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Rev. bras. ortop ; 57(4): 667-674, Jul.-Aug. 2022. tab, graf
Article in English | LILACS | ID: biblio-1394884


Abstract Objective To analyze the results of clinical, radiological, and functional outcomes of tibial plateau fracture (Schatzker Type V, VI) treated with Illizarov ring external fixator with or without minimum opening. Methods A total of 52 tibial plateau fractures of type V, VI were treated with Ilizarov ring external fixator with or without mininum internal fixation were studied. Functional outcome assessment was done using the American Knee Society (AKS) score with clinical, radiological union, and complications were analyzed. Results There were 37 (71.15%) male and 15 (28.84%) female patients, with a mean age of 39.07 ± 12.58 years old. Road traffic accidents (RTAs) were the major cause of fracture, accounting for 32 cases (61.53%) followed by fall injury, with 16 cases (30.76%), and direct impact, with 4 cases (7.69%). Twenty-one (40.38%) cases were type V and 31 (59.61%) cases were type VI fractures, and there were 24 (46.15%) cases of open fracture. The mean AKS score of Type V and Type VI fractures were 82.8 and 80.70, respectively, but this was statistically not significant at p<0.05. The mean AKS score of closed and open fractures were also statistically not significant at p<0.05. Conclusions For Schatzker Types V and VI complex tibial plateau fractures, Ilizarov external fixation is a safe, cost-effective and efficient treatment method that presents a satisfactory outcome.

Resumo Objetivo Analisar os resultados clínicos, radiológicos e funcionais da fratura do planalto tibial (Schatzker Tipo V, VI) tratada com fixador externo do anel Illizarov com ou sem abertura mínima. Métodos Um total de 52 fraturas do planalto tibial dos tipos V e VI foram tratadas com fixador externo do anel Ilizarov com ou sem fixação interna mínima. A avaliação do desfecho funcional foi feita utilizando-se o escore da American Knee Society (AKS, na sigla em inglês) com consolidação clínica, radiológica e complicações encontradas. Resultados Foram 37 (71,15%) pacientes do sexo masculino e 15 (28,84%) do sexo feminino, com idade média de 39,07 ± 12,58 anos. Acidentes de trânsito (ATs) foram a principal causa das fraturas, contabilizando 32 casos (61,53%), seguidos por lesão por queda, com 16 casos (30,76%), e impacto direto, com 4 casos (7,69%). Foram 21 (40,38%) casos de fraturas tipo V, 31 (59,61%) casos do tipo VI e 24 (46,15%) casos de fratura exposta. Os escores médios da AKS para as fraturas tipo V e VI foram de 82,8 e 80,70, respectivamente, mas não foi estatisticamente significativo em p <0,05. O escore médio da AKS para fraturas fechadas e abertas também não foi estatisticamente significativo em p <0,05. Conclusões Para a fratura do planalto tibial complexa dos tipos V e VI de Schatzker, a fixação externa de Ilizarov é um método de tratamento seguro, econômico e eficiente que resulta em resultados satisfatórios.

Humans , Male , Female , Tibial Fractures , External Fixators , Outcome Assessment, Health Care , Ilizarov Technique
Rev. Assoc. Med. Bras. (1992) ; 68(7): 893-897, July 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1394585


SUMMARY OBJECTIVE: This study aimed to investigate the factors associated with behavioral problems in children with congenital pseudarthrosis of the tibia. METHODS: Random sampling is utilized to obtain a sample of 90 patients. The behavioral problems of the patients are detected by Achenbach Children's Behavior Scale. Parental emotional problems are investigated by the Self-Rating Depression Scale and Self-Rating Anxiety Scale. RESULTS: The results demonstrate that the detection rate of behavioral problems in children with congenital pseudarthrosis of the tibia is 53.3% (48/90). Among these behavioral problems, an abnormal rate is higher in the four dimensions: thinking, violation of discipline, social interaction, and aggression. The anxiety and depression scores of caregivers are statistically higher in the abnormal group than in the normal group. The results of the multivariate analysis show that the anxiety degree of the parents had a significant impact on the behavior of the children. CONCLUSIONS: Children with congenital pseudarthrosis of the tibia are facing the issues of high rates of behavioral problems. Parents of children with congenital pseudarthrosis of the tibia had higher levels of anxiety and depression than parents of normal children. The anxiety and depressive state of mind of parents or caregivers had a significant impact on the behavior of children with congenital pseudarthrosis of the tibia.

Rev. bras. ortop ; 57(3): 502-510, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1388008


Abstract Objective The Schatzker classification is the most used for tibial plateau fractures. Kfuri et al.12 reviewed Schatzker's initial classification describing in more detail the involvement of the tibial plateau in the coronal plane, allowing a better understanding of the fracture pattern and a more accurate surgical planning. The objectives of the present study are to evaluate the interobserver agreement of these classifications and to evaluate the influence of the experience of the observer on the reproducibility of the instruments. Methods An observational and retrospective study was conducted by evaluating the radiological study of 20 adult individuals with tibial plateau fractures, including radiographs and computed tomography (CT). The fractures were classified once by 34 examiners with varied experience (24 specialists and 10 residents in Orthopedics and Traumatology), according to the Schatzker classification and to the modification proposed by Kfuri. The Fleiss Kappa index was used to verify interobserver agreement. Results The interobserver agreement index was considered moderate for the Schatzker classification (κ = 0.46) and mild for the Kfuri modification (κ = 0.30). The Schatzker classification showed moderate agreement, with κ = 0.52 for residents and κ = 0.45 among specialists. The Kfuri classification showed mild agreement, with Kappa values for residents and specialists of 0.39 and 0.28, respectively. Conclusion The Schatzker classification and the classification modified by Kfuri presented moderate and mild interobserver agreement, respectively. In addition, the residents presented higher agreement than the specialists for the two systems studied.

