Our aim is to study the epidemiology of delayed union and pseudarthrosis of femoral fractures which were treated in our clinic with intramedullary nailing technique and simultaneously to speculate for the application of the method and for the reasons which might guide to these complications. During a 36 month-period, from 1999 to 2001, 46 patients suffering femoral shaft fractures were treated in our clinic. They were 43 men and 3 women and their average age was 22.8 years. Twenty-eight fractures were in the right leg and 18 in the left. All patients underwent primary closed intramedullary locked nailing with AO type of nail, except 4 patients who also suffered a unilateral intertrochanteric fracture and were treated with AO-PFN nail. Reaming was done in 33 cases. No condition or disease able to inhibit fracture healing was observed. All patients were operated in the first three days after submission by the same team of surgeons. Thirty patients underwent static intranaedullary locked nailing and the rest dynamic from the beginning. The average time of post-operative follow up, clinical and radiological, was seven months. Thirty-three fractures were healed successfully in six months (mean: 4.2 months). In 10 cases delayed union was observed (mean: 7.2 months) and in the rest three pseudarthrosis. The last group underwent revision of the intramedullary nailing with an AO nail of greater diameter. Reasons for delayed union (21, 74%) and pseudarthrosis (6, 52%) are considered: a)soft tissues enclosed between the bony segments, b)lated nail dynamization, c)factors concerning the technique. Undoubtfully, closed intramedullary locked nailing is the method of choice for the surgical treatment of femoral fractures. However, fracture healing sometimes exceeds the usual period of 4–6 months. Unfortunately, whereas infrequently, the surgeon also faces pseudarthrosis which is a difficult to solve problem.
Shoulder arthroscopy has become a valuable method for the diagnosis and treatment of this region’s injuries. The aim of this study is to present our experience on this procedure in young adults who are subjected in special training. During last year, in our clinic underwent arthroscopy 15 men with history of shoulder injury. Eleven of them suffered from anterior recurrent shoulder dislocation and the rest four had only one incident of injury. All patients were military personnel and were operated for the first time after a period of conservative treatment. Imaging control included magnetic resonance in 8 recruits. In all patients with chronic anterior instability a typical Bankart lesion was found. Two of them had also bone deficit of the glenoid, seven had Hill Sachs lesion and three had type II slap lesion. Bankart lesion was treated with Mitek anchors in 4 patients arthroscopically. The rest underwent open procedure. In those patients with one episode of injury were found: small detachment of anterior labrum in one, which was treated arthroscopically with debridement of the chondral surface, traumatic synovitis in another and partial tear of the rotator cuff in two, which was sutured by open procedure. Our experience in this small series shows that shoulder arthroscopy is not only a useful diagnostic method but also an effective, whenever indications are present, surgical method of rehabilitation.