Distal femoral rotational alignment in the Indian population - An important consideration in total knee arthroplasty.

OBJECTIVE: To measure the angular relationships of distal femoral rotational axes in the normal Indian population. MATERIALS AND METHODS: Magnetic Resonance Imaging (MRI) scans of the knee of 40 Indian subjects were used to define the posterior condylar axis, the transepicondylar axis and the Whiteside's line (anteroposterior axis). The posterior condylar angle (PCA) - the angle between the posterior condylar axis and the transepicondylar axis, and the Whiteside-epicondylar angle (W-EP angle) were then calculated. RESULTS: The mean posterior condylar angle in the Indian knee was 4.67° and the mean Whiteside-epicondylar angle was 92.7°. CONCLUSION: There are differences in the distal femoral rotational axes among various races. The mean PCA and the W-EP angle are more externally rotated in the Indian than in the Western, population, but similar to the Chinese. Using fixed values to define the angular relationships between the axes could lead to malrotation of the femoral component. An understanding of the racial differences is essential while designing implants for the Indian population.

Outcome of Schatzker type V and VI tibial plateau fractures.

BACKGROUND: Schatzker type V and VI tibial fractures are complex injuries, usually treated with open reduction and internal fixation (ORIF) using dual plates or ring fixators. ORIF has the advantage of not requiring pin tract care, but has a higher infection rate, especially in open fractures. We have combined the advantages of these two methods to treat these difficult fractures. MATERIALS AND METHODS: Ten Schatzker type V and 11 Schatzker type VI fractures were treated between 2006 and 2010. ORIF with dual plates was performed, only if there was marked articular displacement (> 2 mm) in a closed fracture. All other fractures including open fractures and closed fractures with soft tissue compromise or minimal articular displacement were treated with ring fixators. The outcomes were analyzed and documented using the Honkonen and Jarvinen subjective, clinical, functional, and radiological criteria and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). RESULTS: Nine closed fractures with marked articular displacement (> 2 mm) were treated with dual plates. Eight closed fractures with minimal articular displacement (< 2 mm) and poor skin condition and four open fractures were treated with ring fixators. The mean follow-up period was 2 ½ years. The mean postoperative knee flexion was 128°. All patients could walk, jump, and climb steps. 90% could squat, though only 50% could duck walk properly. Radiologically, 85% had a plateau tilt of less than 5°, 92% had an articular step of less than 2 mm, and a residual articular widening of less than 5 mm. There were no major infections. Two patients had minor pin tract infections and two requested that their plates be removed subsequently. CONCLUSION: The protocol used to treat Schatzker type V and VI tibial plateau fractures has had excellent results and we suggest that all open fractures be treated with ring fixators and that ORIF should be done only for closed fractures with marked displacement.