Resumo Objetivo A classificação de Schatzker é a mais utilizada para as fraturas do planalto tibial. Kfuri et al.12 revisaram a classificação inicial de Schatzker descrevendo com mais detalhes o envolvimento do planalto tibial no plano coronal, permitindo uma melhor compreensão do padrão de fratura e um planejamento cirúrgico mais acurado. Os objetivos do presente estudo são avaliar a concordância inter-observador dessas classificações e avaliar a influência da experiência dos observadores na reprodutibilidade dos instrumentos. Métodos Foi realizado um estudo observacional e retrospectivo, por meio da avaliação do estudo radiológico de 20 indivíduos adultos com fraturas do planalto tibial, incluindo radiografias e tomografia computadorizada (TC). As fraturas foram classificadas 1 vez por 34 examinadores com experiência variada (24 especialistas e 10 residentes em Ortopedia e Traumatologia), de acordo com a classificação de Schatzker e com a modificação proposta por Kfuri. O índice Kappa de Fleiss foi usado para verificar a concordância interobservadores. Resultados O índice de concordância inter-observador foi considerado moderado paraa classificação de Schatzker (κ = 0,46) e leve para a modificação de Kfuri (κ = 0,30). A classificação de Schatzker apresentou concordância moderada, com κ = 0,52 para residentes e κ = 0,45 entre os especialistas. A classificação de Kfuri apresentou concordância leve com valores de Kappa para residentes e especialistas de 0,39 e 0,28, respectivamente. Conclusão A classificação de Schatzker e a classificação modificada por Kfuri apresentaram concordância interobservadores moderada e leve, respectivamente. Além disso, os residentes apresentaram concordâncias superiores aos especialistas para os dois sistemas estudados.

Humans , Adult , Tibial Fractures , Reproducibility of Results , Knee Injuries , Knee Joint/surgery
Article in Chinese | WPRIM | ID: wpr-939993


ObjectiveTo investigate the changes of bone mineral density of distal femur and proximal tibia in patients with spinal cord injury. MethodsNine inpatients with spinal cord injury in Beijing Bo'ai Hospital for rehabilitation from November, 2018 to January, 2021 were recruited. The bone mineral density of distal femur, proximal tibia, total hip and femoral neck at admission and six months after admission was measured. ResultsCompared with the results of admission, the bone mineral density of distal femur, proximal tibia, total hip and femoral neck decreased significantly six months after admission (∣Z∣ > 2.265, P < 0.01). The percentage of decreased bone mineral density in the femoral neck was inversely correlated with the lower extremity movement score at the second measurement (r = -0.515, P = 0.035). ConclusionWithin one year after the onset of spinal cord injury, the bone mineral density of distal femur and proximal tibia decreases.

Chinese Journal of Orthopaedics ; (12): 594-602, 2022.
Article in Chinese | WPRIM | ID: wpr-932870


Objective:To investigate the relationship between anterior tibial translation (ATT) and bony morphology around the knee after anterior cruciate ligament (ACL) injury.Methods:A total of 67 patients diagnosed with acute ACL injury without any meniscal lesions were enrolled in this study between September 2019 and August 2020. Preoperative magnetic resonance imaging (MRI) scans were used to measure the ATT of the lateral compartment, and bony morphology was assessed by measuring lateral femoral condyle (LFC) length, LFC height, lateral tibial plateau (LTP) length, LTP slope and by calculating the following ratios: LFC ratio (LFC length/LFC height), knee extension ratio (LFC length/LTP length), and knee flexion ratio (LFC height/LTP length). The status of the anterolateral ligament (ALL) was assessed by preoperative MRI scans and classified as completely injured (44 patients), partially injured (19 patients), or intact (4 patients). The ATT was compared between patients with completely injured ALL and those with partially injured or intact ALL. Pearson correlation analysis between the ATT and each bony variable was performed in ALL-completely-injured patients and ALL-partially-injured or intact patients.Results:Of the 67 patients, 33 were male and 34 were female, with a mean of age 31.7±9.7 years (range 15-47 years). The average of time interval between ACL injury and MRI examination was 26.0±22.0 days (95% CI: 20.7, 31.4 d). The ATT of the lateral compartment was 5.6±4.0 mm (range, -4.9-16.2 mm), the average of LFC length was 37.3±2.5 mm (range, 30.5-43.2 mm), the average of LFC height was 37.4±3.6 mm (range, 30.6-46.3 mm), the average of LTP length was 46.9±4.1 mm (range, 39.0-56.8 mm), the average of LTP slope was 6.3°±3.1° (range, -3.7°-11.6°), LFC ratio was 100.4%±8.1% (range, 84.1%-119.0%), knee extension ratio was 80.0%±5.8% (range, 66.1%-96.3%), and knee flexion ratio was 80.0%±6.0% (range, 66.4%-93.8%). The ATT was greater in patients with completely injured ALL than in patients with partially injured or intact ALL (6.4±4.3 mm vs. 3.9±2.8 mm, t=2.52, P=0.014). The ATT was negatively correlated with LFC height ( r=-0.43, P<0.001) and LTP length ( r=-0.35, P=0.004) and was positively correlated with LFC ratio ( r=0.48, P<0.001), knee extension ratio ( r=0.36, P=0.003), and LTP slope ( r=0.29, P=0.018). All these correlations were still statistically significant in patients with complete ALL injury ( P<0.05), but were no significant in patients with partial ALL injury or intact ALL ( P>0.05). Conclusion:Bony morphology of the distal femur and proximal tibia was associated with ATT after ACL injury. Such an association was more dramatic in patients with a complete ALL injury.

