Measurements of tibiofibular relationships made on axial CT images are reliable. Because of significant anatomic variation between individuals, using a patient's contralateral ankle for comparison provides a precise definition of normal tibiofibular relationships. These criteria allow for the detection of subtle variations in the tibiofibular relationships indicating instability and provide a tool for postoperatively assessing the reduction of the injured syndesmosis.

Despite recent advances in treatment of severe injured patients, e.g. due to damage control orthopaedics, multi organ dysfunction syndrome (MODS) and sepsis are major complications in daily practice.During one year 94 patients were prospectively collected. Inclusion criteria: ISS 16, age 18-60 y, primary admission to our level-1 trauma center, survival > 48 hours after trauma. The development of MODS and sepsis were observed and different groups were formed (+/−).Demographic data revealed no significant differences between the subgroups. Comparing groups +MODS and −MODS significant differences on admission day were observed, when PCT showed first on day 2 after trauma differences. Regarding the development of sepsis PCT was advantageous to IL-6 showing significant higher plasma levels in group +sepsis from the first day after trauma.Serum levels of IL-6 and PCT could be useful in early identification of high risk patients to develop posttraumatic MODS. For sepsis PCT is the better prognostic factor.

Objectives: The preferred method of fixation for posterior malleolus fractures remains controversial, and practices vary widely among surgeons. The purpose of this study was to compare anterior-to-posterior (AP) lag screws with posterior buttress plating for fixation of posterior malleolus fractures in a human cadaveric model. Methods: Posterior malleolus fractures involving 30% of the distal tibial articular surface were created in 7 pairs of fresh frozen cadaveric ankles. One specimen in each pair was randomly assigned to fixation with either 2 AP lag screws or a one-third tubular buttress plate without supplemental lag screws. Each specimen was then subjected to cyclic loading from 0% to 50% of body weight for 5000 cycles followed by loading to failure. Outcome measures included permanent axial displacement during each test cycle (axial displacement at no load), peak axial displacement during each test cycle (axial displacement at 50% body weight), load at 1-mm axial displacement, ultimate load, and axial displacement at ultimate load. Results: The buttress plate group showed significantly less peak axial displacement at all time points during cyclic loading. Permanent axial displacement was significantly less in the buttress plate group beginning at cycle 200. There were no significant differences between the 2 groups during load-to-failure testing. Conclusion: Posterior malleolus fractures treated with posterior buttress plating showed significantly less displacement during cyclical loading compared with fractures fixed with AP lag screws. Surgeons should consider these findings when selecting a fixation strategy for these common fractures. Further research is warranted to investigate the clinical implications of these biomechanical findings.

Navigated intraoperative measurements of Whiteside's line showed a high inter- and intraobserver reliability. Considering the variability between Whiteside's line and the transepicondylar axis, intraoperative assessment of both the methods is recommended.

Some tibial shaft fractures cannot be accurately reduced using closed or percutaneous techniques during an intramedullary nailing procedure. Under these circumstances, a formal open reduction can be performed. Direct exposure of the fracture facilitates accurate reduction but does violate the soft tissue envelope. The purpose of this study was to evaluate the safety and efficacy of open reduction prior to intramedullary nailing. Using the trauma database at a Level I trauma center, 11 uncomplicated closed displaced tibia fractures treated with formal open reduction prior to intramedullary nailing were identified and matched with a cohort of 21 fractures treated with closed reduction and nailing. The authors attempted to match 2 controls to each patient to improve the power of the study. Clinical and radiographic outcomes were compared. All fractures ultimately healed within 5° of anatomic alignment. No infections or non-unions occurred in the open reduction group, and 1 deep infection and 1 nonunion occurred in the closed reduction group. No significant differences existed between the study groups. Although closed reduction and intramedullary nailing remains the treatment of choice for most significantly displaced tibial shaft fractures, open reduction with respectful handling of the soft tissue envelope can be safe and effective and should be considered when less invasive techniques are unsuccessful.