Tibia Fibula Fracture Abstracts (Subscribe)

50) this.border=1" alt="Bicondylar Tibial Plateau Fractures: A Biomechanical Study of Three Fixation Constructs"> OTA 2002 Posters OTA 2002 Posters Poster #4 Basic Science Bicondylar Tibial Plateau Fractures: A Biomechanical Study of Three Fixation Constructs Kelly L. Mueller, MD; Elizabeth P. Frankenburg, MS; Derek Scott, MD; Madhav A. Karunakar, MD; University of Michigan Medical Center, Ann Arbor, Michigan, USA

50) this.border=1" alt="Bicondylar Tibial Plateau Fractures: Comparison of Early Results with a Locking Plate Compared with Medial and Lateral Plating"> OTA 2002 - Session 7 Session VII - Tibia Sat., 10/12/02 Tibia, Paper #51, 5:08 PM Bicondylar Tibial Plateau Fractures: Comparison of Early Results with a Locking Plate Compared with Medial and Lateral Plating William J. Ertl, MD; Douglas G. Smith, MD; Harborview Medical Center, University of Washington, Seattle, Washington, USA

50) this.border=1" alt="Biomechanical Stability Provided by Oblique Screws in Intramedullary"> OTA 2002 Posters OTA 2002 Posters Poster #1 Basic Science *Biomechanical Stability Provided by Oblique Screws in Intramedullary Nailed Proximal Tibial Fractures Cari M. Whyne, PhD ( a-Zimmer, Inc. USA) ; G. Yves LaFlamme, MD, FRCS(C); Daniela Heimlich, BS; Hans J. Kreder, MD, FRCS(C); David J. Stephen, MD, FRCS(C); Sunnybrook & Women's College Health Science Centre, Toronto, Ontario, Canada Purpose: Intramedullary nailing has become an increasingly attractive treatment method for tibial fractures because of the ability to stabilize the fracture while minimizing disruption of soft tissue and the periosteal blood supply. However, proximal tibia fractures treated with traditional intramedullary nailing have a high incidence of malunion. The purpose of this study was to evaluate the mechanical stability of oblique screws in supplementing intramedullary nail fixation of high proximal fractures. The specific objectives were to compare the stability of the bone-nail construct with two additional proximal oblique screws against both the traditional nail construct (two transverse screws only) and tibial plating in the treatment of short proximal tibial fractures. Methods: Ten paired fresh-frozen human cadaveric tibiae were tested. One tibia of each pair was randomized to be instrumented with an intramedullary nail (M/DN Zimmer), while the other was stabilized with a plate (Synthes AO/ASIF 13-hole stainless steel). Specimens were tested in varus/valgus and flexion/extension up to a maximum bending moment of 12 Nm at a displacement rate of 0.5 mm/sec. Rotation of the tibia (torsion) was carried out up to a torque of 7 Nm at an angular rate of 0.5°/sec. Specimens were tested before (intact) and after a 2-cm gap osteotomy was performed 8 cm below the tibial plateau. Testing of the nailed tibiae after osteotomy was initially performed with four proximal screws (two transverse and two oblique, 4.5 mm in diameter), followed by testing with only two transverse screws in the proximal fragment. Bone density (BD) was physically determined by removing a core of trabecular bone from the distal end of each tibia subsequent to testing. Displacement data in the three loading configurations were statistically analyzed by using a repeated-measures analysis-of-variance design and linear regression (SPSS/PC) to evaluate and compare the different constructs. Results: The maximum displacements in varus/valgus and flexion/extension under bending moments of 12 Nm and maximum rotations under torsional loading of 7 Nm were measured for the five constructs. Maximum Displacements of Tibia Under Loading (mean ± SD)  Repair Construct  Varus/Valgus (mm)   Flexion/Extension (mm)  Torsion (deg)  Intact (with nail)  2.40 ± 1.9  2.47 ± 2.0  2.18 ± 0.6  Intact (with plate)  2.43 ± 1.3  2.71 ± 1.4  2.84 ± 1.8  Nail with 4 screws  7.25 ± 4.4  8.15 ± 6.1  13.80 ± 5.7  Nail with 2 screws  14.10 ± 11.2 15.35 ± 12.9  16.78 ± 5.3  Plate  6.76 ± 3.9  8.74 ± 4.0  12.11 ± 2.8 Intact versus Osteotomy: There was no difference between the nailed intact tibia and the plated intact tibia in varus/valgus ( P = 0.936), flexion/extension ( P = 0.486), and torsion ( P = 0.144). There was, however, a significant reduction in stability between the intact tibiae and all post-osteotomy tibiae ( P <0.01). Effect of Proximal Screws: When the results of the nailed constructs with two and four screws were compared, the addition of the proximally placed oblique screws increased the stability of the construct in varus/valgus by 50% (6.8 mm, P <0.05) in flexion/extension by 47% (7.2 mm, P <0.05) and in torsion by 18% (3.0°, P <0.05). Nail versus Plate Stability: In varus/valgus, flexion/extension, and torsion there was no significant difference between the intramedullary nail construct with four proximal screws and the plated construct (varus/valgus, P = 0.783; flexion/extension, P = 0.740; torsion, P = 0.239). The nail with two transverse screws exhibited a trend towards lower stability than the plate by 52% in varus/valgus (7.3 mm, P = 0.084) and 43% in flexion/extension (6.6 mm, P = 0.133). In torsion, the plate was more stable than the nail with two transverse screws by 30% (5°, P = 0.002). BD and Stability: Trabecular bone density had a significant effect in reducing stability ( P <0.05). Moderate correlations were found between BD and stability in varus/valgus, flexion/extension, and torsion for the nailed construct with four screws (R 2 = 0.47 to 0.52), the nailed construct with two screws (R 2 = 0.20 to 0.40), and the plated tibiae (R 2 = 0.15 to 0.62). Discussion/Conclusion: The results of this study of the fixation of fractured proximal tibiae demonstrated a significant increase in stability when two additional oblique screws were added to the two proximal parallel screws of the bone-intramedullary nail construct in the medial/lateral and anterior/posterior planes, and in torsion. In addition, intramedullary nailing with the four-screw proximal configuration was found to provide comparable stability to the plated constructs in varus/valgus and in flexion/extension, with only slightly less stability in torsion. The stability of both the plated and nailed constructs was reduced in tibiae with lower trabecular densities. Clinically, the M/DN intramedullary nail with two added proximal oblique screws may provide a stable, minimally invasive technique for repairing high proximal tibia fractures. Acknowledgements: This project was supported by Zimmer Inc.

