Maintaining mobility after fracture: A biomechanical analysis of fracture consequences at the Roman Sites of Ancaster (UK) and Vagnari (Italy).

OBJECTIVE: This study uses biomechanical data from tibiae to investigate the functional consequences of lower limb fractures. Adults with malunited fractures are hypothesized to have experienced altered mobility, indicated by asymmetric tibial cross-sectional geometries (CSG). MATERIALS: Ninety-three adults from Roman (1st to 4th centuries CE) Ancaster, UK and Vagnari, Italy (Ancaster n = 16 adults with lower limb fracture:53 without fracture; Vagnari n = 5:19) METHODS: Biplanar radiographs were used to quantify and compare tibial CSG properties and asymmetries between individuals with and without fractures to femora, tibiae, and/or fibulae. The amount of angulation, rotation, and overlap, indicative of linear deformity, were measured for each fracture. Individuals who loaded their fractured leg differently than their opposite, uninjured leg were identified using outlying amounts of CSG asymmetry. RESULTS: Two Ancaster individuals had poorly aligned fractures. None of the Ancaster or Vagnari individuals with lower limb fractures had CSG properties or asymmetries outside the calculated normal ranges. CONCLUSIONS: Regardless of how a fracture healed, individuals at Ancaster and Vagnari generally resumed mobility after trauma whenever possible. SIGNIFICANCE: This research contributes information about injury recovery and suggests that resilient behaviors and persistent mobility may have been valued or required responses to fracture in the study communities. This work advises that impairment should not be inferred based solely on the appearance of lesions. LIMITATIONS: Site, sex, and age patterns in injury recovery are not evaluated due to sample size limitations. SUGGESTIONS FOR FURTHER RESEARCH: Biomechanical assessments of post-traumatic function in varied cultural contexts are advised in order to further characterize the impact that physical and social factors have on injury recovery.

Biographical background and origin of common eponymous terms in orthopedic surgery: anatomy and fractures in knee surgery.

An eponym is a person after whom an eponymous term is named. These eponymous terms are easy shorthand in communication between surgeons. Therefore, they are often used and hard to eradicate. We discuss eponymous terms that describe anatomical features and fracture types in the knee. With these terms, an overview of the historical background of the eponym and its current clinical implication is discussed. The eponymous terms discussed are Gerdy tubercle, Pellegrini-Stieda lesion, Segond fracture, Hoffa fracture and fat pad. The meaning of the eponymous term is clarified, the biography of the namegiver given and its contemporary clinical implication discussed. Since eponymous terms are used frequently in inter-collegial discussion and literature, the meaning should be clear for everyone, since otherwise it might give room for misunderstanding.

The Role of Arthroscopy in the Management of Tibial Plateau Fractures.

Arthroscopy has been advocated as a possible adjunct to the operative treatment of tibial plateau fractures. This review article provides a historical perspective on the development of the technique while focusing on its current role in the management of these injuries. Topics include the possible utility of employing arthroscopy in the diagnosis and management of associated soft tissue lesions and potential for arthroscopic assistance to facilitate achieving fracture reduction without an open arthrotomy. Pertinent literature is reviewed and discussed, with an emphasis on the data related to patient outcomes.

Percival Pott; Pott's fracture, Pott's disease of the spine, Pott's paraplegia.

There is a commonly held belief that Percival Pott sustained that ankle fracture that bears his name. This probably is not true; the injury was more likely a fracture of the tibial shaft, as suggested by careful reading of the account of the accident left to us by his son-in-law.

Fracturas de pilón tibial: estado actual de pacientes que ingresaron al Instituto Autónomo Hospital Universitario de Los Andes entre 1998-2007 aplicando la AOFAS: estudio observacional analítico prospectivo no concurrente / Tibial pilon fractures: currents status of patients admitted to the Instituto Autónomo Hospital Universitario de Los Andes between 1998-2007 using the AOFAS: prospective observacional study non-concurrent

Las fracturas de tibia distal han sido consideradas de difícil manejo debido a los resultados desalentadores descritos hasta el año de 1963 situación que comienza a cambiar a mediados de 1968 cuando se promulgan los principios de ORIF de la AO, sin embargo, actualmente sigue constituyendo un verdadero reto para el cirujano traumatólogo. En el presente estudio prospectivo no concurrente se evaluarán los pacientes adultos (mayores de 16 años de edad) que ingresaron al servicio de Ortopedia y Traumatología del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA) entre 1998 y 2007 con fracturas de tibia distal (pilon tibial), constituyendo en total una población de 80 pacientes de la cual se toma una muestra de 40 pacientes. Para efectos de este estudio obtuvimos para las fracturas tipo A según la AO/ASIF un total de 33,3 por ciento de excelentes resultados, 33,3 por ciento de regulares resultados y 33,3 por ciento de malos resultados. Para las fracturas tipo B 71 por ciento de excelentes resultados, 15 por ciento de regulares resultados y 14 por ciento de malos resultados; mientras que para las fracturas de tipo C fue un 27 por ciento de excelentes resultados, 27 por ciento de regulares resultados y 46 por ciento de malos resultados, todos evaluados según la escala de evaluación de la AOFAS. A la luz de los estudios consultados, resulta evidente establecer como aspectos pronóstico determinantes el estado de las partes blandas la afectación metafisiaria y/o articular, así como la asociación a una lesión de peroné.

