Cases reported "Tibial Fractures"

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1/28. Periprosthetic tibial fractures after cementless low contact stress total knee arthroplasty.

    periprosthetic fractures are a recognized complication of total knee arthroplasty. Fractures may occur intraoperatively or postoperatively, and risk factors have been identified that may predispose an individual to such a complication. We report 7 cases of periprosthetic tibial fractures after low contact stress total knee arthroplasty, a complication encountered by the senior author (D.E.B.) only after a change in practice from a cemented implant to a cementless one. In light of this previously unreported complication in our unit, we attempted to identify common features within this group of patients that may have contributed to fracture occurrence. Statistical analysis revealed a highly significant (P<.005) risk of periprosthetic tibial fracture in patients with a preoperative neutral or valgus knee. Age, gender, and diagnosis did not appear to increase the risk of fracture significantly. All patients displayed evidence of reduced bone mineral density in the lumbar spine and femoral neck regions on dual-energy x-ray absorptiometry scanning. patients with a preoperative neutral or valgus knee and local evidence of osteopenia represent a high-risk group, in whom particular care in alignment should be taken. In this group, it may be preferable to have the tibial component inserted with cement fixation.
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keywords = x-ray
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2/28. Cavus deformity of the foot after fracture of the tibial shaft.

    Twenty-three cases of claw foot with limited talocrural and subtalar mobility were the result of muscle contracture of the leg after tibial-shaft fracture. A roentgenographic study including arteriography was performed. It was concluded that the typical short cavus foot is due to fibrous contracture of the muscles in the deep posterior compartment caused by vascular damage, swelling in the deep posterior compartment, or severe muscle laceration. On physical examination the distance between the lateral malleolus and the achilles tendon was shortened in comparison with the sound side in all cases. This was found to be caused by dorsiflexion in the talocrural joint coincident with adduction in the mid-tarsal joint. The angulation of the foot forced the patients to rotate the leg outward in order to get the feet in parallel position for walking. This deformity could be misinterpreted as an inward malrotation of the tibial fracture. In severe cases a derotating three-dimensional wedge osteotomy of the distal part of the tibia was performed with promising results.
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ranking = 34901.298425091
keywords = roentgen
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3/28. exercise-related longitudinal tibial stress fracture in a young person.

    A 22-year-old man presented to the nuclear medicine Clinic for evaluation of distal right tibial pain. The patient reported recently beginning a rigorous exercise program involving lower extremity impact temporally related to the onset and worsening of the pain. The physical examination was remarkable for significant tenderness to palpation of the distal one-third of his right tibia. The presumptive diagnosis was a stress fracture. Recent roentgenograms of the right tibia were not available for review but were reportedly normal. Scintigraphy, in combination with computed tomography, revealed an unusual type of stress fracture (particularly in a young person and in relation to exercise)--a longitudinal stress fracture.
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ranking = 34901.298425091
keywords = roentgen
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4/28. magnetic resonance imaging in the evaluation of partial growth arrest after physeal injuries in children.

    The precise delineation of the size, shape, and location of an osseous bridge is a critical step in the management of children who have a partial growth arrest of the epiphyseal plate. Five children between the ages of ten and fourteen years were diagnosed, with the aid of conventional roentgenograms, as having a partial growth arrest. Magnetic resonance-imaging studies were carried out to determine the exact size, shape, and location of the osseous bridge. The information derived from the imaging studies was essential for the determination of the appropriate treatment and for the planning and undertaking of any operative intervention.
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ranking = 34901.298425091
keywords = roentgen
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5/28. Stapling for tibial-growth deformity. A case report on roentgen stereophotogrammetric analysis.

    A 9-year-old boy sustained a Salter-Harris Type IV fracture in the proximal tibia. The injury resulted in a progressive valgus deformity, detected already after 3 months by roentgen stereophotogrammetry. After temporary stapling medially, the growth rate increased laterally and the deformity was corrected. Unilateral stapling is an alternative procedure for correcting angular deformity following a physeal injury.
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ranking = 174506.49212546
keywords = roentgen
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6/28. Tricalcium phosphate as a bone graft substitute in trauma: preliminary report.

