Long-Term Outcome After Tibial Shaft Fracture

The evolution of functional bracing of fractures

“…The data obtained indicated that minor angular deformities in weight-bearing bones altered the distribution of pressure on the articular cartilage in the proximal and distal joints to a minimal extent. [38][39][40][41][42][43][44] The fact that some minimally displaced intra-articular fractures might be associated with diaphyseal fractures prompted studies to determine whether permanent degenerative arthritis was unavoidable. These investigations indicated that minor articular incongruity did not necessarily produce progressive arthritis.…”

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

“…They stated the clinical and radiographic results were unaffected by the amount of anterior or posterior and varus or valgus angulation and the level of the fracture [31]. Milner et al reported their findings from 164 patients with followups ranging between 30 and 43 years [33]. Seventeen (15%) patients had overall alignment of the lower limb, defined as a hip-knee-ankle angle outside the normal range of 6.25°v arus to 4.75°valgus.…”

“…Seventeen (15%) patients had overall alignment of the lower limb, defined as a hip-knee-ankle angle outside the normal range of 6.25°v arus to 4.75°valgus. ''Most of the subjects'' in whom osteoarthritis was observed had normal overall alignment of the normal limb [33]. Other factors such as severe cartilage impaction at the time of the injury may be more important in causing osteoarthritis [40].…”

Fit optimisation of a distal medial tibia plate

“…While there are clinical guidelines regarding thresholds for rotational and axial alignments of tibial fragments, (Gregory and Sanders 1995;Wiss and Stetson 1995;McKee et al 1999;Puloski et al 2004) the literature is not clear about the acceptable reduction in the fractured tibia. Some studies indicate that there is merit in reducing tibial fractures as close as possible to a normal alignment in order to lessen the chance of early degenerative arthritis in the knee or ankle (Puno et al 1991;van der Schoot et al 1996), others conclude that tibial malalignment was not the cause of adverse functional outcomes (Boucher et al 2002;Milner et al 2002). Nevertheless, if the shape of a plate can be optimised such that it fits to the largest possible segment in a particular population then this lessens not only the likelihood for additional intra-operative contouring but also the chances of adverse functional outcomes.…”