جستجوی مقالات مرتبط با کلیدواژه « تیبیا » در نشریات گروه « پزشکی »

 The purpose of this study was to investigate possible correlation between vitamin D in 13-36 month old children with tibial bone fracture.

 This cross-sectional study was conducted on children aged 18 to 36 months who referred to a medical center in South-East of Iran with tibial fracture. All the demographic information was collected and vitamin-D levels were measured and statistically analyzed.

 A total of 30 children were included in the study, and the mean vitamin D level in these subjects was 31.6±6.1. This study showed no significant relationship between low vitamin D levels with increase in the risk of tibia fracture in children who had recently started walking.

 The present study revealed a significant association between vitamin D level and its deficiency with an elevated risk of tibia bone fracture in toddlers between 18-36 months.

Various drugs are used as adjuvants for various purposes such as increasing analgesia, reducing analgesic complications and generally improving the quality of anesthesia with topical anesthetics. The use of alpha-2 agonists has recently been considered. One of these drugs is dexmedetomidine, which has been studied recently. The aim of this study was to evaluate the effect of dexmedetomidine as an adjunct to bupivacaine in spinal anesthesia in femoral fracture orthopedic surgery.

This double-blind randomized clinical trial study was performed on 60 patients 18-50 years old with Class I and II anesthesia who were candidates for tibia and femur orthopedic fracture surgery. Patients were randomly divided into two groups of intervention: 12.5 mg bupivacaine (2.5 cc) and 5 µg dexmedomidine (0.5 ml) and control group: 12.5 mg bupivacaine and 0.5 ml normal saline. Systolic, diastolic, and mean arterial blood pressure and pulse counts were recorded before spinal anesthesia, after anesthesia and then every 15 minutes until surgery and at recovery time. At 2, 8, 4, 12, and 24 hours postoperatively, patients were evaluated for pain, opioid administration during the first 24 hours, and the time of first analgesic administration.

There was a significant difference between the bupivacaine-normal saline and bupivacaine- dexmedetomidine groups in terms of systolic and diastolic blood pressure at 15, 30, 45 and 60 minutes during surgery (P<0.05). There was a significant difference in the frequency of pain between the Bupivacaine-Normal Saline and Bupivacaine- dexmedetomidine groups at 4, 8 and 24 hours postoperatively (P<0.05).

The results of this study showed that addition of 5 μg dexmedetomidine to bupivacaine in spinal anesthesia method prolonged analgesia time, decreased pain intensity, decreased postoperative opiate requirement. Conspicoiusly, there was no risk of respiratory suppression even at higher doses than other medicines used. Conclusively, dexamethasone seems to be an appropriate supplement to be added to bupivacaine to reduce postoperative pain.

Nutritional arteries are the main source of blood supply to long bones. These foramina enable the blood vessels and nerves to pass through the cortex of the bone. The exact location and distribution of nutrient foramina are important for preventing damage to blood vessels and maintaining blood circulation during various surgical procedures. While inheritance and race are among the most effective factors in the distribution of these foramina, no relevant study has been conducted in Iran. Therefore, we aimed to evaluate this issue in Iran and find differences in comparison with other studies. This study was performed on 157 lower limb bones present in moulage hall in the school of medicine, including long bones of the femur (N=65), tibia (N=65) and fibula (N=27). In this study, 39.09% of the femurs had two nutrient foramina, 90.78% of the tibia had a nutrient foramen, and 66.67% of the fibulas lacked a nutrient foramen. The location of the nutrient foramen in the femur was 95.35% at the lower two-thirds. In the tibia, the nutrient foramina were mainly in the upper third (72.15%). In the fibula, the nutrient foramina were mostly in the middle third (66.67%). This study provides more information on morphological and topographic anatomy of the nutrient foramina of long bones of the lower extremity. While techniques such as microvascular bone transfer have become more popular, further research is required to determine the effect of inheritance and race for an anatomical description of bone nutrition.

