OBJECTIVE: To measure and compare medial proximal tibial angle (MPTA) of lower limbs under different axial rotation angles(neutral position, 30° internal rotation, 30° external rotation) on the load position radiographs, and explore changes and significance of MPTA measured within and between groups of tibia at different axial rotation positions. METHODS: From January 2018 to December 2018, 40 patients with knee osteoarthritis (KOA) were selected, with a total of 80 limbs, including 12 males and 28 females, aged from 29 to 73 years old with an average of (59.6±12.7) years old. Full length radiographs of the lower limbs were taken on neutral tibia position, 30° internal rotation and 30° external rotation, respectively. MPTA was measured and the results were compared between groups and within groups. RESULTS: MPTA measured on the left lower extremity of neutral tibia, 30° internal rotation and 30° external rotation were (86.08±2.48) °, (88.62±2.94) ° and (83.47±3.10) °, respectively. MPTA measured on the right lower limb were (86.87±1.97) °, (89.02±2.39) ° and (83.80±2.77) °, respectively, and there were no significant difference in MPTA measured between rotation angle group (P>0.05). While there were statistical difference in MPTA on the same limb between groups (P<0.05). On 30° internal rotation, MPTA of left and right lower limbs increased by (2.54±1.74) ° and (2.15±1.78) ° compared with tibia neutral position. On 30° external rotation, MPTA of left and right lower limbs decreased (2.61±2.03) ° and (3.07±1.75) ° compared with tibial neutral position. CONCLUSION When a full-length X-ray film is taken on the weight-bearing position of both lower limbs, if there is axial rotation or external rotation of tibia, MPTA will increase or decrease compared with neutral position, which may cause a certain degree of deviation in clinical operation based on the accurate measurement of MPTA. However, the extent to which this bias affects the clinical operation effect remains to be verified. In addition, limited by the total number of samples and the number of measurement groups, whether there is a linear relationship between MPTA deviation and tibial axial rotation needs to be further studied.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Tibia/surgery* ; Lower Extremity ; Osteoarthritis, Knee/surgery* ; Radiography ; Osteotomy/methods* ; Knee Joint/surgery* ; Retrospective Studies

PURPOSE: There are no previous epidemiological studies to represent the trends of tibia fractures in the urban setting. The purpose of our study was to provide unique epidemiological information on the incidence of tibia fractures requiring admission in the urban population of Singapore. METHODS: This is a retrospective review of clinical and radiological records encompassing three years period from 2012 to 2014 in a tertiary hospital in Northern Singapore, which covers an adult population of 550,000. Clinical information included demographics, mechanism of injury, and Gustillo-Anderson classification. Radiological records were evaluated by two of the authors and fractures were classified using the AO classification after consensus was reached. RESULTS: There were 214 cases of tibia fractures with a population incidence of 13 in 100,000. Among the tibia fractures, 47% were diaphyseal, 43% proximal and 10% distal. Majority of patients were males with a male to female ratio of 3 to 1. The mean age of females was 64 years while that of males was 40 years. The commonest mechanism of injury was road traffic accident, which contributed to 42% of cases, with motorcyclists making up 78% of all road traffic accidents. Compound fractures made up 23% of all fractures, most of which were Gustillo-Anderson type III; 69% of patients underwent surgical intervention. CONCLUSION The incidence of tibia fractures is 13/100,000 with a male-to-female ratio of 3:1. This incidence is lower than other studies, but the proportion of open fractures were surprisingly high at 23%. Distribution of fractures was unimodal with a peak in younger men and older women. This may signify a component of fragility among tibia fractures, especially proximal and distal fractures, which peaks above the age of 80 years old.
Accidents, Traffic ; statistics & numerical data ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Female ; Hospitalization ; statistics & numerical data ; Humans ; Incidence ; Inpatients ; statistics & numerical data ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Sex Factors ; Singapore ; epidemiology ; Tibia ; diagnostic imaging ; Tibial Fractures ; classification ; diagnostic imaging ; epidemiology ; surgery ; Time Factors ; Urban Population ; statistics & numerical data

