Purpose: The purpose of our work was to assess sutures, suturing techniques, and suture anchors used in rotator cuff surgery in order to explore weak parts in our repair.

Material and Methods: Ten types of sutures, four types of suturing techniques and eight types of sutures anchors commonly used in shoulder surgery were tested. Vicryl, Ticron, Dexon, PDS, Panacryl, Ethibond, Durabraid, Fiberwire, HiFi and Orthocord sutures were tested. Simple, mattress, massive cuff tear (MCT) technique and modified Mason Allen.

(MMA) suturing technique in ex-vivo ovine healthy rotator cuff were tested. Four metallic and four bioabsorbable anchors: Arthrex, Smith+Nephew, Linvatec, Mitek and bio respectively were tested. Their pull-out strength and failure mode was determined in ex-vivo ovine humeral heads. Materials Testing Machine and attached load cell run with Emperor Software (MEC-MESIN, UK) was used for the tests with application of tensile load(60mm/min). Load and displacement were recorded at a sampling rate of 100 Hz and breaking load and stiffness were recorded.

Results: The suture mean breaking strength (N) was: Vicryl 89.0, Ticron 70.9, Dexon 111.7, PDS 92.9, Panacryl 52.9, Ethibond 64.5, Durabraid 72.6, Fiber-wire 127.2, HiFi 163.0 and Orthocord 141.8. The mean suture stiffness (N/mm) was: Vicryl 3.4, Ticron 3.0, Dexon 2.4, PDS 1.2, Panacryl 0.7, Ethibond 2.5, Durabraid 3.1, Fiberwire 9.7, HiFi 11.1, and Orthocord 6.9. The technique’s mean breaking strength (N) was: simple 54.1, mattress 102.8, MCT 194.0, MMA 227.7 and their mean stiffness (N/mm) was: simple 10.4, mattress 13.1, MCT 26.0 and MMA 18.9. The anchors had mean pull-out strength (N): Arthrex 534.0 and Smith & Nephew 574.0, Linvatec 707.2N, Mitek 736.4N and Arthrex Bio 257.4, Linvatec Bio 305.2, Mitek Bio 359.6, S& N Bio 330.6. Often either in metallic (10/20) or in bioabsorbable anchors (11/20) the eyelet fails first.

Conclusion: Modern non absorbable sutures (HiFi Orthocord Fiberwire) have higher breaking strength and stiffness than absorbable ones (p< 0.05). MCT suturing technique, arthroscopically applicable, and MMA technique, which is most commonly used in open surgery have no great differences in strength and stiffness (p=0.046 and p=0.352 respectively). Both of them have higher strength and stiffness than simple and mattress technique (p< 0.05). Metallic anchors have a higher pull-out strength than bioabsorbable ones (p< 0.05) and the eyelet is a weak point in both.

Aims: In order to assess the potential pathologic inßuence of any Parathyroid Hormone (PTH) disturbances on the development of Slipped Capital Femoral Epiphysis (SCFE) during adolescence, we conducted a prospective clinical study. Methods: Nineteen patients in total were included in the study. Fourteen patients, 7 boys and 7 girls (16 hips), suffering from SCFE during the proceedings of this study, formed group ÔAñ. Another 5 patients that had been treated for SCFE a few years before the study, were used as a control group (group ÔBñ). We measured the level of I-PTH, along with serum Calcium (Ca) and Phosphorus (P) levels. Furthermore we checked all the necessary anthropometrical characteristics of the patients (age, height, weight and sexual maturation). Each patient of group ÔAñ was categorized from grade I to grade V according to the progress of the slipping. Results: An increased incidence (9 out of 14 patients), of serum PTH level abnormalities (both decrease and increase) in group ÔAñ was detected. Group ÔBñ patients had normal results. It is interesting that the detected I-PTH serum level abnormalities were not in any pattern related to the Ca and P serum levels. Conclusions: We believe that a temporary Parathyroid Hormone disorder or imbalance (along with others etiologic factors) during the early years of adolescence, may play a potentially signiþcant role in the development of SCFE.

Aims: The use of bio-absorbable þxation plates and screws, constructed of self-reinforced (SR) polylactic acid co-polymer for internal þxation of forearm fractures in children is described in this study. These plates (thickness:1,2 mm) and screws (diameter:2,4 mm) are usually used in reconstructive surgery in the mid-face and craniofacial skeleton. Methods: Eleven patients (aged 4–12 years old), who had suffered from fractures of the distal third of the forearm (7 cases) and isolated radial fractures (4 cases), were surgically treated in our Department with absorbable þxation plates and screws, during the last 3 years. As close-reduction attempts failed in all these fractures, surgical treatment was mandatory. The general principles of internal þxation were followed in all cases. The internal þxation, with the use of these plates and screws, was reinforced with the application of a long forearm cast for a period of 4–6 weeks. Antibiotics were administered for 7 days. Results:The follow-up time ranged from 1 to 2 years. No bone or soft tissue infections were noticed postoperatively. Callus formation appeared in the expected time. Conclusions: The use of absorbable plates and screws, as a means of internal þxation, in the surgical treatment of forearm fractures in children that cannot be treated conservatively, combined with the application of a long cast, provides sufþcient and adequate osteosynthesis. The use of these materials renders a second (extremely distressful for children) re-operation for the removal of metallic implants completely unnecessary.

