The classification systems for tibial plateau fractures: how reliable are they?

OBJECTIVE: The aim of the study was to assess the inter-observer reliability and intraobserver reproducibility of three different classification systems for tibial plateau fractures. MATERIALS AND METHODS: Four observers of various levels of experience classified 50 tibial plateau fractures. The same observers repeated the classification of the same fractures after an interval of 8 weeks. Inter- and intra-observer variability was assessed using the mean kappa co-efficient and the mean percentage of agreement. RESULTS: For inter-observer reliability, the mean kappa co-efficient values for Arbeitsgemeinschaft für Osteosynthesefragen (AO), Schatzker and Hohl and Moore classifications were 0.36, 0.47 and 0.14, respectively. The mean percentage of agreement was 0.52, 0.59 and 0.34, respectively. For intra-observer reliability kappa-values were 0.80, 0.91 and 0.76 and the mean percentage of agreement was 0.88, 0.93 and 0.85 in the same order. CONCLUSIONS: Our results show that none of the classification systems were ideal. The Schatzker classification system was superior to the AO and the Hohl and Moore systems both in terms of inter-observer reliability and intra-observer reproducibility. However, there is a need for developing a more comprehensive approach to judge the classification systems.

Simple elbow dislocation among adults: a comparative study of two different methods of treatment.

Post-manipulation treatment of elbow dislocation includes plaster of Paris immobilisation for a mean of 2 weeks followed by physiotherapy, or sling support followed by early mobilisation. This study retrospectively reviewed 42 simple elbow dislocations. The management of 20 patients by the plaster of Paris method and 22 by the sling method was assessed after a minimum follow-up of 2 years using Mayo Elbow Performance Index (MEPI) scores, the Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and time off work. The final functional outcome in the plaster of Paris group showed 10 excellent, 2 good, 5 fair and 3 poor results, compared with 19 excellent, 1 good and 2 fair results in the sling group. The mean times to return to work in plaster of Paris group and sling group were 6.6 and 3.2 weeks, respectively (p<0.001). Early mobilisation did not result in redislocation or late instability of the elbow. Thus the final functional outcome of the sling and early mobilisation group was significantly better than in the plaster of Paris immobilisation group.

Open grade III "floating ankle" injuries: a report of eight cases with review of literature.

INTRODUCTION: "Floating ankle" injuries result from high-energy trauma and are usually associated with extensive soft tissue damage. Such rare and complex injuries in the acute phase pose therapeutic dilemma to the treating surgeon. When salvage instead of amputation is preferred, a variety of treatment options are available ranging from open reduction along with minimal internal fixation to external fixation. In this retrospective case series study we report eight patients with open "floating ankle" injuries who had been treated with external fixation with or without internal fixation. MATERIALS AND METHODS: Eight consecutive patients (7M: 1F) with mean age of 28 years (range 18-35 years) were treated. All had Grade III open fractures of the distal tibia with foot fractures and various degrees of soft tissue injuries. ISS and MESS were used to assess injury severity. Immediate radical wound debridement; skeletal stabilization and early soft tissue coverage were done by combined trauma and plastic surgical services followed by standard post-operative rehabilitation. All the patients were assessed with SF-36 questionnaire at mean follow-up of 2.5 years (range 2-4 years). RESULTS: Three patients were treated primarily with Ilizarov ring fixators, one had hybrid fixation and the other four had Hoffman frames. Four patients needed further surgeries. One patient developed metatarsal osteomyelitis, which was debrided and treated with antibiotics. The SF-36 results were compared with age matched UK norms for men and women in all categories. Only two patients returned to their previous employment. Six suffered varying degrees of disability out of which one underwent amputation. CONCLUSIONS: External fixation with or without internal fixation is an option when salvaging rare injuries like open grade III "floating ankle" injuries. Salvaged patients do suffer a cocktail of crippling disease characterized by psycho-socio-economic and physical disability and result in increased hospital costs. We recommend more prospective studies with long-term follow-up of such complex injuries to identify the indications for salvage and also the criteria for a successful salvage.

Rotational dislocation of the thoracolumbar spine. Case report and review of the literature.

The authors report a rare case of rotational dislocation of the thoracolumbar spine in a 12-year-old girl with neurofibromatosis Type 1. The patient had progressive spinal kyphoscoliosis with acute-onset paraplegia. She was treated with corrective traction preoperatively, followed by spinal decompression and circumferential spinal fusion without instrumentation. She had complete neurological recovery after a solid fusion of her spine.