Geno varum is defined as knee deformity with changes of natural direction of lower extremities where knee joint center is located at exterior side of mechanical axis of the extremity. The present study was admitted to compare the results of guide pin and classic techniques in open wedge proximal high tibia osteotomy.
Material and

In a cross sectional analytical-descriptive study conducted on the patient’s candidate for tibia osteotomy surgery, because of geno varum the results of guide pin and classic techniques in open wedge proximal high tibia osteotomy were compared.

In this observational study, 57 patients who were underwent guided pin tibia osteotomy and 31 patients who were treated with classic techniques. There was a difference meaningfully between pre-operation and post-operation Lysholm score in both groups. There was delayed union in two patients of guide pin group and three patients of the classic technique group. Non-union was not seen in any patient. Superficial infection was seen in two patients and in one patient’s classic group guided pin treated with classic technique. There was intra-articular fracture, in classic group, with no displacement in three patients in guided pin and in 3 patient of classic technique.

According to this study, guide pin technique plays not significant role in decreasing or increasing the intra-articular fracture risk and brings no advantages results in comparison with the classic technique. However, further studies are required.

The congenital absence of the tibia is a rare disease, and an orthopaedic surgeon may not encounter such cases during the course of his/her career. This is the largest report to date of the management of such cases by a single surgeon. The foot and leg were persevered in the majority of the cases, and a functional evaluation system was used to report outcomes.
Thirty-six patients (19 girls, 17 boys) with 48 tibial deficient limbs were evaluated clinically and radiographically. The mean age of patients was 12 years old. The patients or their parents filled out the Pediatric Quality of Life and the parents’ satisfaction forms. The surgical interventions performed, and their effects on school attendance and the shoe type they wore were documented.
The mean time of follow-up was 9 years. The 48 limbs included 14 type I, 16 type II, 11 type IV, and 7 unclassified by using the Jones classification; and 6 type I, 11 type II, 16 type III, 1 type IV, and 14 type VII by using the Weber classification. Primary amputation was performed in 10 limbs (8 patients) and limb preservation surgery on 38 legs (28 patients). Tibiofibular synostosis, centralization of the ankle, and Ilizarov lengthening were the most common procedures. Non:union: of tibiofibular synostosis (2 cases) and knee stiffness (6 cases) were the main complications. Among the reconstructed limbs, 12 were in regular and 18 in modified shoes. The Pediatric Quality of Life of 68 points in the reconstructed group was a significant achievement, and it was also better than the score of patients who had undergone amputation.
Reconstruction of tibial hemimelia with foot preservation provides good functional outcome in the majority of cases.

Introduction & Tibial eminent fractures may be seen in all ages but the most common ages for the incidence of these fractures is in children of the 8 to 14 years. Recent studies have shown that the incidence of fractures in the children of normal weight is 16 percent, reaching 33 percent for obese children. Furthermore, epidemiological studies have shown that the prevalence of obesity has doubled over the past three decades. This study was performed to investigate the relationship between body mass index with tibial eminent fractures. In this case-control study, 68 children of the age less than 14 years, who referred to the Beasat Hospital of Hamadan were studied. Of these, 34 were suffering from tibial eminent fractures (case group) and 34 patients who had referred for other reasons were selected as the control group. BMI and type of weight by age and sex for both groups were calculated and compared. The results were analyzed, using SPSS18, variance analysis, T-test, and Chi-squared analysis. The mean BMI in case group was 20.98 ± 3.88 and for the control group was 20.47 ± 2.93 (P=0.544). In the case group 18 patients (52.9%) of had normal weight, 9 patients (926.5%) were overweight, and 7 patients (20.6%) were obese. In the control group 19 patients (55.9%) had normal weight, 10 patients (29.4%) had overweight, and 5 patients (1407%) were obese (P=0.813). The results of this study showed that, children’s weight and body mass index have no significant effect on the tibial eminent fractures.

