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Background: A lack of data exists on the long-term magnetic resonance imaging (MRI) findings after surgical repair of tibial plateau fractures (TPFs). We evaluated the MRI findings 13 to 31 years after surgical repair of TPFs, focusing especially on the pathological changes in the ligaments, menisci, and cartilage., Methods: Twenty-three patients with 24 TPFs underwent open reduction and internal fixation with the same fork-shaped surgical plate that was used in our institution until 1999. No patient underwent preoperative or immediately postoperative MRI. The knees of all patients who underwent plate removal were examined by axial, coronal, and sagittal MRI. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and whole-organ magnetic resonance score (WORMS) were determined in all patients., Results: All 24 knees exhibited MRI abnormalities. An unexpectedly high number of pathological changes in the menisci and ligaments were observed. No meniscal or ligamentous injuries were documented at the time of the injury or initial surgery, but meniscal injuries manifested in the long term. MRI in almost all cases showed a damage to the lateral meniscal, the severity of which was related to the degree of tibial plateau widening, but not to the severity of the lateral joint surface impression. The overall condition of the knee joint was satisfactory as measured by the WORMS, and there was a weak correlation between WORMS and KOOS.

Purpose: We examined the development of osteoarthritis (OA) and post-traumatic bone loss after surgery for tibial plateau fractures (TPF)., Methods: Patients who had participated in previous follow-up (FU) examinations after TPF and primary reduction and internal fixation were re-evaluated. At the first FU, a median of three years after the accident (short-term FU), the patients underwent functional assessments and standardised X-rays to grade radiological OA and post-traumatic bone loss. At the second FU, a median of 22 years after the accident (long-term FU), 30 patients were available. An identical protocol was applied, and additional investigations [Knee Injury and Osteoarthritis Outcome Score (KOOS) and magnetic resonance imaging (MRI) of the injured knee] were performed., Results: When the subjective and objective results at first FU were compared with those of the second FU for the same patients, deterioration of symptoms, signs and radiological OA was noted; however, ten patients had no OA even after the long-term FU. Some patients developed post-traumatic bone loss. In 13 of 31 knees, there was little or no radiological evidence of bone loss at the second FU., Conclusions: The short-term FU examination results after TPF have little prognostic value for the individual patient, as good results may deteriorate over the long run; however, there were some knees with no OA at the long-term FU. This is the first report focusing on post-traumatic bone loss after TPF.

Objectives: There is substantial variation in the classification and management of scapula fractures. The first purpose of this study was to analyze the interobserver reliability of the OTA/AO classification and the New International Classification for Scapula Fractures. The second purpose was to assess the proportion of agreement among orthopaedic surgeons on operative or nonoperative treatment., Design: Web-based reliability study., Setting: Independent orthopaedic surgeons from several countries were invited to classify scapular fractures in an online survey., Participants: One hundred three orthopaedic surgeons evaluated 35 movies of three-dimensional computerized tomography reconstruction of selected scapular fractures, representing a full spectrum of fracture patterns., Main Outcome Measurements: Fleiss kappa (κ) was used to assess the reliability of agreement between the surgeons., Results: The overall agreement on the OTA/AO classification was moderate for the types (A, B, and C, κ = 0.54) with a 71% proportion of rater agreement (PA) and for the 9 groups (A1 to C3, κ = 0.47) with a 57% PA. For the New International Classification, the agreement about the intraarticular extension of the fracture (Fossa (F), κ = 0.79) was substantial and the agreement about a fractured body (Body (B), κ = 0.57) or process was moderate (Process (P), κ = 0.53); however, PAs were more than 81%. The agreement on the treatment recommendation was moderate (κ = 0.57) with a 73% PA., Conclusions: The New International Classification was more reliable. Body and process fractures generated more disagreement than intraarticular fractures and need further clear definitions.

A cohort study with retrolective and prolective collection of data was carried out 49 of 99 patients with scaphoid fractures, initially treated by plaster cast immobilization and having developed a proximal fragment with increased bone density were studied. More than half of these patients had a good or excellent result according to the modified score of Green and O'Brien 29 of 49 proximal fragments with increased bone density returned to normal density: 45 of 49 showed bony union, and 35 of 49 showed no signs of posttraumatic arthrosis. The appearance of stripes with increased bone density in plain X-rays indicated a problem in the process of fracture healing; the clinical interpretation, however, was difficult. Four patients were treated by percutaneous canulated screw (Streli). These fractures showed bony union, the fragment with increased bone density returned to normal in three of four patients. All of these patients had some remaining clinical problems.

A new roentgenographic index for evaluation of the distal radial joint surface is described. The breadth of the carpal lunate bone und the breadth of the distal articular surface of the radius are measured on an X-ray in a typical lateral view. The quotient of these two measurements is the desired index. Mean and standard deviation of the quotients of 50 normal carpal joints were 0.99 +/-0.05. The corresponding values for 39 intraarticular fractures of the distal articular surface, AO classification C.2 and C.3, were 0.83 +/-0.09. The difference evaluated in a t-test for unpaired observations was significant (p less than 0.001). Widening of the distal articular surface in intraarticular radial fractures can thus be measured and numerically described in a single value.