The purpose of this study is to present the preliminary results after treatment of shoulder sepsis with prolonged implantation of an antibiotic-loaded cement spacer in a selected group of compromised patients.

The current study included 11 patients (9 males and 2 females) with a mean age of 64 years (range: 36–79 years). All patients were treated with radical debridement, implantation of an antibiotic-impregnated polymethylmethacrylate spacer, and 6 weeks of antibiotic therapy. The subjective complaints, range of motion of the shoulder, functional outcome (mini-DASH score), and radiographic findings were evaluated. Nine patients at a mean follow-up time of 21 months (range: 13–18 months) were free of infection with pain relief and adequate shoulder function for activities of daily living. Radiographic evaluation revealed no loosening or fracture of the spacer and no progressive degenerative changes involving the glenoid.

Prolonged implantation of the spacer may be a useful alternative in selected patients with poor general condition.

Introduction: About 5–12 percent of scaphoid fractures are associated with other fractures, and approximately 1 percent of scaphoid fractures are bilateral.

Materials and Methods: Three hundred fifty patients sought treatment for established scaphoid non-union at the author’s department. All patients routinely underwent plain radiographs, taken with both hands in neutral position for preoperative measurement of scapholunate angle and scaphoid length. Unexpectedly however, radiological examination revealed a bilateral scaphoid Herbert type D2 pseudoarthrosis (24 waist) in 12 patients (5 females, 7 males with mean age 25 years, range 14 to 48). No patient was aware of the mechanism of controlateral injury or had previously complained of controlateral wrist pain. All patients received treatment for both sides. The scaphoid was exposed through a volar approach. The fracture was anatomically reduced and fixed with a Herbert screw. Iliac bone graft was used. Mean follow-up was 43 months (range, 25 to 68) using the modified Mayo wrist score.

Results: Fracture union was confirmed both clinically and radiographically and union rates were 96 percent. Mean union time was 7 months (range 4 to 12 months). Non-union occurred in 1 patient. According to the Mayo wrist score, excellent results were achieved in 17 cases, good in 6 and poor in 1.

Conclusion: Bilateral scaphoid pseudoarthrosis has a very rare incidence, and experience showed us that patients do not always complain of both sides. Routine pre-operative evaluation at our institution includes a set of comparative plain radiographs of the wrists and we strongly recommend this policy to avoid missing bilateral injuries.

Purpose: To study the pattern of neurological lesions and the frequency they occur in patients with cervical injuries. The relationship of these lesions with certain types of injuries and the cause of omjury.

Patients and methods: Between 1970–2001, 665 patients suffering a cervical injury were studied in our Department. There were 192 male and 73 female patients aged 42,3 years on average. Two hundred sixty-five of these cases (38,5%) were presented with neurological symptoms.The mean time of hospitalization was 43,45 days. The patients were classified according to the type and the level of injury. ASIA‘s functional classification was used (35,1% were ASIA A, 13,96% ASIA B, 10,57% ASIA C and 40,37% ASIA D). 194 were followed up for a mean period of 7 years. Conservative treatment was applied to 183 (69%) patients while 82 patients (31%) were treated operatively with anterior cervical fusion, posterior cervical fusion, or combined anterior and posterior fusion. Postoperatively, most of the patients with incomplete neurological lesion, were improved.

Conclusions: An analysis of our cases showed the following: a) There is a relationship between the type of neurological signs and the type of osseous or ligamentous injuries. b) There is relationship between type of osseous or ligamentous injury and severity of neurological lesion.. c) Burst fractures are the most severe fractures, followed by bilateral dislocations and tear-drop fractures. d) There is a relationship between mechanism of injury and severity of neurological lesion

Purpose: To check the accuracy of the Internet-derived medical information.

Materials and Method: We tested the validity of randomly chosen Internet-derived statements concerning four common orthopaedics problems. Two-hundred statements were gleaned by two nonmedical persons from 30 chosen websites, after employing a common search engine. Fifty statements were derived on each of four separate topics (knee osteoarthritis, hip osteoarthritis, low back pain, and osteoporosis). Five residents in orthopaedic surgery were then asked, to independently rank the accuracy of these statements using a five point rating scale with 1 being strongly disagree to 5 being strongly agree with the statement. Means were then obtained for each question and ranked on validity with > 4 being very valid, > 3 being somewhat valid and < 3 being invalid.

Results: Overall score for the 200 statements was 3.81 with 61% deemed very valid, 20% deemed somewhat valid and 19% deemed invalid. For knee osteoarthritis, the overall score was 3.63 with 63% being very valid, 18% being somewhat valid and 19% being deemed invalid. For hip osteoarthritis, the overall score was 3.75 with 58% being very valid, 21% being somewhat valid and 19% deemed invalid. For low back pain, the overall score was 3.91 with 48% being very valid, 36% being somewhat valid and 16% deemed invalid. For osteoporosis, the overall score was 3.96 with 59% being very valid, 18% being somewhat valid and 23% deemed invalid.

Conclusion: Approximately 20% of medical information found on the Internet is misleading and, invalid. Patients and physicians who use the Internet to access health information, should be aware of these inaccuracies and better seek advice from reliable medical web sites of universities.

Purpose: To evaluate the modification of the hump in patients with idiopathic scoliosis after the use of Boston brace and to compare this with the change of the Cobb angle.

Material – Methods: Prospective study of 60 female patients with idiopathic scoliosis who were treated with the application of Boston brace. The average age was 12,8 years ( 9–15 years ) and the average Kisser sign was 1,5. According to King classification 14 (23.5%) patients met the criteria for type I, 21 (35%) for type II, 13 (21.5%) for type III and 12 (20%) for type IV .No patients with type V curves were included. The average Cobb angle was 22°. The patients were reviewed every six months with clinical examination, plain x-rays at erect position and twelve hours after the removal of the brace The patient’s hump was evaluated with the use of a special equipment (formulator), it was imprinted on a chart and the hump gradient was measured. The time of brace application was recorded.

