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Ilizarov apparatus
Type of external fixation (medical device)
The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to lengthen or reshape limb bones; as a limb-sparing technique to treat complex and/or open bone fractures; and in cases of infected nonunions of bones that are not amenable with other techniques. It is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique.
History[edit]
Ilizarov used external fixation devices on patients to treat non-unions in the 1950s.[1] Ilizarov observed the callus formation and discovered distraction osteogenesis when one patient lengthened his frame rather than compressing it.[1] The procedure, and the first apparatus he designed for it, was inspired by a shaft bow harness on a horse carriage (see photo to the right).[2] Originally bicycle parts were used for the frame.
The technique gained fame across the Soviet Union when he successfully treated Soviet world-record holder, and gold medalist high jumper, Valery Brumel in 1968.[1][2] Brumel broke his tibia in a motorcycle accident and had 20 unsuccessful operations over a three-year period to try to repair his non-union.[2] Ilizarov used distraction osteogenesis to heal the non-union and 3.5 cm (1.4 in) leg length discrepancy.[2]
Ilizarov gained more fame in 1980 when he successfully treated Italian journalist and adventurer, Carlo Mauri.[1][3] Mauri had broken his leg in a skiing accident ten years earlier and his tibia never properly healed.[1] When he was on an expedition across the Atlantic, the wound on his leg reopened and a Russian doctor advised him to see Ilizarov.[1][3] When Mauri returned to Italy after his treatment, Italian doctors were impressed that his tibial non-union was repaired.[1] They invited Ilizarov to speak at the Italian AO Conference in Bellagio.[1] This was the first time Ilizarov spoke outside of the "Iron Curtain".[3]
The technique was brought to the US in 1987 by Victor Frankel, president of Hospital for Joint Diseases,[3] and Dr. Stuart Green who, in 1992, edited the first English translation of Ilizarov's book.
The Ilizarov external fixators can be used to correct angular deformity in the leg, to correct leg-length differences, and treat non-unions.[1] In most developing countries it is a highly specialized technique used mainly for deformity correction by experienced surgeons due to its complexity. Further development of the ring construct led to the Taylor Spatial Frame which is more versatile and far easier to use, but very costly. Intramedullary limb lengthening devices are also available, but are also a very costly option.
Mechanics and physics[edit]
The device is a specialized form of external fixator, a circular fixator, modular in construction. Stainless steel (or titanium) rings are fixed to the bone via stainless heavy-gauge wire (called "pins" or Kirschner wires). The rings are connected to each other with threaded rods attached through adjustable nuts. The circular construction and tensioned wires of the Ilizarov apparatus provide far more structural support than the traditional monolateral fixator system. This allows early weightbearing.
The apparatus is based on the principle which Ilizarov called "the theory of tensions". Through controlled and mechanically applied tension stress, Ilizarov was able to show that the bone and soft tissue can be made to regenerate in a reliable and reproducible manner.[4] The top rings of the Ilizarov (fixed to the healthy bone by the tensioned wire) allow force to be transferred through the external frame (the vertical metal rods), bypassing the fracture site. Force is then transferred back to the healthy bone through the bottom ring and the tensioned wires. This allows the Ilizarov apparatus to act as a sort of bridge, both immobilizing the fracture site and relieving it of stress, while allowing for the movement of the entire limb and partial weight-bearing. Middle rings (and tensioned wires) act to hold the bone fragments in place and to give greater structural support to the apparatus and limb. However, the critical load bearing rings are the top and bottom rings which transfer the force from the healthy bone down to the healthy bone, bypassing the fracture site.
Bone lengthening and reshaping[edit]
In addition to being used to support a fractured limb, the Ilizarov frame is also commonly used to correct deformity through distraction osteogenesis.
The procedure consists of an initial surgery, during which the bone is surgically fractured and the ring apparatus is attached. As the patient recovers, the fractured bone begins to grow together. While the bone is growing, the frame is adjusted by means of turning the nuts, thus increasing the space between two rings. As the rings are connected to opposite sides of the fracture, this adjustment, done four times a day, moves the now-healing fracture apart by approximately one millimeter per day. The incremental daily increases result in a considerable lengthening of the limb over time. Once the lengthening phase is complete, the apparatus stays on the limb for a consolidation period. The patient is able to fully weight bear on the Ilizarov frame, using crutches initially and pain is lessened. Once healing is complete, a second surgery is necessary to remove the ring apparatus. The result is a limb that is significantly longer. Additional surgery may be necessary, in the case of leg lengthening, to lengthen the Achilles tendon to accommodate the longer bone length. The major advantage of this procedure is that because the apparatus provides complete support while the bone is recovering the patient can remain active aiding recovery.
A further use is in bone transport, whereby a defect in a long bone can be treated by transporting a segment of bone, whilst simultaneously lengthening regenerating bone to reduce the defect and finally dock with the other segment, producing a single bony unit.
While the Ilizarov apparatus is minimally invasive (no large incisions are made), it is not free of complications. Pain is common and can be severe, but is treatable with analgesics. Careful attention to cleaning and hygiene is necessary to prevent pin site infection. Other complications include swelling, muscle transfixion, and joint contractures. Physical therapy is often indicated.
Bone fracture treatment[edit]
The Ilizarov method is widely used to treat complex and/or open bone fractures. This method is preferred over conventional treatment options (such as internal fixator or cast) where there is a high risk of infection or the fracture is of such severity that internal fixators are unworkable. Journalist Ed Vulliamy wrote a detailed description from the patient's viewpoint of Ilizarov apparatus treatment of a bad fracture.[5]
Images[edit]
The following case study illustrates the Ilizarov apparatus treatment procedure for a fractured limb. The photographs are of the same patient during the course of treatment.
X-Ray of fracture and initial external fixator applied within 24 hours of patient's admission to hospital
Front-left view of the Ilizarov apparatus treating a fractured tibia and fibula. The patient suffered an open fracture. It is located slightly above black metal ring. Photographs 1 through 4 are taken four weeks following the fracture and two weeks following the installation of the Ilizarov apparatus.
Front (top) view with a view of the healthy leg. The patient is lying on his stomach.
View of several pin sites (two weeks following surgery)
X-Ray of the fracture site immediately following the application of the Ilizarov method
X-Ray of the fracture site, part 1 (two months following fracture)
X-Ray of the fracture site, part 2 (two months following fracture)
X-Ray of the fracture site (three months following fracture). Note formation of bone callus around fracture site.
X-Ray of the fracture site, part 2 (three months following fracture). Note formation of bone callus around fracture site.
X-Ray of the fracture site, part 2 (four months following fracture)
See also[edit]
References[edit]
- ^ abcdefghiSpiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR. (2010). "Ilizarov principles of deformity correction". Annals of the Royal College of Surgeons of England. 92 (2): 101–5. doi:10.1308/003588410X12518836439326. PMC 3025247. PMID 20353638.CS1 maint: uses authors parameter (link)
- ^ abcdSvetlana Ilizarov (2006). "The Ilizarov Method: History and Scope". In S. Robert Rozbruch; Svetlana Ilizarov (eds.). Limb Lengthening and Reconstruction Surgery. CRC Press. pp. 3–6. ISBN .
- ^ abcdSvetlana Ilizarov (2006). "The Ilizarov Method: History and Scope". In S. Robert Rozbruch; Svetlana Ilizarov (eds.). Limb Lengthening and Reconstruction Surgery. CRC Press. pp. 15–16. ISBN .
- ^Paley, Dror; Kovelman, Harry F; Herzenberg, John E (October 1993). "Ilizarov technology". In Stauffer, Richard (ed.). Advances in Operative Orthopaedics: Volume 1(PDF). Mosby Inc. pp. 243–287. ISBN . Archived from the original(PDF) on 19 March 2012. Retrieved 14 January 2012.
- ^Ed Vulliamy (13 December 2015). "How Comrade Ilizarov saved my leg". The Observer. Retrieved 13 December 2015.
External links[edit]
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Duration of incapacity of work after tibial plateau fracture is affected by work intensity
- Research article
- Open Access
- Published:
BMC Musculoskeletal Disordersvolume 19, Article number: 281 (2018) Cite this article
34k Accesses
13 Citations
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Abstract
Background
Tibial plateau fractures requiring surgery are severe injuries of the lower extremity. Tibial plateau fractures have an impact not only on physically demanding jobs but notably on general professional life too. The aim of this study was to assess how the professional activity of patients will be affected after a tibial plateau fracture.
Methods
39 consecutive patients (ages 20–61 years) were retrospectively included in the study and were clinically examined at a minimum of 14 month postoperatively. Inclusion criteria were surgical treatment of tibial plateau fractures between November 2009 and December 2012. The clinical evaluation included the Lysholm score and the Oxford Knee Score. Fractures were classified and analyzed using the AO classification. Intensity of work was classified as established by the REFA Association. The patients themselves provided postoperative duration of the incapacity of work and subjective ratings.
Results
17 (43.6%) women and 22 (56.4%) men were examined with a mean follow-up of 29.7 ± 10.4 months (range 14–47). According to the AO classification there were 20 (51.3%) B-type-fractures and 19 (48.7%) C-type-fractures. The median incapacity of work was 120 days (range 10–700 days) with no significant differences between B- and C-type-fractures. Four (10.3%) patients reduced their working hours by 10.5 h per week on average. Patients with low workload (REFA 0–1, median incapacity of work 90 days, range 10–390 days) had a significant shorter incapacity of work than patients with heavy workload (REFA 2–4, median incapacity of work 180 days, range 90–700 days) (p < 0.05). The median Lysholm score decreased significantly from 100 points (range 69–100) before the injury to 73 points (range 23–100) at the time of the follow-up. All patients received postoperative physiotherapy (median 25 appointments, range 6–330), with a significant higher number of appointments for C-type-fractures than for B-type-fractures (p = 0.004).
Conclusion
A relationship was found between workload and the duration of incapacity of work after tibial plateau fractures. The post-injury shift to less demanding jobs and the reduction of working hours highlight the impact of a tibial plateau fracture on a patient’s subsequent physical ability to work.
Peer Review reports
Background
Tibial plateau fractures are severe joint injuries of the lower extremity. Since a notable number of patients sustaining tibial plateau fractures are young, active and in the middle of their working life, these injuries may have a profound effect on the individual’s professional career. The fracture patterns range from non-displaced split fractures and slightly or severely displaced depression fractures to complex comminuted fractures with severe destruction of the joint lines and cartilage lesions. Since the clinical outcome after tibial plateau fractures is closely related to the quality of the reduction [1, 2], each surgical technique must aim for an anatomic reconstruction of the injured joint. However, despite sophisticated understanding of the fracture patterns and modern anatomic angular stable implants the precise reconstruction of displaced or comminuted tibial plateau fractures can be challenging even for experienced trauma surgeons [3].
