Journal articles on the topic 'Leg Fractures'
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Flinck, Marianne, Johan von Heideken, Ylva Aurell, and Jacques Riad. "Leg length discrepancy after skeletal maturity in patients treated with elastic intramedullary nails after femoral shaft fractures in childhood." Journal of Children's Orthopaedics 16, no. 4 (August 2022): 276–84. http://dx.doi.org/10.1177/18632521221106388.
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Purpose: The purpose was to study radiographic and perceived leg length discrepancy after skeletal maturity in patients treated for femoral shaft fractures with elastic stable intramedullary nails in childhood. Methods: Thirty-five adults underwent standing radiographs and answered a questionnaire regarding perception of leg length discrepancy. Demographic data, fracture characteristics, angulation, stability of fixation, and callus formation, at time of fracture, were assessed. Results: Mean age at fracture was 10.2 (4.9–16.7) years, and mean follow-up time was 11.1 (3.8–16.8) years. In 8 of 35 participants, the fractured limb was 11–15 mm longer than the non-fractured, and in 16, 1–10 mm longer. In eight participants, the fractured limb was 1–10 mm shorter than the non-fractured, and in three participants, 12–23 mm shorter. The younger the child, the greater the lengthening (Rs = −0.49, p = 0.003). The greater the femoral angulation at time of fracture, the greater the shortening (Rs = 0.42, p = 0.013). There was no significant correlation between stability of fixation or callus formation 1 month postoperatively and radiographic leg length discrepancy after skeletal maturity. Fourteen (40%) had perception of leg length discrepancy at follow-up, of whom eight had a radiographic leg length discrepancy of 10–24 mm. Conclusion: Treatment with elastic stable intramedullary nail of femoral shaft fracture in childhood may result in radiographic leg length discrepancy. Younger children were more prone to lengthening and should possibly be assessed before skeletal maturity. The degree of fracture stability or callus formation at the time of fracture did not significantly affect leg length discrepancy. Perception of leg length discrepancy was not necessarily associated with a radiographic leg length discrepancy (≥10 mm). Level of evidence: level IV, case series.
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Bottai, Vanna, Gabriele Gariffo, Edoardo Ipponi, Roberta Cifali, Nicola Mondanelli, and Stefano Giannotti. "Use of teriparatide in preventing delayed bone healing in complex biosseous leg fracture: a case report." International Journal of Bone Fragility 1, no. 1 (March 20, 2021): 14–16. http://dx.doi.org/10.57582/ijbf.210101.014.
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Fracture nonunion is one of the greatest challenges for orthopedic surgeons. We present the case of a young man with a complex open biosseous fracture of the leg who underwent surgery and early systemic pharmacological treatment with teriparatide. Teriparatide is widely used in the treatment of osteoporosis as its anabolic effects promote the deposition of new bone tissue. Associated tibia and fibula fractures have relatively high rates of nonunion and poor long-term outcomes. In this particular case, the fracture had further negative prognostic factors, such as exposure. Two months after the trauma, the radiological healing signs were insufficient, therefore it was decided to use teriparatide, prior to the possible onset of pseudarthrosis, in order to enhance bone healing and promote adequate callus formation. Complete healing of the fracture was achieved after 99 days of treatment. The authors believe that the use of pharmacological aids may be desirable, especially in the presence of risk factors such as complex and open fractures that could seriously slow down the natural regenerative processes of the fractured bone. In this scenario, teriparatide could have an important role in preventing delayed consolidation and improving the healing of nonunion fractures.
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Stojiljkovic, Predrag, Milan Jovanovic, Ivan Golubovic, Zoran Radovanovic, Goran Stevanovic, Ivana Golubovic, Dusan Djordjevic, Aleksandar Mitic, Svetlana Milijic, and Zoran Golubovic. "Surgical treatment of the lower leg open fracture with lesions of the main blood vessels. A case report." Vojnosanitetski pregled 75, no. 4 (2018): 422–27. http://dx.doi.org/10.2298/vsp160613343s.
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Introduction. Open fractures of the lower leg degree IIIC by Gustilo belong to the most serious open fractures of the lower leg segment.These fractures are, along with the main blood vessels damage, often followed by a severe soft-tissue damage of the lower leg. Case report. Patient 20 years old, sustained a severe open fracture of the left lower leg in a car accident, with the disruption of the continuity of the main left lower leg arteries. After clinical examination and radiography (X-ray) diagnosis, the primary treatment of the open fracture fragment wound, reposition of the left lower leg and stabilization of the open fractures by the external skeletal fixator were performed. In the postoperative period, there was a manifestation of acute ischemia of the left foot. Arteriography verified discontinuity of all three crural arteries at the level of the fracture line. The patient was immediately surgically treated. Revascularization of the extremities was performed by reconstruction of the anterior tibial artery by 15 centimeters long saphenous graft interposition with creation of distal anastomosis at the level of the dorsal artery of the foot. Large soft tissue defect and reconstructed vessels were covered with transpositional fasciocutaneous flap. The postoperative course was accompanied by proper graft flow. Control X-ray examination verified fracture of the distal pin of external skeletal fixator with the healing of fractures of the tibia with angular deformity. The external fixator was removed, except for the residual part of the pin in the distal part of the lower leg. During the control examination after completion of the treatment, the patient walked without mobility aid. Conclusion. External skeletal fracture fixation, damaged blood vessels reconstruction and early covering of the soft-tissue shin defect are basic elements in saving the injured limb. The long term goal of treatment of open lower leg fractures with an injury of the main blood vessels is to allow patients return to usual daily activities and professional work.
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Marks, Ray. "LEG STRENGTH AND HIP FRACTURE MORBIDITY — RESULTS OF 4 SEPARATE CASE STUDIES." Journal of Musculoskeletal Research 09, no. 04 (December 2005): 183–94. http://dx.doi.org/10.1142/s0218957705001618.
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The purpose is to examine the importance of ipsilateral leg strength in mediating hip fracture disability. Leg strength measures were recorded and analyzed for 4 separate data sets: (1) 35 patients hospitalized for acute hip fractures; (2) 72 hip replacement surgical candidates with prior hip fracture histories; (3) 30 hip fracture patients followed prospectively for six months after hospital discharge; (4) 23 hip fracture cases interviewed two years after hospital discharge. (1) 78% of patients with acute hip fracture exhibited leg weakness on the injured side, and 41% exhibited knee extensor muscle weakness on the injured side; (2) 79% of patients readmitted for hip surgery, had deficient muscle power of the previously fractured leg and 33% had specific evidence of knee extensor weakness; (3) Interlimb knee extensor strength differentials greater than 10%, more commonly due to strength deficits on the injured side than the uninjured side, were present in 80% of cases examined six months post surgery, and affected walking speed. (4) knee extensor strength of the affected leg predicted the subject's walking speed, as did leg strength two years post surgery. The conclusion is that knee extensor strength deficits of the affected leg are common features of hip fracture patients, and may contribute to, or perpetuate, functional disability.
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Heaslet, Michael W., and Sneh L. Kanda-Mehtani. "Return-to-Activity Levels in 96 Athletes with Stress Fractures of the Foot, Ankle, and Leg." Journal of the American Podiatric Medical Association 97, no. 1 (January 1, 2007): 81–84. http://dx.doi.org/10.7547/0970081.
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Stress fractures of the foot and ankle are common in the athletic population. Because this population is especially eager to return to activity, such fractures can be challenging to treat. If the biomechanical faults are not addressed or gradual return to activity is not monitored appropriately, fractures occasionally recur. A retrospective analysis was conducted of 96 athletes who presented to a podiatric sports medicine practice over the course of 10 years with stress fractures confirmed by radiograph or bone scan. The most common type of fracture sustained by this population was tibial stress fracture, followed by second metatarsal fracture. Marathon training was the most common pre-injury activity overall, although fitness walking was the most common activity among those with metatarsal fractures. This study relates the most common types of stress fractures of the foot, ankle, and leg to certain athletic activities and correlates duration of symptoms before presentation with return-to-activity time. (J Am Podiatr Med Assoc 97(1): 81–84, 2007)
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Golubovic, Ivan, Branko Ristic, Predrag Stojiljkovic, Milan Ciric, Ivana Golubovic, Zoran Radovanovic, Sladjana Petrovic, Nina Djordjevic, Zoran Golubovic, and Stevo Najman. "Results of open tibial fracture treatment using external fixation." Srpski arhiv za celokupno lekarstvo 144, no. 5-6 (2016): 293–99. http://dx.doi.org/10.2298/sarh1606293g.