Purpose: The supracondylar fractures of the distal humerus are the second most frequent fractures of the developing skeleton. Also their immediate and late complications are very often. The aim of this study is to describe their neurological complications.

Material – methods: In our department 178 children were admitted with supracondylar fracture of the distal humerus during the period 1998–2002. Their age ranged from 2 to 16 years of age (the average was 7 years old, 63 girls and 115 boys). Forty-six patients were treated conservatively and 132 surgically. Neurological complications were appeared in 18 patients that had, according to Gartland classification, II and III type fractures. Manipulations for closed reduction had been made to 6 of them. Neurological deficit of the median nerve appeared to 10 patients, of the radial nerve to 6 patients and of ulnar nerve to 2 patients. The treatment of the fractures was surgical (open reduction, internal fixation with Kirschner wires and immobilization with a long arm cast for 4 weeks). The treatment of the neurological complications was conservative (free mobilization of the elbow was followed after the removal of the arm cast and Kirschner’s wires).

Results: The results of the conservative treatment of the neurological complications of the supracondylar fractures of the distal humerus were excellent and the surgical exploration on the injured nerve was not necessary on any patient. The function of the nerves recovered completely in 2–3 months after the elbow’s fracture.

Conclusion: The prognosis on the neurological complications of the upper limbs due to supracondylar fracture of the distal humerus is very good. They are successfully treated conservatively and the surgical exploration on the injured nerve is rarely necessary.

Objectives. The use of bio-absorbable fixation plates and screws, constructed of self-reinforced (SR) polylactic acid co-polymer for internal fixation of forearm fractures in children is described in this study. This type of plates (thickness:1,2 mm) and screws (diameter:2,4 mm) is usually used in reconstructive surgery in the mid-face and craniofacial skeleton.

Methods. Eleven patients (aged 4–12 years old), who had suffered from fractures of the distal third of the forearm (7 cases) and isolated radial fractures (4 cases), were surgically treated in our Department with absorbable fixation plates and screws, during the last 3 years. As close-reduction attempts failed in all these fractures, surgical treatment was mandatory. The general principles of internal fixation were followed in all cases. The internal fixation, with the use of these plates and screws, was reinforced with the application of a long forearm cast for a period of 4–6 weeks. Antibiotics were administered for 7 days post-operatively.

Results. The follow-up time ranged from 12 to 24 months. No case of bone or soft tissue inflammation was noticed post-operatively. Callus formation appeared in the expected time.

Conclusions. The use of absorbable plates and screws, as a means of internal fixation, in the surgical treatment of forearm fractures in children that cannot be treated conservatively, combined with the application of a long cast, provides sufficient and adequate osteosynthesis. The use of these materials renders a second (extremely distressful for children) re-operation for the removal of metallic implants completely unnecessary.

Purpose: Arthrogryposis is a disease of muscular system, which is characterized by fibrous degeneration of muscles that leads to deformed and rigid joints. Aim of this study is to describe the deformities of the lower limbs and their surgical treatment.

Material – Methods: Twenty children (12 boys-8 girls) with distal arthrogyposis were treated in our department during the decade 1992–2002. The deformities of lower extremities were referred to hip, knee and foot. Congenital dislocation of hip joint was noticed in 4 patients that were treated by open reduction, while fixed flexion and adduction deformity was appeared in 8 patients that were treated by release of flexors and adductors muscles of hip. The main deformity in knee was fixed flexion deformity (19 patients), while hyperextension was presented only in one patient. The flexed knee was corrected with release or lengthening of hamstrings. The most frequent foot deformities were equinovarus deformity (17 patients) and fixed flexion deformity of toes (15 patients). Club foot was treated by posteromedial capsulectomy, lengthening of Achilles tendon, release of posterior tibialis and transfer of anterior tibialis in the lateral aspect of foot, while fixed flexion deformity of toes were corrected by release of flexor longus digitorum and palmar aponeurosis.

Results: All patients had postoperative correction of the deformities. Recurrence of the deformities was noticed in all patients after two years. Fifteen patients were re-operated 4 years after the first surgical treatment.

