Objectives: The aim of this study was to explore the relationship between stress fractures, bone density and factors related to bone metabolism in a comparative group matched study including male military personnel beyond basic training.

Materials and Methods: Thirty two patients with stress fractures were matched with 32 uninjured-healthy volunteers (controls), by gender, age, height, body weight and level of physical performance. A questionnaire concerning the calcium intake, alcohol consumption and smoking was completed, the values of several biochemical markers related to bone metabolism were measured from blood samples, and calcaneal quantitative ultrasound was measured by heel ultrasound for each one of the 64 patients and healthy volunteers.

Results: Statistically significant lower levels of serum Osteocalcin (p=0.012) and higher levels of Albumin (p=0.006) were found among patients compared to controls. The levels of serum Total Protein, Ca, intact Parathormone and 25-hydroxy Vitamin D were lower among patients compared to controls, but none of these differences was statistically significant (all p> 0.10). Moreover, mean values of T-scores and Z-scores were statistically significantly lower in patients than in controls (p=0.018 for T-scores; p=0.016 for Z-scores).

Conclusions: Decreased bone turnover and low calcaneal bone density may increase the incidence of lower extremity stress fractures among men military personnel.

Aims: The purpose of this study is to evaluate the results of intrerlocking nailing (ILMN) as a þnal treatment of non septic femoral shaft pseudarthrosis. Material- Methods: The study involved 35 patiens suffering a femoral pseudarthrosis who underwent þxation with ILMN as a þnal treatment between 1999–2001. 31 male and 4 female individuals with a mean age of 25 years were followed up postoperatively for 24 months. Primary treatment had been done with plating in 29 pts, external þxation in 2 pts, AO nail in 3 and R-Tnail in one patient. The period between primary and þnal treatment ranged from 9 to 46 months. After the removal of primary þxation components all patients treated with ILMN for þxation but only 8 of them underwent autogenous bone grafting. Dynamic ILMN has been done in 32 out of 35 patiens (91%)Results: Clinical healing and radiological callus formation was apparent in all patiens after a period of 18 to 26 weeks (average time 20w). Serious complications were not observed. Light stiffness of the knee joint was noted in one and residual pain in distal metaphysis in two cases. Conclusions: The sort- term results from the use of LIN in treatment of femoral shaft pseudarthrosis have been more than encouraging. We recommend the reaming technique and the dynamization of the nail for optimal outcome. Bone grafting is not necessary.

Aims: The purpose of our study is to present pitfalls and complications of intramedullary nailing in the treatment of femoral fractures and to examine their effect in bone healing. Methods: 180 patiens, suffering a femoral fracture, underwent primary intramedullary nailing and were followed up from 1996 to 2000 in our clinic (mean 16 months). 163 were men and 17 were women with a mean age 28 years. Four types of implants were used including AO, R-T, GK reamed nails and AO-PFN in 15 patiens who suffered also a unilateral intertrochanteric fracture. Results: Almost all fractures (98%) healed successfully. Insigniþcant complications and pitfalls happened in 20% of patients but did not inhibit bone healing. They concerned predominantly the size of the nail, the entry point, the valgus of varus insertion of the wire guide and the position of nail and screws. Serious complications were: one case with ARDS, one with fat embolism, 3 non-unions, 7 malunions, 2 with positive Trendelenburg sign and 15 cases with knee joint stiffness. Conclusions: Pitfalls and complications during intramedullary nailing procedure for the surgical treatment of femoral fractures do happen. Usually they are of less technical importance and have no effect in bone healling.

Aims: The aim of this paper is to present our experience in the treatment of comminuted fractures of the distal humerus. Our surgical target was to reconstruct all three edges of the triangle to achieve the best functional result. Methods: In a period of 5 years, 28 patients who suffered a comminuted fracture of the distal humerus were operated with open reduction and internal fixation. Those were 21 males and 7 females with a mean age of 25 years. According to AO/ASIF classification there were 5 patients with A1 fracture, 3 pts A2, 6 B2, 8 B3, 3 C1, 1 C2 and 2 pt C3. In 25 patients was applied posterior approach after transolecranon osteotomy and lateral approach in the rest 3 patients. All patients were evaluated clinically and radiologically. Results: The mean time of follow up was 12 months. In 7 patients full range of motion was achieved, in 8 functional range of motion and in 4 limited but in functional range. The mean range of elbow flexion – extension arc was 115°. Complications included postoperative paresis of ulnar or radial nerve, ectopic bone formation and material failure. Conclusions: The comminuted intraarticular fractures of the distal humerus demand careful preoperative planning, extensive but atraumatic exposures and the use of the appropriate fixation materials for each case. Low complication rate and excellent functional results are ensured.

