Introduction: Various surgical techniques existed for the treatment of three and four part proximal humeral fractures with variable outcomes. The aim of this study is to present a technique using small materials, to preserve all the biologic principles of fracture fixation, in the treatment of these challenging injuries.

Material: We perform a study taking as inclusion criteria: 3 and 4 parts proximal, closed, humeral fractures, treated surgically by open reduction and a modular biological internal fixation.

Surgical technique: Through a standard deltopectoral approach the fragments reduced, taking care to preserve the periosteum and manipulate meticulously the soft tissues. All the fractures were fixed with a combined system of Kirschner wires inserted to the proximal fragments, connected by “bone clips” forming a modular construction and fixed to the main distal fragment by AO screws.

Results: 24 patients complied with the inclusion criteria and were followed up a mean of 18 months. All patients achieved a satisfactory result except a fracture-dislocation that developed AVN and was revised into a shoulder arthroplasty and two demented elderly patients with metalware failure that were also revised.

Conclusion: In this first series of non-selected cases the outcome of fracture consolidation is promising. Although this technique is in its embryonary phase of development and the functional results are currently been assessed, the radiological outcomes suggest that the technique described is a valid alternative to the treatment of these fractures if we indicate an osteosynthesis method that combines biology and stability.

Introduction: Pelvic ring injuries represent a complex injury pattern and sometimes have significant consequences. The aim of this retrospective study is to delineate the indications of surgical treatment with emphasis in the anatomic reconstruction.

Materials and Methods: 85 patients with pelvic ring fracture with or without acetabular fracture reviewed retrospectively. The average patient age was 34 years. Operative treatment was provided to 26 patients. Six isolated acetabular fractures were treated by ORIF. Twenty pelvic ring fractures were treated, by anterior Ex-Fix in five cases, Ex-Fix plus sacroiliac screws in three, anterior reconstruction plate plus sacroiliac screws in two, anterior plate plus sacral bars in three. The remaining seven patients with an additional acetabular fracture treated with anterior plate for the pelvis and plates for the acetabulum.

Results: All the acetabular fractures were anatomically reduced. All fractures consolidated and no patient has developed hip AVN or post-traumatic arthritis. Brooker’s grade III ossifications complicated two patients. Partial neurological deficit of sciatic nerve was seen in three cases of acetabular fractures that improved spontaneously. A case of vertical shearing sacral fracture through the foramina presented with lumbosacral plexus paresis that recovered near normal function in 6 months. Deep infection complicated a case that subsided at 2 weeks on antibiotics and serial surgical debridement.

Conclusions: The strict application on rational criteria and an exquisite surgical technique caring of the soft tissues produce satisfactory outcome of these injuries. The above-described surgical treatment shortens the hospital stay and allows early physiotherapy to restore function.

Introduction: Management of supracondylar fractures above a TKR is a difficult problem, aggravated by the increasing number of arthroplasties carried out and the increase of the ageing population. The aim of this paper is to determine the limb function after treatment of these fractures.

Materials and Methods: We performed a retrospective study of the outcome of the treatment of suprandylar fractures above an ipsilateral TKR. All fractures were classified according to the Lewis & Rorabeck System. Conservative treatment was provided to eight fractures. Osteosynthesis using a Dynamic Condylar Screw (DCS) was performed to five patients. The largest group of twenty patients was treated with a retrograde supracondylar nail. Three patients underwent a revision surgery.

Results: Four out of eight fractures treated conservatively had a satisfactory outcome. All patients treated with a DCS achieved a satisfactory result. Seventy five percent of patients treated with a supracondylar nail gained adequate functional and anatomical result. Revision surgery was satisfactory in all cases.

Conclusion: The above-described fractures are still not very frequent, but represent a high risk of important complications, with potentially disastrous consequences. For those reasons and the poor bone stock in the elderly its management is controversial. The challenge for the surgeon is to achieve the goals of consolidation of the fracture, preservation of a painless TKR, and, restoration of the previous functional status. A complex group of factors, such as fracture pattern, implant status, bone quality and general condition of the patient, need to be assessed.