Fractures Of Tibia In Adults Research Articles

Dr. Thakur innovative technique of suprapatellar nailing of tibia

Intramedullary nailing is treatment of choice for diaphyseal fractures of tibia in adults. Infrapatellar medullary nailing usually done for diaphyseal tibial fractures but in metaphyseal fractures reduction become a challenge due to anterior deformity due to pull of patellar tendon. Suprapatellar nailing is becoming popular and route of choice for metaphyseal fractures because it is done in semiextended position which helps in good reduction and fixation. But the major disadvantage of this approach is the specific instrument sets and implants are very costly. In this study we used an innovative technique of suprapatellar nailing of fracture tibia which is very cost effective. No special instrument sets used, no jig used, protective sleeve and trocar are used from PFNA2 set and colour coded infrapatellar nail extractor used to introduce the nail in proper position.

Outcome of Biological Plating of Extra-articular Proximal Tibia Fractures

Introduction: The most prominent transformation in the treatment of fractures has been modified from intensive open reduction and internal fixation with absolute stability to the biological fixation with relative stability and secondary healing with callus formation, with priority on preservation of the vascularity of bone and soft tissue to improve fracture healing. Aim: To evaluate the outcome of biological fixation of extra-articular proximal tibia fractures in adults using the locking compression plate. Materials and Methods: The present prospective longitudinal study was conducted at Government Medical College and Hospital, Nagpur, which included 30 patients who had extra- articular proximal tibia fractures belonging to AO type 41A2 and 41A3 treated by proximal tibia lateral locking plate 4.5/5.0 mm. The patients were followed-up at two weeks, six weeks, three months, six months and one year. The fracture union, coronal, sagittal alignment was assessed radiologically at the end of follow-up. Functionally the outcome was evaluated using lower extremity functional score. Descriptive statistics were used for statistical analysis. Results: Biological plating with locking compression plate has shown promising results both in terms of function and radiology. There was non-significant difference in lower extremity functional score between patients with malunion and normal alignment. Mean union time was 19.93 weeks with a standard deviation of 2.21 weeks. There was non-significant difference between the range of motion and fracture type (p-value 0.38) as well as that between Lower Extremity Functional Score (LEFS) and fracture type (p-value 0.0501). On functional evaluation of patients treated with biological plating, there was statistical significance in Knee Range of Motion (ROM) for the patients between malunion and normal alignment (p value 0.01). Conclusion: The biological fixation using minimally invasive techniques is an effective method of stabilisation for extra-articular proximal tibia fracture, yielding good mechanical alignment and protecting soft tissues and blood supply, leading to higher union rates with good functional outcome.

Diagnostic imaging and classification of proximal femoral and tibia fractures in adults

Aconfident diagnosis and classification of proximal femoral and tibia fractures are crucial to determine further therapeutic procedures. In this article the current standards regarding diagnostic imaging of proximal femoral and tibia fractures are presented and the different classification systems are discussed. Plain radiography in two planes remains the initial investigation of choice for suspected osseous injury. While this is usually sufficient to determine further procedures for injuries of the proximal femur, cross-sectional imaging is normally necessary in the diagnosis of proximal tibia fractures.

Occurence of fresh distal tibia fractures in adults

This study has been done to know the commonest causes of occurrence of distal tibia fractures in adults. In this study 20 patients of fresh distal tibia fractures in adults studied between June 2017 to may 2018 in mamta general hospital, khammam. Among these 13 were males and 7 were females and RTA was the chief cause of fractures accounting to 70% and left side accounts for 60%. In this study fracture classified according to AO/OTA classification and fracture pattern according to this classification, there was 12 cases of 43A type of injury and 08 cases of 43B type of injuries and 60% cases were grade 1 compound and 40% grade 2 compound fractures. This is comparable with other series like jing-wei zhang et al. reported average age is 43 years, males preponderance about 75%, RTA was the chief cause of injury accounting to 80% and Sven. A.F. tulner et al. reported average age group 43 years, males accounting to 85% and RTA was the major cause. In the present study of 20 cases, 12(60%) patients had excellent outcome, 6(30%) had good outcome, 2(10%) had fair outcome.

Lessons identified in delivering an orthopaedic training course in Freetown, Sierra Leone as part of the NIHR Global Health Research Group FIXT trial

Abstract Aims There are many challenges in delivering an orthopaedic training programme in Sierra Leone, West Africa, including human resource and equipment constraints. We provide a reflective analysis of adaptive strategies to overcome these. Methods An orthopaedic surgical training course was delivered in preparation for a clinical trial in Connaught Hospital, Freetown, Sierra Leone. The trial examines the implementation of Ilizarov frame fixation for tibia fractures in adults. Results Whilst it is possible to deliver a high-quality course in Sierra Leone, a significant amount of prior planning and preparation, including adaptive and contingency strategies, is required to achieve the desired outcome. Conclusions With the Royal Navy increasing its global reach, including deployment of new aircraft carriers, there are increasing opportunities to deliver medical training in low and middle-income countries in both the military and civilian sector. We believe this article may be useful for service and civilian practitioners intending to deliver education and training around the world.

