Distal Third Of Tibia Research Articles

FUNCTIONAL AND RADIOLOGICAL OUTCOME OF LOWER THIRD TIBIAL FRACTURES IN ADULTS TREATED BY MIPPO WITH LOCKING COMPRESSION PLATE - A PROSPECTIVE STUDY

Background: Treating distal tibia fractures can be challenging because of the limited soft tissue available at this region, the subcutaneous location of the bone , precarious blood supply and its close proximity to ankle joint. Treatment for fractures of distal tibia remains a controversial subject despite an ample amount of advances in both non-surgical (conservative) and operative care. This is a prospective study Material And Methods: to analyse the functional and radiological outcome of xing the distal third of tibia treated with Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO). 30 patients were treated for extra articular dista Results: l third tibia fracture with MIPPO. In our study all 30 patients achieved radiological union at a mean time of 15.6 weeks. 94% had excellent to good objective results based on AOFAS criteria and 97% had excellent subjective criteria. We observed ankle joint stiffness in 2 patients and 3 had supercial infection. Treating the closed distal Conclusion: third tibial fractures with LCP with MIPPO technique provides an early union and excellent to good functional outcome

Outcome of Minimally Invasive Osteosynthesis of Distal Tibial Fractures Using Anterolateral Locking Plate

This prospective interventional study was conducted in the Department of Orthopaedics ,Jalalabad Ragib Rabeya Medical college Hospital and other Private Hospital in Sylhet during Janurary 2019 to December 2020 with a view to evaluate the outcome of Minimally invasive osteosynthesis of Distal Tibial fractures using anterolateral locking plate of distal tibial fracture. For this purpose 21 patients with fracture distal third of tibia were selected. The mean age of the patients was 43.9(SD8.8) years, 12 (57.1%) male and 9 ( 42.9% ) female with a ratio of 4:3.Total operation time was71.1(SD6.1) minutes and time of union was 15.5(SD2.81) . weeks. Functional outcome was excellent ( 66.7% ), good (14.3% ), fair(9.5%) and poor( 9.5% ).The final outcome was satisfactory in 80.9% and unsatisfactory in 19.1% of patients. so, Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate is an effective surgical option for achieving satisfactory and functional outcome.

English

BACKGROUND Open fractures and fractures caused by high-energy trauma are likely to get infected and result in non-union. Infected non-union of long bones is a problem in developing countries like India. Ilizarov external fixator was employed to correct all the complications associated with non-union such as bone gap, infection, shortening, and deformities. Stable fixation, corticotomy and bone transport was employed to reduce or eliminate infection at the same time achieving bone union and correction of limb length discrepancy. Our study assesses the efficacy and safety of Ilizarov external fixation in patients with infected non-union tibial fractures. METHODS A series of 30 patients with infected non-union of tibia were treated with Ilizarov external fixation in Yashoda super speciality hospital and regularly followed-up between May 2014 and April 2016 (2 years). Bony and functional results were estimated and correlated with existing studies. RESULTS Out of thirty patients treated, bony results were excellent in 17 patients, good in 8 patients, fair in 4 patients and poor in 1 patient. Functional results were excellent in 17 patients, good in 5 patients, fair in 5 patients, and poor in 3 patients. Average duration of the fixator period was 8.1 months (min - 3 months, max - 14 months). Average length of regenerate was 3.64 cm (min - 2 cm, max - 6 cm). Average lengthening index in the study was 2.09 months / cm. Our study in all 4 categories of Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria had approached Dror Paley’s Bony results and functional results. CONCLUSIONS In our study results have been encouraging in addressing all the complex problems by Ilizarov principle. Ilizarov external fixator system is the best device to treat infected non-union of tibia. Distal third of tibia is more prone for infection and non-union. Corticotomy or bone grafting is required for augmentation of the healing process. Almost all patients had varying degrees of oedema and pin track infections. Infection was controlled in all the cases and bony union was achieved, no patient had persistence of non-union and infection at the end of 2 years. KEYWORDS Ilizarov External Ring Fixator, Infected Non-Union, ASAMI Criteria, Bony Results, Functional Results, Bony Union

Versatility of the Extensor Digitorum Brevis Muscle Flap in Lower Limb Reconstruction.

