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Volar plating is one of the most used surgical treatments for dorsally displaced extra-articular distal radius fractures. However, the reduction of the dorsal tilt can be difficult. It usually requires a flexion maneuver of the wrist while maintaining and screwing the plate, which is cumbersome. Plate positioning also is a crucial step and is sometimes difficult because of the large size of the plate relative to the width of the distal radius. We use an epiphysis-first technique. We place all the epiphyseal screws before reduction, and then we take advantage of the anatomical shape of a locking plate to automatically reduce the dorsal tilt by fixing the proximal radius to the plate with cortical compression screws. To ensure easy and accurate positioning of the plate, we drill a distal medial pilot hole in a free-hand fashion 10 mm proximal to the watershed line and 10 mm lateral to the medial rim of the radius, without positioning the plate. This allows a clear view of the location of this first hole. The locking plate is then applied to the distal radius with help of a monocortical non-locking screw, and it is controlled under fluoroscopy. When this medial pilot hole is properly positioned and the plate correctly tilted on the anteroposterior view, the remaining epiphyseal holes are filled with locking screws. Then the plate is fixed on the proximal radius with bicortical compression screws, allowing an automatic reduction of the epiphyseal dorsal tilt. We believe this technique is a safe and reproducible way to position volar plates and to reduce anatomically the dorsal tilt in extra-articular posteriorly displaced distal radius fractures (AO A2 and A3). Furthermore, the automatic fracture reduction provided by this technique decreases operation time and radiation., Competing Interests: Declaration of Competing Interest Dr Chelli has nothing to disclose. Dr Bronsard has nothing to disclose. Pr Gonzalez has nothing to disclose. Dr Blasco has nothing to disclose. Dr Gauci is paid consultant for Wright (USA). Pr Boileau is paid consultant for Wright (USA) and has received royalties for the design of shoulder implants. All the authors, their immediate families and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. No funding was received for this study., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: To evaluate mid-term clinical outcomes, complications, bone-block healing, and positioning using suture-button fixation for an arthroscopic Latarjet procedure., Methods: Patients with traumatic recurrent anterior instability and glenoid bone loss underwent guided arthroscopic Latarjet with suture-button fixation. We included patients with anterior shoulder instability, glenoid bone loss >20%, and radiographic and clinical follow-up minimum of 24 months. Patients with glenoid bone loss <20% or those that refused computed tomography imaging were excluded. Bone-block fixation was accomplished with 2 cortical buttons connected with a looped suture (4 strands). The looped suture was tied posteriorly with a sliding-locking knot. After transfer of the bone block on the anterior neck of the scapula, compression (100 N) was obtained with the help of a tensioning device. Clinical assessment was performed at 2 weeks, 3 months, 6 months, and then yearly with computed tomography completed at 2 weeks and 6 months to confirm bony union., Results: A consecutive series of 136 patients underwent arthroscopic Latarjet with 121 patients (89%; mean age 27 years) available at final follow-up (mean follow-up, 26 months; range, 24-47 months). No neurologic complications or hardware failures were observed; no patients had secondary surgery for implant removal. The transferred coracoid process healed to the scapular neck in 95% of the cases (115/121). The bone block did not heal in 4 patients; it was fractured in 1 and lysed in another. Smoking was a risk factor associated with nonunion (P < .001). The coracoid graft was positioned flush to the glenoid face in 95% (115/121) and below the equator in 92.5% (112/121). At final follow-up, 93% had returned to sports, whereas 4 patients (3%) had a recurrence of shoulder instability. The subjective shoulder value for sports was 94 ± 3.7%. Mean Rowe and Walch-Duplay scores were 90 (range, 40-100) and 91 (range, 55-100), respectively., Conclusions: Suture-button fixation is an alternative to screw fixation for the Latarjet procedure, obtaining predictable healing with excellent graft positioning, and avoiding hardware-related complications. There was no need for hardware removal after suture-button fixation. The systematic identification of the axillary and musculocutaneous nerves reduced risk of neurologic injury. A low instability recurrence rate and excellent return to pre-injury activity level was found. Suture-button fixation is simple, safe, and may be used for both open and arthroscopic Latarjet procedure., Level of Evidence: Level IV, therapeutic case series., (Copyright © 2019. Published by Elsevier Inc.)

