Bilateral Tibial Fractures Research Articles

Treatment of the patient with bilateral tibial plateau fractures with posterior column involvement (clinical case)

Treating patients with bilateral tibial plateau fractures remains a difficult task, demanding in the majority of cases staged surgical tactics, thorough preop planning, and combination of approaches and implants. At the same time, various options of osteosynthesis are possible. The aim of the study: to demonstrate the preop planning technology and the possibilities of the use of proposed surgical approaches’ modifications and maneuvers to fix posterior tibial plateau. A clinical case is presented of a patient with bilateral tibial high impact fractures with posterior involvement. At admission, external fixing of fractures was performed. Later, after soft tissues’ normalization and preop planning based on computer tomography, consecutive internal osteosynthesis was done. Variations of surgical approaches and maneuvers for fixing the fragments and implants were used, that allowed for stable fixation of fragments after the articular surface fragments’ anatomical reposition. Good anatomical and functional mid-term result was achieved, without any worsening of the fragments’ position in dynamics or implants’ migration.The clinical case demonstrated that the combination of modified anterolateral and posteromedial approaches together with the use of anatomical implants granting subchondral support for articular surface fragments allows to stably fix even complex tibial plateau fractures. Restoration of axial correlations in the limb, preservation of the joint stability on the whole allows to wager on good functional results, even in case of extensive articular surface lesions.

Interleukin-13 Affects the Recovery Processes in a Mouse Model of Hemorrhagic Stroke with Bilateral Tibial Fracture.

As one form of stroke, intracerebral hemorrhage (ICH) is a fatal cerebrovascular disease, which has high morbidity and mortality and lacks effective medical treatment. Increased infiltration of inflammatory cytokines coupled with pyroptotic cell death is involved in the pathophysiological process of ICH. However, little is known about whether concomitant fracture patients have the same progression of inflammation and pyroptosis. Hence, we respectively established the mouse ICH model and ICH with bilateral tibial fracture model (MI) to explore the potential cross-talk between the above two injuries. We found that MI obviously reversed the expressions of pyroptosis-associated proteins, which were remarkably up-regulated at the acute phase after ICH. Similar results were observed in neuronal expressions via double immunostaining. Furthermore, brain edema was also significantly alleviated in mice who suffered MI, when compared with ICH alone. To better clarify the potential mechanisms that mediated this cross-talk, recombinant mouse interleukin-13 (IL-13) was used to investigate its effect on pyroptosis in the mouse MI model, in which a lower level of IL-13 was observed. Remarkably, IL-13 administration re-awakened cell death, which was mirrored by the re-upregulation of pyroptosis-associated proteins and PI-positive cell counts. The results of hemorrhage volume and behavioral tests further confirmed its critical role in regulating neurological functions. Besides, the IL-13-treated MI group showed poor outcomes of fracture healing. To sum up, our research indicates that controlling the IL-13 content in the acute phase would be a promising target in influencing the outcomes of brain injury and fracture, and meanwhile, provides new evidence in repairing compound injuries in clinics.

Evaluation of bilateral tibial fracture management by external and internal fixation technique in a calf

Unilateral diaphyseal tibial fractures are very common in different species of animals but the occurrence and repair of bilateral diaphyseal tibial fractures are very rare. The aim of the present study is to evaluate the efficacy of bilateral tibial fracture management in a calf. The study was performed in a 75 days old cross-bred calf weighing 42 kgs which was suffering from bilateral tibial fracture and treated by external coaptation technique on left tibia and internal fixation by retrograde intramedullary pinning on the right tibia. The patient was evaluated after treatment at different intervals by recording the lameness grade, functional limb outcome, fracture healing. Satisfactory posture (weight bearing), gait and secondary bone healing in both left and right tibia were noticed up to 93 day of post-treatment with the minor complications of swelling and stiffness of the right hock joint and hyperextension of fetlock joint of left hind limb. This technique can be used in bilateral tibial fracture management in calf in field condition with reasonable cost

Bilateral Tibial Tubercle Fracture in Adolescence: A Case Report and Review of the Literature

Bilateral Tibial Tubercle Fracture in Adolescence: A Case Report and Review of the Literature

Small intestinal bacterial overgrowth as a cause of protracted wound healing and vitamin D deficiency in a spinal cord injured patient with a sacral pressure sore: a case report

