Introduction: Intramedullary nailing is an acceptable method of treatment for femoral shaft fractures today. We present our experience from the use-of four different nails.

Patients and Methods: Thirty fractures of the femoral shaft were treated by intramedullary nailing from Jan98–DecOl in our department. The patients’ age ranged from 19 to 87 (avg 36 ys). Twelve fractures were in poly-trauma patients. In 6 patients, due to an intense comminution, an external fixation was initially applied and a delayed intramedullary nailing was performed. Four different types of nails were used 8 Grosse & .Kempf, 1 Orthofix ,2 ZMS (Zimmer), and 19 Marchetti Vicenzi.

Results: All patients were followed up until complete union of the fracture. A 1.5 cm shortening was found in one patient and two patients presented a valgus 7° at the fracture site. One pseudarthosis with broken implant (Marchetti) was seen and treated with a new nail of the same type. The Orthofix nail was used only once due to its lack of anatomic curvature. The mean surgical time of the GK and ZMS nails was 30 minutes more than that of Marchetti nails, due to the distal locking screws required.

Conclusions: In our own experience, GK and ZMS nails provide a larger contact area in the endosteum as well as the best conditions for biomechanically sound distribution of loading. The placement of distal locking screws constitutes a major problem, as it requires extended surgical time and increased exposure to irradiation. The important advantage of the Marchetti nail is that no distal screws are required, so the operation and fluoroscopy time are much shorter. The main disadvantages of the Marchetti nail are the absence of quidewire during nail insertion, the minimal 13mm femoral canal diameter required proximally, the contraindication for very distal fractures and the inability to fully weightbear early.

Introduction : External fixation is a good alternative method for fractures of the distal end of radius that are not manageable for closed treatment. It is a simple technique, and has proved to be safe and effective in our experience.

Material and Methods: We present 25 patients with 26 fractures of the distal end of radius (age 32 to 85, avg 57 yrs) which were treated by external fixation during the last 4 years. Eight fractures were in polytrauma patients, 16 were unstable and one patient had bilateral fractures. According to Frykman classification 2 were in type II, 5 in type IV, 2 in type V, 5 in type VI, 4 in type VII and 8 in type VIII.

The time of surgical treatment since the date of fracture ranged from 9–15 days (avg 12 days) .We used Pennig’s fixator in 22 cases and Citieffe fixator in 4 cases.

Results: All patients were followed up for 8 to 42 months (mean 27, 7). Clinical union was established at an average of 6.5 weeks following the fracture. There was one infection of the distal pins, 2 cases with algodystrophy, but no malunion. For assessment of the anatomical result we used the Sarmiento and Latta modification of the Lidstrom classification: 16/26 (61.5%) were excellent, 8/26 (30.7%) good, 1/26 (3,87%) fair and 1/26 (3.87%) poor.

Conclusion: In comminuted, badly displaced fractures of the distal end of radius, the upper extremity following initial closed manipulation and application of plaster is characterized by a decrease in finger mobility, oedema, and large mass of bandaging. Instability of the fracture nad poor result is expected as soon as the oedema subsides. Alternatively, an external fixator is applied after remission of the edema and before two weeks from the fracture date, so to the fracture is easily reducible. With the delay in fixator application we avoid reduction difficulty and pin infection as the oedema has subsided, we have time to explain everything to the patient and organize the operation . This delay in the application of external fixation in distal fractures of the radius is favored in our department because of the low complication rate, excellent or good (92%) functional results, easy and safe approach.