Background

The cemented mobile bearing metal backed low contact stress patellofemoral arthroplasty (LCS PFA) is a newer design belonging to the second generation of inlay type implant, based on the more successful knee arthroplasty model. The advantage is the patella can articulate with the trochlear implant as well as the femoral component of a total knee replacement (TKR).

Purpose: To evaluate the intra and inter-observer variation of the Schatzker and AO/OTA classifications in assessing tibial plateau fractures, using plain radiographs.

Summary: Fifty tibial plateau fractures were classified independently by 6 observers as per the Schatzker and AO/OTA classifications, using antero-posterior and lateral plain radiographs. Assessment was done on two occasions 8 weeks apart.

We found that both the Schatzker and AO/OTA classifications have a high intra-observer (kappa=0.57 and 0.53 respectively), and inter-observer (kappa=0.41 and 0.43 respectively) variation. Classification of tibial plateau fractures into unicondylar vs. bicondylar and pure splits vs. articular depression +/− split conferred improved inter and intra-observer variation.

Conclusions: The high inter-observer variation found for the Schatzker and AO/OTA classifications must be taken into consideration when these are used as a guidance of treatment and when used in evaluating patients’ outcome. Simply classifying tibial plateau fractures into unicondylar vs. bicondylar and pure splits vs. articular depression +/− split may be more reliable.

Problem-based learning medical courses are now in the majority in the UK. This type of teaching, based on research by Barrow in the 1960s, seeks to integrate basic sciences and clinical teaching, leading to the acquisition of an integrated knowledge base that is readily recalled and applied to the analysis and solution of problems. We noticed an apparent difference in the core anatomical knowledge in a group of 4th year medical students during their orthopaedic placement, some of whom had been taught a traditional course and some a PBL course. We set out to quantify this difference.

60 simple anatomy questions were asked, with 30 minutes allowed, and no negative marking. 33 students were PBL taught, and 27 by a traditional course, with a roughly equal male: female ratio. The average score in the PBL group was 39.2% (range 11–52%), whereas the traditional group averaged 73.7% (range 63–79%).

A second study was undertaken on two groups of 80 second year medical students, at 2 different UK universities with comparable teaching standards and entry requirements, both being well-established courses. Again, a simple 50-question anatomy paper was used, without negative marking. The traditional course students scored a mean of 37.5 (25–46), and the PBL group scored a mean of 32.3 (18–45). The results were statistically significant (p< 0.0001).

Our results suggest that the difference between the two groups with regard to core anatomical knowledge increases with progression through training. This has significant implications due to PBL courses being in the majority. During the usually short orthopaedic attachment, it will become increasingly difficult for clinicians to teach effectively due to the lack of this knowledge.

To evaluate the functional outcome after anterior cruciate ligament reconstruction using bioabsorbable femoral cross-pin fixation

30 patients with chronic anterior cruciate ligament deficiency, treated by arthroscopic reconstruction using hamstring tendon autograft have been reviewed. 3.3mm bioabsorbable (polylactic acid) cross-pins (Rigidfix, Ethicon) were used for graft fixation in the femoral tunnel. Outcome assessment was performed using Lysholm score,Tegner activity level, KT-1000 Arthrometer laxity measurements, single legged hop test and SF-36 evaluation. There were 20 male and 10 female patients with an age between 17 and 45 years(mean 25.1 yrs).The mean follow up was 20.3 months (range12–29 months). The mean Tegner score was 5.5 with a range of 3 to 7. Lysholm scores averaged 88.27 with a range of 74 to 100. The range of movement in the operated knee was comparable to that in normal knee. The single legged hop was 93.4% of the unoperated side. The average KT-1000 side to side difference was 3.2 mm using a 30 lb force and 3.5mm on manual maximal load.

Biabsorbable femoral cross-pin fixation offers a viable and safe method of graft fixation in anterior cruciate ligament reconstruction and yeilds a satisfactory functional outcome.

Total hip replacement has been very successful in patients with painful, stiff hips associated with protrusio acetabuli, but the heat of polymerisation of methylmethacrylate cement may cause necrosis of the thin medial wall with consequent danger of migration of the cup. Since 1968 at Wrightington, thin slices of the head of the femur have been used as bone grafts to reinforce the acetabulum. We have reviewed 61 hips in 51 patients at an average of 4 years 3 months after operation. Grading for severity is discussed and the degree of physiological remodelling of the medial wall of the acetabulum after grafting assessed. There was an average of about 4 mm of remodelling, but this varied considerably; most took place within the first year. In no case was there relapse of the protrusio.