Tibia


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Tibia

The tibia / ˈ t ɪ b i ə / (plural tibiae / ˈ t ɪ b i i / or tibias), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outside of the tibia), and it connects the knee with the ankle bones. The tibia is found on the medial side of the leg next to the fibula and closer to the median plane or centre-line. The tibia is connected to the fibula by the interosseous membrane of the leg, forming a type of fibrous joint called a syndesmosis with very little movement. The tibia is named for the flute tibia. It is the second largest bone in the human body next to the femur. The leg bones are the strongest long bones as they support the rest of the body.


Tibia

Borrowed from Latin tībia ( “ shin bone, leg ” ) .

Pronunciation Edit

Noun Edit

tibia (plural tibias or tibiae)

  1. ( anatomy ) The inner and usually the larger of the two bones of the leg or hind limb below the knee, the shinbone
  2. ( entomology ) The second segment from the end of an insect's leg, between the femur and tarsus.
  3. ( arachnology ) The third segment from the end of an arachnid's leg, between the patella and metatarsus.
  4. A musical instrument of the flute kind, originally made of the leg bone of an animal.
    • 1975, Francis M. Collinson, The bagpipe: the history of a musical instrument (page 188) The musician on the left is playing the zampogna, a bagpipe with two chanters and two drones. The zampogna is thought to be the bag-provided descendant of the ancient mouth-blown divergent pipes of the Romans, known as the tibia.

Part or all of this entry has been imported from the 1913 edition of Webster’s Dictionary, which is now free of copyright and hence in the public domain. The imported definitions may be significantly out of date, and any more recent senses may be completely missing.
(See the entry for tibia in
Webster’s Revised Unabridged Dictionary, G. & C. Merriam, 1913.)


Contents

The bone has the following components:

Blood supply Edit

The blood supply is important for planning free tissue transfer because the fibula is commonly used to reconstruct the mandible. The shaft is supplied in its middle third by a large nutrient vessel from the fibular artery. It is also perfused from its periosteum which receives many small branches from the fibular artery. The proximal head and the epiphysis are supplied by a branch of the anterior tibial artery. In harvesting the bone the middle third is always taken and the ends preserved (4 cm proximally and 6 cm distally)

Development Edit

The fibula is ossified from three centers, one for the shaft, and one for either end. Ossification begins in the body about the eighth week of fetal life, and extends toward the extremities. At birth the ends are cartilaginous.

Ossification commences in the lower end in the second year, and in the upper about the fourth year. The lower epiphysis, the first to ossify, unites with the body about the twentieth year the upper epiphysis joins about the twenty-fifth year.

Head Edit

The upper extremity or head of the fibula is of an irregular quadrate form, presenting above a flattened articular surface, directed upward, forward, and medialward, for articulation with a corresponding surface on the lateral condyle of the tibia. On the lateral side is a thick and rough prominence continued behind into a pointed eminence, the apex (styloid process), which projects upward from the posterior part of the head.

The prominence, at its upper and lateral part, gives attachment to the tendon of the biceps femoris and to the fibular collateral ligament of the knee-joint, the ligament dividing the tendon into two parts.

The remaining part of the circumference of the head is rough, for the attachment of muscles and ligaments. It presents in front a tubercle for the origin of the upper and anterior fibers of the peroneus longus, and a surface for the attachment of the anterior ligament of the head and behind, another tubercle, for the attachment of the posterior ligament of the head and the origin of the upper fibers of the soleus.

Body Edit

The body of the fibula presents four borders - the antero-lateral, the antero-medial, the postero-lateral, and the postero-medial and four surfaces - anterior, posterior, medial, and lateral.

The antero-lateral border begins above in front of the head, runs vertically downward to a little below the middle of the bone, and then curving somewhat lateralward, bifurcates so as to embrace a triangular subcutaneous surface immediately above the lateral malleolus. This border gives attachment to an intermuscular septum, which separates the extensor muscles on the anterior surface of the leg from the peronaei longus and brevis on the lateral surface.

The antero-medial border, or interosseous crest, is situated close to the medial side of the preceding, and runs nearly parallel with it in the upper third of its extent, but diverges from it in the lower two-thirds. It begins above just beneath the head of the bone (sometimes it is quite indistinct for about 2.5 cm. below the head), and ends at the apex of a rough triangular surface immediately above the articular facet of the lateral malleolus. It serves for the attachment of the interosseous membrane, which separates the extensor muscles in front from the flexor muscles behind.

