Aims: Consideration of gravity of talar neck fractures and evaluation of their treatment results. Methods: From 1992 to 2001 were admitted to our department 26 patients, suffering from talar neck fractures. We were able to reexam 22 patients (17 males and 5 females), with mean age 34,14y. (16 to 64y.). Fourteen pt. (63,6%) were car accident victims. In the rest of them fracture occurred after fall from height more than 3m. There were 8 (36.3%) multi-injured patients. Preoperative diagnostic approach included simple x-rays and CT scan and Hawkins classiþcation was used. All patients underwent surgical treatment. Operative technique included open reduction and internal þxation using screws and/or K-Ws. Postoperatively patients were evaluated with radiological and clinical criteria according to Iowa Ankle Evaluation score. Results: Mean follow up was 58 months (from 12 months to 9 years). Results were excellent in 10 (45,4%), good in 6 (27.2%), fair in 4 (18.1%) and poor in 2 (11%) patients. Two cases developed avascular necrosis (1 type D and 1 type C) followed by body collapse and treated with ankle arthrodesis. Furthermore 1 patient underwent ankle and 6 patients subtalar arthrodesis because of arthritis caused from concomitant fractures. Conclusions: Treatment of talar neck fractures is a challenge because of high rate of complications, because of talusñ shape and vascular anatomy. Anatomic reduction and rigid internal þxation, in combination with immobilization and no weight bearing until restoration of talusñ architecture is achieved, are essential requirements for good result.

Aims: To evaluate the effectiveness of external fixation exchange by intramedullary nailing during consolidation phase following callus distraction phase. Methods: In 12 skeletally mature female sheep, equally divided in two groups (group A and group B), we performed tibial shaft osteotomy and 2cm gradual callus distraction using Ilizarov external fixator in a 0,5mm/12h rate. In group A, Ilizarov fixator was removed immediately after lengthening completion, and static unreamed intramedullary nail was inserted. In group B, Ilizarov device remained during consolidation phase. Formatted callus was studied, with radiographs, ultrasonograms, and triplex. All animals were sacrificed 70 days after osteotomy and bone specimens, were evaluated by DEXA and histopathologic examination. Results: In group A, all animals successfully tolerated intramedullary nailing and limb alignment was attained. All but one formatted mature callus and had started the remodeling phase retaining callus length, before being sacrificed. One animal had delayed callus maturation and 0,5cm loss of callus length, because of failed insertion of distal locking screw in the nail. In group B, all formatted mature callus too, but 2 had serious axis disorder, 3 persistent superficial pin-track infections and 1 deep infection in the same time. Conclusions: Replacement of Ilizarov device by static unreamed intramedullary nail during callus consolidation phase decreases the total duration of external fixation, limits joint stiffness, pin-track infections and axial deformities, and provides protection against refracture. Our results suggest that there is no considerable difference between callus maturation in the two groups.

Aims: Evaluation of postoperative infections in T.H.R. and T.K.R., after randomized prophylactic use of Fusidic acid, Vancomycin and Cefuroxime and assessment of their side effects. Methods: From December 2000 to September 2002, 182 patients (43 males and 139 females), were operated on T.H.R. and T.K.R. in Orthopaedic Department of University of Patras. Mean age was 65.8 years (range 33–90yrs.). The patients were categorized into three groups (A, B and C). In group A was administrated Fusidic acid 500mg and Cefuroxime 1.5gr preoperatively and 2 doses of Fusidic acid 500mg postoperatively. Group B received Vancomycin 1gr and Cefuroxime 1.5gr preoperatively and 2 doses of Vancomycin 1gr postoperatively. Group C received Cefuroxime 1.5gr preoperatively and 2 doses of Cefuroxime 750mg postoperatively. Blood tests were systematically performed preoperatively, and the þrst and þfth postoperative day. Mean follow up was 10,5 months (range 2–21 months). Results: One patient of group B developed deep wound infection. Superþcial infections developed 2 pt. (3.2%) of group A, 2 pt. (3.9%) of group B and 2 pt. (2.8%) of group C. Temperature over 38.3û C attributed to another infection site was observed in 6 pt. (9.8%) of group A, 3 pt. (5.8%) of group B and 5 pt. (7.1%) of group C, while temperature over 38.3û C with unknown origin was noted in 7,3,8 patients respectively. No side effect was recorded. Conclusions: The proper use of antibiotic prophylaxis according to pharmakoki-netic and pharmakodynamic properties combined with sterile surgical techniques prevents early deep wound infections in T.H.R. and T.K.R. The use of speciþc anti-staphylococcal agents is of no beneþt in antimicrobial prophylaxis for the above operations.

Aim: To evaluate time of union and functional recovery of the shoulder joint in humeral shaft fractures treated with antegrade intramedullary nailing.

Methods: During 1998–2002, 29 patients (16 male and 13 female, mean age 43.7 years) with humeral shaft fractures underwent antegrade, proximal locked, intramedullary nailing. A modified extra-articular entry point, 1 cm below the greater tuberosity, was used to avoid rotator cuff damage. The nail, after accurate measurement of its length and proximal metaphysis enlargement up to 10 mm, was impacted into the narrow, cone-shaped, distal part of the humerus, without the necessity of distal screw interlocking. Passive motion of the shoulder joint was initiated from the 2nd postoperative day and active assisted exercises after the 2nd postoperative week.