Background: Most of the complications of the Latarjet procedure are related to the bone block positioning and use of screws. The purpose of this study was to evaluate if an arthroscopic Latarjet guiding system improves accuracy of bone block positioning and if suture button fixation could be an alternative to screw fixation in allowing bone block healing and avoiding complications., Materials and Methods: Seventy-six patients (mean age, 27 years) underwent an arthroscopic Latarjet procedure with a guided surgical approach and suture button fixation. Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging. Clinical examinations were performed at each visit., Results: At a mean of 14 months (range, 6-24 months) postoperatively, 75 of 76 patients had a stable shoulder. No neurologic complications were observed; no patients have required further surgery. The coracoid graft was positioned strictly tangential to the glenoid surface in 96% of the cases and below the equator in 93%. The coracoid graft healed in 69 patients (91%)., Conclusions: A guided surgical approach optimizes graft positioning accuracy. Suture button fixation can be an alternative to screw fixation, obtaining an excellent rate of bone union. Neurologic and hardware complications, classically reported with screw fixation, have not been observed with this guided technique and novel fixation method., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous facet screw fixation following anterior lumbar interbody fusion (ALIF) or anterior pseudarthrosis in adults., Materials and Methods: Institutional review board approval and informed consent were obtained for this study. One hundred seven consecutive adult patients (46 men, 61 women; mean age ± standard deviation: 56.3 years ± 12.9) with ALIF (n = 79) or anterior pseudarthrosis (n = 28) were prospectively treated by means of percutaneous facet screw fixation with CT and fluoroscopic guidance. Two 4.0-mm cannulated screws were placed per level to fix facet joints by using either a translaminar facet or transfacet pedicle pathway. Only local anesthesia was used during these procedures. Procedural time was noted for each patient. Postoperative follow-up ranging from 1 year to 3 years was assessed by using Macnab and radiologic criteria., Results: The mean procedure times for a lumbar single-level and a double-level fusion ranged from 15 to 25 minutes and from 40 to 50 minutes, respectively. All the transfacet pedicle (n = 182) and translaminar facet (n = 56) screws were successfully placed in one attempt. Radiographic fusion was observed within the year following posterior fixation in all patients despite one translaminar screw failure. According to the Macnab criteria, the clinical results were classified as excellent in 92 (86%) and good in 15 (14%) of 107 patients at the time of their last follow-up examination., Conclusion: This feasibility study showed that CT- and fluoroscopy-guided percutaneous facet screw fixation is a rapid, safe, and effective method.

Objective: The aim of this study was to evaluate CT- and fluoroscopy-guided percutaneous screw fixation by radiologists in the management of acetabular roof fractures., Subjects and Methods: Fifty-two consecutive adult patients with a nondisplaced and isolated acetabular roof fracture were prospectively treated by an interventional radiologist who made a percutaneous screw fixation under CT and fluoroscopy guidance. All these procedures were performed under local anesthesia. The postoperative follow-up ranged from 36 to 48 months., Results: For each patient, two 6.5-mm Asnis III screws were inserted to fix the roof acetabular fracture. The mean procedure time was 45 minutes (range, 30-90 minutes). No complications were observed. Follow-up CT showed evidence of fracture healing. No evidence of secondary displacement, degenerative changes, or screw failure was noted. Using the rating system of D'Aubigne and Postel, all patients had excellent results., Conclusion: The results of our study showed that nondisplaced acetabular roof fractures could be successfully treated by a minimally invasive technique with an excellent long-term outcome.

