Le syndrome douloureux du grand trochanter (SDGT) après prothèse totale de la hanche (PTH) est une cause commune de douleurs latérales résiduelles au niveau de la hanche, indépendant de l’approche utilisée. Le but de notre étude était d’évaluer le SDGT après PTH par approche antérieure directe (AAD) comparé à l’approche postérieure (AP), ainsi que les résultats cliniques des deux approches en répondant aux questions suivantes : (1) Quelle est l’incidence des douleurs trochantériennes après PTH primaires avec deux approches différentes ? ; (2) quel est le résultat fonctionnel des patients atteints de SDGT ? ; (3) quelle proportion de patients avec SDGT ont recours aux infiltrations péri-trochantériennes ? Notre hypothèse est que le SDGT est présent suite aux deux approches, mais que la satisfaction est moins élevée après l’AP. Analyse secondaire suite à la publication d’une étude clinique randomisée sur 55 patients traités chirurgicalement par PTH randomisés dans une des deux approches : 27 patients avec une voie d’abord antérieure de Hueter modifiée, l’autre groupe de 28 patients ont bénéficié d’une approche postérieure. Les résultats de l’étude sont mesurés par : le Modified Harris Hip Score (MHHS), un score de satisfaction, douleur lorsque couché sur le côté atteint, et le recours à une infiltration. L’« offset » fémoral, latéralisation fémorale et l’allongement du membre inférieur ont été mesurés avant et après la chirurgie. Quarante-cinq patients étaient disponibles pour un suivi complet avec une moyenne de 62 mois (intervalle : 48-74). L’incidence de SDGT était plus élevée dans l’approche postérieure (AP 6/21 (29 %) vs AAD 4/24 (17 %)) (p = 0,3). Les patients opérés par AP souffraient davantage de douleurs (5/21 (24 %) des patients; EVA moyenne 5,3) lorsqu’ils étaient couchés sur le côté opéré, comparés aux patients AAD (2/24 (8 %) des patients; EVA moyenne 2) (p = 0,2). Cependant, le MHHS, la satisfaction du patient envers la chirurgie, l’évaluation radiologique de l’« offset » fémoral, la latéralisation fémorale ou l’allongement du membre inférieur, ainsi que le recours aux infiltrations étaient similaires pour les deux approches. Dans son ensemble, la satisfaction et le résultat fonctionnel après la chirurgie étaient significativement moindre chez les patients SDGT, indépendamment de l’approche. Le SDGT affecte la satisfaction du patient et le résultat fonctionnel après PTH. Les patients AP ont rapporté plus de douleurs trochantériennes que les patients AAD, affectant leurs résultats cliniques. III.

Background: Greater trochanteric pain (GTP) after total hip replacement is a common cause of residual lateral hip pain, regardless of the approach used. The goal of our study was to evaluate GTP after a direct anterior approach (DAA) compared to a posterior approach (PA) as well as the clinical outcomes of both approaches and answer the following: 1) What is the incidence of trochanteric pain after primary THA with two different surgical approaches? 2) What is the functional outcome of patients with GTP? 3) What proportion of patients with GTP resort to peritrochanteric injections? Hypothesis: Our hypothesis is that GTP is present with both approaches but satisfaction is lower with the PA. Patients and methods: A secondary analysis of a previously published clinical trial with 55 total hip arthroplasty patients randomized in one of two surgical approaches: 27 patients underwent the ante-rior modified Hueter approach, while the other group of 28 patients were operated using the posterior approach. Study outcomes were Modified Harris Hip Score (MHHS), satisfaction score, pain when lying on the affected side, and requiring an injection. Hip offset, femur lateralization and leg lengthening were measured before and after surgery. Results: Forty-five patients were available for complete follow-up at a mean of 62 months (range: 48-74). The incidence of GTP was higher in the posterior approach [PA: 6/21 (29%) vs DAA 4/24 (17%)) (p = 0.3). Patients operated through a PA experienced more pain [5/21 (24%) of patients; VAS = mean 5.3] when lying on their operated side, compared to DAA patients [2/24 (8%) of patients; VAS = mean 2) (p = 0.2)]. However, MHHS, patient satisfaction with surgery, radiological assessment for hip offset, femur lateralization or leg lengthening, and injections required were similar for both approaches. Overall, satisfaction and functional outcome with surgery was significantly lower in GTP patients, regardless of the approach. Conclusions: GTP impacts patient satisfaction and functional outcome in total hip arthroplasty patients. PA patients reported more trochanteric pain than DAA patients, which affected their clinical outcome. Level of evidence: III. (c) 2020 Elsevier Masson SAS. All rights reserved.