The alignment of lower extremities is an important consideration in many clinical situations, including fracture reduction, high tibia osteotomy, total knee arthroplasty, and deformity correction. Mal-alignment of lower extremities is not only a simple cosmetic problem, but it can also produce pain, limp, and early degenerative arthritis. An assessment of lower extremity alignment, including its location and magnitude of deformity, can be achieved via mal-alignment test and mal-orientation test, using a lower extremity standing full-length radiography. Proper evaluation allows the surgeon to determine an effective treatment plan for deformity correction.
Arthroplasty, Replacement, Knee ; Congenital Abnormalities* ; Lower Extremity* ; Osteoarthritis ; Osteotomy ; Radiography ; Tibia

Melorheostosis is a very rare sclerosing bone disease with pain, joint stiffness, and limitation of motion. Its characteristic on radiography is a dense bone formation along the side of the bone, resembling the flow of candle grease. Various conservative or surgical methods have been practiced in treating pain and deformities. This is a report on the successful treatment result of six cases of melotheostosis, involving the metatarsal, metacarpal, clavicle, and tibia, which weretreated by conservative and operative treatment methods.
Arthralgia ; Bone Diseases ; Clavicle ; Congenital Abnormalities ; Melorheostosis* ; Metatarsal Bones ; Osteogenesis ; Radiography ; Tibia

BACKGROUNDFor a child with osteosarcoma, prediction of the limb length discrepancy at maturity is important when planning for limb salvage surgery. The purpose of this study was to provide a reliable prediction method.

METHODSA retrospective review of Chinese children receiving chemotherapy for osteosarcoma before skeletal maturity was conducted. Standing full-length radiographs of the lower extremity were used for length measurements. Length-for-age curves were constructed using the LMS method. The lower limb multiplier for a specific age and gender was calculated using the formula M = Lm/L, where M was the gender- and age-specific multiplier, Lmwas the bone length at maturity, and L was the age-specific bone length. Prematurity and postmaturity radiographs were used to assess the accuracy of the prediction methods.

RESULTSA total of 513 radiographs of 131 boys and 314 radiographs of 86 girls were used to calculate the coefficients of the multiplier. The multipliers of 8-, 9-, 10-, 11-, 12-, 13-, 14-, 15-, 16-, 17-, and 18-year-old boys after chemotherapy for osteosarcoma were 1.394, 1.306, 1.231, 1.170, 1.119, 1.071, 1.032, 1.010, 1.004, 1.001, and 1.000, respectively; while for girls at the same ages, the multipliers were 1.311, 1.221, 1.146, 1.092, 1.049, 1.021, 1.006, 1.001, 1.000, 1.000, and 1.000, respectively. Prematurity and postmaturity femoral and tibial lengths of 21 patients were used to assess the prediction accuracy. The mean prediction error was 0 cm, 0.8 cm, and 1.6 cm for the multiplier method using our coefficients, Paley's coefficients, and Anderson's method, respectively.

CONCLUSIONSOur coefficients for the multiplier method are reliable in predicting lower limb length growth of Chinese children with osteosarcoma.

Adolescent ; Body Height ; physiology ; Bone Neoplasms ; surgery ; Child ; Female ; Femur ; anatomy & histology ; Humans ; Limb Salvage ; Lower Extremity ; anatomy & histology ; Male ; Models, Theoretical ; Osteosarcoma ; surgery ; Radiography ; Retrospective Studies ; Tibia ; anatomy & histology

Adult ; Bone Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Diaphyses ; diagnostic imaging ; pathology ; Humans ; Knee Joint ; diagnostic imaging ; pathology ; Lipoma ; diagnosis ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Male ; Radiography ; Tibia ; diagnostic imaging ; pathology

OBJECTIVETo evaluate long-term result of Scorpio posterior-stabilized total knee arthroplasty.

METHODSThere were 160 patients (240 knees) underwent Scorpio posterior-stabilized total knee arthroplasty between December 1998 and December 2000, which were performed by the same surgeon. Patients were followed up from June 2013 to December 2013. Knee Society Scoring (KSS), Hospital for Special Surgery (HSS) patellofemoral scoring, standard weight-bearing anteroposterior and patellar tangential radiographs were assessed. Satisfaction of outcome was requested. Alignment of components and presence of radiolucent lines were assessed by the radiographic scoring system of knee society. Paired t-test was used compared to the data between preoperation and the time of last follow-up.

