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Tibial plateau fractures, accounting for approximately 1% of adult fractures, are often associated with significant long-term complications such as pain, stiffness, and posttraumatic arthrosis. The optimal treatment approach remains controversial, particularly in resource-limited settings. This study investigated the factors influencing the clinical outcomes of patients with tibial plateau fractures in Ethiopia. Tibial plateau fractures, though common in trauma cases, have been poorly studied in sub-Saharan Africa, particularly in Ethiopia. The primary purpose of this study was to examine the factors influencing the clinical outcomes of patients with tibial plateau fractures and to assess the efficacy of conservative treatment versus surgical intervention. This research aims to provide insights into managing tibial plateau fractures in resource-limited settings, with the hope of contributing to improved clinical practices. A total of 191 patients with tibial plateau fractures were recruited from Tibebe Ghion Referral Hospital and Felegehiwot Specialized Hospital between February 1, 2018, and February 2022. Demographic, clinical, and radiological data were analyzed, and treatment outcomes were assessed via Rasmussen's knee functional outcome score. A correlation analysis was performed to identify factors impacting functional outcomes. Logistic regression was used to identify factors influencing clinical outcomes. The study population was predominantly male (73.8%), with a mean age of 45 years. Road traffic accidents (41.9%) were the most common cause of injury. Schatzker type I fractures (27.2%) were the most common, and compound fractures accounted for 21% of the fractures. The average time to definitive management was 1.59 weeks, with 35% of patients undergoing open reduction and internal fixation (ORIF). The duration of immobilization and weight-bearing significantly influenced functional outcomes. Patients who were immobilized for less than 4 weeks had better outcomes, with functional scores 54 times better than those of patients who were immobilized for more than 8 weeks (p < 0.01). Early initiation of partial weight-bearing also improved outcomes. A strong negative relationship was found between the duration of immobilization and functional outcomes (r = -0.705, p < 0.01). This study highlights the importance of early mobilization and optimal management of tibial plateau fractures for improving functional outcomes. Timely treatment, especially regarding immobilization and weight-bearing, is crucial for achieving better results. These findings emphasize the need for more standardized treatment protocols and further research on tibial plateau fractures in sub-Saharan Africa to increase patient care in resource-limited settings.

s The aim of the present study was to assess, by Raman spectroscopy, the repair of surgical fractures fixed with internal rigid fixation (IRF) treated or not with IR laser ( λ 780 nm, 50 mW, 4 × 4 J/cm 2  = 16 J/cm 2 , ϕ  = 0.5 cm 2 , CW) associated or not to the use of hydroxyapatite and guided bone regeneration (GBR). Surgical tibial fractures were created under general anesthesia on 15 rabbits that were divided into five groups, maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet and had water ad libitum. The fractures in groups II, III, IV and V were fixed with miniplates. Animals in groups III and V were grafted with hydroxyapatite and GBR technique used. Animals in groups IV and V were irradiated at every other day during 2 weeks (4 × 4 J/cm 2 , 16 J/cm 2  = 112 J/cm 2 ). Observation time was that of 30 days. After animal death, specimens were taken and kept in liquid nitrogen and used for Raman spectroscopy. Raman spectroscopy showed significant differences between groups ( p  < 0.001). Basal readings showed mean value of 1,234  ±  220.1 . Group internal rigid fixation + biomaterial + laser showed higher readings ( 3,521  ±  2,670 ) and group internal rigid fixation + biomaterial the lowest ( 212.2  ±  119.8 ). In conclusion, the results of the present investigation are important clinically as spectral analysis of bone component evidenced increased levels of CHA on fractured sites by using the association of laser light to a ceramic graft.

Toddler’s FractureA 20-month-old boy was brought in with pain and swelling of the left lower leg 2 hours after he had been pushed and fell. Radiographs showed a minimally displaced spiral fracture of the tibial shaft.

