Thesis (doctoral)--Københavns universitet.

No description available.

Thesis (doctoral)--University of Uppsala, 1983. / Includes bibliographical references (p. 36-41).

Thesis (doctoral)--Rijksuniversiteit te Utrecht.

Background: Tibial fractures are associated with prolonged recovery. The aim of this study was to identify predictors of long-term physical functioning after tibial shaft fracture. Methods: We used data from the Trial to Re-evaluate Ultrasound in the Treatment of Tibial Fractures (TRUST) to determine, in patients with unilateral, open or closed tibial shaft fracture, the association between baseline factors and physical functioning at 1-year. All fractures were fixed using intramedullary nails. Physical functioning was measured using the 100-point Short Form-36 (SF-36) Physical Component Summary (PCS) score; higher is better; minimally important difference is 2 to 5 points. Results: There were 299 tibial fracture patients with complete data available for analysis. In an adjusted analysis, the factors associated with lower physical functioning at 1-year were: (1) current smokers (mean difference [MD] -2.55, 95% confidence interval [95%CI] -4.63 to -0.46, p=0.017), (2) body mass index >30 kg/m² (MD -2.57, 95% CI -4.86, -0.27, p = 0.029), and (3) patients who were receiving disability benefits or involved in litigation, or planned to be (MD -2.65, 95% CI -4.58 to -0.72, p = 0.007). Patients who were employed at the time of their fracture reported significantly higher physical functioning at 1-year (MD 4.56, 95% CI 2.32 to 6.80, p= <0.001) and those who were allowed to partial or full weight-bear post-operatively (MD 1.98, 95% CI 0.13 to 3.82, p=0.036). Neither age, sex, fracture severity or receipt of physical therapy were associated with long-term physical functioning. Conclusions: Among patients undergoing surgical repair of tibial fractures, partial or full weight-bearing post-operatively and employment at the time of injury predict better long-term functioning, whereas smoking, obesity, and receipt of disability benefits or involvement in litigation (or plans to be) predict worse long-term functioning. / Thesis / Master of Science (MSc)

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

The aims . of this research were twofold, firstly to find out if interferential currents could reduce the healing time for fractures of the tibia and thereby prevent nonunion and secondly to develop a model which could predict nonunion, given the subject characteristics such as race, mechanism of injury, severity of fracture etc. Subjects, males only between the ages of 12 and 86, who had sustained fractures of the tibiae were entered into this double blind clinical trial on admission to the orthopaedic wards at Groote Schuur Hospital (between January 1989 and October 1991). According to strict inclusion and exclusion criteria, a final sample of 227 cases (208 subjects) were entered by block randomisation into three groups; an experimental group (n=41), placebo group (n=35) and control group (n= 151). lnterferential currents were applied to the experimental group via suction electrodes for, 30 minutes per day for 10 days, using a beat frequency of 10 - 25 Hz and a swing mode of 6 ϟ 6. The placebo group had the suction electrodes applied which produce a rhythmical massage effect. Subjects commented on pain relief which resulted in the addition of the control group as a check on the possible effect of suction, the control group received no intervention. The data were analysed firstly, by using the ANOV A with continuous covariates which resulted in a finding of no significant difference in the time taken to union for the three groups. The second statistical analysis using the same data set, were logistic regression models demonstrating risk factors for nonunion within 24, 32 and 40 weeks. These models were then validated, showing sensitivity and specificity for a variety of possible cutoffs. The conclusions reached about the validity of these models were that they could not be used to predict, accurately enough, those cases where surgical intervention would be necessary; however, for low cost non-invasive intervention they may have value.

