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PubMed1992

Use of an intramedullary rod for the treatment of congenital pseudarthrosis of the tibia.

The use of an intramedullary rod as described by Williams, combined with implantation of an autogenous bone graft, resulted in union of an established congenital pseudarthrosis of the tibia in nine of ten patients. One patient needed additional bone-grafting before union occurred. The average age at the time of the operation was five years and three months. A rod of the appropriate length was inserted at the site of the non-union, antegrade through the distal part of the tibia and the hindfoot and then retrograde through the proximal fragment. This resulted in splinting of the tibia, ankle, and subtalar joints. Solid osseous union occurred an average of six months after the procedure in all ten patients. Five patients had a refracture of the tibia after the initial consolidation. Three of the five needed one or more additional operative procedures; one was managed with a cast; and one patient, who had been followed for four years before the refracture, did not return for treatment of the refracture. As is the plan with this method of treatment, the distal part of the tibia grew off the rod and the distal tip of the rod was located proximal to the foot and ankle, or it was located more proximally than it had been at the operation, in six patients. The rod was removed from three patients. At an average of six years, all ten patients were able to walk without pain.

Amputation, Surgical↗

PubMed2005

[Osteomyocutaneous latissimus dorsi scapular combined flap with vascularized rib to repair the large defect of tibia].

OBJECTIVE: To design a combined flap of subscapular axis including vascularized lateral scapular, rib and latissimus dorsi to repair the large defect of tibia. METHODS: The patient was a 39-year-old man who got a posttraumatic 12 cm defect of tibia after primary debridement and external fixation because of open fracture 5 months ago. There was a 12 cm x 6 cm scar involved the proximal medial segment of tibia. After resection of scar and fibular tissue over the bone defect floor, a latissimus dorsi myocutaneous flap 14 cm x 5 cm pedicled with subscapular artery-thoracodorsal artery, a flap 12.5 cm on the outside of the scapular pedicled with thoracodorsal artery, and 6th rib flap 13 cm by serratus were prepared. The tibialis posterior and saphenous vein were used for anastomosis. A proximal anatomic plate was applied to the fixation of tibia. RESULTS: The compound flap survived the operation. The follow-up period was 2 years. Bone union occurred 6 months after operation. CONCLUSION: This combined flap is successful and can provide alternative to the resolution of large defect of tibia.

Adult↗

PubMed1987

Longitudinal growth of the femur and tibia after diaphyseal lengthening.

Growth of the femur and tibia after lengthening of their diaphyses, which had been performed several years before skeletal maturity, was assessed in eighteen patients by serial orthoroentgenograms. The rate of growth of the lengthened femora, which had been congenitally short, increased after each of seven lengthening procedures, from an average preoperative rate of 82 per cent of the normal side to 90 per cent of the normal side. The amount of surgical lengthening was similar for the femora and the tibiae, averaging 18 per cent of the preoperative length of the bone in the femora and 20 per cent of the preoperative length of the bone in the tibiae. However, the rate of growth of the lengthened tibiae decreased after each of eleven lengthening procedures (six performed for a congenital short tibia; three, for patients who had Ollier's disease; one, for a patient who had poliomyelitis; and one, for a patient who had hemangiomas), from an average preoperative rate of 88 per cent of normal to an average of 64 per cent of normal.

Bone Lengthening↗

PubMed1984

Longitudinal growth rate of the distal tibia and fibula in children.

In 61 children (30 boys and 31 girls), the growth rates in the distal tibia and fibula were recorded by use of a roentgen stereophotogrammetric technique. The average observation time was about one year and seven months. The growth rates were correlated with chronologic and skeletal age. Adjusting for skeletal age did not significantly change the average growth rates or the scattering of the values. The mean growth rate and the remaining growth from about nine years of age in the boys and eight years of age in the girls were calculated for separate age groups. In the distal tibia in the boys and the girls, the average growth rate decreases from a plateau of about 11 and ten years of age, respectively. Decreasing growth rates were found somewhat later in the distal tibia than in the distal fibula in both the boys and the girls. The growth rates were close to zero at about the same time in the distal tibia and fibula in both sexes. In determining the remaining growth, the large biologic variability indicates the importance of serial measurements on the individual patient. The individual growth charts, together with clinical and radiographic estimation of maturity, provide a guideline for treatment of a patient with growth disturbance of the distal tibia and fibula.

