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Patrick M Cherveny - One of the best experts on this subject based on the ideXlab platform.
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femoral rotational alignment using the Tibial Shaft axis in total knee arthroplasty
Clinical Orthopaedics and Related Research, 1996Co-Authors: James B Stiehl, Patrick M ChervenyAbstract:The capability of determining femoral component rotation by using a posterior femoral condyle resection made perpendicular to the longitudinal Tibial Shaft axis in posterior cruciate retaining total knee arthroplasty was evaluated. From 100 consecutive cases, 54 used the femoral posterior condyle axis and 46 used an extramedullary alignment rod based on the Tibial Shaft axis. Seventy-two percent of total knee arthroplasties using the posterior condyle axis required lateral release versus 28% using the Tibial Shaft axis. Patellar fracture occurred in 7% using the posterior condyle axis versus none using the Tibial Shaft axis. Two patients had both techniques in opposite knees. Using computed tomography, the posterior condyle axis method gave a posterior condyle angle of 5' and 4' compared with the transepicondylar axis, whereas the Tibial Shaft axis technique measured 0' and lo. The posterior condyle resection using the Tibial Shaft axis restores the anatomic patellofemoral relationships, minimizing patellofemoral complications.
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femoral rotational alignment using the Tibial Shaft axis in total knee arthroplasty
Clinical Orthopaedics and Related Research, 1996Co-Authors: James B Stiehl, Patrick M ChervenyAbstract:The capability of determining femoral component rotation by using a posterior femoral condyle resection made perpendicular to the longitudinal Tibial Shaft axis in posterior cruciate retaining total knee arthroplasty was evaluated. From 100 consecutive cases, 54 used the femoral posterior condyle axis and 46 used an extramedullary alignment rod based on the Tibial Shaft axis. Seventy-two percent of total knee arthroplasties using the posterior condyle axis required lateral release versus 28% using the Tibial Shaft axis. Patellar fracture occurred in 7% using the posterior condyle axis versus none using the Tibial Shaft axis. Two patients had both techniques in opposite knees. Using computed tomography, the posterior condyle axis method gave a posterior condyle angle of 5 degrees and 4 degrees compared with the transepicondylar axis, whereas the Tibial Shaft axis technique measured 0 degrees and 1 degree. The posterior condyle resection using the Tibial Shaft axis restores the anatomic patellofemoral relationships, minimizing patellofemoral complications.
Yingze Zhang - One of the best experts on this subject based on the ideXlab platform.
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the communication line suggests occult posterior malleolar fracture associated with a spiral Tibial Shaft fracture
European Journal of Radiology, 2012Co-Authors: Zhiyong Hou, Liping Zhang, Qi Zhang, Shuangquan Yao, Jinshe Pan, Kaan Irgit, Yingze ZhangAbstract:Abstract Objectives To demonstrate radiographical characteristics of the relationship between distal spiral Tibial Shaft fractures and associated occult posterior malleolar fractures (PMF) that confirmed by CT and MRI. Materials and methods X-rays for a ninety-six patients with spiral tibia fracture and associated PMF were reviewed. All patients additionally had an ankle CT. Patients with a negative CT scans underwent an ankle MRI. Radiographic observations included fracture location, characteristics, and a presence of a fracture line between the two injuries. Results The spiral tibia fracture line was contiguous with PMF in 89 of 96 cases after evaluation with the CT and MRI. The line connecting the two injuries, which occurs between the medial inferior apex of the spiral tibia fracture line and the posterior superior apex of the PMF was identified as the “communication line”. In 47 of the 89 conjunction fractures, the “communication line” was detectable preoperatively and in 12 cases postoperatively by anteroposterior radiograph. By using the CT and MRI scans, we found that no “communication line” was present in only 7 cases. Conclusion It is important to understand the nature of the association between distal spiral Tibial Shaft fractures and occult posterior malleolar fractures for optimal stabilization of the fracture and for appropriate rehabilitation. The “communication line” is a useful diagnostic clue for early recognition the occult PMF and alerts a closer evaluation of the lateral view and further CT examination.
