腓骨钩状钢板在腓骨远端不稳定骨折中的应用

目的 探讨应用腓骨钩状钢板治疗腓骨远端不稳定骨折的经验及临床疗效.方法 2006年1月至2009年1月,对28例伴有腓骨远端粉碎性骨折的踝部骨折行切开复位内固定术,其中19例得到完整随访,男12例,女7例;年龄18～72岁,平均36岁;单纯外踝骨折4例,双踝骨折9例,三踝骨折6例.按Danis-Weber分类,A型8例,B型11例,均为腓骨远端不稳定粉碎性骨折.受伤至接受手术的时间为6h至16d,平均6d.手术顺序为外踝、后踝和内踝.外踝骨折使用腓骨钩状钢板固定,内踝骨折使用松质骨螺钉,后踝骨折根据骨折块大小及形态采用螺钉或钢板固定.结果 术后随访6～32个月,平均18.8个月.术后4～6周X线片均可见骨折线模糊;10例患者于术后12周达到临床愈合,9例于术后20周达到临床愈合.伤口均一期愈合,无一例发生感染、局部不良反应及踝关节不稳.Mazur评分为67～92分,平均86.3分,其中优12例,良4例,可2例,差1例,优良率为84.2%.结论 运用腓骨钩状钢板固定外踝骨折能更好恢复外踝正常外翻角及长度等解剖结构,并有效固定,为早期活动提供稳定性,利于踝关节功能恢复.     

跟骨结节撕脱骨折的手术治疗

 目的 探讨跟骨结节撕脱骨折的治疗方法及疗效。方法 回顾性分析2008年1月至2011年6月治疗15例跟骨结节撕脱骨折患者资料,男9例,女6例;年龄31～68岁,平均51.4岁;均为单侧急性损伤,左足7例,右足8例。根据Beavis分型：Ⅰ型3例,均采用切开复位螺钉固定;Ⅱ型12例,其中10例采用切开复位螺钉固定,2例骨折块较大累及部分距下关节面者采用钢板加螺钉固定。采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分系统评价术后疗效。结果 10例患者获得随访,随访时间12～36个月,平均20个月。骨折愈合时间为8～25周,平均13周。术后AOFAS踝与后足评分为47～100分,平均91.1分;优7例,良2例,差1例,优良率为90%(9/10)。1例术后8周出现皮肤软组织坏死、钢板外露患者,行保留钢板的清创加腓动脉穿支皮瓣移植术后3周切口愈合;1例术后7周复位丢失患者,再次行切开复位螺钉内固定,于初次术后25周骨折愈合。结论 对骨折块移位明显,软组织严重激惹者,应急诊行切开复位内固定手术,防止皮瓣坏死;对骨折块较小者,应采用切开复位大直径螺钉固定;对骨折块较大者,尤其当骨折线延伸至部分距下关节面时,应采用钢板加螺钉固定。     

腓骨钩状钢板在腓骨远端不稳定骨折中的应用

目的 探讨应用腓骨钩状钢板治疗腓骨远端不稳定骨折的经验及临床疗效.方法 2006年1月至2009年1月,对28例伴有腓骨远端粉碎性骨折的踝部骨折行切开复位内固定术,其中19例得到完整随访,男12例,女7例;年龄18～72岁,平均36岁;单纯外踝骨折4例,双踝骨折9例,三踝骨折6例.按Danis-Weber分类,A型8例,B型11例,均为腓骨远端不稳定粉碎性骨折.受伤至接受手术的时间为6h至16d,平均6d.手术顺序为外踝、后踝和内踝.外踝骨折使用腓骨钩状钢板固定,内踝骨折使用松质骨螺钉,后踝骨折根据骨折块大小及形态采用螺钉或钢板固定.结果 术后随访6～32个月,平均18.8个月.术后4～6周X线片均可见骨折线模糊;10例患者于术后12周达到临床愈合,9例于术后20周达到临床愈合.伤口均一期愈合,无一例发生感染、局部不良反应及踝关节不稳.Mazur评分为67～92分,平均86.3分,其中优12例,良4例,可2例,差1例,优良率为84.2%.结论 运用腓骨钩状钢板固定外踝骨折能更好恢复外踝正常外翻角及长度等解剖结构,并有效固定,为早期活动提供稳定性,利于踝关节功能恢复.     

