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.

To determine the bony outcomes of patients treated at our Institution after sustaining femur fracture and arterial injury, due to gunshot, in the ipsilateral limb, studied over a four-year period.

The database at the Department of Vascular Surgery at our Institution was searched for cases that had sustained both arterial injury and femur fracture of the ipsilateral leg. Their case notes and X-rays were reviewed for the following:

Time line from injury to discharge

During the period from 2002 to the end of 2005 there were 12 patients who qualified to be included in the audit group. Three of the 12 (25%) had to undergo a primary amputation upon arrival. The other nine cases underwent surgery. One of these received an intra-medullary device, another skeletal traction and the rest external fixation following the vascular surgery. Five of the 7 external fixation devices were converted to an intramedullary device in due course. All nine cases went on to union. There were no reported cases of iatrogenic vascular repair disruption. Of the 12, only three cases reported any infection. One case developed severe osteomyelitis of the femur.

Primary vascular repair with temporary external fixation that was later converted into an intramedullary device (within 14 days) provided satisfactory results.

Aims: Pharmacological modulation of skeletal muscle reperfusion injury after trauma associated ischaemia may improve limb salvage rates and prevent the associated systemic sequelae. Resuscitation with hypertonic saline restores the circulating volume and has favourable effects on tissue perfusion and blood pressure. The purpose of our study was to evaluate the effects of hypertonic saline on skeletal muscle ischaemia reperfusion (I/R) injury and the associated endorgan injury.

Methods: Adult male Sprague Dawley rats (n=24) were randomised into three groups: control group, I/R group treated with normal saline and I/R group treated with hypertonic saline. Bilateral hind-limb ischaemia was induced by rubber band application proximal to the level of the greater trochanters for 2.5 hours. Treatment groups received either normal saline or hypertonic saline prior to tourniquet release. Following twelve hours reperfusion, the tibialis anterior muscle was dissected and muscle function assessed electrophysiologically by electrical field stimulation. The animals were then sacrificed and skeletal muscle harvested for evaluation. Lung tissue was also harvested for measurement of wet-to-dry ratio, myeloperoxidase content and histological analysis.

Results: Hypertonic saline significantly attenuated skeletal muscle reperfusion injury as shown by reduced twitch and tetanic contractions of the skeletal muscle (Table). There was also a significant reduction in lung injury as demonstrated by differences in wet-to-dry ratio, myeloperoxidase content and histological analysis.

Conclusion: Resuscitation with hypertonic saline may have a protective role in attenuating skeletal muscle ischaemia reperfusion injury and its associated systemic sequelae.

Tibial eminence fractures were historically thought of as a condition of skeletal immaturity. Increasingly this injury has been recognized in adults. The aim was to report on the demographics, mechanism, treatment and outcomes of this injury in adult and paediatric patients. A retrospective review of all patients presenting to Dunedin Hospital, for management of a displaced tibial eminence fracture, between 1989 and 2009. 19 cases were identified, 10 skeletally mature and 9 skeletally immature. Alpine skiing with a forced flexion and rotation injury accounted for 7 cases, primarily adult females (5 cases). A hyper-extension and rotation injury accounted for 7 cases, primarily in skeletally immature males (4 cases), while direct trauma accounted for 5 cases, primarily males (4 cases). Associated injuries were more commonly seen in adults and those with high energy trauma. Stiffness was the most common complication (10 cases). Tibial spine fractures are more common in adults than previously thought. Female skiers appear to be a group at particular risk. Our most common complication was stiffness. Early range of motion is essential to reduce the problem of stiffness and extension impingement. Laxity is an infrequent problem in adults and children

Introduction. This study investigates the epidemiology of proximal radial fractures and potential links to social deprivation. Patients and Methods. From a prospective database we identified and analysed all patients who had sustained a fracture of the radial head or neck over a one year period. The degree of social deprivation was assessed using the Carstairs and Morris index. The relationship between demographic data, fracture characteristics and deprivation categories was determined using statistical analysis. Results. Two hundred and ninety radial head (n=203) and neck (n=87) fractures were diagnosed with a mean age of 44.3years (13–94). There was no significant difference with regards age or gender predominance when comparing radial head and neck fractures directly. The mean age of males was significantly younger when compared to females for radial head (p<0.001) and neck (p<0.001) fractures, but with no gender predominance seen. Associated injuries (n=25) were related to increasing age (p=0.006), radial head fractures (p=0.003) and increasing fracture complexity according to the Mason classification (p<0.001). Social deprivation was related to the mean age at the time of fracture and the mechanism of injury (p<0.05 for both). Conclusions. Proximal radial fractures are frequently fragility fractures affecting older females and assessment for osteoporosis is recommended. Complex radial head fractures require thorough investigation for the presence of associated injuries

