Purpose: We report the operative technique and preliminary results for percutaneous osteosynthesis in the supine position with computed tomography guidance for acetabular fractures without joint displacement.

Material and methods: This prospective study conducted in a single unit included a consecutive non-randomised series of 55 patients who underwent surgery for an unstable pelvic injury between June 1996 and December 2000 under computed tomography guidance. In ten cases, the radiographic and computed tomographic analysis demonstrated a coronal fracture of one of the columns without joint displacement accessible for anteroposterior screw fixation. There were eight men and two women, mean age 35 years.

Surgery: the ten patients were operated on in the supine position, in the scanner room under the same aseptic conditions as in the operation room. The reference computed tomography slice was the Corse slice. The femoral vasculo-nervous bundle was identified. A threaded guide wire was inserted perpendicuallary to the fracture line, anteriorly to posteriorly (Cap Corse technique). A perforated screw with a 7.3 mm diameter was used to fix the fracture. Minimal post-surgical surveillance was 48 hours. Weight bearing was not authorised for six weeks to three months. Al patients were followed prospectively, and mean follow-up ws 16 months (12–36).

Results: Traction was lifted immediately after surgery in all cases. All the patients got up the day after surgery. Mean hospital stay was less than five days postoperatively in all cases. There were no complications (vascular, neurologic, infectious) and no secondary displacement. At last follow-up, he Postel Merle d’Aubigné score was 18 for eight patients, 16 for one and 14 for one. Two patients showed radiographic signs of degenerative hip disease.

Discussion: This percutaneous osteosynthesis method using computed tomographic guidance is reliable (100% well positioned screws) and avoids the need for traction in bed. Morbidity is low (no complications). Even though these eight patients did not present clinical and radiographic signs of osteoarthritis, this technique did not avoid the risk of degenerative hip disease in two patients.

Conclusion: An alternative to traction, percutaneous osteo-synthesis with computed tomographic guidance performed in the supine position for acetabular fractures is a cost-effective procedure.

Purpose: Neer modified the Bankart operation, adding a reinforcement crossing the capsule anteriorly on the humeral side. The purpose of this study was to report results after more than two years.

Material and methods: Between 1991 and 1998, 77 patients underwent surgery for traumatic anteroinferior instability. Clinical and radiological outcome was reviewed in 64 of this patients by an observer different from the operator at a mean follow-up of 45 months (24–120 months). Patients with a unique anterior reinforcement were excluded from the analysis. The patients were generally young (mean 27 years) with sports activities (89%). Recurrent dislocation was observed in 39 patients, subdislocation in seven and painful and unstable shoulders in seven. Ten patients had an associated hyperlaxity, defined by elbow-to-body external rotation greater than 85%, according to the SOFCOT criteria. Three patients had had a prior procedure for a coracoid bone block.

Results: According to the Duplay score: outcome was excellent in 27 cases, good in 22, fair in nine and poor in six. Mean delay to return to former occupational activity was four months; it was seven months for sports activity. The deficit in external rotation was 3.4° on the average. Ten patients had persistent apprehension. Recurrence was observed in seven patients (11%) a mean 25 months after the operation (seven days to six years) as dislocation in two and subdislocation in five and due to trauma in five cases. Young age, hyperlaxity, high-risk sports, an important humeral notch, major capsular distension, and a high number of dislocations or subdislocations were the factors associated with recurrence. According to the Samilson criteria, pre-osteoarthritic lesions of the gleno-humeral joint were present in two cases preoperatively (one grade I and one grade II) and in eight cases postoperatively (four grade I, three grade II, and one grade III).

Discussion, conclusion: The Bankart operation as modified by Neer does not produce a stiff joint as is thought by many, probably due to the upper-lower capsular retention rather than lateral-medial retention. Nevertheless, the stability results are less satisfactory than generally reported for coracoid stop procedures.