Several observational and experimental studies have investigated the potential anabolic effects of statins on undisturbed bone but only a few recent studies have examined the effect of statins on skeletal repair. The goal of the study is to investigate any potential early anabolic effect of the systemic administration of simvastatin in low doses (based on earlier safety and efficacy studies on undisturbed bone) on fracture healing.

Fifty-four skeletally mature male New Zealand White rabbits were used for the study. The rabbits were assigned to one of three experimental groups: a control group, and two groups that were orally administrated a diet with 10 and 30 mg/kg/day of simvastatin, respectively. A complete biochemical blood count was performed to exclude drug-induced complications. Half of the animals of each group were sacrificed at 15 days and the other half at 30 days after surgery at which time intervals healing quality was assessed. The bones were subjected to biomechanical testing, histomorphometric analysis and peripheral Quantitative Computed Tomography.

In animals received simvastatin of 30 mg/kg/day a significant reduction of BMD, stiffness, and energy absorbed to failure were observed. At 15 days, the amount of cartilaginous callus formation was reduced, and the void space was significantly increased, in the animals of both groups that received simvastatin when compared to the control group (p< .05).

Our results suggest that simvastatin doses of 30mg/ kg/day may have a negative anabolic effect on callus formation in rabbits, whereas doses of 10 mg/kg/day seem not to produce a significant positive or a negative effect, especially at the early stages of fracture remodeling.

The purpose of this retrospective study was to report the results using scarf, first metatarsal osteotomies, in correcting Hallux Valgus deformity with H-V angle > 35°.

During the period 2003–2008 we did 23 scarf, first metatarsal osteotomies in 15 patients (8 bilateral).In order to evaluate the effectiveness of this operation, patients were clinically (aofas score) and radiologically (X –ray in 4, 8, 12 weeks) assessed.

Mean follow up was 32 months. The results evaluated with the aofas score in order to study the function, the pain and the overall satisfaction of the patients. We had excellent results in 13 %, very good in 48 % good 32% and poor 7 %.There was only one complication and no one infection.

According the above results it seems that scarf osteotomy is quite reliable surgical treatment of severe Hallux – Valgus deformity with an increased IM angle.

Optimal entry point for antegrade femoral intramedullary nailing (IMN) remains controversial in the current medical literature. The definition of an ideal entry point for femoral IMN would implicate a tenseless introduction of the implant into the canal with anatomical alignment of the bone fragments. This study was undertaken in order to investigate possible existing relationships between the true 3D geometric parameters of the femur and the location of the optimum entry point.

A sample population of 22 cadaveric femurs was used. Computed-tomography sections every 0.5 mm for the entire length of femurs were produced. These sections were subsequently reconstructed to generate solid computer models of the external anatomy and medullary canal of each femur. Solid models of all femurs were subjected to a series of geometrical manipulations and computations using standard computer-aided-design tools.

In the sagittal plane, the optimum entry point always lied a few millimeters behind the femoral neck axis (mean=3.5±1.5 mm). In the coronal plane the optimum entry point lied at a location dependent on the femoral neck-shaft angle. Linear regression on the data showed that the optimal entry point is clearly correlated to the true 3D femoral neck-shaft angle (R2=0.7310) and the projected femoral neck-shaft angle (R2=0.6289). Anatomical parameters of the proximal femur, such as the varus-valgus angulation, are key factors in the determination of optimal entry point for nailing.

The clinical relevance of the results is that in varus hips (neck-shaft angle • 120o) the correct entry point should be positioned over the trochanter tip and the use stiff nails is advised. In cases of hips with neck-shaft angle between 120o and 130o, the optimal entry point lies just medially to the trochanter tip (at the piriformis fossa) and the use of stiff implants is safe. In hips with neck-shaft angle over 130o the anatomical axis of the canal is medially to the base of the neck, in a “restricted area”. In these cases the entry point should be located at the insertion of the piriformis muscle and the application of more malleable implants that could easily follow the medullary canal should be considered.

Introduction: Approximately 15% of fractures account for delayed or impaired healing. The popularity of new

Methods: that enhance fracture healing along with conventional ones is growing. The purpose of this study was to determine the effects, the safety and the efficacy of systemic simvastatin administration to bone healing.

Materials and Methods: Unilateral mid-ulnar osteotomies (approximately 2.0 mm wide) were performed to 56 skeletally mature male rabbits. The limbs were assigned to one of three groups: those treated with 30 mg/kg/day of simvastatin per os, those administered with 10 mg/kg/day of simvastatin orally and the control group. The rabbits were killed at two or four weeks postoperatively after taking blood samples for biochemical analysis to detect drug-induced side effects. After the rabbits were killed, the limbs were scanned with peripheral quantitative computed tomography to assess the area and mineral content of the mineralized callus. The bones were subjected to mechanical bending testing and histomorphometry.