Purpose of the study: High-energy varus or valgus ankle trauma causes severe injury to the capsule and ligaments. We describe a presentation associating massive tears of the lateral/medial collateral ligaments with a transversal wound of the corresponding malleolus. This wound results from excessive tension on the skin cause by the major varus/valgus. We have defined this injury as an open and severe ankle sprain (OSAS). Material and method: This was a retrospective analysis. We search the databases of three participating centres using the corresponding diagnostic and therapeutic codes from January 2005 to January 2009. The identified files were screened to select patients with OSAS. Results: There were 11 cases of OSAS. Eight involved the lateral side of the ankle and three the medial side. Mean age was 41 years (range 21–45). All patients were victims of a high-energy trauma (five motorcycle accidents) and four patients had fallen from a high point. Associated injuries were tendon section (n=3), section of the deep fibular nerve (n=2), and section of the anterior tibial artery (n=1). Pneumarthrosis was the only visible anomaly on the plain x-rays of seven ankles. Diagnosis was confirmed preoperatively in all cases clinically with varus-valgus stress manoeuvres. Conclusion: OSAS is a rare misleading injury. Confusion with a common wound is possible. The risk is to miss acute instability and thus its treatment. The diagnosis should be proposed for all transversal wounds without contusion over the malleolus with normal x-rays

Purpose:. Non-contiguous spinal injury can add significant complexity to the diagnosis, management and outcome in children. There is very little in the paediatric literature examining the nature, associated risk factors, management and outcomes of non-contiguous spinal injuries. The objective is to determine the incidence and clinical characteristics of non-contiguous spinal injuries in a paediatric population. The secondary objective is to identify high risk patients requiring further imaging to rule out non-contiguous spinal injuries. Methods:. All children up to 18 years of age with a spinal injury, as defined by ICD-09 codes at one paediatric trauma hospital were included (n=211). Data for patient demographics, mechanism of injury, spinal levels involved, extent of neurologic injury and recovery, associated injuries, medical complications, treatment and outcome were recorded. Results:. Twenty five (11.8%) out of 211 patients had non-contiguous spinal injuries. The mean age was 10.7 years. The most common pattern of injury was a double thoracic non-contiguous injury. 16% of cases of NCSI were initially missed, but with no clinical deterioration due to the missed diagnosis. Associated injuries occurred in 52% of patients with NCSI. Twenty-four percent of patients with multiple non-contiguous spinal injuries had a neurologic injury compared to 9.7% in patients with single level or contiguous injuries (p=0.046). Conclusions:. There is a high incidence of children with multiple non-contiguous spinal injuries who are more likely to suffer neurological injuries compared to patients with single level or contiguous spinal injuries. Patients with a single level spinal injury on existing imaging and a neurological injury should have entire spine lateral radiographs to exclude non-contiguous injuries. In patients without neurologic injury and a single spinal fracture, radiographs showing at least 7 levels above and below the fracture should be performed. All children with spinal injury should have associated injuries carefully excluded

Firecracker injuries to the hands can cause permanent functional loss and disfigurement. We assessed the injuries and treatment of 16 men, three women, five boys and two girls injured around New Year’s Eve between 1999 and 2004. In 16 of the adult patients, who included a typist and a teacher, it was necessary to amputate one or more digits. Four patients lost both the thumb and the index finger, four lost the thumb and the rest lost other digits. Only soft tissue injuries were sustained by 10 of the 26 patients. Twenty patients (77%) benefited from initial debridement and primary closure alone, but the other six needed more than one procedure, and half of this group developed sepsis. The psychological impact was important in adults. Associated injuries included the loss of an eye in one patient, facial lacerations in 10 and a perforated eardrum. The mean hospital stay was 5 days. Public education and legislative reform may help prevent these unnecessary injuries

