Aim : We investigated the combination of closed reduction, percutaneous osteosynthesis with screws and external fixation in the treatment of high-energy fractures of the tibial condyles with severe soft-tissue lesions.

Method : We studied 35 fractures (11 open) of the tibial condyles. Twenty-eight were Schatzker type VI, 5 type V and 2 type I. The fracture was reduced under fluoroscopic control and the articular surface was fixed with cannulated lag screws. In 23 patients (group A) a unilateral external fixation was applied with the proximal pins placed in the tibial condyles. In 12 patients (group B) an external fixation crossing the knee was used for 6 weeks followed by a knee brace. The follow-up period was 8–45 months

Results: All fractures united in a mean time of 15 weeks except for two in group A that needed conversion to internal fixation. Ten knees developed pintract infection. All knees had range of motion of at least 1000 except for one in group B that developed osteoarththritis. A collapse of the articular surface of more than 5mm and malalignment of more than 60 were observed in 7 and 5 patients in group A and B respectively.

Conclusions: Limited internal and external fixation are a satisfactory technique for selected fractures of the tibial plateau, particularly with poor soft-tissue envelope. Crossing the knee with the external fixator does not necessarily lead to significant stiffness.

During the decade 1986–1996 were admitted in our hospital 2267 patients with hip fractures. From them 179 (7.98%) had already operated on for fracture to their other hip and the majority of them had a good way of life after the first operation. In 125 cases (69.83%) the second fracture was similar to the first.

The mean age was 78.5 years. From the 179 patients, 145 were women and 34 men (rate 4.3/1). The 94 (52.5 %) were intertrochanteric and the other 85 (47.5%) subcabital fractures. The mean time between fractures was 6.5 years in patients under 70 years and decreased in those over 80 years in 3.5 years.

On the bases of our follow up, mean time 18 months (12m–24m), from the 179 patients, 55 (30.7%) died during the first six months, (3 during hospitalization) and 13 (tot 37.98%) later but before our re-examination.

The evaluation of the remaining 111 patients, according pain and activities of the patients was: 16 (14.3%) very good, 52 (47%) good and 43 (38.7%) fair.

The patients with the better results were those under 75 years, who had similar hip fractures and had been operated on the first 3 days. In the other hand the majority of the 43 patients with the fair results were over 85 years.

We found out that the bilateral non simultaneous hip fractures had a high mortality incidence. We believe that, except the age, there were other risk factors for this high mortality, such as, cardiovascular diseases, chest and urinary infections, bed sores etc.

We noticed also that in all patients there was a decrease of the bone mass as a result of the extended immobilization and poor nutrition.