Compartment Syndrome following Intramedullary Nail Fixation in Closed Tibial Shaft Fractures

@#Introduction: Compartment syndrome complicating intramedullary nailing of closed tibia fractures has been described as early as the 1980s, but currently remains less described in literature compared to compartment syndrome directly following trauma. This study aims to review this potentially disabling complication and highlight the importance of timely diagnosis and management of compartment syndrome following fracture fixation, not just after fracture itself, via a review of three cases. Material and methods: A retrospective study of a series of three cases was conducted. The type of fracture, wait time to fixation, surgery duration, reaming, size of nail implant used, tourniquet time, and surgical technique were recorded. Time to diagnosis of compartment syndrome, compartment pressure if available, extent of muscle necrosis, reconstructive procedures performed, and post-operative complications were analysed. Results: The three cases following high-energy trauma from road traffic accidents presented from January to May 2010. Compartment syndrome was diagnosed clinically for all cases, between one to six days post-operatively and supported by elevated compartment pressure measurements in two of the three cases. Conclusion: This study advocates thorough clinical monitoring and maintaining strong clinical suspicion of compartment syndrome in patients even after intramedullary nail fixation of tibial shaft fractures to achieve timely limbsalvaging intervention. While intercompartmental pressure can be used to aid in diagnosis, we do not advise using it in isolation to diagnose compartment syndrome. Tendon transfer improves functional mobility and provides a good result in patients with severe muscle damage, while skin grafting sufficient in patients with minimal muscle damage.

Electric scooter injuries: Incidence and injury patterns at a level I trauma center / 中华创伤杂志(英文版)

PURPOSE@#Electric scooters (e-scooters) have become an increasingly popular mode of public transportation in recent years. As the incidence of related injuries rises, it is important to understand specific fracture patterns unique to e-scooters and electric bikes (e-bikes) to help guide management. The purpose of this study was to review the prevalence and describe specific fracture patterns of e-scooter and e-bike related injuries at the busiest level 1 trauma center in the borough of Manhattan.@*METHODS@#Chart review to determine mechanism of injury was performed on all patients for whom an orthopedic consult was requested from 1/1/2021 to 12/31/2021. All patients whose injuries were sustained due to an e-scooter or e-bike were further reviewed for demographics, injury characteristics including fracture pattern, and definitive injury management. Any patients who had an orthopedic consult placed for a reason other than an acute injury were excluded. Descriptive statistics are reported as frequency (percentage) for categorical variables and means for continuous variables.@*RESULTS@#Of the 1815 orthopedic consults requested, 1357 (74.8%) were for acute injury management. Of those with acute injuries, 119 (8.8%) sustained 136 e-scooter or e-bike related injuries. There were 92 (77.3%) males at an average age of (33.8 ± 15.7) years. Approximately one-fifth of all patients presented in June 2021 (26, 21.8%). There was a 9.2% rate of open fractures. The 136 injuries were evenly split between the upper and lower extremities, with 57 (47.9%) upper extremity, 57 (47.9%) lower extremity injuries, and 5 (4.2%) concomitant upper and lower extremity injuries. The most common fracture patterns were ankle fractures (16, 11.7%), followed by tibial shaft (14, 10.2%), tibial plateau (13, 9.5%), and radial head fractures (11, 8.0%). There was a 33.3% incidence of associated posterior malleolar fractures in the spiral tibial shaft fractures, 31.0% of posterior malleolar involvement and 18.8% of isolated vertical medial malleolar fractures in the ankle fractures, and 61.5% of posterior comminution in the tibial plateau fractures.@*CONCLUSION@#E-scooter and e-bike related injuries have a high incidence of tibial shaft fractures, ankle fractures, tibial plateau fractures, and radial head fractures. There should be a high index of suspicion for posterior and medial involvement in lower extremity fractures sustained due to e-scooter or e-bikes. Identifying specific fracture patterns seen in e-scooter and e-bike related mechanisms will help guide management of these injuries.

