Segmental Tibia Research Articles

Clinical application of intramedullary nail fixation assisted by locking plates in segmental tibia fractures: A retrospective study.

It is unclear whether small plates are needed for augment fixation to provide a more stable mechanical environment in segmental fractures of the tibia treated with intramedullary nail. The purpose of this study was to investigate the efficacy of intramedullary nailing combined with locking plates in the treatment of segmental fractures of the tibia. This study included 41 patients with segmental tibia fractures between January 1, 2018 and January 1, 2023. Eighteen patients were treated with an intramedullary nail assisted by a locking plate (combination group), and 23 patients were treated with an intramedullary nail without a plate (nail group). The perioperative parameters of all patients were recorded, and clinical efficacy was evaluated during follow-up. The operation time was shorter but the incision was longer in the combination group (P < .05). The numbers of fluoroscopy procedures and the time to union were shorter in the combination group (P < .05). The rate of malunion in the nail group (4, 17.4%) was significantly greater than that in the combination group (0, 0%). At the last follow-up, no statistically significant differences in walking ability were detected. Our results suggest that a locking plate combined with an intramedullary nail for segmental tibial fractures may require a longer surgical incision, but it has significant advantages such as a shorter operative time and time to union, a shorter fluoroscopy time, and a lower rate of malunion and nonunion. Intramedullary nail fixation assisted by a locking plate is an effective method for treating segmental fractures of the tibia.

Biomechanical evaluation of interlocking nail and locking compression plating for stabilization of ovine critical-sized segmental tibia defects.

Segmental large volume bone loss resulting from fracture or osseous neoplasia is a major challenge to orthopedic surgeons and there is an ongoing quest to identify treatments that optimize healing. To advance treatment, large animal translational models-such as the ovine critical-sized tibia defect model-are instrumental for testing of novel scaffolds for bone regeneration. However, little standardization in the implants utilized for defect stabilization has been determined and current commercially available implants may be inadequate to replicate the strength of the native tibia. We hypothesize that a 10-mm interlocking nail (ILN) would be stiffer in axial, bending, and torsional loading than its 8-mm counterpart and would be stiffer in axial and torsional loading compared to a 4.5-mm broad locking compression plate (LCP). Tibias were harvested from 24 ovine hind limbs from skeletally mature ewes euthanized for reasons unrelated to this study and were randomized to treatment group. An ex vivo comparison of a novel 10-mm angle-stable non-tapered ILN was compared to a commercially available 8-mm angle-stable tapered ILN and a broad LCP in an ovine critical-sized (5-cm) tibia defect model. Axial stiffness, torsional stiffness, and bending stiffness were determined in control intact tibia and tibial constructs in the three treatment groups. Following implantation, radiography was performed in all limbs and tibia length and cortical and medullary cavity diameter were measured. Comparisons between groups were assessed with a one-way analysis of variance. Significance was set at P<0.05. The 10-mm ILN in tibia containing a 5-cm ostectomy gap most closely replicated the structural properties of intact tibia compared with other constructs. The 10-mm ILN had significantly stronger torsional (P<0.001) and bending (P=0.002) stiffness than the 8-mm ILN, and was significantly stronger than the LCP in axial (P=0.04) and torsional (P=0.01) stiffness. A 10-mm ILN used to stabilize an ovine critically-sized tibia defect most closely mimicked the structural properties of the intact tibia when compared to a 8-mm ILN or broad LCP. Further in vivo testing will aid in determining which stabilization method is best suited for testing of novel tissue engineering and bone healing studies.

In vivo prevascularization strategy enhances neovascularization of β-tricalcium phosphate scaffolds in bone regeneration

