Objective. The aim of the study was to evaluate inter observer reliability and intra observer reproducibility between the three column classification using 3D CT reconstruction models and schatzker classification systems using 2D CT models. Materials and methods. Fifty two consecutive patients with tibial plateau fractures were evaluated by two orthopaedic surgeons. All patients were classified into Schatzker and three column classification systems using CTimages. The Images were evaluated in a randomised and blind fashion. Demographics of the patient were blinded to reduce observer bias. The inter observer reliability was measured for both classfications in round one. In round two the process was repeated after two weeks and the intra observer reproducibility was measured using cohen kappa coefficient and level of agreement based on Landis and Koch. Results. The average inter observer reliability for schatzker classification in round one were (k2D=0.661, 95% CI 0.531–0.697) in round two (k2D = 0.673, 95% CI 0.451–0.774). The three column classification average in round one were (k3D=0.851 95% CI 0.705–0.968), in round two (k3D=0.929 95% CI 0.813–1.00). The average intra observer reproducibility for Schatzker classification in round two for the first obsrever were (k2D=0.689 IQR, 0.6–0.846) for observer two (k2D=0.656 IQR 0.2988–1.0). The average intra observer reproducibility for three column for observer one were (k3D=0.693 IQR, 0.484-.859), for observer two (k3D=0.711 IQR, 0.5185–0.8294). 31 % of patients had a posterior column involvement. Conclusion. Statistically significant inter observer values in both rounds were noted with the three column classification making it, statistically an excellent agreement. The intra observer reproducibility for the three column classification improved as compared to the schatzker classification. The three column classification seems to be effective way to characterise and classify fractures of tibial plateau

Objectives. CT-based three-column classification (TCC) has been widely used in the treatment of tibial plateau fractures (TPFs). In its updated version (updated three-column concept, uTCC), a fracture morphology-based injury mechanism was proposed for effective treatment guidance. In this study, the injury mechanism of TPFs is further explained, and its inter- and intraobserver reliability is evaluated to perfect the uTCC. Methods. The radiological images of 90 consecutive TPF patients were collected. A total of 47 men (52.2%) and 43 women (47.8%) with a mean age of 49.8 years (. sd. 12.4; 17 to 77) were enrolled in our study. Among them, 57 fractures were on the left side (63.3%) and 33 were on the right side (36.7%); no bilateral fracture existed. Four observers were chosen to classify or estimate independently these randomized cases according to the Schatzker classification, TCC, and injury mechanism. With two rounds of evaluation, the kappa values were calculated to estimate the inter- and intrareliability. Results. The overall inter- and intraobserver agreements of the injury mechanism were substantial (κ. inter. = 0.699, κ. intra. = 0.749, respectively). The initial position and the force direction, which are two components of the injury mechanism, had substantial agreement for both inter-reliability or intrareliability. The inter- and intraobserver agreements were lower in high-energy fractures (Schatzker types IV to VI; κ. inter. = 0.605, κ. intra. = 0.721) compared with low-energy fractures (Schatzker types I to III; κ. inter. = 0.81, κ. intra. = 0.832). The inter- and intraobserver agreements were relatively higher in one-column fractures (κ. inter. = 0.759, κ. intra. = 0.801) compared with two-column and three-column fractures. Conclusion. The complete theory of injury mechanism of TPFs was first put forward to make the TCC consummate. It demonstrates substantial inter- and intraobserver agreement generally. Furthermore, the injury mechanism can be promoted clinically. Cite this article: B-B. Zhang, H. Sun, Y. Zhan, Q-F. He, Y. Zhu, Y-K. Wang, C-F. Luo. Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept. Bone Joint Res 2019;8:357–366. DOI: 10.1302/2046-3758.88.BJR-2018-0331.R1

