The frequent choice of treatment for tibial shaft fractures is intramedullary nailing. However there are cases where this treatment is problematic and alternative treatments are chosen with satisfied results.

Twenty-nine patients with complex, unstable tibial shaft fractures (13 males and 16 females) aged 18 to 76 years (mean age 49 years) were treated using Ilizarov external fixation, the last decade in our Department by the same surgeon. The indications were open Gustillo III fractures, comminuted fractures of the proximal or distal third tibia near metaphysis, concomitant plateau or pillon fractures and fractures after total knee arthroplasty (TKA). All frames were applied the first day of injury. Patients without concomitant intraarticular fracture or bone deficit allowed to full weight bearing within2 weeks after surgery.

Union and good to excellent alignment with full range of motion in the knee and ankle joints was obtained in all patients. Three patients needed bone lengthening using the initial applied frame after corticotomy in second operation. There were 7 delayed unions in fractures without bone deficit, 10 superficial pin tract infection treated with antibiotics and local care and 1 deep infection which needed surgical intervention.

Ilizarov external fixation gives the solution in difficult and problematic tibial shaft fractures and allows early weight bearing

Treatment of tibial plateau fractures Schatzker type V and VI or with soft tissues injuries is still remains under discussion. The purpose of this study is to evaluate the results of treatment with circular frame and closed reduction in 25 patients (15 males and 10 females) with tibial plateau fractures, with a mean age of 42 years old (20 – 76 years).

Five fractures were classified as Schatzker type II and III and 20 as type V and VI. Reduction was obtained in 22 cases under foot traction and in 3 arthroscopically. Bone grafts inserted through a hole (• 1 cm) in the inner cortex of the tibia metaphysis under fluoroscopy. Eight unstable knees needed bridging the joint for 4 weeks. In 2 cases a cannulated interfragmentary screw was used. Full weight bearing was allowed 3 months after injury when the device was removed.

Follow up ranged from 1 to 10 years (mean 5 years). All fractures were united and there was no infection. Full range of the knee motion was achieved in 23 patients while 2 needed an open arthrolysis. There were 2 malunions which were treated with one valgus osteotomy and one TKR. Asymptomatic arthritis appeared in 6 patients. According to Knee Society Score (KSS) the results were classified as excellent in 12, good in 8, fair in 3 and poor in 2 patients.

Circular frames are a satisfactory alternative method for the treatment of tibial plateau fractures either in severe soft tissues injuries or in very complex cases

Introduction: the choice of treatment for tibial shaft fractures in adults is intramedullary nailing. However there are cases where this treatment is problematic and alternative treatments are chosen.

Patients and Methods: 29 patients with unstable tibial shaft fractures (13 males and 16 females; aged 18 to 76 years) were treated using Ilizarov technique, last decade, by the authors. The indications were open fractures type III Gustillo, comminuted fractures of the proximal or distal third near metaphysis, concomitant plateau or pillon fractures and fractures after TNR. All frames were applied the first day of injury. Patients without concomitant intraarticular fracture or bone deficit allowed to full weight bearing within two weeks after surgery.

Results: union and good to excellent alignment with full range of motion in the knee and ankle joints was obtained in all patients. Three patients needed bone lengthening using the initial applied frame after corticotomy in second operation. There were 7 delayed unions in fractures without bone deficit. As complications there were superficial pin tract infection in 10 patients treated with antibiotics and local care and one deep infection which needed surgical intervention.

Conclusions: Ilizarov technique gives the solution in difficult and problematic tibial shaft fractures and allows early weight bearing.

Aim: The retrospective evaluation of external fixation as a treatment of choice for fractures of humeral diaphysis.

Material – Method: 24 patients with an equal number of fractures of humerus diaphysis (21 closed, 3 open) were treated with external fixation. Time to bony union, the seriousness and type of complications, the clinical, radiological and functional outcome were evaluated. The minimum time of follow up was six months.

Results: Excellent 20, good 2, fair 1, poor 1. The cause of fair and poor results was limitation of shoulder motion. 22 fractures united within 2–5 months. Complications were 2 cases of non-union, 3 pin-track infections, 3 remanipulations. There was no case of deep infection at the fracture site and no iatrogenic injury of the radial nerve.

Conclusion: The external fixation, used in the treatment of humerus fractures, is a semi-interventional method, easy to apply, well-tolerated by the patient and with very good functional results. It a very good alternative of both the conservative treatment and internal fixation.