The aim of this study was to investigate and to compare the effects of low intensity ultra-sound (LIPUS) and low-level laser therapy (LLLT) during the process of bone healing by means of histopathological and morphometric analysis. The animals were randomly distributed into three groups of 30 animals each: the control group (bone defect without treatment); the laser-treated group: (bone defect treated with laser), and the LIPUS-treated (bone defect treated with ultrasound). Each group was further divided into three different subgroups ( n  = 10) and on days 7, 13, and 25 post-injury, rats were killed with an intra-peritoneal injection of general anesthetic. The rats were treated with a 30-mW/cm 2 low-intensity pulsed ultrasound and a 830-nm laser at 50 J/cm 2 . The results showed intense new bone formation surrounded by highly vascularized connective tissue presenting a slight osteogenic activity, with primary bone deposition being observed in the group exposed to laser in the intermediary (13 days) and late stages of repair (25 days). This was confirmed by morphometric analysis in which significant statistical differences ( p  < 0.05) were noticed when compared to the control. No remarkable differences were noticed in the specimens treated with ultrasound with regard to the amount of newly formed bone in comparison to the control group. Taken together, our results indicate that laser therapy improves bone repair in rats as depicted by histopathological and morphometric analysis, mainly at the late stages of recovery. Moreover, it seems that this therapy was more effective than US to accelerate bone healing.

Open tibia fractures result in substantial lifelong disability for patients, and are expensive to treat. As the injury typically affects young working men, the societal costs from open tibia fractures are likely to also be high in low income countries, but remain largely unknown. We therefore investigated the overall societal costs and cost-effectiveness of different orthopaedic treatments at one year following an open tibia fracture in Malawi. This study was a cost-utility analysis nested in a prospective cohort study from the healthcare- and societal-payer perspectives with a one-year time horizon. We obtained quality-adjusted life years (QALYs) from the EuroQoL 5 Dimension 3 Level (EQ-5D-3L) and patient lost productivity estimates at 6 weeks, and 3, 6, and 12 months post-injury. QALYs were calculated from utility scores were modelled within a hierarchical Bayesian multivariate modelling framework that jointly estimated individual-level trajectories in EQ-5D-3L scores and costs over follow-up. Direct treatment costs were obtained from a micro-costing study, and staff interviews at tertiary and district hospitals. Cost-effectiveness was reported in terms of societal cost per quality-adjusted life year (QALY). All costs were reported in 2021 United States dollars (USD). Between February 2021 and March 2022, 287 participants with open tibia fractures were included. There were substantial costs to participants one year following injury with 42% (n = 112) working with a median monthly household income of US$40 (IQR: US$7-90) compared to 89% (n = 255) working pre-injury, with a median monthly household income of US$60 (IQR: US$36-144). The posterior median of societal costs at one year varied between US$751 (80% credible intervals [CrIs]: US$-751-2,389) for treatment with plaster of Paris (POP) in a district hospital for a Gustilo III injury, to US$2,428 (80% CrIs: US$995-5027) for intramedullary nail in central hospital for a Gustilo III injury. The largest cost-effectiveness from a societal perspective was between an intramedullary nail and amputation for a Gustilo III injury with a posterior mean of US$2,290 (95%HDI: 36-4,547) per QALY. The main finding was that open tibia fractures result in significant costs to patients, the healthcare system and society in Malawi. Although the funding of orthopaedic treatment can be difficult in countries with very limited healthcare budgets, the costs to society of ignoring this issue are very high. A re-balancing of health budgets (including from government and donors) is needed to prioritise trauma care to reduce the growing societal economic burden from injury.

