We compared lower limb coronal alignment measurements obtained pre- and post-operatively with long-leg radiographs and computer navigation in patients undergoing primary total knee replacement (TKR). A series of 185 patients had their pre- and post-implant radiological and computer-navigation system measurements of coronal alignment compared using the Bland-Altman method. The study included 81 men and 104 women with a mean age of 68.5 years (32 to 87) and a mean body mass index of 31.7 kg/m(2) (19 to 49). Pre-implant Bland-Altman limits of agreement were -9.4° to 8.6° with a repeatability coefficient of 9.0°. The Bland-Altman plot showed a tendency for the radiological measurement to indicate a higher level of pre-operative deformity than the corresponding navigation measurement. Post-implant limits of agreement were -5.0° to 5.4° with a repeatability coefficient of 5.2°. The tendency for valgus knees to have greater deformity on the radiograph was still seen, but was weaker for varus knees. The alignment seen or measured intra-operatively during TKR is not necessarily the same as the deformity seen on a standing long-leg radiograph either pre- or post-operatively. Further investigation into the effect of weight-bearing and surgical exposure of the joint on the mechanical femorotibial angle is required to enable the most appropriate intra-operative alignment to be selected.

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Motor vehicle collisions (MVCs) have been reported as the leading cause of major trauma and subsequent morbidity and mortality, for people under 20 and those between 20 and 64 years of age. Crash fatalities have significantly reduced in number since the introduction of appropriate seat belt restraints and air bags for drivers and front seat passengers. Other factors which have positively influenced the outcome of MVCs include information from pre-hospital personnel at the crash scene, regarding the vehicle's exterior and interior damage, in addition to the direction of impact. The patterns of injury sustained by car occupants during a collision depend upon the direction of impact. We provide an up to date review of the key literature regarding injury patterns sustained to occupants of light passenger vehicles (passenger cars, vans, utility vehicles and pickup trucks) in correlation with the direction of impact. We strongly believe that this knowledge can allow pre-hospital personnel and clinicians in the emergency department to gain foresight when suspecting and identifying the injuries sustained by car occupants during a motor vehicle collision.

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