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Osteoporotic distal femoral fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Richard Stange, Michael J. Raschke
Incidence of complex meta-epiphyseal knee fracture is much lower than for fracture of the femoral neck, proximal humerus, or elbow, accounting for around 1% of annual emergency admissions (1). The exact incidence of knee joint fracture is hard to determine, as it varies according to demographic and geographical factors. In a series of more than 6000 fractures, annual incidence of proximal tibia fracture was 13.3 per 100,000 in adults, and 4.5 per 100,000 for distal femoral fracture (2); there was male predominance for proximal tibia fracture and female predominance for distal femoral fracture. Approximately half of all periarticular fractures around the knee occur in osteoporotic patients older than 50 years of age as a result of low-energy trauma. A high 1-year mortality rate (22%) and significant decrease in function and quality of life have been noted in frail elderly patients who sustained supracondylar femoral fractures (3). Fractures of the distal femur in connection with osteoporosis are difficult to deal with because of poor bone quality, preexisting arthritis, high levels of comminution, and osteochondral damage at time of injury (4). Also, the often-impaired health condition of this population has to be taken in account, adding a systemic challenge to the local one. Therefore, the goal of returning a patient to prefracture level of function is often difficult to achieve.
Optimizing Metabolism to Treat Fractures and Prevent Nonunion
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
Jacob Wilson, Scott Boden, Kenneth Cintron, Mara Schenker
There is scientific proof of concept that oxygen plays an important role in fracture healing.89,90 In a rat tibia fracture model, rats who were subjected to a hypoxemic environment had delayed healing. While hypoxia did not lead to changes in stem cell differentiation, it did lead to decreased angiogenesis. In straightforward fractures (those without ischemia), hyperoxia also decreased healing relative to normoxia. However, in the setting of ischemia, hyperoxia reversed the effects of ischemia-induced delayed union, an encouraging result.90
Damage Control Orthopaedics
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
I would position the patient on a radiolucent fracture table and proceed to debride and stabilise the tibia fracture first. Depending on the condition of the wound, soft tissues, fracture after debridement and the patient overall, I would consider siting an intrameduallary nail but if there was any concern I would apply an external fixtator to the tibia.
Anaesthesia for a patient with Friedreich’s ataxia undergoing emergency tibia interlocking nail insertion
Published in Egyptian Journal of Anaesthesia, 2022
A 36-year-old wheel-chaired man with a weight of 70 kg and a height of 173 cm was planned for a right interlocking nail tibia insertion for tibia fracture. The patient was suffering from gait disturbances, lower limb weakness, mild scoliosis and mild cavovarus foot deformity. He had slurring of speech for the past 5 years. He is not a diabetic. On examination, cardiorespiratory system was clinically normal. He had dysarthria, nystagmus, generalised areflexia, weakness of skeletal muscles more in the lower limbs, absent plantar reflex and impaired position and vibration senses. Echocardiography revealed mild left ventricular hypertrophy with preserved ejection fraction. ECG showed frequent atrial premature beats. The patient has a history of ESWL 3 years ago for a ureteric stone under sedation.
Randomized trial comparing suture button with single 3.5 mm syndesmotic screw for ankle syndesmosis injury: similar results at 2 years
Published in Acta Orthopaedica, 2020
Benedikte Wendt Ræder, Ingrid Kvello Stake, Jan Erik Madsen, Frede Frihagen, Silje Berild Jacobsen, Mette Renate Andersen, Wender Figved
10 patients in the SB group and 17 patients in the TS group had ≥ 1 reoperation (p = 0.2) (Table 7, see Supplementary data). 5 patients in the SB group and 11 patients in the TS group had their implants removed because of local irritation alone (p = 0.2). 3 patients in the SB group and 3 patients in the SS group required early reoperation (< 3 weeks) after CT postoperatively revealed unacceptable reduction of the fracture or of the syndesmosis (3 syndesmosis malreductions, 1 fibula malreduction, 2 medial malleolus malreduction). 2 patients (male, age 50 and female, age 52 years) suffered a low-energy tibia fracture through the suture button canal (Figures 5, 6, see Supplementary data). The male patient presented 6 months postoperatively with a healed tibia fracture with 13° varus deformity. Since this patient had no complaints the fracture was not addressed surgically. The female patient presented initially with a large posterior malleolar fracture. She presented with pain while walking 4 months after her initial injury. She had suffered a tibia fracture and was reoperated on with open reduction and internal fixation. A dual energy X-ray absorptiometry (DEXA scan) showed osteoporosis.
20-year trends of distal femoral, patellar, and proximal tibial fractures: a Danish nationwide cohort study of 60,823 patients
Published in Acta Orthopaedica, 2020
Veronique Vestergaard, Alma Becic Pedersen, Peter Toft Tengberg, Anders Troelsen, Henrik Morville Schrøder
The most common knee fracture type was proximal tibia fracture (51%), followed by patella fracture (31%) and distal femur fracture (18%). Table 3 shows distribution of knee fracture type in the study population including surgically and non-surgically treated knee fractures in the DNPR during 1998–2017. 90% of patients had 1 knee fracture registered and 11% patients had > 1 knee fracture registered. The total number of knee fracture treatments was 68,419 (some treatments covered multiple knee fractures). Of these 68,419 treatments, 34% were surgical treatments and 66% non-surgical treatments. 6% of knee fracture patients received both surgical and non-surgical treatments. 89% patients had 1 knee fracture surgery and 11% had > 1 knee fracture surgery. In non-surgically treated patients, the corresponding numbers were 96% with 1 non-surgical knee fracture treatment and 4% with > 1 non-surgical treatment.