Introduction: About 5–12 percent of scaphoid fractures are associated with other fractures, and approximately 1 percent of scaphoid fractures are bilateral.

Materials and Methods: Three hundred fifty patients sought treatment for established scaphoid non-union at the author’s department. All patients routinely underwent plain radiographs, taken with both hands in neutral position for preoperative measurement of scapholunate angle and scaphoid length. Unexpectedly however, radiological examination revealed a bilateral scaphoid Herbert type D2 pseudoarthrosis (24 waist) in 12 patients (5 females, 7 males with mean age 25 years, range 14 to 48). No patient was aware of the mechanism of controlateral injury or had previously complained of controlateral wrist pain. All patients received treatment for both sides. The scaphoid was exposed through a volar approach. The fracture was anatomically reduced and fixed with a Herbert screw. Iliac bone graft was used. Mean follow-up was 43 months (range, 25 to 68) using the modified Mayo wrist score.

Results: Fracture union was confirmed both clinically and radiographically and union rates were 96 percent. Mean union time was 7 months (range 4 to 12 months). Non-union occurred in 1 patient. According to the Mayo wrist score, excellent results were achieved in 17 cases, good in 6 and poor in 1.

Conclusion: Bilateral scaphoid pseudoarthrosis has a very rare incidence, and experience showed us that patients do not always complain of both sides. Routine pre-operative evaluation at our institution includes a set of comparative plain radiographs of the wrists and we strongly recommend this policy to avoid missing bilateral injuries.

Purpose: Purpose of that paper is the presentation of our experience and the evaluation of the results we had, using our method in the treatment of acute raptures of the Achilles tendon.

Methods-materials: A total of 27 patients (26m-1f) were treated in our clinic during the years 1996–2002. There was an age width from 21 to 67 y.o. with an average of 36, 8 years. 70.3% of the cases concerned patients in their 3rd decade of life and 92.2% of the cases involved injuries after participation in acceleration – deceleration pattern sports. All but one (he asked for treatment after a week), underwent an operation within 48 hours. The restoration of tendon’s continuity was achieved with a modified Kessler end to end suture, with plantaris use (24 cases) for repair covering as it was described by Lynn, gastrocnemius fascia use (2 cases), and tendon’s sheath use (1 case). Cordell 1,5mm and Vicryl sutures were used for tendon’s repair. In 4 cases an ABC medium suture and in 1 case a synthetic graft LARS were used. In all cases we applied immobilization with the use of a full length cast from upper thigh to metatarsal necks with the foot in gravity equinus for 3 weeks and then an additional 3 weeks immobilization in a shorter (bellow the knee) cast with the foot gradually brought to the plantigrade position. Physical therapy for 2 weeks followed the immobilization. The average follow up was 3.75 years.

Results: In the majority of the cases the postoperative period was untroubled. Two complications were noted: a case of skin necrosis which necessitate the intervention of plastic surgeons for reconstruction and a case in which the sutures came out through the incision but with preservation of an excellent functional outcome. Subjectively, 87% of the patients were very satisfied, while objectively and after a clinical examination and strength – motion tests this ratio was found higher. The return in their previous activities was clearly influenced by a phobic feeling towards the possibility of a rerapture and not at all by our intervention’s efficiency.

Conclusions: Based on very good results we had using Lynn’s technique for the surgical treatment of acute raptures of the Achilles tendon, in combination with the postoperative rehabilitation program we use, we concluded that this method ensures a curing approach of that injuries in a very efficient and effective way.

Over the last decade 18 patients with thoracic outlet syndrome (T.O.S.) were treated at our department by scalenectomy through transverse supraclavicular approach.Preoperatively all of the patients had experienced pain, paresthesias and tingling of neck and shoulder with radiation to the ipsilateral arm, whereas 8 of them had additionally vascular symptoms.

