Purpose of the study: Pelvic fractures disrupting the pelvic girdle often create a serious challenge for reduction and fixation. Type C fractures of the Tile classification provoke vertical instability. Percutaneous screw fixation under fluoroscopic control in patients positioned in dorsal decubitus enables an extension of early indications for fixation to patients with abdominal or thoracic injuries. The reduction is obtained by progressive transcondylar traction on an orthopedic table. The purpose of this study was to assess functional mid-term outcome and to analyze causes of failure.

Material and methods: From 1995 through 2003, we used the percutaneous sacroiliac screw fixation method for type C fractures in 25 patients; clinical assessment at 45 months mean follow-up was available for 22 patients. Six patients presented a bilateral lesion (C2), seven a vertical sacral fracture (C1-3), and nine sacroiliac disjunction (C1-2). One screw was inserted for ten patients, two screws for twelve. Complementary anterior osteosynthesis was performed for eight patients.

Results: The functional outcome was assessed with the Mageed score. The mean score was 801%. All patients presente satisfactory postoperative reduction (less than 10 mm residual vertical displacement). Early displacement was noted one day 10 in one patient who underwent a revision procedure. There were two late secondary displacements (one with mobilization and one with material fracture) which heal in a misaligned position. There were no iatrogenic complications (neurologic, vascular, infectious) and no cases of nonunion.

Discussion: The long-term functional results were directly related to the quality of the reduction, as previously demonstrated by Matta. In our series, the quality of the postoperative reduction was significantly correlated with time from trauma to surgery. This delay must be as short as possible (less than five days for Routt). The main complication was secondary displacement which was observed in this study among cases with a single posterior screw.

Conclusion: Percutaneous sacroiliac screw fixation provides good functional results and appears to be a safe technique if the initial reduction is satisfactory. Two posterior screws are needed to avoid secondary displacement.

Purpose of the study: The incidence and type of complications observed with arthroscopic procedures remains a timely subject, particularly as the use of new techniques becomes increasingly widespread.

Material and methods: In cooperation with the members of ISAKOS, The International Society of Arthroscopy, Knee surgery and Orthopaedic Surgery, we instituted two studies: a retrospective study of upper limb arthroscopy complications and a prospective incidence study during a 30-day inclusion period with patient review at one month and quality-of-life scoring.

Results: The retrospective study analyzed complications of 57,604 arthroscopic procedures of the upper limb performed by 99 surgeons from 38 countries. Neurological complications, though generally transient, were the most frequent and were related to traction, locoregional anesthesia or the operative technique. Four deaths were recorded, all anesthesia-related. The prospective study included 364 patients operated on by 50 surgeons. There were 16 initial complications (4.39%): material problem (n=12), three intraoperative bleeding (n=3), atelectasia (n=1). The rate of conversion was 2.47%. At one month, there were five complications reported in 133 patients (3.75%): anesthesia-related problem (n=1), bleeding (n=1), synovial fistula (n=1), reflex dystrophy (n=2). There were no infections and no neurological lesions. The one-month outcome was considered good or excellent by 98.5% of surgeons.

Discussion and conclusion: The results of these surveys are in agreement with data in the literature where the rate of complications is higher in prospective studies than in retrospective studies. The prospective study did not disclose any neurological complication while arthroscopy of the upper limb is generally considered to raise the risk of with this type of complication. This study recalls that although arthoscopy has enabled a decreased incidence in complications compared with open surgery, it is not a benign intervention and can produce complications.

Purpose: It was demonstrated in 1986 that to obtain a good radioclinical result at 10–13 years after valgus tibial osteotomy for the treatment of medial femorotibial osteoarthritis that the frontal valgus at this follow-up had to be 3–6°. In 1995, it was demonstrated that the side of deterioration in knees initially aligned between 2° varus and 2° valgus or with genu valgum (≥ 3° valgus) depended on the tibiofemoral axis: a positive index (tibial torsion greater than femoral torsion) favouring medial femorotibial deterioration and progressive varisation, and a negative index favouring lateral femorotibial deterioration and progressive valgisation. Can the post-osteotomy valgus be modified by the tibiofemoral index and prevent obtaining ideal correction at 10–13 years?

Material and methods: Forty-five knees with femortibial deterioration of the medial compartment were treated between 1987 and 1990 by tibial medial opening osteotomy for valgisation. Functional outcome in the 45 knees was assessed at a mean follow-up of 11 years (range 10–13 years). Postoperative frontal axis after healing and frontal axis at last follow-up was measured by goniometry in the standing position for all knees. A scan in the torsion position was obtained for 36 knees to measure the tibiofemoral index.

Results: At maximum follow-up, outcome was good in 58% of the knees, fair in 24%, and poor in 18%, differences which were not statistically different. Frontal axis changed with time. Among the 36 knees which had been realigned correctly (3–6° valgus) after healing, four exhibited an increase in valgus beyond 6° and five lost valgus passing below 3°. But ideal valgus was achieved at last follow-up for three of five knees which had been undercorrected, Among the 38 knees for which a torsion scan was available, 33 were correctly realigned postoperatively and 22 were well aligned at last follow-up. There was no statistical difference between knees with good, fair, or poor outcome among the 33 knees well corrected postoperatively (3–6° valgus). There was however a statistical difference between the good (64%), fair (27%), and poor (9%) functional results among knees with ideal valgus at last follow-up (p = 0.03).

The variation between the postoperative and last follow-up goniometry data exhibited a statistical correlation with the tibiofemoral index (p = 0.0005). If the index was less than 13°, most of the knees showed an increase in valgus (13 out of 19 knees); if valgus was greater than or equal to 13°, valgus was lost (for 12 of 19 knees).

Conclusion: To have the best chance of obtaining a good functional result 10 to 13 years after tibial osteotomy for valgisation, the valgus at this follow-up must be between 3° and 6°. But to achieve this valgus, the postoperative valgus must be modulated in relation to the tibiofemoral index. For an index ≥ 13°, the postoperative valgus should be pushed towards 6°; for an index < 13°, valgisation should aim at achieving a 3° postoperative valgus or less.