Chinese Journal of Orthopaedics ; (12): 272-280, 2022.
Article in Chinese | WPRIM | ID: wpr-932832


Objective:To evaluate the safety and short-term clinical postoperative functional outcomes of a novel 3D-printed porous prosthesis of the distal tibia for the bone defect after tumorectomy.Methods:From December 2017 to December 2019, a total of eight patients diagnosed with malignant bone tumor of the distal tibia were enrolled in this study. All cases received standard preoperative chemotherapy, after which osteosarcoma resection was performed and ankle arthrodesis was reconstructed using a 3D-printed prosthesis developed by our medical center. The contact surface between the distal part of the prosthesis and the talus is a 3D-printed porous surface, which is conducive to ankle fusion. The length of the prosthesis is adjusted by the conical mounting part of the modular prosthesis. The proximal part of the prosthesis can be fixed either biologically or with bone cement. At postoperative follow-up, the function of the fused ankle was assessed by radiographs and the monthly Musculoskeletal Tumor Society (MSTS) score.Results:Of the 8 patients, 5 were male and 3 were female, aged 8-29 years (mean 16.1±7.4 years), including 7 osteoblastic osteosarcomas and 1 telangiectatic osteosarcoma. Among the procedures, the mean length of osteotomy was 16 cm (11-20 cm). The method of fixation of the proximal part of the prosthesis included one case with 3D-printing of trabecular metal bone, one case with autogenous fibular graft, and six cases with bone cement. All patients were followed up for 7-39 months (mean 15.6±10.5 months). The distal prosthesis and talus were completely fused in all cases. The mean fusion duration was 4.3±0.7 months. The mean MSTS score was 84.2%±3.0% (mean 80%-90%). No tumor recurrence, wound complications, or prosthesis loosening were observed during the follow-up period.Conclusion:The novel 3D-printed distal tibial prosthesis is a safe and effective technique for reconstruction of a massive bone defect after tumorectomy of a malignant bone tumor, with high fusion rate, few complications, and satisfactory postoperative function.

Article in Chinese | WPRIM | ID: wpr-932335


Objective:To explore the effects of 3 osteotomy methods on the bone healing in Ilizarov tibial bone transport.Methods:The data of 93 patients were retrospectively reviewed who had been treated by Ilizarov single-segment tibial bone transport at Department of Hand Surgery, The Second Hospital of Tangshan from December 2003 to April 2019. Minimally invasive osteotomy was performed in 16 patients [group A: 16 males with an age of (37.1±8.3) years; 5 cases of type Ⅱ and 11 ones of type Ⅲ by Gustilo classification], subperiosteal saw osteotomy in 57 patients [group B: 47 males and 10 females with an age of (39.1±11.8) years; 17 cases of type Ⅱ and 40 ones of type Ⅲ by Gustilo classification] and extraperiosteal wire saw osteotomy in 20 patients [group C: 19 males and one female with an age of (37.7±11.2) years; 18 cases of type Ⅱ and 2 cases of type Ⅲ by Gustilo classification]. The 3 groups were compared in terms of the bone healing index and the Association for the Study and Application of the Method of Ilizarov (ASAMI) functional scores.Results:The 3 groups were comparable because there was no significant difference in the preoperative general data between them ( P>0.05). All the patients were followed up for 19 to 50 months (average, 27.4 months). All patients achieved bony healing, and their associated complications were cured after corresponding treatments. There were no significant differences in the bone healing index between the 3 groups [(53.09±21.88) d/cm for group A, (59.97±33.29) d/cm for group B and (46.20±14.11) d/cm for group C] ( P>0.05). There were no significant differences either in the good to excellent rate by the ASAMI functional scores between the 3 groups (87.5% for group A, 89.5% for group B and 90.0% for group C) ( P> 0.05). Conclusion:All the 3 osteotomy methods may achieve good bony union, leading to similar bone healing indexes and postoperative functional scores.

Article in Chinese | WPRIM | ID: wpr-932334


Objective:To investigate the effects of a novel retrograde tibial nail (RTN) in the treatment of distal tibial fractures.Methods:A retrospective study was conducted in the 11 patients with distal tibial fracture who had been admitted to Department of Traumatic Orthopedics, The Second Affiliated Hospital, Hengyang Medical School from July 2020 to July 2021. There were 5 male and 6 females, aged from 18 to 70 years (average 54.7 years). By the AO/OTA classification, there were 7 extra-articular distal fractures (3 cases of type 43-A1, 3 cases of type 43-A2 and one type 43-A3) and 4 intra-articular fractures (2 cases of type 43-C1 and 2 cases of type 43-C2); by the Gustilo classification, there were 7 closed fractures and 4 open fractures (2 cases of type I and 2 cases of type Ⅱ). All fractures were fixated with a novel RTN. Deformities like distal tibial varus and valgus as well as fracture-related complications were observed after operation while the curative effects evaluated by the ankle-hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS).Results:This cohort was followed up for an average of 7.4 months (from 5 to 12 months). All patients obtained clinical union and recovered daily life and work. Radiographic evaluation showed no distal tibial varus or valgus. There were no such complications as postoperative infection, exposure of bone and internal fixation, compartment syndrome, or neurovascular lesion. According to the ankle-hindfoot score of AOFAS, 7 cases were excellent and 4 cases good.Conclusion:This novel retrograde tibial nail may result in good efficacy in the treatment of distal tibial fracture, but its advantages still need further verification.

