Objective: The main treatment for unstable distal radius fracture in Québec consists in pinning and cast, with secondary shortening and displacement responsible for lack of motion. The goal of the study is to compare clinical and radiological results after treatment with non-bridging external fixator compared to pinning and cast, with restoration of grip strength as main clinical outcome.

Method: Between June 2003 and June 2005, 120 consecutive patients admitted for unstable extra-articular distal radius fracture were randomized in the 2 groups. Early mobilisation was allowed in the group with external fixator, and patients in the other group had pins and cast for 6 weeks. Follow-up was completed after 6 months with determination of clinical and radiological data for the both wrists.

110 patients completed the study, with 2 comparative groups for epidemiologic and radiological criteria (n = 63 for pins and 57 for external fixator).

Results: Grip strength was significantly better in the fixator group at 3 months (68,36%;p< 0,001) and 6 months (98,26%;p< 0,001). Active ROM was better and obtained earlier in the fixator group in all directions (p< 0,001). Fixator prevent shortening and secondary displacement in a highly significant way (p< 0,001). No difference in pain medication, but fixator group could begin occupation earlier (p< 0,001).

Conclusion: Non-bridging external fixator is a treatment of choice for unstable extra-articular distal radius fractures. The immediate stability allows in all patients (without influence of age, bone quality or fracture displacement) early mobilisation, prevent secondary displacement, and gives earlier and better functional results.

Purpose: The main treatment for unstable distal radius fracture in Québec consists in pinning and cast, with secondary shortening and displacement responsible for lack of motion. The goal of the study is to compare clinical and radiological results after treatment with non-bridging external fixator compared to pinning and cast, with restoration of grip strength as main clinical outcome.

Method: Between June 2003 and June 2005, 120 consecutive patients admitted for unstable extra-articular distal radius fracture were randomized in the 2 groups. Early mobilisation was allowed in the group with external fixator, and patients in the other group had pins and cast for 6 weeks. Follow-up was completed after 6 months with determination of clinical and radiological data for the both wrists. 110 patients completed the study, with 2 comparative groups for epidemiologic and radiological criteria (n = 63 for pins and 57 for external fixator).

Results: Grip strength was significantly better in the fixator group at 3 months (68,36%;p< 0,001) and 6 months (98,26%;p< 0,001). Active ROM was better and obtained earlier in the fixator group in all directions (p< 0,001). Fixator prevent shortening and secondary displacement in a highly significant way (p< 0,001). No difference in pain medication, but fixator group could begin occupation earlier (p< 0,001).

Conclusion: Non-bridging external fixator is a treatment of choice for unstable extra-articular distal radius fractures. The immediate stability allows in all patients (without influence of age, bone quality or fracture displacement) early mobilisation, prevent secondary displacement, and gives earlier and better functional results.

Four matched pairs of fresh frozen human femora were used to compare the biomechanical properties in axial and torsional loading of a Locking Condylar Plate and a retrograde intramedullary nail. One-centimeter gap osteotomy was created in the supracondylar region to simulate an AO/OTA 33-A3 fracture. The instrumented specimens were then mechanically tested under physiologic conditions in axial and torsional loading to determine the stability of the constructs. This laboratory study enhances the biomechanical advantages of the Locking Condylar Plate when fixation stiffness is essential. Devices with head locking screws provide angular rigidity and maximize fixation stability in osteopenic bone.

To compare the biomechanical properties in axial and torsional loading of a Locking Condylar Plate and a retrograde intramedullary nail. To determine the modes of failure of these two devices under axial loading.

Four matched pairs of fresh frozen human femora were used. Plain film radiographs and Dexa scanning were performed to evaluate bone quality and to screen for pathologic lesions. For each pair, one femur was stabilized with the Locking Condylar Plate and the other with a retrograde nail.

One-centimeter gap osteotomy was created in the supracondylar region to simulate an AO/OTA 33-A3 fracture. Radiographs were obtained to exclude iatro-genic fractures before mechanical testing. The instrumented specimens were then mechanically tested under physiologic conditions in axial and torsional loading to determine the stability of the constructs. Three-dimensional displacement across the fracture site was recorded. Finally, all femurs were loaded to fracture under axial loading. The modes of failure were determined by assessing final radiographs.

The Locking Condylar Plate provided statistically significant greater rigidity both in axial (p = 0.048) and torsional loading (p = 0.031) compared to the retrograde nail. The axial mode of failure occurred proximally for the plate and mainly at the distal fixation for the nail.

This laboratory study enhances the biomechanical advantages of the Locking Condylar Plate when fixation stiffness is essential. Devices with head locking screws provide angular rigidity and maximize fixation stability in osteopenic bone.

Purpose: The purpose of our tissue engineering work was to produce a substitute for the anterior cruciate ligament (ACL) in laboratory cultures for human implantation and to conduct fundamental studies on healing mechanisms.

Material: We used cells isolated from ACL biopsies obtained from the host, type I bovine collagen, and two bone blocks to produce ACL in culture.

Methods: Several layers of collagen containing host autologous ACL cells were superposed and linked to two bones that were placed on either side, according to a process currently being patented. The cells, or fibroblasts, enter into contact with the collagen matrix and start remodelling it, in the laboratory, before implantation. This ACL produced by tissue engineering can be ready for implantation 10–12 days after isolating the autologous cells from a ruptured ACL.

Results: Implantation of autologous ACL reconstructs was successful in eight goats. Histological analysis of the implanted grafts showed permanent integration into the tissues after 1–13 months. Th synovial membrane was reformed and rapidly vascularised, about one month after the graft. Thereafter, remodelling of the collagen matrix led to the formation of a very dense network of fibres, organised in bundles, very comparable to the normal histological aspect of the ACL. The bone blocks were also integrated by incorporation into the femur and tibia of the host. Sharpey fibres were present at the bone-ligament surface and a well structured fibro-cartilage was observed. In addition, the synovial membrane around the graft was innervated five months after implantation, suggesting that propioception could be recovered over time. Finally, progressive gain in force reached 20 – 36% of the normal ACL, 9 to 13 months after implantation;

Discussion: These promising data demonstrate that an autologous ACL with an interesting potential for regeneration can be produced in the laboratory, avoiding the risk of rejection and sparing healthy knee structures, thus favouring more rapid functional rehabilitation.

Conclusion: Tissue engineering is a new avenue of research with potential applications in orthopaedic surgery, particularly for reconstruction of the ACL.