We present the results of a multicentre retrospective study of closed fracture dislocations of the Lisfranc joint treated by closed reduction and percutaneous screw fixation (follow-up: almost 5 years).

Forty-two patients that presented between 1994 and 1999 to the authors™ institutions were selected for this study (follow-up AOFAS score 81.0 ± 13.5).

A review of the literature shows that opinions differ as to the most appropriate method of treatment, be it closed or open reduction, screws or K-wires fixation, but most of the authors agree that it is imperative to achieve anatomical reduction.

In our study, no statistically significant differences could be detected when outcome scores of patients with anatomical reduction were compared with outcome scores of patients with nearly anatomical reduction, in both the combined fracture dislocation and pure dislocation subgroups. The conclusion is that even a nearly anatomical reduction is considered acceptable and predictive of a satisfactory outcome.

Furthermore, we found a statistically significant difference in the AOFAS score between patients with combined fracture dislocations and pure dislocations, with the latter having a worse AOFAS score. This suggests that the ligament bone interface cannot heal with sufficient strength to regain stable long-term function.

Application of locked intramedullary nailing in diaphy-seal tibia open fracture after removal of external fixation has a risk of infection.

We have treated 13 patients in 2 years, 2001–2002 (affected by Gustilo 3B open fractures) with this method: 9 before 4 weeks after emergency stabilization and 4 before 5 weeks. Patients were followed for at least 1 year after the second osteosynthesis.

The bone healing was obtained 5 months after 2 osteo-synthesis: we have observed 3 superficial infections(l in the first group and 2 in the second) and 2 deep infections(in the second group). We haven’t observed cronic osteomyelitis.

We recommend to convert external fixation in intra-medullary nail before 4 weeks by trauma to avoid infectious risk.

Autogenous bone grafting is widely used. In particular cancellous bone is osteoconductive, but the morbidity at donor sites is a reason to use bone substitutes.

In 5 years we have treated 64 patients affected by orthopaedic (arthrodesis of the ankle or the foot, THP revision) or traumatologic problems (acute fractures of tibial plateau, non-union or malconsolidation) with mineral bone substitutes (Pyrost or Osteoplantl). In a prospective clinical study, these substitutes were implanted as follows: the bone defect was filled by bone substitute (usually 5 ml)and we evaluated regeneration of bone defect by X-ray, MR and histological evaluation of osteogenic cells (at removal of osteosynthesis). In 85% of cases the regeneration of the bone defects was complete; in the other cases a partial or insufficient regeneration was found.

In different animal investigations Pyrost has been shown to have osteoconductive and osteostimulative effects: these substitutes have no antigenic propriety. In conditions of low osteogenetic potency, the combination of bone substitutes and autogenic bone marrow affects bone formation. In disadvantageous bone bed, bone substitutes must be augmented with bone marrow and in large segmental defects combination with autogenic bone grafts is recommended. A prerequisite for the application of bone substitutes in large defects is a sufficient primary stability of the bone bed. The application in infected tissue is not favourable.