50) this.border=1" alt="Distal Fourth Tibia-Fibula Fractures Treated with Intramedullary Nails"> OTA 2002 - Session 7 Session VII - Tibia Sat., 10/12/02 Tibia, Paper #43, 4:06 PM Distal Fourth Tibia-Fibula Fractures Treated with Intramedullary Nails: Factors Affecting Alignment Russell D. Weisz, MD ; Nirmal C. Tejwani, MD; Kenneth J. Koval, MD; Roy W. Sanders, MD; Tampa General Hospital, Florida Orthopaedics, Tampa, Florida, USA

50) this.border=1" alt="Effect of Nail Design on Cortical Bone Flow after Reamed Intramedullary Fixation of Segmental Tibial Fractures"> OTA 2002 Posters OTA 2002 Posters Poster #8 Basic Science Effect of Nail Design on Cortical Bone Flow after Reamed Intramedullary Fixation of Segmental Tibial Fractures Dennis DiPasquale, MD, FRCS(C); Alex Tov, MD; Emil H. Schemitsch, MD, FRCS(C) ; St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada

50) this.border=1" alt="Intramedullary Nailing of Proximal Quarter Tibia Fractures"> OTA 2002 - Session 7 Session VII - Tibia Sat., 10/12/02 Tibia, Paper #47, 4:37 PM Intramedullary Nailing of Proximal Quarter Tibia Fractures Sean E. Nork, MD ; David B. Barei, MD; Jason L. Schrick, BS; Sarah K. Holt, MSPH; Thomas A. Schildhauer, MD; Bruce J. Sangeorzan, MD; Harborview Medical Center, University of Washington, Seattle, Washington, USA

50) this.border=1" alt="Minimally Invasive Plating of High Proximal Tibial Fractures Unsuitable"> OTA 2002 - Session 7 Session VII - Tibia Sat., 10/12/02 Tibia, Paper #46, 4:31 PM Minimally Invasive Plating of High Proximal Tibial Fractures Unsuitable for Nailing Tadeusz F. Wisniewski, MD, PhD ; Marek J. Radziejowski, MD, FCS (SA); Johannesburg Hospital, University of the Witwatersrand, Department of Orthopaedic Surgery, Johannesburg, South Africa

