Since the introduction of carving skis, the injuries of the tibia is changing from simple fractures of the diaphyse to complex fractures of the epiphyses, according to high energy traumas. There are no studies about results of the treatment and consequences after winter sport accidents. Method: Prospective documentation of all proximal tibia fractures after winter sport accidents, which were treated between 01.12.2006 and 31.04.2009 in the Trauma Department of the Klinikum Garmisch-Parten-kirchen, Germany. X-Rays and CT scans were classified according to the AO –Classification. Operations, complications, co-injuries and the hospital stay were analysed. We performed the Lysholm score, WOMAC Knee-score and the Tegner-index on the day of injury, 6 months, 12 months, and 2 years after injury. Results: 78 patients had a proximal tibia fracture following a skiing accident, 36 Male and 42 female. All except two patients had a monotrauma of the proximal tibia. Mean age 46 ± 15 years. 17 types A.1.3, 41 types B and 18 types C3 fractures. 4 patients developed a compartment syndrome, one patient had a lesion of the n. peroneus. 65 patients were operated in our hospital. In 8 patients we performed a conservative treatment. The mean hospital stay was 12 ± 7.5 days. In 15 patients a menisci reconstruction was necessary. 6 patients had a postoperative complication: 3 thromboses, 2 cardiac decompensations, 1 wound healing problems. By now 42 patients were ready for follow-up. So far the mean follow-up time is 13.8 months. The Lysholm score was at 12 months (n= 22) 78 ± 20 points. The Tegner score was pre-injury 6.2 ± 1.1 and 12 months post-injury 4.1 ± 1,8. The results of the WOMAC score show an improvement in the subcategories pain and function in all patients. In the subcategory stiffness only the type A and B fractures show an improvement during the follow-up. Conclusion: The proximal tibia joint fractures are a serious injury. The most patients’ activity level is tremendously reduced. The major problem after one year seems to be the ligament instability of the knee. A beginning knee arthritis after one year becomes relevant only in the type C fractures. More effort for the prevention of the proximal tibia fractures while skiing is necessary

Osteosynthesis of high-energy metaphyseal proximal tibia fractures is still challenging, especially in patients with severe soft tissue injuries and/or short stature. Although the use of external fixators is the traditional treatment of choice for open comminuted fractures, patients' acceptance is low due to the high profile and therefore the physical burden of the devices. Recently, clinical case reports have shown that supercutaneous locked plating used as definite external fixation could be an efficient alternative. Therefore, the aim of this study was to evaluate the effect of implant configuration on stability and interfragmentary motions of unstable proximal tibia fractures fixed by means of externalized locked plating. Based on a right tibia CT scan of a 48 years-old male donor, a finite element model of an unstable proximal tibia fracture was developed to compare the stability of one internal and two different externalized plate fixations. A 2-cm osteotomy gap, located 5 cm distally to the articular surface and replicating an AO/OTA 41-C2.2 fracture, was virtually fixed with a medial stainless steel LISS-DF plate. Three implant configurations (IC) with different plate elevations were modelled and virtually tested biomechanically: IC-1 with 2-mm elevation (internal locked plate fixation), IC-2 with 22-mm elevation (externalized locked plate fixation with thin soft tissue simulation) and IC-3 with 32-mm elevation (externalized locked plate fixation with thick soft tissue simulation). Axial loads of 25 kg (partial weightbearing) and 80 kg (full weightbearing) were applied to the proximal tibia end and distributed at a ratio of 80%/20% on the medial/lateral condyles. A hinge joint was simulated at the distal end of the tibia. Parameters of interest were construct stiffness, as well as interfragmentary motion and longitudinal strain at the most lateral aspect of the fracture. Construct stiffness was 655 N/mm (IC-1), 197 N/mm (IC-2) and 128 N/mm (IC-3). Interfragmentary motions under partial weightbearing were 0.31 mm (IC-1), 1.09 mm (IC-2) and 1.74 mm (IC-3), whereas under full weightbearing they were 0.97 mm (IC-1), 3.50 mm (IC-2) and 5.56 mm (IC-3). The corresponding longitudinal strains at the fracture site under partial weightbearing were 1.55% (IC-1), 5.45% (IC-2) and 8.70% (IC-3). From virtual biomechanics point of view, externalized locked plating of unstable proximal tibia fractures with simulated thin and thick soft tissue environment seems to ensure favorable conditions for callus formation with longitudinal strains at the fracture site not exceeding 10%, thus providing appropriate relative stability for secondary bone healing under partial weightbearing during the early postoperative phase

