Background

While total shoulder arthroplasty (TSA) is a generally successful procedure, glenoid loosening remains a common complication. Though the occurrence of loosening was related to patient-specific factors, biomechanical factors related to implant features may also affect the fixation of the glenoid component, in particular increased glenohumeral mismatch that could result in eccentric loads and translations. In this study, a novel test setup was used to quantify glenohumeral pressures for different motion patterns after TSA.

Malunion is the most common complication of the distal radius with many modalities of treatment available for such a problem. The use of bone grafting after an osteotomy is still recommended by most authors. We hypothesised that bone grafting is not required; fixing the corrected construct with a volar locked plate helps maintain the alignment, while metaphyseal defect fills by itself. Prospectively, we performed the procedure on 30 malunited dorsally-angulated radii using fixed angle volar locked plates without bone grafting. At the final follow-up, 22 wrists were available. Radiological evidence of union, correction of the deformity, clinical and functional improvement was achieved in all cases. Without the use of bone grafting, corrective open wedge osteotomy fixed by a volar locked plate provides a high rate of union and satisfactory functional outcomes.

Ununited fractures of the scaphoid with extensive bone resorption are usually treated by bone grafting and internal fixation, using either an open or a minimally invasive technique. We studied the feasibility of percutaneous fixation without bone grafting in a consecutive series of 27 patients with established nonunion of an undisplaced fracture of the scaphoid and extensive local resorption of bone. They were treated by a single surgeon with rigid fixation alone, using a headless cannulated screw inserted through a volar percutaneous technique. Clinical examination, standard radiographs and CT confirmed that the fracture had united in all patients at a mean of 11.6 weeks (8 to 16), and that their functional scores had improved.

We concluded that extensive resorption at the fracture site is not an absolute indication for bone grafting, and that percutaneous fixation alone will eventually produce healing of ununited undisplaced fractures of the scaphoid regardless of the size of the gap.

Purpose of the study: The aim of this work was to study the functional and radiological results as well as any complications obtained after minimally invasive treatment of bimalleolar fractures.

Material and methods: The series included 100 fractures in 100 patients who underwent surgery between 1998 and 2000: 52 men and 48 women, mean age 47.1 years (range 17–96 years). According to the AO classification, the fractures were A:18, B:62, C:20. Osteosynthesis of the lateral malleolus was achieved with a Rush nail in 95 cases and with a K-wire in six. Closed osteosynthe-sis was achieved in 67 cases, an open procedure being used for 33 cases. Osteosynthesis was performed on the medial malleolus in 73 patients, 65 with a 3.5-mm screw, a K-wire for five, and a tutor-wire in two, all during an open procedure. The functional outcome was assessed at last follow-up using the Olerund and MOlander and the AOFAS scores.

Results: Mean follow-up was thirteen months (range 3–54 months). All fractures healed at mean eight weeks (range 6–24 weeks). At last follow-up, 90 ankles were radiographically anatomic. Mean function scores were: Olerund and Molander 73.5/90; AOFAS 85.8/100. Clinical outcome (Olerund and Molander) was excellent or good in 86 patients, poor in 12 and very poor in two. According to the AOFAS score, clinical outcome was excellent or good in 90 patients, poor in 9 and very poor in one. Considered by gender and type of reduction of the lateral malleolus, there was no difference in the distribution of the clinical outcome. There was however a strong correlation between the quality of the anatomic result and the functional outcome since poor anatomic results gave poor functional results in 80% of cases. The type of anatomic fracture had a certain importance since excellent and good results were obtained for type A fractures (94%) and type C fractures (90%) but 70% of the poor results were observed in type B fractures. There were few complications: two superficial infections, four cases of reflex dystrophy, and one thromboembolic event.

Conclusion: Compared with other operative techniques, the advantages of this method are basically linked to the ability to respond to all the different forms of bimalleo-lar fracture, irrespective of the anatomic type. The operative protocol is well established. The procedure is easy to perform and rapid and provides excellent results.