This study of surgically treated distal tibia fractures was undertaken to compare the internal fixation with the two external fixation methods.

There were 40 patients with 41 pilon fractures. The mean age was 51.2 years (18–76). 17 of the 40 patients-14 from vehicular accident, 3 from fall – were treated with an ankle-spanning half-pin external fixator (11C, 6B, 11 Weber B- 5 C, 1IIIa, 5I, 6II). 11 patients-10 from vehicular accident, 1 from fall- were treated with a single-ring hybrid ankle-spanning external fixator (9C, 2 B, 6 Weber B-4 C, 5I, 2II). 13 patients-10 from vehicular accident and 1 from fall- were treated with an epiunion plate (1A, 8B, 4C, 5I, 3II, 10 Weber B- 1C). The mean follow-up was 4.2years (1–8). Fracture union was defined as having three cortices bridging on the plain radiographs for a patient who was able to bear full weight. Non union was defined as a fracture that did not heal within a year.

Fracture union was achieved for 36 of the 41 fractures. Three patients with external fixator, one with hybrid and one with plate had septic pseudarthrosis. Fractures in the external fixator and hybrid groups had a tendency to lose the reduction. Four patients with external fixator had delayed union and have lost range of motion in the ankle. Five patients in the external fixator group are candidates for ankle arthrodesis due to arthritis.

The ORIF and hybrid fixator were equally efficacious in achieving bony union and not to lose range of motion in the ankle. Fractures in the external fixator with the ankle – spanning had higher rate of delayed union and loss of motion in ankle. The choice of the external fixator is dependent on the surgeon and the type of the fracture. However the patient must be followed up for the stability of the system.

This study describes the clinical features and treatment of the 53 patients with primary tumors of the hand. A review of primary tumors of the small bones of the hand during a 9 year period (1991–2001) was done. There were 14 enchondromas, 1 malignant fibrous histiocytoma, 15 ganglions, 5 haemangiomas, 1 haemangioma of median nerve, 4 giant cell tumors of tendon sheath, 4 osteoid osteomas, 1 lymphangioma, 1 exostosis, 1 dermatofibrosarcoma, 1 neurilemoma, 2 neurinomas, 1 glomus tumor, 1 benign fibrous histiocytomas and 1 papillary endothelial hyperplasia. There were 34 males and 19 females with an average age 37.7 years. The mean follow-up was 6y (1–8y). There were 33 lesions in the fingers, 3 in the metacarpals, 13 in the carpus and 4 in the palm. Swelling and localized tenderness were the most common presenting complaints. One patient died of metastatic disease. 3 patients were seen initially with locally reccurent lesion. All the patients were treated surgically. The material was analyzed in terms of diagnosis, localization, surgical management and post-operative complications. Primary tumors of the hand are rare. The cases in these series are similar to that of other reports. As in other musculoskeletal neoplasms, a treatment plan must be formulated based on the location, size and biologic behaviour of the lesion.

Purpose: We perform the results of the operative treatment of cubital tunnel syndrome, and a retrospective review of the surgical options of in situ decompression of the ulnar nerve, release and anterior transposition of the ulnar nerve and ulnar nerve release and partial medial epicondylectomy.

Material and Methods: Seventy four patients, 52 male and 22 female, (78 elbows), were treated surgically from October 1991 to November 2002.The mean age was 51 years (range, 13 to 72 years). Sixty four patients were assessed postoperatively with mean follow-up 80 months (range 6–139 months). Twenty patients underwent in situ decompression of the ulnar nerve, 34 patients release and anterior transposition and 14 ulnar nerve release and partial medial epicondylectomy. According to the McGowing evaluation system were classified in Grade I, none, Grade II, 38 patients and Grade III 26 patients. The 64 patients were evaluated clinically and 16 of them by EMG studies postoperatively.

Results: Sixty one patients had had subjective improvment of their symptoms. Thirty seven patients (57.8%) excellent, 21 patients (32.8%) good, 3 patients (4.6%) fair and 3 patients (4.6%) poor results. (Wilson & Krout). The comperative results among the surgical options of our study showed improvement in the subjective outcome of 32 out of 34 patients who had release and anterior transposition of the ulnar nerve. From the 20 patient who had in situ decompression of the ulnar nerve, 19 had improvement and from the rest 14 patients who had had ulnar nerve release and partial medial epicondylectomy, they all had improvement.

Conclusions: The results for the patients in this study who had ulnar nerve release and partial medial epicondylectomy, are comparable in good results with other operative treatment options for the cubital tunnel syndrome.

Purpose: The first 50 free flap operations performed at our clinic by the same surgical team were reviewed and assessed as to the cause and location of the defects, donor sites, complications and results. An attempt was then made to determine what could be learned from this experience.

Material and Methods: There were 46 males and 4 females who underwent free flap operations (mean age, 28.5 years; range 6 to 56 years). The lower extremity was the most frequent site of defect (72.5%). The next most frequent sites were the arm and the hand (27.5%). Trauma was by far the most common cause. Latissimus dorsi and forearm flap were the most useful flaps. Fractures in the wound were present in 26 patients.

Results: The fate of the flaps has been analysed. In two latissimus dorsi flap emergency re-exploration was performed and were successfully managed. Two flaps, underwent necrosis, due to thrombosis at the site of arterial anastomosis. Two flaps were lost due to inappropriate blood flow of the recipient vessels. Other complications included pressure ulcer, infection, and hematoma. The overall survival rate of the 50 cases was 92%.

Discussion: Limb reconstructive surgery has significantly improved and expanded with the use of microsurgical techniques. Evaluation of the recipient vessels is always the first priority. The choice of the flap, specially regarding the length and size of the pedicle is also very crucial in order to achieve good results. In addition important factors seemed to be: improvement in techique of micro-vascular anastomosis, diseased vessels, vascular spasm, hypotension, postoperative edema, and hematoma. We believe that an “orthoplastic” approach in covering soft tissue defects is beneficial.