Article in Chinese | WPRIM | ID: wpr-931710


Objective:To investigate the efficacy of opening wedge high tibial osteotomy (OWHTO) in the treatment of knee osteoarthritis, and analyze the related factors that affect its clinical efficacy.Methods:The clinical data of 80 patients with knee osteoarthritis who underwent OWHTO between December 2016 and May 2020 in Hospital of the Marine Police Corps of the Chinese People's Armed Police Force were retrospectively analyzed. These patients were divided into effective group ( n = 76) and ineffective group ( n = 4) according to clinical efficacy. The Visual Analogue Scale (VAS), the Hospital for Special Surgery Knee Score (HSS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used to assess the severity of knee osteoarthritis before and 3 months after surgery. The influential factors of clinical efficacy were analyzed. Results:VAS score, WOMAC score, HSS score, joint pain, joint function, joint range of motion, muscle strength, and flexion deformity of 80 patients post-surgery were improved compared with those pre-surgery ( t = 24.92, 21.45, 52.62, 15.87, 10.88, 15.28, 42.54, 11.07, all P < 0.05). After surgery, excellent outcomes were observed in 29 (36.25%) patients, good outcomes in 34 (42.50%) patients, fair outcomes in 13 (16.25%) patients, and poor outcomes in 4 (5.00%) patients. Body mass index, preoperative VAS score, and preoperative WOMAC score in the effective group were (24.10 ± 3.06) kg/m 2, (5.55 ± 1.57) points, and (36.96 ± 9.62) points, respectively, which were significantly lower than those in the ineffective group [(27.64 ± 3.62) kg/m 2, (7.87 ± 1.39) points, (47.95 ± 9.63) points, t = 2.23, 2.89, 2.22]. HSS score in the effective group was significantly higher than that in the ineffective group [(52.81 ± 3.71) points vs. (46.83 ± 3.69) points, t = 3.14, P < 0.05)]. Body mass index, preoperative VAS score, and preoperative WOMAC score were positively correlated with clinical efficacy ( r = 0.24, 0.31, 0.24, P < 0.05), and preoperative HSS score was negatively correlated with clinical efficacy ( r = -0.33, P < 0.05). Logistic regression analysis was performed to analyze the above markedly related factors. Preoperative HSS score was an independent protective factor of clinical efficacy of OWHTO, and body mass index and preoperative VAS score were risk factors of clinical efficacy of OWHTO. Conclusion:OWHTO can greatly improve knee function of patients with knee osteoarthritis and reduce postoperative pain. It should be noted that excessive obesity may affect the clinical efficacy of OWHTO, and preoperative VAS score and WOMAC score should be controlled in patients with excessive obesity.

Article in English | WPRIM | ID: wpr-928480


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.

Bone Plates/adverse effects , Fracture Fixation, Internal/methods , Fracture Fixation, Intramedullary/methods , Fracture Healing , Humans , Minimally Invasive Surgical Procedures/methods , Prospective Studies , Tibia/surgery , Tibial Fractures , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-928266


OBJECTIVE@#To investigate the effect of tibial coronal curvature on the alignment of tibial prosthesis in patients undergoing total knee arthroplasty (TKA).@*METHODS@#From July 2019 to April 2021, 100 patients with knee osteoarthritis were treated with total knee arthroplasty. Before operation, the full-length films of lower limbs were taken and the tibial bowing angle(TBA) was measured. TBA more than 2° was tibial bending, which was divided into tibial bending group and non bending group. There were 40 cases in tibial bending group, 9 males and 31 females, aged 56 to 84 years old with an average of (69.22±7.10) years. There were 60 cases in the non bending group, 19 males and 41 females, aged from 51 to 87 years old with an average of (70.80±7.21) years. The preoperative tibial length (TL) and medial proximal tibial angle (MPTA) were measured and compared between the two groups. The full-length X-rays of the lower limbs were taken again 3 days to 1 week after operation. The medial angle of the tibial component coronal aligement angle (TCCA) and the outilier rate of force line of the tibial prosthesis were measured and compared between the two groups. Pearson method was used to analyze the correlation between TCCA and age, TCCA and height, TCCA and weight, TCCA and BMI, TCCA and TBA, TCCA and TL, TCCA and MPTA; Spearman method was used to analyze the correlation between TCCA and gender, TCCA and Kellgren-Lawrence(K-L) grade.@*RESULTS@#All 100 patients successfully completed the operation and obtained satisfactory full-length X-rays in standing position. There was no significant difference in TL, MPTA and TCCA between bending group and non bending group(P>0.05). The outilier rate of force line in tibial bending group was 22.5%, and that in non bending group was 6.67%, the difference was statistically significant(P<0.05). The correlation study found that TCCA was strongly correlated with TBA(r=-0.702, P<0.01), weakly correlated with MPTA(r=0.311, P<0.01), and had no correlation with other parameters(P>0.05).@*CONCLUSION@#In patients with knee osteoarthritis undergoing total knee arthroplasty, tibial bending will lead to poor force line of tibial prosthesis. During operation, attention should be paid to osteotomy of proximal tibial vertical tibial mechanical axis and correct installation of prosthesis to avoid poor alignment of prosthesis.

Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee/adverse effects , Female , Humans , Knee Joint/surgery , Knee Prosthesis/adverse effects , Male , Middle Aged , Osteoarthritis, Knee/surgery , Retrospective Studies , Tibia/surgery
Article in Chinese | WPRIM | ID: wpr-927380


The clinical experience in treatment of somatalgia with "point-zone-strip stimulation technique" of acupuncture of professor ZHANG Wei-hua was summarized. Professor ZHANG integrates the theories of the cutaneous region of meridian, biaoben, "taking tender point as acupoint" and local holography as a whole in treatment of somatalgia. The "point-stimulation technique" of acupuncture (subcutaneous needling technique) is adopted for the painful site less than 3 cm in diameter, the "zone-stimulation technique" (surrounding needling technique) is for the site larger than 3 cm in diameter and the "strip-stimulation technique" (cubit-tibia needling technique) is for various acute and chronic somatalgia. These three needling techniques are applicable singly or in combination in clinical practice.