Purpose It is generally agreed that surgical treatment is warranted for acute posterior cruciate ligament (PCL) avulsion fracture with displacement. However, the amount of displacement that warrants surgical treatment has not been defined. The purpose of this study was to determine the optimal cut-off value for displacement of posterior cruciate ligament avulsion fracture in determining non-operative treatment and to compare the results of non-operative treatment in acute isolated PCL avulsion fractures with non-operative treatment of acute PCL injury. Methods Between 2007 and 2017, 30 consecutive patients with acute isolated PCL avulsion fractures and 70 consecutive patients with acute isolated PCL injuries, all of whom underwent non-operative treatment (cast immobilization with > 2 years of follow-up) were retrospectively analyzed. Clinical scores including the International Knee Documentation Committee subjective score, Lysholm score, and Tegner activity score, as well as side-to-side differences on stress radiographs, were compared between the PCL avulsion fracture and PCL injury groups at the final follow-up. The failure rates of non-operative treatment were also compared. The predictive value of the amount of fracture displacement for successful non-operative treatment was calculated using area under the receiver operating characteristic curve (AUROC). The optimal cut-off of the amount of fracture displacement to determine non-operative treatment was based on the maximal sum of sensitivity and specificity. Results The two groups exhibited comparable clinical scores and mean side-to-side differences on stress radiographs. There were 5 (16.6%) failures of non-operative treatment in the PCL avulsion fracture group and 19 (27.1%) failures in the PCL injury group. (n.s) There was a significant positive correlation between the amount of initial avulsion fracture displacement and side-to-side difference in posterior stress radiographs at final follow up ( P  < 0.001). The optimal cut-off value for the amount of fracture displacement in PCL avulsion fracture to predict failure of non-operative treatment was 6.7 mm (AUROC = 1.0). Conclusion The outcomes of non-operative treatment of acute isolated PCL avulsion fractures were comparable to those of patients with acute isolated PCL injuries. Acute PCL avulsion injuries with displacement of less than 6.7 mm should be considered for non-operative treatment. Level of evidence IV.

Objective To determine whether low intensity pulsed ultrasound (LIPUS), compared with sham treatment, accelerates functional recovery and radiographic healing in patients with operatively managed tibial fractures.Design A concealed, randomized, blinded, sham controlled clinical trial with a parallel group design of 501 patients, enrolled between October 2008 and September 2012, and followed for one year.Setting 43 North American academic trauma centers.Participants Skeletally mature men or women with an open or closed tibial fracture amenable to intramedullary nail fixation. Exclusions comprised pilon fractures, tibial shaft fractures that extended into the joint and required reduction, pathological fractures, bilateral tibial fractures, segmental fractures, spiral fractures >7.5 cm in length, concomitant injuries that were likely to impair function for at least as long as the patient’s tibial fracture, and tibial fractures that showed <25% cortical contact and >1 cm gap after surgical fixation. 3105 consecutive patients who underwent intramedullary nailing for tibial fracture were assessed, 599 were eligible and 501 provided informed consent and were enrolled.Interventions Patients were allocated centrally to self administer daily LIPUS (n=250) or use a sham device (n=251) until their tibial fracture showed radiographic healing or until one year after intramedullary fixation.Main outcome measures Primary registry specified outcome was time to radiographic healing within one year of fixation; secondary outcome was rate of non-union. Additional protocol specified outcomes included short form-36 (SF-36) physical component summary (PCS) scores, return to work, return to household activities, return to ≥80% of function before injury, return to leisure activities, time to full weight bearing, scores on the health utilities index (mark 3), and adverse events related to the device.Results SF-36 PCS data were acquired from 481/501 (96%) patients, for whom we had 2303/2886 (80%) observations, and radiographic healing data were acquired from 482/501 (96%) patients, of whom 82 were censored. Results showed no impact on SF-36 PCS scores between LIPUS and control groups (mean difference 0.55, 95% confidence interval −0.75 to 1.84; P=0.41) or for the interaction between time and treatment (P=0.30); minimal important difference is 3-5 points) or in other functional measures. There was also no difference in time to radiographic healing (hazard ratio 1.07, 95% confidence interval 0.86 to 1.34; P=0.55). There were no differences in safety outcomes between treatment groups. Patient compliance was moderate; 73% of patients administered ≥50% of all recommended treatments.Conclusions Postoperative use of LIPUS after tibial fracture fixation does not accelerate radiographic healing and fails to improve functional recovery.Study registration ClinicalTrialGov Identifier: NCT00667849

Does low intensity pulsed ultrasound (LIPUS) accelerate recovery in adults and children who have experienced bone fractures or osteotomy (cutting of a bone)? An expert panel rapidly produced these recommendations based on a linked systematic review triggered by a large multicentre randomised trial in adults with tibial fracture.