Orthopaedic injuries in the knee are often associated with vascular injury. When these vascular injuries are missed devastating there are devastating outcomes like limb ablation. Pulse examination in these patients is not sensitive to exclude vascular injuries. That often lead to clinicians opting for Computed Tomography Angiogram (CTA) to exclude vascular. this usually leads to a burden in Radiology Department. This study aimed to evaluate the prevalence of vascular injury in patient with orthopaedic injury in the knee. The computed tomography (CT) done in patients with distal femur fracture, knee dislocation and proximal tibia fractures were retrieved from the picture archiving and comunication system (PACS). The CTs were done between June 2017 and June 2022. The computed tomography angiogram (CTA) reports were reviewed to determine cases that vascular injury. A sample size of 511 cases was collected. 386 cases were done CTA and 125 cases were not done CTA. There were 218 tibial plateau fractures, 79 knee dislocations, 72 distal metaphyseal femur fractures, 61 floating knees, 55 distal femure intraarticular and 26 proximal metaphyseal tibia fractures. The mechanisms of injury in these were gunshot, fall from standing height, fall from height, MVA, MBA, PVA and sports. Prevalance was 9.17% (47) of the total injuries in the knee. Prevalance in patients who were sent for CTA was 12.08%. Routine CTA in patients with injuries in the knee is not recomended. The use of ankle brachial index may decrease the number of CTA done

Alpine ski sports changed rapidly in the last decade. Complex fractures of the proximal tibia, typically seen in high energy trauma, has been seen more frequently and more often related to alpine skiing. The aim of our study was to identify reasons for proximal tibia fracture in alpine skiing and observe the outcome. All patients with proximal tibia fractures related to alpine skiing, which were treated in our two trauma centers were included. The patients received a questionnaire at the emergency department, dealing with accident details and the skiing habits. The fractures were classified according to the AO fracture classification scheme. The follow up was performed at least one year after trauma with the Lysholm, the Tegner activity, as well as the WOMAC VAS Score. Between 2007 and 2010 a total of 188 patients with proximal tibia fractures caused by alpine skiing were treated. 43 patients had a type A, 96 patients a type B and 49 a type C injury. The incidence was increasing over the period continuously. The main trauma mechanism was an accident without a third party involvement with an increased rotational and axial compression impact. All outcome scores were related to fracture severity with significant worse results for the type C fractures. In conclusion, proximal tibia fractures are an increasing and serious injury during alpine skiing. Further technical progress in skiing material should focus on these knee injuries in future

Purpose: Proximal tibia fractures present a difficult treatment challenge with historically high complication rates. The purpose of this study is to report the clinical outcome of proximal tibial fractures treated with of a variable-axis locking plate. Patients and Methods: Between 2004 and 2007, 42 patients (23 males) with a mean age of 50 (21–67) with a total of 42 proximal tibia fractures were included in this prospective documented study. Fractures were classified according to the OTA system. All fractures were treated with the polyaxial locked-plate fixation system (DePuy, Warsaw, Indiana). Besides radiography, CT scanning was obtained for type B and C fractures. Clinical and radiographic data, including fracture pattern, changes in alignment, local and systemic complications, hardware failure and time to union were recorded. Functional outcome was measured using the Knee Society Score. Malalingment was defined the presence of more than 5°angulation in any plane at the post-op X-ray and at the final F.U. The mean follow up was 11 months (6–36). Results: According to the OTA classification, there were 7 41-A, 11 41-B and 24 41-C fractures. There were 6 open and 36 closed fractures. The majority were isolated injuries 38/42. 19 cases required bone grafting. Fractures were treated percutaneously in 30% of the cases (MIPO). Double plating was utilised in 8 cases. All fractures but 2 progressed to union at a mean time of 3.8 months (3–5). The two fractures who failed to unite were complicated by deep sepsis and required further intervention. One patient required fasciotomies for compartment syndrome. Superficial infection was treated successfully with a short course of antibiotics in 2 cases. There was no evidence of varus collapse as a result of polyaxial screw failure. No plate fractured, and no screw cut out was noted. There was 1 case of lateral joint collapse (more than 10o) in a patient with open bicondylar plateau fracture. The mean Knee society score at the time of final follow-up was 89 points (59 – 100) and the mean functional score was 83 points. Conclusion: The polyaxial locking plates provided stable fixation of extra-articular and intra-articular proximal tibia fractures and good functional outcomes with a low complication rate. These plates offer more fixation options without an apparent increase in mechanical complications or loss of reduction