Evaluation of mobilization in operated case of fracture tibia

<p class="abstract"><strong>Background:</strong> In spite of all the advances optimal method of treatment, fractures of the tibia still pose a challenge to the orthopaedic surgeons and thus the management of the fractured tibia requires the widest experience, the greatest wisdom, and the nicest of the clinical judgement in order to choose the most appropriate treatment for particular pattern of injury. Therefore, in this study we evaluated the role of mobilization efficacy and results of nailing and plating compression in management of tibial fractures and its VAS scoring.</p><p class="abstract"><strong>Methods:</strong> This is a prospective study of fractures tibia in 150 cases aged from 18-60 years, out of which 109 (72.6%) were males. The left side was involved in 85(56.6%) patients and RTA was the major cause of the tibial fractures 98 (65.3%). Among the patients full weight bearing time was early (<3 weeks) with 90 (60%) and 60 (40%) patients within delay (>3 weeks) of surgery.<strong></strong></p><p class="abstract"><strong>Results:</strong> VAS score was significant better in early (<3 weeks) mobilization and in nailing treatment of tibial fractures in first month (7.8±074 and 7.6±0.81) and (2.1±0.8 and 1.8±0.65) at the final follow-up. Vas score correlation was significant with process and mobilization.</p><p class="abstract"><strong>Conclusions:</strong> We here conclude from our study that interlocking nailing appears to be promising method of treatment of unstable tibia fractures in adults without any external splintage after adequate stabilization and early weight bearing leading to excellent functional results in most of cases.</p>

Occurrence of closed diaphyseal fractures of tibia in adults

This study has been done to evaluate the results and complications of intramedullary interlocking nail for closed diaphyseal fracture of tibia in adults. 50 adult patients of fresh tibial shaft fractures treated surgically between December 2014 to march 2016. Among these 72% males and 28% females and RTA was the common cause of fractures and right side accounts for 60%. Surgery were performed with in 5 days average with interlocking intramedullary nail, trans tendinous approach was used in all 50 cases and reaming performed in all cases. All the fractures united with a union rate of 94%. Radiological union was possible in 12.2 weeks, average range of motion in knee joint flexion was 1350, full ankle motion observed in 90% patients. There were one case of mal union, two cases of superficial infection, twelve cases of knee pain, one case of implant failure, one case of shortening, one case of Nonunion and two cases of delayed union. Functional results according to criteria by Klemm and Borner, 92% of patients achieved good or excellent results, fair result obtained in one patient and one patient functional result was poor.

To study outcome of surgical management of distal 3rd and proximal 3rd fractures of tibia in adults using expert tibial nails

<p class="abstract"><strong><span lang="EN-US">Background:</span></strong><span lang="EN-US"> Tibia is most commonly fractured long bone. Within few years population of India and number of vehicles has increased very much. This has lead to manifold increase in not only rate of tibia fracture but also in complexity of fracture. Using interlocking nail in tibial fracture with short proximal and distal fragment render it unstable leading to frequent loss of reduction causing malunion. Multidirectional interlocking screws ensure that alignment can be well maintained and stability preserved in short proximal or distal tibial segments</span>.</p><p class="abstract"><strong><span lang="EN-US">Methods:</span></strong><span lang="EN-US"> A prospective, non randomized study was conducted comprising of 30 patients of proximal and distal 1/3rd fracture of tibia in, Department of Orthopaedics, Bokaro General Hospital. The method used for fracture fixation was open/closed reduction and internal fixation with expert tibial nail. The duration of study was June 2013 to June 2016. The data thus obtained was evaluated in terms of mode of injury, associated injury, fracture pattern, etc. Also outcome was measured and complication were evaluated and treated. Functional outcome was evaluated using hospital for special surgery (HSS) knee score.<strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong><span lang="EN-US"> All 30 patient were followed up successfully during period of 3 years. The mean duration of radiological union in this study was 20.6 weeks, though it ranged from 18 to 26 weeks. 8 patients developed some complication in form of superficial infection, malunion etc but none of the patient had non-union of fractured bone. On the basis of hospital for special surgery (HSS) knee score13 patients had excellent results; 9 had good results, 05 had fair results and 3 had poor result. Mean HSS knee score was 82.3 (SD 15.3) after 3 years of follow up</span>.</p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong><span lang="EN-US"> Expert tibial interlocking nail is good treatment option for distal and proximal 1/3 fracture of tibia especially in non intra-articular facture. It can be used in simple intra-articular fracture but additional hardware is required</span>.</p>

Study of outcomes of metaphyseal plate fixation in extra articular lower tibia fractures in adults

