Fibula Research Articles

Intramedullary Interlocking Nail in Distal One Third Tibia Fracture: A Retrospective Study in Tertiary Care Center

AIM: To assess functional outcome of intramedullary interlocking nail in distal tibia fracture where distal locking screw is applied after inserting proximal locking screw. PATIENTS AND METHOD: This is a retrospective study which was conducted in Universal college of medical sciences. This study was started one year back and last case was followed for one year. All thirty three cases with distal tibia extraarticular fracture 42A1 and 43A3, according to AO classification, within 7 cm from the ankle plafond of skeletally mature person presented in emergency along with Gustillo Anderson (GA) I, II, IIIa and fibula fracture are included in the study. Intrarticular fracture, GAIIIb and lost follow up cases were excluded from the study. Proximal interlocking screws are placed at first followed by distal interlocking screw. Mechanism of injury, age, sex, union time, foot function index, secondary procedure, complications, deformities are analyzed in the study. RESULTS: All patients were retrospectively analyzed. We could not find any significant relation between post operative malalignment and better foot function index (p = 0.975). Early union may not improve overall foot function index (p = 0.202). Automobile accident is the commonest mode of injury (48.5%) followed by automobile pediastrian (39.4%). Postoperative malalignment consist of cornal (3%), saggital (3%) and shortening (3%). Infection is one of the commonest complication found in our study (6.1%).

FIBULAE OF CHERVONYY MAYAK BURIAL GROUND

Having analyzed of fibulae four chronological periods in the usage of the burial ground Chervony Mayak can be distinguished: the early stage (the second half of the 2nd century BC — the first half of the 1st century BC); the second stage (the second half of the 1st century BC — the first half of the 1st century AD) which is the time of appearance of the first Roman imports; the third «stage of heyday» (the second half of the 1st — the first half of the 2nd century AD) — the time of increase of population at the settlement, the emergence of the «Eastern wave» of Sarmatian migration and the Sarmatization of the Late Scythian culture; the final stage (the second half of 2nd century — the first half of the 3rd century AD), the time of the last Late Scythian funerals on the Chervony Mayak necropolis. The comparison of the number of fibulae with gender of the buried allows to research some patterns of the Late Scythian costume. The chronology of fibulae shows that one catacomb could be used for collective funeral no more than 50 years.

Application of lower leg perforator flap for repair of the soft tissue defects in the donor site of toe transplantation

Objective To explore the clinical effects of lower leg perforator flap in the treatment of the soft tissue defects in the donor site of toe transplantation. Methods From December 2015 to December 2016, 15 cases of thumb or finger defects were reconstructed by the transplantation of big toe nail flap, the fibula side flap of great toe and second toe wrap-around flap. Simultaneously, the free peroneal artery perforator flap or posterior tibial artery perforator flap was used to repair the soft tissue defects in donor site of toe transplantation. Results All the reconstructed fingers and thumbs survived. All the flaps used to cover donor site of the foot survived. The follow-up time ranged from 1 to 18 months with an average of 8.6 months. The donor site of toe transplantation recovered well without influence on wearing shoes and walking. According to the Maryland foot function scoring system issued by Sanders et al, the results were rated as excellent in 14 cases and good in 1 case. Conclusion Lower leg perforator flap for repair of the soft tissue defects in the donor site of toe transplantation can not only reconstruct the good appearance and function of thumbs and fingers, but also can restore the integrity of donor foot. The function and appearance of the foot are well recovered. Key words: Surgical flaps; Treatment outcome; Soft tissue defects; Toe donor site

Prenatal diagnosis of three cases of fetal skeletal dysplasia resulting from loss of heterozigosity of short stature homeobox gene

