Pilon fractures present a unique challenge to the patient and orthopaedic surgeon. Care for the soft tissue envelope is as important as management of this articular fracture. Assessment of the degree of energy causing the fracture and careful planning of the joint reconstruction will lead to acceptable results in most cases.

Forty-five patients (AO-ASIF classification) treated between 2003 and 2008 were examined clinically and radiologically at an average of 24 months after injury. The patients were treated in three different ways: primary internal fixation with a plate following, which was reserved for patients with closed fractures without severe soft tissue trauma; one-stage minimally invasive osteosynthesis for reconstruction of the articular surface with long-term transarticular external fixation of the ankle for at least eight weeks and hybrid external fixation. Objective evaluation criteria were infection rate, pseudarthrosis, amount of posttraumatic arthritis, range of ankle movement.

In 65% of all pilon tibial fractures we observed an uncomplicated course of healing. Early complications were mainly soft tissue infections, whereas we found pseudarthrosis to be the most frequent late complication.

The complication rate depends mainly on the type of fracture, the soft tissue damage and the type of treatment. In the case of low-grade soft tissue damage, good to excellent results were accomplished. In the case of higher-grade soft tissue damage, the problem of soft tissue coverage and reconstruction of the joint surface could be solved with good results by the hybrid external fixation. Herewith it is important to use limited open reduction of displaced fragments and fixation by cannulated screws and K-wires

Objective: To evaluate retrospectivelly the outcome of periarticular tibial pilon fractures treated by hybrid external fixation.

Method: Between 1999–2003, 44 patients(44 fractures) were treated with a combination of hybrid external fixation and minimal internal fixation(k-wires or lag-screws). There were 31 men and 13 women with a mean age of 41 years. A high energy trauma( accident or fall from a height) was the mechanism of injury for 32(73%) patients. According with A.O. clasiffication 4 fractures were A1, 5-A2, 5-A3, 8-C1, 12-C2,10-C3. All fractures were treated within a 10 days from the initial injury (10(23%) of them were open and treated immediately). The use of bone grafts reguired in 8 cases. Primary postop mobilization of adjacent joints was performed in all cases. Fourty patients were available for clinical and radiographic evaluation(using Teeny’s and Wiss ancle score). The average follow-up was 26 months.

Results: There were 9(23%) excellent, 12(30%) good, 10(25%) fair, and 9(23%) poor results. Union achieved in 40(92%) cases. Overall, 12(30%) complications reported: 6 pin track infections, 2 deep infections, 4 non-unions and 1 malunion. Post-traumatic osteoarthritis noticed in 11(28%) cases.

Conclusions: Hybrid external fixation permits early mobilization of the ankle joint and decrease the soft tissue trauma. Poor results associated with the presence of infection, the degree of intraarticular involvement and the inability to achieve adeguate fracture reduction.

Aim of the study: Lunate dislocation is very uncommon injury which occur due to acute hyperextension of the wrist.Factors who affecting the prognosis still controversial.The aim of this study is to present the classification,the management and the outcome of this type of dislocation.

Methods: Four patients were treated the last four years in our clinic with lunate dislocation.All patiends treated immediately.In two cases was followed dorsal approach and fixation, in one case performed palmar approach and decompression of the median’s nerve tunnel from the hematoma, and in one case dorsal approach and ligaments repair.

A functional score sustem in combination with radiological assesment were used for the postoperative evaluation of the patiends.The mean time of follow-up was 23,5 months.

Results: Two patiends had excellent, one good and one poor results. Complications as ligamentous instability, avascular necrosis, osteoarthritis or infection they didn’t remarked. One patient complains for a mild pain due to his work.

Conclusion: Early diagnosis of the lunate dislocation in combination with open reduction and fixation can offer satisfactory results.

Aim: Complex tibial plateau fractures, Shatzker type VI, rare in the past, became more common nowadays because of high energy injuries. These complex fractures usually accompanied by compromised skin and soft tissue envelope requires deliberate planning as treatment in the past invite a high rate of complications.

Materials and method: During a period of 24 months, 16 fractures of tibial plateau, Shatzker VI, were treated in 16 patients, all regarding vehicle accidents.11 patients were men and 5 women with a mean age of 42 years old (27–67).There were 2 open and 14 closed fractures (3 type I, 8 type II and 3 type III according to Tscherne’s classification).All cases were treated with circular external fixators (hybrid), whereas 9 of them needed additional mini internal fixation (one or two screws).

Results: 14 patients were evaluated with a mean period of follow up 1.9 years. Healing was achieved in all 14 cases with a mean period of 16 weeks (12–24).Fixator removal was performed when bone healing was completed. There was no deep infection. 12 patients at the end of treatment had a range of motion between 0° – 120°. 3 fractures developed a malunion (1 valgus deformity, 2 anterior angular deformity). Radiographic evidence of arthritis appeared in 2 patients during follow up. Pin tract infection occurred in one case, treated with antibiotics.

Conclusion: The use of circular external fixators (three olive wires to tibial plateau) obtains good stabilization while allows early joint motion, protects soft tissue envelope and in combination with minimal internal fixation achieves satisfactory reduction of comminuted fractures making the technique promising for the management of these complex fractures.