Objective Primary motor (M1) cortical excitability alterations are involved in the development and maintenance of chronic pain. Less is known about M1-cortical excitability implications in the acute phase of an orthopedic trauma. This study aims to assess acute M1-cortical excitability in patients with an isolated upper limb fracture (IULF) in relation to pain intensity. Methods Eighty-four (56 IULF patients < 14 days post-trauma and 28 healthy controls). IULF patients were divided into two subgroups according to pain intensity (mild versus moderate to severe pain). A single transcranial magnetic stimulation (TMS) session was performed over M1 to compare groups on resting motor threshold (rMT), short-intracortical inhibition (SICI), intracortical facilitation (ICF), and long-interval cortical inhibition (LICI). Results Reduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures. Discussion These findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.

OBJECTIVES:Intra-articular screw cut-out is a common complication after proximal humerus fracture (PHF) fixation using a locking plate. This study investigates novel technical factors associated with mechanical failures and complications in PHF fixation.DESIGN:A retrospective radiological study.SETTING:Level 1 trauma center.PATIENTS/PARTICIPANTS:Clinical and radiological data from consecutive PHF patients treated between January 2007 and December 2013 were reviewed.INTERVENTION:Open reduction and internal fixation with the Synthes Philos locking plate.MAIN OUTCOME MEASUREMENTS:Postoperative radiographs were assessed for quality of initial reduction, humeral head offset, screw length, number and position, restoration of medial calcar support or the presence of calcar screws, and intra-articular screw perforations. Using SliceOMatic software, we validated a method to accurately identify screws of 45 mm or longer on AP radiographs. Follow-up radiographs were reviewed for complications.RESULTS:Among 110 patients included [mean age 60 years, 78 women (71%), follow-up 2.5 years] and the following factors were associated with a worse outcome. (1) Screws >45 mm in proximal rows [Odds Ratio (OR) = 5.3 for screw cut-out); (2) lateral translation of the humeral diaphysis over 6 mm (OR = 2.7 for loss of reduction); (3) lack in medial support by bone contact (OR = 4.9 for screw cut-out); (4) varus reduction increased the risk of complications (OR = 4.3).CONCLUSION:The importance of reduction and calcar support in PHF fixation is critical. This study highlights some technical factors to which the surgeon must pay attention: avoid varus reduction, maximize medial support, avoid screws longer than 45 mm in the proximal rows, and restore the humeral offset within 6 mm or less.LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

BACKGROUND The ideal approach for a total hip arthroplasty (THA) would be kind to soft tissues, have the lowest complication rates and be easily reproducible. Although there have been several attempts to find the best approach for THA in the last decade, a definitive answer has not been found. We performed a prospective study to compare the direct anterior and posterior approaches for THA in terms of hospital length of stay, functional outcome, pain, implant position, complications and surgical time. METHODS A prospective, randomized, multicentre clinical study was conducted between February 2011 and July 2013, with an average follow-up of 55 months. Patients undergoing the direct anterior or posterior approach for THA were enrolled. Hospital length of stay, surgical time and complications were documented. The Harris Hip Score and visual analogue scale were used to monitor functional outcome and pain until 5 years postoperatively. Radiologic analysis was used to assess implant position. RESULTS Fifty-five patients (28 undergoing the direct anterior approach, 27 undergoing the posterior approach) were enrolled in this study. Length of stay, functional outcome, pain, implant position and complications were similar for the 2 approaches. There was a trend toward a better functional outcome for patients who underwent the direct anterior approach in the first 3 months postoperatively, with a peak at 4 weeks (Harris Hip Score 76.7 v. 68.7; p = 0.08). Average surgical time for the direct anterior approach was significantly longer (69.9 v. 45.7 min; p = 0.002). CONCLUSION The direct anterior approach for THA appears to be a safe and effective option. However, there is no significant difference in hospital length of stay or postoperative recovery between the 2 approaches. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, no. NCT03673514.

