Introduction and purpose: The VIRA system allows reconstruction of the fractured bone and its arthrodesis with the talar bone eliminating all movement of the subtalar joint by means of a minimally invasive approach. The aim is to restore the shape of the foot and prevent joint degenerative changes in the long term without the complications and sequelae of open surgery.

Material and methods: Between November 2004 and June 2006, 30 intraarticular calcaneal fractures in 25 patients were treated surgically by means of the Vira System. Using Sanders’ classification 6 cases were classified as type II, 13 as type III and 11 as type IV. Five patients had open fractures. There was a mean period of 8.7 days between the accident and surgery. Seven cases had associated lesions and fractures in other locations. Only 2 cases required iliac crest grafts in the operated area.

Results: All patients except 10 have returned to their usual occupations. Eight cases evolved favorably but have had a short follow-up. Two cases experienced a delayed healing of the subtalar arthrodesis and had to be reoperated; they required an autologous graft. The mean period of temporary disability in patients discharged from hospital was 163.7 days. Clinical assessment using the AOFAS scale reached a mean value of 76.6 points. No surgical or post-surgical complications were seen in the group studied.

Conclusions: The VIRA System seems capable of achieving its purpose in the first series of patients operated. It allows a quick recovery both postoperatively and in the subsequent evolution without any associated complications. It accelerates the patients’ return to work by decreasing convalescence and minimizing sequelae.

Purpose of the study: Accidents caused by power-take-off shafts produce different types of injuries. The lesions can vary from simple skin abrasion to amputation or serious, sometimes fatal, limb damage. We present a series of injuries treated in our institution since 1997 in order to analyze the circumstances of these accidents and their pathophysiological mechanisms as well as the most appropriate treatment. We also analyzed the mechanism of the power-take-off shaft with a few fundamental aspects to better understand the potential health hazard.

Material and methods: Ten victims of power-take-off accidents were treated in our institution since 1997. All were men aged 26 to 66 years. In all cases but one, a cord caught on the turning shaft was the cause of the accident. Eight of the patients presented upper limb injuries of variable gravity.

Results: Outcome after treatment depended on several factors: the severity of the injury, the circumstances of the accident and the proximity to a health care center. In general, the sequelae were worse for serious injuries, producing permanent disability.

Discussion: The power-take-off transmits power from the tractor to agriculture machines via a turning shaft. Correct use requires several safety measures. Serious injury, disability or death can result from inadequate protective measures or inadequate knowledge about proper use.

Purpose of the study: The purpose of this presentation was to focus on the situation where rotator cuff tears are associated with nerve injury and to clarify the clinical nosology of the shoulder triad (glenohumeral dislocation, acute cuff tear, and circumflex nerve injury) and of the «dead shoulder syndrome» (chronic massive cuff tear, acute glenohumeral dislocation, and circumflex nerve injury).

Material and methods: This series included seven patients with the shoulder triad and five patients with dead shoulder syndrome who were treated in our department between 1996 and 2002. There were nine men and three women, aged 50–74 years (mean 58 years). Follow-up was two years or more. The Neer and Cofield classification was used to assess functional outcome and the simple shoulder test (SST) was recorded.

Results: For the patients with the shoulder triad, outcome was excellent to satisfactory in all, with frontal and vertical elevation greater than 90°, nearly normal rotations, and acceptable force and range of motion for daily, occupational and sports activities. The patients with dead shoulder syndrome were a more heterogeneous population. Clinical outcome was less satisfactory although there was a real improvement in range of motion. Occasional pain was reported and some of the patients were satisfied.

Conclusion: Combined lesions of the shoulder create a difficult diagnostic and therapeutic situation. As when occurring alone, it is important to recognize injury early in order to adapt treatment to achieve functional improvement.

Introduction and purpose: Large defects of diverse aetiology (traumatic, oncological, etc.) in long bones pose a number of difficulties for reconstruction because of their dual condition: structural and functional.

The free fibular flap can be a useful method for reconstructing large defects in bones such as the tibia or humerus.

We present our experience with 15 patients in whom this bone flap was used to reconstruct defects of different pathological origins.

Materials and methods: Retrospective analysis of 15 patients between the ages of 6 and 55 in whom a vascularised fibular flap was used to reconstruct bone defects in the following locations and pathologies: Tibia: 7 cases of congenital pseudoarthrosis, 1 case of posttraumatic pseudoarthrosis, 1 case of firearm wound, 1 case of chronic osteomyelitis, 2 cases of Ewing’s sarcoma in the distal third of the tibia; Humerus: 2 cases of Ewing’s sarcoma; Radius: 1 case of osteosarcoma. Of the 15 cases 14 fibulae were used with a single bar, with different attachment methods, and one with a double bar.

Results: The viability rate of the flaps was 100%, and adequate function was achieved in all cases except one case of posttraumatic pseudoarthrosis that required further procedures.

Conclusions: The vascularised fibular flap is the best option for treating congenital pseudoarthrosis of the tibia and a good option for reconstruction after oncological bone surgery.