Objectives: To evaluate the feasibility of computed tomography (CT)- and fluoroscopy-guided percutaneous screw fixation for the treatment of low-grade isthmic spondylolisthesis in adults., Methods: Ten consecutive adult patients (four men and six women; mean age: 57.1 [range, 44-78 years]) were prospectively treated by percutaneous screw fixation for low-grade (six grade 1 and four grade 2) isthmic spondylolisthesis of L5. For each patient, two 4.0-mm Asnis III cannulated screws were placed to fix the pars interarticularis defects. All procedures were performed under local anaesthesia by using CT and fluoroscopy guidance. Post-operative outcome was assessed using the visual analogue scale and Oswestry Disability Index (ODI) scores., Results: The procedure time ranged from 45 to 60 min. The mean screw length was 27 mm (range, 24-32 mm). The VAS and ODI measurements ± SD decreased from 7.8 ± 0.9 preoperatively to 1.5 ± 1.1 at the last 2-year follow-up, and from 62.3 ± 17.2 to 15.1 ± 6.0, respectively (P < 0.001 in both cases). Neither slip progression nor screw failure was noted., Conclusions: This feasibility study showed that CT- and fluoroscopy-guided percutaneous screw fixation could be a rapid, safe and effective method of treating low-grade isthmic spondylolisthesis., Key Points: CT- and fluoroscopy-guided percutaneous screw fixation of isthmic spondylolisthesis is feasible. It could become an effective method to treat low-grade isthmic spondylolisthesis. Percutaneous trans-isthmic screw fixation can be performed under local anaesthesia. This new technique can be performed as an outpatient procedure.

We report on a new minimally invasive technique for the vertebral pedicle fracture after placement of a prosthetic disc. This intervention is an adaptation of CT-guided sacroiliac and acetabular fracture screw fixation. This type of procedure enables the perfect placement and measurement of the screw, as well as an extremely small incision under local anesthesia. CT guided Transpedicular fixation could be a useful strategy in the treatment of future cases involving poorly healing pedicle fractures causing persistent symptoms. This intervention confirms the range of capacities of CT scan-controlled interventions in terms of precision, safety, speed, minimal invasiveness, rapid return to everyday activity and consequently, economical management., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To evaluate the reproducibility and safety of a novel arthroscopic technique combining a Bristow-Latarjet procedure with a Bankart repair and to report the early clinical and radiologic results., Methods: Forty-seven consecutive patients with glenoid bone loss and capsular deficiency were treated with this all-arthroscopic technique; six patients had a failed arthroscopic capsulolabral repair. The coracoid fragment was osteotomized, passed with the conjoined tendon through the subscapularis muscle, and fixed in the standing position with a cannulated screw on the abraded glenoid neck. The capsule and labrum were then reattached on the glenoid rim, leaving the coracoid bone block in an extra-articular position. Potential intraoperative and postoperative complications were recorded. All patients were reviewed and had postoperative radiographs; 35 had computed tomography scans., Results: The procedure was performed entirely arthroscopically in 41 of 47 patients (88%); a conversion to open surgery was needed in 6 patients (12%). The axillary nerve was identified in all cases, and no neurologic injuries were observed. No patient had any recurrence of instability at the most recent follow-up (mean, 16 months). The mean Rowe score was 88 ± 16.7, and the mean Walch-Duplay score was 87.6 ± 12.9. The Subjective Shoulder Value was 87.5% ± 12.7%. The bone block was subequatorial in 98% of the cases (46 of 47) and flush to the glenoid surface in 92% (43 of 47); it was too lateral in 1 (2%) and too medial (>5 mm) in 3 (6%). There was 1 bone block fracture and 7 migrations., Conclusions: The arthroscopic Bristow-Latarjet-Bankart procedure is reproducible and safe. This procedure allows restoration of shoulder stability in patients with glenoid bone loss and capsular deficiency, as well as in the case of failed capsulolabral repair. Arthroscopy offers the advantage of providing adequate visualization of both the glenohumeral joint and the anterior neck of the scapula, allowing accurate placement of the bone block and screw. Surgeons should