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1.
Ali Seker Adnan Kara Mustafa Faik Seckin Mesut Sonmez Erden Erturer Irfan Ozturk 《International journal of surgery case reports》2014,5(8):509-512
INTRODUCTION
Bilateral intertrochanteric femur fractures are relatively rare injuries. This study aims to present a case of a patient with simultaneous bilateral intertrochanteric femur fractures and femoral diaphyseal fractures and proximal tibial fracture with his twelve years follow-up.PRESENTATION OF CASE
A 44-year-old man presented to emergency department after a motor vehicle accident. Bilateral intertrochanteric femur fractures (OTA classification – 31A.1.2) and bilateral femoral diaphyseal fractures (OTA classification – 32A.2) and nondisplaced right proximal tibial fracture (OTA classification – 41B.1) were determined in radiographs. Following closed reduction, fractures were fixed with intramedullary nails bilaterally. Proximal tibial fracture was fixed with cannulated screws following open reduction. At twelfth year follow-up he was able to do his daily activities with minimal limitation.DISCUSSION
High energy traumas, stress fractures, systemic disorders (osteomalacia, chronic renal failure), steroid treatments, seizures and electric injuries are possible causes for bilateral hip factures. However bilateral femoral diaphyseal fractures are mostly due to high energy traumas. Long-term biphosphonate use may also cause bilateral fractures. Single-stage surgery should be performed in order to avoid secondary damages of surgical interventions. All fractures of our patient were fixed in a single session. This prevented further deterioration of patient''s status and made rehabilitation easy.CONCLUSION
Careful evaluation of all systems should be performed in multi-trauma patients to find out concomitant injuries. Single staged surgical treatment may decrease morbidities. 相似文献2.
Siddhartha Venkata Paluvadi Hitesh Lal Deepak Mittal Kandarp Vidyarthi 《Journal of Clinical Orthopaedics and Trauma》2014,5(3):129-136
Background
Minimally invasive plate osteosynthesis (MIPO) is an established technique for fixation of fractures of the distal third tibia. Our study aimed to manage intra articular and extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed. Though many studies on the subject have been done previously, these have been retrospective reviews or small series.Methods
From May 2010 to May 2013, 50 patients of closed distal tibial fractures were operated by MIPO technique with a distal tibial anatomical locking plate having 4.5/5 proximal and 3.5/4 distal screw holes. The follow up duration was for 3 years.Results
The mean fracture healing time was 21.4 weeks (range 16–32 weeks) and average AOFAS score 95.06 was out of a total possible 100 points. At last follow up, superficial infection occurred in 5 patients (10%); deep infection, implant failure and malunion in 1-patient each (2%).Conclusion
MIPO technique provides good, though slightly delayed bone healing and decreases incidence of nonunion and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminuted fractures and in fractures with intra-articular extension. 相似文献3.
Background & purpose
Distal tibial Triplane fracture with ipsilateral tibial shaft fracture is a rare but important problem. This rarely reported combination of injuries if not recognised may lead to deleterious consequences.Methods/Patients
The local database of all emergency admissions was scrutinised to identify subjects before interrogation of the clinical notes and relevant radiographic imaging.Findings
This paper reports a series of five children who were found to have triplane fracture of the distal tibia with concomitant ipsilateral fracture of the tibial shaft.Conclusions
We suggest that a high index of suspicion for concomitant fractures should be maintained in the presence of either triplane fracture of the distal tibia or tibial shaft fractures in the peri-adolescent child. Minimum appropriate imaging should include orthogonal full length plain radiographs of the tibia as well as formal ankle radiographs. 相似文献4.