BackgroundNeovascularization is critical for bone regeneration. Numerous studies have explored prevascularization preimplant strategies, ranging from calcium phosphate cement (CPC) scaffolds to co-culturing CPCs with stem cells. The aim of the present study was to evaluate an alternative in vivo prevascularization approach, using preimplant-prepared macroporous beta-tricalcium phosphate (β-TCP) scaffolds and subsequent transplantation in bone defect model.MethodsThe morphology of β-TCPs was characterized by scanning electron microscopy. After 3 weeks of prevascularization within a muscle pouch at the lateral size of rat tibia, we transplanted prevascularized macroporous β-TCPs in segmental tibia defects, using blank β-TCPs as a control. Extent of neovascularization was determined by angiography and immunohistochemical (IHC) evaluations. Tibia samples were collected at different time points for biomechanical, radiological, and histological analyses. RT-PCR and western blotting were used to evaluate angio- and osteo-specific markers.ResultsWith macroporous β-TCPs, we documented more vascular and supporting tissue invasion in the macroporous β-TCPs with prior in vivo prevascularization. Radiography, biomechanical, IHC, and histological analyses revealed considerably more vascularity and bone consolidation in β-TCP scaffolds that had undergone the prevascularization step compared to the blank β-TCP scaffolds. Moreover, the prevascularization treatment remarkably upregulated mRNA and protein expression of BMP2 and vascular endothelial growth factor (VEGF) during bone regeneration.ConclusionThis novel in vivo prevascularization strategy successfully accelerated vascular formation to bone regeneration. Our findings indicate that prevascularized tissue-engineered bone grafts have promising potential in clinical applications.The translational potential of this articleThis study indicates a novel in vivo prevascularization strategy for growing vasculature on β-TCP scaffolds to be used for repair of large segmental bone defects, might serve as a promising tissue-engineered bone grafts in the future.

Artificial intelligence-based automatic assessment of lower limb torsion on MRI

Abnormal torsion of the lower limbs may adversely affect joint health. This study developed and validated a deep learning-based method for automatic measurement of femoral and tibial torsion on MRI. Axial T2-weighted sequences acquired of the hips, knees, and ankles of 93 patients (mean age, 13 ± 5 years; 52 males) were included and allocated to training (n = 60), validation (n = 9), and test sets (n = 24). A U-net convolutional neural network was trained to segment both femur and tibia, identify osseous anatomic landmarks, define pertinent reference lines, and quantify femoral and tibial torsion. Manual measurements by two radiologists provided the reference standard. Inter-reader comparisons were performed using repeated-measures ANOVA, Pearson’s r, and the intraclass correlation coefficient (ICC). Mean Sørensen-Dice coefficients for segmentation accuracy ranged between 0.89 and 0.93 and erroneous segmentations were scarce. Ranges of torsion as measured by both readers and the algorithm on the same axial image were 15.8°–18.0° (femur) and 33.9°–35.2° (tibia). Correlation coefficients (ranges, .968 ≤ r ≤ .984 [femur]; .867 ≤ r ≤ .904 [tibia]) and ICCs (ranges, .963 ≤ ICC ≤ .974 [femur]; .867 ≤ ICC ≤ .894 [tibia]) indicated excellent inter-reader agreement. Algorithm-based analysis was faster than manual analysis (7 vs 207 vs 230 s, p < .001). In conclusion, fully automatic measurement of torsional alignment is accurate, reliable, and sufficiently fast for clinical workflows.

Temporal Changes in Reverse Torque of Locking-Head Screws Used in the Locking Plate in Segmental Tibial Defect in Goat Model.

The objective of this study was to evaluate changes in peak reverse torque (PRT) of the locking head screws that occur over time. A locking plate construct, consisting of an 8-hole locking plate and 8 locking screws, was used to stabilize a tibia segmental bone defect in a goat model. PRT was measured after periods of 3, 6, 9, and 12 months of ambulation. PRT for each screw was determined during plate removal. Statistical analysis revealed that after 6 months of loading, locking screws placed in position no. 4 had significantly less PRT as compared with screws placed in position no. 5 (p < 0.05). There were no statistically significant differences in PRT between groups as a factor of time (p > 0.05). Intracortical fractures occurred during the placement of 151 out of 664 screws (22.7%) and were significantly more common in the screw positions closest to the osteotomy (positions 4 and 5, p < 0.05). Periosteal and endosteal bone reactions and locking screw backout occurred significantly more often in the proximal bone segments (p < 0.05). Screw backout significantly, negatively influenced the PRT of the screws placed in positions no. 3, 4, and 5 (p < 0.05). The locking plate-screw constructs provided stable fixation of 2.5-cm segmental tibia defects in a goat animal model for up to 12 months.

Ilizarov bone transport using an intramedullary cable transportation system in the treatment of tibial bone defects.

