Aim: To evaluate the results of management of Char-cot foot and ankle deformities by the use of the Ilizarov apparatus.

Material-Method: This is a retrospective study of 11 cases (9 patients) aged from 39 to 60 years old (mean 44 years), all suffering from Charcot foot neuroarthropathy. All cases showed established midfoot breakdown. In four cases hindfoot deformity coexisted. Three feet were ulcerated. In six cases the Iizarov frame was applied using complex hinges and closed compression fusions were performed, utilizing the bent wire technique. In five cases the correction of the deformities was performed acutely with the use of percutaneous cannulated screws. In the later cases the Ilizarov frame neutralized the former osteosynthesis method. The Ilizarov device remained attached for 8 weeks, regardless the presence of other osteosynthesis hardware. The Maryland Foot score (MFS) was utilized for objective assessment by the physician and the SF-36 questionaire for subjective assessment by the patient.

Results: A statistically significant improvement in MFS and SF-36 score was recorded. In all cases the aim for a stable and painless extremity was achieved. All patients returned to their previous activities and kept using normal shoe wear.

Conclusions: A lot of references are found in the literature describing failure in the treatment of Charcot foot deformity with the use of internal fixation. This is justified by the poor bone quality and decreased bone density of the diabetic and alcoholic patients. The use of tensioned wires in multiple levels provides adequate fixation in cases where a frame is used solely and safe neutralization where a frame is combined with internal fixation.

Purpose: The results of infected total knee arthroplasty management are studied, in order to evaluate the effectiveness of our treatment protocol, which is based on clinical manifestations of the infection.

Material: 22 infected total knee arthoplasty were studied (9 of them had been send from other hospitals).

Method: According to the clinical manifestations of the infection, patients were treated with one of the following methods: In the first group, 7 patients with primary postoperative infection (within the first 3 weeks after the operation) and with no MRSA pathogen, were treated with surgical debridement, keeping off the wound drainage for a long period and with antibiotic administration for 6–12 weeks. In the second group, 10 patients with late onset of infection or primary infection with MRSA pathogen or acute hematogenic infection with loose implant, were treated with wide surgical debridment, removal of all the materials and revision surgery after a 2–3 months period of antibiotic administration. In the third group, 3 patients with acute hematogenic infection but stable implants 2 to 6 years postoperatively, were treated with meticulous surgical debridement, exchange of polyethylene and administration of antibiotics for a long period. In the fourth group, 2 very old patients with bad general condition, were treated only with antibiotics.

Results: In the first group there is full eradication of the infection and there is no indication of recurrence (F.U 2–6 years). In the second group 8 patients had their infection fully eradicated and 2 patients recurrended 6 and 8 months postoperatively. One underwent arthrodesis and the other is still receiving antibiotics under pathologist directions. In both patients there was a great amount of bone absorption and soft tissue necrosis around the implant. For patients of the third group complete eradication was achieved. Finally, for the 2 patients of the forth group, periods of exacerbation and remission of the infection exist, with good and poor quality of life, respectively.

Conclusions: The treatment protocol that we apply was based on the clinical manifestations of the infection and was successful in most cases. Bone absorption, tissue necrosis and microorganism resistance are bad prognostic factors.

Introduction. We present the results of the management of irreducible dislocation or fracture / dislocation of the elbow using the “Orthofix” external fixator in cases where the condition of the soft tissues was contraindicated for extensile surgical approaches or the internal fixation would not be stable enough to permit safe joint mobilization postoperatively.

Materials and methods. Twelve (12) patients were treated using elbow external fixation,5 with supracondylar fracture and severe osteoporosis and 7 with fracture / dislocation of the elbow and excessive soft tissue impairment (two of them with open fracture). For the patients with fracture, we performed minimal internal fixation using small incisions and minor soft tissue detachments and then we applied the elbow external fixator for the neutralization of the fixation. This permitted the immediate active assisted joint mobilization postoperatively without interfering with the stability of the joint and of the fixation. The same happened for the patients that their elbow remained unstable after reduction of traumatic dislocation, where the external fixation maintained the reduction of the joint. Prerequisite for the safe mobilization of the joint was the application of the external fixation at the center of rotation of the elbow which is the transepicondylar axis, in order to comply with the biomechanics of the joint.

Results. The fixator was applied for a mean of 10 weeks (6 – 16 weeks). All the fractures united and no instability of the joint was noted. The range of motion was between useful limits with lack of extension less than 30 degrees and flexion more than 130 degrees, pronation 60 degrees and supination 55 degrees (mean values). Pin track infection was presented in 3 patients and the treatment was local care and antibiotics. One patient had radial nerve palsy immediately after the operation, who recovered totally after four months without any treatment.

Conclusions. The external fixation of the elbow provides sufficient stability permitting the immediate mobilization of the joint postoperatively and in combination with the minimal soft tissue damage during the operation prevents the postoperative stiffness. It is a safe alternative solution when the condition of soft tissues around the elbow do not permit a thorough open procedure.