43 research outputs found
Tibia, Diaphysis
No full textFractures of the tibia are brought on by a variety of high-energy injury mechanisms and are prone to complications. The lack of a circumferential soft tissue envelope around the bone makes the bone ends more likely to fail to unite. The soft-tissue envelope is the most important component in the evaluation and subsequent care of tibia fractures. Surgeons have moved away from plates and external fixators in favor of intramedullary nails in the operative treatment of both closed and open tibia diaphyseal fractures. Nailing is done with the patient in the supine position on a radiolucent table or on a fracture table with the knee flexed at least 90°. Experimental data suggest that reamed nails offer greater biomechanical stability and increased soft tissue blood flow, while non-reamed nails preserve blood flow to the bone. Locking with bolts or interlocking screws is mandatory for small-diameter nails in order to improve stability in a wide medullary canal and is recommended in all other situations. Poller screws aid in obtaining satisfactory alignment during surgery and provide additional stability. When strategically placed, these screws guide the reamers and the nail to a suitable trajectory, thereby achieving indirect reduction. Fibula fixation will provide good landmarks for the length of the tibia and add stability. The most common complication of intramedullary nailing of tibia fractures is anterior knee pain, which has been reported in more than half of patients. Malalignment, malunion and nonunion can be avoided by a meticulous surgical technique
Ligamentous Lisfranc injuries: analysis of CT findings under weightbearing.
No full textPURPOSE
The aim of this study was to investigate the influence of different ligamentous Lisfranc injuries on computed tomography (CT) findings under weight-bearing and to emphasize the indications for surgical treatment of their various types.
METHODS
Sixteen human cadaveric lower limbs were placed in weight-bearing radiolucent frame for CT scanning. All intact specimens were initially scanned, and then, dorsal approach was used for sequential ligaments cutting of: (1) the dorsal and the interosseous (Lisfranc) ligaments between medical cuneiform (MC) and metatarsal 2 (MT2); (2) the plantar ligament between the MC and MT3; (3) the plantar ligament between MC and MT2. Based on sequential CT scans, the distances MT1-MT2, MC-T2, as well as the alignment and dorsal displacement of MT2 were measured.
RESULTS
Slight increase in the distances MT1-MT2 and MC-MT2 was observed after the disruption of the dorsal and the interosseous ligaments. Further increase in MT1-MT2 and MC-MT2 distances was registered after the disruption of the ligament between MC and MT3. The largest distances MT1-MT2 and MC-MT2 were measured after the final plantar ligament cut between MC and MT2.
CONCLUSIONS
Unequivocal instability is observed with simultaneous transection of the Lisfranc ligament with both plantar ligaments. On CT used as diagnostic tool, plantar injuries at the basis of the second and the third metatarsal are indirect signs of violation of the ligaments and represent an indication for surgical treatment. When using magnetic resonance imaging as diagnostic tool, a ruptured Lisfranc ligament alone without dislocation does not necessarily need surgical intervention
