Purpose of the study: The purpose of this study was to evaluate and compare the functional and radiographic results of these two surgical techniques using a prospective study.

Material and methods: This study involved two consecutive series of 70 patients with a posterior fracture of the distal radius. Mixed multiple pinning (MMP) consisted in the combination of two styloid pins and two infrafocal dorsal pins. The anterior plate was a locked ITS. The patients decided when it was appropriate to wear a brace postoperatively. Functional assessment used the range of motion, the Quick DASH score, and a self-evaluation of the number of days the brace was worn. Ulnar variance, sagittal and frontal inclination of the radial epiphysis were measured pre- and postoperatively at 45 days.

Results: At mean follow-up of 11.8 months (3–34), the functional outcome was comparable in the two groups but the patients with a plate fixation wore the brace less. Radiographically, there was no loss of final reduction with the plate fixation whereas with the pinning, there was a progressive loss of ulnar variance and less than 2% over-reduction. Major complications (tendon tears, nerve injury) were less frequent with pinning.

Conclusion: Globally, plate fixation enabled more rapid mobilisation of the wrist. Nevertheless this method has its drawbacks (duration of the operation, material availability, cost). In our opinion the mixed multiple pinning method is the treatment of choice for fractures free of major instability or anterior or circumferential comminution.

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.

Aims: The purpose of this prospective study is to evaluate the outcome of 15 subtrochanteric femoral fractures treated by MIPO condylar screw (DCS) in 8 cases. Methods: The fractures were classified according to Seinsheimer (10 type IV and 5 type V). In order to limit the amount of both medial and lateral dissection, the plates were carefully inserted through isolated proximal incision only, behind the vastus lateralis; while the CBP was initially inserted with the blade pointing towards the surgeon, the MIPO technique was simplified by the technique, using a condylar blade plate (CBP) in 7 cases or a dynamic use of the two-part and two-plane alignment achieved by DCS. Results: All fractures healed, with a mean time of 12 weeks (range 8–16 weeks). There were no infections or implant failure. At follow-up, there were 3 varus deformities above 5°, 2 leg length discrepancies over 15 mm and 1 malrotation of 20°. The functional outcome (according to the Neer scale) was excellent in 10 cases and satisfactory in 5 cases. Conclusions: This demanding technique has the advantages of a faster rate of union, with no need for bone grafting. Care should be taken to ensure adequate axial and rotational alignment.