Outcome of distal tibial physeal injuries.

In a retrospective review of 725 children's tibial fractures between 1990 and 2004, we found paediatric tibial fractures to have a bimodal distribution according to age, peaking at the age 14 years with incidence of 17.1 in 1000 in boys and 5.1 in 1000 in girls. Two hundred and twenty-five (31.0%) cases involved the distal tibial physis, associated with Salter-Harris (SH) I (0.4%), SH II (56.9%), SH III (21.7%) and SH IV (20%) injury patterns. Of these fractures, 77% had initial displacement of more than 2 mm and independent of treatment modality, 20% of cases still had residual displacement of more than 2 mm after reduction. There was significantly less residual displacement in patients who had a computed tomography scan before the intervention versus those who did not (0.3 vs. 1.4 mm, P=0.003). Twelve cases (11.2%) of premature physeal closure were identified after SH II (67%), SH III (17%) and SH IV (17%) fractures. No significant link was found between premature physeal closure and displacement (either initial or residual), mechanism of injury, or treatment modality. In those fractures with an intact fibula, we found significantly less initial displacement (4.7 vs. 7.4 mm, P<0.05) and significantly shorter time to union (6.27 vs. 7.55 weeks, P=0.001). Good anatomical reduction with or without open reduction and internal fixation is one of the important factors in reducing complication rates, and we suggest but cannot statistically prove that open reduction and internal fixation is indicated in fractures with a residual displacement of 2 mm or more. The presence of an intact fibula at the time of tibial fracture has a significant positive influence on fracture outcome. Level III: Retrospective Review.

Experimental evaluation of the effect of raised pressure in a single compartment in the lower leg on neighbouring compartments using fresh above knee amputated legs-a study of interstitial pressures with two case reports.

STUDY DESIGN: Experimental evaluation of intracompartmental pressures in a fresh above knee amputated human leg. OBJECTIVES: To determine what effect raised pressure in one compartment of the lower leg had upon its neighbour. SUMMARY OF BACKGROUND DATA: There has been no previous reports of isolated compartment pathology, following low velocity trauma, causing a compartment syndrome in all four compartments of the lower leg. METHODS: Immediately after leg amputation, the intracompartmental pressure in the deep posterior compartment was artificially raised to 100 mmHg with infused 0.9% sodium chloride solution. The resultant pressure changes in remaining compartments were recorded over 30 min. RESULTS: Five legs were evaluated. After 30 min, the mean maximum intracompartmental pressure increase found in the superficial posterior, anterior and peroneal compartments was 78.4 mmHg (range 65-94 mmHg), 25.2 mmHg (range 14-31 mmHg) and 24.8 mmHg (range 15-31 mmHg), respectively. CONCLUSIONS: This experimental data and case reports show that a compartment in which there is raised pressure may exert external pressure on a neighbouring compartment that can result in physiological changes to induce a compartment syndrome within that neighbour. The importance of assessing all compartments within a limb segment, even when associated with low velocity trauma, remains paramount.

Measurement of fracture kyphosis with the Oxford Cobbometer: intra- and interobserver reliabilities and comparison with other techniques.

STUDY DESIGN: Statistical analysis of 3 techniques for measuring thoracolumbar kyphosis secondary to fracture. OBJECTIVES: To determine the reliability of using an Oxford Cobbometer and assess the most reliable measurement technique. SUMMARY OF BACKGROUND DATA: The reproducibility of Cobb angles for the assessment of saggital plane deformity on spine radiographs has been shown to have significant variability in both intra- and interobserver error. METHODS: Twenty-four lateral spine radiographs of patients with thoracic and lumbar vertebral fractures were measured on 2 separate occasions, in random order, by 4 blinded observers using the same Oxford Cobbometer and ruler. RESULTS: Method 2, the angle from the inferior endplate of the vertebra above the fractured vertebra to the superior endplate of the vertebra below the fractured vertebra, had the greatest intraobserver and interobserver reliabilities (rho = 0.856-0.976 and rho = 0.95, respectively). The other 2 methods had lower reliabilities; however, all 3 methods were well above the statistically acceptable threshold of >0.8, and the intraobserver reliabilities with each observer was 99% overall. These reliabilities supersede results reported previously using the conventional Cobb technique. The absolute mean difference between readings and 95% limit of agreement also improves on previous data, 2 degrees and +/- 5.8 degrees , respectively. CONCLUSIONS: Highest intraclass correlation coefficients were obtained using method 2. Using the Oxford Cobbometer to measure fracture kyphosis has higher reliability than the standard Cobb angle technique. It is easy and quick to use in a clinical setting.