A small group of 15 patient with scoliosis less than 15°, was used as control group. A Boston brace was notn applied to this patients.

T -test and x square test were used for statistical analysis.

Results: The follow-up period was on average 25 months. The brace was applied for 18–20 hours in 24-hours with the tendency of gradual decrease of the time of the application as the patient was getting older. An average decrease of 13,5% of the hump gradient was found after using the Boston brace. This was 17% for King type I, 22.29%, for King type 1lo 9.73% for King type III and 1.19% for King type IV. The average increase of the Cobb ankle was 2, 6 .

Conclusion: The application of the Boston brace in patients with idiopathic scoliosis seems to improve the pattern of the hump, mainly in type II and III patterns and less in type IV.

Unstable intertrochanteric fractures present a difficult problem with a high incidence of complications such as mechanical failure of the implants or cut-out. The use of bone cement (PMMA) has been suggested in the past but the application with hand to fill the existing voids has not given good results and also has high incidence of pseudarthrosis and infection.

A new technique is presented in which the PMMA is injected with syringe through the hole opened for the compression screws. The aim is to augment mechanical stability and also to replace the compressed spongiosa.

The study population of 105 patients with unstable intertrochanteric fractures was separated in 2 groups, hi group A (51 patients, 4 male/47 female, mean age 72.3) a conventional sliding nail was performed, while in group B (54 patients, 3 male/51 female, mean age 78.9) the new technique was applied. The two were similar regarding age and gender.

Post-operatively in group A 95% of the patients remain in bed for 1–2 weeks according to the surgeon opinion regarding the stability of osteosynthesis. 45% of them remain in a regime of bed to chair existence for 6 weeks. 72% return to its previous domicile and activity. In group B all patients were sat out the bed in the 1st day post-op and walked in the 2nd day post-op with partial weight bearing where that ability preexisted. 91% return to its previous domicile and activity.

In group A ll cases of cut-out were noted while in group B only 1 cut-out and also 2 cases, where we had screw failure, but fracture went on to union. All the difference are in favor in group B and statistical significant (p< 0,0 5). No infection was noted.

The suggested method appears to give a satisfactory solution to the problem of unstable intertrochanteric fractures, allowing fast and safe mobilization of the patient, reducing thus morbidity. Technically it is simple, easy to apply and does not require instrumentation while the extra cost is only that of a butch of PMMA.

Diving injuries are the cause of devastating trauma, primarily affecting the cervical spine. The younger male population is more often involved in such injuries. This study describes our experience on diving injuries treatment and offers a long follow-up.

During a 31-year period (1970–2001) 20 patients, 19 male and one female have been admitted with cervical spine trauma following a diving injury. All admissions have been made between May and September. One patient was lost to follow-up. The mean age of the patients was 23 years (16–47). The lower cervical spine was involved in 13 patients; four patients had lesions in the middle and upper cervical spine, while one patient had combined lesions. The most commonly fractured vertebrae were C5 and C6. Fracture-dislocation was evident in 10 patients, while a teardrop fracture was diagnosed in six patients. Six patients were classified, as ASIA A upon admission and bladder control was absent in 12. Only four patients were treated surgically, two with iliac bone grafting alone, one with posterior plating and one with an anterior plate plus graft. The other patients with initial neurological deficit were treated conservatively, because of their rapid neurological improvement, their lesion being regarded as stable. Fourteen patients were treated conservatively with steroids and Crutchfield skull traction or halo vest, followed by the application of a Minerva or Philadelphia orthosis.

The mean follow-up was 11 years (6 mo to 23.8 years). Four patients in the ASIA A category died in the first month of their hospitalization (two of cardiac arrest, one from pulmonary embolism and one from respiratory infection) and two remained unchanged. Six patients with ASIA B and C improved neurologically and one remained unchanged. Nine patients had developed urinary tract infection and two had respiratory infections. Two out of the four operated on developed superficial trauma infection.

In conclusion, diving injuries of the cervical spine demonstrate a high mortality and morbidity rate. The initial neurological deficit may improve with appropriate conservative treatment. The indications for surgical management are post-traumatic instability and persistent or deteriorating neurologic deficit.

Purpose: This is a prospective study to examine the post-operative self-satisfaction of the patients and the stability of the lumbar spine.

Material and Method: Twenty patients (11 female and 9 male), mean age 40 years old (range 35–58 years) were operated on for: central disc protrusion-sequestration (14 cases), lumbar Stenosis (3 cases) and lumbar instability (3 cases). For the stabilization of the lumbar spine, the Dynesis system (Sulzer-Medica) was applied. In 9 cases a one-motion segment was included in the stabilization, in 8 cases a two-motion and finally in 3 cases a three-motion segment were included. The pre and post-operative examination included a) the self assessment evaluation included the Oswesrty and Roland-Morris questionnaires and b) the radiological parameters related to the type of spinal problem and to the lumbar stability.

Results: The mean follow up was 12 months (range 9 to 24 months).There was statistically significant improvement of both the self assessment tests. The radiological examination demonstrated stable lumbar spines and no implant loosening or hardware failure.

Conclusion: In spite of the short follow-up the overall results prove that the dynamic stabilization of the lumbar spine with the Dynesis system, in cases of wide laminotomy (ies) for disc excision, and Stenosis as well as for stabilization of depenerative type lumbar instability, is able to provide satisfactory early results.