Background The purpose of this study was to quantify the incidence of total knee arthroplasty (TKA) and other osteoarthritis-related procedures following surgical and conservative treatment of tibial plateau fractures (TPF). Secondary goal was to analyse the long-term clinical outcomes and identify risk factors for secondary interventions and poor outcomes. Methods All patients diagnosed with TPF at a single level 1 university trauma centre between January 1, 2008 and December 31, 2016 were retrospectively reviewed. Clinical outcomes were measured by use of the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Score (IKDC) and the Tegner Activity Score (TAS). Joint-preserving interventions and conversions to TKA were recorded as well as demographic data, injury mechanisms, treatment specifics and complications. Results 105 cases of TPF, 89 with surgical and 16 with conservative treatment, with a median follow-up of 10.4 years (interquartile range, IQR 9–13), were included. The conversion rate to TKA was 2%, with all cases occurring in the conservative treatment group. 9% underwent a joint-preserving intervention. Higher body mass index (BMI) was associated with an increased risk for secondary intervention (HR 1.4, p  = 0.03). The overall KOOS was 78.7 (IQR 69–87) for surgical and 86 (IQR 70–93) for conservative treatment. The IKDC score was 63.6 ± 16.5 for surgical and 66.3 ± 22.2 for conservative treatment and the median TAS was 3 (IQR 3–4 vs. 3–6) for both groups. In the surgical treatment cohort, a negative correlation was found between Schatzker classification (Spearman´s r p  = -0.24, p  = 0.03), duration of surgery (Spearman´s r p  = -0.23, p  = 0.03), American Society of Anesthesiologists (ASA) risk classification (Spearman´s r p  = -0.28, p  = 0.01) and the IKDC score. A higher TAS was observed for non-smokers (median 3, IQR 3–4) compared to smokers (median 2.5, IQR 2–3, p  = 0.02). Conclusions There was a low incidence of TKA and joint-preserving, osteoarthritis-related procedures following TPF. Both conservative and surgical treatments can achieve satisfactory long-term clinical outcomes, when appropriately indicated. Obese patients are at increased risk for secondary interventions. The expectations of patients with a higher ASA risk score and complex fractures, accompanied by longer surgical times, should be managed carefully to ensure a realistic outlook on functional outcomes.

Background Earthquakes frequently cause injuries to the musculoskeletal system. Studies conducted after earthquakes often report on injured limbs, fractures, and surgeries. This study aimed to enhance preparedness for future earthquakes by acquiring knowledge about the prevalence of fractures and the relationship between fracture types and injury mechanisms. Methods A retrospective analysis was conducted on medical records of patients with fractures admitted to our hospital following the 2023 Kahramanmaraş Earthquake. Patients with fractures resulting from traffic accidents or other causes unrelated to earthquakes were excluded. The recorded data included age, gender, fracture site, fracture type, mechanism of injury, date, duration of surgery, and peak creatine kinase (CK) level. The injury mechanisms were classified into four main categories: injured by falling objects, falling while running, falling from height, and being trapped under rubble. The study investigated the relationship between fractures and other factors. Results The study included 185 patients with a mean age of 39.62 ± 20.83 years. The most frequent mechanism of injury was being trapped under rubble. In total, there were 214 fractures, with pelvic fractures being the most common (21.50% of all fractures). Tibia fractures were the most common fractures in the lower extremities (15.89%). Women had a significantly higher occurrence of pelvic fractures (33.3%) compared to men (14.5%) ( p  = 0.003). The frequency of pelvic fractures significantly increased as age decreased ( p  = 0.007). Patients with pelvic fractures had a significantly greater peak CK concentration ( p  = 0.006). Open fractures were more common in the first few days, and Kirschner wires were the first treatment applied at a mean of 74 h and external fixators at a mean of 94.3 h. Conclusion Injuries from falling objects from roofs and jumping from heights are important in earthquakes. In addition to lower extremity fractures, pelvic fractures are common in earthquake disasters. Most pelvic fractures are simple lateral compression fractures and it is important to follow the patients for crush syndrome in the first days instead of focusing on definitive fracture treatment. Open fractures should be prioritized for fracture surgery within the first few days. External fixators and Kirschner wires are recommended. Closed fractures should be treated conservatively and definitive surgical procedures should be postponed to the following weeks.