Tibial plateau fractures: Fracture patterns and computed tomography evaluation of tibial plateau fractures in winter sports.

The purpose was to analyze tibial plateau fractures (TPF) by computed tomography (CT) by creating a frequency map (FM). We hypothesized that a FM shows clinically important aspects of involvement that are not expressed in classic classifications. 185 TPF were retrospectively evaluated in this single center study. We created a FM onto an axial template of an intact subarticular tibial plateau and separated the joint surface in 9 areas, counted the frequency of involvement. The FM gives information of location and grade of damage and expressed three major fracture areas in 76%. 5 specific fracture types add up to 51%. The dorsal parts of the tibial plateau are involved in a higher percentage (+8%). True lateral fractures are less often than plane radiographs suggest. An impression was found in 50%. The complexity of TPFs is high, but 5 specific types could be identified in >50%. The complexity is not sufficiently covered in common classifications, especially the dorsal involvement. The FM is a simple and useful tool that complements common classifications and can be used as guideline for surgical treatment.

[An outcome-oriented quality management strategy for the inpatient rehabilitation of orthopedic patients--towards an empirically based "best practice"]. / Outcome-orientiertes Qualitätsmanagement in der orthopädischen Rehabilitation--Auf dem Weg zu einer empirisch begründeten "best practice".

This paper presents the development and testing of an outcome-oriented quality management system for the inpatient rehabilitation of orthopaedic patients, with a special focus on the indication of knee-replacement. On the level of outcomes we describe the development of appropriate indication-specific outcome indicators, capable of being used to rank the performance of hospitals. With regard to the process-quality of the empirical analysis of the rehabilitative-therapeutic services possibilities and limitations are shown. Furthermore an inkling of the shape that an expert-consent-based base of evidence for identifying best practice--arrived at by using primary empirical findings--might assume is presented. The procedure for establishing the latter offers a methodical approach toward continuous quality development of orthopaedic inpatient rehabilitation, one that is characterised by guidelines and performance transparency. Development potentials are recognised in the formal and the content quality of the therapeutic services.