one developed delayed consolidation and other developed overcorrection. Conclusions: Correction of Blount disease can be achieved by gradual correction using Ilizarov or TSF external fixator with low risk of soft tissue complication. Longer duration of frame application should be considered to reduce the risk of pathological fracture or subsequent deformation of the corrected bone.
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Sigwalt, Loic, Brice Rubens-Duval, Billy Chedal-Bornu, Regis Pailhe, and Dominique Saragaglia. "Concept of Combined Femoral and Tibial Osteotomies." Journal of Knee Surgery 30, no. 08 (June 14, 2017): 756–63. http://dx.doi.org/10.1055/s-0037-1603640.
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AbstractMedial knee osteoarthritis is not uncommon, and high tibial osteotomy (HTO) for some surgeons is a unique treatment option for young and active patients. However, the deformity is not always located at the level of proximal part of the tibia and the overcorrection needed to achieve a lasting functional result can lead to an oblique joint line. To avoid this undesirable effect to the joint line, a double-level osteotomy (DLO), one at the distal part of the femur and another one at the proximal part of the tibia, is a viable option. The aim of this article is to present the preoperative radiological assessment, the operative procedure, the indications of HTO, distal femoral osteotomy (DFO), and DLO presenting the rationale behind the treatment options. Long-leg radiographs are mandatory to measure the hip–knee–ankle angle, and the femoral and tibial mechanical axes to plan the location of the osteotomy. The best indication for DLO is a severe varus knee deformity with femoral and tibial mechanical axes in varus. This argument can be applied to a genu valgum deformity, especially when the femur is in valgus as well as the tibia, which is not rare. Although the operative technique is demanding, the biggest challenge is not the procedure itself but rather how to reach the exact degree of overcorrection. Computer-assisted surgery is a good alternative and can improve the accuracy of the surgery.
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Bruce, WJ, J. Rooney, SR Hutabarat, MC Atkinson, JA Goldberg, and WR Walsh. "Exposure in Difficult Total Knee Arthroplasty Using Coronal Tibial Tubercle Osteotomy." Journal of Orthopaedic Surgery 8, no. 1 (June 2000): 61–65. http://dx.doi.org/10.1177/230949900000800111.
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Exposure in a total knee arthroplasty can be challenging regardless of whether it is a difficult primary or a revision. Various techniques both proximal and distal to the patella have been described and implemented to gain exposure and improve knee flexion.3,6,12 When patella eversion is not possible due to previous surgery or severe preoperative knee flexion contracture, a coronal tibial tubercle osteotomy may be utilized.15,16 We present successful results utilizing the coronal tibial tubercle osteotomy procedure. The technique involved in this series is based on that described by Whiteside.15,16 It involves the development of a long lateral musculoperiosteal flap incorporating the tibial tubercle and anterior tibia, and leaving the proximal tibial cortex intact. This is extended along the tibia distally for 10 cm. It finishes by gradually osteotomising the anterior surface of the tibial crest. The tubercle is reattached with wires at the end of the procedure. This technique minimizes complications that have been associated with the tibial tubercle osteotomy.10,11,17 The 10 knees in 9 patients, who had total knee arthroplasty with a coronal tibial tubercle osteotomy, were reviewed pre and postoperatively. All knees were assessed using the Hospital for Special Surgery knee score (HSS). The scores averaged 43.6 preoperatively (range, 29–57) and 79.2 postoperatively (range, 67–90), and the mean range of motion was 59.5° preoperatively and 78.0° postoperatively. There were no cases of extension lag. Fixed flexion deformity was present in 3 cases postoperatively. Average time to union at the proximal and distal ends of the osteotomy was 8 and 24 weeks respectively. There was no evidence of nonunion and no other significant complications occurred.
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Steiner, D., S. Laurich, R. Bauer, J. Kordelle, and R. Klett. "Evaluation of aseptic loosening of knee prostheses by quantitative bone scintigraphy." Nuklearmedizin 47, no. 04 (2008): 163–66. http://dx.doi.org/10.3413/nukmed-0123.