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Introduction. Open lower leg fractures are the most common open fractures of the locomotor system and their treatment is associated with a number of complications. Objective. The aim of the paper was to present the results of the treatment of 68 patients with open lower leg fractures, as well as the complications that accompany the treatment of these fractures. Methods. In the analyzed group, there were 45 (66.18%) men and 23 (33.82%) women. The majority of patients - 33 (48.53%) of them - were injured in motor vehicle accidents, whereas 24 (35.29%) patients sustained injuries due to falls from heights. In two (2.94%) patients the cause of open tibial fractures was gunshot injuries. In the analyzed group, there were 18 (26.47%) type I open fractures, 21 (30.88%) type II open fractures, 19 (27.94%) type IIIA open fractures, seven (10.29%) type IIIB open fractures, and three (4.41%) type IIIC open fractures. Results. The tibial shaft fracture healed without serious complications in 50 (73.53%) patients, whereas in 18 (26.47%) patients we observed some complications. Nonunion was found in 10 (14.71%) patients, osteitis in four (5.88), malunion in two (2.94%) patients. Milder complications such as soft tissue pin tract infection developed in 13 (19.12%) patients, infection of the open fracture wound soft tissue was observed in four (5.88%) patients. Conclusion. Basic principles in the treatment of open lower leg fractures in this study are thorough primary open fracture wound treatment followed by the delayed wound closure, stable fracture fixation using unilateral external skeletal device, proper antibiotic treatment and tetanus prophylaxis. The results correlate with similar studies.
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Davydkin, V. I., I. Yu Ippolitov, A. I. Kistkin, and S. A. Charyshkin. "CLINICAL RESULTS OF TREATING PATIENTS WITH COMPOUND LOWER LEG FRACTURES." Ulyanovsk Medico-biological Journal, no. 1 (March 30, 2021): 92–97. http://dx.doi.org/10.34014/2227-1848-2021-1-92-97.
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Management of patients with open diaphyseal fractures of the lower leg remains an urgent problem in traumatology and orthopedics. The aim of the study is to improve the results of surgical treatment of patients with open lower leg injuries by means of disease management. Materials and methods. The study under consideration was both retrospective and prospective. It included 67 patients with open lower leg injuries. The patients were divided into 3 groups depending on the fracture type and treatment modality. Results. The two-stage modality of surgical treatment of open lower leg fractures (types 1 and 2) made it possible to significantly shorten the time frame compared to the period of treatment in patients with open lower leg fractures with installation of the external fixator. Active surgical modelling of the open diaphyseal fractures of the lower leg reduced the purulent complications from 60 % to 11 %. Conclusion. In the case of an open lower leg fracture (type 1) blocking internal fixation is desirable, whereas in the case of open lower leg fractures (types 2, 3A and 3B) external fixation is preferable. In patients with open injuries (types 2 and 3A) two-stage fixation of bone fragments using external fixation with subsequent transition to internal one can be suggested. Keywords: intramedullary rod, non-union, Ilizarov apparatus. Ведение больных с открытыми диафизарными переломами костей голени остается актуальной проблемой травматологии и ортопедии. Цель работы – улучшение результатов хирургического лечения пациентов с открытыми повреждениями голени путем оптимизации лечебной тактики. Материалы и методы. Исследование ретроспективное и проспективное. В работу включены 67 больных с открытыми повреждениями костей голени. Пациенты были разделены на 3 группы в зависимости от типа перелома и способа лечения. Результаты. Двухэтапная тактика оперативного лечения открытых переломов костей голени I и II типов позволила значительно сократить сроки лечения по сравнению со сроками лечения больных, у которых сращение открытого перелома костей голени протекало в стержневом аппарате наружной фиксации. Активная хирургическая тактика в отношении открытых переломов диафиза костей голени позволила сократить процент гнойных осложнений с 60 до 11. Выводы. При открытом повреждении голени I типа оптимальным является применение блокирующего интрамедуллярного остеосинтеза, а при открытых переломах II, III А и III B типов – стержневого аппарата наружной фиксации. У пациентов с открытыми повреждениями II и III А типов показана двухэтапная фиксация костных отломков с применением стержневых аппаратов наружной фиксации с последующим переходом на интрамедуллярный штифт. Ключевые слова: интрамедуллярный штифт, несращение, аппарат Илизарова.
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Netz, P., E. Olsson, H. Ringertz, and A. Starke. "Functional restitution after lower leg fractures." Archives of Orthopaedic and Trauma Surgery 110, no. 5 (1991): 238–41. http://dx.doi.org/10.1007/bf00572879.
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Golubović, Zoran, Predrag Stoiljković, Ivan Golubović, Milan Pejčić, Milan Lazarević, Mihailo Ille, Ivana Golubović, Ivan Milošević, Nebojša Mitić, and Dejan Tabakavić. "Complications in the treatment of Segmental tibial fractures." Timocki medicinski glasnik 46, no. 3 (2021): 132–36. http://dx.doi.org/10.5937/tmg2103132g.
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Segmental tibial fractures belong to the group of the most severe fractures of the locomotor system. They are most common in polytraumatized patients. Treatment of segmental tibial fractures can be conservative or operative. Treatment of segmental tibial fractures is accompanied by a number of complications, such as delayed healing, dislocation of fragments in one or the other fracture point, healing of fractures in poor position, non-healing of fractures, aseptic and septic pseudoarthrosis, infection around fixator wedges, wound infection of open segmental tibial fracture, iatrogenic infection, osteomyelitis, and limb amputation. The paper presents a female patient with a severe segmental tibial fracture on two levels, who was treated with external skeletal fixation. Without opening the fracture point, repositioning was performed in the proximal and distal part and the fractures were stabilized with an external skeletal fixator. After the operation, the patient was activated with underarm crutches with relief support on the injured leg. For the purpose of stimulating fracture healing, low molecular weight heparin, Fraxiparine (to prevent thrombosis and pulmonary thromboembolism) and Forticolinn were prescribed. After the fracture healed, the external skeletal fixator was removed and the patient returned to her working and living activities. At the follow-up examination five years after the segmental tibial fracture, the patient had a stable and firm support on the injured leg.
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Gorodnichenko, A. I., and O. N. Uskov. "Treatment of comminuted fractures of the bones of the lower leg with rod and pincer apparatus." N.N. Priorov Journal of Traumatology and Orthopedics 7, no. 4 (March 17, 2022): 8–12. http://dx.doi.org/10.17816/vto104409.
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From 1997 to 1999 thirty eight patients with splintered and polyfocal crus fractures (9 patients had open fractures) were treated by transosseous osteosynthesis using rod or pin-rod devices. Splintered diaphyseal fractures were of В and C groups according to AO/ASIF classification but peri- and intraarticular fractures were of A2,3 and C groups. In fractures with large intermediate fragments an universal reposition device with floating fixators of rods was applied. In cases of peri- and intraarticular fractures as well as in fractures with small intermediate fragments Gorodnichenkos pin-rod device was used. The device provided stable fixation and patients with diaphyseal crus fractures were allowed full weight bearing from 3-5 postoperative day. The operative intervention is a low traumatic one that promotes early postoperative mobilization of patients, decreases the term of hospital treatment (mean 8.9 days). Fracture healing was achieved in all patients, no complications such as the imfiammation of soft tissues surrounding pins or rods were observed. The fixation was 12-18 weeks.
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Roytman, Gregory R., Alim F. Ramji, Brian Beitler, Brad Yoo, Michael P. Leslie, Michael Baumgaertner, Steven M. Tommasini, and Daniel H. Wiznia. "Simulating Prophylactic Fixation Methods for Osteoporotic Femoral Neck Fracture Prevention." Geriatric Orthopaedic Surgery & Rehabilitation 13 (January 2022): 215145932211413. http://dx.doi.org/10.1177/21514593221141376.
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Introduction Geriatric patients who suffer femoral neck fractures have high morbidity and mortality. Prophylactic fixation of the femoral neck is a potential avenue to reduce the incidence of femoral neck fractures. We studied 3 different implants traditionally used to stabilize the femoral neck: 6.5 mm cannulated screws (CANN), the femoral neck system (FNS) (Depuy Synthes), and the dynamic hip screw (DHS) (Depuy Synthes). Materials and Methods Five osteoporotic Sawbone femurs were used for each model and a control group. Two scenarios were investigated: single leg stance to measure construct stiffness and lateral impact to measure construct stiffness, energy to fracture, and qualitative examination of fracture patterns. Stiffness for each femur and energy to fracture for the lateral impact scenario were calculated and compared between groups using one-way ANOVA. Results DHS showed significantly higher stiffness than the other 2 implants and the control in single leg stance. In the lateral impact scenario, the DHS and CANN were significantly stiffer FNS and the control. Femurs implanted with CANN tended to fracture at the greater trochanter while FNS fractured in a transverse subtrochanteric pattern, and DHS fractured obliquely in the subtrochanteric region. Discussion FNS and DHS experienced fracture patterns less amenable to surgical correction. CANN and DHS proved better able to resist external forces in the lateral fall scenario. CANN also proved better able to resist external forces in the single leg stance scenario and experienced a more amenable fracture pattern in the lateral fall scenario. Conclusions FNS was less able to resist external forces compared with the other implants. This work informs the potential implications between the choice of implants that, although historically have not been used prophylactically, may be considered in the future for prophylactic stabilization of the femoral neck. Cadaveric study and clinical trials are recommended for further study.
