The aim of this study was to compare the clinical and radiographic results of a interlocking nail with a releasing antibiotic core of PMMA with a standard interlocking nail for the treatment of open fractures of the tibia.

Prospective, controlled trial, randomized by surgeon preference, including 30 patients with open fractures of the tibia. Patients were divided into two groups according to the treatment method: Group I (STD), consisting of 14 patients treated by delayed interlocking standard nailing, after an antibiotic treatment and bed rest. Group II (SAFE) comprising 16 patients treated with a interlocking intramedullary nail with a core of PMMA cement with antibiotics, 5 of which had a temporary stabilization with an external fixator. Antibiotics chosen to impregnate the SAFE nail in cases without prior bacteriology were vancomycin (2gr) and flucloxacillin (2gr)

There were no statistically significant differences between groups with respect to demographic data (age, gender), type of fracture and degree of exposure (p>0,05). The mean follow-up was 2.4 years (5 months to 4 years) for the STD group and 2.1 years (4 months to 3 years) for the SAFE group. 15 of the 30 patients had positive bacteriology, including 13 cases with aggressive agents predominating Enterobacter, Enterococcus, Pseudomonas and MSSA groups.

The infection rate after nailing was 43% (6/14 patients) for the STD group and 6% (1/16 cases) to the SAFE group, a statistically significant difference (p=0.02)

The mean time to union was 7.5 months (3 months to 1.5 years) for the STD group and 4.5 months (2 months to 8.5 months) for the SAFE group, a statistically significant difference (p=0.02). The complication rate was 64% (9/14) in the STD group and 25% (4/16) for the SAFE, including a infection rate of 43% in the STD group and 6% in the SAFE group, a statistically significant difference (p=0.03).

We observed that the open fractures of the tibia treated with SAFE nails presented a statistically significant lower rate of infection, faster consolidation and fewer complications compared with treatment with deferred standard nails. Compared to similar devices available on the market, it has the advantage of allowing selection of the type and dose of antibiotics, it allows fixation with screws of intermediate bone segments, it shorten the period of hospitalization and treatment time, reducing the costs associated with the treatment of this pathology

The goal of this paper is to compare the results and complication namely infection rates, of the techniques of Standard Ilizarov lengthening, lengthening over nail (LON) and lengthening then nailing (LTN) utilizing a standard nail (STD) and a special nail with a core of cement releasing antibiotics (SAFE).

In a first study done between 1993 and 2008, we have compared 25 patients treated with lengthening with a Ilizarov frame (LIF) with 26 patients where a standard nail was used to do a lengthening over nail technique (LON).

From 2009 and 2012 we have utilized the SAFE nail in 17 patients to perform lengthening over nail (SAFE-LON) and lengthening then nailing (SAFE-LTN) techniques. 7 patients had a pseudarthrosis, 5 a malconsolidation with shortening and or axial deviation and 5 a bone loss after infection of total knee replacements.

We used a lengthening over nail in 4 cases, a lengthening and axial correction then nailing in three, acute compression and proximal lengthening then nailing in five patients and knee arthrodesis and femoral or tibial lengthening then nailing in another 5 cases. We have used a Ilizarov frame in all cases.

We found that with LON technique, the external fixation time was 3 times lower, promoting the recovery of full range of knee mobility in half the time, comparatively with LIF technique, with statistically very significant differences.

We found a rate of 30% of intercurrences on the LON group and 24% in the Ilizarov, difference that was not statistically significant. 3 patients got bone infection after LON technique, a rate of 11.5%. Late consolidation and fracture of regenerate appeared only in the Ilizarov technique group, whereas in the LON technique we had 3 cases of premature consolidation of the regenerate.

In the SAFE-LON and SAFE-LTN techniques utilizing the SAFE nail with antibiotics, we found a decrease of the overall intercurrence rate from 30% to 12% and namely, bone infection was cured or didn't appeared after nailing with this new device in all cases.

LON and LTN techniques are somehow more demanding, but much more comfortable for the patient, which need to carry the frame for less time, It permits an earlier return to activity, about half the time, it controls better delayed regenerate and its fracture does not increase complication rate and costs of treatment and prevents infection when converting from external to internal fixation.

The aim of this paper is to describe the technique and evaluate the effectiveness of the RIA system in the first cases of bone loss treated by the authors with this technique.

Between January 2010 and January 2011, ten patients were treated with an average age of fourty six years, with infected bone loss as a result of open fractures in various bone segments, with multiple failed treatment attempts, including three humeri, four femurs and three tibiae. The average size of the initial bone loss was 4 cm, varying from 1 to 8 cm. In 4 patients it was used simultaneously a Ilizarov apparatus with acute compression of the focus, in two patients a Ender pin and monolateral external fixator, three other cases with a SAFE nail with core with antibiotics and in one case an osteosynthesis with a plate and screws. The RIA was introduced with a percutaneous technique with a one pass drilling. The graft thus collected was mixed with appropriate antibiotics and aplied at the defect. The volume of the harvested graft, complications of the donor and recipient and the final results was recorded.

The review showed that the average volume of graft was 60 cc, from 20 to 90 cc. In two female patients older than 70 years with osteoporosis, insufficient bone of poor quality was obtained. Problems included a case of iatrogenic fracture of the donor site, due to poor surgical technique and a case of relapse of the nonunion. Regarding the effectiveness of grafts extracted with the RIA system, 90% of the cases achieved consolidation in average of 5 months after grafting, range 3–9 months.

This short experience with the RIA system showed that it is an attractive method allowing a rapid removal of a large volume of bone graft with a minimally invasive approach and a short learning curve. It is not indicated in elderly patients with osteoporosis and those with a narrow medullar canal less than 11 mm. Special attention must be done to the need to choose a drill no larger than 1 mm of the diameter of the isthmus, to do a single entry point and with only one drill passage to prevent the weakening of the donor site.

The pelvic ring unstable disruptions are by itself life threatening and its stabilization is one of the priorities. On the other hand the surgical approach and internal fixation of this type of injuries represent a long and aggressive intervention, with high blood loss and complications. By these reasons a methodology that not only allows a precocious and less aggressive intervention with the possibility of stabilization of the posterior and anterior elements of the pelvic ring, and also the possibility to introduce postoperative corrections is indicated.

In January 1999 we introduce in our Unit the treatment of pelvic ring fractures and disruptions with the association of Ilizarov frame and minimal invasive internal fixation. It is our intention to present the preliminary protocol of treatment and its results.

Until 2002 we have treated 97 cases of pelvic ring disruptions. We have treated surgically 26 patients. From those, 10 cases were of open book and closed book injury type (2 pubic platting, 4 static external fixator and 4 dynamic Ilizarov frame) and 7 cases were of vertical shear injury type (4 pubic plating and sacro-iliac bar/ screw, 3 dynamic Ilizarov frame).

Results were evaluated with our own protocol. Infection rate compromised final results of the cases treated by ORIF (4:6) and reduction was poorer with the static external fixator (2:4). Treatment with Ilizarov frame revealed 5 good results and 2 fair results.

The authors conclude that even with a limited number of patients and follow-up, the use of the dynamic Ilizarov frame with a minimal invasive approach, showed to be a simple, fast and efficient method for the handling of serious fractures and disruptions of the pelvic ring, allowing a good stabilization of the anterior and posterior components, permitting the “fine tuning” in the postoperative period, without major complications.