Results: Mean follow up period was 27 months. Solid callus formation was noted in all fractures, between the 14th and 18th postoperative week. No cases of intra-operative fractures, nerve irritation, rotational instability, nail migration and loss of distal impaction were noted. Mean Constant-Murley score was 93 points at the 16th postoperative week.

Conclusion: Antegrade intramedullary nailing is a reliable and beneficial procedure for the treatment of humeral shaft fractures, regarding union and functional recovery of the arm. The extra-articular entry point should be preferred to avoid rotator cuff and articular surfaces damage whereas the accurate measurement of the nail length and the firm impaction of it at the olecranon fossa makes distally interlocking unnecessary, decreasing significantly the overall operative time and the associated complications.

Purpose: To present our clinical experience of intramedullary nail application during the consolidation phase after bone lengthening or bone transport.

Material and method: Thirty patients (33 cases) with secondary intramedullary nailing during consolidation phase after callus distraction with an external devise (Ilizarov frame or unilateral system) were evaluated. Docking site nonunion (17 patients), angular deformity or fracture of the lengthened area (8 patients) or intolerance of the external device (5 patients), in combination or not with a delayed distracted callus maturation, were the main reasons for this replacement.

Results: Average follow-up time was 4 (2–12 years). Average external fixation index was 40 days/cm of distraction. Intramedullary infection afterwards the placement of the nail was presented in one case (3,03%), and slight callus length loss in 5 cases (15,2%). Failure of union at the docking site with nail breakage was happened in 1 case (3,03%). In the other patients, ossification was achieved in the lengthened callus area as well as at the docking site, in an average time of 5,9 months from the moment of the nail insertion. All the patients were satisfied after the abstraction of the external devise, while their joint mobility and functionalism were improved rapidly.

Conclusions: The use of intramedullary nailing during consolidation phase after callus distraction, is a treatment option for delayed callus maturation or docking site nonunion, reducing the prolonged use of the external fixator.

Aim: The evaluation and guantification of radiologic parameters observed in the late stages of hip arthritis.

Materials and Methods : The present study concerns the retrospective evaluation of the preoperative X-rays of 80 patients affected from primary hip arthritis only on one side in an advanced stage, that were treated in our department with total hip arthroplasty. From the present study we excluded patients with hip arthritis secondary to trauma, rheumatoid arthritis or congenital hip dislocation. The onset of the symptoms ranged between six months and twenty years (mean time5, 6 years).

We evaluated the following parameters:

Neck-shaft angle

These parameters were measured from two idependent observers. Every single measurement was done twice from both observersjn order to estimate the interobserver and the intraobserver error. The measurements were done in both hips of the patients-the affected and the healthy one-on an A-P pelvis radiogramm.

Results: From the above measurements, it results that in hip arthritis the neck-shaft angle changes (it becomes varous).The calcar was found thickened in the affected hip in a mean value of 1,45mm. The thickness of the cortex at the level of the lesser trochanter was found greater in the non-affected side in a mean value of 0,7mm. The bone loss of the femur head was approximately 2,5mm. The distance between the rotation center of the hip and the point at which the neck axis crosses the transtrochanteric line was found greater in the non-affected side, in a mean value of 3,12mm.

Conclusions: The modifications observed in hip arthritis that concern the load transmission across the neck of the femur result in changes that can be radiologically identified and measured. In the first place the thickness of the calcar is influenced, as it does the distance between the rotation center of the hip and the trochanteric line. In the advanced stages of hip arthritis the sedimentation (bone loss) of the femur head can also be measured.

We evaluate the patients with lumbar spinal stenosis in multiple levels that were treated with posterior decompression and posterolateral fusion, using transpedicular screw fixation system. Twenty-six patients, mean age 65.7 years (range 49 to 77years), with lumbar spinal stenosis, in more than three levels, were treated surgically between 1994 and 2002. Indications for surgical treatment included low back pain and neurogenic claudication for more than 6 months. The diagnostic approach consisted of x-rays, MRI, myelography and myelo-CT. Oswestry disability score and VAS (visual analog scale), were used for the clinical evaluation of the patients. Surgical procedure consisted of wide posterior decompression, regarding laminectomy, complete or incomplete facetectomy and foraminotomy, combined with posterolateral fusion, using transpedicular screw systems and bone graft. Fusion in three levels was performed at seven patients, in four levels at ten, in five levels at seven, in six and seven levels at one patient respectively.

Mean follow-up was 26.8 months (range 12 to 38 months). Oswestry score and VAS revealed improvement 40.75% and 5.4 levels respectively. The better results were concerned to pain (2.88 levels improvement) and the less good to lifting (1.58 levels improvement). Two cases with superficial infections were observed and treated with surgical debridement. Screw breakage was observed in 1 patient and treated conservatively. Loosening of two sacral screws, which were removed, was observed in one patient.

