Tibia Fibula Research Articles

A Case of Fat Embolism Syndrome after Fracture of Tibia Fibula

Fat embolism syndrome is a fatal condition that affects several organs. It often occurs after trauma or orthopedic surgeries. Most are unnoticed, and treatment of it is primarily supportive, with early fracture repair as a preventative measure. This case report describes a patient who had a left tibia fibula fracture diagnosed using Gurd's criteria and verified by a CT pulmonary angiography and MRI, and was treated with supportive care. Bangladesh Crit Care J September 2024; 12 (2): 167-171

How Effective is Fibula Pro Tibia Plating in Treatment of Distal Tibial Fractures: A Pilot Study.

Despite recent advances, management of distal tibial fractures is challenging, with high rate of complications. Fibula pro tibia plating technique fixes fibula and tibia together, via laterally placed fibular plate without disturbing the tibial soft tissue sleeve. We contemplated this pilot study to assess effectiveness of fibula pro tibia plating in management of distal tibia fibula fractures. A total of 30 patients with distal tibia fibula fractures with fracture line extending within 5cm from tibial plafond were managed with fibula pro tibia plating, with or without minimal articular fixation. Outcome evaluation was done by union, union time, alignment and functional outcome as assessed by AOFAS score. Mean age in the series was 39.4 years with male to female ratio of 3:2. Mean duration of surgery, blood loss and C arm exposure were 79 minutes (range 52 to 98min), 80ml (range 62 to 102ml) and 48 shoots (range 36 to 81 shoots), respectively. All fractures united in mean union time of 10.2 weeks (range 9 to 14 weeks) with acceptable alignment in all the patients except one. Mean AOFAS score was 86.3 (range 70 to 93) with 29 patients having good to excellent outcome. One patient had varus malunion and in one case infection was seen. Fibula pro tibia plating can be successfully used to manage complex distal tibia fractures which leaves the soft tissue and periosteal sleeve undisturbed, thus avoiding wound related problems and leading to early union.

Comparative Study of Dexmedetomidine versus Fentanyl as an adjuvant to Ropivacaine (0.75%) in Epidural Anaesthesia in Lower Limb Orthopaedic Surgery

Background: Dexmedetomidine and Fentanyl both possess hypnotic, sedative, analgesic properties and have been utilised as an additive in epidural anaesthesia. The purpose of this study is to compare the sedative and analgesic effects of Dexmedetomidine and Fentanyl when added epidurally with Ropivacaine (0.75%) during lower limb orthopaedic surgery.
 Methods: The study comprised of 60 patients, both male and female, aged 18 to 60, who had ASA classification I or II for tibia fibula surgery. Two groups of patients were split up at random: Group RD contains– Ropivacaine (0.75%) 15ml + Dexmedetomidine (1microgm/kg) 0.5ml + 0.5ml sterile water (Total volume-16ml) and Group RF - Ropivacaine 15ml (0.75%) + 1ml Fentanyl (1microgm/kg) (Total volume-16 ml). The epidural space was maintained 4 cm within and situated between L3 and L4 space. Investigations were conducted on parameters such as sensory and motor block features, sedation score, hemodynamic factors and pain assessment. Using the student `t` test, statistical analysis was performed using STATAIC13 software.
 Results: Onset of sensory analgesia at L1 and Complete sensory and motor blockage occurred much earlier in the RD group. Higher sedation scores and significantly prolonged postoperative analgesia was observed in RD group.
 Conclusion: Dexmedetomidine is a safer and more effective epidural adjuvant than fentanyl because it provides stable hemodynamics, extended post-operative analgesia, early onset and development of sensory and motor effects and sedation.

