Tissue sparing hip replacements have recently gained popularity, in an attempt to provide shorter hospital stay, faster recovery time and potentially to reduce morbidity and complications. Direct anterior approaches (DAA) have been shown to allow faster recovery, but also appear to be associated with a higher incidence of complications, especially during the learning curve. Mini-posterior approaches have the advantage of increased familiarity, however may not be maximally muscle sparing.

Prospective and retrospective data was collected following a published protocol. This included patient demographic data, theatre time, units of blood transfused, length of stay, functional scores and radiological parameters. Rates of conversion to posterior approach and complications were also documented.

The results of our first 100 cases completed are presented: Within this initial cohort, three patients suffered major complications: These included an anterior dislocation, which was successfully reduced with closed reduction under general anaesthetic, an early (day 6) periprosthetic fracture, which was successfully revised to a cemented prosthesis, and a case of stem subsidence.

Our results also suggest a learning curve effect, limited to theatre time and blood loss. Complications were evenly distributed throughout the period of study and are of similar frequency to standard approaches.

As the first European centre to adopt the SuperPATH approach, we have shown that the published results from America can be reproduced. In contrast to DAA, the learning curve is not associated with higher rates of femoral fracture and other complications. The fact that the approach is extensile, being the superior part of the posterior approach, allows for all of the advantages of muscle preservation with the safety of potential extension when necessary.

Tibial plateau fractures are common fractures which most of the times require surgery. Recovery can take several months. The aim of our study was to estimate the effect of tibial plateau fractures in quality of life of patients one year after the surgery.

During the time period 2004–2007 we treated 86 patients, with a mean age of 44 years (23–68). Fracture classification was according to Schatzker, hence, there were 9 patients with type I, 14 with type II, 20 with type III, 22 with type IV, 13 with type V and 8 with type VI. In 45 (52.3%) patients the articular surface was reduced with limited use of internal fixation and bone grafts, whereas the remaining patients had syndesmotaxis performed. In all patients stabilization was achieved with hybrid external fixators. Sixty four patients returned in one year postoperative for the study, at which time they completed the Short Form-36 (SF-36) general health surveys.

Compared to the standardized SF-36 categorical and aggregate scores there was no statistically significant difference between the healthy age-matched population and young patients with Schatzker I, II, III and IV fractures. But in 16 patients over 40 years old with Schatzker V and VI fracture, SF-36 score was lower in all categories, despite that 13 of them had full or partial return to pre-injury levels of functioning

We conclude that the age of patients and the complexity of tibial plateau fractures influence the quality of their life one year post-operative

In this study we try to evaluate the results of intramedullary nailing in the treatment of fractures of diaphysis of humerus.

During the time period of 2002 to 2006 46 patients were admitted in our clinic with fracture of the diaphysis of the humerus and 23 patients were treated surgically with intramedullary nailing. 14 patients were directly submitted to intramedullary nailing, 6 patients after unsuccessful conservative treatment and 3 patients due to nonunion after internal fixation. Average age was 51 years old. In 5 patients open reduction was applied while bone grafts were not used in any case. In all cases bone healing was obtained within 6 to 20 weeks (average 11 weeks). Final functional outcome was evaluated with Constant Score and according to it 10 patients demonstrated excellent score (> 75), 7 satisfactory (50–75) and 6 poor(< 50). Postoperative evaluation was based on clinical findings such as pain, range of motion and rehabilitation. As far as complications are concerned 2 cases with severe stiffness of the shoulder were observed and 1 case with malunion. There were no cases with non-union, sterile necrosis or neurological impairment.

Intramedullary nailing shows significant advantages such as limited damage to soft tissues, satisfactory retention of osteoporotic fractures, immobility of complex fractures and allows immediate postoperative mobilization.

The aim of this study was to evaluate the severity of pelvic fractures, to emphasize the appearance of major complications and to record the possible permanent damage of these patients.

