Open reduction for developmental dislocation of the hip (DDH) is invasive and sometimes results in femoral head deformity while open reduction has been the first choice in case non-operative reduction is failed in. We treated 3 patients with 3 affected hips using minimum invasive arthroscopic reduction method. Pre-operative MRIs represented these 3 hips had obstruction of interposed thick limbus. The average age of patients treated by this method was 23 months. This method consists of arthrogram, arthroscopic limboplasty, and arthroscopic reduction. This series of maneuvers was able to lead unreducable hips to the reduction position. Post-operative MRIs represented that the interposed thick limbus had been removed to the outside of acetabulum and the limbus covered the reduced femoral head. There were no signs of residual subluxation of the hips in radiographic examination. This new minimum invasive arthroscopic reduction method have a possibility to take the place of the invasive open reduction in the treatment of DDHs with obstruction of interposed thick limbus

Background. The usefulness of arthroscopic reduction for the intra-articular fracture of the distal radius has been reported, although it is technically difficult. Hypothesis. Our hypothesis is that the reduction using the external fixator is useful as equivalent to the arthroscopic reduction for the intra-articular fracture of the distal radius fracture in the fixation with the volar locking plate. Materials & Methods. The surgery was performed in both methods randomly for 40 patients; average age 64(24 to 92) years, 11 male, 29 female. Image evaluations were performed at 24 weeks after surgery. Ulnar variance, Radial inclination, Volar tilt in the X-ray image, and gap and step in the computed tomogram were evaluated. Clinical evaluation was performed at 6, 12, 24 weeks after surgery. Objective evaluations were ranges of motion and grip strength. Subjective evaluations were disabilities of the arm, shoulder, and hand (DASH). Results. The results of image and objective evaluation had no significant difference between the two groups. DASH in arthroscopic group was significantly inferior at 24 weeks because of minor complications. Discussion & Conclusion. The external fixator and the arthroscopy are equally valuable in reduction of articular surface

Purpose: Arthroscopy offers a view of intra-articular pathology, but its use in the treatment of intra-articular distal radius fractures remains controversial. This study compares functional and radiologic outcomes of arthroscopically assisted (AA) versus fluoroscopically assisted (FA) reduction and external fixation (EF) of distal radius fractures.

Type of study: double randomised prospective, comparison of 2 different procedures.

Methods: Between January 2000 and December 2003, 20 patients with comminuted intra-articular distal radius fractures underwent AA EF and percutaneous pinning and 20 patients underwent and FA EF reduction and pinning.

Results: Follow-up period was 9–27 months. Evaluation was clinical (grip strength, range of motion) and radiographic (palmar tilt, radial shortening, stepoff). The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the MAYO wrist score were used 3-9-12 months postoperatively. In 9/20 patients of AA group the subchodral pins were changed after artrhroscopic view because of stepoff. The following tears were found: TFCC (12 of 20 patients), SL (9/20), LT (4/20). Patients who underwent AA surgery had significantly better supination; wrist extension; and flexion compared with the FA surgery group (86 vs 75; 76 vs 65; and 76 vs 63 degrees respectively). Radial shortening and DASH scores were better for the AA group compared to the FA group (AA:12, FA:25) the 3rd and 6th postoperative month but the difference decreased after the 12th month.

Conclusions: A reduction and fixation of intra-articular distal radius fractures provides improved inspection of the ulnarsided components of the injury. Long term evaluation revealed that patients with AA procedures returned in decreased periods to their previous activities (based on DASH score) and had better of supination, flexion, and extension than patients with FA surgery.

Aims

Wrist arthroscopy is a standard procedure in hand surgery for diagnosis and treatment of wrist injuries. Even though not generally recommended for similar procedures, general administration of perioperative antibiotic prophylaxis (PAP) is still widely used in wrist arthroscopy.

Radial head fractures with fragment displacement should be reduced and fixed, when classified as Mason II type injuries. We describe a method of arthroscopic fixation which is performed as a day case trauma surgery, and compare the results with a more traditional fixation approach, in a case controlled manner. We prospectively reviewed six Mason II radial head fractures which were treated using an arthroscopic reduction and fixation technique. The technique allows the fracture to be mobilised, reduced, and anatomically fixed using headless screws. All arthroscopic surgeries were conducted as day-cases. We retrospectively collected age and sex matched cases of open reduction and fixation of Mason II fractures using headless screws. The arthroscopic cases required less analgesia, shorter hospital admissions, and had fewer complications. The averaged final range of follow-up, at 1 year post-operation was 15 to 140 degrees in the arthroscopic group and 35 to 120 degrees in the open group. The Mayo Elbow Performance Score was 95/100 and 90/100 respectively. No acute complications were noted in the arthroscopic group, and a radial nerve neuropraxia [n=1], superficial wound infection [n=1], and loose screw [n=1]. Two patients of the arthroscopic group required secondary motion gaining operations [n=1 arthroscopic anterior capsulectomy for a fixed flexion contracture of 35 degrees, and n=1 loss of supination requiring and arthroscopic radial scar excision]. Three patients in the open group required secondary surgery [n=2 arthroscopic anterior capsulectomy for fixed flexion deformities, and n=1 arthroscopic anterior capsulectomy for fixed flexion deformities, and n=1 arthroscopic radial head excision for prominent screws, loss of forearm rotation, and radiocapitellar arthrosis pain]. The technique of arthroscopic fixation of Mason II radial head fractures appears to be valid, with respect to anatomical restoration of the fracture, minimal hospital admission, reduction in analgesia requirement, fewer complications, and a decreased need for secondary surgery

