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1/18. Nonunion of tibial stress fractures in patients with deformed arthritic knees. Treatment using modular total knee arthroplasty.

    In two years we treated four women with ununited stress fractures of their proximal tibial diaphyses. They all had arthritis and valgus deformity. The stress fractures had been treated elsewhere by non-operative means in three patients and by open reduction and internal fixation in one, but had failed to unite. After treatment with a modular total knee prosthesis with a long tibial stem extension, all the fractures united. A modular total knee prosthesis is suitable for the rare and difficult problem of ununited tibial stress fractures in patients with deformed arthritic knees since it corrects the deformity and the adverse biomechanics at the fracture site, stabilises the fracture and treats the arthritis.
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keywords = tibia
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2/18. Juvenile Blount's disease: bilateral case with asynchronous onset.

    We encountered a rare case of bilateral juvenile Blount's disease diagnosed as unilateral at the onset. The patient was a 9-year-old girl who visited our outpatient clinic with pain and deformity in the left knee. Examination of the left knee showed severe varus deformity. Correction of the varus deformity and tibial shortness was carried out at the same time by the callotasis method using an Orthofix external fixator. During follow-up the varus deformity in her right knee gradually progressed. At 18 months after the initial surgery, the right varus deformity and tibial shortness were corrected at the same time by the callotasis method using an Orthofix external fixator; proximal epiphysiodesis was also performed. The coronal-plane alignment of both knees remains good. In cases with bilateral involvement of Blount's disease, the onset of the deformity is usually nearly synchronous. In some cases, however, it begins unilaterally, as with this patient, so it is essential to check both sides by means of tomography or magnetic resonance imaging and not just radiography. Moreover, we must be careful to plan the treatment in such a case so as to anticipate possible leg-length discrepancy problems.
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ranking = 0.28571428571429
keywords = tibia
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3/18. The use of an external tibial fixator in the treatment of genu varum.

    This paper reports 72 cases of genu varum treated by a U-shaped osteotomy of the tibia and an oblique osteotomy of the fibula in combination with immobilization effected by a specially designed external tibial fixator. Owing to this modified approach, the patients were able to stand up and move about much earlier than usual. Our trial yielded 80.7% excellent, 16.6% good and 2.7% fair results. The treatment course was shortened to two thirds of the time required when using previously described techniques.
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ranking = 0.85714285714286
keywords = tibia
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4/18. arthroplasty in treating knee osteoarthritis and proximal tibia stress fracture.

    The authors describe two cases of severely angulated tibial non-unions after proximal tibia stress fractures associated with ipsilateral osteoarthritis treated with modular knee endoprosthesis with a long tibial stem to stabilize non-union fragments. During the procedure, no additional osteosynthesis or bone grafting was added. Both non-unions healed after 6 months with no post-operative complications. The authors suggest implantation of modular knee endoprosthesis, as a single procedure, in treatment of proximal tibia non-union after a stress fracture as a result of severe varus/valgus deformity. It provides a solution for osteoarthritis treatment, axis correction and non-union osteosynthesis.
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ranking = 1.1428571428571
keywords = tibia
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5/18. Opening-wedge osteotomy, allografting with dual buttress plate fixation for severe genu recurvatum caused by partial growth arrest of the proximal tibial physis: a case report.

    Injuries to the proximal tibial physis are among the least common epiphyseal injuries. We present a case of severe genu recurvatum deformity (45 degrees) with leg length discrepancy (4 cm) following a neglected proximal tibial physeal injury incurred 6 years previously. The 16-year-old patient was successfully treated by open-wedge osteotomy, allograft reconstruction, and dual buttress plate fixation. At 3 years' follow-up, the patient was asymptomatic, fully active with a full range of motion (0 - 140 degrees) of the leg, and equal leg lengths. There were no signs of genu recurvatum clinically.
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ranking = 0.85714285714286
keywords = tibia
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6/18. The 'anvil' osteophyte-a primary cause of fixed flexion of the knee?