Adolescent↗

PubMed1980

Hemopoietic support capacity of W/WV femurs and tibias.

We evaluated the capacity of "stromal stem cells" of the bones of W/WV mice to effect regeneration of functional "stromal" tissue by implanting femurs and tibias from congenic W/WV and +/+ mice subcutaneously into congenic mice of normal hematologic phenotypes. Eight weeks after implantation, we assayed the hemopoietic progenitor cell contents of the bones. Pluriopotent hemopoietic stem cells (CFUs) were assayed by the spleen colony forming assay in lethally irradiated CAF1 mice. Granulocyte/macrophage progenitor cells (CFUGM) and early erythroid (BFUe) and late erythroid (CFUE) progenitor cells were assayed in agar and methylcellulose semi-solid culture systems, respectively. total cellularity was greater in implanted W/WV femurs and tibias than in +/+ femurs. Although there was substantial variation in the repopulation of W/WV femurs compared to that of +/+ femurs, on the whole, in the W/WV implanted femurs, the numbers of CFUs may have been slightly less and the numbers of maturer progenitor cells slightly greater than they were in the +/+ femurs. All of the progenitor cells assayed were more numerous in the implanted W/WV tibias than in the +/+ tibias. These findings suggest that "stromal stem cells" of W/WV marrow are not defective. In addition, the fact that there were more CFUs in th W/WV that in the +/+ tibias suggests that the CFUs which are native to the implanted bones are not needed to effect reconstitution of normal numbers of CFUs in the implants as all of the CFUs detected in W/WV femurs must have come from the host, for W/WV CFUs do not form surface spleen colonies and, therefore, would not have been counted.

Anemia, Hemolytic, Congenital↗

PubMed1982

Physiological bowing and tibia vara. The metaphyseal-diaphyseal angle in the measurement of bowleg deformities.

The metaphyseal-diaphyseal angle is the angle created by the intersection of a line through the transverse plane of the proximal tibial metaphysis with a line perpendicular to the long axis of the tibial diaphysis. This angle represents the degree of deformity of the proximal end of the tibia in a patient with clinical bowleg deformity and permits early differentiation between infantile tibia vara and physiological bowleg, before the appearance of the radiographic changes of tibia vara. In twenty-nine of thirty affected extremities with an initial metaphyseal-diaphyseal angle of more than 11.0 degrees, radiographic changes of tibia vara later developed. However, only three of fifty-eight extremities with a metaphyseal-diapyseal angle of 11.0 degrees or less had any of the diagnostic changes. In addition, the ratio of the metaphyseal-diaphyseal angle (proximal tibial metaphyseal deformity) to the tibiofemoral angle (deformity of the entire extremity) showed that approximately 60 per cent of the deformity in tibia vara originates in the proximal metaphysis, whereas only 20 per cent of the deformity in physiological bowing originates there. The metaphyseal-diaphyseal angle allows accurate early diagnosis of bowleg deformity, as well as accurate assessment of its progression.

Bone Diseases, Developmental↗

PubMed1993

The effect of immobilization on the torsional strength of the rat tibia.

