Background. The aim of this study is to determine the diagnostic accuracy of lever sign test in acute, chronic, and postreconstructive ACL injuries. Methods. In total, 78 patients (69 male, 9 female) were subjected to clinical instability tests including Lachman, anterior drawer, pivot shift, and lever sign when an injury of the ACL was suspected. All tests were performed bilaterally in all patients in acute, chronic period and patients who underwent surgery after the anaesthesia and after the reconstruction at the last follow-up by two senior orthopaedic surgeons. MRI was taken from all patients and MRI image was taken as the reference test when evaluating the accuracy of the tests. Results. The mean age of patients was 26.2±6.4 years (range, 17-44 years). Sensitivity and accuracy values of the Lachman, anterior drawer, pivot shift, and lever tests in the acute phase were calculated as 80.6%, 77.4%, 51.6%, 91.9% and 76.9%, 75.6%, 60.3%, 92.3%, respectively, and in the chronic (preanaesthesia) phase were calculated as 83.9%, 79.0%, 56.5%, 91.9% and 80.8%, 78.2%, 64.1%, 92.3%, respectively. Lachman, anterior drawer, pivot shift, and lever sign Acute’s significant [AUC: 0.716, 0.731, 0.727, 0.928, respectively] activity were observed in the prediction of ACL rupture in MRI. Conclusion. An ideal test to diagnose the integrity of the ACL should be easy to perform and reproducible with high sensitivity and specificity. From this perspective, the lever test seems to be a good test for clinicians in acute, chronic and postreconstructive ACL injuries.

Objective: The aim of this study was to evaluate the long-term follow-up and functional and radiological outcomes of minimally invasive medial plate osteosynthesis in distal tibia fractures. Methods: From January 2011 to November 2015, we reviewed the medical records of 60 patients with 62 tibia fractures (41 men and 19 women; mean age: 45.3±14.9 years) who were treated with open reduction and internal fixation for distal tibia pilon fractures. The mean follow-up time after surgery was 42.7±4.6 months. Union time, coronal plan deformity, complication rates and AOFAS and Olerud-Molander functional outcome scores were evaluated. Results: According to the AO/OTA classification, there were thirty four (54.8%) type 43-A fracture, eight (12.9%) type 43-B fractures, twenty (32.3%) type 43-C fractures. The average time for fracture union was 16.1 weeks. The mean AOFAS score was 86.6±9.1. The mean Olerud-Molander score was 85.6±9.8. There were four patients (6.5%) with a varus of less than 5°, two patients (3.2%) with a valgus of less than 5°, 39 patients (62.9%) with recurvatum (34 of them less than 5°; five of them less than 10°), and 14 patients (22.6%) with procurvatum (12 of them less than 5°; two of them less than 10°). The AOFAS and Olerud-Molander scores in the smoker and diabetic patients were significantly lower than the non-smoker (p=0.002; p=0.005) and non-diabetic patients (p=0.022, p=0.002). The duration of union was significantly higher in both diabetic (p=0.025) and smoker patients (p=0.041). There was no association between the fracture type and the presence of varus, valgus, recurvatum and rotation deformity. The AOFAS score, Olerud-Molander score and plantar-flexion were significantly higher in type A fractures than in type C fractures (p=0.021; p=0.030, and p=0.033, respectively). AOFAS score, Olerud-Molander score, plantar-flexion value did not differ between type B and type C fractures. There was no significant difference among the dorsi-flexion (p=0.211), the follow-up time (p=0.531) and duration of union (p=0.908) of type A, type B and type C fractures. Three patients with open fracture had delayed wound healing. One patient developed skin necrosis. They were treated by local wound care. Conclusion: Minimally invasive medial plate osteosynthesis is a reliable method of treatment for tibial pilon fractures. This technique provides a high fracture healing rate and satisfying functional outcome with minimal wound healing complications. Sagittal plan deformity remains a common complication with minimally invasive medial plate osteosynthesis. Level of Evidence: Level IV, Therapeutic Study Cite this article as: Barış A, Çirci E, Demirci Z, Öztürkmen Y. Minimally invasive medial plate osteosynthesis in tibial pilon fractures: Longterm functional and radiological outcomes. Acta Orthop Traumatol Turc 2020; 54(1): 20-6.

Objective: The aim of this study was to analyze the clinical and functional results of hook plate fixation in Neer type 2 distal clavicle fractures. Methods: We retrospectively analyzed 16 patients (11 males, 5 females) who were diagnosed with Neer type 2 distal clavicle fractures and treated with hook plate fixation between 2013 and 2014. Mean age was 38 (range: 27e61), and mean follow-up time was 14.3 (range: 12e18) months. Complications seen on radiographs were implant failure and subacromial osteolysis. The clinical results were evaluated with modified UCLA (University of California Los Angeles) scoring system. Results: Bone union was achieved in all patients at the end of the first 4 months. Mean modified UCLA score was 32.75 (range 31e35). In 12 patients (68%), the implants had to be removed due to complications. After removal, the complaints regressed and shoulders' range of motion increased. Conclusion: Clinical and radiological results on the fixation of Neer type 2 distal clavicle fractures with a hook plate are good in terms of fracture union and function. The major disadvantage of the method was the requirement of early implant removal due to the hardware related complications and good results can be achieved only after plate removal. Optimizing the length of hook plate may lower the rate of complications. Level of evidence: Level IV, Therapeutic study.