In the past surgeon oriented outcome measurements such as the Tegner-, Lysholm- or Oxford-Score were widely accepted and established as the only clinical outcome measurement in knee surgery [4, 5]. Other studies focused on return to sports after tibial plateau fractures [6, 7] but overtime patient-reported outcome measurements have gained importance as well as tools for assessing the return to daily activity and working life [8, 9].
However, so far no study has considered the sequelae after tibial plateau fractures and the impact on returning to work or subsequent work intensity. Therefore, the aim of this study was to determine the time until return to work and the professional capacity of patients after operative treatment of tibial plateau fractures. In particular, the study analyzed different work categories and different work intensities. The hypothesis was that heavy load workers would return to work later than white-collar workers.
Methods
One hundred and twenty-four consecutive patients were treated surgically for tibial plateau fractures between November 2009 and December 2012 at a level I trauma center. Thirty –nine patients were included in this retrospective study. Inclusion criteria were surgically treated tibial plateau fractures, working capacity/employability at the time of the injury, age between 18 and 65 years (65 years is the normal date of retirement). Exclusion criteria were concomitant injuries of the same extremity (5), polytraumatized patients (9), posttraumatic conditions (3), age under 18 (4) / over 66 (42) – Fig. 1.
Patient flow chart
Full size image
All fractures were classified according to the AO-classification (Arbeitsgemeinschaft Osteosynthese) [10].
Clinical outcome and scores: Lysholm and Oxford Knee Score
The follow-up visit included a clinical examination, the assessment of the Lysholm score [4] and the Oxford-knee-score.
Work incapacity, REFA classification and reduction in earning capacity
A specific questionnaire was applied to gather data about the patient’s working live, work intensity, rehabilitation and sporting activity. The work intensity was classified according to the REFA Association (Table 1) [11,12,13]. To evaluate the health-related quality of life the SF-36-questionnaire was used.
Full size table
Radiological assessment
All fractures were assessed radiologically on plain radiographs of the knee in two planes. The severity of posttraumatic osteoarthritis was judged according to the score of Kellgren and Lawrence [14].
Surgical procedures
The treatment of tibial plateau fractures in this study group was performed according to the AO principles [15,16,17]. CT scans are in most cases essential; in case of temporary external fixation, the CT scan is recommended to be performed after the external stabilization because with stretching of the fixateur an initial reposition is achievable [3]. Due to better visualization and understanding of the fractures themselves postero-lateral or postero-medial fragments were addressed as key fragments [16,17,18] (Figs. 2, 3, 4, and 5). Luo et al. have established a three-column fixation approach, especially useful for multiplanar fractures involving the posterior column [19], which was applied in this study group when necessary.
Massive destruction of the joint lines. Initial reposition in external fixator. AO 41 C3
Full size image
Double buttress plating and reconstruction of the joint lines
Full size image
Long-term, 4 years follow-up with signs of osteoarthritis - Lysholm 89
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Long standing X-ray showing straight axis with no difference to contra-lateral side
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Post-operative protocol
Partial weight bearing is essential in the aftercare of tibial plateau fractures. The aftercare protocol was standardized and equal for all patients with 6 weeks of partial weight bearing.
Statistics
SPSS (Version 22, IBM Corp for Windows) was used for statistical analysis of the data. Correlation tests were performed using the Pearson and Spearman correlation coefficient and normally distributed results were compared using student’s t test. Non-normally distributed data were compared using the Mann-Whitney U test. All results are stated as mean ± standard deviation or median. The level of significance was presumed at p < 0.5. The statistical analysis was performed under guidance of the local institute for Clinical Epidemiology and Applied.
Results
Demographics
In total 39 patients were examined in the survey. All questionnaires were duly completed and all patients consented to the x-ray-examination. In 14 cases the treatment was performed in a two-stage procedure (external fixator / definite surgery). In all patients angular stable implants were used. Within the study group there were no infections, compartment syndromes or vascular injury.
The mean postoperative follow-up was 29.7 ± 10.4 months (range, 14–47). Our study group included 17 (43.6%) women and 22 (56.4%) men. The average age for both men and women at the time of the accident was 45.9 ± 10.1 years (range, 20–61).
27 (69.2%) fractures affected the left leg, 12 (30.8%) the right leg. According to the AO classification 51.3% of the fractures were B-type-fractures and 48.7% were C-type-fractures – Table 2.
Full size table
Causes of accident
The most common cause of tibial plateau fractures in the presented study group was sports accidents (41.0%), followed by low-energy-traumas (28.2%) such as falls from low height. Other common causes were traffic accidents (23.1%) and domestic accidents (7.7%). 13 (33.3%) fractures resulted from work-related accidents.
Work incapacity, REFA classification and reduction in earning capacity
The median stay at hospital took 12 days (range 4–32) for the whole patient group. Patients with B-type-fractures (10 days, range 4–21) stayed a significantly shorter period than patients with C-type-fractures (20 days, range 5–32) (p = 0.034).
The median incapacity of work was 120 days (range 10–700) and there was no significant difference between B- and C-type-fractures. Four (10.3%) patients had to reduce their working hours by 10.5 h per week on average. Two patients retired after the rehabilitation due to the sustained tibial plateau fracture. Five patients had to reduce their work intensity, but four of them stayed within the same profession due to workplace modifications. One of these patients had to change his profession due to the functional impairment after the tibial plateau fracture.
According to the REFA classification patients (n = 23) with low work intensity (REFA 0 and 1) had a significantly shorter duration of work incapacity than patients (n = 13) with heavy work intensity (REFA 2–4) (Table 3). The longest duration of work incapacity was seen in the patients with C-type-fractures, who coincidentally were heavy load workers.
Full size table
Reduction in earning capacity was noted in seven patients. The reduction in earning capacity was scored between 10 to 30% on average. The distribution of fracture types was equal between B (3 patients)- and C (4 patients)-type-fractures.
Clinical outcome and scores
Thirty-one patients received postoperative physiotherapy (median 25 appointments, range 6–330). Eight patients were directly discharged to a rehabilitation clinic. There was a significant difference in the number of appointments between B- and C-type-fractures. The median of appointments for physiotherapy in patients with C-type-fractures was significantly more (50, range 10–330) than patients with B-type-fractures (18, range 6–56) (p = 0.004).
The patients were asked how physically fit they felt compared to the time before the fracture. At follow-up 72% of the patients felt physically less fit, 25,6% felt like having an equal level of physical fitness and only one patient felt fitter.
The median of the Lysholm Score decreased significantly from 100 (range 69–100) before the injury to 73 (range 23–100) at the time of the follow-up. Regarding the categories of the Lysholm score (excellent 91–100 points, good 84–90, fair 65–84, poor < 65) 92.3% of the patients had excellent results before the injury, whereas after the fracture 71.8% showed fair or poor results. In C-type-fractures a higher percentage showed fair or poor results (78.9%) compared to B-type-fractures (65.0%).
The median of the Oxford knee score (OKS) was 41 points (range 15–48) with no significant differences between B- and C-type-fractures.
All results for the SF-36 subscales were compared to the results of a standard population (Table 4). The results of 5 subscales for our study cohort were lower than for the standard population, the results of 3 subscales (general health perception, social role functioning, mental health) were higher. There were no significant differences in the results for B- and C-type-fractures.
Full size table
Radiological outcome
In 12 cases (30.8%) there was no difference in the x-ray assessment regarding osteoarthritis in comparison to contralateral. In 18 patients the injured knee joint was rated to be more affected by osteoarthritis compared to contralateral by one subscale according to Kellgren / Lawrence [13]. There was a difference by two subscales in eight patients (20.5%) and by three subscales in one case (2.6%).
Discussion
The most important finding of this study was that incapacity of work was longer in the group with higher workload (median 180 days) compared to the group with low workloads (median 90 days). Given that we noted good mid-term results 29.7 months postoperatively (SD 10.4 months (range 14–47)), this cohort showed a good maintenance of knee function over time, particularly when considering that posttraumatic arthrofibrosis can often have a quick onset. However, a notable number (9 / 23.1%) of patients reported difficulties at their jobs forcing five employees to change to jobs with lower physical strains over time and forcing four patients to reduce the number of working hours per week (10.5 h/week). Although, despite there a relationship being found between the incapacity of work and workload, there was no such correlation concerning the fracture type. The median incapacity of work was 120 days (range 10–700 days) with no significant differences between B- and C-type-fractures.
In the literature several studies have already reported the outcomes after tibial plateau fractures (Table 5). The clinical results concerning the Lysholm Score 73.0 and Oxford Knee Score 37.3 ± 9.81 were in all subgroups comparable to those reported previously (Table 5).
Full size table
In recent years patient reported outcome measures (PROMs) are gaining importance as these measures more reflect the satisfaction of patients after surgery rather than other outcome measures [20]. Just recently Baumann et al. reported on a study group of 77 skiers after tibial plateau fractures in a long-term follow-up study. It was found out that the PROM-score “forgotten knee score (FJS)”, which had been measured initially at arthroplasty, also significantly correlates with osteoarthritic radiologic knee joint degeneration in fracture cases [9].
However, to our knowledge there is no study that specifically considered return to work after sustained tibial plateau fractures.
Roßbach et al. recently examined patients after operatively treated tibial plateau fractures regarding the quality of life and the job performance. In that study polytraumatized patients and patients with other concomitant injuries of the same limb were included [21] making a comparison to other studies difficult. Eleven out of forty-one patients did not return to work, three patients had to change the profession after the injury after a follow-up of 47 month postoperatively.
Stevens et al. (2001) examined the outcome of 47 patients with operatively treated tibial plateau fractures with a mean follow-up of 8.3 years. They found similar results in the SF-36 scores for most of their patients under the age of forty compared to the healthy age-matched population. In the forty-and-over age group nine patients showed lower results in the SF-36 score compared to the healthy age-matched group. They found that the age of the patients seems to have more influence on the functional outcome rather than the type of the fracture and adequacy of reduction [22]. Also whereas the workload showed an effect on the incapacity of work in this study, age seems to be a minor factor for the clinical outcome. The subgroup analysis showed no differences in patients between 20 and 29 years, 30–45 years and patients between 46 and 65 years of age. We limited the inclusion to an age of 65 years of age because most employees retire at 65 years. This may create a certain bias in our study group as 42 elderly patients were excluded. So we cannot give any details about the recovery and final outcome of these patients. However, the average ages of the patients in this study group can be compared to the previously published studies.
In 2005 Litz et al. reported in his study significant differences in the results of the functional and radiological scores for the different types of tibial plateau fractures. Patients with C-type-fractures had worse results than patients with A- or B-type-fractures. Patients with C-type-fractures had a significant longer incapacity of work (40.5 weeks on average) than patients with A-type-fractures (21.1 weeks) and B-type-fractures (21.9 weeks) [23]. Yao et al. (2014) also found that C-type-fractures had the worst functional score results [24]. It would also be interesting to compare outcomes of infected osteosynthesis or patients with compartment syndrome in a long-term follow up. Fortunately we cannot provide any data, as none of the included patients sustained any of these complications. These complications were noted in the excluded polytraumatized patients.
