An analysis of Clinical Experience with Closed Tibia Fractures

Orthopedicrnimplants manufacturers and Delta Tibia / Femur Nailing System specialists in India. In thisrnstudy, we will try to summarize clinical research performed on a group of 1000+rnpatients with closed fractures of the tibia treated with prefabricated bracesrnat the Los Angeles County Institute of Southern California Medical Center. Asrnmentioned further that due to some social and economic factors, the finalrnevaluation of orthopedic implants and orthopedic instruments was possible inrnapproximately 800 patients only. Another considerable factor was that sevenrnnonunion were encountered (0.8%). Also, seventeen orthopedic implants and instruments like braces were removed orrnstopped in use because of shortening or for unacceptable angulation or becausernof skin complications. The method of injury that created these closed fracturesrnindicated that some were sustained in vehicle-related accidents and the remainingrnhad been caused by a direct blow over the extremity. On further analysis andrninsight of the extremities indicated that 35% of the patients had nornshortening. The remaining shortening ranged from the range of 1-30 mm. Thisrnalso implied that approximately 85% of the patients had shortening of less thanrn10 mm; in 8% shortening ranges somewhere between 1 and 15 mm, in other 3%rnbetween 16-20 mm, and in 0.5% between 21-30 mm.

The orthopedic implants manufacturersrnreport further suggested that no angular deformity was measured in some of thernpatients. More than 90% healed their fractures with less than 8 or 8.2rnangulation and a few rare cases had angulation in 11°. The most commonly observedrndeformity was of Varus. A total of 1.3% out of 700+ analyzed had angularrndeformities between 9° and 10° and few had varus angulation between 11°rnand15°. 
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rnOther major findings as analyzed by our team of ortho surgical implants in India and traumarnimplants suggested that as per the report we can conclude that the degreernof initial displacement of the fracture is somewhat claimed responsibility for thernspeed of healing. This was observed on the fact that the fractures with lessrnthan 10 % displacement healed in an average of 15 weeks, those between 42% - 50%displacementrnin an average of 19.8 weeks, and those between 81° and 90° in an average of 23.3rnweeks; while those higher healed in 20 weeks.

Going further, let’s analyzernsome other factors. Talking about the age, the age of these patients was in thernrange 22-54 years and the fractures in 18 patients were the result of vehicular accidents. Fractures were categories in three grade I, grade II and grades III,rnand one exception caused by a gunshot wound. Eighteen ortho surgicalrnimplants fractures had an associated fibula fracture and most among these casesrnwere initially treated by closed reduction and application of a long-leg cast.rnRemaining was treated with an external fixator or interlocking nails andrnlocking plates. A fibular osteotomy (A surgical procedure for medialrncompartment knee osteoarthritis and is an alternative to highrntibial osteotomy) was performed in two cases, one at 2 weeks with anrnintact fibula and one at 6 months in a patient with an oblique middle fracturernand an associated fibular fracture that had already joined earlier.

Many bracesrn(40+) were discontinued during treatment owing to progressive angulation or duernto loss of corrected shortening. These cases of patients were advised tornundergo an operation to correct their abnormality. Some others could not wearrntheir brace due to exasperation of preexisting soft tissue wounds and wererntreated in a below-the-knee functional cast until joining of the bone. Out of these,rnsome were unable to handle the functional brace. These patients were treated inrna below-the-knee functional cast until union.

After thernapplication of the prefabricated brace,rn3% of them required manipulation of fractures which was performed with thernpatient flexing his leg over the rim of the examining table which was donernunder sedation. In these cases, the braces were temporarily discontinued forrnfew weeks and long-leg casts were applied.
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