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a occult and regular combination injury the posterior malleolar fracture associated with spiral Tibial Shaft fracture
Journal of Trauma-injury Infection and Critical Care, 2009Co-Authors: Zhiyong Hou, Yingze Zhang, Qi Zhang, Jinshe PanAbstract:Purpose:It is known that Tibial diaphyseal fractures are often associated with the posterior malleolar fracture (PMF). There are a few studies on Tibial Shaft fractures with respect to posterior malleolus fracture. However, we found that the incidence of PMF was higher than the previously reported.M
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clinical epidemiological analysis of adult spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture
National Medical Journal of China, 2008Co-Authors: Zhiyong Hou, Qi Zhang, Jinshe Pan, Haitao Zhao, Wei Chen, Peng Xue, Yingze ZhangAbstract:Objective To investigate the clinical epidemiological features of adult spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture, a special kind of fracture. Methods The clinical data of 1685 cases of adult Tibial and fibular Shaft fracture were analyzed retrospectively. The cause and mechanism of spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture were studied in detail. Results The male and female ratio in adult Tibial and fibular Shaft fracture was 4. 52: 1. Most of adult Tibial and fibular Shaft fracture occurred in the persons aged 31 -40 (26. 0% ) and type A fracture accounted for 57.7% of the cases. The male and female ratio in adult spiral tibiul fracture was 2. 95: 1. Most of the adult spiral Tibial fracture occurred in those aged 41 -50 (32. 6% ). With a male and female ratio of 6:1 (24:4) and mostly occurring in the persons aged 41 -50, spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture composed 9. 7% (28/288) of total Tibial fractures and 1.7% (28/1685) of total spiral Tibial and fibular fractures. Missed diagnosis rate of spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture was 67.9% (19/28) in the Department of Radiology and 53.6% in the Department of Orthopedics. Conclusion With a high incidence, spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture was caused by a low energy but not an iatrogenic damage. With a high rate of missed diagnosis, the spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture should be paid more attention to clinically. Key words: Tibia Fractures ; Ankle joint; Epidemiologic studies
Mohit Bhandari - One of the best experts on this subject based on the ideXlab platform.
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smoking obesity and disability benefits or litigation are not associated with clinically important reductions in physical functioning after intramedullary nailing of Tibial Shaft fractures a retrospective cohort study
Clinical Orthopaedics and Related Research, 2021Co-Authors: Fawaz Findakli, Jason W Busse, Emil H Schemitsch, Eva Lonn, Forough Farrokhyar, Mohit BhandariAbstract:BACKGROUND Forty percent of long bone fractures involve the tibia. These fractures are associated with prolonged recovery and may adversely affect patients' long-term physical functioning; however, there is limited evidence to inform what factors influence functional recovery in this patient population. QUESTION/PURPOSE In a secondary analysis of a previous randomized trial, we asked: What fracture-related, demographic, social, or rehabilitative factors were associated with physical function 1 year after reamed intramedullary nailing of open or closed Tibial Shaft fractures? METHODS This is a secondary (retrospective) analysis of a prior randomized trial (Trial to Re-evaluate Ultrasound in the Treatment of Tibial Fractures; TRUST trial). In the TRUST trial, 501 patients with unilateral open or closed Tibial Shaft fractures were randomized to self-administer daily low-intensity pulsed ultrasound or use a sham device, of which 15% (73 of 501) were not followed for 1 year due to early study termination as a result of futility (no difference between active and sham interventions). Of the remaining patients, 70% (299 of 428) provided full data. All fractures were fixed using reamed (298 of 299) or unreamed (1 of 299) intramedullary nailing. Thus, we excluded the sole fracture fixed using unreamed intramedullary nailing. The co-primary study outcomes of the TRUST trial were time to radiographic healing and SF-36 physical component summary (SF-36 PCS) scores at 1-year. SF-36 PCS scores range from 0 to 100, with higher scores being better, and the minimum clinically important difference (MCID) is 5 points. In this secondary analysis, based on clinical and biological rationale, we selected factors that may be associated with physical functioning as measured by SF-36 PCS scores. All selected factors were inserted simultaneously into a multivariate linear regression analysis. RESULTS After adjusting for potentially confounding factors, such as age, gender, and injury severity, we found that no factor showed an association that exceeded the MCID for physical functioning 1 year after intramedullary nailing for Tibial Shaft fractures. The independent variables associated with lower physical functioning were current smoking status (mean difference -3.0 [95% confidence interval -5 to -0.5]; p = 0.02), BMI > 30 kg/m2 (mean difference -3.0 [95% CI -5.0 to -0.3]; p = 0.03), and receipt of disability benefits or involvement in litigation, or plans to be (mean difference -3.0 [95% CI -5.0 to -1]; p = 0.007). Patients who were employed (mean difference 4.6 [95% CI 2.0 to 7]; p < 0.001) and those who were advised by their surgeon to partially or fully bear weight postoperatively (mean difference 2.0 [95% CI 0.1 to 4.0]; p = 0.04) were associated with higher physical functioning. Age, gender, fracture severity, and receipt of early physical therapy were not associated with physical functioning at 1-year following surgical fixation. CONCLUSION Among patients with Tibial fractures, none of the factors we analyzed, including smoking status, receipt of disability benefits or involvement in litigation, or BMI, showed an association with physical functioning that exceeded the MCID. LEVEL OF EVIDENCE Level III, therapeutic study.
