The study of effectiveness of PHILOS plate in the internal osteosynthesis of humeral head fractures.

Since 2006 23 patients with 24 humeral head fractures ere treated in our clinic. 10 of them were men (43,48%) and 13 women (56,52%). The average age was 50,4 years (range 16–89 years). Fractures of the surgical neck of humerus were 8 of these (33,33%), 12 were 3 parts fractures according to Neer classification (50%) and finally in 3 cases there was a 4 part fracture (16,66%). Shoulder of dominant upper limb was injured in most of the cases (68%).

19 patients (82,6%) were examined periodically in an average follow-up period of 19 months (range 13–26 months). All the fractures were healed. In 4 cases (16,66%) insufficient reduction was detected postoperatively. Constant score was calculated 12 months post-operatively up to 82,05 by mean (range 62–100). Differentiation was observed between the patients of age less than 60 years (12 patients with average constant score 91,25 with range from 78 until 100) and these of age of 60 years or more (7 patients with average constant score 71,43 with range from 62 until 81).

Internal osteosynthesis humeral head fractures with PHILOS plate is a reliable method of treatment not only for simple head fractures but also for them of 3 or even 4 parts, without complications and with very good functional results

Introduction: The chevron osteotomy is an accepted method for the correction of mild and moderate hallux valgus and generally advocated for patients younger than the age of sixty years. In the current work the finite element analysis applied to calculate the stress (force per unit area) on different cuts in the metatarsal bone model of the first ray in the human foot.

Material and Methods: The cuts have the form of a simple angle with 90 degrees ‘modified chevron osteotomy’, 60 ‘typical chevron osteotomy’ 70, 50 and 30, openings correspondingly, and share a common corner C, which is at the centre of a circle that fits the head of the metatarsal. In order to calculate the maximum stresses on the cuts, the bone is assumed to be with a 150 angle to the floor, which is the angle that it takes during the push-off phase.

Results: The calculations show a considerable difference on the stress distribution on the differnt cuts. In particular in the ‘90 degrees cut’ the normal (to the cut) stress is much larger than the shear stress. The opposite is true for the 60 cut. Since shear stresses are the ones that cause material failure, it is predicted that the 90 cut will heal much faster than the 60 cut. The nodes along the cuts where the normal and the shear stress were calculated in different osteotomies.

Conclusion: The FEM analysis confirm our clinical results of this modified chevron osteotomy of 90 degrees. The osteotomy site is firmly secured, avoiding early displacement of the lateral fragment and give earlier fusion.

INTRODUCTION: Cases of aseptic non-unions in patients with a femoral shaft fracture, who have initially been subjected to internal fixation by plating, are not rare. The aim of this retrospective, polycentric study was to evaluate intramedullary nailing as method of treatment of these patients.

MATERIALS AND METHODS: Thirty patients with aseptic femoral shaft non-union, after plating, were treated by reamed intramedullary nailing (IMN). The type of nailing was chosen according to the type of non-union. The mean follow-up time was 30 months and for statistical analysis, the student’s t-test was used.

RESULTS: All non-unions were healed in a mean time of 7.8 months (5–18) after nailing. The mean healing time after fracture was about 18.6 months (9–54). The healing times were irrelevant to whether the fracture was open or closed, the type non-union (atrophic or hypertrophic) and the type of fracture, according the AO classification. On the contrary, the delay from the initial plating to definitive treatment (IMN) affected the healing time and the final outcome, in a statistically significant way. Healing time was increased by 34.45% when the definitive operation was performed after between 8 and 16 months compared to the ones before the 8th month and by 72.28% if the IMN was delayed to between 16 and 24 months.

DISCUSSION: In conclusion IMN can be an ideal and cost effective method in treating patients with aseptic femoral non-union, after plating failure. This definitive operation should be performed as soon as the non-union is diagnosed in order to avoid unnecessary delay in fracture healing.

Aims: To evaluate the functional recovery of the complex tibial plateau fractures Schatzker type V and VI treated with hybrid ex. þx. Methods: Twenty-eight patients with intra-articular fractures of the proximal tibia were treated with hybrid external þxation in a three years period (1998–2001). The mean age was 35 years (17–76). According to Schatzker classiþcation, there were 11(39.3%) fractures type V and 17(60.7) type VI, whereas 5(17.8%) fractures were open. Complex injury was recorded in 15(53.5%) patients. Closed reduction and hybrid external þxation was achieved in 21 (75%) fractures. Additional limited internal þxation was performed in 9(32%) cases. Open reduction was necessary in 7(25%) patients. Mobilization of the injured articulation was started at the 3rd postoperative day. Results: Mean follow up period was 18 months. All fractures but one united at an average of 13.5 weeks (range from 11 to 18 weeks). The results were assessed according to the criteria of Honkonen and Jarvinen. An overall 22(78%) excellent and good results was recorded at the þnal follow up. Complications included one axial deformity, one septic pseudarthrosis, one peronial palsy and þve pin tract infections. Conclusions: The use of hybrid external þxation in the comminuted tibial plateau fractures (Schatzker V, VI), insure good restraining and early union, avoid major soft tissue complications and allow early mobilization and functional recovery of the knee joint.