腓骨钩状钢板在腓骨远端不稳定骨折中的应用

目的 探讨应用腓骨钩状钢板治疗腓骨远端不稳定骨折的经验及临床疗效.方法 2006年1月至2009年1月,对28例伴有腓骨远端粉碎性骨折的踝部骨折行切开复位内固定术,其中19例得到完整随访,男12例,女7例;年龄18～72岁,平均36岁;单纯外踝骨折4例,双踝骨折9例,三踝骨折6例.按Danis-Weber分类,A型8例,B型11例,均为腓骨远端不稳定粉碎性骨折.受伤至接受手术的时间为6h至16d,平均6d.手术顺序为外踝、后踝和内踝.外踝骨折使用腓骨钩状钢板固定,内踝骨折使用松质骨螺钉,后踝骨折根据骨折块大小及形态采用螺钉或钢板固定.结果 术后随访6～32个月,平均18.8个月.术后4～6周X线片均可见骨折线模糊;10例患者于术后12周达到临床愈合,9例于术后20周达到临床愈合.伤口均一期愈合,无一例发生感染、局部不良反应及踝关节不稳.Mazur评分为67～92分,平均86.3分,其中优12例,良4例,可2例,差1例,优良率为84.2%.结论 运用腓骨钩状钢板固定外踝骨折能更好恢复外踝正常外翻角及长度等解剖结构,并有效固定,为早期活动提供稳定性,利于踝关节功能恢复.     

循原骨折线截骨矫正跟骨骨折畸形愈合

目的 探讨循原骨折线截骨矫正跟骨骨折畸形愈合方法的可行性.方法 2004年8月至2007年5月,跟骨骨折畸形愈合患者25例28足,男23例26足,女2例2足;年龄22～56岁,平均31岁;受伤至手术时间1.5～12个月,平均4.6个月.采用循原骨折线截骨术进行治疗.按照Zwipp和Rammelt跟骨骨折畸形愈合的分类方法进行分类,其中Ⅲ型11例12足,Ⅳ型14例16足.术前均摄双足跟骨侧位、轴位X线片及行CT检查,12例患者(14足)行三维CT重建.根据Sander及Essex-Lopresti分类,参考原始X线片对不同骨折类型制定截骨线,重现原始骨折.根据CT轴位载距突及外侧骨块所带关节面的宽度和轴位骨折线的斜度从前外上到后内下斜行截骨,恢复跟骨的高度,将后关节骨折块向后上撬起,使塌陷的后关节面骨块复位.骨缺损处,用劈下的跟骨外侧壁填塞植骨,或取自体髂骨植骨,最后用钢板螺钉固定.结果 24例26足获得随访,随访时间10～16个月,平均12个月.骨折愈合时间10～14周,平均12周.2例发生伤口感染,经抗生素治疗后10周取出钢板伤口愈合.无一例发生钢板螺钉断裂和骨折再移位.按照Maryland足部评分标准,优10足,良12足,可4足,优良率84%.结论 循原骨折线截骨重现原始骨折,可恢复跟骨的骨性结构,能更好地矫正跟骨各方位畸形,同时保留距下关节,减少了手术对足踝功能的影响,近期疗效满意.     

Custom AO small T plate for transcondylar fractures of the distal humerus in the elderly

The purpose of this study was to present a new internal fixation technique for transcondylar fractures of the humerus in elderly patients. Seventeen patients, aged older than 70 years, with displaced transcondylar fractures were treated by our new surgical method. All fractures were fixed by a customized AO small T plate and a transcondylar screw passed from the lateral epicondyle to the medial wall of the trochlea across the humeral condyle. The plate was hand-shaped, trimmed, and applied at the lateral side of the fracture site, and either a cannulated cancellous screw or an AO one-third tubular plate was applied at the medial side of the fracture site. All patients in this study had osteoporotic bone and a small distal fragment. They were followed up for a mean of 30 months (range, 24 to 60 months). Radiographically, union was achieved completely in all patients, and all except 1 had maintained the postoperative alignment. Bone graft or cement fixation was not required in any case. The assessment of the results by use of the modified Cassebaum's rating scale was excellent in 3 cases, good in 11, and fair in 3. With the custom AO small T plate and transcondylar screw fixation technique, the screw that passes through the humeral condyle provides good stability even in cases with a small osteoporotic fragment of the distal humerus. The screw does not damage the articular surface of the elbow joint, and stable fixation can be obtained even in osteoporotic bone.     

Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture-dislocations

PURPOSE: Surgical intervention may be necessary to treat unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint of the hand. One method of stabilization is open reduction and internal fixation (ORIF). The purpose of this study was to assess the outcomes of ORIF for unstable dorsal fracture-dislocations of the PIP joint using mini-screws via a volar approach. METHODS: A retrospective chart review with clinical follow-up evaluation was performed on 9 patients who had ORIF for unstable dorsal fracture-dislocations of the PIP joint. The fracture fragment(s) from the middle phalangeal base were reduced and secured using mini-screws. RESULTS: A clinical evaluation was performed at an average of 42 months after surgery. The average arc of motion for the involved PIP joint was 70 degrees (range, 55 degrees -90 degrees ). The average PIP joint motion in the 2 patients with 1 fracture fragment was 85 degrees , and the average PIP joint motion for the remaining 7 patients was 65 degrees . One joint was subluxated with an intra-articular screw. Nine patients had an average flexion contracture of 14 degrees . Seven patients had no pain, and 2 had pain only with heavy activity. CONCLUSIONS: Open reduction and internal fixation of unstable dorsal PIP joint fracture-dislocations using mini-screws can be considered if the fracture fragment(s) can accommodate the screws. The procedure attempts to restore the concave contour of the middle phalangeal base and permits early protected range of motion. The procedure should be approached cautiously, especially in the presence of comminution. Proximal interphalangeal joint range of motion is usually compromised; 8 of our 9 joints had a residual flexion contracture. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.     

Pediatric medial epicondyle fractures with intra-articular elbow incarceration

BackgroundIntra-articular incarceration of the epicondylar fragment occurs in 5–18 % of all cases of medial epicondyle fracture. It requires stable fixation to allow early motion, since elbow stiffness is the most common complication following medial epicondyle fracture. In this retrospective study, we report the clinical and functional outcomes and the complications that occurred following open reduction and screw fixation of medial epicondyle fractures with intra-articular fragment incarceration.MethodsThirteen children who had a fracture of the medial epicondyle with incarceration of the fragment in the elbow joint (type III) were surgically treated in our university hospital between 1998 and 2012. There were eight male and five female patients. The mean age at the time of injury was 13 years (range 9–16). Operative treatment consisted of open reduction and internal fixation with one or two 4.0-mm cannulated screws under fluoroscopic control.ResultsAll of the patients were clinically reviewed at an average follow-up of 29 months. The overall range of motion limitation was about 5° for flexion–extension and 2° for pronation–supination. The score was excellent in all patients (mean 96.3). Complications occurred in four (31 %) children: two cases of symptomatic screw head prominence, irritation with partial lesion of the distal triceps myotendinous junction in one patient, and median nerve entrapment syndrome in one patient.ConclusionsIn conclusion, open reduction and screw fixation yielded excellent clinical and functional outcomes for the treatment of medial epicondyle fractures with intra-articular fragment incarceration. However, particular attention is should be paid when treating these potentially serious injuries in order to minimize the risk of possible complications.

Level of evidence

Therapeutic IV.     

有无骨片的工型锤状指手术后疗效的比较分析

目的 探讨有骨片和无骨片的Ⅰ型锤状指手术疗效的差异.方法 2005年至2010年,收治46例Ⅰ型锤状指患者,其中A组22例,为伸肌腱止点处有撕脱骨折,术中采用克氏针固定远指间关节和撕脱骨片;B组24例,为单纯伸肌腱止点处断裂,不伴撕脱骨折,术中采用克氏针固定远指间关节,根据肌腱断裂情况选择缝合方法.两组均在术后5～7周拔除克氏针.结果 术后两组随访时间为5～38个月,平均16个月.依据Patel标准评价结果:A组优7例,良5例,中3例,差7例;B组优7例,良3例,中10例,差4例.A组中功能评分为差的比例占31.8％,多于B组差的比例16.7％,但B组中功能仅恢复到中的患者占41.7％.两组优良率的差异无统计学意义(P＞0.05).结论 有远节指骨基底部撕脱骨片的锤状指功能差的患者是无撕脱骨片患者的近2倍,无骨片的锤状指功能为中的比例较大(41.7％),但两组疗效基本相同.     

