Case report
Distal tibia peri-implant fracture with an intramedullary nail: A case report
Fractura peri-implante de tibia distal con clavo intramedular: presentación de un caso
J.M. Reyes-Cabrera
, R. González-Alconada, M.D. García-Mota
Corresponding author
Servicio de Cirugía Ortopédica y Traumatología, Hospital Virgen del Puerto, Plasencia, Cáceres, Spain
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Discusión de cuál es la mejor estrategia terapéutica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 648 "Ancho" => 1800 "Tamanyo" => 121374 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Anteroposterior and lateral radiographs of the cervical spine on the day of the traffic accident. Magnetic resonance imaging scan obtained subsequently by the private healthcare provider, showing the dislocation of an articular facet and subluxation of the other between C5–C6 and assessment of the disk component.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Gallego-Goyanes, J.R. Caeiro-Rey, M.A. Díez Ulloa, J. Pino-Mínguez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Gallego-Goyanes" ] 1 => array:2 [ "nombre" => "J.R." "apellidos" => "Caeiro-Rey" ] 2 => array:2 [ "nombre" => "M.A." "apellidos" => "Díez Ulloa" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Pino-Mínguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441513001355" "doi" => "10.1016/j.recot.2013.08.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441513001355?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885613000849?idApp=UINPBA00004N" "url" => "/19888856/0000005700000006/v1_201312121036/S1988885613000849/v1_201312121036/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1988885613000928" "issn" => "19888856" "doi" => "10.1016/j.recote.2013.11.008" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "435" "copyright" => "SECOT" "documento" => "article" "crossmark" => 0 "subdocumento" => "ssu" "cita" => "Rev Esp Cir Ortop Traumatol. 2013;57:434-42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1955 "formatos" => array:2 [ "HTML" => 1724 "PDF" => 231 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Sacral fracture with spino-pelvic dissociation: A literature review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "434" "paginaFinal" => "442" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fractura de sacro con disociación espóndilo-pélvica. Revisión de la literatura" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1835 "Ancho" => 1271 "Tamanyo" => 346461 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Images from a 24-year-old female patient who suffered an autolytic fall. (a) Simple radiograph showing a transverse sacral fracture with flexion and antepulsion of the distal fragment. (b) CT scan showing an H-shaped fracture of the sacrum with SP dissociation. She presented perineal hypoesthesia, fecal incontinence and urinary retention. The patient underwent surgery within 48<span class="elsevierStyleHsp" style=""></span>hours of admission. (c) A bilateral, decompressive laminectomy, from L5 to S3, was performed by a direct posterior approach to the sacrum and last lumbar segments, as well as partial reduction of the fracture and SP fixation with L4, L5 and iliac pedicled screws and double longitudinal bars with transverse reinforcement. Since we achieved adequate decompression with this action and did not have complete control of the distal sacral fragment, we did not opt for complete anatomical reduction in order to avoid possible morbidity resulting from manipulation. We associated posterolateral arthrodesis with an iliac crest autograft. (d) Satisfactory postoperative radiographic control. (e) Control at 7 months after surgery, showing fracture consolidation and arthrodesis of the L4-S1 levels. In the annual control, the patient was able to walk without aids and pain, presenting residual perineal hypoesthesia and an acceptable sphincter control, although mild urinary dysfunction persisted.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Cearra, R. Alonso, D. Martínez-Ogalla, J. Hoyos, A. Lauzirika, R. Mongil, E. Alvarez-Irusteta" "autores" => array:7 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Cearra" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Alonso" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Martínez-Ogalla" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Hoyos" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Lauzirika" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Mongil" ] 6 => array:2 [ "nombre" => "E." "apellidos" => "Alvarez-Irusteta" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S188844151300132X" "doi" => "10.1016/j.recot.2013.08.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S188844151300132X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885613000928?idApp=UINPBA00004N" "url" => "/19888856/0000005700000006/v1_201312121036/S1988885613000928/v1_201312121036/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Distal tibia peri-implant fracture with an intramedullary nail: A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "443" "paginaFinal" => "445" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.M. Reyes-Cabrera, R. González-Alconada, M.D. García-Mota" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J.M." "apellidos" => "Reyes-Cabrera" "email" => array:1 [ 0 => "jomareca83@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "González-Alconada" ] 2 => array:2 [ "nombre" => "M.D." "apellidos" => "García-Mota" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital Virgen del Puerto, Plasencia, Cáceres, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fractura peri-implante de tibia distal con clavo intramedular: presentación de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 746 "Ancho" => 1295 "Tamanyo" => 67634 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Tibial diaphyseal fracture. The osteosynthesis material of the distal fibula with a consolidated fracture can be observed. (B) Six months postoperatively.