Objective Uneven settlement of the proximal tibia significantly contributes to the onset and progression of medial compartment knee OA; however, the specific location and variations of proximal tibial deformity remain unclear. Therefore, this study aimed to explore the effects of the anatomic morphology of different tibial regions on proximal tibial vara and proximal tibial microstructural changes with age in both sexes to reveal the pattern of uneven settlement of the proximal tibia. Methods In this retrospective study, we reviewed the radiographs of 414 patients (789 legs) between May and September 2021. The medial proximal tibial angle (MPTA) and four anatomic angles of the tibia (i.e., the tibial plateau‐epiphyseal line [PT‐EL] angle, epiphyseal line‐tibial platform [EL‐PF] angle, epiphyseal axis inclination angle [EAIA], and subepiphyseal axis inclination angle [SAIA]) were measured. The effect of each angle on MPTA and their changes with age in both sexes were investigated using Pearson's correlation coefficient and multiple linear regression. Results In females, PT‐EL angle, EL‐PF angle, and SAIA negatively correlated with MPTA (r = −0.325, −0.246, and −0.502; p < 0.05), and EAIA positively correlated with MPTA (r = 0.099, p < 0.05). Regression analysis showed that the correlations between MPTA and PT‐EL angle, EL‐PF angle, and SAIA were significant (β = −1.003, −0.013, and −0.971; adjusted R2 = 0.979). Furthermore, MPTA negatively correlated with age (r = −0.202, p < 0.05); PT‐EL angle and EAIA positively correlated with age (r = 0.237 and 0.142, p < 0.05). Regression analysis showed that only the correlation between PT‐EL angle and age was significant (β = 5.635, p < 0.05). In males, PT‐EL angle, EL‐PF angle, and SAIA negatively correlated with MPTA (r = −0.270, −0.267, and −0.533; p < 0.05), and EAIA positively correlated with MPTA (r = 0.135, p < 0.05). Regression analysis showed that the correlations between MPTA and PT‐EL angle, EL‐PF angle, and SAIA were significant (β = −0.992, −0.017, and −0.958; adjusted R2 = 0.970). However, there was no significant correlation between age and any of the measured angles (p > 0.05). Conclusions Proximal tibial vara is affected by the anatomic morphology of the epiphyseal and subepiphyseal regions. In females, the uneven settlement of the epiphysis progresses with age and may be responsible for dynamic varus deformity of the proximal tibia.
Rationale: Congenital dysfibrinogenemia (CD) is a rare coagulation system disease that is often treated without unified management. Individualized treatment thereof presents clinicians with great challenges.Patient concerns: A patient who was about to undergo total knee arthroplasty was found to have CD.Diagnoses: Coagulation screening revealed low fibrinogen, prolonged thrombin time, minor prolonged prothrombin time, and normal activated partial thromboplastin time were detected during admission, but no abnormal personal and family history findings were observed. Therefore, CD and hypofibrinogenemia were suspected. The gene sequencing confirmed the diagnosis of CD. Interventions:The patient received plenty and low level of fibrinogen concentrate during 2 perioperative periods, respectively.Outcomes: Successful clinical outcomes were obtained using different treatment strategies.Lessons: In contrast to prior case reports, this case illustrates the feasibility of low dosing of fibrinogen supplements within an asymptomatic patient in a selective operation. Changes in the level of fibrinogen and fibrin degradation product are of great importance for individualized treatment after supplementation.Abbreviations: CD = congenital dysfibrinogenemia, CH = congenital hypofibrinogenemia, DVT = deep vein thrombosis, FC = fibrinogen concentrate, LMWH = low molecular weight heparin, TKA = total knee arthroplasty, TXA = tranexamic acid.
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