Background: This study aimed to compare the functional and clinical outcomes between the deltoid split (DS) approach and the classic deltopectoral (DP) approach for locking plate fixation of proximal humerus fractures (PHF) in a prospective randomized multicenter study. Methods: From 2007 to 2015, all patients with a PHF Neer II/III were invited to participate. Exclusion criteria were pre-existing pathology to the limb, patient refusing or too ill to undergo surgery, patient needing another type of treatment (nail, arthroplasty), and axillary nerve impairment. After consent, patients were randomized to one of the 2 treatments using the dark envelope method. Functional outcome was evaluated by validated questionnaires (12-Item Short Form Health Survey: version 2, Quick-DASH) with a minimum follow-up of 12 months. Complications were noted. Results: A total of 85 patients (44 DS, 41 DP) were randomized (mean age of 62). Groups were equivalent in terms of age, gender, body mass index, severity of fracture, and preinjury scores. The mean follow-up was 26 months. All clinical outcome measures were in favor of the deltopectoral approach. Specifically, the Q-DASH and SF-12v2 were better in the DP group (12 vs. 26, P=.003 and 56 vs. 51, P=.049, respectively). There were more complications in DS patients, but they did not reach statistical significance. Conclusions: The primary hypothesis on the superiority of the deltoid split incision was rebutted. On the basis of our study, the DP approach seems to offer better function compared with the DS approach for fixation of Neer 2 and 3 PHF fractures fixed with a locking plate. (C) 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Objective Primary motor (M1) cortical excitability alterations are involved in the development and maintenance of chronic pain. Less is known about M1-cortical excitability implications in the acute phase of an orthopedic trauma. This study aims to assess acute M1-cortical excitability in patients with an isolated upper limb fracture (IULF) in relation to pain intensity. Methods Eighty-four (56 IULF patients <14 days post-trauma and 28 healthy controls) performed a single transcranial magnetic stimulation (TMS) session over M1 (resting motor threshold (rMT); short-intracortical inhibition (SICI); intracortical facilitation (ICF); long-interval cortical inhibition (LICI)). IULF patients were divided into two subgroups according to pain intensity (mild versus moderate to severe pain). Results Reduced SICI and ICF were found in IULF patients with moderate to severe pain, whereas mild pain was not associated with M1 alterations. Age, sex, and time since the accident had no influence on TMS measures. Discussion These findings show altered M1 in the context of acute moderate to severe pain, suggesting early signs of altered GABAergic inhibitory and glutamatergic facilitatory activities.

Femoral neck stress fractures (FNSFs) can be treated conservatively or surgically, depending on initial displacement and patient condition. Surgical treatment options include internal fixation, with or without valgus osteotomy or hip arthroplasty, either hemi or total. The latter is mainly considered when initial treatment fails. A review of the literature shows that total hip arthroplasty (THA) is only considered as primary treatment in displaced fractures (type 3) in low-demand patients. We present a case of successive bilateral FNSF in a young active patient, where a THA was performed on one side, after failed internal fixation, and where it was chosen as primary treatment on the other side after failed conservative treatment.

BACKGROUND:This study explored the in vitro efficacy of antibiotics mixed with calcium sulfate (ACS) against Cutibacterium acnes (C. acnes). METHODS:C. acnes isolates from orthopaedic infection sites were tested for antimicrobial susceptibility with ACS. Minimal inhibitory concentrations (MIC) were determined with a gradient diffusion method (Etest® strips). RESULTS:When tested with Etest®, all 22 isolates were susceptible to penicillin, ceftriaxone, vancomycin, and two were resistant to clindamycin (MICs of 4 and 8 mg/L). Penicillin and rifampin had the largest inhibition zone diameters. CONCLUSIONS:Antibiotics retained activity against C. acnes when mixed with calcium sulfate.