Torsion testing is considered a suitable method for measuring the strength of long bones. The aim of the current study was to investigate the effect of immobilization on the mechanical strength of rat bone and its relation to mineral content. The influence of freezing on the bone strength was also studied. The precision of the method, studied by comparing the maximum torque capacity of the contralateral tibiae of intact rats, was found to be 6.4%. No significant dominance of either side in the strength of the tibia could be observed. Tibiae that had been frozen for one week before thawing had a significantly lower maximum torque capacity and rigidity than fresh contralateral bones, the differences being -6.3 +/- 3.2% (mean +/- SEM) (p < 0.05) and -9.37 +/- 9.48% (p < 0.05), respectively. The change in the maximum angle of deformation was not statistically significant. Three weeks' cast immobilization reduced the femur ash weight by 13.8 +/- 2.5% (p < 0.001) relative to that of the nontreated contralateral leg. The maximum torque capacity and rigidity of the tibia also decreased in the immobilized leg, the differences being 11.6 +/- 3.5% (p < 0.01) and 16.6 +/- 5.3% (p < 0.01), respectively. The maximum angle of deformation was not significantly influenced by immobilization. The maximum torque capacity of the tibia correlated well with femur ash weight (r = 0.71, p < 0.001). The method used here is valid for measuring the strength of diaphyseal bones; it showed weakening of the bone during three weeks' cast immobilization.

Animals↗

PubMed2002

Anterior versus posterior approach in reconstruction of infected nonunion of the tibia using the vascularized fibular graft: potentialities and limitations.

The potentialities, limitations, and technical pitfalls of the vascularized fibular grafting in infected nonunions of the tibia are outlined on the basis of 14 patients approached anteriorly or posteriorly. An infected nonunion of the tibia together with a large exposed area over the shin of the tibia is better approached anteriorly. The anastomosis is placed in an end-to-end or end-to-side fashion onto the anterior tibial vessels. To locate the site of the nonunion, the tibialis anterior muscle should be retracted laterally and the proximal and distal ends of the site of the nonunion debrided up to healthy bleeding bone. All the scarred skin over the anterior tibia should be excised, because it becomes devitalized as a result of the exposure. To cover the exposed area, the fibula has to be harvested with a large skin paddle, incorporating the first septocutaneous branch originating from the peroneal vessels before they gain the upper end of the flexor hallucis longus muscle. A disadvantage of harvesting the free fibula together with a skin paddle is that its pedicle is short. The skin paddle lies at the antimesenteric border of the graft, the site of incising and stripping the periosteum. In addition, it has to be sutured to the skin at the recipient site, so the soft tissues (together with the peroneal vessels), cannot be stripped off the graft to prolong its pedicle. Vein grafts should be resorted to, if the pedicle does not reach a healthy segment of the anterior tibial vessels. Defects with limited exposed areas of skin, especially in questionable patency of the vessels of the leg, require primarily a fibula with a long pedicle that could easily reach the popliteal vessels and are thus better approached posteriorly. In this approach, the site of the nonunion is exposed medial to the flexor digitorum muscle and the proximal and distal ends of the site of the nonunion debrided up to healthy bleeding bone. No attempt should be made to strip the scarred skin off the anterior aspect of the bone lest it should become devitalized. Any exposed bone on the anterior aspect should be left to granulate alone. This occurs readily when stability has been regained at the fracture site after transfer of the free fibula. The popliteal and posterior tibial vessels are exposed, and the microvascular anastomosis placed in an end-to-side fashion onto either of them, depending on the length of the pedicle and the condition of the vessels themselves. To obtain the maximal length of the pedicle of the graft, the proximal osteotomy is placed at the neck of the fibula after decompressing the peroneal nerve. The distal osteotomy is placed as distally as possible. After detaching the fibula from the donor site, the proximal part of the graft is stripped subperiosteally, osteotomized, and discarded. Thus, a relatively long pedicle could be obtained. To facilitate subperiosteal stripping, the free fibula is harvested without a skin paddle. In this way, the use of a vein graft could be avoided. Patients presenting with infected nonunions of the tibia with extensive scarring of the lower extremity, excessively large areas of skin loss, and with questionable patency of the anterior and posterior tibial vessels are not suitable candidates for the free vascularized fibular graft. Although a vein graft could be used between the recipient popliteal and the donor peroneal vessels, its use decreases flow to the graft considerably. These patients are better candidates for the Ilizarov bone transport method with or without free latissimus dorsi transfer.

