Purpose of the study: Both conventional plates (CP) and volar locking plates (VP) are used for the ttreatment of distal fractures of the radius (Crognet 2006, Jupiter 2009). This was a retrospective analysis to compare the respective results of these two plating methods with a one year follow-up and to study the clinical outcomes and quality and duration of the reduction achieved.

Material and methods: From 2005 to 2008, 48 CP and 33 VP were inserted for the same indications, simultaneously in the same unit. The four operators chose the material as needed. The time to treatment was less than 12 hours for 81% of patients. For CP, the fractures were comminutive in 60%, articular in 40% and associated with ligament injury for more than 10%. For VP, the fractures were comminutive in 80%, articular in 86% and in a context of multiple trauma in 20%. The clinical analysis included range of motion, index of reduction (IR), stability (IS) and efficacy (IF) defined at the SOFCOT symposium.

Results: For the two series, the mean range of motion was flexion-extension 118, pronosupination 166; the recovered force was > 75% of the controlateral side. The QuickDash was excellent in more than 75%, good in 10%, fair in 10%, poor in 5%. More than 75% had an anatomic result. Complications were the same in percentage and in type for the two types of plates with no significant difference. For the VP, 95% of the clinical and radiographic outcomes were good or very good. For the CP, the results were the same. There was only one real loss of reduction with migration of an epiphyseal screw with no observable clinical impact.

Discussion: This study was limited by the non randomization; there was a difference in the type of injury between the two series. Use of non-locked plates for fractures of the distal radius has proven efficacy as amply noted in the literature. This was analysed, and in particular with a few comparative CP/VP studies. Locking the volar plate does not guarantee stability in fragile cancellous bone. The problems encountered when removing the VP were not within the scope of this work. The cost of locking can limit systematic use. These two types of plates should not be considered in opposition but rather as complementary techniques.

Treatment of advanced Kienbock’s disease is challenging, and controversial. Palliative procedures should be chosen.

The goal of this study was to analyse the results of scaphocapitate arthrodesis with lunarectomy in advanced cases. Fourteen consecutive wrists in 13 patients were re-examined at a ranged follow-up of 31,7 months (range 3 to 103). Preoperative radiographs showed Lichtman stage 3a disease in 4 patients, stage 3b in 9 patients, and stage 4 in the last patient. Eight patients were women, and the involved wrist was the dominant in 8 cases. The age at operation averaged 36,6 years (range 24 to 55). Symptoms consisted in pain or pain with stiffness. Operative techniques consisted through a dorsal approach in excision of the dorsal interosseus nerve, lunarectomy, and scaphocapitate arthrodesis. Autologous bone graft was used in 8 cases, and osteosynthesis used K wires or staples. The wrists were immobilized in arm cast during 6 weeks, and rehabilitation was started. Postoperatively, one patient developed a complex regional pain syndrome.

At longest follow-up, patients were very satisfied in 8 cases, satisfied in 4, and poorly or not satisfied in 2 cases. Three wrists were painless, and only one wrist had no improvement. One wrist had no improvement. All the employed patients returned to their original work. Mean wrist motion increased slightly. Flexion increased from 33.3 to 33.9°, extension from 39.6 to 39.3°, ulnar deviation from 20 to 23.7°, and radial deviation from 18.8 to 17°. The arc of motion was useful (Flexion- Extension: 73.7° range, Pronation-Supination: 172.7°) Grip strength increased and reached 64.5% of the controlateral wrist. The mean gain was 5.6 Kg (+199%). The improvement was slow and very progressive over one year. On radiographs the arthrodeseses were consolidated in all cases, but the union seemed partial but asymptomatic in two wrists. Correction of scaphoid in flexion was difficult to obtain. No arthritis or degenerative changes were observed, but the distal radial epiphysis seemed to be reshuffled to the new joint and articular surfaces, with progressive disappearance of the radial lunar notch

Scaphocapitate arthrodesis associated with lunarectomy allows getting a painful and functional wrist. This simple procedure theoretically decreases load across the radiolunate joint, prevents further carpal collapse, and stabilizes the midcarpal joint.

Purpose of the study: Locked centromedullary nailing (LCMN) has become the gold standard treatment for fractures of the femur (I. Kempf, Chirurgie 91 ; 117 : 478 / Borel R.C.O. 93 ; 79,553 / Wolinsky J. trauma 99, 46 : 382). Nevertheless, the SOFCOT 2004 round table emphasized the frequency of complications related to inappropriate material and techniques. The series studied had several biases: multicentric recruitment, materials with different designs, high percentage of patients lost to follow-up. In order to overcome these shortcomings we reviewed retrospectively a consecutive series of LCMN performed in a single center from 2001 to 2002, attempting to be as exhaustive as possible.

Material and methods: The study group included 78 patients (81 LCMN) aged 30 years on average (range 16–87 years) with male predominance (69%). A large proportion of patients were traffic accident victims (44% two-wheel vehicles, 42% four-wheel vehicles). The fracture was open in 8% and 65% of patients had multiple fractures (11% floating knees, 23% multiple trauma). The fractures were simple (43%), wedge (47%) and comminutive (10%). Time to operation was 7.4 hr on average for 83% of patients. Mean reaming was 12 mm (range 11–14 mm). An 11-mm (range 10–13 mm) static Grosse and Kempf (Stryker) nail was used in all patients. Intraoperative complications occurred in 8% of cases with no effect on bone healing.

Results: Three patients died from severe head trauma. Five patients were lost to follow-up. Written follow-up data were available for six patients and 64 patients were reviewed clinically. Among the 70 fractures with known outcome, four had not healed (with two screw failures and one nail failure). Knee motion was normal in all patients. Anteroposterior and lateral alignment was normal (±5°) in 94% with no leg length discrepancy (< 10 mm)in 87%. The nail was withdrawn in 84% of patients and the withdrawal procedure was complicated in three cases (hematoma, screw failure). Mean hospital stay for single-fracture patients was 9.7 days for nailing and 2.2 days for nail removal.

Discussion: LCMN is a reliable technique which provides constant clinical results when applied with rigorous technique. The logistics is resource intensive. Nonunion can be revised with the same method. A new nailing with second reaming should be performed early in the event of late healing.