Cases reported "Tibial Fractures"

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11/26. Use of the extended-pedicle vastus lateralis free flap for lower extremity reconstruction.

    BACKGROUND: Soft-tissue coverage in the lower extremity usually requires a flap with a long pedicle, low donor-site morbidity, and versatility in terms of shape and volume. The extended-pedicle free vastus lateralis muscle flap has previously been described for head and neck cancer, and it fulfills these requirements. methods: Twelve patients with lower extremity defects underwent reconstruction with an ipsilateral free vastus lateralis muscle flap. The flap included a segment of the distalmost part of the muscle, distal to the entry point of the motor nerve to the vastus lateralis, based on the descending branch of the lateral femoral circumflex vessels. Up to 20 cm of vascular pedicle with a large caliber was obtained. In three cases, a combined distal vastus lateralis and anterolateral thigh flap was used as a chimeric flap. RESULTS: All flaps were successful. infection developed in two cases and required flap reelevation and new wound debridement. There was no substantial subjective donor-site morbidity. CONCLUSIONS: Elevation of the flap can be performed with the patient in the supine position and is extremely fast and straightforward, without the added difficulty of anatomical variation or extensive intramuscular vascular dissection. The pedicle is long and of large caliber. Although the series is short, the authors conclude that this is a useful free flap for lower extremity reconstruction.
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ranking = 1
keywords = nerve
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12/26. peroneal nerve damage associated with the proximal locking screws of the AIM tibial nail.

    We report a case of division of the deep peroneal nerve resulting from a drill used in the insertion of an oblique proximal locking screw in an AIM tibial intramedullary nail (DePuy). Operative findings and anatomical study indicate there is a risk of damage to the peroneal nerve associated with the oblique proximal locking screws used in this nail design. If a patient has peroneal nerve palsy after nailing of the tibia, the possibility of nerve division should be considered, so that early exploration and repair of the nerve can be performed.
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ranking = 9
keywords = nerve
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13/26. Extensor mechanism disruption after contralateral middle third patellar tendon harvest for anterior cruciate ligament revision reconstruction.

    The contralateral central third patellar tendon autograft is a reliable graft choice for revision, and recently, for primary reconstruction of the anterior cruciate ligament (ACL). We report 2 complications including a lateral third tibial tuberosity fracture and a distal patellar tendon avulsion with contralateral patellar tendon autograft with disruption of the extensor mechanism of the donor knee. A patient sustained a lateral tibial tuberosity fracture of the donor knee and underwent open reduction and internal fixation. At 1-year follow-up, she had no extensor lag and full range of motion. Another patient sustained a distal patellar tendon avulsion of the donor knee and underwent primary repair. Three years postoperatively, she had a full range of motion and no extensor lag. Although contralateral middle third patellar tendon autograft for primary and revision ACL reconstruction is established in the literature, extensor mechanism complications can occur. Technical considerations are important to avoid weakening the remaining patellar tendon insertion. Postoperative nerve blocks or local anesthetics may alter pain feedback for regulation of weight bearing and contribute to overload of the donor knee.
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ranking = 1.3486263134407
keywords = nerve, block
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14/26. [Primary Ilizarov ankle fusion for nonreconstructable tibial plafond fractures]

    OBJECTIVE: Ankle arthrodesis in a plantigrade position. In high-energy open injuries with segmental bone loss: proximal tibial metaphyseal corticotomy with distal Ilizarov bone transport for compensation of leg length discrepancy. INDICATIONS: Posttraumatic loss of the tibial plafond, usually resulting from open fracture type IIIC. CONTRAINDICATIONS: Ipsilateral foot injuries impairing ambulation after fusion. Severe injury to the posterior tibial nerve with absent plantar sensation. Soft-tissue injury not manageable surgically. Inadequate patient compliance. Advanced age. Severe osteoporosis. Acute infection. SURGICAL TECHNIQUE: Standard technique: anteromedial longitudinal incision. Removal of remaining articular cartilage. Passing of Ilizarov wires through the distal fibula, talar neck and body. Placement of 5-mm half-pins through stab incisions, perpendicular to the medial face of the tibial shaft. A lateral to medial 1.8-mm Ilizarov wire in the proximal tibial metaphysis is optional. Callus distraction/Ilizarov bone transport: exposure through an anteromedial incision or transverse traumatic wound. Removal of small residual segment of tibial plafond blocking transport. Retain small vascularized bone fragments not blocking transport. For Ilizarov external fixation, two rings in the proximal tibial region. Drill osteoclasis of the tibial metaphysis 1 cm distal to the tibial tuberosity and complete with Ilizarov osteotome. Secure the Ilizarov threaded rods or clickers. Weight bearing as tolerated. Begin distraction 14 days after corticotomy at a rate of 0.5-1 mm per day depending on patient's age. After docking: Ilizarov ankle arthrodesis. RESULTS: Between January 1993 and September 1996, four patients (two men, two women) with severe, nonreconstructable fractures of the tibial plafond were treated. Callus distraction and Ilizarov bone transport in three patients. Age range 19-68 years (average age 45.7 years). Mean follow-up 6.6 years (4 years 9 months to 7 years 4 months). Average duration of the entire treatment in external fixation 54.4 days/cm for the three bone distraction patients. Mean transport 6 cm (4.5-8.5 cm). One patient required repeat ankle arthrodesis.
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ranking = 1.6972526268814
keywords = nerve, block
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15/26. Saphenous nerve entrapment caused by pes anserine bursitis mimicking stress fracture of the tibia.