Postoperatively (6 months – 2 years) 12 patients were still suffering or they had a deterioration of symptoms. 9 were male (80%) whereas 3 were female (20%).

Resection of the first rib through transaxillary approach was performed and six months later they all had returned back to work, reporting complete relief (80%) or significant improvement (20%).After 4 years of follow up there were no recurrences.

In one case there was a long thoracic nerve palsy that spontaneously recovered after 6 months.

Whilst the cause of recurrence remains controversial, many authors suggest that this is due to adhesions of scar tissue to the nerves and vessels at the axilla. Therefore, intervention should be planned and performed by an experienced surgeon, avoiding complications and minimizing tissue trauma.

In conclusion, prevention is the best way of managing recurrences; accurate clinical evaluation, careful preoperative planning and meticulous dissection are the cornerstones of a successful outcome.

378 patients have been studied since 1988 when we started the investigation of scaphoid fractures and pseudarthrosis. 306 patients were scaphoid pseudarthrosis and 72 scaphoid fractures or control of fracture healing. This study consists of 3 groups:

Group l: 72 patients with acute injury of the carpus are examined radiographically and no scaphoid fracture was observed. A scaphoid cast is applied in these patients for 10 days. In follow up, the cast is removed and new comparative radiologic examination is performed. In 30 of these patients a scaphoid fracture was observed and the limb was inmmobilized in a scaphoid cast for 4 weeks. In the remaining 42 patients, in whom a fracture line could not be observed in a simple x-Ray, but continued to have clinical findings, a CT-scan was performed in 2 planes. In 26 patients with no fracture in the CT-scan were discharged, while in the remaining 16 patients with obvious fracture in the CT-scan a scaphoid cast was applied for 4 weeks.

Group 2: 30 patients with scaphoid fracture, from which the cast was removed and the fracture line was still visible in a simple X-Ray were examined with CT-scan in 2 different planes. In 18 we found intense healing of the fracture in all the width of the scaphoid and the patients were discharged . The remaining 12 displayed delayed non union with obvious fracture line in all the width of the scaphoid. These patients were treated operatively, by compressing the fracture line with a Herbert screw.

Group 3: This is the largest group of patients concerning the scaphoid pseudarthrosis and consists a topic of a different study. In conclusion the computer tomography scan in two different planes is the most reliable method for the investigation not only of scaphoid fractures but also of the efficiency of the callus. The contribution of the above method in the study of the scaphoid pdeudarhrosis is very important and valuable.

Humeral shaft fractures are among the most frequent fractures encountered in Orthopaedic Traumatology. Their treatment can be either conservative or operative depending on the location (proximal, middle or distal third), type (spiral, oblique, or transverse), radial nerve involvement, concomitant presence of thoracic injuries that preclude general anesthesia, as well as surgeon’s experience. Non union or delayed union complicates some of the conservatively and very few of the operatively treated fractures.

We report of our experience with the management of humeral shaft non unions in 28 patients treated at our institution from 1990 to 2000. Six were male and twelve female aging from 21 to 68 years (mean 45 years).The interval between initial injury and operation varied from 6 months to 3 years (average 10 months).Regarding the location of non union,20 cases were located in the middle, 6 cases in the upper and 2 cases in the distal third.

Operative technique: under general anesthesia using anterolateral approach for middle and distal third and deltopectoral approach for proximal third , the site of pseudarthrosis was exposed. In transverse and slightly oblique fractures a self compression plate was implanted without resection of pseudarthrosis or excessive soft tissue detachment .In spiral and true oblique fractures reduction performed initially, maintained with k-wires and fixated with self compression plate. Upon completion of osteosynthesis suction drain was put ,followed by wound closure and elastic bandage.

Postoperatively a colar cuff was used for 2 weeks .Follow up examination with radiographic evaluation was done after 3 and 6 months.

Signs of incomplete callus formation were obtained after 3 months whereas solid union was achieved after 6 months in all patients without any serious complication.