Purpose of the study: Because of the difficulty of maintaining anatomic reconstruction, plate fixation is limited for complex fractures of the calcaneum. Implants with angular stability can broaden classical indications and improve outcome.

Material and method: From February 2004 to February 2008 we treated 35 articular fractures of the calcaneum: 26 male, 6 female, 3 bilateral cases, mean age 41.46±15.99 years, age range 17–71, ≥ 3 displace fragments [Duparc IV:16; Duparc V: 16], preoperative CT [Sanders III: 22; IV: 13]. The surgical procedure was performed by one operator on days 4 to 7: lateral wide-L incision; articular and extra-articular reduction; lateral fixation using an AO-LCP^® plate with locking screws. Intra- and postoperative X-rays (Boehler angle, talo- and cubocalcaneal congruence), postoperative CT. Rehabilitation: mobilisation of the talocalcaneal joint on day 21; partial weight bearing after 2 months; complete weight bearing after 3 months. Radiological and clinical (Kitaoka) follow-up every 60 months.

Results: Anatomic joint reduction was achieved and maintained by osteosynthesis (35/35). Late healing (smoking) (6/35). Healing: 2 months (21/35), 3 (14/35). Plate failure at 3 months without displacement (2/35). Anatomic joint reduction sustained ≥12 months (35/35). Gait without crutches after three months (35/35). Infection at 12 months (1/35). Mean follow-up (40 months, range 12–60).

Discussion: The purpose of surgical treatment is to achieve anatomic reconstruction of all joint surfaces and restore calcaneal height, length, width and alignment until bone healing. Complex joint fractures with a high risk of loss of correction or secondary nonunion have limited the use of conventional reduction-osteo-synthesis methods in favour of first-line reconstruction-arthrodesis. These complex fractures require plates with multiple fixations to maintain stability. Optimal recover of function can be achieved if the anatomic reduction of the joint surface and extra-articular elements can be maintained stable from the start and sustained to healing, demonstrating the usefulness of reconstruction. No series has reported this innovating therapeutic concept.

Conclusion: The reconstruction plate with locked screws enabled osteosynthesis of the most complex calcaneal joint fractures for which the discussion remains open concerning the role of osteosynthesis. The resistant fixation of all the fragments using screws with angular stability enabled stable reconstruction without loss of primary reduction, either secondarily or late, and allowed rapid rehabilitation. The long-term stability of the anatomic reconstruction guarantees good functional outcome which persists over time.

Aims: Internal Fixation of complex calcaneal articular fractures is debated: a perfect and upheld reduction is challenging. Could locked screws calcaneal plates drive back the limits of Internal Fixation instead of initial arthrodesis, involve a faster rehabilitation and improve the results?

Methods: Between 2004 and 2008, 32 patients (26 men, 6 women), sustained 35 complex calcaneal articular fractures. Age: 41.46 [17–71] ±15.99 years. Pre operative TDM: ≥3 displaced articular fragments (Sanders III: 22 and IV: 13). ORIF by the same surgeon, between D4 and D7, through a lateral approach and using an AO LCP^® locked screws calcaneal plate. Intra operative X-ray controls, postoperative TDM. Articular re-education at D30. Complete weight bearing at D90. Follow-up until 60 months (X-ray and Kitaoka score).

Results: Obtained and upheld anatomical articular reduction -Boehler’s angle, talo and cubo-calcaneal congruence-: (35/35). Bone healing: 8 weeks (21/35) and 12 weeks (14/35). Delayed wound healing -smokers-: (6/35). Anatomical articular upholding after 12 months: (35/35). Plate ruptures at D90 without displacement: (2/35). Walking without crutch after D90: (35/35). Mean follow up: 40 months.

Conclusion: Locked screws calcaneal plate used for the fixation of complex articular calcaneal fractures showed no displacement in the primary and secondary healing time. These facts limit the place of initial arthrodesis and streamline the initial recovery process. This may be beneficial for clinical use and the long term follow-up.

PURPOSE: Oldest elderly trochanteric fractures treatments are common but long term follow up studies are indistinct. Previous data about all outcomes are not reported for oldest one. The purpose was to update all the results for these oldest old patients.

METHODS: A prospective, longitudinal study was undertaken of 455 “31 A1, A2, A3” (OTA) peritrochanteric femur fractures through 2002. There were 84% female patients. The age was 88 (80–105) ±5 years. Associated hip arthritis rate was 10%. 31 A1 and 31 A2 really trochanteric fractures were 90% (31 A1: 52% and 31 A2: 38%), 31 A3 subtrochanteric were 10%. Surgical treatment was achieved for 97%: [extramedullary internal fixation (dynamic hip screw): 36%, intramedullary (trochanteric nail): 56%, hip arthroplasty: 5%]. Functional treatment (not displaced or contra-indicated) was achieved for 3%. Katz, mental, Parker, walking scores, live place before and at long term after fracture, radiological healing and complications were registered.

RESULTS: The radiological healing rate after 3 months was 85% and after 6 was 97%. Complications rate: the general complications rate during 1st month was 12% and between 1st and 3rd month was 8%. The local complications rate during the 1st month was 4% (local infection: 1%) and between 1st and 3rd month was < 1%. The new surgical procedures rate during the 1st month was < 0.5%, between 1st and 3rd month was 3%, between 3rd and 6th month was 3%. Clinical results: Post-operative weight bearing was uncertain. 6th month after fracture 72% of the patients were alive (dead: 28% and non-surgically treated: twice more). All scores and live place demonstrated dependence increase. > 6th month after fracture mortality was common.

CONCLUSION AND SIGNIFICANCE: Intra/extra capsular hip fractures ratio increases after 80. These are older, more dependant and help demanding. Hip arthritis inflates hip fracture risk. Success points technical procedures had been demonstrated by randomised studies: dynamic hip screws for stable fractures and trochanteric nails for unstable; hip prosthesis for arthritis or poor bone. Practice surgery for all trochanteric fractures. Don’t separate trochanteric/subtrochanteric. The prognostic is rather poor (mortality rate, functional outcomes), depending on initial functional score and dependence. Modern internal fixation is reliable. Arthroplasty should be considered.

Aims: Functional outcome following pelvic ring fractures is closely correlated with the anatomic results. ORIF is correlated with good anatomic results but with morbidity. Isolated sacro-iliac screws are inadequate. We assessed outcome after complete Minimal-Invasive-Surgery. Methods: Between 1998 and 2001, 21 consecutive patients with unstable pelvic-ring disruptions [15 AO C, 6 AO B] were treated operatively. In a supine position, after close reduction of the fractures, anterior þxation, percutaneous stabilization of the posterior lesions was accomplished using ßuoroscopically-guided ilio-transsacral 7,3 mm cannulated lag-screws inserted through the body of S1 to the opposite sacroiliac joint. Results: Delay from injury to þxation was 4 (0–8) days. 13 anterior þxations and 21 ilio-transsacral cannulated screws were placed. No secondary complications. The main outcome was 2 years; radiographically, 19 anatomic reductions of the posterior fractures and 2 vertical ascensions (5 mm) were achieved. The mean Majeed score was 95. Conclusions: Early stabilization of instable pelvic-fractures in a supine position using percutaneous ilio-transsacral screws and anterior þxation is a technique that lends itself to a variety of unstable pelvic fractures. This diminishes potential blood loss and operative times in multiply injured patients. An obvious limitation in the percutaneous technique is the inability to restore the normal anatomy. Surgical stabilization allows early mobilization of the patients, prevents progressive deformity and obtains good functional results.