Objective To analyze the genotype-phenotype correlation in fetal skeletal dysplasia, and to investigate the methods of prenatal diagnosis and genetic counseling. Methods From May 2016 to November 2017, three gravidas whose fetuses were diagnosed with short stature homeobox (SHOX) gene deficiency were recruited from those receiving invasive prenatal diagnosis and single nucleotide polymorphism-array (SNP-array) due to fetal structural abnormalities detected by prenatal ultrasound scan in Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine. Fetus 1 and 3 were singleton pregnancies and fetus 2 was twin pregnancy. Amniotic fluid cells were isolated and analyzed by karyotyping and SNP-array. Peripheral blood samples were collected from their parents and also analyzed by SNP-array. Results All three fetuses were diagnosed with fetal skeletal dysplasia based on second trimester ultrasound findings showing the lengths of femora, humeri, tibiae, fibulae, ulnae and radii length below the 5th percentile of corresponding gestational age. Karyotypes of the three fetuses were normal. SNP-array examination showed that each case had 1 to 2.5 Mb deletion in the pseudoautosomal region of the short arms of sex chromosomes, including SHOX gene. Their skeletal dysplasia were all caused by SHOX haploinsufficiency. Microdeletions of fetus 1 and 3 were inherited from their mothers, while that of fetus 2 was inherited from the father. After genetic counseling, two singleton gravidas decided to terminate their pregnancies and the twin pregnant one underwent selective reduction. Conclusion Prenatal ultrasound, in combination with SNP-array, offers fast and efficient detection of fetal skeletal dysplasia due to SHOX gene deficiency. Key words: Osteochondrodysplasias; Chromosome deletion; Polymorphism, single nucleotide; Microarray analysis; Short Stature Homeobox protein; Prenatal diagnosis

Planned Fibular Non-Union for the Treatment of Genu Varum in Achondroplasia: Results through Skeletal Maturity

Purpose: Clinical manifestations of achondroplasia often include genu varum, but the exact etiology of this manifestation is unknown. Current surgical treatment options include tibial osteotomy with or without fibular osteotomy and growth modulation by plates and screws. Frustrated by his results with these techniques, a single surgeon began performing a planned fibular nonunion (PFN) with the belief that fibular overgrowth was the main contributing factor. The purpose of this study is to describe this pediatric technique and report the clinical and radiographic outcomes through skeletal …

Morphology of femur, tibiotarsus and fibula of local hill fowl of Uttarakhand.

This study was conducted on femur, tibiotarsus and fibula from six adult local hill fowl of Uttarakhand. The femur of the local hill fowl was a long cylindrical bone consisted of a shaft and two extremities. The shaft was curved and twisted in appearance. The proximal extremity had spherical head separated from shaft by neck. The trochanter minor was indistinct. The distal extremity hadposteriorly medial and lateral condyles and anteriorly trochlea. The tibiotarsus was the longest bone among the leg bones. The shaft was anteriorly curved in its proximal half and posteriorly curved in its distal half. The fibular crest was well developed and on posterior-lateral aspect of it’smid-shaft very small nutrient foramen was observed. The cnemial crest was originates from cranial border of transverse ridge and extended ventro-medially. The distal extremity showed large medial and small lateral condyles separated by the deep intercondylerfossa. The fibula was a reduced long bone with distinct head and rudimentary shaft. The shaft of fibula extended up to the distal one third of the shaft of tibiotarsus.

A study of open tibia and fibula fractures in fifty patients

Introduction: The incidence of high energy trauma is increasing with increase in traffic. Due to its subcutaneous anatomical location, tibia is vulnerable to direct blow in high energy trauma. Open tibial fractures are true surgical emergencies because of the risk of extensive infection to bone and devitalized soft tissue. The most serious consequence of open tibial fractures is amputation-which usually can be prevented by prompt early surgical intervention. Materials and Methods: Open tibial fractures often are the result of trauma from motor vehicle collisions, farm accidents, falls from heights, or fall of heavy objects. We studied 50 patients with compound tibia-fibula fractures for their mode and grade of injury, methods of stabilization, rate of union, rate of infection, method of soft tissue coverage used, requirement of change of implants, requirement of secondary procedures, amputation & postoperative rehabilitation. Result: Majority of the patients belonged to the age group of 41-50 years with a male preponderance and the commonest mode of injury was road traffic accidents. Bone grafting was required in 38% patients. The average time of union for the patients who required bone grating was 43 weeks and in those who didn't need was 26.12 weeks. Six patients required amputation and two patients died. Conclusion: As the Gustilo-Anderson grade increases, the chances of infection and non-union also increase and outcome is poorer. So we feel that more aggressive treatment has to be carried out for Grade III injury within first 48 hours to achieve optimum outcome.