Accidents, Traffic↗

PubMed1999

Tibia and fibula fractures in soccer players.

We performed a retrospective review of 31 athletes who sustained a fracture of the lower leg from a direct blow while playing soccer. Fifteen fractures involved both the tibia and fibula 11 only the tibia, and 5 only the fibula. Information was collected using a standardized questionnaire. The mean follow-up from the time of injury was 30 months. Injuries typically occurred in young, competitive athletes during game situations. The mechanisms were broadly classified into several categories: contact during a slide tackle (13, 42%), a collision with the goalkeeper (8, 26%), two opposing players colliding while swinging for a loose ball (7, 23%), or a player being kicked by a standing opponent (3, 10%). The majority of fractures (26, 90%) occurred while the athletes were wearing shin guards. The point of impact was with the shin guard prior to the fracture in 16 cases (62%). Return to competitive soccer averaged 40 weeks for combined tibia and fibula fractures, 35 weeks for isolated tibia fractures, and 18 weeks for isolated fibula fractures. Injuries were associated with a high incidence of major complications (12 out of 31, 39%), especially in concurrent tibia and fibula fractures (8 out of 15, 50%). These findings suggest that lower leg fractures in soccer players are serious injuries, often necessitating a prolonged recovery time. In addition, this study questions the ability of shin guards to protect against fractures.

Adolescent↗

PubMed2005

Spinal glial activation in a new rat model of bone cancer pain produced by prostate cancer cell inoculation of the tibia.

Studies suggest that astrocytes and microglia in the spinal cord are involved in the development of persistent pain induced by tissue inflammation and nerve injury. However, the role of glial cells in bone cancer pain is not well understood. The present study evaluated the spinal glial activation in a novel rat model of bone cancer pain produced by injecting AT-3.1 prostate cancer cells into the unilateral tibia of male Copenhagen rats. The structural damage to the tibia was monitored by radiological analysis. The thermal hyperalgesia, mechanical hyperalgesia and allodynia, and spontaneous flinch were measured. The results showed that: (1) inoculation of prostate cancer cells, but not the vehicle Hank's solution, induced progressive bone destruction at the proximal epiphysis of the tibia from day 7-20 post inoculation; (2) the inoculation also induced progressive thermal hyperalgesia, mechanical hyperalgesia, mechanical allodynia, and spontaneous flinches; (3) astrocytes and microglia were significantly activated in the spinal cord ipsilateral to the cancer leg, characterized by enhanced immunostaining of both glial fibrillary acidic protein (GFAP, astrocyte marker) and OX-42 (microglial marker); (4) IL-1beta was up-regulated in the ipsilateral spinal cord, evidenced by an increase of IL-1beta immunostained astrocytes. These results demonstrate that injection of AT-3.1 prostate cancer cells into the tibia produces progressive hyperalgesia and allodynia associated with the progression of tibia destruction, indicating the successful establishment of a novel male rat model of bone cancer pain. Further, bone cancer activates spinal glial cells, which may release IL-1beta and other cytokines and contribute to hyperalgesia.

Animals↗

PubMed1994

Production of a standard closed fracture in the rat tibia.

In order to develop a technique for producing a standard closed transverse fracture in the rat tibia, the method of Bonnarens and Einhorn was modified and tested on 176 tibiae. A 0.9-mm Kirschner wire was inserted percutaneously near the tibial tuberosity into the intramedullary canal, and a tibial fracture was created at the junction of the middle and distal third of the tibia with a blunt guillotine driven by a dropped weight. Radiographs confirmed the production of a highly reproducible transverse mid-shaft tibia fracture in 90% of the fractures. Minimal comminution of the fracture or angulation of the Kirschner wires resulted. The Kirschner wires were removed without difficulty after the rats were put to death and did not disturb the fracture site. Mechanical testing and histological studies showed that a standard fracture healing process was obtained by using this method. The results indicate that this modified method creates a standard, reproducible transverse closed fracture of rat tibia.