Jitendra Maheshwari Vinay Kumar Pandey Vikram Arun Mhaskar 《Indian Journal of Orthopaedics》2014,48(5):507-510
Background:
In most classifications of tibial plateau fractures, including one used most widely-Schatzker classification, fractures are described as a combination of medial and lateral condyle, primarily in the sagittal plane. Coronal component of these fractures, affecting the posterior tibial condyle is now well recognized. What is not described is anterior coronal component of the fracture, what we are calling “anterior tibial condyle fracture”. These fractures are often missed on routine antero-posterior and lateral knee X-rays due to an overlap between the fracture and the normal bone.Materials and Methods:
Eight cases of anterior tibial condyle fractures with posterior subluxation of the tibia, six of which were missed by the initial surgeon and two referred to us early, are described. Two of the six late cases and both the early ones were operated. Reconstruction of the anterior condyle and posterior cruciate ligament reconstruction was done. Primary outcome measures such as union of the fracture, residual flexion deformity, range of motion and stability were studied at the end of 6 months.Results:
All operated fractures united. There was no posterior sag in any. In those presenting late and were operated, the flexion deformity got corrected in all (average from 15° to 0°) and mean flexion achieved was 100° (range: 80-120°). In those presenting early and were operated, there was no flexion deformity at 6 months and a mean flexion achieved was 115° (range: 100-130°). None of the operated patients had instability.Conclusion:
This article attempts to highlight that this injury is often missed. They should be suspected, diagnosed early and treated by reconstruction of anterior condyle, posterior cruciate ligament reconstruction. 相似文献5.
Ramin Mehin Peter O��Brien Henry Broekhuyse Piotr Blachut Pierre Guy 《Canadian journal of surgery》2012,55(2):87-94
Background
Patients with tibial plateau fractures are believed to have an increased risk for posttraumatic arthritis that may require reconstructive surgery. The incidence of this problem is, however, unknown. We sought to determine the average 10-year incidence of posttraumatic arthritis necessitating reconstructive surgery following tibia plateau fractures.Methods
We used data from our orthopedic trauma database to identify patients with operatively treated tibia plateau fractures. Their cases were cross-referenced with the data from our province’s administrative health database and tracked over time for the performance of reconstructive knee surgery. The average follow-up was 10 years.Results
There were 311 tibial plateau fractures treated at our institution between 1987 and 1994. The 10-year Kaplan–Meier survival analysis for the primary outcome of endstage arthritis was 96%. Analysis of the secondary outcome measure, specifically surgeries for what was thought to be “minor arthritis,” revealed a 10-year Kaplan–Meier survival of 87%.Conclusion
Our findings may be used to counsel patients who require surgical treatment of tibia plateau fractures about the long-term risk of requiring reconstructive knee surgery for endstage arthritis in the knee. 相似文献6.
J Stammers D Williams J Hunter M Vesely D Nielsen 《Annals of the Royal College of Surgeons of England》2013,95(3):184-187
Introduction
The British Orthopaedic Association/British Association of Plastic, Reconstructive and Aesthetic Surgeons guidelines for the management of open tibial fractures recommend early senior combined orthopaedic and plastic surgical input with appropriate facilities to manage a high caseload. The aim of this study was to assess whether becoming a major trauma centre has affected the management of patients with open tibial fractures.Methods
Data were obtained prospectively on consecutive open tibial fractures during two eight-month periods: before and after becoming a trauma centre.Results
Overall, 29 open tibial fractures were admitted after designation as a major trauma centre compared with 15 previously. Of the 29 patients, 21 came directly or as transfers from another accident and emergency deparment (previously 8 of 15). The time to transfer patients admitted initially to local orthopaedic departments has fallen from 205.7 hours to 37.4 hours (p=0.084). Tertiary transferred patients had a longer hospital stay (16.3 vs 14.9 days) and had more operations (3.7 vs 2.6, p=0.08) than direct admissions. As a trauma centre, there were improvements in time to definitive skeletal stabilisation (4.7 vs 2.2 days, p=0.06), skin coverage (8.3 vs 3.7 days, p=0.06), average number of operations (4.2 vs 2.3, p=0.002) and average length of hospital admission (26.6 vs 15.3 days, p=0.05).Conclusions
The volume and management of open tibial fractures, independent of fracture grade, has been directly affected by the introduction of a trauma centre enabling early combined senior orthopaedic and plastic surgical input. Our data strongly support the benefits of trauma centres and the continuing development of trauma networks in the management of open tibial fractures. 相似文献7.
