We describe a symptomatic, progressive restriction of knee flexion due to an accessory quadriceps femoris in a nine-year-old girl. There was no history or findings of post-injection fibrosis, nor any obvious swelling of the affected quadriceps. At arthroscopy no intra-articular pathology was found. An accessory ‘quinticeps femoris’ was diagnosed by ultrasonography and MRI. Following excision of the muscle and tendon full flexion of the knee was regained and there was no recurrence of the contracture.

We have reviewed our experience in managing 11 patients who sustained an indirect sternal fracture in combination with an upper thoracic spinal injury between 2003 and 2006. These fractures have previously been described as ‘associated’ fractures, but since the upper thorax is an anatomical entity composed of the upper thoracic spine, ribs and sternum joined together, we feel that the term ‘fractures of the upper transthoracic cage’ is a better description. These injuries are a challenge because they are unusual and easily overlooked. They require a systematic clinical and radiological examination to identify both lesions. This high-energy trauma gives severe devastating concomitant injuries and CT with contrast and reconstruction is essential after resuscitation to confirm the presence of all the lesions. The injury level occurs principally at T4–T5 and at the manubriosternal joint. These unstable fractures need early posterior stabilisation and fusion or, if treated conservatively, a very close follow-up.

Purpose of the study: Treatment of distal fractures of the radius with posterior displacement remains a controversial issue. In the past, the anterior approach used for osteosynthesis failed to enable sustained reduction. With the recent development of locked plating systems, it might be useful to revisit this technique.

Material and methods: Between November 2001 and April 2003, 23 patients (15 females, 8 males), mean age 55 years (range 17–75 years) were treated with an LCP 3.5 T plate (Mathys Medical SA, Bettlach, Switzerland). The anterior Henry approach was used. There were 16 extra-articular fractrures and seven with an associated intra-articular fracture line. Radiographic analysis searched for secondary displacement and was coupled with clinical examination with force measurement (DASH). The Herzberg score used for the SOFCOT 1999 symposium was noted.

Results: Eighteen patients were reviewed with mean follow-up of 16 months. Radiologically, all fractures had healed at twelve months, with only one case of secondary loss of reduction. According to the SOFCOT symposium criteria, bone healing was anatomic for 13 cases and with moderate misalignment for five. Wrist force (Jamar) on the operated side was 95% of the opposite side. The mean DASH was 22.7. The Herzberg outcome was: excellent (n=9), good (n=6), fair (n=3), and poor (n=0). Complications were: reflex dystrophy (n=4), carpal tunnel syndrome (n=1), cheloid scar (n=1), irritation of the common extensor of the fingers (n=1).

Discussion: Secondary displacement after fracture of a posteriorly displaced fracture of the distal radius frequently lead to misalignment which is often poorly tolerated. The LCP system maintains a stable reduction long enough to reduce the rate of secondary displacement.

Conclusion: A comparative study of the commonly applied techniques (pinning) would be necessary to define the appropriate indications for this more costly technique.

Introduction The aims of this paper was to check the main clinical features of the posterior ankle impingment syndrom and to evaluate the results of the surgical treatment according to a retrospective study. Material and Methods 21 patients (17 males,4 females),(mean age of 33 years)were operated on between 1991 and 1999. 71 % had sporting activities. Plantar flexion were painful in 94 % of cases with various radiological changings of the posterior process of the talus and soft tissues surrounded (XRays, radionucleid imaging, CTscan and MRI). A posterior approach were performed with bone resection and peritalar joints debridment. Results All the patients were clinically and radiologically reviewed using AOFAS score. The mean follow-up was of 5 years(range 3 to 10 years). No septic evolution were reported. The overall functional results were excellent with a mean AOFAS score of 90/100 points with no degenerative changings in the peritalar joints. The patients were satisfied in 90 % of the cases Discussion-Conclusion Surgical managment is a successful and reliable procedure to treat the posterior ankle impingment syndrom, very frequent in sporting population and nowadays well documented by conventional Xrays and uptodate radiological examinations.

Introduction: Previously, we noticed loss of initial reduction with conventional palmar plate osteosynthesis for dorsally displaced distal radius fractures. Locking Compression T plate may provide more stable fixation and we report our early experience.

Materials and methods: Between November 2002 and April 2003, 23 patients (15 women, 8 men), mean age 55, (17–80) underwent open reduction and internal fixation using 3.5 mm locking compression oblique T plate (SYNTHES) through a Henry ‘s approach and a 2 weeks plaster cast immobilisation. All fractures were dorsally displaced. According to AO classification there were 15 A3 and 8 C1 and C2 fracture. 18 patients could be reviewed with a mean follow up of 16 months (6 to 30) Pre operatively, radial inclination was 11.7 ° (0–20), dorsal angulation 25.9 ° (8–48) and ulnar variance:4 mm (0–10)

Results: Post-operatively, radial inclination was 23,2. ulnar variance: 1,2 mm and ventral angulation 4,6 °. At one year follow-up, there was no loss of post-operative reduction. According to SOFCOT ‘s criteria, there were 13 anatomical results and 5 moderate malunion. According to Green and O ‘Brien’s criteria, there were 9 excellent, 6 good, 3 fair and no poor results. Mean DASH score was 22.8 (5.8 – 62.5). Strengh and pinch were respectively 95 % and 91 % when compared with the opposite side. There were 6 complications concerning 4 reflex sympathetic dystrophy, one carpal tunnel syndrome and one hypertrophic scar.

