Introduction: High tibial osteotomy is an established procedure for the mid-term treatment of unicompartmental osteoarthritis of the knee, especially in young patients. Nevertheless, its performance at the proximal end of the tibia, close to the site of insertion of the extensor mechanism of the knee, might produce anatomic alterations of the latter, which, in turn, could influence the final result.

Aim: The purpose of the present retrospective study is the radiologic evaluation of the anatomic changes of the extensor mechanism of the knee, caused by high tibial valgus osteotomy (closed-wedge step osteotomy, with internal fixation).

Material – Method: For this purpose we studied the X-rays of 44 kness (pre-op, p-op and 1 year p-op) that had undergone the above procedure. The assessed variables were the horizontal and vertical shift of tibial tubercle as well as the position of the patella (patellar vertical height, Linclau, Caton).

Results: We didn’t find any statistically significant difference of the postoperative position of the patella with respect to the preoperative one (p=0.88), whereas there was definite proximal and anterior shift of the tibial tubercle in a statistically significant degree (p< 0.01) with respect to the preoperative situation.

Conclusions: The certain type of high tibial osteotomy seems to impart an unloading effect on the patellofemoral joint (due to the anterior shift of the tibial tubercle). On the contrary, the vertical shift of the tibial tubercle seems to have no effect to the postoperative position of the patella.

Introduction: Modern nailing techniques are the gold standard in the treatment of multifragmentary fractures of femur. Nevertheless, the use of plate and screws, in accordance with the principles of biologic fixation, remains an effective alternative.

Aim: The purpose of this retrospective study is the evaluation of the results of biologic fixation, with plate and screws, of multifragmentary femoral fractures.

Material – Methods: Our material consists of 32 multifragmentary subtrochanteric and diaphyseal femoral fractures that were treated in our department, between 1992 and 2000, in accordance with the principles of biologic fixation with plates and screws. All fractures were reduced indirectly with traction on the fracture table without any direct manipulation at the comminution zone. Emphasis was given to the restoration of the proper length, axial and rotational alignment of each fracture. The exposure of the femur was done proximally and distally to the fracture site through two separate incisions of the vastus lateralis near its insertion to the linea aspera. There was no direct exposure of the comminution zone. The fixation was done with a long bridge plate, without the use of interfragmentary screws. No iliac bone graft was used in the primary procedures.

Results: Twenty nine of the fractures (91%) united, without serious complications, within 3–5 months. One fracture failed to unite and had to be operated upon with a new plate and screws and additional bone grafting. In another one, the plate was bent, due to early weight bearing, and had to be exchanged with a nail. The third fracture united in a mild varus position, as some of the screws were broken and the plate was mildly bent.

Conclusions: The bio-“logic” use of plate and screws in the treatment of multifragmentary fractures of femur gives excellent results, comparable with those of the modern nailing techniques.

Introduction: Heterotopic ossification around the tip of intramedullary nail is a well-known complication of the nailing technique, since the time of Kuntscher. Nevertheless, little attention has been given to it in the current literature.

Aim: The evaluation of the incidence, clinical significance and possible risk factors of this complication after intramedullary nailing of femur with reaming.

Material – Method: For this purpose we studied the X-rays and medical charts of 30 patients who had undergone the above procedure at the Orthopaedic Departments of both Institutions mentioned above, between 2000 and 2002. The preoperative diagnoses were diaphyseal fracture: 13 patients, subtrochanteric fracture: 7 patients, refracture of femur: 1 patient, non-union: 5 patients, imminent fracture (due to intraosseous lesion): 2 patients, failure of previous fixation: 2 patients. In 18 cases the G.K. nail was used, whereas, in the remaining twelve, the long gamma nail was used. The patients’ follow-up ranged from 6 to 18 months (mean: 11 months). The presence of heterotopic bone around the proximal tip of the nail was graded according to the grading system of Brumback et al.

Results: In 12 patients (40%) there was no development of heterotopic bone around the proximal tip of the nail. In 14 patients (47%) minimal and moderate grade of heterotopic ossification was developed (grade I and II). Finally, in 4 patients (13%) there was significant heterotopic bone formation (grade III). None of the above patients presented with any significant limitation of ipsilateral hip joint motion. There was no correlation between type of fracture, type of nail fixation, presence of concomitant injuries, nail prominence above the tip of greater trochanter and the formation of heterotopic bone. The only positive correlation was between male sex and the presence of heterotopic ossification.

Conclusion: Heterotopic ossification of minimal and moderate grade is a common complication of the technique of intramedullary nailing of femur, without any further clinical significance. The formation of heterotopic bone of significant degree in the hip region, though it does not results in serious clinical problems for the patient, it will surely make future extraction of the nail difficult.