BackgroundPressure sores are sometimes refractory to treatment, often due to malnutrition. Small intestinal bacterial overgrowth (SIBO) obstructs absorption in the digestive tract and causes malnutrition. However, little is known about the association between pressure sore wound healing and SIBO. Here, we report a case of a patient with a refractory sacral pressure sore and SIBO.Case presentationA 66-year-old woman who was spinal cord injured 14 years before visiting our hospital presented with the chief complaint of a sacral pressure sore, 10.0 × 6.5 cm in size, which was refractory to treatment. Physical examination showed abdominal distension and emaciation, with a body mass index of 15. Further examination revealed elevated serum alkaline phosphatase (1260 U/L), bilateral tibial fracture, multiple rib fracture, and osteoporosis. We diagnosed the patient with osteomalacia with vitamin D deficiency. Despite oral supplementation, serum levels of calcium, phosphorous, and vitamin D remained low. Also, despite concentrative wound therapy for the sacral pressure sore by plastic surgeons, no wound healing was achieved. Due to a suspicion of disturbances in nutrient absorption, we performed bacterial examination of collected gastric and duodenal fluid, which showed high numbers of bacteria in gastric content (104E. coli, 105Streptococcus species, and 105Neisseria species) and duodenal content (106E. coli, 104Candida glabrata). Therefore, we diagnosed the patient with SIBO and started selective decontamination of the digestive tract using polymyxin B sulfate and amphotericin B. After starting treatment for SIBO, the sacral pressure sore began to heal and was nearly healed after 285 days. The patient’s serum levels of calcium, phosphorous, vitamin D, and other fat-soluble vitamins also gradually increased after starting treatment for SIBO.ConclusionWe report a case of a patient with a refractory sacral pressure sore that healed after starting treatment for SIBO. We conclude that SIBO may be an overlooked cause of malnutrition and poor wound healing in patients with chronic pressure sores.

SUN-LB19 Novel Homozygous Mutation in BMP1 Causing Osteogenesis Imperfecta

Background: Osteogenesis imperfecta (OI) is characterized by bone fragility and increased fracture susceptibility. Most mutations occur in COL1A1 and COL1A2 genes. Rarely, mutations in BMP1 have been reported in association with OI type XIII. Disease severity is generally more severe when the mutation affects both gene products encoded by BMP1 that serve as procollagenases: bone morphogenic protein 1 and mammalian tolloid (mTLD) [1]. Clinical Case: A 7-year-old Hispanic boy, with speech and gross motor delays, sustained five bilateral tibial fractures with minimal trauma since age 2.5 years. At age 6 years, he developed severe back pain after a minor fall. Diffuse spinal osteopenia and multiple vertebral compression fractures (VCF) at T9, L1, L3 were identified radiographically, with progressive vertebral height loss in the ensuing 9 months. Fatigue was reported after walking >10 min, with difficulty running and climbing stairs. There was no family history of musculoskeletal disorders.Stature was consistently between 10-15th% for age. Subtle facial dysmorphism included micrognathia and small chin, with patchy blue-gray sclerae, and normal dentition. The lumbar spine was tender to percussion. Gait was slow and antalgic with external rotation of the right hip.Laboratory evaluation revealed normal serum calcium, iPTH, magnesium, phosphate, 25-hydroxyvitamin D and alkaline phosphatase for age. P1NP was slightly high (193 µg/L, 30-110 µg/L) and CTX was slightly low (554 pg/mL, n: 574-1849 pg/mL), the latter being atypical for OI. Total hip BMD (adjusted for height Z-score) was normal (Z-score = 1.76) and adjusted femoral neck BMD was high (Z-score = 2.67). VCFs precluded assessment of lumbar spine BMD. Genomic analysis revealed a homozygous missense mutation in exon 4 of BMP1 resulting in an amino acid substitution (c. C505T; p.Arg169Cys) in both the bone morphogenetic protein 1 and mTLD gene products of BMP1. The mutation is predicted to be damaging to both proteins, and associated with this rare form of OI. Conclusion: We report a novel homozygous mutation in BMP1 identified in a child with autosomal recessive OI. Unlike most forms of OI, patients with type XIII often have normal or increased BMD [1], making a correlation between BMD and fracture risk difficult. While bisphosphonates (BP) may help reduce recurrent fractures and provide symptomatic relief, the broad phenotypic spectrum and concern for further increasing BMD complicate management. A high resolution peripheral quantitative CT scan to assess bone microarchitecture and quality may aid in the decision of BP therapy. As evidence is limited on the effectiveness of BP in this rare form of OI, it is important to consider each case individually.1.Sangsin, A., et al., Two novel compound heterozygous BMP1 mutations in a patient with osteogenesis imperfecta: a case report. BMC Med Genet, 2017. 18(1): p. 25.

