Cases reported "Tibial Fractures"

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31/860. Osteofibrous dysplasia of the tibia: case report and review of the literature.

    A case of osteofibrous dysplasia (OFD) of the tibia with 10 years of follow-up is presented. Spontaneous healing of this lesion occurred without any surgical intervention at the age of 10 years. The diagnosis was made retrospectively on the basis of clinical and radiographic appearance and evolution. The capricious nature and indolent course of this neoplasm has led to uncertainty regarding its etiology, evolution, and treatment. A review of the literature and the ongoing discussion about this matter is presented. ( info)

32/860. Double-stress fracture of the tibia in a ten-year-old child.

    A double-stress fracture of the tibia in a 10-year-old girl is described. Double-stress fracture of the tibia has previously been described in association with osteoarthritic varus deformity of the knee but not, to our knowledge, in a child. It is important to establish the diagnosis of stress fracture in childhood because the differential diagnosis, both clinically and on imaging, includes malignancy that must be excluded while avoiding unnecessary invasive investigations. The site of the lesions, their appearance on magnetic resonance imaging, the absence of any soft-tissue involvement, and the clinical history made the diagnosis possible. The characteristics of stress fracture shown on magnetic resonance imaging are described. ( info)

33/860. Intraoperative imaging of the tibial plafond fracture: a potential pitfall.

    STUDY DESIGN: Human tibial plafond cadaveric specimens were coronally sectioned and imaged to assess the accuracy of evaluation of ankle joint line congruity using anteroposterior radiography. Two interesting representative clinical cases are discussed. OBJECTIVES: To evaluate the validity of the routine use of anteroposterior radiographs to evaluate intra-operative ankle joint line congruity in circumstances where lateral radiographs are infeasible due to obscuring internal or external hardware. methods: Eleven frozen human cadaveric lower extremity specimens were used in this study. At the level of the tibial plafond, the specimens were sequentially sliced into 0.5cm sections in the coronal plane. True anteroposterior radiographs were taken with the specimen en bloc. Sequentially, the posterior slices were removed one by one, with an image taken after removing each section. The process was then repeated by removing the anterior sections sequentially with intervening radiographs. Each series of anteroposterior radiographs was then evaluated to characterize which portion of the joint line on the whole specimen view had been contributed by each of the sections. This then allowed us to make inferences about the evaluation of the joint line if it had been derived solely by anteroposterior radiography. Two poignant clinical cases demonstrating the clinical relevance of this information are discussed. RESULTS: By sequentially imaging after removing coronal sections of the tibial plafond we were able to accurately characterize the contribution of each portion of the plafond to the overall anteroposterior view. By primarily imaging the anterior portions of the plafond, with the posterior portions removed, the joint line image was virtually unchanged from the en bloc anteroposterior radiograph. However, removal of the anterior coronal sections caused large variation in the joint line image. These observations demonstrate that the anteroposterior radiograph of the tibial plafond characterizes the anterior portion of the joint well, while it represents a poor assessment of the posterior portion of the joint. This was well illustrated in our clinical case presentations. CONCLUSION: In severe fractures of the tibial plafond multiple forms of internal and external devices are frequently used for fixation. In these circumstances hardware may obscure the lateral view making it impossible to obtain adequate lateral radiographs to assess fracture reduction and joint line congruity. In this scenario, the anteroposterior radiograph is frequently relied upon to confirm the anatomic relationship of the displaced fragments. However, this view fails to accurately characterize reduction in the entire joint line and, intra-operatively, may mislead the surgeon to accept a reduction as anatomic when intra-articular incongruity still exists. Strict attention to pre-operative radiographs and the use of additional rotated views may aid the surgeon in this setting to assess fracture reduction and joint line congruence. ( info)

34/860. Posterolateral approach for tibial pilon fractures: a report of two cases.

    Open reduction and internal fixation (ORIF) of displaced tibial pilon fractures can lead to a high percentage of good and excellent functional results, but has also been associated with a meaningful incidence of wound breakdown and infection. The use of the posterolateral approach to the distal tibia for ORIF of tibial pilon fractures is presented. This may be used instead of the standard anteromedial incision in certain fracture configurations. The flexor hallucis longus muscle coverage overlying the plate fixation of the tibia and ability to fix both the tibia and fibula through the same incision may decrease the risk of deep infection and wound complications in these injuries frequently associated with marked soft tissue trauma. ( info)

35/860. Immediate tibiocalcaneal arthrodesis with interposition fibular autograft for salvage after talus fracture: a case report.

    Treatment goals in the operative management of talus fractures include prompt, anatomic, open reduction with rigid internal fixation; functional outcome is measured by degree of arthrosis, pain, range of motion, limb length, cosmesis, and return to premorbid activities. If restoration of the articular surfaces is precluded secondary to comminution, immediate and/or staged reconstructive salvage procedures must be considered. This report describes an immediate reconstructive procedure for salvage after a comminuted talus fracture with an ipsilateral tibia fracture. A standard antegrade tibial nail extending into the calcaneus was selected to stabilize both fracture sites. The technique of tibiocalcaneal arthrodesis using interposition fibular autograft and intramedullary fixation is presented as a unique treatment option. ( info)

36/860. Prolonged coma due to cerebral fat embolism: report of two cases.