The postero-lateral border is prominent it begins above at the apex, and ends below in the posterior border of the lateral malleolus. It is directed lateralward above, backward in the middle of its course, backward, and a little medialward below, and gives attachment to an aponeurosis which separates the peronaei on the lateral surface from the flexor muscles on the posterior surface.

The postero-medial border, sometimes called the oblique line, begins above at the medial side of the head, and ends by becoming continuous with the interosseous crest at the lower fourth of the bone. It is well-marked and prominent at the upper and middle parts of the bone. It gives attachment to an aponeurosis which separates the tibialis posterior from the soleus and flexor hallucis longus.

The anterior surface is the interval between the antero-lateral and antero-medial borders. It is extremely narrow and flat in the upper third of its extent broader and grooved longitudinally in its lower third it serves for the origin of three muscles: the extensor digitorum longus, extensor hallucis longus, and peroneus tertius.

The posterior surface is the space included between the postero-lateral and the postero-medial borders it is continuous below with the triangular area above the articular surface of the lateral malleolus it is directed backward above, backward and medialward at its middle, directly medialward below. Its upper third is rough, for the origin of the soleus its lower part presents a triangular surface, connected to the tibia by a strong interosseous ligament the intervening part of the surface is covered by the fibers of origin of the flexor hallucis longus. Near the middle of this surface is the nutrient foramen, which is directed downward.

The medial surface is the interval included between the antero-medial and the postero-medial borders. It is grooved for the origin of the tibialis posterior.

The lateral surface is the space between the antero-lateral and postero-lateral borders. It is broad, and often deeply grooved it is directed lateralward in the upper two-thirds of its course, backward in the lower third, where it is continuous with the posterior border of the lateral malleolus. This surface gives origin to the peronaei longus and brevis.


Tibial Plateau Fractures Clinical Presentation

Full clinical assessment is required, including evaluation of the soft tissues to determine whether a compartment syndrome is present and whether the patient has sustained a neurovascular injury. Gentle stress testing can be performed with the leg in extension to evaluate the stability of the ligaments and to assess any sign of fracture displacement.

Approximately 50% of knees with closed tibial plateau fractures have injuries of the menisci and cruciate ligaments that usually necessitate surgical repair. Because of the valgus stress at the moment of impact, the medial collateral ligament is at greater risk than the lateral collateral ligament however, disruption of the lateral collateral ligament is of grave concern because of possible injuries to the peroneal nerve and the popliteal vessels. Dislocation-relocation injuries are more common with medial plateau injuries and carry an increased risk of peroneal nerve damage.

References

Agnew SG. Tibial plateau fractures. Oper Tech Orthoped. 1999. 9(3):197-205.

BURROWS HJ. Fractures of the lateral condyle of the tibia. J Bone Joint Surg Br. 1956 Aug. 38-B (3):612-3. [Medline].

Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am. 1973 Oct. 55 (7):1331-50. [Medline].

Sarmiento A. Functional bracing of tibial and femoral shaft fractures. Clin Orthop Relat Res. 1972 Jan-Feb. 82:2-13. [Medline].

Maripuri SN, Rao P, Manoj-Thomas A, Mohanty K. The classification systems for tibial plateau fractures: how reliable are they?. Injury. 2008 Oct. 39 (10):1216-21. [Medline].

HOHL M, LUCK JV. Fractures of the tibial condyle a clinical and experimental study. J Bone Joint Surg Am. 1956 Oct. 38-A (5):1001-18. [Medline].

Hohl M. Tibial condylar fractures. J Bone Joint Surg Am. 1967 Oct. 49 (7):1455-67. [Medline].

Moore TM. Fracture--dislocation of the knee. Clin Orthop Relat Res. 1981 May. (156):128-40. [Medline].

Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res. 1979 Jan-Feb. (138):94-104. [Medline].

Weaver MJ, Harris MB, Strom AC, Smith RM, Lhowe D, Zurakowski D, et al. Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures. Injury. 2012 Jun. 43 (6):864-9. [Medline].

Dennan S. Difficulties in the radiological diagnosis and evaluation of tibial plateau fractures. Radiography. 2004. 10:151-8.

