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Sisella M, Hoekstra H, Bori E, Innocenti B. Biomechanical analysis of the effect of postero-latero-central tibial plateau fractures in the knee joint: Can posterior soft tissues prevent instability? A finite element study. Clin Biomech (Bristol, Avon) 2024; 120:106353. [PMID: 39332326 DOI: 10.1016/j.clinbiomech.2024.106353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 09/18/2024] [Accepted: 09/20/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND Almost 86 % of all tibial plateau fractures involves the failure of the postero-latero-central region of the tibial plateau. Surgical treatment of this region is technically demanding and in case of limited depression, it's occasionally chosen to leave them untreated. The aim of the study is to numerically check to what extent this choice can be accepted avoiding inferior outcomes (i.e. joint instability), and to analyze posterior soft tissues role in presence of this fractures. METHODS Starting from a previous validated finite element model with baseline structures, several configurations were developed by inserting posterior soft tissues and postero-latero-central fracture, with different articular depressions. Squat motion was numerically simulated and tibio-femoral kinematics were compared among configurations. FINDINGS An increasing step-off led to a progressive joint instability, especially in the first 35°-40° of flexion. Posterior soft tissues showed to be beneficial in initial stabilization and early flexion. Tibial Axial Rotation didn't show any restorative effect of posterior soft tissues on knee kinematics. Tibial Antero-Posterior Translation is the most significant biomechanical parameter, showing posterior soft tissues restoring native antero-posterior translation, completely for 1-mm step-off fracture, only partially for 2-mm step-off fracture, and not sufficiently for 3-mm step-off fracture, at least in the first 30° of flexion. INTERPRETATION The results suggest that postero-latero-central fractures with step-off ≥2 mm should be treated to restore articular kinematic, whereas fractures with step-off <2 mm need a broad evaluation to assess the effective need of surgery. These information can be valuable for surgeons, to aid their decision to surgically operate or not.
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Affiliation(s)
- Mattia Sisella
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium.
| | - Harm Hoekstra
- University Hospitals Leuven, Department of Trauma Surgery, Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Edoardo Bori
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Bernardo Innocenti
- BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Bruxelles, Belgium
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Mantecón R, Ruiz A, Wheatley BM, Díaz-Álvarez J, Miguélez H, Youssef G. Feasibility Study of Experimental Protocol for the Time-Dependent Mechanical Response of Synthetic Tibia. J Biomech Eng 2024; 146:084502. [PMID: 38426592 DOI: 10.1115/1.4064974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/29/2024] [Indexed: 03/02/2024]
Abstract
In this research, an experimental biomechanics construct was developed to reveal the mechanics of distal tibial fracture by submitting synthetic tibiae to cyclic loading, resulting in a combined stress state due to axial compression and bending loads. The synthetic tibia was fixed at the knee but allowed to rotate in the coronal and sagittal planes at the ankle. The first three loading regimes lasted for 4000 cycles/each, and the final until ultimate failure. After 12k±80 cycles, the observed failure patterns closely resembled distal tibial fractures. The collected data during cyclic loading were fitted into a phenomenological model to deduce the time-dependent response of the synthetic tibiae. Images were also collected and analyzed using digital image correlation to deduce the full-field state of strain. The latter revealed that longitudinal strain contours extended in the proximal-distal direction. The transverse strain contours exemplified a medial-to-lateral distribution, attributed to the combined contributions of the Poisson's effect and the flexural deformation from axial and bending components of the applied load, respectively. The experimental construct, full-field characterization, and data analysis approaches can be extended to elucidate the effect of different fixation devices on the overall mechanical behavior of the bone and validate computational models in future research.
