Introduction

Reverse Total Shoulder Arthroplasty (rTSA) is an efficient treatment, to relieve from pain and to increase function. However, scapular notching remains a serious issue and post-operative range of motion (ROM) presents many variations. No study compared implant positioning, different implant combinations, different implant sizes on different types of patient representative to undergo for rTSA, on glenohumeral ROM in every degree of freedom.

Purpose of the study: The purpose of this retrospective work was to analyse a series of ten patients (11 osteotomies) who underwent closed rotation osteotomy of the femur performed with an endomedullary saw and stabilized with a centromedullar locked nail. We identified the proper indications, technical aspects, clinical and radiological outcome and describe the complications of this surgical technique.

Material and method: The 11 osteotomies were performed in ten patients from January 1999 to July 2007 for post-trauma rotation defects or congenital deformity. On average the rotation defect was 33.5 (range 24–52), mainly internal rotation (10 cases versus 1 with external rotation). One female patient required a bilateral procedure in a context of congenital bilateral trochlea dysplasia. For two other patients the corrective osteotomy was associated with a lengthening procedure performed during the same operative time (totally closed operation). Clinical and radiological follow-up was available to 4 years 9 months on average (range 26–104 months). The angle corrections were determined on bone tomographs.

Results: Ten of the 11 osteotomies yielded correction to ±4° physiological values (or controlateral values if the other side was healthy) for anteversion of the femoral neck. There were no infections (bone, joint, skin, soft tissue) and not late healing or non-union. There was one transient neurological complication involving the pudendal nerve during a rotation-lengthening procedure and one bilateral fracture of the femur during a bilateral osteotomy. All patients healed within 3 to 5 months. Subjective outcome was satisfactory very satisfactory for 8 of 9 patients (one lost to follow-up) in terms of functional recovery and aesthetic aspect of the scars.

Discussion: The closed procedure for rotation osteotomy of the adult femur is a reliable, effective, safe and reproducible technique for the correction of rotation defects of the femur resulting from trauma or congenital disorders. These results can be obtained only with rigorous technique requiring experience and skill with centromedullary nailing.

Purpose: The Sauvé-Kapandji procedure is often performed for the treatment of posttraumatic degeneration of the distal radioulnar joint. Few studies have been devoted specifically to the proximal stump of the ulnar after this procedure. The aim of our study was to conduct a radioclinical evaluation of the dynamics of the proximal ulnar stump.

Material and methods: This retrospective analysis involved fourteen patients (four women and ten men), mean age 48 years who underwent the procedure between January 1991 and March 2002. All presented posttraumatic degradation of the distal radioulnar joint. The operation took place twelve months after trauma on average. Mean ulnar resection was 11 mm, performed as distally as possible. The pronator quadratus was not advanced into the false joint. Pronation-supination rehabilitation exercises were instituted shortly after surgery. A static and dynamic x-rays protocol was designed for analysis.

Results: Patients were reviewed at five years two months on average. There were two complications: fusion of the intentional ulnar pseudarthrosis and one pseudarthrosis of the distal radioulnar joint. Time to resumption of former activity was nine months on average. Two patients could not resume their former activity. Seven patients complained of mechanical pain at the ulnar resection. Three patients reported cracking sounds along the ulnar border of the wrist and two patients presented an objective snap during pronosupination. Clinically, the ulnar stump was unstable in the sagittal plan in all cases. Radiographs confirmed this instability. Clinically, there was also an instability in the frontal plane in three patients. The dynamic films did not confirm frontal instability.

Discussion: Although less so than after the Darrach procedure, the proximal ulnar stump is the principle complication of the Savué-Kapandji procedure. Preservation of the structures stabilising the distal ulnar stump is crucial: periosteum, interosseous membrane, ulnar extensor of the carpus, pronator quadratus. Our use of a shorter resection made as distally as possible was only able to avoid a certain degree of instability which was nevertheless well tolerated.

Conclusion: The Sauvé-Kapandji procedure provides very satisfactory results for pain and motion. All patients appeared to have some degree of distal ulnar stump instability which was as a rule well tolerated. Nevertheless, one patient required a revision for stabilisation. This instability remains an unsolved problem which apparently cannot be prevented even with a very rigorous technique.

Purpose: The pisitriquetral articulation can be a source of pain, particularly after trauma. If conservative treatment fails, pisiformectomy appears to be the best alternative. The purpose of this work was to assess clinical and functional outcome after pisiformectomy.

Material and method: Thirteen patients were reviewed 31.5 months (mean) after pisiformectomy. Two patients had a bilateral procedure giving 15 pisiformectomies. Occupation-related trauma was the principal cause. Four patients also had ulnar neuropathy. The same operative technique was used for all patients and a visual analogue scale was used to assess pain.

Results: There were no postoperative complications. At last follow-up, outcome was excellent in twelve cases, good in two and fair in one (n=15). Residual pain was scored a mean 0.8 points versus 6.4 points preoperatively (p< 0.001). Wrist motion was improved after surgery.

Conclusion: There are many causes of pisotriquetral disease, but trauma, or microtraum, predominates. Pisiformectomy is the best treatment after failure or deterioration of results of conservative treatment. It must be remembered however that pisotriquetral disease may be a revealing sign of a regional disorder that must be identified.