We studied the clinical presentation of 105 patients with solid or multiple fractures during the period 2000–2007. Thirty one patients presented with acetabular fracture (5 of which showed dislocation of the corresponding hip), 52 patients presented with pelvic ring fractures and 22 patients presented with ischio-pubic and sacral fractures. The demographic data and patient history were recorded. The patients were re-evaluated in out-patient department.

There were several major complications. Pulmonary embolism occurred in 6 patients, 15 days following the fracture. One patient had a myocardial infraction, 19 days after the fracture and 1 stroke victim, 10 days following fracture. Five patients had urinary bladder rupture. Fourteen patients presented severe injury of the sciatic nerve. Three patients had a permanent urinary tract catheter and one had penile erectile dysfunction. In 13 patients there were minor complications such as numbness of limbs, groin pain and limping during gait. We needed, on average, 3.8 units of blood.

We conclude that pelvic fractures, solid or multiple, are very severe injuries. They require high level of observation due to major complications, of which increase morbidity and mortality.

Aim: This retrospective study presents the results of humeral pseudarthrosis management, in our clinic, during the period 1997–2002.

Material: 21 patients with humeral pseudarthrosis were treated during this period. 7 were men, with an average age of 48, 6 (range 22–63) and 14 were women, with an average age of 63, 3 (range 42–80). The initial treatment in 19 cases was conservative and in 2 cases surgical (internal fixation with plate – screws or intramedullary nailing). The average time of the humeral pseudarthrosis management was 5,9 months (4–10 months).3 pseudarthrosis were oligotrophic and 18 atrophic.

Method: All patients underwent an open reduction, internal fixation and bone grafting (autografts and/or allografts).In humeral shaft pseudarthrosis a wide plate was applied, while in superior humeral metaphysis pseudarthrosis, a T-plate. In all cases impaction of the fracture edges was achieved.

Results: The average follow-up was 40,2 months (range 4–68 months).Union was achieved in all cases in an average of 2,8 months (range 2–8 months). Direct postoperative mobilisation and physical therapy was applied in 20 cases and only in 1 case a “Sarmiento” splint was applied for 3 weeks. In 2 cases a postoperative haematoma presented. In 1 case a pre-existed paresis of the radial nerve after the initial treatment of the fracture with internal fixation, came back 3 months after the management of pseudarthrosis and the release of the nerve. All patients’ revealed good functional rehabilitation, about 85–90% compared with the normal arm. Arm shortening in no case was greater than 2 cm.

Conclusion: Open reduction and internal fixation is the treatment of choice in the management of the humeral pseudarthrosis. The impaction of the fracture edges into each other strengthens significantly the stability of the fracture and promotes union.

Introduction: The growth plate almost always is involved in periarticular fractures in children. Treatment and prognosis of these fractures depends on the extend of the injury. Reduction has to itle and anatomical while fixation has to be secure and minimal secondary to the small size of epiphysis. The K-wires do not cause so much tissue damage but there is the possibility of sliding suiting in loss of fixation. On the other hand they offer no fracture compression. The use of screws may result in bone collapse. It is also inappropriate for small fragments.

Patients and Methods: From November 1999 untill December of 2001 17 patients with a diagnosis of a periarticular fracture were admitted to the pediatric orthopaedic department of KAT Hospital. There were 9 fractures of the elbow and 8 ankle fractures. Mean age was 12 years (6–14) (11 boys and 6 girls). Plain radiographs and CT were obtained before surgery to evaluate the kind and extend of the fracture. After limited arthrotomy percutaneous fixation was obtained with the use of at least wires 2 FFS wires and then a splint or cast was applied.

Results: FFS screws were removed in 3–6 weeks without anesthesia. In all of the patients the fracture was healed and there was not any infection or loss of reduction. Screws breakage was seen in Datient with no any functional consequences.

Conclusion: The use of FFS allows compressive fixation in periarticular fractures in children. It can be used percutaneously and it can be removed without need for another surgery.