Introduction: Fracture classification systems help in communication, treatment planning, assessing prognosis and form standards to report treatment results. The ideal classification system should be reliable, reproducible, all-inclusive, mutually exclusive, logical and clinically useful. The aim of our study was to assess the inter observer reliability and intra observer variability for the AO, Schatzker and Hohl and Moore classification systems. Materials and Methods: We randomly selected fifty sets of radiographs of tibial plateau fractures occurred between 2000 and 2005. Exclusion criteria: Only one available view, inadequate films. Four orthopaedic surgeons at various level of experience i.e. one senior senior house officer, two registrars and a trauma consultant classified the fractures. Radiographs were blinded and each time the radiographs were presented to the observers in a different order. Radiographs were viewed at two separate sittings 8 weeks apart. The data was analysed using kappa statistics through SPSS version 14. The Kappa co-efficients were interpreted according to Landis and Koch grading. (< 0.00=poor; 0.0–0.2=slight, 0.21–0.4=fair, 0.41–0.60=moderate, 0.61–0.8=substanti al,> 0.8=excellent). Results: For the AO classification the mean kappa co-efficients for inter-observer and intra-observer reliability were 0.36 (0.33–0.39) and 0.83(0.61–1.00) respectively. For the Schatzker classification the mean kappa co-efficients for inter-observer and intra-observer reliability were 0.47(0.45–0.49) and 0.90(0.75–1.00) respectively. For the Hohl& Moore classification mean kappa values for inter-observer and intra-observer variability were 0.14 and 0.81(0.59–1.00) respectively. According to Landis and Koch grading, AO classification is fair in terms of interobserver reliability, the Schatzker classification is moderate and the Hohl& Moore is slight. Conclusions: None of the three systems fulfils the criteria for an ideal classification system. However, the Schatzker classification system was found to be superior. The Hohl& Moore system was least reliable of all. Hence, we recommend usage of Schatzker classification system in tibial plateau fractures both in clinical practice and clinical studies until a superior classification system evolves

We aimed to determine the rate of and risk factors for post-traumatic osteoarthritis (PTOA) and total knee arthroplasty (TKA) requirement after operative management of tibial plateau fractures (TPF) in older adults. We conducted a retrospective cohort study of 182 operatively managed TPFs in 180 patients ≥60 years old over a 12-year period with minimum follow up 1 year. Data including patient demographics, clinical frailty scores, mechanism of injury, management, reoperation and mortality were recorded. Radiographs were reviewed for: Schatzker classification; pre-existing knee osteoarthritis (KOA); severe joint depression >15mm; and development of PTOA. Kaplan Meier survival analysis was performed. Regression analysis was used to identify risk factors for radiographic indication for TKA and actual TKA. Forty-seven percent were Schatzker II fractures. Radiographic KOA was present at fracture in 32.6%. Fracture fixation was performed in 95.6% cases and acute TKA in 4.4%. Thirteen patients underwent late TKA (7.5%). At five-years, 11.8% (6.0-16.7 95% CI) had required TKA and 20.9% (14.4-27.4 95% CI) had a radiographic indication for TKA. Severe joint depression and pre-existing KOA were associated with worse survival for endpoints radiographic indication for TKA and actual TKA. Severe joint depression (HR 2.49(1.35-4.61 95% CI), p=0.004), pre-existing KOA (HR 2.23(1.17-4.23), p=0.015) and inflammatory arthropathy (HR 2.4(1.04-5.53), p=0.039) were independently associated with radiographic indication for TKA. In conclusion, severe joint depression and pre-existing arthritis are independent risk factors for both severe PTOA and TKA after TPFs in older adults. These features should be considered as an indication for primary management with acute TKA

During the last few years, the arthroscopically assisted technique for reduction and internal fixation of tibial plateau fractures is of increasing popularity. The accumulated surgical experience allowed the possibility of treating type I, II, III according to Schatzker classification. During the last two years 17 patients who had suffered a tibial plateau fracture were treated this way. The mean age was 44 years, while the mean FU was 16 months. According to Schatzker classification 8 fractures were type I, 6 fractures type II and 3 fractures type III. The bone reduction was achieved under arthroscopic view and flouroscopy. In all cases the fracture was fixed by the with cannulated Herbert type screws. Meniscal lesions were fixed in 9 patients, while in 5 patients ruptures of the ACL were detected, which were reconstructed at a later stage. Full range of motion of the knee was restored in 11 patients, while lack of full knee flexion (mean 100) was found in 6 patients. All patients were assessed with a modified Lyslom Knee Scale. The Knee score was 85 points to 96 points (mean 92 points), while the anterior knee pain was the common problem especially following increased activities. The proposed arthroscopically assisted technique for reduction and fixation of certain types of tibial plateau fractures consists a alternative minimal invasive approach. Visualization of the whole joint is possible and concomitant lesions can be detected and possibly fixed at the same time