50) this.border=1" alt="Reverse-Flow Sural Artery Flap for Soft Tissue Injuries of the Lower Third of the Leg"> OTA 2002 - Session 3 Session III - Polytrauma Fri., 10/11/02 Polytrauma, Paper #13, 3:38 PM The Reverse-Flow Sural Artery Flap for Soft Tissue Injuries of the Lower Third of the Leg David A. Volgas, MD; Brian M. Scholl, MD; James P. Stannard MD; Jorge E. Alonso, MD; University of Alabama at Birmingham, Birmingham, Alabama, USA Purpose: Soft tissue injuries associated with fractures are common and are usually treated by a plastic surgeon and covered by a free flap. Problems can arise when the availability of the plastic surgeon does not coincide with the need for immediate coverage of these injuries. Furthermore, free flaps frequently require 8 to10 hours of operative time, which may not be possible early in the hospitalization of the multiply-injured patient. Free flaps are associated with donor-site complications in as many as 30% of cases and significant impairment in as many as 15%. An alternative to free muscle transfer is a fasciocutaneous flap. The purpose of this study was to report a series of 47 consecutive patients treated with a reverse-flow sural artery flap for soft tissue defects in the lower one-third of the leg by an orthopaedic traumatologist. Methods: Forty-seven consecutive patients with soft tissue defects of the lower one-third of the leg requiring coverage were enrolled in an Institutional Review Board-approved prospective study. Each patient underwent coverage with a fasciocutaneous flap based on the sural artery by a single orthopaedic traumatologist. Patients were followed prospectively for wound healing problems, further surgery, infections, and outcomes. Results: There were 30 male and 17 female patients with an average age of 41 years (range, 19 to 76). The mechanism of injury was a motor vehicle crash, 19; falls, 13; pedestrian versus auto, 4; shotgun wound, 2; unknown, 2; chronic osteomyelitis, 2; and single cases of necrotizing fasciitis, assault, crush, diabetic ulcer, kicked by a horse, and soft tissue tumor excision. There were 27 open fractures, 10 calcaneus fractures, and 18 distal tibia fractures. The average follow-up was 6.7 months (range, 1 to 29). Most cases involved wound dehiscence after operative treatment of the fracture (30 patients), but there were 13 cases of early wound coverage with a flap. Sixteen patients had preoperative deep infections prior to flap coverage. There were three flap failures (6.4%), two in patients who failed to return to the clinic for postoperative follow-up, and the third in an elderly diabetic patient with renal failure and chronic osteomyelitis of the calcaneus. Four patients, who had pre-existing deep infections, had transtibial amputation even though the flap healed. Tourniquet time was reduced from 90 minutes early in the series to less than 45 minutes currently, and blood loss was routinely under 100 cc. No patient who had a negative preoperative culture developed a post-flap infection. Discussion/Conclusions: Fasciocutaneous flap coverage can be successful in the treatment of soft tissue injury of the distal third of the leg. It can be learned by the orthopaedic traumatologist and does not require microsurgical skills. It should be used with caution in patients with preoperative deep infection.

50) this.border=1" alt="The Effect of Human Recombinant Bone Morphogenic Protein RHBMP 7 on the Healing of Open Tibial Shaft Fractures"> OTA 2002 - Session 7 Session VII - Tibia Sat., 10/12/02 Tibia, Paper #45, 4:18 PM *The Effect of Human Recombinant Bone Morphogenic Protein (RHBMP-7) on the Healing of Open Tibial Shaft Fractures: Results of a Multi-Center, Prospective, Randomized Clinical Trial Michael D. McKee, MD, FRCS(C) ; Emil H. Schemitsch, MD, FRCS(C); James P. Waddell, MD, FRCS(C); Hans J. Kreder, MD, FRCS(C); David J. G. Stephen, MD, FRCS(C); Ross K. Leighton, MD, FRCS(C); Richard E. Buckley, MD, FRCS(C); James N. Powell, MD, FRCS(C); Lisa M. Wild, BScN; Piotr A. Blachut, MD, FRCS(C); Peter J. O'Brien, MD, FRCS(C); S. Pirani, MD, FRCS(C); Robert G. McCormack, MD; and the Canadian Orthopaedic Trauma Society St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (a-Stryker Biotech, Inc.)