Background
The main indications for surgery for old thoracolumbar fractures are pain, progressive deformity, neurological damage, or increasing neurological deficit. These fractures have been one of the greatest therapeutic challenges in spinal surgery. Anterior, posterior, or combined anterior and posterior procedures have been successful to some extent. As far as we know, there is no report in the literature of transforaminal lumbar interbody fusion (TLIF) for old thoracolumbar fracture and dislocation.Methods
Case report.Results
A 26-year-old man with old fracture and dislocation of T12/L1 was treated with TLIF. At 12 months'' follow-up, multi-slice computed tomography (CT) scans showed that solid fusion had been achieved between T12 and L1. Back pain had resolved completely at 2-year follow-up.Conclusions
We performed TLIF for in a man with old fracture and dislocation of T12/L1, with good clinical outcome. TLIF might be an option in the treatment of old thoracolumbar fracture. 相似文献8.
9.
Sanjay Agarwala Pranshu Agrawal Anshul Sobti 《Journal of Clinical Orthopaedics and Trauma》2015,6(3):207-211
Objective
Fractures of patella constitute 1% of all fractures. Various techniques have been described for internal fixation of patella fractures. Superiority of one technique over the other has long been debated. We reviewed a series of fifty-one patients with transverse or comminuted fractures of patella treated with a novel technique to assess if it had any advantages over the existing methods of fixation.Design
Retrospective.Setting
A tertiary care centre.Patients & methods
Fifty-one patients with patella fracture OTA 34C, with a mean age of 39 years (range 18–61) were treated with technique of cerclage and two tension bands at our institute. Forty-eight patients completed the study.Main outcome measurements
Range of Motion and evidence of radiological union were assessed at regular follow-ups.Results
Forty-four out of forty-eight patients had gained up-to 90 degrees of active flexion at the end of 1 week. Two patients (4.2%) developed superficial infection. All fractures had united at the end of 12 weeks. Five patients (10.3%) underwent a second surgery; four (8.3%) due to implant related complications. Malunion or non-union was not noted in any of the cases.Conclusion
The advantages of the described method are early mobilization, elimination of k-wire related complications, and ease of use in comminuted fracture pattern as well and a lower reoperation rates as compared to the available literature. We strongly recommend its use in cases of displaced comminuted/transverse fractures of patella as an alternate method of treatment.Level of evidence
Level III. 相似文献10.
Purpose
The less invasive stabilization system (LISS) can effectively treat tibial fractures. However, the LISS is technically demanding, has a long learning curve, and presents a heavy economic burden to patients. The U-grooved locking compression plate (U-LCP), characterized by a U-groove at each end, is designed to treat tibial fractures. This paper reports the outcomes of tibial fractures treated using the U-LCP compared with the LISS.Methods
Seventy-eight patients with unilateral tibial fractures treated with either the U-LCP (group I) or LISS (group II) were enrolled. In group I, a U-LCP was inserted subcutaneously with two Kirschner wires embedded into the U-grooves to temporarily secure the plate. A second identical plate was placed over the first to guide screw insertion. In group II, the LISS was used to fix the tibial fractures. Patient age, sex, fracture type, severity of soft tissue injury, operative time, fluoroscopic time, complications, and functional recovery of affected limbs were recorded.Results
The two groups were comparable in age, sex, fracture type, and severity of soft tissue injury (p > 0.05). The average operation and fluoroscopic times in group I were significantly less than those in group II (p < 0.05). At follow-up, all fractures healed. There were no significant differences between both groups in time to bony union, wound complication rate, or functional recovery of injured limbs (p > 0.05).Conclusions
The U-LCP can yield good outcomes in the treatment of proximal tibial fractures, with less radiation exposure, a shorter operation time, and a sustainable price compared with the LISS. 相似文献11.
