Morphology of the tibial tuberosity

The influence of anterior projection of the tibial tuberosity in the pathogenesis of anterior knee pain syndromes has been given relatively little attention. This point has been investigated by performing a morphological study of 77 knee-joints with a standard radiological method. The knees fell into two groups: one of them included typical patellar syndromes, the other group included knees presenting with some other conditions, mostly meniscal. A subjective evaluation of the shape of the tuberosity was made and correlated with clinical status. An objective rating was attempted by measuring the anterior projection of the tuberosity, in order to eliminate the influence of skeletal size, it was expressed as a ratio between two values. Subjective evaluation of the shapes of the tuberosities was found unreliable. The individual values for the calculated index of anterior projection were found to be scattered for every morphological type. It appeared difficult to conclude that there is a definite proven relationship between hypoplasia of the tuberosity and overloading of the femoro-patellar joint. Evaluation of the anterior projection of the tuberosity should take into account the position of the tuberosity in the coronal plane.     

Advancement of the tibial tuberosity.

Surgical modifications of the biomechanics of osteoarthritic and chondromalacic patellofemoral joints reduce the joint pressure by distributing pressure evenly along the articular surfaces. Forward displacement of the patella tendon lengthens the lever arm of the tendon. It also increases the angle formed by the forces exerted by the quadriceps muscle and by the patella tendon. As a result, the compressive forces transmitted from the femur to the tibia and from the patella to the femur are decreased. If the anterior tuberosity of the tibia is displaced forward and medially, the subluxated patella is brought back into the intercondylar groove and the weight-bearing areas of the patello-femoral joint are increased. Consequently the operation much reduces the compressive stresses in the joint. In osteoarthritis of the patellofemoral joint and in chondromalacia of the patella, surgical displacement of the patella tendon forward consistently relieved pain.     

Fractures of the tuberosity of the calcaneus

We describe 24 fractures of the tuberosity of the calcaneus in 22 patients. Three were similar to the type of avulsion fracture which has been well-defined but the remainder represent a group which has been unrecognised previously. Using CT and operative findings we have defined the different patterns of fracture of the calcaneal tuberosity. Ten fractures extended into the subtalar joint, but did not fit the pattern of the common intra-articular fracture as described classically. We have defined a new pattern which consists of a fracture of the medial calcaneal process with a further fracture which separates the upper part of the tuberosity in the semicoronal plane. Non-operative treatment of displaced fractures resulted in a mis-shapen heel and a poor functional outcome. Open reduction and internal fixation with either a plate or compression screw did not give satisfactory fixation. We prefer to use an oblique lateral tension-band wire. This technique gave excellent fixation and we recommend it for the treatment of displaced fractures of the tuberosity of the calcaneus.     

Fracture of the tibial tuberosity in adolescents

Summary Fracture of the tibial tuberosity is an uncommon injury and rarely occurs after closure of the proximal tibial epiphysis. Three cases of tibial tuberosity fracture over a period of 11 years were treated by open reduction, internal fixation, and immobilization for 6 weeks in plaster of Paris (1970–1980). The postoperative follow-up times were 5, 6, and 7 years. No subsequent deformities were detected. Two patients had secondary posttraumatic patella infera without any symptoms. All patients returned to normal activity. The results demonstrated that this injury in the adolescent knee heals without deformity of functional loss when adequate reduction and fixation of the fracture fragments have been achieved.

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Zusammenfassung Frakturen der Tuberositas tibiae sind selten und treten kaum nach dem Epiphysenschluß auf. Im Zeitraum von 11 Jahren (1970–1980) wurden drei Fälle von Tuberositastibiae-Fraktur operativ durch Reposition und interne Fixation sowie postoperative Immobilisation im Gips für 6 Wochen behandelt. Die Beobachtungszeiten waren 5, 6 und 7 Jahre. Sekundäre Deformierungen wurden nicht beobachtet. Zwei Patienten hatten eine symptomlose Patella infera posttraumatica. Es konnte keine Behinderung der Aktivität der Patienten festgestellt werden. Die Ergebnisse zeigen, daß diese Verletzung der Epiphysenplatte des wachsenden Kniegelenkes ohne Deformität der Tibia oder Funktionsverlust ausheilt, wenn eine adäquate Reposition und Fixation erzielt wird.

     

Fractures of the greater tuberosity of the humerus

Isolated fractures of the greater tuberosity of the humerus can occur in anterior shoulder dislocations or as the result of an impaction injury against the acromion or superior glenoid. Greater tuberosity fractures may be associated with partial-thickness rotator cuff tears and labral tears, which may be the cause of persistent pain after fracture healing. Nondisplaced and minimally displaced fractures are typically treated successfully nonsurgically. Surgical fixation is recommended for fractures with >5 mm of displacement in the general population or >3 mm of displacement in active patients involved in frequent overhead activity. Open surgical repair is performed with suture or screw fixation. Recently, arthroscopic techniques have produced promising results. Careful follow-up and supervised rehabilitation optimize results after both nonsurgical and surgical treatment.     