The dachshund, a chondrodystrophic dog breed, presents a unique challenge in the treatment of tibial fractures by having short and curvaceous tibiae, leading to high implant failure risk. In this study, intramedullary pins with full cerclage wires as an option in the treatment of oblique diaphyseal tibial fractures was studied in vitro. This fixation technique was biomechanically compared with the current gold standard in internal stabilization, namely bone plates and screws. Twenty tibiae recovered from adult dachshund cadavers were randomly allocated into two groups of ten bones each. Oblique fractures running in a proximo-cranial-disto-caudal direction in the middle third of the tibial diaphysis were simulated by osteotomy and each bone repaired by using one of the following methods: <ul> <li> Pre-bent intramedullary pin, filling 40% to 60% of the medullary cavity at its narrowest point, inserted normograde and combined with a set of three full cerclage wires (group 1).</li> <li> Lag screw at the osteotomy site, combined with a six hole 2.7 mm contoured dynamic compression plate and cortical screws in neutral mode (group 2).</li> </ul> Each test specimen was subjected to a two point single cycle axial compression test by applying a standardized, increasing compression load to the point of fixation failure or bone collapse. A stress-strain graph for each test specimen was drawn from the raw data. Radiographs and digital photographs were made pre-osteotomy, post-osteotomy, post-repair and post-test, and modes of failure noted for each test specimen. Stress (applied load) and strain (deformation) at yield, ultimate strength, and at failure were determined for each test specimen from the stress-strain graphs and the mean values statistically compared between the groups using the ANCOVA method. Significance levels of p < 0.05 were used, while p < 0.1 and p < 0.01 were also indicated. In group 1, 50% specimens failed due to unraveling or slippage with displacement of the cerclage wires, 30% due to bone fracture at a cerclage wire, and 20% due to bone fracture elsewhere. In group 2, 80% specimens failed due to bone fracture at one or more of the screw holes, whereas 20% failed due to bone fracture not directly associated with implants. No bone plate or screw underwent plastic (permanent) deformation, whereas 80% of the intramedullary pins and 30% of the cerclage wires underwent plastic deformation. Mean stress at the yield point in groups 1 and 2 were 0.323 MPa and 0.403 MPa respectively, at the point of ultimate strength 0.383 MPa and 0.431 MPa respectively, and at the failure point 0.345 MPa and 0.403 MPa respectively. Mean strain at the yield point in groups 1 and 2 were 0.296% and 0.362% respectively, at the point of ultimate strength 0.412% and 0.472% respectively, and at the failure point 0.713% and 0.838% respectively. Clinically, there was an indication that plates and screws were more resistant to deformation by the loads applied than intramedullary pins and cerclage wires. However, statistically, there were no significant differences in stress at yield (p = 0.299), ultimate strength (p = 0.275), or failure (p = 0.137) between the two groups. Similarly, there were no significant differences in strain at yield (p = 0.684), ultimate strength (p = 0.778), or failure (p = 0.505) between the two groups. Main limitations of the study were the relatively small number of specimens tested, the smoothness of the osteotomy cuts which limited interdigitation between the fragments, and that only three of the five recognized loads acting on bones in vivo, were tested in vitro. In conclusion, this study did not show enough evidence to prove a significant difference between the two methods of fixation. Therefore, it is suggested that intramedullary pins and full cerclage wires be used as an acceptable alternative to bone plates and screws in the treatment of oblique mid-diaphyseal tibial fractures in chondrodystrophic dog breeds. / Die dachshund, ‘n chondrodistrofiese honderas, bied ‘n unieke uitdaging in die behandeling van frakture van die tibia, deurdat hulle tibias kort en krom is, wat lei tot ‘n hoë risiko van inplantaat mislukking. In hierdie studie is intramedullêre penne met vol sirkeldrade as ‘n keuse in die behandeling van skuins frakture van die tibiale skag in vitro bestudeer. Hierdie tegniek van herstel is vergelyk met die huidige goue standaard in interne stabilisering, naamlik beenplate en skroewe. Twintig tibias wat van volwasse dachshund kadawers herwin is, is lukraak aan twee groepe van tien bene elk toegewys. Skuins frakture in ‘n proksimo-kranio-disto-koudale rigting in die middelste derde van die tibiale skag is nageboots deur ‘n osteotomie, waarna elke been herstel is deur die gebruik van een van die volgende metodes: <ul> <li> Vooraf gebuigde intramedullêre pen, wat 40% tot 60% van die murgholte by die dunste punt vul, normograad geplaas en gekombineer met ‘n stel van drie vol sirkeldrade (groep 1).