Background
During intramedullary nailing of tibial fractures, the insertion angle of the nail is of great importance. When the nail impacts the posterior cortex due to a large insertion angle with a dorsal target course, higher insertion forces are needed, and the danger of iatrogenic fractures increases. Accordingly, the insertion direction should be as parallel as possible to the longitudinal axis of the tibia. We aimed to confirm the hypothesis that intramedullary nailing of tibial fractures can be performed with smaller insertion angles via a suprapatellar approach rather than infrapatellar approach.Methods
In 19 human bodies of donors with intact tibiae, we performed intramedullary nailing by both a suprapatellar and an infrapatellar approach. The correct entry point was determined by fluoroscopy. Subsequently, the medullary canal was reamed up to a diameter of 10 mm, and a 9 mm polytetrafluorethylen tube was inserted instead of a tibia nail. The angle between the proximal aspect of the tube and the longitudinal axis of the tibia was measured using a computer-assisted surgery system.Results
The angle between the proximal aspect of the inserted tube, simulating the tibial nail, and the longitudinal tibial axis was significantly larger when using the infrapatellar approach.Conclusions
We achieved an insertion angle significantly more parallel to the longitudinal axis when using a suprapatellar approach for intramedullary nailing of tibial fractures. Thereby, both the risk of iatrogenic fracture of the posterior cortex and apex anterior angulation of the short proximal fragment can be reduced during intramedullary nailing of tibial fractures.12.
Shigeshi Mori MD Masao Akagi MD PhD Shigeki Asada MD Tetsunao Matsushita MD Kazuhiko Hashimoto MD 《Clinical orthopaedics and related research》2013,471(5):1465-1471
Background
Tibia vara seen in Japanese patients reportedly influences the tibial component alignment when performing TKA. However, it is unclear whether tibia vara affects the component position and size selection.Questions/purposes
We therefore determined (1) the amount of medial tibial bow, (2) whether the tibia vara influences the aspect ratio of the tibial resected surface in aligning the tibial component with the tibial shaft axis, and (3) whether currently available tibial components fit the shapes of resected proximal tibias in terms of aspect ratio.Methods
We measured the tibia vara angle (TVA), proximal varus angle (PVA), and the mediolateral and middle AP dimensions of the resected surface using three-dimensional preoperative planning software in 90 knees of 74 female patients with varus osteoarthritis. We determined the correlations of the aspect ratio with TVA or PVA and compared the aspect ratios to those of five prosthesis designs.Results
The mean TVA and PVA were 0.6° and 2.0°, respectively. The aspect ratio negatively correlated with both TVA and PVA (r = −0.53 and −0.55, respectively). The mean aspect ratio of the resected surface was 1.48 but gradually decreased with increasing AP dimension, whereas four of the five prostheses had a constant aspect ratio.Conclusions
The aspect ratio of resected tibial surface was inversely correlated to the degree of tibia vara, and currently available prosthesis designs do not fit well to the resected surface in terms of aspect ratio.Clinical Relevance
The design of a tibial component with a smaller aspect ratio could be developed to obtain better bone coverage in Japanese patients. 相似文献13.
Klaus John Schnake Andreas Pingel Matti Scholz Frank Kandziora 《European spine journal》2012,21(11):2198-2202
IntroductionInjuries of the occipital condyles are rare. While the majority of occipital condyle fractures can be treated conservatively, surgery is recommended in craniocervical misalignment and instability. Open reduction and temporary occipito-cervical stabilization might be an alternative to fusion or halo treatment.
Materials and methods
This Grand Round case presentation describes temporary C0–C3 stabilization in a 29-year-old man who was involved in a car accident. Radiological examination revealed a rotational burst fracture (type AO C3.1) of C7, and a slight displaced right occipital condyle fracture (Anderson/Montesano type III) with rotational misalignment of the C0–C2 complex.Results
The C7 fracture was stabilized and fused from anterior and posterior. The occipital condyle fracture was reduced and temporarily stabilized from C0–C3 from posterior. Bony healing occurred after 6 months and consequently the internal fixator was removed to preserve upper cervical mobility. 相似文献14.