Introduction: Osteoid osteomas (OO) are benign skeletal tumours with a predilection for the long bones of young patients. Many different methods are used for their treatment, conservative or operative, less or more radical with variable technology applications to destruct the “nidus”.

Material & Method: We present thirty eight patients with OO who were treated in our hospital between 1995–2001. Their medical records and radiographs are retrospectively reviewed and the patients were contacted and interviewed with a telephone discussion.

Results: In thirty two cases OO were located in the lower limb, two in upper limb and four in spine. Thirty seven of those were treated operatively using open wide excision of nidus in twenty two of which with additional bone grafting.In three of the cases after excision of OO, precautious internal fixation was applied to the bone. Two patients developed deep vein thrombosis, another two had increased pain in anterior superior iliac spine from the bone graft harvesting area. We had one recurrence, which was treated with a second operation.

Conclusion: We conclude that although the traditional method of treatment is the wide surgical excision, this technique has increased morbidity and higher risk for complications comparing to more minimally invasive procedures. We suggest that it should be the first choice of treatment for either spinal or recurrent OO.

Purpose: We present the rate of osteochondritis disse-cans in a specific group of patients and the results after treatment which was done arthroscopic.

Material-Method: During a period from 1995 to 2001, in 39 patients with mean age 23.4 years suffering of knee pain, osteochondritis dissecans was diagnosed. The classification of the lesions was based on magnetic resonance and surgically treatment was decided. In 32 pts, a partially detached lesion was found and reattachment with biodegradable pins took place. In five pts the lesion was recently detached and treated similarly with pinning after debridement of the crater. In the last two patients the detachment was old, the osteochondral segment was removed and drilling took place.

Results: All patients were followed up for two years and the evaluation was based on the Lyscholm score. Successful healing certified radiologically was achieved in 33 patients.

Conclusion: Osteochondritis dissecans of the knee is seen between young adults who participate in sports activities. The arthroscopic treatment in our clinic was successful in the 84% of patients with good and excellent clinical results.

Introduction: Enchondromas are benign cartilaginous tumors, which are most often localized, in the small bones of the hand. Treatment methods fall into a broad spectrum ranging from conservative, medical therapies, to a variety of surgical procedures, which may or may not employ the use of local adjuvant treatment or bone grafting.

Material & Method: We present thirty four patients with hand enchondromas treated surgically in our department during the last eleven years. Their medical records and radiographs were reviewed retrospectively and the patients were contacted and interviewed by telephone.

Results: The patients were treated operatively with an intralesional approach, with meticulous curettage of the bone lesion, use of phenol 5% and grafting using coralline hydroxyapatite. X-rays taken over the first postoperative year revealed adequate bone synthesis at the site of enchondroma excavation, and there was no evidence of recurrence, fracture, infection or other complication related to the procedure.

Conclusion: We conclude that the combination of curettage of the lesion with the use of phenol as local adjuvant and grafting using coralline hydroxyapatite during the surgical treatment of enchondromas, is a safe technique to reduce or prevent recurrence and allow adequate and uncomplicated local new bone formation.

Purpose: We present our experience in recurrence of anterior knee instability after reconstruction of anterior cruciate ligament.

Material-methods: In our department, from 1996 to 2002, 359 patients with average age 24.2 years were treated for anterior knee instability. 159 patients underwent acl reconstruction with the use of bone-patellar tendon-bone graft, 188 pts with hamstrings tendons and 19 pts with quadriceps tendon-bone graft. During the follow-up period, 12 cases with recurrence of anterior knee instability came up. In nine patients BPTB graft was used and in three hamstrings. Five patients suffered a sports accident while seven presented a progressive graft laxity. At the revision, hamstrings were used in nine patients and quadriceps tendon-bone graft in three pts.

Results: All patients had a follow-up period free of complications, were subjected to the same rehabilitation program and returned to their usual activities into the expected for the particular operation period.

Conclusion: The revision of ACL reconstruction demands careful preoperative planning, organized surgery with capability to apply alternative solutions and understanding of the patient’s demands.

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.