Tibial shaft fracture following tibial tubercle osteotomy

Tibial tubercle osteotomy has been reported to be an excellent exposure for a very stiff primary or revision knee requiring total knee arthroplasty. In 1993, the Center for Hip and Knee Surgery performed 657 primary and 16 revision total knee arthroplasties, using tibial tubercle osteotomy in 9 cases, 2 of which sustained tibial shaft fractures, because of which the Center's experience is reviewed.     

Type IV tibial tubercle fracture revisited: a case report

Tibial tubercle avulsions and proximal tibial physeal fractures are uncommon. An even more rare case was seen when an adolescent athlete presented with a combined Type III tibial tubercle avulsion and a Salter-Harris Type IV proximal tibial physeal fracture. There was no previous report in the literature of the combination of these two uncommon fracture patterns, both of which are associated with serious potential complications and long-term sequelae. The two fracture patterns must be recognized individually, with treatment directed appropriately.     

Tibial fracture after transposition of the tibial tubercle

Eight weeks after transposition of the tibial tubercle for recurrent subluxation of the patella, the patient sustained a tibial fracture during rope jumping. In spite of consolidation of the osteotomy in the frontal plane, there remained a small gap in the anterior cortex in the transverse plane through which the tibia failed during bending stress.     

Nonunion after a tibial shaft fracture complicating tibial tubercle osteotomy

Tibial shaft fracture after tibial tubercle osteotomy in total knee replacement is a rare complication. We report on a 67-year-old man who had a knee revision arthroplasty in which a long tubercle osteotomy was performed to facilitate exposure. Three weeks after surgery, he presented with a transverse shaft fracture, which became a nonunion requiring surgical management. This shaft nonunion and its solution after tibial tubercle osteotomy is discussed as well as relevant literature.     

Tibial tubercle fracture with avulsion of the patellar ligament: a case report

Fractures of the tibial tubercle are infrequent injuries in adolescents. A combined injury of the tibial tubercle and patellar ligament is an even more rare event. The literature includes only a few case reports of this injury pattern. In this article, we describe another case and a repair technique and try to increase awareness of this combined injury.     

Pseduarthrosis of a tibial plateau fracture: report of a case

In an elderly woman a tibial condylar pseudarthrosis was angulated with disabling pain, significant deformity, and progressive articular deterioration. The treatment of this non-union consisted of arthrotomy, mobilization of the ununited medial condyle, slight over-elevation of the tibial plateau, iliac bone grafting to reconstitute loci of bone loss, and rigid interfragmentary and buttress plate fixation. Postoperative management consisted of early knee motion and delayed weight-bearing to facilitate functional restoration of the extremity. Within 3 months, union occurred in anatomic position.     

Lateral tibial plateau fracture as a postoperative complication of high tibial osteotomy

Fractures associated with valgus producing high tibial osteotomy are generally reported as operative complications which involve the medial proximal segment. Factors associated with this fracture at the time of surgery include forceful closure of the osteotomy after an inadequately perforated medial cortex, a proximal segment being less than 1.5cm in thickness, and osteotomes entering the medial compartment due to excessive bone loss. Three patients are reported with postoperative fracture of the lateral tibial plateau after tibial osteotomy. One patient's fracture was clearly due to trauma and the other two occurred in patients with a thin proximal segment.     

极易误诊为胫骨平台外侧撕脱性骨折1例

<正>患者,男,58岁,主因左膝部肿痛伴活动不利2 d于2016年7月10日入院。患者2 d前不慎摔倒致左膝部内翻及内旋,出现左膝部肿痛伴活动不利,当时无胸闷气急,无恶心呕吐,无头痛头晕。随即由家人送至当地医院诊治,拍摄X线片示左胫骨平台外侧撕脱性骨折,予以患肢过膝长腿石膏固定。为求进一步治疗,转入我院就诊,门诊以"左胫骨平台外侧撕脱性骨折"收住院。患者既往体健,无高血压、糖     

Tibial fractures after tibial tubercle osteotomies for patellar instability: a comparison of three osteotomy configurations

Purpose  

Tibial tubercle osteotomies (TTOs) are a seemingly straightforward technique; however problems with bony union, implant failure, wound infections, and fractures have been reported in the literature.     

Osteonecrosis of the medial tibial plateau: a case report

Medial tibial plateau osteonecrosis is a disease that lacks distinguishing signs and symptoms, especially in the early stage, and requires clinicians to exercise a high degree of suspicion to prevent disease progression. We present a case of spontaneous osteonecrosis of the medial tibial plateau in a 59-year-old woman. Within 5 months of the onset of symptoms, the entire medial tibial plateau collapsed down into the metaphyseal region, causing severe varus deformity, instability, and inability to walk without crutches and a hinged knee brace. Initial symptoms of medial joint line pain and generalised swelling of the knee were attributed to early degenerative changes. Subsequent radiographs were misinterpreted as simple medial compartment arthritis. Due to severe bone loss and significant lateral collateral ligament attenuation, a total joint arthroplasty was required, using a stemmed tibial component with medial metal block and bone graft augmentation. The speed of bone collapse and the extension into the metaphysis, requiring complex joint arthroplasty, makes this case unique.     