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tibial diaphyseal fracture is one of the most common fractures in adults, and intramedullary nailing is the most commonly used option for its surgical treatment. Rupture of the osteosynthesis material before fracture consolidation has been widely reported, including breakage of the nail and locking screws. This can cause angulation, shortening, consolidation delay and pseudoarthrosis (or nonunion) associated with migration of the nail. However, distal tibial fracture through the locking screws of the intramedullary nails is very rare, with only 2 cases reported in the literature.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 62-year-old female with a history of distal fibular fracture treated by osteosynthesis using a plate and screws 4 years earlier, with no other relevant medical history. She attended the emergency room with left tibial diaphyseal fracture after suffering a fall from her own height (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). This was treated through intramedullary nail fixation with 2 proximal and 2 distal locks. No material from the previous osteosynthesis was removed. At 6 months after the intervention, the patient presented a good clinical evolution and radiographic signs of fracture consolidation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">After 6 years of the fracture, the patient suffered a fall from her own height with subsequent pain, edema and loss of function of the left lower limb. The radiograph showed a distal tibial fracture which crossed the locking screws. In addition, the lateral projection revealed a locking screw on the outside of the nail, which had been placed in a wrong position from the outset (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We opted for an orthopedic treatment through a long leg cast for 6 weeks. Subsequent radiographic controls showed signs of consolidation.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Result</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient presented a favorable clinical and radiographic evolution.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Tibial diaphyseal fractures are some of the most common long bone fractures in adults and osteosynthesis with intramedullary nails is generally used as a surgical treatment method.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Peri-nail fractures have been reported in patients with proximal femoral fractures associated with short nails, with a higher incidence in uniaxial fixation than in biaxial.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Peri-implant fractures have also been described in the forearm with osteosyntheses using plates in the pediatric population with an incidence of up to 7.3%. These may be due to falls, stress of the osteosynthesis material, iatrogenic causes, avascular necrosis, implant failure and pathological fractures.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The literature contains 2 cases of peri-implant tibial fractures, of which the first was associated to a delay in consolidation of the tibial fracture with scarce support of the fibula due to the unfixed fracture and significant external rotation strength associated with the obesity of the patient. The second case was secondary to a moderate-high energy torque force caused by a fall off a skateboard in a young patient.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In our case, out of the 2 distal locking screws, the most proximal, which was well placed in the nail locking orifice, may have acted as a fulcrum at the time of the fall and thus caused the peri-implant fracture after 6 years of consolidation. We decided to perform orthopedic treatment due to scarce displacement of the fracture, presenting a good clinical and radiographic outcome.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Peri-implant tibial fractures are very rare complications which may be associated with moderate-high energy torsion forces, scarce structural support due to associated fibular fracture or to a fulcrum point which may cause a peri-implant fracture after a relatively low-energy trauma.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Level of evidence</span><p id="par0055" class="elsevierStylePara elsevierViewall">Level of evidence <span class="elsevierStyleSmallCaps">v</span>.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Ethical responsibilities</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Protection of people and animals</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that this investigation did not require experiments on humans or animals.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Confidentiality of data</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of patient data and that all patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Right to privacy and informed consent</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare having obtained written informed consent from patients and/or subjects referred to in the work. This document is held by the corresponding author.