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      Hindfoot Valgus following Interlocking Nail Treatment for Tibial Diaphysis Fractures: Can the Fibula Be Neglected?

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          Abstract

          Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level) managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function. Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Disability Index Score (FADI). Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%). Fibular shortening was identified in 42 fractures (68%). Mean fibular shortening was 1.2 cm (range, 0.5–2 cm). Clinical exams showed increased hindfoot valgus in 42 fractures (68%). The mean KOOS was 88.4, and the mean FADI score was 90. Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening.

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          Most cited references22

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          The hindfoot alignment view.

          A modification of Cobey's method for radiographically imaging the coronal plane alignment of the hindfoot is described. Using this view, we estimated the moment arm between the weightbearing axis of the leg and the contact point of the heel. Normative data on 57 asymptomatic adult subjects are presented. The weightbearing line of the tibia falls within 8 mm of the lowest calcaneal point in 80% of subjects and within 15 mm of the lowest calcaneal point in 95% of subjects. The technique for measuring coronal plane hindfoot alignment is reliable, with an interobserver correlation coefficient of 0.97. This radiographic technique should help in the evaluation of complex hindfoot malalignments.
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            Factors influencing functional outcomes after distal tibia shaft fractures.

            Surgical treatment of displaced distal tibia fractures yields reliable results with either plate or nail fixation. Comparative studies suggest more malalignment and nonunions with nails. Some studies have reported knee pain after tibial nailing. However, plates may be associated with soft tissue complications, such as infections or wound-healing problems. The purpose of this study was to assess functional outcomes after distal tibia shaft fractures treated with a plate or a nail. We hypothesized that tibial nails would be associated with more knee pain and that plates would be associated with pain from implant prominence, each of which would adversely affect functional outcome scores.
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              Vascularity in a new model of atrophic nonunion.

              Our aim was to develop a clinically relevant model of atrophic nonunion in the rat to test the hypothesis that the vessel density of atrophic nonunion reaches that of normal healing bone, but at a later time-point. Atrophic nonunion is usually attributed to impaired blood supply and is poorly understood. We determined the number of blood vessels at the site of an osteotomy using immunolocalisation techniques in both normally healing bones and in atrophic nonunion. At one week after operation there were significantly fewer blood vessels in the nonunion group than in the healing group. By eight weeks, the number in the atrophic nonunion group had reached the same level as that in the healing group. Our findings suggest that the number of blood vessels in atrophic nonunion reaches the same level as that in healing bone, but at a later time-point. Diminished vascularity within the first three weeks, but not at a later time-point, may prevent fractures from uniting.
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                Author and article information

                Journal
                Adv Orthop
                Adv Orthop
                AORTH
                Advances in Orthopedics
                Hindawi Publishing Corporation
                2090-3464
                2090-3472
                2014
                7 December 2014
                : 2014
                : 806363
                Affiliations
                1Orthopaedic Department, Acıbadem Maslak Hospital, Darüşşafaka Street, Büyükdere Street No. 40, Maslak, Sarıyer, Istanbul, Turkey
                2Orthopaedic Department, Şişli Etfal Training and Education Hospital, Şişli, Istanbul, Turkey
                3Okmeydani Education and Training Hospital, Okmeydani, Istanbul, Turkey
                4Orthopaedic Department, Kasımpaşa Military Hospital, Istanbul, Turkey
                5Orthopaedic Department, Medipol University, Istanbul, Turkey
                6Orthopaedic Department, Acıbadem University, Darüşşafaka Street, Büyükdere Street No. 40, Maslak, Sarıyer, Istanbul, Turkey
                Author notes

                Academic Editor: Allen L. Carl

                Article
                10.1155/2014/806363
                4273594
                dfb1039f-ff7f-481c-b63e-f0a79c08ba36
                Copyright © 2014 Metin Uzun et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 July 2014
                : 21 November 2014
                : 22 November 2014
                Categories
                Research Article

                Orthopedics
                Orthopedics

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