Results: At 2 weeks the total density for the mineralized callus was on average 531.7±32.7 for the control group, 466.05±10.6 for the first group (p< .01) and at 4 weeks the total density was 617.5±12.42 for the control group, 551.26±27.61 for the first group, and 553.72±20.66 for the second group respectively (p< .001). Biomechanical properties were similar to all groups at 2 and 4 weeks. The% cartilage portion area was 17.28±2.61 for the control group, 11.89±1.84 for the first group (p< .001) and 14.06±2.17 for the second group (p< .05).

Discussion: The data show that daily systemic administration of simvastatin in 30 mg/kg/day or 10 mg/kg/day do not seem to produce a clear anabolic effect in fracture healing through the remodeling phase.

Conclusion: The use of simvastatin to promote fracture healing is still under study. The limitations from its use are the side effects from its systematic administration over 30 mg/kg/day. Most likely, alternative ways of administration should be considered for future studies.

Objective: To evaluate the clinical and radiographic outcomes of unstable proximal femoral fractures treated by minimal invasive technigues.

Method: In a retrospective study, between 1991–2003, 93 patients with closed pertrochanteric femoral fractures were treated with gamma-nail.This intramedullary device was used only for unstable intra and subtrochanteric( A3 and A,B respectively, according A.O. clasiffication) fractures and only in cases which adeguate closed reduction was attainable. There were 32 men and 61women with an average of 76 years( range 50 to 95 years). Immediate weight bearing was permitted in 75 patients. Sixty eight patients were available for clinical and radiographic assesment (at least 1 year F.U.).

Results: At 6 months 92% of the fractures were healed. Complications included intraoperative was: 1 diaphyseal fracture required cerclage wiring ,and postoperative were:2 diaphysial fractures at the distal end of nail, 1migration of the lag screw within the femoral head,2 perforations of lag screw towards cranial,1 infection and 2 nonunions reguired T.H.R. Two patients complained of thigh pain.

Conclusions: Gamma nail is a good minimal invasive implant of unstable proximal femoral fractures, if closed reduction is feasible. Permitts early immobilization and weight bearing even and in elderly patients.

Objective: To evaluate retrospectivelly the outcome of periarticular tibial pilon fractures treated by hybrid external fixation.

Method: Between 1999–2003, 44 patients(44 fractures) were treated with a combination of hybrid external fixation and minimal internal fixation(k-wires or lag-screws). There were 31 men and 13 women with a mean age of 41 years. A high energy trauma( accident or fall from a height) was the mechanism of injury for 32(73%) patients. According with A.O. clasiffication 4 fractures were A1, 5-A2, 5-A3, 8-C1, 12-C2,10-C3. All fractures were treated within a 10 days from the initial injury (10(23%) of them were open and treated immediately). The use of bone grafts reguired in 8 cases. Primary postop mobilization of adjacent joints was performed in all cases. Fourty patients were available for clinical and radiographic evaluation(using Teeny’s and Wiss ancle score). The average follow-up was 26 months.

Results: There were 9(23%) excellent, 12(30%) good, 10(25%) fair, and 9(23%) poor results. Union achieved in 40(92%) cases. Overall, 12(30%) complications reported: 6 pin track infections, 2 deep infections, 4 non-unions and 1 malunion. Post-traumatic osteoarthritis noticed in 11(28%) cases.

Conclusions: Hybrid external fixation permits early mobilization of the ankle joint and decrease the soft tissue trauma. Poor results associated with the presence of infection, the degree of intraarticular involvement and the inability to achieve adeguate fracture reduction.

Aim: This study aimed to investigate the ability of vascularized periosteum to induce bone formation under functional loading in vivo. Method: Sixteen juvenile mini pigs were used, assigned in 4 different groups. In goup A, a 1,4 cm rib gap was internally þxated and the periosteum ßap was entirely preserved and sutured in situ. In group B the same method was followed, but the periosteum adjacent to the gap was completely excised. In group C, the periosteum was preserved; þxation was used and in addition to these, a biologically inert cement was used to obliterate the marrow cavities at the osteotomy sites. Finally, group D (control) included animals in which the gap was left without þxation and periosteum was completely removed. Specimens were harvested at 8 weeks and were evaluated macroscopically, radiologically and histopathologically. Data was analyzed using Fisherñs exact test and non-parametric statistics. Results: Results of this study showed that all gaps created in group A and 10 of 11 in group C demonstrated complete bone formation, bridging the entire defect. No traces of bone formation were observed in groups B and D. Conclusion: Rib periosteum has extremely high osteogenic capacity and can bridge large defects in vivo under the following conditions: a) its vascular supply is preserved and b) rigid þxation and functional loading is applied.