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Affiliation(s)
- Ramiro Mantecón
- Experimental Mechanics Laboratory, Mechanical Engineering Department, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182; Department of Mechanical Engineering, Universidad Carlos III de Madrid, Avenida de la Universidad 30, Leganés, Madrid 28911, Spain
- Universidad Carlos III de Madrid
| | - Alvaro Ruiz
- Experimental Mechanics Laboratory, Mechanical Engineering Department, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182
- San Diego State University
| | - Benjamin M Wheatley
- Department of Orthopedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA 92134
- Naval Medical Center San Diego
| | - José Díaz-Álvarez
- Department of Mechanical Engineering, Universidad Carlos III de Madrid, Avenida de la Universidad 30, Leganés, Madrid 28911, Spain
- Carlos III University of Madrid
| | - Henar Miguélez
- Department of Mechanical Engineering, Universidad Carlos III de Madrid, Avenida de la Universidad 30, Leganés, Madrid 28911, Spain
| | - George Youssef
- Experimental Mechanics Laboratory, Mechanical Engineering Department, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182
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Alidina S, Luxenburg D, Castro A, Subhawong TK, Ferreira de Souza F. Imaging Review of Different Subchondral Insufficiency Fractures. J Comput Assist Tomogr 2024; 48:663-668. [PMID: 38834938 DOI: 10.1097/rct.0000000000001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
ABSTRACT Subchondral fractures are a common cause of joint pain that may ultimately lead to articular collapse and the need for arthroplasty. This type of fracture has been reported at multiple joints throughout the body. While clinical and radiographic resolution can be achieved, progressive bone collapse can occur and lead to a variety of complications. Understanding the pertinent imaging findings can aid in the early evaluation of subchondral fractures and in the prevention of their associated complications.
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Affiliation(s)
- Sameer Alidina
- From the Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL
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Xu Y, Gao S. Clinical value of quantitative parameters of MSCT in the diagnosis of occult femoral neck fractures. Biotechnol Genet Eng Rev 2024; 40:275-283. [PMID: 36848034 DOI: 10.1080/02648725.2023.2183581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
To explore the clinical value of quantitative parameters of multi-slice computer tomography (MSCT) in the diagnosis of occult femoral neck fractures.The clinical data of 94 patients with suspected occult femoral neck fractures admitted to our hospital from April 2021 to April 2022 were selected for retrospective analysis, and they were divided into group A (accurate diagnosis, n = 63) and group B (non-occult femoral neck fractures, n = 31) according to the results of pathological and surgical diagnosis as the gold standard. All patients received MSCT examination to obtain quantitative parameters related to imaging, and receiver operator characteristic (ROC) curves were used to comprehensively evaluate the clinical value of quantitative parameters of MSCT in the diagnosis of occult femoral neck fractures.The quantitative parameters of MSCT in group A were overtly lower than those in group B (P < 0.05). The AUC value, Youden index and sensitivity of the combined detection were higher than those of single detection.The use of quantitative parameters of MSCT effectively reduces the missed diagnosis rate of occult femoral neck fractures, which could make an accurate diagnosis of the fracture type, as a basis for the formulation of clinical treatment plans.
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Affiliation(s)
- Yongzhong Xu
- Imaging Department, Yantai Mountain Hospital, Yantai, Shandong, China
| | - Shan Gao
- Emergency Department, Qingdao West Coast New Area Central Hospital, Qingdao, Shandong, China
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Meng J, Tang H, Gao S. A traumatic knee injury. BMJ 2023; 383:e077119. [PMID: 37945038 DOI: 10.1136/bmj-2023-077119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Jiahao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Hunan, China
| | - Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Hunan, China
| | - Shuguang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Hunan, China
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Yang Z, Chen W, Liang J, Liu T, Zhang B, Wang X, Yang X, Fang S, Daoji C, Yin X, Jiang J, Yun X. Association of obesity with high retears and complication rates, and low functional scores after rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg 2023; 32:2400-2411. [PMID: 37419440 DOI: 10.1016/j.jse.2023.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/07/2023] [Accepted: 05/21/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Obesity influences the outcomes of orthopedic surgeries such as total knee arthroplasty and spinal surgery. However, the effect of obesity on the outcomes of rotator cuff repair is unknown. This systematic review and meta-analysis aimed to examine the effect of obesity on rotator cuff repair outcomes. METHODS PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched to identify relevant studies published from their inception till July 2022. Two reviewers independently screened titles and abstracts using the specified criteria. Articles were included if they indicated the effect of obesity on rotator cuff repair and the related outcomes after surgery. Review Manager 5.4.1 software was used to perform statistical analysis. RESULTS Thirteen articles involving 85,497 patients were included. Obese patients had higher retear rates than nonobese patients (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.23-5.41, P = .01), lower American Shoulder and Elbow Surgeons scores (mean difference [MD]: -3.59, 95% CI: -5.45 to [-1.74]; P = .0001), higher visual analog scale for pain (mean difference: 0.73, 95% CI: 0.29-1.17; P = .001), higher reoperation rates (OR 1.31, 95% CI 1.21-1.42, P < .00001), and higher rates of complications (OR 1.57, 95% CI 1.31-1.87, P = .000). Obesity did not affect the duration of surgery (MD: 6.03, 95% CI: -7.63 to 19.69; P = .39) or external rotation of the shoulder (MD: -1.79, 95% CI: -5.30 to 1.72; P = .32). CONCLUSION Obesity is a significant risk factor for retear and reoperation after rotator cuff repair. Furthermore, obesity increases the risk of postoperative complications and leads to lower postoperative American Shoulder and Elbow Surgeons scores and higher shoulder visual analog scale for pain.