M Czerwinski W L Parker A Chehade H B Williams 《CANADIAN JOURNAL OF PLASTIC SURGERY》2008,16(1):36-40
BACKGROUND:
Mandibular fractures can lead to significant functional and aesthetic sequelae if treated improperly. They may act as an indicator of concomitant trauma and are very demanding on the public health care system. Thus, knowledge of mandibular fracture epidemiology is critical to effective prevention, as well the establishment of accurate trauma evaluation protocols.OBJECTIVES:
To identify the epidemiology of mandibular fractures treated at a level 1 Canadian trauma centre, clarify the pathogenesis of these epidemiological patterns and suggest potential targets for preventive efforts.METHODS:
A retrospective review of all mandibular fracture patients presenting to the Montreal General Hospital between 1998 and 2003 was performed. Medical records and digitized radiographic imaging were used to collect patient demographics and injury data.RESULTS:
The chart review identified 181 patients with 307 mandibular fractures. Fifty-two per cent of the fractures occurred in individuals 21 to 40 years of age, 78% of patients were male, and there was wide ethnic diversity. Sixty percent of patients had multiple mandibular fractures; 29% were symphyseal/parasymphyseal fractures, 25% were condylar fractures and 23% were angle fractures. Assault was the most common mechanism of injury, with 29% of fractures involving alcohol or illegal drug use. Thirty percent of patients had an associated facial fracture, and more than one-third had another major injury.CONCLUSIONS:
The present epidemiological review reveals several potential prevention targets as well as significant trends. Further research into the impact of these preventive measures could more objectively identify their impact on mandibular trauma. 相似文献15.
Purpose
The purpose of this study was to review the results of external fixation combined with vacuum sealing drainage (VSD) to treat patients who sustained tibial and fibular fractures in the Wenchuan earthquake.Methods
We retrospectively analysed 179 cases (of which 85 were classified as Gustilo grade III) of open comminuted fracture of the tibia and fibula caused by the Wenchuan earthquake. The patients were followed up for an average of 15 months; detailed records were kept on their function and recovery.Results
After caring for the life-threatening injuries; fractures were treated by external fixation, with VSD used on the surface or in the cavity of the wound after debridement. Antibiotics were administered on the basis of drug sensitivity test results. After the infection had been controlled and healthy granulation tissue had developed, the patients underwent secondary suture, free skin grafting, or skin flap transfer.Conclusion
Good results can be achieved when external fixation combined with vacuum sealing drainage were used to treat open comminuted fractures of tibia and fibula in the Wenchuan earthquake. 相似文献16.
Young-Bok Jung Chang-Hyun Nam Ho-Joong Jung Yong-Seuk Lee Young-Bong Ko 《Clinics in Orthopedic Surgery》2009,1(2):68-73
Background
To determine if tibial positioning affects the external rotation of the tibia in a dial test for posterolateral rotatory instability combined with posterior cruciate ligament (PCL) injuries.Methods
Between April 2007 and October 2007, 16 patients with a PCL tear and posterolateral rotatory instability were diagnosed using a dial test. The thigh-foot angle was measured at both 30° and 90° of knee flexion with an external rotation stress applied to the tibia in 2 different positions (reduction and posterior subluxation). The measurements were performed twice by 2 orthopedic surgeons.Results
In posterior subluxation, the mean side-to-side difference in the thigh-foot angle was 11.56 ± 3.01° at 30° of knee flexion and 11.88 ± 4.03° at 90° of knee flexion. In the sequential dial test performed with the tibia reduced, the mean side-to-side difference was 15.94 ± 4.17° (p < 0.05) at 30° of knee flexion and 16.88 ± 4.42° (p = 0.001) at 90° of knee flexion. The mean tibial external rotation was 5.31 ± 2.86° and 6.87 ± 3.59° higher in the reduced position than in the posterior subluxation at both 30° and 90° of knee flexion.Conclusions
In the dial test, reducing the tibia with an anterior force increases the ability of an examiner to detect posterolateral rotary instability of the knee combined with PCL injuries. 相似文献17.
Salem KH 《International orthopaedics》2012,36(7):1471-1477
Purpose
Unreamed nails have revolutionised the treatment of tibial shaft fractures. Many authors, however, have reported increasing bone healing complications with these implants. Unfortunately, few studies have addressed the factors affecting bone healing after unreamed tibial nailing.Methods
One-hundred and sixty tibial fractures in 158 patients (mean age 39.5 years) fixed using unreamed nails were reviewed. There were 78 AO type-A, 65 type-B and 17 type-C fractures (115 closed and 45 open fractures). Twelve patient, injury and surgery variables were analysed for their influence on fracture healing.Results
Union occurred in all fractures after a mean time of 24.3 weeks. Additional surgery to achieve union, apart from dynamisation, was done in nine (6%) cases. The most important variables affecting healing were the mechanism of trauma (p = 0.005), fracture site gap (p = 0.01), degree of comminution (p = 0.0003), associated soft tissue injuries (p = 0.02) and the time to dynamisation (p = 0.0001).Conclusions
High-energy trauma and fracture comminution have a negative impact on bone union and require close follow-up. It is essential to avoid distraction over three millimetres with unreamed nailing. Dynamisation is advised within ten weeks in axially stable fractures to encourage bone healing and avoid failure of the locking screws. 相似文献18.
