Purpose of the study: Different posterior osteosynthesis techniques have been described for the treatment of unstable injury of the pelvic girdle. Bi-iliac fixation using threaded rods or plate-screw fixation has been proposed. The purpose of this work was to describe a modification of the posterior osteosynthesis using instrumentation designed for the spinal column.

Material and methods: From January 2006 to October 2008, four patients (three men, one woman, mean age 24 years, range 18–34) underwent surgery in our unit for unstable fractures of the pelvis with a trans-sacral posterior fracture line (AO classification C1.3–4). Two patients presented neurological signs including one by head trauma with hemiplegia. Two patients had an anterior fixation with an external fixator and another an anterior plate fixation. The operation was conducted via a posterior midline incision. After reduction of the fracture, the osteosynthesis was achieved with two poly-axial screws inserted in each of the iliac wings and connected by two rods and one or two cross connectors.

Results: Mean follow-up was 7.5 months (range 5–17). None of the patients developed infectious, neurological or mechanical complications postoperatively. Complete pain-free weight-bearing and walking were achieved in patients at three months. None of the patients had a horizontal or vertical misalignment callus measuring more than 5 mm. Screw analysis showed that three screws penetrated the sacroiliac joint in the first patient of the series with no clinical consequence.

Discussion: This posterior fixation technique for unstable fractures of the pelvis appears to be reliable and reproducible for type C fractures in combination with anterior fixation. It uses standard instrumentation for spinal osteosynthesis. A study with a larger population and longer follow-up is needed.

Disruption of the interosseous membrane is easily missed in patients with Essex-Lopresti syndrome. None of the imaging techniques available for diagnosing disruption of the interosseous membrane are completely dependable.

We undertook an investigation to identify whether a simple intra-operative test could be used to diagnose disruption of the interosseous membrane during surgery for fracture of the radial head and to see if the test was reproducible.

We studied 20 cadaveric forearms after excision of the radial head, ten with and ten without disruption of the interosseous membrane. On each forearm, we performed the radius joystick test: moderate lateral traction was applied to the radial neck with the forearm in maximal pronation, to look for lateral displacement of the proximal radius indicating that the interosseous membrane had been disrupted. Each of six surgeons (three junior and three senior) performed the test on two consecutive days.

Intra-observer agreement was 77% (95% confidence interval (CI) 67 to 85) and interobserver agreement was 97% (95% CI 92 to 100). Sensitivity was 100% (95% CI 97 to 100), specificity 88% (95% CI 81 to 93), positive predictive value 90% (95% CI 83 to 94), and negative predictive value 100%).

This cadaveric study suggests that the radius joystick test may be useful for detecting disruption of the interosseous membrane in patients undergoing open surgery for fracture of the radial head and is reproducible. A confirmatory study in vivo is now required.

The goal of this retrospective study was to evaluate the result of this technique proposed as initial treatment (group 1: 17 cases) or after a failure of repairing cuff (group 2: 7 cases).

Materials and Methods: Eleven females and thirteen males with an average age of fifty six years were available for this study. Initial rupture was always massive (2 tendons, retracted to the glenoid level), superior and posterior(20 cases) with superior lesion of the subscapularis in 4 cases. An ascension of the humeral head was found in 18 cases. Degree of fatty degeneration evaluated with CT arthrogram was 3.45 for the supra spinatus and 3.25 for the infra spinatus. The latissimus dorsi was harvested with axillary approach and released from the angle of the scapula to be able to cover the humeral head. Coraco acromial arch was preserved. Abduction splint was maintained 6 weeks.

Results: The average follow up was 21 months(12/48). For the 24 patients Constant score was improved from 34,6 to 55,6(+21): a significant improvement of forward active elevation from 98° to 153 (+55°) but a little improvement of external rotation from 23 to 33 (+10°). The best results were obtained in group 1: constant score progressed from 34 to 58 (+24) with an increasing of 66° (98 to 164°) of forward active elevation and 13°(22 to 35°) of external rotation. Results of group 2 are less: Constant score progressed from 36 to 51(+15), forward elvevation 33°(96 to 129°) and 3° (27 to 30°) of active external rotation. 2 failures caused by a rupture of the transfer. Painrelief was obtained in 90% but any improvement of strength.

Discussion and Conclusion: Ours results indicate that latissimus dorsi transfer improves range of motion, pain, function and patient satisfaction with irreparable rotator cuff tear. We recommend to use it for pseudoparalytic and painfull shoulder, with a persistent acriomo humeral space, after failure of rehabilatation, for young patient. A stable humeral head with a good subscapularis without previous operation are good pronostic factors.

Total shoulder arthroplasty is a well-established and widely accepted method of treatment for a variety of shoulder disorders, loosening of the glenoid prosthesis is the main complication in total shoulder arthroplasty, it is highly dependent on the quality of the glenoid cancellous bone. Very little is known about mechanical properties of this cancellous bone. The objectives of this study were to determine the mechanical properties (elastic modulus and strength) of glenoid cancellous bone in the axial, coronal and sagittal planes including regional variation using a uniaxial compression test. To our knowledge, this kind of study was not done before.

Eleven scapulas were obtained from six fresh-frozen, unembalmed human cadavers (mean age eighty-eight years). Eighty-two cubic cancellous bone specimens of 6×6×6mm3 were used for mechanical testing in the three planes. The test was a uniaxial compression along each direction, Elastic modulus and strength were determined from the stress-strain curve. Apparent density was also calculated.

The study showed significant differences in the mechanical properties with anatomic location and directions of loading. Young modulus and strength were found to be significantly higher at the posterior part of the glenoid with the weakest properties at the antero-inferior part. Cancellous bone was found to be anisotropic with higher mechanical properties in the latero-medial direction (perpendicular to the articular surface of the glenoid). The apparent density was on average equal to 0.29 g/cm3 with the higher values at the posterior and superior part of the glenoid. Good correlation between apparent density and elastic modulus was found only in the sagittal plane but not in the coronal and axial plane, the overall correlation was low (r2 = 0.22, p< 0.0001) which emphasizes the role of trabecular bone architecture in predicting mechanical properties.

The mechanical properties determined in this study provide input data for finite element method analyses and may help to assist in uncemented shoulder prosthesis design.