1/31. Displacement of the common peroneal nerve associated with upper tibial fracture: implications for fine wire fixation.The constant anatomic position of the common peroneal nerve is relied on when performing fine wire external fixation in the upper tibia. We report the case of a sixty-two-year-old woman with a Schatzker Type V fracture of her right tibial plateau and upper-third diaphyseal fracture associated with displacement and shortening of the upper tibia. She was treated by minimal internal fixation of the intraarticular fracture and application of a Sheffield Hybrid External Fixator. During percutaneous insertion of the reference wire in the fibular head, a distal muscle twitch alerted the surgeon, and the common peroneal nerve was duly explored and found displaced forward over the fibular head, dangerously close to the wire. It is postulated that at the time of injury, the common peroneal nerve was displaced anteriorly and that despite reduction of the tibial fractures, it had failed to return to its original position.The mechanism of this was confirmed by an anatomic study on an above-the-knee amputation specimen in which the metaphyseal-diaphyseal element of the fracture was reproduced. We recommend insertion of the reference fibular wire with the knee in flexion. Open insertion of this wire, with an incision down to bone and exposure of the fibular head, is recommended in cases in which severe trauma with shortening of the upper tibia, with possible disruption of the tibiofibular joint, puts the nerve in danger of injury.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/31. Longitudinal tibial fatigue fracture: an uncommon stress fracture with characteristic features.PURPOSE: The author reports three cases of longitudinal tibial fatigue fractures, reviews the literature, and discusses characteristic features that suggest the diagnosis may be made by bone scintigraphy. methods: Radiographs and two- or three-phase bone scintigraphs with Tc-99m MDP were obtained in three runners who had exercise-related leg pain and whose clinical symptoms suggested either stress fractures or shin splints. The literature was reviewed and previously reported scintigraphic findings were compared with those seen in these three cases. RESULTS: In contrast to the focal, elliptical, cortex-based abnormal activity usually seen in the upper or middle tibia in patients with tibial stress fractures, all three patients had a long area of abnormal diffusely increased tibial activity that extended from the tibiotalar region proximally. This finding was seen on the 3-hour delayed static images of all three patients and was suggested on the blood-pool (tissue phase) images. The literature also contained reports of these same scan characteristics. Radiographs subsequently disclosed a longitudinal tibial stress fracture in one patient, computed tomography was positive in the second patient, and findings of clinical follow-up and radiographs were consistent with this diagnosis in the third patient. CONCLUSION: In the appropriate clinical setting and with normal or nondiagnostic radiographs, the presence of a long area of diffusely increased activity in the distal tibia extending proximally from the tibiotalar junction is indicative of a longitudinal fatigue fracture.- - - - - - - - - - ranking = 0.125keywords = upper (Clic here for more details about this article) |
3/31. Hydatid cyst of the tibia.A case of hydatid cyst of the tibia, which manifested as a pathologic fracture is being reported. Pain and swelling of left lower limb with inability to bear the weight were the main features. Tender swelling was also noted at the upper and middle third of tibia. Open biopsy revealed the hydatid cyst wall and scolices of echinococcus granulosus. albendazole treatment was followed by curettage and bone grafting.- - - - - - - - - - ranking = 0.125keywords = upper (Clic here for more details about this article) |
4/31. Ultrasound guidance for a lateral approach to the sciatic nerve in the popliteal fossa.Descriptions of the use of ultrasound for nerve location have focused on upper limb blocks. We present a case in which ultrasound imaging was used for a lateral approach to the sciatic nerve in the popliteal fossa. Ultrasound images taken proximal to the popliteal crease showed tibial and common peroneal nerves as round hyperechoic structures superficial and lateral to the tibial artery. Under direct ultrasound guidance, we placed a block needle close to the tibial nerve and confirmed its position with nerve stimulation. Injected local anaesthetic was seen on ultrasound as it spread around both tibial and common peroneal nerves.- - - - - - - - - - ranking = 0.125keywords = upper (Clic here for more details about this article) |