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Zaur, Zulfiqar Ali, Imtiaz Ahmed Tago, Niaz Hussain Keerio, Mehtabullah, Ghiasuddin Jan, Sartaj Lakhani, and Syed Shahid Noor. "A Cross-Sectional Study for the Analysis of Commonly Attained Fractures in Patients Admitted Followed by a Motorcycle Accident." International Journal of Current Research and Review 14, no. 10 (2022): 71–74. http://dx.doi.org/10.31782/ijcrr.2022.141011.
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Introduction: Road traffic accidents (RTA) are more common in developing countries due to a lack of resources to meet the societal challenges, economic challenges and health care services. Individuals responsible for such accidents are vulnerable users of roads, pedestrians and motorcyclists. The injuries attained by the RTAs considerably contribute to the burden of mortality on a global level. Studies show this pattern is seen more significantly in developing countries. Out of all kinds of accidents that happen on the road, the most dangerous and traumatic ones are associated with motorbikes. They are a serious reason for morbidity and mortality in the productive age, especially in the male gender. Aim: To determine the frequency of various fractures commonly attained during the motorcycle accidents. Methodology: The study included 140 participants presenting in the orthopedic unit with a history of motorbike accidents. A brief history of the patients was noted on an individual proforma. The examination was done for making a provisional diagnosis. All the patients were advised X-ray of the region where the fracture was expected. Results: The mean age of the patients was 32 ± 7.94 years. Out of 140 participants, 116 (82.86%) were male and 24 (17.15%) were females. A total of 41 (29.29%) were detected with fracture of the femur, 78 (55.71%) were detected with a fracture in the tibia, 11 (7.86%) had fractures in the humerus, and the remaining 10 (7.14%) were determined with fractures in radius and ulna. Conclusion: The highest percentage of fractures in a motorbike accident was determined in the bones of the leg. The commonest fractured bone was the tibia followed by femur. Arm and forearm bones had a lesser percentage of fracture compared to leg bones. However, these fractures can be prevented by following the rules and regulations of traffic as well as through preventive campaigns.
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Han, Sang-Hyun, Seung-Jae Hyun, Tae-Ahn Jahng, and Ki-Jeong Kim. "Posterior osteosynthesis of a spontaneous bilateral pedicle fracture of the lumbar spine." Journal of Neurosurgery: Spine 24, no. 3 (March 2016): 398–401. http://dx.doi.org/10.3171/2015.7.spine141207.
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Spontaneous bilateral pedicle fractures of the lumbar spine are rare, and an optimal surgical treatment has not been suggested. The authors report the case of a 50-year-old woman who presented with low-back pain and right leg radiating pain of 1 year’s duration. Radiological studies revealed a spontaneous bilateral pedicle fracture of L-5. All efforts at conservative treatment failed, and the patient underwent surgery for osteosynthesis of the fractured pedicle using bilateral pedicle screws connected with a bent rod. Her low-back and right leg pain were relieved postoperatively. A CT scan performed 3 months postoperatively revealed the disappearance of the pedicle fracture gap and presence of newly formed bony trabeculation. In rare cases of spontaneous bilateral pedicle fracture of the lumbar spine, osteosynthesis of the fractured pedicle using bilateral pedicle screws and a bent rod is a motion-preserving technique that may be an effective option when conservative management has failed.
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Chen, Jian-Xun, Shao-Yun Hsu, Mei-Chen Lin, and Pin-Keng Shih. "The Correlation between Lower Extremity Fracture and Subsequent Arterial Embolism and Thrombosis—A National Population Cohort Study." Journal of Clinical Medicine 10, no. 22 (November 15, 2021): 5312. http://dx.doi.org/10.3390/jcm10225312.
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The hazard of subsequent arterial embolism and thrombosis (SAET) in patients with lower leg fractures is not yet well demonstrated. The purpose of this study is to determine the correlation between lower leg fracture and SAET in Taiwan. A total of 134,844 patients with lower leg fractures (ICD-9-CM: 823) and chronological diagnosis as SAET (ICD-9-CM: 444.22) was matched (1:1) to the non-fracture cohort according to their propensity score (data coming from the National Health Insurance database between January 2000 to December 2012). Patients were matched by age, gender, and comorbidities. The incidence of SAET and correlation between SAET development and lower leg fracture was statistically analyzed, and subgroup analysis categorized by characteristics and comorbidities was conducted as well. The cumulative incidence of SAET was calculated by Kaplan–Meier analysis. Kaplan–Meier analysis plot showed that, by the end of the ten-year follow-up period, the cumulative incidence of SAET was significantly higher for the lower leg fracture cohort than for the non-fracture cohort (log-rank test: p < 0.001). The lower leg fracture, male, elder age (45–64-year-old; ≥65-year-old), hypertension, diabetes mellitus, and gout were significantly associated with lower extremity SAET risk compared with the matched group. There was an inseparable correlation between the lower leg fracture group and the risks of SAET; subgroup analysis by gender (male, female), age (age < 40 years, age 40–64 years, and age > 65 years) and comorbidities (hypertension, diabetes mellitus, and gout) show compatible results as well. Patients with lower leg fracture have a significantly increased risk of SAET since then two years after the fracture. The hazard of SAET was significantly higher in patients with lower leg fracture than in the non-fracture cohort, and the high incidence was found since then two years after fracture. Further studies are warranted.
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Hunt, Kenneth J., Jennifer Cogburn, Lauren Pierpoint, Jennifer R. Kordell, Anahita Saeedi, Jack Spittler, and Morteza Khodaee. "Epidemiology of Lower Leg Fractures at a Colorado Ski Resort." Foot & Ankle Orthopaedics 7, no. 4 (October 2022): 2473011421S0069. http://dx.doi.org/10.1177/2473011421s00694.
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Category: Trauma; Ankle; Sports Introduction/Purpose: Lower extremity fractures are relatively common among winter sports participants. The purpose of this study is to evaluate the demographics, injury mechanisms and environmental features among patients evaluated for lower leg fractures at a high-volume Colorado ski resort during five consecutive ski seasons. Methods: We conducted a retrospective descriptive analysis of patients with lower leg fractures at the Denver Health Winter Park Medical Center during the 2012/13 to 2016/17 ski seasons. We included all fractures below the knee (excluding tibial plateau and isolated fibular head fractures) sustained by skiing or snowboarding. Chart review was performed on the patient cohort, confirming diagnosis and evaluating factors associated with these fractures. Results: There were 346 lower leg, ankle, and/or foot fractures (5.4% of all clinic visits) during the study period. The average age was 33.1 years (range 4-74) with the majority being male (60.7%) and mainly as a result of skiing (84.7%). The majority of fractures were sustained among skiers and snowboarders who self-identified as beginner or intermediate skill level (64.8%), and on easy (green) or intermediate (blue) runs (64.9%). The most common fractures sustained were complete tibia-fibula fractures (30.9%) and lateral malleolus fractures (27.5%). More than half (57.0%) of complete tibia-fibula fractures were classified and boot top (mid- shaft just above the ski boot) fractures. The most common type of lateral malleolus fractures was Danis-Weber B (72.0%) with only 5.4% being Weber C fractures. Foot fractures were rare with only 12 total cases (3.5%). Conclusion: Skiers are much more likely to sustain lower leg fractures compared to snowboarders. Men were much more likely than women to sustain lower leg fractures. Most fractures occurred in mild or moderately difficult ski runs relative to advanced runs. Fractures appear to be more common with advancing age. Complete tibia-fibula fractures were the most common fractures sustained in all riders with lateral malleolus fractures being the second most common. Foot fractures are very rare in this population. Given the frequency of these injuries, additional education around prevention may be warranted.
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Ekenman, Ingrid, Li Tsai-Felländer, Pär Westblad, Ibrahim Turan, and Christer Rolf. "A Study of Intrinsic Factors in Patients with Stress Fractures of the Tibia." Foot & Ankle International 17, no. 8 (August 1996): 477–82. http://dx.doi.org/10.1177/107110079601700808.