Augmenting locking plate with autologous bone graft for the treatment of nonunion of long bone fracture in the lower extremity with retaining of the original intramedullary nail / 中国骨伤

OBJECTIVE@#To explore clinical effect of attaching locking plate with bone grafting based on retaining the original intramedullary nail in treating non-union after intramedullary nail fixation of long shaft fractures of lower limbs.@*METHODS@#A retrospective study was conducted on 20 patients treated with non-union fractures after intramedullary nailing of long shaft fractures of lower limbs from June 2015 to June 2020. All patients were treated with the original intramedullary nailing and bone grafting from the iliac bone, and were underwent open reduction plate internal fixation and bone grafting for old fractures. Among them, 14 were males and 6 were females, aged from 35 to 56 years old with an average of (42.2±9.6) years old. Nine patients were femoral shaft fracture and 11 patients were tibial shaft fracture. According to characteristics of fracture end nonunion, 6 patients were stable/atrophic, 9 patients were unstable/large, and 5 patients were unstable/atrophic. The nonunion time ranged from 8 to 12 months with an average of(9.8±2.0) months after the initial surgery. Visual analogue scale (VAS), knee range of motion, bone healing time, complications and fracture-end healing were recorded before and at the latest follow-up.@*RESULTS@#All patients were followed up for 18 to 48 months with an average of (36.3±10.5) months. The incision of all patients were healed at stageⅠwithout complications such as infection or internal fixation ruptur. Healing time of femur and tibia was (8.5±2.6) months and (9.5±2.2) months. Knee joint motion increased from preoperative (101.05±8.98) ° to postoperative (139.35±8.78) ° at the latest follow-up (t=-12.845, P<0.001). VAS decreased from preoperative (5.15±1.72) to postoperative (0.75±0.96) at the latest follow-up (t=11.186, P<0.001).@*CONCLUSION@#On the basis of retaining the original intramedullary nail, the addition of locking plate internal fixation and autogenous iliac bone grafting have advantages of simple operation, less trauma, fewer complications and high fracture healing rate. It is one of the effective surgical schemes for the treatment of nonunion after intramedullary nail fixation of long bone fracture of lower extremity.

Comparison of cannulated screwing versus plating in combination with interlocking intramedullary nailing for ipsilateral discontinuous fractures of tibial shaft and plateau / 中华创伤骨科杂志

Objective:To compare the clinical effects between cannulated screwing and plating in combination with interlocking intramedullary nailing for the treatment of ipsilateral discontinuous fractures of the tibial shaft and plateau.Methods:A retrospective analysis was performed of the clinical data of 34 patients who had been treated for ipsilateral discontinuous fractures of the tibial shaft and plateau at Department of Orthopedics and Trauma, Honghui Hospital Affiliated to Xi′an Jiaotong University from January 2015 to January 2020. There were 17 males and 17 females, aged from 26 to 60 years (average, of 43.6 years). The left side was affected in 18 cases and the right side in 16. The patients were divided into 2 groups according to their internal fixation methods: a cannulated screw group of 16 cases treated with cannulated screwing and intramedullary nailing and a plate group of 18 cases treated with plating and intramedullary nailing. The 2 groups were compared in terms of operation time, intraoperative blood loss, incision length, tibial plateau collapse, consumables cost, hospital stay, fracture healing time, weight-bearing time, range of knee motion, reduction of tibial plateau fracture by Rasmussen radiology, Lysholm knee function score at the last follow-up and complications.Results:There was no significant difference in the preoperative general data between the 2 groups, showing the 2 groups were comparable ( P>0.05). All the 34 patients were followed up for 12 to 28 months (average, 17.4 months). There was no significant difference either in operation time, hospital stay, tibial plateau healing time, tibial fracture healing time, weight-bearing time or range of knee motion between the 2 groups ( P>0.05). In the cannulated screw group, the intraoperative blood loss [(89.4 ± 14.5) mL] and consumables cost [(2.0 ± 0.2) ten thousand yuan] were significantly less than those in the plate group [(120.8 ± 22.1) mL and (2.6 ± 0.4) ten thousand yuan], the incision length [(4.1 ± 0.8) cm] was significantly shorter than that in the plate group [(7.1 ± 0.9) cm], and the Lysholm knee function score at the last follow-up [(89.8 ± 4.5) points] was significantly lower than that in the plate group [(93.0 ± 4.2 points] (all P<0.05). The difference was statistically significant between the 2 groups in the quality of tibial plateau reduction ( P<0.05). The postoperative tibial plateau collapse in the plate group [0.5 (0, 2) mm] was insignificantly less than that in the cannulated screw group [1.0 (0, 2) mm] ( P>0.05). In the cannulated screw group, one tibial shaft fracture did not achieve union after operation and deep vein thrombosis occurred in 2 cases after operation; in the plate group, 2 cases suffered from delayed wound healing, one from delayed fracture healing, one from deep venous thrombosis of lower extremity, and one from knee discomfort which was relieved after removal of internal fixation. Conclusions:In the treatment of ipsilateral discontinuous fractures of tibial shaft and plateau, both cannulated screwing and plating in combination with interlocking intramedullary nailing can achieve good clinical effects. Although plating in combination with intramedullary nailing lead to more severe trauma and higher costs, it is conducive to improving the reduction quality of the tibial plateau and postoperative functional recovery of the knee joint.

Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture / 中国修复重建外科杂志

Objective: To explore the application value of lithotomy position in the treatment of tibial shaft fracture with closed reduction and interlocking intramedullary nail fixation. Methods: The clinical data of 78 patients with tibial shaft fractures treated with closed reduction and interlocking intramedullary nail fixation between January 2015 and May 2018 were retrospectively analyzed. Among them, 33 patients were treated with lithotomy position (trial group) and 45 patients were treated with traditional supine position (control group). There was no significant difference between the two groups in general data such as gender, age, the cause of injury, the interval between injury and admission, the interval between injury and operation, and fracture type and site ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, the number of patients with open reduction, postoperative incision infection, and fracture healing were recorded. Pain visual analogue scale (VAS) score and Harris score were used to evaluate the effectiveness. Results: Both groups of operations were successfully completed. The trial group was superior to the control group in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy times, and the number of patients with open reduction ( P0.05). At 3 days after operation, the VAS score was lower in the trial group than in the control group, and the Harris scores of knee joint and ankle joint were higher in the trial group than in the control group, and the differences were significant ( P<0.05). Conclusion: Application of lithotomy position in closed reduction and interlocking intramedullary nail fixation for tibial shaft fracture is favorable for fracture reduction, with less bleeding, shorter operation time, and fewer fluoroscopy.

Evaluation of the Treatment of GustiloIiia Open Tibial Shaft Fracture TransosseousOsteosynthesis Technique with Ilizarov External Fixator