Animals↗

PubMed2006

Reconstruction of distal tibia fractures using a posterolateral approach and a blade plate.

OBJECTIVE: The aim of this article is to report a technique for the management of distal tibia fractures with significant anteromedial soft-tissue injury. The patients were initially treated with a spanning external fixator, open reduction and internal fixation (ORIF) of the fibula at the discretion of the surgeon, and soft-tissue management or flap coverage. ORIF of the tibia was performed on a staged basis, using a 90-degree cannulated blade plate and autogenous iliac crest bone graft through a posterolateral approach. DESIGN: Retrospective analysis of a consecutive series of patients. SETTING: Two academic level-1 trauma centers. PATIENTS: Fifteen patients with 15 distal tibia fractures (13 open fractures), Orthopedic Trauma Association (OTA) type 43A3 and 43C1, were definitively treated and followed to union between July 2000 and July 2004. Five patients were referred from outside sources after initial stabilization. INTERVENTION: Initial stabilization in an external fixator and management of the open fracture and soft tissue. Staged ORIF of the tibia with bone graft was performed through a posterolateral approach when the soft tissues allowed. OUTCOME MEASUREMENTS: Radiographic union, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and complications. RESULTS: All 15 fractures were followed to union. Average time to union was 20 (12 to 47) weeks from the time of fixation with blade plate and bone grafting. (AOFAS) ankle-hindfoot score was used to measure outcome. The average score was 81 (60 to 97) out of a possible 100. There were no deep infections. There was one nonunion; the fracture united after revision with a locked plate and bone graft. The average length of follow-up was 14 months (4 to 37). CONCLUSIONS: The staged treatment of high-energy distal tibia fractures with soft-tissue injury can lead to good outcomes and consistent bone union. Our results were obtained by the combination of the posterolateral approach, careful soft-tissue management, and stable internal fixation.

Adult↗

PubMed1995

Open tibia fractures in the splenectomized trauma patient: results of treatment with locking, intramedullary fixation.

OBJECTIVE: To confirm our clinical impression that patients with traumatic splenectomy had more complications in the treatment of open tibia fractures, we retrospectively reviewed the records of patients with open tibia fractures treated between 1989 and 1992. MATERIALS AND METHODS: Eight patients with open tibia fractures and traumatic splenectomies were compared to 43 patients with open tibia fractures and intact spleens. The latter group typically underwent either exploratory laparotomy or peritoneal lavage. The two groups were similar with respect to age, mechanism of injury, fracture wound classification, and injury severity score (22.4 in the splenectomized patients, 18.6 in the control). All tibia fractures were treated with a nonreamed, cross-locked, titanium intramedullary nail, and all patients were treated according to the same protocol of antibiotic therapy. Patients were followed for two years or until roentgenographic and clinical union. RESULTS: The splenectomized patients had a significantly higher incidence of chronic osteomyelitis (25% vs. 4.6%), and the need for additional tibial surgeries to achieve union (75% vs. 16%). Time to union averaged 11.3 months in the splenectomized group and 7.6 months in the patients with intact spleens. CONCLUSIONS: The increased risk for chronic osteomyelitis and other complications of tibial fracture in the splenectomized patients should be taken as an argument favoring splenic, repair, when possible, rather than splenectomy in victims of blunt multiple trauma.

Adolescent↗

PubMed2005

Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol.

