Twenty-one patients with fractures of the distal tibial metaphysis, some with minimal displacement in the ankle, were treated by percutaneous plate osteosynthesis with a narrow limited contact-dynamic compression plate. Using the classification by the Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association, 17 fractures had no articular involvement, whereas four included intraarticular extension. At final followup (mean, 20 months), all the fractures healed without second procedures and the mean union time was 15.2 weeks. One patient had malalignment of the limb with 10؇ internal rotation, but there were no angular deformities greater than 5؇ or any shortening greater than 1 cm. All patients had excellent or satisfactory ankle function. There were no infections or any soft tissue compromise. Percutaneous plate osteosynthesis is a safe and worthwhile method of managing such fractures, which avoids some of the complications associated with conventional open plating methods.Conservative treatment of fractures of the distal tibia with extension into the ankle results in an unacceptable deformity and ankle stiffness. Conventional open reduction and plate fixation often requires extensive exposure and can result in the devitalization of surrounding tissue, infection, wound breakdown, and ankle stiffness. 20 These results have motivated orthopaedic surgeons to do biologic surgical techniques to reduce damage to soft tissues and the vascular supply to bone. 2 Intramedullary nailing, a main treatment of tibia diaphyseal fractures, sometimes fails to stabilize fractures in the distal metaphysis because of malreduction.Because of problems with other operative techniques, osteosynthesis with a percutaneous plate in which the fracture site is minimally exposed was investigated to better define its advantages and disadvantages as a treatment method for distal tibia metaphyseal fractures. MATERIAL AND METHODS PatientsThis retrospective study included 21 patients who sustained fractures of the distal tibia metaphysis.

Vascularized fibular grafting was associated with better clinical results and was more effective than nonvascularized fibular grafting for the prevention of collapse of the femoral head in a matched population with a Steinberg Stage-IIC or larger osteonecrotic lesion. The results of vascularized grafting were best when the procedure was used to treat precollapse lesions (Steinberg Stage IIC).

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The purpose of this study was to describe soft tissue injury patterns and report the clinical results of primary ligament repair with use of protected early mobilisation in unstable elbow dislocations with pure capsulo-ligamentous injuries. Twenty-four patients who presented with traumatic unstable elbow dislocation without associated intra-articular fracture were reviewed. Anatomical repair was performed using metal anchor screws and the bone tunnel method. Ligament avulsion was noted in 55% for the medial collateral ligament, 80% for the lateral collateral ligament, 60% for the flexor tendon and 80% for the extensor tendon. The overall mean Mayo Elbow Performance Score was 93.2. Brachial artery injuries occurred in two elbows. Heterotopic calcification was noted in 14 patients and there was one severe traumatic arthrosis. This study showed a high incidence of reattachable avulsion injuries to ligaments, tendon/muscle and capsule in unstable elbow dislocations. Primary ligament repair coupled with early rehabilitation provided satisfactory outcomes at two to four years postoperatively.Résumé Le but de cette étude est de décrire les lésions et de rapporter les résultats chez les patients présentant une luxation du coude avec lésion ligamentaire traitée par réparation ligamentaire et mobilisation précoce. Matériel et méthode: 24 patients présentant ce type de traumatisme sans lésion fracturaire intra articulaire ont été revus. Les lésions anatomiques ont été réparées avec soit une ancre soit une fixation ligamentaire par tunnels trans-osseux. Résultats: l'avulsion ligamentaire est notée dans 55% des cas pour le MCL, dans 80% pour le LCL, dans 60% pour le tendon fléchisseur et dans 80% dans le tendon extenseur. En tout état de cause, le score MEPS a été de 93,2. Une lésion de l'artère humérale a été observée sur deux coudes et des lésions de calcifications hétérotypiques ont été observées chez 14 patients avec, dans un cas, une arthrose sévère. Conclusion: cette étude montre l'influence que peut avoir la réinsertion ligamentaire dans ces lésions secondaires à une luxation du coude. Les réparations précoces associées à une réhabilitation également précoce permettent d'avoir des résultats satisfaisants après deux mois de suivi post-opératoire.

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We treated 31 femoral shaft fractures in 28 children with a mean age of 6.7 (5-10) years with retrograde flexible intramedullary nailing. There were 16 isolated fractures, while 12 children had associated injuries. The average time for union was 10.5 weeks and there were no delayed unions. There was one broken nail requiring change of treatment, but no infection or refractures. At follow-up after a mean time lapse of 27 months there was no limb-length inequality exceeding 1 cm and no malunion. We feel that femoral fractures in patients aged 5-10 years can be safely treated with retrograde flexible intramedullary nailing with minimal risk of surgical complications.Résumé Nous avons traité 31 fractures de la diaphyse fémorale chez 28 enfants avec un âge moyen de 6.7 (5-10) années par enclouage flexible centro-médullaire rétrograde. Il y avait 16 fractures isolées alors que 12 enfants avaient des lésions associées. Le temps moyen de consolidation était 10,5 semaines et il n'y a eu aucune retard de consolidation. Il y avait un clou cassé qui né-cessita un changement de traitement, mais aucune infection ou fracture itérative. Au suivi moyen de 27 mois il n'y avait aucune inégalité de longueur qui dépasse 1 centimètre et aucun cal vicieux. Nous pensons que ces fractures fémorales dans la tranche d' âges de 5 à 10 ans peuvent être traitées par un enclouage flexible centromédullaire rétrograde avec des risques minimes de complications chirurgicales.

High prevalence of rotator-cuff and acromioclavicular pathology was found by ultrasonographic examination in the elite wheelchair tennis players in both dominant and nondominant shoulders. A high index of suspicion of these pathologies in wheelchair athletes is required.

BackgroundFew studies have evaluated surgical outcomes in patients with refractory de Quervain's disease using validated outcome measures. We assessed the clinical outcomes of dorsal release of the first extensor compartment for the treatment of de Quervain's disease using the disabilities of the arm, shoulder and hand (DASH) score.MethodsFrom October 2003 to May 2009, we retrospectively evaluated 33 patients (3 men and 30 women) who underwent surgical treatment for de Quervain's disease. All patients had a positive Finkelstein test and localized tenderness over the first dorsal compartment. All operations were performed under local anesthesia. A 2-cm-long transverse skin incision was made over the first extensor compartment and the dorsal retinaculum covering the extensor pollicis brevis was incised longitudinally. Preoperative and postoperative clinical evaluation included the use of DASH score, Finkelstein test, and visual analogue scale (VAS) score.ResultsIn 18 patients (55%), the extensor pollicis brevis tendon compartment was separated from the abductor pollicis longus compartment. Eight patients had intracompartmental ganglia in the extensor pollicis brevis subcompartment. All patients except one had negative sign on Finkelstein test at the last follow-up. The average VAS score decreased from 7.42 preoperatively to 1.33 postoperatively (p < 0.05), and DASH score was improved from 53.2 to 3.45 (p < 0.05). There were no postoperative complications such as subluxation of the tendon of the first dorsal compartment or injury to the sensory branch of the radial nerve.ConclusionsIntracompartment ganglia and the separate septum of extensor pollicis brevis are often related to de Quervain's disease. The release of the first extensor compartment for refractory de Quervain's disease resulted in good clinical outcomes with minimal morbidity.