RESULTSNinety-five patients (141 knees) (59.4%) were followed up. Average follow-up duration was 13.3 years (range 12 to 15 years). Eight knees were revised due to periprosthetic infection (4 knees), aseptic loosening of tibial tray (3 knees) and wear-out of polyethylene insert (1 knee). Compared with preoperative ones, KSS knee score, KSS functional score and range of motion improved significantly (pre-operation: 26±16, 34±18, 87°±25°; follow-up time: 93±8, 78±27, 114°±22°) (t=45.55, 15.60, 13.03, all P<0.01). In terms of KSS knee score and HSS patellofemoral score, 106 knees were rated as excellence respectively. Ninety-five knees had satisfaction with outcome for maximum. The presences of radiolucent lines occurred around 5 femoral and 11 tibial components with range less than 2 mm. The survival rate at 10 years was 94.5% with revision for any reason as the end point.

CONCLUSIONThe long-term study indicates that Scorpio posterior-stabilized knee system shows favorable clinical and radiological results.

Arthroplasty, Replacement, Knee ; methods ; Femur ; diagnostic imaging ; Follow-Up Studies ; Humans ; Knee Joint ; surgery ; Knee Prosthesis ; Patella ; diagnostic imaging ; Polyethylene ; Radiography ; Range of Motion, Articular ; Reoperation ; Tibia ; diagnostic imaging ; Treatment Outcome

PURPOSE: The purpose of this study is to evaluate the usefulness of computed tomography (CT) for spiral tibia shaft fracture by analyzing associated distal tibia intra-articular fractures diagnosed by CT only which met the indication of surgical fixation and were fixed. MATERIALS AND METHODS: Ninety-five spiral tibia shaft fractures with preoperative ankle plain radiographs and CT were analyzed retrospectively. The incidence and type of associated distal tibia articular fractures were evaluated by reviewing ankle plain radiography and CT. The number of fractures diagnosed by CT that correspond with the indication of fixation and that were actually fixed were analyzed. RESULTS: Among 95 spiral tibia shaft fractures, 62 cases (65.3%) were associated with distal tibia intra-articular fracture. There were 37 cases of posterior malleolar fracture, 5 cases of avulsion fracture of the distal anterior tibiofibular ligament, 5 cases of medial malleolar fracture, and 15 cases of complex fracture. Among 52 posterior malleolar fractures including complex fracture, 20 cases were diagnosed by ankle plain radiograph. Of these 20 cases, 16 posterior malleolar fractures (80.0%) met the indication of surgical fixation, and 14 cases were actually fixed with a screw. Among 32 posterior malleolar fractures diagnosed by CT only, 26 cases (81.3%) met the indication of surgical fixation and 18 cases (56.3%) were fixed by screw. CONCLUSION: Approximately 50% of associated fractures were diagnosed by CT only and more than 80% of associated posterior malleolar fractures met the indication of surgical fixation and among these fractures, 18 cases (56.3%) were actually fixed by screw. This result suggests that CT is useful in diagnosis and treatment of distal tibia intra-articular fracture associated with spiral tibia shaft fracture.
Ankle ; Ankle Fractures ; Diagnosis ; Incidence ; Intra-Articular Fractures* ; Ligaments ; Radiography ; Retrospective Studies ; Tibia*