    Fat embolism syndrome remains a rare, but potentially life threatening complication of long bone fractures. The true incidence is difficult to assess as many cases remain undiagnosed. Cerebral involvement varies from confusion to encephalopathy with coma and seizures. Clinical symptoms and computed tomography are not always diagnostic, while magnetic resonance imaging is more sensitive in the detection of a suspected brain embolism. Two cases of post-traumatic cerebral fat embolism, manifested by prolonged coma and diffuse cerebral oedema, are presented. The clinical course of the disease as well as the intensive care unit management are discussed. ( info)

37/860. The application of arthroscopic principles to bone grafting of delayed union of long bone fractures.

    The purpose of this study was to explore the potential of applying arthroscopic techniques to autogenous bone grafting of long bone fracture delayed union. There were 9 patients in this initial series, including 4 patients (average age, 37 years) with humeral lesions and 5 patients (average age, 25 years) with tibial fractures. There were 6 men and 3 women. Techniques customarily employed in arthroscopy were used to visualize, expose, and deliver the onlay cancellous bone grafts. Bony union occurred in all but 1 patient in an average of 4 months. This patient had a fibrous union and sustained a reinjury that led to successful repeat open bone graft surgery. The arthroscopic approach for bone grafting of certain long bone delayed union appears to be a safe and effective procedure. The procedure is best suited for patients with mechanically stabilized fragments, and it lends itself to those with overlying skin or soft tissue compromise. There are some relative contraindications: grossly unstable fragments, severe malunion, and/or infection. ( info)

38/860. The influence of mechanical stimulus on the pattern of tissue differentiation in a long bone fracture--an FEM study.

    2D, coronal plane, finite elements models (FEMs) were developed from orthogonal radiographs of a diaphyseal tibial fracture and its reparative tissue at four different time points during healing. Each callus was separated into regions of common tissue histology by computerised radiographic analysis. Starting point values of tissue material properties from the literature were refined by the model to simulate exactly the mechanical behaviour of the subject's callus and bone during loading. This was achieved by matching measured inter-fragmentary displacements with calculated inter-fragmentary forces. Stress and strain distributions in the callus and bone were calculated from peak inter-fragmentary displacements measured during natural walking activity, and were correlated with the subsequently observed pattern of tissue differentiation and maturation of the callus. The growth and stiffening of the external callus progressively reduced the inter-fragmentary gap strain. Partial maturation of the gap tissue was apparent only one week before fixator removal. Principal stresses in the callus were compared with 'yield stresses' in corresponding tissue from the literature. This indicated the presence of stress concentrations medial and lateral to the fracture gap, which probably caused tissue damage during normal activity levels. Tissue damage may also have precipitated partial structural failure of the callus, both of which were believed to have delayed healing during the middle third of the fixation period. Had the fixation device provided greater inter-fragmentary support during early healing, this may have prevented callus failure and the consequent delay in healing. A further benefit of this would have been the reduction of the initially high intra-gap tissue strains to a magnitude more conducive to earlier maturation of the bridging tissue that united the bone. ( info)

39/860. Combined pedicled flaps for grade IIIB tibial fractures in children: a report of two patients.

    Severe open tibial fractures in children are associated with notable morbidity and require early aggressive management to ensure a successful outcome. Free flaps are currently the gold standard in distal extremity reconstruction in which large soft-tissue defects exist, as is often the case with grade IIIB fractures. In severe lower limb trauma, however, free flaps are associated with a relatively high risk of failure, particularly when definitive soft-tissue coverage is delayed. Alternative methods of soft-tissue reconstruction may, therefore, occasionally require consideration. The authors describe the combined use of three pedicled flaps to attain soft-tissue coverage in 2 children with grade IIIB tibial fractures. These three flaps are individually in common use for lower limb soft-tissue coverage, are simple to raise, and in combination can cover extensive soft-tissue defects of the lower extremity. The major vascular axes of the limb are not sacrificed; however, the aesthetic result is modest. ( info)

40/860. Anaesthesia in myotubular (centronuclear) myopathy.

    A patient with a known history of myotubular myopathy presented for surgery for insertion of a tibial nail. Anasthesia was induced and maintained using an intravenous anasthetic technique. Neuromuscular function was assessed using mechanomyography, which showed a profound reduction in muscle contractility. In view of this, the use of muscle relaxants was avoided altogether. Nerve conduction was normal but electromyography showed small motor units, with generalised distribution, suggesting mild to moderately severe myopathy. The patient made a slow but uneventful recovery. ( info)
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