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Affiliation(s)
- Zhitao Yang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Wei Chen
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Junwen Liang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Tao Liu
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Borong Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xihao Wang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xudong Yang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Sen Fang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Cairang Daoji
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xiaoli Yin
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Jin Jiang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
| | - Xiangdong Yun
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, China.
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Faraji N, Goli R, Shaddeli S, Rahmati A, Amirashayeri M, Yengejeh SY. Surgical management on a rare type of vertical liner fracture of tibia: A case report study. Int J Surg Case Rep 2023; 110:108692. [PMID: 37633194 PMCID: PMC10509799 DOI: 10.1016/j.ijscr.2023.108692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The vertical liner fracture of the tibia is an infrequent and intricate injury that presents considerable difficulties in terms of its diagnosis, treatment, and long-term consequences. This particular fracture pattern is distinguished by a vertical line of fracture along the length of the tibial shaft, spanning from the proximal to the distal end. CASE PRESENTATION The 31-year-old female patient, who had no prior medical conditions, presented to the emergency department with complaints of intense pain and impaired ambulation in her right lower limb. She reported an accidental fall while descending a staircase, resulting in substantial impact and pressure on her right leg. CLINICAL DISCUSSION While fractures of the tibia are frequently encountered, there exist exceptional instances of vertical liner fractures within this category. A vertical long liner fracture of the tibia denotes a distinct fracture type in the elongated bone of the lower limb, characterized by a vertical fracture line that extends along the length of the bone. CONCLUSION Vertical liner fractures of the tibia, although rare, are distinct from more common tibial fracture patterns. Accurate diagnosis and thorough evaluation using various imaging methods are crucial for assessing the extent of the fracture and any associated injuries.
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Affiliation(s)
- Navid Faraji
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Sevda Shaddeli
- School of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
| | - Ata Rahmati
- School of Paramedical, Hamedan University of Medical Sciences, Hamedan, Iran
| | | | - Sepideh Yousefi Yengejeh
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University of Urmia, Urmia, Iran
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Arya N, Harjpal P. Otago Exercise Program as an Adjunct to Routine Physiotherapy in a Patient With Tibial Plateau Injury: A Case Report. Cureus 2023; 15:e44136. [PMID: 37753011 PMCID: PMC10518427 DOI: 10.7759/cureus.44136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
The tibia is a long bone in the lower limb. Tibial fractures account for approximately 20% of adults and 8% of older people. A tibial plateau fracture may result from low-energy forces, most commonly in older people with low bone density. The tibial plateau fractures vary widely, from stable non-displaced fractures with little soft tissue damage to severely comminated unstable fractures with severe soft tissue damage. Fractures of the tibia plateau had a significant impact on patients' lives, lowering their quality of life and limiting their participation in sports. Other effects of the injury itself, such as arthritis later developing, muscle, bone wasting, and joint stiffness, can have an impact on patients' lives. For these patients, physical therapy can target areas to improve some of such conditions. A 50-year-old female was diagnosed with lateral tibial plateau injury in the left knee and post tibial plateau injury in the right knee joint on an X-ray after a road accident, and a bilateral above-knee cast was applied for four weeks, following a period of non-weight-bearing. Along with this, a physiotherapy treatment plan was advised, which included a variety of exercises, electrotherapy, and an Otago exercise program, which resulted in pain reduction and improvements in range of motion (ROM), strength, balance, and gait ability. A structured physiotherapy program with an Otago exercise program gradually improved the functional goals, balance, and gait patterns progressively.
