Lateral tibial plateau fractures are articular fractures that can have a severe prognosis involving a joint biomechanically and functionally very important.

Osteosynthesis is very often required as the articular surface must be accurately restored.

In many cases rigid devices were implanted, often sacrificing lateral meniscus and leading to osteoarthritic changes in the following years.

In the recent years new diagnostic tools as TC and MRI and the growing role of arthroscopy have allowed a more precise diagnosis and the possible use of less invasive devices.

Considering all fractures classified as B3 according AO (or type 2 by Schatzker), we considered 10 cases treated with Barr screw and 8 cases treated with K-wires positioned as a shelf after reduction and bone grafting.

All patients underwent an accelerated rehabilitation protocol with immediate mobilization and full weight bearing within 10 weeks.

At the follow-up at 24 months, both the groups showed very good and comparable clinical, radiographical and functional results.

We can conclude that after an accurate preoperative planning also the use of less invasive devices allow a quick recovery of range of motion without compromising the stability of osteosynthesis and the morphology of knee joint.

Introduction: In temperate places pyomyositis is very uncommon in children and adolescents. West European and North American Literature about is relatively poor (104 articles from 1998 to nowadays and most of these papers are case-rep orts). S. Aureus is the etiologic agent in 90% of cases. Muscle of the thighs and hips are the most frequent localisation and severe complications are observed in 10% of cases.

Material and Methods: We reviewed all patients affected by primary pyomyositis and admitted in our Department from 1995 to nowadays. Age, sex, history and clinical findings, general and local risk factors were reported. X-rays, Ultrasonography, MRI, Scintigraphy, Haematological investigation and culture were considered in order to state the imaging and laboratory findings of the disease.

Result: Pyomyositis was diagnosed in three males, aged 11, 13 and 16. There was no evidence of medical or familiar risk factors. Soleus, Otturatorius and Psoas muscles were respectively involved. In all cases fever, local signs of inflammation and pain, neutrophylic leukocytosis, increased ESR and CRP levels were present. Blood culture was positive in one case. Standard X-Rays were normal in all cases. Ultrasound scan, RMI and Scintigraphy were positive but non-specific in all cases. 2 cases underwent to surgical drainage and a 3 weeks antibiotic therapy; 1 case resolved performing only medical treatment (5 weeks of antibiotic). All patients showed complete clinical, haematological, and RMI recovered without reliquates.

Conclusions: Pyomyositis is uncommon in temperate climate and it may be easy misdiagnosed at the onset. In our patients the mean time from onset of symptoms to diagnosis was 10 days. History and clinical examination might be evocative, but there are no pathognomonic haematological or radiological findings so that diagnosis is often the result of extensive and wide considerations. Pyomyositis should be suspected in any unclear septic condition of the musculoskeletal apparatus. High index of suspicion, prompt diagnosis, and early treatment can prevent complications and allow the recovery of this potentially life-threatening disease.

Aims: The purpose of our review is to evaluate results of surgical treatment in bone metastases and to relate the surgical indications to these results. Methods: 297 patients operated between 1980 and 1998 were reviewed. Main age of the patients was 60.9 (18–86). The involved bones were femur (169cases), humerus (77), spine (33), tibia (8), pelvis (4), cubitus (2)others (4). The primary tumours (of 215 reviewed diagnosis) were breast (80cases), lung (31), myeloma (21), kidney (18), intestine (8), thyroid (7), prostate (6), uterus (6), pharynx (4), sarcoma (4), bladder (2), liver (2), others (4), well differentiated unknown origin (14), undifferentiated (8). The operations performed were nailing (86cases), interlocked-nailing (59), prosthesis (58), spinal osteosynthesis (34), plating+cement (25) nailing+cement (17), resection (10), resection+cement (6), amputation (2). Minimal conditions for surgery were life expectancy of at least 60 days, possibility of a solid implant and acceptable blood parameters (wbc> 2,000, plt> 30,000). Most of the patients underwent postoperative radiotherapy. Results: The Karnofsky index at sixty days showed a mean improvement of 30pts% using nails and prosthesis, and 10pts% with plating+cement (performed in patients in better general conditions). After surgery, all of the patients reached a score over 70pts% and in every case pain was sensibly reduced. There were 3 perioperative deaths (1%) and 10 major complications (3.4%). Conclusions: An operation performed after an accurate planning leads to an improvement in the quality of life and self-sufþciency of these patients, thereby reducing the cost of care. The choice of technique must allow to obtain a quick result (no bone grafting) and a fast functional improvement, considering the limited life expectancy of the patients.