EVALUATION OF SURGICAL TREATMENT OF OPEN TIBIA SHAFT FRACTURES WITH UNREAMED TIBIA NAIL (UTN)     ntroduction: The goal of treatment of open TIBIA fracture is to prevent infection. fracture healing and restore normal limb function. Unreamed TIBIA nail (UTN. Synthese) is now replaced with external fixation for treatment of open TIBIA fracture because of easy insertion and low complications. The purpose of this study is to evaluate union rate with this device in open TIBIA fracture and compare complications with other studies.Material and Methodes: From 1998 to 2001, sixty-eight patients with open grade I to grade IIIa TIBIA fracture were treated with unreamed TIBIA nailing and evaluated to find results and complications of this fixing tool. Of this group 46 patients were available for follow up at an average of 6 months after surgery. 31 patients were type IIIa, 9 patients, type II and 6 patients had type I Gastilo open TIBIA fracture. Operation was performed at a mean of 6 days after fracture.Results: Union occurred at a mean of 18/66 weeks for type I, 20/8 weeks for type II and 26/2 weeks for type IIIa open TIBIA fracture. Superficial and deep infection occurred in 10%, malunion in 4/35%, delayed union in 2/17%, nonunion in 2/17%, ankle joint stiffness in 6/52%, knee joint stiffness occurred in 2/17%, locking screw failure in 6/25 % and nail failure occurred in 4/35% of patients.Conclusion: The advantages of the UTN is less infection rate incontrast to external fixators, lesser need for secondary operation and greater patient comfort. Therefore, we find UTN to be a good alternative in companissan with other fixation devices in the treatment of open fractures of the TIBIA.  

Background: Intramedullary interlocking nailing has emerged as one of the suitable management options for distal TIBIA fractures as it allows mechanical compression on weight-bearing, which stimulates bone healing. We studied 40 cases of extra-articular distal TIBIA fracture treated by intramedullary nailing. Methods: We retrospectively studied 40 patients of both sexes above the age of 18 years with closed fractures and grade 1, 2, and 3A compound fractures treated at SVP Hospital, Ahmedabad, India. Clinically, the fracture was considered to be united when the patient was completely pain-free. Patients were followed up at monthly intervals till union. At each follow-up, patients were assessed both clinically and radiographically, and details were recorded based on proforma. Results: The evaluation of the result was done using American Orthopedic Foot and Ankle Society (AOFAS) criteria. Thirty-three patients had excellent functional results, five had good functional results, and Two had fair functional results. In this study, 38 (95%) patients had radiological union within 24 weeks. Two patients had union after 28 weeks. Conclusion: Intramedullary nailing is a minimally invasive procedure that preserves the soft tissue and the fracture hematoma. It maintains the length, alignment, and rotation and allows micromotion at the fracture site on weight-bearing, which stimulates callus formation. It has a good functional outcome with gratifying results when used in extra-articular distal TIBIA fractures.

We present a case of unilateral TIBIA vara associated with an area of focal fibrocartilaginous dysplasia in the medial aspect of the right proximal TIBIA. Such a case has not been described previously. The affected child was 8 months old. Deformity resolved without aggressive treatment. The pathogenesis of the focal lesion remains controversial. The most likely explanation is that the mesenchymal anlage of the TIBIAl metaphysis has for unknown reasons, developed abnormality at the insertion of the pes ansennus.

Background: This study aimed to compare a new posteromedial approach with a conventional anteromedial approach to treat extra-articular distal TIBIA fractures. Method: Thirty-two patients underwent distal TIBIA fracture surgery. The patients were divided into two groups (anteromedial: n=17 and posteromedial: n=15) and followed for one year. Approaches were compared regarding their union time, American Orthopedics Foot and Ankle Society (AOFAS) score, and complications. Results: AOFAS score was 87. 3 ±,3. 1 and 88. 5 ±,2. 8 in anteromedial and posteromedial groups, respectively, and there was no statistically significant difference (P-value = 0. 282). The union time was 6. 1 ±,3. 8 months and 6. 4 ±,3. 1 months in the groups, which was not statistically significant (P-value = 0. 807). The prevalence of non-union and delayed union was not significantly different between the two groups (p-value = 0. 99). Conclusion: The modified posteromedial approach is a safe and feasible alternative surgical method for distal TIBIA extra-articular fractures.