OBJECTIVES: This study evaluated the use of a staged protocol involving temporary spanning external fixation and delayed formal definitive fixation in the management of high-energy proximal tibia fractures (OTA types 41) with regard to soft-tissue management, development of complications, and functional outcomes. SETTING: Two level-one trauma centers and a tertiary care orthopaedic center. PATIENTS: Fifty-three patients with 57 high-energy tibial plateau fractures. METHODS: The authors instituted a protocol of immediate placement of knee spanning external fixation with management of soft-tissue injuries for all high-energy proximal tibia fractures. Between August 1999 and May 2002, 62 consecutive patients with 67 high-energy proximal tibia fractures (OTA types 41A, B, C) underwent temporary knee spanning external fixation on the day of admission. Nine patients with 10 fractures who transferred care after initial stabilization or sustained an extraarticular fracture were excluded. The remaining 53 patients with 57 fractures underwent repair of articular fractures and meta-diaphyseal fracture repair with plates and screw constructs or conversion to a ring fixator. These patients had a mean age of 47 years (standard deviation (SD), 14). Of these 53 patients, 42 (79%) were men and 11 (21%) were women. Characteristics of the 57 fractures were: 42 Schatzker VI (74%), 12 Schatzker V (21%), 2 Schatzker IV (4%), and 1 Schatzker II (2%). There were 41 closed fractures and 16 open fractures. (One patient had bilateral fractures with 1 extremity open and 1 closed). Orthopaedic evaluation at latest follow-up included a clinical and radiographic examination and functional outcome measurement with the Western Ontario McMaster functional knee score (WOMAC). Eight patients with 8 fractures were lost to follow-up. This left 45 patients with 49 fractures with a mean follow-up of 15.7 (SD, 5.7; range, 8-40) months. RESULTS: Complications included 3 (5%) deep wound infections, 2 (4%) nonunions, and 2 patients (4%) with significant knee stiffness (<90 degrees). Nine patients (16%) underwent additional surgery after definitive skeletal stabilization related to their injury. Range of knee motion at final follow-up was 1 degrees (SD, 4) to 106 degrees (SD, 15). The mean WOMAC was 91 (SD, 55). Poor results did not correlate with demographic or injury characteristics. DISCUSSION: We had a relatively low rate of wound infection in these complex injuries (5% overall). There was only 1 wound problem in our subset of patients with closed fractures and 2 infections in those with open fractures. One downside of this technique may be residual knee stiffness. The benefits of temporizing spanning external fixation include osseous stabilization, access to soft tissues, and prevention of further articular damage. Our relatively low rates of complications in patients who sustain high-energy proximal tibia fractures and the access this technique affords in open fractures and those with compartment syndrome lead us to recommend this technique in all high-energy intra-articular and extra-articular fractures of the proximal tibia. CLINICAL RELEVANCE: This study supports the practice of delayed internal fixation until the soft-tissue envelope allows for definitive fixation.

Adult↗

PubMed2006

Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures.

BACKGROUND: The management of unstable distal tibia fractures remains challenging. The mechanism of injury and the prognosis of these fractures are different from pilon fractures, but their proximity to the ankle makes the surgical treatment more complicated than the treatment tibial midshaft fractures. A variety of treatment methods have been suggested for these injuries, including nonoperative treatment, external fixation, intramedullary nailing, and plate fixation. However, each of these treatment options is associated with certain challenges. Nonoperative treatment may be complicated by loss of reduction and subsequent malunion. Similarly, external fixation of distal tibia fractures may result in insufficient reduction, malunion, and pin tract infection. Intramedullary nailing can be considered the "gold standard" for the treatment of tibial midshaft fractures, but there are concerns about their use in distal tibia fractures. This is because of technical difficulties with distal nail fixation, the risk of nail propagation into the ankle joint, and the discrepancy between the diaphyseal and metaphyseal diameter of the intramedullary canal. Open reduction and internal plate fixation results in extensive soft tissue dissection and may be associated with wound complications and infections. The optimal treatment of unstable distal tibia without articular involvement remains controversial. OBJECTIVES: This study was designed to review the outcomes of different treatment methods for extra-articular distal tibia fractures. The English literature was systematically reviewed and the rates of malunion, nonunion, infection, fixation failure, and secondary surgical procedures were extracted.

Bone Plates↗

PubMed2005

Reoperation rate in diaphyseal tibia fractures.

