Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures / 中华创伤杂志(英文版)

PURPOSE@#Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.@*METHODS@#This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0).@*RESULTS@#Average malunion (degrees) in the MIPPO group was 5 (3-7) ± 1.41 vs. 10.22 (8-14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001).@*CONCLUSION@#Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.

Evaluation of the Interobserver Agreement of the Fraser and Blake & McBryde Classifications for Floating Knee / Avaliação da concordância interobservador das classificações de Fraser e Blake & McBryde para joelho flutuante

Abstract Objective To evaluate the interobserver agreement of two classifications for floating knee: Fraser and Blake & McBryde. Method Thirty-two observers, subdivided according to the degree of titration (26 resident physicians and 6 orthopedic physicians specialized in orthopedic trauma), classified 15 fractures of the ipsilateral femur and tibia. Interobserver agreement was evaluated by using the Kappa coefficient. Result When evaluating the agreement between the 9 R1, a Kappa index of 0.58 was obtained for the Fraser classification and of 0.46 for the Blake & McBryde classification. Among the 7 R2, a rate of 0.59 was obtained for the Fraser rating and 0.51 for the Blake & McBryderating. Among the 10 R3, theagreement index was higher for both classifications: 0.72 for the Fraser and 0.71 for the Blake & McBryde classification. Considering the 3 groups (R1, R2, R3) as one large group, the general Kappa index was calculated, which resulted in 0.63for the Fraser classification and 0.56 for the Blake & McBryde classification. In the group of traumaand orthopedic knee specialists, in turn, an agreement of 0.597 was obtained for the Blake and McBryde classification and of 0.843 for the Fraser classification. Conclusion Comparatively, the two classifications presented a weak to moderate degree of agreement. Fraser classification had better agreement in both groups. The agreement was higher when evaluating orthopedic trauma physicians.

Resumo Objetivo Avaliar a concordância interobservador de duas classificações para joelho flutuante: Fraser e Blake & Mcbryde. Método Trinta e dois observadores, subdivididos de acordo com o grau de titulação (26 médicos residentes e seis médicos ortopedistas especialistas em trauma ortopédico) classificaram 15 fraturas de fêmur e tíbia ipsilaterais. A concordância interobservador foi avaliada pelo coeficiente Kappa. Resultado Ao avaliar a concordância entre os 9 R1, obteve-se índice Kappa para classificação de Fraser de 0,58 e para a classificação de Blake & McBryde de 0,46. Entre os 7 R2, obteve-se índice de 0,59 para a classificação de Fraser e 0,51 para a classificação de Blake & McBryde. Entre os 10 R3, o índice de concordância foi maior para as duas classificações: 0,72 para a classificação de Fraser e 0,71 para a de Blake & McBryde. Considerando os 3 grupos (R1, R2, R3) como um só grande grupo, calculou-se o índice Kappa geral, que teve como resultado 0,63 para a classificação de Fraser e 0,56 para a classificação de Blake & McBryde. No grupo dos traumato-ortopedistas especialistas em joelho, por sua vez, obteve-se uma concordância para a classificação de Blake e McBryde de 0,597 e para a de Fraser de 0,843. Conclusão Comparativamente, as duas classificações apresentaram grau de concordância fraco a moderado. A classificação de Fraser teve melhor concordância em ambos os grupos. A concordância foi maior quando se avaliou médicos ortopedistas especialistas em trauma ortopédico.

Comparison of functional outcomes among subtypes of Fraser's type Ⅱ floating knee / 中华创伤杂志(英文版)

