Introduction: Transient posterolateral subluxation of the lateral femoral condyle has been postulated as a non-contact mechanism of ACL rupture. The consistent location of MRI bone bruises on the anterior half of the lateral femoral condyle and the posterior rim of the lateral tibial plateau in ACL injuries suggest this mechanism of injury. Previous studies utilizing radiographs have investigated and eliminated the possibility of an increase in posterior tibial slope angle as a risk factor for ACL injury. None, however, have specifically measured the slope angle of the lateral tibial plateau. This study was designed to utilize MRI images for specific measurement of the lateral tibial slope angle and investigate this as a risk factor for ACL injuries.

Materials & methods: The MRI images of 30 knees with complete ACL ruptures (Group I) and those of 30 knees with an intact ACL were studied. Both groups were age-matched (range 15 to 50 years) and predominantly male. The slope angles of the medial plateau and the lateral tibial plateau were measured separately. Statistical comparison was made between the slope angles of the medial and lateral tibial plateaus within both groups, and between the lateral tibial slope angles of Group I and Group II., using a Student’s t-Test.

Results: The mean slope angle of the medial plateau was 3.43 degrees in Group I and 3.67 in Group II. The mean slope angle of the lateral tibial plateau was 6.40 degrees in Group I, and 5.43 in Group II. The difference between medial and lateral slope angles was statistically significant, as well as that between the lateral tibial slopes of Group I and Group II. There was no statistical difference between the mean slope angles of the medial plateau of both groups.

Conclusion: There is a significant difference in slope angles of the medial and lateral tibial plateaus, and thus the need to specify the lateral tibial slope angle in determining slope angles as a risk for ACL injuries. While there is a statistically significant difference in lateral tibial slope angles of patients with ACL tears, the actual measured difference of one degree is not clinically useful as a predictor of ACL injury risk.

Introduction: The balance between achieving stable fixation and maintaining hand and wrist function during the treatment of distal radius fractures has continuously plagued the orthopaedic surgeon. A radio-radial external fixation system was developed by Dr. Guillermo Bruchmann to address these concerns. This study was designed to evaluate the immediate functional and anatomical results of the fixation system on intra-articular and extra-articular fractures. This is the first study documenting the use of this technique in Asia.

Materials and methods: Fifty-four consecutive patients, 18 male and 36 female, with 56 distal radius fractures were treated with closed reduction and application of the COBRA radio-radial external fixator. The operative procedure is described in detail. Immediate use of the affected hand for activities of daily living (ADL’s) was encouraged. Each patient was evaluated regarding functional and anatomical recovery at 2, 4 and 6 weeks postoperatively. Using the modified system of Green and O’Brien, functional recovery was based on the presence of pain, ability to do ADL’s, and range of motion. The grading system of Sarmiento was used to evaluate the overall maintenance of anatomic reduction by comparing the post-operative radiographs with those taken at 2, 4 and 6 weeks and on removal of the fixator.

Results: Assessment of functional status showed that patients had occasional to no pain at the pin sites at 2 weeks; improving on biweekly follow-up. Those with extra-articular fractures were able to do restricted ADL’s wearing the device within the 1st 2 weeks; with wrist motion arc between 50–75°. Patients with intra-articular fractures were functionally delayed by 2 weeks but with a dramatic improvement at 3–4 weeks, doing light ADL’s with wrist motion between 20–60°; progressively improving on follow-up. Biweekly radiographic evaluation showed good to excellent maintenance of reduction for both intra- and extra-articular fractures up to time of fixator removal. Average time of fixation was 7 weeks (range, 6 – 9 weeks) with removal depending on radiographic evidence of fracture union.

Summary: The COBRA external fixator is a versatile tool in the treatment of intra-articular and extra-articular fractures that any general orthopaedic surgeon can use. The overall functional and anatomical outcome is good to excellent during the time of fixation up to the time of fixator removal. Hand and wrist function is initiated immediately markedly limiting the usual complications of stiffness and disability commonly associated with these fractures.