</li> <li> Trekskroef by die osteotomie area, gekombineer met ‘n ses-gat 2.7 mm gekontoerde dinamiese drukplaat en kortikale skroewe geplaas op neutrale wyse (groep 2).</li> </ul> Elke toetsmonster is onderwerp aan ‘n twee-punt enkel siklus aksiale druktoets deur die toepassing van ‘n gestandardiseerde, verhogende druklading tot by die punt van fiksasie breuk of kollaps van die been. ‘n Druk-spanning grafiek vir elke toetsmonster is vanaf die rou data saamgestel. X-straalfoto’s en digitale foto’s van elke been is pre-osteotomie, post-osteotomie, post-herstel and post-toets geneem en die maniere van faal vir elke toetsmonster aangeteken. Druk (toegepaste lading) en spanning (vervorming) by meegee (“yield”), treksterkte (“ultimate strength”) en faal (“failure”) is vir elke toetsmonster bepaal vanaf die druk-spanning grafieke en die gemiddelde waardes statisties vergelyk tussen die groepe deur gebruik te maak van die ANCOVA metode. Beduidenis vlakke van p < 0.05 is gebruik, terwyl p < 0.1 en p < 0.01 ook aangedui is. In groep 1 het 50% toetsmonsters gefaal as gevolg van losgaan of gly van die sirkeldrade met verplasing, 30% as gevolg van beenfrakture by ‘n sirkeldraad, en 20% as gevolg van beenfrakture elders. In groep 2 het 80% toetsmonsters gefaal as gevolg van beenfrakture by een of meer skroefgate, terwyl 20% gefaal het as gevolg van beenfrakture wat nie direk met die inplantate geassosieer is nie. Geen beenplaat of skroef het plastiese (permanente) vervorming ondergaan nie, terwyl 80% van die IM penne en 30% van die sirkeldrade plastiese vervorming ondergaan het. Gemiddelde druk by die meegeepunt in groepe 1 en 2 was 0.323 MPa en 0.403 MPa onderskeidelik, by die punt van treksterkte 0.383 MPa en 0.431 MPa onderskeidelik, en by die faalpunt 0.345 MPa en 0.403 MPa onderskeidelik. Gemiddelde spanning by die meegeepunt in groepe 1 en 2 was 0.296% en 0.362% onderskeidelik, by die punt van treksterkte 0.412% en 0.472% onderskeidelik, en by die faalpunt 0.713% en 0.838% onderskeidelik. Klinies was daar ‘n indikasie dat plate en skroewe meer weerstandbiedend was teen vervorming deur die toegepaste ladings as intramedullêre penne en sirkeldrade. Statisties was die druk wat die toetsmonster laat meegee (p = 0.299), en die druk by die treksterkte- (p = 0.275) en faalpunte (p = 0.137) egter nie beduidend verskillend tussen die twee groepe nie. Net so was die spanning by die meegee- (p = 0.684), treksterkte- (p = 0.778) en faalpunte (p = 0.505) nie beduidend verskillend tussen die twee groepe nie. Hoof beperkings van die studie was die relatief klein getal monsters wat getoets is, die gladheid van die osteotomie-snitte wat interdigitasie tussen die fragmente beperk het, en dat slegs drie van die vyf erkende ladings wat op bene in vivo inwerk, in vitro getoets kon word. Laastens het hierdie studie nie genoeg getuienis opgelewer om ‘n beduidende verskil te bewys trussen die twee metodes van herstel nie. Derhalwe word voorgestel dat IM-penne en vol sirkeldrade gebruik word as aanvarbare alternatief tot beenplate en skroewe in die behandeling van skuins midskag tibia frakture in chondrodistrofiese honderasse. / Dissertation (MSc)--University of Pretoria, 2012. / Companion Animal Clinical Studies / unrestricted

