Ipsilateral tibial shaft fracture and distal tibial triplane fracture with an intact fibula: a case report

We present a case of an ipsilateral tibial shaft fracture and a distal tibial triplane fracture with an intact fibula in a 14-year-old boy. Computed tomography revealed the distal tibial triplane fracture with a 2.6-mm displaced Tillaux fragment and a posterior malleolar shear fragment. Open reduction and internal fixation was performed to optimise healing and outcome. This is a rare injury, for which a high index of suspicion is needed for diagnosis. Missing the intra-articular distal tibial triplane fracture could result in a disabling angular deformity (mostly varus) or limb-length discrepancy secondary to premature partial closure of the distal physis.     

Isolated tibial shaft fracture

A nineteen-year-old otherwise healthy woman is seen in the emergency room after being struck by a car. The patient reports left lower extremity pain and has no other injuries. Exam shows a Tscherne grade I soft tissue injury with otherwise normal motor and sensory exam. There are no signs of compartment syndrome. A closed reduction was performed.     

The tibial shaft fracture.

Two large series of civilian-incurred (212) and combat-incurred (228) tibial shaft fractures are compared. Closed tibial fractures were treated by closed manipulation and weight bearing ambulation in a long leg plaster cast. Open injuries following wound exploration and debridement were treated similarly with wound closure. Combat-incurred tibial shaft fractures responded similarly to civilian-incurred injuries. Allowing an open fracture to heal with exposed bone at the fracture site resulted in an average time to removal of external immobilization only two weeks greater than for the uncomplicated tibial fracture. Whether weight bearing ambulation was instituted immediately (24-48 hr) or early (3-4 wk) did not shorten the time to removal of external immobilization. The infection rate in 289 open tibial fractures (228 combat-incurred and 61 civilian-incurred) was 3.8%, and all infections occurred in the open penetrating injuries.     

Distal tibial triplane fracture with ipsilateral tibial shaft fracture: A case series

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.

Scintigraphic evaluation of tibial shaft fracture healing

A scintigraphic study of the healing process of type A and B closed tibial shaft fractures was carried out in 40 cases treated non-operatively, comprising 32 men and eight women aged 30.6 yr on average. Scintigraphic scans were obtained with technetium methylenediphosphonate (MDP-Tc99m, 25 mCi) at 6, 12 and 24 weeks after the fracture and an activity index was calculated taking the mean of three consecutive uptake counts for both fractured and normal opposite leg, used for comparison. The results showed that the activity index in general decreased progressively from the first to the third evaluation, with little difference in behaviour between the two types of fractures. However, for B type fractures the activity index remained stable from the first to the second evaluation, followed by a marked decrease at the third evaluation, with a comparable end result for both fracture types. It was concluded that a decrease of the activity index occurs in both types of closed fractures undergoing uneventful healing and that such a decrease can be taken as a parameter for further studies which include delayed union and non-union.     

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.     

Changes in bone-mass after tibial shaft fracture

We studied 20 patients who had suffered tibial shaft fractures 30 months previously. The bone-mineral content in diaphyseal and metaphyseal bone of the femur and tibia was determined by photon absorptiometry. There was a moderate, but significant, deficit of bone-mineral in metaphyseal bone at the knee and distal tibia. This loss was, however, far smaller than that previously reported. Persisting bone-mineral changes in diaphyseal bone were insignificant except in the fracture area where there was a 28 per cent increase. This may indicate that bone may, under some circumstances, locally increase in strength after remodelling of the fracture.     

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.     

Changes in bone-mass after tibial shaft fracture

We studied 20 patients who had suffered tibial shaft fractures 30 months previously. The bone-mineral content in diaphyseal and metaphyseal bone of the femur and tibia was determined by photon absorptiometry. There was a moderate, but significant, deficit of bone-mineral in metaphyseal bone at the knee and distal tibia. This loss was, however, far smaller than that previously reported. Persisting bone-mineral changes in diaphyseal bone were insignificant except in the fracture area where there was a 28 per cent increase. This may indicate that bone may, under some circumstances, locally increase in strength after remodelling of the fracture.     

非扩髓带锁髓内钉治疗开放性胫骨骨折

1997年 3月～ 2 0 0 0年 8月 ,我们使用Ｏｒｔｈｏｆｉｘ型带锁髓内钉非扩髓治疗 6 5例开放性胫骨骨折 ,取得良好的效果。1　材料与方法1 1　病例资料　本组 6 5例 ,6 8侧胫骨 ;男 38例 (41侧 ) ,女 2 7例 (2 7侧 ) ;年龄 2 5～ 76岁。受伤原因 :车祸伤 39侧 ,坠伤 18侧 ,跌伤 11侧。按Ｇｕｓｔｉｌｌｏ开放性骨折分型 :Ⅰ型 39侧 ,Ⅱ型 17侧 ,Ⅲ型 12侧 (Ⅲａ型 4侧、Ⅲｂ和Ⅲｃ型 8侧 )。见图 1。图 1　开放性胫骨骨折术前1 2　治疗方法　Ⅰ型开放性骨折 ,常规清创 ,行闭合髓内钉内固定 ;Ⅱ型和Ⅲａ型在常规清创后 ,行开放髓内钉内固定手…     