There are also studies that report on the outcomes in sportsmen, including alpine skiers. Loibl et al. reported that overall only 49% of skiers returned to alpine slopes after a sustained tibial plateau fracture [7]. However, alpine skiing demands highest grades of physical exertion.
Similar results are reported by Kraus et al. in a study with 89 patients after tibial plateau fractures [6]. In this detailed study patients were asked about their sporting habits before, 1 year after injury and at 4.4 years after injury. Interestingly the hours of sports performance did not significantly shrink in the final follow-up. It was observed that patients continued to perform sports but on a less demanding level, shifting form high-impact sports to sports like Nordic walking or swimming.
In the context of knee surgery Schröter et al. studied specific impairments after high tibial osteotomy and also measured the time of return to work and the postoperative workload [12]. In this study the patients returned to work 87 days after surgery (median 87; range 14–450 days). Whether the earlier return to work is related to a better fitness and activity level of the patients undergoing elective surgery remains speculation. Also in that study patients in heavy workload groups needed more time for recovery. The Lysholm Score revealed values of 81.7 ± 12.7 that are similar values to the study group presented and to the studies as shown in Table 5.
In comparison to the upper extremity the time until return to work is longer for patients undergoing knee surgery. A recently published study describes return to work after arthroscopic Bankart repair after 2.06 month (95% CI 1.55–2.68) for jobs with low physical strains and 3.40 month (95% CI 2.70–4.24) for jobs with high physical strains [11].
Several limitations of this study should be considered. The rehabilitation program was only standardized in the first weeks post-surgery. Also an impaired proprioceptive function after successful tibial plateau reconstruction may have hindered return to heavy work. As we assessed operatively treated fractures only, conclusions regarding conservatively treated, possibly less severe fractures are therefore not possible. A further limitation is the small inclusion rate of only 31%. Furthermore the retrospective study design, the heterogeneous patient population and the variation in the length of the follow-ups are noted limitations. However, this study provides first data concerning the incapacity of work and the rehabilitation time for different work groups according to their intensity of work. With the improved anatomically pre-shaped implants and the improved understanding of the tibial plateau fractures future studies need to prove the presented data in a prospective and longitudinal manner.
Conclusion
In this study, a relationship was found between work intensity and the duration of incapacity of work after surgically treated tibial plateau fractures. The post-injury shift to less demanding jobs and the reduction of working hours highlight the impact of a tibial plateau fracture on a patient’s physical ability to work.
The long rehabilitation periods may stimulate demand for intense and standardized rehabilitation programs, especially for high intensity workers.
Abbreviations
Arbeitsgemeinschaft Osteosynthese
“Reichsausschuß für Arbeitszeitermittlung”
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Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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BG Trauma Center, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
Tobias M. Kraus, Charlotte Abele, Atesch Ateschrang, Ulrich Stöckle, Fabian M. Stuby & Steffen Schröter
Paracelsus University Salzburg, Landeskrankenhaus Salzburg, Salzburg, Austria
Thomas Freude
Contributions
TMK, CS, TF, AA, US, FMS, SS contributed in a significant way in the steps of processing the patient history as well as writing and editing the manuscript. TMK and AA conceived the idea for the study/publication, planning of the whole study and engaged in writing the manuscript. SS and CA provided expertise in collection of the data, statistics and graphical work. TF edited and reviewed the manuscript and gave advice throughout the project and reviewed the manuscript. US and FMS were involved in the planning and the review process. All authors read and approved the final manuscript.
Corresponding author
Correspondence to Tobias M. Kraus.
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Kraus, T.M., Abele, C., Freude, T. et al. Duration of incapacity of work after tibial plateau fracture is affected by work intensity. BMC Musculoskelet Disord19, 281 (2018). https://doi.org/10.1186/s12891-018-2209-1
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Keywords
- Knee
- Tibial plateau fracture
- Professional activity
- REFA
- Return to work
Broken leg
A broken leg (leg fracture) will be severely painful and may be swollen or bruised. You usually will not be able to walk on it.
If it's a severe fracture, the leg may be an odd shape and the bone may even be poking out of the skin.
There may have been a "crack" sound when the leg was broken, and the shock and pain of breaking your leg may cause you to feel faint, dizzy or sick.
What to do
If you think you or someone else has broken their leg, go immediately to your nearest accident and emergency (A&E) department.
Call 999 for an ambulance if the injury seems severe or you're not able to get to A&E quickly.
While you make your way to A&E or wait for an ambulance:
- avoid moving the injured leg as much as possible – keep it straight and put a cushion or clothing underneath to support it
- do not try to realign any bones that are out of place
- cover any open wounds with a sterile dressing, a clean cloth or a clean item of clothing – maintain direct pressure on the wound if it is bleeding
If the person is pale, cold and sweaty (in shock), lie them down and keep them warm and calm until you can get medical help.
How a broken leg is treated
Immobilisation
First, a healthcare professional will give you painkillers and may fix a splint to your leg to secure it in position and prevent further damage.
For severe pain, you may be given painkilling gas through a face mask or medicine through a drip into a vein.
An X-ray will be done to assess the fracture.
If the broken bone is still in position, you'll usually just need a plaster cast. This holds the bone in place so it can heal.
If there's a lot of swelling, you may just have a splint or cast around the back half of your leg until the swelling goes down. A full cast can be fitted a few days later.
You may be provided with painkillers to take home and information on how to look after your cast.
Read more about how to care for your plaster cast.
Reduction
If the bones are misaligned, a doctor or surgeon may need to put them back into place. This is known as reduction.
Sedatives are sometimes provided before the procedure and local or regional anaesthetic is used to numb the site of the break.
In some cases a general anaesthetic is needed, which means you'll be asleep during the procedure.
Once the bones are in the correct position, a plaster cast can be applied.
Surgery
Severe fractures are often treated with surgery to realign and fix the broken bones. Surgeons can fix bones with metal wires, plates, screws or rods.
Plates, screws and rods will usually be left in place permanently unless they become a problem, whereas wires will be removed 4 to 6 weeks after the operation.
Sometimes an external frame (external fixator) is attached to the broken bones with metal pins to help keep them in place. This is removed once the fracture has healed.
After surgery, a plaster cast may be applied to protect the leg.
Follow-up appointments
An appointment will be made for you to attend a fracture clinic so specialist orthopaedic doctors can monitor your fracture.
The first appointment is usually booked for a week or 2 after you're discharged from hospital.
Severe fractures will usually heal within 3 to 6 months, but may require follow-up appointments every few months for a year or more afterwards.
Further X-rays are often necessary to check how well your leg is healing.
Recovering from a broken leg
You'll be given advice by your doctor about how much you should move your leg and when you can put weight on it.
It takes around 6 to 8 weeks for a minor fracture to heal. You'll probably need to use crutches or a wheelchair during this time, until it's possible to put weight on the leg again.
You'll be shown how to safely use any mobility equipment you're provided with.
More severe fractures can take between 3 and 6 months to fully heal. Some can take even longer.
The hospital may recommend regular physiotherapy appointments to help you maintain or regain muscle strength, movement and flexibility.
This will include specific exercises to do before and after the cast is removed.
Do not try to rush your recovery by returning to your normal activities too quickly, as the broken bone may not be fully healed even when the pain has gone.
Follow the advice of your doctor, who'll probably recommend gradually increasing how much you use your leg over time.
You should not drive while in a cast. Seek advice from your doctor about when you can drive again.
Possible complications
For most people, a broken bone will heal within a few months and there will not be any further problems.
But complications can sometimes occur.
Damaged muscle, nerves or blood vessels
Damage around the fracture can occur during the initial injury or during surgery.
It may lead to loss of movement or feeling, or may affect the blood supply to the limb.
Bone infection
This is more likely if surgery is performed or the broken bone stuck out of the skin.
It can significantly delay healing and will often require treatment with antibiotics, surgery, or both.
Compartment syndrome
Compartment syndrome is a painful and potentially serious condition caused by bleeding or swelling within a bundle of muscles.
This can occur soon after a fracture, after the plaster cast has been applied, or after surgery.
Emergency surgery will usually be needed to relieve the build-up of pressure in your leg.
Other complications
Occasionally, a further operation may be needed if the bone does not heal properly.
This can happen if the bone doesn't align properly during surgery, you put too much weight on the bone before it heals, the fracture is severe, you have diabetes, or you smoke during your recovery.
Types of fracture
Some broken bones are more serious than others – it depends on the location of the fracture, how the bone has broken, and whether there's any damage to the surrounding tissue.
The most common types of fracture are:
- stress fractures – tiny cracks in the bone caused by overuse, common in athletes
- undisplaced or hairline fracture – a fracture through the bone with little damage to the surrounding tissue
- displaced fracture – the 2 parts of the broken bone have moved apart (misaligned)
- comminuted fracture – the bone has broken (shattered) into several pieces
- open or compound fracture – a complicated break where the bone has broken through the skin, or the initial injury has exposed the broken bone
Page last reviewed: 15 September 2021
Next review due: 15 September 2024
How much is a broken leg worth in a lawsuit?
Broken legs are the most commonly reported fractures resulting from car, truck, or motorcycle accidents and occur when the legs come in contact with a hard surface such as a dashboard, car door, or pavement.
Treatment of these types of injuries depends on their severity.
Surgery is often necessary and implant devices such as screws or pins may be needed to keep the bones properly aligned while they heal.
In the most severe compound fractures, doctors will use external rods, braces, and attachments to stabilize the fracture and allow it to fuse properly.
Leg fractures requiring external hardware for stabilization have significantly higher values because they are extremely painful and tend to lead to long-term arthritis.
Recovery of lower extremity fractures can take anywhere from several weeks to over a year.
Even when a broken leg doesn’t require extensive surgical procedures, it can still limit a person’s ability to work or do the things they used to enjoy until the fracture is fully healed.
You may not be able to work at all. Or you may have to miss work frequently to attend doctor appointments and physical therapy.
Being out of work for weeks or months at a time is bad enough. And in some cases, a broken leg never fully heals, and patients must contend with a long-term disability and a lifetime of pain.
In cases of extreme severity, amputation may be necessary.
How much compensation will I get for a broken tibia and fibula?
Because each accident is different – different types of vehicles involved, different circumstances that led to the crash, different insurance policies, different treatment plans needed, etc. – there is no set number for determining the compensation that you will receive for a broken leg.
Remember, the facts of the case are the most important factor in any personal injury case.
If your accident was caused by another person’s negligence, you are entitled to recover damages for the cost of your immediate medical treatment, any surgical procedures, long-term care, lost wages, out-of-pocket expenses, and pain and suffering.
What is the average settlement for a broken leg?
You cannot negotiate with the insurance company for a fair settlement for your injury until you have an idea of what your broken leg claim is worth.