Reconstruction of complex defects in the lower leg is a challenge. Although microvascular free tissue transfer is a popular technique, experience and available resources limit its use. Furthermore, free tissue transfer is not always required in the reconstruction of small lower leg defects, as many of them can be reconstructed with local alternatives such as an extensor digitorum brevis flap (EDB). Our aim was to describe our experience of the last 20 years with the EDB as a local muscle flap to cover small complex lower leg defects to establish its clinical feasibility and to document its associated complications. All adult patients who were operated with EDB flap reconstruction of the lower limb during 1997-2017 at the Department of Hand and Plastic Surgery, Linköping University Hospital, were included in this retrospective study. Of 64 patients operated, only 7 had total flap failure, and the rate of complete success was 73% (47/64). Most of the skin defects were associated with fractures or complications thereof and were located in the ankle region, the dorsum of the foot, and the distal third of tibia or even the proximal tibia. Defects in the malleolar region and coexisting cardiovascular condition were factors associated with flap loss (either partial or total). The pedicled EDB-flap has, in our hands, proved to be a versatile and safe reconstructive option in the reconstruction of small defects in the lower leg and foot. Long-time follow-up is, however, recommended.

Distally Based Medial Hemisoleus Flap: Reliable Option for Distal Tibial Wounds.

To determine the success (flap survival as a whole without necrosis or dehiscence up to two months as judged clinically) of distally based medial hemisoleus muscle flap for the coverage of distal tibial defects. Case series. Jinnah Burn and Reconstructive Surgery Centre, AIMC, Lahore, from July 2014 to July 2017. Patients with middle and distal third tibial defects were enrolled and stratified according to the site of the wound in middle or distal third of tibia. Soft tissue coverage was provided with distally based medial hemisoleus muscle flap on which split thickness skin graft was applied. Postoperatively, patients were followed-up after one week of discharge and then fortnightly for at least 2 months. Outcome variable was taken as flap success. Out of 37 cases, flap was successful in 33 patients as complete flap survived with primary wound healing. Partial flap necrosis without dehiscence was seen in 3 cases and partial necrosis of flap with dehiscence in only one case that required another surgery for the defect. Complete flap loss was not seen in any case. Distally based medial hemisoleus muscle flap is reliable coverage option for middle and distal third of tibial defects.

A prospective randomized comparative study on fractures of lower third of both bones of the leg treated by interlock nailing of tibia with or without fixation of fibula

<p class="abstract"><strong>Background:</strong> In the treatment of fractures of the distal third of tibia and fibula treated by interlocking nail of tibia, the role of fixing the fibular fracture is not clearly defined. This study was conducted to assess the benefits of fixation of fibular fracture in distal third leg bones fractures<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> 95 patients were enrolled into study and divided randomly into two groups based on whether fibula fixed or not with interlock intramedullary nailing tibia. Patients were followed for an average period of 11 months both radiologically and clinically.<strong></strong></p><p class="abstract"><strong>Results:</strong> We observed that the average valgus angulation was significantly less<strong> </strong>(P =0.001) in the group where fibula was fixed. The outcome of the two groups for clinical ankle score, time of union and complication showed no difference (P ≥0.05)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> We concluded that fixation of fibula decrease the malalignment of tibia in distal third fractures of tibia and fibula treated with interlocking nail of tibia<span lang="EN-IN">.</span></p><p class="abstract"> </p>

Significant Incidence of Extra-Articular Tibia Vara Affects Radiological Outcome of Total Knee Arthroplasty.

PurposeTo identify and quantify the presence of extra-articular tibia vara that might influence the mechanical axis alignment after total knee arthroplasty (TKA).Materials and MethodsA total of 48 TKAs in 30 osteoarthritic Indian patients were prospectively evaluated. The hip-knee-ankle angle (HKA), joint line convergence angle, and varus angulation at the femur and tibia were measured from the preoperative and postoperative standing hip-to-ankle radiographs. Four different methods were used to measure the varus angulation at the tibia: metaphyseo-diaphyseal angle (MDA), the angle between the anatomical axis and mechanical axis of the tibia, the angle between the proximal third and distal third of tibia and the angle between the proximal half and distal half of tibia.ResultsExtra-articular tibia vara quantified using MDA had the most positive correlation with HKA. Receiver operating characteristic plotting showed that MDA of >4° predicts abnormal postoperative HKA. Twenty-eight out of 48 knees had MDA of >4°, and 78.6% of these had postoperative HKA under-correction and 21.4% had less than ideal tibial component position.ConclusionsA significant inherent extra-articular varus angulation best measured using MDA exists in the proximal tibia in osteoarthritic Indian patients undergoing TKA. MDA of >4° is associated with abnormal postoperative HKA. Computer navigation may be useful for achieving ideal correction in such cases.

