We report our experience of a humanitarian mission to treat the earthquake victims of October 2005 in Pakistan. The team with their equipment, in two periods of four and ten days respectively, treated 26 fractures in 25 patients with the Ilizarov frame and principles. There were 21 III B open fractures and three Tscherne III closed fractures. Seventeen fractures were infected with discharging pus and non-viable bone. Injuries were treated aggressively using different Ilizarov techniques of reconstruction surgery. All but two open fractures required a plastic surgical procedure for wound cover. Three months post-operatively eight out of thirteen fractures which had been treated in the first four days of the visit were healed and corticotomy for bone lengthening, performed during the second 10 days period visit. All wounds have remained clean with no evidence of superficial or deep infection. Limb lengthening procedures are planned for the rest of the patients.

We estimated the long term results of the different methods in chirurgical treatment of lumbar disk herniation in consideration with the presence or absence of degenerative changes and the grade in witch these factors influence the result of this kind of treatment.

Seventy eight patents with lumbar disk herniation have been submitted in partial discectomy. The men were 42 and 36 women. The patients were separated in tow groups. In the first group [48 patients, 31 of them (A1) without degenerative changes, while the 17 (A2) with degenerative changes], was applied macrodiscectomi. In the second group [30 patients, 18 of them (B1) without degenerative changes and the 12 (B2) with changes], was applied microdiscectomi with use of magnifying lenses. The mean age during operation was 44 years (18–67) and 38 years (24–62) respectively for the tow groups, and the mean time of follow-up was 7 years and 8 months (18 months-13 years). For all patients, the operation was executed from the same surgeon. The elements that were evaluated were the Visual analog scale (VAS, O-10), the Oswestry Disability Index (ODI), as well as the complications during and after the operation and the cases that required a reoperation.

In the first group VAS score was improved from 9.1 to 3.1 and the ODI score was improved from 86% to 24.2%. In the second group VAS score was improved from 9 to 2.6 and the ODI score was improved from 84.2% to 19.2%. From all patients, subgroup B1 without degenerative changes, which was submitted in microdiscectomy presented the biggest improvement. We have had to reoperate 6 patients (7.8%).

In cases of lumbar disk hernia both methods are appropriate and lead to a considerable improvement of the symptoms. Degenerative changes of the lumbar spine is a factor that leads in less satisfactory results

We treated 60 patients with type III Pilon fractures (Ruedi and Allgower Classification) between 1996 and 2005. The fractures were distracted and then fixed with an Ilizarov circular ring fixator, without the use of open surgery. No internal fixation was used for the tibia or fibula. No bone grafting was performed.

The average time from injury to frame application was four days. The patient stayed ib frame for a mean time of 15 weeks. No second operative procedure was needed. All cases united in good alignment.

The patients were reviewed from ten years to nine months after frame removal. Four separate evaluations were performed (functional, objective, radiological and an SF-36). The function and the range of movement were better than the radiological assessment suggested.

This method of treatment gives better results with fewer complications than open surgery with internal fixation

We report our experience in treating victims of the recent Earthquake Disaster in Pakistan. Our experience was based on 2 humanitarian missions to Islamabad. First in October 2005, 16 days after the earthquake and the second in January 2006, three months later. The mission consisted of a team of orthopaedic and a second team of plastic surgeons. The orthopaedic team bought all the equipment for application of Ilizarov External Fixators (IEF). We treated patients who had already received basic treatment in the region of the disaster and subsequently had been evacuated to Islamabad.

During the first visit we treated 12 injured limbs in 11 patients. 7 of these were children (ages 6 – 14). All the cases were complex and severe multifragmentary fractures associated with crush injuries. All of the fractures involved the tibia, which were treated with IEF.

Nine fractures were type 3b open injuries. Eight were infected requiring debridement of infected bone and acute shortening of the limb segment. After stabilization, the plastic surgeons provided soft tissue cover.