High tibial osteotomy (HTO) is a common surgical procedure for treatment of patients with varus malalignment. The success rate of the procedure is strongly dependent on the quality of correction. The purpose of this study was to simulate the HTO in a patient with varus deformity in order to explore the interactions between the wedge angle, the mechanical axis, and the knee joint configuration.
A finite-element model of the knee joint of a patient with varus deformity was developed. The geometry was obtained using the whole limb CT scans and the knee MR images. The bones were assumed as rigid bodies, the articular cartilage and the meniscus as elastic solids, and the ligaments as nonlinear springs. A 600N force was applied at the femoral head in the line of the mechanical axis and the resulting knee configuration was investigated. The HTO was simulated by insertion of wedges with different angles beneath the tibial plateau and application of the resulting alteration of the loading axis in the model.
The results indicated that the actual change of the mechanical axes was always smaller than was predicted by a geometric pre-planning approach that does not consider the effect of soft tissue on the post-operative configuration of the knee joint.
It was suggested that subject-specific models can improve the results of the HTO by simulating the operation before surgery and determining the optimal wedge angle that locates the mechanical axis in the middle of the knee.

One of the common operations for lower limb mal-alignment below 50 years of age is proximal tibial osteotomy. In the open wedge technique، the superficial medial collateral ligament (MCL) usually needs to be released. This study seeks to evaluate the results of open wedge high tibial osteotomy with or without releasing MCL. In a prospective clinical trial، 59 patients with symptomatic genu varum between 16-50 years of age who were candidates of tibial osteotomy were divided into open wedge surgery with (30 patients، 40 knees) or without MCL release (29 patients، 36 knees). The outcome was studied comparing the stability in valgus، pattelar height slope of tibial plateau، and also the knee score (KSS) in a 17. 4 months (3-24 months) follow-up. The patients from MCL preserving group، with mean age of 26. 7±9 improved their scores of 53. 5±15. 2 to 81. 9±13. 4. The cases from MCL-releasing group with mean age of 25. 5±8. 4 improved the score of 52. 4±14. 6 to 65. 4+17. 8. The rates of surgical complication and valgus instability were lower in MCL preserving ones، but tibial slope remained unchanged in either group. Both techniques lead to an improvement in the KSS score; however it was more significant in MCL preserving group with lower complication and without valgus instability.

Knee osteoarthritis is a common etiology of disability in older age group. There are evidences suggesting that varus or valgus deformity can be from distal of femur، proximal of tibia or because of ligamentous laxity. Osteotomy in incorrect location may create zigzag deformity and may contribute to increase risk of osteoarthritis. The objective of this study was to find the correct location of deformity in genuevarum or genuevalgum. We studied 40 patients with knee deformity at a mean age of 27. 4 years (19-38)، prospectively. Standing 3-point view radiographs were obtained on each patient، and the limb axis was determined. The data on limb malalignment was analyzed statistically. In 94. 5% of cases the location of varus deformity was proximal of tibia and in 5. 5% in distal of femur، the best location of osteotomy. Our study also revealed multiple factors contributing to varus deformity، i. e. distal femur in 67. 5%of cases، proximal tibia deformity in 92. 5% of cases and ligamentous laxity in 77. 5%. Varus knee deformity can be from proximal tibia، distal femur or knee laxity. Before any corrective surgery one must clarify location of deformity