Aim: To describe a radiographic biomechanical classification of tibial plateau fractures which dictates treatment. To compare the intra- and interobserver reliability and reproducibility of this, the Chertsey (C1-3) classification, and the Schatzker (SK1-6) classification. Method: This classification system has been used at this institution for 8 years by the orthopaedic trauma consultants and consists of C1 – valgus fractures, C2 – Varus fractures and C3 axial fractures. Our treatment regime is based on this classification and results presented in a sperate study. These consultants were excluded from the study on reliability and reproducibility. 2 Orthopaedic consultants, 2 orthopaedic registrars and 2 radiologists were selected randomly to classify 30 sets of AP and Lateral radiographs, of randomly selected patients treated in this institution with tibial plateau fractures, consisting of 9 SK1-3/C1, 8 SK4/C2 and 13 SK5,6/C3 fractures, and again with the same radiographs in a random order 1 month later. Radiographs of fractures treated conservatively were excluded. Statistical analysis included Kappa concordance according to Landis and Koch, and the Mann-Whitney U test. Results: The Schatzker system was only moderately reliable (K=0.66), and the Chertsey classification system significantly more reliable (K=0.82) (p=0.03) with regards to interobserver reliability. Excellent reproducibility (intra-observer reliability) was seen amongst all observers. The consultant orthopaedic surgeons were significantly more reliable than the radiologists, but not the orthopaedic registrars. No particular fracture type in any classification proved to be significantly more difficult to classify. Conclusion: We present a classification used in our institution based on plain radiographs, which depicts investigations and treatment. The Chertsey classification is significantly more reliable between observers than the Schatzker classification and is reproducible

Background. The Schatzker classification is applied in the management of tibial plateau fractures. The unique pattern of Schatzker VI fractures requires recognition for proper fixation. Method:. We have treated 33 patients with Schatzker IV tibial plateau fractures including non-unions and mal-unions. Patients had a temporary spanning Ilizarov frame with intraoperative distraction, articular reconstruction and olive wires for indirect reduction. No open surgery was performed. Patients mobilised fully weight-bearing and underwent post-operative CT scan and regular outpatient reviews. At six weeks the femoral ring was removed, and patients underwent a staged dynamisation protocol prior to frame removal. Results:. Twenty seven patients have achieved union and completed at least 1-year follow-up. Of these, 25 were reviewed at a mean follow-up of 5.4 years. The mean IOWA score was 85 and the mean ROM was 119 degrees. Two patients were not contactable for final review. The remaining six patients are still undergoing treatment. The mean time to union was 145 days. Conclusion:. Shatzker IV fracture requires understanding of the axial/valgus pattern of injury so that appropriate fixation can be applied to produce good results

To determine the effectiveness of Ilizarov external fixator in the treatment of complex fractures of the tibial plateau. From July 2006 to April 2009, we treated 10 patients with the Ilizarov fixator. Six men and four women ranging in age from 31 to 70 (mean age 56.3 years) were evaluated. All patients were preoperatively evaluated with Computed Tomography scans for better preoperative planning. Eight cases had fractures type VI according to Schatzker Classification and 2 cases type V. In all patients fixation included pushing olive wires or simple wires and 2 to 4 frames. In 4 patients minimal invasive open reduction was performed with use of bone allograft. In 2 fractures, we combined the treatment with minimal internal fixation. There was no major complication trans- or postoperatively. The mean follow-up was 16 months (4–30). The mean hospitalization was 8 days and there were no cases of blood transfusion. Mobilization with no weight-bearing was immediately allowed, with partial weight bearing after 2 months and full weight bearing after 3 months. Three patients had minor pin tract complications. The average duration of external fixation was 120 days. All the fractures united and patients achieved full extension with more than 110 degrees of flexion. Ilizarov circular fixation is an alternative method of treatment for these fractures when internal fixation is contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution

Objective. To determine differences in fracture stability and functional outcome between synthetic bone graft and allograft/autograft with internal fixation of tibia plateau metaphyseal defects. Patient & Methods. Between 2007- 2008, 84 consecutive cases of internal fixation of tibia plateaux were identified from our theater logbook. 29 patients required additional autologous, allogenic bone graft, or synthetic bone graft substitute to ensure fracture stability. 5 patients were excluded due to lost to follow up leaving a cohort of 24 patients. Hydroxyapatite calcium carbonate synthetic bone graft was utilised in 14 patients (6 male and 8 female). Allograft/autograft were utilised in the remaining 10 patients (6 male and 4 female). All 24 patients had closed fractures, classified using the AO and Schatzker classification. Roentograms at presentation, post-operatively and regular follow-up till 12 months were analysed for maintenance of reduction, early and late subsidence of the articular surface. Functional outcomes such as knee range of movement and WOMAC Knee scores were compared between groups. Results. There was no significant statistical difference between groups for post-operative joint reduction, long term subsidence, and WOMAC scores. The degree of subsidence was not related to age or fracture severity. Maintenance of knee flexion was found to be better in the allograft/autograft group (p=0.015) when compared between groups. Multivariate analysis compared graft type, fracture severity, postoperative reduction, subsidence rate, range of movement and WOMAC score. The only finding was a statistical significant (p=0.025) association with the graft type and range of movement. Conclusion. Allograft/autograft may allow better recovery of long-term flexion, possibly due to reduced inflammatory response compared with synthetic bone graft. However, all other parameters such as maintenance of joint reduction and subjective outcome measures were comparable with the use of hydroxyapatite calcium carbonate bone graft. This study shows that synthetic bone graft is a suitable option in fixation of unstable tibia plateau fractures, avoiding risk of viral disease transmission with allograft and donor site morbidity associated with autograft

Aims: To evaluate the functional recovery of the complex tibial plateau fractures Schatzker type V and VI treated with hybrid ex. fix. Methods: Twenty-eight patients with intra-articular fractures of the proximal tibia were treated with hybrid external fixation in a three years period (1998–2001).The mean age was 35 years (17–76). According to Schatzker classification, there were 11(39.3%) fractures type V and 17(60.7) type VI, whereas 5(17.8%) fractures were open. Complex injury was recorded in 15(53.5%) patients. Closed reduction and hybrid external fixation was achieved in 21 (75%) fractures. Additional limited internal fixation was performed in 9(32%) cases. Open reduction was necessary in 7(25%) patients. Mobilization of the injured articulation was started at the 3rd postoperative day. Results: Mean follow up period was 18 months. All fractures but one united at an average of 13.5 weeks (range from 11 to 18 weeks). The results were assessed according to the criteria of Honkonen and Jarvinen. An overall 22(78%) excellent and good results was recorded at the final follow up. Complications included one axial deformity, one septic pseudarthrosis, one peronial palsy and five pin tract infections. Conclusions: The use of hybrid external fixation in the comminuted tibial plateau fractures (Schatzker V,VI), insure good restraining and early union, avoid major soft tissue complications and allow early mobilization and functional recovery of the knee joint

Background: Complex fractures of the tibial plateau can be difficult to characterize on plain radiographs and two-dimensional computed tomography scans. We tested the hypothesis that three-dimensional computed tomography reconstructions improve the reliability of tibial plateau fracture characterization and classification. Methods: Forty-five consecutive intra-articular fractures of the tibial plateau were evaluated by six independent observers for the presence of six fracture characteristics that are not specifically included in currently used classification schemes:. posteromedial shear fracture;. coronal plane fracture;. lateral condylar impaction;. medial condylar impaction;. tibial spine involvement;. separation of tibial tubercle necessitating anteroposterior lag screw fixation. In addition, fractures were classified according to the AO/OTA Comprehensive Classification of Fractures, the Schatzker classification system and the Hohl and Moore system. Two rounds of evaluation were performed and then compared. First, a combination of plain radiographs and two-dimensional computed tomography scans (2D) were evaluated, and then, four weeks later, a combination of radiographs, two-dimensional computed tomography scans, and three-dimensional reconstructions of computed tomography scans (3D) were assessed. Results: Interobserver agreement improved for all classification systems after the addition of three-dimensional reconstructions (AO/OTA κ2D = 0.536 versus κ3D = 0.545; Schatzker κ2D = 0.545 versus κ3D = 0.596; Hohl and Moore κ2D = 0.668 versus κ3D = 0.746). Three-dimensional computed tomography reconstructions also improved the average intraobserver reliability for all fracture characteristics, from κ2D = 0.624 (substantial agreement) to κ3D = 0.687 (substantial agreement). The addition of three-dimensional images had limited infiuence on the average interobserver reliability for the recognition of specific fracture characteristics (κ2D = 0.488 versus κ3D = 0.485, both moderate agreement). Three-dimensional computed tomography images improved interobserver reliability for the recognition of coronal plane fractures from fair (κ2D = 0.398) to moderate (κ3D = 0.418) but this difference was not statistically significant. Conclusions: Three-dimensional computed tomography is helpful for;. individual orthopaedic surgeons for preoperative planning (improves intraobserver reliability for the recognition of fracture characteristics), and for. comparison of clinical outcomes in the orthopaedic literature (improves interobserver reliability of classification systems)