Lower limb fractures in children are common. These fractures can be managed in a variety of ways, and the method chosen depends on a number of factors including:. Age of the child. Site of fracture. Whether the fracture is open or closed. Associated injuries. Surgeon’s expertise and experience. Parental wishes. Femur: Immediate or early hip spica gives good results withminimal shortening particularly in the younger child. Flexible IM nails have been widely reported and give good results. It is important to appreciate the mechanics of how the nails function to stabilise the bone and to recognise that pre-bending the nails is a vital step in the operation. As surgeons become more confident in using the nails, the range of indications can be extended to include proximal or distal fractures, comminuted, open and pathological fractures. Tibia: Skeletal stabilisation of open tibial fractures can be provided by application of an external fixator. The use of flexible IM nails in the tibia is more controversial. Introduction of these nails into the proximal tibia can be difficult and even with pre-bending of the wires, additional cast protection may be required

We conducted a prospective evaluation of patients with anterior dislocation of the shoulder associated with a fracture of the greater tuberosity. Thirty-four anterior dislocations of the shoulder with greater tuberosity fractures were reviewed with a minimum follow-up of one year from the time of injury. Eight required open reduction. The final outcome with regard to pain, range of movements, and function was assessed in 34 patients. In open reduction, there were five good results, one fair, one poor and one patient died. In the non-operative group, results were good in 11 patients, fair in eight, poor in one, not assessed in five and one patient died. Two patients have died in this series, one in the open reduction group. Associated injuries are: axillary nerve damage (three), brachial plexus injury (one), loose fragment under the acromion (one) and stiffness of the shoulder (three). Anterior dislocations of the shoulder with fracture of the greater tuberosity do not always lead to good results. Close observation after reduction is important to check for later displacement of the fractures

In 1996 the quality of the early management of 100 consecutive patients referred to a regional pelvic and acetabular unit between 1989 and 1992 was studied. The management of these patients was assessed in four specific areas, and guidelines were laid down. It was found that in 56% of patients the early management did not meet these suggested standards, with 34% having deficiencies in more than one area. These results were presented, published and circulated to referring hospitals. Five years later, the early management of a further 100 consecutive referrals was assessed using these same guidelines. The treatment of 57% of patients still did not reach the guideline standards, but the number with problems in more than one area fell to 20%. There has been some improvement in the early management of pelvic and acetabular injuries. The use of external fixators to control severe haemorrhage increased, but frames were often poorly applied. Wider access to CT scanners has reduced delays in definitive imaging. Associated injuries are still regularly overlooked, and occasionally treatment of ipsilateral hip or femur fractures compromises pelvic surgery. Early communication with the specialist centre is encouraged but unfortunately delays in referral are still common

Introduction: Although a relationship between long-bone fractures and patient morbidity and mortality has been previously identified, the cause and effect of bilateral femoral fractures remain obscure. Aim of Study: This study was designed to determine whether patients with bilateral femoral fractures with associated injuries die more frequently than patients with isolated bilateral femoral fractures, and the contribution of the associated injuries to patient mortality. Materials and Methods: Retrospective analysis using the UK trauma Audit & Research Network (TARN) registry data from 1989 to 2005 on isolated bilateral femoral fractures ‘Group I’ (92) or with associated injuries ‘Group II’ (380). Univariate data analysis was performed to compare the groups’ ages, Injury Severity Scores, Glasgow Coma Scales, mortality, physiological parameters, the time to arrive to scene and the time to arrive to hospital. Logistic regression data analysis was performed to determine variables statistically associated with mortality. Results: Patients in Group II had a significantly higher Injury Severity Score (23 vs 9), lower Glasgow Coma Scales value (12 vs 15), higher mortality rate (31.6 vs 9.8%) and lower mean systolic pressures (116 vs 135) than patients in Group I. Associated injuries included; head, thoracic, abdominal, spinal, and limb injuries. Regression analysis of variables on admission revealed a significant correlation between bilateral femoral fractures with associated injuries and. Conclusion: From the results of this study, we conclude that patients sustaining bilateral femoral fractures with associated injuries are at a greater risk of than patients with isolated bilateral femoral fractures

