Purpose of the study: The purpose of this study was to compare two types of treatment for fractures of the distal radius with posterior shift: the volar locking plate (c) or mixed multiple pinning (MMP). We conducted a prospective randomised trial.

Material and methods: One hundred ten patients aged over 50 years victims of an articular or extra-articular fracture of the distal radius with posterior shift were included in this study. Mean age was 74 years. Patients were recruited via our emergency unit. After obtaining the written informed consent of the patients, patients were assigned to a treatment group using the nQuery Advisor 6.01 available on the internet, 24 hours/d 7d/7. Patients were treated by one of the two surgical techniques according to the randomisation. Patients were reviewed at 3 and 6 weeks and at 3 and 6 months. The DASH and Herzberg scores were noted and plain x-rays of the wrist (ap and lateral views) were obtained at each visit.

Results: Fifty-two patients were treated with MMP and 50 with VLP. Postoperative anteversion of he radial glenoid was significantly better in patients treated with MMP. At six months, the DASH and Herzberg score were significantly better in the LAP group.

Discussion: MMP allows better anteversion of the glenoid than VLP. However, with MMP there is a risk of over reduction (15% of patients in our series). Treatment with VLP should enable restoration of better radius length with a lesser loss at three months than with MMP. All studies reported, irrespective of the function score used, have found better functional outcome with plating than with pinning.

Conclusion: MMP offers a less costly alternative for the treatment of most all distal fractures of the radius with posterior shift. This option provides quite satisfactory clinical and radiographic outcomes. There is a risk of postoperative defect in reduction or stability with MMP, suggesting surgeons should opt for another technique, VLP for example.

Purpose of the study: Surgical management of neurological injury encountered in patients with a ruptured pelvic girdle remains exceptional. In this work, we present our experience and compare our results with data in the literature.

Material and methods: This retrospective analysis concerned four clinical css. Mean patient age was 20.2 years for two men and two women. All patients were victims of high-energy trauma and presented type C (Tile) pelvic girdle injury. All presented a paralysis of the lumbosacral plexus. One patient presented bilateral paralysis of the pudendal plexus. The work-up included: saccora-diculography, myeloscan, lumbar magnetic resonance imaging. One patient presented a pseudomeingocele.

Results: Surgical exploration was performed within a mean delay of 3.75 months. Two types of exploration were used: for two patients the transperitoneal approach was used because of a suspected lesion of the lumbosacral trunk and for two others, the trans-sacral approach because of suspected intra-spinal rupture. Neurolysis was performed for three patients and an caudia equina nerve graft for one. Nervous injuries involved section or rupture of the roots. There were no cases of medullary avulsion. All patients presented signs of nerve regeneration at last follow-up (mean 5.5 years).

Discussion: Even though injury to the lumbosacral plexus is exceptional, advances in surgical techniques offer therapeutic options adapted to each type of injury and nerve territory. One or more motor functions can be restored. Microsurgical nervous repair of the lumbo-sacral plexus is possible irrespective of the level of the injury. Nerve repair by grafting or neurotization can be achieved via a combination of trans-sacral and anterior retroperitoneal approaches or even a transabdominal approach.

Purpose of the study: The introduction of ceramic bearings in the 1970s raised several issues, including the definition of what should be considered as a ceramic. The simplest definition would appear to refer to the periodic table: a ceramic is composed of a non-metal ion, generally with oxygen as the covalent ion. Alumina is the most commonly used bearing, and is generally considered the most reliable despite certain worrisome reports. Zirconium is also a very promising ceramic as was shown by a review of our firs 97 cases at ten years follow-up.

