Aims: The purpose of this roentgenographic study is to quantify patellar tilt after total knee arthroplasty and substantiate which factors might affect it. Methods: We reviewed the þles of 446 patients with 485 primary total knee arthroplasties, solely on the diagnosis of degenerative osteoarthritis. Mean follow-up approximated 8.5 (range, 5–20) years. Resurfacing-type prostheses were exclusively used. Patellar resurfacing was accomplished in 51 (11.4%) knees. Patellar tilt was measured pre- and postoperatively using standard Merchant views. Chi-square analysis was used in an attempt to disclose any relationship of patellar tilt with variables like button positioning, lateral release, patellar thickness, limb alignment, joint line elevation, patellar height and posterior cruciate ligament retention or sacriþce. Results: Pre-operatively, 27%, 40% and 33% of patellae demonstrated neutral, lateral and medial tilt respectively. These þgures subsequently changed to 49%, 19% and 32% immediately post-op. However, at þnal follow-up, patellar tilt pattern looked much like the pre-operative one, namely, 31%, 38% and 31% respectively. A statistically signiþcant positive correlation was only documented for patellar thickness, buttonmedialization and pre-operative tilt. The rest of the parameters tested were found not to have any statistical signiþcance with post-operative tilt values. Conclusions: After knee arthroplasty, the patella has, on the long term, a tendency to revert laterally. Lateral release does not seem to ameliorate this tendency. Finally, pre-operative tilt does not correlate to post-operative external mechanism complications.

Evaluations of 32 adults with 50 complete digital nerve injuries were made more than 1 year after surgery. Twenty patients were men and 12 were women. The mean age of the patients at operation was 30 years. The mean follow-up time was 2 years. Patients were excluded if they had a skin graft, had a second surgery after digital nerve repair or graft, were diagnosed with diabetes, had additional proximal nerve injuries, had postoperative infections, had a complete digital amputation or had a dorsal digital nerve injury. According to the initial injury mechanism, patients were classified into three grades : grade I was defined as a sharp, clean-cut injury, grade II was mild crush and grade III was a severe crush injury. Overall, there were 30 primary digital nerve repairs, 12 secondary repairs and 8 secondary nerve grafts. Moving and static two-point discrimination was determined on both lateral aspects of the injured and contralateral uninjured digits. Digits with primary repairs in mild or severe crush injuries had significantly worse two-point discrimination compared with digits that had a primary repair of a simple laceration. Futhermore, in mild crush injuries, digits with secondary nerve grafting had significantly better results than those with primary repair. Patients under 30 years age had better results than those over 30 years. These results support the hypothesis that better recovery is obtained if tension is avoided at the nerve repair site in mild crush injuries.

Between 1988 and 1998, a total of 12 patients (6 men and six women, of average age 36 years) underwent surgery for schwannoma of the peripheral nerves of the upper extremity. The incidence according to the involved nerve was analyzed and the follow-up results and complications after surgical treatment were reviewed. The median nerve was most frequently involved (6 cases), followed by the ulnar nerve (4 cases) and the radial nerve (2 cases). The average duration of symptoms was 2 years (3 months-8 years). Pain or painful paresthesias were usually the main complains. None of the patients suffered from Recklinhausen’s disease. Magnetic resonance imaging is the preferred exploration technique, particularly useful in case of deep tumor. EMG studies were carried out in all patients. Preservation of nerve continuity is the underlying goal of the therapeutic strategy. Marginal excision was performed in all cases. The tumors were extricable displacing the nerve fiber bundles without penetrating into the bundle itself and it was possible thus to be resected without interrupting the nerve continuity. Postoperatively, 7 patients were pain free, while 5 improved. Neurological deficits were favourably influenced by the operation. Out of 4 patients with motor deficits 3 had complete and 1 had partial recovery. Three out of 6 patients with sensory deficits had complete recovery, 2 remained unchanged, while 1 worsened. One patient developed new motor and another one new sensory deficits. New deficits developed predominantly in patients with large tumorsor longstanding symptoms. There was no reccurence or malignant transformation until the average of 52 months of follow-up.

Purpose: To evaluate the diagnostic parameters for detection of pelvic bone infections and to present the results of conservative and operative treatment.

Materials-methods: 17 children with acute osteomyelitis of the pelvis or septic sacroiliitis were treated from 1992 to 2000. They were followed-up for 1,5 to 8 years.

10 patients presented with leukocytosis. In 15 patients ESR exceeded 40 mm and in 10 patients CRP exceeded 20 mg%. Blood cultures yielded Staphylococcus aureus in 6 cases and Streptococcus in one. In only 2 cases were plain X-Rays suggestive of infection. Every patient had a positive Tc99m MDP bone scan (increased absorption), which permitted localization of the infection. Furthermore, MRI was performed on 12 patients, yielding abnormal findings in all cases.

All patients received antistaphylococcal antibiotics intravenously for 10–14 days, followed by a further 3–8 week course per os, depending upon the response to treatment. Treatment started with considerable delay for 3 patients; they all were submitted to surgical drainage and debridement.

Results: All patients were normal at clinical follow-up by the end of treatment. By the end of follow-up no signs of osteomyelitis or residual deformity appeared.

Conclusions: The usual laboratory and radiological investigations can be misleading. Tc99m MDP bone scan and MRI permit prompt diagnosis and localization of the infection. With the appropriate antibiotics the clinical results are usually excellent, provided that the disease is diagnosed without delay. Surgical drainage and debridement is necessary in cases of delayed or missed diagnosis.

Introduction: The aim of this study is to present a modification of the single tension band technique for the treatment of olecranon fractures, using a double tension band with smaller wires, preserving all the biological parameters for fracture fixation, in an effort to decrease related complications.

Material: Thirty-three patients with olecranon fractures treated with a double tension band fixation. Surgical Technique: Through a posterior approach the fracture is reduced keeping all principles for biologic fixation and stabilized with two parallel small K-wires inserted from the olecranon process and exit through the anterior cortex of the ulna. Then the extensor carpi ulnaris and flexor carpi ulnaris are partly elevated from the ulna and two 1.5-mm transverse drill holes are made through the ulna 3 and 4 cm distal to the fracture. Two 22-gauge wires are passed through the proximal and distal holes, bent into a figure of 8 over the dorsal ulna and simultaneously tightened. The proximal ends of the K-wires are bent and impacted into the olecranon process.

Eleven patients needed supplemental fixation with screws. All patients mobilized the first postop day.

Results: All the fractures consolidated. All patients but two regained full range of motion. No hardware failure was noted except one patient in whom one band was broken but without clinical relevance.

Conclusion: It seems that a double tension band fixation despite the smaller material utilized, provides a very stable construct, permitting early mobilization. Furthermore two bands tensioned independently provide greater compression forces at the fracture site and offer a back up in case that one band fails.