自锁髓内钉治疗胫骨干多段骨折

四肢骨干骨折采用髓内固定目前在国内已得到了广泛的使用和认可,特别是多段骨折行髓内固定更成为首选。2003年5月～2005年9月,笔者采用自锁髓内钉治疗胫骨干多段骨折23例,取得满意疗效     

Magnetic resonance imaging of tibial shaft fracture repair

Summary Magnetic resonance imaging (MRI) of normal fracture repair was evaluated in six randomly chosen adult patients with solitary, closed fractures of the tibial shaft by obtaining serial MRI scans until union of the fracture. The mean time to union was 14.3 weeks. Ultralow-field 0.02-Tesla magnet equipment was used. The MRI scans showed a characteristic pattern of events common for all the patients studied and compatible with the recognized histomorphology of fracture repair. The intramedullary cavity demonstrated a marked decrease in the signal intensity. In the soft tissues surrounding the fracture the initially evenly high signal intensity gradually developed a granular appearance with embedded low-intensity nodules. These nodules corresponded to the first areas to become mineralized, as could be seen on plain radiographs several weeks later. The question of whether MRI renders it possible to predict delayed union calls for continued investigations.     

Effect of smoking on tibial shaft fracture healing

Of 146 consecutive closed and Grade I open tibia shaft fractures treated with cast immobilization, external fixation, or intramedullary rod fixation during a 4-year period, 44 of 76 (58%) tibias of patients who smoked and 59 of 70 (84%) tibias of patients who did not smoke had followup to union or followup beyond 1 year. The demographics, fracture patterns, and treatments of the two groups were similar. Two of the 44 patients who smoked had nonunions at the 1-year followup, whereas none of the patients who did not smoke had nonunions. Of the 103 tibias with complete followup to union, the median time to clinical healing for patients who smoked (269 days) was significantly greater than that of patients who did not smoke (136 days). Likewise, there was a 69% delay in radiographic union in the group that smoked as interpreted by a radiologist blinded to the two groups. Statistical differences in clinical and radiographic healing rates between those who smoked and those who did not smoke were observed for patients receiving intramedullary fixation or external fixation. Statistical differences were not seen in the clinical and radiographic healing of tibias treated with cast immobilization, although tibias of patients who smoked took 62% longer to heal. The current data suggest that tibias of patients who smoke who require treatment with intramedullary nailing or external fixation require more time to heal than do those of patients who do not smoke.     

不同方法治疗胫骨干骨折疗效分析

目的 探讨适合胫骨干骨折的手术治疗方法及并发症的预防措施。方法 回顾性分析手术治疗胫骨干骨折患者67例，根据选择手术方式不同，将患者分为交锁髓内钉、加压钢板组和外固定支架3组，临床观察结合x线片评价骨折愈合、延迟愈合、不愈合作为判断临床疗效标准。结果 髓内钉组的骨折愈合率明显高于加压钢板组和外固定支架组，外固定组的骨折延迟愈合率高于其他两组；并发症包括骨不连、关节僵硬及畸形愈合，发生率为22.4％，其中骨不连发生率为13.4％。结论 髓内钉内固定治疗胫骨干骨折的临床疗效优于加压钢板和外固定支架；骨不连为胫骨骨折常见并发症，应严格掌握手术适应证、规范手术操作。     

微创内固定术治疗复杂胫骨干骨折

由于胫骨特殊的解剖位置结构,胫骨干骨折是骨科的常见损伤,复杂的胫骨干骨折由于血供薄弱,力学不稳定,其治疗对于外科医生是一项巨大的挑战。微创内固定系统（less invasive stabilization system,LISS）主要用于治疗股骨下端和胫骨近端骨折,2004年1月至2005年12月我们使用LISS治疗11例复杂胫骨干骨折,发现LISS治疗复杂胫骨干骨折有其独特优势。     

Expected long-term outcome after a tibial shaft fracture

OBJECTIVE: A prospective study of 207 laymen and professionals answered a questionnaire regarding the expectations of the long-term outcome 6 months after a unilateral tibial shaft fracture. The aim was (1) to disclose the expected outcome after unilateral tibial shaft fracture, and (2) to compare these expectations with the outcome measured in patients. METHODS: There were five groups of nonpatients: (1) 42 orthopedic surgeons, (2) 36 physiotherapists, (3) 42 students, (4) 49 white collar workers, and (5) 38 blue collar workers. Outcome was measured by Sickness Impact Profile (SIP). The SIP scores were compared with SIP scores obtained from 33 patients with a unilateral tibial fracture. RESULTS: Marked variation was observed between the groups. CONCLUSION: Physiotherapists expected the lowest degree of disability and orthopedic surgeons the highest. In the three groups of students, white collar workers and blue collar workers only minor variations were observed and their SIP scores showed better correlation with the SIP scores obtained from the patients than those of orthopedic surgeons and physiotherapists.     

Disability of the hindfoot after fracture of the tibial shaft.

Hindfoot (subtalar) movement and disability after fracture of the tibial shaft have been studied. One hundred patients with soundly healed fractures of the tibial shaft treated by immobilisation in a long leg plaster cast were examined at least one year after the fracture had healed. Subtalar movement was accurately measured by a special technique and the patients were questioned specifically about any disability associated with their hindfoot. Subtalar movement was limited to some degree in 72% of patients. Forty-three per cent of patients complained of symptoms related to their subtalar joint and 12% found these symptoms troublesome.