Acupuncture , Acupuncture Points , Acupuncture Therapy/methods , Meridians , Skin
Arch. méd. Camaguey ; 26: e8611, 2022. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1403282


RESUMEN Introducción: La fractura de Segond es una modalidad de las lesiones por avulsión que ocurren en la articulación de la rodilla. Objetivo: Brindar información actualizada sobre los elementos más importantes de esta entidad traumática. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 30 días (del primero al 30 de enero de 2021) y se emplearon las siguientes palabras: tibial plateau fractures, Segond fractures, avulsion fracture, anterolateral ligament a partir de la información obtenida se realizó una revisión bibliográfica de un total de 312 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos, se utilizaron 32 citas seleccionadas para realizar la revisión, 29 de los últimos cinco años. Resultados: La estructura anatómica involucrada en esta fractura es el ligamento anterolateral, el cuadro clínico de esta enfermedad se caracteriza por dolor e inflamación articular inmediatos que limitan la función articular. Para confirmar el diagnóstico los estudios imagenológicos de avanzadas son los más efectivos entre ellos la imagen de resonancia magnética, la que además ayuda a realizar el diagnóstico diferencial con otras afecciones. El tratamiento puede ser conservador o quirúrgico basado en indicaciones precisas, propias del enfermo y las características de la fractura. Conclusiones: La fractura de Segond traduce la presencia de inestabilidad tibiofemoral rotacional por lesión del ligamento cruzado anterior y las estructuras capsulares laterales. El diagnóstico de esta enfermedad es en lo fundamental imagenológico y el tratamiento quirúrgico está basado en técnicas de reparación o reconstrucción.

ABSTRACT Introduction: Segond's fracture is a modality of avulsion injuries that occur in the knee joint. Objective: To provide updated information on the most important elements of this traumatic entity. Methods: The search and analysis of the information was carried out in a period of 30 days (from January 1st to 30th, 2021) and the following words were used: tibial plateau fractures, Segond fractures, avulsion fracture, anterolateral ligament. From the information obtained, a bibliographic review of a total of 312 articles published in the databases PubMed, Hinari, SciELO and Medline was carried out using the search manager and reference manager EndNote, of which 32 selected citations were used to carry out the review, 29 of the last five years. Results: The anatomical structure involved is the anterolateral ligament, the clinical symptoms of this entity is characterized by immediate joint pain and inflammation that limits joint function. To confirm the diagnosis, advanced imaging studies are the most effective, including magnetic resonance imaging, which also helps to make the differential diagnosis with other conditions. Treatment can be conservative or surgical based on precise indications specific to the patient and the characteristics of the fracture. Conclusions: Segond's fracture reflects the presence of rotational tibiofemoral instability due to injury to the anterior cruciate ligament and the lateral capsular structures. The diagnosis of this entity is fundamentally imaging and surgical treatment is based on repair or reconstruction techniques.

Rev. cuba. med. mil ; 51(3): e1876, 2022. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1408854


RESUMEN Introducción: La fractura de huesos largos es común, la de tibia presenta una elevada incidencia. No solo es frecuente, sino que a menudo es difícil de tratar. Su localización subcutánea provoca complicaciones como fractura abierta, pseudoartrosis y consolidación defectuosa. Objetivo: Determinar las características clínicas y epidemiológicas de los pacientes con fractura abierta de tibia, tratados con fijación externa. Método: Se realizó un estudio descriptivo transversal. El universo estuvo constituido por 134 pacientes con diagnóstico de fractura abierta de tibia. Se escogió a 64 lesionados que cumplieron con los criterios de inclusión. Se analizaron las variables edad, sexo, etiología, localización anatómica, clasificación y trazo de la fractura, además de tipo de fijador externo utilizado y complicaciones. Para el análisis de los datos se utilizaron frecuencias absolutas y relativas como medidas resumen. Resultados: El grupo de edad más afectado fue el de 28-37 años, con el 60,9 % del total. Hubo predominio del sexo masculino, para el 95,3 %. Predominó el accidente automovilístico como causa, con un 54,7 %. El fijador externo Ilizarov es el modelo más utilizado para tratar la fractura abierta de tibia y las complicaciones asociadas, para un 89,7 %. Conclusiones: En pacientes con fractura abierta de tibia predomina en el sexo masculino, entre la tercera y cuarta década de la vida; los accidentes de tránsito son la causa principal y el fijador externo Ilizarov es el modelo más utilizado para tratar la fractura abierta de tibia y las complicaciones asociadas.

ABSTRACT Introduction: Long bone fractures are common; among them the tibia presents a high incidence. They are not only common, but often difficult to treat. Its subcutaneous location causes complications such as open fractures, pseudoarthrosis and defective consolidations. Objective: To determine the clinical-epidemiological characteristics of patients with open fracture of the tibia treated with external fixation. Method: A cross-sectional descriptive study was carried out. The universe consisted of 134 patients with a diagnosis of open fracture of the tibia. Sixty-four injured patients who met the inclusion criteria were chosen. The variables age, sex, etiology, anatomical location, classification and fracture line were analyzed, in addition to the type of external fixator used and complications. Results: The most affected age group was 28-37 years old, with 60.9 % of the total. There was a predominance of the male sex for 95.3 %. The car accident prevailed as the cause of the injury with 54.7 %. The Ilizarov external fixator is the most used model for 89.7 % to treat open fracture of the tibia and associated complications. Conclusions: The open fracture of the tibia predominates in males between the third and fourth decade of life; traffic accidents are the main cause of this traumatic injury, and the Ilizarov external fixator is the most widely used model for treating open tibial fractures and associated complications.