PURPOSE@#The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement (Fraser's type Ⅱ). This study aims to evaluate and compare the functional outcomes among different Fraser's type Ⅱ floating knee injuries after surgical management.@*METHODS@#Twenty-seven patients with Fraser's type Ⅱ floating knee injuries (54 fractures) between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser's floating knee classification into three different groups as type ⅡA (ipsilateral femoral shaft and tibial intra-articular involvement, n = 11), type ⅡB (ipsilateral tibial shaft and femoral intra-articular involvement, n = 9) and type ⅡC (both femoral and tibial intra-articular involvement, n = 7). The differences among the groups were evaluated and compared. The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score (KOOS) which covers 5 subscales of pain, other symptoms, activities of daily living, sports and recreation, and quality of life. The result was also compared with standardized age-sex matched healthy population using paired samples t-test.@*RESULTS@#All the patients were male, and the injury mechanism was solely roadside accident. The mean age was 29.8 years and injury severity score 17.9 (comparable in all the three groups). Most injuries were observed on the right side (20 cases, 74.1%). Based on paired samples t-test, the KOOS score of patients with Fraser's type ⅡA was found to be better than that of type ⅡB and type ⅡC. Compared with the reference age-sex matched control group, patients with Fraser's type ⅡB and ⅡC fractures had significantly lower mean score in all KOOS subscales (all p < 0.01). However, Fraser's type ⅡA only revealed significant difference regarding the subscales of activities of daily living (p < 0.0001), sports and recreation (p < 0.0001), and quality of life (p < 0.0001).@*CONCLUSION@#The results of this study show that patients with Fraser's type ⅡA fractures had a better functional outcome as compared to those with type ⅡB and ⅡC fractures. This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.

Intramedullary nailing through suprapatellar approach with semiextended position for the treatment of tibial fractures / 中国骨伤

OBJECTIVE@#To explore clinical effects of intramedullary nailing through suprapatellar approach with semiextended position in treating tibial fractures.@*METHODS@#From January 2018 to June 2019, 23 patients with tibia fractures were treated with suprapatellar approach intramedullary nailing on knee semiextended position, including 18 males and 5 females, aged from 26 to 67 years old with an average age of (38.5±9.6) years old. Eight patients were tibial proximal fractures, 7 patients were tibial shaft fractures, 6 patients were tibial distal fractures and 2 patients were tibial segmental fractures. Operation time, intraoperative blood loss, complications and fracture healing time were recorded. Range of motivation of knee joint between 3 days and 3 months after operation were compared, Hospital for Special Surgery (HSS) score and visual analogue scale (VAS) were used to evaluate clinical effects.@*RESULTS@#All patients were followed up from 8 to 19 months with an average of (12.3±7.6) months. Operation time was (55.3±5.1) min, intraoperative blood loss was (84.0±8.7) ml. No obvious complications occurred. All patients were achieved bony union at stageⅠ, fracture healing time ranged from 3 to 8 months with an average of (4.6±1.5) months. Flexion extension range of knee motion at 3 days after operation was (110.4±15.3)°, and increased to (123.7±16.5)° at 3 months after operation (@*CONCLUSION@#Intramedullary nailing through suprapatellar approach with semiextended position in treating tibia fractureshas advantages of simple operation, less trauma for soft tissue, less pain, rapid recovery of function and less complication. It is especially suitable for patients with tibial multi-segment fracture and multiple fractures of ipsilateral lower limb for safety and simple.

Functional Outcome of Intra–Articular Proximal Tibia Fractures (41C) Treated with Dual Plate Osteosynthesis

The fractures of proximal tibia particularly plateau fractures are more difficult to treat due to complexity of configuration and associated soft tissue injuries. AO 41C fractures are high energy fractures often accompanied by other injuries and complications, such as postoperative inflammation, wound problems and infections. Aim and objectives: functional outcome of intra-artcular proximal tibia fractures (41C) treated with dual plate osteosynthesis. Methods: The study will be conducted over a period of 19 months in department of Orthopaedics, BMCH.All cases attending OPD and emergency >18years of age with intra articular fracture proximal tibia (41C) will be assessed by clinically and radiologically .Clinically assessment will be done by Rasmussen’s score treated with open reduction internal fixation with dual plate osteosynthesis of intra-articular proximal tibia fractures , and those followed up at 2,6,10,14,20,24 weeks for any complications and morbidity. Results: The mean age among patients was 31.38+-11.37 years. The male: female ratio was 2.33.Among 10 patients; 2 had Diabetes Meliteus while 1 had hypertension. Mean duration of surgery from time of injury was 7.89 ±3.98 days. Mean hospital stay in patients was 18.16 ±3.69 days. Mean time for union in patients was 12.18±4.83 weeks. Radiographic results Rasmussen anatomic outcome (immediately postoperatively) was excellent in 6, good in 3, and fair in 1 patients. Conclusion: Dual plate osteosynthesis is the best , effective and simple procedure in treatment of complex inta-articular proximal tibia fractures (41C).