Material and methods: All patients were reviewed by the same investigator who was not one of the operating surgeons. The patients were classified by group according to their BLMI correlated by the Tanner curve, associated with the Charnley index and the Devane classification

Results: There were no septic complications. There was one dislocation and one head fracture. For the other patients, no revision was required nor planned. Preoper-ative Postel-Merle-d’Aubigné (PMA) score was 8.8 pre-operatively and 17.3 postoperatively. Radiographically, the Barrack, Guen, DeLee and Charnley and Brooker classifications for filling, lucent lines and periprosthetic calcifications were assessed on digitalized films with 115% magnification. Wear was measured on 250% magnification weight-bearing images two or three times more accurate than the classical Charnley Cupic, Liver-more or Ebra methods. This study found that 72% of the prostheses were free of femoral lucent lines, that 82% had no acetabular lucent line, and that wear was 0.114 mm/yr with an accuracy two or three times better than classical non-weight-bearing methods. There were no revisions for loosening and none were planned.

Discussion: These good results should be considered with caution because of the presence of one head fracture. In the event of a head fracture, use of these ceramic bearings almost always requires the use of another ceramic bearing, raising many technical, ethical, and legal problems which do not all have an adequate solution.

Purpose: Intra-osseous leiomyosarcoma (IOLM) is a rare tumour. Imaging aspects are not specific. Pathology is required to establish diagnosis. The appropriate treatment remains controversial because no method has demonstrated certain efficacy. We report two cases and review the literature on this malignant tumour.

Material and methods: The first patient was a 43-year-old woman who suffered right knee pain for six months. Plain x-rays of the tibia revealed an metaphyseo-epiphyseal zone of osteolysis with soft tissue involvement as did 18-FDG uptake on the scintigram and computed tomography. Pathology diagnosis was high-grade IOLM. Search for extension was negative. Tumour resection was performed with implantation of a massive prosthesis followed by chemotherapy and radiotherapy. The second patient was a 50-year-old man who was referred ten days after spontaneous fracture of the lower femur. Plain x-rays, computed tomography and magnetic resonance imagine as well as the PET-scan were difficult to interpret. Pathology examination of a biopsy specimen was in favour of a benign lesion. The final diagnosis was IOLM. Search for extension was negative and radiotherapy was given.

Results: At mean 18-month follow-up, both patients were living. The first patient was able to walk without crutches and the second patient achieved bipodal stance with crutches. Radiologically, the prosthesis was stable and the graft healed. Positive diagnosis was established on the basis of immunohistochemistry and study of the ultrastructure. Unfortunately, treatment of this malignant tumour remains difficult. Chemotherapy and radiotherapy are ineffective. Surgical treatment, even when oncological resection can be achieved, has not demonstrated superior efficacy compared with more conservative treatment in terms of survival or secondary spread. Associating medical and surgical treatment does not guarantee a better result.

Conclusion: IOLM is a rare tumour which requires immunohistochemistry and study of the ultrastructure for positive diagnosis. The appropriate therapeutic option cannot be established, but it would appear that tentatively curative surgery associated with radiotherapy may provide better outcome despite the poor short-term prognosis.

Purpose: The purpose of this study was to assess outcome after first-intention total hip arthroplasty for fresh fractures of the acetabulum in elderly patients.

Material and methods: We present a retrospective analysis of 18 recent fractures of the acetabulum observed in nine men and nine women, mean age 74.8 years which were treated by first-intention total hip arthroplasty. The fractures were considered equivalent to acetabular bone deficits observed at revision of total arthroplasty (five grade III, 13 grade IV in the SOFCT 1988 classification).

The prosthesis was implanted 15.6 days (mean) after initial trauma and included a metal-backed acetabular implant (except one case) and a bone autograft (except three cases). Complete weight bearing was authorised on day 3 postop for five patients, and at six weeks for ten; at three months for the other three.

Mean follow-up was 2.5 years. Thirteen surviving patients were reviewed clinically and radiographically. Five patients who had died were also included in the analysis using data reported by family before death.

The Postel-Merle d’Aubigné (PMA) and Harris scores were recorded. Survival curves were plotted. Radiological assessment included bone healing, status of the prosthetic assembly, presence of a lucent line or signs of loosening in the three acetabular zones described by De Lee and Charnley.

