OBJECTIVE: To explore the effect of a modified three-point bending fracture device for establishing a rabbit model of closed tibial fracture. METHODS: The model of closed tibial fracture was established in 40 6-month-old male New Zealand white rabbits with a body weight of 2.5 to 3.0 kg, and the model was verified at 6 weeks after operation. Five rabbits underwent pre modeling without temporary external fixation before modeling, and then were fractured with a modified three-point bending fracture device;35 rabbits underwent formal modeling. Before modeling, needles were inserted, and splints were fixed externally, and then the fracture was performed with a modified three-point bending fracture device. The fracture model and healing process were evaluated by imaging and histopathology at 2 hours, 4 weeks, and 6 weeks after operation. RESULTS: Two hours after modeling, the prefabricated module showed oblique fracture in varying degrees and the broken end shifted significantly;Except for 1 comminuted fracture, 2 curved butterfly fractures and 2 without obvious fracture line, the rest were simple transverse and oblique fractures without obvious displacement in formal modeling group. According to the judgment criteria, the success rate of the model was 85.71%. Four weeks after modeling, the fixed needle and splint of the experimental rabbits were in good position, the fracture alignment was good, the fracture line was blurred, many continuous callus growths could be seen around the fracture end, and the callus density was high. Six weeks after modeling, many thick new bone trabeculae at the fracture, marginal osteoblasts attached, and a small number of macrophages were seen under the microscope. The intramembrane osteogenesis area was in the preparation bone stage, the medullary cavity at the fracture had been partially reopened, the callus was in the absorption plastic stage, and many osteoclasts were visible. The X-ray showed that the fracture line almost disappeared, part of the medullary cavity had been opened, the external callus was reduced around, the callus was in the plastic stage, and the bone cortex was continuous. It suggests that the fracture model showed secondary healing. CONCLUSION The improved three-point bending fracture device can establish a stable rabbit model of closed tibial fracture, and the operation is simple, which meets the requirements of closed fracture model in basic research related to fracture healing.
Rabbits ; Male ; Animals ; Bony Callus ; Fracture Healing ; Tibial Fractures/surgery* ; Osteogenesis ; Radiography

Adolescent ; Adult ; Female ; Femoral Fractures ; diagnostic imaging ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Knee Injuries ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography ; Tibial Fractures ; diagnostic imaging ; surgery

OBJECTIVETo explore the clinical effects of closed reduction and less invasive stablization system for the treatment of proximal tibial multi-segment comminuted fractures, and to discuss the influence of LISS on reduction and bone union.

METHODSFrom 2003.7 to 2007.12, 19 patients with proximal tibial multi-segment comminuted fractures were treated with closed reduction and LISS fixation. Fourteen patients were male, 5 patients were female, ranging in age from 21 to 49 years, with an average of 39.2 years. Fifteen patients were injured with direct violence, 4 indirect violence. The reasons of the injuries were vehicle crashes for 14 cases and falling from high places for 3 cases and falling to the ground for 2 cases. All the patients were followed up postoperatively. Callus formation and bony union were recorded by X-ray.

RESULTSAll the patients were followed up for a period averaged 12.2 months (ranged 8 to 21 months). No failure of fixation and nonunion. No deformation of plates and screws occurred in patients,no superficial wound infection. According to the criteria of Merchan, 14 patients got an excellent result, 3 good, and 2 poor.

CONCLUSIONClosed reduction and less invasive stabilization systems can provide rigid internal fixation for proximal tibial multi-segment comminuted fractures. The LISS provides stable fixation, a high rate of union, and a low rate of infection for proximal tibial multi-segment comminuted fractures.