PURPOSE: To identify the accuracy of postoperative implant alignment in minimally invasive surgery total knee arthroplasty (MIS-TKA), based on the degree of varus deformity. MATERIALS AND METHODS: The research examined 627 cases of MIS-TKA from November 2005 to December 2007. The cases were categorized according to the preoperative degree of varus deformity in the knee joint in order to compare the postoperative alignment of the implant: less than 5degrees varus (Group 1, 351 cases), 5degrees to less than 10degrees varus (Group 2, 189 cases), 10degrees to less than 15degrees varus (Group 3, 59 cases), and 15degrees varus or more (Group 4, 28 cases). RESULTS: On average, the alignment of the tibial implant was 0.2+/-1.4degrees, 0.1+/-1.3degrees, 0.1+/-1.6degrees, and 0.3+/-1.7degrees varus, and the tibiofemoral alignment was 5.2+/-1.9degrees, 4.7+/-1.9degrees, 4.9+/-1.9degrees, and 5.1+/-2.0degrees valgus for Groups 1, 2, 3, and 4, respectively, in the preoperative stage, indicating no difference between the groups (p>0.05). With respect to the accuracy of the tibial implant alignment, 98.1%, 97.6%, 87.5%, and 86.7% of Groups 1, 2, 3, and 4, respectively, had 0+/-3degrees varus angulation, demonstrating a reduced level of accuracy in Groups 3 and 4 (p<0.0001). There was no difference in terms of tibiofemoral alignment, with 83.9%, 82.9%, 85.4%, and 86.7% of each group, respectively, showing 6+/-3degrees valgus angulation (p>0.05). CONCLUSION: Satisfactory component alignment was achieved in minimally invasive surgery in total knee arthroplasty, regardless of the degree of varus deformity.
Aged ; Arthroplasty, Replacement, Knee/*methods ; Bone Anteversion/complications/*radiography ; Bone Malalignment/etiology/*radiography ; Female ; Humans ; Joint Deformities, Acquired/*surgery ; Knee Joint/radiography/*surgery ; Knee Prosthesis ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures/*methods ; Osteoarthritis, Knee/complications/radiography/*surgery ; Postoperative Period ; Preoperative Period ; Range of Motion, Articular ; Tibia/surgery ; Treatment Outcome

OBJECTIVETo reveal the possible mechanism involved in patella-femoral degenerative arthritis (PFDA) in- duced by torsion-deformity of tibia via analyzing the relationship between torsion-deformity of the tibia in patients with PFDA and the disorder of patella-femoral joint under the static and dynamic conditions.

METHODSFrom October 2009 to October 2010, 50 patients (86 knees, 24 knees of male patients and 62 knees of female patients) with PFDA were classified as disease group and 16 people (23 knees, 7 knees of males and 16 knees of females) in the control group. The follow indexes were measured: the torsion-angle of tibia on CT scanning imagings, the patella-femoral congruence angle and lateral patella-femoral angle under static and dynamic conditions when the knee bent at 30 degrees of flexion. Based on the measurement results, the relationship between the torsion-deformity of tibias and the disorders of patella-femoral joints in patients with PFDA were analyzed. Finally,the patients were divided into three groups including large torsion-angle group, small torsion-angle group and normal group according to the size of torsion-angle, in order to analyze the relationship between torsion-deformity and disorders of patella-femoral joint, especially under the dynamic conditions.

RESULTSCompared with patients without PFDA, the ones with PFDA had bigger torsion-angle (30.30 ± 7.11)° of tibia, larger patella-femoral congruence angle (13.20 ± 3.94)° and smaller lateral patella-femoral angle (12.30 ± 3.04)°. The congruence angle and lateral patella-femoral angle under static and dynamic conditions had statistical differences respectively in both too-big torsion-angle group and too-small torsion-angle group. The congruence angle and lateral patella-femoral angle under static and dynamic conditions had no statistical differences in normal torsion-angle group.

CONCLUSIONTorsion-deformity of tibia is the main reason for disorder of patella-femoral joint in the patients with PFDA. Torsion-deformity of tibia is always accompanied by instability of patella-femoral joint,especially under the dynamic condition, thus causing PFDA. It can not only provide arrangement information and degenerative condition of patella-femoral joint,but also provide guidance through the analysis on the relationship for better clinical prevention and early treatment of degenerative bone and joint disease.

Adult ; Female ; Femur ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Osteoarthritis, Knee ; diagnostic imaging ; etiology ; Patella ; diagnostic imaging ; Radiography ; Tibia ; diagnostic imaging ; Torsion Abnormality ; complications ; diagnostic imaging