Segmental tibia defects remain challenging for orthopedic surgeons to treat. The aim of this study was to demonstrate bone-related and functional outcomes after treatment of complex tibial bone defects using Ilizarov bone transport with a modified intramedullary cable transportation system (CTS). We conducted a single-center, retrospective study including all 42 patients treated for tibial bone loss via Ilizarov bone transport with CTS between 2005 and 2018. Bone-related and functional results were evaluated according to the Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system. Complication and failure rates were determined by the patients' medical files. Patients had a mean age of 45.5 ± 15.1 years. The mean bone defect size was 7.7 ± 3.4 cm, the average nonunion scoring system (NUSS) score was 59 ± 9.5 points, and the mean follow-up was 40.8 ± 24.4 months (range, 13-139 months). Complete bone and soft tissue healing occurred in 32/42 patients (76.2%). These patients had excellent (10), good (17), fair (2), and poor (3) results based on the ASAMI functional score. Regarding bone stock, 19 patients had excellent, 10 good, and 3 fair results. In total, 37 minor complications and 62 major complications occurred during the study. In 7 patients, bone and soft tissue healing occurred after CTS failure with either an induced membrane technique or classic bone transport; 3 patients underwent lower leg amputation. Patients with treatment failure were significantly older (57.6 vs. 41.8 years; p=0.003). Charlson score and treatment failure had a positive correlation (Spearman's rho 0.43; p=0.004). Bone transport using both intramedullary CTS and Ilizarov ring fixation is viable for treating patients with bone loss of the tibia and complex infection or soft tissue conditions. However, a high number of complications and surgical revisions are associated with the treatment of this severe clinical entity and should be taken into account.

A study of functional outcome of management of segmental fracture of tibia

Aim of the Study: To evaluate the Functional and Radiological outcome following various modalities of management of segmental fractures of tibia.Background: Segmental fracture of tibia is rare accounting for 3-15% of fractures of tibia. It is characterized by distinct fracture at two or more levels creating one or more completely separate intercalary fragments of tibia.Materials and Methods: The data for this study will be collected from the patient admitted to Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram. This study is a prospective and retrospective study.45 cases of segmental tibia surgically treated are followed up for a minimum period of twelve months and functional outcome observed by Johner and wruch’s criteria.Results: In study group 45 cases treated 39 were male and 6 were female. RTA was the most common cause. Right side limb more affected than left side. Common age group affected were 40-60 years. 26 were closed injury and 19 were open injury.32 cases were treated with IMIN nailing, external fixator in 6 cases, MIPO in 5 cases, illizarov in 2 cases. The final outcome based on johner and wruch’s criteria is excellent in 75.6%, good in 15.6%, fair in 6.7%, and poor in 2.2%. Conclusion: The results of our study suggest that if soft-tissue handling and restoration of anatomical alignment are successful in the treatment of challenging segmental tibial fractures, both IMN and MIPO will be good treatment methods. But in reality study/research lack in definitely proving the superiority of one over the other.

Segmentation of tibia femoral bone using graph cut method and 3D rendering for FEA

Development of a 3D model of tibia femoral bone is very important for diagnosis and treatment. Knee pain is most commonly observed problem in old age people and it is a very complex joint. Hence analysis of knee joint is very essential. Analysis can be done using 3D model and finite element model. Physical and mechanical properties of knee joint can be analyzed using Finite Element Analysis (FEA) technique. To develop 3D model segmentation process plays an important role which extracts the Region of Interest (ROI) or foreground from background image. This paper presents the graph cut method to segment tibia femoral bone from MRI/CT knee images. Also proposed algorithm illustrates the removal noise using median filter, graph cut method is used for segmenting tibia and femur bones. For volume rendering 3D model of a tibia femoral bone is created using segmented images. Finally finite element meshing is done on 3D model of tibia femoral bone to develop meshed model. This meshed model can be used for analysis and pre surgical planning of knee joint.

3D Printed Gene-activated Octacalcium Phosphate Implants for Large Bone Defects Engineering.