Do Patient-specific or Fracture-specific Factors Predict the Development of Acute Compartment Syndrome After Pediatric Tibial Shaft Fractures?

Tibial shaft fractures are the most common injuries preceding acute compartment syndrome (ACS), so it is important to understand the incidence of and risk factors for ACS after pediatric tibial shaft fractures. The purposes of this study were to determine the rate at which ACS occurs and if any patient or fracture characteristics are significantly associated with developing ACS. All patients aged 5 to 17 years treated for a tibial shaft fracture at a level 1 pediatric trauma center, a level 1 adult trauma center, and an outpatient orthopaedic practice between 2008 and 2016 were retrospectively identified. Demographics, mechanisms of injury, and fracture characteristics were collected from the medical records. Radiographs were reviewed by study authors. ACS was diagnosed clinically or by intracompartmental pressure measurement. Univariable analysis was performed using the Fisher exact test for nominal variables and simple logistic regression for continuous variables. Multivariable analysis was performed using stepwise logistic regression. Among 515 patients with 517 tibial shaft fractures, 9 patients (1.7%) with 10 (1.9%) fractures developed ACS at a mean age of 15.2 years compared with a mean age of 11 years in patients without ACS (P=0.001). One patient with bilateral tibial fractures developed ACS bilaterally. Age greater than 14 years (P=0.006), higher body mass index (P<0.001), motorcycle or motor vehicle accidents (P=0.034), comminuted and segmental tibial shaft fractures (P<0.001), ipsilateral fibular fracture (P=0.002), and associated orthopaedic injuries (P=0.032) were all significantly more common in the ACS group. ACS developed in 1.7% of the patients with tibial shaft fractures in this retrospective study-a rate significantly lower than previously reported. Age greater than 14 years, higher body mass index, motor vehicle or motorcycle accidents, comminuted or segmental fracture pattern, ipsilateral fibular fracture, and associated orthopaedic injuries are all significantly associated with its development. Level III-retrospective comparative study.

Bilateral Tibial Tubercle Avulsion Fractures in Children - Clinical Results of a Rare Fracture.

Tibial tubercle avulsion fractures are rare, they represent less than 1% of all physeal fractures. Compared to monolateral tibial tubercle avulsion fractures, bilateral occurrence is even rarer. The purpose of this study is to report about the so far largest group of bilateral avulsion fractures and to compare them to unilateral fractures as well as to current literature. All patients who suffered from bilateral tibial tubercle fractures between January 2009 and March 2019 were included. All medical records and radiographs were reviewed and a clinical follow-up was performed. The examined criteria were age, gender, mechanism of injury, classification, risk factors, complications, management and outcomes. Clinical outcome was measured using the well established Tegner activity scale and Lysholm-Gillquist score. The same criteria were analyzed in a literature review of bilateral tibial tubercle fractures to compare our results to available literature. We found four children with bilateral tibial tubercle avulsion fractures. All patients were male with a mean age of 14.5 ± 0.7 years (13 - 15). Mean follow-up examination was 13.6 ± 6.5 months (8 - 29) after surgery. The avulsions occurred during jumping activities in all cases. All children could no longer stand or move because of sudden pain in the knee. We found type IV fractures in three cases, type III fractures in four cases and one type V fracture according to the Ogden classification. All children were treated by open or closed reduction and stabilization with screws or K-wires. Follow-up showed complete fracture healing without complications in all patients. There were no changes in Tegner activity scale and Lysholm-Gillquist Score and knee function comparable to prior to the accident was achieved in all cases. Good clinical results without restrictions regarding function of the knee joint can be achieved by direct operative treatment of bilateral tibial avulsion fractures. A reduction in sporting activity has not to be expected. There were no differences between bilateral or unilateral tibial tubercle avulsion fractures.

Acceleration of Fracture Healing in Experimental Model: Platelet-Rich Fibrin or Hyaluronic Acid?

