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Jae Yoon Chung - One of the best experts on this subject based on the ideXlab platform.

Sung Taek Jung - One of the best experts on this subject based on the ideXlab platform.

Hyeong-won Park - One of the best experts on this subject based on the ideXlab platform.

Charles E Johnston - One of the best experts on this subject based on the ideXlab platform.

  • congenital pseudarthrosis of the tibia results of technical variations in the charnley williams procedure
    Journal of Bone and Joint Surgery American Volume, 2002
    Co-Authors: Charles E Johnston
    Abstract:

    Background: Results of the Charnley-Williams method of intramedullary fixation for treatment of congenital pseudarthrosis of the tibia have varied, in part because of variations in surgical technique. The outcomes of three variations of this procedure were compared to determine which technique was the most likely to result in union. Methods: The results in twenty-three consecutive patients with congenital pseudarthrosis of the tibia were reviewed at four to fourteen years following initial surgical treatment with an intramedullary rod. Three types of procedures were performed: type A, which consisted of resection of the tibial pseudarthrosis with shortening, insertion of an intramedullary rod into the tibia, and tibial bone-grafting combined with Fibular resection or osteotomy and insertion of an intramedullary rod into the Fibula; type B, which was identical to type A except that it did not include Fibular fixation; and type C, which consisted of insertion of a tibial rod and bone-grafting but no Fibular surgery. The outcome was classified as grade 1 when there was unequivocal union with full weight-bearing function and maintenance of alignment requiring no additional surgical treatment; grade 2 when there was equivocal union with useful function, with the limb protected by a brace, and/or valgus or sagittal bowing for which additional surgery was required or anticipated; and grade 3 when there was persistent nonunion or refracture, requiring full-time external support for pain and/or instability. Results: Eleven patients (48%) ultimately had a grade-1 outcome; nine, a grade-2 outcome; and three, a grade-3 outcome. The final outcome was not associated with either the initial radiographic appearance of the lesion or the age of the patient at the time of the initial surgery. The results following type-A and B operations were better than those after type-C procedures. Surgery on an intact Fibula resulted in a lower prevalence of grade-3 outcomes than was found when an intact Fibula was not operated on (p = 0.05). Transfixation of the ankle joint by the intramedullary rod did not decrease the prevalence of grade-3 outcomes. Conclusions: There is little justification for a type-C operation, as it either resulted in a persistent nonunion or failed to improve an equivocal outcome in every case. Leaving an intact Fibula undisturbed to maintain stability or length also was not successful in this series. In addition, the presence of Fibular insufficiency (fracture or a pre-pseudarthrotic lesion) was highly prognostic for subsequent valgus deformity (occurring in ten of twelve cases), whether or not the Fibula eventually healed.

Burak Beksac - One of the best experts on this subject based on the ideXlab platform.

  • hindfoot valgus following interlocking nail treatment for tibial diaphysis fractures can the Fibula be neglected
    Advances in orthopedics, 2014
    Co-Authors: Metin Uzun, Adnan Kara, Mujdat Adas, Bulent Karslioglu, Murat Bulbul, Burak Beksac
    Abstract:

    Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant Fibula fractures (except at the distal one-third level) managed conservatively with an associated Fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function. Methods. Sixty middle one-third tibial shaft fractures with associated Fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and Fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Disability Index Score (FADI). Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%). Fibular shortening was identified in 42 fractures (68%). Mean Fibular shortening was 1.2 cm (range, 0.5–2 cm). Clinical exams showed increased hindfoot valgus in 42 fractures (68%). The mean KOOS was 88.4, and the mean FADI score was 90. Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to Fibular shortening.