Anterior wall and/or column acetabular fractures (AW/ C) have a low incidence rate. Paucity of information exists regarding the clinical results of these fractures. We present our experience in treating AW/C at a tertiary referral centre. Between Jan-2002 and Dec-2007, 200 consecutive patients were treated in our institution with displaced acetabular fractures. All AW/C fractures according to the Letournel classification were included in the study. All patients underwent plain radiography and CT investigations. Retrospective analysis of the medical notes and radiographs was performed for type of associated injuries, operative technique, peri-operative complications. Radiological assessment of fracture healing was determined by Matta’s criteria and functional hip scores were assessed using Merle-d’-Aubigne scoring. The mean follow up was 44.5 months (28–64). 15 patients (10 males) met the inclusion criteria (mean age 55.5 years). Four had associated anterior dislocation. Associated injuries included pneumothorax, splenic rupture, tibial and distal radius fractures. Five were treated by percutaneous methods, 8 with plate-screw fixation, and 2 with circlage wire, (10 ilioinguinal approaches). Mean time-to-surgery was 14 days(10–21 days). The average operative time for the percutaneous group was 75min vs. 190min in the orif group. Mean postoperative-in-patient-stay was 4 days(3–7 days), and 21 days(14–37 days). One patient developed chest infection post-operatively, two loss of sensation over the distribution of lateral cutaneous nerve. None of them developed incisional hernia, deep venous thrombosis and pulmonary embolism. At the last follow-up radiological outcome was excellent in 11 and good in 4 patients; clinical outcome was excellent in 12 and good in 3 patients, and none of the patients has developed heterotopic calcification or early osteoarthritis. Our results on management of these fractures are comparable to the early results reported by Letournel. Operative treatment for the rare anterior wall and anterior column fractures yields a favourable outcome resulting in early mobilization with limited patient morbidity

Introduction. Paediatric hip fracture accounts for less than one percent of paediatric fractures. Previous studies report complication rates between 20 and 92%. Method. We retrospectively identified patients with fixation for neck of femur fractures at Birmingham Children's Hospital. All patients were under age sixteen. Data were reviewed over a 10 year period (1997-2006). Fractures were classified by Delbet's classification and Ratliff's system to grade avascular necrosis (AVN). Function was assessed using Ratcliff's criteria, incorporating clinical examination and radiographic findings. Results. 15 femoral neck fractures were treated in 14 patients over a ten year period (R=1997-2006). One patient sustained bilateral fractures. Three patients had osteogenesis imperfecta and one osteopetrosis. Mean age at injury was 10.3 years (R=6-14 years). Mean follow-up was 31 months (R=6-110 months). Two fractures were Delbet type-I (13.3%), four type-II (26.7%), six type-III (40%) and three type-IV fractures (20%). Associated injuries included calcaneal fracture, head injury, pubic rami, acetabular and tibial fractures, hip dislocation, and depressed skull fracture with extradural haematoma. Eleven patients were operated on within 24 hours (R=4-19 hours) and four after 24 hours (R=2-11 days). One patient operated on within seven hours had a poor outcome. Premature physeal closure (PPC) occurred in all patients with physeal penetration (Fishers Exact test: p=0.077). The results were ‘good’ in 14 patients (93%) and ‘poor’ in one patient with Ratliff's Type I avascular necrosis (6.7%). This 13 year old male sustained a Delbet type 1 fracture with dislocation of the femoral epiphysis after a road traffic accident. The AVN and PPC rates were 6.7% and 33%. Coxa vara was diagnosed in two patients. One patient developed a significant leg length discrepancy (>2cm). Superficial wound infections occurred in two patients. No non-unions occurred. Conclusion. Complication rates are lower than historical studies