    Ceramic tricalcium phosphate (TCP) has been implanted in bony defects in 43 patients following trauma. It is an osteoconductive material that facilitates trabecular bone formation. The average follow-up time was 12 months, with a 6-month minimum. There were 33 fractures in 30 patients and 13 nonunions in 13 patients. Three of the patients with acute fractures were unavailable for follow-up observation. Ninety percent of the fractures and 85% of the nonunions were healed at the time of this review. The resorption of TCP was estimated from the roentgenograms to be approximately 10% per month, with complete resorption occurring in 6-24 months. There were eight complications, five among the 30 fractures and three among the 13 nonunions that were observed later. There were three fractures and two nonunions that failed to heal. There were two fractures that had initially been open and one previously infected nonunion that united but were complicated due to infection. These preliminary results demonstrate TCP's usefulness as a substitute for cancellous bone. This is accompanied by other advantages, including increased patient safety, lack of donor site morbidity, unlimited shelf life and reduced operating time.
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ranking = 34901.298425091
keywords = roentgen
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7/28. Displaced malleolar fractures associated with spiral fractures of the tibial shaft.

    A displaced fracture of the lateral malleolus, of the posterior tibial margin (posterior malleolus), or of both requiring open reduction and internal fixation was observed in association with ipsilateral spiral tibial shaft fracture in five patients. The malleolus fracture components all were managed using AO (ASIF) instrumentation. The tibial shaft fracture was treated nonoperatively in three patients and with interfragmentary screw fixation in two with more severe initial displacement. The bony healing of all fractures was uneventful. These combined injuries amounted to 0.9% of all admitted tibial shaft fractures and 3.9% of those with spiral configuration. An associated displaced malleolar fracture in tibial shaft fractures, sometimes even indiscernible in the anteroposterior view, may be overlooked unless roentgenograms are focused on the ankle joint. Examination of the joints above and below the fracture is of particular importance in clinics advocating functional treatment of tibial shaft fractures.
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keywords = roentgen
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8/28. Free vascularized fibular grafts in the treatment of congenital pseudarthrosis of the tibia.

    Five patients with congenital pseudarthrosis of the tibia treated by a free vascularized fibular graft are described. Follow-up evaluation ranged from 15 to 81 months, with a mean of 40 months. Bony union was attained in three of five cases as determined roentgenographically. The remaining two cases failed to attain bony union. All cases except one, who was treated with a below-knee amputation, subsequently attained bony union. However, four cases had five fractures after bony union. We discussed unsolved problems regarding the free vascularized fibular graft and fracture after bony union.
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ranking = 34901.298425091
keywords = roentgen
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9/28. Functional management of stress fractures in female athletes using a pneumatic leg brace.

    Thirteen consecutive female athletes complaining of activity-induced lower extremity pain were evaluated. Ten of the 13 athletes had either an x-ray film or bone scan positive for stress fracture of the tibia or fibula. Three athletes with classic signs and symptoms of tibial stress fractures and negative x-ray films refused the bone scan. Three athletes had bilateral tibial stress fractures. The athletes were treated by the application of a pneumatic leg brace to the affected leg or legs. Following this, all 13 athletes were able to return to their sport and participate at a high level of competition with little or no symptoms.
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ranking = 2
keywords = x-ray
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10/28. Posterior tibial artery pseudoaneurysm following tibial fracture. A case report.

    The presence of distal pulses is often times misleading and the severity of the fracture roentgenographically is frequently unrelated to the possibility of a vascular injury. Pseudoaneurysms following long bone injuries, although not as commonly seen in blunt as in penetrating trauma, are potentially limb threatening injuries requiring a high index of suspicion and the liberal use of angiography for early diagnosis and repair. A case of a pseudoaneurysm of the posterior tibial artery associated with a grade I open fracture following blunt trauma and a review of the literature concerning arterial injury in blunt trauma are presented.
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ranking = 34901.298425091
keywords = roentgen
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