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We aimed to study intrinsic factors in 29 consecutive patients with well-documented unilateral stress fractures of the tibia. Anthropometry, range of motion, isokinetic plantar flexor muscle performance, and gait pattern were analyzed. The uninjured leg served as the control. A reference group of 30 uninjured subjects was compared regarding gait pattern. Anterior stress fractures of the tibia (N = 10) were localized in the push-off/ landing leg in 9/10 athletes, but were similarly distributed between legs in posteromedial injuries (N = 19). Ten (30%) of the stress fracture subjects had bilateral high foot arches, similar to those found in the reference group. There were no other systematic differences in anthropometry, range of motion, gait pattern, or isokinetic plantar flexor muscle peak torque and endurance between injured and uninjured legs. No other differences were found between anterior and posteromedial stress fractures. We conclude that anterior stress fractures of the tibia occur mainly in the push-off/landing leg in athletes. Within the limitations of our protocol, no registered intrinsic factor was found to be directly associated with the occurrence of a stress fracture of the tibia.
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Kim, Tae Gyun, Moon Seok Park, Sang Hyeong Lee, Kug Jin Choi, Byeong-eun Im, Dae Yeung Kim, and Ki Hyuk Sung. "Leg-length discrepancy and associated risk factors after paediatric femur shaft fracture: a multicentre study." Journal of Children's Orthopaedics 15, no. 3 (June 1, 2021): 215–22. http://dx.doi.org/10.1302/1863-2548.15.200252.
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Purpose This study was performed to investigate leg-length discrepancy (LLD) and associated risk factors after paediatric femur shaft fractures. Methods A total of 72 consecutive patients under 13 years old (mean age 6.7 years; 48 boys, 24 girls) with unilateral femur shaft fracture, and a minimum follow-up of 18 months, were included. The amount of LLD was calculated by subtracting the length of the uninjured from that of the injured limb. Risk factors for an LLD ≥ 1 cm and ≥ 2 cm were analyzed using multivariable logistic regression analysis. Results Hip spica casting, titanium elastic nailing and plating were performed on 22, 40 and ten patients, respectively. The mean LLD was 7.8 mm (sd 8.8) and 29 (40.3%) had a LLD of ≥ 1 cm, while nine (12.5%) had a LLD of ≥ 2 cm. There were significant differences in fracture stability (p = 0.005) and treatment methods (p = 0.011) between patients with LLD < 1 cm and ≥ 1 cm. There were significant differences in fracture site shortening (p < 0.001) and LLD (p < 0.001) between patients with length-stable and length-unstable fractures. Fracture stability was the only factor associated with LLD ≥ 1 cm (odds ratio of 4.0; p = 0.020) in the multivariable analysis. Conclusion This study demonstrated that fracture stability was significantly associated with LLD after paediatric femur shaft fractures. Therefore, the surgeon should consider the possibility of LLD after length-stable femur shaft fracture in children. Level of Evidence Prognostic level III
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Putra, Fajar Defian, and Marvin Pili. "Management and Clinical Outcome of Trimalleolar Fracture of Ankle: a case report." Orthopaedic Journal of Sports Medicine 7, no. 11_suppl6 (November 1, 2019): 2325967119S0047. http://dx.doi.org/10.1177/2325967119s00473.
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Objectives: Ankle fractures are one of the most common lower limb fractures, where account for 9% of all fractures. Most ankle fractures are isolated malleolar fractures, while trimalleolar fractures occur in the remaining 7-11% cases. The trimalleolar fracture involves fracture of the medial malleolus, fibula and posterior lip of articular surface of the tibia, associated with subluxation or dislocation of tibiotalar joint and rupture of one or more ligaments. These fractures are commonly caused by a twisting mechanism. The management of the trimalleolar fracture is by open reduction and internal fixation due to its unstable position. The postoperative outcome is evaluated by using the American Orthopedics Foot and Ankle Society (AOFAS) scoring system. Case presentation: A 38-year-old woman was admitted to the ER with chief complain a painful left ankle after a motor vehicle accident. She was previously riding a motorcycle, then stopped at the traffic light with left leg stepping on the road. Her left leg was hit from behind by a moving car. On the physical examination at the left ankle region, there was laceration with size 5x1x1 cm at the anteromedial side. There was also swelling around the left ankle with no deformity. From the palpation, there was tenderness around the left ankle and a. dorsalis paedis was still palpable with capillary refill time < 2 seconds. We performed the ankle X-Ray which considered as a fracture of distal os. tibia and os. fibula. We diagnosed this patient as a closed fracture of the left ankle with a classification of Lauge-Hansen supination external rotation (SER) injury. We did an ORIF, and the patient has been doing rehabilitation for 12weeks. We evaluated the outcome by the AOFAS scoring system, resulting in 85out of 100. Results The incidence of ankle fractures is approximately 187 fractures per 100,000 people each year, where the percentage of trimalleolar fracture occurs in 7 to 11% cases. Many of stable fractures are reduced by conservative treatment and the other unstable displaced and open fractures require open reduction internal fixation. From anamnesis, physical examination and radiographic imaging, we diagnosed this patient as closed fracture of left ankle Lauge-Hansen supination external rotation (SER). SER injury is the most common occurring among Lauge-Hansen’s categories, where firstly in the first stage the anterior inferior tibiofibular ligament (AITFL) was injured. Then in the second stage, an oblique/spiral fracture of the distal fibula occurred. With more force, the posterior inferior tibiofibular ligament (PITFL) was injured or the posterior malleolus was fractured in third stage. Finally, in fourth stage, the medial malleolus was fractured or the deltoid ligament was injured. We considered the fracture as unstable trimalleolar fracture, therefore we performed ORIF by using plate for lateral malleolus, wires for medial malleolus and screw for posterior malleolus. The patient was kept non-weight-bearing for a total of nine weeks postoperatively. We did a 3-months follow-up by clinical outcome and ankle X-Ray. The clinical outcome was measured by AOFAS scoring system and showed a good result which is 85/100. This result is in accordance with the previous study in 2014 which showed a quick recover of adults in activity limitation in the first 3 months following the fracture. Conclusion Trimalleolar fracture is a rare case which needs a challenging management to achieve the goal of reduced and stable fixation. Understanding the trauma mechanism is essential for good reduction and internal fixation. The concern of treatment and clinical outcome evaluation are needed to prevent complications, e.g. non-union, joint stiffness and secondary osteoarthritis.
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Numoto, Robert Tomohiko, Miyuki Takeda, Satoshi Tani, and Toshiaki Abe. "Fractures of the Lumbar and Sacral Superior Articular Processes: Report of Two Cases." Neurosurgery 56, no. 1 (January 1, 2005): E214—E218. http://dx.doi.org/10.1227/01.neu.0000145867.25167.cf.
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AbstractOBJECTIVE AND IMPORTANCE:Injury to the posterior vertebral elements of the lumbar spine represents a common cause of lower back pain in athletes. However, associations between nontraumatic fracture, nonathletic populations, and treatment remain poorly described. Diagnosis and treatment of two extremely rare symptomatic fractures of the superior articular process are discussed.CLINICAL PRESENTATION:Two male nonathletes presented with sudden lower back and leg pain after usual daily activities. No obvious abnormalities were revealed by radiography, magnetic resonance imaging, or myelography.INTERVENTION:In both patients, small fractures of the superior articular facet compressing the root shoulder were recognized after further examination, including detailed neurological evaluation of symptoms and targeted thin-slice computed tomography. After failure of conservative treatment, surgical debridement and removal of nonunion fracture were accomplished.CONCLUSION:Symptoms were resolved surgically without further complications or rehabilitation. Fractures of the superior articular facet causing intolerable lower back and sciatic leg pain are rare. We present the first reported cases of these fractures.
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Ungerholm, S., J. Gierup, U. Lindsjö, and A. Magnusson. "Skiing Injuries in Children: Lower Leg Fractures." International Journal of Sports Medicine 06, no. 05 (October 1985): 292–97. http://dx.doi.org/10.1055/s-2008-1025854.
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Wolfe, J. H. "Postphlebitic syndrome after fractures of the leg." BMJ 295, no. 6610 (November 28, 1987): 1364–65. http://dx.doi.org/10.1136/bmj.295.6610.1364-a.
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Butler, Bennet A., Cort D. Lawton, Robert Christian, Ryan E. Harold, Prasad Gourineni, and John F. Sarwark. "Long leg splinting for pediatric femur fractures." Journal of Orthopaedics 15, no. 4 (December 2018): 971–73. http://dx.doi.org/10.1016/j.jor.2018.08.043.