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SummaryIn not infected knee prostheses bone scintigraphy is a possible method to diagnose mechanical loosening, and therefore, to affect treatment regimes in symptomatic patients. However, hitherto studies showed controversial results for the reliability of bone scintigraphy in diagnosing loosened knee prostheses by using asymptomatic control groups. Therefore, the aim of our study was to optimize the interpretation procedure and to evaluate the accuracy using results from revision surgery as standard. Methods: Retrospectively, we were able to examine the tibial component in 31 cemented prostheses. In this prostheses infection was excluded by histological or bacteriological examination during revision surgery. To quantify bone scintigraphy, we used medial and lateral tibial regions with a reference region from the contralateral femur. Results: To differentiate between loosened and intact prostheses we found a threshold of 5.0 for the maximum tibia to femur ratio of the both tibial regions and a threshold of 18% for the difference of the ratio of both tibial regions. Using these thresholds, values of 0.9, 1, 0.85, 1, and 0.94 were calculated for sensitivity, specificity, negative predictive value, positive predictive value, and accuracy, respectively. To get a sensitivity of 1, we found a lower threshold of 3.3 for the maximum tibia to femur ratio. Conclusion: Quantitative bone scintigraphy appears to be a reliable diagnostic tool for aseptic loosening of knee prostheses with thresholds evaluated by revision surgery results being the golden standard.
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Quinn, Courtney A., Mark D. Miller, Robert D. Turk, Daniel C. Lewis, Christopher M. Gaskin, and Brian C. Werner. "Determining the Ratio of Wedge Height to Degree of Correction for Anterior Tibial Closing Wedge Osteotomies for Excessive Posterior Tibial Slope." American Journal of Sports Medicine 49, no. 13 (September 30, 2021): 3519–27. http://dx.doi.org/10.1177/03635465211044136.
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Background: Anterior closing wedge osteotomy of the proximal tibia may be considered in revision anterior cruciate ligament (ACL) reconstruction surgery for patients with excessive posterior tibial slope (PTS). Purpose: (1) To determine the ratio of wedge thickness to degrees of correction for supratubercle (ST) versus transtubercle (TT) osteotomies for anterior closing wedge osteotomies and (2) to evaluate the accuracy of ST and TT osteotomies in achieving slope correction. Study Design: Controlled laboratory study. Methods: The computed tomography (CT) scans of 38 knees in 37 patients undergoing revision ACL reconstruction were used to simulate both ST and TT osteotomies. A 10° wedge was simulated in all CT models. The height of the wedge along the anterior tibia was recorded for each of the 2 techniques. The ratio of wedge height to achieved degree of correction was calculated. ST and TT osteotomies were performed on 3-dimensional (3D)–printed tibias of the 12 patients from the study group with the greatest PTS, after the desired degree of correction was determined. Pre- and postosteotomy slopes were measured for each tibia, and the actual change in slope was compared with the intended slope correction. Results: According to CT measurements, the ratio of wedge height to degree of correction was 0.99 ± 0.07 mm/deg for the ST osteotomy and 0.83 ± 0.06 mm/deg for the TT osteotomy ( P < .001). When these ratios were used to perform simulated osteotomies on the twelve 3D-printed tibias, the mean slope correction was within 1° to 2° of the intended slope correction, regardless of osteotomy location (ST or TT) or whether slope was measured on the medial or lateral plateau. The ST technique tended to undercorrect and the TT technique tended to overcorrect. Conclusion: When anterior tibial closing wedge osteotomies were removed to correct excessive PTS, removing a wedge with a ratio of 1 mm of wedge height for every 1° of intended correction for an ST technique and a ratio of 0.8 mm to 1° for a TT technique resulted in overall average slope correction within 1° to 2° of the target. Clinical Relevance: The calculated ratios will allow clinicians to more accurately correct PTS when performing anterior closing wedge tibial osteotomy.
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Shehadeh, Ahmad, Muhamad Al-Qawasmi, Omar Al Btoush, and Zeinab Obeid. "Tibia Multiplanar Deformities and Growth Disturbance Following Expandable Endoprosthetic Distal Femur Replacement." Journal of Clinical Medicine 11, no. 22 (November 14, 2022): 6734. http://dx.doi.org/10.3390/jcm11226734.
