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It is uncommon to observe a nonunion of an isolated ulnar shaft fracture after surgical treatment; therefore, complications due to this nonunion are very rare. Adults are more likely to develop nonunions compared to children. We report the case of a 34-year-old man, who had a left ulnar shaft fracture, treated with a screwed plate. Four months later, a septic nonunion occurred causing a type 3 Monteggia equivalent lesion with a lateral dislocation of the radial head. We describe the consecutive methods of treatment that resulted in complete bone consolidation. The case report aims to underline the diagnostic particularities and the therapeutic challenges of this rare complication.

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The wrist is a rare location of septic arthritis. It often involves patients with preexisting joint disease which symptoms could be confused with infection making the diagnosis more difficult and usually delayed. It is often responsible for residual functional impairment and for a high mortality rate among vulnerable patients. We report 6 cases of septic arthritis of the wrist in 3 males and 3 females. The mean age was 32 years in the male patients and 66 in the female patients. All the women were followed for rheumatoid arthritis. Biological results showed elevated rates of white blood cells and c-reactive protein in all the patients. Joint fluid analyses showed elevated white blood cell count. The treatment was medico-surgical consisting in synovectomy, joint debridement and immobilization of the wrist. At the average follow-up of 1 year and 4 months, 3 patients recovered a perfect mobility of the wrist without any limitation of the range of motion nor the strength. Three patients developed stiffness of the wrist.

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INTRODUCTION: Total knee replacement after high tibial osteotomy becomes more and more indicated. This intervention needs to identify some pearls and pitfalls. AIM: To evaluate results of total knee arthroplasty after closing wedge high tibial osteotomy. METHOD: Fourty total knee arthroplasty following closing wedge high tibial osteotomy were identified. Demographic features, tibiofemoral alignment and radiolucent lines were documented on postoperatively. Clinical and functional evaluations were performed preoperatively and postoperatively according IKSS score. RESULTS: The average duration of follow-up was 11,5 years. The mean function score increased from 39 points to 70,4 points postoperatively. The mean knee score increased from 40 points to 84,9 points postoperatively. The mean average tibio-femoral angle was 177,7° in preoperatively and 178° (min 176°, max 185°) at the last follow-up. CONCLUSION: The closing wedge high tibial osteotomy does not compromise subsequent total knee replacement. Knowing pearls and pitfalls lead to better outcome.

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BACKGROUND: The treatment of radial neck fractures is controversial and typically depends on displacement. Surgical procedures based on open reduction-internal fixation (ORIF) may lead to several complications, such as avascular necrosis of the radial head, nonunion, malunion, and elbow stiffness. Closed reduction with intramedullary pinning of radial neck fractures, which is commonly used in children, is a viable option for these fractures in adults and may allow for a lower complication rate compared with ORIF. The aim of this study was to report the functional outcome of closed reduction and intramedullary stabilization in isolated radial neck fractures. METHODS: Fourteen cases were retrospectively reviewed between January 2007 and December 2016. The inclusion criteria were isolated radial neck fractures of type I to III according to the Mason classification, absence of previous injuries of the elbow, and a minimum of 1 year of follow-up. The Mason classification was used to classify these injuries. At final follow-up, functional assessment was established based on functional scores: Morrey Elbow Score, Elbow Self-Assessment Score, and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score. Range of motion was evaluated similarly. RESULTS: The mean follow-up period was 86 months. The mean age was 44.2 years. Regarding the functional outcome, 78% of patients claimed satisfaction. Concerning the functional scoring, the mean visual analog scale score was 0.2 (range, 0-4) and the mean Morrey Elbow Score was 95.7 (range, 85-100). The mean QuickDASH score was 6.4 (range, 7-22). The complication rate was 35%. Malunion was observed in 7% of patients. CONCLUSION: Intramedullary pinning of radial neck fractures represents a viable technique in adults because of its safety and simplicity. The complication rates are lower than those in other reports of ORIF.

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The management of high-energy pilon fractures is still controversial. Open reduction and internal fixation are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. The aim of this retrospective study was to analyze the clinical and radiographic outcome of the ILIZAROV technique in patients with high-energy pilon fractures. Thirty cases of distal tibia epiphysis fractures (pilon fractures) were managed from 1999 to 2012. The study group included 5 cases of open fractures. The mean age was 47 years. According to Rüedi and Algower classification; 11 fractures were type II, and 19 type III. All fractures were a consequence of high-energy trauma. Fractures of the lower fibula were present in 28 of the patients. An external Fixator was applied for open fractures. Closed injuries were operated on 3 to 13 days after injury, with an average of 8 days. The mean follow-up was 48 months. All fractures united. The external fixator was removed after a mean of 22 weeks (10 - 28 weeks). Two patients with a type III fracture had a delayed union and were treated with corticotomy and dynamisation of the ILIZAROV fixator. Only one secondary displacement of a type III fracture was noted after two months and was treated by adjuction of 2 olive wires. There were no cases of osteomyelitis or deep infections. Pin-tract infections occurred in ten patients. We had not any case of nervous injury due to introduction of the pins. Using radiological criteria for assessement of reduction of the articular fragments, there was excellent and good restoration of articular structure in 24 cases. The average American Orthopeadic Foot and Ankle Society ankle-hind foot score was excellent in 16, good in 6, fair in 6 and poor in 2. Soft tissue healing occurred without need for plastic surgery in all cases. The movements of the ankle ranged from 0 to 20° of dorsiflexion and 5° to 40° of plantar flexion. Twenty patients had gone back to their preinjury profession. The ILIZAROV technique is a safe and a very effective treatment for severe pilon fractures with minimum complications and good healing results.

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BACKGROUND: The treatment of isolated internal tibiofemoral knee osteoarthritis on young and active patients is controversial. This treatment can be a high tibial osteotomy or a joint replacement that can be a partial unicompartmental knee arthroplasty (UKA) or total knee replacement (TKR). The aim of our study is the long-term evaluation of functional outcome of partial unicompartmental knee arthroplasty (UKA) in elderly patients under than 60 years. METHODS: This is a retrospective study of 25 unicompartmental knee arthroplasties in 22 patients, collected between1993 and 2003 whose age was less than 60 years. The minimum follow-up was 10 years. At last follow, an analysis of IKS score (International Knee Score) with assessment of both articular and functional components have been established. The Radiological score of Knee Society (KS) was used. RESULTS: At mean 14.2 years (min: 10, max: 20), the mean of knee flexion was 110 °. The IKS function score going 47 points preoperatively to 77 points postoperatively and IKS score 40 points knee preoperatively to 94 points postoperative. The radiological assessment found a postoperative mean tibiofemoral mechanical axis of 174.8 ° (172 ° min, max 182 °). The survival of implants at 12 years postoperatively was 84%. The survival of the prostheses was de84 to 12%, with a revision for polyethylene wear, a second for conflict of the femoral component with tibia thorns responsible of chronic pain, a third revision for infection and two for osteoarthritis evolution. CONCLUSION: The long-term evaluation of patients with a unicompartmental does not objective an obvious deterioration of outcome with a normal rate of revision comparatively to other series without particular difficulties during revision.

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