be aware that the procedure is technically difficult and potentially dangerous because of the proximity of the brachial plexus and axillary vessels. Training on cadaveric specimens and transition from open to mini-open and, finally, to all arthroscopic is recommended., Level of Evidence: Level IV, therapeutic case series., (Copyright © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To report a new technique of arthroscopic biceps tenodesis using bioabsorbable interference screw fixation and the early results., Type of Study: Prospective, nonrandomized study., Technique: The principle of arthroscopic biceps tenodesis is simple: after biceps tenotomy, the tendon is exteriorized and doubled on a suture; the biceps tendon is then pulled into a humeral socket (7 or 8 mm x 25 mm) drilled at the top of the bicipital groove, and fixed using a bioabsorbable interference screw (8 or 9 mm x 25 mm) under arthroscopic control., Patients: 43 patients treated with this technique between 1997 and 1999 were followed-up for at least 1 year. The technique was indicated in 3 clinical situations: (1) with arthroscopic cuff repair (3 cases), (2) in case of isolated pathology of the biceps tendon with an intact cuff (6 cases), and (3) as an alternative to biceps tenotomy in patients with massive, degenerative and irreparable cuff tears (34 cases). The biceps pathology was tenosynovitis (4 cases), prerupture (15 cases), subluxation (11 cases), and luxation (13 cases)., Results: The absolute Constant score improved from 43 points preoperatively to 79 points at review (P <.005). There was no loss of elbow movement and biceps strength was 90% of the strength of the other side. Two patients, operated on early in the series, presented with a rupture of the tenodesis. In both cases the bicipital tendon was very friable and the diameter of the screw proved to be insufficient (7 mm). No neurologic or vascular complications occurred., Conclusions: Arthroscopic biceps tenodesis using bioabsorbable screw fixation is technically possible and gives good clinical results. This technique can be used in cases of isolated pathologic biceps tendon or a cuff tear. A very thin, fragile, almost ruptured biceps tendon is the technical limit of this arthroscopic technique.

Background: While 2 screws are traditionally used for coracoid bone block fixation, no gold standard technique has yet been established when using cortical buttons. Purpose: To compare anatomic and clinical outcomes of the arthroscopic Latarjet procedure using either 2 or 4 buttons for coracoid bone block fixation. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 23 patients with 4-button fixation (group 4B) were matched for age at surgery, sex, and follow-up to 46 patients who had 2-button fixation (group 2B). All patients underwent guided arthroscopic Latarjet (using coracoid and glenoid guides), and a tensioning device was used to rigidify the suture button construct and get intraoperative bone block compression. The primary outcome was assessment of bone block positioning and healing using computed tomography scans performed at 2 weeks and at least 6 months after surgery. The mean ± standard deviation follow-up was 49 ± 7 months (range, 24-64 months). Results: The bone block healing rate was similar in both groups: 91% in group 4B versus 95.5% in group 2B. The transferred coracoid was flush to the glenoid surface in 21 patients (91%) in group 4B and 44 patients (96%) in group 2B (P =.6); it was under the equator in 22 patients (96%) in group 4B and 44 patients (96%) in group 2B (P ≥.99). There was no secondary bone block displacement; the rate of bone block resorption was similar between the groups: 28% in group 4B and 23% in group 2B (P =.71). Patient-reported outcomes, return to sports, and satisfaction were also similar between the groups. The operating time was significantly longer in group 4B (95 vs 75 minutes; P =.009). Conclusion: A 4-button fixation technique did not demonstrate any anatomic or clinical advantages when compared with a 2-button fixation technique, while making the procedure more complex and lengthening the operating time by 20 minutes. A 2-button fixation is simple, safe, and sufficient to solidly fix the transferred coracoid bone block. The use of drill guides allows accurate graft placement, while the use of a tensioning device to rigidify the suture button construct provides high rates of bone block healing with both techniques (>90%). [ABSTRACT FROM AUTHOR]