Introduction & Tibial shaft open fractures are the most common long bone fractures and are prone to complications such as infection. Tibial open fracture is one of the orthopedic urgencies. Standard surgical technique for the management of this problem is fixation and surgical debridement within the first 6 hours. But appropriate time for the debridement is not agreed upon. We aimed to evaluate the role of delayed surgical management in prevalencies of infection in open tibial fractures. The 92 patients with open tibilal fractures who were candidate for surgical management in the orthopedic ward of the university hospital، from 2008 to 2013، enrolled in this cross sectional descriptive prospective study. Analysis was done by SPSS 16. Patient were divided into 4 groups according to the average period of time from the damage (tibial fracture) to the time of surgery (0-6، 6-12-، 12-24 and more than 24 hours). The severity of injury was classified based on Gastilo criteria. The number of patients with infection was determined and compared in each group by chi2 test and fisher exact test. No increase in infection was seen in operation time delay. Infection had occurred in 7، but five of the underwent the operation during the first six hours after injury. One person was in 6-12 hours group and the management (operation) was done in one patient later than 24 hours after injury. There were direct correlation the between severity of injury، ime interval between gustillo type and infection. The prevalence of infection is related to severity of injury more than the of injury and surgical operation. So surgery can be delayed to a suitable situation.

White MTA، and Portland cement have similar chemical structures. The aim of this study was to evaluate the inflammatory reaction of rabbit bone tissues to implanted white MTA، and Portland cement. Subjects and In this in vivo study، twenty 1-year old male Iranian rabbits (experiment white Specie)، were divided into 5 groups (4 in each group). After preparation of 3 holes (distance 2 cm- depth and diameter 2 mm) in tibia، the allocated groups received an intra-bony implant of the test materials (White MTA، or Portland cement) and the third hole، with no implant، was created to evaluate inflammatory reaction related to surgical trauma. Samples were processed for histological study after 7، 15، 30، 60، and 90 days. Furthermore، blood samples were taken for evaluation of systemic inflammation for ESR test. The results were analyzed using Kruskal-Wallis and Mann–Whitney tests. At similar time points، statistical analysis revealed significant difference between implanted material (white MTA، Portland cement) in the first and second holes with control hole due to bone tissue reaction but pair-wise evaluation Between all of implanted material found no significant differences. In different times bone tissue reaction showed significant differences. The finding of this study demonstrated a similar tissue compatibility between both implantable materials and improvement of tissue healing occur with similar time profile after material implanting.

High tibial open wedg osteotomy is one of the most important modality for treatment of varus deformity in order to correct deformity and improving signs and symptoms of patients with primary degenerative osteoarthritis. The aim of this study was to investigate the results of high tibial open wedge osteotomy in patients with varus deformities. This retrospective study conducted on twenty nine patients (36 knees) undergone proximal tibial osteotomy operation in Shafa Yahyaian University Hospital from 2004 to 2010. Inclusion criteria were: age less than 60 years، high physical activity، varus deformity and involvement of medical compartment of knee. Patients with obesity، smoking، patelofemoral pain، lateral compartment lesion، deformity degree more than 20 degree، extension limitation and range of motion less than 90 degree were excluded. The clinical and radiologic characteristics were measured before and after operation. Fourteen patients were females. All of them were younger than 50 years، with mean (±SD) 27. 64 (±10. 88). The mean (±SD) of follow up time was 4. 33 (±1. 7). All the patients were satisfied with the results of operation. Tenderness and pain decreased in all of them. In all patients autologus bone graph were used، in 15 cases (42. 5%) casting and in the rest T. Buttress plate were used for fixation of fractures. In both groups of primary and double varus the International knee documentation committee (IKDC) and modified Larson indices were improved after operation، but there was no significant difference between two groups. High tibial open wedge osteotomy can have satisfying results in clinical signs and symptoms of patients with primary medial joint degenerative osteoarthritis. This procedure also may correct the deformity and improves the radiologic parameters of the patients.