BACKGROUND: Tibia fractures often require secondary surgery to achieve union. Reoperation is an objective outcome measure that is clinically relevant to the patients and treating doctors. This study determined the complication and reoperation rates for diaphyseal tibia fractures and identified variables predictive of reoperation. METHODS: One-hundred and sixty-seven patients with 175 consecutive tibia shaft fractures (Association for the Study of Internal Fixation classification 42) presenting between July 2000 and June 2003 were included in the study. There were 4 deaths and 12 patients lost to follow up. The remaining 151 patients (159 fractures) were reviewed at a minimum of 6 months post-injury for the main outcome measures; union and reoperation. Univariate and multivariate analyses by logistic regression were used to identify any relationship between revision surgery and fracture classification, grade of the soft-tissue injury, mechanism of injury, age, sex, and treating surgeon. RESULTS: The overall reoperation rate was 35.8% (57/159) with 13.2% (21/159) tibiae requiring minor revision surgery and 22.6% (36/159) tibiae requiring major revision surgery. Thirteen (8.2%) patients underwent major revision surgery specifically for non-union. The fracture classification and the Gustilo grade of soft-tissue injury were significant predictors of revision surgery overall, and of major revision surgery. CONCLUSIONS: Tibial shaft fractures have a high revision rate as a consequence of non-union and infection. Revision surgery is best predicted by the fracture classification and the severity of the soft-tissue injury. This information is important for patient information and clinical decision making.

Adolescent↗

PubMed1988

In vivo tibia lead measurements as an index of cumulative exposure in occupationally exposed subjects.

In vivo tibia lead measurements of 20 non-occupationally exposed and 190 occupationally exposed people drawn from three factories were made using a non-invasive x ray fluorescence technique in which characteristic x rays from lead are excited by gamma rays from a cadmium-109 source. The maximum skin dose to a small region of the shin was 0.45 mSv. The relation between tibia lead and blood lead was weak in workers from one factory (r = 0.11, p greater than 0.6) and among the non-occupationally exposed subjects (r = 0.07, p greater than 0.7); however, a stronger relation was observed in the other two factories (r = 0.45, p less than 0.0001 and r = 0.53, p less than 0.0001). Correlation coefficients between tibia lead and duration of employment were consistently higher at all three factories respectively (r = 0.86, p less than 0.0001; r = 0.61, p less than 0.0001; r = 0.80, p less than 0.0001). A strong relation was observed between tibia lead and a simple, time integrated, blood lead index among workers from the two factories from which blood lead histories were available. The regression equation from two groups of workers (n = 88, 79) did not significantly differ despite different exposure conditions. The correlation coefficient for the combined data set (n = 167) was 0.84 (p less than 0.0001). This shows clearly that tibia lead, measured in vivo by x-ray fluorescence, provides a good indicator of long term exposure to lead as assessed by a cumulative blood lead index.

Adolescent↗

PubMedDate not supplied

Tuberculum intercondylare tibiae tertium as a predictive factor for anterior cruciate ligament injury.

The aim of this study was to assess the presence of tuberculum intercondylare tibiae tertium, also known as Parsons' knob, and to determine its prominence. Knee radiographs of 171 patients operated on for anterior cruciate ligament injury were examined. The control group included 120 sex- and age-matched patients who underwent orthopaedic examination for knee pain, in whom anterior cruciate ligament injury was ruled out. Knee radiographs revealed the presence of tuberculum intercondylare tibiae tertium in 55 (32.2%) and 16 (13.3%) patients from the study and control groups, respectively. The between-group difference was statistically significant. The authors developed their own method of tuberculum intercondylare tibiae tertium measurement using proportional coefficients based on the length of the tibial plateau to compare the values of the tuberculum intercondylare tibiae tertium. The results showed tuberculum intercondylare tibiae tertium to be not only more common but also more pronounced, especially in height, in the patients with anterior cruciate ligament lesions.

Adolescent↗