Early and safe mobilization remains the mainstay of treatment for the intertrochanteric fractures. Many implants have been used but the intramedullary implants seem to provide maximum stability in unstable fractures. The aim of this study was to compare two intramedullary devices which have different philosophy and modes of action.

Between 01.07.2005 to 30.06.2007, 110 patients with trochanteric fractures treated with the intramedullary hip screw (IMHS, Smith & Nephew) nail and 105 with the ENDOVIS (Citieffe) nail. The data recorded were the fracture’s type, preoperative hemoglobin level, pre-fracture walking ability. Postoperatively were recorded the operative time, the level of hemoglobin on the first day, mobility status, complications and 12 months mortality rate. The results were comparable regarding blood loss, operative time, and mortality rate. However, the rehabilitation and functional outcome were superior in the IMHS group. This probably was attributed to the higher number of complications of the ENDOVIS nail.

IMHS is a valuable tool for the treatment of stable intertrochanteric fractures, offering also excellent results in the management of reverse obliquity, comminuted fractures and those with a subtrochanteric extension. Further investigations are necessary to prove which the ideal intramedullary implant is. However, it seems that devices combining the principles of the sliding hip screw with those of an intramedullary nail present safe and accurate fixation, fewer mechanical failures and exceptional functional outcomes

Fractures of metacarpals and phalanges are common in hand injuries. The goal of treatment is the immediate mobilization of the fingers and restoration of the hand anatomy thus avoiding contractures of the metacarpo-phalangeal and phalangophalangeal joints and hand dysfunction. The aim of this study is the comparison between two methods of fixation of these fractures.

Between 2000–2007, 74 patients who suffered meta-carpophalangeal fractures were treated by K-wires and 62 patients were treated by mini external fixation. Parameters recorded were the operating time, postoperative range of motion, cost and complications. The surgical time was lesser with the use of K-wires, the operative technique much simple and the cost minimum as compared to mini external fixators. The postoperative range of motion was inferior with the external fixation. However, there was no statistical difference between the two groups. 2 patients with the external fixation and 1 patient with K-wires developed pin-track infection. There were 3 failures of fixation in the external fixator group but no failure occurred with the use of K-wires. The majority of the fractures healed within 6 weeks.

K-wires seem to be the ideal method of treatment considering the fractures of metacarpals and phalanges. The use of mini external fixation presents many disadvantages and probably is restricted to the treatment of the open and comminuted hand fractures.

Introduction: Metacarpal and phalangeal fractures are frequent (13% of the total number of fractures). It seems that the best treatment for the displaced fractures is fixation. Various methods have been used, such as plates and screws, wires, IM-nailing, external fixation. The main problems are adhesions of extensor tendons, scarring and stiffness of the joints.

The purpose of this study is to examine the efficacy of internal fixation using Kirschner wires, applied open or closed, treating metacarpal and phalangeal fractures.

MATERIALS AND Methods: Between 1998 and 2005 145 out of a total of 2848 (5.2%) metacarpal and phalangeal fractures underwent operative treatment. Fixation was achieved by placing extrarticularly two or more Kirschner wires.

The wires were removed after 4 weeks and patients underwent physiotherapy for 2 to 4 weeks. The follow-up period was 3 – 15 mos (average 12 mos) and total range of movement and function of the injured hand was evaluated.

Results: Bone union was evident in 3 to 5 weeks. Range of movement was approximately 90% of normal, except for cases of comminuted intraarticular fractures and also in 6 cases of elderly non-cooperative patients.

One case of infection, complicating a metacarpal fracture and well responding to antibiotic treatment, was recorded. Three further infections resulted after neglected intraarticular fractures, all of which underwent arthrodesis. No rotational deformities were observed. There was no mechanical failure of the fixation in any case.

Conclusion: The fixation of metacarpal and phalangeal fractures using K-wires seems to be a useful method minimally invasive, stable and well tolerated by the patient, not interfering with the mobility of the joints. K-wires are easily removed and of low cost. The functional outcome of this method seems to be quite satisfactory.

