Objectives

Implant-related infection is one of the most devastating complications in orthopaedic surgery. Many surface and/or material modifications have been developed in order to minimise this problem; however, most of the in vitro studies did not evaluate bacterial adhesion in the presence of eukaryotic cells, as stated by the ‘race for the surface’ theory. Moreover, the adherence of numerous clinical strains with different initial concentrations has not been studied.

We present in this work our experience with the sural fasciocutaneous flap to treat coverage defects following a lower limb posttraumatic lesion. This work is a review of the fasciocutaneous sural flaps carried out in different centres between 2000 and 2005. The series consist of 14 patients, 12 men and 2 women with an average age of 38 years (23–54) and with a medium follow-up time of 2 years (12–48 months). In all of the cases, aetiology was a lower limb injury being the most frequent the distal tibial fracture (eight patients), followed by sequelae from Achilles tendon reconstruction (two patients), fracture of the calcaneus (two patients) and osteomyelitis of the distal tibia (two patients) secondary to an open fracture. Associated risk factors in the patients for performing a fasciocutaneous flap were diabetes (1 case) and cigarette smoking (4 cases).

The technique is based on the use of a reverse-flow island sural flap with the superficial sural artery dependent on perforators of the peroneal arterial system. The anatomical structures which constitute the pedicle are the superficial and deep fascia, the sural nerve, external saphenous vein, superficial sural artery together with an islet of subcutaneous cellular tissue and skin.

The flap was viable in 13 of 14 patients. Only in one case, a diabetic patient, the graft failed. No patient showed signs of infection. Slight venous congestion of the flap occurred in two cases. No further surgical intervention of the donor site was required because of morbidity. In two cases partial necrosis of the skin edges occurred which resolved satisfactorily with conservative treatment.

The sural fasciocutaneous flap is useful for the treatment of complex injuries of the lower limbs. Its technical advantages are: easy dissection with preservation of more important vascular structures in the limb, complete coverage of the soft tissue defect in just one operation without the need of microsurgical anastomosis. All of that results in a well vascularised cutaneous islet and thus a reliable flap

Introduction and objectives: The purpose of the research is to show the agreement and reproducibility among 5 observers when they are questioned about 51 open fractures using two open fracture classifications for long bones (Gustilo and Aybar), interpreting the results obtained between both classifications.

Material and Method: A classification protocol is established for open fractures. The fractures are graded independently using each of the systems being evaluated (Gustilo and Aybar), by visualising slides with clinical and radiologic images in addition to a report of the data in the clinical history. The survey is conducted twice with a time difference of one to eight weeks. 5 members of the Orthopedic and Traumatologic Surgery Department (OTSD) were questioned (1 Professor, 2 Specialists and 2 Residents). The statistical method used to analyse the results was the interobserver agreement percentage and the inter- and intraobserver kappa index.

Results: The interobserver agreement percentage for the Gustilo classification was 58.82% and 39.21% for the Aybar classification. The kappa index for the interobserver agreement for the Gustilo classification was 0.51 and for the Aybar classification was 0.54. The kappa index for the intraobserver reproducibility was 0.69 for the Gustilo classification and 0.58 for the Aybar one.

Conclusions: The interobserver agreemnet was considered moderate-poor for the Gustilo and Aybar classifications. The intraobserver reproducibility was considered substantial for the Gustilo classification and moderate for the Aybar one. We conclude that this agreement shows too much variability as to accept just one classification as the only valid method to take therapeutic decisions or for comparing results. Therefore, it’s necessary to create a more detailed and careful classification, which is quick to use, reliable, reproducible and which contains a more objective criteria.

CLS Spotorno cotyle consists of an expansible hemispheric external component with troncoconic internal thin thread of Protasul Titanium. It also has a polyethylene UHMW internal threaded element which adapts prosthesic femoral heads (28–32 mm of diameter).

The implant procedure is technically simple. First of all, the acetabulum is prepared by milling the cartilaginous surface with hemispheric mills. The external element is inserted pressthorn;t, later it is expanded with a troncoconic thread, the high density polyethylene is threaded inside the expanded component.

The aim of this comunication is to expose the clinical and radiological outcome of 50 patients whom a CLS Spotorno expansible cotyle were implanted with a mean clinical follow up of 14 years.

The indications are exposed considering the age, cotyle morphology and bone quality. The evaluation included both clinical and radiographic parameter. Test of Postel and Merle DñAubigne were assessed for this clinical outcome. Radiological evaluation included: Acetabular angle desviation, periprosthesic osteolysis, proximal and medial migration of the cotyle and polyethylene wear. The primary stability of the acetabular stems were found excellent. Good osteointegration and biocompatibility were demostrated by serial radiographic and funtional scores. We also present the surgical procedure, the complications and the conclusions of the study.