Adult ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Radiography ; Tibia ; diagnostic imaging ; surgery ; Tibial Fractures ; surgery ; Treatment Outcome ; Young Adult

BACKGROUND: To identify the fracture configuration and treatment results for patients with triplane and Tillaux fractures in the ankle joint. METHODS: A retrospective study was performed on 14 patients with a more than one year follow-up. This study investigated the fracture configuration, concomitant fibula fracture, treatment methods and complications. The treatment outcomes were analyzed using modified Weber protocol. RESULTS: Among the 14 cases, 11 were triplane fractures and 3 were Tillaux fractures. Seven were two part triplane fractures, and 4 were three part triplane fractures. Eight were lateral triplane fractures, and 3 were medial triplane fractures. A fibula fracture was accompanied by 7. The fibular fracture comprised of oblique fractures in all cases. A closed and open reduction was performed in 6 and 8 cases, respectively. All but one showed excellent treatment outcomes at the final follow-up. Traumatic arthritis developed in 1 case. CONCLUSIONS: Precisely detecting the fracture configuration by computed tomography and understanding the injury mechanism have greatly improved the outcomes of triplane fractures and Tillaux fractures of the ankle in adolescent patients.
Adolescent ; Ankle Injuries/diagnosis/radiography/*surgery ; Arthroscopy ; Child ; Female ; Fracture Fixation, Internal ; Humans ; Intra-Articular Fractures/diagnosis/radiography/*surgery ; Male ; Tibial Fractures/diagnosis/radiography/*surgery ; Tomography, Emission-Computed, Single-Photon ; Tomography, X-Ray Computed

BACKGROUND: This study evaluated the outcomes of surgical management of ipsilateral femoral and tibial fractures in adults. METHODS: Fifteen patients (13 men, 2 women; mean age, 34.8 years; range, 18 to 65 years) were enrolled in this study. The fractures types were classified according to the classification by Fraser et al. as follows: type I (5), type IIa (3), IIb (4), IIc (3). Femur fractures were treated using locked intramedullary nails, plate-screws, or dynamic condylar screws, and tibia fractures were treated with an external fixator (in open fractures), or plate-screws, and locked intramedullary nailing. The mean follow-up duration was 2.2 years (range, 1.3 to 4 years). RESULTS: The extent of bony union according to the Karlstrom criteria was as follows: excellent, 8; good, 4; acceptable, 2; poor, 1. CONCLUSIONS: The associated injuries and type of fracture (open, intra-articular, comminution) are prognostic factors in a floating knee. The best management of the associated injuries for good final outcome involves intramedullary nailing of both the fractures and postoperative rehabilitation.
Adolescent ; Adult ; Aged ; Female ; Femoral Fractures/radiography/*surgery ; Follow-Up Studies ; Fracture Fixation, Intramedullary/instrumentation/*methods ; Humans ; Male ; Middle Aged ; Multiple Trauma/radiography/*surgery ; Orthopedic Fixation Devices ; Prognosis ; Tibial Fractures/radiography/*surgery ; Treatment Outcome ; Young Adult

