Introduction

Posterolateral tibial plateau fractures account for 7 % of all proximal tibial fractures. Their fixation often requires posterolateral buttress plating. Approaches for the posterolateral corner are not extensile beyond the perforation of the anterior tibial artery through the interosseous membrane. This study aims to provide accurate data about the inferior limit of dissection by providing measurements of the anterior tibial artery from the lateral joint line as it pierces the interosseous membrane.

Introduction

Application of an external fixator for type B and C pelvic fractures can be life saving. Anteriorly the fixator half pins can be placed in the long and thick corridor of bone in the supra-acetabular region often referred to as the low anterior ex-fix. Pins in this location are favoured as they are more stable biomechanically. The bone tunnel for the low anterior ex-fix can be visualised with an iliac oblique projection intra-operatively. In some cases despite being outside the articular surface it may still be low enough to pass through the capsular attachment of the hip joint on the anterior inferior iliac spine. We aim to provide radiological markers for the most superior fibres of the capsule to help accurate extra-capsular pin placement within the supra-acetabular bone tunnel.

Injuries to growth plates may initiate the formation of reversible or irreversible bone-bridges, which may lead to partial or full closure of the growth plate resulting in bone length discrepancy, axis deviation or joint deformity. Blood vessels and vascular invasion are essential for the formation of new bone tissue. The aim of our study was to investigate the spatial and temporal expression VEGF and its receptors R1 and R2 as well as the ingrowth of vessels in the formation of bone bridges in a rat physeal injury model. Quantitative Real Time - Polymerase Chain Reaction (qRT-PCR) was performed for Vascular Endothelial Growth Factor (VEGF) and its R1 and R2 receptors. Samples from the proximal epiphysis, physis and metaphysis of the tibial bone were prepared for immunohistochemical analysis to demonstrate the spatial expression of VEGF and its R1 and R2 receptors as well as laminin. Kinetic expression of VEGF and VEGF-R1 mRNA documented a tendency towards an expression increase on day 7. Histological analysis showed a haematoma containing bone fragments on day 1which was replaced by a bony bridge by day 14. This remodelled and consolidated by day 82. These trabeculae were accompanied by vessel formation. Expression of VEGF was observed on the bone fragments and the haematoma from day 1 through to day 82. Although VEGF-R1 was expressed at all time points the expression of VEGF-R2 was noted until the 14th day. Physeal bone bridge formation is a combination of both enchondral and intramembranous ossification. This is in part triggered by the bony debris observed within the lesion in the first few days. By washing this debris out the likelihood of bone bridge formation may be reduced. We recommend this practice when operating on the physis in order to avoid iatrogenic physeal bar formation.

Introduction: Pediatric radial neck fractures account for 5 to 10 % of all elbow fractures. Depending on the degree of radial head displacement either operative intervention or conservative treatment is recommended. Open reduction offers anatomic fracture fixation but compromises the vulnerable blood supply. Intramedullary nailing combines the advantages of closed reduction and stable internal fracture fixation. The purpose of the presented study was to evaluate the outcome of treatment of a series of pediatric radial neck fractures. Special contributions in our algorithm were made to the age dependant capacity for spontaneous fracture remodelling.

Materials and Methods: The medical data of all children with fractures of the radial head between 1999 and 2008 were retrospectively analyzed. Fractures were classified according to the classification system described by Judet et al. Depending on the angulation of the fracture and on the age of the patient the treatment algorithm was defined. Type I fractures were treated conservatively and Type IV fractures operatively independent of age. Type III fractures in patients younger than 6 years of age were treated conservatively without reduction and Type II fractures were reduced in children older than 12 years of age. The functional outcome was graduated from excellent to poor according to the score of Linscheid and Wheeler.

Results: In our study 168 patients, 88 male and 80 female, were included. The average age of the patients was 9 years (range 3 to 16 years). There were 103 Type I injuries, 21 Type II, 30 Type III and 14 Type IV injuries. Conservative treatment was possible in 124 (73.8%) patients (103 Type I, 12 Type II, 9 Type III injuries). Operative intervention was performed in 44 (26.2%) patients (9 Type II, 21 Type III, 14 Type IV injuries). In 10 patients a K-wire was used to leverage the radial head percutaneous. Open fracture reduction was required in 4 patients. Necrosis of the radial head was found in 2 patients with open reduction. One child presented with hypoesthesia in the area of the superficial radial nerve. The latest follow up examination was performed after 26 months mean (range 11 months to 7 years). We found excellent results in 158 patients, good results in 5, fair in 3 and poor in 2 patients.

Discussion: An intact vascular supply to the radial head is essential to avoid complications. The iatrogenic impact to the nutritive vessels should be kept to a minimum. Closed fracture reduction and intramedullary nailing has improved the prognosis. Spontaneous fracture remodeling might successfully replace unnecessary maneuvers for fracture reduction. However, the proximal physis of the radius is responsible for only 20–30% of the growth of the radius and therefore spontaneous fracture remodeling is restricted. Following our treatment algorithm we found excellent results in the majority of cases.