Background Low-molecular-weight heparin (LMWH) is a recommended anticoagulant for thromboprophylaxis after major orthopedic surgery. Dabigatran etexilate is an oral anticoagulant recognized as noninferior to LMWH. We aimed to assess the incidence of symptomatic venous thromboembolic events (VTEs) after discharge in patients who underwent joint replacement, using a hospital registry. Patients and methods Patients who underwent total knee and hip arthroplasty between September 2011 and March 2015 were selected. Subcutaneous enoxaparin (30 mg twice daily) was given during hospitalization. At discharge, patients received either enoxaparin 30 mg twice daily/40 mg once daily or dabigatran 220 mg/150 mg once daily. Patients were seen or called at 2, 6, and 12 weeks after surgery. Outcomes were the number of VTEs, including deep venous thrombosis, pulmonary embolism, and the number of major/minor bleeding events after discharge. Results After discharge, 1468 patients were prescribed enoxaparin and 904 dabigatran (1396 total knee arthroplasty and 976 total hip arthroplasty patients). Mean age was 66±10 years, and 60% were female. The cumulative incidence of VTEs during the 12-week follow-up was 0.7%. One patient sustained a VTE during the switch window. Seven patients sustained a pulmonary embolism (0.3%). There was no statistical difference between the total knee arthroplasty and total hip arthroplasty groups. The incidence of major and minor bleeding events during follow-up was 0.3% and 30.3%, respectively. These events had a higher incidence in the dabigatran group compared to the enoxaparin group after discharge (p<0.05), but not between knee and hip replacement groups for major bleeding events. Conclusion A pharmaceutical prophylaxis protocol using LMWH and dabigatran during the post-discharge period resulted in low incidences of VTE and equivalence between treatments. However, the increased number of major and minor bleeding events in patients taking dabigatran is of concern regarding the safety and needs to be evaluated using analyses adjusted for risk factors.

Introduction. Quadriceps tendon ruptures (QTR) frequently occur in patients with end-stage renal failure, while triceps brachii tendon ruptures (TTR) are less common. This is the first properly documented report of a simultaneous ipsilateral traumatic rupture of both of these tendons. Case Report. A 50-year-old patient, on hemodialysis for end-stage renal failure, fell on his right side. He presented with sudden right knee and elbow pain, with functional impairment of both joints. X-rays showed avulsion-like osseous lesions on the olecranon and patella with a low-riding patella. Ultrasound confirmed complete quadriceps and triceps avulsion ruptures. Both lesions were treated surgically. Fixation was performed with anchors using the Krackow suture technique for both tendons. Postoperative clinical and radiological results were satisfactory, and follow-up was uneventful. The patient regained his preinjury functional level with a complete range of motion of both his knee and elbow. Discussion. Isolated QTR and TTR are frequent lesions in chronic renal failure patients treated with hemodialysis. Simultaneous ipsilateral rupture of both tendons however is extremely rare and should therefore not be overlooked. Surgical treatment is recommended for complete ruptures.

Drapeau-Zgoralski, Véronique; Baroudi, Maher MD; Benoit, Benoit MD, FRCS Author Information

Background: The objective is to explore the effects of concomitant mild traumatic brain injury (mTBI) on return to work (RTW), among patients suffering from an isolated limb fracture. This follow-up study included a total of 170 working age subjects with an isolated limb fracture, and was conducted in a phone interview approximately 1-year post trauma. 41 had experienced an mTBI and 129 did not. Methods: Data were obtained through a phone interview conducted on average 20.7 months (SD = 9.6 months) post-accident. The main outcome measure was the number of days taken to RTW after the injury. Demographic information was also gathered during the phone interview. Workers’ compensation status was obtained through the hospitals’ orthopaedic clinic data. Results: The mTBI group took on average 329.7 days (SD = 298.0) to RTW after the injury, as opposed to 150.3 days (SD = 171.3) for the control group (p < 0.001). After excluding patients who received workers’ compensation, the mTBI group still missed significantly more days of work (M = 299.4 days; SD = 333.0) than the control group (M = 105.2 days; SD = 121.6) (p < 0.0001). Conclusion: This study shows that mTBI increases work disability by preventing working-age individuals from rapidly returning to work.

