Cases reported "Tibial Fractures"

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1/860. A metallurgical examination of fractured stainless-steel ASIF tibial plates.

    Between 1970 and 1973 99 tibial fractures were treated by rigid internal fixation with ASIF plates. The fractures were all regarded as sufficiently stable for exercise without weight bearing, thus needing no additional external support during the healing period. Four of the plates broke late in the healing period, after the onset of weight bearing. These fractures had some degree of delayed union with slight resorption of the bone ends, resulting in cyclical bending of the plate. Examination of 2 of the fractured plates by scanning electron microscopy, electron microprobe analysis and optical metallography revealed that the primary cause of plate fracture was fatigue. There was no evidence that corrosion fatigue or inclusion content were factors leading to plate fracture. ( info)

2/860. Chronic clostridium septicum infection of a tibial fracture: a case report.

    An open transverse fracture of the mid-shaft of the tibia of a professional footballer became infected by clostridium septicum and, after early compression plating, required surgical intervention on three further occasions and extensive antibiotic treatment before healing occurred. Clostridial infection is a recognized complication of open fractures contaminated with soil, and the necrotizing toxins produced by the C. septicum were probably responsible for the persistence of this infection. infection occurred in less than 1 per cent of our series of 215 operations of compression plating of fresh fractures of the tibial shaft. infection by clostridium species is a serious complication of open fractures. This patient did not show the spreading inflammation and necrosis, or the marked systemic upset, characteristic of acute clostridial infection, but persistent local infection necessitated prolonged surgical and antibiotic treatment. ( info)

3/860. Use of a reversed-flow vascularized pedicle fibular graft for treatment of nonunion of the tibia.

    Ten patients with nonunion of the lower tibia were treated with a vascularized ipsilateral fibular graft, that was transferred distally and based on retrograde peroneal vessel flow. Eight patients were treated for congenital pseudarthrosis of the tibia; one had a nonunion subsequent to infection, and another patient had bone and skin loss due to infection. A posterior approach was used to expose the tibia and to harvest the fibula. Bone union and full weight-bearing were achieved in all cases by 9 months. The patients were followed-up for a mean of 1.8 years (range: 1.5 to 3 years). ( info)

4/860. Oncogenic osteomalacia presenting as bilateral stress fractures of the tibia.

    We report on a patient with bilateral stress fractures of the tibia who subsequently showed classic biochemical features of oncogenic osteomalacia. Conventional radiographs were normal. MR imaging revealed symmetric, bilateral, band-like low-signal lesions perpendicular to the medial cortex of the tibiae and corresponding to the only lesions subsequently seen on the bone scan. A maxillary sinus lesion was subsequently detected and surgically removed resulting in prompt alleviation of symptoms and normalization of hypophosphatemia and low 1,25-(OH)2 vitamin D3. The lesion was pathologically diagnosed as a hemangiopericytoma-like tumor. patients with oncogenic osteomalacia may present with stress fractures limited to the tibia, as seen in athletes. The clue to the real diagnosis lies in paying close attention to the serum phosphate levels, especially in patients suffering generalized symptoms of weakness and not given to unusual physical activity. ( info)

5/860. Recognition and management of Tillaux fractures in adolescents.

    Tillaux fractures are relatively uncommon Salter Harris III fractures of the tibia. The importance of recognizing this fracture is that a residual deformity in the joint surface can lead to premature degenerative arthritis. For this reason, it is important that accurate imaging to assess the congruity of the joint, as well as adequate reduction, is obtained. These fractures can occur in adolescents in the 18-month period during which the distal tibial epiphysis is closing. These injuries occur either by lateral rotation of the foot or by medial rotation of the leg on the fixed foot. Closed reduction is sufficient in most cases; however, if a gap of > or = 2 mm of the articular surface remains, open reduction is usually required to adequately reduce the articular surface. Orthopedic injuries are one of the most common reasons children are brought to the emergency department (ED). Most of these injuries are easily managed by splinting, with outpatient orthopedic follow-up. However, certain fractures need closer evaluation and immediate consultation with an orthopedic surgeon. One relatively uncommon fracture that needs special attention is the Tillaux fracture. Paul Jules Tillaux first described this particular fracture in 1892. He performed experiments on cadavers and found that stress to the anterior inferior tibiofibular ligament could lead to this type of avulsion fracture, which today is termed the Tillaux fracture. The distal tibial epiphysis is involved, and the mechanism usually is forced external rotation of the foot in a 12- to 14-year-old adolescent. This fracture only occurs during a certain time of adolescence, owing to the differential growth rate of the epiphysis, and only under certain circumstances. The fracture is of great importance because it involves a major weight-bearing articular surface. A residual deformity of the joint surface can lead to premature degenerative arthritis. We present a patient with a Tillaux fracture to elaborate on the mechanism of injury and to summarize the importance of its recognition and imaging and treatment options. ( info)

