A computer tomographic method is described for measuring tibial torsion in vivo. The basis of the method depends on transverse scans of the tibia through the knee and ankle joint region by means of which it is possible to establish normal values and abnormal posttraumatic or in congenital torsion. Traumatologists, as well as orthopaedic surgeons, require reproducible measurements, since a detorsion operation may rectify deformities which would lead to degenerative joint changes. A review of previously available methods with torsiometer or conventional radiography shows the limitations of these methods.

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Subject of this investigation is the influence of postoperative tibio-fibular ossification on the development of arthrosis of the ankle. Changes of the biomechanics of the joint can be evaluated by computed tomography. Posttraumatic and postoperative changes of the mobility of the fibular in relation to the tibia may be quantified by CT investigation and evaluated with respect to the development of arthrosis.

The infection rate of open lower leg fracture is extremely high. Surgical treatment guarantees a reduced risk of infection when compared with conservative treatments. But even osteosynthetic methods such as screw or compression plate fixation show unsatisfactory results because of the additional traumatization of the primarily injured soft tissue combined with a reduction of blood circulation. From July 1973 till September 1976 we treated 57 2nd and 3rd degree open shank fractures with osteosynthetic methods: 46 with compression plate osteosynthesis and 11 primarily or secondarily with external fixation. The osteitis-rate was 14%, in addition to that there was a soft-tissue infection rate of 5%. In order to change our therapeutical procedure we stabilized 2nd and 3rd degree open lower limb fractures and lower leg fractures complicated by soft-tissue damages consequently by external fixation. From October 1976 till May 1978 we treated 39 open shank fractures; 24 of them were 2nd and 3rd degree open fractures. They were treated by external fixation. This change in our surgical treatment resulted in an osteitis-rate of 2.6%, there was no case of soft-tissue inflammation. These results underline the superiority of treating 2nd and 3rd degree open lower leg fractures and fractures combined with soft-tissue injuries consequently and chiefly with AO external fixation.

Primary operative care with debridement and the soft tissue protective osteosynthesis is the method of choice in the management of open fractures. A follow-up study of 307 so treated fractures was performed over an average of 3 years after the initial trauma. The overall rate of osteomyelitis was 8.5% in below knee compound fractures and 4.9% in all other areas. During the past two years while using the external fixation device in 2nd and 3rd degree compound fractures in the lower leg the osteomyelitis rate was reduced to 5.5%. In the 2nd and 3rd degree compound crural fractures due to the delayed bone healing with the external fixation method alone we recommend the so called "combination osteosynthesis" in which a screw or a AO-2-hole-plate is employed additionally. Furthermore it seems essential to perform an autologous cancellous bone graft in these fractures to reduce the long healing time.