Mustonen AO, Koivikko MP, Lindahl J, Koskinen SK. MRI of acute meniscal injury associated with tibial plateau fractures: prevalence, type, and location. AJR Am J Roentgenol. 2008 Oct. 191 (4):1002-9. [Medline].

Laible C, Earl-Royal E, Davidovitch R, Walsh M, Egol KA. Infection after spanning external fixation for high-energy tibial plateau fractures: is pin site-plate overlap a problem?. J Orthop Trauma. 2012 Feb. 26 (2):92-7. [Medline].

Pernaa K, Koski I, Mattila K, Gullichsen E, Heikkila J, Aho A, et al. Bioactive glass S53P4 and autograft bone in treatment of depressed tibial plateau fractures - a prospective randomized 11-year follow-up. J Long Term Eff Med Implants. 2011. 21 (2):139-48. [Medline].

Lubowitz JH, Elson WS, Guttmann D. Part I: Arthroscopic management of tibial plateau fractures. Arthroscopy. 2004 Dec. 20 (10):1063-70. [Medline].

Lubowitz JH, Elson WS, Guttmann D. Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures. Arthroscopy. 2005 Jan. 21 (1):86-92. [Medline].

Chen XZ, Liu CG, Chen Y, Wang LQ, Zhu QZ, Lin P. Arthroscopy-assisted surgery for tibial plateau fractures. Arthroscopy. 2015 Jan. 31 (1):143-53. [Medline].

Kayali C, Oztürk H, Altay T, Reisoglu A, Agus H. Arthroscopically assisted percutaneous osteosynthesis of lateral tibial plateau fractures. Can J Surg. 2008 Oct. 51 (5):378-82. [Medline].

Kumar P, Singh GK, Bajracharya S. Treatment of grade IIIB opens tibial fracture by Ilizarov hybrid external fixator. Kathmandu Univ Med J (KUMJ). 2007 Apr-Jun. 5 (2):177-80. [Medline].

Craiovan BS, Keshmiri A, Springorum R, Grifka J, Renkawitz T. [Minimally invasive treatment of depression fractures of the tibial plateau using balloon repositioning and tibioplasty: video article]. Orthopade. 2014 Oct. 43 (10):930-3. [Medline].

Yoon RS, Liporace FA, Egol KA. Definitive fixation of tibial plateau fractures. Orthop Clin North Am. 2015 Jul. 46 (3):363-75, x. [Medline].

Krappinger D, Struve P, Smekal V, Huber B. Severely comminuted bicondylar tibial plateau fractures in geriatric patients: a report of 2 cases treated with open reduction and postoperative external fixation. J Orthop Trauma. 2008 Oct. 22 (9):652-7. [Medline].

Yu B, Han K, Ma H, Zhang C, Su J, Zhao J, et al. Treatment of tibial plateau fractures with high strength injectable calcium sulphate. Int Orthop. 2009 Aug. 33 (4):1127-33. [Medline].

Lasanianos N, Mouzopoulos G, Garnavos C. The use of freeze-dried cancelous allograft in the management of impacted tibial plateau fractures. Injury. 2008 Oct. 39 (10):1106-12. [Medline].

Russell TA, Leighton RK, Alpha-BSM Tibial Plateau Fracture Study Group. Comparison of autogenous bone graft and endothermic calcium phosphate cement for defect augmentation in tibial plateau fractures. A multicenter, prospective, randomized study. J Bone Joint Surg Am. 2008 Oct. 90 (10):2057-61. [Medline].

Duan XJ, Yang L, Guo L, Chen GX, Dai G. Arthroscopically assisted treatment for Schatzker type I-V tibial plateau fractures. Chin J Traumatol. 2008 Oct. 11 (5):288-92. [Medline].

Mills WJ, Barei DP. High-energy tibial plateau fractures: Staged management. Oper Tech Orthoped. 2003. 13(2):96-103.

Chan YS, Chiu CH, Lo YP, Chen AC, Hsu KY, Wang CJ, et al. Arthroscopy-assisted surgery for tibial plateau fractures: 2- to 10-year follow-up results. Arthroscopy. 2008 Jul. 24 (7):760-8. [Medline].

Rossi R, Bonasia DE, Blonna D, Assom M, Castoldi F. Prospective follow-up of a simple arthroscopic-assisted technique for lateral tibial plateau fractures: results at 5 years. Knee. 2008 Oct. 15(5):378-83. [Medline].

Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN. Complications after tibia plateau fracture surgery. Injury. 2006 Jun. 37 (6):475-84. [Medline].

Mehin R, O'Brien P, Broekhuyse H, Blachut P, Guy P. Endstage arthritis following tibia plateau fractures: average 10-year follow-up. Can J Surg. 2012 Apr. 55 (2):87-94. [Medline].

Garner MR, Thacher RR, Ni A, Berkes MB, Lorich DG. Elective removal of implants after open reduction and internal fixation of Tibial Plateau fractures improves clinical outcomes. Arch Orthop Trauma Surg. 2015 Nov. 135 (11):1491-6. [Medline].


Contents

There were several kinds of aulos, single or double. The most common variety was a reed instrument. [4] Archeological finds, surviving iconography and other evidence indicate that it was double-reeded, like the modern oboe, but with a larger mouthpiece, like the surviving Armenian duduk. [5] A single pipe without a reed was called the monaulos (μόναυλος, from μόνος "single"). [4] A single pipe held horizontally, as the modern flute, was the plagiaulos (πλαγίαυλος, from πλάγιος "sideways"). [4] A pipe with a bag to allow for continuous sound, that is a bagpipe, was the askaulos (ἀσκαυλός from ἀσκός askos "wineskin"). [6]

Like the Great Highland Bagpipe, the aulos has been used for martial music, [7] but it is more frequently depicted in other social settings. It was the standard accompaniment of the passionate elegiac poetry. It also accompanied physical activities such as wrestling matches, the broad jump, the discus throw and to mark the rowing cadence on triremes, as well as sacrifices and dramas. [5] Plato associates it with the ecstatic cults of Dionysus and the Korybantes, banning it from his Republic but reintroducing it in Laws.

It appears that some variants of the instrument were loud, shrill, and therefore very hard to blow. A leather strap, called a phorbeiá (φορβεία) in Greek or capistrum in Latin, was worn horizontally around the head with a hole for the mouth by the auletai to help support the lips and avoid excessive strain on the cheeks due to continuous blowing. Sometimes a second strap was used over the top of the head to prevent the phorbeiá from slipping down. Aulos players are sometimes depicted with puffed cheeks. The playing technique almost certainly made use of circular breathing, very much like the Sardinian launeddas and Armenian duduk, and this would give the aulos a continuous sound. [ citation needed ]

Although aristocrats with sufficient leisure sometimes practiced aulos-playing as they did the lyre, after the later fifth century the aulos became chiefly associated with professional musicians, often slaves. Nevertheless, such musicians could achieve fame. The Romano-Greek writer Lucian discusses aulos playing in his dialogue Harmonides, in which Alexander the Great's aulete Timotheus discusses fame with his pupil Harmonides. Timotheus advises him to impress the experts within his profession rather than seek popular approval in big public venues. If leading musicians admire him, popular approval will follow. However, Lucian reports that Harmonides died from excessive blowing during practicing.

In myth, Marsyas the satyr was supposed to have invented the aulos, or else picked it up after Athena had thrown it away because it caused her cheeks to puff out and ruined her beauty. In any case, he challenged Apollo to a musical contest, where the winner would be able to "do whatever he wanted" to the loser—Marsyas's expectation, typical of a satyr, was that this would be sexual in nature. But Apollo and his lyre beat Marsyas and his aulos. And since the pure lord of Delphi's mind worked in different ways from Marsyas's, he celebrated his victory by stringing his opponent up from a tree and flaying him alive.

King Midas was cursed with donkey's ears for judging Apollo as the lesser player. Marsyas's blood and the tears of the Muses formed the river Marsyas in Asia Minor. [8]

This tale was a warning against committing the sin of "hubris", or overweening pride, in that Marsyas thought he might win against a god. Strange and brutal as it is, this myth reflects a great many cultural tensions that the Greeks expressed in the opposition they often drew between the lyre and aulos: freedom vs. servility and tyranny, leisured amateurs vs. professionals, moderation (sophrosyne) vs. excess, etc. Some of this is a result of 19th century AD "classical interpretation", i.e. Apollo versus Dionysus, or "Reason" (represented by the kithara) opposed to "Madness" (represented by the aulos). In the temple to Apollo at Delphi, there was also a shrine to Dionysus, and his Maenads are shown on drinking cups playing the aulos, but Dionysus is sometimes shown holding a kithara or lyre. So a modern interpretation can be a little more complicated than just simple duality.