INCIDENCE OF FRACTURE IN SMALL RUMINANTS: A RETROSPECTIVE STUDY

The availability of information or data regarding various affections forms a powerful tool for rendering appropriate treatment. The present study was designed to acquire data on fracture in small ruminants. This study will act as a base for policymakers to implement future projects in orthopedics for different species of animals. All the cases of bone affection at the indoor surgery clinic, Department of Veterinary Surgery, the University of Veterinary and Animal Sciences, Lahore, for four years from 2016 to 2019 were enrolled in the study. The diagnosis was based on the clinical history, signs, and clinical examination and by radiograph. Treatment as medicinal or surgical interventions was provided wherever feasible. The data concerning species, sex, age, bone, type of fracture, and cause were compiled and analyzed by using the Chi-Square test. The overall incidence of fracture was found to be 4.47%. Caprine was the most common (96.136%) subject exposed to bone fracture. The fracture incidence was highest between 7 and 12 months of age, 76.40% in goats and 67.857% in sheep. Furthermore, male subjects were more prone to fracture (69.617%) and (15.405%) than females (30.383%), and (6.527%) in goats and sheep, respectively. The metacarpal (43.953%) in goats was affected bone most commonly with fracture, followed by the metatarsal (28.319%), tibia fibula (14.159%), radius–ulna (11.504%), humerus (1.475%), femur (0.590%). While in the case of sheep, metacarpal (40.476%) was followed by metatarsal (22.619%), tibia-fibula (26.190%), and radius–ulna (10.714%). Moreover, in bovines, the overall incidence of fracture was 1.82%. Similarly, in equines, fractures were mostly of radius-ulna (16.66%) and metatarsal (23.33%). The most common site of the fractures was located in the mid-shaft of a bone. Trauma (46.018%) was the most common cause of a fracture in goats, while in sheep, it fell from a height (40.476%). It was concluded that the metacarpal bone fracture was the most common fracture in goats than other animals.

Straightness of Central Anatomical Axes of Human Tibia–Fibula System: Role of Fibula and Its Importance in Biomechanics

Abstract Fracture may occur in human lower leg bones considering varying loads acting on them while performing various functions. Implants, commonly used in healing the fractures, must be properly aligned with the bones' anatomical axes for their proper functioning. While attempts to establish tibial anatomical axis have been made previously, combined central anatomical axis of human tibia and fibula remains unexplored. In this study, profiles of individual and combined central anatomical axes of tibia and fibula have been obtained using computed tomography (CT). These profiles are found to be approximately straight with the deviation from straight line for the centroidal axis of the combined system being approximately half of that for the tibia. It is further utilized in assessing the role of fibula in determining the critical stresses in the tibia with the help of static finite element analysis (FEA) of a tibia–fibula model. Even though fibula takes a smaller proportion of the total axial load, its absence increases the compressive stresses in the tibia due to increased bending moments at the critical cross section. Furthermore, FEA has been carried out to understand the clinical significance of the mismatch in the centroidal axis of an implant and its parent bone taking the example of the human tibia alone. FEA suggests that these central anatomical axes are in fact the load bearing axes of the bones and any misalignment of implant with the central anatomical axis may lead to patient discomfort and premature failure of the implant.

STUDI KASUS: HIPERTERMIA DENGAN KOMPRES HANGAT PADA PASIEN TUBERCULOSIS

One of the symptoms of pulmonary tuberculosis is hyperthermia which is the body response to infection process. Tuberculosis sufferers are usually subfebrile, resembling fluenza, but sometimes they can be infected by influenza with body temperature ranging between 38,0oC and 38,5oC. The effort made to overcome hyperthermia is by giving warm compresses to reduce fever. Method this is descriptive research using case study approach that focuses on hyperthermia with warm compresses in pulmonary tuberculosis patients at Tk II Putri Hijau Hospital, Medan. Results after nursing interventions in patients 1 dan 2 with warm compresses on the forehead, axilla, tibia fibula, for 4 days, the patients body temperature decreases from 38oC to 37oC. Conclusion it is concluded that there is a nursing problem in patient 1 and patient 2, namely hyperthermia. Suggestions It is expected that the health workers improve their nursing skills in providing nursing care, especially in taking actions to reduce patients fever, so as to reduce is incidence.

Studi Kasus: Hipertermia dengan Kompres Hangat Pada Pasien Tuberculosis

One of the symptoms of pulmonary tuberculosis is hyperthermia which is the body response to infection process. Tuberculosis sufferers are usually subfebrile, resembling fluenza, but sometimes they can be infected by influenza with body temperature ranging between 38,0oC and 38,5oC. The effort made to overcome hyperthermia is by giving warm compresses to reduce fever. Method this is descriptive research using case study approach that focuses on hyperthermia with warm compresses in pulmonary tuberculosis patients at Tk II Putri Hijau Hospital, Medan. Results after nursing interventions in patients 1 dan 2 with warm compresses on the forehead, axilla, tibia fibula, for 4 days, the patients body temperature decreases from 38oC to 37oC. Conclusion it is concluded that there is a nursing problem in patient 1 and patient 2, namely hyperthermia. Suggestions It is expected that the health workers improve their nursing skills in providing nursing care, especially in taking actions to reduce patients fever, so as to reduce is incidence.

