The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing...The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.展开更多
Background:Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury.Runners encounter varied surface steepness(gradients)when running outdoors and may adapt their spe...Background:Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury.Runners encounter varied surface steepness(gradients)when running outdoors and may adapt their speed according to the gradient.This study aimed to quantify tibial bending moments and stress at the anterior and posterior peripheries when running at different speeds on surfaces of different gradients.Methods:Twenty recreational runners ran on a treadmill at 3 different speeds(2.5 m/s,3.0 m/s,and 3.5 m/s)and gradients(level:0%;uphill:+5%,+10%,and+15%;downhill:-5%,-10%,and-15%).Force and marker data were collected synchronously throughout.Bending moments were estimated at the distal third centroid of the tibia about the medial-lateral axis by ensuring static equilibrium at each 1%of stance.Stress was derived from bending moments at the anterior and posterior peripheries by modeling the tibia as a hollow ellipse.Two-way repeated-measures analysis of variance were conducted using both functional and discrete statistical analyses.Results:There were significant main effects for running speed and gradient on peak bending moments and peak anterior and posterior stress.Higher running speeds resulted in greater tibial loading.Running uphill at+10%and+15%resulted in greater tibial loading than level running.Running downhill at-10%and-15%resulted in reduced tibial loading compared to level running.There was no difference between+5%or-5%and level running.Conclusion:Running at faster speeds and uphill on gradients≥+10%increased internal tibial loading,whereas slower running and downhill running on gradients≥-10%reduced internal loading.Adapting running speed according to the gradient could be a protective mechanism,providing runners with a strategy to minimize the risk of tibial stress injuries.展开更多
Background:Tibial stress fracture(TSF)is an overuse running injury with a long recovery period.While many running studies refer to biomechanical risk factors for TSF,only a few have compared biomechanics in runners wi...Background:Tibial stress fracture(TSF)is an overuse running injury with a long recovery period.While many running studies refer to biomechanical risk factors for TSF,only a few have compared biomechanics in runners with TSF to controls.The aim of this systematic review and meta-analysis was to evaluate biomechanics in runners with TSF compared to controls.Methods:Electronic databases PubMed,Web of Science,SPORTDiscus,Scopus,Cochrane,and CINAHL were searched.Risk of bias was assessed and meta-analysis conducted for variables reported in 3 or more studies.Results:The search retrieved 359 unique records,but only the 14 that compared runners with TSF to controls were included in the review.Most studies were retrospective,2 were prospective,and most had a small sample size(5-30 per group).Many variables were not significantly different between groups.Meta-analysis of peak impact,active,and braking ground reaction forces found no significant differences between groups.Individual studies found larger tibial peak anterior tensile stress,peak posterior compressive stress,peak axial acceleration,peak rearfoot eversion,and hip adduction in the TSF group.Conclusion:Meta-analysis indicated that discrete ground reaction force variables were not statistically significantly different in runners with TSF compared to controls.In individual included studies,many biomechanical variables were not statistically significantly different between groups.However,many were reported by only a single study,and sample sizes were small.We encourage additional studies with larger sample sizes of runners with TSF and controls and adequate statistical power to confirm or refute these findings.展开更多
Motor reinnervation after repair of tibial nerve defects using autologous vein grafts in rats has previously been reported, but sensory reinnervation after the same repair has not been fully investigated. In this stud...Motor reinnervation after repair of tibial nerve defects using autologous vein grafts in rats has previously been reported, but sensory reinnervation after the same repair has not been fully investigated. In this study, partial sensory reinnervation of muscle spindles was observed after repair of lO-mm left tibial nerve defects using autologous vein grafts with end-to-end anasto- mosis in rats, and functional recovery was confirmed by electrophysiological studies. There were no significant differences in the number, size, or electrophysiological function of reinnervated muscle spindles between the two experimental groups. These findings suggest that repair of short nerve defects with autologous vein grafts provides comparable results to immediate end-to-end anastomosis in terms of sensory reinnervation of muscle spindles.展开更多
Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial a...Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging(MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density(BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture(TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order tofacilitate healing and prevent future re-occurrence.展开更多
