Aims. To describe outcome reporting variation and trends in non-pharmacological randomized clinical trials (RCTs) of
Aims. We retrospectively report our experience of managing 30 patients with a primary malignant tumour of the
The ideal form of fixation for displaced, extra-articular
fractures of the
Aims. To report the outcomes of patients with a fracture of the
Aims. To systematically review qualitative studies of patients with
Aims. The aim of this study was to report the results of three forms of reconstruction for patients with a ditsl tibial bone tumour: an intercalary resection and reconstruction, an osteoarticular reconstruction, and arthrodesis of the ankle. Methods. A total of 73 patients with a median age of 19 years (interquartile range (IQR) 14 to 36) were included in this retrospective, multicentre study. Results. Reconstructions included intercalary resection in 17 patients, osteoarticular reconstruction in 11, and ankle arthrodesis in 45. The median follow-up was 77 months (IQR 35 to 130). Local recurrence occurred in eight patients after a median of 14 months (IQR 9 to 36), without a correlation with adequacy of margins or reconstructive technique. Major complications included fracture of the graft in ten patients, nonunion of the proximal osteotomy in seven, and infection in five. In the osteoarticular group, three of 11 patients developed radiological evidence of severe osteoarthritis, but only one was symptomatic and required conversion to ankle arthrodesis. Functional evaluation showed higher values of the Musculoskeletal Tumour Society (MSTS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores in the intercalary group compared with the others. Conclusion. Preservation of the epiphysis in patients with a
We have carried out prosthetic reconstruction in six patients with malignant or aggressively benign bone tumours of the
The purpose of this study was to evaluate and to compare the mechanical stability of external fixation with and without ankle spanning fixation using a foot plate in an in-vitro model of periarticular
Introduction: Unstable fractures of the
Endoprosthetic replacement of the
Aims: There has been recent interest in the use of external þxation for the treatment of distal peri-articular fractures. The current study was undertaken to evaluate the role of the hybrid external þxation system in the treatment of the distal tibial fractures. Methods: We treated 137 fractures of the
Introduction: Primary or secondary bone tumours of the
Introduction and Aims: I was presented with a Land-mine victim with closed fracture of right talus, compound injury to left lower limb, and defect in heelpad. Distal third of tibia and most of hindfoot were missing. Left foot neurovascularly intact and he was able to move his toes. Aim: reconstruct left
Introduction. Posterior malleolar fractures are present in up to 44% of all ankle fractures. Those involving > 25% of the articular surface have a higher rate of posterior ankle instability which may predispose to post traumatic arthritis. The posterolateral approach to the
Purpose: Amputation is often proposed for malignant tumours of the
We report the results of limb salvage for non-metastatic osteosarcoma of the
Fractures of
Wire crossing angle affects the stability of circular fine wire frames. Anatomical atlases document safe ‘corridors’ to avoid neurovascular structures, although this may limit crossing angle. In the
Aim. The aim of this study was to compare the cost-effectiveness of
intramedullary nail fixation and ‘locking’ plate fixation in the
treatment of extra-articular fractures of the
Introduction: An important factor affecting the stability of circular fine wire frames is the wire crossing angle, where an angle of 90 degrees confers optimal stability. Safe anatomical ‘corridors’ have been described to avoid neurovascular structures, but often limit the crossing angle. In the
Most high-energy trauma to lower legs, ankles and feet result in severe crush injuries. We performed a retrospective case series study. Eight patients (7M: 1F) with mean age of 28 years (range -18 -35 years) were included. Four had Grade 3 open fractures of the
Non-unions of pilon fractures are difficult Orthopaedic problems. Significant bone loss and infection can lead to amputation. Joint stiffness in conjunction with disuse osteopenia make stabilization in this area challenging. We present the use of a custom blade plate design that offers sufficient stability for successful treatment in six successive cases. With a mean follow-up of thirty-three months, all fractures treated with this method healed. The five infected cases healed without recurrence of infection. With average scores of 70.7 on the Maryland Foot Score, and sixty-eight on the Foot and Ankle Society Ankle-Hindfoot Scale, the patients overall had satisfactory results. The purpose of this study was to describe a new technique of treating non-unions of