Extra-articular distal tibial fractures, is interlocking nailing an option? A prospective study of 147 cases / 中华创伤杂志(英文版)

PURPOSE@#Distal tibia fractures comprise about 7%-10% of lower extremity trauma. Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures. Plating is fraught with complications of wound dehiscence and infection. There are limited studies which document outcomes in such cases using intramedullary interlocking nail. We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing.@*METHODS@#This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India. There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study. Only cases with fresh injury (less than 1 week), fracture below the isthmus, closed and open Gustilo Anderson type 1 and 2 fractures were included in the study. Patients were reviewed at 3, 6, 12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing, any complications, time to union and functional outcome.@*RESULTS@#There were 102 males and 45 females (male/female ratio is 2.3:1) with a mean age of 38.96 (range 23-65) years. According to AO classification, there were 78 cases (53.06%) of 43-A1, 39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%. The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks), none of the patient in our series had a delayed or non-union. Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°). The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score, there were no cases with poor score.@*CONCLUSION@#Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome. Wound complications related to plating can be avoided but meticulous surgical technique is key to avoid malunion.

Epidemiology of inpatient tibia fractures in Singapore - A single centre experience / 中华创伤杂志(英文版)

PURPOSE@#There are no previous epidemiological studies to represent the trends of tibia fractures in the urban setting. The purpose of our study was to provide unique epidemiological information on the incidence of tibia fractures requiring admission in the urban population of Singapore.@*METHODS@#This is a retrospective review of clinical and radiological records encompassing three years period from 2012 to 2014 in a tertiary hospital in Northern Singapore, which covers an adult population of 550,000. Clinical information included demographics, mechanism of injury, and Gustillo-Anderson classification. Radiological records were evaluated by two of the authors and fractures were classified using the AO classification after consensus was reached.@*RESULTS@#There were 214 cases of tibia fractures with a population incidence of 13 in 100,000. Among the tibia fractures, 47% were diaphyseal, 43% proximal and 10% distal. Majority of patients were males with a male to female ratio of 3 to 1. The mean age of females was 64 years while that of males was 40 years. The commonest mechanism of injury was road traffic accident, which contributed to 42% of cases, with motorcyclists making up 78% of all road traffic accidents. Compound fractures made up 23% of all fractures, most of which were Gustillo-Anderson type III; 69% of patients underwent surgical intervention.@*CONCLUSION@#The incidence of tibia fractures is 13/100,000 with a male-to-female ratio of 3:1. This incidence is lower than other studies, but the proportion of open fractures were surprisingly high at 23%. Distribution of fractures was unimodal with a peak in younger men and older women. This may signify a component of fragility among tibia fractures, especially proximal and distal fractures, which peaks above the age of 80 years old.

Intramedullary nailing versus plating for distal tibia fractures in adults: a systematic review / 中华创伤骨科杂志

Objective To systematically review the clinical efficacy and complications of in-tramedullary nailing (IMN) versus plating for distal tibia fractures in adults. Methods A comprehensive search was conducted for the randomized controlled trials from January 2005 to October 2016 on the IMN versus plating for distal tibia fractures in The Cochrane Library, Springer, Pubmed, Medline Embase, CNKI, Wanfang Data and manually as well. The quality of the included literature was evaluated accordingly. RevMan5.3 provided by Cochrane was used to analyze the data. Results A total of 7 randomized con-trolled trials (n=514) were included involving 514 participants (IMN: 267; Plating: 247). IMN achieved a significantly lower superficial infection incidence [MD=2.41, 95% CI (1.11, 5.23), P=0.03]. There were no significant differences between IMN and plating in deep infection [MD=1.43, 95% CI (0.51, 4.04), P=0.50], nonunion [MD=1.35, 95% CI (0.56, 2.38), P=0.51], malunion [MD=0.88, 95% CI (0.50, 1.57), P=0.67], delayed union [MD=0.69, 95% CI (0.26, 1.85), P=0.46],or removal of metal work [MD=1.05, 95% CI (0.81, 1.36), P=0.72]. Conclusion Since plating may lead to a significantly higher rate of superficial infection for adult distal tibial fractures than intramedullary nailing, special attention should be paid to aseptic manipulation during plating, and minimally invasive pro-cedures and soft tissue protection measures should be taken as far as possible.

