We report on the use of the Ilizarov method to treat 40 consecutive fractures of the tibial shaft (35 AO 42C fractures and five AO 42B3 fractures) in adults. There were 28 men and 12 women with a mean age of 43 years (19 to 81). The series included 19 open fractures (six Gustilo grade 3A and 13 grade 3B) and 21 closed injuries. The mean time from injury to application of definitive Ilizarov frame was eight days (0 to 35) with 36 fractures successfully uniting without the need for any bone-stimulating procedure. The four remaining patients with nonunion healed with a second frame. There were no amputations and no deep infections. None required intervention for malunion. The total time to healing was calculated from date of injury to removal of the frame, with a median of 166 days (mean 187, (87 to 370)). Minor complications included snapped wires in two patients and minor pin-site infections treated with oral antibiotics in nine patients (23%). Clinical scores were available for 32 of the 40 patients at a median of 55 months (mean 62, (26 to 99)) post-injury, with ‘good’ Olerud and Molander ankle scores (median 80, mean 75, (10 to 100)), ‘excellent’ Lysholm knee scores (median 97, mean 88, (29 to 100)), a median Tegner activity score of 4 (mean 4, (0 to 9)) (comparable to ‘moderately heavy labour / cycling and jogging’) and Short Form-12 scores that exceeded the mean of the population as a whole (median physical component score 55 (mean 51, (20 to 64)), median mental component score 57 (mean 53, (21 to 62)). In conclusion, the Ilizarov method is a safe and reliable way of treating complex tibial shaft fractures with a high rate of primary union

Aim: To describe and evaluate the use of the limited contact plate in complex humeral shaft fractures. Certain sub-groups of humeral shaft fractures can be very difficult to treat. These ‘complex fractures’ include fractures in very osteoporotic bone, those associated with shoulder or elbow prosthesis, non-unions and those associated with intra articular extensions and dislocations. The AO limited contact plate (LCP) is a new form of fixation whether the screw heads lock into the holes in the plate. The plate is not designed to cause compression and does not need to lie perfectly adjacent to the bone. Methods: A prospective study of six consecutive complex humeral shaft fractures treated with LCP plate. Rate of union, complications, and subjective and objective outcome (DASH scores) are analyzed. Results: Union occurred in 9/10 patients. The final patient is progressing to union. There were no serious complications. Good subjective and objective outcome in all patients. Conclusion: This heterogeneous series of complex and complicated humeral shaft fractures all pose significant management problems. Treatment with the LCP plate demonstrated good results with no significant complications. This completely new rational for treatment seems particularly suitable for the treatment of complex or complicated humeral shaft fractures

Background: Pediatric comminuted femoral shaft fractures are not frequent but difficult in treatment due to concomitant injuries and instability. Although orthopaedic literature is rich in reports on paediatric femoral shaft fractures only few focus on comminuted ones. Purpose: The aim of the study is to present results and complications of surgical treatment in comminuted femoral shaft fractures during growing age. Material and Methods: Between 2001–2006 twenty eight children presented with 29 wedge or complex femoral shaft fractures. All children underwent clinical and radiographic examination on follow up and their medical data was retrospectively reviewed. TEN scoring criteria, time to solid union, early and late complications were of the primary interest during follow up assessment. Results: There were 18 boys (64,3%) and 10 (35,7%) girls. Their mean age during injury was 10,1 years and average follow up period was 35,7 months. In 15 children (53,6%) multiple injuries were present. Three fractures were treated conservatively, the remaining 26 underwent closed or open reduction with stabilization using EBI external fixation, intramedullary Rush or TEN rodding, multiple screws or plate osteosynthesis. On follow up there were 12 (41,4%) excellent, 14 satisfactory (48,2%), 3 poor (10,4%) results. All fractures united and a mean time to achieve solid union was 20,7 weeks. Leg length discrepancy occurred in 20 children (71,4%), and in 10 (35,7%) was greater than 10 mm. Four children required in early secondary surgical procedures to achieve better alignment or fracture stabilization. One femoral osteomyelitis required in surgical drainage and prolonged intravenous antibiotic therapy. Conclusions: Comminuted femoral shaft fractures in children heal well after surgical treatment although the risk of serious complications is high. Intramedullary rodding seems to be sufficient in most cases. Screw fixation alone should be avoided