Purpose: We assess the results of the surgical treatment of intra-articular fractures of the calcaneus using the Ilizarov external fixator.

Materials and Methods: During the period of January 2004 to June 2009 we treated 72 intra-articular calcaneus fractures in 68 patients, 51 male and 17 female with a mean age of 34 (range 18–56). The mean follow –up period was 2 years and 10 months (range 3 months to 4 years). All patients received preoperative CT-scan to facilitate classification and pre-operative planning. Of the 72 fractures, 37 (51.4%) were Sanders type II, 30 (41.6%) were type III and 5 (7%) were type IV.

The Ilizarov fixator used consisted of 2 rings positioned above the ankle joint and a foot plate. 1.5 and 1.8 mm wires were used, as well as 1.8 mm wires with an olive for the reduction of displaced fragments. Under image intensification and distraction the fracture was reduced and the articular surface was restored as close as possible.

Results: The clinical outcome was excellent in 29 patients (40.4%), good in 32 (44.4%), moderate in 7 (9.7%) and poor in 4 (5.5%). As far as the complications are concerned, we had 17 cases of pin track infection treated with the removal of the pins, ankle joint stiffness in 12 patients treated with physiotherapy, 2 patients developed reflex sympathetic algodystrophy, 2 malunion, 8 developed post-traumatic osteoarthritis and 1 of them underwent subtalar arthrodesis.

Conclusion: The use of the Ilizarov external fixator for the treatment of intra-articular calcanear fractures has proved itself to be an alternative method to O.R.I.F with similarly good results. Given the fact that the learning curve is relatively steep, it has proven, from our experience, to be a safe and valuable tool for the treatment of these challenging fractures.

Aim: This retrospective study presents the results of humeral pseudarthrosis management, in our clinic, during the period 1997–2002.

Material: 21 patients with humeral pseudarthrosis were treated during this period. 7 were men, with an average age of 48, 6 (range 22–63) and 14 were women, with an average age of 63, 3 (range 42–80). The initial treatment in 19 cases was conservative and in 2 cases surgical (internal fixation with plate – screws or intramedullary nailing). The average time of the humeral pseudarthrosis management was 5,9 months (4–10 months).3 pseudarthrosis were oligotrophic and 18 atrophic.

Method: All patients underwent an open reduction, internal fixation and bone grafting (autografts and/or allografts).In humeral shaft pseudarthrosis a wide plate was applied, while in superior humeral metaphysis pseudarthrosis, a T-plate. In all cases impaction of the fracture edges was achieved.

Results: The average follow-up was 40,2 months (range 4–68 months).Union was achieved in all cases in an average of 2,8 months (range 2–8 months). Direct postoperative mobilisation and physical therapy was applied in 20 cases and only in 1 case a “Sarmiento” splint was applied for 3 weeks. In 2 cases a postoperative haematoma presented. In 1 case a pre-existed paresis of the radial nerve after the initial treatment of the fracture with internal fixation, came back 3 months after the management of pseudarthrosis and the release of the nerve. All patients’ revealed good functional rehabilitation, about 85–90% compared with the normal arm. Arm shortening in no case was greater than 2 cm.

Conclusion: Open reduction and internal fixation is the treatment of choice in the management of the humeral pseudarthrosis. The impaction of the fracture edges into each other strengthens significantly the stability of the fracture and promotes union.

Purpose: We will present our experience regarding sub-capital femoral fractures that were treated by cemented bipolar hemiarthroplasty with Chanley stem during the years 1987 to 2002.

Method: We treated 159 patients with subcapital femoral fractures, type Garden stage 3 and 4. Of those 57 were men and 102 women aged between 65 and 85 years old. All the patients underwent surgical treatment by the same surgeon team, using cemented bipolar hemi-arthroplasty Hastings types, with Chanley stem. The preferred surgical approach was the anterolateral with partial incision of the gluteus medius muscle and preservation of the posterior capsule of the hip joint, so that the prosthesis would be stable and the abductor muscles retained their strength.

Results: The observation time ranged from 6 months to 15 years. During this period 38 patients passed away and 24 never returned for follow up. The observed complications were: 1 aseptic loosening of the femoral stem that was dealt with THA, 1 superficial inflammation that was taken care of with surgical cleaning and antibiotic administration and 1 dislocation of the metal cup (with the internal polyethylene bearing) from the femoral stem that was corrected by OR. Postoperative hip mobility was found to be excellent (62%), fair (32%), poor (6%). 6 patients reported light to moderate pain during walking. We observed that the dual motion of the bipolar prosthesis is considerably reduced and eventually disappears over time.

Conclusions: From our long time experience regarding subcapital femoral fractures types Garden 3 and 4 in patients aged between 65 and 80 years old, we believe that the cemented bipolar hemiarthroplasty is a very good method of choice.