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.

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.

Purpose: We report the clinical and radiological course in a continuous series of 194 patients treated by the same team between 1996 and 2001 for thoracolumbar fracture. Cotrel frame instrumentation and Boëhler corset immobilisation were used.

Material and methods: In this series of 65 women and 129 men, age range 16 – 77 years, we retained one year follow-up at least for inclusion in the study. More than 85% of the patients were retained for study and the final analysis concerned 150 patients who were contacted.

All patients were in Frankel class E. In compliance with the SOFCOT 1995 Symposium, the method described by Rosset and Laulin and the international classification described by Magerl were applied to pre-operative x-rays to search for the pathogenic mechanism involved. The radiological analysis was conducted on preoperative, immediate post-operative, 1-month, 3-month, and last follow-up x-rays. The course of spinal kyphosis and angular deformation of the trauma zone and the subjacent disc were analysed. In addition to the overall series, patients with limit therapeutic indications, according to the local kyphosis and trauma-induced regional angular deformation, were also studied.

Results: For the initial indication of choice, type A1 fracture, gain in reduction was minimal for the constraining treatment. For type A3 fractures, posterior displacement of the posterior wall was not a contraindication because the posterosuperior reduction could be achieved by ligamentotoxis in the majority of the cases The gain in correction of spinal kyphosis was greater in these patients. Nevertheless, for this type of fracture, spinal kyphosis greater than 15° was an implicit sign of a potential posterior distraction lesion where osteosynthesis might be indicated, especially since the USS fixator uses a parallel assembly and authorises short instrumentations.

Conclusion: The Boëhler technique is a safe, minimally invasive and low-cost method for the treatment of thoracolumbar spine fractures, which enabled 30% correction of the spinal kyphosis. This method retains its indications for type A fractures.