Articles: tibia-surgery.
-
Meta Analysis Comparative Study
A meta-analysis of reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures.
Controversy exists regarding the clinical outcomes of reamed vs unreamed intramedullary nailing in the treatment of closed tibial fractures. This study assessed the effects of reamed vs unreamed intramedullary nailing for closed tibial fractures. The authors searched PubMed, EMBASE, BIOSIS, and the Cochrane Controlled Trials Register for randomized and quasi-randomized controlled clinical trials from January 1980 to June 2012 comparing reamed with unreamed intramedullary nailing for closed tibial fracture in adults. ⋯ The subgroup analysis of implant failures (broken screws vs broken nails) indicated that reamed nailing significantly reduced the risk of screw breakage (P<.001); however, there was no significant difference between reamed and unreamed intramedullary nailing in nail breakage (P=.94). The subgroup analysis of a secondary procedure showed that the reamed intramedullary nailing resulted in significantly lower risks of implant exchange (P=.01) and dynamization (P=.04); however, there was no significant difference in bone grafting rate (P=.73). Evidence comparing reamed with unreamed intramedullary nailing for closed tibial fractures indicates that reamed intramedullary nailing may lead to significantly lower risks of nonunion, screw failure, implant exchange, and dynamization without increasing operative complications.
-
Clin. Orthop. Relat. Res. · Apr 2014
Medial open wedge high tibial osteotomy: can delayed or nonunion be predicted?
The opening wedge approach to high tibial osteotomy (HTO) is perceived to have some advantages relative to the closing wedge approach but it may be associated with delayed and nonunions. Because nonunions evolve over months, it would be advantageous to be able to identify risk factors for and early predictors of nonunion after medial opening wedge HTO. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
-
Well-balanced charge of femoral and tibial cartilage by lateral transfer of the mechanical leg axis in osteoarthritis of the medial compartment and of genu varum. ⋯ Between January 2006 and December 2008, procedure performed in 50 patients (27 men, 23 women, mean age 44 years); arthroscopic treatment in 43 patients, and osteotomy of the fibula in 10 patients. The valgus correction was 8.4° (6-13°). No complication during surgery. One non-union was treated by cancellous bone grafting.
-
This study investigated the efficacy of tibial tubercle osteotomy (TTO) with screw fixation as part of the surgical treatment of primary complicated total knee arthroplasty (TKA) and revision TKA. From January 2000 to April 2011, 15 patients (15 knees) underwent revision TKA and 20 patients (21 knees) underwent primary TKA. The average patient age was 68.7±8.7 years. ⋯ Solid bone-to-bone fixation was achieved using TTO with 2 screws, and although the overall complication rate was 8.3%, none of the complications were associated with TTO itself. It is recommended that the bone fragment be 60 mm long, 20 mm wide, and 10 mm thick at the proximal end. Appropriate size of the osteotomized bone and solid screw fixation are essential to prevent complications during this procedure.
-
Posterior tibial slope (PTS) has recently been identified as a risk factor for anterior cruciate ligament (ACL) injuries because of an associated increase in anterior tibial translation (ATT) and ACL loading. However, few studies concerning the correlation between PTS and postoperative ATT have been published. ⋯ There was a significant correlation between PTS and postoperative anterior knee static stability in this study. Patients with a steeper medial or lateral PTS showed a higher risk of ATT ≥5 mm at thresholds of 5.6° and 3.8°, respectively.