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Purpose Malunions are a common complication after tibial plateau fractures (TPF), leading to stiffness, pseudo-instability and posttraumatic osteoarthritis. The purpose of this study was to analyse the clinical outcome after intraarticular osteotomy of malunited TPF and to perform a failure analysis. Methods Between 2013 and 2018, 23 patients (11 males, 12 females; 43.8 ± 12.8 years) with intraarticular osteotomy after malunited TPF were included in the retrospective study. Clinical examination and postoperative scores were collected with a minimum follow-up of 24 months. Malunion was measured on pre- and postoperative CT scans and localized according to the 10-segment classification while the leg axis in the frontal plane was measured pre- and postoperatively on long leg standing radiographs. Results Excellent and good clinical outcome was achieved in 73.9% (n = 17) of the cases and patient related outcome improved significantly (Tegner 3.3 ± 1.6–5 ± 1.8, p p p p = 0.003). Failure analysis showed that an impaired clinical result correlated with a postoperative extension (n = 3, p n = 4, p = 0.035). Conclusion Intraarticular osteotomy of malunited TPF lead to good clinical results with significant clinical and radiological improvement in most cases while an impaired patient outcome correlated with a limited range of motion. This study is the first failure analysis of intraarticular osteotomy after malunited TPF published up to now.

Malreduced tibial plateau fractures often lead to pain and can be accompanied by instability, deviation of the mechanical axis, restricted mobility, and constant wear of the joint [1]. The main reasons for malreduction after tibial head fracture are insufficient visualization of the fractured joint surface or insufficient fixation with secondary loss of reduction [1]. It has been demonstrated, that through standard approaches only 30–40% of the joint surface can be visualized [2]. With standard approaches and intraoperative fluoroscopy around 30% of lateral tibial plateau fractures are not sufficiently reduced, especially in the posterolateral quadrant [3]. In bicondylar fractures the “posterolateral-central segment” is involved in 85% of all cases [4] and cannot be visualized by fluoroscopy [5] nor by a lateral standard approach [2]. Remaining steps of more than 5 mm in the posterolateral quadrant of the tibial head are associated with a worse clinical result [1, 6].

Complex fracture dislocations of the elbow present a challenge for the upper extremity surgeon. The extent of the osseous and soft tissue injuries determines the stability of the elbow joint. Post-traumatic elbow stiffness is a debilitating complication which poses a major threat to the integrated function of the entire limb. Thus, restoration of motion is the fundamental basic of most reconstructive efforts following traumatic injury to the elbow. More recently, hinged external fixation has become an important tool in both the acute treatment of severe fracture dislocation and post-traumatic reconstruction of the elbow. Its use has expanded from a “last hope effort” to earlier utilization in a standardized protocol, the so- called elbow fixator concept. In this chapter we will describe the philosophy, the operative technique, and the tips and tricks of performing hinged fixation in acute elbow trauma.

In recent years, the incidence of anterior cruciate ligament (ACL) injuries in skeletally immature patients increased significantly [26, 51]. Although available epidemiological information on ACL tears in skeletal immature patients is limited, the number of ≤10 age patients accounts for 0.4 % of all ACL injuries in Sweden [69]. Most of sports-related ACL injuries are non-contact in nature, that is, cutting or pivoting motion on a fixed foot during change of direction, sudden stopping or landing from a jump, or a hyperextension trauma [9]. The diagnostic accuracy of this young population is lower than in adults due to a lack of ability to state the circumstance of the injury or symptoms encountered since the injury [59]. For the physician it may be of help to assess the injury mechanism together with the patients and patients. In any case it is very important to include the parents in the decision making of the treatment. A close cooperation and compliance of the young patients is essential and needs the support and confidence of the patients, too.