The tibialis anterior used as a local muscle flap over the tibia after soft tissue loss.

BACKGROUND: A series of 12 extremities among 11 patients with open wounds exposing the tibia were treated using a local tibialis anterior muscle flap. There was an associated tibial shaft fracture in 11 of the 12 extremities, which were managed by external fixation or intramedullary nailing. The wounds, ranging from 1 to 15 cm in length, were located anteriorly over the middle and distal thirds of the tibia. METHODS: A retrospective chart review included patients whose open anterior tibial wounds were managed with an anterior tibialis rotational flap. These patients had been treated at the Medical College of Ohio between 1995 and 1999. No patients were excluded, and all the patients had at least 1 year of follow-up evaluation. RESULTS: Complete coverage was obtained in all cases. All the wounds healed without complication. All the associated tibial shaft fractures had a delayed union or nonunion, with 10 of the 11 requiring bone graft or an exchange intramedullary nail. CONCLUSION: The anterior tibialis is a relatively easy flap to use for covering anterior tibial open wounds. The high rate of nonunion seems related more to the injury than to the coverage technique.

Dynamic changes in the contact area of the sacroiliac joint.

Thirty adult dry-bone ilium specimens were used in conjunction with computer analysis to determine the average articular contact area between the sacrum and ilium at the sacroiliac joint. Simulating an unstable pelvic injury, the sacroiliac joint was displaced in three directions by moving the ilium posteriorly, superiorly, and posterosuperiorly. After each displacement, the contact area between the sacrum and ilium at the sacroiliac joint was calculated. The data showed that the average articular surface area of the male sacroiliac joint (1138.3 mm2) was approximately 12.8% greater than the average surface area of the female sacroiliac joint (992.5 mm2). The average articular contact area between the sacrum and ilium at the sacroiliac joint was lowest with the ilium displaced posterosuperiorly compared to equal displacements superiorly or posteriorly. This study quantitatively illustrated the loss of contact surface area between the sacrum and ilium during various displacements of the ilium, thus indicating the clinical cross-section area available for open reduction and internal fixation or fusion.