The posterior cruciate ligament (PCL) plays a major role in knee stabilization, and clinical studies have shown an increase in incidence of its injury. Due to the surrounding neurovascular elements in the popliteal space, open approaches to repair such injury are difficult to perform. The "safe postero-medial approach" to PCL avulsion fracture is a simple approach, does not require exploration of the neurovascular elements, and produced satisfactory results in the majority of patients.
Knee and ankle function after tibial shaft fractures have not been evaluated comparing intramedullary nailing (IMN) and plate fixation (PF). In a retrospective case review study we evaluated 50 patients with history of closed tibial and fibular shaft fracture who have been treated by IMN or PF from 1999 to 2003. Twenty-five patients in each group evaluated for knee and ankle function using Iowa knee score, ankle rating score and VAS for the pain. 18.3±4.8 weeks after PF (mean follow up 35±11.7) and 16.4±4.6 weeks after IMN fixation (mean follow up 36.8±11.3) union has been achieved (P<0.17). The knee score was 89.4±10.4 in IMN group and 95.7±6.7 in PF one (P<0.01). The ankle rating score was 94.7±7.2 in IMN and 96.8±6.1 in PF (P<0.28). The nail to knee distance (average 14±5.2 mm) was significantly correlated to the knees' function and pain (r=0.599, P<0.002, r=0.583, P<0.002, respectively). T-test reveals that knees' function are significantly inferior with transpatellar approach in comparison with parapatellar one (86.1±10.6 vs. 95.3±7.4, P<0.01). Our study discloses that using plate may lead to better knee function, while IMN causes higher amount of knee pain with controversial reasons.
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