Postraumatic rehabilitation represent a dynamic field, with specific protocols and technics. Our prospective study targets the tibial pilon fractures admitted in our clinic, to which a new treatment ...protocol was applied, consisting of two surgical steps, assesing in the end the results achieved at the discharge of the patient and later follow up. The study group consist of 196 patients (198 fractures), in the period 2019-2022. The average evaluation time was of 16 months. The most frequently applied osteosynthesis principle was staged osteosynthesis which consisted of first stage fibula plate osteosynthesis and external fixator tibia pilon, followed by minimally invasive or limited approach locked plate tibia pilon fixation. (64.14%) Olerud and Molander clinical score at more than one year after the last surgical intervention highlights good results: excellent results in the amount of 37% to 15% in the first lot, good results 52% to 29%, moderate success 7% to 39% and poor 4% to 17%. Two stage surgery protocol with external fixation in emergency and minimally invasive internal fixation with locked plate performed after the dissappearance of the local edema, as the second surgical step, allows anatomically correct articular reconstruction without skin complications, with decrease of arthitic late complications.
Posterior pilon fracture is speculated to occur by a combination of rotation and axial load, which makes it different from rotational posterior malleolar fracture or pilon fracture, but is not ...validated in vitro. The aim of the current study is to investigate the injury mechanisms of posterior pilon fracture on cadaveric specimens.
Eighteen cadaveric specimens were mounted to a loading device to undergo solitary vertical loading, solitary external rotational loading, and combined vertical and external rotational loading until failure, in initial position of plantarflexion with or without varus. The fracture characteristics were documented for each specimen.
Vertical loading force combined with external rotation force diversified the fracture types resulting in pilon fracture, tibial spiral fracture, rotational malleolar fracture, talar fracture or calcaneal fracture. Vertical violence combined with external rotational loading in position of 45° of plantarflexion and 0° of varus produced posterior pilon fracture in specimens No. 13 and 14.
Combination of vertical and external rotational force in plantarflexion position on cadaveric specimens produce posterior pilon fracture.
Background: The purpose of this study was to investigate social media posts regarding pilon fractures and its relationship to patient injury perception. We evaluated Instagram media posts in patients ...who have suffered pilon fractures for the following variables: gender, tone, discussion of rehabilitation, activities of daily living (ADL) reference, incision/scar reference, pain, post of radiograph/imaging, external fixation reference, discussion of bracing/splinting, pre- or postoperative swelling, and need for reoperation. Results were determined by comparing each variable to gender and tone of the post to study patient injury perception. Methods: Public Instagram posts from within a 1-year time period were isolated and evaluated using the hashtag “#pilonfracture.” Individual posts were analyzed by authors. In total, 241 patient posts were included for investigation and analysis of patient injury perception via social media. Results: Of all included posts, 88% of posts had a positive tone. A majority of the posts (66.8%) mentioned rehabilitation and postoperative progress. There were significant associations between positive tone and rehabilitation (P = .0001), as well as positive tone and ADLs (P = .0361). Conclusion: Reported outcomes after surgical management of pilon fractures are generally poor. Nonetheless, this analysis of patients sharing their experience on social media after open reduction internal fixation of pilon fractures demonstrates a mostly positive attitude toward the injury and recovery. A positive tone of the post was significantly associated with mentions of rehabilitation and ADLs.