Development of a Bionic Tube with High Bending-Stiffness Properties Based on Human Tibiofibular Shapes.

The human tibiofibular complex has undergone a long evolutionary process, giving its structure a high bearing-capacity. The distinct tibiofibular shape can be used in engineering to acquire excellent mechanical properties. In this paper, four types of bionic tubes were designed by extracting the dimensions of different cross-sections of human tibia-fibula. They had the same outer profiles, but different inner shapes. The concept of specific stiffness was introduced to evaluate the mechanical properties of the four tubes. Finite-element simulations and physical bending-tests using a universal testing machine were conducted, to compare their mechanical properties. The simulations showed that the type 2 bionic tube, i.e., the one closest to the human counterpart, obtained the largest specific-stiffness (ε = 6.46 × 104), followed by the type 4 (ε = 6.40 × 104) and the type 1 (ε = 6.39 × 104). The type 3 had the largest mass but the least stiffness (ε = 6.07 × 104). The specific stiffness of the type 2 bionic tube increased by approximately 25.8%, compared with that of the type 3. The physical tests depicted similar findings. This demonstrates that the bionic tube inspired by the human tibiofibular shape has excellent effectiveness and bending properties, and could be used in the fields of healthcare engineering, such as robotics and prosthetics.

A Rare Case: Ganglion Cysts in the Proximal Tibiofibular Joint Causes Lateral Side Knee Pain: A Case Report

Introduction: Proximal tibiofibular joint (PTFJ) ganglion cysts are very rare. The pathophysiology remains unclear. Lateral knee pain was present in dominant case, and some cases accompanied with common peroneal nerve symptoms. In cases of chronic trauma, it is sometimes confused with proximal tibiofibular joint instability. Thorough examination and investigations such as MRI are highly recommended. There is no consensus of management, but some studies indication that excision of the ganglion associated with low recurrences number. Method: We report a case of 28 yeara-old woman, with a chief complain of pain on the lateral side of her right knee. Pain increasing on one last year. She had a trauma on her knee in 5 years ago. She was diagnosis with Lateral Instability of her knee by a previous surgeon and refer to our clinic for second opinion. In physical exam we found, tenderness around fibula head, Lachman, McMurray, Lelli’s test was negative. Shuck test was not evident.. MRI was done and showing partial tear of anterior horn of lateral meniscus and partial tear of anterior proximal tibia fibula ligament also a fluid collection around the fibular head. We planned to repair the meniscus through arthroscopic and stabilize the Proximal tibiofibular joint with open surgery. Results: Standard arthroscopic surgery was performed. Tear anterior horn meniscus was repair using inside out technique. In open surgery we found the anterior proximal tibiofibular ligament quite stable, and also we found a ganglion cyst around the PTFJ. We decided to leave the anterior PTFJ ligament, and excise the ganglion until its sac and follow up the case forward. Conclusion: Symptoms of pain caused by ganglion cysts in PTFJ, although rarely, can be very disturbing. The history of chronic trauma obscures this case with instability condition. There for careful diagnosis is required. Excision of the ganglion into the sac is the treatment of choice because of the very low recurrence rate. The complex anatomical composition of the lateral side of the knee can cause pain to arise from various components. The presence of PTFJ ganglion cysts should not be ignored

Combined Axillary Block with Spinal Block Anaesthesia

<p><strong>Background: </strong>Patients undergoing upper limb trauma surgery have reported various benefits of regional anesthesia over general anesthesia, including better perioperative analgesia, less opiate use, less postoperative nausea and vomiting (PONV), and a shorter post-anesthesia care period. ……………………………..<br /> <strong>Case Illustration: </strong>We reported an evaluation of 72 years old, 165 cm height and 60 kg weight male patient who was planned for open reduction and internal fixation surgery for neglected left radius ulna close fracture and left neglected tibia fibula close fracture that he was beneath follow-up for hypertension (HT), and was using antihypertensive drugs. Preoperative risk of the patient was assessed as with American Society of Anesthesiologists (ASA) with score 3.General anesthesia would be unsafe due to geriatric issue, cardiovascular problem and delayed surgery term, we chosed to utilize combine axillary block with spinal block. we utilized USG guided infusion procedure in arrange to diminish local anesthetic dosage, and minimize error. During surgical procedure there is no hypotension, bradycardia or decreased oxygen saturation. Surgical anesthesia occurred in left hand within 20 minutes after drug delivery and 10 minutes in lower extremity. Surgery complications was not reported particularly related to vascular punction or adjacent anesthetic and nerve block applications. No complaint was detailed from the patient who was watched for 12 hours after the surgery.<strong></strong></p><p class="Default"><strong>Conclusion:</strong> Peripheral nerve block and neuraxial block, when utilized appropriately in combination, appear be able to supplant common anesthesia within the larger part of case.</p>

