Fracture of the Proximal Tibia With immediate Weightbearing after a Fulkerson Osteotomy

Stetson, William B.; Friedman, Marc J.; Fulkerson, John P.; Cheng, Margaret S.; Buuck, David

doi:10.1177/036354659702500422

Cited by 96 publications

(64 citation statements)

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“…5 Fracture has been reported in a few cases 3,4 after the original protocol for rehabilitation, which consisted of complete immobilisation in extension for four weeks, had been modified to early movement exercises and weight-bearing as tolerated. 4 All fractures occurred within the first three months after surgery. On the basis of these experiences the protocol was modified again to early continuous passive movement and protected weight-bearing for six to eight weeks.…”

Section: Discussionmentioning

confidence: 94%

“…Our patients sustained fractures of the proximal tibia six months after operation followed by the current rehabilitation protocol. 4,5 In both, the healing of the osteotomy had been demonstrated on radiographs at ten and 12 weeks. There had been no complications and full weight-bearing had been achieved without discomfort for more than ten weeks when the fractures occurred.…”

Section: Discussionmentioning

confidence: 99%

“…2 Bellemans et al 3 and Stetson et al 4 described fractures of the proximal tibia occurring within the first 13 weeks with early weightbearing. The postoperative regime was therefore changed with full weight-bearing allowed only after the osteotomy had consolidated.…”

mentioning

confidence: 99%

“…The postoperative regime was therefore changed with full weight-bearing allowed only after the osteotomy had consolidated. [2][3][4] Sports were discouraged for at least six months. 5 We describe two patients who sustained a fracture of the proximal tibia during recreational sports six months after a Fulkerson procedure.…”

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confidence: 99%

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Fracture of the proximal tibia six months after Fulkerson osteotomy

Gödde¹,

Rupp²,

Dienst³

et al. 2001

The Journal of Bone and Joint Surgery. British volume

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The Fulkerson osteotomy has proved to be a reliable treatment for subluxation of the patella due to malalignment. Aggressive rehabilitation in the early postoperative period is unwise since the proximal tibia is weakened by the oblique osteotomy. Early weight-bearing and unrestricted activity have caused fractures in a few patients. Even late in the postoperative period the osteotomy may adversely influence the biomechanical properties of the proximal tibia.We describe two athletes who sustained a fracture of the proximal tibia, during recreational activities, six months after a Fulkerson osteotomy. Both had been bearing full weight for about ten weeks without complaint. Bony healing of the osteotomy had been demonstrated on plain radiographs at ten and at 12 weeks. After a Fulkerson osteotomy, jogging and activities which impose considerable impact force should be discouraged for at least nine to 12 months. tibia occurring within the first 13 weeks with early weightbearing. The postoperative regime was therefore changed with full weight-bearing allowed only after the osteotomy had consolidated. 2-4 Sports were discouraged for at least six months. 5We describe two patients who sustained a fracture of the proximal tibia during recreational sports six months after a Fulkerson procedure. Case reportsTwo men, aged 30 and 51 years, underwent anteromedialisation of the tibial tuberosity for chronic patellofemoral pain. Both had subluxing malalignment with positive clinical and arthroscopic findings of patellofemoral osteoarthritis. After a lateral release, an anteromedial tibial tubercle transfer was carried out as described by Fulkerson, 1 with an osteotomy angle of 45°. The postoperative regimen of physiotherapy included unrestricted passive and active mobilisation and toe-touch weight-bearing with a detachable knee immobiliser for six weeks. Full weightbearing was not allowed until the osteotomy had consolidated. Neither patient had skeletal dysplasia, metabolic bone disease or other types of skeletal disorder. After six months, while jogging, both patients sustained transverse, undisplaced fractures of the proximal tibia (Fig. 1). The mechanism of injury was a stumble and fall with distortion of the knee. Both patients had started weightbearing two weeks after the osteotomy had consolidated, as shown on plain radiographs taken at 12 and at 14 weeks after surgery.These were the only such injuries in our series of 37 osteotomies of the tibial tuberosity. In both cases, the fracture occurred at the level of the inferior aspect of the osteotomy. Treatment was by immobilisation in a long leg cast and healing occurred without complication (Fig. 2). When seen at 24 months, both patients had a full range of movement. The clinical results were excellent (95/100 points) and good (85/100 points) according to a modified Lysholm knee score. 6,7 Pain was rated on a visual analogue scale from 0 to 100 and decreased from 80 to 20 and from 40 to 30, respectively. DiscussionThe Fulkerson procedure 1 is one of the more common techn...

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Fracture of the proximal tibia six months after Fulkerson osteotomy

Gödde¹,

Rupp²,

Dienst³

et al. 2001

The Journal of Bone and Joint Surgery. British volume

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“…The Fulkerson osteotomy, a multiplane anteromedialising modification of the Elmslie-Trillat procedure, also elevated the tibial tubercle up to 15 mm, decreasing the lateral facet contact pressures as well as realigning the joint, without the need for bone graft [13][14][15]. Though obtaining good/ excellent short-term clinical results in 60-93% of patients [14,16] and with improved wound healing compared with the Maquet procedure, non-union, loss of fixation and tibial fractures still occurred [17][18][19][20][21][22], and this sliding osteotomy suffered from the loss of ability to adjust each of the single planes alone, once made. Adaptations to the Maquet osteotomy that have combined tibial tubercle medialisation and elevation have also been reported to reduce patellofemoral contact pressures and improve patellar tracking; these have been reported to have lower complication rates and up to 84% overall subjective improvement in symptoms [23].…”

Section: Introductionmentioning

confidence: 99%

Tibial tubercle advancement osteotomy with bone allograft for patellofemoral arthritis: a retrospective cohort study of 50 knees

Atkinson

Bailey

Anand

et al. 2011

Arch Orthop Trauma Surg

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Tibial tubercle advancement osteotomy can be an effective treatment for anterior knee pain and for patients with arthroscopic evidence of patellar chondral damage. It can provide excellent/good long-term functional results in the majority of patients, with very high satisfaction levels and sustained improvement in pain symptoms. The use of femoral head bone allograft is both effective in obtaining bony union and by definition avoids the donor-site morbidity. Knees with patellar malalignment may also undergo individualised medialisation of the tibial tubercle such that the patella lies in the centre of the femoral trochlea, and may benefit from lateral trochleaplasty surgery in the presence of trochlear dysplasia. However, the major operative complication rate is high at 12%, and fracture of the tibial tubercle is associated with a poorer outcome. One can expect 10% of operated knees to have had some clinical deterioration in the patellofemoral joint by a mean follow-up of 93 months.

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