A comparative study in patients with fractures of the lower limbs between rivaroxaban versus enoxaparin and its impact on bone healing time / Estudio comparativo en pacientes con fracturas de extremidades inferiores entre rivaroxaban versus enoxaparina como terapia profiláctica antitrombótica y su impacto en el tiempo de consolidación

Abstract: Background: Each year it is estimated in the United States an approximate of 8 million fractures; 5 to 10% develop delayed union or absence of periosteal new bone. There are several factors that can cause delay in fracture healing, among the well known, is the use of prophylactic antithrombotic therapy for deep vein thrombosis (DVT). DVT appears in 40 to 60% of the patients undergoing orthopedic surgery without prophylactic antithrombotic therapy. The goal of this study was to assess whether there is a difference in time of bone healing in lower limb fractures (femur and tibia) comparing rivaroxaban to enoxaparin as the prophylactic antithrombotic management. Material and methods: We present a retrospective observational and analytic study in a sample of cases. It is a cross-sectional study with patient data from the database of the American British Cowdray (ABC) Medical Center. We included patients with femur and tibia fractures under antithrombotic prophylactic management with rivaroxaban or enoxaparin during the period of January 2011 to December 2012. Our sample included 32 patients separated into two groups. Student's t-test was used for comparing parametric variables and the Mann-Whitney U test for nonparametric variables. Linear regression model was preformed considering the variables related to the time it took the fracture to heal. Results: All fractures consolidated in a time of 13 and 14 weeks for rivaroxaban and enoxaparin respectively (p = 0.67). Discussion: We found no difference in bone healing time for lower limb fractures in patients receiving antithrombotic prophylaxis treatment comparing rivaroxaban with enoxaparin.

Resumen: Antecedentes: En Estados Unidos se presentan aproximadamente ocho millones de fracturas anuales y de ellas entre cinco y 10% desarrollan retraso o ausencia en la consolidación ósea. Existen diferentes factores bien conocidos que promueven este retraso, entre los cuales se encuentra el uso de los antitrombóticos como terapia profiláctica de la trombosis venosa profunda, la cual aparece de 40 a 60% en pacientes que no los utilizan y son sometidos a cirugías ortopédicas. El objetivo de este estudio fue evaluar si existe diferencia en el tiempo de consolidación de las fracturas de los huesos de las extremidades pélvicas (fémur y tibia) en pacientes sometidos a terapia profiláctica antitrombótica comparando rivaroxabán con enoxaparina. Material y métodos: Presentamos un estudio descriptivo y analítico con muestreo a conveniencia de casos retrospectivos. Es un estudio transversal con datos recolectivos. Se revisó la base de datos del Centro Médico ABC y se incluyeron pacientes con diagnóstico de fracturas de fémur y tibia sometidos a manejo profiláctico antitrombótico con rivaroxabán o enoxaparina durante el periodo de Enero 2011 a Diciembre de 2012. La muestra total se constituyó de 32 pacientes divididos en dos grupos. Se utilizó la prueba T de Student para comparar variables paramétricas y la prueba U de Mann-Whitney para las no-paramétricas. Se realizó un modelo de regresión lineal considerando las variables relacionadas con el tiempo de consolidación ósea. Resultados: Todas las fracturas consolidaron, presentando un tiempo de 13 semanas con rivaroxabán y de 14 semanas (p = 0.67) con enoxaparina. Discusión: No encontramos diferencia en el tiempo de consolidación de las fracturas de los huesos de las extremidades pélvicas (fémur y tibia) en pacientes que reciben antitrombóticos como profilaxis comparando rivaroxabán con enoxaparina.