The aim of the study was the development of three-dimensional (3D) printed gene-activated implants based on octacalcium phosphate (OCP) and plasmid DNA encoding VEGFA. The first objective of the present work involved design and fabrication of gene-activated bone substitutes based on the OCP and plasmid DNA with VEGFA gene using 3D printing approach of ceramic constructs, providing the control of its architectonics compliance to the initial digital models. X-ray diffraction, scanning electron microscopy (SEM), Fourier transform infrared spectroscopy, and compressive strength analyses were applied to investigate the chemical composition, microstructure, and mechanical properties of the experimental samples. The biodegradation rate and the efficacy of plasmid DNA delivery in vivo were assessed during standard tests with subcutaneous implantation to rodents in the next stage. The final part of the study involved substitution of segmental tibia and mandibular defects in adult pigs with 3D printed gene-activated implants. Biodegradation, osteointegration, and effectiveness of a reparative osteogenesis were evaluated with computerized tomography, SEM, and a histological examination. The combination of gene therapy and 3D printed implants manifested the significant clinical potential for effective bone regeneration in large/critical size defect cases.

Outcome of expert tibia nail in proximal and segmental tibia fractures-a prospective study

Outcome of expert tibia nail in proximal and segmental tibia fractures-a prospective study

Segmental tibial fracture with physeal and diaphyseal fracture causing popliteal artery and common peroneal nerve injury in a 12-year-old child: A rare case with a unique injury mechanism

Proximal tibial physeal injuries with neurovascular injuries are rare. Here, we report the case of a 12-year-old boy with a rare fracture pattern that is segmental tibia fracture with physeal and diaphyseal fracture with popliteal artery and common peroneal nerve injury, which has never been reported earlier to the best of our knowledge. We also discuss the possible mechanism of injury and also describe the surgical decision-making and highlight the importance of prompt identification and early management of such patients for a good clinical outcome.

Precision repairing of compound tissue defect at limbs by 3-Dimentional contrast printing and fibular head compound tissue flap transplantation

Objective To explore the clinical application and effect of fibular head compound soft tissue flap transplantation on precision repairing of compound tissue defect at limb joints assisted by 3 -Dimensional contrast printing technology. Methods From March, 2014 to September, 2017, 9 patients with bone and soft tissue defect at limb joints were selected. In which, 2 were distal radius bone defect with joint capsule and ligament defect, 2 were lower segment tibia bone and soft tissue defect, 2 were femur under section of the bone and soft tissue defect, 2 were medial malleolus bone and ligament defect, and 1 was external ankle ligament and bone defect. Using 3-Dimensional printing to conduct bilateral mirror-image contrast prior to the operation, morphology of bone defect at limb joints was acquired. Based on the texture printed out, corresponding fibular head compound blocks with blood vessels were removed from the donor site and transplanted to the recipient site before anastomosing the blood vessels and restoring the blood flow. The regular post-operative followed-up was performed. Results The 9 transplanted tissue blocks survived. The donor sites and the recipient sites were healed. The followed-up for restoration of limb function was from 9 to 35 (average, 17.5) months. The ankle function was assessed according Kofoed scale, resulted in 2 excellent and 1 good; The wrist function was assessed according Mayo scale, resulted in 1 excellent and 1 good. The medial malleolus bone defect and criteria bone defect were healed at 6 months. The patients were satisfied with the efficacy. Conclusion The application of 3-Dimensional contrast printing of fibular head compound tissue flap transplantation in repairing compound tissue defects at limb joints can reduce damage to the donor site, realizing precise repairing on limb tissue defect, and make good function restoration. Key words: Fibular head transplantation; 3-Dimensional printing; Tissue defects; Repair; Microsurgical technique