难复位性股骨颈骨折的概念提出与治疗

目的 提出难复位性股骨颈骨折的概念,并探讨其分型与治疗方法.方法 对2006年1月至2008年12月收治的519例移位型股骨颈骨折患者进行前瞻性研究,男241例,女278例;年龄21 ～ 66岁,平均54.9岁;左侧295例,右侧224例.所有患者首先尝试牵引闭合复位,若经3次整复骨折不能达到理想复位效果,则认为属于难复位性股骨颈骨折,改用股骨头干三维互动复位技术复位,并采用3枚空心钉固定.分析难复位性股骨颈骨折的特点并对其进行分型,评价股骨头干三维互动复位技术的临床疗效.结果 共有31例(6.0％)难复位性股骨颈骨折,男20例,女11例;年龄21 ～58岁,平均39.6岁;均为GardenⅣ型骨折.均采用股骨头干三维互动复位技术复位成功,28例骨折复位质量达Garden指数Ⅰ级,3例达Garden指数Ⅱ级.根据X线片及CT影像学特点,难复位性股骨颈骨折可分为3型:Ⅰ型5例(16.1％):骨折线为斜形,近端骨折片呈“鹰嘴”状嵌插入骨折远端;Ⅱ型17例(54.8％):骨折线不规则,骨折远端外旋并嵌插入近端;Ⅲ型9例(29.0％):骨折端完全移位,股骨头和股骨干之间有分离,股骨头成漂浮状态,旋转移位较大.29例患者术后获2～4年(平均3.3年)随访,骨折均获骨性愈合,愈合时间为16～24周(平均20.1周).3例发生股骨头坏死,其中Ⅱ型l例,Ⅲ型2例.结论 难复位性股骨颈骨折可分为3型,采用股骨头干三维互动复位技术复位、3枚空心钉固定可获得较好的临床疗效.     

国产聚-DL-乳酸可吸收螺钉治疗松质骨骨折

目的探讨国产聚-DL-L乳酸(PDLLA)可吸收螺钉治疗松质骨骨折的效果及安全性，方法用PDLLA可吸收螺钉治疗松质骨骨折24例．随访观察术后骨折愈合、关节功能恢复情况和影像学表现。结果14例伤口均Ⅰ期愈合．全部病例随访6～25个月．平均12．3个月。6个月时X线片显示骨折线均已消失．获得骨性愈合；涉及关节面的骨折，术后关节功能均基本恢复正常。结论PDLLA可吸收螺钉是治疗松质骨骨折尤其是关节内骨折的理想内固定物。     

钢板与空心钉治疗Haraguchi Ⅰ型后踝骨折的疗效比较

目的：比较钢板与空心钉治疗HaraguchiⅠ型后踝骨折的疗效,为临床治疗提供参考依据。方法回顾性分析2012年6月至2014年10月于我院采用切开复位内固定（钢板或空心钉）治疗HaraguchiⅠ型后踝骨折40例患者的资料,使用钢板内固定的24例患者纳入钢板组,使用空心钉固定的16例患者纳入空心钉组,比较两组患者的骨折愈合时间及其术后3、12、18个月的美国足踝外科医师协会（AOFAS）踝与后足功能评分。结果34例患者获得随访（钢板组20例,空心钉组14例）。钢板组与空心钉组的平均骨折愈合时间分别为（9.4±2.5）个月和（12.5±2.9）个月,差异有统计学意义（t=-3.604,P=0.001）。术后3个月,空心钉组有2例患者出现后踝骨折块移位。术后3个月时,钢板组的AOFAS评分为（70.6±7.1）分,低于空心钉组的（76.9±6.2）分,差异有统计学意义（t=-2.888,P=0.036）;术后12、18个月时,钢板组的AOFAS评分分别为（85.1±8.5）分、（93.7±9.8）分,均优于空心钉组的（79.5±6.9）分、（83.5±7.3）分,差异均有统计学意义（t=2.194,P=0.044;t=3.552,P=0.001）。结论采用钢板内固定治疗合并后踝骨折的踝关节损伤,较空心钉内固定具有固定牢靠、后期功能恢复较好等优点,值得推广。     

