Aim: The aim of the study was to investigate the efficacy of the multidetector CT scan in the diagnosis and classification of pelvic and acetabular fractures.

Material and Method: 41 patients, 13 women and 28 men suspect for acetabular or pelvic fracture were examined. Patient’s ranged from 15 to 72 years. Fracture classification was based in that of Letournel and Judet. Examination was performed with a Multidetector CT scanner (Phillips-Brilliance), withnmultiple detectors and thin slices of 2 mm Multilevel and three dimensional reconstructions were performed.

Results: in 15 patients suspects for pelvic or acetabular fracture in plain xray, the CT scan was negative for revealing a fracture. In the rest 26 patients, there were 19 fractures of the anterior column, 4 fractures of the posterior column, 11 acetabular fractures and 7 sacral fractures. All the fractures were detected at the horizontal plane. MPR views were offered additional information for the sacral and acetabular fractures. In 7 patients the fractures diagnosed only after the CT scan was performed. In these patient plain x-rays were negative for fracture. In 6 patients the treatment algorithm was modified, based on CT scans findings

Conclusion: We believe that MDCT is an appropriate as well as an essential method in patients suspects for pelvic or acetabular injuries. MPR and three dimensional reconstructions are very helpful in revealing the personality of the fracture element very important for classification purposes as well as for planning treatment.

Aim: The aim of the study is to evaluate the usefulness of the MDCT scan in the diagnosis of calcaneal fractures and its use in the surgical treatment

Material. 112 calcaneal fractures were examined with a MDCT scan (slices one to two mm, pitch 1.5) with multilevel reconstruction as well as three dimensional reconstruction. The fractures were classified according to Munich classification system. Findings that were evaluated were the involvement of the subtalar joint, the number of fragments of the posterior facet and the extent of displacement.

Results: There were 85 intraartiular fractures and 27 extraarticular. 32 fractures were of type I according to Munich classification system (extraarticular without displacement). 15 fractures were of type II (extraarticular with some displacement). 2 fractures were of type III (intraarticular without displacement). 27 were of type IV (two fragments). 19 were of type V (with free fragments in the joint and 17 were type VI (more than four fragments).

Conclusion: The above mentioned radiological method of evaluating calcaneal fractures offers a quick diagnosis since it can depict the fragments and its displacement very accurately. Furthermore this method permits a very precise preoperative planning for the surgical treatment of these injuries

Backround: To present the results in a series of patients with complex distal radius fractures featuring comminution of the articular surface and the metaphysis in whom we used a volar as well as a dorsal approach in order to control the axial alignment and reconstitute the articular surface.

Material: There were sixteen patients with an average age of 26 years. All the fractures were classified as C3 according to AO Universal Classification. All the patients underwent an open reduction and internal fixation through a dorsal as well as a volar approach. Secondary operations were necessary for five patients.

Results: The average extension was 56, the average flexion was 51, pronation 70 and supination 76. The grip strength was 75% of the contralateral hand. The average ulnar inclination was 20°, 3 dorsal inclination, 0.9 mm ulnar variance and 1 mm articular incongruity. Three patients had radiological signs of radiocarpal arthritis. Excellent or good results achieved in the 40% of the patients according to the system of Green and O’Brien

Conclusion: The combination of dorsal and volar approach it is necessary for the carpus to be well aligned in order to achieve stability and give the opportunity for early mobilization. Sometimes additional operations are necessary.

Aim: The aim of this study is to evaluate the efficacy of the multidetector CT scan in shoulder fractures and to correlate these findings with those of plain x-rays.

Material and Method: A 105 patients with shoulder fracture were examined with a multidetector CT scanner after the acute injury. There were 64 male and 41 female with an average age of 52 yrs (range 16–95 yrs). The examination was performed with a CT PHILIPS BRILLIANCE, and six groups of detectors were used, with thin slices (1.6–2 mm). MPR and three dimensional reconstructions were performed.