Materials & Methods: A retrospective study. 25 cases of fracture Calcaneum during April 2001–2004 were reviewed for their clinical outcome. Aim of the study: To assess the clinical and functional outcome of the Management of Intra and Extra articular Calcaneal fractures in district general hospital. Results: 22 male and 3 female. Intraarticular fractures 15 (60%)of which 10 were displaced and 5 undisplaced. Extraarticular were 10 (40%) of which displaced and undisplaced were 5 each. Fall from height was seen in 20 (80%)patients. Associated injuries was seen in 10(40%) patients of which 8(32%) of them had fracture spine. All the cases of intaarticular fractures had C.T. scan. 5 cases had MUA and pinning for the extraarticular fracture. 8(32%) displaced intraarticular fractures underwent ORIF. 2((8%) intraarticular displaced fractures were treated conservatively. The average follow-up one-year. The final outcome assessed clinical and radiologically. 2 cases of infection, 4 cases of stiffness, 2 cases of deformity seen.1 case had parasthesia. The final outcome all the fractures treated conservatively were good. Fractures underwent ORIF had better outcome and more complication rate as compared to conservative treatment. Conclusion: Commonest mode of injury is fall from height and associated injury incidence is usually high. Even the undisplaced intraarticular fractures of calcaneum do develop residual stiffness and difficulty in walking on uneven ground. Displaced fractures needs fixation for better results and facilitation for secondary operations. Wound infection, stiffness and deformity are known complications. In this small audit all three group did develop stiffness and we recommend a bigger, independent audit

Introduction: Anterior wall and/or column acetabular fractures (AW/C) have a low incidence rate. Paucity of information exists regarding the clinical results of these fractures. We present our experience in treating AW/C at a tertiary referral centre. Methods: Between Jan-2002 and Dec-2007, 200 consecutive patients were treated in our institution with displaced acetabular fractures. All AW/C fractures according to the Letournel classification were included in the study. All patients underwent plain radiography and CT investigations. Retrospective analysis of the medical notes and radiographs was performed for type of associated injuries, operative technique, peri-operative complications. Radiological assessment of fracture healing was determined by Matta’s criteria and functional hip scores were assessed using Merle-d’-Aubigne scoring. The mean follow up was 44.5 months (28–64). Results: 15 patients (10 males) met the inclusion criteria (mean age 55.5years). Four had associated anterior dislocation. Associated injuries included pneumothorax, splenic rupture, tibial and distal radius fractures. Five were treated by percutaneous methods, 8 with plate-screw fixation, and 2 with circlage wire, (10 ilioinguinal approaches). Mean time-to-surgery was 14days(10–21days). The average operative time for the percutaneous group was 75min vs. 190min in the orif group. Mean postoperative-in-patient-stay was 4 days(3–7days), and 21days(14–37days). One patient developed chest infection post-operatively, two loss of sensation over the distribution of lateral cutaneous nerve. None of them developed incisional hernia, deep venous thrombosis and pulmonary embolism. At the last follow-up radiological outcome was excellent in 11 and good in 4 patients; clinical outcome was excellent in 12 and good in 3 patients, and none of the patients has developed heterotopic calcification or early osteoarthritis. Conclusion: Our results on management of these fractures are comparable to the early results reported by Letournel. Operative treatment for the rare anterior wall and anterior column fractures yields a favorable outcome resulting in early mobilization with limited patient morbidity

Background: We aimed to study the relationship between the number of fractured scapular regions, and the severity and distribution of associated injuries in blunt trauma patients. Methods: 107 consecutive patients with fractured scapulae (100 males) with a mean age of 35 (8–65) years were prospectively studied between January 2003 and December 2005. Mechanism of injury, associated injuries, injury severity scale (ISS) and the number of anatomical scapular regions involved in each fracture were studied. Patients were divided into single-region, two-region fracture, and more than two-region fracture groups. Computer tomography was used for fracture classification in 99 patients and plain X-rays in the remaining 8. Results: Road traffic collisions were the most common cause of scapular fracture. 95 patients (89%) sustained associated injuries. The most frequent was chest injury (68 (64%)). The median ISS was 9 (4–57) for the single-region fracture group (n 55), 20 (4–59) for the two-region fracture group (n 30), and 22.5 (4–54) for more than two-region fracture group (n 22) (p=0.02, Kruskal Wallis test). The median values of abbreviated injury scale (AIS) for chest injuries for the three groups were 1 (0–4), 3 (0–5) and 3 (0–5), respectively (p=0.001, Kruskal Wallis test). The single-region fracture group had significantly less posterior structure injury (9/55) compared with the multiple-region fracture group (46/52) (p=0, Fisher’s exact test). Conclusion: Associated injuries are common in patients having scapular fractures. ISS and AIS for chest injuries are higher and posterior structure injuries more frequent in patients with fractures involving multiple scapular regions

