Purpose of the study: Locked centromedullary nailing has proven efficacy for the treament of tibial shaft fractures but its use remains controversial for the most distal fractures. The purpose of this work was to assess clinical and radiological outcome of nailing procedures used to treat fractures of the lower quarter of the leg.

Material and methods: Fifty-eight fractures of the lower quarter of the leg were treated by locked centromedul-lary nailing between 1999 and 2002. All patients were included in the analysis. Twenty-four patients aged 44 years on average (range 18–68 years) were reviewed by an independent operator at mean 43.2 months follow-up (range 18–70). Four types of nail were used, on an orthopedic table for 47 procedures and with a hanging leg for 11. The fibula was not fixed.

Results: Early complications were: compartment syndrome (n=2) and infection (n=3). Postoperative alignment was anatomic or good in 86%. Mean time to weight bearing was 66 days (range 0–180). Nonunion occurred in six patients who required revision. Secondary displacement was noted in ten patients. Knee motion was normal in all patients and ankle motion was normal in 80%. Mean time to resumed occupational activity was 5.7 months (range 1–18). At last follow-up, bone healing had been achieved in all patients.

Discussion: As compared with data in the literature, we found that locked centromedullary nailing allows early weight bearing with less risk of infection for radiological results comparable with those obtained with plate fixation. The secondary displacements resulted from defective locking of inappropriately adapted materials (holes insufficiently distal).

Conclusion: Locked centromedullary nailing is a treatment of choice for fractures of the distal quarter of the leg. Use of new nails with more distal holes should improve outcome by allowing distal locking with at least two screws in all cases.

Purpose: Appropriate treatment of fractures of the acetabulum is well known but there is a risk of subsequent degeneration. Few reports of series reviewed after ten years are available. We report a series of 136 treated fractures of the acetabulum with a mean follow-up of 16 years.

Material and methods: Between 1972 and 1996, a total of 554 fractures of the acetabulum were treated. An independent operator reviewed 136 cases. The Judet Letournel classification was applied. Reduction was studied on the AP and 3/4 oblique views of the pelvis using the SOFCOT (November 1981) criteria. Intra- and postoperative parameters (blood loss, complications) were noted. Functional outcome was assessed with the Postel-Merle-d’Aubigné score.

Results: Orthopaedic treatment was used for 38% of the fractures. Forty-one percent were non-displaced and 54% were minimally displaced; 5% of patients had a contraindication for surgery. Reduction was achieved in 28% of the displaced fractures. Among the patients treated orthopaedically, 71% had a good or very good outcome. Anatomic reduction was achieved in 80%. The main complications were sciatic nerve injury (14%), heterotopic ossifications (18%), infection (5%) and intraarticular screws (5%). Good or very good outcome was achieved in 69%. A total hip arthroplasty was implanted in 19% at mean 8 years. Factors significantly related with poor outcome (p< 0.05) were age, posterior displacement, and surgeon experience. There was a good correlation between the function score and radiological signs of osteoarthritis.

Discussion: This is the longest follow-up reported in the literature. For operated patients, the percentage of good and very good outcomes was lower than in other series despite a good rate of anatomic reduction which thus is not a guarantee of good long-term outcome. Other prognostic factors found in the literature include fracture of the femoral head, type of fracture, and quality of the reduction. Long term follow-up remains essential for pertinent analysis of joint surgery.