Background: Fractures of the tibial shaft are important for tworeasons. The first is that they are common, the second is thatthey are controversial - and anything that is both common andcontroversial must be important. Fractures of the shaft of thetibia cannot be treated by following simple sets of rules.Because of its location tibia is exposed to frequent injury and itis the most commonly fractured long bone.Objective: To evaluate the treatment of open tibial shaftfracture of Gustilo IIIA grade by Trans osseous osteosynthesistechnique with Illizarov External Fixator as a primary anddefinite mode of treatment.Methods: Clinical trial (Quasi Experimental study) fromJanuary 2009 to June 2010 (18 months) at National Institute ofTraumatology and Orthopaedic Rehabilitation Purposivesampling was done according to availability of the patients andstrictly considering the inclusion and exclusion criteria andsample size was 17 no of cases.Results: 14 male and 1 female patient between 17 and 51years were studied. Most common age group in this serieswere 26-35 year age group ((53.33%) and average age of thepatients was 30 years with SD of ±8.67. Most of the patientswere male and road traffic accident was the leading cause ofinjury (70.58%). Left side involved in (58.82%) most of thecases and 2 patients had bilateral fractures. Commonest site ofthe fractures were middle third (58.82%) of the tibia. Most ofthe fractures were comminuted type of fractures (47.05%).Most of the patients were operated on the day of admissionand in some cases within 4 - 7 days of admission. Averageduration of hospital stay was 8.06 days ranging from 1 day to28 days. Total duration of treatment was average 186.66 days(26 weeks) highest 291 days (42 weeks) and lowest 140 days(20 weeks). Most of the patient had soft tissue healing bygranulation tissue formation (35.29%). Others were treated byprimary closure, Delayed primary closure, secondary closure,partial thickness skin grafting.Conclusion: In this study the results of open tibia fracture(Gustilo IIIA) by Transosseous osteosynthesis technique withIlizarov External Fixator has been found to be satisfactory.Though there were a few minor complications with the fixatorthe dynamisation and compressing ability of this stable frameprovided good union without any second surgical procedure orbone grafting and prevented any malunion.

Fractura de Toddler. Reporte de un caso y revisión de la literatura / Toddler's fracture, case report and review of literature

Resumen: Introducción: La sospecha del diagnóstico de una fractura de Toddler a menudo es complicada debido a una historia poco clara, a la falta de hallazgos específicos en la clínica y a la ausencia de cambios evidentes en las radiografías iniciales. Presentamos el caso de una infante de tres años y siete meses de edad con el antecedente de caída desde su propia altura con mecanismo de rotación del miembro pélvico izquierdo. La finalidad de este escrito es describir la etiología, patología, diagnóstico y el manejo terapéutico en este tipo de fracturas. Discusión: La historia clínica, la exploración física y el uso de estudios de imagenología ayudan a identificar las fracturas de Toddler, patología que debe ser conocida por médicos especialistas para su manejo ideal.

Abstract: Introduction: The suspected diagnosis of a Toddler's fracture can often be complicated by an unclear history, the lack of specific clinical findings and the absence of obvious changes in the initial radiographs. We present the case of an infant of 3 years and 7 months old with a history of falling from her own height with a rotation mechanism of the left pelvic limb. The purpose of this paper is to describe the etiopathology, diagnosis and therapeutic management of these fractures. Discussion: The clinical history, physical examination and the use of imaging studies help identify Toddler's fractures, pathology that must be known to medical specialists for an ideal treatment.

Open reduction and osteosynthesis of common minimally invasive percutaneous plate osteosynthesis in treat-ment of high energy tibial fracture / 中国基层医药

Objective To open the reset common bone and open ordinary osteosynthesis(MIPPO)(in effect in the treatment of high energy tibial fracture.Methods High energy tibial fracture in 42 cases of patients,according to the condition of the patient and the treatment were divided into two groups,using open reduction and bone treatment (open group,22 cases),treated with MIPPO technique(MIPPO group,20 cases).The indicators of operation,postop-erative complications and clinical efficacy of the two groups were observed.Results The operation time,intraopera-tive bleeding volume,fracture healing time of the MIPPO group were (75.2 ±9.7)min,(107.3 ±11.3)mL,(13.1 ± 3)weeks,which of the open group were (73.4 ±10)min,(208.5 ±16.3)mL,(18.2 ±4.7)weeks,the two groups had no statistically significant differences in operative time(P >0.05),two groups of blood loss,fracture healing time, the differences were statistically significant(t =23.153,4.143,all P <0.05);the complication rate in the MIPPO group was 10.0%,tibial shaft fracture healing function excellent rate was 95.0%.The complication rate of the open groupwas healing function excellent rate was 72.7%,36.4% tibial shaft fracture,there were significant differences between the two groups(χ2 =12.316,22.964,all P <0.01).Conclusion MIPPO technology in the treatment of high energy tibial shaft fractures,with less bleeding,fracture healing fast,and the characteristics of a significant effect, which is worth promoting.