Modalities of treatment for segmental tibia fracture

Background: Segmental tibia fractures (AO 42-C2) are defined by two or more distinct fracture lines isolating an interposed cortical segment which excludes butterfly fragmentation. Severe soft tissue defects are common due to their association with high energy trauma mechanisms of injury. Objectives: This study is an attempt to observe the various outcome of operative management of segmental tibia fracture treated by various modalities like intramedullary nailing, plating and external fixator. The results have been studied in depth to determine which modality is better for management of this type of fracture. Material & Methods: This is a prospective study of 25 cases of segmental tibia fracture treated by intra medullary nailing or plating or external fixator with minimum 6 months of follow up. All cases are evaluated according to time of union, complications, range of motion and modified knee society score. Modified knee society Score on residual effects on clinical ground at final examination. Points are given for pain, function and range of motion in modified knee society score. Result: Mean knee ROM in intramedullary nailing group is 118, while in plating group is 113.33.Average time of union in intramedullary nailing group is 18.61weeks; while in plating group is 25.33 weeks. Result according to Modified knee society score was found to be excellent to good in 18(72%) patients.11(73%) patients treated by interlocking intramedullary nailing had excellent to good knee score. Conclusion: Interlocking intramedullary nailing is a excellent method of treatment for the segmental tibia fracture as it provides rotational stability, gives excellent to good result, lower rate of complications and good knee ROM. Key words: Segmental tibia fracture, Modified knee society score, Intramedullary nailing.

Hyperbaric oxygen therapy for severe blast injury of lower extremity after terrorist attack: case report

More blast injuries are encountered in the civilian setting in recent years as terrorist attacks have increased globally. A 17-year-old male patient with severe blast injury of the right lower extremity was admitted to our department on the fifth day after a terrorist bombing attack. Initially he had been admitted to an emergency department with segmental tibia fracture and arterial injury (Gustilo IIIC). An amputation had been foreseen due to ischemia that persisted even after orthopedic fixation and revascularization interventions, followed by fasciotomy incisions. After consultation with our department hyperbaric oxygen (HBO2) therapy was administered twice daily for the first week. Ischemia improved prominently after 10 HBO2 sessions. HBO2 therapy was continued together with antibiotherapy and wound care. The patient underwent a total of 40 HBO2 sessions and two reconstructive operations and healed without amputation. Vascular injuries with concomitant orthopedic trauma cause most of the delayed amputations in bombing attacks since ischemia can persist at the microvascular level even though adequate treatments are applied. HBO2 corrects hypoxia at tissue level and so provides oxygen for the critically ischemic cells in the injured area. HBO2 also enhances host defense and decreases the ischemia reperfusion injury. In this case, HBO2 was effective in survival and functional recovery (salvage) of the extremity together with regular wound care, antibiotherapy and surgical repair.

Outcomes of segmental tibia fractures treated with circular external fixation at a single centre in a developing world setting

Background: Segmental tibia fractures historically are treated with special consideration due to their complexity, high complication rate and the propensity for associated injuries. Circular external fixators (CEFs) offer several potential advantages in this situation due to their modularity and minimally invasive application. These advantages have been demonstrated in several developed countries but not as yet in the developing world. This analysis aimed to evaluate if these beneficial outcomes are reproducible in a developing world environment. Methods: We retrospectively assessed the data pertaining to skeletally mature patients who sustained segmental tibia fractures and were treated with CEFs between January 2008 to December 2015. These cases were performed in our tertiary hospital and overseen by a consultant with limb reconstruction experience. Union rates, time to union and complications encountered over a median of 10 months (range 6–20 months) follow-up period were among the outcomes measured. Results: Fourteen male and three female patients with a median age of 34 years were included. Sixteen patients (94%) were injured as a result of high energy trauma, nine patients (53%) had associated injuries, fourteen cases (83%) were compound injuries and there were no cases of compartment syndrome. Fifteen patients (88%) united with the use of the initial CEF at a median of 25 weeks (16–52 weeks), the two cases of non-union were treated with adjustments to the CEF and distraction across the affected fracture site with ultimate union. Two cases (12%) of superficial pin infection were encountered and one case (6%) of deep infection occurred after union of the fractures necessitating removal of the CEF. Three cases (18%) developed malunion. Conclusion: Circular external fixators used for segmental tibia fractures, when applied in a developing setting by clinicians with limb reconstruction experience, display a satisfactory union rate and acceptable complication frequency, as compared to that achieved in developed countries. Level of evidence: Level 4

Collagen sponge functionalized with chimeric anti-BMP-2 monoclonal antibody mediates repair of nonunion tibia defects in a nonhuman primate model: An exploratory study.