Internal fixation with elastic intramedullary nail versus plate-screw system for treatment of fibular diaphyseal fracture

Objective To compare elastic intramedullary nail (EIN) and plate-screw (P+S) system in the treatment of fibular diaphyseal fractures. Methods From January 2014 to April 2017, 48 tibiofibular fractures were treated with internal fixation using EIN (21 cases) or plate-screw (27 cases) . The 2 groups were compared in terms of intraoperative blood loss, operative time, fibular healing time, fibular union rate, ankle function and postoperative complications. Results All the patients were followed up for 3 to 24 months (average, 14.0 months) .The intraoperative blood loss (17.9±4.9 mL) , operative time (23.2±5.8 min) and fibular healing time (10.3±1.8 weeks) for the EIN group were significantly less than those for the plate-screw group (28.9±9.6 mL, 30.0±10.7 min and 11.6±2.0 weeks) (P 0.05) . The AOFAS ankle-hindfoot scoring revealed 12 excellent, 8 good and one fair cases (91.0±5.3 points on average) in the EIN group, and 14 excellent, 10 good and 3 fair cases (90.1±6.1 points on average) in the plate-screw group, showing no significant difference between the 2 groups (P=0.594) . Conclusions Compared with plate-screw system, elastic intramedullary nail for fibular diaphyseal fractures may be in line with the biomechanical characteristics of the fibula and with the basic principles of minimally invasive surgery. It may be advantageous in blood loss, operative time and fracture healing but not in fibular union rate or functional recovery of the ankle. An appropriate way of internal fixation for a fibular diaphyseal fracture should be chosen according to the specific conditions of the patient. Key words: Fibula; Fractures, Bone; Fracture fixation, internal; Bone nails; Bone plate

Comparison of medial and lateral locking plates for Schatzker type VI fractures of tibial plateau: a finite element analysis

Objective To compare the biomechanical characteristics of medial and lateral locking plates for Schatzker type Ⅵ fractures of tibial plateau by finite element analysis. Methods A 38 year-old male volunteer was enrolled for CT scan of his lower limbs. His CT images of the left tibial plateau were used for 3D reconstruction of a model of Schatzker type Ⅵ fracture by NX 9.0 software. After the boundary conditions were set, a 500 N load was applied to the tibial plateau to simulate the stress on a single leg when an adult weighing 60 kg walked. The displacement and stress on plate and screws were analyzed by Abaqus software. Results The ultimate stress on the model fixated with a medial locking plate was 81.7 MPa, located at the proximal tibiofibular joint surface. The ultimate stress on the model fixated with a lateral locking plate was 487.4 MPa, located at the junction of plate and screws. The ultimate stress on the fibula was much larger in the model fixated with a medial locking plate than in the model fixated with a lateral locking plate. The ultimate displacement was smaller and more homogeneous in the model fixated with a medial locking plate (1.15 mm) than in the model fixated with a lateral locking plate (3.44 mm) . Conclusion The Schatzker type Ⅵ fractures of tibial plateau should be fixated with a medial locking plate because it has more biomechanical advantages than a lateral locking plate. Key words: Tibia; Fractures fixation, internal; Bone plates; Finite element analysis

Novel bone marrow stem cell Screen-Enrich-Combine (-Biomaterials) Circulating System for limb bone nonunion

