Fractures of the distal tibia metaphysis comprise a challenge for the orthopaedic trauma surgeon because of the poor blood irrigation they do not heal very easy leading sometimes to pseudarthrosis and many times arise problems with the skin.

We compare the following techniques: LC-DCP and LCP plates, MIPO, External fixators (hybrids or simple one), intramedullary nailing with multiple screws at the distal end.

94 cases of distal tibia fractures from all AO types were treated during last 3 years (2005–2008) with the following techniques:

16 ORIF with LC-DCP plates

The simple oblique or spiral fractures which treated with the 1st and 2nd method (ORIF), they do not seem any remarkable difference in healing but both methods demonstrate a delay in fracture healing over 5 months. The 3rd method display faster healing 2,5 months average in simple fractures with no skin wound at all. The 4th method display 3 pin track infections and dealt with removal of the material and 2 pseudarthrosis which encountered with ORIF and bone grafting from the iliac. The 5th method display 2 malunions but because of the small angle in varus we do not perform any treatment. Every technique has its own position on those type of fractures, depending of the personality of the fracture and the skill of the surgeon.

Aim: The addition of the Trochanteric Support Plate (TSP) to the Dynamic Hip Screw is a very effective way of treatment of the reverse oblique fractures of the proximal femur. It secures the stabilisation of the greater trochanter as well as it prevents from the lateral transposition of the greater trochanter during the impaction of the fracture postoperatively.

Method: The reversed oblique fractures of the proximal femur is a group of unstable fractures characterised by a fracture line going from lateral distal to medial proximal of the lesser trochanter. The OTA classifies them as 3.1 A3 fractures and subdivides them in 31 A3.1, 31 A3.2. and 31 A3.3 groups. We operated on 1535 fractures of the hip in our Department during Jan. 1998 to Dec. 2002, 997 of them were introchanteric or subtochanteric fractures. Among them there were 35 reversed oblique fractures. Five of them were fixed by an interlocking nail (gamma nail), nire of them by a Dynamic Hip Screw and twenty one by the Dynamic Hip Screw with the addition of a Trochanteric Support Plate. We surveyer the duration of the operation as well as the duration of the operation as well as the radiation time in each of them.

Results: Five out of nine fractures treated by the dynamic hip screw alone failed and were reoperated one out of four fractures treated by the gamma nail developed a pseudarthrosis and was reoperated, too. Only one out of twenty one fractures treated by the dynamic hip screw with the addition of the trochanteric support plate (TSP) failed because of inadequate reduction of the fracture and wrong placement of the screw.

Conclusion: The addition of the Trochanteric Support Plate to the Dynamic Hip Screw is a more satisfactory way of treatment of the reversed oblique fractures of the proximal femur when compared to the other methods of osteosynthesis. The advantages are: lower percentage of complications, easy application of the plate and short radiation time. However the result may be disastrous in case of a bad reduction of the fracture and a wrong placement of the screw.

Aim: We present our experience of the treatment of the ipsilateral fractures of the femur and tibia. The so called “floating knee” is such a fracture caused by a high energy injury.

Method: During the last five years we admitted 19 patients with ipsilateral fractures of the femur and tibia. There were 18 men and one woman. Seven of them had a late treatment, after their discharge from th I.C.U. (Intensive Care Unit.).

We classified our patients in three groups.

In the first group there were 9 closed fractures of the femoral and the tibial shafts. The treatment composed of a tibial nailing combined with a retroverted femoral one.

Three out of six patients of the second group had a joint fracture of the femur combined with a closed fracture of the tibia. In the rest of them an exactly reversed condition existed. They were all treated with internal fixation of the femur combined with an external fixation of the tibia. In thee out of four patients of the third group there was an open fracture of the shaft of the femur. They were all treated with intramedulary nailing of both femur and tibia. The fourth one had an open fracture of the tibia and had external fixation of both femur and tibia.

Results: Six patients developed a delayed union and finally healed: one patient developed a pseudarthrosis that was healed after a second osteosynthesis and bone grafting: two patients had a shorter leg of 1–1.5 cm and another one had a50 varus knee. There were no postoperative infections or amputations one femoral nail failed because of breakage.

Conclusion: We consider that the intramedullary nailing of the femur and the tibia is mostly indicated for the floating knee in cases with no soft tissue damage or pacticipation of the joint itself. Our results were very satisfactory in all cases we applied this method.