No abstract

No abstract

There is no universally accepted method of classification of tibial plateau fractures, with more than six classification schemes having been described. Of these, the Schatzker and AO/OTA classifications are the most commonly used methods for classifying such fractures. 1,2 There is little information regarding inter-and intra-observer variation when classifying tibial plateau fractures using the Schatzker and AO/OTA classification systems and hence this study was performed. Patients and MethodsThe Schatzker classification divides tibial plateau fractures into six types (Fig. 1). The AO/OTA classification divides proximal tibial fractures into types A, B and C. Each of the three types is divided into three groups described as 1-3, each of which having three further sub-groups. In this study, the broad AO/OTA classification consisting of the tibial plateau types and groups was used (Fig. 2). In the AO/OTA classification, each group ( e.g. B1, B2) is further subdivided into sub-groups(.1 to .3) but this division was not used for purposes of simplicity.Fifty tibial plateau fractures presenting to our hospital over a 4-year period were used. All patients had anteriorposterior (AP) and lateral radiographs, as per hospital protocol. To ensure good quality radiographs, the hospital protocol requires the clinician assessing each patient to repeat any poor-quality radiograph. To determine intra-and interobserver variation, each of six observers (two research fellows, two senior training orthopaedic surgeons [SpRs] and two lower limb orthopaedic and trauma consultants) independently assessed the AP and lateral radiographs of these 50 tibial plateau fractures and classified them according to the Schatzker and AO/OTA classifications. All participants in the study were familiar with both the Schatzker and AO/OTA classification systems. They were not given any clinical details regarding presentation or management of the The aim of this study was to evaluate the intra-and inter-observer variation of the Schatzker and AO/OTA classifications in assessing tibial plateau fractures, using plain radiographs.

No abstract

Little is known about factors that may predict the response of dysthymia or other forms of chronic depression to treatment with antidepressant medication. We investigated several sociodemographic and clinical variables for their relationship to the acute treatment response to desipramine in subjects with DSM-III-R dysthymia. Subjects with DSM-III-R dysthymia were treated with desipramine in an open fashion for 10 weeks. Various clinical and sociodemographic variables were assessed at baseline. Ratings of depressive symptoms and severity and determination of categorical outcome were done during treatment. Baseline extended family adjustment as measured by the Social Adjustment Scale Self-Report was significantly better in the responders compared with the nonresponders (2.1 +/- 0.5 vs. 2.6 +/- 0.8; t = 2.84, df = 52.11, p = 0.006). There was a trend (p = 0.06) for overall baseline social impairment (SAS-SR) to be higher in nonresponders versus responders. Older age was a significant predictor of higher depressive severity (Cornell Dysthymia Rating Scale) and global impairment in the last week of the study. No other variable significantly distinguished responders from non-responders. Although few of the variables that were examined were found to affect acute treatment response, better extended family adjustment as reported on the SAS-SR was a significant predictor of good acute treatment response to desipramine in patients with dysthymia.