Abstract. Objective. To compare the clinical and radiological outcome between less invasive stabilization system (LISS, Synthes, Paoli, PA.) and open reduction with internal fixation (ORIF) for the treatment of extraarticular proximal tibia fractures through the lateral approach. Background. Proximal tibial fractures present a difficult treatment challenge with historically high complication rates. ORIF has been in vogue for long time with good outcome. But these are associated with problems especially overlying skin conditions, delayed recovery and rehabilitation with limited functional outcome. LISS is an emerging procedure for the treatment of proximal tibial fractures. It preserves soft tissue and the periosteal circulation, which promotes fracture healing. Patients and methods. Thirty patients with closed proximal tibial fractures were included in this study. They were randomly divided into 2 groups. Group I (n=15) patients were treated by LISS and group II (n=15) by ORIF. Major characteristics of the two groups were similar in terms of age, sex, mode of injury, fracture location, and associated injuries. All patients were followed up at least 6 months. Results. In each group, 12 patients were united, 2 patients were non- united and one patient showed delayed union. The mean operative time in LISS patients was 79.3 min, while in ORIF patients; it was 122 min. All patients of LISS group were exposed to radiation, while only 40% of ORIF group were exposed. The mean time of union of LISS patients was 10.87weeks. While in ORIF patients, the mean time of union was 21.13 weeks. There was no significant difference between both groups regarding the postoperative complications. Functional outcome was satisfactory in both groups. Conclusion. LISS achieves comparable results with ORIF in extraarticular fractures of the proximal tibia. Although LISS potentially has the radiation hazard, it reduces the perioperative complications with a shortened operation time and minimal soft tissue dissection. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Purpose: To evaluate the efficacy of intramedullary nailing for the treatment of the fractures of the proximal quarter of the tibia with special respect on the reduction accuracy. Patients: This is a retrospective study which was conducted in our institution between October 2004 and March 2007. 30 extrarticular proximal tibia fractures were treated with intramedullary nailing. The mean age of the patients was 27 years (19 to 47). Seven fractures (23%) were open – Gustillo grade I-, twelve fractures (12%) had segmental comminution and six (6%) were bifocal fractures. Static intramedullary nailing was chosen in all cases. Distal dynamization was performed routinely in all fractures at an average of 7 weeks (6 to 12 weeks) after the primary operation. Union of the fracture and the accuracy of the reduction were assessed clinically and radiologically. Results: The average follow up was 16 months (9 to 22). All fractures united without additional procedures. Acceptable alignment was obtained in 28 of 30 fractures (93%). Postoperative angulation was satisfactory (average frontal and sagittal plane deformity of less than 2 degrees) in 26 fractures (87%). Two patients had frontal plane deformities (one 4° varus and one valgus 7°) and two patients had a saaggital plane deformities (7° procuvartum). No significant complication was recorded. Conclusions: The proximity of the upper tibia fracture to the knee makes the treatment of these fractures more challenging. Closed intramedullary nailing combined with special reduction technique is a safe and effective method of managing of the proximal tibia fractures