The average settlement value for a fibula or tibia fracture in a personal injury lawsuit is around $70,000 to $90,000.
Broken femurs get twice as compensation with an average settlement value of $150,000 to $175,000.
Do you need an attorney for your broken leg claim?
If you've suffered a broken leg or any broken bone in a car crash or other accident, you need legal advice to ensure that you get a fair settlement amount from the insurance company.
You have been injured and there’s no shame in getting reimbursed for lost wages and trying to get back what the accident took away from you. Our team will walk with you every step of the way. No gimmicks.
We set ourselves apart by taking the time to actually listen and go the extra mile.
We will work with your doctors to get a full understanding of your injury and limitations.
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Broken Leg: If my tibial shaft fracture gets surgery, when can I start walking on it?
When surgery is required for a broken bone, its important for patients to realize that the bone still needs time to heal after surgery . The purpose of surgery for treating a broken bone is to re-align the bone so that it heals in the correct position...however, the bone still needs 6 weeks or longer (depending on the location of the break) to fully heal. Basically surgery does not cause the bone to immediately fuse back together, it just holds the bone together so that over time, it fuses in the correct position.
If a broken bone does not require surgery, it usually means that the break didn't cause the bone to move out of position, and therefore the bone just needs time to heal. However, most orthopedic surgeons dont allow people to walk on a broken leg bone immediately because they dont want something to happen that causes the bone to move out of normal alignment. Therefore, if a tibia (leg bone) is broken and not going to get surgery, its usually placed in a long leg cast for a few weeks.
One advantage of surgery, is that people dont have to wait up to 22 weeks for the broken leg to heal before they can start walking again. If an "intramedullary nail" is used to fix the broken tibia (this is the most common type of surgery for a broken leg), people can typically walk on the leg immediately after surgery without a risk of the bone moving out of position or failing to heal properly.
You would think that walking on a broken bone would prevent it from healing...but in reality, the pressure on the bone stimulates growth factors and the bone cells (osteoblasts) to start healing. There have been a number of studies to suggest immediate weight bearing after fixing a broken tibia with an intramedullary nail (tibial IMN) is safe and effective.
Its also been shown in other bones, like the femur, that immediate weight bearing is ok.
References.
1. Coles CP, Gross M. Closed tibial shaft fractures: management and treatment complications. A review of the prospective literature. Can J Surg. 2000;43:256–262. full article.
2. Can Tibial Shaft Fractures Bear Weight After Intramedullary Nailing A RandomizedControlled Trial. Gross SC et al. J Orthop Trauma. 2016 Jul;30(7):370-5. see paper. no difference in full weight bear and nonweight bearing on overall healing (still takes about 22 weeks to achieve union).
3. Sarmiento A, Latta LL. Fractures of the middle third of the tibia treated with a functional brace. Clin Orthop Relat Res. 2008;466:3108–3115. see paper.
4. Brumback RJ, Toal TR Jr, Murphy-Zane MS, et al. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail. J Bone Joint Surg Am. 1999;81:1538–1544. full article.
5. Arazi M, Ogun TC, Oktar MN, et al. Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures: is it a safe procedure? J Trauma. 2001;50:711–716. see full article.
6. McKibbin B. The biology of fracture healing in long bones. J Bone Joint Surg Br. 1978;60-B:150–162. weight bearing is good for stimulating bone healing. full article.
7. Bone LB, Johnson KD. Treatment of tibial fractures by reaming and intramedullary nailing. J Bone Joint Surg Am. 1986;68:877–887
Broken leg
A broken leg (leg fracture) will be severely painful and may be swollen or bruised. You usually southeast financial credit union phone number not be able to walk on it.
If it's a severe fracture, the leg may be an odd shape and the bone may even be poking out of the skin.
There may have been a "crack" sound when the leg was broken, and the shock and pain of breaking your leg may cause you to feel faint, dizzy or sick.
What to do
If you think you or someone else has broken their leg, go immediately to your nearest accident and emergency (A&E) department.
Call 999 for an ambulance if the injury seems severe or you're not able to get to A&E quickly.
While you make your way to A&E or wait for an ambulance:
- avoid moving the injured leg as much as possible – keep it straight and put a cushion or clothing underneath to support it
- do not try to realign any bones that are out of place
- cover any open wounds with a sterile dressing, a clean cloth or a clean item of clothing – maintain direct pressure on the wound if it is bleeding
If the person is pale, cold and sweaty (in shock), lie them down and keep them warm and calm until you can get medical help.
How a broken leg is treated
Immobilisation
First, a healthcare professional will give you painkillers and may fix a splint to your leg to secure it in position and prevent further damage.
For severe pain, you may be given painkilling gas through a face mask or medicine through a drip into a vein.
An X-ray will be done to assess the fracture.
If the broken bone is still in position, you'll usually just need a plaster cast. This holds the bone in place so it can heal.
If there's a lot of swelling, you may just have a splint or cast around the back half of your leg until the swelling goes down. A full cast can be fitted a few days later.
You may be provided with painkillers to take home and information on how to look after your cast.
Read more about how to care for your plaster cast.
Reduction
If the bones are misaligned, a doctor or surgeon may need to put them back into place. This is known as reduction.
Sedatives are sometimes provided before the procedure and local or regional anaesthetic is used to numb the site of the break.
In some cases a general anaesthetic is needed, which means you'll be asleep during the procedure.
Once the bones are in the correct position, a plaster cast can be applied.
Surgery
Severe fractures are often treated with surgery to realign and fix the broken bones. Surgeons can fix bones with metal wires, plates, screws or rods.
Plates, screws and rods will usually be left in place permanently unless they become a problem, whereas wires will be removed 4 to 6 weeks after the operation.
Sometimes an external frame (external fixator) is attached to the broken bones with metal pins to help keep them in place. This is removed once the fracture has healed.
After surgery, a plaster cast may be applied to protect the leg.
Follow-up appointments
An appointment will be made for you to attend a fracture clinic so specialist orthopaedic doctors can monitor your fracture.
The first appointment is usually booked for a week or 2 after you're discharged from hospital.
Severe fractures will usually heal within 3 to 6 months, but may require follow-up appointments every few months for a year or more afterwards.
Further X-rays are often necessary to check how well your leg is healing.
Recovering from a broken leg
You'll be given advice by your doctor about how much you should move your leg and when you can put weight on it.
It takes around 6 to 8 weeks for a minor fracture to heal. You'll probably need to use crutches or a wheelchair during this time, until it's possible to put weight on the leg again.
You'll be shown how to safely use any mobility equipment you're provided with.
More severe fractures can take between 3 and 6 months to fully heal. Some can take even longer.
The hospital may recommend regular physiotherapy appointments to help you maintain or regain muscle strength, movement and flexibility.
This will include specific exercises to do before and after the cast is removed.
Do not try to rush your recovery by returning to your normal activities too quickly, as the broken bone may not be fully healed even when the pain has gone.
Follow the advice of your doctor, who'll probably recommend gradually increasing how much you use your leg over time.
You should not drive while in a cast. Seek advice from your doctor about when you can drive again.
Possible complications
For most people, a broken bone will heal within a few months and there will not be any further problems.
But complications can sometimes occur.
Damaged muscle, nerves or blood vessels
Damage around the fracture can occur during the initial injury or during surgery.
It may lead to loss of movement or feeling, or may affect the blood supply to the limb.
Bone infection
This is more likely if surgery is performed or the broken bone stuck out of the skin.
It can significantly delay healing and will often require treatment with antibiotics, surgery, or both.
Compartment syndrome
Compartment broken tib and fib surgery is a painful and potentially serious condition caused by bleeding or swelling within a bundle of muscles.
This can occur soon after a fracture, after the plaster cast has been applied, or after surgery.
Emergency surgery will usually be needed to relieve the build-up of pressure in your leg.
Other complications
Occasionally, a further operation may be needed if the bone does not heal properly.
This can happen if the bone doesn't align properly during surgery, you put too much weight on the bone before it heals, the fracture is severe, you have diabetes, or you smoke during your recovery.
Types of fracture
Some broken bones are more serious than others – it depends on the location of the fracture, how the bone has broken, and whether there's any damage to the surrounding tissue.
The most common types of fracture are:
- stress fractures – tiny cracks in the bone caused by overuse, common in athletes
- undisplaced or hairline fracture – a fracture through the bone with little damage to the surrounding tissue
- displaced fracture – the 2 parts of the broken bone have moved apart (misaligned)
- comminuted fracture – the bone has broken (shattered) into several pieces
- open or compound fracture – a complicated break where the bone has broken through the skin, or the initial injury has exposed the broken bone
Page last reviewed: 15 September 2021
Next review due: 15 September 2024
Duration of incapacity of work after tibial plateau fracture is affected by work intensity
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- Published:
BMC Musculoskeletal Disordersvolume 19, Article number: 281 (2018) Cite this article
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Abstract
Background
Tibial plateau fractures requiring surgery are severe injuries of the lower extremity. Tibial plateau fractures have an impact not only on physically demanding jobs but notably on general professional life too. The aim of this study was to assess how the professional activity of patients will be affected after a tibial plateau fracture.
Methods
39 consecutive patients (ages 20–61 years) were retrospectively included in the study and were clinically examined at a minimum of 14 month postoperatively. Inclusion criteria were surgical treatment of tibial plateau fractures between November 2009 and December 2012. The clinical evaluation included the Lysholm score and the Oxford Knee Score. Broken tib and fib surgery were classified and analyzed using the AO classification. Intensity of work was classified as established by the REFA Association. The patients themselves provided postoperative duration of the incapacity of work and subjective ratings.
Results
17 (43.6%) women and 22 (56.4%) men were examined with a mean follow-up of 29.7 ± 10.4 months (range 14–47). According to the AO classification there were 20 (51.3%) B-type-fractures and 19 (48.7%) C-type-fractures. The median incapacity of work was 120 days (range 10–700 days) with no significant differences between B- and C-type-fractures. Four (10.3%) patients reduced their working hours by 10.5 h per week on average. Patients with low workload (REFA 0–1, median incapacity of work 90 days, range 10–390 days) had a significant shorter incapacity of work than patients with heavy workload (REFA 2–4, median incapacity of work 180 days, range 90–700 days) (p < 0.05). The median Lysholm score decreased significantly from 100 points (range 69–100) before the injury to 73 points (range 23–100) at the time of the follow-up. All patients received postoperative physiotherapy (median 25 appointments, range 6–330), with a significant higher number of appointments for C-type-fractures than for B-type-fractures (p = 0.004).
Conclusion
A relationship was found between workload and the duration of incapacity of work after tibial plateau fractures. The post-injury shift to less demanding jobs and the reduction of working hours highlight the impact of a tibial plateau fracture on a patient’s subsequent physical ability to work.