Int. j. morphol ; 40(4): 1035-1042, 2022. ilus, tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1405240


SUMMARY: Peripheral nerve damage (PNI) can cause demyelination, axonal degeneration and loss of motor and sensory function. Melatonin with its antioxidative effect, has been reported to reduce scar formation in nerve injury, take a role in repair process by suppressing fibroblast proliferation in the damaged area. It was aimed to investigate the effect of melatonin in the repair of peripheral nerve damage and the relationship between S100 proteins and angiogenic regulation. Wistar albino rats were divided into 3 groups. In the Defect group, 6 mm tibial bone defect using a motorized drill was created and kept immobile for 28 days. In Defect + graft group, tibial bone defect with allograft treatment was applied and kept immobile for 28 days. In Defect + graft + Melatonin group, melatonin was administered to defect + allograft group. All rats were sacrified by decapitation, skin and tibia bone were removed then fixed with 10 % neutral buffered formalin and embedded in paraffin, sections were examined under light microscopy. In the Defect+Graft group, enlargement and occlusion of the vessels with degeneration of the epineural sheath, thickening of the endoneural sheath and mild hyperplasia of schwannocytus (Schwann cells) were remarkable. In the Defect+Graft+Melatonin group, the epineural sheath was tight and regular, the axonal structures were prominent in the endoneural area. Mild S100 expression was observed in Defect+Graft group in fibers of the endoneural region with a prominent expression in schwannocytus. In Defect+Graft+Melatonin group (10mg/kg), S100 expression was moderate in areas where schwannocytus proliferated and nerve-connective tissue sheaths were reconstructed. VEGF expression was moderate in endoneural, perineural and epineural connective tissue sheaths in the Defect+Graft+Melatonin group, with negative expression in blood vessel endothelial cells, but with a positive expression in schwannocytus. We conclude that with the application of melatonin; oxidative stress decreases, schwannocytus proliferation increases, having positive influence on nerve repair with the regulation of S100 signaling and angiogenetic structuring.

RESUMEN: El daño a los nervios periféricos puede causar desmielinización, degeneración axonal y pérdida de la función motora y sensorial. Se ha informado que la melatonina, con su efecto antioxidante, reduce la formación de cicatrices en lesiones nerviosas y desempeña un papel en el proceso de reparación al suprimir la proliferación de fibroblastos en el área dañada. El objetivo de este trabajo fue investigar el efecto de la melatonina en la reparación del daño de los nervios periféricos y la relación entre las proteínas S100 y la regulación angiogénica. Ratas albinas Wistar se dividieron en 3 grupos. En el grupo Defecto, se creó un defecto óseo tibial de 6 mm con un taladro motorizado y se mantuvo inmóvil durante 28 días. En el grupo Defecto + injerto, se aplicó tratamiento de defecto óseo tibial con aloinjerto y se mantuvo inmóvil durante 28 días. En el grupo Defecto + injerto + Melatonina, se administró melatonina al grupo defecto + aloinjerto. Todas las ratas fueron sacrificadas por decapitación, se extrajo la piel y el hueso de la tibia y luego se fijaron con formalina tamponada neutra al 10 % y se incluyeron en parafina, las secciones se examinaron bajo microscopía óptica. En el grupo Defecto+Injerto, fueron notables el agrandamiento y la oclusión de los vasos con degeneración de la vaina epineural, engrosamiento de la vaina endoneural e hiperplasia leve de los schwannocitos (neurolemnocitos). En el grupo Defecto+Injerto+Melatonina, la vaina epineural era estrecha y regular, las estructuras axonales eran prominentes en el área endoneural. Se observó expresión leve de S100 en el grupo Defecto+Injerto en fibras de la región endoneural con una expresión prominente en los schwannocitos. En el grupo Defecto+Injerto+Melatonina, la expresión de S100 fue moderada en áreas donde proliferaron los schwannocitos y se reconstruyeron las vainas de tejido conectivo nervioso. La expresión de VEGF fue moderada en vainas de tejido conectivo endoneural, perineural y epineural en el grupo Defecto+Injerto+Melatonina, con expresión negativa en células endoteliales de vasos sanguíneos, pero con expresión positiva en schwannocitos. Concluimos que con la aplicación de melatonina; disminuye el estrés oxidativo, aumenta la proliferación de schwannocitos, influyendo positivamente en la reparación nerviosa con la regulación de la señalización S100 y la estructuración angiogenética.

Animals , Rats , Tibia/pathology , Peripheral Nervous System Diseases/drug therapy , Melatonin/administration & dosage , Antioxidants/administration & dosage , Peripheral Nerves/drug effects , Tibia/innervation , S100 Proteins , Rats, Wistar , Vascular Endothelial Growth Factor A , Disease Models, Animal , Fibroblasts
Rev. Col. Bras. Cir ; 49: e20223301, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1406747


ABSTRACT Introduction: open tibial fractures are challenging due to the frequent severe bone injury associated with poor soft tissue conditions. This is relevant in low- and middle-income countries, mainly related to delayed definitive fixation and lack of adequate training in soft tissue coverage procedures. Due to these factors, open tibial fracture is an important source of disability for Latin American countries. Herein we sought to provide an epidemiological overview of isolated open tibial shaft fracture across seven hospitals in southern cone of Latin America. The secondary goal was to assess the impact on quality of life based on return-to-work rate (RWR). Methods: patients with an isolated open tibial shaft fracture treated in seven different hospitals from Brazil and Argentina from November 2017 to March 2020 were included in the study. Clinical and radiographic results were evaluated throughout the 120-day follow-up period. Final evaluation compared RWR with the SF-12 questionnaire, bone healing, and gait status. Results: Seventy-two patients were treated, 57 followed for 120 days and 48 completed the SF-12 questionnaire. After 120 days, 70.6% had returned to work, 61.4% had experienced bone healing. Age, antibiotic therapy, type of definitive treatment, and infection significantly influenced the RWR. Gait status exhibited strong correlations with RWR and SF-12 physical component score. Conclusions: Isolated open tibial shaft fractures are potentially harmful to the patient's quality of life after 120 days of the initial management. RWR is significantly higher for younger patients, no history of infection, and those who could run in the gait status assessment.

