The outcome of 169 fractures of the distal radius in adults under the age of 50 were assessed at least 18 months after injury (mean follow-up, 4.9 years) using a validated, patient-based outcome questionnaire. The questionnaire responses demonstrated that neither the Frykman nor the Mayo classifications of distal radial fractures predicted outcome. Fracture union with more than 10 degrees of dorsal tilt was associated with increased difficulty with everyday activities and work, while union with a step in the radiocarpal articular surface was associated with loss of wrist mobility and difficulty with fine dextrous tasks. No measure of either intra- or extra-articular malunion influenced the severity or frequency of persistent wrist pain.

The aim of this study was to assess bone heating caused by the passage of fine (<2 mm) K-wires of different types. Stainless steel K-wires of trocar and diamond point configurations (0.8-2.0 mm) were drilled into the metatarsal bones from a freshly amputated lower limb at a constant force. Temperature measurements were made by miniature thermocouples inserted into the bones, at 3 second intervals over a period of 3 minutes while each K-wire was drilled three times. The temperature reached varied with the tip configurations and the diameter of the K-wires. Regardless of point configuration, thinner wires generated more heat than thicker ones.

Background Arthroscopy is nowadays a well-establish method to treat a wide range of injuries and overuse syndromes of the shoulder. The role of arthroscopy is extremely important for the treatment of soft-tissue injuries and specific-type fractures of the shoulder. Aim to estimate the applicability of shoulder arthroscopy as an effective method for the treatment of fractures of the greater tuberosity in athletes. Patients–Methods Twelve athletes (six professional–six recreational, four skiers–two horse riders–two motorcycle racers–one cyclist–one football player–one hardle jumper–one judoka, eight males-four females) with a mean age of 29 (20–45) years, sustaining an avulsion fracture of the greater humeral tuberosity were treated arthroscopically over a 5-year period. Nine were managed acutely and three as malunion and rotator cuff dysfunction cases. For the imaging evaluation, standard plain radiographs (anteroposterior and axillary views), CT scans (with 3D reconstruction) and MRI were performed. In three patients the fragment dislocation was found ≤5 mm, in four was 6–10 mm and in two was more than 10 mm. Anchors were used to fix the avulsed fragment. In nine patients, accompanying soft-tissue lesions (seven rotator cuff tears and two Bankart lesions) were recognized and properly treated. Postoperatively a shoulder abduction brace 30° was applied for six weeks and a careful rehabilitation plan was utilized. Passive external rotation exercises were started immediately. Results During the follow up period no major complication was observed. Radiographic outcome was assessed on plain X-rays. No patient developed non-union. All patients achieved UCLA scores over 30 at six months. Professionals returned to practicing at 10–12 weeks with customized programs. All athletes returned to their pre-operative activity level with no residual pain. Discussion The investigation of indications of shoulder arthroscopy is a continuous process. Surgical familiarity is important to perform advanced techniques in shoulder arthroscopy. Arthroscopic treatment of minimally displaced greater tuberosity fractures should be considered for athletes or people who perform overhead activities. Conclusions Arthroscopic treatment of fractures of the greater humeral tuberosity can offer excellent functional results and permits the treatment of concomitant critical lesions.

