Classification systems for tibial plateau fractures suffer from poor interobserver agreement, and their value in preoperative assessment to guide surgical fixation strategies is limited. For tibial plateau fractures four major characteristics are identified: lateral split fragment, posteromedial fragment, anterior tubercle fragment, and central zone of comminution. These fracture characteristics support preoperative assessment of fractures and guide surgical decision-making as each specific component requires a respective fixation strategy. We aimed to evaluate the additional value of 3D-printed models for the identification of tibial plateau fracture characteristics in terms of the interobserver agreement on different fracture characteristics.

Preoperative images of 40 patients were randomly selected. Nine trauma surgeons, eight senior and eight junior registrars indicated the presence or absence of four fracture characteristics with and without 3D-printed models. The Fleiss kappa was used to determine interobserver agreement for fracture classification and for interpretation, the Landis and Koch criteria were used.

3D-printed models lead to a categorical improvement in interobserver agreement for three of four fracture characteristics: lateral split (Kconv = 0.445 versus K3Dprint = 0.620; P < 0.001), anterior tubercle fragment (Kconv = 0.288 versus K3Dprint = 0.449; P < 0.001) and zone of comminution (Kconv = 0.535 versus K3Dprint = 0.652; P < 0.001).

The overall interobserver agreement improved for three of four fracture characteristics after the addition of 3D printed models. For two fracture characteristics, lateral split and zone of comminution, a substantial interobserver agreement was achieved.

Fracture characteristics seem to be a more reliable way to assess tibial plateau fractures and one should consider including these in the preoperative assessment of tibial plateau fractures compared to the commonly used classification systems.

Introduction & aims

Different racial groups show variations in femoral morphometry. Femoral anteroposterior measurement and mediolateral measurement are key variables in designing femoral implant for TKR. Their aspect ratio determines the shape and mediolateral sizing for the proper patellofemoral tracking and uniform stress distribution over the resected distal femoral surface.

Hip fracture is a common cause of hospital admission and is often followed by reduced quality of life, or by death. International experiences indicate there are many benefits to be gained from national hip fracture registries. This pilot project aims to implement a hip fracture registry at three sites, a large metropolitan public hospital (Flinders Medical Centre), a large metropolitan private hospital (Epworth HealthCare) and a rural regional hospital (Goulburn Valley Health) to assess the feasibility of establishing a national registry.

Patients undergoing surgery for a hip fracture will be recruited from the three participating hospitals between March and September 2009. A minimum data set will be collected at discharge, from hospital records. Items include patient demographics, fracture descriptors, length of stay, residential status, mobility, health status, surgical details and discharge destination. A phone interview at four months after surgery will measure outcomes by using the Extended Glasgow Outcomes Scale and documenting residential status, mobility, hip pain and readmissions. Re- operations, if any, will be collected. The availability of data from State Health Departments for validation of hospital case data will be reported.

The pilot study is in progress at the time of writing. Ethical approval has been obtained, data collection, transmission and storage systems have been developed and deployed, and case data collection is underway. Case data will be summarised to describe hip fracture at the participating hospitals. Analysis will review the data elements in the pilot data set and assess their priority for inclusion in a national register—taking account of the quality of the data obtained and the time and other resources required for their collection. We will also evaluate the four-month review process. Any potential obstacles to a national registry that are identified during the pilot will be described and ways to overcome them will be proposed.

A national hip fracture registry will improve the quality of care and safety of patients following hip fracture by developing an efficient mechanism to compare and improve the effectiveness of acute health care delivery by all hospitals involved in the management of hip fractures.

The management of distal radius fractures has evolved with the availability of locking plates to control the fracture fragments from the volar surface. This study compares volar locking plates (VLP) with any other available treatment including K-wires, screws, non-locking plates, external fixateurs or any combination of these.

Patients with distal radius fractures requiring surgical intervention were invited to participate and were randomised to the VLP group or the other surgical treatment group. Outcome was assessed on radiology(radial length, angle, inclination and articular step), function (range of motion and grip strength) and the Disability of Arm Shoulder and Hand (DASH) score. The final assessment was at one year. Complications were recorded. The target was one hundred and sixty patients. Comparisons of sub groups based on fracture classification are made, including intra-articular and extra-articular fractures.

By August 2008, one hundred patients will have completed their one year follow up assessment. Initial results show no significant difference between the groups.

New fixation techniques for common fractures require objective assessment under normal conditions of use. This prospective study compares locked plate fixation with techniques available before its introduction. It aims to examine a range of fracture severities to determine which fracture types are appropriate for this fixation technique.