Introduction: Antegrade intramedullary locked nailing is a reliable method for the treatment of humeral shaft fractures. There is a still debate on the functional effect due to a possible damage during surgical approach of the rotator cuff, but in the Literature few paper deal with the analysis of tendons in these patients. Ultrasonography is still considered a reliable method in evaluating rotator cuff tendons. The aim of this study is to evaluate if antegrade intramedullary nailing may induce a possible damage on rotator cuff.

Methods: Between May 2002 to December 2005 42 patient suffering of humeral shaft fractures were surgically treated with Unreamed Humeral Nail. Of them 21 (13 males and 8 female) were followed (average follow-up 22,9 months). All the fractures were traumatic except 1 due to bone metastasis of carcinoma. Follow up was clinical with Constant Score, radiographic in 3 projection (neutral, internal and external), and ultrasonographic, evaluating tendon of m. Sovraspinosus.

Results: Healing of fractures was obtained after 2 month from surgery in all cases; Constant Score’s average was 77,0. Three cases of impingement syndrome due to excessive length of nail were observed, healed after the nail removal. Ultrasonography showed that in 13 cases rotator cuff was normal. In 5 cases we have found a signicative hyperecogen area, related to the scarf. We have never had a damage of tendon in all its tickness.

Conclusion: Our study confirms that antegrade intra-medullary nail is a reliable method for the treatment humeral shaft fractures, not adversely influenced shoulder tendons. Damage of rotator cuff observed in few cases is not related to surgical technique, but depends on surgical pitfall with an excessively long nail and then impingement syndrome.

Lateral unstable fractures of the femoral neck represent a controversial problem for the surgical treatment, due to the difficulty in achieving an adequate mechanically stable bone-devices system. Compression hip screw alone has proven to be inadequate, while in association with the trochanteric stabilizing plate (TSP) it offers better results. The authors analyse functional results and complications of a series of 87 lateral unstable fractures of the femoral neck (type A2 and A3 of the AO classification). Weight bearing was allowed 48 hours after surgery. The most important complications reported were: persistent trochanteric pain (12 cases) shaft medialization and device mobilization (2 cases) shortening of more than 2cm (3 cases). All complications were reported in A3 type fractures. Our data confirm the efficacy of the TSP the treatment of lateral unstable fractures of the femoral neck (type A2) because it stabilizes the lateral cortex. In A3 type fractures, intramedullary devices offers better results than compression hip screw and TSP in terms of complications rate and stability.

Aim: Unstable lateral fractures of the proximal femur (type A2 and A3 of AO classiþcation) present a controversial problem for surgical treatment, due to the difþculty to achieve an adequate mechanically stable bone-device system, so to allow an early weight-bearing. To improve the stability of bone-device complex, a trochanteric stabilizing plate (TSP) has been introduced. The properties of TSP is to avoid shaft medialization in the postoperative. The aim of our study was report results of surgical treatment of unstable trochanteric fractures using a dynamic hip screws in association with TSP. Methods: From January 2000 to March 2002, 51 patients affected by this kind of fractures (type A2 of the AO classiþcation 37 cases and type A3 14 cases) were treated with the association of dynamic hip screw and trochanteric stabilizing plate. Results: The average time that patients spent in the hospital was 7.8 days for the group A2,2, 8.5 days for the group A2,3, 9.9 days for A3,1 and 10.3 days for A3,2. The average healing time was 6 weeks for A2 fractures and 7.2 weeks for the A3. According to the HSS at 6 months for the group A2,2 the average score was 85,5 for the group A2,3 was 81,7 for the group A3,1 was 74,4 and for the group A3,2 was 70,1. The main postoperative complications were 3 superþcial infection of surgical wound, 3 deep vein trombosis and 1 pulmonary embolism. Conclusions: Our series show that this device, although it interferes with trochanteric structures, is a real aid for the dynamic hip screw system in the treatment of unstable lateral fractures of proximal femur due to the possibility of stabilizing the great trochanter and the lateral cortex in order to avoid the medialization forces of the femoral shaft.

Aims: The aim of our study was to assess results of treatment of trochanteric fractures using a speciþc algorythm Methods: From January 2000 to March 2002, 215 patients affected by fractures of trochanteric region were treated. 130 were female and 85 male, the average age was 72,5 (5–96). Author used an algorythm based on the analysis of stability of the bone-device system considering three groups: GROUP 1: stable fractures (A1 and A2.1 according to AO classiþcation) in which dynamic hip screw was employed, GROUP 2: unstable fractures (A2.2, A2.3, A3.1) in which dynamic hip screw and trochanteric stabilizing plate were employed, GROUP 3:unstable fractures (A3.2 and A3.3) in which intramedullary nailing was performed. Results: The average healing time was 6 weeks for GROUP 1 and GROUP 2 and 7,2 weeks for GROUP 3. According to the HHS at 12 months the average score for GROUP 1 was 83,1, with 72% of excellent results, 20% good, 4% fair and 4% poor; for GROUP 2 the average score was 79,7 with 56% of excellent results, 25% good, 10% fair and 9% poor; for GROUP 3 the average score was 77,2 with 40% of excellent results, 29% good, 18% fair and 13% poor. In GROUP 2 we observed 2 cases of limb shortening more then 2 cm and 9 cases of pain due to trochanteric plate. In 2 cases of cut-out of the lag screw cemented endoprosthesis was required. In GROUP 3 we observed 5 cases of limb shortening more then 2 cm and 4 cases of persistent trochanteric pain. Conclusions: Following this algorythm a low rate of complication were observed specially in GROUP 2.