Discussion: In our experience, classic palmar plate fixation showed inability for maintaining reduction during time. Locking Compression 3,5 T plate by a palmar approach which is a demanding technique, avoids loss of post-operative recution

Conclusion Locking Compression 3.5 T Plate by palmar approach is an effective treatment for dorsally displaced distal radius fracture but the plate itself and ancillary tools have to be improved to reduce operatively difficulty.

Purpose: The aim of this work was to evaluate functional and anatomic results of MacIntosh quadriceps plasty reinforced with a free fascia lata transplant used for the treatment of severe anterior laxity of the knee.

Material and methods: We considered severe laxity to be defined as a differential greater than 10 mm (manual Lachmann maximum on KT1000) compared with the healthy side and/or an explosive pivot test scored +++ and/or absolute laxity measured at 20 mm. This retrospective series included 108 patients treated between 1995 and 1998 by the same operator (DS). There were 70 men and 38 women, mean age 29±8.7 years (15–52). Average time from trauma to treatment was 38 months (2–324). Among the 98 patients practicing sports, 47 (43.5%) practiced pivot sports with contact and 51 (47.2%) practiced pivot sports without contact. Mean preoperatiove laxity KT1000 was 18±3 mm (13–30) on the diseased side and 5.34±1.9 mm on the healthy side (15 knees excluded due to rupture of the contralateral anterior cruciate ligament). Mean differential laxity was 12.6±2.3 mm (9–21) and in 44 patients (40.8%) the pivot test was scored +++. Only 37 knees (34%) were totally free of meniscal lesions. Outcome was evaluated by an independent operator using the IKDC method.

Results: Results were analysed for 71 patients (37 lost to follow-up giving a review rate of 65.8%) with a mean follow-up of 63.4±12.9 months (40–86). Absolute postoperative laxity was 8.9±2.9 mm (2–18) and differential laxity was 2.6±2.3 (−2 to +8) giving a mean gain in laxity of 10 mm. The pivot test was negative in 73.2% of the knees, 22% were scored +, and 4.2% ++. The overall IKDC score was 87.3±9.6 (56–100). 90% of the patients were satisfied or very satisfied with outcome. Furthermore, 80.3% of patients were able to resume their sports activities at the same or higher level.

Conclusion: Mixed plasty using the MacIntosh method with lateral reinforcement using the fascia lata enables effective treatment of severe anterior laxity of the knee. Few studies have differentiated laxity according to severity. Prospective randomised studies devoted to patients with very severe laxity are needed to confirm the results of this technique in comparison with isolated plasty of the anterior cruciate ligament without lateral reinforcement.

Purpose: We present a prospective review of 30 unstable pelvic ring fractures treated with iliosacral screw fixation under fluoroscopic guidance with or without anterior osteo-synthesis.

Material and methods: Thirty patients were included between January 1997 and June 2000. They were all treated in an emergency setting by traction with or without a pelvic clamp. Osteosynthesis was deferred for a mean eight days. Percutaneous iliosacral screw fixation was used in all patients associated with symphsis osteosynthesis in eight. The radioscopic technique used three views: inlet, outlet and lateral. There were three Tile B fractures, 26 Tile C fractures and one sacral fracture. The ISS was 30.8/75. Eleven patients experienced haemorrhagic shock, 16 had injuries to the lower limbs, four had surgical urological injuries, and seven had emergency arterography. A neurology examination and CT scan were obtained pre- and postoperatively. Clinical assessment used a visual analogue scale, the Majeed score, and the WHO score. Peroperative radiation was quantified in minutes, Kvots and mA.

Results: Fifty-one screws were implanted, 24 patients with two screws. There were 12 outside the bone and seven potentially iatrogenic lesions among the 18 neurological lesions observed. Mean radiatio was 1.03 min per patient and 0.6 min per screw. Mean follow-up was 24 months (9–50). Clinically the mean scores were: Majeed 8.5/100, WHO 0.7/3, visual analogue scale 3.2/10). Twenty patients suffered pain related to associated injuries. There were three dismantelings including one requiring revision surgery. Deformed callus was: anterior vertical translation 2.9 mm, posterior vertical translation 4.5 mm and horizontal anterior translation 3 mm. There was one complication for the symphysis fixation.

Discussion: These results are comparable to those reported in the literature. Complications are less frequent with this method. External reduction is good when achieved early. This series represents a learning curve where the 12 screws in extraosseous positions occurred during our first 16 cases. Implanting two screws per articulation increases the risk of extraosseous screws. Screw insertion is safer with the lateral view.

Conclusion: This series demonstrates that iliosacral percutaneous screw fixation is a valid method for the treatment of severe fractures of the pelvic ring. The rigorous method required is emphasised.