Conclusion: High degree of recurrent deformities of lower limbs is appeared after their surgical treatment, but this treatment is the only one for patients with distal arthrogryposis in order to succeed independent ambulation.

Introduction: The open reduction of C.D.H. (Congenital Dislocation of the Hip) during infancy associated with an incomplete osteotomy of the iliac bone in the roof of the acetabulum with a use of a wedge bone graft are described in this study.

Material and Methods: Ten children with C.D.H. (aged from 5 to 12 months) were surgical treatment under gone during the last 2 years in our department. Eight of them were boys and 2 girls. The left hip joint was involved in 7 and the right in 2 while one patient had bilateral C.D.H.Conservative treatment without success was performed in all patients until their admission in our hospital. The treatment’s method was the same in all the patients. By an anterior approach to hip joint with a Smith – Petersen’s skin incision open reduction of the dislocated hip was succeeded. We had to eliminate the teres ligament, cut the insertion part of the iliopsoas tendon and remove the inverted limbus to achieve reduction of the hip.

An incomplete innomitate osteotomy was followed above to the roof of the acetabulum. A corticotrabecular wedge human bone graft .human in 3 cases or a allograft in 7patients ( 8 hips) were used to reconform the acetabulum.

Results: The follow-up time ranged from 1 to 2 years. Normal range of movements was detected during clinical review. The radiological follow-up findings were shown that the bone roof of the acetabulum and the femoral neck anteversion was reconformed. No avascular necrosis of the femoral head was noticed.

Conclusion: The C.D.H. could be perfectly recostucted during infancy by open reduction associated with a use of a corticotrabecular wedge bone graft.

The type and the location of the fractures of the long bones in children that can be treated by elastic intra-medullary nailing are described in this study.

Fourty-one patients (aged from 5–18 years old) were treated in our department with fractures of the long bones located on the metaphysis or diaphysis (5 on the distal third of radious and ulna ,8 diaphyseal fractures of the forearm ,7 diaphyseal fractures of the tibia ,5 of the distal end of tibia ,6 of the femoral diaphysis,7 on the distal end of femur and 3 on the diaphysis of the humerus).

All operations were performed under radiological control ,to avoid any damage of the growth plates. Tibial , femoral and humeral fractures were fixed with 2 nails whereas forearm fractures were reducted with one nail.

Postoperative immobilization with a long cast was applied in forearm fractures at least for 4 weeks.

The follow-up time ranged from 1–3 years. The following clinical findings were noticed at the examination : skin infection at the point of the nail insertion area (3 patients), limitation of the range of movements at the carpal joint (2 patients).

Radiological findings showed satisfactory callus formation at an early stage in all cases and rotational deformity in 2 femoral obligue fractures due to insufficient stabilization.

According to our clinical and radiological findings the results were excellent in 34 cases and good in 7 cases.

Fractures of the diaphysis or metaphysis of the long bones in children are fully indicated for intramedullary nailing with elastic nails and the postoperative complications are minor when the fractures are not close to the growth plates.

The method is not indicated for comminuted or oblique fractures and fractures – separations.

The aim of this paper is to present our experience from the surgical treatment of lower limb fractures in the developing skeleton with the use of bio-absorbable PLLA implants as a means of internal fixation.

From 1997 until 2002, twenty-three patients (15 boys and 8 girls, ages ranging from 7 to 15 years old, mean of 12 years) who had suffered from 30 lower limb fractures were operated on in our department, with the use of PLLA screws as a means of internal fixation that followed the standard open reduction procedure.

We surgically treated 20 tibial fractures (distal metaphysis:1,medial malleolar:6,distal epiphysis lesions:9,tibial spine:2, lateral tibial condyle:1, tibial shaft:1), 8 fibular fractures (distal metaphysis:2, distal epiphysis lesions:5, fibular shaft:1), one transtrochanteric fracture and 1 patellar fracture.

All patients were operated on under constant radiographic control. A cast was applied, post-operatively, to all patients, for a period of 3–4 weeks. Gradual and assisted weight-bearing and ambulation, was commencing immediately after the cast removal.

All patient’s (with the exception of 1 case of delayed callus formation) post-operative period was completely normal. However, follow-up revealed the development of osteolytic lesions (bone absorption cysts) in 3 of our patients. All lesions were located in the border between epiphysis and metaphysis, at the exact position were the PLLA screws had been placed.

The use of PLLA implants in the treatment of fractures renders unnecessary a second operation for the removal of the osteosynthesis’ material. Nevertheless, we should be quite reluctant when deciding to use the PLLA screws in the treatment of these fractures in the developing skeleton, especially of the lower limbs, were the applied weight bearing forces are quite powerful.