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Affiliation(s)
- Neha Arya
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Pankratov AS, Lartsev YV, Rubtsov AA, Ogurtsov DA, Kim YD, Shmel'kov AV, Knyazev NA. Application of 3D modeling in a personalized approach to bone osteosynthesis (A literature review). BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2023.1.ictm.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Three-dimensional printing opens up many opportunities for use in traumatology and orthopedics, because it takes into account personal characteristics of the patients. Modern methods of high-resolution medical imaging can process data to create threedimensional images for printing physical objects. Today, three-dimensional printers are able to create a model of any complexity of shape and geometry. The article provides a review of the literature about three-dimensional digital modeling in shaping implants for osteosynthesis. Data search was carried out on the Scopus, Web of Scince, Pubmed, RSCI databases for the period 2012–2022. The effectiveness of three-dimensional printing for preoperative modeling of bone plates has been confirmed: implants perfectly corresponds with the unique anatomy of the patient, since the template for it is based on the materials of computed tomography. Individual templates can be useful when the geometry of patients' bones goes beyond the standard, and when improved results of surgery are expected due to better matching of implants to the anatomical needs of patients.
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[Application of a new universal locking anatomical plate in treatment of tibial plateau posterolateral column fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1351-1356. [PMID: 36382451 PMCID: PMC9681591 DOI: 10.7507/1002-1892.202207093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the effectiveness of a new tibial plateau posterolateral column universal locking anatomical plate (hereinafter referred to as "new universal locking anatomical plate") in the treatment of tibial plateau posterolateral column fractures. METHODS Between October 2020 and December 2021, 14 patients with tibial plateau posterolateral column fracture were treated with a new universal locking anatomical plate. There were 7 males and 7 females with an average age of 59 years ranging from 29 to 75 years. There were 5 cases on the left side and 9 cases on the right side. The causes of injury included falling from height in 5 cases, traffic accident in 7 cases, and other injuries in 2 cases. The time from injury to operation ranged from 3 to 10 days, with an average of 6 days. According to Schatzker classification, there were 4 cases of type Ⅱ, 8 cases of type Ⅴ, and 2 cases of type Ⅵ. All fractures involved the posterolateral tibial plateau. Three column classification: two columns (anterolateral column+posterior column) in 4 cases, three columns in 10 cases. The operation time, intraoperative blood loss, fracture healing, and complications were recorded. The reduction of tibial plateau fracture was evaluated by Rasmussen radiographic score, and the recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score. RESULTS All 14 cases completed the operation successfully. The operation time was 95-180 minutes, with an average of 154 minutes, and the intraoperative blood loss was 100-480 mL, with an average of 260 mL. All patients were followed up 6-19 months, with an average of 12.5 months. All fractures healed, and the healing time was 15-24 weeks, with an average of 18.7 weeks. During the follow-up, there was 1 case of common peroneal nerve palsy and 1 case of traumatic osteoarthritis. There was no other complication such as vascular injury, incision infection, deep venous thrombosis of lower limbs, heterotopic ossification, bone nonunion, and failure of internal fixation. The reduction of tibial plateau fractures was good immediately after operation, and the Rasmussen radiological score was 10-18, with an average of 15.7; 3 cases were excellent, 10 cases were good, and 1 case was fair, with an excellent and good rate of 92.9%. The scores and grades of HSS at 3 months after operation and at last follow-up significantly improved when compared with those before operation ( P<0.05). There was no significant difference between 3 months after operation and last follow-up ( P>0.05). CONCLUSION For the fractures involving the posterolateral column of the tibial plateau, the new universal locking anatomical plate can provide strong fixation, satisfactory postoperative fracture reduction, and good recovery of knee function.
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Effect Evaluation of Perioperative Fast-Track Surgery Nursing for Tibial Fracture Patients with Computerized Tomography Images under Intelligent Algorithm. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2629868. [PMID: 35845737 PMCID: PMC9249477 DOI: 10.1155/2022/2629868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022]
Abstract
This study aimed to study the application value of computerized tomography (CT) images under the graph cut algorithm in the effect evaluation of perioperative fast-track surgery (FTS) nursing in tibial fracture. In this study, 80 tibial fracture patients in the perioperative period were selected as the research objects. These objects were randomly divided into two groups according to the examination method. In group A, routine CT examination was performed; in group B, CT examination under the graph cut algorithm was applied. The imaging results showed that there were still 16 cases with collapse of group A and 34 cases with collapse of group B; the difference was statistically significant (P < 0.05). As for 16 cases with collapse in both groups, the average collapse shown in group A was about 2.79 ± 1.31 mm, while that in group B was 5.51 ± 1.88 mm, with a statistically significant difference (P < 0.05). The average broadening in the images of group A was 3.17 ± 1.41 mm and that of group B was 5.72 ± 1.83 mm, suggesting that the difference was statistically significant (P < 0.05). The broadening distance of 3-4 mm was mainly shown in the images of group A and that of 5-8 mm was shown in group B, with a statistical difference (P < 0.05). In terms of the total score, there were 26, 44, 8, and 2 cases that were assessed as excellent, good, common, and bad, respectively, in group A, while 44 cases were assessed as good and 36 cases were assessed as common in group B, which were significantly different (P < 0.05). In summary, the graph cut algorithm not only had a good segmentation effect and segmentation efficiency but also could improve the evaluation of CT images for perioperative FTS nursing effect in patients with tibial fracture.
