To present the results of femoral fracture treatment with long cephalomedullary nails.

We used long cephalomedullary nails for the treatment of certain femoral fractures. There were 30 fractures in 30 patients (12 male – 18 female), age from 32 to 87 years old, operated in our department in a 9 year period (1998 to 2007). The fractures were classified as follows: combined fractures 10 (Ia: 4, IIa:3, IIb: 3 according to Lampiris’ classification), subtrochanteric fractures 18 (IIa:2, IIb:1, IIIa:3, IIIb:7, IV:3, V:2 according to Seinsheimer’s classification), periprothetic fractures 2 (previous nailing with short g-nail). One fracture was open grade II according to Gustilo’s classification and a pathologic fracture (metastatic Ca).

We used 13 long trochanteric g-nails, 14 long gamma-3 nails and 3 long Super nails.

All nails were statically locked.

The patients were allowed partial weight bearing since 2nd post-op day. Average hospital stay: 8 days. Patient X-rays were reviewed monthly until fracture healing. In one case, the nail was dynamised in the 2nd post op month.

All fractures healed in 3–5 months (average: 17 weeks). There was no functional deficit.

The treatment of combined and subtrochanteric femoral fractures with long cephalomedullary nails is a safe and reliable choice.

It ensures early mobilization and excellent functional outcome

A 64-year-old man presented with a severe deformity of the tibia caused by Paget’s disease and osteoarthritis of the ipsilateral knee. Total knee replacement required preliminary correction of the tibial deformity. This was successfully achieved by tibial osteotomy followed by distraction osteogenesis using the Taylor spatial frame. The subsequent knee replacement was successful, with no recurrence of deformity.

Objective: 57 open tibia fractures treated with external fixation during the period 1996–2001 are presented.

Material and Methods: 57 open tibia fractures concerning 52 patients (45 males, 12 females) were treated with external fixation during the period 1996–2001. Fracture classification according Gustilo included 5 type I fractures, 14 type II fractures, 18 type IIIA fractures and 20 type IIIB fractures. The following external fixation devices were used: STAR in 3 patients, EXFIRE in 9 patients, HOFFMANN in 18 patients, ORTHOFIX in 27 patients. All open wounds were left to heal at secondary intention. The devices were fully functional within 4 to 8 weeks in 37 patients depending on the type of the fracture.

Results: 39 fractures were completely healed in a mean time of 16 weeks. Nine fractures had delayed union and finally were completely healed without using alternate devices. In 8 cases there was pseudarthrosis; internal fixation with intramedullary nail was used in seven of these cases, and 2 cases were treated with grafts. One case was complicated with septic pseudarthrosis that was treated by bone transfer in a tertiary centre.

Wound healing was achieved in 45 cases. Delayed skin surgical closure was needed in 12 cases. Needle infection rate was 27%, while in 4 cases there was deep infection and needles were removed.

Conclusion: For the vast majority of open tibia fractures, external fixation can be used as a permanent way of treatment. Clinicians should set external fixation with this permanent prospective.