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A prospective study was undertaken to determine the clinical importance of the different carpal instabilities following dorsally displaced distal radial fractures (Colles' type). All patients were followed for 1 year and a Cooney score and X-ray evaluation were done. Nine different carpal instabilities were evaluated. Only dissociative DISI and ulnar translocation showed significant clinical differences at 1 year follow-up. It is therefore recommended that a dissociative DISI, usually caused by scapholunate dissociation, should be treated by percutaneous pinning at the time of the initial treatment.

Purpose The purpose of this study is to determine whether the lexion irst balancing technique, developed in an attempt to solve the dissatisfaction due to instability in total knee arthroplasties, leads to better restoration of joint line height and medial posterior condylar ofset. This might result in better knee lexion, compared to the classic extension irst gap balancing technique. The secondary objective is to show non-inferiority of the lexion irst balancing technique in terms of clinical outcomes as measured by the Patient Reported Outcome Measurements. Methods A cohort of 40 patients (46 knee replacements) operated using the lexion irst balancing technique was retrospectively analyzed and compared with a cohort of 51 patients (52 knee replacements) operated using the classic gap balancing technique. Radiographic analysis of the coronal alignment, joint line height and posterior condylar ofset was performed. Clinical and functional outcome data were analyzed pre-and postoperatively and compared between both groups. The two sample t test, Mann-Whitney U test, Chi-square test and a linear mixed model were used for performing statistical analyses, after normality analyses were executed. Results Radiologic evaluation showed a decrease in posterior condylar ofset using the classic gap balancing technique (p = 0.040) versus no change using the lexion irst balancing technique (p = n.s.). No statistically signiicant diferences were noted for joint line height and coronal alignment. Using the lexion irst balancer technique leads to a greater postoperative range of motion with deeper lexion (p = 0.002) and a better Knee injury and Osteoarthritis Outcome Score (KOOS) (p = 0.025). ConclusionThe Flexion First Balancing technique is a valid and safe technique for TKA, resulting in better preservation of PCO with consequently greater postoperative lexion and better KOOS scores. Level of evidence III.

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