<p>Kompleksnost visokoenergetskih preloma platoa i pilona tibije i njihova udruženost sa značajnim povredama mekog tkiva oko pripadajućeg zgloba veoma je dobro opisana. Lečenje ima za cilj da multifragmentarni prelomi platoa i pilona tibije postanu stabilni, artikularno poravnani, bezbolni, da koleno i skočni zglob budu pokretni i da se minimizira rizik do nastanka posttraumatskog osteoartritisa. Aparat po Ilizarovu sa nategnutim iglama, koristi opterećenje da stvori jedinstvenu podr&scaron;ku za zglob i stabilnu imobilizacju preloma da se postigne njegovo srastanje. Ovo omogućuje ranu pokretljivost zgloba bez rizika od gubitka redukcije. Cilj istraživanja je procena i poređenje rezultata lečenja unutarzglobnih vi&scaron;ekomadnih preloma kostiju proksimalnog i distalnog okrajka potkolenice tretiranih spoljnjim unilateralnim rigidnim fiksatorom i aparatom po Ilizarovu primenom ASAMI ko&scaron;tanog skoring sistema i funkcionalnog skoring sistema po Karlstrom &ndash; Olerudu.Takođe je jedan od ciljeva istraživanja bio da se uoče faktori koji utiču na različite rezultate lečenja unutarzglobnih vi&scaron;ekomadnih preloma kostiju gornjeg i donjeg okrajka potkolenice tretiranih spoljnim unilateralnim rigidnim fiksatorom i aparatom po Ilizarovu. Istraživanje je dizajnirano kao kontrolisana komparativna klinička studija a podaci su se prikupljali retrospektivno i delom prospektivno na osnovu medicinske dokumentacije od 2008. do 2013. godine. Studija je u potpunosti izvedena na Klinici za ortopediju i traumatologiju Kliničkog centra Vojvodina u Novom Sadu. Studija je obuhvatila ukupno 103 ispitanika kod kojih je u toku 2008 do 2013. godine postavljena dijagnoza unutarzglobnog vi&scaron;ekomadnog preloma gornjeg ili donjeg okrajka tibije. Ispitanici koji su obuhvaćeni ovim kliničkim istraživanjem razvrstani su u tri grupe: Prvu grupu od 53 ispitanika činili su oni sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice lečenih isključivo spoljnjim unilateralnim rigidnim fiksatorom. Drugu grupu ispitanika, njih 31, činili su oni sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice lečenih isključivo aparatom po Ilizarovu. Treću grupu činila su 19 ispitanika sa vi&scaron;ekomadnim unutarzglobnim otvorenim ili zatvorenim prelomima gornjeg ili donjeg okrajka kostiju potkolenice koji su lečenje započeli spoljnjim unilateralnim rigidnim fiksatorom, a u kasnijem periodu zbog nastalih komplikacija (lo&scaron;e srastanje, produženo srastanje, nesrastanje, infekcija, pseudoartroza) lečenje nastavili konverzijom spoljnjeg unilateralnog rigidnog fiksatora u aparat po Ilizarovu. Osnovni izvor podataka za prikazano istraživanje bio je protokol formiran za svakog bolesnika pojedinačno, istorije bolesti i poliklinička evidencija. Za potrebe istraživanja dizajniran je protokol istraživanja gde su se prikupljeni podaci analizirali hronolo&scaron;ki : podaci o pacijentu, klinički nalaz na prijemu, postoperativni tok, monitoring aparata, klinički nalaz na otpustu i klinički nalaz na kontrolama od 6, 12 i 18 meseci. Kliničke nalaze na kontrolama na 6, 12 i 18 meseci beležili smo upotrebom skoring sistema ASAMI ( Udruženja za istraživanje i primenu metoda po Ilizarovu) &ndash; za ko&scaron;tane rezultate, i Karlstrom &ndash; Oleruda za procenu funkcionalnih rezultata. Neki do najvažnih rezultata dobijenih prilikom ovog istraživanja jesu da je najbrže vreme srastanja imala grupa Ilizarov, nakon 16&plusmn;2 nedelja. Grupa konverzija zabeležila je prosečno vreme srastanja u 17&plusmn;2 nedelji, dok je kod ispitanika u grupi fiksator zabeženo srastanje u 21&plusmn;4 nedelji. Pojava povr&scaron;nih i dubokih infekcija značajno je veća kod grupe tretiranih spoljnim unilateralnim fiksatorom nego kod grupa tretiranih aparatom po Ilizarovu. Vreme postizanje ranog, punog oslonca na operisani ekstremitet je značajno kraće kod grupe Ilizarov i konverzija nego kod grupe fiksator. Procena ko&scaron;tanih rezultata kori&scaron;ćenjem ASAMI bodovnog sistema ko&scaron;tanog srastanja ukazuje na statistički značajno bolje rezultate kod grupa Ilizarov i konverzija u odnosu na grupu spoljnji fiksator u periodu praćenja i analize na 6,12 i 18 meseci. Funkcionalni rezultati primenom sistema funkcionalne evaluacije po Karlstrom &ndash; Olerudu govore u prilog značajno statistički boljim rezultatima kod grupe Ilizarov i konverzija u odnosu na grupu spoljni fiksator u periodima praćenja i analize na 6,12 i 18 meseci. Na osnovu dobijenih rezultata dolazimo do zaključka da je tretman ispitanika sa multifragmentarnim, intraarikularnim prelomima gornjeg i donjeg okrajka kostiju potkolenice znatno efikasniji aparatom po Ilizarovu &scaron;to sveukupno daje smernice za brži i kvalitetniji oporavak ispitanika i njihov povratak svakodnevnim aktivnostima sa &scaron;to manjim posttraumatskim sekvelama.