RESUMO Introdução: o tratamento de fraturas expostas isoladas da diáfise da tíbia (FEIDT) apresenta desafios por frequentemente associar severa lesão óssea com condições ruins de tecido mole, fatores relevantes em países de média e baixa renda, especialmente devido a atrasos na implementação da fixação definitiva e falta de treinamento adequado no manejo de tecidos moles. Consequentemente, FEIDTs representam importante fonte de incapacitação na América Latina. Este estudo objetivou apresentar uma visão geral das FEIDTs em sete hospitais do cone sul da América Latina. O objetivo secundário foi avaliar o seu impacto na qualidade de vida baseado na taxa de retorno ao trabalho (TRT). Métodos: foram incluídos no estudo pacientes com FEIDT tratados em sete hospitais de Brasil e Argentina entre novembro de 2017 e março de 2020. Resultados clínicos e radiográficos foram analisados num período de 120 dias. Avaliação final comparou TRT com o questionário SF-12, consolidação óssea e condições de marcha. Resultados: setenta e dois pacientes foram tratados, 57 seguidos por 120 dias e 48 completaram o questionário SF-12. Após 120 dias, 70,6% havia retornado ao trabalho, 61,4% tinha fratura consolidada. Idade, antibioticoterapia, tipo de tratamento definitivo e infecção influenciaram significativamente na TRT. A condição de marcha apresentou forte correlação com TRT e o componente físico do SF-12. Conclusão: FEIDTs são potencialmente deletérias à qualidade de vida dos pacientes 120 dias após o tratamento inicial. TRT é significativamente maior para pacientes mais jovens, sem história de infecção e que conseguem correr na avaliação da condição de marcha..

Rev. cuba. med. mil ; 50(4)dic. 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1408763


RESUMEN Introducción: Las luxaciones de rodilla son poco frecuentes, lo que hace que su combinación abierta, con fracturas de rótula y del tercio superior de la tibia, sea rara y grave. Constituye una entidad causada por traumas de alta energía y se asocia a otras lesiones. Objetivo: Presentar un caso raro y complejo de luxación femorotibial posterior abierta con fractura del polo inferior de la rótula y tercio superior de la tibia. Caso clínico: Paciente masculino de 37 años de edad, que ingresó en el servicio de ortopedia y traumatología, quien como consecuencia de un accidente de tránsito, presentó luxación femorotibial posterior con fractura abierta del polo inferior de la rótula y tercio superior de la tibia, grados III-B, en el inferior derecho. Fue intervenido quirúrgicamente de urgencia; se realizó amplio desbridamiento quirúrgico, reducción de la luxación, reparación primaria de las lesiones ligamentosas, patelectomía parcial, reparación del tendón rotuliano y fijación externa para la fractura del tercio superior de la tibia. El paciente evolucionó bien, sin infección de la herida quirúrgica y recuperación total a los 4 meses. Conclusiones: La combinación de luxación femorotibial posterior abierta, con fractura del polo inferior de la rótula y tercio superior de la tibia es rara y obedece a altas energías traumáticas, como los accidentes automovilísticos. La cirugía de urgencia y la profilaxis antimicrobiana, es el método eficaz para el tratamiento definitivo de esta lesión.

ABSTRACT Introduction: Knee dislocations are infrequent, which makes the combination with open fractures of the patella and the upper third of the tibia, rare and serious. It is an entity caused by high-energy trauma and is associated with other injuries. Objective: To present a rare and complex case of open posterior femorotibial dislocation with fracture of the lower pole of the patella and the upper third of the tibia. Clinical case: A 37-year-old male patient, who was admitted to the orthopedic and trauma service, who, as a consequence of a traffic accident, presented posterior femorotibial dislocation with an open fracture of the lower pole of the patella and upper third of the tibia. grades III-B, in the lower right. He underwent emergency surgery; extensive surgical debridement, dislocation reduction, primary repair of ligamentous injuries, partial patellectomy, patellar tendon repair, and external fixation were performed for the fracture of the upper third of the tibia. The patient evolved well, without infection of the surgical wound and full recovery at 4 months. Conclusions: The combination of open posterior femorotibial dislocation, with fracture of the lower pole of the patella and upper third of the tibia is rare and is due to high traumatic energies, such as motor vehicle accidents. Emergency surgery and antimicrobial prophylaxis is the effective method for the definitive treatment of this lesion.

Rev. Círc. Argent. Odontol ; 79(230): 24-28, dic. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1358462


Objetivos: Demostrar la utilidad y la facilidad técnica del injerto tibial en defectos óseos orales y maxilofaciales, para tenerlo como un recurso alternativo en la práctica general del cirujano oral y maxilofacial. Caso clínico: Se presenta un caso clínico con el uso de injerto óseo autólogo de tibia para el relleno de un defecto óseo a raíz de una lesión quística. Se realizó la exéresis de la patología quística por medio de un abordaje oral y posteriormente se recolectó hueso medular tibial a través de un abordaje medio al tubérculo anterior de la tibia, para poder colocarlo en el defecto óseo. Conclusión: El injerto de hueso medular de epífisis tibial representa un sitio de recolección de fácil acceso, del que se puede obtener una cantidad de hueso ideal para defectos de pequeño y mediano tamaño de la región maxilofacial, de baja morbilidad y con muy pocas complicaciones post-operatorias, lo que lo convierte en una alternativa para rellenos de cavidades óseas de gran utilidad (AU)

Objective: To demonstrate the utility and technical ease of the tibial graft in oral and maxillofacial bone defects so as to have it as an alternative resource in the general practice of the oral and maxillofacial surgeon. Case report: A clinical case is shown with the use of an autologous tibial bone graft to fill a bone defect as a result of a cystic lesion. The cyst was excised by an oral approach and the medial tibial bone was collected through a middle approach to the anterior tubercle of the tibia, to place it in the bone defect. Conclusion: The tibial epiphysis medullary bone graft represents an easily accessible collection site, from which an ideal amount of bone can be obtained for small and mediumsized defects of the maxillofacial region, with low morbidity and very few post-operative complications, which makes it a useful option for bone cavity filling (AU)