Introduction and purpose: Fractures of the tibial plateau account for 1% of the total. Among them, 55–70% involve the lateral plateau with differences in separation and subsidence. Minimally invasive osteosynthesis under arthroscopic control increases the indications in these cases. Our purpose is to assess the long-term clinical and radiological outcomes. Materials and methods: We carried out a retrospective analysis of the medium-term results of closed fractures of the tibial plateau treated with arthroscopic reduction and percutaneous fixation with cannulated screws. A series of 32 patients with displaced fractures of the tibial plateau underwent surgery between 1993 and 2004. We used the AO classification. We analysed the clinical, functional and radiological results. Results: The mean follow-up was 6 years. We treated 12 type 41B1, 7 type 41B21, 5 type 41B22, 7 type 41B31 and 1 type 41B12. All the fractures were consolidated and 79.1% had anatomical reduction. External meniscal injuries that could be sutured were present In 11 cases (34.3%). Joint balance was complete in 24 knees. According to the Lysholm scale 23 had an excellent outcome and 9 good. One case presented infection of the surgical wound, which was resolved by surgical debridement and antibiotic therapy. Conclusions: The results suggest that this is a good method for treating selected fractures of the tibial plateau

Introduction: To improve the therapeutic results for AO type C intraarticular distal radius fractures in young and middle-aged patients, it is important to achieve and maintain anatomical reduction, and evaluate and treat soft-tissue injuries. We previously employed arthroscopically assisted reduction and percutaneous pinning (ARPP) combined with external fixation. Since 2003, we have employed ARPP combined with open reduction and internal fixation (ORIF) using volar locking plates. Methods: The subjects were twenty-six patients under 60 years old. The patients comprised thirteen men and thirteen women aged from 16 to 57 (mean 43.5) years. The type of fracture according to the AO classification was C1 in six patients, C2 in ten, and C3 in ten. The follow-up period was 12–18 (mean 13.5) months. The radial inclination (RI), volar tilt (VT), and ulnar variance (UV) were measured radiographically at the time of injury, immediately after surgery, and at final evaluation. The Mayo wrist score was used for clinical evaluation. Results: Union was achieved in all patients. The triangular-fibrocartilage complex injury was detected in nineteen patients, the scapholunate-interosseous ligament injury in twenty-three, and the lunotriquetral-interosseous ligament injury in nineteen. Radiographic evaluation showed that the mean RI, VT, and UV at presentation, immediately after surgery, and at final evaluation was 12.8, 21.0, and 20.9 degrees, −15.4, 9.7, and 9.6 degrees, and 3.10, 0.30, and 0.35 mm, respectively. The Mayo wrist score averaged 87.6 points. Conclusion: Although treatment of AO type C intraarticular distal radius fractures is difficult, ARPP combined with ORIF achieved relatively good results

Anatomic reduction and appropriate implant placement is essential for optimal treatment of intraarticular tibial plateau fractures. Standard intraoperative fluoroscopy provides limited visualization of the reduction and hardware placement compared with pre- or postoperative 3-D imaging modalities. As such, post-operative computer tomography (CT) has become a common procedure to evaluate the quality of the reduction and fixation. The Iso-C3D provides 3-D intraoperatively imaging to dynamically assess the surgical reduction and fixation at different anatomic regions. We report on our first 19 clinical tibial plateau fractures scanned intra-operatively with the Iso-C 3D. Between January and November 2003, 19 intraarticular tibia plateau fractures were scanned intraoperatively with the Iso-C3D (Siemens, Germany). No formal selection criteria were utilised except for the presence of a tibial plateau fracture. Operative procedures included 14 cases of open reduction internal fixation and 5 cases of internal fixation with arthroscopic assisted reduction. Imaging Technique: All patients were positioned on full-carbon tables for the operative procedure. After initial operative reduction and fixation, conventional two-dimensional fluoroscopic imaging was performed using standard AP and lateral projections. These images were evaluated by the operating surgeon; if the reduction and fixation was judged to be appropriate, Iso-C3D imaging was initiated. In 21% (n=4) of all cases an immediate revision of the operative procedure was performed after Iso-C3D imaging. These revisions were not deemed necessary with conventional fluoroscopy alone. In two cases, significant intra-articular incongruencies (greater than two millimetres) were noted. Additionally, in two cases, implant mal-position was detected. All patients had a postoperative CT scan. All CT scans confirmed the intraoperative Iso-C imaging, no further additional articular incongruencies or malpositioned implants were identified. When compared to conventional C-arm images, the Iso-C 3D scans demonstrated improved ability to identify the articular malreduction and implant mal-position in all cases. We have demonstrated that the Iso-C3D provides reliable intraoperative evaluation of reduction and hardware placement compared to traditional CT scans for tibial plateau fractures. In addition, clinically relevant intra-operative information was gained with its use in this study. In four (21%) cases, the operative treatment was modified due to the use of the multiplanar imaging modality. On average, 10 minutes of additional operative time was required for the use of Iso-C3D scanning and the evaluation of the images. Further prospective clinical studies are needed to improve our findings

Objective

Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia.