In this retrospective study, we re-evaluated the case histories of patients treated for diaphyseal and meta-epiphyseal fractures of the humerus by fasciculated nailing, using the Hackethal method. Our experience, beginning in 1992 through to the present, includes over 400 cases of fractures treated using this method. Among these cases, there were 250 meta-epiphyseal fractures and 200 diaphyseal fractures. Follow-up was possible in 250 cases.

The number of complications encountered in the case studies considered was relatively low, including five cases of a delayed union and four cases of non-union. There were no deep or articular infections, five cases of superficial infection, four cases of fracturing of the means of synthesis, 10 cases of procidence of the wires at the level of the insertion site, and two cases of distal migration at the level of the articular cartilage of the humeral head. We did not encounter any cases of periarticular ossification or iatrogenic palsy of the radial nerve.

Our methodology foresaw in all cases closed reduction of the fracture as well as epicondylar access distal to the humerus, which in some instances of multi-fragmented fractures was performed bilaterally, with the Eiffel Tower assembling method and four or five retrograde bundle wires. By using the epicondylar point of insertion, the fracture could be reduced and and torsional stability obtained, which together with the bone defect filling contributed to the primary stability of the fracture.

In this retrospective study, we wanted to demonstrate the validity of the bundle nailing according to Hackethal’s method, which is distinguished by being a minimally invasive technique as well as by providing good consolidation and a low rate of complications.

The authors present case histories relating to experience gained over 18 months of using deantigenic osseous grafts together with platelet growth factor for posterior spine arthrodesis. The spinal column was the last section of the skeleton to recover from the use of this kind of bone graft to promote spinal fusion. This is due to the negative experience encountered during the proposals bought forward during the 1960s and 1970s by French orthopaedic surgeons who used heterologous lyophilised bone for long vertebral arthrodesis.

The high incidence of pseudoarthrosis developed as a result of difficulties in absorption of the skeletal implant, which, in order to ensure sufficient mechanical resistance, should have been thicker (8 mm). Therefore it could not be assimilated. This then resulted in relying only on external protection (plastered brace) to provide the necessary rigidity during the process of fusion.

The beginning of stable synthesis obtained with transpeduncular fixation and double instrumentation as used in the Cotrel Doubousset technique and methods derived from it made it possible to maintain primary stability over time, therefore positively influencing the process of consolidation. This is why the practice of exclusively using osseous derivations has grown only in the past few years in vertebral surgery, preferring to implant small chips which can be assimilated much easier and to avoid having to search for mechanically resistant areas for bone replacement.

In conclusion, the use of heterologous bone grafts in the vertebral column represents a situation similar to that in other mobile osseous areas, in which the immobilisation depends on the use of a mechanical instrument (when it concerns short arthrodesis 2–3 segments). In the case of long spinal fusion such as in correcting vertebral deformity (scoliosis and kyphosis), the problem is more complicated, even though today’s new biological tools (large extension of the bed of arthrodesis) make this possible and offer the advantages of the lack of problems at the donor site. In these cases it is particularly suitable to routinely combine heterologous bone replacement with growth factors (osteoinductive bone proteins) for treatment, which according to our preliminary results should notably shorten the period of assimilation and the fusion healing.

In this work we report our experience, which began in 1981, with 200 patients in the correction of complex deformities (rotational and angular) of the inferior limbs by using the IIizarov method. In our case histories, we demonstrate the advantages of treatment of complex deformities using correction techniques such as epiphysiodesis operations performed in open surgery access or by using percutaneous stapling or osteotomic corrections, which in our experience are only indicated in single plane lower limb deformities.

On the other hand, we demonstrate the complete validity of the IIizarov method in the progressive correction of the multi-planar deformities. Such methods allow progressive correction of the deformities in three different spatial planes, resulting, in addition to the possible improvement in the angular defects, in the simultaneous correction of the torsional defects.

The critical analysis of our experience also demonstrates the possible complications inherent in the IIizarov method and which have been subdivided into further and greater complications, such as in the acute treatment of serious deformities (joint stiffness, nerve paralysis, and deep pin track infection) and in minor complications (superficial pin track infection).