Aim and Purpose of the study

The authors evaluate the efficacy of athrodiatasis as possible alternative to arthrodesis or arthroplasty in the treatment of ankle arthritis in young patients. They present the long term results (average 19 years) of a small series of patients (10 cases) treated with a monolateral transarticular external fixator associated to different open or athroscopic procedures.

A minimally-invasive procedure using percutaneous reduction and external fixation can be carried out for Sanders’ type II, III and IV fractures of the os calcis. We have treated 54 consecutive closed displaced fractures of the calcaneum involving the articular surface in 52 patients with the Orthofix Calcaneal Mini-Fixator. Patients were followed up for a mean of 49 months (27 to 94) and assessed clinically with the Maryland Foot Score and radiologically with radiographs and CT scans, evaluated according to the Score Analysis of Verona. The clinical results at follow-up were excellent or good in 49 cases (90.7%), fair in two (3.7%) and poor in three (5.6%). The mean pre-operative Böhler’s angle was 6.98° (5.95° to 19.86°), whereas after surgery the mean value was 21.94° (12.58° to 31.30°) (p < 0.01). Excellent results on CT scanning were demonstrated in 24 cases (44.4%), good in 25 (46.3%), fair in three (5.6%) and poor in two (3.7%). Transient local osteoporosis was observed in ten patients (18.5%), superficial pin track infection in three (5.6%), and three patients (5.6%) showed thalamic displacement following unadvised early weight-bearing.

The clinical results appear to be comparable with those obtainable with open reduction and internal fixation, with the advantages of reduced risk using a minimally-invasive technique.

Standard external fixators have always caused difficulties in visualising fracture fragments radiologically in both planes; for this reason multiple shots are often required, exposing patients and surgeons to high X-ray levels. Radiolucent external fixator X-calibre is composed of a new thermoplastic material reinforced by carbon fibres (PEEK-CA 30). The aim of this study is to evaluate the first 30 tibial fractures treated with this device.

Thirty external fixators X-calibre were used to treat 30 patients with tibial fractures with an average age of 40.4 years (range 21–60). According to the AO classification we have treated nine type A, 13 type B, and eight C fractures. Five were open fractures. The average follow-up was of 18 months. The time of healing was the same as seen using the standard fixator and the average time was 115 days (range 85 to 190). One tibial plafond fracture healed with 8° valgus deformity and persistence of pain during walking. There was loss of reduction on the third day after surgery due to erroneous evaluation of the fracture, which presented a butterfly fragment.

This new radiolucent fixator showed the following advantages: single use, sterile package, radiolucency, less X-ray exposure for patients and surgeons, deal mechanical performance for each use, reduced storage and sterilisation costs, less instrumentation, less weight and increased comfort for the patient, average healing time and results comparable to the existing radio-opaque system.

Different methods of filling bone defects are reported: shortening followed by lengthening or bone transplant. In both cases the resection and docking bone site (immediately or after transplant) has a high risk of delayed consolidation or non-union. The aim of this study was to evaluate the strategies to avoid this risk.

We studied 19 patients treated from 1997 to 2002: 11 (group 1) were treated with immediate shortening and proximal callotasis. In eight patients (group 2) we performed monofocal proximal-distal bone transplant. In seven patients of group 1 we performed only decortication of the docking site (group 1A); in four cases (group 1B) decortication was associated with an autologous bone graft. The docking site was checked radiologically and considered healed when we allowed full weight-bearing after fixator removal.

In two patients (28.5%) in group 1A, three (75%) in group 1B and two (25%) in group 2 healing was achieved without any other operations. Docking site refracture or pseudoarthrosis was treated in all patients by new decortication and autologous bone graft with an average healing time of 90 days.

We suggest performing acute bone loss shortening in combination with decortication and autologous bone graft when local conditions permit. After bone transplant it is not necessary to wait for spontaneous consolidation, but better to plan from the beginning another operation before the two the docking site fragments are in contact.

Now we are using AGF and BMP-7 (OP-1) for treatment of the docking site but the study is still underway.

Elbow dislocations are difficult to treat because of the high incidence of short- (vascular and neurological lesions) and long-term (decreased range of motion and instability) complications. We report the results obtained in 20 elbow dislocations treated with hinged cast tutorisation or hinged external fixator.

We treated 20 patients with an average age of 45 years (range 16– 62 years). The average follow-up was 7 months (range 5–18 months). We divided the patients into two groups: patients treated by a hinged tutor for 4 weeks (group A), patients treated by hinged external fixator, removed after 5 weeks (group B). All the patients were evaluated clinically using the “Mayo elbow performance score” after 3 weeks, 1 month and 1 year.

Results were excellent in six elbows and good in 14; none of the patients had an insufficient or poor score. We observed deficit in prono-supination in three patients and deficit in flexion and extension in six patients; three patients complained of epicondylar pain when carrying something. At the end of the treatment none of the patients complained of instability.

According to our data normal function can be restored after early mobilisation. Our experience suggests that the most important aspect in the choice of treatment is the evaluation of joint stability after reduction. The results obtained with the external fixator are very good in terms of restoring function; the incidence of complications is very low and was equally distributed between the two groups.

Aims: The purpose of the study is to review retrospectively a series of consecutive unstable closed fractures of the humerus in order to evaluate clinical results. Methods: 40 patients affected by closed diaphyseal fractures of the humerus have been treated by Dynamic Axial Fixator (DAF Orthofix). Minimum follow up is two years. Only unstable fractures has been included in the protocol of treatment. Patients affected by uncontrolled diabetes, HIV and psychotic diseases have been excluded. Results were evaluated considering healing time, complications (number and quality), long term clinical results including back to work activity, functional findings and radiographic aspects. Results: Average time of healing is between 10 and 14 weeks. Results were: Excellent: 35; Good: 2; Fair: 2; Poor: 1. Complications were: non-union: 1; replacement of screws: 1; osteolysis of pin track: 4; realignments due to secondary displacement: 3; refracture after frame removal: 1. Conclusions: We believe that this semi-invasive, versatile and well tolerated method may be considered a valid alternative to conservative treatment or to internal synthesis even in case of single trauma, provided a careful selection of patients due to the necessity of close follow up during treatment time.