Objective To evaluate the validity and security of our self-designed bone marrow stem cell Screen-Enrich-Combine (-Biomaterials) Circulating System (SECCS) for bone non-union of limbs. Methods From May 2013 to December 2015, 24 patients with limb non-union were treated at our department. They were aged from 20 to 65 years (mean, 42.8 years) . Their non-union involved femur in 17 cases, tibia in 4, radius in one, humerus in one and fibula in one. In surgery, 80 mL bone marrow blood was aspirated from the anterior superior iliac spine for rapid preparation of bone substitute (β-TCP) composite with bone marrow stem cells by SECCS which was then implanted at the non-union locations. The bone marrow blood was collected before and after enrichment for stem cell counts. The bone union, clinical union time and related complications were evaluated by follow-up X-rays at 1, 3, 6 and 9 months after surgery. Results Each collection of bone marrow blood took 13.5 minutes on average. The enrichment rate of stem cells was 81.2%.11, 751±1, 011 stem cells were implanted per patient on average. All the patients were followed up for 9 to 48 months (mean, 19.2 months) . Twenty-two patients acquired clinical union 9 months after operation and the other 2 suffered from malunion due to insufficient bone implant, yielding a union rate of 91.6% and an average union time of 6.5 months. No graft infection or internal fixation failure occurred and no severe complications happened at the donor or implant sites. Conclusion The bioactive bone substitute manufactured by our self-designed SECCS can be used as a novel therapy for limb non-union, and this device is moreover characterized with convenience, limited invasion and satisfactory osteogenesis so that complications of autologous bone transplantation can be avoided. Key words: Stem cells; Fractures, ununited; Extremities; Enrichment

Risk factors related to refracture after union of congenital pseudarthrosis of the tibia with a combined surgical

Objective To explore the risk factors related to refracture after union of congenital pseudarthrosis of the tibia with a combined surgical, and to provide an important reference for clinical treatment. Methods From April 2007 to August 2011, 40 cases of congenital pseudarthrosis of the tibia (CPT) confirmed by the use of intramedullary nail combined Ilizarov external fixator treatment of bony union were obtained for retrospective analysis. There were 27 males and 13 females, and the average age was 3.6±2.7 years (ranged from 0.8 to 11.3 years), and the follow-up time are all over 36 months. Survival analysis were applied respectively on gender, whether the merger of neurofibromatosis type 1 (NF-1) and ankle joint, operative age, fibular status and the cross-sectional area ratio of healing site. Multifactorial Cox proportional hazards regression analysis was performed on the single factor with statistical significance. Results No significant inter-group differences existed in gender or whether combined NF-1. In operative age ≥3 years group whose refracture-free survival was significantly better than those 0.05). Conclusion The major risk factors for refracture after union of congenital tibia pseudarthrosis with the use of intramedullary nail combined Ilizarov external fixator are the smaller cross-sectional area of pseudarthrosis and with fibula pseudarthrosis. Key words: Pseudarthrosis; Tibia; Fracture fixation; Risk factors

An Unusual Cause of Common Peroneal Nerve Palsy following Total Hip Arthroplasty: A Case Report:

An unusual cause of an ipsilateral common peroneal nerve palsy, at the level of the fibula head following left total hip arthroplasty (THA), in a 48-year-old female patient is reported. The complic...

Nursing points of open tibia and fibula fracture treated by VSD combined with external fixation

Objective To explore the nursing points of the treatment of open tibia and fibula fracture patients treated by VSD combined with external fixation. Methods A total of 65 cases of open tibia and fibula fracture treated by VSD combined with external fixation in our hospital from Augest 2013 to September 2014 were enroll in the study, and were randomly divided into observation group (33 cases) and control group (32 cases). Patients in the control group received routine nursing care (diet nursing, wound care, VSD drainage and external fixation support), while patients in the observation group received comprehensive nursing care (on the basis of routine nursing care, psychological care, pain care and rehabilitation care). The functional recovery and complication rate of the two groups were observed. Results After receiving different nursing care, the optimal rate of function of Tornetta was 90.91% in the observation group, significantly higher than 65.63% in the control group, and the difference was statistically significant(P<0.01). The complication rate was 15.15% and the control group was 28.13% six months after surgery, and the difference was statistically significant (P<0.05). Conclusions When VSD combined external fixator is used to have treatment for open tibiofibula fracture, professional psychological nursing should be given before surgery and good wound nursing should be give after surgery. In addition, preventive nursing and rehabilitation nursing of specific osteofascial compartment syndrome should be conducted, which can promote the injured limb to get recovered and reduce complications to happen. It's important to help treatment reach the expected result. Key words: Fracture of tibia and fibula; Open; Negative pressure closed drainage; External fixation; Nursing