Background: Brucellosis, a zoonotic disease with worldwide spread, is a common disease in Iran and is endemic in Markazi Province. Brucella osteomyelitis, on the other hand, is a rare disease. Here we reported a case of brucella osteomyelitis of the TIBIA following trauma.Case: The patient was a 22 year old man referring with chronic draining TIBIA ulcer. He had a history of trauma of the TIBIA, dating back to 3 years ago, for which local prosthesis had been prescribed. Later on, the prosthesis had been removed due to infection. Staining of the tissue samples indicated the presence of gram-negative coccobacill and brucella growth in the culture of excretions. Conclusion: This case was reported because of rare presentation of brucella and the educational implications of the patient with respect to the possibility of brucella development in chronic ulcers or prosthesis. Although uncommon, brucellosis should be regarded as a potential cause of osteomyelitis in patients with a record of physical contact with animals.

BACKGROUND: The treatment of comminuted fractures in long bones has continued to be a problem in orthopedic surgery. Recently, fixation without exploration of the fracture site, known as "biologic fixation”, has been introduced. This study was performed to assess the results and complications of this method for the treatment of comminuted fractures of the TIBIA and femur. METHODS: The study included 41 patients with comminuted fractures of the TIBIA and femur treated with biologic plating from 2003 to 2006 (25 femur fractures and 16 TIBIAl fractures). After biological fixation joint motion was started but weight bearing was avoided until radiographic evidence of union was shown. RESULTS: The mean time of union in the TIBIAl fractures was 19±2 weeks and 17±2 weeks for the femur fractures. All patients had fracture union without any infection, non-union or implant failure. In one patient with a femur fracture there was a 10o internal rotation deformity. Two of the femoral fractures had shortening of 1 cm, and one patient had shortening of about 2 cm. Compared to similar studies, all results were statistically significant (P<0.05). CONCLUSIONS: The biologic plating method is a safe, simple and effective method of fixation for comminuted fractures of long bones. It has a high rate of union with minimal complications.

BACKGROUND AND OBJECTIVE: TIBIA fracture is one of the most common long bone fractures in body and primary treatment of open fracture always worries surgeons. The aim of this study was to evaluate the treatment of open TIBIA fractures by flexible medullary nailing.METHODS: This descriptive-analytical study was performed on 44 patients suffering from open TIBIAl fractures treated with flexible medullary nails in Shahid Beheshti and Yahyanejad hospitals from 1998-2001. In this study with limited incision, fixation of open fractures (gustilo type I to type IIIA) was done by 2-3 nails (3mm or 3.5mm). Demographic information associated with variables such as infection, for 1.5 years followed up in patients and data was analyzed by ANOVA test.FINDINGS: Mean age of patients was 29.8 years and 37(84.1%) patients were male. The average time of union was 6.1 months. There were 2(4.5%) patients with deep infection and 7(15.9%) with superfacial infection. Delayed union was seen in 4(9.1%) patients and malunion was seen in 1(2.3%) patient and there was not non-union.CONCLUSION: Results of this study showed that flexible medullary nailing is a reliable method for treatment of open TIBIA fractures.

Background: Open TIBIAl shaft fracture is the most common long bone open fracture, and its main complications are infection and non-union. Unreamed TIBIAl nails have been introduced to reduce such complications. We are reporting our experience with this instrument. Methods: 54 consecutive open TIBIAl fractures that had been treated with unreamed TIBIAl nails (UTN) were studied. There were 22 grade I, 19 grade II, 13 grade IIIA Gustilo-Anderson open fractures. The cases had an average of 11.5 months follow-up. Results: In the short-term follow-up of one year 14 cases (26%) of delayed union, 2 (3.6%) aseptic non-union, and 2 infections (3.6%) were encountered. The two non-unions and six of delayed unions were grade IIIA open fractures. The delayed unions were distal third shaft fractures in half of the cases. The time to union was 17.5 weeks on average- being longer for grade IIIA and distal shaft fractures. Conclusions: With this short-term follow-up report, UTN seems to be an effective instrument for open TIBIAl fractures.