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.