We conclude that myelography and myelo-CT revealed with satisfactory accuracy intra and outer foraminal lumbar spinal stenosis. Posterior decompression and instrumented fusion, offer satisfactory clinical results in patients with lumbar spinal stenosis in multiple levels when performed by experienced surgical team.

Aims: Evaluation of postoperative infections in T.H.R. and T.K.R., after randomized prophylactic use of Fusidic acid, Vancomycin and Cefuroxime and assessment of their side effects.

Methods: From December 2000 to April 2002, 128 patients were operated on T.H.R. and T.K.R. in Orthopaedic Department of University of Patras (64 for T.H.R. and 47 for T.K.R.). Mean age was 66.5 years (range 45–90yrs.). The patients were categorized into three groups. In the first group was administrated Fusidic acid 500mg and Cefuroxime 1.5gr preoperatively and 2 doses of Fusidic acid 500mg postoperatively. The second group received Vancomycin 1gr and Cefuroxime 1.5gr preoperatively and 2 doses of Vancomycin 1gr postoperatively. The third group received Cefuroxime 1.5gr preoperatively and 2 doses of Cefuroxime 750mg postoperatively. Blood tests were systematically performed preoperatively, and the first and fifth postoperative day. Mean follow up was 8 months. Results: No deep wound infection was observed. Superficial infections developed 2 pt. (1.58%) of the first group, 2 pt. (1.58%) of the second group and 3 pt. (2.3%) of the third group. Temperature over 38.3° C attributed to another infection site was observed in 4 pt. of the first group, 2 pt. of the second group and 7 pt. of the third group, while temperature over 38.3° C with unknown origin was noted in 7,2,6 patients respectively. No side effect was recorded.

Conclusions: The proper use of antibiotic prophylaxis according to pharmakokinetic and pharmakodvnamic properties combined with sterile surgical techniques, prevents early deep wound infections in T.H.R. and T.K.R. The use of specific antistaphylococcal agents is of no benefit in antimicrobial prophylaxis for the above operations.

We evaluate the effectiveness of external fixation exchange by intramedullary nailing during consolidation phase following callus distraction phase. In 12 skeletally mature female sheep, equally divided in two groups (group A and group B), we performed tibial shaft osteotomy and 2cm gradually callus distraction using Ilizarov external fixator in a 0.5mm/12h rate. In group A, immediately after lengthening completion, Ilizarov fixator was removed, and static unreamed intramedullary nail was inserted under fluoroscopic guidance. In group B (control group), Ilizarov frame remained (according to the usual technique) during consolidation phase. Callus maturity was studied in both groups, in specific time intervals, with plain x-rays, ultrasonograms, triplex and digital subscription angiograms. All animals were sacrificed 70 days after osteotomy and bone specimens including callus, were evaluated with MRI, DEXA and histopathologic examination.

In group A, all animals successfully tolerated intramedullary nailing, keeping limp alignment. All but one formatted a mature callus and kept callus length before being sacrificed. One sheep had a delayed formation of the callus and 0.5cm loss of callus length, because of failed insertion of distal locking screw in the nail. In group B, four of six formatted mature callus, two had axis disorder, three superficial pin-track infections and one deep infection in the same time.

We conclude that replacement of Ilizarov device by static unreamed intramedullary nail during callus consolidation phase decreases the total duration of external fixation, limits articular stiffness, pin-track infections and axial deformities, and provides protection against refracture. Our results suggest that there is no considerable difference between callus formations in the two groups.

Aim of the study

End results analysis of operative treatment in transcaphoid perilunate dislocations.

Material and method

From 1/1/91 to 1/1/01 twenty transcaphoid perilunate dislocations were operative treated. Ligamentous lesions were repaired through a dorsal approach, either by directly suturing the ligaments (10cases), or by using mini Mitek anchors (8 cases). Simple approximation and stabilization with K-wires was performed in 2cases. Scaphoid fractures were treated by open reduction and internal osteosynthesis with Herbert screw (12 cases), cortical AO 2.0 screw (2cases) or K-wires (6 cases). The wrist remained immobilized in a slight flexed position with short arm plaster for 8 weeks. Physiotherapy was necessary for all patients to regain full range of motion. Clinical and radiological evaluation was possible for all patients. The end results were estimated according to Cooney’s evaluation system. Kinematics of the injured wrists was also tested by cineradiography in order to estimate the dynamic behaviour of the wrist. The Average follow-up time was 52 months (range 11–76).

Results

Twelve patients had excellent result, 4 good, 1 fair, and 3 poor. Fourteen out of 16 cases returned to their previous work. Additional operations were required in two patients: 1) four corner arthrodesis because of aseptic necrosis of the proximal pole of the scaphoid with arthritic changes, 2) Scaphoid reoperation because of non-union by Matti-Russe procedure. The later was found in cineradiography to present a painless rotational instability.

Conclusions

Transcaphoid perilunate dislocation has a very good response to early operative treatment. Dorsal ligament repair with mite mini anchors seems to be a reliable easy made method. Scaphoid fracture stabilization requires a stable compressive fixation. Herbert screw is ideal and can be safely placed from proximal to distal via the dorsal incision. Cineradiography is the best way to evaluate normal wrist kinematics.