Les fractures acétabulaires périprothétiques sont des complications graves d'une prothèse totale de hanche. Il n'y a pas assez d'information disponible pour guider le chirurgien dans la bonne gestion de ces lésions complexes. Nous croyons que la perte osseuse sévère en association avec une fracture acétabulaire périprothétique a un effet significatif sur les résultats cliniques et fonctionnels. De 2005 à 2014, le registre hospitalier était examiné pour identifier les fractures acétabulaires postprothèse totale de hanche. Les cas ont été classifiés selon Peterson et Lewallen en fonction de la stabilité du Cotyle en stable de type 1 et instable de type 2. Un type 3 a été ajouté pour distinguer un sous-groupe de patients présentant une perte osseuse. Tous les patients ont été évalués en clinique par un thérapeute physique. Les résultats fonctionnels ont été recueillis à l'aide du SF-12, et Harris Hip score WOMAC. Quarante-cinq patients ont été recrutés avec un suivi moyen de 52 mois (26–116). Toutes les cupules révisées étaient non cimentées. La fracture la plus fréquente était la transverse chez 18 patients. La composante acétabulaire a été jugée stable (type 1) chez 8 patients. Seuls deux patients ont été traités chirurgicalement avec des signes d'intégration osseuse démontrée chez tous les patients de ce groupe au dernier suivi. Les fractures associées à une cupule instable (10 de type 2 et 27 de type 3) ont été traitées chirurgicalement. Les complications majeures incluent 2 infections profondes et deux dislocations. Les six non-unions avec échec du matériel ont été vus dans les fractures de type 3. Ce type avait également le plus haut taux de réintervention et les plus bas résultats fonctionnels (p0,05). Les taux de réopération et de complication sont significatifs. La perte osseuse sévère a un effet significatif sur le résultat fonctionnel des fractures acétabulaires périprothétiques similaire au côté fémoral.

OBJECTIVES:This study seeks to evaluate the effects of a mild traumatic brain injury (mTBI) on pain in patients with an isolated limb fracture (ILF) when compared to a matched cohort group with no mTBI (control group). PATIENTS AND METHODS:All subjects included in this observational study suffered from an ILF. Groups were matched according to the type of injury, sex, age, and time since the accident. Main outcome measurements were: Standardized semi-structured interviews at follow-up of a Level I Trauma Center, and a questionnaire on fracture-related pain symptoms. Factors susceptible to influence the perception of pain, such as age, sex, severity of post-concussive symptoms, and worker compensation were also assessed. RESULTS:A total of 68 subjects (36 females; 45 years old) with an ILF were selected, 34 with a comorbid mTBI and 34 without (24/34 with an upper limb fracture per group, 71% of total sample). Patients with mTBI and an ILF reported significantly higher pain scores at the time of assessment (mean: 49days, SD: 34.9), compared to the control group (p<0.0001; mean difference 2.8, 95% confidence interval 1.8-4.0). Correlational analyses show no significant association between the level of pain and factors such as age, sex, severity of post-concussive symptoms, and worker compensation. CONCLUSIONS:Results suggest that mTBI exacerbate perception of pain in the acute phase when occurring with an ILF, and were not explained by age, sex, post-concussive symptoms, or worker compensation. Rather, it appears possible that neurological sequelae induced by mTBI may interfere with the normal recovery of pain following trauma.

L’abaissement de la rotule après une prothèse totale du genou (PTG) est décrit de façon inconstante dans la littérature. Ce phénomène de patella baja est attribué à un raccourcissement progressif du tendon rotulien. L’objectif de cette étude était d’évaluer la migration de la rotule post-PTG primaire. Les objectifs secondaires étaient de déterminer l’impact de facteurs tels que l’âge, le sexe, le site et les techniques chirurgicales. Un total de 124 patients (144 genoux) ayant subi une PTG cimentée avec stabilisation postérieure dans notre centre hospitalier entre 2009 et 2013 ont été inclus dans l’étude. La hauteur rotulienne a été mesurée par deux observateurs indépendants sur des radiographies latérales du genou en flexion à 90 degrés lors des suivis à 4 semaines, 1, 2 et 3 ans postopératoires. Nous avons utilisé trois ratios pour évaluer la position de la rotule : Insall-Salvati, Insall-Salvati modifié et Caton-Deschamps. L’analyse statistique (student t tests et Anova) a été effectuée avec le logiciel SPSS 12.0. Dans l’ensemble, un raccourcissement statistiquement significatif de plus de 10 % du tendon rotulien a été observé. L’index de Caton-Deschamps était la mesure la plus fiable et a montré la plus forte baisse : M = 1, SD = 0,18 vs. M = 0,91, SD = 0,18, t (91) = 7,.46, p = 0,005. Soixante-quinze pour cent de la variation a été observée dans l’année suivant la chirurgie. L’analyse des sous-groupes n’a pas montré de différences statistiquement significatives. Un haut coefficient de fiabilité interobservateur a été obtenu : 0,91, p = 0,000. Comme décrit dans des cas isolés de la littérature, il y a une variation de la longueur rotulienne post-PTG primaire, et cette variation est plus marquée au cours de la première année postopératoire sans impact de l’âge, sexe, site et technique opératoire. L’arthroplastie totale du genou est associée à une migration inférieure progressive de la rotule. D’autres études sont nécessaires afin d’évaluer l’impact clinique de ces résultats.