Ранние фибулы Кавказа в работах Ю. Н. Воронова

Ранние фибулы Кавказа в работах Ю. Н. Воронова

439 Extraosseous ewing’s sarcoma presenting as a scrotal mass

Case reportEwing’s sarcoma is a highly malignant, poorly differentiated bone tumour of childhood and adolescence primarily involving diaphysis of long bones; femur, tibia, fibula, and humerus and may also occur in other bony structures and cartilage tissue. It is a very clinically aggressive tumour

Application of early repair with free tissue transplantation in hand and foot destructive injury

Objective To explore the method of limb salvage therapy for hand and foot destructive injury, and to clarify the role of free tissue transplantation in limb salvage therapy in patients with hand and foot destructive injury. Methods From January, 2015 to January, 2016, 17 hand and foot destructive injuried patients were treated with limb sal-vage. The anterolateral thigh free flap, free fibular flap and arterial vein flap were used to repair the skin, soft tissue and bone defects. All patients were followed-up for 12 months. The appearance and function of the patients were evaluated af-ter the treatment. The hand scoring criterion was the finger replantation function evaluation standard on probation of the Chinese Medical Association of Hand Surgery. The foot scoring criterion was the Maryland score system. Results All flaps survived in 17 patients. One flap had vascular crisis after operation, and survived after vascular exploratory opera-tion. One case had infection postoperation and healed after several debridements. After 12 months, the functional scores were excellent in 5 cases, good in 5 cases, moderate in 3 cases and poor in 4 cases. Conclusion The early repair with free tissue transplantation can preserve limb length, cover the exposed bone and tendon, and improve the anti- infective ability, so as to improve the function of limb salvage and patient's satisfaction. Key words: Free flap; Hand; Foot; Destructive Injury; Transplantation; Limb salvage therapy; Mi-crosurgical operation

The hyperplantarflexion ankle fracture variant

Objective To investigate the characteristics, trauma mechanism and treatment of the hyperplantarflexion ankle fracture variant. Methods Between January 2013 and June 2015, 125 consecutive patients with ankle fracture received operative treatment. In 18 of them, the ankle joint had been subjected to excessive violence of plantarflexion. They were 6 males and 12 females, aged from 15 to 67 years (average, 47.6 years). Their pre-operative ankle radiographs showed sagittal ankle instability and posterior ankle dislocation or subluxation. The injury was complicated with medial malleolus fracture and fibular fracture. Posterolateral approach or posterolateral and posteromedial approach was adopted to treat the patients. Lag screws and anti-glide plates were applied. Results All the 18 patients were followed up for 10 to 25 months (average, 16.8 months). All their fractures healed after 11 to 16 weeks (average, 13 weeks). Superficial skin necrosis occurred in one patient undergoing dual-plate fixation of the dual malleoli but responded to change of dressing 3 weeks later. No screw loosening, fixation breakage or failure, nonunion or malunion happened. Their final follow-ups showed an average American Orthopedic Foot Ankle Society score of 94.8 ponits (from 76 to 100 points), yielding 13 excellent and 5 good cases (an excellent to good rate of 100%). Conclusions The hyperplantarflextion ankle fracture variant is caused by excessive violence of planter flexion to the ankle joint, with the force on the sagittal plane going from anteriorly to posteriorly, resulting in posterior talar displacement. Its treatment should vary from that for other ankle fractures because it has its own characteristics. Appropriate treatment may lead to satisfactory outcomes. Key words: Ankle; Fracture, bones; Therapy; Hyperplantarflexion

Locking plate plus endosteal fibular allograft augmentation for proximal humeral fractures with com-minuted medial column