A series of 3061 patients with fracture of the
Surgical treatment of distal tibia fractures is usually associated with extensive soft tissue compromise and high complication rates (infection, delayed or non-union, ankle stiffness and osteoarthritis). Wound infection is one of the most common complication (deep infection rates up to 15%) and can develop into an infected non-union. In 1973, Papineau described a staged technique for treating infected non-union of long bones, consisting of (1) surgical debridement of necrotic tissue, temporary splinting, specific antibiotic treatment, postoperative wet-to-dry wound dressing changes; (2) packing of the bone defect with cortico-cancellous autograft; (3) closure of the soft-tissue wound by a flap or secondary intent. The authors aim to report a clinical case of a successful treatment of a
A series of 49 pilon fractures in a tertiary referral centre treated definitively with open reduction and internal fixation have been assessed examining the complications associated with such injuries. A retrospective analysis of casenotes, radiographs and computerised tomographs over a seven year period from 1999–2006 was performed. Infection was the most common post operative problem. There were 7 cases of superficial infection. There was a single case of deep infection requiring intravenous antibiotics and removal of metalwork. Other notable complications were those of secondary osteoarthritis (three cases) and malunion (one case). The key finding of this paper is the 2% incidence of deep infection following the direct operative approach to these fractures. The traditional operative approach to such injuries (initially advocated by Ruedi and All-gower) consisted of extensive soft tissue dissection to gain access to the
Aims: Nonunions of the
We have reviewed 15 cases of triplane fracture of the
Fractures of the
Percutaneous plating of the
This study identified imaging parameter(s) which best predict the mechanical properties of
Unstable fractures of the
The treatment of high energy fractures of
This paper describes the outcome of type III pilon fractures of the
This paper describes the outcome of type III pilon fractures of the
Salter-Harris II fractures of the
Aims: The evaluation of indications and results of the treatment of C fractures (according to AO) of the
Purpose: To evaluate the outcome of salvage surgery with external fixation in these rare and severe lower limb injuries. Methods: Eight patients (7M: 1F) with mean age of 28 years (range −18 −35 years) were included. Four had Grade 3 open fractures of the
In a series of 126 consecutive pilon fractures, we have described anatomically explicable fragments. Fracture lines describing these fragments have revealed ten types of pilon fracture which belong to two families, sagittal and coronal. The type of fracture is dictated by the energy of injury, the direction of the force of injury and the age of the patient.
The aim of this study was to evaluate the results of a consecutive series of distal tibial fractures treated by percutaneous plating. 85 patients with distal tibial fractures were treated using minimally invasive medial plate fixation. 18 patients had open fractures. Eight had displaced intra-articular fractures (AO type 43C). The majority had extra-articular fractures (AO type 42 or 43A). Patients ranged in age from 16–89 years. All were followed to union with a minimum follow-up period of 6 months (average 47 months). Outcome measures assessed retrospectively were alignment, time to full weight bearing and complications including infection, delayed or non-union and secondary surgery. The mean time to surgery after injury was 5 days (range 0–22). 51 patients had unlocked pre-contoured plates and the remaining 34 had locking plates. The fibula was plated in 41 cases. Post-operative mal-alignment greater than 5 degrees varus or valgus occurred in 3 cases (3.5%). The average time to full weight bearing was 11 weeks. Superficial infection occurred in 6 patients (7%) and deep infections in 4 cases (4.7%). There was one case of plate fracture. 4 patients, including this case, required further surgery to achieve union. There was a high rate of metalware symptoms that prompted plate removal. Percutaneous plate fixation of distal tibial fractures is a reliable method of treatment with complication rates lower than reported for open techniques.