Peer Review reports
Background
Tibial plateau fractures are severe joint injuries of the lower extremity. Since a notable number of patients sustaining tibial plateau fractures are young, active and in the middle of their working life, these injuries may have a profound effect on the individual’s professional career. The fracture patterns range from non-displaced split fractures and slightly or severely displaced depression fractures to complex comminuted fractures with severe destruction of the joint lines and cartilage lesions. Since the clinical outcome after tibial plateau fractures is closely related to the quality of the reduction [1, 2], each surgical technique must aim for an anatomic reconstruction of the injured joint. However, despite sophisticated understanding of the fracture patterns and modern anatomic angular stable implants the precise reconstruction of displaced or comminuted tibial plateau fractures can be challenging even for experienced trauma surgeons [3].
In the past surgeon oriented outcome measurements such as the Tegner- Lysholm- or Oxford-Score were widely accepted and established as the only clinical outcome measurement in knee surgery [4, 5]. Other studies focused on return to sports after tibial plateau fractures [6, 7] but overtime patient-reported outcome measurements have gained importance as well as tools for assessing the return to daily activity and working life [8, 9].
However, so far no study has considered the sequelae after tibial plateau fractures and the impact on returning to work or subsequent work intensity. Therefore, the aim of this study was to determine the time until return to work and the professional capacity of patients after operative treatment of tibial plateau fractures. In particular, the best vegan food san francisco analyzed different work categories and different work intensities. The hypothesis was that heavy load workers would return to work later than white-collar workers.
Methods
One hundred and twenty-four consecutive patients were treated surgically for tibial plateau fractures between November 2009 and December 2012 at a level I trauma center. Thirty –nine patients were included in this retrospective study. Inclusion criteria were surgically treated tibial plateau fractures, working capacity/employability at the time of the injury, age between 18 and 65 years (65 years is the normal date of retirement). Exclusion criteria were concomitant injuries of the same extremity (5), polytraumatized patients (9), posttraumatic conditions (3), age under 18 (4) / over 66 (42) – Fig. 1.
Patient flow chart
Full size image
All fractures were classified according to the AO-classification (Arbeitsgemeinschaft Osteosynthese) [10].
Clinical outcome and scores: Lysholm and Oxford Knee Score
The follow-up visit included a clinical examination, the assessment of the Lysholm score [4] and the Oxford-knee-score.
Work incapacity, REFA classification and reduction in earning capacity
A specific questionnaire was applied to gather data about the patient’s working live, work intensity, rehabilitation and sporting activity. The work intensity was classified according to the REFA Association (Table 1) [11,12,13]. To evaluate the health-related quality of life the SF-36-questionnaire was used.
Full size table
Radiological assessment
All fractures were assessed radiologically on plain radiographs of the knee in two planes. The severity of posttraumatic osteoarthritis was judged according to the score of Kellgren and Lawrence [14].
Surgical procedures
The treatment of tibial plateau fractures in this study group was performed according to the AO principles [15,16,17]. CT scans are in most cases m and t bank online check deposit in case of temporary external fixation, the CT scan is recommended to be performed after the external stabilization because with stretching of the fixateur an initial reposition is achievable [3]. Due to better visualization and understanding of the fractures themselves postero-lateral or postero-medial fragments were addressed as key fragments [16,17,18] (Figs. 2, 3, 4, and 5). Luo et al. have established a three-column fixation approach, especially useful for multiplanar fractures involving the posterior column [19], which was applied in this study group when necessary.
Massive destruction of the joint lines. Initial reposition in external fixator. AO 41 C3
Full size image
Double buttress plating and reconstruction of the joint lines
Full size image
Long-term, 4 years follow-up with signs of osteoarthritis - Lysholm 89
Full size image
Long standing X-ray showing straight axis with no difference to contra-lateral side
Full size image
Post-operative protocol
Partial weight bearing is essential in the aftercare of tibial plateau fractures. The aftercare protocol was standardized and equal for all patients with 6 weeks of partial weight bearing.
Statistics
SPSS (Version 22, IBM Corp for Windows) was used for statistical analysis of the data. Correlation tests were performed using the Pearson and Spearman correlation coefficient and normally distributed results were compared using student’s t test. Non-normally distributed data were compared using the Mann-Whitney U test. All results are stated as mean ± standard deviation or median. The level of significance was presumed at p < 0.5. The statistical analysis was performed under guidance of the local institute for Clinical Epidemiology and Applied.
Results
Demographics
In total 39 patients were examined in the survey. All questionnaires were duly completed and all patients consented to the x-ray-examination. In 14 cases the treatment was performed in a two-stage procedure (external fixator / definite surgery). In all patients angular stable implants were used. Within the study group there were no infections, compartment syndromes or vascular injury.
The mean postoperative follow-up was 29.7 ± 10.4 months (range, 14–47). Our study group included 17 (43.6%) women and 22 (56.4%) men. The average age for both men and women at the time of the accident was 45.9 ± 10.1 years (range, 20–61).
27 (69.2%) fractures affected the left leg, 12 (30.8%) the right leg. According to the AO classification 51.3% of the fractures were B-type-fractures and 48.7% were C-type-fractures – Table 2.
Full size table
Causes of accident
The most common cause of tibial plateau fractures in the presented td bank secured personal loans group was sports accidents (41.0%), followed by low-energy-traumas (28.2%) such as falls from low height. Other common causes were traffic accidents (23.1%) and domestic accidents (7.7%). 13 (33.3%) fractures resulted from work-related accidents.
Work incapacity, REFA classification and reduction in earning capacity
The median stay at hospital took 12 days (range 4–32) for the whole patient group. Patients with B-type-fractures (10 days, range 4–21) stayed a significantly shorter period than patients with C-type-fractures (20 days, range 5–32) (p = 0.034).
The median incapacity of work was 120 days (range 10–700) and there was no significant difference between B- and C-type-fractures. Four (10.3%) patients had to reduce their working hours by 10.5 h per week on average. Two patients retired after the rehabilitation due to the sustained tibial plateau fracture. Five patients had to reduce their work intensity, but four of them stayed within the same profession due to workplace modifications. One of these patients had to change his profession due to the functional impairment after the tibial plateau fracture.
According to the REFA classification patients (n = 23) with low work intensity (REFA 0 and 1) had a significantly shorter duration of work incapacity than patients (n = 13) with heavy work intensity (REFA 2–4) (Table 3). The longest duration of work incapacity was seen in the patients with C-type-fractures, who coincidentally were heavy load workers.
Full size table
Reduction in earning capacity was noted in seven patients. The reduction in earning capacity was scored between 10 to 30% on average. The distribution of fracture types was equal between B (3 patients)- and C (4 patients)-type-fractures.
Clinical outcome and scores
Thirty-one patients received postoperative physiotherapy (median 25 appointments, range phone number santander customer service. Eight patients were directly discharged to a rehabilitation clinic. There was a significant difference in the number of appointments between B- and C-type-fractures. The median of appointments for physiotherapy in patients with C-type-fractures was significantly more (50, range 10–330) than patients with B-type-fractures (18, range 6–56) (p = 0.004).
The patients were asked how physically fit they felt compared to the time before the fracture. At follow-up 72% of the patients felt physically less fit, 25,6% felt like having an equal level of physical fitness and only one patient felt fitter.
The median of the Lysholm Score decreased significantly from 100 (range 69–100) before the injury to 73 (range 23–100) at the time of the follow-up. Regarding the categories of the Lysholm score (excellent 91–100 points, good 84–90, fair 65–84, poor < 65) 92.3% of the patients had excellent results before the injury, whereas after the fracture 71.8% showed fair or poor results. In C-type-fractures a higher percentage showed fair or poor results (78.9%) compared to B-type-fractures (65.0%).
The median of the Oxford knee score (OKS) was 41 points (range 15–48) with no significant differences between B- and C-type-fractures.
All results for the SF-36 subscales were compared to the results of a standard population (Table 4). The results of 5 subscales for our study cohort were lower than for the standard population, the results of 3 subscales (general health perception, social role functioning, mental health) were higher. There were no significant differences in the results for B- and C-type-fractures.
Full size table
Radiological outcome
In 12 cases (30.8%) there was no difference in the x-ray assessment regarding osteoarthritis in comparison to contralateral. In 18 patients the injured knee joint was rated to be more affected by osteoarthritis compared to contralateral by one subscale according to Kellgren / Lawrence [13]. There was a difference by two subscales in eight patients (20.5%) and by three subscales in one case (2.6%).
Discussion
The most important finding of this study was that incapacity of work was longer in the group with higher workload (median 180 days) compared to the group with low workloads (median 90 days). Given that we noted good mid-term results 29.7 months postoperatively (SD 10.4 months (range 14–47)), this cohort showed a good maintenance of knee function over time, particularly when considering that posttraumatic arthrofibrosis can often have a quick onset. However, a notable number (9 / 23.1%) of patients reported difficulties at their jobs forcing five employees to change to jobs with lower physical strains over time and forcing four patients to reduce the number of working hours per week (10.5 h/week). Although, despite there a relationship being found between the incapacity of work and workload, there was no such correlation concerning the fracture type. The median incapacity of work was 120 days (range 10–700 days) with no significant differences between B- and C-type-fractures.
In the literature several studies have already reported the outcomes after tibial plateau fractures (Table 5). The clinical results concerning the Lysholm Score 73.0 and Oxford Knee Score 37.3 ± 9.81 were in all subgroups comparable to those reported previously (Table 5).
Full size table
In recent years patient reported broken tib and fib surgery measures (PROMs) are gaining importance as these measures more reflect the satisfaction of patients after surgery rather than other outcome measures [20]. Just recently Baumann et al. reported on a study group of 77 skiers after tibial plateau fractures in a long-term follow-up study. It was found out that the PROM-score “forgotten knee score cox login pay bill, which had been measured initially at arthroplasty, also significantly correlates with osteoarthritic radiologic knee joint degeneration in fracture cases [9].
However, to our knowledge there is no study that specifically considered return to work after sustained tibial plateau fractures.
Roßbach et al. recently examined patients after operatively treated tibial plateau fractures regarding the quality of life and the job performance. In that study polytraumatized patients and patients with other concomitant injuries of the same limb were included [21] making a comparison to other studies difficult. Eleven out of forty-one patients did not return to work, three patients had to change the profession after the injury after a follow-up of 47 month postoperatively.
Stevens et al. (2001) examined the outcome of 47 patients with operatively treated tibial plateau fractures with a mean follow-up of 8.3 years. They found similar results in the SF-36 scores for most of their patients under the age of forty compared to the healthy age-matched population. In the forty-and-over age group nine patients showed lower results in the SF-36 score compared to the healthy age-matched group. They found that the age of the patients seems to have more influence on the functional outcome rather than the type of the fracture and adequacy of reduction [22]. Also whereas the workload showed an effect on the incapacity of work in this study, age seems to be a minor factor for the clinical outcome. The subgroup analysis showed no differences in patients between 20 and 29 years, 30–45 years and patients between 46 and 65 years of age. We limited the inclusion to an age of 65 years of age because most employees retire at 65 years. This may create a certain bias in our study group as 42 elderly patients were excluded. So we cannot give any details about the recovery and final outcome of these patients. However, the average ages of the patients in this study group can be compared to the previously published studies.