Effect comparison between minimally invasive percutaneous plate fixation and open reduction internal fixation on patients with tibial shaft fracture / 中国医学装备

Objective: To analyze the effect between minimally invasive percutaneous plate fixation and open reduction internal fixation on patients with Tibial shaft fracture. Methods:Chosen patients with tibial shaft fracture as research subjects, randomly divided observed groups receiving minimally invasive percutaneous plate fixation and control group receiving open reduction internal fixation, detecing surgery-related indicators, AKSS knee score and adverse conditions incidence. Results:1)After surgery, surgery time and total hospital stay of observation group patients were significantly shorter than control group patients, blood loss was significantly less than control group patients (P<0.05);2)After surgery, patients AKSS knee function scores were significantly higher than control group patients(P<0.05);3)After surgery, observation group patients’ adverse events incidence was significantly lower than control group patients (P<0.05). Conclusion:Minimally invasive percutaneous plate osteosynthesis can effectively optimize the surgical procedure to improve postoperative joint function and reduce adverse events healing is ideal tibia fracture mode of operation.

Chronic Osteomyelitis in Distraction Osteogenesis Area of Tibial Shaft: A Case Report

Distraction osteogenesis with an Ilizarov external fixator is one of the most successful treatment options for large segmental bone defects after extensive debridement of chronic osteomyelitis in the tibial shaft. Its complications include skin irritation, pin tract infection, and non-union due to infection. There are few case reports on chronic osteomyelitis occurring in the distraction osteogenesis area. The authors experienced a chronic osteomyelitis in the distraction osteogenesis area of the tibial shaft and report this case with references.

A comparative study of patients with tibial shaft fracture underwent interlocking intramedullary nail postoperative between dynamization and non-dynamization / 重庆医学

Objective To prospectively compare the clinical outcome of dynamization and non-dynamization of interlocking intr-amedullary nail on union of tibial shaft fractures (fracture gap0 .05];16 weeks after internal fixation surgery ,VAS score of the dynamization group was statistically higher than that of the non-dynamization group [(4 .1 ± 0 .6) vs .(2 .3 ± 0 .8) ,t=16 .100 ,P<0 .05];the knee pain rate of the dynamization group was statistically higher than that of the non-dynamization group (28 .7% vs .12 .9% ,χ2 =5 .764 ,P<0 .05) .Conclusion When treating tibial shaft fractures with closed reduction and intramedullary nail fixation ,the main fracture gap<2 .0 mm ,early dynamization didn′t have any advantage .

Anterior Knee Pain after Intramedullary Nailing for Tibial Shaft Fractures

PURPOSE: To analyze the possible causes and incidence of the chronic anterior knee pain follow after closed intramedullary nailing for the tibial shaft fractures, in a retrospective aspect. MATERIALS AND METHODS: 52 patients who treated with intramedullary nailing for the tibial shaft fractures from January 2001 to October 2008 were reviewed. We analyzed the relationship between knee pain and the variables (sex, age, types of fracture, protrusion extent of intramedullary nailing on proximal tibia). The aspects of pain, its onset and relieving time, and how much it influences on daily living were analyzed retrospectively. For categorical variables, group variences were estimated using Chi-square test. RESULTS: 34 patients of 52 (65%) complaint of anterior knee pain followed after intramedullary nailing, and there were no statistical differences between pain and sex/age (p>0.05). Incidence of anterior knee pain becomes higher as the severity of fracture increases, but there was no statistical difference between pain and intramedullary nailing protrusion. Pain severity was mostly not influencing on daily living, and it mostly responded to conservative treatment. CONCLUSION: The incidence of anterior knee pain followed after intramedullary nailing was 65%, and its severity was mostly not influencing on daily living. There were no significant differences between pain and sex, age, protrusion extent of intramedullary nailing on proximal tibia, but as the severity of frature increases, the incidence of anterior knee pain became higher.

