The present study sought to assess the clinical and radiological results and long-term joint impact of different techniques of lateral ankle ligament reconstruction.

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: 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.

Excision is not a suitable treatment for all comminuted fractures of the radial head. In elbows where instability can be predicted, a replacement arthroplasty of the radial head is more effective. The aim of this paper was to present the medium-term results of the Judet floating radial head prosthesis.

This operation was performed on 14 patients between 1992 and 2003, of whom 12 were reviewed at a mean follow-up of five years and three months (1 to 12 years). The outcome was assessed using the Mayo elbow performance score and a modified Disability of Arm Shoulder Hand (DASH) questionnaire. There were six excellent results, four good, one fair and one poor, as graded by the Mayo score. The mean DASH score was 23.9/100 (0 to 65.8/100). The only significant complication occurred in one patient who developed a severe complex regional pain syndrome. There were no patients with secondary instability of the elbow, implant loosening, cubitus valgus, osteoporosis of the capitellum, or pain in the forearm and wrist. Our experience, combined with that of other authors using this device, has encouraged us to continue using the Judet prosthesis in comminuted fractures of the elbow where instability is a potential problem.

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.