The purpose of this study is to determine the indications and effectiveness of hybrid external fixation in the treatment of tibial plateau fractures and to evaluate the patient’s functional recovery. Twenty-seven patients with 28 intra-articular fractures of the proximal tibia were surgically treated with hybrid external fixation in a two years period (1999–2001). There were 25 patients (19 men and 6 women) available for the last follow up evaluation. The mean age was 35 years (17–76). According to Schatzker classification, there were 6 fractures type V and 22 type VI. Three of them were open fractures. The method included, indirect reduction based on ligamentotaxis and compression of the fractured segments with olive pins, in most patients. Additional limited internal fixation with free screws was also performed in 5 cases. Open reduction was necessary in 6 patients. Mobilization of the injured articulation was started at the third postoperative day, while full weight bearing was allowed after three months. The fixator was removed in average 12th week. Final evaluation was done according subjective, functional, clinical and radiological criteria. Mean follow up period was 14 months. All fractures except one united at an average time of 13, 5 weeks. Twenty-two patients (77.6%) graded as excellent and good, hi detail, subjective results were acceptable in 72%, functional in 84%, clinical in 70% and radiological in 80%. Complications included one axial deformity, one septic pseudarthrosis, one peronial palsy and superficial pin path infections. The use of hybrid external fixation in the comminuted tibial plateau fractures (Schatzker V, VI), insure good restraining and early union, avoid major soft tissue complications and allow quick mobilization and functional recovery of the knee joint. Moreover it is an application rather atraumatic because, only occasionally requires open reduction

Introduction: The treatment of comminuted intra-articular fractures around the knee is one of most difficult areas of Orthopaedic traumatology. Open reduction and internal fixation is recommended by many authors. However, in severe comminuted fractures sometime it is difficult to achieve stable fixation and most cases need an additional cast immobilization following surgery. We present our experience with arthroscopic assisted closed reduction in severe comminuted knee fractures followed by fixation with Ilizarov frame. Materials and Methods: Since 1998, 17 patients with comminuted intra-articular fractures around the knee were treated by this method. 8 patients had comminuted intra-articular fractures of the distal femur and 9 patients had comminuted fractures of the tibial plateau, one of them with fractures of both knees. There were 4 males and 4 females with femoral fractures (age: 22– 56Y; mean -31Y) and 8 males and 1 female with tibial plateau fractures (age: 34–68Y; mean – 51Y). Three fractures of the distal femur and 2 of the tibial plateau were open fractures. 5/17 Pts had polytrauma. We used AO classification for distal femoral fractures and Schatzker classification for tibial plateau fractures. All patients were operated within 48 hours after injury. Results: In all patients, except two with unstable knee, closed reduction and Ilizarov external fixation was performed without knee immobilization, under knee arthroscopic control. In two cases split thickness skin graft was done following leg fasciotomies. Weight bearing was allowed 6 to 8 weeks following surgery. A second look arthroscopy was performed in 3 cases. The average time of fixation in Ilizarov frame was 4.5 months (range 3–6.5 months). On follow up of 2 to 8 years, 6/17 patients (35%) had excellent results, 8/17 patients (47%) had good results and 3 patients (17%) had fair results. No cases of osteomyelitis, neuro-vasular injuries or deep wound infection were observed. Conclusions: Based on this study it seems that arthroscopic assisted closed reduction and Ilizarov fixation is very useful for severe intra-articular comminuted knee fractures. Arthroscopy of knee enables accurate reduction of these fractures, removal of free bone fragments and treatment of other intra-articular injuries. There is an early restoration of motion in injured knee, with short immobilization time, and there are no major complications