Introduction and objectives. Intramedullary nailing is indicated to stabilization of tibia shaft fractures. Intramedullary nailing through an infra-patellar incision is commonly the technique of choice. While intramedullary nailing of simple diaphyseal fracture patterns is relatively easy, proximal tibia fractures, extremely comminuted/segmental tibia fractures, politrauma with multiple fractures in both extremities and reconstruction of bone loss segment with stiffness of the knee joint can be very challenging to treat. A novel technique for intramedullary tibia nailing through the patella-femoral joint is described. This technique allow extension tibia during intervention time and it supplies easier reduction of the pattern of fracture above. The purpose of our investigation was to evaluate the use of this new technique in described above pattern fracture and patient situation; because we have thought that new technique can perform better outcomes in this situations. Materials and Methods. An observational study of tibia fractures or bone defect was performed for consecutive patients who presented: proximal tibia fractures, extremely comminuted/segmental tibia fractures, politrauma with multiple fractures in both extremities and reconstruction of bone loss segment in the Trauma unit of our institution from September 2009 to August 2010. A total of 32 were included in our study, which performed surgery intervention with Trigen tibia nail (Smith & Nephew, Memphis) with suprapatelar device. Demographic data, mechanism of injury, fracture classification, ROM (2 and 6 weeks, and 3 months), consolidation rate, reduction fracture quality and knee pain at 3 months were recorded. Results. Male was the gender most frequent (64%), the average age was 39,5 years and the main mechanism of injury was motor vehicle injury (30,6%). There were 7 proximal fractures, 1 bifocal fracture, 6 politrauma and 2 reconstruction bone loss segment, the others were comminuted and segmental tibia fracture. In all the patients, the fracture was consolidated between 8 to 14 weeks with average of 10,6 weeks. The quality of reduction was correct in all patients in different axis. The average of ROM at 2 weeks was (−2°/95°) at 3 months was (−0,4°/133°). The knee pain (VAS) average was 0,6 only in 2 patients were (4). Poller screw was used in 7 patients. Conclusion. The suprapatelar nailing is optimal technique to resolve complex fracture of the tibia (proximal, segmental conminution, politrauma) that perform correct consolidation rate without misalignment in the patients. Concerns about knee pain (VAS) from the technique not appear in our data. Prospective and clinical trials are needed to validate this approach

Aims: Severe proximal tibia fractures, which include intra- and extraarticular fractures with metaphyseal-diaphyseal dissociation, pose a difþcult treatment problem for the surgeon with signiþcant complication rates. The aim of this study is to report the experience with a series of consecutive severe proximal tibial fractures treated with hybrid external þxators. Methods: Between 1997 and 2001, we treated 118 cases of proximal tibia fractures of which 52 were treated with hybrid external þxation. Inclusion criteria for hybrid treatment was severe soft-tissue injury, intra-articular displacement, and unstable fracture patterns involvment. In addition to routine demographic data, objective data collected included healing, deformity, complications, and motion. Patient were also evaluated with an SF-36 12 months after healing. Results: All proximal tibial fractures healed without additional procedures. Most patients demonstrated healing by 16 weeks. Accuracy of redution was 0–1mm in 28 patients, 2–3 mm in 19 patients, and 4–5 mm in 4 patients and greater than 5 mm in one patient. Only 5 (10%) of the 52 patients had an angular malunion greater than 6û. One case had a loss of reduction. Four patients developed a mild varus deformity. Radiographic and clinical evidence of degenerative arthritis was seen in 12/52 (23%) patients 18 months after healing. The SF-36 proþlese were health state/rate, daily activity, work activity, emotional problems, pain. Conclusion: We found that hybrid external þxation is a good alternative method for treatment of meta- and/or epiphiseal fractures. The technique and post-op management we describe respects soft-tissue and bone biology and allows early articular mobilization

Aims

The aim of this systematic review and meta-analysis was to gather epidemiological information on selected musculoskeletal injuries and to provide pooled injury-specific incidence rates.

Aims

Patient decision aids have previously demonstrated an improvement in the quality of the informed consent process. This study assessed the effectiveness of detailed written patient information, compared to standard verbal consent, in improving postoperative recall in adult orthopaedic trauma patients.

Anatomically contoured periarticular plates for treatment of proximal tibia fractures is fast becoming the standard for care. The aim of our study was to assess the accuracy of the anatomic contour of proximal lateral tibial plates of AO Stryker and Zimmer in Indian patients. We assessed the accuracy of the anatomic contour of proximal lateral tibial plates of AO Stryker and Zimmer in 50 Indian dry tibiae. All the plates were placed on the 50 tibia by two independent surgeons according to what they felt was the best fit. The tibiae and the plate fits were mapped, quantified, and analysed using digital image capturing and adobe photoshop software. By corresponding the clinical appearance of good fit with our digital findings, we created numerical criteria for plate fit in three planes: coronal (volume of free space between the plate and bone), sagittal (alignment with the tibial plateau and shaft), and axial (match in curvature between the proximal horizontal part of the plate and the tibial plateau). An anatomic fit should mirror the shape of the tibia in all three planes and only ten plates of different companies qualified this. Recognising and understanding the substantial variations in fit that exist between anatomically contoured plates, it might be worthwhile developing proximal tibia plates specific for the Indian population or validating this study by having a larger multicentric study group. This paper would suggest caution when these plates are used as a tool for indirect reduction of the fractures