Incidence, Occurrence and Classification of Long Bone Fractures in Dogs: A Retrospective Study

Background: Long bone fracture in small animals has become a problem of concern in urban areas as well as rural areas because of road accidents. Canine long bone fracture cases presented at surgery wards of the hospital during 2017-20 were analysed for determining their incidence, occurrence and classification of fractures. Methods: The present study was conducted on long bone fractures in dogs presented to the surgery ward of SVVU Super Speciality Veterinary Hospital, Visakhapatnam from 2017 to 2020. Detailed history and signalment was followed by detailed physical examination to determine the site of fracture, extent of soft tissue swelling and presence of open wounds. Radiographic evaluation was done to localize the seat of fracture, to identify the type of fracture and to find out relation between the fracture fragments Result: Of all the cases of dog patients presented to the surgery ward 2.02% were diagnosed to have fracture of different bones. Fracture of long bones (326), comprised 1.50% of total cases and 74.42% of fractures cases. The highest incidence was recorded in mongrel dogs and the most common affected bone was tibia fibula. Fall from height was reported as an etiological factor in majority of the cases and Juvenile group of animals was found more affected.

Outcome of modified physiotherapy rehabilitation protocol on neuro-deficit foot drop secondary to postoperative stiffness of knee joint

Post-operative stiffness of knee joint along with neuro-deficit foot drop damage is a complication following open fracture of lower limb. To prevent damage of soft tissue, flap is needed. Lifting of limb is hampered in foot drop, seen in problems such as stroke. Aim of Modified physiotherapy rehabilitation is to help in early sensory and motor reeducation in foot drop secondary to postoperative stiffness. A 19 Year male was diagnosed as compound grade IIIB fracture of tibia fibula and was operated for interlocked nail with skin graft. After 1 week patient was referred to physiotherapy OPD with complaints of pain, restricted range of motion, stiffness, decreased strength adhesion formation and swelling over right leg. Patient was treated 5 days per week for 8 weeks. Modified physiotherapy rehabilitation was given for 8 weeks which include muscle energy technique, electrical stimulation, Maitland’s mobilization, mulligan’s technique. Physical examination and phase wise exercise is described in case report. So this case report concluded that modified physiotherapy rehabilitation have significantly improve and restore normal range of motion, reduce pain and stiffness, increase strength and functional activities.

Hind limb muscles influence the architectural properties of long bones in frogs.

The Mechanostat Theory states that osteocytes sense both the intensity and directionality of the strains induced by mechanical usage and modulate the bone design accordingly. In long bones, this process may adapt anterior-posterior and lateral-medial strength to their mechanical environment showing regional specificity. Anuran species are ideal for analyzing the muscle-bone relationships related to the different mechanical stresses induced by their many locomotor modes and habitat uses. This work aimed to explore the relationships between indicators of the force of the most relevant muscles to locomotion and the mechanical properties of femur and tibia fibula in preserved samples of three anuran species with different habitat use (aquatic, arboreal) and locomotion modes (swimmer, jumper, walker/climber). For that purpose, we measured the anatomical cross-sectional area of each dissected muscle and correlated it with the moments of inertia and bone strength indices. Significant, species-specific covariations between muscle and bone parameters were observed. Pseudis platensis, the aquatic swimmer, showed the largest muscles, followed by Boana faber, the jumper and Phyllomedusa sauvagii, the walker/climber. As we expected, bigger muscles correlate with bone parameters in all the species. Nevertheless, smaller muscles also play an important role in bone design. In aquatic species, muscle interaction enhances mostly lateral bending strength throughout the femur and lateral and antero-posterior bending strength in the tibia fibula. In the jumper species, muscles affected the femur and tibia fibula mostly in anterior-posterior bending. In the walker/climber species, responses involving both antero-posterior and lateral bending strengths were observed in the femur and tibia fibula. These results show that bones will be more or less resistant to lateral and antero-posterior bending according to the different mechanical challenges of locomotion in aquatic vs. arboreal habitats. This study provides new evidence of the muscle-bone relationships in three frog species associated with their different locomotion and habitat uses, highlighting the crucial role of muscle in determining the architectural properties of bones.

