Total talar fracture - long-term results of internal fixation of talar fractures. A multicentric study of 114 cases.

INTRODUCTION: Displaced talar neck and body fractures are rare and challenging for the surgeon. Results are often disappointing due to inadequate reduction or internal fixation and high rates of osteoarthritis and osteonecrosis. Very few published series describe the long-term results after internal fixation of talar factures. One of the goals of the 2011 SOO meeting symposium was to specifically evaluate the long-term results after internal fixation of talar fractures. This study included only central fractures. MATERIAL AND METHODS: We reviewed the results of 114 central talar fractures that had been treated by internal fixation between 1982 and 2006 in nine hospitals in the Western part of France. The clinical and radiological follow-up was 111 months on average. All the patients with a radiological assessment had at least 5 years of follow-up. RESULTS: Poor reduction was apparent in 33% of cases. The average Kitaoka score was 70/100, which corresponds to an average functional level. At the last follow-up evaluation, 34% of cases had osteonecrosis and 74% had peritalar osteoarthritis. Secondary fusion was required in 25% of cases with an average follow-up of 24 months. DISCUSSION: The complication rate for talar fractures was high, mostly due to osteonecrosis and osteoarthritis; these conditions had an impact on the final outcome. The outcome could be improved by better evaluating these fractures with a CT scan, developing dual surgical approaches to best preserve the bone vascular supply and achieve better reduction, and improving the internal fixation hardware, especially the use of plates for comminuted fractures.

Scapular notching in reverse shoulder arthroplasties: the influence of glenometaphyseal angle.

UNLABELLED: Solutions described to limit the risk of scapular notching mainly concern the glenoid. Our hypothesis is that this risk also depends upon the glenoid-humeral relationship when the arm is resting along the body. PATIENT AND METHODS: This is a retrospective study of a continuous series of 85 reverse shoulder arthroplasties; 62 of these fulfilled inclusion criteria. The following parameters were studied: body mass index (BMI), inferior overhang of the glenosphere, the angles showing the position of the glenoid (GH) and the humerus (MH) in the scapular plane as well as the glenometaphyseal angle (GM=MH-GH), during an initial postoperative follow-up, at 1 and 2 years, and at a final follow up of a mean 45 months (24-81). The parameters studied were compared in two groups with and without scapular notching. RESULTS: There were 21 instances of notching at the final follow-up. This rate was significantly correlated to the BMI, which was a mean 27.2 in patients without a notch and 22.6 in patients with a notch, while the preoperative inclination of the glenoid in these groups was respectively 92.3° versus 85° respectively, the inferior overhang of the glenosphere was 4mm versus 2.8mm, the GM angle was 36° versus 47°, the MH angle at one year of follow-up was 135° versus 145° and the GH angle at the final follow-up was 103° versus 94° respectively. The BMI was significantly correlated to the GM angle, and a low BMI was associated with high values of this angle. DISCUSSION: The relative position of the glenoid and humeral components, as shown by the GM angle, was an essential factor in the development of a scapular notching. The humeral component of the GM angle evolved in thin patients with progressive adduction of the arm, which is associated with a risk of notching. This should be taken into account when performing reverse shoulder arthroplasties. LEVEL OF EVIDENCE: Level IV retrospective study.

[Tibial valgus osteotomy]. / Ostéotomie tibiale de valgisation.

The tibial valgus osteotomy whatever its technique has a survival rate of about 85 % to 10 years, if we consider the reoperation as a criterion of failure, with a confidence index at 78%. The age, weight, sex and functional signs have no impact on the outcome. We have found no evidence in the preoperative radiographic assessment, neither the medial pinch, or varus epiphyseal neither varisant gap, which could be a failure and a reoperation before the tenth year. Good results were observed significantly when there is an over-valgus at least 3 degrees of global axis of the lower limb. This corresponds to a valgus epiphyseal by more than 2 degrees . The substantial reduction in the gap varisant that lowers the overall time varisant below 200 kg cm provides the same positive results. The outcome will depend directly on the accuracy of the calculation of the preoperative correction performed and the quality of surgical achievement. Because of the need for precision, navigation technique appears as reliable, simple which makes it also possible to monitor the front slope and tibial rotation induced. The osteosynthesis must be stable and rigid to avoid postoperative loss of correction.