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Zhou W, Li M, Ma R, Yao G, Zhu C, Chen G. Diagnosis and Treatment of Schatzker Type II Tibial Plateau Fracture with An Isolated Bone Fragment: A Case Report and Literature Review. Orthop Surg 2022; 14:1011-1015. [PMID: 35343059 PMCID: PMC9087443 DOI: 10.1111/os.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 12/14/2021] [Accepted: 12/20/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND An isolated bone fragment from the posterolateral tibial plateau retrieved from the patellofemoral compartment is a rarely seen Schatzker type II tibial plateau fracture and is prone to misdiagnosis. To the best of our knowledge, this injury mechanism has not been previously described. CASE PRESENTATION A 63-year-old female sustained left knee pain and activity limitation after falling off an electric bicycle. Local hospital ignored the intra-articular bone fragment and failed to provide effective treatment. This case described an uncommon Schatzker type II tibial plateau fracture with an isolated bone fragment, its physical examination and radiological findings, the potential injury mechanism, and surgical protocol. CONCLUSIONS Combining the physical examination and radiological findings to evaluate the potential injury mechanism is important for developing an appropriate surgical protocol.
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Affiliation(s)
- Wei Zhou
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Meng Li
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Ruixiang Ma
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Gang Yao
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Chen Zhu
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
| | - Guang Chen
- Department of Orthopaedics, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, China
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Li HF, Yu T, Zhu XF, Wang H, Zhang YQ. Locking compression plate + T-type steel plate for postoperative weight bearing and functional recovery in complex tibial plateau fractures. World J Clin Cases 2022; 10:502-510. [PMID: 35097075 PMCID: PMC8771395 DOI: 10.12998/wjcc.v10.i2.502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/24/2021] [Accepted: 12/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Complex tibial plateau fractures can seriously affect quality of life and physical and mental health of patients. The anatomical relationship between the proximal tibial bone and soft tissue is complex, resulting in different types of tibial plateau fractures. Violent trauma can lead to displaced fracture, serious soft tissue injury, and potentially, dislocation of the knee joint. Therefore, tibial plateau fractures are extremely unstable.
AIM To assess the use of locking compression plate (LCP) + T-type steel plate for postoperative weight bearing and functional recovery of complex tibial plateau fractures.
METHODS Ninety-seven patients with complex tibial plateau fractures who underwent surgery at our hospital were selected for retrospective study. Forty-nine patients had been treated with LCP + T-type steel plate limited internal fixation (study group), and 48 patients with bilateral ordinary steel plate support (control group). The operation process index, postoperative rehabilitation related index, Rasmussen score of the knee joint, tibial plateau varus angle (TPA), tibial plateau retroversion angle (PA), and surgical complications of the two groups were compared.
RESULTS The operation time and intraoperative bone graft volume in the study group were lower than those in the control group (P < 0.05). There were no significant differences in surgical bleeding, anterior external incision length, postoperative drainage, hospital stay duration, and fracture healing time between the groups (P > 0.05). There was no significant difference in the TPA and PA angle between the groups immediately and 18 mo after surgery (P > 0.05). At 12 mo after surgery, the Rasmussen scale score was higher in the study group than in the control group (P < 0.05). There was no significant difference in the Rasmussen scale score at 18 mo after surgery, and the radiology score at 12 and 18 mo after surgery, between the two groups (P > 0.05). The postoperative complication rate in the study group (3.77%) was lower than that in the control group (15.09%; P < 0.05).
CONCLUSION LCP + T-type steel plate internal fixation has advantages in terms of minimizing trauma and enabling early postoperative functional exercise, promoting functional recovery and lower limb weight-bearing, and reducing postoperative complications.
