Introduction: Always more orthopaedic surgeons are nowadays putting all their efforts in improving knee osteochondral defects treatment.

Material and Methods: In order to relieve patient symptoms we have retained of value, among other treatment options in use at our institution, to rely, in older patients, on a new, non biological, method of treating chondral and osteochondral defects and since November 2002 we started using artificial synthetic cartilage implants made of polyvinylalcohol-hydrogel (SaluCartilage™ – Salumedica).

Results: Serial clinical and MRI follow-ups have been conducted. The 65 treated patients have shown significant improvement over preoperative values of 2000 International Knee Documentation Committee Knee Examination Forms. In fact at one year follow-up patients showed an average increase of 24 points over preoperative values of IKDC score, this improvement further raised up at the two year follow-up to a 33 points improvement (range of improvement 14,94 – 68,67) and has been confirmed at the three years evaluation.

Follow-up MRI images revealed normal healing process, without signs of osteolysis or wear. No synovial joint reaction has been observed, but one case of implant’s dislocation occurred.

Conclusions: Based on our mid term results, that have confirmed the short term ones, this study demonstrates that, in middle aged patients, between the fourth and the seventh decade, the use of a non biologic device, the implantation of a polyvinyl alcohol prosthesis in the chondral defect, represents an innovative treatment choice that knee surgeons need to be aware of and prompt to use it in the correct cases. In fact, in our opinion, the “chondral surgeon” must be ready to use different treatments in the different patients. To facilitate the use of Salucartilage ™ implant we suggest the rationale of it’s use with the auspice that surgeon’s experience and round tables will be able to better define the correct indications of each surgical possible solution of chondral defects. The immediate postoperative weight bearing and full regaining of recreational and sport activities are an added advantage of this technique that can be therefore when needed associated to other surgical procedures, such as osteotomies or ACL reconstructions.

We present the results of a multicentre retrospective study of closed fracture dislocations of the Lisfranc joint treated by closed reduction and percutaneous screw fixation (follow-up: almost 5 years).

Forty-two patients that presented between 1994 and 1999 to the authors™ institutions were selected for this study (follow-up AOFAS score 81.0 ± 13.5).

A review of the literature shows that opinions differ as to the most appropriate method of treatment, be it closed or open reduction, screws or K-wires fixation, but most of the authors agree that it is imperative to achieve anatomical reduction.

In our study, no statistically significant differences could be detected when outcome scores of patients with anatomical reduction were compared with outcome scores of patients with nearly anatomical reduction, in both the combined fracture dislocation and pure dislocation subgroups. The conclusion is that even a nearly anatomical reduction is considered acceptable and predictive of a satisfactory outcome.

Furthermore, we found a statistically significant difference in the AOFAS score between patients with combined fracture dislocations and pure dislocations, with the latter having a worse AOFAS score. This suggests that the ligament bone interface cannot heal with sufficient strength to regain stable long-term function.

Application of locked intramedullary nailing in diaphy-seal tibia open fracture after removal of external fixation has a risk of infection.

We have treated 13 patients in 2 years, 2001–2002 (affected by Gustilo 3B open fractures) with this method: 9 before 4 weeks after emergency stabilization and 4 before 5 weeks. Patients were followed for at least 1 year after the second osteosynthesis.

The bone healing was obtained 5 months after 2 osteo-synthesis: we have observed 3 superficial infections(l in the first group and 2 in the second) and 2 deep infections(in the second group). We haven’t observed cronic osteomyelitis.

We recommend to convert external fixation in intra-medullary nail before 4 weeks by trauma to avoid infectious risk.