Purpose of the study: The purpose of this study was to compare two types of treatment for fractures of the distal radius with posterior shift: the volar locking plate (c) or mixed multiple pinning (MMP). We conducted a prospective randomised trial.

Material and methods: One hundred ten patients aged over 50 years victims of an articular or extra-articular fracture of the distal radius with posterior shift were included in this study. Mean age was 74 years. Patients were recruited via our emergency unit. After obtaining the written informed consent of the patients, patients were assigned to a treatment group using the nQuery Advisor 6.01 available on the internet, 24 hours/d 7d/7. Patients were treated by one of the two surgical techniques according to the randomisation. Patients were reviewed at 3 and 6 weeks and at 3 and 6 months. The DASH and Herzberg scores were noted and plain x-rays of the wrist (ap and lateral views) were obtained at each visit.

Results: Fifty-two patients were treated with MMP and 50 with VLP. Postoperative anteversion of he radial glenoid was significantly better in patients treated with MMP. At six months, the DASH and Herzberg score were significantly better in the LAP group.

Discussion: MMP allows better anteversion of the glenoid than VLP. However, with MMP there is a risk of over reduction (15% of patients in our series). Treatment with VLP should enable restoration of better radius length with a lesser loss at three months than with MMP. All studies reported, irrespective of the function score used, have found better functional outcome with plating than with pinning.

Conclusion: MMP offers a less costly alternative for the treatment of most all distal fractures of the radius with posterior shift. This option provides quite satisfactory clinical and radiographic outcomes. There is a risk of postoperative defect in reduction or stability with MMP, suggesting surgeons should opt for another technique, VLP for example.

Excision is not a suitable treatment for all comminuted fractures of the radial head. In elbows where instability can be predicted, a replacement arthroplasty of the radial head is more effective. The aim of this paper was to present the medium-term results of the Judet floating radial head prosthesis.

This operation was performed on 14 patients between 1992 and 2003, of whom 12 were reviewed at a mean follow-up of five years and three months (1 to 12 years). The outcome was assessed using the Mayo elbow performance score and a modified Disability of Arm Shoulder Hand (DASH) questionnaire. There were six excellent results, four good, one fair and one poor, as graded by the Mayo score. The mean DASH score was 23.9/100 (0 to 65.8/100). The only significant complication occurred in one patient who developed a severe complex regional pain syndrome. There were no patients with secondary instability of the elbow, implant loosening, cubitus valgus, osteoporosis of the capitellum, or pain in the forearm and wrist. Our experience, combined with that of other authors using this device, has encouraged us to continue using the Judet prosthesis in comminuted fractures of the elbow where instability is a potential problem.