Uptilting osteotomy of the lateral tibial plateau for a knee deformity. A case report.

A middle-aged woman had had anterior poliomyelitis at 11 years of age that had left her with residual weakness in both legs. She gradually developed a recurvatum and valgus deformity in both knees, which caused pain and instability. A technique to restore the top of the tibia by means of a rotational osteotomy of the lateral tibial plateau is presented. This operation resulted in painless, asymptomatic knees and improved function.     

Posterior tibial artery pseudoaneurysm following tibial fracture. A case report

The presence of distal pulses is often times misleading and the severity of the fracture roentgenographically is frequently unrelated to the possibility of a vascular injury. Pseudoaneurysms following long bone injuries, although not as commonly seen in blunt as in penetrating trauma, are potentially limb threatening injuries requiring a high index of suspicion and the liberal use of angiography for early diagnosis and repair. A case of a pseudoaneurysm of the posterior tibial artery associated with a grade I open fracture following blunt trauma and a review of the literature concerning arterial injury in blunt trauma are presented.     

胫骨平台骨折术后对钛合金钢板内固定植入物过敏1例

患者,女,56岁,因右胫骨平台骨折术后半年于2014年3月14日前来复查.该患者于2013年6月27日因摔伤致右膝部肿痛伴活动障碍3d入院,体格检查：右膝关节肿胀,皮肤完整呈青紫色,右膝部疼痛明显,活动障碍,右膝内外侧副韧带应力试验阴性,右下肢末梢血循环感觉良好.X线片示右胫骨平台骨折,关节面塌陷.入院诊断：右胫骨平台骨折.入院后1周硬膜外麻醉下行右胫骨平台骨折切开复位内固定术,沿右胫骨平台外侧入路切口,置入国产奥斯迈钛合金4孔钢板1块及6枚螺钉.术后第2天,患者右小腿出现凹陷性水肿,予第3代头孢、常规消毒;术后10 d切口处红肿疼痛,挤压红肿处,可见暗红色血性液体,考虑为感染,拆除3枚皮钉。     

Comminuted simultaneous bilateral tibial tubercle avulsion fractures: a case report

A 16-year-old male had simultaneous bilateral tibial tubercle avulsion fractures after making a sudden stop while running at full speed. The left knee injury (type V) was minimally displaced, was treated conservatively with closed reduction, and the patient recovered uneventfully. The right tibial tubercle injury was unusual. The tuberosity and anterior aspect of the proximal epiphysis remained as one, but there was severe intra-articular comminution posterior to the displaced tubercle fragment. The right knee injury (type III) required open reduction and internal fixation to reduce the apophyseal fragment and 2 intra-articular displaced fragments. The patient's recovery was complicated by a severe, persistent flexion deformity on the right side. Eventually, the patient required manipulation under anaesthesia, extensive continuous passive mobilisation and a turnbuckle extension splint. A residual 5-degree flexion deformity remained at 16 months post-injury. This case highlights the importance of identifying any intra-articular fragments, their careful anatomical reduction, and aggressive mobilisation when treating tibial tubercle avulsion fractures.     

False popliteal aneurysm after tibial osteotomy: a case report

A 55-year-old man developed a pseudoaneurysm of the popliteal artery after tibial valgization osteotomy performed for degenerative genu varum. A tourniquet was used for the procedure. A wedge osteotomy was performed two centimeters under the joint line; the correction angle was ten degrees. Immediately after the end of the procedure, the distal pulses disappeared for ten minutes. Doppler exploration of the arterial network did not demonstrate any anomaly. Ten days postoperatively, the patient complained of sudden onset pain in the knee and tension in the popliteal fossa. Arteriography demonstrated a pseudo-aneurysm of the popliteal artery. The lesion caused an interruption of arterial flow and was successfully treated by emergency resection and suture.     

Medial opening wedge high tibial osteotomy in patients with posttraumatic medial tibial plateau bone defect: A case report

IntroductionTraumatic uncontained bone defect in the knee joint is one of the most serious knee injuries. As the knee joint is the main weight-bearing joint of the body, the problem of weight loading should be addressed while restoring the bone defect. However, no consensus exists regarding the treatment of this injury.Presentation of caseTwo patients in separate cases initially sustained traumatic uncontained proximal tibial bone defects secondary to passenger traffic accidents. After recovery from the initial trauma, these patients underwent medial opening wedge high tibial osteotomy (MOWHTO) and femoral head allograft augmentation simultaneously.DiscussionTreatment of traumatic uncontained bone defect in the knee joint should be considered separately as tumorous or osteoarthritic bone defects. Especially, the effects of the defective supporting soft tissue structures should be considered.ConclusionWe considered that MOWHTO was capable of solving problems of both bone stock restoration and weight loading. After the operation, the patients’ knee joint pain was relieved and stable ambulation was possible.