Tibia plateau fracture mapping and its influence on fracture fixation.

BACKGROUND: Tibial plateau fracture classifications are based on anteroposterior radiographs. Precontoured locking plates are commonly used to treat such fractures. The aims of this study are to: (1) describe tibial plateau fracture anatomy in the axial plane and (2) assess whether current plating systems allow screws to be placed suitably. MATERIALS AND METHODS: A graphical tibial plateau template was developed. One hundred twenty-five tibial plateau fractures (four bilateral) were reviewed (80 men, 41 women; average age 45.5 years, range 21-77.7 years). The axial computed tomography (CT) slice 0.3-0.5 mm below the medial articular surface was reviewed in all cases. Fracture lines were drawn on the template. Four lateral locking plates were placed against a cadaveric adult tibia. Based on the projected screw directions, suitable fracture patterns were identified. Fractures were considered "suitable" if the screws passed 90 ± 22° to the fracture line. RESULTS: Two hundred sixty-one different fracture lines were identified. One hundred thirty-four fractures involved the lateral plateau; 96 were suitable for lateral plating. Ninety fractures involved the medial plateau, 82 were treatable using the various plate positions on medial-posterior aspect of the medial plateau. Thirty-seven fractures were bicondylar; 20 were treatable with a posteromedial plate. CONCLUSIONS: Tibial plateau fractures follow consistent patterns, with most lateral and medial plateau fracture lines being in the sagittal plane, although there is greater variation medially. Positioning of modern locking plates will deal effectively with 72 % of all lateral plateau fractures and 91 % of medial plateau fractures. LEVEL OF EVIDENCE: Level 3.

[Simplified active motion protocol following Extensor indicis to Extensor pollicis longus tendon transfer using a side-to-side suture]. / Vereinfachte aktive Nachbehandlung nach Extensor-indicis auf Extensor-pollicis-longus-Sehnentransfer mit Seit-zu-Seit-Naht.

BACKGROUND: Ruptures of the Extensor pollicis longus tendon are commonly treated by Extensor indicis transfer using Pulvertaft suture technique. Current literature does not yet give evidence for a preferable post-operative therapy protocol. A side-to-side suture technique is significantly stronger than the Pulvertaft repair technique and therefore allows an immediate active postoperative treatment. We present a new postoperative protocol, which is simple, fast and safe, and should make treatment easier for patients and therapists. PATIENTS AND METHODS: We treated 10 patients with a transfer of the extensor indicis tendon between 07/2016 and 08/2017 according to the new active protocol. Patients were seen for follow-up at 2, 4 and 8 weeks. Thumb range of motion, pinch and grip strength as well as subjective parameters like pain and general satisfaction were measured. RESULTS: All patients regained full function of their thumbs with retropulsion over the level of the palm at 4 weeks. Median pinch strength was 89 % and grip strength 74 % of the contralateral side at week 4. There was no secondary rupture of the reconstructed tendon over a one-year period. All patients were satisfied with the result of the operation and the protocol. CONCLUSION: Our new active postoperative protocol for extensor indicis transfer using a side-to-side suture has proven to be safe and less strenuous for patients and therapists and has been established as standard treatment in our clinic.