Syndesmosis Changes before and after Syndesmotic Screw Removal: A Retrospective Radiographic Study.

Background and Objectives: In patients with ankle fractures complicated by syndesmotic injuries, no consensus has been reached on the best method of syndesmosis fixation using syndesmotic screws. One previous study revealed no difference in the tibiofibular overlap between two groups with or without syndesmotic screw removal. Other studies have indicated that distal tibiofibular diastasis exists after the removal of syndesmotic screws. In this study, we aimed to confirm the effect of syndesmotic screw removal on diastasis occurrence. We further analyzed the risk factors that may contribute to the widening of the tibiofibular syndesmosis. Materials and Methods: This retrospective study involved a review of the records of 63 patients with ankle fractures accompanied by syndesmosis injuries that required syndesmotic screw fixation. Anteroposterior radiographs were analyzed for each patient at various time points, from syndesmotic screw fixation to outpatient department follow-ups after screw removal. The changes in tibia–fibula overlap (OL), tibia–fibula clear space (CS), and medial clear space (MCS) were analyzed. Further analysis was performed to reveal potential factors that may have contributed to radiographic differences. Results: Compared with the postoperation radiographs following syndesmotic screw fixation, OL decreased (2.0 mm) and CS increased (0.8 mm) in the anteroposterior radiographs from outpatient department follow-ups. No significant changes were noted in OL or CS after syndesmotic screw removal. However, OL decreased (1.8 mm) and CS increased (0.5 mm) before syndesmotic screw removal. No significant change in MCS occurred during the whole observation period. Linear regression analysis did not reveal any significant correlations between potentially related factors and radiographic changes. Conclusions: Marked diastasis had occurred at final follow-up. Notably, the diastasis occurred before rather than after screw removal. This implies that screw removal does not significantly influence the radiographic outcomes of rotational ankle fractures.

Exchange nailing, for atrophic non-union of the tibia, after implant breakage, post a non-traumatic event

Background: The most feared complication of fracture management is non-union. Non-union can be of the following types, hypertrophic, oligotrophic, atrophic, and septic. In view of a non-union, exchange nailing is preferred and so routinely performed for non-unions and fractures of the tibia. Case Presentation: Here, we present a case of an implant failure from an atraumatic event in a case of atrophic non-union of the tibia, which was treated by exchange nailing and bone grafting. A 22-year-old male, with a history of the left closed tibia fibula diaphysis fracture 1 year ago, underwent exchange nailing with bone grating after having an atrophic non-union with implant breakage. Conclusion: Implant failure and non-union are caused due to a wide variety of factors. Appropriate implant selection for fracture type, reaming, fracture site compression, good reduction, and adequate and early mobilization are important factors for a satisfactory union and prevention of secondary surgeries.

Fracture union in extra articular distal tibia fracture after definitive delta frame external fixation in COVID 19 pandemic: a case report

<p class="abstract">Distal tibia fractures account for 10% of lower limb fractures. Mode of trauma also determines the fate of soft tissue recovery. In low energy fractures soft tissue show better healing whereas fractures due to high energy trauma show high chances of soft tissue complications like poor soft tissue coverage, wound infection and necrosis. We presented a 50 years old male case of extra articular left distal tibia fibula open fracture managed by delta frame external fixator with fibular K wiring used as a definitive management with good fracture healing and range of motion 5 months postoperative. Ankle spanning external fixation is a good modality of surgical management of extra articular compound distal tibia fractures as both temporary and definitive surgical fixation.</p>

Discovery of a Flexor Digitorum Accessorius Longus (FDAL) Muscle – Implications for Tarsal Tunnel Syndrome

The flexor digitorum accessorius longus (FDAL) is a variant posterior leg muscle with a reported incidence of 2-8% of lower limbs. The FDAL can originate from many structures in the lower limb, including the tibia fibula, posterior intermuscular septum, or any muscle within the deep posterior leg compartment.1 The FDAL typically travels through the tarsal tunnel before inserting in the flexor digitorum longus (FDL) or the quadratus plantae. In this case, we present a FDAL variant that originates from the flexor hallucis longus (FHL) and the neurovascular bundle containing the tibial nerve and posterior tibial artery and vein and inserts distally into the FDL. We observed this variant travel superficial to the neurovascular bundle within the tarsal tunnel, closely associated with the tibial nerve. After it traversed the tarsal tunnel, the FDAL variant dove deep to the neurovascular bundle before inserting into the FDL. Because of the size and proximity of the FDAL to the tibial nerve, a person with this accessory muscle may be predisposed to symptoms of tarsal tunnel syndrome.