The curative effects of intramedullary interlocking nailand small incision for the treatment of tibial shaft fracture / 中国基层医药

Objective To evaluate the clinical applied effects of tibial shaft fracture with intramedullary interlocking nail and small incision. Methods From November 2004 to October 2005,47 cases of tibial shaft fracture were treated with intramedullary interlocking nail, all the cases were adopted with small incision and intramedullary interlocking nail, and analysed the curative effects Results 47 cases were followed-up ranged 8 ～ 27 months. All cases resumed normal knee function 6 to 12 weeks after operation,without nonunion and malunion. Conclusion Treatment of tibial shaft fracture with intramedullary interlocking nail and small incision had the advantages of little trauma,good stability, high rate of fracture union and rapid functions recovery. It is worthy deserveed to be put into application and populatization in clinics.

The Comparison of Minimally Invasive Plate Osteosynthesis and Intramedullary Nailing in the Treatment of the Proximal and Distal Tibia Fracture

PURPOSE: To compare the efficacy of the surgical treatment through the comparison of Minimally Invasive Plate Osteosynthesis (MIPO) and Intramedullary (IM) nailing in the treatment of the tibial shaft fractures expended to metaphysis retrospectively. MATERIALS AND METHODS: Patients with proximal or distal third fracture of tibial shaft from May 2003 to Aug. 2006 were divided into two groups depending on the surgical method. Group A consisted of 30 patients treated with IM nailing, Group B was 29 patients treated with MIPO. The clinical outcomes were evaluated retrospectively from the time for bone union and callus formation confirmed by X-ray, functional score of knee or ankle joint, and complications including nonunion, malalignment and infection. RESULTS: Bone union was seen radiologically at a mean of 17.4 weeks in group A, and 17.0 weeks in group B. In postoperative complications, group A showed two nonunion, two delayed-union, six malalignment, and two wound infection while group B showed only one delayed-union and one wound infection. CONCLUSION: There were no significant differences in the time for bony union and functional score between IM nailing and MIPO. Conventional IM nailing with only interlocking technique showed higher incidence of malalignment and deformity than MIPO for the treatment of the proximal or distal third fracture of the tibial shaft.

Resultado funcional de las fracturas diafisiarias de tibia tratadas con clavo intramedular y placa / Functional oucomme of tibial shaft fractures treated with intramedullary nail and plate

Objetivo Determinar el resultado funcional de las fracturas cerradas de la diáfisis tibial tipo A tratadas con clavo intramedular y placa, en el servicio de Traumatología del hospital Obrero N° 1, durante las gestiones 2003 a 2008. Material y métodos Estudio descriptivo de corte transversal, con tamaño muestral de 28 casos. La recolección de datos se realizó mediante revisión de los expedientes clínicos y la evaluación funcional mediante la escala de Karstrom - Olerud modificada. El procesamiento de datos se realizó con el paquete estadístico SPSS 11.5. Resultados El resultado funcional de las fracturas diafisarias de tibia tipo A tratadas con clavo intramedular fue excelente en 50% (7 casos) y bueno en 50% (7 casos); las tratadas con placa tuvieron resultado excelente en 42,9% (6 casos), bueno 50% (7 casos), regular 7,1% (1 caso). El tiempo de apoyo con clavo intramedular fue 2-4 meses en 57,1% (8 casos), 4-6 meses en 28,6% (4 casos) y mayor a 6 meses en 14,3% (2 casos); con placa 50% (7 casos) apoyaron en 2-4 meses, 35,7% (5 casos) en 4-6 meses y 14,3% (2 casos) más de 6 meses. Conclusión El resultado funcional de las fracturas diafisarias de tibia se relaciona con el tipo de implante, siendo el clavo intramedular el que mejor resultado funcional obtuvo en relación a la placa; además el tiempo de apoyo fue menor con el clavo intramedular; por lo que se recomienda el uso de este tipo de implante en el tratamiento de este tipo de fracturas.