50) this.border=1" alt="The Incidence Results of Treatment and Causes of Tibial Osteomyelitis"> OTA 2002 - Session 7 Session VII - Tibia Sat., 10/12/02 Tibia, Paper #44, 4:12 PM The Incidence, Results of Treatment, and Causes of Tibial Osteomyelitis after Reamed Intramedullary Nailing Stuart D. Anderson, MD ; Charles M. Court-Brown, MD, FRCS; Royal Infirmary of Edinburgh, Edinburgh, United Kingdom

50) this.border=1" alt="The Less Invasive Stabilization System for Bicondylar Fractures of"> OTA 2002 - Session 7 Session VII - Tibia Sat., 10/12/02 Tibia, Paper #50, 5:02 PM *The Less Invasive Stabilization System for Bicondylar Fractures of the Proximal Tibia Thomas Gosling, MD ; Mathias Müller, MD; Martinus Richter, MD; Tobias Hüfner, MD; Christian Krettek, MD, FRACS; Hannover Medical School, Hannover, Germany (a-AO Clinical Investigation and Documentation)

50) this.border=1" alt="The Use of Hybrid Fixators in Proximal Tibia Fractures"> OTA 2002 - Session 7 Session VII - Tibia Sat., 10/12/02 Tibia, Paper #48, 4:43 PM The Use of Hybrid Fixators in Proximal Tibia Fractures Roberto Varsalona, MD ; Bruce H. Ziran, MD; S. Avondo, MD; Q. Mollica, MD; University of Catagnia, Sicily, Italy; and University of Pittsburgh, Department of Orthopaedics, Pittsburgh, Pennsylvania, USA Purpose: Severe proximal tibia fractures, which include intra- and extraarticular fractures with metaphyseal-diaphyseal dissociation, pose a difficult treatment problem for the surgeon with significant complication rates. Use of external or internal fixation remains the main methods of treatment, with strong advocates for each method. Although there are pros and cons to both methods, we have found that accurate reduction (closed or open) with hybrid fixation has provided the best results. The purpose of this study was to report experience with a series of consecutive severe proximal tibial fractures. Methods: We treated 118 cases of proximal tibia fracture, of which 52 were treated with hybrid external fixation as part of a protocol that used a consistent approach and method of hybrid external fixation. Inclusion criteria for hybrid treatment (as opposed to closed treatment) were severe soft tissue injury, intraarticular displacement, and unstable fracture pattern involvement (AO A2, A3, and C patterns). Patients were treated on a fracture table with calcaneal traction. Reduction was achieved with ligamentotaxis and percutaneous clamps when possible. If necessary, limited incisions were used to elevate depressed fragments and place bone grafts. Articular congruity was assessed with fluoroscopy or arthroscopy or both. Fixation of the condyles was achieved with cannulated screws or beaded olive wires or both. The distal frame consisted of a multi-clamp or a single clamp and used three to four 5-mm half pins. The distal frame was connected to the ring with adjustable components (rods or a monolateral external fixator). A standard postoperative management protocol was followed involving immediate range of motion, weight-bearing as tolerated, and pin care. The management of the rigidity of the external fixations began with three to four rods, and rods were progressively removed or replaced or both with a dynamic axial monotube assembly. Clinical and radiographic evaluation was performed at routine intervals. In addition to routine demographic data, objective data collected included healing, deformity, complications, and motion. Patients were also evaluated with an SF-36 questionnaire 12 months after healing. Results: There were 52 patients with an average age of 42 years (range,17 to 78) with a mean follow-up of 24 months (range, 12 to 30). There were 40 men and 12 women, who sustained 31 fractures of the right leg and 21 fractures of the left leg. The mechanisms of injury were a motorcycle accident (18 patients), a pedestrian-motor-vehicle accident (13 patients), a motor-vehicle accident (9 patients), a fall from a height (9 patients), being struck by an object (2 patients), and sports activity (1 patient). There were 13 open fractures and 3 A2, 3 A3, 16 C1, 12 C2, and 18 C3 injuries. Seven patients had other major fractures of the ipsi- or contralateral limb, involving the femur, the shaft of the tibia, the ankle, the calcaneus, the femur, and the distal part of the other tibia. Two patients had upper limb fractures (one humeral and one wrist fracture). Two patients had a rupture of the patellar ligament, necessitating repair. All proximal tibia fractures healed without additional procedures. All patients were radiographically and