During the second, we reviewed all patients treated during our first mission. In addition we treated 13 new patients [Table 3] with complex non – unions. Eight out of 13 non-unions were deemed to be infected. All patients had previous treatment with monolateral fixators (AO type) as well as soft tissue coverage procedures, except one patient who had had a circular fixator (Ilizarov) applied by another team. All these patients had revision surgery with circular frames

Introduction: Mitchell’s operation is a double step-cut osteotomy through the neck of first metatarsal (MT) which displaces laterally and plantar flexes the metatarsal head and minimally shortens the first MT. In coexisted further forefoot abnormalities this osteotomy can be combined by additional corrective osteotomies of the rest metatarsals and straightening of toes.

Material and Methods: A prospective study was carried out in our Department, on 42 patients (51feet) operated with this osteotomy alone or combined.

The mean follow-up time was 10 years (range, 3–15 years). The average age of patients was 58 years. The average angle of HV deformity was 38 degrees (in nine feet this angle was more than 40 degrees). Mean inter-metatarsal (IM) angulation was 15 degrees.

The procedure was always followed by Y or V capsuloplasty of first metatarsophallangeal (MTP) joint. Moderate arthritis of first MTP joint was not considered by us as a contraindication for this operation. The osteotomy was secured by two crossed K-wires.

In 20 feet (15 patients) with coexisted forefoot abnormalities oblique osteotomies of the rest metatarsals, arthrodeses of proximal interphalangeal (PIP) joints and elongation of extensor tendons were carried out.

Results: In examination, we checked the correction of the deformities; we assessed pain and comfortability in wearing shoes and the joints motion, hi early postoperative examination the mean correction in HV angle was 18 degrees and in IM angle was 5 degrees, but in last examination there was a loss of 5 degrees in the HV angle correction. One hallux was overcorrected. 90% of the results were satisfactory including all feet with osteoarmritis of first MTP joint. 10% of the results considered as poor including all feet with preoperative HV deformity of more than 40 degrees. Ten feet (eight patients) suffered from metatarsalgia established because of fall of MT arch. We feel that Mitchell’s osteotomy is not suitable for HV deformity exceeding the 40 degrees.

Introduction: Moderate and major operation concerning trauma or selective procedures (like total ¥2) joint replacement) can lead to considerable amount of blood loss and postoperative anaemia. This loss affects negatively the patients’ postoperative course concerning mortality, morbidity as well as patients’ recovery. We decided to provide these patients with Epoetin Alpha in the early postoperative period to control anaemia.

Material and Methods: In our Department, from July 2000 until March 2002, we treated 42 patients with postoperative anaemia due to moderate or major operations (like hip and femoral fractures, total joint replacements). Patients’ age ranged from 28 to 85 years, hi this study we included all patients with 9g/dl < Hb < 1 Ig/dl on second postoperative day, without coexisted contraindications for administration of Epoetin Alpha. Patients having been transfused due to serious postoperative anaemia were not included in this study. Laboratory tests included full blood count check up to the end of treatment.

Patients were divided in two groups, hi the first group (18 patients) were provided 2 X 10000 units Epoetin Alpha daily for 15 days, hi the second group (after August 2001) we provided 40000 units X 4 every three days, hi all cases we provided Fe per os. One patient (in the second group) sustained diffuse intravascular coagulation (DIG) on the 13th postoperative day and finally she died. In the first group we noticed an increase of Ht by 4 units (mean rate) and in the second group by 6 units. Two cases in the first group presented a slight raise of the Ht (one unit), while the patient who presented DIG belonged to the second group. No patient was transfused postoperatively. Mobilization of patients especially the elderly was earlier than usual. An interesting notice was the raise of platelets (> 600000) in nine cases of the second group and in only two cases of first group, without complications. This raise was attributed to the stimulation of bone marrow due to the fast blood loss during the operation.

Conclusion: The effectiveness and safety of Epoetin Alpha has been proved in many studies concerning selective orthopaedic operations. Update results show that Epoetin Alpha has a significant effect in the treatment of postoperative anaemia. Of course further investigations (like double blind studies and control of potential complications from administration) are mandatory.