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Metaizeau, Jean-Damien, and Delphy Denis. "Update on leg fractures in paediatric patients." Orthopaedics & Traumatology: Surgery & Research 105, no. 1 (February 2019): S143—S151. http://dx.doi.org/10.1016/j.otsr.2018.02.011.
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Meyer, Scott A., Charles L. Saltzman, and John P. Albright. "Stress Fractures Of The Foot And Leg." Clinics in Sports Medicine 12, no. 2 (April 1993): 395–413. http://dx.doi.org/10.1016/s0278-5919(20)30442-7.
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WORCESTER, SHARON. "Thromboprophylaxis May Be Unnecessary in Leg Fractures." Internal Medicine News 39, no. 3 (February 2006): 24. http://dx.doi.org/10.1016/s1097-8690(06)72773-1.
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Mar, Winnie, J. Schilling, Laurie Lomasney, Eric Chen, Mihra Taljanovic, and Jason Lowe. "Radiologic Evaluation of Lower Leg, Ankle, and Foot Fracture Fixation Hardware." Seminars in Musculoskeletal Radiology 23, no. 02 (March 29, 2019): e36-e55. http://dx.doi.org/10.1055/s-0039-1681049.
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AbstractRadiologists should be familiar with basic principles of fracture fixation and the normal imaging appearances of implant constructs and their complications. The surgeon's selection of external fixation, intramedullary nail fixation, open reduction and internal fixation, or some combination depends on patient factors, fracture configuration, injury to the soft tissue envelope, and surgeon experience. Complications including loss of fixation with resultant malalignment, nonunion, infection, and posttraumatic osteoarthritis present additional challenges for the surgeon as well as the radiologist. This article reviews the rationale behind fracture fixation in fractures of the lower leg, ankle, and foot. Examples of postoperative complications are also reviewed.
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Mitrasinovic, Stefan, Georgios Kiziridis, Shauni Wellekens, Charline Roslee, and Syed Neshat Anjum. "Innovative Method of Traction in a Bilateral Diaphyseal Femur Fracture in a Polytrauma Below-Knee Amputee." Case Reports in Orthopedics 2019 (March 24, 2019): 1–6. http://dx.doi.org/10.1155/2019/8691398.
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While diaphyseal femoral shaft fractures are common, it is uncommon to see this injury in leg amputees. Traditionally, these fractures are internally fixed using a fracture table with reduction obtained by traction and adequate rotation exerted on a slightly abducted extremity. Special considerations need to be given in the management of patients with leg amputations. We report the case of a 24-year-old gentleman with bilateral diaphyseal femoral shaft fractures and a previous right below-knee amputation, who was transferred to our centre following a road traffic collision. We highlight important planning that needs to be undertaken for appropriate positioning, ease of reduction, and fracture fixation. We have reviewed the literature to highlight the methods that have been previously described and our use of skeletal traction through the amputation stump that can be utilised by other surgeons in challenging situations like this.
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Galwa, Rajneesh, Pookhraj Choudhary, and Ramratan Yadav. "Standard cross leg flap, still a work horse for compound fracture leg bones with extensive soft tissue damage: a case report." International Journal of Research in Orthopaedics 2, no. 3 (September 3, 2016): 198. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20163131.
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<p><span lang="EN-IN">This case report presents a 32 year old male patient with h/o road traffic accident resulting in compound fracture of the right tibia and fibula with extensive soft tissue injury and exposed tibia of 12×5 cm. The fractures were stabilized with ext. fixator and exposed tibia was covered by a medially based standard Cross Leg flap of dimensions 16×12 cm, though the largest dimensions described for standard cross leg is 22×10 cm.</span></p>
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Premaor, Melissa Orlandin, Fabio Vasconcellos Comim, and Juliet E. Compston. "Obesity and fractures." Arquivos Brasileiros de Endocrinologia & Metabologia 58, no. 5 (July 2014): 470–77. http://dx.doi.org/10.1590/0004-2730000003274.
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Until recently obesity was believed to be protective against fractures. However, a report from a Fracture Liaison Clinic in the UK (2010) reported a surprisingly high proportion of obese postmenopausal women attending the clinic with fractures, and in the GLOW study (2011), a similar prevalence and incidence of fractures in obese and non-obese postmenopausal women was observed. Subsequently, other studies have demonstrated the importance of obesity in the epidemiology of fractures. Obese women are at increased risk of fracture in ankle, leg, humerus, and vertebral column and at lower risk of wrist, hip and pelvis fracture when compared to non-obese women. In men, it has been reported that multiple rib fractures are associated with obesity. Furthermore, falls appear to play an important role in the pathogenesis of fractures in obese subjects. Regarding hip fracture and major fractures, the FRAX algorithm has proven to be a useful predictor in obese individuals. Obese people are less likely to receive bone protective treatment; they have a longer hospital stay and a lower quality of life both before and after fracture. Moreover, the efficacy of antiresorptive therapies is not well established in obese people. The latter is a field for future research.
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Bonnevialle, P., J. M. Lafosse, L. Pidhorz, A. Poichotte, G. Asencio, and F. Dujardin. "Distal leg fractures: How critical is the fibular fracture and its fixation?" Orthopaedics & Traumatology: Surgery & Research 96, no. 6 (October 2010): 667–73. http://dx.doi.org/10.1016/j.otsr.2010.07.002.
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Lalic, Ivica, Mirko Obradovic, Mirka Lukic-Sarkanovic, and Vladimir Djan. "Definite management of bilateral lower leg nonunion fractures by Ilizarov apparatus in polytraumatized patient: Case report." Medical review 68, no. 3-4 (2015): 137–42. http://dx.doi.org/10.2298/mpns1504137l.
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Introduction. Nonunion of long bones may often be associated with significant function loss of affected extremity, joint stiffness, and even extremity amputation or systemic manifestations in the case of infection. The aim of this case report is to highlight the possibilities of Ilizarov apparatus in the treatment of fracture nonunions of both lower legs treated by different operative methods and to show that it is not necessary to remove osteosynthetic material (intramedullary nail) in every case when nonunion occurs to achieve its recovery. Case Report. A 62 year-old man was injured in a traffic accident as a pedestrian in April 2012, when he experienced polytrauma, including shaft fracture of the right femur, and segmental open fractures of the right (Gustillo-Anderson grade I) and left (Gustillo-Anderson grade II) lower leg. The fractures of right femur and right tibia were stabilized initially with intramedullary nails, while the left lower leg fracture was treated by unilateral external fixator. After 5 months, there were no clinical and radiographic signs of union on lower legs, therefore the patient underwent re-surgery. Ilizarov apparatus was applied on both lower legs. The patient was early verticalized and both apparatus were removed after 4 months. According to the modified protocol of the Association for the Study and Application of Methods of Ilizarov, the lower leg bony results were good and excellent, and the functional results were excellent on both sides. Conclusion. Nonunion fracture of the right lower leg initially treated by the method of intramedullary osteosynthesis and afterwards by placing Ilizarov apparatus shows that in some cases it is not indicated to remove fixative material in order to achieve full recovery of fracture, thus eliminating the danger of all negative effects resulting from the classical extensive surgical treatment.
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Hudson, Ian, Krystalyn Mauch, Meg Schuurman, Muhammad T. Padela, Petra Gheraibeh, and Rahul Vaidya. "Effect of inherent tibial asymmetry on leg length discrepancy measurements after intramedullary nailing of comminuted femoral shaft fractures." SICOT-J 5 (2019): 1. http://dx.doi.org/10.1051/sicotj/2018053.
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Introduction: Locked intramedullary nailing (IMN) is the standard treatment for femoral shaft fractures in adults with high rates of union and relatively low rates of complications. Leg length discrepancy (LLD) after IMN of femoral shaft fractures is common, and is reported in 20–43% of cases. A known surgical challenge when trying to obtain equal leg lengths is comminuted fracture, which results in a loss of bony landmarks that guide reduction. The purpose of this study was to assess the effect of inherent tibial asymmetry on LLD measurements after IMN. Methods: Postoperative CT scanograms were performed on 79 consecutive patients after locked IMN for comminuted femoral shaft fracture. Leg lengths were determined by measurements taken from the scout view of a CT scanogram. Calculations of discrepancy were made for both femurs, tibias, and total leg length. Assessment was also made on the frequency wherein the tibial discrepancy compounded the femoral discrepancy. In situations where a limb segment was exactly symmetric to the contralateral side, the total leg was not regarded as a having compounded asymmetry. Results: Notable discrepancies were found in tibial length that significantly departed from the null of symmetry (p < 0.0001). Forty-two patients (53.2%) were found to have a tibial asymmetry of 3 mm or more, and 20 patients (25.3%) were found to exhibit a difference of 6.3 mm or more. Median femoral discrepancy was 5.3 mm and median tibial discrepancy was 3.0 mm. Seven patients were found to be asymmetric in total leg length as a consequence of underlying tibial asymmetry. Conversely, 11 patients benefited from their tibial asymmetry, which compensated for femoral asymmetry after IMN. Conclusion: Tibial symmetry cannot be assumed. If not accounted for, inherent tibial asymmetry may influence LLD after IMN of femur fractures.