A biomechanical study of new developed external fixation system on tibia fracture / 局解手术学杂志

Objective To test the biomechanical properties and evaluate the feasibility of the new developed external fixator system,so as to provide reliable theoretical basis for further clinical research.Methods The tibia of 10 fresh male cadaver were made into fracture model.In order to fix the fracture of tibia,experimental group were treated with the new developed external fixator system and the control group were treated with the Hoffman 2 external fixator which was used in clinic commonly.Then axial compression and horizontal torsion test were made on tibia fracture model.The test results were recorded and statistically analyzed.Results There was no statistical difference on the aspect of the ability to resist axial compression and horizontal torsion between the experimental group and the control group(P >0.05). The new developed external fixator system could meet the criterion in clinical application.Conclusion The new developed external fixation system can meet the requirement of biomechanics on fixing the fracture of bone,and it can greatly simplify and diversify the clinical applica-tion of external fixation device.

Clinical application of double support plate via posteromedial approach in the treatment tibial plateau fracture of posterior column / 天津医药

Objective To observe the clinical effects of double support plate via posteromedial approach in the treat?ment of tibial plateau fracture of posterior column. Methods A total of 21 cases of tibial plateau fracture in closed posterior column with an average age of 34.6 (range, 21 to 56) years old were treated using double support plate through posteromedial approach from January in 2010 to January in 2013(16 males and 5 females). Among all, 4 cases were combined with lateral column fracture and 17 cases were three column fracture. Wound healings were observed after operation. X-ray examina?tions were performed at 2 weeks, 3 months, 4 months, 6 months and 12 months after operation as well as at last follow up. The averaged healing time was calculated. Changes of tibial plateau angle and posterior slope angle were compared between time points at 2 weeks after operation and at last follow up. Rasmussen knee score criteria was employed to assess knee joint recovery. Results The mean follow-up was (18.2 ± 1.8) months. No infection was reported. The average fracture healing time was 3.8(3.8±0.6)months. There was no significant difference between tibia plateau angle and posterior slope angle be?tween time points at 2 weeks after operation and at last follow-up (P<0.05). According to Rasmussen knee score criteria at last follow-up, 13 cases were graded as excellent, 6 cases as good, and 2 case as fair, with an excellent and good rate of 90.5%. Conclusion With posteromedial approach, the fractures of medial column, posteromedial and posterolateral of pos?terial column can be exposed well. Using double support plates to fix posteromedial and posterolateral of posterior column fracture can effectively prevent loss of reduction and the function of knee recovered well postoperatively.

Retrograde soleal muscle with periosteum-cortex bone flap for treatment of Gustilo type Ⅲ distal tibial fractures / 中华创伤杂志

Objective To design a new combination transplantation method for management of Gustilo type Ⅲ distal tibial fractures.Methods The study involved 46 patients with Gustilo type Ⅲ distal tibial fractures ( 16 patients with Gustilo type Ⅲa fractures and 30 with Gustilo type Ⅲ b fractures)treated with retrograde soleal muscle with periosteum-cortex bone flap grafting from October 1998 to November 2008.There were 29 males and 17 females at an average age of 36 years (range,23-77 years).After the complement of fracture fixation,the attachment point of the medial half of the soleal muscle to the upper tibia was exposed.The periosteum together with thin cortex bone flap on the surface of tibia was incised.The soleal muscle with pefiosteum-cortex bone flap was turned downwards to cover the bone and the soft tissue defects.Results All patients were followed up for average 26 months ( range,30-46 months).Nine patients were treated with autologous iliac grafts and the other 37 patients underwent periosteum-cortex bone flap grafting.The mean time of bone union was 22 weeks ( range,18-37 weeks).One patient had infection of external fixation pin tract.The ankle joint movement of 38 patients was recovered to a normal or nearly normal,but the other eight patients had limitation in the activity.All patients were able to walk normally after operation,but five patients felt powerless when running.Conclusions Retrograde soleal muscle with periosteum-cortex bone flap grafting is characterized by simple operation,simultaneous reconstruction of bone and soft tissue defects and promotion of fracture healing,and hence is a feasible and effective method to repair bone and soft tissue defects in Gustilo type Ⅲ distal tibial fractures.