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nonunion in patients with Tibial Shaft fractures is early physical status associated with fracture healing
Cureus, 2020Co-Authors: Raman Mundi, Jason W Busse, Diane Heelsansdell, Brad Petrisor, Daniel Axelrod, Harman Chaudhry, Olufemi R Ayeni, Lehana Thabane, Mohit BhandariAbstract:Background Nonunions of Tibial Shaft fractures have devastating physical and psychological consequences for patients. It remains unknown if early functional status can identify patients at risk for nonunion. Questions/Purposes To determine if functional status at three months after surgery, as measured by either the short form 36 (SF-36) or the short form 12 (SF-12) health survey physical component summary (SF-12 PCS) score, can serve as a prognostic indicator for nonunion at one year in patients with fractures of the Tibial Shaft. Patients/Methods This study was an observational cohort study nested within two multicenter, randomized controlled trials. Patients who met the following eligibility criteria were included: (1) sustained a Tibial Shaft fracture that was treated with intramedullary nailing, (2) were unhealed at the three-month follow-up, (3) had a reported SF-36 or SF-12 PCS score at three months, (4) had the final 12-month follow-up with a reported radiographic healing status (bone union or nonunion), and (5) were enrolled in either the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Shaft Fractures (SPRINT) or Fluid Lavage of Open Wounds (FLOW) randomized trials. Multivariable logistic regression was performed to evaluate the association between healing status at 12 months and seven prognostic variables (open fracture, fracture pattern, nailing technique, smoking, fracture gap, three-month PCS score, and FLOW vs. SPRINT trial). Results A total of 940 patients were included in this study with an overall rate of radiographic nonunion of 13.3% (n=125) at the 12-month follow-up. Absolute nonunion risk increased with incrementally lower PCS scores (8.2%, 12.8%, 15.9%, 23.7% for scores ≥ 40, 30.0-39.99, 20.0-29.99, and < 20, respectively). In the multivariable regression analysis, PCS scores of < 20 were associated with a 2.6-times greater odds and 10% absolute risk increase of non-union, as compared to scores of ≥ 40 (OR 2.58, 95%CI: 1.02-6.53, ARI: 10.3, 95% CI: 0.1 - 28.2), whereas scores between 20 and 30 were associated with a nearly two-times greater odds of nonunion and a 6.4% absolute risk increase of nonunion (OR 1.94, 95%CI: 1.08-3.49, ARI: 6.4, 95% CI 0.6 - 15.3). Open fractures also conferred a 2.8-fold increase in odds of nonunion as compared to closed injuries (OR 2.77, 95%CI: 1.58-4.83), as did complex fractures when compared to simple fractures (OR 2.57, 95%CI: 1.64-4.02). Conclusion A considerable portion of patients with fractures of the Tibial Shaft treated with intramedullary nailing will experience nonunion at one-year postoperatively. Nonunion can be accurately predicted by patient functional recovery at three months as measured by the PCS of the SF-36 and SF-12 instruments.
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which surgical treatment for open Tibial Shaft fractures results in the fewest reoperations a network meta analysis
Clinical Orthopaedics and Related Research, 2015Co-Authors: Clary J Foote, Gordon H. Guyatt, Diane Heelsansdell, Paul Tornetta, Raman Mundi, Harman Chaudhry, Lehana Thabane, Nithin K Vignesh, Mohit BhandariAbstract:Background Open Tibial Shaft fractures are one of the most devastating orthopaedic injuries. Surgical treatment options include reamed or unreamed nailing, plating, Ender nails, Ilizarov fixation, and external fixation. Using a network meta-analysis allows comparison and facilitates pooling of a diverse population of randomized trials across these approaches in ways that a traditional meta-analysis does not.
