Objectives

The most prevalent disorders of the shoulder are related to the muscles of rotator cuff. In order to develop a mechanical method for the evaluation of the rotator cuff muscles, we created a database of isometric force generation by the rotator cuff muscles in normal adult population. We hypothesised the existence of variations according to age, gender and dominancy of limb.

Introduction: There is a controversy regarding the treatment of the intra articular fracture of the distal radius. Plating for anatomical reduction vs the minimally invasive method by mini external device and K wires. We report our experience with the minimal invasive technique.

Materials and Methods: Between January 2003 and march 2005, 43 patients with intra articular fracture of distal radius were treated. 22 females, 16 males were followed. Age range 23–81 (mean 55 years). All cases were uni lateral. 38 patients were followed out of 43 fractures. Causes: 23 fall, 9 RTA, 6 sport accidents. The fractures were classified according the Frykman classification: 5 F3, 6 F4, 6 F5, 9 F6, 5 F7 and 7 F8. Follow up was 6 weeks after treatment and 6 months later. A Lateral and PA views were performed and the angles were measured. The V.A.S. was used to quantify the painful level. The Lidstrom criteria scale was used to evaluate the functional outcome. The surgical procedure was performed on the same day or one day later. In all cases the mini external device of AO (2 threaded rods in the second metacarpal and another 2 rods in the radius) was used. In 20 cases, 1 or 2 K wires were inserted in addition from the radial styloid to stabilize the fracture. The mini external was removed 6 weeks later.

Results: According to Lidstorm criteria, 12 patients (31%) had excellent results, 23 (61%) good, 2 (5.5%) fair and 1 (2.5%) poor outcome. The results of the VAS were good: 33 had less than 3, 4 patients less than 5 and one patient chose the number 9 to quantify his pain. At the follow up, 35 patients restored a very good range of motion (ROM) of the wrist, while 3 patients had markedly reduced ROM. The best outcome is shown in the younger population, except one case, a young man 33 years old, who was unable to return to work 6 months later. Four patients (1%) had a pin tract infection treated by PO antibiotics.

Conclusion: In our hands, the minimally invasive technique seems to be a satisfactory procedure. In the young population, the restoration of the range of motion was very good. The loose of few degrees in the arc of motion in the elderly population didn’t disturb there functional performance. We think that the mini-invasive method is excellent tool for treating intra-articular fractures of the distal radius; the procedure is shorter and there is less chance of infection and less damage to the surrounding tissues.

Recently, secondary life-threatening inflammatory reactions have been identified with molecular biological techniques in patients with multi-system injuries who were submitted to immediate or early intramedullary fixation of their fractured femora. This phenomenon was called “The second hit”, and it caused ARDS, PE, and Renal Failure.

In a consecutive series of 135 trauma patients with high energy long bone fractures, 40 had sustained multiple-injuries. All fractures were reduced and stabilized on admission by AO-Tubular External Fixation systems. After 72–96 hours, this system was converted to an hybrid-ring-tubular system, which had three dimensional stability. They commenced partial weight bearing 24 hours later, and were followed by bony union.

One patient developed DVT, none developed ARDS, PE, Renal Failure.

Superficial pin-tract infection was common, but no-deep infection and’or osteomyelitis were encountered.

With this minimal-invasive surgical technique, life threatening complications were avoided while preserving the integrity of the soft tissue envelope, the critical contributing biological factor for fracture healing.

Introduction: There is a controversy regarding conservative or surgical treatment of calcaneal fracture. We report our experience in surgical treatment of calcaneal fractures.

Materials and Methods: Between March 1998 and May 2004, 30 patients with 32 calcaneal fractures were treated surgically in our departments. Twenty four fractures were caused after a fall from height, 4 fractures were consequence of a road accident, 2 fractures after a blast injury and one after a football injury. There were 4 females and 26 males. Two cases were bi-lateral fractures. Age range 20–66 (mean 33). Follow-up time 7 to 72 months (mean 24 months). The fractures were classified according to Sanders classification: there were 22 patients with Sanders III, 8 patients with Sanders IV and one patient with Sanders II. All patients were operated with the same procedure and the same surgeon. The surgical procedure was delayed from 10 to 14 days post trauma, until swelling subsided. Open Reduction Internal Fixation was performed using lateral approach, “L” shape with subperiosteal dissection of lateral wall, and using a calcaneal reconstruction plate.

Results: The functional outcome was evaluated according to Rowe Score. The clinical results were excellent in 3 patients (10%), good in 22 patients (70%), fair in 4 patients (14%) and poor in 2 patients (6%). The Boehler angle was reconstructed in 29 of 32 calcaneus. 3 patients returned to their previous level of activity, 9 patients returned to work, 14 patients mentioned some pain in the site of the operation. Two patients were treated successfully with oral antibiotics for superficial wound infection. Six patients suffered from peripheral nerve damage. One patient experienced subtalar pain, and underwent a subtalar arthrodesis, furthermore the patient developed Complex Regional Pain Syndrome (CRPS), finally he underwent below knee amputation (BKA). One patient had a flap necrosis and underwent sural flap coverage with excellent results. All the patients were recognized in a process to be recognized as disabled by the social security.

Conclusion: Our results were good in majority of patients according to the known classification systems. However, the recovery period from calcaneal fractures is long and the majority of patients do not achieve their previous functional level. The secondary gain might bias the results.