Electrical stimulation techniques are utilised in orthopedics field for the treatment of pseudoarthroses; the more widespread methods are the inductive system with Pulsed Electromagnetic Fields (PEMFs). We report the results of a retrospective study, between February 1987 to February 2002, of 57 patients with pseudoarthroses of tibia (22 treated with PEMFs against 35 without this treatment). The objectives of the study have been to know the influence, the consolidation percentage and the influence of electrical simulation.

The average age was 38 years (14–89); the average follow-up 3,2 years. 17 fractures were open and 40 fractures were closed. All the fractures were affect the tibia shaft, in 19 cases extended to the articulation. For the admission to the study had not united after at less 6 month. All the patients were treated with surgery to the pseudoarthroses (looking nail in 54 cases, fixation extern in 2 cases and osteotomy to fibula in one case). Statistical analysis utilised was the SPSS program.

The results were statistically significantly (p< 0,05) in:

The consolidation with the PEMFs increase compared without this method (91% vs 83%).

Experience supports its role as a successful method of treatment for ununited fractures of the tibia.

This is an ongoing retrospective study of 35 children treated from 1986 to 2001 for chronic osteomyelitis following acute haematogenous osteomyelitis. The purpose was to validate the use of a modified Cierny classification to predict behaviour, to assess the timing of sequestrectomy in relation to involucrum formation, and to evaluate the results of dealing with the resultant defect by conventional methods of bone grafting.

The mean age of the patients was 7 years (1 to 12). All except 18, who were treated within five days of acute onset, were delayed presentations or transfers. In 14 children the tibia was involved, in 13 the femur, in five the humerus and in three the fibula. Monthly radiographs were taken and the size and location of the sequestrum and involucrum was documented.

Our classification represents the size and location of the sequestrum. We divided the patients into cortical (one), medullary (three), corticomedullary (12) and structural (19) types. Fractures occurred in all the structural types, as well as in five of the 12 corticomedullary types. A sequestrum was apparent at a mean of 2.4 months (1 to 3). The mean length of the sequestrum at diagnosis was 8.5 cm and at surgery 5.8 cm, suggesting partial resorption. Involucrum formed in 69% of patients at a mean of 1.9 months (1 to 3) after sequestrum. In 31% of patients no involucrum formed from 4 to 12 months after surgery. This suggests that involucrum formation depends on viable periosteum and not on the sequestrum, and in the absence of involucrum early rather than late sequestrectomy is warranted.

The resultant incomplete bone defects in the corticomedullary type ranged from 1 cm to 15 cm, but had an intact cortical bed on one or more sides. These and complete defects of less than 6 cm in the structural type united after autogenous cancellous bone grafting, with or without an exoskeleton. Four structural defects greater than 6 cm united after fibular strut grafting (humerus) or bone grafting from fibula to tibia via a posterolateral approach (tibia).

Patients were followed up both clinically and radiologically for a mean of 2.9 years. Twenty patients (57%) had an excellent result and 15 (43%) a good result.