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prognostic factors for predicting outcomes after intramedullary nailing of the tibia
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Emil H Schemitsch, Gordon H. Guyatt, Mohit Bhandari, David W Sanders, Marc F Swiontkowski, Paul Tornetta, Stephen D Walter, Rad Zdero, J C Goslings, David C TeagueAbstract:Several widely accepted systems classify long-bone injuries according to the nature and severity of damage to the bone1-3 and surrounding soft tissue2,3. Intramedullary nailing is the most common repair method for Tibial Shaft fractures2-5. The choice between the use of reamed or unreamed intramedullary nailing, however, has been controversial4-18. Following Tibial Shaft fracture repair with use of nails, annual reoperation rates have been reported to be between 12% and 44%5. This substantial problem is due to nonunion, malunion, knee pain, osteomyelitis, infection, and/or broken implants2,3. The question of which characteristics are most predictive of risk of a negative outcome following Tibial Shaft fracture repair remains unresolved19-26. Investigators have assessed a number of potential prognostic factors, such as age, sex, fracture morphology, injury mechanism, severity of soft-tissue damage, surgical delay, diabetes, vasculopathy, alcohol use, smoking, corticosteroids, antibiotics, anticoagulants, anticonvulsants, and anti-inflammatory medications27-47. However, prior investigations were limited methodologically by small sample sizes, few participating health-care centers, lack of adjustment for confounders, and/or nonstandardized perioperative patient-care regimens. Accurate prediction of patients who are at an increased risk for poor outcomes following Tibial nailing may facilitate optimal patient care. We recently completed the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT), a large, multicenter trial of reamed and unreamed intramedullary nailing in patients with Tibial Shaft fractures48. This trial suggested a benefit for reamed intramedullary nailing in patients with closed Tibial Shaft fractures, largely because of fewer dynamizations, and a potential advantage for unreamed intramedullary nailing in open Tibial fractures48,49. Using the SPRINT data, we conducted an investigation of baseline and surgical factors previously documented to determine which were associated with increased risk of negative events within one year of Tibial intramedullary nailing.
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current management of Tibial Shaft fractures a survey of 450 canadian orthopedic trauma surgeons
Acta Orthopaedica, 2008Co-Authors: Jason W Busse, Emily Morton, Christina Lacchetti, Gordon H. Guyatt, Mohit BhandariAbstract:Background and purpose Strategies to manage Tibial fractures include nonoperative and operative approaches. Strategies to enhance healing include a variety of bone stimulators. It is not known what forms of management for Tibial fractures predominate among Canadian orthopedic surgeons. We therefore asked a representative sample of orthopedic trauma surgeons about their management of Tibial fracture patients.Methods This was a cross-sectional survey of 450 Canadian orthopedic trauma surgeons. We inquired about demographic variables and current Tibial Shaft fracture management strategies.Results 268 surgeons completed the survey, a response rate of 60%. Most respondents (80%) managed closed Tibial Shaft fracture operatively; 47% preferred reamed intramedullary nailing and 40% preferred unreamed. For open Tibial Shaft fractures, 59% of surgeons preferred reamed intramedullary nailing. Some surgeons (16%) reported use of bone stimulators for management of uncomplicated open and closed Tibial Shaft fractures, ...
Zhiyong Hou - One of the best experts on this subject based on the ideXlab platform.
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the communication line suggests occult posterior malleolar fracture associated with a spiral Tibial Shaft fracture
European Journal of Radiology, 2012Co-Authors: Zhiyong Hou, Liping Zhang, Qi Zhang, Shuangquan Yao, Jinshe Pan, Kaan Irgit, Yingze ZhangAbstract:Abstract Objectives To demonstrate radiographical characteristics of the relationship between distal spiral Tibial Shaft fractures and associated occult posterior malleolar fractures (PMF) that confirmed by CT and MRI. Materials and methods X-rays for a ninety-six patients with spiral tibia fracture and associated PMF were reviewed. All patients additionally had an ankle CT. Patients with a negative CT scans underwent an ankle MRI. Radiographic observations included fracture location, characteristics, and a presence of a fracture line between the two injuries. Results The spiral tibia fracture line was contiguous with PMF in 89 of 96 cases after evaluation with the CT and MRI. The line connecting the two injuries, which occurs between the medial inferior apex of the spiral tibia fracture line and the posterior superior apex of the PMF was identified as the “communication line”. In 47 of the 89 conjunction fractures, the “communication line” was detectable preoperatively and in 12 cases postoperatively by anteroposterior radiograph. By using the CT and MRI scans, we found that no “communication line” was present in only 7 cases. Conclusion It is important to understand the nature of the association between distal spiral Tibial Shaft fractures and occult posterior malleolar fractures for optimal stabilization of the fracture and for appropriate rehabilitation. The “communication line” is a useful diagnostic clue for early recognition the occult PMF and alerts a closer evaluation of the lateral view and further CT examination.