Wallerian degeneration and nerve regeneration after injury are complex processes involving many genes, proteins and cytokines. After different peripheral nerve injuries the regeneration rate can differ. Whether this i...Wallerian degeneration and nerve regeneration after injury are complex processes involving many genes, proteins and cytokines. After different peripheral nerve injuries the regeneration rate can differ. Whether this is caused by differential expression of genes and proteins during Wallerian degeneration remains unclear. The right tibial nerve and the common peroneal nerve of the same rat were exposed and completely cut through and then sutured in the same horizontal plane. On days 1, 7, 14, and 21 after surgery, 1–2 cm of nerve tissue distal to the suture site was dissected out from the tibial and common peroneal nerves. The differences in gene and protein expression during Wallerian degeneration of the injured nerves were then studied by RNA sequencing and proteomic techniques. In the tibial and common peroneal nerves, there were 1718, 1374, 1187, and 2195 differentially expressed genes, and 477, 447, 619, and 495 differentially expressed proteins on days 1, 7, 14, and 21 after surgery, respectively. Forty-seven pathways were activated during Wallerian degeneration. Three genes showing significant differential expression by RNA sequencing (Hoxd4, Lpcat4 and Tbx1) were assayed by real-time quantitative polymerase chain reaction. RNA sequencing and real-time quantitative polymerase chain reaction results were consistent. Our findings showed that expression of genes and proteins in injured tibial and the common peroneal nerves were significantly different during Wallerian degeneration at different time points. This suggests that the biological processes during Wallerian degeneration are different in different peripheral nerves after injury. The procedure was approved by the Animal Experimental Ethics Committee of the Second Military Medical University, China (approval No. CZ20160218) on February 18, 2016.展开更多
Objective:To report our experience with the hybrid external fixator in emergency.Methods:We assessed 80 cases of pilon fracture treated with the external fixator during the period of January 2009 and December 2016:55 ...Objective:To report our experience with the hybrid external fixator in emergency.Methods:We assessed 80 cases of pilon fracture treated with the external fixator during the period of January 2009 and December 2016:55 men (69%) and 30 women (33%) with a mean age of 40 years (range between 16 and 70 ). About 45 occurred as isolated trauma, 35 instead were politrauma. Each patient underwent standard radiographic examination and a CT examination. There were 28 open fractures (35%), (Gustilo type 1, 2 and 3) while closed fractures showed soft tissue involvement of various grade (2-3 Tscherne classification). In all cases, the external fixation, sometimes associated with other reduction and synthesis techniques, was used. The timing of surgery was dictated by the condition of the soft tissues. For clinical evaluation, the Mazur score with mean follow-ups at 12 months was utilized.Results:The final range of ankle motion was 15 dorsal and 10 plantar flexion. In about 80 cases there was an average Mazur score of83. The mean score was 90;in open fractures 85 to 72. Radiographic healing of fractures in 60 patients occurred in 120 days (mean 105 days), at the time when the external fixator was removed.Conclusion:Pilon fractures are complex and often present complications;the definitive treatment, in emergency or delayed, with hybrid external fixator permits a stable synthesis with minimal soft tissue damage. Weight bearing maybe allowed early and functional recovery is generally good.展开更多
Targeted muscle reinnervation(TMR)is a surgical procedure used to transfer residual peripheral nerves from amputated limbs to targeted muscles,which allows the target muscles to become sources of motor control informa...Targeted muscle reinnervation(TMR)is a surgical procedure used to transfer residual peripheral nerves from amputated limbs to targeted muscles,which allows the target muscles to become sources of motor control information for function reconstruction.However,the effect of TMR on injured motor neurons is still unclear.In this study,we aimed to explore the effect of hind limb TMR surgery on injured motor neurons in the spinal cord of rats after tibial nerve transection.We found that the reduction in hind limb motor function and atrophy in mice caused by tibial nerve transection improved after TMR.TMR enhanced nerve regeneration by increasing the number of axons and myelin sheath thickness in the tibial nerve,increasing the number of anterior horn motor neurons,and increasing the number of choline acetyltransferase-positive cells and immunofluorescence intensity of synaptophysin in rat spinal cord.Our findings suggest that TMR may enable the reconnection of residual nerve fibers to target muscles,thus restoring hind limb motor function on the injured side.展开更多
BACKGROUND Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment.However,the early complications associated with t...BACKGROUND Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment.However,the early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed.AIM To analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.METHODS A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a Level 1 trauma center from 2014 to 2018 were enrolled in this retrospective study.Data regarding the demographic information,Tscherne soft tissue injury,fracture site,entry point placement,and duration of traction were recorded.Procedure-related complications such as movement and sensation disorder,vessel injury,discharge,infection,loosening,and iatrogenic fractures were analyzed.RESULTS The mean patient age was 42.5(18-71)years,and the mean duration of traction was 7.5(0-26)d.In total,19(4.7%)patients presented with procedure-related complications,including technique-associated complications in 6 patients and nursing-associated complications in 13.Differences in the incidence of complications with respect to sex,affected side,soft tissue injury classification,and fracture sites were not observed.However,the number of complications due to hammer insertion was significantly reduced than those due to drill insertions(2.9%vs 7.4%).CONCLUSION We found a low incidence of early complications related to the fixation.Furthermore,the complications were not significantly associated with the severity of the soft tissue injury and fracture site.Although relatively rough and more likely to cause pain,the number of complications associated with hammer insertion was significantly smaller than that of complications associated with drill insertion.展开更多
文摘The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.