Recombinant human bone morphogenetic protein (BMP)-2 is an FDA-approved therapy for nonunion tibia fracture, though it has a number of biological and practical disadvantages. Our research group has developed a novel tissue engineering strategy termed antibody-mediated osseous regeneration. This entails application of anti-BMP-2 monoclonal antibodies (mAbs) to capture endogenous BMP's to mediate invivo bone formation. This has been documented in a number of animal models. The present exploratory study sought to investigate the application of antibody-mediated osseous regeneration for repair of nonunion tibia defect in a nonhuman primate model. A 20 mm segmental osteotomy was performed in tibia of 6 Macaca fascicularis and was implanted with absorbable collagen sponge that was functionalized with chimeric anti-BMP-2 or isotype matched control mAb. Cone beam computed tomography (CBCT), histologic and histomorphometric analyses were performed 12 weeks post-operatively. CBCT analyzed by quantitative 3D volumetric analysis revealed that sites implanted with absorbable collagen sponge functionalized with anti-BMP-2 mAb demonstrated numerically higher mineralized tissue (408 ± 127 mm3) compared with sites implanted with isotype matched control mAb (214 ± 81 mm3), though the difference was not statistically significant ( p = 0.09). Histologic and histomorphometric analysis showed de novo bone formation with greater ( p < 0.01) percentage of bone volume in sites implanted with anti-BMP-2 (41.3 ± 4.4%), compared with isotype matched control mAb (14.6 ± 5.6%). Results from the present exploratory study provide evidence for the potential of anti-BMP-2 mAb to mediate repair of a large segmental tibia defects in a nonhuman primate model. Therapeutic antibodies have generally been shown to have great safety and efficacy profile, though their application in tissue engineering has been limited in the past. Following further investigation, anti-BMP-2 mAbs immobilized on appropriate scaffold may have application in repair of large skeletal defects without the need for exogenous growth factors.

The treatment of segmental tibial fractures: does patient preference differ from surgeon choice?

IntroductionSegmental tibial fractures are complex injuries with a prolonged recovery time. Current definitive treatment options include intramedullary fixation or a circular external fixator. However, there is uncertainty as to which surgical option is preferable and there are no sufficiently rigorous multi-centre trials that have answered this question. The objective of this study was to determine whether patient and surgeon opinion was permissive for a randomised controlled trial (RCT) comparing intramedullary nailing to the application of a circular external fixator. Materials and methodsA convenience questionnaire survey of attending surgeons was conducted during the United Kingdom’s Orthopaedic Trauma Society annual meeting 2017 to determine the treatment modalities used for a segmental tibial fracture (n=63). Patient opinion was obtained from clinical patients who had been treated for a segmental tibial fracture as part of a patient and public involvement focus group with questions covering the domains of surgical preference, treatment expectations, outcome, the consent process and follow-up regime (n=5). ResultsBased on the surgeon survey, 39% routinely use circular frame fixation following segmental tibial fracture compared to 61% who use nail fixation. Nail fixation was reported as the treatment of choice for a closed injury in a healthy patient in 81% of surgeons, and by 86% for a patient with a closed fracture who was obese. Twenty-one percent reported that they would use a nail for an open segmental tibia fracture in diabetics who smoked, whilst 57% would opt for a nail for a closed injury with compartment syndrome, and only 27% would use a nail for an open segmental injury in a young fit sports person. The patient and public preference exercise identified that sleep, early functional outcomes and psychosocial measures of outcomes are important. ConclusionWe concluded that a RCT comparing definitive fixation with an intramedullary nail and a circular external fixator is justified as there remains uncertainty on the optimal surgical management for segmental tibial fractures. Furthermore, psychosocial factors and early post-operative outcomes should be reported as core outcome measures as part of such a trial.

Prospective study of management of close or compound segmental fracture tibia by close reduction and internal fixation with interlocking nail