空心螺钉内固定治疗青壮年股骨颈骨折

目的评价空心螺钉内固定治疗青壮年股骨颈骨折的临床疗效。方法2001年1月～2005年12月，采用空心螺钉内固定治疗股骨颈骨折42例。其中男22例，女20例；年龄19～59岁，平均41岁。车祸伤21例，高处坠落伤14例，重物砸伤7例。无移位骨折15例，移位骨折27例。均为新鲜骨折。按照Garden分型：Ⅱ型15例，Ⅲ型16例，Ⅳ型11例。损伤至手术时间7h～15d，平均4．6d。结果42例患者均获随访1～6年，平均2．5年。骨折均愈合，平均愈合时间6．5个月。螺钉无松动及折断。术后2年3例出现股骨头缺血坏死迹象，1例出现股骨头塌陷，建议扶拐不负重活动，观察病情。髋关节功能按Brumbaek评价标准，优18例，良20例，差4例，优良率90．4％。结论空心螺钉内固定是治疗青壮年股骨颈骨折的一种有效方法，能提高骨折愈合率，降低股骨头坏死发生率。     

Scaphoid nonunions: a 3-dimensional analysis of patterns of deformity

We tested the hypothesis that the fracture location of scaphoid nonunions relates to the fracture displacement, development of dorsal intercalated segment instability (DISI) deformity, and changes in the contact area of the bones in the radiocarpal joint. Eleven patients with scaphoid nonunions were examined with 3-dimensional computed tomography and a new method of proximity mapping. Two different patterns of displacement of scaphoid nonunions were demonstrated, 1 volar and 1 dorsal. All patients with a volar pattern scaphoid nonunion had a DISI deformity. Only a few of the patients with a dorsal pattern scaphoid nonunion, mostly in longstanding nonunions, had a DISI deformity. The fracture line was generally distal to the dorsal apex of the ridge of the scaphoid in the volar-type fractures and proximal in the dorsal displaced fractures. The proximity map of the distal fragment of the scaphoid on the radius in the volar type shifts radial compared with normal; in the distal type it shifts dorsal. Neither of the patterns showed any significant changes of the proximity map in the radiocarpal joint at the proximal scaphoid fragment and the lunate. Whether the fracture line passes distal or proximal to the dorsal apex of the ridge of the scaphoid appears to determine the likelihood of subsequent fracture displacement, DISI deformity, and contact area of the bones in the radiocarpal joint.     

Comparing Different Surgical Techniques for Addressing the Posterior Malleolus in Supination External Rotation Ankle Fractures and the Need for Syndesmotic Screw Fixation

Trimalleolar ankle fractures are unstable injuries with possible syndesmotic disruption. Recent data have described inherent morbidity associated with screw fixation of the syndesmosis, including the potential for malreduction, hardware irritation, and post-traumatic arthritis. The posterior malleolus is an important soft tissue attachment for the posterior inferior syndesmosis ligament. We hypothesized that fixation of a sizable posterior malleolar (PM) fracture in supination external rotation type IV (SER IV) ankle fractures would act to stabilize the syndesmosis and minimize or eliminate the need for trans-syndesmotic fixation. A retrospective review of trimalleolar ankle fractures surgically treated from October 2006 to April of 2011 was performed. A total of 143 trimalleolar ankle fractures were identified, and 97 were classified as SER IV. Of the 97 patients, 74 (76.3%) had a sizable PM fragment. Syndesmotic fixation was required in 7 of 34 (20%) and 27 of 40 (68%), respectively, when the PM was fixed versus not fixed (p = .0002). When the PM was indirectly reduced using an anterior to posterior screw, 7 of 15 patients (46.7%) required syndesmotic fixation compared with none of 19 patients when the PM fragment was fixated with direct posterior lateral plate fixation (p = .0012). Fixation of the PM fracture in SER IV ankle fractures can restore syndesmotic stability and, thus, lower the rate of syndesmotic fixation. We found that fixation of a sizable PM fragment in SER IV or equivalent injuries through posterolateral plating can eliminate the need for syndesmotic screw fixation.     

Analysis of scaphoid fracture displacement by three-dimensional computed tomography

Scaphoid fracture displacement was studied in twenty-five patients using three-dimensional computed tomography. Fracture displacement was more readily detected and distinct in three-dimensional computed tomography images than in plain radiography. Two different types of offset of the distal fragment with respect to the proximal fragment are described on three dimensional computed tomography; volar type and dorsal type. In the volar type, the distal fragment overhung in the volar direction relative to the proximal fragment and was frequently accompanied by humpback deformity and axial rotation. In the dorsal type, the distal fragment slipped dorsal on the proximal fragment and was commonly accompanied by humpback deformity. The volar type had a transverse or vertical fracture line on both the volar and dorsal surfaces of the scaphoid, while the dorsal type had a horizontal fracture line. The volar type was frequently found when the fracture was distal, whereas the dorsal type was noted more frequently for proximally located fracture.     