In this study, we compared the bone-healing effects of the local application of platelet-rich fibrin (PRF) and hyaluronic acid (HA) to bilateral tibial fractures in rats. Twenty-three adult male Sprague-Dawley rats were used. Twenty-two animals were randomly allocated to a control group (n = 6) and 2 study groups: PRF (n = 8) and HA (n = 8). The 23rd rat was used as a donor to obtain PRF. Each group was divided into 2 subgroups for histomorphometric and radiologic assessments at 2 and 6 weeks. Foreign body reaction, necrosis, inflammation, new bone formation, and fibrosis were investigated as bone healing parameters in terms of histopathologic analysis. The difference between the groups for these parameters was evaluated. The radiologic evaluation was performed by comparing the 3-dimensional reconstruction images of the fracture sites between the study and control groups. Histomorphometric evaluation showed that at 2 weeks postoperatively, the control group showed lesser bone formation (26.1 ± 6.6%) when compared to the study (HA: 54.7 ± 9.7%; PRF: 75.3 ± 19.2%) groups and PRF group showed highest total ossification. At 6 weeks postoperatively the PRF group showed lesser total ossification (50.7 ± 28.2%) when compared to control (76.3 ± 21.7%) and HA group. The HA (88.8 ± 13.3%) showed highest total ossification. In the control group, fibrosis was more prominent at week 6, whereas in the HA and PRF groups the amount of ossification increased. In contrast to histopathologic healing, radiologic bone healing did not differ significantly among the study and control groups 2 weeks after surgery, whereas at 6 weeks, the results of radiologic bone formation were in accordance with those of histopathologic bone healing.

Risk Factors for Knee Stiffness Surgery After Tibial Plateau Fracture Fixation.

To determine the risk factors for knee stiffness surgery after tibial plateau fixation. Retrospective observational cohort study. Academic Level I trauma center. A study group of 110 patients who underwent knee stiffness surgery (manipulation while under anesthesia, arthroscopic lysis of adhesion, or quadricepsplasty) at a time remote from open reduction and internal fixation of tibial plateau fractures and a control group of 319 patients with tibial plateau fractures treated with open reduction and internal fixation who did not undergo knee stiffness surgery and who had either a minimum of 1 year of follow-up or clearly documented range of motion ≥110 degrees with a minimum of 90 days of follow-up. Each case was assessed from the time of index admission through study event, end of minimum follow-up, or achievement of ≥110 degrees range of motion. Knee stiffness surgery. Total number of weeks in an external fixator (odds ratio, 1.5 per week; 95% confidence interval, 1.3-1.7; P < 0.001) and the presence of bilateral tibial plateau fractures (odds ratio, 3.3; 95% confidence interval, 1.2-9.1; P = 0.02) were significant predictors of knee stiffness intervention. Clinicians should be aware that the time spent in external fixation and the presence of bilateral tibial plateau injuries are strong risk factors for requiring subsequent surgery to treat knee stiffness. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Bilateral tibial stress fracture successfully treated with ESWT in a runner

Bilateral tibial stress fracture successfully treated with ESWT in a runner

Bone healing in an aged murine fracture model is characterized by sustained callus inflammation and decreased cell proliferation.

Greater understanding of age-dependent molecular changes with healing will help form a mechanistic basis for therapies to improve patient outcomes. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:149-158, 2018.

Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study

BackgroundThe aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome.MethodsAll consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome.ResultsThe charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the development of acute compartment syndrome in multivariable regression analysis, while younger age (<45 years), male sex, higher Schatzker grade (IV-V-VI), higher tibial widening ratio (≥1.05) and higher femoral displacement ratio (≥0.08) were significantly associated in the analysis adjusted for age and sex.ConclusionsTwo parameters related to the occurrence of ACS in tibial plateau fractures were highlighted in this study: the presence of a non-contiguous tibia fracture or knee dislocation, and higher AO/OTA classification. They may be especially useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients), and should rise the suspicion level of the treating surgeon. In these cases, regular clinical examinations and/or intra-compartmental pressure measurements should be performed before and after surgery, even if acute compartment syndrome seemed unlikely during initial assessment. However, larger studies are mandatory to confirm and refine both factors in predicting the occurrence of acute compartment syndrome.

