PURPOSE: There is an argument in the literature regarding the use of intramedullary nail or the external fixation followed by intramedullary nail in tibial fractures with severe damage of soft tissues, threatened compartment syndrome, open type IIIA fractures and in polytrauma patients. The purpose of this retrospective study was to evaluate the results of non-jointed external fixators as a definite treatment for these type of tibial shaft fractures.

MATERIAL AND METHOD: 86 patients (91 tibial shaft fractures) were treated at the authors’ institute with a non-jointed external fixator. The mean patient age was 35 years (range, 15–80). There were 70 male and 16 female patients. The average time of surgery from the accident was 10 hours. The indications for application an external fixator was: severe damage of the soft tissues in 11 fractures, an incipient compartment syndrome in 12 fractures, open type III Gustilo fractures in 57, and 11 tibia fractures in polytrauma patients. According to AO classification 46 fractures were type A, 32 type B and 13 type C.

RESULTS: The average follow up was 2.9 years (ranged, 1–5 years). The average operative time was 50 min. Complications included: 3 non-unions, 5 delayed unions, 1 malunions, 1 tibia shortening, 3 superficial infections of soft tissues in open fractures, 26 pin infections and 1 osteomyelitis in open fractures. In 2 patients fat embolism was diagnosed while pulmonary embolism was a complication in 2 patients. Deep venous thrombosis (DVT) developed in 5 patients. A re-operation was performed in 11 out of 91 fractures. Change of the method was necessary in 2 out of 91 fractures. The primary callus in 10 out of 91 fractures was due to the stiffness of the unilateral non-jointed external fixators and did not influence the final results. Mean time of fracture union for the open fractures that did not require change of the method nor bone graft was 25 weeks, while for the closed fractures was 18 weeks. The dynamization of the system and partial weight bearing was started at 6 weeks and all the patients had full weight bearing by the 12th week.

CONCLUSION: The unilateral external fixators were the definite treatment in 88 out of 91 fractures. The unilateral external fixators can be used as a definite treatment for tibial shaft fractures in the majority of the cases. Re-operation or change of the method is unusual and must be performed only when there is a delay in callus formation.

Purpose: The purpose of this study was to investigate the results of the surgical treatment of intra-articular calcaneum fractures according to the Ilizarov method or in combination with mini open reduction.

Materials and Methods: In the period 1996–2003, 17 patients with 19 calcaneal fractures (14 men and 3 women) were surgically treated by the Ilizarov method. 2 patients had calcaneum fractures on both sides. 15 fractures were caused by fall, whereas 4 of them by car accident. Fractures were classified according to the Saunders CT classification: 12 fractures were type II, 5 type III and 2 type IV.

The device consisted of two rings applied at the distal tibia and a foot plate. The closed reduction of the calcaneum fracture was achieved with the use of a 1,8 mm pin in the posterior side of the calcaneum body, which improved the Bohler angle, along with the Gissane angle. In cases where necessary a short approach to the posterior subtalar joint was implemented for the reduction of the articular surface. The patients were encouraged to partially load their foot from the 1st postoperative day.

Results: Results were evaluated according to the Maryland Foot Score. 7 fractures gave excellent results, 10 gave very good results, 1 fracture good result and 1 poor result.

Conclusion: Traditional methods of open reduction and internal fixation of calcaneum fractures are usually a contraindication in cases of severe fractures and severe soft tissue damage. According to several authors the use of pins in the reduction of fractures is comparable to the open reduction.

From this study the Ilizarov method was found to be particularly safe and can be used in cases associated with severe soft tissue damage offering a quick surgical treatment.

A significant number of hallux valgus is associated with valgus deviation of 2nd, 3rd and 4th toes. We recommend correction of the valgus deformity of all four rays simultaneously., because recurrence of the hallux valgus is very frequent if only the first ray is realigned.

From 1978 to 1990 a series of 236 feet were operated upon for hallux valgus deformity using a distal osteotomy of the first rnetatarsal. These cases were followed up for a mean of 6, 1 years and showed that the recurrence rate was as high as 28%. Our observation was that, in the majority’ of cases, recurrence of the deformity occurred in those feet in which hallux valgus was combined with valgus deformity of the lesser toes due to varus deviation of the corresponded metatarsals. From 1990 to 1998, another series of 386 feet were operated for hallux valgus. In more than one third of them (142 feet in 96 patients) hallux valgus was associated by valgus deformity of the 2nd, 3rd, and 4th toes. These cases were operated using a distal osteotomy of the first rnetatarsal combined with osteotomies of lesser metatarsals aiming not only to face metatarsalgia, but to correct valgus deformity of the lesser toes simultaneously. These patients were followed up for a mean of 4.8 years.

The results were excellent in 73 feet, good in 47, fair in 17 and poor in 5. The recurrence rate dropped to 7%.

If hallux valgus is combined with valgus deformity of the lesser toes, correction of only the first ray creates a gap between first and second toe. Consequently there is no blocking effect toward valgus deviation of the great toe due to the gap remaining between the first and second toe.

The above combined procedure seems to give better results with low recurrence rate in comparison with the results of single correction of the first ray.