BACKGROUND: Relatively few studies have addressed plate osteosynthesis for open proximal tibial fractures by now. The purpose of this study was to assess the results of minimally invasive plate osteosynthesis (MIPO) for open fractures of the proximal tibia. METHODS: Thirty-four patients with an open proximal tibial fracture were treated by MIPO. Thirty of these, who followed for over 1 year, constituted the subject of this retrospective study. According to the AO Foundation and Orthopaedic Trauma Association (AO-OTA) classification, there were 3 patients of type 41-C, 6 of type 42-A, 8 of type 42-B, and 13 of type 42-C. In terms of the Gustilo and Anderson's open fracture grading system, 11 patients were of grade I, 6 were of grade II, and 13 were of grade III (III-A, 6; III-B, 6; III-C, 1). After thorough debridement and wound cleansing, when necessary, a soft tissue flap was placed. Primary MIPO (simultaneous plate fixation with soft tissue procedures) was performed in 18 patients, and staged MIPO (temporary external fixation followed by soft tissue procedures and subsequent conversion to plate fixation after soft tissue healing) was performed in 12 patients. Results were assessed according to the achievement and time to union, complications (including infections), and function of the knee joint using Knee Society scores. Statistical analysis was performed to identify factors influencing results. RESULTS: Primary union was achieved by 24 of the 30 study subjects. Early bone grafting was performed in 6 cases with a massive initial bone defect expected to result in non-union. No patient had malalignment greater than 10degrees. The mean Knee Society score was 88.7 at final follow-up visits, 23 patients achieved an excellent result, and 7 a good result. There were 3 superficial and 5 deep infections, but none required early implant removal. Functional results were similar for primary and staged MIPO (p = 0.113). Fracture pattern (p = 0.089) and open fracture grade (p = 0.079) were not found to influence the results. CONCLUSIONS: If soft tissue coverage is adequately performed, MIPO could be regarded as an acceptable method for the treatment of open proximal tibial fracture.
Adult ; Aged ; Chi-Square Distribution ; Female ; Fracture Fixation, Internal/adverse effects/*methods ; Fractures, Open/*surgery ; Humans ; Male ; Middle Aged ; Surgical Procedures, Minimally Invasive/adverse effects/*methods ; Tibia/pathology/radiography/surgery ; Tibial Fractures/pathology/radiography/*surgery

OBJECTIVETo investigate the clinical effects of surgery reduction and internal fixation through posteromedial knee approaches in the treatment of posteromedial condylar split fracture of tibial plateau.

METHODSFrom January 2006 to July 2009,21 patients with posteromedial condylar split fracture of tibial plateau were treated by posteromedial knee approaches. Among the patients, 14 cases were males and 7 cases were females,ranging from 28 to 68 years old with an average of 36.9 years old. For traumatic causes, 14 cases were injured by traffic accident and 7 cases by fall. Compound injury, 15 cases combined with anterior cruciate ligament injury and tibia insertion avulsion fracture; 14 cases combined with posterolateral de-pressed tibial plateau fracture. Rasmussen assessment criteria was used to evaluate the therapeutic effects.

RESULTSAll patients were followed up,from 12 to 30 months with an average of 17.3 months. All patients didn't undergo infection,looseness and rupture of fixation,nonunion of fracture,inversion and eversion of the knee or displacement of fracture. All cases attained anatomical reduction after operation,only 1 patient felt numbness of posterior lower part of the calf. According to Rasmussen assessment criteria, 12 cases got an excellent result, 7 good and 2 fair.

CONCLUSIONIt is beneficial for the postermedial knee approaches to be used in the reduction and fixation of posteromedial condylar split fracture of tibial plateau. It has advantages of clearly exposure, convenient placement of the internal fixation, less trauma and good therapeutic effects.

Adult ; Aged ; Bone Nails ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; Fractures, Closed ; surgery ; Humans ; Knee Injuries ; surgery ; Knee Joint ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography ; Tibial Fractures ; surgery

BACKGROUND: The locking plates are often used for internal fixation of closed tibial fractures. The use of a locking plate as an external fixator is still controversial, particularly for closed fractures. The purpose of this study is to evaluate the results of external fixation using the femoral less invasive stabilization system (LISS) plate in proximal metaphyseal fractures of the tibia. METHODS: We prospectively evaluated 35 patients (26 males and 9 females) with a mean age of 42 years (range, 21 to 62 years) who presented with fresh tibial proximal metaphyseal fractures. According to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, the fractures were identified as type 41-A2 in 18 cases and type 41-A3 in 17 cases, including 25 closed fractures and 10 open fractures. The femoral LISS plate was used to fix these fractures, which was placed on the anteromedial aspect of the tibia as an external fixator. The mean follow-up period was 18 months (range, 13 to 22 months). RESULTS: All fractures healed in a mean time of 14 weeks (range, 10 to 20 weeks). There was no case of nonunion, deep infection, and loosening of screws and plates. One month after the appearance of cortical bridging on biplanar radiographs, the locking plate was removed within 3 minutes in the clinic without any difficulty. According to the Hospital for Special Surgery (HSS) knee scoring system and American Orthopaedic Foot & Ankle Society (AOFAS) ankle scoring system, the mean HSS score was 91 (range, 85 to 100) and 98 (range, 93 to 100), and the mean AOFAS score was 94 (range, 90 to 100) and 98 (range, 95 to 100) at 4 weeks postoperatively and final follow-up, respectively. CONCLUSIONS: For proximal metaphyseal fracture of the tibia, external fixation using the femoral LISS plate is a safe and reliable technique with minimal complications and excellent outcomes. Its advantages include ease of performing the surgery, use of a less invasive technique, and convenience of plate removal after fracture healing.
Adult ; *Bone Plates ; External Fixators ; Female ; Fracture Fixation/*instrumentation/methods ; Humans ; Male ; Middle Aged ; Prospective Studies ; Tibial Fractures/radiography/*surgery ; Young Adult