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Affiliation(s)
- Hai-Feng Li
- Department of Orthopaedic Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Tao Yu
- Department of Orthopaedic Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Xing-Fei Zhu
- Department of Orthopaedic Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Hua Wang
- Department of Orthopaedic Surgery, Zhabei Central Hospital, Shanghai, Shanghai 200070, China
| | - Ying-Qi Zhang
- Department of Orthopaedic Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
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14
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Huang YC, Jiao J, Cheng WJ, Xiao F, Zuo W, Wang JW. Joint line plate fixation for tibial plateau fractures caused by hyperextension varus. Exp Ther Med 2021; 21:621. [PMID: 33936278 PMCID: PMC8082576 DOI: 10.3892/etm.2021.10053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/06/2020] [Indexed: 12/02/2022] Open
Abstract
The present study evaluated the outcomes of internal fixation with a joint line plate in the treatment of tibial plateau fractures caused by hyperextension of the varus. The study included 25 cases (13 males and 12 females; age, 19-71 years) of tibial plateau fracture caused by hyperextension of the varus, which were treated at Puai Hospital, Tongji Medical College (Wuhan, China) between January 2015 and June 2017. Fractures were treated with internal fixations of the inner cortex with a self-clipped joint line plate made of steel. After the surgery, patients were examined immediately and at 3, 6 and 12 months. Healing was evaluated by X-ray examination. All cases were cured during follow-up. After surgery, one patient developed partial necrosis of the skin margin of the incision and recovered after a dressing change. Furthermore, one patient with a concomitant peroneal nerve injury and hypoesthesia recovered after treatment with neurotrophic drugs. No screw loosening, fractures or failure of the internal fixations occurred. According to the X-ray results, there were significant differences in the tibial plateau angle (TPA) and medial posterior slope angle (m-PSA) between the pre-operative stage and 12 months post-operatively (P<0.05). However, no significant differences in either the TPA or m-PSA were present between the immediate post-operative stage and 12 months post-operatively (P>0.05). In conclusion, internal fixation with a joint line plate is an appropriate treatment for tibial plateau fractures involving the anteromedial margin with good clinical efficacy.
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Affiliation(s)
- Yu-Cheng Huang
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
| | - Jing Jiao
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
| | - Wen-Jun Cheng
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
| | - Fei Xiao
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
| | - Wei Zuo
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
| | - Jun-Wen Wang
- Department of Orthopaedics, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430032, P.R. China
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15
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Goyal T, Paul S, Choudhury AK, Abdusamad V. Use of Osteochondral and Meniscal Allografts from Bone Cuts of Total Knee Arthroplasty for the Treatment of Tibial Plateau Malunions: A Case Series of Four Patients Showing Early Results. Indian J Orthop 2021; 55:375-383. [PMID: 33927816 PMCID: PMC8046859 DOI: 10.1007/s43465-020-00347-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/31/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Intra-articular malunion of tibial plateau fracture is a complex problem to treat. We are presenting outcomes of our series of patients of malunited tibial plateau fractures treated with osteo-chondro-meniscal allograft from lateral tibial plateau harvested from patients undergoing total knee arthroplasty (TKA). METHODS The technique was used in four patients. Preoperative computed tomography (CT) scan was used to match donor and recipient graft dimensions and to measure any malalignment. Patients were evaluated for Visual analogue Scale (VAS) for pain (scale 1-10 cm), WOMAC (Western Ontario McMaster Osteo-Arthritis Index) score, knee range of motion, and limb alignment. RESULTS There were three medial tibial plateau malunions and one lateral tibial plateau malunion. Articular comminution with depression was seen in all of them. One patient underwent concurrent high tibial osteotomy for the elevation of the medial tibial plateau and posterior cruciate ligament reconstruction was performed concurrently in one patient. All patients showed improvement in knee range of motion, WOMAC score, and VAS score for knee pain. Limb alignment improved in all cases. Radiologically there was consolidation of the allograft in all the cases at 6 months. The mean follow-up was 15.2 months (range 12-18 months). CONCLUSION Osteochondral allograft can be a good choice for reconstructing large articular cartilage defects in tibial plateau malunions. Osteo-chondro-meniscal grafts obtained during TKA can be a viable alternative for reconstructing such defects with excellent early clinical, functional, and radiological outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab 151001 India
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | | | - V. Abdusamad
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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