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The purpose of the present study was to see results of metaphyseal plate fixation in fractures of distal tibia in adults.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This is a retrospective study of 45 patients with 45 open fractures of tibia operated primarily by either Solid Titanium or Stainless steel tibia interlocking nail within 24 hours of injury</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">In Our Study we had studied 30 lower tibial fractures treated by precontoured metaphyseal anatomical plate. 24 (80%) patients were male. 19 patients were 20-45 years age group. Mean age was 34 years. 24(80%) fractures were due to Road traffic accidents. We had 26 (86%) patients with closed fracture and 4(14%) patients with open fracture. Average time of surgery in our series was 52 minutes. 6(20%) patients had infection. And 2(6.67%) patients had nonunion and both were due to infection and required implant removal and conversion to external fixation. Average time for fracture union was 18 months. In our study of 30 patients 23(76.67%) patients had good to excellent results as assessed by AOFAS score. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">From this study we can conclude that when properly indicated the use of anatomically precontoured medial tibial metaphyseal plate in treatment of distal tibia fractures gives good union and good functional result.</span></p>

Proximal and distal metaphyseo-diaphyseal fractures of tibia in adults treated with tibia interlock nail with multiaxial locking (A Study of 30 Cases)

Introduction: In recent years, closed reduction and minimally invasive plating and multidirectional locked intramedullary nailing have both become widely used treatment modalities for proximal and distal tibial metaphyseal fractures. This study was performed to evaluate the functional outcome of proximal and distal metaphyseo-diaphyseal fractures of tibia in adults treated with tibia interlock nail with multiaxial locking.Materials and Methods: This randomized prospective clinical study was conducted on 30 adult patients with proximal and distal metaphyseo-diaphyseal fractures of tibia in adults at a tertiary trauma centre.Results: We had achieved excellent results in 24 (80%) of patients, good results in 5 (16.66%) of patients and satisfactory result in 1 patient (3%). Conclusions: From this study, it is our interpretation that multiaxial locked intra-medullary nail is a good option in treatment of both closed and minimally open fractures of proximal and distal metaphyseo-diaphyseal fractures of tibia.

Management of Tibial Metaphyseal Fractures by Hybrid External Fixator

Introduction: The Hybrid External Fixator combines the advantages of the monolateral pin fixators and the circular Ilizarov wire fixators. Principle of early motion has been touted as the functional savior of major intra articular injuries in application of hybrid external fixation. Materials & Methodology: 48 patients were considered for the study with tibial fractures admitted in Mamata General Hospital from May 2011 to May 2013. Results: The union and functional outcome of hybrid external fixator in simple and complex proximal and distal metaphyseal fractures of tibia in adults was evaluated at our centre. The fractures of the proximal tibia united with an average of 13.3 weeks (12 - 16 weeks). The fractures of the distal tibia united with an average of 14.42 weeks (13 - 22 weeks) with minimal complications. Conclusion: Our study shows high satisfaction rate after fixation, provides adequate stability and allows early motion of the joint. It is also effective in extra articular fractures occurring within 5 cm of the joint as the IM nails often do not provide enough stability and plating requires extensive soft tissue dissection.

A newly designed intramedullary nail with distal interlocking system for tibia fractures in adults - the clinical results

The surgical treatment of fractures of the tibia includes reamed and unreamed options. Reamed nails have mechanical advantages but they significantly harm the endosteal circulation. Unreamed nails spare the endosteal circulation, but provide a less stable fixation. In both systems, immediate full weight-bearing is not possible due to instability related to distal interlocking (DI). Further, DI is responsible for the majority of the fluoroscopy requirement and a significant loss of surgical time. In our study, we present the clinical results of a new intramedullary (IM) nail and system, which allows stable fixation with an unreamed technique that permits immediate full weight-bearing, with a minimum fluoroscopy requirement for DI. Fifty tibia fractures (49 patients) operated using our new IM system between 2008 and 2010 were evaluated retrospectively. They were allowed full weight-bearing the day after surgery. The patients were followed at least 10 months postoperatively. Mean fluoroscopy time was 18 seconds (min: 10, max: 30) for DI. Mean union time was 9 weeks (min: 6, max: 12). There was no neurovascular injury, deep infection, malunion, delayed union, or nonunion. We demonstrated that our newly developed IM nail and new DI system may be an option to solve the stability problems sourced from the DI screw. It also significantly decreases the requirement of fluoroscopy.

Fractures of the Tibial Diaphysis in Adults with Head Injuries

The charts and roentgenograms of 41 adult patients with severe head injuries who sustained 47 tibial shaft fractures were reviewed. Twenty-seven (57%) of the fractures were open and the incidence of peroneal nerve injury was 17%. The average time to weight-bearing was 3.1 months. Closed fractures united at 5.4 months and open fractures at 5.8 months. Three nonunions (6.5%) occurred in 2 patients. This review failed to demonstrate either an early rate of union or an abnormally high union rate. Furthermore, exuberant callus was not observed roentgenographically. Tibia fractures in adults with head injuries, whether on the normal or paralyzed extremity, appeared to heal in a fashion similar to fractures in normal patients. Conventional methods of treatment render satisfactory results.