This study reports the results of hybrid stem fixation in difficult revision hip arthroplasties where proximal femoral bone stock loss was severe.

Twenty-six revision arthroplasties (21 women and 5 men, aged from 58 to 86 years), were performed between 1998 and 2008. The indication for surgery was aseptic loosening. In all cases, stabilization of the stem presented problems because of severe proximal femoral bone stock loss (due to extensive periprosthetic osteolytic defects), or because of iatrogenic defects or surgical procedures (attempts to remove the stem and cement with fenestration or extended osteotomy). The average follow-up was 48 months (range 16 to 120).

Primary stability is necessary for the successful definite fixation of a cementless implant by bone. When this was not possible (because of proximal cortical insufficiency), we used a modular distally cemented long stem, bypassing the area of bone defect for at least 6–7 cm. Proximally bone defects were grafted and osteotomy was closed with cerclage wires.

Four stems (15%) had an asymptomatic subsidence (3 stems subsided less than 3–4 mm and 1 stem about 15mm). No stem was revised to date. Major complications did not occur. The mean Harris hip score improved from 32 points preoperatively to 82.3 points (at the most recent evaluation).

Hybrid fixation offers the advantage of initial and secure stability of the cemented stem on the short term, until stabilization of the entire implant by bone occurs. Thus early subsidence and loosening is avoided and on the long term benefits of the cementless fixation are attained. Our results support the method of hybrid fixation in patients with severe femoral bone loss (and consequently problematic stabilization), when primary stability is needed.

Aim: The aim of this study is to evaluate the efficacy of the multidetector CT scan in shoulder fractures and to correlate these findings with those of plain x-rays.

Material and Method: A 105 patients with shoulder fracture were examined with a multidetector CT scanner after the acute injury. There were 64 male and 41 female with an average age of 52 yrs (range 16–95 yrs). The examination was performed with a CT PHILIPS BRILLIANCE, and six groups of detectors were used, with thin slices (1.6–2 mm). MPR and three dimensional reconstructions were performed.

Results: The mechanism of injury was fall during walk in 66 patients, fall from a height in 11 patients, and road traffic accident in 28 patients. They were detected 210 fractures at the shoulder region. A 135 fractures were located at the proxd imal end of the humerus, 75 at the scapula, in 95 out of 105 patients. In 10 patients with a comminuted fracture of the upper end of the humerus, the exact number of fragments as well as the precise location of them was not accurately assessed with plain xrays. MDCT control with multilevel anasynthesis and three dimensional reconstruction improved the understanding of the anatomic orientation in complex fractures and fractures–dislocations and in detection of subluxation of the fragments of the shoulder headin four part fractures in two patients.

Conclusion: Our results would orient us for using the MDCT scan in patients with acute shoulder injury, especially in cases with comminuted fractures, because it is better assessed the place, the orientation and the displacement of fragments, which are not easily identified in plain xrays. Furthermore, these reconstructions improve the preoperative planning in those patients

The intra-articular supracondylar fractures of the femur are difficult fractures that occur with increasing frequency in the last years. Their complex management is a source of controversy, since surgical outcome is not acceptable in all instances.

In the last 6 years we treated 30 comminuted intra-articular supracondylar fractures of the femur (type-C). The mean age was 28 years (17– 65 years).

We made any effort to apply a method which could guarantee reduction and articular reconstruction, rigid fixation and bridging of metaphysic-epiphysis, in order to achieve early mobilization and to avoid post-traumatic osteoarthritic lesions. The extra-articular portion of the fractures was fixed using DCS, condylar plates, Ô plates and in some cases the whole construct was protected by an external fixation device. In some other cases, stability was enhanced using a second bridging plate in the medial side or applying a massive cortical graft properly adapted and fixed to the plate. The articular surface was reconstructed using cancellous lag-screws. Intra-articular epiphyseal portions were regularly bone grafted when there was comminution and bone loss, Bone grafting was also carried out in cases of meta-diaphyseal severe comminution and major bone defects.

Clinical and radiological outcome was evaluated. Radiological parameters (axial valgus deformity, shortening, development of post-traumatic osteoarthritis etc.) were correlated to the method of surgical treatment.

There were major complications (such as infection, especially in open fractures, delayed healing, hardware failure, refracture etc.). In some instances re-operation was necessary.

In problematic C3 supracondylar fractures of the knee, poor surgical results are associated to early complications and development of degenerative lesions. This handicap is particularly is particularly important since it occurs in a major weight bearing joint of young patients. Using meticulous surgical technique (including bone-grafting, minimal devitalization of the fragments etc.), and choosing the most appropriate implant in every case, reconstruction can be performed reliably with good results and a low rate of complications.