Objective To determine the functional outcome in closed fractures of the tibial shaft type A treated with intramedullary nail and plate at the Orthopedics and Traumatology service of the Hospital Obrero No. 1 during 2003 to 2008. Material and methods Cross sectional study with sample size of 28. Data collection was conducted by reviewing medical records and by functional assessment scale Karstrom - Olerud modified. Data processing is performed with the SPSS 11.5 statistical package. Results Functional outcome of tibial shaft fractures treated with intramedullary nail was excellent in 50% (7 cases) and good in 50% (7 cases); those treated with plate had excellent result in 42.9% (6 cases), well 50% (7 cases), regular 7.1% (1 case). Support time with intramedullary nail was 2-4 months in 57.1% (8 cases), 4-6 months, 28.6% (4 cases) and more than 6 months in 14.3% (2 cases); plate 50% (7 cases) supported in 2-4 months, 35.7% (5 cases) in 4-6 months and 14.3% (2 cases) more than 6 months. Conclusion Functional outcome of tibial shaft fractures is related to the type of implant, with the intramedullary nail which got better functional outcome in relation to the plate, plus support time was less with the intramedullary nail, so it is recommended using this type of implant in the treatment of such fractures.

Anterior Knee Pain after Intramedullary Tibial Nailing / 대한정형외과학회잡지

PURPOSE: To document the incidence and analyze the causes of anterior knee pain following closed intramedullary nailing for tibial fractures. MATERIALS AND METHODS: Between January 2005 and February 2007, 50 tibial fractures (48 patients) were treated using locked intramedullary nails. We examined the relationship between postoperative anterior knee pain and age, gender distribution, mechanism of injury, cause and type of fracture, method of patellar tendon incision, and position of the nails on radiography. Anterior knee pain was assessed using a visual analogue scale (VAS). Pearson chi-square test was used to assess the incidence of knee pain. RESULTS: At a mean follow-up period of 16 months (range 13-30 months), 23 cases (46%) had developed anterior knee pain. Knee pain was more common in woman (p=0.000), but there was no statistically significant difference with regard to age, cause or type of fracture, reaming or incision technique. If the knee apex distance was below -30 mm on radiological analysis, there was no statistically significant increase in postoperative knee pain (p=0.000). Nail removal resolved or improved the symptoms in 77% of patients with anterior knee pain. CONCLUSION: Based on these data, nail prominence correlated with increased knee pain. We believe surgeons can decrease the severity of knee pain after tibial nailing by burying the tip of the nail as reflected on lateral radiographs.

Treatment of tibial shaft fractures with Kuntscher nail without opening fracture cavity in condition of without C-ARM in Da Nang General Hospital

Background: Leg bone fracture is common seen in orthopedic trauma. Currently, the trend of treatment is using a less invasive technique. Especially, with application of C-Arm in surgery, closed Kuntscher nailing technique has made the treatment of leg bone fractures achieving more new improvements. Objectives: To summarize the experiences in the technical implementation process and to assess results of treatment. Subjects and method: A descriptive, retrospective study was conducted on 112 patients was confirmed diagnosed with leg bone fractures (81 males, 31 females, the average aged 29\xb15.3), were operated in Da Nang General Hospital from January, 2004 to June, 2006. All of them were performed with Kuntscher intramedullary nail in tibia without opening fracture cavity, in condition of without C-Arm. Results: The patients with combined injuries included 5 cases of 2 legs fracture, 2 cases of hip fracture, 5 cases of leg fracture in 2 stages, 1 case of collabone fracture. Postoperative observations: no case of infection, patients were discharged after 2-7 days, the average length of hospitalization was 3\xb12.4 days. Complication: 1 case of secondary deviation, no case of any delay to heal bone, broken nails. Recording a case of nail was rise up to cause painfully and synovial capsule inflammation of knee joint. Conclusion: The implementation of this less invasive technique should be orderly done. The most ideal indication was tibial shaft fractures in stage of middle 1/3. Because of a minimally invasive technique so patients were less painful, fracture healing quickly, early mobilization could be set, surrounding joints were not affected.

