The tibia is the most common long bone at risk for nonunion with an annual incidence ranging from 12% to 19%. This topic continues to be an area of research as management techniques constantly evolve. A foundational knowledge of the fundamental concepts, etiology, and risk factors for nonunions is crucial for success. Treatment of tibial shaft nonunions often requires a multidisciplinary effort. This article provides guidance based on the most recent literature that can be used to aid the treating provider in the diagnosis, workup, and management of tibial shaft nonunions.
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http://dx.doi.org/10.5435/JAAOS-D-23-00453 | DOI Listing |
Eur J Trauma Emerg Surg
January 2025
Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Purpose: (1) To evaluate the incidence and combination types of concomitant malleolar and fibular fractures in patients with distal spiral tibial shaft fractures. (2) To evaluate the risk factors for concomitant malleolar fractures in patients with distal spiral tibial shaft fractures.
Methods: A retrospective review was performed on 64 cases of surgically treated distal spiral tibial shaft fractures with complete radiographs and computed tomography (CT) scans.
JB JS Open Access
January 2025
Saint Francis Health System, Trauma Institute, Tulsa, Oklahoma.
Background: Tibial shaft fractures are common, causing substantial morbidity. Intramedullary nailing offers advantages but often leads to anterior knee pain and functional issues.
Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review on outcomes for different surgical approaches-suprapatellar (SP), infrapatellar (IP), medial parapatellar (MPP), and lateral parapatellar (LPP).
J Orthop Trauma
January 2025
Geisinger Health System, Department of Orthopaedic Surgery, Danville, PA.
Objectives: To explore outcomes after tibial rigid intramedullary nailing (RIMN) in skeletally immature patients, with a focus on post-operative complications and iatrogenic changes in tibial slope due to anterior physeal arrest.
Methods: Design: Retrospective case series.
Setting: A large, tertiary care health system in the rural Mid-Atlantic United States, including two Level 1 trauma centers and one Level 2 trauma center.
Bone Joint Res
January 2025
Department of Mechanical Engineering & Mechanics, Lehigh University, Bethlehem, Pennsylvania, USA.
Aims: The "2 to 10% strain rule" for fracture healing has been widely interpreted to mean that interfragmentary strain greater than 10% predisposes a fracture to nonunion. This interpretation focuses on the gap-closing strain (axial micromotion divided by gap size), ignoring the region around the gap where osteogenesis typically initiates. The aim of this study was to measure gap-closing and 3D interfragmentary strains in plated ovine osteotomies and associate local strain conditions with callus mineralization.
View Article and Find Full Text PDFCureus
November 2024
Information Technology, Mandayam Osuri Parthasarathi Vaishnav College for Women, Chennai, IND.
Introduction: Intramedullary interlocking nailing is a common surgical procedure for tibial fractures, enabling early patient mobilization. Traditionally, the infrapatellar approach has been used for intramedullary interlocking nailing of tibial fractures, but the suprapatellar approach is gaining attention for its potential benefits. This randomized controlled study aimed to compare the duration of the surgery, intra-operative blood loss, and fluoroscopy time between the suprapatellar and infrapatellar approaches.
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