Introduction. 47 yrs male patient had a prior history. 2005 Fx. proximal tibia (open Fx.). 2007 Metal removal. 2008 Arthroscopic debridement (2 times). He visited out hospital with severe pain and tenderness X-ray (Fig 1) and MRI (Fig 2) findings as follows. Conclusively, He had a chorinic osteomylitis of proximal tibia with soft tissue absess. 1st Surgery. I did arthroscopic debridement Arthroscopic finding shows synovitis, meniscus tear and chondromalacia. I did meticulous debridement (irrigation & curettage). 2nd Surgery. He did primary total knee arthro-plasty instead of two-stage exchange arthroplasty in may, 2010 at the another hospital. 3rd Surgery. After 7 months since he had did total knee arthroplasty, he visited to my hospital again with sudden onset of painful swelling & heating sensation. 4th Surgery. I did second stage reimplantation for infected total Knee arthroplasty after 7 weeks. Now he got a pain relief & ROM restroration. Results. Follow up 12 months X-ray showing all implants to be well-positioned and stable. Clinically, there was no implant considered to be loose. In this study, the knee society and functional scores at final follow up were 82 and 68. Conclusion. The infection after sequales of open proximal tibia fracture is treated by two-stage exchange total knee arthroplasty instead of primary total knee arthroplasty. Two-stage reimplantation of an infected total knee arthroplasty using a static antibiotic-cement spacer achieved an infection control and improvement in the clinical result 3). We use an antibiotic-loaded cement spacer(ALACS) preserved knee function between stages, resulting in effective treatment of infection, facilitation of reimplantation, and improved patient satisfaction 1). The principle surgical technique used for two-stage revision of infected total knee including: (1) exposure, (2) implant removal and debridement, and (3) construction of both static and mobile antibiotic spacers 2

Purpose: The objectives of this project were to compare four commercially available hybrid external fixator systems under multiple loading conditions, and to compare each system to an idealized «rigid» frame to distinguish between motion allowed by the pins and wires and motion allowed by frame deformation. Methods: A mechanical testing investigation was performed using fifteen fiberglass composite tibias (Pacific Research Laboratories, Vashon Island, WA, USA) with a 2 cm proximal metaphyseal gap osteotomy (simulating OTA classification 41-A3.3) to test four hybrid systems (Ace-Fischer, DePuyACE, Warsaw, IN; Hoffmann II, Stryker Howmedica Osteonics, Rutherford, NJ; Synthes Hybrid, Synthes USA, Paoli, PA; EBI DynaFix®, EBI, Parsippany, NJ) and a custom built «rigid» frame. Setting: A biomechanics laboratory using a servohydraulic load frame (MTS Bionix 858, Minneapolis, MN). Measurements were made of the motion produced when loads were applied to the proximal tibia through a custom load plate. Results: The only significant difference between commercial systems was in axial loading where the Ace-Fischer allowed less motion than the other frames. In all cases the «rigid» reference frame allowed significantly less motion than the commercial systems. Approximately 50% of the motion comes from frame deformation and 50% from deformation of the pins and wires. Conclusions/Significance: There are few differences between commercially available hybrid external fixation systems for treating unstable proximal tibia fractures. Approximately half of the motion at the fracture site is due to bending deformation in asymmetric frame designs, which leads to unwanted angular and shear displacements at the fracture site

Introduction: Although originally designed to aid the management of primary malignant bone tumours, the indications for modular endoprosthetic replacement (EPR) have expanded to include complex periprosthetic fractures and failed internal fixation. The incidence of these challenging cases is increasing with an aged population. We reviewed retrospectively our experience with the use of EPR in patients who had undergone limb salvage following complex trauma presentations. Methods: Between 2003 and 2008 twenty one patients presented with complex trauma related problems and underwent EPR at a specialist tertiary referral centre. The mean age was 71 years (range 44–87) and the median number of previous surgical procedures was 3 (range 0–11). Eight patients presented following failed internal fixation of proximal femoral fractures. Nine patients had periprosthetic fractures around joint arthroplasties, seven relating to total knee replacements (TKRs) and two to total hip replacements (THRs). One case of periprosthetic fracture around THR had undergone failed internal fixation. Two patients had distal femoral fractures, of which one was infected and had undergone failed internal fixation, while the other was unrecon-structable. Two patients had proximal tibia fractures which had both undergone failed internal fixation. Results: The mean Harris Hip Score was 89.5 (range 64–85) at a mean follow up period of 8 months (minimum 4 months). The mean American Knee Society Score was 82 (range 62–100) and the mean functional score was 62 (range 30–75) at a mean follow up period of 6 months (minimum 2 months). Complications included two cases of deep infection; one resulted in a two stage revision procedure, while the other retained the EPR following a washout. Discussion: Modular EPR in the lower limb is a durable reconstructive option in complex trauma problems, particularly in the elderly and those patients with significant bone loss. Preliminary functional results indicate very satisfactory results