Free Radial Forearm Fasciocutaneous Flap in the Treatment of Distal Third Tibial Osteomyelitis

Osteomyelitis of the lower limb, associated with soft-tissue defects, is a reconstructive challenge. Microvascular free-tissue reconstruction is an important surgical option with the superiority of free muscle and myocutaneous flaps being explored by various publications. Muscle flaps provide good quality vascularized tissue which can be contoured into defects, but their bulk can often lead to the reconstruction having a suboptimal aesthetic outcome. This result is usually most evident in the lower third of the tibia. We present our series of free radial forearm fasciocutaneous flaps for reconstruction of distal third tibial soft-tissue defects following debridement of osteomyelitic foci and bony stabilization. A retrospective case-note review of 20 patients treated with free radial forearm fasciocutaneous flap reconstruction of distal third tibial soft-tissue defects following excision of osteomyelitis and adjacent scar tissue, and bony stabilization between January 1999 and December 2006 was conducted. There were 20 patients who had established osteomyelitis of the distal third of tibia following previous open fractures. The mean size of the soft-tissue defect at the time of the free fasciocutaneous flap procedure was 72.3 cm(2) and the mean bony defect was 3.4 cm. The mean duration of the procedure was 417 minutes and flap ischemia time did not extend beyond 60 minutes in any of the cases. Overall flap survival was 100% and all patients had radiologic bony union at a mean of 5.73 months. The average period of follow-up was 22.5 (range, 19-36) months, and none of the patients had a recurrence of the disease during the follow-up period. Free fasciocutaneous flap reconstruction for soft-tissue defects of the lower limb in our series was seen to be safe, reliable, and provided an aesthetic outcome with high patient satisfaction rates. We advocate the use of free fasciocutaneous flaps for small-to-moderate sized defects of the distal third of the tibia after debridement for chronic osteomyelitis. Although we have used radial forearm flaps in our series, more modern free fasciocutaneous flaps with less donor-site morbidity may be preferred.

Crural Fascia and Muscle Origins Related to Medial Tibial Stress Syndrome Symptom Location

Traction-induced injury, related to muscles of the superficial and deep posterior compartments, has been implicated as the cause of medial tibial stress syndrome (MTSS) with symptoms commonly occurring in the distal third of the posteromedial tibia. Standard anatomic texts do not identify this region as an attachment site for these structures. Research into the anatomical arrangement of these structures has been inconclusive. The deep crural fascia (DCF) has been implicated as a cause of traction-induced injury in MTSS but not fully researched. The purpose of this study was to define the tibial origins of the DCF and the muscles of the superficial and deep posterior compartments relative to MTSS-related pain commonly reported along the distal one half to one third of the diaphysis of the medial tibial border and to identify the prevalence of a soleal aponeurosis. The tibial attachments of the DCF, the soleus, the flexor digitorum longus, and the tibialis posterior were quantified relative to the medial malleolus in sixteen cadaver specimens. Mean distal attachments to the medial tibial border were superior to the distal third of the tibia for the muscles of the posterior compartments, suggesting that the role of the soleus, the tibialis posterior, and the flexor digitorum longus in producing pain typically associated with MTSS may be limited. The DCF of all but three specimens attached along the entire length of the medial tibia investing the medial malleolus. Traction-induced injury theories involving the muscles of the superficial and deep posterior compartments are not supported by anatomical evidence in the present study. The tibial attachments of the DCF in this study support theories implicating DCF involvement in creating traction-induced injury.

Conservative management of simple tibial fracture in a tiger cub

After restraining the cub in a squeeze cage, a mixture of Xylazine hydrochloride (Xylazil) 50mg and Ketamine hydrochloride (Ketamil) 50mg was injected intramuscularly. The cub was taken out after 10 minutes to take a radiograph of the affected region. It was found to have a transverse fracture with proximal segment being impacted into distal segment at the distal third of tibia. The fractured leg was immobilised using four well-padded bamboo splints with a thick layer of cotton and retained in place by leukoplast from stifle joint up to the foot. However, the animal removed all the splints and bandages within 24 hours.