Fracture-avulsion of the anterior tibial tuberosity in adolescents

A rare case of a 14-year-old girl with an avulsion-fracture of the tibial tuberosity is reported (type III-A). This lesion is described mainly in boys. The authors explain the classification of the different types of avulsion fracture according to the epiphyseal development of the upper end of the tibia and the stage of maturation at the time of trauma.     

胫骨结节撕脱性骨折的治疗

1997年8月～2010年9月,我科手术治疗32例胫骨结节撕脱性骨折患者,效果良好,报道如下。1材料与方法1.1病例资料本组32例,男27例,女5例,年龄14～19岁31例,52岁1例。左侧19例,右侧13例。骨折按Watson-Jones分型[1]:Ⅰ型4例,Ⅱ型19例,Ⅲ型9例。伤后至就诊时间50min～2 d。     

Clinical assessment of Maquet tibial tuberosity advancement

Advancement of the tibial tuberosity (TTA) or Maquet procedure is a controversial procedure. Between 1978 and 1982, 27 consecutive patients were treated by TTA with an average follow-up period of 5.5 years in 25 patients. In eleven cases with concomitant medical compartment osteoarthritis, TTA was combined with high tibial osteotomy (HTO). Patellar pain relief was noted soon after surgery and was sustained in 80% of the patients. Systemic complications included one patient with lethal pulmonary embolus. Local complications occurred as follows: three patients had severe local necrosis of skin, which required a rotation skin flap in two. In one patient, the bone graft displaced, and in two patients, nonunion of this graft was noted. Following appropriate treatment in these six patients their final rating was excellent in two, good in three, and poor in one. Contrary to other reports in the literature, the combination of HTO and TTA was as successful as the Maquet procedure alone. TTA is an important procedure for severe patellofemoral arthritis after all other methods of conservative treatment have been exhausted and no other surgical procedure is clearly indicated.     

Fractures of the tibial pilon

Fractures of the tibial pilon are difficult to manage because of their severity. They are the product of high-energy compression forces and too frequently result in comminution and impaction of the weight-bearing surface of the distal tibia. Other fractures involving the roof of the ankle joint may be called "pilon fractures," but have a better prognosis because the compressive force is coupled with torsional forces. Operative reduction with the application of stable fixation in a clinically proven sequence of steps may lead to a satisfactory outcome in approximately three fourths of the cases, but must be accomplished with a sound understanding of the anatomy of the ankle joint and the principles of stable internal fixation by a surgeon with good atraumatic technique.     

Fractures of the tibial plafond

The cases of one hundred and forty-two patients with 145 fractures of the ankle joint that involved the tibial plafond were reviewed. The fractures were classified into five types according to the severity of the injury. The methods of treatment were divided into two groups: open reduction and rigid internal fixation by the AO technique, and other methods. The most important variables that affected the final clinical result were the type of fracture, the method of treatment, and the quality of the reduction (p less than or equal to 0.05). The best results were obtained by rigid open reduction and internal fixation, with which 65 per cent of the more severe type-III, IV, and V fractures obtained a good or excellent result.     

Fractures of the tibial shaft

Fractures of the tibial shaft are common and predominantly occur in the younger population. They require careful treatment to achieve the best functional outcome while avoiding complications. Advances in operative stabilization techniques have reduced the incidence of malunion and delayed union. Modern plastic surgical techniques have revolutionized the treatment of open fractures associated with soft-tissue loss. The aim of this paper is to describe epidemiology and management of tibial shaft fractures with particular reference to open fractures and compartment syndrome.     

Avulsion fracture of the tibial tuberosity in late adolescence

Between January 1982 and May 1985, eight patients with avulsion fractures of tibial tuberosity were seen at the University of South Alabama Medical Center. All were boys, average age, 15 years 8 months. Six of eight had a positive history of Osgood-Schlatter disease. Seven patients underwent open reduction and internal fixation, one had closed reduction and cast. Followup ranged from 5 months to 3.5 years, averaging 19.5 months. All, except one who had lateral meniscectomy, regained practically full ROM and reported no pain or limitation of activities. No patient developed genu recurvatum deformity or leg length discrepancy due to the injury. Open reduction and internal fixation is the treatment of choice in displaced intra-articular fractures. Lateral parapatellar incision is a more direct approach to this fracture and is less likely to injure the infrapatellar branch of the saphenous nerve.