</p> / <p>The complexity of high-energy fractures of the tibia plateau and pilons and their association with significant violations of the soft tissue around the corresponding joint is well described in the literature. Main aim of the treatment is to multiple fractures of the tibia plateau and pilon become stable, articularly aligned, without pain, and with full motion in the knee and ankle joint with minimum risk for post-traumatic osteoarthritis. Ilizarov apparatus with taut needles is used to create a unique load support for the ankle and create conditions for good healing. This strong stability allows early joint movement, without risk of loss position of fracture parts. The aim of this research is assessment and comparation of the results of treatment, for intraarticular multiple fractures of the proximal and distal part of lower leg tretaed with unilateral external rigid fixator and Ilizarov apparatus, with ASAMI bone scoring system and functional scoring sistem by Karlstrom &ndash; Olerud. One of the goals of the study was to detect factors which affecting different treatment results of the intraarticular multiple fractures of the proximal and distal part of lower leg, tretaed with unilateral external rigid fixator and Ilizarov apparatus. The study was designed as a controlled comparative clinical study and data were collected retrospectively and prospectively form medical records from 2008 to 2013. The study has been fully implemented at the Department for orthopedic surgery and traumatology in the Clinical Center of Vojvodina in Novi Sad and included 103 patients who had intraarticular multiple fractures of the proximal and distal part of tibia. Subjects covered in this clinical study were classified into three groups: The first group of 53 patients were with intraartiulary multifragmentary open or closed fractures of the upper or distal part of lower leg, treated exclusively with unilateral external rigid fixator. The second group included 31 patients with intraarticular open or closed fractures of the upper or distal lower leg, treated exclusively with Ilizarov apparatus. 19 patients made the third group with intraarticulary open or closed fractures of the upper or distal lower leg, which were treated at the begining with unilateral external rigid fixator and later because of the complications (poor or prolonged healing, nonunion, infection and pseudoarthrosis) tretment was continued by Ilizarov apparatus. The main source of data for this study was protocol wich was established for each patient individually. In this protocol collected data analyzed by date: patient data, clinical findings at admission, postoperative course, monitoring apparatus, clinical findings at discharge and clinical findings at the controls which were at 6, 12 and 18 months after surgery. Clinical findings at control examinations (6, 12 and 18 months after surgery), we recorded by scoring system ASAMI (Association for the Study and Application of the Methods of Ilizarov) - that represent the results of the bone healing, and Karlstrom - Olerud for assessment functional outcomes. The most important results were: the fastest time of bone union was in the group of Ilizarov, and it was after 16 &plusmn; 2 weeks and the third group (conversion group) recorded an average time after 17 &plusmn; 2 weeks, while the patients in the first group (external fixator) had average time of union after 21 &plusmn; 4 week. The appearance of superficial and deep infection was significantly higher in the group treated with unilateral external fixator than in the group treated by the Ilizarov apparatus. Fastest full weight bearing on the injured leg, had patients in the group treated with Ilizarov apparatus. Evaluation of results using bone ASAMI fusion scoring system indicating a statistically significantly better results in the conversion and Ilizarov group compared to the group of external fixator in the period of monitoring at 6,12 and 18 months after surgery. Functional results by Karlstrom - Olerud scoring system show statistically significantly better results in the Ilizarov and conversion group contrary to the external fixator group in periods of monitoring at 6,12 and 18 months. Based on these results we conclude that the treatment of subjects with intraarticulary, multifragmentary fractures of the upper and lower part of the lower leg are more efficient after Ilizarov apparatus which provides overall guidance for faster and better recovery of patients and their return to their daily activities with minimal post-traumatic sequelae.</p>