Fractures and fracture dislocations involving the lower lumbar spine and lumbosacral junction are uncommon. These high velocity injuries are often associated with neurological deficit, incontinence and dural tears. The accepted treatment has been posterior stabilisation with fusion, but loss of reduction has often been reported. We reviewed our experience over the past four years in the management of eight male patients, two of whom sustained injuries in motor vehicle accidents and two in falls from a height. Two patients had L5/S1 traumatic spondylo-listhesis with no neurological deficit. Of the six patients with fracture dislocations of L3/4, four had translation in the sagittal and coronal planes and incomplete neurological deficit. Associated injuries in four patients included an ankle fracture, multiple rib fractures, dislocation of knee and hip, and a fracture dislocation of the midfoot. Following satisfactory reduction, seven patients were treated by posterior spinal fusion (PSF) with instrumentation. One patient had anterior decompression, strut-grafting and posterior instrumentation. Three patients had dural tears. In three patients treated by single segment PSF, reduction was not maintained. The maintenance of alignment was attributed to stable facet joints in one patient, two-segment instrumentation in three, and anterior strut grafting in one. One patient developed postoperative wound sepsis, which settled after repeated debridement and antibiotic treatment. Symptoms of nerve root compression improved in two of the four patients with neurological deficit. Posterior reduction and instrumentation alone did not maintain reduction in these severe injuries. Anterior column support and multisegmental instrumentation may be required where there is marked vertebral body compression and neurological deficit

We investigated the results of complex acetabular fractures that were treated through the extended triradiate approach between January 1996 and September 2002 in our clinic. Sixty acetabular fractures were treated surgically during this period in total. Twenty-nine complex fractures that were treated through the triradiate approach with a minimum 2 years follow-up included in the study. The mean patient age was 43 years. There were 10 both column, 9 T shaped, 2 anterior column – posterior hemitransverse, 4 transverse with comminuted roof area, 5 posterior wall with comminuted roof area and 1 posterior column posterior wall fractures. Associated injuries were 2 full-thickness chondral injury of the head, one Pipkin type II fracture, 5 posterior and one central dislocation of the ipsilateral femoral head; and in 4 hips acetabular marginal impaction. The average follow-up was 63.2 months. The postoperative reduction was graded as excellent in 72.4 % and imperfect in 6.9 % of the patients. The hips were evaluated functionally according to the modified Postel D’Aubigne score and rated as excellent in 10 patients (34.5 %), good in 14 patients (48.2 %), fair in 3 patients (10.3 %) and poor in 2 patients (6.9 %). There were 2 deep infections (6.9 %), 2 avascular necrosis of the head (6.9 %), and 4 (13.8 %) non-disabling heterotopic ossification. We beleive that triradiate approach provides good visualization for anatomical reduction of the complex acetabular fractures, but the surgeon should be aware of its possible complications

Aim: To review the operative results and to determine factors that may significantly influence the outcome. Method: We retrospectively reviewed 38 patients treated with femoral interlocking nailing and tibial external fixation in a 5-year period (1996–2000). Two patients were excluded because of early death. Minimum follow-up was 2 years. There were 29 men and 7 women with a mean age of 27 years. Eight femoral (22%) and 29 tibial fractures (81%) were open. Associated injuries to th head, chest, and abdomen were seen in 17 patients (47%). Concomitant musculoskeletal trauma was present in 30 patients (83%). Final functional results were evaluated according to Karlstrom’s and Olerud’s criteria. Various factors were assessed including age, severity of open fractures, neurovascular injuries, fracture comminution, ligamentous knee injuries, concomittant injuries in the same limb or in the contralateral limb, existence of multiple trauma. Multivariate models were derived to detetermine predictors of outcome. Results: All femoral fractures and 31 tibial fractures (86%) united without additional intervention. Radiographic femoral union averaged 14 weeks and tibial union 20 weeks. A total of 18 secondary procedures were required. Functional results were excellent or good in 26 patients (72%). Increasing age, fracture comminution and associated injury in the contralateral limb were not influenced the final result. Open grade III tibial fractures (p< 0.03), severity of knee ligamentous injury (p< 0.02) and concomitant trauma to the same extremity (particularly to the ankle and foot – p< 0.02), contributing significantly to an unsatisfactory outcome