Bilateral tibial shaft fractures: a multicenter analysis

Background: Bilateral tibial shaft fractures represent high-energy trauma. While treatment and complications of bilateral femoral fractures are well defined, there is limited literature on bilateral tibial shaft fractures. We present a multicenter study on bilateral tibial shaft fractures, analyzing the most commonly associated injuries and complications. Methods: A retrospective review was performed to identify all patients with bilateral tibial shaft fractures treated during a 5-year period. Demographics, injury measures, treatments, and complications were collected. Categories were evaluated and ranked based on frequency of occurrence. Results: Approximately 2000 tibial shaft fractures were treated during a 5-year period, of which 68 patients (19 females, 49 males) had sufficient records for inclusion. The average age was 39 yr (range 15-83 yr). There were 80 open fractures in 55 patients. Other musculoskeletal trauma and chest trauma were the two most common associated injuries (followed by face, head, and abdominal trauma). Two patients had definitive casting, 67 patients (129 tibias) were surgically treated, and four patients required amputation on arrival. Fourteen patients developed nonunions, 13 had compartment syndrome, and 34 were affected by nonsurgical complications. Thirty-one patients required subsequent surgery to promote healing. There were six mortalities. Conclusions: We present the largest group of patients with bilateral tibial fractures and show a high rate of open fractures, severe systemic injuries, and frequent complications. Orthopaedic surgeons must balance early surgical treatment with the presence of associated injuries and educate patients regarding complications and the possibility of subsequent surgeries to promote healing of these serious injuries.

Visual Vignette

Case Presentation: A 44-year-old male was hospitalized after being hit by a motor vehicle, sustaining bilateral tibial plateau fractures. His physical exam was also remarkable for short stature, facial asymmetry, and visual impairment (blind in right eye since childhood). His serum sodium was 133 mmol/L (136–145mmol/L) on admission and steadily decreased to 121 mmol/L over the next several days. Thyroid-stimulating hormone (TSH) was 10.48 μIU/mL (0.34–5.60 μIU/mL) with a free thyroxine (T4) of 0.42 ng/dL (0.71–1.85 ng/dL). Endocrinology was consulted, and further laboratory testing showed a random cortisol of 1.5 mcg/dL (7–25 mcg/dL), morning cortisol of 1.2 mcg/dL, adrenocorticotropic hormone (ACTH) of 14.4 pg/mL (7.2–63.3 pg/mL), insulin-like growth factor-1 of 15 ng/mL (75–216 ng/mL), and prolactin of 18.40 ng/mL (2.74–19.64 ng/mL). A 250-mcg cosyntropin stimulation increased cortisol to 19.2 mcg/dL. Magnetic resonance imaging of the brain with pituitary imaging was ordered (Fig. 1 through 3). What is the diagnosis? Fig. 3 View Large Image Figure Viewer

Re-evaluation of low intensity pulsed ultrasound in treatment of tibial fractures (TRUST): randomized clinical trial

Objective To determine whether low intensity pulsed ultrasound (LIPUS), compared with sham treatment, accelerates functional recovery and radiographic healing in patients with operatively managed tibial fractures.Design A concealed, randomized, blinded,...

Activation of the protein C pathway and endothelial glycocalyx shedding is associated with coagulopathy in an ovine model of trauma and hemorrhage.

Acute traumatic coagulopathy (ATC) is an endogenous coagulopathy that develops following tissue injury and shock. The pathogenesis of ATC remains poorly understood, with platelet dysfunction, activation of the protein C pathway, and endothelial glycocalyx shedding all hypothesized to contribute to onset. The primary aim of this study was to develop an ovine model of traumatic coagulopathy, with a secondary aim of assessing proposed pathophysiological mechanisms within this model. Twelve adult Samm-Border Leicester cross ewes were anesthetized, instrumented, and divided into three groups. The moderate trauma group (n = 4) underwent 20% blood volume hemorrhage, bilateral tibial fractures, and pulmonary contusions. The severe trauma group (n = 4) underwent the same injuries, an additional hamstring crush injury, and 30% blood volume hemorrhage. The remaining animals (n = 4) were uninjured controls. Blood samples were collected at baseline and regularly after injury for evaluation of routine hematology, arterial blood gases, coagulation and platelet function, and factor V, factor VIII, plasminogen activator inhibitor 1, syndecan 1, and hyaluranon levels. At 4 hours after injury, a mean increase in international normalized ratio of 20.50% ± 12.16% was evident in the severe trauma group and 22.50% ± 1.00% in the moderate trauma group. An increase in activated partial thromboplastin time was evident in both groups, with a mean of 34.25 ± 1.71 seconds evident at 2 hours in the severe trauma animals and 34.75 ± 2.50 seconds evident at 4 hours in the moderate trauma animals. This was accompanied by a reduction in ROTEM EXTEM A10 in the severe trauma group to 40.75 ± 8.42 mm at 3 hours after injury. Arterial lactate and indices of coagulation function were significantly correlated (R = -0.86, p < 0.0001). Coagulopathy was also correlated with activation of the protein C pathway and endothelial glycocalyx shedding. While a significant reduction in platelet count was evident in the severe trauma group at 30 minutes after injury (p = 0.018), there was no evidence of altered platelet function on induced aggregation testing. Significant fibrinolysis was not evident. Animals in the severe trauma group developed coagulation changes consistent with current definitions of ATC. The degree of coagulopathy was correlated with the degree of shock, quantified by arterial lactate. Activation of the protein C pathway and endothelial glycocalyx shedding were correlated with the development of coagulopathy; however, altered platelet function was not evident in this model.