PURPOSE OF THE STUDY: Arthroscopic assisted treatment of tibial plateau fractures may reduce morbidity compared to open articular surgery, but bony fixation is necessarily percutaneous and minimal. The purpose of our study was not only to assess immediate results but also long term functional and anatomic results after arthroscopic treatment of tibial plateau fractures, with special reference to radiographical Results:. MATERIAL AND METHODS: seventy patients (mean age 47 years, range 18 to 72 years, 43 men, 27 women) were arthroscopically assisted treated for a fresh tibial plateau fracture. According to Schatzker classification, there was 20 type I, 27 type II, 18 type III and 5 type IV. The fixation device was: Kirchner wire in Schatzker I, percutaneous cannulated screw in Schatzker II,III,IV, and bone cement filing of the fracture site in 1 case. In 32 cases, where bone loss was significant. we use autologous bone graft, in 18 cases SRS. There were 15 meniscal injuries: 3 underwent arthroscopic suture, 8 had partial meniscectomy and 4 sub subtotal meniscectomy. We also diagnosticated 7 lesions of the medial pivot 6 ACL, 1 PCL : all were left in place. Al patients in the first post-operatory day start passive rehabilitation with kinetech All cases were suitable for immediate post op follow up. 19 were reviewed at long term. A clinical (Hospital for Special Surgery) and radiographical examination were done with an average follow-up of 46.7 months. RESULTS: There were no complications except two immediate compartimental syndromes that stopped the arthroscopic treatment. Passive motion of the knee started at 1 day postop with no pain. Mean flexion at 3 months was 130 degrees. At revision, the average score was: 93 for Schatker I, 91 for Schatker II, 87 for Schatker III, 86 for Schatker IV. In eight cases we found early signs of osteoarthritis. There were no secondary bony depression or significant valgus deformity on X-rays. CONCLUSION: Arthroscopic management of tibial plateau fractures allows a complete articular screening. Rapid rehabilitation, short hospital stay, and low rate of complications reduce morbidity. The long term results are as good as those with open surgical technique for the types of fracture that we have treated (type III and IV). A minimal, percutaneous osteosynthesis which was the only possibility under arthroscopic control, did not modify the anatomical Results:

Aims

To investigate health-related quality of life (HRQoL) of older adults (aged ≥ 60 years) after tibial plateau fracture (TPF) compared to preinjury and population matched values, and what aspects of treatment were most important to patients.

The purpose of this study was to review the long term functional results of patients undergoing treatment for high energy tibial plateau fractures. Between January 1994 and June 2013 our unit managed 105 high energy tibial plateau fractures (Schatzker IV-VI) with an Ilizarov frame. All cases were treated via ligamentotaxis and percutaneous fine wire fixation or with a limited open reduction of the joint surface. A retrospective analysis of all patients that have undergone Ilizarov fixation of a tibial plateau fracture was performed with radiological and clinical functional outcome measurements. We analysed 105 patients with a mean follow up of 93.5 months (range 5–200). The patient group had an average age of 49 years (range 15–87) with 62 patients being male. Fracture pattern was analysed with Schatzker's classification showing 18 type IV, 10 type V and 77 type VI tibial plateau fractures. All fractures had an average time to union of 145 days. Patients had and average range of movement of 117 degrees. Patients undergoing Ilizarov treatment for high energy tibial plateau fractures achieve successful results long term. Definitive treatment should be decided with respect to fracture pattern and the soft tissue envelope. The management aim should be to achieve anatomical reduction and stable fixation to enable early mobilization. Our study confirms the good functional outcomes and low morbidity that can be achieved in high energy fractures treated with Ilizarov fixation

Aims

Tibial plateau fractures (TPFs) are complex injuries around the knee caused by high- or low-energy trauma. In the present study, we aimed to define the distribution and frequency of TPF lines using a 3D mapping technique and analyze the rationalization of divisions employed by frequently used classifications.

Aims

In contrast to operations performed for other fractures, there is a high incidence rate of surgical site infection (SSI) post-open reduction and internal fixation (ORIF) done for tibial plateau fractures (TPFs). This study investigates the effect of induced membrane technique combined with internal fixation for managing SSI in TPF patients who underwent ORIF.

The December 2015 Trauma Roundup³⁶⁰ looks at: Delay to surgery in hip fracture; Hexapod fixators in the management of hypertrophic tibial nonunions; Thromboembolism after nailing pathological fractures; Tibial plateau fracture patterns under the spotlight; The health economic effects of long bone nonunion; Adverse outcomes in trauma; The sacral screw in children; Treating the contralateral SUFE