Purpose of the study: The constantly increasing incidence of extracapsular fractures of the proximal femur are a public health concern. The basic therapeutic options are screw-plate fixation and proximal reconstruction with nails. The purpose of this retrospective study was to assess the mid-term results with a new osteosynthesis material, the proximal femoral nail antirotation (PFN-A^®) which has a spiral blade.

Material and methods: One hundred eight 108 PNF-A^® performed from January 2007 to July 2008 were included in a retrospective clinical and radiographic study. These series included exclusively extracapsular fractures of the proximal femur in subjects aged over 70 years. All patients were assessed with the Parker score pre- and postoperatively. Blood loos, position of the spiral blade on the AP and laterals views and operative time were analysed. We searched for complications (femoral head slide, blade protrusion, head rotation, non-union, fracture on material, and operative site infection). We searched for risk factors.

Results: One hundred eight patients (94% ASA 2 or 3) were reviewed at mean 5.3 months (±1.5). None of the patients were lost to follow-up. At revision, 19 patients had died (17.6%). The mean Parker score declined 1.4 points. All fractures healed at mean 10.4 weeks (±0.6). Six complications were noted: three operative site infections, three head slidings, one intraacetabular protrusion. No statistically significant could be identified. Nevertheless, the three cases with femoral head sliding occurred on fractures that were unstable (type 31-A2) which had a malpositioned blade.

Discussion: There appears to be a consensus on the treatment of proximal fractures of the femur: screw-plate fixation for stable fractures, centromedullary nailing for the others. Arthroplasty is a second-line solution. There are few publications on the new spiral blade of the PFN-A^®. This method spares bone stock and allows compaction of the cancellous bone, particularly adapted for osteoporotic bone: the efficacy is comparable with reference techniques with lower rates of sliding (2.%) and acetabular protrusion (< 1%).

Purpose of the study: Treatment of comminutive fractures of the distal radius in elderly subjects remains a debated issue. Use of locked plates has given interesting results, particularly in the young subject. External fixation remains the simple osteosynthesis technique with the advantage of being minimally invasive and well adapted to the quality of bone in the elderly subject. The purpose of this work was to evaluate the mid-term results of a series of radiometacarpal joint bridgings of comminutive fractures of the distal radius.

Material and methods: From January 2003 to December 2007, 44 radiometacarpal fixations were assemblied and included in a retrospective radioclinical study. All of the fractures were comminutive (AO classification: C2 20.4%, C3 79.6%) in subjects aged over 60 years. Surgery consisted in a radiocarpal assembly alone (25%) or associated with another fixation (75%). The PRWE score was used for the functional assessment and the Sofcot 2000 symposium criteria for the radiographic analysis. Factors of poor prognosis were studied.

Results: Forty-four patients were reviewed with a mean follow-up of 28 months. Five patients were lost to follow-up. All patients had healed at mean 6.8 weeks. The functional outcome was good or very good in 45.4% of patients. Radiographically, anatomic restitution was achieved in 15.9% with a moderate to severe callus deformity in 84.1%. Fifteen complications were noted: reflex dystrophy (n=5), neuroma (n=2), material migration (n=6), disassembly with surgical revision (n=2) and superficial infection (n=2).

Discussion: Unlike observations in the young subject, there does not appear to be a consensus on the treatment of comminutive fractures of the distal radius in the elderly osteoporotic subject. External fixation has been used for many years for comminutive fractures. Our results nevertheless illustrate the limitations of this technique, both in terms of the functional outcome (54.6% insufficient results) and radiographic outcome (84.1% callus deformities). The only good results obtained with the external fixator occurred when the technique was associated with another fixation method. This suggests we should consider fixation of the wrist as a temporary osteosynthesis which should be replaced by another method (locked plating).