Levels of Evidence: Level III: Retrospective comparative study
This article reports on an exhumation of an individual identified to be a victim of albinism from a trench dug for a well on 16 April 2018, Ukonga, Dar es Salaam, Tanzania. The skeletal remains were ...sent to the Forensic Bureau of the Tanzania Police Force for further investigation. Ante-mortem and postmortem information, the deoxyribonucleic acid (DNA) and skeletal diagnosis were used in the identification. Skeletal diagnosis suggests that the victim was a young African male aged between 19 and 26 years old with stature of 157–166 cm. Ante-mortem trauma suggest that the individual was wounded with a sharp object on the left shoulder resulting in severe infection. The victim had a problem with acute dental caries suggesting the existence of biochemical reaction. He also had porosity lesions on cranium and vertebral column which is indicative of chronic malaria infection or anemic condition. The distal end of the tibia exhibited a peri-mortem pilon fracture on the articular surface of the malleolus. This signifies he fell into that long edge trench either intentionally or accidentally or pushed by people and that is the circumstances of death. This article also provides a general picture of challenges facing people with albinism in Africa. People with albinism have been victimized in many ways such as restricted right of self-expression, deficiency of freedom, being hunted or repudiated to death, and deficiency of medical treatment. They also are suffering from dermal diseases, injuries and infections that can easily lead to skin cancer and skeletal diseases due to their disability. In fact, this problem requires urgent resolution for health departments and those involved in the protection of civilians, especially the security agencies. It is an intolerable life; therefore, African governments should take serious measures to curtail atrocities committed to people with albinism.
To identify the incidence and fracture characteristics associated with syndesmotic injury in tibial plafond fractures and report the incidence of posttraumatic osteoarthrosis (PTOA).
Retrospective ...comparative study.
Two level-1 academic trauma centers.
Of the 735 tibial plafond fractures (OTA/AO 43-B3 and 43-C) treated from January 2006 through December 2015, 108 patients (108/735, 15%) were identified with syndesmosis injury.
Either acute or missed syndesmotic injury.
PTOA.
Fourteen fractures (14/735, 2%) had missed syndesmotic injury. Volkmann fragment of ≤10 mm (P = 0.04) and fibular avulsion fracture (P = 0.05) were significantly more common in missed syndesmosis. Ninety fractures (14/14 missed, 76/94 acute) had greater than 12-month follow-up (mean, 26 months; range, 12-102 months). Nearly all patients with missed syndesmosis injury developed arthrosis (13/14, 93%), and 45% (34/76 fractures) of plafond fractures with acute syndesmosis injury developed arthrosis (P < 0.001). Although controlling for malreduction, patients with missed syndesmosis had significantly more PTOA development (P = 0.018). Controlling for malreduction, patients with syndesmotic fixation and a ≤10-mm Chaput or Volkmann fragment or fibular avulsion fracture (8/31, 26%) were less likely to develop PTOA than if they had a similar fracture pattern without syndesmotic fixation (9/10, 90%) (P = 0.011).
Fifteen percent of tibia plafond fractures have a syndesmosis or syndesmotic equivalent injury. Missed syndesmosis injury has a high rate of PTOA development. Patients with a ≤10-mm Chaput or Volkmann fragment and/or fibular avulsion fracture benefit from syndesmotic fixation.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Tibial pilon fractures are difficult to treat. These fractures are associated with a high frequency of soft tissue complications. Therefore, two-stage surgery and less invasive surgical strategies ...using external fixation have been reported. The patient was a 79-year-old man. The right tibial pilon fracture was diagnosed as AO/OTA 43C3.1, Rüedi and Allgöwer type 2. He was treated with a low-profile mini-fragment plate and circular (Ilizarov type) external fixation. Herein, we report on a combination of these two methods: circular external fixator with low-profile mini-fragment plate fixation. At 18 months postoperatively, the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot score was a perfect score of 100. Radiographs taken in the loading position showed no narrowing of the joint fissure. There were no soft tissue infections, no plate breakage, no bone fusion, no symptoms of plate irritation, and no need for nail extraction.
We present the genome sequence of
Leishmania mexicana
MNYC/BZ/62/M379 modified to express Cas9 and T7 RNA-polymerase, revealing high similarity to the reference genome (MHOM/GT2001/U1103). Through ...RNAseq-based annotation of coding sequences and untranslated regions, we provide primer sequences for construct and sgRNA template generation for CRISPR-assisted gene deletion and endogenous tagging.