Introduction: Although originally designed to aid the management of primary malignant bone tumours, the indications for modular endoprosthetic replacement (EPR) have expanded to include complex periprosthetic fractures and failed internal fixation. The objective of this study was to evaluate the success of endoprosthetic replacement (EPR) in patients who had undergone limb salvage following complex trauma presentations. Materials and Methods: Between 2003 and 2008 twenty one patients presented with complex trauma related problems and underwent EPR at a specialist tertiary referral centre. The mean age was 71 years (range 44–87) and the median number of previous surgical procedures was 3 (range 0–11). Eight patients presented following failed internal fixation of proximal femoral fractures. Nine patients had periprosthetic fractures around joint arthroplasties, seven relating to total knee replacements (TKRs) and two to total hip replacements (THRs). One case of periprosthetic fracture around THR had undergone failed internal fixation. Two patients had distal femoral fractures, of which one was infected and had undergone failed internal fixation, while the other was unreconstruc-table. Two patients had proximal tibia fractures which had both undergone failed internal fixation. Results: The mean Harris Hip Score was 89.5 (range 64–85) at a mean follow up period of 8 months (minimum 4 months). The mean American Knee Society Score was 82 (range 62–100) and the mean functional score was 62 (range 30–75) at a mean follow up period of 6 months (minimum 2 months). Complications included two cases of deep infection; one resulted in a two stage revision procedure, while the other retained the EPR following a washout. Conclusion: Modular EPR in the lower limb is a durable reconstructive option in complex trauma problems, particularly in the elderly and those patients with significant bone loss. Preliminary functional results indicate very satisfactory results

Non- or semi-constraint TKA implants do have their limitations in the absence of collateral ligaments, severe deformity, large osseous defects and gross flexion - extension instability or mismatch, even in primary TKA. Additionally instability is increasingly recognised as a major failure factor in primary and revision TKA. Historically most of the first pure hinged TKA implants have shown disappointing results, due to early loosening based on excessive force transmission from the hinge mechanism to the bone-cement interface, used the use of all metal articulation, suboptimal instrumentation or design. Consequently a hinged design was abandoned by most US surgeons. However, some European centres continued with the use of some early European designed pure- and rotating hinged implants. Although most indication in primary TKA can be solved with modular non- or semi-constrained implants, an adequate balancing might require a relevant soft tissue release or reconstruction with allografts. This consequently increases the complexity and operative time with less predictable results in the elderly patient with principal less healing potential, desirable early post-operative full weightbearing and full range of motion. Thus potential indications in the elderly for a rotating- or pure hinged implant in primary TKA include: . –. Complete MCL instability. –. Severe varus or valgus deformity (>25°) with necessary relevant soft tissue release. –. Relevant bone loss with insertions of collaterals. –. Gross flexion-extension in balance. –. Post-traumatic with distal femur or proximal tibia fracture. –. Stiff knee. –. Severe osteoporosis in the old patient. –. Post infectious for a one staged implantation with specific antibiotics in cement. While some authors showed excellent survival rates in of 96% after 15 years in primary TKA, some recent studies revealed high complication rates of up to 25%, including a high infection rate of 2.9%. This remains inconsistent with our clinical results in primary TKA, which revealed an overall survival rate in patients over 60 years of 94% after 13 years, while patients < 60 years revealed a survival rate of only 77%. Correlation between survival rate and deformity revealed in varus alignment a survival rate of 97%, whereas in valgus only a rate of 79%. Consequently we strictly reserve a rotational hinge for patients > 60 years with a combined varus alignment, whereas in severe valgus deformities a pure hinged should be used for our implant design. Limitations of most hinged implants are relatively rare. In our hands the main limitation is hyperextension and weak extensor mechanism, because this leads to early loosenings

