Treatment of large bone defects represents a great challenge for orthopedic surgeons. The main causes are congenital abnormalities, traumas, osteomyelitis and bone resection due to cancer. Each surgical method for bone reconstruction leads its own burden of complications. The gold standard is considered the autologous bone graft, either of cancellous or cortical origin, but due to graft resorption and a limitation for large defect, allograft techniques have been identified. In the bone defect, these include the placement of cadaver bone or cement spacer to create the ‘Biological Chamber’ to restore bone regeneration, according to the Masquelet technique.

We report eight patients, with large bone defect (for various etiologies and with an average size defect of 13.3 cm) in the lower and upper limbs, who underwent surgery at our Traumatology Department, between January 2019 and October 2020. Three patients were treated with both cortical and cancellous autologous bone grafts, while five received cortical or cement spacer allografts from donors. They underwent pre and postoperative radiographs and complete osseointegration was observed in all patients already undergoing monthly radiographic checks, with a restoration of length and range of motion.

In our study, both the two stage-Masquelet and the cortical bone graft from a cadaver donor proved to be valid techniques in patients with very extensive defects to reconstruct the defect, restore the length, minimize implant left in situ and achieve complete functional recovery.

Background: The treatment of post-traumatic elbow stiffness has seen many important changes over the years, particularly greater the development of arthroscopy. In this study mid-term clinical results of arthroscopy for post-traumatic elbow stiffness are evaluated in 15 sporting patients, with an average age of 32.

Methods: 8 patients reported post-traumatic stiffness due to fracture of the radial head, 3 to fracture-dislocation, 1 to fracture of the radial diaphysis complicated by osteosynthesis, and the remaining 3 patients to stress syndromes with osteochondral detachment. Surgical treatment consists in debridment, arthroscopic capsular release, and removal of bone fragments by arthroscopy. Patients were followed-up from 4 up to 36 months, with a mean follow-up time of 18 months.

Results: Results obtained have been good to excellent in 84% of cases with a average range in post-operative movement of 13–137° and reduction in pain symptomatology.

Conclusion: In light of our mid-term clinical results on a small series of cases, arthroscopic surgical treatment would appear to be an acceptable option in management of the post-traumatic stiff elbow.

In the reconstruction of the anterior cruciate ligaments of the knee, early loading of the leg is usually desirable. Thus, it is of a great interest to evaluate the early stability of screws used for tibial fixation of the ligament, rather than long-term stability of such devices when the neoligament is certainly integrated. The purpose of this study (controlled laboratory study) was to investigate the early osteointegration and biodegradation of hydroxyapatite (HA)/poly(L-lactide)(PLLA) (HA/PLLA) composite screws compared with tricalcium-phosphate (TCP)/PLLA (TCP/PLLA) composite screws used for tibial fixation in the reconstruction of the anterior cruciate ligaments.

We used two types of resorbable screws: BioRCI (Smith& Nephew) composite screws (30% HA and 70% PLLA) and Biocryl (Mitek) composite screws (30% TCP and 70% PLLA) that were inserted into the distal femur of three skeletally mature sheep. Each animal received one HA/PLLA composite screw and one TCP/ PLLA composite screw. The three sheep were sacrificed 20, 40 and 60 days after surgery. Results were evaluated by radiological (RX, TC and RMN), histological and microradiographic analyses.

The amount of bone tissue osteointegrating the screw was higher for TCP/PLLA screws than for HA/PLLA screws. No sign of real biodegradation was observed in any of the specimens.

In conclusion, TCP/PLLA composite screws provide a favourable early osteointegration compared to HA/PLLA composite screws; this could provide an early loading of the leg, which is the primary goal of clinicians and patients in this case. In addition, this could provide a considerable reduction of medical expenses, due to the decrease in hospitalisation and rehabilitation time.