Aim: The aim of this study was to compare the treatment results of
In this cohort study, we present comprehensive injury specific and surgical outcome data from one of the largest reported series of distal tibial pilon fractures, treated in our tertiary referral centre. A series of 76 pilon fractures were retrospectively reviewed from case notes, plain radiographs and computed tomography (CT) imaging. Patient demographics, injury and fracture patterns, methods and timing of fixation and clinical and radiological outcomes were assessed over a mean follow up period of 8.6 months (range 2–30).Introduction:
Methods:
A series of 76 distal tibial pilon fractures treated with surgical fixation were retrospectively reviewed from case notes, plain radiographs and CT imaging. Patient demographics, injury and fracture patterns, methods and timing of fixation and clinical and radiological outcomes were assessed over a mean follow up period of 8.6 months (range 2–30). Definitive fixation was most commonly performed through an open technique (71 cases) with plate fixation. CT imaging was used to plan the most direct approach to access the fracture fragments. Single or double incision techniques were used to access the tibia, with fixation of the fibular performed when necessary. Superficial infection occurred in 5 cases (6.9%) and deep infection in 2 (2.8%). Aseptic wound breakdown occurred in 5 cases (6.9%). The rate of wound breakdown after three-incision technique was 37.5%. There were 10 cases of non-union (13.9%) and 8 of mal-union (10.5%). Post-traumatic arthritis was present on the most recent x ray in 17 cases (23.4%). Further surgery was required in 20 cases (27.8%), most commonly for metalwork related problems and also for treatment of non-union, post-traumatic arthritis and infection. This review gives comprehensive injury specific and surgical outcome data from one of the largest reported series of these complex and problematic injuries.
Osteoid osteoma is a benign bone-forming lesion, characterized by its small size, its clearly demarcated outline and by the usual presence of a surrounding zone of reactive bone formation. It often poses a diagnostic challenge due to its ambiguous presentation. The aetiology of osteoid osteoma is poorly understood. The previous suggestion that osteoid osteoma was not associated with trauma or infection has been challenged by more recent literature raising the possibility that it could be a reactive or healing response or a phenomenon associated with the revascularisation process. This case report describes an unusual presentation of a post-traumatic osteoid osteoma. Two years following a diaphyseal, spiral tibial fracture treated nonoperatively, the patient developed new pain at the previous fracture site. The pain was constant, relieved by non-steroidal analgesia and not associated with systemic upset. It was initially attributed to other more likely diagnoses such as osteomyelitis and neuropathic pain. Multiple investigations and interventions were undertaken prior to the definitive diagnosis being obtained by surgical excision of the lesion and histological studies five years after the injury and three years following the initiation of the discomfort. In both English and foreign language literature there are only seven case reports that document osteoid osteoma following fracture, these are predominantly in the lower limb with no predominance to operative or nonoperative management. This case report should raise the index of clinical suspicion of osteoid osteoma occurring post fracture.
Distal tibial metaphyseal fractures pose many complexities. This study assessed the outcomes of distal tibial fractures treated with percutaneously inserted medial locking plates. Eighteen patients were selected based on the fracture pattern and classified using the AO classification and stabilised with an AO medial tibial locking plate. Time to fracture union, complications and outcomes were assessed with the American Orthopaedic Foot and Ankle Society ankle score at 12 months.Background
Methods
This is an outcome study of the use of plate fixation for treatment of comminuted fractures of the distal third of tibia to determine prognostic factors such as age, sex, type of fractures, soft tissue injury and type of implant on healing. Since 1999, a single surgeon (VP) has performed minimally invasive fixation in 18 patients for complex transitional fractures of the tibia. Follow up has been achieved by a combination of clinical and radiological assessment and notes review. An overall excellent-good result was obtained in 17 of 18 patients. In one patient, the fixation was revised due to a 20 degree external rotation mal position. In two cases there was mild external rotation of 10 degrees. There were no infections. The treatment of difficult juxta-articular fractures with a minimally invasive fixation is a useful management option. Peri-articular plates are easy to insert and give better results with respect to alignment correction.
The aim of this study was to determine the immediate post-fixation stability of a distal tibial fracture fixed with an intramedullary nail using a biomechanical model. This was used as a surrogate for immediate weight-bearing postoperatively. The goal was to help inform postoperative protocols. A biomechanical model of distal metaphyseal tibial fractures was created using a fourth-generation composite bone model. Three fracture patterns were tested: spiral, oblique, and multifragmented. Each fracture extended to within 4 cm to 5 cm of the plafond. The models were nearly-anatomically reduced and stabilized with an intramedullary nail and three distal locking screws. Cyclic loading was performed to simulate normal gait. Loading was completed in compression at 3,000 N at 1 Hz for a total of 70,000 cycles. Displacement (shortening, coronal and sagittal angulation) was measured at regular intervals.Aims
Methods