Aim: The purpose of the present retrospective study was to evaluate reasonable routine transposition of the ulnar nerve in bicondylar humeral fractures.

Material and method: From 1996 to 2007 112 bicondylar fractures were operated. 88 pateints (47 women and 41 men) were followed up for average 56 months. Average age was 48 (14–80) years. Open fractures were 17. Fractures were distributed by the AO classification as follows: type C1.2 – 16, C1.3 – 10, C2.1 – 22, C2.2 – 7, C2.3 – 3, C3.1 – 17, C3.2 – 8 and C3.3 -5. All fractures were operated by the AO method with dorsal approach, osteotomy of the olecranon (83 fractures) and fixation with 2 plates. In 47 cases the ulnar nerve was routinely anteriorly transposed and for the rest 41 patients transposition was not done.

Results: From 47 patients with routine anterior transposition 7 had Mc Gowan I dysfunction that was resolved in 3 months. From 41 patients without transposition 9 had a type Mc Gowan I dysfunction. There was no statistical significance between the two groups. (p> 0,05). However, 12 to 18 months later 3 patients from the group without transposition with type C1.3, C3.1 and C3.3 fractures returned with late postoperative nerve palsy Mc Gowan II and III. They were treated by neurolysis and transposition.

Conclusion: Routine anterior transposition of the ulnar nerve is not reasonable in every type of bicondylar humeral fractures. The type of the bicondylar fracture defines whether the nerve transposition is reasonable or not. In low bycondilar humeral fractures and type C3 fractures the nerve transposition is obligatory.

Objectives: To evaluate and compare the results of interlocking nailing (ILN) and plating (PL) in fresh humeral shaft fractures (HSF)

Material and Methods: During 7 years period 145 patients with HSF (84 males and 61 females) were operated and followed up for 8 – 60 months (mean 18 months). According to AO there were 64 Type A, 53 Type B and 28 Type C fractures. Of 18 open injuries there were 10 grades I, 5 grades II and 3 grades IIIA. There were 33 patients with polytrauma, 11 cases with associated limb injuries, 9 cases with floating elbow and 22 patients with primary neurological deficit. In 75 fractures ILN was performed and PL in rest 70.

Results: The mean operative time was 85 min for ILN vs./117 min for PL and the mean blood loss 100ml vs./250 ml. Healing occurred in 139(95.6%) fractures with mean healing time 75 days vs./85 days. Functional results according to Rommens score were as follows. Shoulder: excellent 62(82.6%) vs./55(78.5%), good 11(14.6%) vs./11(15.7%), poor 2(2.8%) vs./4(5.8%).

Elbow: excellent 69(92%) vs./52(74.3%), good 6(8%) vs./16(22.8%), poor 0 vs./2(2.9%). Complications noted were iatrogenic nerve palsy 1(1.3%) vs./12(17%), delayed union 5(7%) vs./2(3%), non union 1(1.3%) vs./5(7%), infection 0 vs./1(1.4%), fixation failure 1(1.3%) vs./5(7%) and reosteosynthesis 1(1.3%) vs./1(1.4%), shoulder impingement 8(11%) vs./2(3%).

Conclusions: Interlockimg nailing reduces risk of nerve injury and infection, provides more stability in segmental, complex and osteoporotic HSF. No significant differences in the term of healing in the both methods. Plating should be preferred in open Fx with incidental nerve palsy or vascular injury and juxtaarticular Fx, especially distally located. The method provides anatomical reduction, but requires extended approach and increases risk of iatrogenic nerve palsy.

Objective: To evaluate the results of operative treatment of complex fractures of the acetabulum. Material and methods: For the period 1992 Ð 2001 þfty one patients with complex acetabular fractures were treated surgically and followed up for an average 4 years 3 months (range, 1 Ð 11 years). There were 34 males and 17 females of an average age of 39 years (range, 18 Ð 64 years). Thirty one of the patients sustained multiple trauma. The mean operation time was 9 days (range, 3 Ð 22 days). According to Judet-Letournel classiþcation there were 2 posterior clolumn/posterior wall fractures, 10 Ð transversal/posterior wall, 7 Ð T-type, 9 Ð T-type/posterior wall, 11 Ð anterior column/posterior hemitransversal and 12 Ð both column injuries. Posterior Koher-Langenbeck, ilioinguinal, extended iliofemoral or combined approaches were used depending of fracture pattern. Internal þxation was done with lag column screws, column shaped plates, brim plates or buttress plates. Spring plating with stright or T plates was widely used in cases of comminution. Ealy weight-protected motion was conducted after surgery. Results: Average operative time was 3.5 h (range 1.5 Ð 8 h), and average blood loss was 1200 ml (range 450 Ð 2300 ml). According to Mattañs criteria anatomical reduction was achieved in 23 cases, good Ð in 13, fair Ð in 11 and poor Ð in 4. Late outcome was evaluated according to Merl dñAubigne-Postel-Matta scale. Nineteen ecxellent, 16 good, 11 fair and 5 poor results were recorded. The last were due to arthritis, avascular necrosis or chondrolysis. The late results correlated strongly with quality of reduction and initial cartilage damage. Early complications were 1 case of operative bleeding, 1 intraarticular screw penetration, 5 jatrogenic nerve palsies (2 of femoral cutaneus nerve and 3 of peroneal nerve) and 1 superþcial inection. Late complications were 1 case of chondrolysis, 2 avascular necroses and 2 Grade III heterotopic ossiþcations. Conclusion: ORIF provides high prevalance of excellent and good results in complex acetabular fractures and should be considered as a method of choice. The quality of reduction is of most importance for þnal outcome. Initial cartilage condition, fracture type and degree of comminution should also be taken in mind for late prognosis. As the surgery is demanding perfect surgical skills, special experience and adequate equipment are required for þnal success.