Background: Fractures of tibia are rated as one among the list of common and major skeletal injuries as one third of its surface is subcutaneous. Segmental tibial fractures feature a unique fracture type characterized by a completely isolated intercalary osseous fragment separated by at least two different fracture lines. Since tibia is a large bone and one of the principal load bearing bones in the lower extremity, fractures can cause prolonged morbidity, extensive disability unless treatment is appropriate. Treatment of such fractures in adults is a challenge to orthopaedic surgeons due to its poor soft tissue coverage and poor blood supply. Moreover, compartment syndrome, neurovascular injuries and infection might add to the burden. Later non union, delayed union and Mal-union may occur. The acceptable treatment goal for the segmental fracture tibia is union maintaining normal length, normal alignment without rotational deformity, normal joint movements and reduced hospital stay. Interlocking nailing has proven to be the method of choice for fixation of these fractures. The intramedullary nailing under image intensifier fulfills the objective of stable fixation with minimal tissue damage resulting in better and quicker fracture unions. Materials and methods: This study included 51 patients admitted in the Department of Orthopaedics with either open (37) or close segmental tibia fractures with compromised soft tissue (14) and treated with interlocking nail. Anterioposterior and lateral radiograph were done to diagnose fracture type. Routine preoperative investigation was followed. Patients were operated within 48 hours of hospital admission. Patients were followed up periodically on an outpatient basis on 2nd, 4th, 6th, 10th, 14th, 18th week and 6th month. Clinical and radiological assessment was done for pain, deformity, shortening, range of motion of knee, ankle, subtalar joints and radiological union.The final outcome was assessed using Johner and Wruh’s criteria Results and Discussion: In our series, out of 51 cases, 47 (92.15%) had acceptable Johner and wruth's criteria for functional results (sum of excellent and good results). Excellent in 36 (70.59%), good in 11 (21.57%), fair in 3 (5.87%) and poor in 1 (1.97). These results were comparable with results btained by Ekeland and Alho who reported results excellent in 29, good in 13 and fair in 2 and poor in one out of 45 cases.Conclusion: From this study, it was concluded that the preferred method of initial fracture stabilisation is the use of unreamed interlocking inramedullary tibial nail with immediate soft tissue cover whenever possible, this procedure require less surgical time, hospital stay, is cost effective and have minimum complications with good functional outcome.

Segmental tibial fractures treated with unreamed interlocking nail – A prospective study

Introduction: Fractures of tibia are common and major skeletal injuries. Treatment of such fractures in adults is a challenge to orthopaedic surgeons due to its poor soft tissue coverage and poor blood supply. The aim towards treatment for the segmental fracture tibia is union maintaining normal length, normal alignment without rotational deformity, normal joint movements and reduced hospital stay. Method: In our department since 2012 to 2014, 51 segmental tibia fractures were treated with unreamed interlocking intramedullary nailing technique with one proximal and one distal locking screws. Postoperatively, early mobilization exercises and weight-bearing were begun. The functional results were assessed by measuring union period and knee range of movements at 6 months. Results: Fracture healing was obtained in 49(96%) cases within the expected time period. 2(3.9%) patients had non union between proximal and middle segment. 46 (90%) were anatomic (valgus/varus

Treatment of compound tibia fracture with microvascular latissimus dorsi flap and the Ilizarov technique: A cross-sectional study of long-term outcomes

Extensive compound tibial fractures present reconstructive challenges. The present study aimed to assess the outcomes of microvascular latissimus dorsi (LD) flap combined with the Ilizarov technique for extensive compound tibial fractures with bone loss and bone healing complications. Patient records were reviewed retrospectively. The Lower Extremity Functional Scale (LEFS), the Disabilities of the Arm, Hand and Shoulder (DASH), and the 15D health-related quality of life (HRQoL) instrument were applied. Between 1989 and 2014, 16 patients underwent reconstruction with a microvascular LD flap and bone transport (11/16) or late bone lengthening (5/16). The mean clinical follow-up time was 6.6 (standard deviation (SD): 6.5) years. Three patients had minor complications requiring reoperation. Partial necrosis of one flap required late flap reconstruction in one case. Late bone grafting was used to enhance union in eight of 16 cases. The mean new bone gain was 3.8cm (SD: 2.5). Overall, 11 patients completed the questionnaires in a mean of 22.3 years (SD: 2.4) after surgery. The main findings revealed a relatively good function of the reconstructed limb and good shoulder function. The mean HRQoL was comparable to that of an age-standardized sample of the general population. Segmental tibia transport and lengthening to correct limb length discrepancy do not compromise the microvascular muscle flap. Combined microvascular LD flap reconstruction and the Ilizarov technique can be used in treating acute compound tibial defects, pseudoarthrosis, and osteitis, all associated with significant amputation risk. Fair long-term functional outcomes and HRQoL are achieved when these combined techniques are used.