This opposition is mostly an Athenian one. It might be surmised that things were different at Thebes, which was a center of aulos-playing. At Sparta—which had no Bacchic or Korybantic cults to serve as contrast—the aulos was actually associated with Apollo, and accompanied the hoplites into battle. [9]

Chigi vase Edit

The battle scene on the Chigi vase shows an aulos player setting a lyrical rhythm for the hoplite phalanx to advance to. This accompaniment reduced the possibility of an opening in the formation of the blockage the aulete had a fundamental role in insuring the integrity of the phalanx. In this particular scene, the phalanx approaching from the left is unprepared and momentarily outnumbered four to five. More soldiers can be seen running up to assist them from behind. Even though the front four are lacking a fifth soldier, they have the advantage because the aulete is there to bring the formation back together. [10]


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I am happy to announce that our team will begin to focus on loot statistics on newer monsters. Over the last couple of years our active team members haven't been able to play as much as we would like but we hope to be able to begin to build up our database over the last couple of updates. Thank you for your patience and support.

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We recently took the time to interview CM Rejana. Here is what she had to say about herself, her job and her thoughts on the current state of tibia.

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This article will serve the purpose of explaining how this works, how fast you gain skills offline, and how this correlates to online training. As you read this article, and for the future, you might be interested to test out some of your own values on our skill calculator.

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The magic level skill is one of the few skills trained by all vocations. As you may know this skill increases the magic spells power (with some exceptions of several physical offensive spells). Since this skill has such impact on damage and healing power it's vital to have a decent magic level.

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The shielding skill is very important, especially for knights and paladins, since it reduces the total damage of physical melee attacks against you. The higher the shielding skill, or melee skill if you use a two-handed weapon, and defense value of the weapon or shield, the better you will block. In general, the defense value is slightly more important than the skill when calculating the amount of damage reduction. read more

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There is much controversy over what constitutes perfect training, and I will try and make it clear once and for all. There is something, which I like to call a Hit Counter, which makes sure you must draw blood on your victim after a certain amount of time. You can think of a Hit Counter as a 30oz glass that you will fill up one ounce at a time. read more

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For almost one year Tibians have been able to try their hand at sculpting from clay and marble. After extensive testing, we have decided to release the results of our sculpting research. read more

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Medial tibial stress syndrome can be diagnosed reliably using history and physical examination

Background: The majority of sporting injuries are clinically diagnosed using history and physical examination as the cornerstone. There are no studies supporting the reliability of making a clinical diagnosis of medial tibial stress syndrome (MTSS).

Aim: Our aim was to assess if MTSS can be diagnosed reliably, using history and physical examination. We also investigated if clinicians were able to reliably identify concurrent lower leg injuries.

Methods: A clinical reliability study was performed at multiple sports medicine sites in The Netherlands. Athletes with non-traumatic lower leg pain were assessed for having MTSS by two clinicians, who were blinded to each others' diagnoses. We calculated the prevalence, percentage of agreement, observed percentage of positive agreement (Ppos), observed percentage of negative agreement (Pneg) and Kappa-statistic with 95%CI.

Results: Forty-nine athletes participated in this study, of whom 46 completed both assessments. The prevalence of MTSS was 74%. The percentage of agreement was 96%, with Ppos and Pneg of 97% and 92%, respectively. The inter-rater reliability was almost perfect k=0.89 (95% CI 0.74 to 1.00), p<0.000001. Of the 34 athletes with MTSS, 11 (32%) had a concurrent lower leg injury, which was reliably noted by our clinicians, k=0.73, 95% CI 0.48 to 0.98, p<0.0001.

Conclusion: Our findings show that MTSS can be reliably diagnosed clinically using history and physical examination, in clinical practice and research settings. We also found that concurrent lower leg injuries are common in athletes with MTSS.

Keywords: diagnosis history medial tibial stress syndrome physical examination reliability.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Conflict of interest statement

Competing interests: MW received a small grant from The Dutch National Olympic Committee during the course of this study for the performance of a prospective cohort study in athletes at risk for medial tibial stress syndrome (MTSS), investigating the relation between local tibial bone changes and MTSS.


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Ponadto, zajęliśmy się*kilkoma graficznymi problemami z beastmasterem i outfitem championa. Ponadto, mały problem z NPC Chemar został również naprawiony.