![]() Expand your knowledge base of nursing assessments, interventions, goal formulation, and nursing diagnoses, all customized to meet the distinct needs of patients with fracture. Although varus malalignment of the lower limb occurs occasionally and may cause osteoarthritis in the medial compartment of the knee, other factors are more important in causing osteoarthritis after a tibial shaft fracture.Make use of this in-depth nursing care plan and management roadmap to aid in the care of patients with fracture. Fracture malunion is not the cause of the higher prevalence of symptomatic ankle and subtalar osteoarthritis on the side of the fracture. The thirty-year outcome after a tibial shaft fracture is usually good, although mild osteoarthritis is common. Most of the subjects in whom osteoarthritis was observed had normal overall alignment of the lower limb. In limbs with varus malalignment, there was a nonsignificant trend toward more frequent radiographic evidence of osteoarthritis in the medial compartment of the knee joint. In limbs with varus or valgus malalignment, there was an excess of subtalar stiffness (p = 0.04) and a nonsignificant trend toward more frequent knee pain. This malalignment was due to the fracture malunion in nine subjects and predated the fracture in eight. Seventeen (15%) of 114 eligible subjects had overall malalignment of the lower limb, defined as a hip-knee-ankle angle outside the normal range of 6.25 degrees of varus to 4.75 degrees of valgus. Apart from an association between shortening of > or = 10 mm and self-reported knee pain (p = 0.016), there were no significant univariate associations between these malunions and the development of osteoarthritis. Forty-seven fractures (29%) healed with coronal angulation of > or = 5 degrees. Knee osteoarthritis was frequently bilateral. The ipsilateral side demonstrated a higher prevalence than the contralateral side in terms of pain with passive ankle movement (nineteen versus nine subjects, p = 0.02), pain with passive subtalar movement (fifteen versus four subjects, p = 0.01), and radiographic signs of ankle joint space narrowing (twelve subjects versus one subject, p = 0.0055). Seventeen (13%) of the 135 subjects who reported no other knee or ankle injury reported at least moderate disability. Twenty-two (15%) of the 151 subjects who reported no other knee injury reported at least moderate knee pain, and eight (6%) of the 145 subjects who reported no other ankle injury reported at least moderate ankle pain. The subjects were evaluated with regard to self-reported lower limb joint pain, stiffness, and disability (assessed with the Western Ontario and McMaster Universities osteoarthritis questionnaire) clinical signs of osteoarthritis and radiographic evidence of osteophytes and joint-space narrowing in the knees, ankles, and subtalar joints. ![]() ![]() One hundred and sixty-four individuals who had sustained a tibial shaft fracture were assessed in a research clinic thirty to forty-three years after the injury. Although there is biomechanical evidence that such angulation alters load transmission through the joints of the lower limb, it is not clear whether it can eventually lead to osteoarthritis. Fractures of the shaft of the tibia often heal with some angulation. ![]()
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