Introduction: Video assisted thoracoscopic surgery (VATS) is associated with good correction ability for spinal deformity and allow the reconstruction of the anterior column of the spine in tumors, deformity and trauma cases. Stand alone and instrumented procedures are possible. VATS has shown to be safe and can reduce the morbidities of traditional open anterior surgery but is a technically demanding procedure with a steep learning curve. The potential technique-related complication rate is low in experienced hands.

Material and Methods: From 2006 till today, 22 thoracic vertebral fractures have been treated with thoracoscopic approach. The mean patients age was 32 years (24–58) and the levels treated between T6 and L1.

Five fractures required only anterior approach, with corpectomy, implantation of an expandable cage (Obelisk, Ulrich, Germany) with autologous bone graft and an anterior Macs TL plate (Aesculap, Germany). The others seventeen fractures were treated by combined anterior – posterior approach in the same operating session or, the second, previously performed immediately after the admission.

The endoscopic splitting of the diaphragm was performed in 9 cases to expose the L1/L2 levels.

Seven patients received decompressive laminectomy during the first posterior approach performed in emergency settings. Endoscopic anterior decompression was required in 5 cases. One thoracic drainage was inserted and removed on third day in most cases.

Results: The thoracoscopic approach allowed a reduction of blood loss, better pulmonary function, an earlier mobilization of the patients and a shorter hospital stay. With the experience the duration of surgical time decreased of one third. The mean duration of the procedure was 190 minutes and the blood loss of 220 ml.

There were no major complications. In the first group of 8 cases a delayed removal of the thoracic drain and three conversion in open thoracotomy occurred. The patients were radiologically evaluated for bony fusion, sagittal alignement and by VAS and Oswestry scale for the overall satisfaction about the treatment.

The mean follow-up time was 10 months (4–32). We didn’t found any loss of correction more than 5 degree.

Conclusion: VATS permits a better visualization of the anatomic structures and allows the same reconstruction capabilities of the open technique with a faster recovery, a shorter hospitalization and a better cosmetic results.

We observed a significant reduction in postoperative pain and drugs delivered for it.

The clinical results have been encouraging. We believe that this technique can be a valuable tool in the management of the thoracolumbar fractures with acceptable morbidity and a little impact of pulmonary function. A careful selection of the patients scheduled for anterior stand alone procedure is required to avoid the risk of failure of the instrumentation.

Introduction: Discomfort and pain are common but unspecific symptoms in orthopaedic prosthetics. The majority of these symptoms are secondary to mechanical failure or loosening, while only a small proportion is related to infection. The differentiation between synovitis, loosening or infection is important for a correct therapeutical management, but it is often difficult using noninvasive techniques.

Positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) has evolved from a research imaging modality to a clinical practice for the assessment of malignancies. FDG, a nonspecific tracer of increased intracellular glucose metabolism, has been found to accumulate not only in malignant cells but also in infection and inflammation foci.

Aim of the study was to evaluate the usefulness of FDG PET scan in patients with joint replacement.

Materials and Methods: In this study we describe PET findings in 33 patients (age 42–88 yrs.) with hips (n. 16) and knees (n. 17) prostheses who had a complete operative and/or clinical follow-up; 42.5% had a pattern of mobilization. All patients underwent PET scan 60 minutes after i.v. injection of 185 MBq of 18F-FDG (transmission-emission, 3D acquisition). PET tomograms were evaluated by nuclear physicians without knowledge of the clinical diagnosis by visual interpretation, which was graded on a four-point scale according with common clinical classification (0 = normal pattern: not significant locoregional uptake; 1 = synovitis: synovial localized uptake; 2 = prosthesis loosening: synovial and soft tissues uptake; 3 = prosthesis infection: synovial, soft and bone tissues diffuse uptake).

Results: The results will be discussed in detail and correlated with clinical findings. The diagnostic value of PET, in terms of sensitivity, specificity and accuracy was compared with traditional radionuclear techniques (dynamic bone scan, 99mTc-labelled granulocytes).

Conclusion: We underline a good correlation between PET and clinical pattern (88% of cases). Particularly PET was able to correctly differentiate the prostheses loosening in the 100% of cases without infection and in the 77% of patients with infectious disease suggesting its usefulness in clinical practice also for detecting only inflammatory tissue such as synovitis. Moreover, the capability of PET to quantificate the inflammatory activity could be useful in the monitoring of the therapy. Further evaluation in a large group of patients is indicated.

Non-union of the radius and/or ulna is comparatively common in the treatment of forearm fractures. Bone graft from the iliac crest secured by rigid plate fixation under compression is indicated in non-unions with a bone defect longer than 2 cm. The aim of the study is to compare the results with the current literature.

Thirteen patients (female: 1; males: 12), mean age 44 years (23–75 years), were treated in our department between 1993 and 2003. In 10 patients the original injury involved both radius and ulna; in the remaining three only the ulna was affected. All the fractures had been internally fixed, except for a radius fracture. Non-unions involved the ulna in eight cases, the radius in one case and both radius and ulna in four cases. A cortico-cancellous graft was used to fill a defect of the ulna in 11 cases and of the radius in two cases. In the non-unions of both bones only one bone was operated (one radius and three ulna); a different treatment was performed in the other bone. The mean time between the original injury and the indexed procedure was 7 months (3–14 months). The mean bone defect was 4 cm (2–6 cm). A T-shaped cortico-cancellous graft was always used. All the patients were evaluated clinically and radiographically with a mean follow-up of 4 years (1–10 years).

Bony union was achieved in all the patients at an average time of 4 months (3–6 months). At the follow-up the mean elbow flexion was 130°, the mean extension lag 4°, the mean pronation 71° and the mean supination 61°. The mean grip strength was 38 kg, 81% of the contralateral side.

Cortico-cancellous bone graft from the iliac crest is an effective technique to fill a bone defect of between 2 and 6 cm. Up to this length the mechanical properties of the graft are optimal for a rigid plate fixation under compression; moreover, biological conditions allow ready integration of the graft. Rigid fixation with cortico-cancellous bone graft from the iliac crest is a useful technique for forearm non-unions with a bone defect of between 2 and 6 cm.