文摘Background:Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury.Runners encounter varied surface steepness(gradients)when running outdoors and may adapt their speed according to the gradient.This study aimed to quantify tibial bending moments and stress at the anterior and posterior peripheries when running at different speeds on surfaces of different gradients.Methods:Twenty recreational runners ran on a treadmill at 3 different speeds(2.5 m/s,3.0 m/s,and 3.5 m/s)and gradients(level:0%;uphill:+5%,+10%,and+15%;downhill:-5%,-10%,and-15%).Force and marker data were collected synchronously throughout.Bending moments were estimated at the distal third centroid of the tibia about the medial-lateral axis by ensuring static equilibrium at each 1%of stance.Stress was derived from bending moments at the anterior and posterior peripheries by modeling the tibia as a hollow ellipse.Two-way repeated-measures analysis of variance were conducted using both functional and discrete statistical analyses.Results:There were significant main effects for running speed and gradient on peak bending moments and peak anterior and posterior stress.Higher running speeds resulted in greater tibial loading.Running uphill at+10%and+15%resulted in greater tibial loading than level running.Running downhill at-10%and-15%resulted in reduced tibial loading compared to level running.There was no difference between+5%or-5%and level running.Conclusion:Running at faster speeds and uphill on gradients≥+10%increased internal tibial loading,whereas slower running and downhill running on gradients≥-10%reduced internal loading.Adapting running speed according to the gradient could be a protective mechanism,providing runners with a strategy to minimize the risk of tibial stress injuries.
文摘Background:Tibial stress fracture(TSF)is an overuse running injury with a long recovery period.While many running studies refer to biomechanical risk factors for TSF,only a few have compared biomechanics in runners with TSF to controls.The aim of this systematic review and meta-analysis was to evaluate biomechanics in runners with TSF compared to controls.Methods:Electronic databases PubMed,Web of Science,SPORTDiscus,Scopus,Cochrane,and CINAHL were searched.Risk of bias was assessed and meta-analysis conducted for variables reported in 3 or more studies.Results:The search retrieved 359 unique records,but only the 14 that compared runners with TSF to controls were included in the review.Most studies were retrospective,2 were prospective,and most had a small sample size(5-30 per group).Many variables were not significantly different between groups.Meta-analysis of peak impact,active,and braking ground reaction forces found no significant differences between groups.Individual studies found larger tibial peak anterior tensile stress,peak posterior compressive stress,peak axial acceleration,peak rearfoot eversion,and hip adduction in the TSF group.Conclusion:Meta-analysis indicated that discrete ground reaction force variables were not statistically significantly different in runners with TSF compared to controls.In individual included studies,many biomechanical variables were not statistically significantly different between groups.However,many were reported by only a single study,and sample sizes were small.We encourage additional studies with larger sample sizes of runners with TSF and controls and adequate statistical power to confirm or refute these findings.
基金supported by the Medical Science and Technology Innovation Foundation of Nanjing Military Area Command of Chinese PLA in 2013,ZX22
文摘Motor reinnervation after repair of tibial nerve defects using autologous vein grafts in rats has previously been reported, but sensory reinnervation after the same repair has not been fully investigated. In this study, partial sensory reinnervation of muscle spindles was observed after repair of lO-mm left tibial nerve defects using autologous vein grafts with end-to-end anasto- mosis in rats, and functional recovery was confirmed by electrophysiological studies. There were no significant differences in the number, size, or electrophysiological function of reinnervated muscle spindles between the two experimental groups. These findings suggest that repair of short nerve defects with autologous vein grafts provides comparable results to immediate end-to-end anastomosis in terms of sensory reinnervation of muscle spindles.
文摘Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging(MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density(BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture(TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order tofacilitate healing and prevent future re-occurrence.
