A series of 91 patients (59 males, 32 females, mean age 41 years) with middle-shaft clavicle fracture were assessed at a mean of 8.7 years after injury. Based on Allman's classification, fractures were placed in group Ia, Ib and Ic. The majority (66%) were allocated to groups Ib or Ic. Clinical evaluation was made using the Constant score and simple shoulder test. On post-injury radiographs, we measured the amount of overlapping of the fracture fragments (OV) both in centimetres and as percentage of the length of the clavicle and the mean distance between cranio-caudally displaced fragments (DS). The mean Constant scores were 87.1% and 85.6% in groups Ib and Ic, respectively. In patients with a Constant score > or =90%, the mean OV was 7.7% and the average DS was 1.59 cm. In those with a Constant score of 81-89% the average OV and DS were 12% and 1.6 cm, respectively, with the greatest OV being 12.9. In the nine patients whose Constant score was > or =80% the mean OV was 13.2 and the average DS was 1.7; however, the majority of patients had an OV > 15% and DS > or = 2 cm. In these nine patients the mean Constant score was significantly lower than that in the group with a score of > or =90%. The simple shoulder test showed that 20% of patients were dissatisfied with the outcome; a low score was associated with a severe degree of OV or DS. Fracture nonunion occurred in five cases (5.5%). We conclude that there is a clear-cut indication for surgery in patients with OV > or = 15% or DS > or = 2.3 cm as well as in those with an OV > or = 13% associated with a DS > or = 2 cm. This holds particularly for young and middle-aged patients.

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IV.

The aim of this study was to address, in normal knees, the variability of posterior offset of femoral condyles and tibial slope, and the presence of any correlation between the two that might be needed to achieve an adequate joint motion in flexion. Magnetic resonance images of normal knees of 80 subjects, 45 males and 35 females, with a mean age of 38.9 years, were analysed. Measurements were performed by two independent observers using an imaging visualization software. The tibial slope averaged 8 and 7.7°, on the medial and lateral sides, respectively (P = 0.2); the mean posterior offset of femoral condyles was 27.4 and 25.2 mm on the two sides, respectively (P = 0.0001). The variation coefficient of the condylar offset and tibial slope was 11.5 and 38%, respectively. In the medial compartment, a significant correlation was found between the femoral condylar offset and the tibial slope, while the same was not observed in the lateral compartment of the knee. Magnetic resonance imaging allows the assessment of tibial slope and femoral condylar offset in the medial and lateral side separately, taking into account any difference between the two compartments. The sagittal tibial slope exhibits a greater variability compared with the posterior offset of femoral condyles. The correlation found, in the medial compartment, between the tibial slope and femoral condylar offset suggests that the reconstitution of the proper morphology of the posterior part of the knee joint may be necessary to obtain a full range of motion in flexion after total knee replacement.

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