Introduction. Sternoclavicular dislocations are well-known adult injuries. The same traumatism causes growth-plate fracture of the medial clavicle in children and young adults. At this location, the emergence of the secondary ossification center and its bony fusion are late. We report the results of 20 cases hospitalized in the Toulouse University Hospital Center that were treated surgically. Materials & Methods. 20 patients were treated between 1993 and 2007, 17 boys and 3 girls, 16 years old (6–20). The traumatism was always violent (rugby 75%). Two physeal fractures were anteriorly displaced, and 18 posteriorly. The follow-up is 64 month (8–174). Clinical, radiographic and therapeutic characteristics were assessed. The long-term results were analysed with: an algo-functional scale (Oxford shoulder score), the subjective Constant score, a functional disability scale (Shoulder simple test), a quality of life scale (DASH), and global indicators (SANE and global satisfaction). Results. all the patients were symptomatic before surgery: pains, oedema and partial functional impotence. Only 2 dysphagia, 1 dyspnea and 1 venous circulation alteration were observed. The first clinical and radiological examination, before CT scan, didn't diagnose the injury in 8 cases. The CT scan were realized for all the patients: it diagnosed the physeal fracture and showed 4 cases of vascular or respiratory compressions. There were 5 attempts of closed reduction, without success: all the patients were surgically-treated. The open reduction were completed by pinning (12 cases) or cerclage with absorbable suture (3 cases). Per-operatory findings lead to realize costo-clavicular repair plasties with the sub-clavicular muscle (3 cases) and/or capsular-ligamentous-perosteal selective plasties (13 cases). Two cases of broken Kirschner wires were noticed, without migration. Functional outcomes are largely good or excellent: STT 11,74/12 (10–12)–OSS 12,95/60 (12–19)–DASH 2,07/100 (0–17,6)–SANE 93,16% (60–100). Discussion and Conclusion. we present the largest case series in the literature. CT scanner is the essential element of the diagnostic process and may allow the distinction between true sterno-clavicular dislocation and displaced physeal fractures. This distinction is difficult at younger ages and is facilitated by the progression of ossification. Very good results were obtained, but classical pitfalls of treatment were found: instability after closed reduction, broken K-wires, recurrent anterior instability, inesthetic scars

Introduction. Conservative treatment of Achilles tendon ruptures may lead to re-rupture. Open surgical repair entails a risk of skin necrosis or infection. Several percutaneous techniques have been used, like Tenolig® or Achillon®, but these techniques are costly and may be marred by wound healing problems. Ma and Griffith described a technique for percutaneous repair witch left the suture and the knot under the skin, thus reducing the risk for infection. Material and Methods. From January 2001 to September 2006, we used this percutaneous treatment for 60 acute ruptures of Achille tendon. The repair was made under local anaesthesia, using a single or double absorbable suture. Postoperative care was 3 weeks immobilisation in a cast in equinus position with no weight bearing, followed by another 3 weeks in a cast with the ankle at 90° with progressive weight bearing. Results. Mean follow-up was 19 months. Complications were 2 re-ruptures at 2 and 5 months respectively, 1 infection in a patient who presented with re-rupture after a previous surgical treatment, and 1 Achilles tendonitis. There was no sural nerve lesion. Mean time to return to working activities was 85 days and mean time to return to sports activities was 5 months. The three competitive sportsmen returned to sports at six months, at the same level. Monopodal weight-bearing was possible for all the patients except one. Hopping was not possible in eight cases. Walking on tiptoe was not possible in four cases. A 5° limitation of dorsiflexion of the ankle was observed in four patients. Clinical results were good with no loss in range of motion. The patients’ subjective evaluation was as follows: 18 judged the outcome as very satisfactory, 40 as satisfactory and two as poor. Discussion. The percutaneous suture technique used in this series differs from other methods of surgical repair in being inexpensive. The only specific equipment required is a long needle with an eyelet, sufficiently rigid to transfix the tendon. In this study we had used a custom needle as the prototype of the “Suturach®” (FH Orthopedics, Heimsbrunn, France) needle which we now use. The technique does not require expensive surgical material and above all, does not leave any foreign body externally in contact with the skin (5) which could be a source of local inflammation, or even of cutaneous necrosis (12). This is particularly important for countries with a hot climate where it is not customary to wear closely fitting shoes. The technique used is reliable, reproducible and easily taught. In this series, it was performed by a number of operators with various levels of training. Conclusion. Percutaneous suture of the Achilles tendon appears as a simple, rapid, effective, reproducible and inexpensive technique. It combines the advantages of open surgery with a low risk of re-rupture and those of functional treatment with a low risk of infection

Aims

Open reduction and plate fixation (ORPF) for displaced proximal humerus fractures can achieve reliably good long-term outcomes. However, a minority of patients have persistent pain and stiffness after surgery and may benefit from open arthrolysis, subacromial decompression, and removal of metalwork (ADROM). The long-term results of ADROM remain unknown; we aimed to assess outcomes of patients undergoing this procedure for stiffness following ORPF, and assess predictors of poor outcome.