PURPOSE: The purpose of this study is to evaluate the relationship between the angle formed between the proximal most screw through the locking compression plate-proximal lateral tibia (LCP PLT) and the joint line, and to evaluate if this angle can be used intraoperatively as an assessment tool to determine normal alignment of the tibia in the coronal plane. MATERIALS AND METHODS: There are two parts to this study: in the first part, LCP PLT was applied to 30 cadaveric adult tibia. The angle between the joint line and the proximal most screw was measured and termed as the 'joint screw angle' (JSA). In the second part, 56 proximal tibial fractures treated with LCP PLT were retrospectively studied. Two angles were measured on the radiographs, the medial proximal tibial angle (MPTA) and the JSA. Their relationship was analyzed statistically. RESULTS: The average JSA was 1.16 degrees in the anatomical study. Statistical analysis of the clinical study showed that the normal MPTA had a direct correlation with an acceptable JSA. CONCLUSION: We therefore conclude that the JSA can be used intraoperatively to assess the achievement of a normal coronal axis.
Adult ; Aged ; Aged, 80 and over ; *Bone Screws ; Female ; Humans ; Male ; Middle Aged ; Orthopedic Procedures/*methods ; Retrospective Studies ; Tibial Fractures/radiography/*surgery

OBJECTIVETo study the characteristic, treatment and prognosis of tibial plateau fracture Schatzker type IV.

METHODSAccording to the roentgenogram and CT scan in 51 patients, Schatzker type IV injury is divided into 3 types: split, total condylar, depression. In the treatment of split and total condylar injury, if there was no articular depression on CT scan, reduction is done through medial approach; if CT scan demonstrated articular depression, middle approach was used to reduce the depression and bone graft. In split injury, buttress plate was fix on posterior-medial side. In total condylar injury, buttress plate is fix on medial side. In depression injury, fracture was reduced through medial approach, bone graft and buttress plate was fix on medial side. Thirty-three patients were followed up in 41 months averagely. And the statistical analysis was done.

RESULTSThe average Lysholm score of 33 patients was 83.2. Eight patients were excellent, 9 were good, 14 were fair, 2 were poor. The range of motion from 30 degrees to 147 degrees (average 110 degrees ). The factors that caused bad results were: the fracture was not anatomical reduced; tibial plateau is more than 4 mm wider than femoral condylar or lateral subluxation exceed 8 mm; varus deformity of knee. They also caused the increase of osteoarthritis.

CONCLUSIONSIn order to get anatomical reduction and stable fixation, the approach and fix pattern should be chosen on the bases of classification and CT scan of Schatzker IV injury. The factors which influence the prognosis are: (1) tibial plateau is more than 4mm wider than femur condylar, or lateral subluxation more than 8 mm; (2) Varus deformity. Attention should be paid to avoid these during operation.

Adult ; Aged ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Tibial Fractures ; classification ; diagnostic imaging ; surgery