OBJECTIVES: Posterior malleolar fractures (PM) have been linked to inferior outcome in malleolar fractures. This study aims to analyze the prevalence and pathoanatomy of PM fractures in Bosworth fracture-dislocations (BF). MATERIALS & METHODS: Radiographs and computed tomography (CT) scans of 13 patients treated at our institution and 97 cases published between 1947 and 2018, identified in a systematic literature search, were evaluated with respect to the pathoanatomy of BF. In all 13 cases from the present study and in 10 cases from the literature, axial CT scans were performed. RESULTS: All 13 patients (100%) with BF from the present series and 61 of 97 documented cases (63%) of BF from the literature were associated with a PM fracture. In patients with a complete CT analysis, dislocation of the fibula behind the posterior tibial rim was associated with extraincisural (Bartoníček / Rammelt type 1) PM fractures. Displacement of the fibula between the displaced PM fragment and the tibia was associated with Bartoníček / Rammelt types 2 and 3 PM fractures. CONCLUSIONS: Seventy prevent of all reported BF are associated with a PM fracture. The true prevalence may be even higher because of the historically infrequent use of CT imaging. The pathoanatomy of the PM fragment is highly variable as is the kind of fibular displacement in BF. Therefore, CT scanning should be performed routinely in BF. Displaced PM fractures in BF involving the incisura should be treated operatively via a direct posterolateral approach.
- MeSH
- dislokovaná fraktura diagnostické zobrazování patologie MeSH
- dospělí MeSH
- fibula diagnostické zobrazování zranění fyziologie MeSH
- fraktury kotníku diagnostické zobrazování patologie MeSH
- fraktury tibie diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- počítačová rentgenová tomografie MeSH
- senioři MeSH
- tarzální kosti diagnostické zobrazování zranění patologie MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Although Maisonneuve fracture (MF) is a well-known type of ankle fracture-dislocation, there is still a lack of information about the epidemiology and the extent of all associated injuries. The aim of study is to describe MF pathoanatomy on the basis of radiographs, CT scans and intraoperative findings. MATERIALS AND METHODS: The study comprised 54 adult patients. MF was defined as an ankle fracture-dislocation with a fracture of the fibula in its proximal quarter. Ankle radiographs and lower leg radiographs were obtained in all patients. Computed tomography (CT) examination was performed in 43 patients, of these in 34 patients in combination with 3D CT reconstructions. A total of 51 patients were treated operatively, and in 38 of these an open procedure was performed. RESULTS: The fibular fracture-fibular head was involved in four cases, and the subcapital region of the proximal quarter of the fibula was affected in 50 cases. Fractures of the posterior malleolus were identified in 43 of 54 patients (80%). Injury to the deltoid ligament was recorded in 27 cases (50%), a fracture of the medial malleolus in 20 cases (37%) and medial structures were intact in 7 cases (13%). Position fibula in fibular notch-in 9 cases the position changed only minimally, in 11 cases the space between the tibia and the fibula was larger than 2 mm, in 20 cases widening of the tibiofibular space was associated with external rotation of the fibula, in 2 cases fibula was trapped behind the posterior tibial tubercle and in 1 case it was associated with a complete tibiofibular diastasis. CONCLUSION: MF is a variable injury, always associated with rupture of the anterior and interosseous tibiofibular ligaments. CT examination should be employed widely in MF, and MRI should be considered under special circumstances.
- MeSH
- dislokovaná fraktura * diagnostické zobrazování patologie MeSH
- dospělí MeSH
- fraktury kotníku * diagnostické zobrazování patologie MeSH
- fraktury tibie * diagnostické zobrazování patologie MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- tarzální kosti * diagnostické zobrazování zranění patologie MeSH
- tibie * diagnostické zobrazování zranění patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Fractures of the proximal tibia are high energy fractures. According to available literature, 3-4% of all fractures heal problematically with non-union or osteomyelitis. Usage of locking compression plating system as well as usage of hybrid fixator is associated with the risk of compartment syndrome, local infection and subsequent malunion, osteomyelitis or non-union. We present a case of 30-year-old male suffering from posttraumatic non-union. The medial femoral condyle flap was selected due to its favourable properties providing a highly vascularised osteogenic tissue in combination with anterolateral thigh flap and Corlett loop. Our case report describes a reconstruction of a long weight-bearing bone. Despite the amount of anastomoses and usage of vein graft, the selected method of reconstruction seems to be safe and with a long-lasting benefit for the patient.