clinically healed by 24 weeks. Most patients demonstrated healing by 16 weeks. Full weightbearing was established at a mean of 8.4 weeks (range, 5 to 10). Forty-six patients (88%) achieved full extension, and the remaining 6 (11%) had an extension deficit of less than 10°. Three patients (5%) had less than 90° of flexion, 27 had flexion beyond 100°, and 22 patients were able to flex beyond 110°. Thigh atrophy of more than 1 cm was noted in only one patient. The SF-36 profiles were health state/rate, daily activity, work activity, emotional problems, and pain. There were no intraoperative injuries to nerves or major vessels. Postoperative complications included superficial pin tract infections in 15 K-wires or pins, all of which resolved with local pin care and a short course of oral antibiotics. One patient had a deep venous thrombosis. None required removal of the fixator before healing of the fracture. No patient developed osteomyelitis or septic arthritis. Accuracy of reduction was 0 to 1mm in 28 patients, 2 to 3 mm in 19 patients, 4 to 5 mm in 4 patients, and more than 5 mm in 1 patient. Only 5 (10%) of the 52 patients had an angular malunion greater than 6°. One patient had a loss of reduction during treatment with hybrid external fixation. Four patients developed a mild varus deformity, when compared with the contralateral uninvolved knee. There were no valgus malunions and no nonunions. Final malalignment of the tibiofemoral axis did not exceeded 3° on full-length weight-bearing radiographs. Radiographic and clinical evidence of degenerative arthritis was seen in 12 of 52 patients (23%) 18 months after healing. Ten of these patients had C3 and 2 had C2 fracture patterns. Six of these patients were those that had angular malunions noted above. The remaining six patients had reductions to within 3 mm. Discussion: The benefit of restoration of normal anatomic structure by means of an open procedure must be weighed against the risk of infection, soft tissue complications, and malunion. Traditional open reduction and plating carries a significant incidence of wound complications and unsatisfactory results. Complex proximal tibial fractures sometimes require two plates for optimal fixation, which can result in an unacceptably high rate of infection. A hybrid fixator can maintain length and alignment while spanning a zone of comminution in the metaphyseal-diaphyseal region. It allows for access to any open wounds or compromised soft tissue. The device allows secondary correction of angular or rotational deformities when necessary and also early weightbearing and range of motion of the knee and ankle. We found that in a fairly large series of patients with medium to long-term follow up, the hybrid fixator performed very well from a technical standpoint. The development of radiographic arthrosis seemed to correlate more with the initial articular injury and alignment than to the nature of treatment. Intuitively, the quality of reduction will obviously impact the outcome but we were able to achieve satisfactory reductions in the majority of cases. We found that patients were allowed to bear weight and regain excellent knee motion. Our regimen of beginning with absolute construct rigidity in the first 2 to 6 weeks of healing, followed by gradually decreasing the stiffness of the frame (rod removal and conversion to monotube dynamic tube), allowed for progressively increased load-sharing with the developing fracture callous. In summary, we found that hybrid external fixation is a good alternative method for treatment of meta- or epiphyseal fractures or both. The technique and postoperative management we describe respects soft tissue and bone and allows for early articular mobilization.

50) this.border=1" alt="Tibia Fractures A Patient Based Decision Analysis"> OTA 2002 - Session 7 Session VII - Tibia Sat., 10/12/02 Tibia, Paper #42, 4:00 PM Tibia Fractures: A Patient-Based Decision Analysis Paul Tornetta, III, MD; Timothy Bhattacharyya, MD ; Jonathan Kuo, MD; Boston University Medical Center, Boston, Massachusetts, USA

50) this.border=1" alt="Tibial Plateau Fractures Functional Outcome and Incidence of Osteoarthritis in 156 Cases"> OTA 2002 - Session 7 Session VII - Tibia Sat., 10/12/02 Tibia, Paper #49, 4:56 PM Tibial Plateau Fractures: Functional Outcome and Incidence of Osteoarthritis in 156 Cases Anis Dosani, FRCS; Peter V. Giannoudis, MD ; Asad Ali Syed, FRCS; Manish Agarwal, FRCS; Stuart J. Matthews, FRCS; Malcolm R. Smith, MD, FRCS; St. James' University Hospital, Leeds, United Kingdom