Many investigators have attempted to find the cause of the osteoarthritic changes after meniscectomy. Alteration of the mechanical factors resulting in stress concentration, is now thought to be one of the most important causes but few experimental studies have reported the differences in contact area and pressure distribution after partial or total meniscectomy. By using pressure sensitive film, we have calculated the contact area and the pattern of weight distribution in three different situations; intact meniscus, partial and total meniscectomy. The experimental materials were obtained from 5 above knee amputation specimens. The knee joint was fixed in full extension to an Instron machine using an aluminium box and mounting resin. Load was transmitted to the tibiofemoral joint containing the special film, within a physiological range. Analysis of the contact area for each situation (intact meniscus, partial and total meniscectomy) was made by reviewing the film. By measuring the contact area after meniscectomy, we showed that the meniscus performs a load transmitting function in the knee joint. The medial contact area of the tibiofemoral joint with an intact meniscus is always larger than the lateral compartment (1.36:1), but in partial and total meniscectomy the difference between them gradually decreased. There was a minor decrease in contact area after partial meniscectomy and a much greater decrease after total meniscectomy. The degree of stress concentration in the contact area was increased when part or all the meniscus was excised. There was little change of contact area in the opposite, intact side of the joint after partial meniscectomy, but marked change after total meniscectomy.

Twenty-one patients with fractures of the distal tibial metaphysis, some with minimal displacement in the ankle, were treated by percutaneous plate osteosynthesis with a narrow limited contact-dynamic compression plate. Using the classification by the Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association, 17 fractures had no articular involvement, whereas four included intraarticular extension. At final followup (mean, 20 months), all the fractures healed without second procedures and the mean union time was 15.2 weeks. One patient had malalignment of the limb with 10؇ internal rotation, but there were no angular deformities greater than 5؇ or any shortening greater than 1 cm. All patients had excellent or satisfactory ankle function. There were no infections or any soft tissue compromise. Percutaneous plate osteosynthesis is a safe and worthwhile method of managing such fractures, which avoids some of the complications associated with conventional open plating methods.Conservative treatment of fractures of the distal tibia with extension into the ankle results in an unacceptable deformity and ankle stiffness. Conventional open reduction and plate fixation often requires extensive exposure and can result in the devitalization of surrounding tissue, infection, wound breakdown, and ankle stiffness. 20 These results have motivated orthopaedic surgeons to do biologic surgical techniques to reduce damage to soft tissues and the vascular supply to bone. 2 Intramedullary nailing, a main treatment of tibia diaphyseal fractures, sometimes fails to stabilize fractures in the distal metaphysis because of malreduction.Because of problems with other operative techniques, osteosynthesis with a percutaneous plate in which the fracture site is minimally exposed was investigated to better define its advantages and disadvantages as a treatment method for distal tibia metaphyseal fractures. MATERIAL AND METHODS PatientsThis retrospective study included 21 patients who sustained fractures of the distal tibia metaphysis.

Vascularized fibular grafting was associated with better clinical results and was more effective than nonvascularized fibular grafting for the prevention of collapse of the femoral head in a matched population with a Steinberg Stage-IIC or larger osteonecrotic lesion. The results of vascularized grafting were best when the procedure was used to treat precollapse lesions (Steinberg Stage IIC).

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