- MeSH
- dospělí MeSH
- fraktury tibie * chirurgie patologie MeSH
- kosti a kostní tkáň chirurgie MeSH
- lidé MeSH
- osteogeneze MeSH
- osteomyelitida chirurgie MeSH
- volné tkáňové laloky MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
ÚVOD: Procento infekčních komplikací po nitrodřeňovém hřebování je 1–4 %. Otevřené zlomeniny způsobené vysokoenergetickými úrazy mají procento infektu vyšší. KAZUISTIKA: Je prezentován průběh léčení 20letého muže s infikovaným pakloubem tibie po nitrodřeňovém hřebování otevřené zlomeniny. Léčení zahrnovalo postupné procedury extrakce hřebu a konverze na zevní fixátor. Po radikální resekci infikovaného pakloubu a měkkých tkání byl kostní defekt řešen bifokálním segmentálním transportem pomocí unilaterálního zevního fixátoru. Popisujeme komplikace segmentálního transportu – pin tract infekci a potřebu revize místa docking site s použitím spongioplastiky. Pacient se po náročném léčení zhojil a byl schopen plné zátěže po 30 měsících. DISKUZE: Léčení infikovaného pakloubu tibie zahrnuje radiální resekci infektem postižené kosti a měkkých tkání s následnými sekundárními rekonstrukčními výkony na skeletu a měkkých tkáních, jako jsou segmentální kostní transport a spongioplastika. ZÁVĚR: Segmentální transport je používán v léčbě kostních defektů. Terapie infikovaných pakloubů vyžaduje opakované operační výkony a individuální přístup k pacientovi.
INTRODUCTION: The rate of infection complications after intramedullary nailing of long bone is 1-4 %. After high energy open fractures is considerably higher. CASE REPORT: This is case of 20 – year man with infected nonunion of the tibia following intramedullary nailing of open tibia fracture. We present a series of sequential surgical procedures such as nail removal, debridement of fracture site, stabilisation by external fixation and fibular osteotomy. The final treatment of infected nonunion of the tibia was radical bone resection and reconstruction by bifocal segmental transport using monolateral external fixation. We describe complications of segmental transport such as pin-tract infection and necessity of revision and bone grafting at the docking site. The pacient was healed to full weight bearing after 30 months. DISCUSSION: The classic techniques for the treatment of a tibial nonunion associated with chronic osteomyelitis include the resection of the infected and nonviable, avascular bone and soft tissue following reconstructive procedures such as bone transport or grafting. CONCLUSION: Bone transport is indicated for segmental bone defects. The treatment of infected tibial nonunion need a series of sequential surgical procedures.
- MeSH
- debridement MeSH
- externí fixátory MeSH
- fibula diagnostické zobrazování zranění MeSH
- fixace fraktur metody MeSH
- fraktury tibie * chirurgie patologie MeSH
- infekce v ráně farmakoterapie MeSH
- kostní náhrady * MeSH
- lidé MeSH
- mladý dospělý MeSH
- osteotomie MeSH
- otevřené fraktury chirurgie patologie MeSH
- transplantace kostí * MeSH
- Check Tag
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Avulsion fractures of the intercondylar eminence (ICE) of the tibia have become increasingly frequent in older school age. Due to recent advances in arthroscopic techniques, it is now possible to treat them by minimally invasive methods. This retrospective study presents evaluation of clinical outcomes of an arthroscopic technique using crossed K-wires. MATERIAL Thirty-five patients with ICE avulsion fracture, 17 girls and 18 boys at an average age of 13 years (7-18), were included in this study. All were indicated for surgical treatment on the basis of radiographic evidence of McKeever type II and III fractures. METHODS The technique of arthroscopic reduction and fixation with crossed K-wires was used. The clinical evaluation of knee stability (anterior drawer test and Lachmann s-test) was made by one clinician. The modified Tegner-Lysholm score was assessed. RESULTS Of the 35 patients, 26 (74%) had minimal knee instability (anterior drawer up to 5 mm), two patients were primarily converted to open reduction with good results, and three (8.5%) experienced temporary knee instability (anterior drawer of 5-10 mm) that resolved spontaneously within 24 months of surgery. Four patients (11.5%) had symptoms of persistent residual instability (anterior drawer more than 10 mm) and were indicated for anterior cruciate ligament reconstruction at a later stage. The average Tegner-Lysholm scores were 86.3/100 and 98.6/100 at 6 and 24 months, respectively. DISCUSSION At the present time at our department, McKeever type II and III avulsion fractures of the intercondylar eminence are indicated for minimally invasive surgical treatment. By exact reduction it is possible to decrease the risk of post-operative knee instability. The current trend is the use of arthroscopy-assisted minimally invasive techniques such as the method of K-wire fixation described here. CONCLUSIONS Arthroscopic surgery for ICE avulsion fractures shows good results, is associated with low post-operative risks, is minimally invasive and easy to reproduce. It can be recommended as the method of choice for treating ICE avulsion injury in children
Painless fractures with delayed healing or abnormal callus formation require exclusion of a systemic disorder. We report a 9-year-old girl with hereditary sensory and autonomic neuropathy type IV who developed bone changes in the hind foot after a protracted healing of a tibia fracture. Osteomyelitis was considered as a possible cause of destruction of the tarsal bones. Negative sweat test documented anhydrosis. Late diagnosis in our patient occurred because of an unusual clinical course of the disease.