Distal tibia fracture have been considered difficult to use because of the disappointing results described until the years 1963 which begins to change in mid-1968 when it enacted the principles of ORIF of AO, however, currently still be a real challenge to the trauma surgeon. This prospective study will assess the concurrent non-adult patients (older than 16 years of age) who entered the service of Orthopedics and Traumatology Institute of the University Hospital of Los Andes (IAHULA) between 1998 and 2007 with fractures distal tibia (tibia pylon), constituting a total population of 80 patients of which took a sample of 40 patients. For purposes of this study, we obtained for type A fractures according to AO/ASIF a total of 33,3 percent of excellent results, 33,3 percent of regular results, and 33,3 percent poor results. For fractures type B 71 percent of excellent results, 15 percent regular results, and 14 of poor results, whereas for type C fractures was 27 percent excellent results, 27 percent of regular results, and 46 percent of poor results all assessed according to the scale of assessement of the AOFAS. In light of the studies consulted, as is evident establish prognostic determinants respects the status of soft tissue involvement, metaphyseal and/or joints, as well as the association of a fibula injury.

A functional below-the-knee cast for tibial fractures. 1967.

An experimental method of treating tibial fractures with use of the below-the-knee total-contact weight-bearing cast is discussed. The success of this method appears to depend on the careful application and molding of plaster to the fractured leg after the swelling has been reduced to a minimum and a closed reduction has been obtained. Good alignment is essential, but slight shortening or overriding of fragments can be accepted with the expectation that little or no increase in the amount of shortening will occur. The results obtained indicate that this type of cast not only holds reduction well but also permits healing of tibial fractures in a relatively short period of time. The maintenance of the limb in a near physiological condition throughout the entire reparative process is offered as an explanation for rapid healing. Treatment of tibial fractures by this method offers the advantages of retaining functional activity of the extremity during healing and eliminating the need for extensive rehabilitation of the knee and thigh muscles after healing has occurred.

Avulsed posterior edge of the tibia. Earle's or Volkmann's triangle?

The term Volkmann's triangle for the avulsed posterior edge of the tibia in fracture-dislocations of the ankle is incorrect. Volkmann did not publish any articles relating to the posterior edge of the tibia. Credit should go to Henry Earle, who was an outstanding British surgeon of the first half of 19th century. He described avulsion of the posterior edge of the tibia in 1828. In 1823 he also published a monograph entitled Practical observations in surgery in which he described a specially designed bed for the conservative treatment of proximal fractures of the femur.

The nomenclature for intra-articular vertical impact fractures of the tibial plafond: pilon versus pylon.

Although most of the controversy surrounding the treatment of intra-articular, vertical impact fractures of the lower tibia is due to the difficult clinical problems they pose, there is a minor, ongoing dispute regarding nomenclature. In the last several decades, these fractures have been called either pilon or pylon fractures. This study traces the etymology of both terms and relates them to their usage in the orthopaedic literature. Based on the origins of each word, and how they were introduced into the orthopaedic literature, it is concluded that the correct term for an intra-articular, vertical impact fracture of the lower tibia is pilon fracture.

[A severe traffic accident--250 years ago. Medical history presentation]. / Ein schwerer Verkehrsunfall--vor 250 Jahren. Eine medizinhistorische Darstellung.

During a scientific examination in July 1999 both crypts below the St. Martin's Church in Grünstadt, Germany, were opened and 9 coffins from the county family of Leiningen examined. This paper is concentrating on one of these persons: Georg Hermann (1679-1751), count of Leiningen-Westerburg-Altleiningen, who gave during the 18. century the city its barock character. He was also responsible for the rebuilding of the church. His skeleton revealed interesting pathological changes. Few years before his death the count had the accident to get run over by a heavy wagon which crushed the distal part of his legs. The fractures healed, but gave him an ancylotic and shortened left leg, which must have caused him a lot of suffering in his last years.

Early limb salvage: open tibia fractures of Ambroise Paré (1510-1590) and Percivall Pott (1714-1789).

Ambroise Paré and Percivall Pott were preeminent clinicians, writers, and educators who advanced the cause of surgery through their independent thinking and insightful observations. In addition to their legacies and numerous enduring contributions, both men sustained open tibial fractures that were successfully managed during times when most often amputation was prescribed for such injuries. This article explores their lives and their fractures.