Articles: tibia-surgery.
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A systematic review was performed to assess reamed and unreamed tibial nailing. Only prospective, randomised studies comparing reamed and unreamed tibial nailing in adults were included. A literature search found 1200 possible articles. ⋯ There was an increased non-union rate when the tibia was not reamed (p = 0.02). Screw breakage was more common in the unreamed group (p<0.0001). This study could find little difference in the incidence of other complications following reamed or unreamed tibial nailing.
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Oper Orthop Traumatol · Feb 2005
Clinical TrialLimb lengthening with the Intramedullary Skeletal Kinetic Distractor (ISKD).
Callus distraction of the femur or tibia with an intramedullary distractor, which lengthens mechanically through alternating rotations of at least 3 degrees. ⋯ Intramedullary lengthening with the ISKD was performed in four patients having an average age of 29 years (18-36 years). Two femoral shortenings were combined with complex rotational and angular deformities. The average lengthening of three femora and one tibia was 31 mm (26-40 mm). The average intraoperative blood loss was 230 ml (110-320 ml), the mean surgical time 108 min (90-145 min). The average daily distraction amounted to 1.2 mm (0.9-1.8 mm). Full weight bearing was permitted after 10 weeks (7-14 weeks), return to regular work after 11 weeks (7-16 weeks). At follow-up examination of an average of 2.3 years postoperatively the knee range of motion was full. Consolidation was noted 80 days (51-111 days) postoperatively with an average consolidation index of 2.9 days/mm (1.8-4.1 days/mm). No complications were observed. According to the Paley Score all patients had an excellent outcome.
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The aim of this study was to evaluate the accuracy of correction and short-term outcomes of treatment by opening-wedge tibial osteotomy with the use of allograft and a modified Puddu plate fixation. ⋯ Opening-wedge tibial osteotomy with the use of a Puddu plate and allograft in our modification is an effective, exact and simple method of correcting the lower extremity axis, and is associated with few complications. We do not recommend this method for interventions planned to achive corrections of more than 16 degrees, because these have a higher occurrence of complications. The use of allograft seems to have good prospects; another option for achieving large correction includes application of an LCP plate.
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A retrospective review was performed of 46 consecutive ambulatory children with cerebral palsy and tibial torsion who underwent 72 distal tibial derotational osteotomies without concomitant fibular osteotomy. The average amount of derotation measured at surgery was 21 +/- 5 degrees. The average change in thigh-foot angle at follow-up was 21 +/- 9 degrees. ⋯ Preoperative and postoperative three-dimensional gait analysis data were used to determine the effect of distal tibial osteotomy on foot progression angle in seven subjects (11 limbs). Foot progression improved significantly. This study shows that distal tibial osteotomy alone (without concomitant fibular osteotomy) is an effective and safe procedure for correcting and maintaining correction of tibial torsion in patients with cerebral palsy.
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J Bone Joint Surg Br · Mar 2004
Limb lengthening and correction of deformity in the lower limbs of children with osteogenesis imperfecta.
We performed limb lengthening and correction of deformity of nine long bones of the lower limb in six children (mean age, 14.7 years) with osteogenesis imperfecta (OI). All had femoral lengthening and three also had ipsilateral tibial lengthening. Angular deformities were corrected simultaneously. ⋯ The abnormal bone of OI tolerated the external fixators throughout the period of lengthening without any episodes of migration of wires or pins through the soft bone. The regenerate bone formed within the time which is normally expected in limb-lengthening procedures performed for other conditions. We conclude that despite the abnormal bone characteristics, distraction osteogenesis to correct limb-length discrepancy and angular deformity can be performed safely in children with OI.