Intramedullary interlocking nail and minimal invasive internal fixation in the treatment of type C2 fractures of tibia / 中国矫形外科杂志

[Objective] To summarize the clinical characteristics of type C2 fractures of tibia,to study the surgical management and its results of type C2 fractures of tibia through intramedullary interlocking nail and minimal invasive internal fixation.[Method]From May 2000 to March 2006,30 patients of type C2 fractures of tibia were treated surgically through intramedullary interlocking nail and minimal invasive internal fixation.The patients included 21 men and 9 women with a mean age of 41.5 years(range 20~ 63 years).Forteen closed fractures were treated by the limitedly reamed interlocking intramedullary nail.Sixteen open fractures(including Grade I and Ⅱ injuries)were treated by the unreamed interlocking intramedullary nail.All fractures were fixed statically.The mean time from the injury to surgery was 4.5 days(rang,2 hours~ 12 days).[Result]Mean follow-up period was 16.5 months(7~ 21 months).All patients had bony union within 4~9 months,with the average time of bone union being 6.2 months.The function recovery was evaluated by Johner-Wruch system in which 24 cases were excellent,3 cases were good.No osteofascial compartment syndrome of the lower leg,deep part infection,anterior kneeache,broken nails and screws and malunion were found in this series.Two cases were found delay union.[Conclusion]The type C2 fractures of tibia are often caused by high energy injuries.Most of type C2 fractures happen at the field of tibial shaft.The treatment of type C2 fractures of tibia using intramedullary interlocking nail and minimal invasive internal fixation has advantages of easy operation,less trauma,rigid fixation,high healing rate,lower complications,and satisfactory effect.It is a perfect method.The standard and less invasive operative methods should be paid more attention.

Stress Fracture in Posterior Aspect of the Tibia

PURPOSE: To determine correlation between stress fracture of the posterior tibia and flexor digitorum longusmuscle injury caused by athletic or sporting activity during adolescence. MATERIALS AND METHODS: Eleven casesdiagnosed as stress fracture after X-ray and MR imaging of the lower leg were reviewed. With regard to eachfracture, the following features were noted: age, sex, and athletic or sporting activity of the patient, and site.Using MR imaging techniques, axial and sagittal T1 and T2 weighted images were obtained in all cases and T1-GdDTPA images in seven. RESULTS: The activities undertaken were running (n=3), football (n=2), ballet (n=2),taekwando (n=1), badminton (n=1), field hockey (n=1), and basketball (n=1). MR images revealed localized corticalthickness (n=11), linear intramedullary callus showing a low signal on T1 and T2 weighted images (n=9), marrowhyperemia (n=7), and flexor digitorum longus muscle injury showing a high signal on T1-Gd DTPA and T2 weightedimage (n=7). CONCLUSION: Stress fracture of the posterior tibia might be induced by flexor digitorum longusmuscle activity induced by athletic or sporting activities during adoleseence.

MR Imaging Findings of Fatigue Fractures of Lower Extremity in Young Soldiers

PURPOSE: To evaluate the MR imaging findings of fatigue fractures of the lower extremity in young soldiers. MATERIALS AND METHODS: In 22 cases of fatigue fractures of the lower extremity in young soldiers proven byclinical findings and radiological follow up, the MRI findings were retrospectively evalvated. All patients weremale and aged between 19 and 21 years. As seen on MRI, the bone marrow edema, intramedullary low signal intensityband, cortical fracture line, periosteal reaction, surrounding soft tissue edema, and enhancement pattern wereanalyzed and the site of involvement was determined in the axial plane. RESULTS: The locations of fatiguefractures of the lower extremity were the tibia (n=12), fibula (n=8), femur (n=1) and second metatarsus (n=1). Alloccurred in diaphyses: the junction of the proximal and middle (n=10), middle (n=9), proximal (n=2), and distalshaft (n=1). The sites of involvement were the posteromedial (n=6) and medial side (n=6) of the tibia, and theentire portion of the fibula(n=5) in the axial plane. MRI findings were bone marrow edema in 20 cases,intramedullary low signal intensity band in 14 (which were continuous with the cortex or cortical fracture line),cortical fracture line in 13, and periosteal reaction and surrounding soft tissue edema in all. Ongadolinium-enhanced images, enhancement was seen in the bone marrow in 19 cases, in the subperiosteal region in18, and in the surrounding soft tissue in 22. CONCLUSION: In fatigue fractures of the lower extremity in youngsoldiers, the main locations were the tibia and fibula, and characteristic MR imaging findings were intramedullarylow signal intensity bands, which were continuous with the cortex or cortical fracture line and often accompaniedby bone marrow edema, periosteal reaction, and surrounding soft tissue edema.