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres298315" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec281553" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres298316" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec281554" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Result" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Level of evidence" ] 10 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-04-18" "fechaAceptado" => "2013-05-06" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec281553" "palabras" => array:3 [ 0 => "Peri-implant fracture" 1 => "Intra-medullary nail" 2 => "Tibia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec281554" "palabras" => array:3 [ 0 => "Fractura peri-implante" 1 => "Clavo intramedular" 2 => "Tibia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Peri-implant fractures of the distal tibia after intramedullary nailing are rare. We present a case of a fracture of the distal tibia at the site of the distal interlocking screw. We found two cases reported in the world literature. There are no cases reported in the Spanish literature.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Las fracturas peri-implante de tibia distal con clavo intramedular son poco frecuentes. Exponemos un caso de una fractura de tibia distal mediante los tornillos de bloqueo a este nivel. Hemos encontrado 2 casos obtenidos en la literatura mundial. En la literatura española no existe ningún caso estudiado.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Reyes-Cabrera JM, González-Alconada R, García-Mota MD. Fractura peri-implante de tibia distal con clavo intramedular: presentación de un caso. Rev Esp Cir Ortop Traumatol. 2013;57:443–445.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 746 "Ancho" => 1295 "Tamanyo" => 67634 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Tibial diaphyseal fracture. The osteosynthesis material of the distal fibula with a consolidated fracture can be observed. (B) Six months postoperatively.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 655 "Ancho" => 989 "Tamanyo" => 51042 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Peri-implant fracture of the distal tibia (AP projection). (B) The distal locking screw can be seen outside the intramedullary nail.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peri-implant fracture of the distal tibia after intra-medullary nailing of a tibial fracture: a report of two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Mounasamy" 1 => "P. Desai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Eur J Orthop Surg Traumatol" "fecha" => "2012" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intramedullary nailing for tibial shaft fractures in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "X. Duan" 1 => "M. Al-Qwbani" 2 => "Y. Zeng" 3 => "W. Zhang" 4 => "Z. 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Parker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2011.10.027" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2012" "volumen" => "43" "paginaInicial" => "706" "paginaFinal" => "711" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22142841" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retention of forearm plates: risks and benefits in a pediatric population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N.D. Clement" 1 => "F. Yousef" 2 => "Duckworth A.D." 3 => "K.H. Teoh" 4 => "D.E. Porter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1302/0301-620X.94B11.30830" "Revista" => array:6 [ "tituloSerie" => "J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 1 | 10 |
| 2024 October | 43 | 7 | 50 |
| 2024 September | 67 | 4 | 71 |
| 2024 August | 50 | 4 | 54 |
| 2024 July | 77 | 3 | 80 |
| 2024 June | 41 | 5 | 46 |
| 2024 May | 42 | 5 | 47 |
| 2024 April | 66 | 3 | 69 |
| 2024 March | 56 | 10 | 66 |
| 2024 February | 141 | 7 | 148 |
| 2024 January | 123 | 12 | 135 |
| 2023 December | 116 | 11 | 127 |
| 2023 November | 156 | 5 | 161 |
| 2023 October | 190 | 20 | 210 |
| 2023 September | 88 | 8 | 96 |
| 2023 August | 100 | 3 | 103 |
| 2023 July | 94 | 13 | 107 |
| 2023 June | 80 | 2 | 82 |
| 2023 May | 119 | 5 | 124 |
| 2023 April | 151 | 4 | 155 |
| 2023 March | 98 | 4 | 102 |
| 2023 February | 74 | 10 | 84 |
| 2023 January | 67 | 5 | 72 |
| 2022 December | 63 | 13 | 76 |
| 2022 November | 70 | 17 | 87 |
| 2022 October | 49 | 7 | 56 |
| 2022 September | 42 | 21 | 63 |
| 2022 August | 65 | 16 | 81 |
| 2022 July | 42 | 7 | 49 |
| 2022 June | 40 | 11 | 51 |
| 2022 May | 55 | 12 | 67 |
| 2022 April | 33 | 10 | 43 |
| 2022 March | 65 | 10 | 75 |
| 2022 February | 36 | 9 | 45 |
| 2022 January | 88 | 10 | 98 |
| 2021 December | 45 | 16 | 61 |
| 2021 November | 49 | 11 | 60 |
| 2021 October | 59 | 15 | 74 |
| 2021 September | 45 | 19 | 64 |
| 2021 August | 68 | 5 | 73 |
| 2021 July | 22 | 10 | 32 |
| 2021 June | 14 | 9 | 23 |
| 2021 May | 15 | 9 | 24 |
| 2021 April | 22 | 20 | 42 |
| 2021 March | 9 | 16 | 25 |
| 2021 February | 7 | 15 | 22 |
| 2021 January | 14 | 12 | 26 |
| 2020 December | 4 | 0 | 4 |
| 2018 May | 1 | 0 | 1 |
| 2018 February | 45 | 1 | 46 |
| 2018 January | 50 | 0 | 50 |
| 2017 December | 35 | 1 | 36 |
| 2017 November | 22 | 0 | 22 |
| 2017 October | 24 | 3 | 27 |
| 2017 September | 30 | 2 | 32 |
| 2017 August | 22 | 4 | 26 |
| 2017 July | 25 | 3 | 28 |
| 2017 June | 28 | 7 | 35 |
| 2017 May | 30 | 1 | 31 |
| 2017 April | 22 | 1 | 23 |
| 2017 March | 21 | 1 | 22 |
| 2017 February | 41 | 1 | 42 |
| 2017 January | 23 | 2 | 25 |
| 2016 December | 26 | 6 | 32 |
| 2016 November | 20 | 2 | 22 |
| 2016 October | 34 | 2 | 36 |
| 2016 September | 35 | 8 | 43 |
| 2016 August | 20 | 3 | 23 |
| 2016 July | 22 | 3 | 25 |
| 2016 June | 19 | 6 | 25 |
| 2016 May | 17 | 10 | 27 |
| 2016 April | 22 | 3 | 25 |
| 2016 March | 22 | 11 | 33 |
| 2016 February | 13 | 10 | 23 |
| 2016 January | 22 | 6 | 28 |
| 2015 December | 11 | 13 | 24 |
| 2015 November | 11 | 7 | 18 |
| 2015 September | 0 | 3 | 3 |
| 2015 July | 0 | 2 | 2 |
| 2015 May | 0 | 1 | 1 |
| 2015 April | 0 | 7 | 7 |
| 2015 March | 0 | 5 | 5 |
| 2015 February | 3 | 1 | 4 |
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