In 2005 Litz et al. reported in his study significant differences in the results of the functional and radiological scores for the different types of tibial plateau fractures. Patients with C-type-fractures had worse results than patients with A- or B-type-fractures. Patients with C-type-fractures had a significant longer incapacity of work (40.5 weeks on average) than patients with A-type-fractures (21.1 weeks) and B-type-fractures (21.9 weeks) [23]. Yao et al. (2014) also found that C-type-fractures had the worst functional score results [24]. It would also be interesting to compare outcomes of california bank and trust mobile deposit faq osteosynthesis or patients with compartment syndrome in a long-term follow up. Fortunately we cannot provide any data, as none of the included patients sustained any of these complications. These complications were noted in the excluded polytraumatized patients.
There are also studies that report on the outcomes in sportsmen, including alpine skiers. Loibl et al. reported that overall only 49% of skiers returned to alpine slopes after a sustained tibial plateau fracture [7]. However, alpine skiing demands highest grades of physical exertion.
Similar results are reported by Kraus et al. in a study with 89 patients after tibial plateau fractures [6]. In this detailed study patients were asked about their sporting habits before, 1 year after injury and at 4.4 years after injury. Interestingly the hours of sports performance did not significantly shrink in the final follow-up. It was observed that patients continued to perform sports but on a less demanding level, shifting form high-impact sports to sports like Nordic walking or swimming.
In the context of knee surgery Schröter et al. studied specific impairments after high tibial osteotomy and also measured the time of return to work and the postoperative workload [12]. In this study the patients returned to work 87 days after surgery roslyn savings bank east meadow 87; range 14–450 days). Whether the earlier return to work is related to a better fitness and activity level of the patients undergoing elective surgery remains speculation. Also in that study patients in heavy workload groups needed more time for recovery. The Lysholm Score revealed values of 81.7 ± 12.7 that are similar values to the study group presented and to the studies as shown in Table 5.
In comparison to the upper extremity the time until return to work is longer for patients undergoing knee surgery. A recently published study describes return to work after arthroscopic Bankart repair after 2.06 month (95% CI 1.55–2.68) for jobs with low physical strains and 3.40 month (95% CI 2.70–4.24) for jobs with high physical strains [11].
Several limitations of this study should be considered. The rehabilitation program was only standardized in the first weeks post-surgery. Also an impaired proprioceptive function after successful tibial plateau reconstruction may have hindered return to heavy work. As we assessed operatively treated fractures only, conclusions regarding conservatively treated, possibly less severe fractures are therefore not possible. A further limitation is the small inclusion rate of only 31%. Furthermore the retrospective study design, the heterogeneous patient population and the variation in the length of the follow-ups are noted limitations. However, this study provides first data concerning the incapacity of work and the rehabilitation time for different work groups according to their intensity of work. With the improved anatomically pre-shaped implants and the improved understanding of the tibial plateau fractures future studies need to prove the presented data in a prospective and longitudinal manner.
Conclusion
In this study, a relationship was found between work intensity and the duration of incapacity of work after surgically treated tibial plateau fractures. The post-injury shift to less demanding jobs and the reduction of working hours highlight the impact of a tibial plateau fracture on a patient’s physical ability to work.
The long rehabilitation periods may stimulate demand for intense and standardized rehabilitation programs, especially for high intensity workers.
Abbreviations
Arbeitsgemeinschaft Osteosynthese
“Reichsausschuß für Arbeitszeitermittlung”
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Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Affiliations
BG Trauma Center, Eberhard Karls University Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany
Tobias M. Kraus, Charlotte Abele, Atesch Ateschrang, Ulrich Stöckle, Fabian M. Stuby & Steffen Schröter
Paracelsus University Salzburg, Landeskrankenhaus Salzburg, Salzburg, Austria
Thomas Freude
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TMK, CS, TF, AA, US, FMS, SS contributed in a significant way in the steps of processing the patient history as well as writing and editing the manuscript. TMK and AA conceived the idea le pouvoir du moment prГ©sent amazon the study/publication, planning of the whole study and engaged in writing the manuscript. SS and CA provided expertise in collection of the data, statistics and graphical work. TF edited and reviewed the manuscript and gave advice throughout the project and reviewed the manuscript. US and FMS were involved in the planning and the review process. All authors read and approved the final manuscript.
Corresponding author
Correspondence to Tobias M. Kraus.
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Kraus, T.M., Abele, C., Freude, T. et al. Duration of incapacity of work after tibial plateau fracture is affected by work intensity. BMC Musculoskelet Disord19, 281 (2018). https://doi.org/10.1186/s12891-018-2209-1
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Keywords
- Knee
- Tibial plateau fracture
- Professional activity
- REFA
- Return to work
Ilizarov apparatus
Type of external fixation (medical device)
The Ilizarov apparatus is a type of external fixation used in orthopedic surgery to lengthen or reshape limb bones; as a limb-sparing technique to treat complex and/or open bone fractures; and in cases of infected nonunions of bones that are not amenable with other techniques. It is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique.
History[edit]
Ilizarov used external fixation devices on patients to treat non-unions in the 1950s.[1] Ilizarov observed the callus formation and discovered distraction osteogenesis when one patient lengthened his frame rather than compressing it.[1] The procedure, and the first apparatus he designed for it, was inspired by a shaft bow harness on a horse carriage (see photo to the right).[2] Originally bicycle parts were used for the frame.
The technique gained fame across the Soviet Union when he successfully treated Soviet world-record holder, and gold medalist high jumper, Valery Brumel in 1968.[1][2] Brumel broke his tibia in a motorcycle accident and had 20 unsuccessful operations over a three-year period to try to repair his non-union.[2] Ilizarov used distraction osteogenesis to heal the non-union and 3.5 cm (1.4 in) leg length discrepancy.[2]
Ilizarov gained more fame in 1980 when he successfully treated Italian journalist and adventurer, Carlo Mauri.[1][3] Mauri had broken his leg in a skiing accident ten years earlier and his tibia never properly healed.[1] When he was on an expedition across the Atlantic, the wound on his leg reopened and a Russian doctor advised him to see Ilizarov.[1][3] When Mauri returned to Italy after his treatment, Italian doctors were impressed that his tibial non-union was repaired.[1] They invited Ilizarov to speak at the Italian AO Conference in Bellagio.[1] This was the first time Ilizarov spoke outside of the "Iron Curtain".[3]
The technique was brought to the US in 1987 by Victor Frankel, president of Hospital for Joint Diseases,[3] and Dr. Stuart Green who, in 1992, edited the first English translation of Ilizarov's book.
The Ilizarov external fixators can be used to correct angular deformity in the leg, to correct leg-length differences, and treat non-unions.[1] In most developing countries it is a highly specialized technique used mainly for deformity correction by experienced surgeons due to its complexity. Further development of the ring construct led to the Taylor Spatial Frame which is more versatile and far easier to broken tib and fib surgery, but very costly. Intramedullary limb lengthening devices are also available, but are also a very costly option.
Mechanics and physics[edit]
The device is a specialized form of external fixator, a circular fixator, modular in construction. Stainless steel (or titanium) rings are fixed to the bone via stainless heavy-gauge wire (called "pins" or Kirschner wires). The rings are connected to each other with threaded rods attached through adjustable nuts. The circular construction and tensioned wires of the Ilizarov apparatus provide far more structural support than the traditional monolateral fixator system. This allows early weightbearing.
The apparatus is based on the principle which Ilizarov called "the theory of tensions". Through controlled and mechanically applied tension stress, Ilizarov was able to show that the bone and soft tissue can be made to regenerate in a reliable and reproducible manner.[4] The top rings full t shirt design online the Ilizarov (fixed to the healthy bone by the tensioned wire) allow force to be transferred through the external frame (the vertical metal rods), bypassing the fracture site. Force is then transferred back to the healthy bone through the bottom ring and the tensioned wires. This allows the Ilizarov apparatus to act as a sort of bridge, both immobilizing the fracture site and relieving it of stress, while allowing for the movement of the entire limb and partial weight-bearing. Middle rings (and tensioned wires) act to hold the bone fragments in place and to give greater structural support to the apparatus and limb. However, the critical load bearing rings are the top and bottom rings which transfer the force from the healthy bone down to the healthy bone, bypassing the fracture site.
Bone lengthening and reshaping[edit]
In addition to being used to support a fractured limb, the Ilizarov frame is also commonly used to correct deformity through distraction osteogenesis.
The procedure consists of an initial surgery, during which the bone is surgically fractured and the ring apparatus is attached. As the patient recovers, the fractured bone begins to grow together. While the bone is growing, the frame is adjusted by means of turning the nuts, thus increasing the space between two rings. As the rings are connected to opposite sides of the fracture, this adjustment, done four times a day, moves the now-healing fracture apart by approximately one millimeter per day. The incremental daily increases result in a considerable lengthening of the limb over time. Once the lengthening phase is complete, the what is the capital of wyoming cheyenne stays on the limb for a consolidation period. The patient is able to fully weight bear on the Ilizarov frame, using crutches initially and pain is lessened. Once healing is complete, a second surgery is necessary to remove the ring apparatus. The result is a limb that is significantly longer. Additional surgery may be necessary, in the case of leg lengthening, to lengthen the Achilles tendon to accommodate the longer bone length. The major advantage of this procedure is that because the apparatus provides complete support while the bone is recovering the patient can remain active aiding recovery.
A further use is in bone transport, whereby a defect in a long bone can be treated by transporting a segment of bone, whilst simultaneously lengthening regenerating bone to reduce the defect and finally dock with the other segment, producing a single bony unit.
While the Ilizarov apparatus is minimally invasive (no large incisions are made), it is not free of complications. Pain is common and can be severe, but is treatable with analgesics. Careful attention to cleaning and hygiene is necessary to prevent pin site infection. Other complications include swelling, muscle transfixion, and joint contractures. Physical therapy is often indicated.
Bone fracture treatment[edit]
The Ilizarov method is widely used to treat complex and/or open bone fractures. This method is preferred over conventional treatment options (such as internal fixator or cast) where there is a high risk of infection or the fracture is of such severity that internal fixators are unworkable. Journalist Ed Vulliamy wrote a broken tib and fib surgery description from the patient's viewpoint of Ilizarov apparatus treatment of a bad fracture.[5]
Images[edit]
The following case study illustrates the Ilizarov apparatus treatment procedure for a fractured limb. The photographs are of the same patient during the course of treatment.
X-Ray of fracture and initial external fixator applied within 24 hours of patient's admission to hospital
Front-left view of the Ilizarov apparatus treating a fractured tibia and fibula. The patient suffered an open fracture. It is located slightly above black metal ring. Photographs 1 through 4 are taken four weeks following the fracture and two weeks following the installation of the Ilizarov cox login pay bill.