基金funded by the National Natural Science Foundation of China,No.81572146(to HDL)the Program of Outstanding Medical Talent of Shanghai Municipal Health Bureau,China,No.2017BR034(to HDL)+1 种基金the Shuguang Program of Shanghai Education Development FoundationShanghai Municipal Education Commission,China,No.15SG34(to HDL)
文摘Wallerian degeneration and nerve regeneration after injury are complex processes involving many genes, proteins and cytokines. After different peripheral nerve injuries the regeneration rate can differ. Whether this is caused by differential expression of genes and proteins during Wallerian degeneration remains unclear. The right tibial nerve and the common peroneal nerve of the same rat were exposed and completely cut through and then sutured in the same horizontal plane. On days 1, 7, 14, and 21 after surgery, 1–2 cm of nerve tissue distal to the suture site was dissected out from the tibial and common peroneal nerves. The differences in gene and protein expression during Wallerian degeneration of the injured nerves were then studied by RNA sequencing and proteomic techniques. In the tibial and common peroneal nerves, there were 1718, 1374, 1187, and 2195 differentially expressed genes, and 477, 447, 619, and 495 differentially expressed proteins on days 1, 7, 14, and 21 after surgery, respectively. Forty-seven pathways were activated during Wallerian degeneration. Three genes showing significant differential expression by RNA sequencing (Hoxd4, Lpcat4 and Tbx1) were assayed by real-time quantitative polymerase chain reaction. RNA sequencing and real-time quantitative polymerase chain reaction results were consistent. Our findings showed that expression of genes and proteins in injured tibial and the common peroneal nerves were significantly different during Wallerian degeneration at different time points. This suggests that the biological processes during Wallerian degeneration are different in different peripheral nerves after injury. The procedure was approved by the Animal Experimental Ethics Committee of the Second Military Medical University, China (approval No. CZ20160218) on February 18, 2016.
文摘Objective:To report our experience with the hybrid external fixator in emergency.Methods:We assessed 80 cases of pilon fracture treated with the external fixator during the period of January 2009 and December 2016:55 men (69%) and 30 women (33%) with a mean age of 40 years (range between 16 and 70 ). About 45 occurred as isolated trauma, 35 instead were politrauma. Each patient underwent standard radiographic examination and a CT examination. There were 28 open fractures (35%), (Gustilo type 1, 2 and 3) while closed fractures showed soft tissue involvement of various grade (2-3 Tscherne classification). In all cases, the external fixation, sometimes associated with other reduction and synthesis techniques, was used. The timing of surgery was dictated by the condition of the soft tissues. For clinical evaluation, the Mazur score with mean follow-ups at 12 months was utilized.Results:The final range of ankle motion was 15 dorsal and 10 plantar flexion. In about 80 cases there was an average Mazur score of83. The mean score was 90;in open fractures 85 to 72. Radiographic healing of fractures in 60 patients occurred in 120 days (mean 105 days), at the time when the external fixator was removed.Conclusion:Pilon fractures are complex and often present complications;the definitive treatment, in emergency or delayed, with hybrid external fixator permits a stable synthesis with minimal soft tissue damage. Weight bearing maybe allowed early and functional recovery is generally good.
基金funded by the National Natural Science Foundation of China,Nos.81760416,81960419,81927804(all to LY)Science and Technology foundation of Guizhou Province,No.[2017]1226(to LY)Support Plan for High Level Talents in Guizhou High Education Institutions,No.KY[2018]056(to LY).
文摘Targeted muscle reinnervation(TMR)is a surgical procedure used to transfer residual peripheral nerves from amputated limbs to targeted muscles,which allows the target muscles to become sources of motor control information for function reconstruction.However,the effect of TMR on injured motor neurons is still unclear.In this study,we aimed to explore the effect of hind limb TMR surgery on injured motor neurons in the spinal cord of rats after tibial nerve transection.We found that the reduction in hind limb motor function and atrophy in mice caused by tibial nerve transection improved after TMR.TMR enhanced nerve regeneration by increasing the number of axons and myelin sheath thickness in the tibial nerve,increasing the number of anterior horn motor neurons,and increasing the number of choline acetyltransferase-positive cells and immunofluorescence intensity of synaptophysin in rat spinal cord.Our findings suggest that TMR may enable the reconnection of residual nerve fibers to target muscles,thus restoring hind limb motor function on the injured side.
文摘BACKGROUND Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment.However,the early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed.AIM To analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.METHODS A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a Level 1 trauma center from 2014 to 2018 were enrolled in this retrospective study.Data regarding the demographic information,Tscherne soft tissue injury,fracture site,entry point placement,and duration of traction were recorded.Procedure-related complications such as movement and sensation disorder,vessel injury,discharge,infection,loosening,and iatrogenic fractures were analyzed.RESULTS The mean patient age was 42.5(18-71)years,and the mean duration of traction was 7.5(0-26)d.In total,19(4.7%)patients presented with procedure-related complications,including technique-associated complications in 6 patients and nursing-associated complications in 13.Differences in the incidence of complications with respect to sex,affected side,soft tissue injury classification,and fracture sites were not observed.However,the number of complications due to hammer insertion was significantly reduced than those due to drill insertions(2.9%vs 7.4%).CONCLUSION We found a low incidence of early complications related to the fixation.Furthermore,the complications were not significantly associated with the severity of the soft tissue injury and fracture site.Although relatively rough and more likely to cause pain,the number of complications associated with hammer insertion was significantly smaller than that of complications associated with drill insertion.
