Introduction: We carried out a revision of Necrotizing Fasciitis diagnosed in our Hospital from January 2000 to July 2008. Necrotizing Fasciitis is an infection of soft tissues, caused in most of cases by Streptococcus pyogenes. It is a dangerous infection, because it progresses quickly, and it can lead to death due to systemic toxicity.

Materials and Methods: The study includes 18 patients afected by Necrotizing fasciitis treated in our Hospital from January 2000 until July 2008. In order to identify risk factors and clinical emergency signs, clinical detailed information was obtained for each patient.

Results: In 70% of the cases, Streptococcus pyogenes was found as the main germ involved in Necrotizing Fasciitis. In inicial stages, the patients complained of pain, heat, swelling, reddening and crepitation of the affected subcutaneous tissues. In advanced stages, patients went in a state of neurogenic shock. Specific antibiotical therapy was necessary in all cases. Surgical treatment was performed in 80 % of the cases, consisting of fascial aperture and debridement of devitalized tissues. In spite of the intensive medical and surgical treatments, 10% of the cases died.

Conclusion: We consider the suspicion and knowledge of Necrotizing fasciitis is crucial in order to diagnose early and properly this infection disease. Then we can be able to establish a precocious and suitable treatment which can avoid the potentially fatal outcome.

Introduction: Osteoarthritis of the thumb basal joint is a very common and disabling condition that frequently affects middle-aged women, sometimes bilaterally. The purpose of this work is to present the methodology of the preoperative and postoperative assessment carried out in 52 patients who underwent a trapeziometacarpal joint replacement procedure (Roseland prosthesis).

Material and Methods: Total joint arthoplasty of the trapeziometacarpal joint was performed on 52 thumbs in 44 patients (15 dominants hands) to treat osteoarthritis (Eaton-Littler stages II and III) between 1995 and 2007. 18 patients were missed for follow-up purposes. Average age of 59,4 years. The Roseland trapeziometacarpal joint prosthesis was used in this study. We analyzed the ROM for abduction-adduction, flexo-extension of the trapeziometacarpal joint and the opposition of the thumb by the modified Kapandji test. We also measured radiographic distance of the TMC space in preoperative radiographies and compared it with the postoperative ones. Finally, strength was quantified for the lateral, tip-to-tip, and tridigital pinch in the treated hands. Pain was measured with VAS and the DASH questionnaire was completed by all the patients. The average follow-up period was of 5,3 years (range, 1,1–12,1 years).

Results: At the final follow-up visit we obtained the following Results: for thumb abduction average 66°, thumb opposition to the base of the smaller finger was present in 58%, and thumb flexo-extension average 59°. The average tip-to-tip pinch strength was 2,7, for the lateral pinch 3,6 and for the tridigital pinch was 3,7. We observed that in 36% of the radiographies the TMC space was the same pre and postoperative. Average VAS and DASH scores were of 1,6 and 26,3 respectively. Five patients (10%) needed a revision surgery (2 for infection and 3 for aseptic loosening of the prosthesis)

Conclusions: Most of the protocols evaluating surgical outcomes on the trapeziometarcarpal joint don’t allow a functional analysis of ROM and strength of this joint. That’s why we developed the idea of designing a new methodology, that we currently use in our centre, to analyze the functional outcome of the surgery on the trapeziometacarpal joint. We specially recommend the measurement of the tridigital pinch strength, as is the most representative feature of the hand function.

Intro: There are few modern reports which document the results of all-polyethylene tibial components in younger, more active patients. The potential benefits of this design are the elimination of backside wear and lower implant cost than modular, metal-backed components.

From January 1992 to the present, 56 TKRs were implanted in 41 patients less than 60 years of age at the time of index surgery using a cemented all-poly tibial component with a PS design. Indications included all patients with osteoarthritis or post-traumatic arthritis without significant tibial bone loss. All patientswere followed prospectively with clinical and radiographic criteria asdefined by the Knee Society. Patient Assessment Questionnaires were used to quantify patient satisfaction, pain, and activity levels.

From January 1992 to the present, 56 TKRs were implanted in 41 patients less than 60 years of age at the time of index surgery using a cemented all-poly tibial component with a PS design. Indications included all patients with osteoarthritis or post-traumatic arthritis without significant tibial bone loss. All patientswere followed prospectively with clinical and radiographic criteria asdefined by the Knee Society. Patient Assessment Questionnaires were used to quantify patient satisfaction, pain, and activity levels.

Discussion: Since the mid 1980s, modular, metal-backed tibial trays have dominated the TKR market based on finite-element analysis studies which demonstrated superior force distribution compared to conventional all-poly components. As a result, backside wear has become an emerging problem and refocused design efforts on unitized components. Our clinical experience indicates an all-poly tibial component fixed with cement provides excellent performance and survivorship even in younger, more active patients.