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.

Introduction: The ventral thoracoscopic spondylodesis of the thoracolumbal spine is an elegant treatment strategy in cases of incomplete vertebral burst fractures.

Materials and Methods: In the years 2002/03 29 patients with incomplete burst fractures of the thoracolumbal spine, were treated by a ventral thoracoscopic spondylodesis and were included prospectively. The individual treatment plan depended on the patient’s general condition and the vertebral stability. The data acquisition was done according the DGU guidelines of documentation preoperative, postoperative, and after 3, 6, 12, and 18 months. After 5 years a follow-up examination was performed in 21 of these patients (9 men, 12 women, average age: 46.3 years, follow-up rate: 72%). 9 patients were treated ventral only. In all of them the ventral spondylodesis was done monosegmental with autologous iliac crest. In 12 cases a dorsoventral procedure was performed, 5 patients ventral monosegmental with iliac crest, and 7 patients bisegmental with cage. Parameters of interest were the bisegmental kyphotic angle, the SF-36 score, the visual analogue scale (VAS), and the morbidity of the surgical approach.

Results: The 5-year results of the 21 patients dependent on the treatment strategy:

5 years/Reposition- Loss of Reposition- VAS- PSC (SF36)- MCS (SF36)

Only three patients complained of intermittent weak pain sensation at the region of the thoracoscopic approach (14%). During the 5 years one revision surgery was performed because of the development of an incisional hernia.

The computertomographic controls of the 14 patients who gained a monosegmental spondylodesis with an iliac crest showed in 12 cases a complete osseous consolidation (86%) after 5 years. In the other two cases the osseous consolidation was only partly visible with an area of consolidation of more than 30% (14%). In both cases a sufficient stability was existent. 4 patients (29%) had no symptoms at the site of the iliac crest removal. 8 patients (57%) reported of weak residual pain, 2 patients (14%) reported of more intense pain sensation.

Conclusions: After 5 years the ventral thoracoscopic spondylodesis of the throracolumbar spine after incomplete burst fractures prove to be a save and successful therapy strategy. There are no significant differences between the isolated ventral spondylodesis and the dorsoventral spondylodesis in respect of loss of reposition of the bisegmental angle, persisting pain sensations, and quality of life after 5 years. The ventral thoracoscopic monosegmental spondylodesis seems to be by trend superior to the bisegmental strategy in respect of the physical summary score.

Introduction: The aim of this study was to evaluate direct mechanical measurements from an external fixator as an alternative method to DEXA to examine the healing progress of patients undergoing distraction osteogenesis (DO).

Methods: Five patients were evaluated concurrently by BMD estimates and direct mechanical measurements from an external fixator to examine bone consolidation approximately every six weeks after the end of distraction. For mechanical measurements, all rods were removed from the external fixator and replaced with three load cells. An axial load of 10 kg was applied to the tibia and the load recorded from the three load cells was used to calculate the proportion of the load supported by the fixator (Load Share Ratio, LSR), which indicates the stiffness of the newly developed bone.

Results: The LSR decreased significantly for all patients (r2=0.63, p < 0.01), indicating increased bone stiffness. DEXA based BMD estimates decreased for two of five patients despite normal healing progress and likewise BMD and LSR were weakly correlated (r2=0.22, p > 0.05).

Discussion: Bone consolidation is often accompanied by changes in bone geometry, which can make DEXA based BMD estimates inaccurate for this application. Mechanical measurements from external fixators are not subject to this error and therefore could be a more reliable method to evaluate the healing progress of patients undergoing DO.

Conclusion: Direct mechanical measurements from an external fixator may be an alternative procedure to improve the evaluation of healing progress during DO.