Overgrowth Following TibialShaft Fractures in Children / 대한정형외과학회잡지

PURPOSE: To assess the comparative growth of the four long bones of the lower extremities after the tibial shaft fractures in children. MATERIALS AND METHODS: Thirty-eight children (age, 8.2+/-2.6) with tibial shaft fractures treated with a closed reduction and a long leg cast were enrolled in this study. The mean follow-up was 54.4 months (range, 24-96). The medical records and Bell-Thompson images were retrospectively reviewed. RESULTS: The clinical results were excellent in all cases. The fractured tibia showed overgrowth (4.4+/-3.3 mm) compared with the contralateral side. The ipsilateral femur showed mild over-growth (0.9 mm+/-3.7), and the final leg length discrepancy was 5.3 mm+/-5.4. Four ipsilateral femurs showed overgrowth >10 mm. Gender, the level of the fractures and associated fibular fractures did not affect the overgrowth of the fractured tibia (p>0.05). However, age might affect the amount of overgrowth (p=0.005). CONCLUSION: Tibial shaft fractures in children treated with a long leg cast showed variable overgrowth. The final leg length discrepancy was influenced by the overgrowth of the ipsilateral femur as well as by overgrowth of the tibia.

Analysis of causes of postoperative anterior knee pain after intramedullary nailing freatment for tibial shaft fractures / 中国矫形外科杂志

[Objective]To analyze the causes of anterior knee pain after intramedullary(IM) nailing treatment of tibial shaft fractures.[Method]A total of 256 patients with tibial shaft fractures were treated with intramedullary nailing from 2000 to 2007 in our hospital.There were 183 males and 73 females with a mean age of 45 years.All patients were followed up at least once after fracture healing.[Result]Among 256 patients,166 experienced anterior knee pain,accounting for 65%.Ninety-six(58%) treated with transtendinous nailing complained of and 70(42%) treated with paratendinous nailing complained of anterior knee pain.It was worsened after activity but relieved only in 33(20%) by resting or taking analgesic drugs.The anterior knee pain disappeared one year after the IM nailing was taken out.[Conclusion]Anterior knee pain can not be reduced by different approaches of operation for tibial shaft fractures.However,the removal of intramedullary nailing and the muscle exercises around the knee joint can reduce the occurrence of anterior knee pain.

Relationships of the posterior condylar angle to the femoral shaft-transcondylar angle,the tibial plateau-tibial shaft angle and the femoral shaft-tibial shaft angle in ostoearthritic knees / 中国矫形外科杂志

[Objective] To develop a new method of measuring the posterior condylar angle(PCA)interoperatively,and determine the relationships of the PCA to the femoral shaft-transcondylar angle(FSXC)、the tibial plateau-tibial shaft angle(TPTS)and the femoral shaft-tibial shaft angle(FSTS)in southern Chinese people with osteoarthritic knees.[Methods]During July 2007 to March 2008,the PCA was measured directly in 30 osteoarthritic knees undergoing total knee arthroplasty with the PCA Conimeter designed by the author.There were 29 patients including 3 males and 26 females,and the average age was 66.6 years(range,50~78 years),18 left knees and 12 right knees.The radiologic measurements were performed preoperatively on weight-bearing long leg AP radiographs,which included FSXC,TPTS and FSTS.A linear correlation analysis was performed to determine the relationships of PCA to the FSXC,TPTS and FSTS.[Results]The value of the PCA was 5.2??2.6?.The values of the FSXC and TPTS were 8.6??2.9?and 4.1??4.0?,and both had significant linear correlationships with the value of the PCA(P