Objective To evaluate the clinical and radiographic outcomes of locking plate plus endosteal fibular allograft augmentation for unstable proximal humeral fractures with comminuted medial col-umn. Methods We retrospectively analyzed the 48 patients who had been treated by locking plate plus endosteal fibular allograft augmentation and fully followed up for unstable proximal humeral fractures with comminuted medial column between June 2014 and March 2016. They were 12 men and 36 women, with an average age of 64.3 years (from 33 to 87 years). By the Neer classification, 7 cases were two-part fractures, 21 three-part fractures and 20 four-part fractures. Postoperative assessments included Constant-Murley scores, shoulder scores of Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), Short Form Health Survey (SF12), humeral head height loss, change in humeral neck shaft angle, postoperative complications and revision rate. Results Their follow-ups averaged 16.7 months (from 12 to 30 months). Their final follow-ups showed a mean Constant score of 83.3 (from 67 to 98), a mean DASH shoulder score of 18.9 (from 6.6 to 49.9), and a mean SF12 of 82.8 (from 56 to 98). Postoperatively, the humeral head height loss averaged 1.2 mm (from 0.1 to 3.4 mm) and the neck-shaft angle 3.1° (from 0.1° to 9.1°). Compli-cations happened in 5 cases (10.4%): loss of reduction in one and screw penetration out of the articular surface in 4. Conclusion Locking plate along with endosteal fibular strut allograft augmentation is a promising technique for the treatment of proximal humeral fractures with comminuted medial column because fibular strut allograft may enhance mechanical stability of the humeral head, maintain fracture reduction, re-duce humeral head height loss and complications to ensure good clinical outcomes. Key words: Shoulder fractures; Fracture fixation, internal; Bone plates; Bone transplantation

Recontraction by the microdissected thin fibular skin flap of the great toe for soft tissue defects of the finger

Objective To investigate the therapeutic effect of the microdissected thin fibular skin flap of the great toe to repair the finger pulp defect, and to discuss the operation and outcome of the flap for finger pulp defect. Methods From September, 2012 to January, 2016, 12 cases of finger pulp defect were treated with the thin fibular skin flap of great toe removed partially subcutaneous fat under the microscope. One case for index finger, 3 cases for middle finger, 4 cases for ring finger, and 4 cases for little finger. Among them, 5 cases were crush injury, 6 cases were stamping injury, 1 case was avulsion injury. The flap area was 3.0 cm×1.5 cm-3.2 cm×2.2 cm. The donor site was closed directly or covered with flap. Results All the 12 flaps survived completely without blood supply crisis, and the primary healing was achieved in donor site. Ten cases were followed-up from 6 months to 36 months. The blood-supply, texture and elasticity of transferred flaps and the shape of fingers pulp were excellent. Function recovery of the fingers was good. Pain and temperature sense were regained without hypersensitivity, two-point discrimination of finger pulp was 5-8 mm. Conclusion It is a reliable approrach for the repare of the finger pulp defects using the microdissected thin fibular skin flap of the great toe, especillay in repare finger pulp defect of ring and little finger. Key words: Finger injuries; Surgical flaps; Microsurgical operation

A finite element analysis of fractures of extended tibial plateau

Objective To analyze the stress distributions under static loading and impact simulation in the process of tibial plateau fracture using finite element analysis, providing evidence for individualized diagnosis and treatment of tibial plateau fracture. Methods A healthy male volunteer was recruited. A 3D finite element model of a whole knee joint with ligaments, menisci and articular surfaces was generated using CT, MRI and 3D finite element software. The knee joint model was given the nature and parameters after reconstruction. According to the features of tibial plateau fracture, different operating conditions were designed. The stress distributions under static loading and impact simulation in the process of tibial plateau fracture were characterized by finite element analysis. Results Under static loads on the lateral condyle of the tibia, the stress was mainly concentrated on the front edge of the tibial plateau, especially the lateral stress. The stress on the medial condyle of the tibia was significantly increased, and the medial stress extended downwards to the tibial shaft. When the vertical stress moved towards outside, it extended from both sides of the internal and external condyles downwards to the tibia, and the value of lateral platform stress was slightly larger than that on the inside. In collisions, the stresses distributed on the neutral position were the same with the static loads. The stress on the medial condyle of the tibia was significantly increased, extending downwards the tibial shaft when it fell to the inside slope. When it fell to the outside slope, the stress on the tibial plateau was mainly distributed on most of the front edges of lateral and medial platforms, and the stress distributed on the fibula increased obviously. Conclusions The medial tibial plateau plays a major role in bearing stress loads. The stress is more concentrated on the lateral platform but distributed on a larger area of the medial platform, extending downwards the metaphysis. Therefore, small split fractures are likely to occur on the outer edge of the platform while fractures of a large fragment are likely to occur on the medial platform, even involving the metaphysis. Key words: Knee joint; Tibial fractures; Finite element analysis; Static load; Collision