Results: The mechanism of injury was fall during walk in 66 patients, fall from a height in 11 patients, and road traffic accident in 28 patients. They were detected 210 fractures at the shoulder region. A 135 fractures were located at the proxd imal end of the humerus, 75 at the scapula, in 95 out of 105 patients. In 10 patients with a comminuted fracture of the upper end of the humerus, the exact number of fragments as well as the precise location of them was not accurately assessed with plain xrays. MDCT control with multilevel anasynthesis and three dimensional reconstruction improved the understanding of the anatomic orientation in complex fractures and fractures–dislocations and in detection of subluxation of the fragments of the shoulder headin four part fractures in two patients.

Conclusion: Our results would orient us for using the MDCT scan in patients with acute shoulder injury, especially in cases with comminuted fractures, because it is better assessed the place, the orientation and the displacement of fragments, which are not easily identified in plain xrays. Furthermore, these reconstructions improve the preoperative planning in those patients

This paper reports on the results of intramedullary nailing in open tibial fractures.

We studied 20 patients (18 men, 2 women) with open fractures of the tibia diaphysis treated with intramedullary nailing between 1998–2002. The mean age at surgery was 29 years (range 18–57 years). Fractures were the result of motor vehicle accidents (12 cases), car accidents (4 cases), or falling from a height (4 cases).

We treated 5 type É, 11 type ÉÉ and 4 type ÉÉÉÁ fractures (Gustilo classification). Patients were operated within the first 8 hours after injury. The mean follow-up was 22 months.

The treatment protocol included extensive and thorough cleansing of the wound and aggressive debridement, intramedullary nailing and wound closed primarily, when possible, and somministration of parenteral prophylactic antibiotics. The mean hospital stay was 6 days, and the mean time of healing was 25 weeks. The protocol management included also early postoperative mobilization of the knee and of the ankle joint and toe touch weight bearing till the second post-op day.

Complications in this group included 3 infections, in one case we had to perform an osteotomy of the fibula and bone grafting because of delated healing and in 2 cases we had to remove failed screws.

In the last follow-up examination, the range of motion of the knee and ankle joints was quite normal in the majority of the patients.

Success rate in this study compares favourably with other groups of patients treated with “less aggressive” methods.

The overall complication rate (including infection) was not higher in the open fractures treated with nailing compared with other operative methods. This technique allowed early mobilization on a partial weight-bearing regimen and rapid recovery. There were few re-operations only. These results suggested that intramedullary-nailing technique is at least as effective, if not more so, than external fixation for the treatment of open fractures of the tibia, since the method has been found to be safe, and complication rate is acceptable.

Reconstruction acetabular surgery with bone stock loss is still a difficult and challenging problem for the orthopaedic surgeon.

The goals of acetabular revision are: stable bone coverage that can support the new acetabular component, restoration of the anatomy and bone stock for future revisions, equalization of leg length and restoration of the centre of hip motion. These goals are difficult to achieve when the pelvic defect is particularly severe.

We examine the case of a female 73 years old who underwent a third revision arthroplasty of the hip joint because of extensive bony defect of the acetabular cavity (massive protrusio defect-type III –D’Antonio- combined segmental/cavitary acetabular defect).

The femoral component which was revised in a previous operation with a mega stem (type Kotz), was radiologically stable and symptomless.

Preoperative radiological assessment was performed using standard radiographic views, Judet views and CT scan.

The surgical approach that we used was a slight modification of the previous incision achieving a better visualization of the entire acetabulum and iliac wing. The loose acetabular cup as well as soft tissue and debris were removed from the acetabulum. The large acetabular defect was filled with a massive allograft (tibial plateau) properly cut and shaped. The stability of the allograft was achieved fixing the allograft to the iliac bone with screws. A large amount of particulate allograft bone was placed in the depths of the acetabular defect restoring a proper level of the acetabular floor. Then a Burke-Schneider cage was firmly seated and fixed with screws in the prepared acetabular bed. A polyethylene cup was cemented into the acetabular shell. The superior part of the Kotz femoral prosthesis was also revised with a new one.

Postoperatively we din not have any complications, the graft incorporation was successful with a satisfactory functional result.

We believe that the use of structural allograft bone is essential for the reconstruction of large segmentalace-tabular defects. The results however are less predictable because of important technical difficulties and sometimes serious complications occur.