Results: The mean functional scores were 13.6/18 (PMA) and 71.8/100 (Harris). There were no cases of infection or dislocation. Median Kaplan-Meier survival was six years. The one-year survival rate was 94.4%. Five deaths were recorded, all due to causes independent of the surgical intervention.

Radiologically, all fractures had healed. There were no mechanical complications and no signs of acetabular loosening.

Discussion: Several authors have demonstrated that prognosis is poor in elderly subjects undergoing surgical osteosynthesis or functional treatment due to the presence of risk factors (osteoporosis, comminution, deferred surgery due to poor general status). Prolonged bed rest may also have life-threatening consequences. Other work has emphasised the very high rate of complications after revision surgery for dismounted material, post-traumatic deterioration, or osteonecrosis.

The absence of early deaths and the low rate of intervention-related morbidity in this series of elderly patients is in agreement with a very small number of publications devoted to this topic.

Conclusion: This therapeutic attitude enables early verticalisation avoiding the complications related to the bedridden state in the elderly. In addition, subsequent revision for osteonecrosis of the femoral head or post-traumatic deterioration can be avoided. These results have incited us to pursue this therapeutic option.

Purpose: We report a retrospective series of 28 patients with trauma-induced dislocation of the knee. The purpose of our study was to evaluated long-term outcome after orthopaedic as well as surgical management of these injured knees and to propose a therapeutic attitude best adapted to the initial situation.

Material and methods: The series included 28 patients, including one who had a bilateral dislocation. There were four women and 24 men, mean age 35.3 years at the time of the accident (17–69). Mean follow-up was 10.8 years. Nineteen knees were treated orthopaedically after reduction, surgery was used for ten patients. Five patients underwent an initial operation (during the first week following the accident), five had a secondary operation one to eight years after the accident. Mobility and laxity were assessed clinically. The Lysholm-Tegner and the Meyers scores were used to assess function. Radiological results were assessed with the Ahlback classification and the IKDC score to judge potential progression to single-or triple compartment osteoarthritis.

Results: Clinically, mean amplitude was 105° flexion and −2° extension. Four knees were stiff with flexion = 80°. There was a persistent anterior drawer sign for all knees except four. Medial laxity (valgus) was often important (83% of the patients). Functionally, the mean Lysholm score was 80.5 (17–100). The mean pre and post-trauma Tegner score was 5.1/3. The Meyes classification showed 15 good and excellent results and eight fair and six poor results. Radiographically, more than half the patients had no sign of degenerative joint disease and only four knees has signs of true three-compartment osteoarthritis according to the Ahlback classification. Separate analysis of patients treated orthopaedically and surgically showed that good results with orthopaedic treatment concerned patients with an anterior or posterior dislocation with predominantly anterior laxity. The fair and poor results concerned six of the eight patients with initially multidimensional laxity, particularly postero-lateral laxity that persisted at last follow-up. Surgical treatment gave good results mainly when given early (four very good results out of five knees).

Discussion: Recent work has demonstrated very satisfactory results for femorotibal stability after ligament reconstruction, usually with allografts. Our good functional results, comparable with earlier series, and the encouraging radiographic results have led us to chose orthopaedic treatment for selected patients (correct preservation of the posterolateral plane, particularly in case of dislocation with hyperextension corresponding to grade II in the Schenck classification), and on the contrary, to prefer early surgical treatment for the posterolateral plane.

Conclusion: Management of injury to knee ligaments after femorotibial dislocations should be guided by a precise examination of the initial laxities conducted under general anaesthesia. If the posteriolateral plane is satisfactory, orthopaedic treatment followed by active rehabilitation can provide good functional and radiographic results.

We report a case of an aneurysmal cyst localized in the patella of a 37-year-old man. The lesion was secondary to a chondroblastoma at six years follow-up after initial curettage and bone graft. It were no recurrence. Treatment of aneurysmal cysts depends on the degree of articular involvement. We made a detailed study of 11 cases of this rare localization of aneurysmal cysts reported in the literature.