两种方法治疗桡骨小头骨折的疗效研究

目的 比较Herbert螺钉与微型接骨板治疗桡骨小头骨折的临床疗效.方法 将23例桡骨小头骨折患者分为2组,分别采用Herbert螺钉与微型接骨板固定并进行早期功能锻炼.Herbert螺钉组13例,其中男8例,女5例,年龄23～55岁,平均32.6岁;微型接骨板内固定组10例,男6例,女4例,年龄21～53岁,平均32.5岁.对2组患者的肘关节功能、骨折愈合情况、肌力、并发症进行比较.结果 2组病例随访2年,骨折均愈合良好,两组Broberg和Morrey评分比较,Herbert螺钉组优于微型接骨板组(P＜0.01),术后并发症发生率Herbert螺钉组低于微型接骨板组(P＜0.05),两组差异比较有统计学意义.结论 Herbert螺钉内固定治疗桡骨小头骨折疗效优于微型接骨板内固定.     

手术治疗髋臼骨折的临床疗效

目的探讨手术治疗髋臼骨折的临床疗效,并对相关因素进行分析。方法分别采用K-L入路、髂腹股沟入路、前后联合入路行切开复位骨盆重建钢板、螺钉内固定治疗48例髋臼骨折患者。结果术后按Matta影像学评分,解剖复位28例,满意复位14例,不满意复位6例。患者均获随访,时间12~58个月。按改良的Merle d'Aubigné和Postel评分标准:优28例,良9例,可7例,差4例。简单骨折和复合骨折临床优良率分别为94.4%和66.7%,解剖复位和非解剖复位的临床优良率分别为96.4%和50%,差异均有统计学意义(P0.05)。结论手术治疗髋臼骨折可获得满意的疗效,骨折的复位质量、骨折类型与疗效密切相关。     

颈前路中空螺丝钉内固定治疗齿突骨折

目的评估颈前路中空螺丝钉内固定治疗齿突骨折的临床疗效。方法对15例新鲜齿突骨折的患者行颈前路中空螺丝钉内固定，AndersonⅡ型骨折11例，浅Ⅲ型4例，观察术后骨折愈合、颈部功能状态以及术后并发症情况。结果随访3～24个月，平均6个月，骨折均获骨性愈合，均无明显颈部活动受限，未出现明显的术后并发症。结论如严格掌握手术适应证，颈前路齿突螺钉内固定可以获得良好的治疗效果，其主要优点在于保存了寰枢椎生理活动，骨折愈合率高以及术后并发症相对较少。     

Pediatric and adolescent tibial eminence fractures: arthroscopic cannulated screw fixation

BACKGROUND: Fractures of the intercondylar spine of the tibia are enigmatic injuries. The mechanism of injury remains obscure, and appropriate treatment is unclear. METHODS: The authors analyzed a series of 26 cases of displaced fractures of the intercondylar eminence of the tibia treated with an arthroscopically placed, intrafocal screw with spiked washer. The patients were reviewed after a minimum follow-up of 24 months and a maximum of 8 years. RESULTS: Sixteen patients had a type II tibia eminence fracture according to Meyers and McKeever (mean age, 15 years; male/female ratio, 11:5). Ten patients had a type III tibia eminence fracture (mean age, 17 years; male/female ratio, 1:1). We encountered neither stiffness nor iatrogenic chondral abrasion. Only three patients with type II had no laxity. The 13 other patients in this fracture group had a minor laxity without correlation with the clinical result. In four patients with a type III lesion, a residual laxity without functional deficit was noticed. In two cases with a type III lesion, a reconstruction of the anterior cruciate ligament was necessary 3 years after trauma. In four patients with a type III fracture, the fragment remained elevated, with minor impairment of the mobility (extension lag). No mechanical failure or infection was seen in this series. CONCLUSION: The authors found the intrafocal screw fixation for displaced fracture of the intercondylar eminence to be a reliable and safe technique, although complete restoration of the anteroposterior knee stability was seldom seen.