Expandable nails were developed in order to eliminate operating time and radiation exposure. The authors present the results of the use of expandable nails in the treatment of long bone fractures.

Material and method: Fifty three patients (males females) 17 to 78 yrs of age, who suffered from 32 femoral, 5 humeral and 16 tibial fractures, were treated with the above technique. Three pts had ipsilateral femoral and tibial fractures, one a femoral and controlateral tibial fractures and three were grade II open. All patients received prophylactic anticoagualation. All but the open fracture patients have had three doses of antibiotics. The suitable candidate was a patient with a two part non comminuted fracture, although some degree of comminution was not a contraindication, provided there was at least 10 cm of intact bone beyond that comminution.

The mean operating time was 50 minutes (20 to 80 min) and fluoroscopy time 22 sec (from 0 to 45 sec). All but one fractures were united by week 16.5 for the femur, 14 for the humerus and 18.5 for the tibia.

Complications: A transient radial nerve palsy, two soft tissue (extra osseous) ossifications, one rotational malaligment, one pseudarthrosis due to failure of the nail to expand distally to the fracture site in a patient with controlateral tibial fracture, 1cm shortening, two fractures NOF and one non fatal massive pulmonary embolism. Fracture propagation was evident in 5 fractures, but further action was not needed.

Conclusions: Expandable nail system is a good alternative to classic locked IM, provided careful patient selection is done as well as thorough checking of nail distal expansion and fracture propagation. The reduction of the operating and fluoroscopy time opposed to lesser stability and greater cost.

To describe the success rate of surgical debridement and primary closure without implant removal in the treatment of postoperative spinal wound infections with instrumentation.

One thousand four hundred fifty two posterior instrumented fusions were performed between 2000 and 2006. A retrospective record review identified 63 cases with acute (< 6 weeks) postoperative infection (4.6%). The preoperative diagnosis included fracture (24), adolescent idiopathic scoliosis (4), stenosis/degenerative spondylolisthesis (24), adult deformity (4), neuromuscular scoliosis (3), tumor (2), cervical myelopathy (2). All patients were treated with irrigation – debridement and closed suction drainage placement. Cultures were obtained, all wounds closed primarily and appropriate intravenous antibiotic treatments were initiated. The treatment protocol dictated the appropriate time to discontinue drains and antibiotics. The follow-up period ranged from 6 to 24 months.

The majority of infections occurred during the early postoperative period (less than 2 weeks). Fifty-six (89%) resolved without recurrence with only one surgical debridement. Seven patients (11%) required a second operation for irrigation and debridement. Two patients (3%) required implant removal.

Aggressive surgical treatment of postoperative spinal infections is essential for successful outcomes. Removal of implants is not necessary in acute infections. Delayed wound closure or second look operation could be avoided since primary closure offers accepted success rate.

PURPOSE: To record our experience in surgical treatment of thoracic spine fractures with posterior stabilization, decompression and ligamentotaxis.

MATERIALS AND METHODS: From January 2000 until July 2006, 67 patients (48 males and 19 females), aged 16 to 85 years old (average 41,2 y.o) were surgically treated in our department due to thoracic spine fractures. Preoperative X-Ray and CT scan were used in all cases while in most of the cases we performed MRI to further evaluate the damage. In all cases we performed decompression and posterior stabilization using four different hardware types and whenever possible ligamentotaxis. Continuous electrophysiological monitoring was alo ued in all operations. We recorded the pre- and postoperative neurological status, the vertebral height loss, the kyphotic angle and spinal canal occupation. Moreover we recorded the average hospitalization time, the transfusion needs as well as major and minor complications. At the follow-up we measured the loss of correction at 3, 6 and 12 months postoperatively. The follow up ranged from 4 to 48 months.

RESULTS: Neurological damage was recorded in 43 % of the patients. The average preoperative kyphotic angle was 38.2° while the average spinal canal occupation was 29.8 %. The immediate postoperative correction was 16.7 °. During the follow-up we observed small, insignificant loss of correction. There were no major complications.

CONCLUSION: In cases of thoracic spine fractures the surgical treatment with posterior stabilization and ligamentotaxis is offering significant stability and adequate long term results.

The aim of this paper is to study patients who have had surgery for spinal tumors. Indications for surgical treatment are pain(not resolving with analgesics), impending as well as manifested neurologic symptomatology or spinal instability, compression of neighboring structures and failure of radiotherapy or chemotherapy. In this study we present 50 patients, 30 women and 20 men, aged 15 to 75, suffering from benign(10 pts), malignant(15 pts)and metastatic(25 pts) spinal tumors. All were treated surgically by wide excision during a four-year period (1997–2002) using an anterior, posterior, posterolateral or combined approach to the spine. Most of the 30 pts who presented with neurologic compromise improved to a significant degree postoperatively with the exception of 5 whose condition did not change. One patient, whose preoperative neurologic status was Frankel D, deteriorated postoperatively and underwent a second operation to no avail. One patient died on day 12 p.op. CT-assisted biopsy was not successful in half the patients with metastatic cancer. 18 patients suffering from malignancy(primary or metastatic) underwent angiography and selective embolism of the feeding vessels. All patients were evaluated preoperatively by CT-scan, MRI, bone scan and in most cases myelography as well. Complications that were observed were wound infection(3 pts), intraoperative meningeal trauma and CSF leak(2 pts) and lymfatic duct trauma and lymph leak(1 pt).