Bilateral Spontaneous Bisphosphonate Insufficiency Fractures of the Proximal Tibia and Unilateral Distal Femur: A Case Report and Recommendation

Bisphosphonate insufficiency fractures of the proximal femur have been increasingly described in literature. Bilateral proximal tibial fractures due to non-traumatic loading in patients with low bone density and on long term Bisphosphonate treatment are very rare and under reported in orthopaedic literature. We present a 77 years old Caucasian female with spontaneous onset of pain in both knees prior to presenting to casualty then to our fracture clinic. The patient is known to have Rheumatoid arthritis (RA) and has been on Bisphosphonate treatment for over 24 months following DEXA scan proven osteoporosis. Plain radiographs showed subtle linear areas of sclerosis bilaterally in her proximal tibiae. Magnetic resonance imaging (MRI) confirmed the presence of insufficiency fractures in these areas as well as her right distal femur. These fractures were treated successfully with activity modification and a hinge knee brace. This rare presentation in a rheumatoid patient with osteoporosis and long-term bisphosphonate treatment highlights the importance of being vigilant and having a high index of suspicion for these atypical fractures around the knees and not to relate symptoms to the inflammatory process associated with rheumatoid arthritis. We think that these insufficiency fractures around the knees are under diagnosed and often confused with the inflammatory process. We would like to raise awareness and recommend MRI scan in any patient with long-term bisphosphonate treatment and a new onset of pain around the knee.

Bilateral Diabetic Knee Neuroarthropathy in a Forty-Year-Old Patient.

Diabetic osteoarthropathy is a rare cause of neuropathic joint disease of the knee; bilateral involvement is even more exceptional. Diagnosis is often made late due to its unspecific symptoms and appropriate surgical management still needs to be defined, due to lack of evidence because of the disease's low incidence. We report the case of a forty-year-old woman with history of diabetes type I who developed bilateral destructive Charcot knee arthropathy. Bilateral total knee arthroplasty was performed in order to achieve maximal functional outcome. Follow-up was marked by bilateral tibial periprosthetic fractures treated by osteosynthesis with a satisfactory outcome. The diagnosis of Charcot arthropathy should always be in mind when dealing with atraumatic joint destruction in diabetic patients. Arthroplasty should be considered as an alternative to arthrodesis in bilateral involvement in young patients.

Monolateral frame external fixators in the definitive management of open limb fractures in North-western Nigeria

Background: The use of external fixators became popular in the last ten years in our environment with the availability and expertise to apply them being popularised by the AO foundation. They have virtually supplanted the application of casts which had high levels of complications and unpredictable outcomes in patients with open fractures. This manuscript describes its use in trauma in our environment. Aims: The aim of this study is to demonstrate that monolateral frame external fixators are a means of definitively treating open limb fractures. Materials and Methods: For a period of nine years (2006-2014), we prospectively studied the use of monoframe external fixation in one hundred and six limbs in three hospitals in the northwest of Nigeria. Gustillo II and III A, B and C patients were included in the study. External fixators from different manufacturers were used. The adherence to the principles of application, duration of application, pin track infection, union and non-union rates were observed for both groups. Results: One hundred and six limbs in were studied. Ninety four males and eleven females in the study group with five of the males being children of less than twelve years. Ninety seven cases had open tibial fractures (one lady had bilateral open tibial fractures) and four cases involved the femur. Union rate of 60% was observed. Pin tack infection rate of 80%, average duration of stay of the patient was three month; fracture union rate of 60% and reoperation rate of 2%were observed. Conclusion: Monolateral external fixators can be used successfully in the management of open diaphyseal fractures of long bones with reasonably high success rates and few complications.