CU Menakaya AS Rigby Y Hadland E Barron H Sharma 《Annals of the Royal College of Surgeons of England》2014,96(2):106-110
Introduction
The optimal treatment of high energy tibial fractures remains controversial and a challenging orthopaedic problem. The role of external fixators for all these tibial fractures has been shown to be crucial.Methods
A five-year consecutive series was reviewed retrospectively, identifying two treatment groups: Ilizarov and Taylor Spatial Frame (TSF; Smith & Nephew, Memphis, TN, US). Fracture healing time was the primary outcome measure.Results
A total of 112 patients (85 Ilizarov, 37 TSF) were identified for the review with a mean age of 45 years. This was higher in women (57 years) than in men (41 years). There was no significant difference between frame types (p=0.83). The median healing time was 163 days in both groups. There was no significant difference in healing time between smokers and non-smokers (180 vs 165 days respectively, p=0.07), open or closed fractures (p=0.13) or age and healing time (Spearman''s r=0.12, p=0.18). There was no incidence of non-union or re-fracture following frame removal in either group.Conclusions
Despite the assumption of the rigid construct of the TSF, the median time to union was similar to that of the Ilizarov frame and the TSF therefore can play a significant role in complex tibial fractures. 相似文献19.
Seong-Man Lee Chang-Wug Oh Jong-Keon Oh Joon-Woo Kim Hyun-Joo Lee Chang-Soo Chon Byoung-Joo Lee Hee-Soo Kyung 《Clinics in Orthopedic Surgery》2014,6(3):312-317
Background
To determine relative fixation strengths of a single lateral locking plate, a double construct of a locking plate, and a tibial nail used in treatment of proximal tibial extra-articular fractures.Methods
Three groups of composite tibial synthetic bones consisting of 5 specimens per group were included: lateral plating (LP) using a locking compression plate-proximal lateral tibia (LCP-PLT), double plating (DP) using a LCP-PLT and a locking compression plate-medial proximal tibia, and intramedullary nailing (IN) using an expert tibial nail. To simulate a comminuted fracture model, a gap osteotomy measuring 1 cm was created 8 cm below the knee joint. For each tibia, a minimal preload of 100 N was applied before loading to failure. A vertical load was applied at 25 mm/min until tibial failure.Results
Under axial loading, fixation strength of DP (14,387.3 N; standard deviation [SD], 1,852.1) was 17.5% greater than that of LP (12,249.3 N; SD, 1,371.6), and 60% less than that of IN (22,879.6 N; SD, 1,578.8; p < 0.001, Kruskal-Wallis test). For ultimate displacement under axial loading, similar results were observed for LP (5.74 mm; SD, 1.01) and DP (4.45 mm; SD, 0.96), with a larger displacement for IN (5.84 mm; SD, 0.99). The median stiffness values were 2,308.7 N/mm (range, 2,147.5 to 2,521.4 N/mm; SD, 165.42) for the LP group, 4,128.2 N/mm (range, 3,028.1 to 4,831.0 N/mm; SD, 832.88) for the DP group, and 5,517.5 N/mm (range, 3,933.1 to 7,078.2 N/mm; SD, 1,296.19) for the IN group.Conclusions
During biomechanical testing of a simulated comminuted proximal tibial fracture model, the DP proved to be stronger than the LP in terms of ultimate strength. IN proved to be the strongest; however, for minimally invasive osteosynthesis, which may be technically difficult to perform using a nail, the performance of the DP construct may lend credence to the additional use of a medial locking plate. 相似文献20.
Deniz Cankaya Serdar Yilmaz Alper Deveci Bulent Ozkurt 《International journal of surgery case reports》2014,5(2):49-51