    Numerous studies have addressed saphenous nerve entrapment at the level of the adductor canal. In this case, we report an entrapment syndrome located further distally occurring as part of an athletic overuse injury. Distal tibial pain, initially managed as a stress fracture, resolved when a pes anserine bursitis was treated. This was associated with return of saphenous nerve potentials along the tibia.
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ranking = 6
keywords = nerve
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16/26. Posterior tibial nerve neurotmesis complicating a closed tibial fracture. A case report.

    A case of complete transection of the posterior tibial nerve complicating a closed mid-shaft fracture of the tibia is reported. Early surgical exploration and repair resulted in return of function within 6 months. Such injuries are not common, but the case described highlights the importance of vigilance in assessment of all limb fractures.
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ranking = 5
keywords = nerve
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17/26. Sciatic block in lower limb surgery.

    A series of cases is described in which sciatic nerve block (by the lateral approach of Guiardini et al., 1985), with or without femoral nerve blockade, proved useful in the manipulation of tibial and ankle fractures without recourse to general anaesthesia. A case is presented in which this approach was the method of choice.
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ranking = 4.0917578806442
keywords = nerve, block
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18/26. Combined osteocutaneous microvascular flap procedure for extensive bone and soft tissue defects in the tibia.

    Recent experience with bone healing seems to advocate vascularized bone grafts in cases of large bone gaps or significant scarring, following irradiation, in the presence of low-grade infection, and in congenital pseudarthrosis of the tibia. When extensive bone and skin replacement are needed, the microvascular procedures currently available may not meet specific reconstructive requirements. To augment the advantages of the vascularized fibular graft for tibial substitution (strength, straightness, length, and predictability of vascular supply) with the benefits of free skin, muscle, or musculocutaneous flaps, separate on-demand harvesting of these tissue units and their microvascular combination can be useful in selected cases. In a study of 4 patients, the vascularized fibula was combined with a free latissimus dorsi flap. The procedure was facilitated and shortened by connecting the peroneal vessels to branches of the thoracodorsal or to the scapular circumflex artery and vein outside the operative field. The main supporting vessels of the combined composite tissue block were then anastomosed only to one pair of vessels in the leg.
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ranking = 0.34862631344071
keywords = block
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19/26. Bony entrapment of the superficial peroneal nerve.

    Peripheral nerve injury occasionally results from long bone fractures, but bony entrapment of a peripheral nerve occurs infrequently. Bony entrapment of a peripheral nerve is usually associated with upper extremity fractures. In a 34-year-old man bony entrapment of the superficial peroneal nerve occurred in a healed midshaft fibular fracture. The patient complained of progressive pain over the distribution of the superficial peroneal nerve after sustaining a closed displaced tibial and fibular fracture that healed in nonanatomic alignment. Exploration revealed bony entrapment of the superficial peroneal nerve in the fracture callus, with reactive neuroma formation. Excision of the neuroma resulted in complete relief of the symptoms. Persistent pain over the distal anterolateral leg and dorsal foot following a fibular and tibial fracture is usually derived from a compartment syndrome. If this has been ruled out, the differential diagnosis should include bony entrapment of the superficial peroneal nerve.
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ranking = 11
keywords = nerve
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20/26. Combined skeletal and vascular injuries of the lower extremities.

    In order to determine the long-term results of surgical treatment in patients with significant combined skeletal and arterial injuries, the authors reviewed the records of those patients treated for this injury between 1970 and 1981, at their institutions. These cases were confined to fractures and/or dislocations of the femur, knee, and tibia which were associated with vascular injuries. Thirty-one patients with 32 injured extremities fit these criteria for our review. The distribution of the orthopedic injuries were as follows: femoral fractures, 16; tibial fractures, 20; and knee dislocations, four. Fifty percent of the injuries had neurologic deficit; significant soft tissue injury was present in 22 extremities; and all but 4 had attempted arterial revascularization. Vascular procedures included saphenous vein by-pass, saphenous vein interposition, end-to-end anastomosis and lateral arteriorrhaphy. Orthopedic repairs were generally accomplished by external means with only five cases treated by immediate internal fixation. Long-term results were categorized as excellent, fair, or poor. Amputations were classified as primary and secondary. Excellent results were found in only five of the reconstructed extremities. Thirty-five percent of the extremities were classified as having a fair result. Two extremities had a poor result. Four extremities were primarily amputated, and secondary amputation was performed on seven extremities. Associated nerve deficits and/or significant soft tissue injuries were found to be the major factors determining the eventual success or failure of reconstructive efforts.
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ranking = 1
keywords = nerve
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