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a occult and regular combination injury the posterior malleolar fracture associated with spiral Tibial Shaft fracture
Journal of Trauma-injury Infection and Critical Care, 2009Co-Authors: Zhiyong Hou, Yingze Zhang, Qi Zhang, Jinshe PanAbstract:Purpose:It is known that Tibial diaphyseal fractures are often associated with the posterior malleolar fracture (PMF). There are a few studies on Tibial Shaft fractures with respect to posterior malleolus fracture. However, we found that the incidence of PMF was higher than the previously reported.M
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clinical epidemiological analysis of adult spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture
National Medical Journal of China, 2008Co-Authors: Zhiyong Hou, Qi Zhang, Jinshe Pan, Haitao Zhao, Wei Chen, Peng Xue, Yingze ZhangAbstract:Objective To investigate the clinical epidemiological features of adult spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture, a special kind of fracture. Methods The clinical data of 1685 cases of adult Tibial and fibular Shaft fracture were analyzed retrospectively. The cause and mechanism of spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture were studied in detail. Results The male and female ratio in adult Tibial and fibular Shaft fracture was 4. 52: 1. Most of adult Tibial and fibular Shaft fracture occurred in the persons aged 31 -40 (26. 0% ) and type A fracture accounted for 57.7% of the cases. The male and female ratio in adult spiral tibiul fracture was 2. 95: 1. Most of the adult spiral Tibial fracture occurred in those aged 41 -50 (32. 6% ). With a male and female ratio of 6:1 (24:4) and mostly occurring in the persons aged 41 -50, spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture composed 9. 7% (28/288) of total Tibial fractures and 1.7% (28/1685) of total spiral Tibial and fibular fractures. Missed diagnosis rate of spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture was 67.9% (19/28) in the Department of Radiology and 53.6% in the Department of Orthopedics. Conclusion With a high incidence, spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture was caused by a low energy but not an iatrogenic damage. With a high rate of missed diagnosis, the spiral Tibial Shaft fracture associated with ipsilateral posterior malleolar fracture should be paid more attention to clinically. Key words: Tibia Fractures ; Ankle joint; Epidemiologic studies
James B Stiehl - One of the best experts on this subject based on the ideXlab platform.
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femoral rotational alignment using the Tibial Shaft axis in total knee arthroplasty
Clinical Orthopaedics and Related Research, 1996Co-Authors: James B Stiehl, Patrick M ChervenyAbstract:The capability of determining femoral component rotation by using a posterior femoral condyle resection made perpendicular to the longitudinal Tibial Shaft axis in posterior cruciate retaining total knee arthroplasty was evaluated. From 100 consecutive cases, 54 used the femoral posterior condyle axis and 46 used an extramedullary alignment rod based on the Tibial Shaft axis. Seventy-two percent of total knee arthroplasties using the posterior condyle axis required lateral release versus 28% using the Tibial Shaft axis. Patellar fracture occurred in 7% using the posterior condyle axis versus none using the Tibial Shaft axis. Two patients had both techniques in opposite knees. Using computed tomography, the posterior condyle axis method gave a posterior condyle angle of 5' and 4' compared with the transepicondylar axis, whereas the Tibial Shaft axis technique measured 0' and lo. The posterior condyle resection using the Tibial Shaft axis restores the anatomic patellofemoral relationships, minimizing patellofemoral complications.
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femoral rotational alignment using the Tibial Shaft axis in total knee arthroplasty
Clinical Orthopaedics and Related Research, 1996Co-Authors: James B Stiehl, Patrick M ChervenyAbstract:The capability of determining femoral component rotation by using a posterior femoral condyle resection made perpendicular to the longitudinal Tibial Shaft axis in posterior cruciate retaining total knee arthroplasty was evaluated. From 100 consecutive cases, 54 used the femoral posterior condyle axis and 46 used an extramedullary alignment rod based on the Tibial Shaft axis. Seventy-two percent of total knee arthroplasties using the posterior condyle axis required lateral release versus 28% using the Tibial Shaft axis. Patellar fracture occurred in 7% using the posterior condyle axis versus none using the Tibial Shaft axis. Two patients had both techniques in opposite knees. Using computed tomography, the posterior condyle axis method gave a posterior condyle angle of 5 degrees and 4 degrees compared with the transepicondylar axis, whereas the Tibial Shaft axis technique measured 0 degrees and 1 degree. The posterior condyle resection using the Tibial Shaft axis restores the anatomic patellofemoral relationships, minimizing patellofemoral complications.