The aim of this study is to evaluate the mid-term results of the Genesis Total Knee Prosthesis, one of the first prostheses with asymmetric shape of the tibial component .The arthroplasty was performed on our patients with retention of the posterior cruciate ligament and, in most of the cases, without replacement of the patella. During the period 1992–1999, 90 patients (116 knees) were operated in our clinic: 81 of them were women and 9 were men with an average age of 68 (52–82) years. The primary indication for the operation was osteoarthritis. 84 patients (109 knees) were evaluated clinically and roentgenographically (Knee Society Knee Score) for a mean time of 98.1 (29.6 – 137.7) months after surgery. There were no infections. (Three) Four of the patients had to undergo a second operation . Two of them, eventually, had their patellae replaced (1,5 and 3 years postoperatively) due to persisting pain of the patellofemoral articulation and lateral patellar subluxation .The other two patients had to undergo revision arthroplasty due to wear of the polyethylene component, one at five years and the other at nine years . Moreover, wear of the polyethylene was also observed on another patient, radiographically, six years after the operation. However, the patient seemed to have no symptoms and was, therefore, unwilling to undergo a revision. The clinical results were satisfactory with a Knee Score of 97(74–100) and Function Score 80 (5–100) .The mean range of motion was 113°(85°–135°). There was no evidence of loosening or any radiolucent lines found radiographically .We consider the results of the Genesis Total Knee Arthroplasty satisfactory .The asymmetric shape of the tibial condyles ensures the fitting of the tibial component. With the exception of cases of severe patella damage, replacement of the patella is not required. The presence of any problems in the patellofemoral articulation is usually connected to the maltracking of the patella or to errors in the surgical technique.

Aims: Evaluation of the efficacy of autotransfusion in reducing the need for homologous blood transfusion in total knee arthroplasty. Methods: Prospective randomized study. Patients undergoing total knee arthroplasty were divided in: Group A (72 patients) receiving autotransfusion (Suretrans) and control group B (30 patients) with suction drainage only. Preoperative Hb and demographics of the two groups were comparable. The level of Hb was followed for the first 5 days postoperatively. The amount of homologous blood transfused was also recorded. Results: The average autotransfusion volume in group A was 405±191ml. On the day of the operation and the first postoperative day the Hb in group A was found statistically significantly higher (p< 0.05). On the second and third day the Hb in group B, achieved levels comparable to group A, because patients received homologous blood transfusion. The amount of homologous blood transfused to the patients was significantly higher in group B (average: group A 0.36 ± 0.74u, group B 1.2 ±1u, p< 0.001). Multiple regression analysis suggests that the only factor reducing the need for homologous blood transfusion is the use of the autotransfusion system. Conclusions: there is a statistically significant reduction in the need for blood transfusion by using an autotransfusion system reducing also the possible dangers and complications. Autotransfusion is a simple, safe and cost effective method.

The aim of this study is to evaluate the mid-term results of the Genesis I Total Knee prosthesis (asymmetric tibial component plateaus), retaining the posterior cruciate ligament and not resurfacing the patella in all patients.

Between 1992 and 1999, 90 patients (116 knees) were operated (81 women and 9 men) of an average age of 68 (52–82) years. The indication for the operation was osteoarthritis. 84 patients (109 knees) were evaluated clinically and roentgenographically (Knee Society Knee Score). The average follow-up time was 74.1 (29.6–113.7) months.

There were no cases of infections. Three of the patients required a second operation. Two of them had their patellae replaced (1,5 and 3 years postoperatively) due to persisting patellofemoral pain. In a third patient the knee was revised due to excessive wear of the polyethylene component five years postoperatively. Moreover, major polyethylene wear was also observed six years postopertively on another patient, asymptomatic and unwilling to undergo a revision. The clinical results were satisfactory with a mean Knee Score of 97 (74–100) and a Function Score of 80 (5–100). The mean range of motion was 113° (85°–135°). There was no evidence of loosening or any radiolucent line found radiographically.

We consider the results of the Genesis I Total Knee Arthroplasty satisfactory. The asymmetric shape of the tibial condyles ensures the fitting of the tibial component. Even in cases of severe patella damage, we believe that replacement of the patella is not required. Occurrence of patellofemoral problems can be usually attributed to mal-tracking of the patella or to component malposisioning.