Introduction: The Expert Tibia Nail was designed to address proximal, shaft, segmental and distal tibia fractures in one implant. Multiple locking options in various directions provide more stability and reduce the risk of secondary malalignment. Angle stable cancellous bone locking screws in the tibia head also improve fixation. We evaluated this new implant in our series in a prospective, multicenter setting. Methods: 190 patients were treated in 10 participating centers using the Expert Tibia Nail (Synthes). 127 patients suffered polytrauma, 58 presented as open fractures. Within the framework of the study 5 cases were proximal tibia fractures, 108 shaft fractures, 56 distal fractures, and 21 segmental fractures. These were followed-up postoperatively, after 3 months and one year and evaluated radiologically and clinically with regard to malalignment, union rate and complications. Results: Non union occurred in 9 cases after one year of follow up (n=150). 20 patients showed delayed union. The rate of open and complex fractures was high in this group. Dynamisation was performed in 10 cases. Valgus/varus and recurvatum/antecurvatum malalignment of more than 5 degrees occurred in 13 cases. Stable reduction was achieved in 144 cases. In 4 complex fractures, initial reduction went into malalignment. 2 patients developed a deep infection after 3rd degree open fractures. 34 patients suffered from pain in the operated area. 6 screws broke during the follow-up. Discussion: The Expert Tibia Nail proved to be an excellent tool to treat tibia fractures. Not only shaft fractures but also complex fractures in the proximal and distal metaphyseal area can be successfully stabilized due to advanced locking options and design of the nail. The rate of malalignment, non-union and complications was low

Background. There exists no consensus opinion as to the most suitable post-operative rehabilitation and weight bearing status for proximal tibia articular fractures treated with internal fixation using plates and screws. Objectives. The aim of this study is to investigate whether the post-operative weight bearing status is associated with loss of reduction and articular collapse. Study Design and Methods. Data was retrospectively analysed from our prospective database in a major trauma centre. Group I were non-weight bearing for the first six weeks post-operation and Group II were instructed to weight bear fully immediately post-operation. Radiographs were taken day one post-operation, at six weeks and at three months and analysed for fracture displacement and joint depression or loss of fixation. Results. 90 patients were included in the study. The follow up radiographs demonstrated no failure of fixation in either study group. One patient from the weight bearing group had >1mm joint depression (4mm) identified at the first follow up, which did not worsen by the second. Conclusions. This study shows immediate post-operative full weight bearing does not affect the fixation or cause articular collapse up to three months after surgery. We propose that patients should be encouraged to weight bear immediately post-operation

Introduction: Unstable, extra-articular, proximal, tibia fractures are difficult clinical problems often complicated by mal-alignment and soft-tissue breakdown. Aim: To evaluate the biomechanical properties of a traditional double plating (DP) technique, the Less Invasive Stabilization System (LISS) and hybrid external fixation. Secondarily, the clinical outcomes of an initial series of 20 fractures treated with the LISS system were to be evaluated. Methods: The axial stiffness and biaxial tilt (varus/valgus and anterior/posterior) of the three systems were tested. Five synthetic tibiae per system were loaded in sequence under the following conditions of instability:. 1)Intact. 2)1 cm medial wedge osteotomy (proximal metaphysis). 3)1 cm gap osteotomy. Twenty proximal tibial fractures treated with the LISS system were reviewed to assess union rates, complications, knee motion and secondary procedures. Results: There were no significant differences between the different systems when they were used on the intact specimens. The DP system was significantly stiffer axially and in varus tilt than the LISS and the hybrid systems for the wedge osteotomy for all loads. The LISS was significantly stiffer in varus tilt than the hybrid with the wedge at maximal loading. With the gap osteotomy, all three systems were significantly different from each other in both stiffness aspects (DP> LISS> hybrid). The hybrid exhibited axial gap closure at approximately one third of the force of the other systems. No implant failed or exhibited plastic deformation. In the clinical review all fractures united and only three required bone grafting. No fixation failed but there were three deep infections. Over 80% of the cases had knee motion of 90 degrees or better. Conclusions: The DP was significantly stiffer than both the LISS and the hybrid system for axial displacement and varus tilt at comparable loads for the wedge and gap models. The LISS was significantly stiffer than the hybrid in the completely unstable gap model. The tibial LISS system gave encouraging initial clinical results