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Background: Expandable distal femur endoprosthesis (EDFE) is commonly used to compensate for the loss of the distal femoral epiphyseal plate in skeletally immature children who have undergone surgical resection of bone malignancies. However, the effect of the passive tibial component of the EDFE on tibial growth has not been extensively studied in the literature. This study aims to delineate the type, frequency, and associated risk factors of multiplanar proximal tibial deformities in skeletally immature children following the use of the expandable distal femur endoprosthesis (EDFE). Moreover, we plan to detect how these deformities influence the long-term functionality of the endoprosthesis in defining the need for subsequent implant revision or further surgical management. Patients and Methods: A total of 20 patients aged (7–12) years underwent expandable distal femur replacement. Two types of implants were used: Juvenile Tumor System (JTS) non-invasive prosthesis in 14 patients, and Modular Universal Tumor and Revision System (MUTARS)® Xpand Growing Prostheses in six patients. A scanogram and CT scan documented the measurements of longitudinal and multiplanar growth as leg length discrepancy (LLD), femur length discrepancy (FLD), tibia length discrepancy (TLD), and the yield values of rotational, sagittal, and coronal deformities of the tibia. The patients were followed up to assess the need for further management. Sex, age, size of tibial plate perforation, and type of implant used were studied for possible correlation with deformities or growth disturbance. Results: The patients were followed up for a mean of 3 (2–7) years. A total of 14 patients, (10 JTS, 4 implant cast) had a tibial deformity and/or growth disturbance. A single patient was found to have all deformities (growth, rotational, coronal, and sagittal). Fourteen patients were found to have an LLD ranging from 5.3 to 59 mm (median 21 mm), 12 had a TLD from 3 to 30 mm, (median 10 mm), and 11 patients showed evidence of malrotation from 6 to 32 degrees (median 11 degrees). TLD was found to contribute entirely to LLD in three patients, and >50% of LLDs in seven patients. All LLDs were treated conservatively, except in three patients; two received contralateral tibia epiphysiodesis and one received revision with a new implant. A single patient had a posterior tibia slope angle (PTSA) of −2.8 degrees, and three patients had a coronal deformity with a mean medial proximal tibia angle (MPTA) of 80.3 (77–83 degrees). Conclusions: Tibial growth disturbance and multiplanar deformities occur in the majority of patients following EDFE replacement, exacerbating LLD. Yet, these disturbances may be well tolerated, managed conservatively, and rarely mandate endoprosthetic revision or subsequent corrective surgery. Age at the time of surgery was found to be the only significant contributor to the development of tibia growth disturbance.
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Toumazos, Kimon, Peter Stavrou, Olivier Gauthier-Kwan, and Christopher H. Brown. "CT Analysis of the Posteromedial Neurovascular Bundle in Patients with End Stage Ankle Arthritis for Planning of Total Ankle Replacement Surgery." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0097. http://dx.doi.org/10.1177/2473011421s00976.
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Category: Ankle Arthritis; Ankle Introduction/Purpose: Aim of this study is to identify reliable anatomical landmarks of the posterior tibial neurovascular bundle during Total Ankle Replacement (TAR) to minimise the risk of iatrogenic injury. Secondary aim is to identify if there is associated translation of the bundle when anterior translation of the talus is present. Methods: A radiological landmark protocol was devised to create a consistent method for measuring the relations of the bundle to the tibia, talus and medial gutter line when measured at levels mimicking those of resection undertaken in TAR. Analysis between patients with and without anterior subluxation was undertaken. Results: Total of 42 ankles were reviewed with 38% patient having anterior translation of the talus. At the tibiotalar joint, the bundle lies less than 5mm lateral to the medial gutter line and less than 8mm posterior to the posterior tibia. The same measurements at 10mm superior to the tibiotalar joint are less than 8mm and less than 6.5mm respectively. At 5mm distal to the dome of the talus, the bundle is less than 4mm lateral to the medial gutter line and between 8.4-16.0mm posterior to the posterior talus. The bundle to posterior tibia distance does not increase in the sagittal plane for patients with anterior subluxation of the talus. Conclusion: This study provides relevant guidance for surgeons to use intraoperatively when undertaking tibial and talus resections in TAR to identify their relations to the vulnerable neurovascular structures. The measurements of this study indicate for the first time that there is not an increased risk of iatrogenic injury during bone resection at the tibia in patients with anterior subluxation of the talus.