Treatment of tibial plateau fracture with minimal invasion spinal surgery in 36 cases / 中华创伤杂志

Objective To investigate the clinical results of minimal invasion spinal surgery (MISS) in treating tibial plateau fractures to provide best procedure for such treatment.Methods The study involved 36 cases with tibial plateau fractures resulted from traffic injury,fall-from-height injury and strain injury including 24 males and 12 females at age of 19-65 years (average 42.6 years).According to Schatzker classification,there were seven cases of typeⅠ,five typeⅡ,five typeⅢ,five type IV,sev- en typeⅤand seven typeⅥ.All cases were treated by different methods of MISS.Results Follow up for 8-24 months in 35 cases showed fracture healing within 3-4 months,without severe complications such as poor wound healing,infection or osteofascial compartment syndrome.Meanwhile,no traumatic knee osteoarthritis,inversion or eversion of the knee were found.The mean range of knee motion was 94?,with fine knee function in 32 cases (91.4%) according to Merchant score.Conclusions Treatment of tibi- al plateau fractures should adopt limit incision,indirect reduction and biofixation to take place widespread exposure and rigid plate fixation.MISS is safe and effective for tibial plateau fractures.

Valgus Deformity after Non-displaced Fracutre of the Proximal Tibia in Children / 대한정형외과학회잡지

Tibia valga has been described as a consequence of non-displaced fractures of the proximal metaphysis of the tibia in children. There has been considerable speculation about the cause of this deformity. Four cases of estabilished valgus deformity following injury to the proximal tibia metaphysis in children are presented. In one case of them, it was showed that an infolding of a portion of the periosteum of the tibiain medial opening of this fracture. It was treated by surgical clearence of the infolding periosteum and varus osteotomy with slight over-correction and partial fibulectomy. The recurrence of valgus deformity was absent during post operative one year. In another case, roentgenogram showed an asymmetrical growth arrest line of the pmximal tibia. The presence of asymmetrical growth arrest lines in the pmximal metaphysis of the tibia demonstrates that the valgus deformity in this patient was caused by overgrowth of the medial portion of the proximal tibial epiphyseal plate. In the remainder, we observed the deformity developed without any specific cause.

Clinical Study for Open Fracture of Tibia / 대한정형외과학회잡지

118 Cases of open tibia fractures treated in Chosun university Hospital were survayed and evaluated. Results: 1. The cases are predominantly male(80%) and most often in their 4th decade. 2. They were very often comminuted(44%) 3. Treatments consists of debridement with or without initial internal(plate and screws) or external (Hoffmann's device) fixations. The end results seems to be better in cases with initial fixations of bone(internal or external)than those treated with initial debridement and plaster cast immobilization only and osteosynthesis later.

TIBIAL FRACTURES TREATED WITH INTERLOCKING INTRAMEDULLARY PIN (REPORT OF 33 PATIENTS) / 解放军医学杂志

Thirty three tibial fractures treated with interlocking intramedullary nail(IMN) were reviewed. Of all the patients, 16 were fixed with reamed IMN, and 17 with nonreamed IMN. There were 22 closed and 11 open fractures. Twenty seven patients were followed up for an average of 17.9 months (4 to 31 months). Of all the patients, 22 healed in 6 months, delayed healing occurred in 1,and in 1 the distal locking screw was broken. In the close fractures, the mean time from fracture to operation was 3.55 days (from the injury day to 27 days) , and in the open fractures operation was all done on the day of injury. Nonreamed IMN was used in 12 closed fractures (54.5%, 12/22 ) , and reamed IMN was used in 4 open fractures (36.3%, 4/11). There was no postoperative compartment syndrome or infection. The interlocking intramedullary pin is indicated for the tibia fractures, and early operation is feasible . The nonreamed interlocking intramedullary pin is suitable for open fractures and multi injuries.