Fractures of the distal metaphysis of the tibia represent 7–10% of tibial fractures and less than 1% of the lower limb fractures. Their treatment is difficult and presents a high percentage of bad results because of comminution of the metaphyseal bone fragments, articular involvement, poor circulation in the distal third of the leg. Until few years ago, in presence of a comminuted fracture, the only surgical possibility was the use of plate and screws. The external fixation represented a temporaneous treatment in case of open fracture or severe soft tissue damage. The recent technology applicated to external fixation has transformed the external fixator in synthesis device less uncomfortable, to increase the compliance of the patient, and more stable, to be used in the definitive treatment of this fractures. Recently we change the external fixator with double ring in a monolateral external fixator with single ring, in the “hybrid frame”.
The aim of the study was review all the type B and Type C according with A.O. classification tibial plateau fractures from January 1995 to August 2004 with a minimum follow up of six months. It has been selected all the patients treated with closed surgery. In the treatment of type B fractures we used cannulated screws, sometimes with external fixator. In the treatment of type C fractures we used external fixator. As a result of the technical improvements, in the recent years, external fixation has become a surgical technique not only for the treatment of open fractures but also for the management of comminuted fractures with percutaneous synthesis, since there is no need to open the fracture site. In our recently experience we have used a hybrid fixator which is single-use, pre-assembled and radiolucent.
The main problem in revision hip surgery is the loss of bone, expression of the reactive phenomena to the granulation tissues secondary to debris production. The choice of surgical system and strategy is related to the bony loss. The tantalum, due to its elevated porosity and microarchitecture and elasticities similar to trabecular bone, facilitates the periprosthetic osteointegration, so to be considered particularly indicated in acetabular revisions. The Authors present clinical and radiological results of a two years experience with tantalum hemispheric cup, emphasizing its versatily, with possible choice between a model with reinforce net-like function with a cemented polyethylenic component and other with standard modular inlay. In case of serious bone-loss bone banking graft has been used (except in septic mobilization, although a two-stage proedure with the use of temporary antibiotic-impregnated spacer) and two or more screws for additional fixator.