Humans , Female , Aged , Tibia , Dentigerous Cyst/surgery , Bone Transplantation , Reconstructive Surgical Procedures , Osteotomy , Surgical Flaps , Tooth Extraction , Dentigerous Cyst/diagnostic imaging , Mandible
Article in English | LILACS-Express | LILACS | ID: biblio-1374887


ABSTRACT Introduction: Clear cell chondrosarcomas are a rare type of low-grade chondrosarcoma. Unlike conventional chondrosarcomas, these tumors occur mainly in the epiphyses of long bones, especially in the proximal femur and proximal humerus. Given their lytic characteristics with a cystic appearance, they can be mistaken for bone cysts and diagnosed late. Diagnosis must be made based on histopa-thology and immunohistochemistry. Likewise, negativity for cytokeratins and anti-endomysial antibodies are tools to rule out the differential diagnosis of metastasis. The treatment of this low-grade chondral lesion is surgical, either with intralesional management or complete resection. Case presentation: This is the case of a 46-year-old woman who consulted the orthopedic oncology service of a quaternary care institution due to medial knee pain at the level of the proximal tibia for 8 months. Diagnostic imaging studies showed a cystic lesion in the lateral tibial plateau; a biopsy of the lesion was performed, and clear cell chondrosarcoma was diagnosed based on histopathology and immunohistochemistry. Surgical management included tumor-free resection margins and reconstruction of the bone defect with a structural allograft of the proximal tibia. The patient progressed satisfactorily. Conclusions: This was the case of a patient with a subtype of low-grade chondrosarcoma that is rare in incidence and location, who was diagnosed based on immunohistochemistry and treated surgically to achieve a successful limb salvage.

RESUMEN Introducción. El condrosarcoma de células claras es un subtipo de tumor poco frecuente del grupo de los condrosarcomas de bajo grado. A diferencia de los condrosarcomas convencionales, estos tumores se presentan principalmente en epífisis de huesos largos. Dadas sus características líticas de aspecto quístico, pueden confundirse con quistes óseos, por lo que su diagnóstico debe hacerse por histopatología e inmunohistoquímica mediante biopsia. Igualmente, la negatividad para citoqueratinas y anticuerpos antiendomisio es una herramienta para descartar el diagnóstico diferencial de metástasis. Su tratamiento es quirúrgico, bien sea con manejo intralesional o resección completa con márgenes libres. Presentación del caso. Mujer de 46 años quien consultó al servicio de ortopedia oncológica de una institución de IV nivel de atención por un cuadro clínico de 8 meses de evolución consistente en dolor en la cara medial de la rodilla izquierda a nivel de la tibia proximaluna. Se practicaron imágenes diagnósticas que mostraron una lesión quística en el platillo tibial lateral; se ordenó biopsia de la lesión, y mediante histopatología e inmunohistoquímica se diagnosticó condrosarcoma de células claras. Se realizó un manejo quirúrgico con resección de la lesión con márgenes libres y una reconstrucción del defecto óseo con un aloinjerto estructural de tibia proximal, con lo cual se obtuvo una evolución satisfactoria. Conclusiones. Se presenta el caso de una paciente con un subtipo de condrosarcoma de bajo grado infrecuente en su presentación y localización, quien fue diagnosticada mediante inmunohistoquímica y tratada quirúrgicamente para lograr un salvamento exitoso de su extremidad.

Acta ortop. mex ; 35(5): 461-464, sep.-oct. 2021. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1393808


Resumen: Introducción: La osteomielitis crónica es una enfermedad generalmente de origen infeccioso, la principal causa es postraumática, afecta el tejido óseo y el tejido circundante, el germen causal más frecuente es Staphylococcus aureus. El hueso más afectado es la tibia. Descripción del caso: Masculino de 42 años con diagnóstico de osteomielitis crónica de tibia, con secuelas de intervenciones quirúrgicas previas, múltiples tratamientos antibióticos y clasificación tipo IV B de Cierny-Mader. Material y métodos: Se optó por un manejo quirúrgico en dos tiempos. En el primer tiempo, desbridamiento óseo extenso y de partes blandas, colocación de perlas de cemento medicado con amikacina en cavidad medular y sistema de osteoclisis para irrigación con vancomicina. En el segundo tiempo, colocación de injerto óseo peroné libre, fijación y estabilización con tornillos, colocación de vidrio bioactivo en zonas de interface entre peroné estabilizado y cortical posterior de tibia. Resultados: Ante una osteomielitis crónica multitratada se tiene que individualizar y valorar alternativas de tratamiento; en este caso el manejo quirúrgico en dos tiempos, el uso de perlas de cemento, injerto óseo y el uso de vidrio bioactivo logró una erradicación de la infección y evolución clínica favorable con recuperación funcional de la extremidad afectada.

Abstract: Introduction: Chronic osteomyelitis is a disease usually of infectious origin. The main cause is post-traumatic, it affects the bone tissue and surrounding tissue, the most frequent causative agent is Staphylococcus aureus. The most affected bone is the tibia. Case description: A 42-year-old male with a diagnosis of chronic tibia osteomyelitis, with sequelae of previous surgical interventions, multiple antibiotic treatments, and type IV B classification by Cierny-Mader. Material and methods: Two-stage surgical management was chosen. Firstly, extensive bone and soft tissue debridement, placement of cement beads medicated with amikacin in the medullary cavity and osteoclast system for irrigation with vancomycin. In the second stage, free fibular bone grafting, fixation and stabilization with screws, bioactive glass placement in areas of interface between stabilized fibula and posterior tibial cortex. Results: Before a multitratada chronic osteomyelitis it is necessary to individualize and evaluate treatment alternatives, in this case the surgical management in two time, the use of medication beads, bone graft and the use of bioactive glass, achieved a complete eradication of the infection and favorable clinical evolution with optimal functional recovery of affected limb.