5/31. Reduced perception of pain in schizophrenia: its relevance to the clinical diagnosis of compartment syndrome.An atypical presentation of compartment syndrome is reported in a chronic schizophrenic patient with a closed upper tibial fracture. The features of this case and a review of the literature pertaining to pain perception in this group of patients are presented to raise clinical awareness of this combination of disorders, which may lead to delayed treatment of a surgical emergency, consequent on lack of development of classic symptoms in these patients. We suggest continuous intracompartmental pressure monitoring, even in awake schizophrenic patients with injuries at risk of compartment syndrome.- - - - - - - - - - ranking = 0.125keywords = upper (Clic here for more details about this article) |
6/31. Femoral and tibial fractures in a child with myelomeningocele.Femoral and tibial fractures can occur from accidents, child abuse or pathological causes. It is often very difficult to distinguish the cause among those cases. Radiological diagnosis may be needed for clinicians and medical examiners in order to assist determining the reason of fractures. In this report, we submit a case with femoral and tibial fractures associated with myelomeningocele. This patient was diagnosed as child abuse by clinicians. On review it was decided that her fractures were not because of non-accidental injury. The values of bone mineral density of the upper limb were low and illness caused her fractures.- - - - - - - - - - ranking = 0.125keywords = upper (Clic here for more details about this article) |
7/31. Arteriovenous shunts in free vascularized tissue transfer for extremity reconstruction.Local vessels are occasionally unsatisfactory donor choices for vascularized tissue transfer in extremity reconstruction. Construction of a temporary arteriovenous loop facilitates not only tension-free anastomoses outside the zone of injury but also affords vascular distention at physiological pressures, an opportunity to verify vein graft patency before tissue transfer, and presumably a decrease in the ischemia time of the vein graft itself. We reviewed the cases of 25 consecutive patients who underwent upper and lower extremity reconstruction facilitated by temporary arteriovenous shunts. In single-stage procedures, greater or lesser saphenous veins were used; the venous end was left in situ in its bed in 17 patients and the entire vein harvested freely in 8. The most common destination was the leg (11), followed by the thigh (7), foot (2), sacrum (2), knee (1), arm (1), and forearm (1). There were three (12%) failures. We conclude that construction of temporary arteriovenous shunts using vein grafts is a productive adjunctive technique in vascularized tissue transfer where additional pedicle length is needed.- - - - - - - - - - ranking = 0.125keywords = upper (Clic here for more details about this article) |
8/31. Genu recurvatum due to partial growth arrest of the proximal tibial physis: correction by callus distraction. Case report.The formation of a genu recurvatum after partial growth arrest of the proximal tibial physis is uncommon. This contribution deals with the case of a 16 years old male patient who after a direct injury to the proximal tibia four years ago showed a genu recurvatum of 18 degrees. An incomplete upper tibial corticotomy was performed and a hinge type de Bastiani fixator applied. The deformity was corrected at a distraction rate of one millimetre a day. The corticotomy gap filled with callus during the distraction process. The advantages of this concept are omision of iliac crest grafts, maintainance of a full range of knee motion with partial weight bearing during distraction and determination of the final degree of correction with the aid of proper radiographs.- - - - - - - - - - ranking = 0.125keywords = upper (Clic here for more details about this article) |
9/31. biopsy proven eradication of an aneurysmal bone cyst treated by superselective embolization: a case report.A large aneurysmal bone cyst of the upper tibia in a 17-year-old patient was treated by superselective embolization with excellent clinical and radiological results. Extensive curettage and detailed pathologic analysis performed 2 years following embolization revealed only healing bone. The presented case and reviewed cases in the literature indicate that embolization is a promising method for definitive therapy of the aneurysmal bone cyst.- - - - - - - - - - ranking = 0.125keywords = upper (Clic here for more details about this article) |
10/31. Progressive valgus deformity after juxta-epiphyseal fractures of the upper tibia in children.Four cases of progressive valgus deformity following a juxta-epiphyseal fracture of the proximal end of the tibia are presented. We suggest that the deformity is due to asymmetrical growth of the physis. Since this type of fracture tends to create a deformity, an anatomical or even overcorrected reduction is required. Long follow-up is necessary.- - - - - - - - - - ranking = 0.5keywords = upper (Clic here for more details about this article) |
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