Front (top) view with a view of the healthy leg. The patient is lying on his stomach.
View of several pin sites (two weeks following surgery)
X-Ray of the fracture site immediately following the application of the Ilizarov method
X-Ray of the fracture site, part 1 (two months following fracture)
X-Ray of the fracture site, part 2 (two months following fracture)
X-Ray of the fracture site (three months following fracture). Note formation of bone callus around fracture site.
X-Ray of the fracture site, part 2 (three months following fracture). Note formation of bone callus around fracture site.
X-Ray of the fracture site, part 2 (four months following fracture)
See also[edit]
References[edit]
- ^ abcdefghiSpiegelberg B, Parratt T, Dheerendra SK, Khan WS, Jennings R, Marsh DR. (2010). "Ilizarov principles of deformity correction". Annals of the Royal College of Surgeons of England. 92 (2): 101–5. doi:10.1308/003588410X12518836439326. PMC 3025247. PMID 20353638.CS1 maint: uses authors parameter (link)
- ^ abcdSvetlana Ilizarov (2006). "The Ilizarov Method: History and Scope". In S. Robert Rozbruch; Svetlana Ilizarov (eds.). Limb Lengthening and Reconstruction Surgery. CRC Press. pp. 3–6. ISBN .
- ^ abcdSvetlana Ilizarov (2006). "The Ilizarov Method: History and Scope". In S. Robert Rozbruch; Svetlana Ilizarov (eds.). Limb Lengthening and Reconstruction Surgery. CRC Press. pp. 15–16. ISBN .
- ^Paley, Dror; Kovelman, Harry F; Herzenberg, John E (October 1993). "Ilizarov technology". In Stauffer, Richard (ed.). Advances in Operative Orthopaedics: Volume 1(PDF). Mosby Inc. pp. 243–287. ISBN . Archived from the original(PDF) on 19 March 2012. Retrieved 14 January 2012.
- ^Ed Vulliamy (13 December 2015). "How Comrade Ilizarov saved my leg". The Observer. Retrieved 13 December 2015.
External links[edit]
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General Considerations
- Non-weightbearing status for 4 weeks post-op.
- Patients will be huntington beach senior center hours a hinged brace for support and to serve as a reminder not to weight-bear
- Seek full hyperextension equal to opposite side.
- Regular manual treatment should be conducted to the patella and all incisions--with particular attention to the anterior medial portal--to decrease the incidence of fibrosis.
- Early recruitment of the vastus medialis muscle is important.
- No resisted leg extension machines (isotonic or isokinetic) at any point.
*Use the free printable number recognition worksheets for kindergarten stimulator once per day (preferably at same time each day) for 30 minutes for 3 months.
*Use the CPM set at 0 to 50 degrees for 6 hours a day for 4 weeks.
Week 1
- M.D. visit day 1 post-op to change dressing and review home program.
- Icing and elevation frequently per instruction.
- CPM at home for 6 hours daily/at night.
Exercises
- Straight leg raise exercises (lying, seated, and standing), quadriceps/straight ahead plane only.
- No side-lying leg raises.
- Range of motion exercises.
- Hip and foot/ankle exercises, well-leg stationary cycling, upper body conditioning.
Manual
- Soft tissue treatments and gentle mobilization to posterior musculature and patella.
- Knee extension range of motion should be full.
Goals
- Decrease pain, edema.
- Range of motion 0-50 degrees or per MD.
- Gait non weightbearing X 4 weeks.
Weeks 2 - 4
- M.D. visit at 8 - 10 days for suture removal (if any) and check-up.
Exercises
- Continue with previous exercises.
- Nonweightbearing aerobic exercises (i.e. unilateral cycling, UBE, Schwinn Air-Dyne arms only).
Manual
- Continue with pain control, range of motion, soft tissue treatments.
Goals
- Decrease pain, edema.
- Range of motion 0-50 degrees or per MD.
- Gait non weightbearing X 4 weeks.
Weeks 4 - 6
- M.D. visit at 4 weeks post-op, will progress to full weightbearing weaning down to 1 crutch, cane, or no assistive device.
Exercises
- Incorporate functional closed-chain exercises.
- Gait training.
- Balance/proprioception exercises.
- Road cycling as tolerated.
- Slow to rapid walking on treadmill (preferably a low-impact treadmill).
Manual
- Continue soft tissue treatment as needed, patellar glides; work towards full knee range of motion.
Goals
- Range of motion 0-130 degrees.
- Gait full weightbearing, focus mechanics.
Weeks 6 - 8
- Increase the intensity of functional exercises (i.e. add stretch cord for resistance, increase weight with weightlifting machines)
- Add lateral training exercises (side-stepping, Theraband resisted side-stepping)
Goals
- Gait without a limp.
- Full range of motion.
Weeks 8 - 12
- Patients should be pursuing a home program with emphasis on sport/activity-specific training
- Continue to push strength, endurance per tolerance.
Goals
- Initiate return to sport/activity- specific training.
NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.
Broken Leg Cost
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3 Common Types of Fibula Fractures
A fibula fracture occurs when there is an injury to the smaller of the two bones of the lower leg (the segment between the knee and ankle), the fibula.
The larger bone of the lower leg, the tibia, carries most of the body weight. The smaller bone, the fibula, is located on the outside of the leg.
The Fibula
The fibular bone starts just below the knee joint on the outside of the leg and extends all the way down to the ankle joint. The bone is a long, thin bone.
While the bone does little to support the weight of the body, it is a critical site of attachment for ligaments at both the knee and the ankle joint and is also connected to the tibia bone by a thick ligament called the syndesmosis.
While the fibula is an important bone, it is possible to excise some of the bone for surgical procedures where bone is needed elsewhere in the body. When these grafting procedures are performed, people are able to function very normally, despite missing a large part of the fibula bone.
Types of Fibula Fractures
There are a number of different types of injury to the fibula bone:
- Fibula fractures that result from injury to the ankle joint
- Fibula fractures that occur in conjunction with tibia fractures
- Stress fractures of the fibula
These are not the only types of injury that can occur to the fibula but account for the vast majority of injury to the fibula bone. By far the most common are injuries that occur when the ankle joint is damaged. Typically, the ankle buckles or is twisted and the fibula is damaged as part of the injury.
Symptoms
As mentioned, fibula fractures can occur in association with injuries to other bones, ligaments, and tendons around the knee and ankle.
The most common symptoms associated with the fibula fracture include:
- Pain directly over the fibula bone (outside of the leg)
- Swelling in the area of the fracture
- Bruising over the site of the injury
Diagnosis of a fibular fracture can typically be made with an X-ray image. Other imaging studies such as magnetic resonance imaging (MRI) or computerized tomography (CT) scan are typically not necessary, but there are some situations where a fibular fracture may not show up on a regular X-ray.
These situations include injuries such as stress fractures (described below). Your healthcare provider will examine the site of the injury, and also examine the knee and the ankle joints for associated injuries which may impact the treatment of the fibular fracture.
Signs You Might Have a Fracture and What to Do
Ankle Injuries
Fibula fractures typically occur as part of an ankle injury. Whenever a fibula fracture is found, the ankle joint should also be examined for possible injury.
The most common type of fracture to occur to the fibula bone is an isolated injury to the end of the fibula bone at the level of the ankle joint. These injuries occur in a similar manner to a badly sprained ankle. Often the injury can be treated similarly to a badly sprained ankle.
Ankle-Level Fibula Fracture Without Other Ankle Injury
Isolated fibular fractures, when the ankle joint is unaffected, often can be treated with simple protection. Known as a lateral malleolus fracture, these injuries occur when the ankle twists or bends awkwardly and the inner (medial) side of the ankle is unaffected.
In these situations, a brace is sufficient to support the ankle. Crutches are often used for a few days or weeks to allow swelling and pain to subside. Once the pain has lessened, patients begin rehabilitation to resume mobility exercises, jose ramirez signed bat, and walking.
Fibula Fracture With Associated Ankle Injury
Fibula fractures that are associated with injury to the inner side of the ankle, the medial malleolus, or deltoid ligament, often require more aggressive treatment.
In these situations, called bimalleolar ankle fractures, surgery is usually necessary to stabilize the ankle joint. Without surgery, the ankle joint often heals in abnormal alignment, leading to the development of ankle arthritis.
Another type of injury that can occur with a fibular fracture is damage to the syndesmosis of the ankle. The syndesmosis is the group of ligaments that hold the two bones of the leg together, just above the ankle joint.
When the syndesmosis is damaged at the ankle, an injury that can occur along with a fibula fracture, surgery is often required to restore the alignment of the bones.
Fibular fractures with ankle injuries will usually require surgery to correct.
Fibula and Tibial Shaft Fractures
Severe injuries resulting from car crashes, sports injuries, or falls may lead to an injury of both the tibia and the fibula above the ankle joint. These injuries, often referred to as "tib-fib" fractures, typically require surgery to support the alignment of the leg.
When the tibia is surgically repaired, the fibula does not normally require a separate surgery to align this bone. In some tib-fib fractures, a long-leg cast (thigh to foot) will provide necessary support without requiring the surgery.
Stress Fractures of the Fibula
In some people, particularly long-distance runners or hikers, the fibula may be injured as a result of repetitive stress. This type of injury is known as a stress fracture. The pain of a stress fracture may begin gradually. Usually, the pain worsens with cub bank shelbyville levels of activity and is relieved by rest.
Stress Fracture: Causes, Treatment, Prevention
Treatment
How a fibula fracture is treated depends on a number of factors, including where the fracture is located and if other injuries have occurred in association with the fracture.
Surgery may be recommended, but usually a splint or cast is given to help prevent movement and allow the bone to heal. If possible, your healthcare provider can realign your broken bones without open surgery as well.
While isolated fibula fractures usually heal quickly, some may involve more complex injuries that require further treatment. That's why it's critical for a medical professional familiar with the treatment of fibula fractures to evaluate your injury and ensure that appropriate treatment is recommended.
Community wide bank near me only a small amount of body weight is transmitted through the fibula (most weight is transmitted through the larger tibia bone) many types of fibula fractures can be treated nonsurgically. However, as described, fibula fractures that occur in association with other fractures or ligament injuries often do require more invasive treatment.
How Does It Feel When a Broken Bone is Healing?
Surgery on the Fibula
The most common way to repair a fractured fibula bone is with a metal plate and screws. Typically a plate is applied to the outside of the bone, with several screws above the location of the fracture, and several screws below. Sometimes other techniques are used when repairing a fracture of the fibula, depending on its type and location.
When reviewing an operative report from the time of surgery, your surgeon will dictate the method in which they repaired the broken fibula, as well as any other treatment needed. The diagnosis of a fibula fracture is recorded as ICD-10 code S82. Any modifying codes can designate fracture side, mechanism, and other characteristics.
