46 patients with occult fracture on middle third of tibia shaft due to many causes were surgical treated by intramedullary fixation with Küntscher nail: 37 patients were treated at Viet Duc Hospital from January 1996 to July 1999 and 9 patients were treated at Hospital No 103 from April 1993 to July 1999. Outcomes: very good 27 cases (84.37%), good 5 cases (15.63%). Advantages of this procedure were firm fixation; early rehabilitation that helping bone union; easy to use so that it can be used at all hospitals; dissection of periosteum in this procedure is less than fixation with screw that making less vascular damages and better healing. Disadvantages were higher risk of infections, slower bone union, and this procedure can’t be used for fracture of upper or lower third of tibia shaft
Tibial Fractures ; Fractures, Bone ; Therapeutics ; surgery ; nails

Background: Leg bone fracture is common seen in orthopedic trauma. Currently, the trend of treatment is using a less invasive technique. Especially, with application of C-Arm in surgery, closed Kuntscher nailing technique has made the treatment of leg bone fractures achieving more new improvements. Objectives: To summarize the experiences in the technical implementation process and to assess results of treatment. Subjects and method: A descriptive, retrospective study was conducted on 112 patients was confirmed diagnosed with leg bone fractures (81 males, 31 females, the average aged 29\xb15.3), were operated in Da Nang General Hospital from January, 2004 to June, 2006. All of them were performed with Kuntscher intramedullary nail in tibia without opening fracture cavity, in condition of without C-Arm. Results: The patients with combined injuries included 5 cases of 2 legs fracture, 2 cases of hip fracture, 5 cases of leg fracture in 2 stages, 1 case of collabone fracture. Postoperative observations: no case of infection, patients were discharged after 2-7 days, the average length of hospitalization was 3\xb12.4 days. Complication: 1 case of secondary deviation, no case of any delay to heal bone, broken nails. Recording a case of nail was rise up to cause painfully and synovial capsule inflammation of knee joint. Conclusion: The implementation of this less invasive technique should be orderly done. The most ideal indication was tibial shaft fractures in stage of middle 1/3. Because of a minimally invasive technique so patients were less painful, fracture healing quickly, early mobilization could be set, surrounding joints were not affected.
Tibial Fractures/surgery ; Fracture Fixation ; Intramedullary/ methods ;

High-energy tibial plateau fracture poses a significant challenge and difficulty for orthopaedic surgeons. Fracture of tibial plateau involves major weight bearing joint and may alter knee kinematics. Anatomic reconstruction of the proximal tibial articular surfaces, restoration of the limb axis (limb alignment) and stable fixation permitting early joint motion are the goals of the treatment. In cases of complex bicondylar tibial plateau fractures, isolated lateral plating is frequently associated with varus malalignment and better results have been obtained with bilateral plating through dual incisions. However sometimes a complex type of bicondylar tibial plateau fractures is encountered in which medial plateau has a biplaner fracture in posterior coronal plane as well as sagittal plane. In such fractures it is imperative to fix the medial plateau with buttressing in both planes. One such fracture pattern of the proximal tibia managed by triple plating through dual posteromedial and anterolateral incisions is discussed in this case report with emphasis on mechanisms of this type of injury, surgical approach and management.
Adult ; Bone Plates ; Humans ; Male ; Tibia ; surgery ; Tibial Fractures ; surgery

Adult ; Humans ; Male ; Tibial Fractures ; complications ; surgery ; Tibial Meniscus Injuries ; etiology ; surgery

OBJECTIVEThe objective of this article is to summarize the development of evaluation and treatment of posterior malleolus fracture (PMF).

DATA SOURCESData used in this review were mainly from English literature of PubMed data base. Study selection Articles were included in this review if they were related to the PMF or trimalleolar fracture.

RESULTSNo consensus was found regarding what sizes of posterior malleolus fragments would lead to ankle instability thus affecting prognosis and should be fixed. X-ray measurement is unreliable, while CT scan is widely recommended and it can recognize the occult posterior malleolus fractures associated with tibia shaft fractures, which are always undetected previously. Direct posterior malleolus fixation is suitable to stabilize syndesmotic injury. The basic and clinical researches support direct reduction and buttress plate fixation of posterior malleolus fracture through the posterolateral approach. Operative indications and timing of weight bearing are still in discussion.

CONCLUSIONSKnowing whether ankle instability occurs and the proper methods to diagnose, evaluate, and operate can help manage the fracture. Further biomechanical research on ankle stability and clinical study to compare various treatment methods are required.

Fractures, Ununited ; surgery ; Humans ; Ilizarov Technique ; Male ; Middle Aged ; Postoperative Complications ; surgery ; Tibial Fractures ; surgery

There is a lack of ideal clinical classification systems for posterior tibial plateau fractures, and they need to be perfected in clinical practices. There are controversies over surgical approaches due to special characters of posterior tibial plateau fractures. It is difficult for the conventional techniques and approaches to achieve satisfactory reduction and fixation. A modified posterior approach is an ideal approach for the treatment of posterior tibial plateau fractures. This paper summarizes the classification, approach and internal fixation of posterior tibial plateau fractures.
Fracture Fixation, Internal ; methods ; Humans ; Tibial Fractures ; surgery

Characteristics of collapsed tibial plateau fracture determines that the joint surface must remain anatomical reduction,line of force in tibial must exist and internal fixation must be strong. However, while renewing articular surface smoothness, surgeons have a lot of problems in dealing with bone defect under the joint surface. Current materials used for bone defect treatment include three categories: autologous bone, allograft bone and bone substitutes. Some scholars think that autologous bone grafts have a number of drawbacks, such as increasing trauma, prolonged operation time, the limited source, bone area bleeding,continuous pain, local infection and anesthesia,but most scholars believe that the autologous cancellous bone graft is still the golden standard. Allograft bone has the ability of bone conduction, but the existence of immune responses, the possibility of a virus infection, and the limited source of the allograft cannot meet the clinical demands. Likewise, bone substitutes have the problem that osteogenesis does not match with degradation in rates. Clinical doctors can meet the demand of the patient's bone graft according to patient's own situation and economic conditions.
Bone Substitutes ; Bone Transplantation ; Humans ; Tibial Fractures ; surgery

Diaphyses ; Fracture Fixation, Intramedullary ; Humans ; Tibial Fractures/surgery*

The necessity and superiority of the surgical operation on children with floating knee injury and the fracture union and complications were investigated. Twenty-eight children with floating knee injury were subjected to open reduction and internal fixation or external fixator. The patients were followed up for 18 months to 7 years. The curative effectiveness was scored by Karlstrom criteria. The results showed that no nonunion or deformity was found. The affected limb was 1.2 cm to 1.5 cm longer in 2 cases, 0.8 to 1.2 cm shorter in 3 cases than the contralateral. No severe dysfunction of knee joint occurred. The excellent-good rate was 92.8% and the curative rate 71.4% respectively. So for children whose age is older than 5 years, it's a good way to treat the fractures of femur and tibia with open reduction and internal fixation or external fixator. The method can be advantageous for the nursing care, early function recovery, shortening of the hospital stay and avoidance of severe complications.
Femoral Fractures/complications ; Femoral Fractures/*surgery ; Fracture Fixation ; Knee Injuries/classification ; Knee Injuries/etiology ; Knee Injuries/*surgery ; Tibial Fractures/complications ; Tibial Fractures/*surgery ; Treatment Outcome