We report our experience on complications of intra-medullary nailing on 150 femoral shaft fractures.

Material concerns 147 patients (103 men and 44 women) that were operated in a 7 years period. Mean age was 37 years old (15–77). Thirty patients were older than 65 years. Indications for femoral intramedullary nailing were 120 acute fractures (7 pathological), 9 non-unions, 2 malunions and 19 fractures with delayed union previously operated by another method. Twenty two were polytrauma patients. Twenty one fractures were open (grade a and b). Various types of reamed long antegrade nails were used in 117 cases and a long g-nail in 33 cases.

Main complications were: shortening 10, heterotopic ossification 6, knee stiffness 8, fat embolism 2, deep venous thrombosis 4, pulmonary embolism 2, superficial wound infection 8, deep infection 1, lengthening 4, rotational deformity 10, nonunion 0, missed distal screw targeting 10, drill breakage 7, malposition of the nail 7, additional intraoperative fracture occurrence 7. In 60 cases the insertion of the guide was performed by a small incision at the fracture site. Mean union time was approximately 4 weeks shorter when a closed reduction was performed.

Technical complications in the majority of cases affected fractures that were operated after midnight. Elderly patients (> 65 years old), were most probably to be subjected a complication while less complications occurred in younger patients. A well prepared operating room and prevention of surgeons fatigue is needed to reduce complications.

Purpose: The results of infected total knee arthroplasty management are studied, in order to evaluate the effectiveness of our treatment protocol, which is based on clinical manifestations of the infection.

Material: 22 infected total knee arthoplasty were studied (9 of them had been send from other hospitals).

Method: According to the clinical manifestations of the infection, patients were treated with one of the following methods: In the first group, 7 patients with primary postoperative infection (within the first 3 weeks after the operation) and with no MRSA pathogen, were treated with surgical debridement, keeping off the wound drainage for a long period and with antibiotic administration for 6–12 weeks. In the second group, 10 patients with late onset of infection or primary infection with MRSA pathogen or acute hematogenic infection with loose implant, were treated with wide surgical debridment, removal of all the materials and revision surgery after a 2–3 months period of antibiotic administration. In the third group, 3 patients with acute hematogenic infection but stable implants 2 to 6 years postoperatively, were treated with meticulous surgical debridement, exchange of polyethylene and administration of antibiotics for a long period. In the fourth group, 2 very old patients with bad general condition, were treated only with antibiotics.

Results: In the first group there is full eradication of the infection and there is no indication of recurrence (F.U 2–6 years). In the second group 8 patients had their infection fully eradicated and 2 patients recurrended 6 and 8 months postoperatively. One underwent arthrodesis and the other is still receiving antibiotics under pathologist directions. In both patients there was a great amount of bone absorption and soft tissue necrosis around the implant. For patients of the third group complete eradication was achieved. Finally, for the 2 patients of the forth group, periods of exacerbation and remission of the infection exist, with good and poor quality of life, respectively.

Conclusions: The treatment protocol that we apply was based on the clinical manifestations of the infection and was successful in most cases. Bone absorption, tissue necrosis and microorganism resistance are bad prognostic factors.

The aim of this study was to evaluate the results of total hip arthropiasty in osteoarthritis secondary to congenital hip disease.

During the period 1986 to 1999, we performed 48 hip replacements with congenital hip disease. According to classification of Chanophylakidis there were 18 dysplastic hips without dislocation, 17 hips with low dislocation and 12 hips with high dislocation The mean age of the patients was 49 years (range from 31 to 64) Depended on the pathology of each case, different types of prostheses or combinations of them were used. The acetabular cup was placed in the anatomic position and in the majority of cases a component of 22 aim was used. In 28 cases the bottom of the acetabulum was fractured and protruded in order to fit the cup (acetabuloplasty). In these cases copious amounts of auto- and aiiografts were used and the cup was fixed with PMMA, Special femoral stems for CDH were used and in the majority of cases they were fixed with PMMA. In 17 cases with good acetabular bone stock and good femoral canal a standard prosthesis was used without PMMA. In 31 cases the hip was approached after osteotomy of the grater trochader and in 17 cases an anterolateral approach was used.

Intra-operatively there were many problems and difficulties but we had no true complications. Early postoperative complications presented in eight patients and had to do with 2 haematomas, 3 DVT, 1 mild PE and 2 superficial infections. There was no case of deep infection, neurovascular damage, dislocation or fracture. The late results after a mean of 6, £ years were very satisfaaory. There was improvement of the HIP SCORE from 38 to 83 and subjective satisfaction of nearly all the patients. The late complications were limited and they concerned three migrations of the acetabular cup, one aseptic loosening of the femora) stem and one extensive osteoiysis the proximal femur. All the above cases were revised successfully.