Hip arthroscopy has gradually evolved over the past two decades.Recently hip arthroscopy has increase its role in diagnosis and treatment for specific intraarticular and extraarticular hip injuries and especially for soft tissue injuries.Material and methodsFebruary 2004–March 2010, 48 athletes, football players, basketball players, weight lifters, gymnasts, three water polo players. Mean age: 32 years. (19–39 year old)Instrumentation and equipment70°, 4.5 mm arthroscope, High flow rate mechanical pump, 15 gauge 6″ cardiac needle, Convex full radius chondroplasty blades, special electrocautery. Distraction apparatus, DVD unit, mechanical water pump unit, mage intensifierIndicationsUndiagnosed hip pain, early osteoarthritic signs, labral pathology, loose bodies, osteochondral defects, sepsis, ligamentum teres, trauma, synovitis, femoral acetabular impingment (FAI), ‘frozen hip’, chondrocalcinosis.SymptomsDeep dull ache pain during hip flexion and external or internal rotation, decrease range of motion, decreased hip flexion.Clinical findings30/48 Cam sign: positive, 12/48 Pincher sign: positive, impingement syndrome in hip flexion and internal and rotation and occasionally in external rotation, snapping hip, iliopsoas tendinitis.SurgeryStandard orthopaedic traction table, supine position, hip is extended and abducted 25°PortalsAnterolateral, posterolateral, modified anterolateralIntraoperative findingsDetachment of the labrum, 10/48 erosion of the articular cartilage of the acetabulum and drilling of the bare area, 30/48 Cam sign excision, 12/48 pincer sign excision, 8/48 superior medial and superior lateral labrum repair with anchors. (intra-articularly)ResultsThe modified Harris Hip Score was used for their classification of their symptoms. Two of the athletes had a residual pain due to an iliopsoas tendinitis. 45/48 had relief from their arm symptoms, 1/48 will need to be reoperated shortly (after he developed FAI), 2/48 are treated for the iliopsoas tendinitis.ConclusionThe athletes with symptoms of an internal hip pain and FAI signs after a detailed clinical exam of their hip and after failure of their conservative treatment, will certainly get a benefit from an arthroscopic procedure (which is technically demanding).

BackgroundPainful limitation of ankle movement in athletes is commonly caused by soft-tissue or osseous formations. The impingement syndromes of the ankle are attributed to initial injuries which, undertreated, in a subacute or chronic basis, lead to development of thickenings within the ankle joint.AimTo present the outcome of arthroscopic excision of restrictors in ankle movement with concomitant anatomic ankle ligament reconstruction in athletes.Patients and MethodsEighteen athletes, twelve males and six females, (of which, nine basketball-players, four football-players, two dancers) were treated over the last ten years. The mean age was 22 years. The sports activities of all patients were dramatically deteriorated due to chronic ankle pain and/or a “giving way” feeling. The thorough clinical examination included reproduction of impingement pain (anterior, anterolateral, anteromedial, or posterior) and stability testing in comparison to the contralateral ankle. Radiographs included anteroposterior, lateral and oblique views in a weight-bearing position. Ultrasound and plain MRI testing was performed without exception. Each patient underwent arthroscopic evaluation. Arthroscopic debridement of hypertrophic tissue arising from AITFL, ATFL or deltoid was performed in 16 patients. Arthroscopic decompression of bony impingement (excision of tibial or talar osteophyte) was needed in ten patients. Ankle ligament reconstruction was performed in 13 cases (modified Brostrom in 11 athletes, deltoid reconstruction in two others). Excision of osseous and soft-tissue components of posterior impingement via open posterolateral approach was performed in two dancers. We also had to remove meniscoid lesions in four cases. In addition, debridement and microfractures were indicated in four patients with osteochondral lesions and to two patients was applied Autologous Chondrocyte Implantation. A custom rehabilitation program was utilized for each individual.ResultsPatients were followed up at one, three, six, nine, and twelve months postoperatively using the FADI score. The results at 12 months were ranged above 90 for 13 athletes, between 85–90 for 4 athletes and between 80–85 for one athlete. Poorer results are correlated with concomitant osteochondral lesions. The highest scores were achieved when ligament reconstruction had been performed.DiscussionChronic ankle instability should always be suspected in an athlete with chronic ankle pain and findings of ankle impingement. A clinical exam and an ultrasound exam contribute in a more accurate diagnosis for an ankle instability. The appearance of an injured ligament on plain MRI varies and is not reliable to estimate the functional sufficiency of the ligament. Ankle arthroscopy provides great visualization of joint pathology in impingement syndromes that is amenable to repair. Open ligament repair is reliable and optimizes the functional results.ConclusionArthroscopic treatment of anterior ankle impingement together with ankle ligament reconstruction, when indicated, is essential for obtaining a stable and functionally efficient ankle.