Complications
Common complications associated with surgery for treatment of a fibula fracture can be related to the incision and the underlying hardware. Because there is very little soft tissue between the skin and the bone, problems related to wound healing, infection, and painful hardware are common surgical complications.
Wound healing complications are most worrisome in people who have underlying conditions such as diabetes which may inhibit wound healing. Smokers are also at increased risk of wound complications.
Infection can occur after any surgical procedure, but is most common in people who have conditions that may impair immune defenses.
Lastly, pain associated with implanted hardware is not uncommon. Some people may choose to have surgical plates and screws removed after the fracture has healed.
Other types of complications, including slow healing and development of arthritis, are also possible depending on your type of injury.
Can Cigarettes Affect Your Bones?
A Word From Verywell
Have an open conversation with your healthcare provider about the best solution for your fracture. You may be nervous if more invasive treatments are required. Ask if they're truly the best option and confirm that alternatives would not be helpful. Remember that ultimately, the procedure is meant to heal your injured fibula.
Once healed, make sure to ask your healthcare provider for prevention and safety tips to reduce your risk of further injury, particularly if your injury resulted from an activity. It may be frustrating to wait until you're better to continue doing what you love, but it's well worth it.
In general, you can reduce your risk of a fibula fracture by working to maintain your bone mass. Some factors such as age and gender are out of your control, but others such as quitting smoking and practicing sports safety can help.
Thanks for your feedback!
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Mukherjee AN, Pal AK, Singharoy D, Baksi D, Nath C. Harvesting the free fibular graft: A modified approach. Indian J Orthop. 2011;45(1):53-6. doi:10.4103/0019-5413.73657
Kortekangas T, Haapasalo H, Flinkkilä T, et al. Three week versus six week immobilisation for stable Weber B type ankle fractures: randomised, multicentre, non-inferiority clinical trial. BMJ. 2019;364:k5432. doi:10.1136/bmj.k5432
Goost H, Wimmer MD, Barg A, Kabir K, Valderrabano V, Burger C. Fractures of the ankle joint: investigation and treatment options. Dtsch Arztebl Int. 2014;111(21):377-88. doi:10.3238/arztebl.2014.0377
Gupton M, Kang M. Anatomy, Bony Pelvis and Lower Limb, Fibula. StatPearls Publishing. December 2018.
Amaha K, Arimoto T, Saito M, Tasaki A, Tsuji S. Shorter recovery can be achieved from using walking boot after operative treatment of an ankle fracture. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2017;7:10-14. doi:10.1016/j.asmart.2016.09.001
Feigenbaum LA, Baraga M, Kaplan LD, et al. Return to Sport Following Surgery for a Complicated Tibia and Fibula Fracture in a Collegiate Women's Soccer Player with a Low Level of Kinesiophobia. Int J Sports Phys Ther. 2015;10(1):95-103.
Harrast MA, Colonno D. Stress fractures in runners. Clin Sports Med. 2010;29(3):399-416. doi:10.1016/j.csm.2010.03.001
Hsu H, Nallamothu S. Ankle Splinting.StatPearls Publishing. January 2019.
Mehta SS, Rees K, Cutler L, Mangwani J. Understanding risks and complications in the management of ankle fractures. Indian J Orthop. 2014;48(5):445-52. doi:10.4103/0019-5413.139829
- Anderson RB, Hunt KJ, McCormick JJ. "Management of common sports-related injuries about the foot and ankle." J Am Acad Orthop Surg. 2010 Sep;18(9):546-56.
- Fields, KB. Fibular Fractures. In: UpToDate, Grayzel, J(Ed). UpToDate. 2017.
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"What was exciting about our project was that all the mechanical analysis was done blinded to the clinical treatment of the patients, and the surgeon never saw any of our data," says Hannah Dailey, an assistant professor of mechanical engineering and mechanics at San jose earthquakes game University's P.C. Rossin School of Engineering and Applied Science. "When we put it all together, we were able to answer the question, 'Can the virtual mechanical test predict how long it will take the patient to heal?' We found that it could."
Dailey, who is also affiliated with Lehigh's Institute for Functional Materials and Devices (I-FMD), is the lead author of "Virtual Mechanical Testing Based On Low-Dose Computed Tomography Scans for Tibial Fracture." The paper appeared in the July 3 issue of the Journal of Bone and Joint Surgery.
Most people who break their tibia, or shin bone, proceed along a normal healing timeline. As the weeks go by, more and more new bone called callus forms along the fracture line. Callus starts out as a spongy material that over time hardens into bone that is just as strong -- or stronger -- than it was before the break. Patients typically come in for X-rays at regular intervals, and as long as the images reveal there's increasingly more callus in the region, all is well.
But some people don't heal normally. This failure to heal is called a nonunion, and it can be utterly debilitating.
"Musculoskeletal injuries are very, very painful," says Dailey. "And when a bone isn't healing properly, patients can be in pain for weeks or months."
Ideally, she says, surgeons would re-operate early on a patient with a nonunion. But differentiating between a true nonunion -- where no new bone is forming at all -- and a bone that is healing -- just very slowly -- is difficult. And that difference is critical. If it's the former, a second surgery is imperative. If it's the latter, it may be better for the patient to wait and avoid the risk and expense of another operation.
Pinpointing that crucial difference between who needs additional surgery and who does not is difficult because surgeons typically rely on X-rays to determine the extent of bone healing. X-rays, however, are two-dimensional, often fuzzy, and can reveal an incomplete picture.
"Our approach was, 'Can we measure healing in a structural way, and put a number on how healed a bone is?'" says Dailey. "Instead of using X-rays to determine, 'Yes, healed,' or 'No, not healed,' can we be more accurate? By using engineering tools, the answer was, yes. We could."
In this study, adults with tibial shaft fractures were prospectively recruited for observation following standard reamed intramedullary nailing, a procedure in which a titanium rod is inserted in the hollow space of the tibia and secured at the top and bottom with screws. The screws allow the patient to bear weight soon after surgery by keeping the upper bone fragment from collapsing onto the lower bone fragment.
Patient follow-up included radiographs and completion of patient-reported outcome measures, all performed at 6, 12, 18, and 24 weeks post-surgery. Low-dose computed tomography (CT) scans winchester cooperative bank woburn hours done at 12 weeks. These scans provided a detailed, three-dimensional picture of what was going on inside each patient.
Using specialized, commercially available software on the scans, Dailey's PhD student and study co-author, Peter Schwarzenberg, built 3-D mechanical structural models that identified the regions of bone and new bone, or callus. Schwarzenberg then ran the models through finite element analysis software -- the same program used by civil engineers to simulate how much deformation happens to a bridge when a load (like cars or pedestrians) is applied to it. Schwarzenberg and Dailey wanted to do the same thing for bones -- apply a force and see how much the bone flexed. The less it flexed, the more healed it was.
Schwarzenberg used the finite element software to divide each bone model into tiny chime card free atm near me called tetrahedra that all have a mathematical relationship to each other. He and Dailey then simulated fixing the bottom of the bone so it couldn't move and putting a load on the top of the bone in the form of a one-degree rotational twist. The technique is called a virtual torsion test.
"So we know what's happening to the tetrahedra at the edges of the bone," says Schwarzenberg. "But finite element analysis allows you to calculate what is happening at the neighbors of those tetrahedra and then the neighbors of those tetrahedra, and it calculates all the way through until you've evaluated every piece inside the bone."
Those calculations revealed how much the bone flexed when it was twisted.
"You want to do one test you can apply to everybody, and a twist is a standard one," says Dailey. "It comes from the history of animal experimentation. We had a pretty good idea about what happens in the bones of animals at 12 weeks, but before we did this, nobody knew how much structural healing has taken place in humans at 12 weeks."
The pair then used the CT scans to digitally re-create a healthy version of each person's leg. Schwarzenberg performed the same virtual torsion test on that healthy model then measured the flex of the unbroken leg against the fractured leg. The resulting percentage helped them determine how stiff the broken bone was compared with the healthy bone. The stiffer a bone was early in the healing process, the quicker the patient could bear weight.
Schwarzenberg and Dailey found that their results from the virtual mechanical test significantly correlated with how long it took each patient to heal. It also clearly identified the single instance of a nonunion.
Dailey says the goal is to produce a diagnostic test that can help surgeons determine if an additional operation is necessary. It could also potentially help doctors determine when it's safe for patients broken tib and fib surgery bear weight, and it could help measure the effectiveness of devices like bone growth stimulators that might be alternatives to surgery in some nonunion cases.
Dailey and her team acknowledge one flaw in their experimental design: how they're currently characterizing the callus.
"There's a lot of data for the mechanical properties of bone," says Schwarzenberg. "It's impossible to get cadaver bones with callus because callus disappears when a broken bone is fully healed. Bone is this organized, hard structure, and callus is almost like cartilage. It remodels into bone, but at the time points we're looking at, we don't expect the callus to have the same underlying structure as bone. We think we're making it too strong because we're using a model that was developed from bone."
Schwarzenberg is currently trying to fill that knowledge gap at the Musculoskeletal Research Unit at the University of Zurich, as part of the International Education's Graduate International Research Experiences program (IIE-GIRE). During his six-month fellowship, he is combining the virtual technique with an optimization algorithm to measure the mechanical properties of callus.
To be able to answer the question of whether a bone is healing and when it may be capable of bearing weight is revolutionary, says Dailey.
"These advanced modeling and simulation techniques are providing the opportunity to answer fundamental questions like, 'What are the mechanical properties of newly formed bone?' Questions that, believe it or not, haven't been addressed before. Because it's not like you can take a person, cut out a uniform piece of material, then put it in a machine and test it," she says. "That's impossible. But now we can do that in a virtual way."
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Story Source:
Materials provided by Lehigh University. Note: Content may be edited for style and length.
Journal Reference:
- Hannah L. Dailey, Peter Schwarzenberg, Charles J. Daly, Sinéad A.M. Boran, Michael M. Maher, James A. Harty. Virtual Mechanical Testing Based on Low-Dose Computed Tomography Scans for Tibial Fracture. The Journal of Bone and Joint Surgery, 2019; 101 (13): 1193 DOI: 10.2106/JBJS.18.01139
Cite This Page:
Lehigh University. "Knowing when patients with tibial fractures can bear weight." ScienceDaily. ScienceDaily, 10 September 2019. <www.sciencedaily.com/releases/2019/09/190910134333.htm>.
Lehigh University. (2019, September 10). Knowing when patients with tibial fractures can bear weight. ScienceDaily. Retrieved November 24, 2021 from www.sciencedaily.com/releases/2019/09/190910134333.htm
Lehigh University. "Knowing when patients with tibial fractures can bear weight." ScienceDaily. www.sciencedaily.com/releases/2019/09/190910134333.htm (accessed November 24, 2021).
Источник: https://www.sciencedaily.com/releases/2019/09/190910134333.htm