- MeSH
- dědičné senzorické a autonomní neuropatie komplikace patologie MeSH
- deformity nohy (od hlezna dolů) MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- fraktury tibie komplikace patologie MeSH
- hojení fraktur MeSH
- lidé MeSH
- neuropatická artropatie etiologie patologie MeSH
- osteomyelitida diagnóza MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Segmental tibial fractures are commonly believed to be more difficult to manage, requiring surgical treatment. Our experience with forty-eight segmental tibial fractures suggests that these fractures, if closed and with shortening of an acceptable initial degree and a corrected deformity, may be successfully treated with functional braces. MATERIAL AND METHODS Forty-eight closed segmental fractures of the tibia that had initial shortening .12 mm and angular deformity manually corrected to .7 degrees were stabilized in an above-the-knee cast for a median time of 33 days and a mode of 15 days. They were subsequently stabilized in a functional brace that allowed unencumbered motion of all joints. All other segmental fractures outside the established parameters were managed by other methods. RESULTS All fractures healed at a median time of 15.3 weeks. The final shortening was 4.7 millimeters with a mode of 12 millimeters. The maximum shortening was 14 millimeters. Fractures healed with a medial-lateral (M.L) angular deformities ranging zero to 19 degrees, a median of 5.9 degrees and a mode of 3.4 degrees. CONCLUSION The relatively early introduction of weight bearing and the freedom of motion of all joints that the brace permits seem to result in motion at the fracture site, which in turn enhances osteogenesis. As we have previously documented, the initial shortening that closed tibial fractures experience does not increase with the physiological use of the extremity. The final shortening and angulation observed in most of the fractures should not be considered complications, simply inconsequential deviations from the normal. The same should apply to closed segmental fractures.
- MeSH
- dospělí MeSH
- fraktury tibie komplikace patologie terapie MeSH
- hojení fraktur MeSH
- lidé středního věku MeSH
- lidé MeSH
- manipulace ortopedická MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nestejná délka dolních končetin etiologie MeSH
- senioři MeSH
- uzavřené fraktury patologie terapie MeSH
- výztuhy MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- absorpční fotometrie metody statistika a číselné údaje MeSH
- artroskopie metody MeSH
- dospělí MeSH
- fraktury tibie patologie terapie MeSH
- hydroxyapatit terapeutické užití MeSH
- lidé středního věku MeSH
- lidé MeSH
- osteointegrace MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- dítě MeSH
- fixace fraktur metody MeSH
- fraktury tibie komplikace patologie terapie MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony MeSH
- mladiství MeSH
- ortopedické fixační pomůcky MeSH
- poranění kolena etiologie patologie terapie MeSH
- sportovní úrazy MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- MeSH
- elektronová mikroskopie MeSH
- experimenty na zvířatech MeSH
- fraktury femuru patofyziologie patologie ultrastruktura MeSH
- fraktury kostí patofyziologie patologie ultrastruktura MeSH
- fraktury tibie patofyziologie patologie ultrastruktura MeSH
- hojení ran MeSH
- krysa rodu rattus MeSH
- regenerace kostí MeSH
- Check Tag
- krysa rodu rattus MeSH
- Publikační typ
- srovnávací studie MeSH