Extra-articular distal tibia fibula fracture managed with single posterolateral approach: a case report

<p class="abstract">Extra-articular distal tibia fractures involve distal tibia approximately 4 cm within tibia plafond with no articular extension. The proper preoperative care, planning and selection of surgical approach is very essential to prevent postoperative wound-related complications. We present a case of a 29 year female patient, presented with left ankle pain and swelling with a wound over the medial aspect of the ankle. X-ray of the left ankle showed extra-articular distal tibia fibula fracture with no neurovascular deficit. We managed both the fractures with open reduction and internal fixation using a single posterolateral approach. At present 1 year follow-up, the patient is having a good range of ankle motion with radiological union with no implant failure and wound-related complications. Extra-articular distal tibia fibula fracture fixation using single posterolateral approach is a viable alternative approach to medial or anterolateral approach in cases of medial or anterior soft tissue problems. It helps in getting a better functional outcome, early mobilisation with less wound-related complications.</p>

Functional outcome of distal tibia extra articular fractures treated by Joshi’s External Stabilization System (JESS)

Objective: Distal tibia extra articular fractures amount to nearly 10-13% of all tibial fractures. Precarious vascularity, propensity for open fractures and poor soft tissue coverage over these fractures make them particularly vulnerable for infection and non-union and surgical site complications.We evaluated the shortterm functional outcome of fracture distal tibia fibula treated by single stage external fixation using Joshi’s External stabilizing system (JESS). Methods: In a non-control prospective interventional study on 30 patients with extra articular distal tibia fractures we used the JESS fixator as a definitive treatment modality. Fibula was internally fixed using a nail or plate when fractured. After achieving temporary fracture reduction, two pins were inserted each in tibia and calcaneum and were connected by JESS rods using clamps. In case of open fractures wound was managed by serial debridement and dressings as required. The patients were followed up for a minimum of 12 months. Results: There were 20 male and 10 females. The mean age was 39.1 years (range 18-60 years). There were 18 open and 12 closed fractures. According to the AO/OTA classification of extra articular distal tibia fractures 20 belonged to type A1, 3 in type A2 and 7 in type A3. The mean time to union was 15 weeks and the average duration of surgery was 35 minutes. At the final follow up all fractures united except one and the mean AOFAS score was 83.13. There were 2 cases of pin track infections, one non-union and one mal-union. One patient had ankle arthritis managed conservatively till last follow up. Conclusions: Definitive fixation of distal tibia extra- articular fractures with JESS is a simple procedure with good functional outcome and avoids complications associated with open reduction and internal fixation. Keywords: Distal tibia, JESS, Plating, ORIF, Fixator.

Repeat Rate Analysis Of Lower Limb Radiograph For Digital Radiography In General Radiography At Pantai Klang Hospital Selangor

Introduction: Assessing the repeat rate is crucial to reduce unnecessary dose to the patient by identifying the major cause for repeating the x-rays exposure to the patient and apply corrective measures Aim: to analyse the repeat rate of routine lower limb projections in direct digital radiography (DR) from general radiology department of Pantai Klang Hospital. Methods: 26 months retrospective repeated radiograph was acquired from Picture Archiving and Communication System (PACS) at Hospital Pantai Klang. The retrieved radiographs were grouped based on the reason for the i radiographs being rejected which are incorrect positioning, incorrect collimation, patient movement, incorrect exposure factors, artefact, and other reasons. Results: Total repeated radiographs retrieved for basic lower limbs projections were 13616. Knee was the highest repeted examination and the lowest repeat rate was tibia fibula. (repeat rate: knee = 1.04%, tibia fibula = 0.57%). incorrect positioning is the major causes for repeat exposure for all examinations type, followed by incorrect collimation, other categories, centring ray error, incorrect exposure factors and artifact.