Aim of the study: In the present retrospective report, the clinical and radiographic results of implantation of the Perfecta cementless T.H.R. were analyzed, in patients who were followed for a mean period of 6.9 years.

Material and methods: Between January 1993 – March 1998, 227 Perfecta T.H.R were performed in 214 patients. Five patients died and 14 patients were lost to follow-up, leaving 195 patients (208 T.H.R) available for the study. There were 50 men and 145 women with a mean age at operation of 65 years (27–83). The most common diagnosis was primary osteoarthritis (69%). The patients were assessed clinically using the HHS and radiographically for signs of loosening, polyethylene wear and osteolytic lesions.

Results: There were 14 intraoperative femoral fissures (6%) in the metaphyseal area. The mean HHS at the most recent follow-up was 90. Four patients (2%) had moderate thigh pain. Radiolucent lines around the porous coated part of the components were not observed, and progressive loss of proximal density was not seen. In the cup, a measured migration (> 3mm) in the plain films was not seen, while stem migration was noticed in 5 hips but the patients were asymptomatic. Fifteen cups (7%) had polyethylene wear and in 12 hips (6%) small osteolytic lesions were seen. Seven hips (3%) were revised: 2 hips for deep infection, 2 for acetabular loosening and 3 for instability.

Conclusions: Our clinical and radiographic medium – term results of Perfecta cementless T.H.R are very encouraging.

Aim of the study: Lunate dislocation is very uncommon injury which occur due to acute hyperextension of the wrist.Factors who affecting the prognosis still controversial.The aim of this study is to present the classification,the management and the outcome of this type of dislocation.

Methods: Four patients were treated the last four years in our clinic with lunate dislocation.All patiends treated immediately.In two cases was followed dorsal approach and fixation, in one case performed palmar approach and decompression of the median’s nerve tunnel from the hematoma, and in one case dorsal approach and ligaments repair.

A functional score sustem in combination with radiological assesment were used for the postoperative evaluation of the patiends.The mean time of follow-up was 23,5 months.

Results: Two patiends had excellent, one good and one poor results. Complications as ligamentous instability, avascular necrosis, osteoarthritis or infection they didn’t remarked. One patient complains for a mild pain due to his work.

Conclusion: Early diagnosis of the lunate dislocation in combination with open reduction and fixation can offer satisfactory results.

Purpose: To investigate whether osteosynthesis with biodegradable plates and screws of an unstable part of the zygomatic arch in pigs could provide sufficient fixation for normal bone healing in the area.

Material and Methods: Six healthy pigs were operated under general anesthesia. Two osteotomy lines were created in the right zygomatic arches of the animals leaving the central part of the arch free. This part then was fixated with 2,0 mm Lactosorb® (Walter Lorenz Surgical, Inc., Jacksonville, FL,USA) plates and screws. The left zygomatic arches of the animals were osteotomized in the same fashion but were left without fixation, serving as controls.

Animals were sacrificed at 4,6,8 and 10 weeks. Specimens were evaluated macroscopically, radiographically and histopathologically.

Results: The histopathologic analysis showed that 4 of 6 fixated specimens from the experimental site demonstrated lack of callus formation and bone continuity.

Conclusion: These results indicate that biodegradable osteosynthesis in load bearing areas of the middle third of the facial skeleton provides most likely no sufficient fixation for callus formation and bone healing.

This study aimed to investigate the ability of vascularized periosteum to induce bone formation under functional loading in vivo.

To achieve this, a gap was created in the ribs of mini pigs while functional loading was provided by the respiratory movements.

Sixteen juvenile mini pigs were used, assigned in 4 different groups. In group A, a 1,4 cm rib gap was internally fixated (KLS Martin LP 2,0 mm mini plates and screws) and the periosteum flap was entirely preserved and sutured in situ. In group B the same method was followed, but the periosteum adjacent to the gap was completely excised. In group C, the periosteum was preserved; fixation was used and in addition to these, a biologically inert cement was used to obliterate the marrow cavities at the osteotomy sites. Finally, group D (control) included animals in which the gap was left without fixation and periosteum was completely removed.

Specimens were harvested at 8 weeks and were evaluated macroscopically, radiologically and histopathologically.

Data was analyzed using Fisher’s exact test and non-parametric statistics.

Results of this study showed that all gaps created in group A and 10 in 11 in group C demonstrated complete bone formation, bridging the entire defect. No traces of bone formation were observed in groups B and D.

These results indicate that rib periosteum has extremely high osteogenic capacity and can bridge large defects in vivo under the following conditions: a) its vascular supply is preserved and b) rigid fixation and functional loading is applied.