Purpose of the study: Three-bone arthrodesis, described in 1997, is designed for radiocarpal osteoarthritis with mediocarpal extension. The procedure consists in a capitolunohamate fusion after resection of the scaphoid and the triquetrum. It is associated with carpal shortening proportional to the degree of preoperative wrist stiffness. The objective is to achieve less stiffness than with four-bone fusion.

Material and methods: To verify our hypothesis, the first 24 patients (25 wrists) were reviewed with mean 5.2 years (2–8.5 years) follow-up. All wrists were painful and stiff, and presented radiocarpal and mediocarpal osteoarthritis. There were twelve SLAC III, nine SNAC III and four SCAC III. Mean age was 59 years (range 37–79 years). Mean preoperative range of motion was 50.5° flexion-extension (range 10–105°), mean force was 17 kg (range 10–35 kg). Radiological assessment was performed preoperatively and at last follow-up to determine the Youm index (carpal height) and the Bouman index (carpal translation) and to study the radiolunate joint space.

Results: At last follow-up, all patients had improved but one. Ten wrists were pain free twelve caused some pain at forced wrist movements, and two caused pain daily but at a level below the preoperative level. One patient still suffered from severe pain and required revision for total radiocarpal arthrodesis. The final mean flexion-extension range of motion was 67.8°, for a 13.3° gain in extension and a 3.8° gain in flexion. Ulnar inclination was improved 14° on average. Mean force was 24 kg (73% of healthy side), for a 40% improvement over the pre-operative force. RAdiographically, there was one case of capitolunate nonunion. The radiolunate space remained unchanged. Carpal height decreased 15% on average and the Bouman index increased from 0.90 to 0.93 with no significant ulnar misalignment on the carpus.

Discussion: For pain and force, these results are similar to those achieved with four-bone fusion. The overall results for range of motion are however better for flexion-extension and unlar inclination. In our practice, we have decided to replace the four-bone technique by three-bone fusion because the outcome is a less stiff wrist with a simpler surgical technique. Better results are obtained for stiffer wrists which achieve a significant improvement in motion due to carpal shortening.

Purpose of the study: Analyze failures (recurrent anterior instability) and other complications (pain, stiffness) compromising the overall outcome after arthroscopic anterior shoulder stabilization.

Material and methods: We studied failures and complications in a consecutive inaugural series of 43 patients undergoing an arthroscopic Bankart procedure for chronic anterior shoulder instability. The procedure was performed with knitted resorbable threads on metallic anchors. Outcome was reviewed at mean 26 months (range 6–63 months). There were 19 recurrent dislocations, 12 recurrent subluxations, 4 cases of recurrent subluxation and dislocation and 6 cases of painful unstable shoulder. Mean patient age was 35.6 years (range 19–59 years). Thirty-two patients practiced sports, including 21 who practiced high-risk sports.

Results: One patient, a competition basketball player, presented recurrent traumatic dislocation due to a violent shock after premature resumption of sports activities five months after surgery. There were no recurrent dislocations among the subluxation cases. Pain persisted in three of the six painful unstable shoulders. Sixteen patients presented persistent apprehension but none complained of instability. Nine patients had a positive relocation test. Limited external rotation of less than 30% as observed in five patients and of 30–50% in two. Residual pain was observed in 14 patients (33%) (when carrying a heavy load with the arm hanging along the body, with fatigue, and for forced movements without warm-up in the morning). For four patients, pain occurred in the armed position. Seventeen patients (43%) interrupted their sports activity. The Duplay score showed 13 (30%) fair and poor objective overall results. Subjectively, only seven patients (15%) were only partially satisfied or dissatisfied.

Discussion: Analysis of failures and complications disclosed a discordance between the low rate of failure using the classical definition (recurrent dislocation or subluxation) and the high rate of fair or poor overall outcomes. Residual pain and non-resumption of sports activities appeared to be the major problems. These two factors were analyzed in detail to compare this series with data in the literature. It was found that non-resumption of sports activities is not always related to shoulder instability or apprehension and that pain is often related to associated injury (SLAP, cuff). Conversely, pain associated with a positive relocation test should be considered as a true recurrence, especially in a subject who was unable to resume sports activities.

Purpose: Orthopaedic treatment of Achilles tendon tears was detailed by Rodineau. Equine immobilisation for eight to twelve weeks without weight bearing is necessary. The rate of recurrent tears varies from 10 to 20%. Conventional surgery provides very low re-tear rates but can lead to cutaneous complications in 10 to 20% of cases. In 2001, Moller et al. conducted a prospective comparison between surgical and functional treatment in 112 patients followed for two years. The rates of recurrent tears were 1.7% for surgery versus 20.8% for functional treatment. The percutaneous suture with Tenolig(r) has not totally eliminated these problems and raises a cost issue. The Achillon procedure is presented as a minimally invasive technique which does not appear to be extremely easy to perform. Several other techniques have been proposed using an external fixator (Nada, 1985), subcutaneous arthroscopy (Aldam, 1989), or a transverse miniincision (Thermann, 2001). The oldest truly percutaneous method was published by Ma and Griffith in 1977. In 2001, Lim et al. conducted a prospective comparison between conventional surgery and percutaneous treatment using the Ma and Griffith method on 66 patients reviewed at six months. Average immobilisation was 12.4 weeks. There were seven infections (21%) in the surgery cohort versus three cases of painful nodules (9%) in the percutaneous cohort in addition to one case of sural nerve paraesthesia.

Material and methods: The percutaneous technique we used was derived from the Ma and Griffith technique. The purpose of this percutaneous technique is to obtain rapidly and easily a solid suture which can be achieved under local anaesthesia at little cost. We developed a special needle with an eye which accepts the type of thread desired. Early in our experience, we used a non-resorbable thread (Ethicon(r) N1) but because of painful nodules we changed to a resorbable thread (Vincryl n2) used for a double suture. The suture is performed under local anaesthesia, the patient in the ventral supine position. An equine plaster boot is worn for three weeks followed by a 90° boot with a walking heal for another three weeks during which weight bearing is allowed. From 1999 to 2002, we have used this technique for 43 patients (28 men and 15 women), mean age 51 years.

Results: The only complications were one case of superficial infection, one painful subcutaneous nodule, and one sural thrombophlebitis. There were no cases of recurrent tear or sural neurinoma.

Discussion: The contraindications for this technique are old tears, recurrent tears, and tears too close to the cal-caneal insertion.

Conclusion: This technique is easy to perform and low-cost. The suture is solid allowing rapid recovery without cutaneous complications.