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Kumar, B. S. Vijaya. "Treatment of diaphyseal fractures of tibia with intramedullary interlocking nail." International Journal of Research in Orthopaedics 5, no. 5 (August 26, 2019): 783. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20193130.
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<p class="abstract"><strong>Background:</strong> The tibia, or shinbone, is the most commonly fractured long bone in the body. A tibial shaft fracture occurs along the length of the bone, below the knee and above the ankle. It typically takes a major force to cause this type of broken leg. Motor vehicle collisions, for example, are a common cause of tibial shaft fractures. In many tibia fractures, the smaller bone in the lower leg (fibula) is broken as well. The objective was to study fracture healing and union rates with closed intra-medullary interlocking nailing.</p><p class="abstract"><strong>Methods:</strong> Patients of both sexes belonging to adult age group presenting with fracture tibia to Orthopedic Department, Vydehi Institute of Medical Sciences, of are admitted from January 2015 to December 2015.<strong></strong></p><p class="abstract"><strong>Results:</strong> In the present study maximum number of patients belongs to 18 to 27 years age group (18 cases) followed by 28 to 37 years age group (15 cases), maximum number of patients sustained tibia fracture due to RTA (38 cases) followed by fall (12 cases), maximum number of patients sustained simple tibia fracture (32 cases), followed by type 2 compound tibia fracture (13 cases) and 36 patients had excellent functional results and 8 patients had good functional outcome, while only 4 patients had fair functional outcome.</p><p class="abstract"><strong>Conclusions:</strong> IM rods are secured within the bone by screws both above and below the fracture. The metal screws and the rod can be removed if they cause problems, but can also be left in place for life. Tibial rodding provides excellent fixation and alignment of the bones.</p>
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Tada, M., Y. Yamada, K. Mandai, and N. Hidaka. "POS0514 IMPORTANCE OF BODY MASS MEASUREMENT AND THE GRIP STRENGTH TEST TO PREDICT FALLS IN PATIENTS WITH RHEUMATOID ARTHRITIS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 491.2–491. http://dx.doi.org/10.1136/annrheumdis-2021-eular.940.
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Background:We previously reported that the prevalence of sarcopenia was 28% in patients with rheumatoid arthritis (RA) in a cohort study 1. RA patients have a high risk of falls and fractures 2. However, the predictors of falls and fractures in RA patients are not known.Objectives:Whether evaluation of muscle mass and function at baseline could predict falls and fractures during four-year follow-up was investigated.Methods:The four-year follow-up data from a prospective, observational study (CHIKARA study: Correlation researcH of sarcopenIa, sKeletal muscle and disease Activity in Rheumatoid Arthritis) were used. Muscle mass was measured by a body impedance analyzer, and leg muscle mass was calculated. The leg muscle score (max: 100, min: 0) reflected the ratio of leg muscle mass to overall weight. Grip strength as an indicator of muscle function was evaluated using a digital, hand-held, isokinetic dynamometer. The correlations between muscle mass or function and falls or fractures were analyzed by survival rates and Cox hazard ratios. Leg muscle mass and grip strength were investigated by receiver operating characteristic (ROC) curve analysis for correlations with falls or fractures.Results:A total of 100 RA patients (female: 78%, mean age: 66.1 years) were enrolled; 35 patients had falls, and 19 patients had fractures during the four-year follow-up. The leg muscle score, grip strength, age, and fractures at baseline were significantly correlated with falls. The cut-off values of the leg muscle score and grip strength were calculated to be 84.5 points (sensitivity: 0.79, specificity: 0.43) and 15.9 kg (sensitivity: 0.56, specificity: 0.70), respectively, by ROC curve analysis. The patients were divided into four groups by their leg muscle scores and grip strength; the numbers of falls and fractures are shown in Table 1 for each group. The fall-free survival rate was significantly lower in the group with low leg muscle score and low grip strength (35.3%) than in the other groups (P=0.002) (Figure 1). The hazard ratio for the both low group was significantly increased, 3.6-fold (95%CI: 1.1-11.5), compared to that in the both high group.Table 1.Numbers of falls and fractures by category of leg muscle score and grip strengthLG + GS+(n=34)LG - GS+(n=12)LG + GS-(n=37)LG - GS-(n=17)P value*Falls, N6515110.010Fractures, N34660.072LG+: leg muscle score >84.5 points, GS+: grip strength >15.9kg, LG-: leg muscle score ≤84.5 points, GS+: grip strength ≤15.9kg*: compared in four groups by Kruskal-Walls test.Figure 1.Fall-free survival rate in the four groupsConclusion:RA patients with both low leg muscle score and low grip strength at baseline were at high risk for falls during the four-year follow-up period. Evaluation of muscle mass and function can predict falls in RA patients.References:[1]Tada, M., Yamada, Y., Mandai, K. & Hidaka, N. Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis - results from the CHIKARA study. Int J Rheum Dis21, 1962-1969, doi:10.1111/1756-185X.13335 (2018).[2]van Staa, T. P., Geusens, P., Bijlsma, J. W., Leufkens, H. G. & Cooper, C. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum54, 3104-3112, doi:10.1002/art.22117 (2006).Disclosure of Interests:None declared
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Ankin, Mykola L., Taras M. Petryk, Oleksander A. Radomski, Viktoria A. Ladyka, Іryna V. Кerechanyn, Larysa Y. Fedoniuk, and Mykhailo P. Sas. "LONG-TERM RESULTS OF TREATING PATIENTS WITH OPEN FRACTURES OF LOW-LEG BONES." Wiadomości Lekarskie 75, no. 4 (2022): 803–8. http://dx.doi.org/10.36740/wlek202204110.
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The aim: To analyse long-term results of treating patients with open fractures of low-leg bones within a specific time period and to describe concomitant problems. Materials and methods: A retrospective study was carried out to evaluate the results of the final treatment of patients after one year and after five years. Patients were divided into two groups. Group I included 47 (61.84%) patients for whom the treatment method was changed from external fixation to internal fixation. Group II included 29 (38.16%) patients for whom the final treatment of an open fracture was performed with an external fixation device without changing the method. The study exclusion criteria were patients under 18 years old and patients with gunshot fractures of the lower leg bones. Results: Patient treatment included initial surgical debridement and fracture stabilization with external fixation devices. In all patients, wound healing occurred within 30 days (on average, 24 ± 4.5 days). When evaluating the treatment of patients in group I, 32 (68.09%) of them underwent a one-stage removal of an external fixation device and osteosynthesis of fragments during the first 7-10 days. In 3 (20.0%) patients, osteosynthesis was performed with an intramedullary locking nail, in 12 (80.0%) patients – with a plate. The decision to change the fixation method was made taking into account clinical and laboratory parameters. It is noted that the treatment of patients with type III open fractures of the lower leg bones according to the Gustilo-Andersen classification, provided that the method of external fixation is replaced with an internal one, gives better results compared to osteosynthesis with external fixation devices. Conclusions: Treatment of patients with high-energy injuries of the lower leg bones is a long-term process. It is possible to improve the therapy efficiency by changing the fixation method from external to internal one. In this regard, the main evaluative characteristics are such indicators as uncomplicated wound healing combined with the absence of laboratory and clinical signs of inflammation.
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Wiener, Bradley D., Jeffrey F. Linder, and Joseph F. G. Giattini. "Treatment of Fractures of the Fifth Metatarsal: A Prospective Study." Foot & Ankle International 18, no. 5 (May 1997): 267–69. http://dx.doi.org/10.1177/107110079701800504.
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Successful treatment of avulsion fractures of the base of the fifth metatarsal has been achieved using both short leg casts and soft (Jones) dressings. Sixty patients who presented to our institution were prospectively randomized to be treated with either a short leg cast or a soft (Jones) dressing for the purpose of assessing the efficacy of each treatment modality. Our results demonstrated that radiographic evidence of fracture healing was present in all patients by 65 days with 44 days representing the average elapsed time for such change. All patients returned to full weightbearing and full physical activity within 96 days. Significantly, the average length of recuperation for patients treated with a soft (Jones) dressing was 33 days as compared to 46 days for those treated with a short leg cast. Also, the average modified foot score for patients treated in a soft dressing was 92 (excellent) compared to 86 (good) for patients treated in a short leg cast. We conclude that a soft dressing allows patients to return to pre-injury levels of activity faster than when treated in a short leg cast and without compromising clinical or radiographic union of avulsion fractures of the base of the fifth metatarsal.
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Ram, Ganesan, Deebak Kumar, and Vijayaraghavan Phagal. "Surgical dilemma's in treating distal third leg fractures." International Surgery Journal 1, no. 1 (2014): 13. http://dx.doi.org/10.5455/2349-2902.isj20140505.
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Habernek, Hans, Oskar Kwasny, Lothar Schmid, and Franz Ortner. "COMPLICATIONS OF INTERLOCKING NAILING FOR LOWER LEG FRACTURES." Journal of Trauma: Injury, Infection, and Critical Care 33, no. 6 (December 1992): 863–69. http://dx.doi.org/10.1097/00005373-199212000-00012.
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Hiragami, Ken, and Jyunji Ishii. "Embedding the lateral end of the lag screw within the lateral wall in the repair of reverse obliquity intertrochanteric femur fracture." Journal of International Medical Research 46, no. 3 (October 30, 2017): 1103–8. http://dx.doi.org/10.1177/0300060517726195.
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Objective The management of reverse oblique intertrochanteric femoral fractures is difficult because such fractures have unique biomechanical characteristics. This study was performed to review the results of treating reverse oblique intertrochanteric femoral fractures with a long cephalomedullary nail by embedding the lateral end of the lag screw to secure axial compression. Methods We herein report the surgical outcomes in seven patients with reverse oblique intertrochanteric fractures treated with our procedure. Patients whose hip screws obviously had no contact with the distal fragment and whose follow-up time was too short were excluded. The lateral end of the lag screw was embedded within the lateral cortex, and the screws were locked to the nail. All nails were long, and a distal locking screw was inserted in the dynamized position. Results No reoperation, definite leg length discrepancy, or malunion occurred in this study. Conclusions These data suggest that early complications do not seem to increase when the lateral end of the lag screw is embedded and the screw is locked to the nail in the treatment of reverse oblique intertrochanteric fracture at this stage.
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Contedini, F., L. Negosanti, E. Fabbri, V. Pinto, B. Tavaniello, R. Sgarzani, and R. Cipriani. "Cross-Leg as Salvage Procedure after Free Flaps Transfer Failure: A Case Report." Case Reports in Orthopedics 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/205029.
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Posttraumatic wounds of the lower leg with soft tissue defects and exposed fractures are a reconstructive challenge due to the scarce availability of local tissues and recipient vessels. Even when a free tissue transfer can be performed the risk of failure remains considerable. When a free flap is contraindicated or after a free flap failure, the cross-leg flap is still nowadays a possible option. We report a case of a male with a severe posttraumatic wound of the lower leg with exposed tibia fracture firstly treated with two consecutive latissimus dorsi muscular free flaps, failed for vascular thrombosis; the coverage was then achieved with a cross-leg flap with acceptable results.
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Kristinsson, Sigurdur Y., Min Tang, Ruth M. Pfeiffer, Magnus Björkholm, Cecilie Blimark, Ulf-Henrik Mellqvist, Anders Wahlin, Ingemar Turesson, and Ola Landgren. "Monoclonal gammopathy of undetermined significance and risk of skeletal fractures: a population-based study." Blood 116, no. 15 (October 14, 2010): 2651–55. http://dx.doi.org/10.1182/blood-2010-04-282848.
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AbstractPatients with multiple myeloma (MM) have an increased risk of fractures. On the basis of small numbers, patients with monoclonal gammopathy of undetermined significance (MGUS) have been reported to have an increased fracture risk. Using population-based data from Sweden, we assessed the risks of fractures in 5326 MGUS patients diagnosed from 1958 to 2006, compared with 20 161 matched controls. MGUS patients had an increased risk of any fracture at 5 (hazard ratio [HR] = 1.74; 95% confidence interval [CI], 1.58-1.92) and 10 (HR = 1.61; 95% CI, 1.49-1.74) years. The risk was significantly higher for axial (skull, vertebral/pelvis, and sternum/costae) compared with distal (arm and leg) fractures (P < .001). On the basis of 10 years of follow-up, there was an increased risk of vertebral/pelvic (HR = 2.37; 95% CI, 2.02-2.78), sternal/costae (HR = 1.93; 95% CI, 1.5-2.48), arm (HR = 1.23; 95% CI, 1.06-1.43), leg (HR = 1.40; 95% CI, 1.26-1.56), and other/multiple fractures (HR = 4.25; 95% CI, 3.29-5.51). Risks for fractures did not differ by isotype or M protein concentration at diagnosis. MGUS patients with (versus without) fractures had no excess risk of MM or Waldenström macroglobulinemia. Our results suggest that bone alterations are present in early myelomagenesis. Our findings may have implications for the development of better prophylaxis for bone disease in MGUS, and they provide novel clues on pathogenesis of MM bone disease.
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T. P., Shafeed, and Bijo Paul. "Pulsatile lavage for wound debridement in compound fractures of leg: a randomized control trial." International Journal of Research in Orthopaedics 2, no. 4 (November 19, 2016): 263. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20163999.
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<p class="abstract"><strong>Background:</strong> Management of compound fractures is a real challenge to the orthopaedic surgeon. Thorough wound irrigation and debridement is necessary to get a good outcome. Power-pulsed lavage (PPL) is a method of wound irrigation that has been popularised as an adjuvant in wound debridement.</p><p class="abstract"><strong>Methods:</strong> 39 patients of 28 to 40 years with Gustilo Anderson Type II and Type III fractures were divided in to two groups randomly and given pulsatile lavage or continuous flow lavage. Both the groups were followed up from January 2014 to January 2016, microbiology of the swab collected, pre and post lavage, and various other factors influencing the outcome were studied.<strong></strong></p><p class="abstract"><strong>Results:</strong> Most of the successful outcome was in the age group of 25-29 years (46.7%) and in the male gender 66.7%. The success outcome rate was 73.3% in those with Type II Gustilo Anderson fracture compared to Type III (26.7%). All persons with successful outcome had Tscherne grade II fracture. Also a clean or clean contaminated wound (CDC classification) had more chance for successful outcome (86.7%) than contaminated or dirty wounds.</p><p><strong>Conclusions:</strong> Heavy growth in pre-lavage blood agar culture was the single most important factor that determines the persistence of infection in compound fracture of both bones of leg. Type of lavage did not affect the union of fracture because presence of radiological signs of union was comparable in pulsatile group (66.7%) and continuous flow group (61.9%). </p>
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Maruo, Keishi, Toshiya Tachibana, Shinichi Inoue, Fumihiro Arizumi, and Shinichi Yoshiya. "Unilateral Pedicle Stress Fracture in a Long-Term Hemodialysis Patient with Isthmic Spondylolisthesis." Case Reports in Orthopedics 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/426940.
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Most unilateral pedicle stress fractures occur on the contralateral side of patients with unilateral spondylolysis. However, there are few reports of unilateral pedicle stress fractures in patients with bilateral spondylolysis and spondylolisthesis. We report a unique case of unilateral pedicle stress fracture in a long-term hemodialysis patient with isthmic spondylolisthesis. A 65-year-old man who had undergone hemodialysis presented with lower back pain that had persisted for several years. The patient experienced severe right lower extremity pain with no history of trauma. Computed tomography revealed unilateral pedicle fracture with bilateral L5 spondylolysis and spondylolisthesis with progression of scoliosis. The patient underwent Gill laminectomy of L5 with pedicle screw fixation at L4-S1 and interbody fusion at L5-S1. The patient’s leg pain ceased immediately, and he began walking without leg pain. In our present patient, development of scoliosis caused by destructive spondyloarthropathy may have contributed to a unilateral pedicle fracture.
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Almigdad, Ahmad, Ayman Mustafa, Sattam Alazaydeh, Mu’men Alshawish, Mohammad Bani Mustafa, and Hamza Alfukaha. "Bone Fracture Patterns and Distributions according to Trauma Energy." Advances in Orthopedics 2022 (September 9, 2022): 1–12. http://dx.doi.org/10.1155/2022/8695916.
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Background. This study investigates the effect of injury mechanism and energy on fracture patterns and distributions. Also, it compares differences in bone fracture patterns based on injury mechanism, gender, and age. Methods. Three thousand and sixty-six admitted patients with bone fractures were reviewed retrospectively, and the fractures were analyzed regarding age, gender, and mechanism of injury. Fractures were located in eleven bones. However, the forearm, hand, leg, and foot were considered one bone, and the fracture was then subclassified according to the anatomic position within each bone. Trauma energy was classified according to the mechanism of injury where simple falls were considered low-energy injury while falling from a height, road traffic accidents, bullet, and industrial injuries were considered high energy. Results. Males represented most of the patients, and most injuries occurred in adults. However, the male patients were more prone to injuries than females across all age groups below fifty years, women above fifty years were more frequent, and a third of females’ injuries occurred in the elderly. Simple falls represent two-thirds of the trauma mechanism, and falling from a height and road traffic accidents are the most common high-energy injuries and more prevalent in males. Scapular, clavicular, distal humerus, and shaft of long bones fractures were more prevalent in males. In contrast, females had a higher frequency of proximal humerus, proximal and distal femur, distal leg, and thoracic spine fractures. Industrial injuries are more frequent in males; thus, hand injuries are more frequent. Pathological fractures were higher in females, and spine and pelvic fractures were more associated with high-energy injuries. Conclusions. The trauma’s energy determines the bone injury’s extent and nature. Knowing the trauma mechanism is essential to expect the extent of injuries and construct preventive measures accordingly.
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Bacic, Boris, Philippe Gicquel, Marie-Christine Giacomelli, Claud Karger, and Jean-Michel Clavert. "ANKLE FRACTURES IN CHILDREN. A REVIEW." Acta Medica Saliniana 37, no. 2 (December 28, 2008): 106–13. http://dx.doi.org/10.5457/ams.v37i2.6.
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The biomechanical differences between mature and immature bones, as well as the differing forces applied to those bones, help explain the differences between adult and pediatric fractures. The potential complications associated with pediatric ankle fractures include those seen with adult fractures (such as posttraumatic arthritis, stiffness, and reflex sympathet-ic dystrophy) as well as those that result from physeal damage (including leg-length discrepancy, angular deformity). The goals of treatment are to achieve and maintain a satisfactory reduction and to avoid physeal arrest. A knowledge of common pediatric ankle fracture patterns and the pitfalls associated with their evaluation and treatment will aid in the effective management of these injuries.
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Berianto Agustian, Tertianto Prabowo, and Dian Marta Sari. "Leg Length Discrepancy." Indonesian Journal of Physical Medicine & Rehabilitation 11, no. 01 (June 1, 2022): 1–11. http://dx.doi.org/10.36803/ijpmr.v11i01.322.
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ABSTRACT
Leg length discrepancy (LLD) is a condition of length differences in the lower extremity, caused by variety of factors, both congenital and acquired. Measurement using measuring tape, block test, and supine-tositting test based on bony landmarks is considered less accurate than imaging techniques. Measuring LLD can be difficult in certain cases such as obesity, leg deformities, and post arthroplasty. Individuals will develop biomechanical strategies to compensate inequality of leg when standing, walking, andrunning on their feet, ankles, knees, hip, and or pelvis to minimize energy consumption. It can causes several complications, including osteoarthritis, functional scoliosis, intervertebral disc degeneration, stress fractures, cardiovascular and neuromuscular problems. Management varies from wearing a shoelift, relieve muscle and joint contracture, and surgical procedures. This paper was written to review measurement technique, biomechanical compensation strategies, complication, and management of LLD from Physical Medicine and Rehabilitation point of view .Keyword: biomechanical compensation strategies, leg length discrepancy, lower extremity, management, measurement
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Singh, Niten, Eric Bluman, Benjamin Starnes, and Charles Andersen. "Dynamic Wound Closure for Decompressive Leg Fasciotomy Wounds." American Surgeon 74, no. 3 (March 2008): 217–20. http://dx.doi.org/10.1177/000313480807400307.
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Decompressive fasciotomy for preservation of lower extremity function and salvage is an essential technique in trauma. The wounds that result from the standard two incision four-compartment leg fasciotomy are often accompanied by a wide soft tissue opening that in the face of true compartment syndrome are often impossible to close in a delayed primary fashion. We describe a technique using a device that allows for dissipation of the workload across the wound margin allowing for successful delayed primary closure. Consecutive patients who presented to the 28th Combat Support Hospital in Baghdad, Iraq with a diagnosis of compartment syndrome of the leg, impending compartment syndrome of the leg, or compartment syndrome of the leg recently treated with fasciotomies were followed. All patients underwent placement of the Canica dynamic wound closure device (Canica, Almonte, ON, Canada). Eleven consecutive patients treated at a combat support hospital in support of Operation Iraqi Freedom underwent four-compartment fasciotomies for penetrating injuries. There were five patients that underwent a vascular repair [three superficial femoral artery (SFA) injuries and two below knee popliteal artery injuries] and six patients that had orthopedic injuries (three comminuted tibial fractures, two fibula fractures, and one closed pilon fracture). Patients returned to the operating room within 24 hours for washout and wound inspection. Mean initial wound size was 8.1 cm; mean postplacement size was 2.7 cm; average time to closure was 2.6 days. All patients were able to undergo primary wound closure of the medial incision and placement of the Canica device over the lateral incision. Ten of the 11 patients (91%) could be closed in delayed primary fashion after application of the device. In our series of patients with penetrating wartime injuries and compartment syndrome of the leg we have found the use of this dynamic wound closure device to be extremely successful and expedient.
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Manoli, Arthur, Anton J. Fakhouri, and Timothy G. Weber. "Concurrent Compartment Syndromes of the Foot and Leg." Foot & Ankle 14, no. 6 (July 1993): 339–42. http://dx.doi.org/10.1177/107110079301400606.
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We reviewed the case summaries of eight patients who developed concurrent compartment syndromes of the foot and leg after trauma. Patients with multiple fractures of the lower extremities, particularly the tibia, femur, and foot, may develop this disorder. The obvious causes of the concurrent syndromes, concurrent fractures and generalized limb ischemia, were seen only in two patients. The communication between the compartments of the foot and leg may be an additional causative factor. Delayed fasciotomy resulted in muscle necrosis and/or tibial nerve dysfunction. Suspected cases should have the diagnosis established by catheterization of the involved compartments. Prompt fasciotomies of the foot and leg should be performed if the pressures are significantly elevated.
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Singh, Ajeet, Rakesh Kumar, Rajni Ranjan, and Avijit Mahajan. "Dynamization of external fixator is single stage definitive procedure for open fractures both bone leg." International Journal of Research in Orthopaedics 3, no. 6 (October 25, 2017): 1152. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20174705.
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<p class="abstract"><strong>Background:</strong> Open fracture both bone leg is a common fracture present in orthopaedic causality. Treatment consists of I. V. antibiotics, debridement and external fixator. Judicious selection of the patients on basis of Gustilio and Anderson classification leads to external fixator as a definitive and single stage procedure with dynamization. It reduces the risk of infection at time of definitive procedure and number of hospital stay and surgery.</p><p class="abstract"><strong>Methods:</strong> In school of medical sciences and research, We treated 68 patients with open both bone fracture (Gustilio and Anderson type 2 and 3b) with debridement and external fixator. All patients underwent dynamization depending upon fracture pattern. Majority of our cases were road traffic accident involving male. Average duration of union was 22 to 26 weeks. There was no need for any major plastic surgery procedure. Removal of external fixator and Patellar tendon brace (PTB) was given for the period of 4 to 6 weeks at the time of clinical and radiological union.<strong></strong></p><p class="abstract"><strong>Results:</strong> Eighty eight percent of our cases united well. This reduces the burden of secondary definitive procedure, infection and cost of treatment. So careful selection of the patients and dynamization of external fixator hold the place for definitive surgical option for open both bone fractures.</p><p><strong>Conclusions:</strong> External fixator is simple effective surgical procedure for open fractures both bone leg. Staged dynamization of external fixator add in the better union with functional outcome and cost effective. </p>
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Hernández-Cortés, Pedro, Miguel Pajares-López, and Miguel Angel Hernández-Hernández. "Ischemic Contracture of Deep Posterior Compartment of the Leg Following Isolated Ankle Fracture." Journal of the American Podiatric Medical Association 98, no. 5 (September 1, 2008): 404–7. http://dx.doi.org/10.7547/0980404.
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Compartment syndromes and ischemic contractures after ankle fractures are exceedingly rare. We report a case in which a Weber type-C ankle fracture resulted in an unrecognized compartment syndrome and ischemic contracture of deep posterior compartment of the leg. Six weeks after injury, the patient had an obvious deformity and clawing of the toes. The deformities were corrected by lengthening the flexor hallucis longus and the flexor digitorum longus. Full correction of all clawed toes was evident. A deep posterior compartment syndrome may follow an ankle fracture and should be considered in any patient with unrelenting pain in the immediate postoperative period. (J Am Podiatr Med Assoc 98(5): 404–407, 2008)