CALF PAIN - SWIMMING

HISTORY: A 17 year old swimmer presents with right calf pain for the past month. He states that this pain began acutely the morning after a run. He had been running about 7 miles a week for the previous 2–3 weeks to stay in shape for swimming. There was no pain prior to this event. Since then he has had increasing pain in his leg which has even affected walking and swimming. He acknowledges some swelling in the area, but denies any acute trauma or additional training. Ice and NSAID's have provided mild relief. He admits to a recent URI but denies any fever, chills or sweats. PHYSICAL EXAMINATION Examination of his gait reveals a marked pes planus. Examination of the right leg reveals tenderness on the posterior aspect of the distal third of the tibia. There is also slight tenderness along the lateral head of the gastrocnemius. No swelling or ecchymosis is present. He has full active and resisted range of motion about the knee, foot and ankle. There is no pain to resisted gastrocnemius or soleus testing. Neurovascular status is intact. DIFFERENTIAL DIAGNOSIS: Medial tibial stress syndrome Tibial stress fracture Gastrocnemius strain Myositis ossificans Osteoid osteoma Compartment syndrome Tibiofibular synostosis TESTS AND RESULTS: X-rays - A/P and lateral tib/fib views of right leg - Area of periosteal elevation in the distal third of the posterior tibia possibly representing callus formation CT scan, right leg: - Periosteal new bone along the posterior aspect of the distal right tibia - No evidence of lamination or frank bone destruction - No evidence of sclerotic or lucent nidus FINAL/WORKING DIAGNOSIS: Stress fracture of the distal tibia TREATMENT: Ambulation with air-filled walking boot X6 weeks after pain-free Non-weight bearing if not clinically improved in 2–3 weeks Repeat radiographs in 6–8 weeks to check for healing

A case of adamantinoma of the fibula

Adamantinoma of long bones represent 0.36 percent of all malign bone tumors. Approximately 84.5 percent of these are located in tibia (7). 21 year-old-man with adamantinoma is presented. Primary lesion was located in distal third of fibula It recurred locally three times respectively in seven, three and one year after the resection of distal third of fibula and consequently, lesion affected talus and distal third of tibia. On the other hand, previous biopsy of the case had been reported as synovial sarcoma in another clinic. Various patterns and typical findings were on the histologic section. Case is rare and unusual by its localization, it can not be distinguished from synovial sarcoma because of its morphological similarity and it can show locally persistent recurrences in spite of wide resection. By reasons, case is interesting by proving the necessity of radical approach in early stages.

The somatotopy of the gracile nucleus in cats with agenesis of a hindfoot.

The somatotropic representation of the hindlimb in the gracile nucleus was studied in two cats who had a congenital defect of one hindfoot. The defect comprised all of the foot downward from and including the heel, and the distal third of tibia and fibula. The part of the sciatic nerve normally supplying the lower hindlimb and the hindfoot was reduced in diameter by one third. The motoneurones corresponding to the absent muscles were lacking and replaced by glial elements. The cross-sectional area of the dorsal columns at segment S2 was reduced by more than 20%. The gracile nuclei, in contrast, were not reduced in size. Only the diameter of its neurones was significantly smaller. Electrophysiological single and multi-neurone recordings revealed an altered somatotopic representation in the gracile nucleus on the defective side. The nuclear area normally representing the missing parts of the body surface now received input from the stump. There was no nuclear area devoid of afferent input, and there was no input in the gracile from the forelimb or from the contralateral side. It is concluded that the remaining parts of the leg project onto the gracile nucleus in an ordered fashion, sharing the entire nucleus according to their present afferent fibres.

Conservative Treatment of Nonarticular Fractures of distal third Tibia

Distal one third tibial fractures can be difficult to manage. Variety of treatment methods have been suggested for these injuries, including conservative treatment, external fixation, intramedullary nailing, and plate fixation. None of these techniques can be considered the "gold standard" for these injuries. The purpose of this prospective study is to evaluate the results of conservative treatment of these fractures. Total 39 fractures of distal third of tibia were treated with closed reduction and long leg cast for six to eight weeks followed by PTB cast for six to eight weeks from January 2004 to October 2008. One year follow up was done with 32 patients, eight months follow up with three patients and four patients were lost to follow up. All the fractures united within six months of duration. Immediate post-reduction average angulation was 3.72 degree in sagital plane and 3.32 degree in coronal plane. Average final angulation was 5.04 degree in sagital plane and 4.32 degree in coronal plane. Average limb length shortening was 6.8 mm. Full range of motion of ankle and knee joint was achieved compared to the normal side by six months of follow up. Though there was displacement of fracture during conservative treatment final outcome was within acceptable limit. Hence distal one third tibial fractures can be treated conservatively with closed reduction and cast immobilization with numerous advantages over operative methods.