Introduction & Osteotomy is the classic operation for the treatment of patients with primary degenerative osteoarthritis and for the correction of their deformity. Considering the existence of different methods for their treatment، preoperational assessment and its comparison with post operation measures has a significant role in determining the prosperity of surgery and patient''s follow up. The aim of this study is to investigate the radiologic changes in these patients. In a case series study from 2004 to 2010 in Shafa Yahyaeeian hospital (a referral hospital in Tehran، Iran) patients with osteoarthritis who had signs and symptoms of medial compartment of knee and varus deformity underwent open wedge tibial osteotomy. Using anteroposterior and lateral radiography in standing position، the limbs alignment before and after the operation were investigated. Totally 29 patients (36 knees) were investigated. Fourteen patients were females. All of them were younger than 50 years with mean ± SD (27. 64± 10. 88). The follow up time was (4. 33 ±1. 7). Tibial slope and grade DJD increased after operation. Insall-salvati and Blackburn-peel indices had no change. Two cases were not corrected completely، due to simultaneous deformity in the distal of femur. Three cases had fracture of lateral plateau due to some technical problems during operation. They had little dislocation and were treated completely in next follow up by using nonsurgical treatment. Open wedge osteotomy can have good results in the radiologic finding and deformity correction of patients with primary degenerative osteoarthritis.

Hihg tibia osteotomy has its own position even with successful total knee replacement. A high tibial osteotomy affects not only the joint function as a whole، but also the dyferent sections of the knee joint. The biomechanical changes affect the patella inedial collateral ligament، quadriceps alignment and Q-angle and tibial plateau slope. The goal of high tibia osteotomy is more normal load distribution in nonarthritic knee in young persons، and slowing degeneration in arthritic knee in adults. All the high tibia osteotomies cause patellofemoral biomechanical changes، through tubercle displacement، or patellar tendon fibrosis or calcification. Q angle also increase with lateral displacement of tibial tuberosity when osteotomy is done proximal to the tibial tuberosity. The medial collateral ligament needs to be released in open wedge high tibia osteotiomy. If intact medial ligament is necessary، osteotomy should be done distal to medial collateral attachment. The proximal tibia configuration is roughly similar to a rectangle. Lateral cortex is in right angle to the posterior one. The posteromedial corner opens three times the anterior one in open wedge osteotomy otherwise there would be tibial slope change.

Sometimes, because of lack of proper coverage of distal fractured legs, these fractures cause loss of the skin and expose the distal Tibial bones on the medial sides. In such situations, there are two ways for the soft tissue reconstruction: 1. Cross leg flaps and 2. using free flap with microvascular anastomosis. In the present article a case of free Gracilis flap transfer for reconstruction of the soft tissue defect due to the use of heavy plate in distal Tibial fracture is reported. This procedure was performed for a 40 year old man with the soft tissue defect in distal of Tibia by a single team of surgery and after two months it proved successful. Reviewing the articles about free flap operation has proved its success in more than 90% of cases and, as a result, Gracilis free flap suggests an appropriate option for soft tissue reconstruction.

Interlocking nailing and plating are two conventional methods of treatment of tibial-shaft fracture. Both methods have advantages and disadvantages. Therefore, the aim of this study was to compare the advantages and disadvantages of the two methods. This clinical-trial study was done on 90 patients with fracture of tibia and fibula. Patients were randomly divided into two groups. The individuals in groups one and two treated with plating and interlocking nailing methods, respectively. The mean time of union, hospitalization and returning to work as well as thickness of callus, range of motion of knee and ankle joints were compared between the two groups. The data was analyzed using t-test. The average time of bone union, hospitalization, callus thickness, time to return to work, range of motion of knee up to 130 degree, and ankle up to 50 degree in group one (plating) and two (interlocking nailing) were 4.8±0.2.5 months vs. 3.4±0.24 months (p<0.05), 5 vs. 3 days (p<0.05), 2.5±0.05 mm vs. 4±0.06 mm (p<0.05), 3±0.05 months vs. 1.5±0.06 months (p<0.05), 0.3.5±0.04 months vs. 2±0.03 months (p<0.05), 5.2±0.07 months vs. 3±0.04 months (p<0.05), respectively. Based on the results, interlocking nailing method is better than the other one and is preferred for fixation and treatment of tibial-shaft fractures.