6/860. Lessons to be learned: a case study approach diuretic therapy and a laxative causing electrolyte and water imbalance, loss of attention, a fall and subsequent fractures of the tibia and fibula in an elderly lady.

    The case is described of a hitherto well, alert and intelligent lady of 85 years of age, who commenced medication with diuretics--prescribed for mild congestive cardiac failure; she developed constipation consequent upon the diuresis and dehydration thereby provoked. As a result she began to take, unknown to her general practitioner, regular and increasing amounts of laxatives. At about this time she was noted by her son to become "rapidly senile"--with the result that she fell on account of losing her normally good concentration and attention; she sustained fractures of the right tibia and fibula. Shortly after admission to hospital she was premedicated, anaesthetised and operated upon, following which there was a postoperative regimen comprising several litres of low sodium isotonic infusions, all given intravenously. She was found at this point to be severely hyponatraemic with a low serum osmolality, but following the institution of water restriction rapidly improved as her serum sodium rose again; there was an accompanying massive diuresis as the previously retained water was voided. Concomitant with the serum sodium rise her mental concentration and attention regained their former levels. The biochemical and cellular mechanisms underlying this patient's symptoms are discussed. ( info)

7/860. The treatment of tibial and fibular fractures with a rectangle-shaped intramedullary nail.

    A study is reported in which excellent results were achieved with use of a flexible rectangle-shaped intramedullary (RIM) nail in the treatment of 171 tibial and fibular shaft fractures in a series of 165 patients. Mechanical analysis showed improved fracture stability compared to fractures treated with an Ender nail. To the best of the authors' knowledge, the method of treatment described in this report has not been discussed previously in the Western literature. ( info)

8/860. Difficulty in removal of the distal locking device of the Brooker-wills tibial nail.

    Complications in removal of the Brooker-wills tibial nail were encountered in eight patients, and breakage of the distal fins occurred in four of these patients. Although none of the patients experienced residual effects related to removal of the tibial nail, the procedure is associated with potential risks such as infection or nonunion. Three methods of nail removal are described. ( info)

9/860. Decline in bone mineral density with stress fractures in a woman on depot medroxyprogesterone acetate. A case report.

    BACKGROUND: Depot medroxyprogesterone acetate is a popular contraceptive among young, physically active women. However, its administration has been linked to a relative decrease in estrogen levels. Since bone resorption is accelerated during hypoestrogenic states, there has been growing concern about the potential development of osteoporosis and fractures with the use of this contraceptive method. CASE: A physically active, 33-year-old woman demonstrated a 12.4% drop in femoral neck bone mineral density (BMD), 6.4% drop in lumbar BMD and 0.8% drop in total BMD with the subsequent development of a tibial stress fracture while on depot medroxyprogesterone acetate. Bone mineralization rapidly improved, and the stress fracture resolved with discontinuation of the medication. CONCLUSION: The long-term effects of depot medroxyprogesterone acetate on bone mineralization in physically active women should be evaluated more thoroughly. ( info)

10/860. Case report. Post-traumatic tibial recurvatum: resolution with growth.

    The outcome of proximal tibial fractures in children is often complicated by the development of malalignment. Progressive valgus deformity is frequently seen, but is known to correct spontaneously in a high proportion of cases; however, recurvatum of the tibia usually requires surgical intervention. We present a child with a proximal tibial metaphyseal fracture who developed increasing tibial recurvatum which corrected spontaneously. ( info)
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