Background: We present our further experience with the Orthofix tibial nailing system, concurrently evaluating the easy and safety of the distal targeting system for the distal locking.

Materials & Methods: Ninety-seven fresh tibial fractures in the same number of patients with a mean age of 38,5 years (17–85) were treated. Three were lost from the follow-up. Twenty of the fractures were grade I open fractures, four grade II and one grade IHA. All operations were performed in a conventional operating theater on a simple transparent operating table, with reduction of the fracture performed under manual traction and manipulation of the fracture site, hi most of the cases closed reduction was achieved and conventional reaming performed; in 14 patients the fracture was reduced through a small incision at the fracture site. Conventional reaming (power reaming) was performed in 69% of the patients; however, in 31% of the cases (30 patients), only minimal hand reaming was performed. The mean duration of the operation was 30 min. The external targeting device failed in 10 distal locking screws, in six of which the second attempt was successful. In four an image intensifier had to be used.

Results: Fracture healing, confirmed clinically and radiographically, was observed at a mean of 17 weeks (12–28 weeks). No tibial non-union necessitating reoperation occurred, however six fractures showed delayed union. Open reduction didn’t compromise the healing of the fracture. All patients eventually gained a full range of motion knee and ankle joint and only twelve of them (12%) complained of mild anterior knee pain. All patients returned to their previous activity, except for one disabled from a head injury. The later evaluation showed preservation of the tibial axis in all patients and additionally that no mechanical failure of either the nail or the screws occurred.

Conclusions: We conclude that the Orthofix nailing system is a clinically effective system. Distal locking can be performed with ease without significant exposure to radiation, provided that the operative technique is accurately followed, the nail is inserted without significant force and the distal targeting device is not subjected to any violation, such as hammering.

We evaluated the clinical outcome of IM nailing for the treatment of femoral shaft pseudarthrosis in patients who had multiple failed plate osteosyntheses. From January 2000 untill April 2001, 20 (19 male-1 female, mean age 28) patients were treated because of femoral shaft non-union in our institution. All patients had two or more failed plate osteosyntheses. There were no septic non-unions in this group. Eight patients had an established non-union on an average of nine months post-op and the remaining eleven had radiological and clinical evidence of implant failure. There was no segmental bone loss, hi all patients the implants were removed and nailing was performed. Extensive periosteal stripping, bone necrosis and soft-tissue scaring were constant findings in all patients. Twelve patients received interlocking nails. Eight femurs were grafted with iliac crest bone graft. All patients were followed by serial x-rays until union.

There were no postoperative complications. All pseudarthroses were healed within an average of 9.7 months (8–12). Non-unions which received bone graft (eight out of twenty) in day one, were healed faster than those which didn’t. There were no re-operations among these patients. Among the remaining ten patients five were grafted five to six months postoperatively and three had had nail dynamization.

IM nailing for femoral shaft non-unions after multiple failed plate osteosyntheses is a safe and effective method of treatment. Autologous bone graft reduces healing time and re-operation rate.

Purpose: The efficacy of nasal salmon calcitonin (CT) in preventing bone loss after a hip fracture and in reducing the incidence of further contralateral hip fractures was evaluated.

Material and Methods: Fifty women aged 70–80 years who sustained a pertrochanteric fracture were randomly allocated to Group A (200 IU of nasal salmon calcitonin daily for three months) and Group B (placebo). Biochemical bone markers (1st, 7th, 15th, 45th and 90th day post injury) and bone mineral density of the lumbar spine and the intact contralateral hip (4th and 90th postoperative day, and one year after the fracture) were measured.

Results: Patients in the calcitonin group showed statistically significantly higher total (p< 0,005) and bone alkaline phosphatase (p< 0,002) and osteocalcin (p< 0, 05) levels on the 15th day, while statistically significantly lower uCTX values on the 15th (p< 0,045), 45th (p< 0,002) and 90th (p< 0,002) day and uHpr/Cr values on the 15th (p< 0,015) and on the 45th (p< 0.05) day post injury. In the placebo group patients showed a statistically significant reduction (all p values < 0.05) of bone density values at 3 months and one-year post surgery while in the calcitonin group no significant changes from baseline. When the two groups were compared, patients in the calcitonin group showed statistically significantly higher bone mineral density values (all p values < 0.05), in all recorded sites, at 3 months and one-year post operatively. After a four years clinical follow-up, five patients (5/25, 20%) sustained a new fracture of the contralateral hip in the placebo group.

Conclusion: Nasal salmon calcitonin prevented early bone loss in these patients and may have a protective role on the occurrence of a new fracture of the contralateral hip in the same patient.