    Three cases are reported in which clinical presentation was with arthritic symptoms and inability to straighten the knee. An unusually prominent anterior tibial osteophyte, whose shape is remarkably suggestive of a blacksmith's anvil, appeared to be a contributory factor through its apparent impingement with the femoral trochlea at the limit of extension. The osteophyte was radically removed arthroscopically in each case as an isolated gesture, and the patients were followed up with particular emphasis on fixed flexion deformity. At clinical review, after a mean follow-up period of 5.3 years, it was concluded that there had not been a convincing or sustained improvement in knee function, although the fixed flexion deformities had not increased significantly. Our conclusion is that the 'anvil' osteophyte may simply be a part of a more diffuse degenerative process and that it was probably not, in itself, the primary cause of fixed flexion deformity in these cases.
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ranking = 0.14285714285714
keywords = tibia
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7/18. regeneration of the proximal tibial epiphysis after infantile osteomyelitis: report of three cases with an eight- to 22-year follow-up.

    We reviewed three infants with destructive osteomyelitis involving the proximal tibial epiphysis at a follow-up of eight to 22 years. All cases showed early radiographic destructive changes in the medial or lateral aspects of the epiphysis and metaphysis. Despite the ominous early appearance of the epiphysis, all cases showed spontaneous re-ossification of the epiphysis with restoration of the tibial condyle and preservation of joint congruity. The patients, however, developed a valgus or varus deformity which was treated satisfactorily with one to three proximal tibial osteotomies. The potential for regeneration of the epiphysis following infantile osteomyelitis of the proximal tibia suggests these cases should be treated expectantly with regard to joint congruity.
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ranking = 1.1428571428571
keywords = tibia
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8/18. The management of leg-length discrepancy in Ollier's disease with a fully implantable lengthening nail.

    Ollier's disease is characterised by severe deformity of the extremities and retarded growth because of multiple enchondromas. For correction of deformity, the Ilizarov method has been used although it has many complications. A 17-year-old boy with Ollier's disease had a limb-length discrepancy of 17.4 cm, with a valgus deformity of the right knee and recurvatum of the femur of 23 degrees . He had undergone three unsuccessful attempts to correct the deformities by using external fixators. We used a fully implantable, motorised, lengthening and correction nail (Fitbone) to achieve full correction of all the deformities without complications. We decided to carry out the procedure in three stages. First, we lengthened the femur by 3.6 cm and the tibia by 4 cm. We then exchanged the femoral nail for a longer implant and achieved a further 6 cm of length. This reduced the shortening to 3.8 cm. When the boy has finished secondary school we will adjust the remaining discrepancy.
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ranking = 0.14285714285714
keywords = tibia
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9/18. A reversed tibial flip autograft technique for correcting over-valgus knee after high tibial closing-wedge osteotomy in total knee arthroplasty.

    Excessive valgus deformity after a failed high tibial osteotomy presents problems for subsequent total knee arthroplasty because the proximal tibia is deformed, necessitating a much larger resection of bone from the medial aspect of the tibia. Other researchers have reported the tibial flip autograft technique to augment the tibial medial compartment to correct varus knee. We have modified this technique, which we call the reversed tibial flip autograft technique, for a patient with valgus knee after failed high tibial osteotomy. Clinical results were excellent, and no signs of loosening were apparent 2 years after surgery, suggesting that this technique is useful for management of tibial bone loss and correction of valgus angular deformity in total knee arthroplasty.
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ranking = 2.2857142857143
keywords = tibia
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10/18. Stress fracture of the distal tibia secondary to severe knee osteoarthritis: a case report.

    Stress fracture of the tibia secondary to sports-related activities is relatively common, but rarely occurs secondary to osteoarthritis of the knee. Such fractures usually involve the proximal tibia. We report a 61-year-old woman with osteoarthritis and severe varus deformity of the knee who had a stress fracture of the distal tibial shaft. The patient had declined total knee replacement for severe osteoarthritis. She developed a stress fracture that subsequently malunited. The patient presented late and the diagnosis was not made for several months. The pathomechanics, diagnosis, and management options for this patient are discussed.
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keywords = tibia
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