Objectives This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of fractures present with the highest incidence of mild TBI. Patients and methods Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a limb fracture were recruited between August 2014 and May 2015. No intervention was done (observational study). Main outcome measurements: Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident. Results A total of 251 patients were recruited (54% females, Mean age=49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ2=78.47; p<0.0001). Patients suffering from an upper limb monotrauma (29.6%; n=42/142) are significantly more at risk of sustaining a mild TBI compared to lower limb fractures (15.6%; n=17/109) (χ2=6.70; p=0.010). More specifically, patients with a proximal upper limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper limb fractures (20.25%; 16/79) (χ2=7.07; p=0.008). Conclusions Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper limb fracture are particularly at risk of sustaining concomitant mild TBI.

Objectives: To assess the accuracy of a new radiographic measurement of the distal tibia and fibula on the lateral view of the ankle in normal adults: the anteroposterior tibiofibular (APTF) ratio. Method: Thirty adults without history of trauma or disease of the ankle were included. Bilateral ankles were x-rayed with a true lateral view of the ankle. A line from the anterior tibial physis scar to the posterior tibial cortex, passing by the intersection of the physis and the fibula anterior cortex, was drawn. The APTF ratio was calculated as the ratio of the anterior segment to the posterior segment. The measurements were done by 3 independent evaluators. Intra-and interobserver reliability was obtained using intraclass correlation. Results: The APTF ratio was 0.94 +/- 0.13 with a range of 0.63-1.31. Sex and age had no effect on the results. Inter-and intraobserver reliability was good to very good with an intraclass correlation between 0.6 and 0.8. A strong correlation between the left and the right APTF ratio was observed (r = 0.501 and P = 0.001). Conclusion: The distal tibiofibular joint anatomy in the sagittal plane can be accurately assessed with a new reliable radiographic measurement, the APTF ratio. The reduction of this joint during surgery can be confirmed with a true lateral view of the ankle. The anterior fibula cortex crosses the tibial physeal scar at the center of the line crossing this point and the anterior cortex of the tibia at the level of the physeal scar in the normal ankle.

Purpose: The literature contains little information on an objective method of measuring radiocapitellar joint translations, as would be seen with joint instability. The purpose of this study was to develop and validate a measurement method that was simple and that could be easily reproducible in a clinical setting or intra-operatively to assess radiocapitellar joint translations. Method: We performed a radiological study on a synthetic elbow specimen in order to quantify radial head translations as related to the capitellum: the Radio-capitellum ratio (RCR). Thirty (30) lateral elbow x-rays were taken in different magnitude of subluxation of the radial head. The subluxation was created randomly by manipulation. X-rays where taken by fluoroscopy to obtain a perfect lateral view of the distal humerus. First, the evaluators determined the long axis of the radius and the center of the capitellum. The displacement of the radial head (in mm) was obtained by measuring the distance of the line perpendicular to the long axis of the radius passing through the center of the capitellum. Then, in order to adjust for variation of magnification, a ratio of the displacement of the radial head about the diameter of the capitellum was done. The RC ratio would be of zero because the long axis of the radius always crosses the center of the capitellum in a perfectly aligned joint. A five mm translation of the radial head and a capitellum diameter of twenty (20) mm would give a RCR of 25% and would be positive if anterior and negative if posterior. The measurements were done two times at one week intervals by three independent evaluators to test inter-observer agreement and intra-observer consistency. The radiological incidences were randomly ordered to minimize observer recall bias. Intra/inter-observer reliability was calculated using Intra-Class Correlation (ICC) and paired T-tests. Results: The mean translation in the trial group was of 6,06% (SD 70.7%) from – 167% to 125%. A result over 100% means that it is a complete dislocation ie – the axis of the radius is outside of the capitellum. Negative values signify posterior translation and positive values an anterior translation. Intra-observer reliability was excellent for the Radio-capitellum ratio (ICC 0.988 and 0.995) and inter-observer reliability was excellent (ICC 0.984 in average). Paired T-test results confirm a high intra-observer repeatability (p=0.97 and p=0.99) as well as a large inter-observer reproducibility (p=0.98 in average). Conclusion: The proposed measurement of radial head translation about the capitellum (in percent): radio-capitellum ratio (RCR) has excellent inter – and intra-observer reliability when using our measurement method.