Fractures of the Middle Third of the Tibia Treated with a Functional Brace

Sarmiento, Augusto; Latta, Loren L.

doi:10.1007/s11999-008-0438-6

Cited by 10 publications

(5 citation statements)

References 39 publications

(66 reference statements)

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“…It was previously thought that sagittal plane proximal tibial deformity was well tolerated because it was in the plane of adjacent joint motion. 27 This concept has since been challenged because knee recurvatum is linked to pathologic intra-articular mechanics and ligamentous injuries. 28 Published literature on indications for surgical treatment is limited.…”

Section: Indications For Treatmentmentioning

confidence: 99%

Proximal Tibial Recurvatum-Valgus: Analysis and Treatment

Georgiadis,

Nahm,

Dahl

2023

J Am Acad Orthop Surg

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Genu recurvatum-valgus arises from the proximal tibia and poses challenges in its treatment. The etiology of the combined deformities can include physeal trauma (often unrecognized), iatrogenic injury, infection, tumor, Osgood-Schlatter syndrome, skeletal dysplasia, and ligamentous laxity. Both osseous and ligamentous contributions must be recognized for successful treatment. A graphical planning method identifies the true (oblique) plane of deformity. Surgical treatment options include epiphysiodesis to prevent progressive deformity, guided growth, opening-wedge proximal tibial osteotomy, and gradual correction with concomitant limb lengthening using external fixation or motorized internal lengthening. Opening-wedge proximal tibial osteotomy conducted along the true deformity plane is a reliable surgical method for lesser-magnitude deformities. Gradual correction using circular external fixation is considered when the magnitude of correction is greater than 25º or when limb shortening and/or multiplanar deformity is present. After successful surgical management, patients can expect to achieve correction of knee hyperextension, posterior tibial slope, and mechanical axis. Restoration of these parameters re-establishes physiologic loading of the knee. This review illustrates the clinical and radiographic assessment of the deformity, relevant anatomy, and five surgical techniques for the genu recurvatum-valgus deformity of the proximal tibia.

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Section: Indications For Treatmentmentioning

confidence: 99%

Proximal Tibial Recurvatum-Valgus: Analysis and Treatment

Georgiadis,

Nahm,

Dahl

2023

J Am Acad Orthop Surg

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“…55 Despite this shift, closed treatment remains a potentially viable option. 56,57 Patients are typically placed in above knee long leg casts and switched to functional braces after three to five weeks. 58 In Sarmiento's 1989 series of 780 tibial fractures, the nonunion rate was 2.5%, shortening of < 10mm occurred in 90% of patients, and an acceptable angular deformity of < 10 degrees was generally attained.…”

Section: Humeral Diaphysis Fracturesmentioning

confidence: 99%

“…63 2019 systematic review and meta-analysis found that conservative treatment of ankle fractures led to a lower rate of infection, decreased need for further surgery, and improved cost-effectiveness. 57 Despite these findings, closed reduction often failed, and a large percentage of patients were transitioned to the operative group. The rates of malunion (15%) and nonunion (10%) were also higher in the nonoperative group.…”

Section: Ankle Fracturesmentioning

confidence: 99%

Closed Fracture Treatment in Adults, When is it Still Relevant?

Coon

Denisiuk

Woodbury

et al. 2022

Spartan Medical Research Journal

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Fracture treatment has been documented since the times of ancient Egyptian and Greek civilization, with fracture reduction techniques and the apparatus for immobilization developed over three millennia. Over the last 150 years, aseptic technique, anesthesia, antibiotics, and internal implants have changed how orthopedic specialists approach fracture care. More recently, there has been an increased promotion in the medical literature to evaluate the clinical outcomes of nonsurgical treatment of common upper and lower extremity closed fractures. METHODSIn this paper, the authors review the history of closed extremity fracture treatments, outline contemporary studies regarding treatments of non-displaced fractures, and discuss the recent literature that has informed orthopedic surgeon-patient decision-making discussions regarding closed fracture management. CONCLUSIONSBased on the results of this literature review, orthopedic providers should consider the preferable outcomes associated with nonoperative fracture management such as lower infection rates, the possibility of rapid functional improvements and lower healthcare costs. Nonoperative methods for closed fractures can sometimes be more safely delivered even with more difficult fractures. This may be of particular benefit to patients with higher surgical risks, minimizing exposure to treatments that are not only more invasive and expensive, but that can impose greater postoperative risks.

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“…Although less commonly practiced, closed treatment is a potentially viable option, and typically involves reduction and casting followed transition to functional bracing 5 , 6 , 7 , 8 . The largest case series to date of closed treatment of tibial fractures is by Sarmiento 5 , 6 , 7 , 8 , and shows that in the right practice environment, non-operative treatment can achieve excellent radiographic results in some patients. However, these results were obtained at a specialty clinic in a relatively unique organization, and the generalizability and reproducibility of that system to other orthopaedic surgeons is not well-established 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

Modern treatment of tibial shaft fractures: Is there a role today for closed treatment?

Swart

Lasceski

Latario

et al. 2021

Injury

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Paper Highlights Attempted closed treatment of isolated tibial shaft fractures has a 70% rate of conversion to surgery. Coronal/sagittal translation, sagittal angulation, fracture morphology, and smoking status were shown to be significant predictors of success of nonoperative treatment. There is a cohort of over 1/3 of isolated closed tibial shaft fracture that can be treated nonsurgically with a success rate over 60%.

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Fractures of the Middle Third of the Tibia Treated with a Functional Brace

Abstract: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 10 publications

References 39 publications

Proximal Tibial Recurvatum-Valgus: Analysis and Treatment

Proximal Tibial Recurvatum-Valgus: Analysis and Treatment

Closed Fracture Treatment in Adults, When is it Still Relevant?

Modern treatment of tibial shaft fractures: Is there a role today for closed treatment?

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