Purpose: To assess the extended trochanteric osteotomy approach, used for revision of hip replacement.

Material – Methods: Between January 1998 and December 2002, sixteen (16) hip replacement revision procedures were performed on 16 patients, (10 male, 6 female), with extended trochanteric osteotomy approach. Average age was 67 years (52–79).

Nine (9) procedures involved the femoral stem only, and seven (7) both components. Six (6) stems were fixed with cement and ten (10) without.

In all cementless cases, fixation of the stem in the medullary canal was achieved for at least 4 cm below the osteotomy level. The length of the stem beyond the osteotomy was three times the width of the canal.

The length of the osteotomy varied from 12 to 18 cm (av. 14 cm), and the length of the inserted components ranged from 210 – 280 mm (av.225 mm).

Results: Union of the osteotomy was achieved in all cases from 4 – 9 months (av 5.5). There was no intra-operative or postoperative fracture. No dislocation or infection was recorded. Two prostheses presented sinkage of 1 and 1.5 cm respectively. So far no patient has been reoperated in the revised hip.

Conclusions: The extended trochanteric osteotomy approach for hip replacement revision, offers excellent view of the femoral canal and facilitates the removal of the prosthesis, while the complications due to approach are minimal.

Purpose: The evaluation of the results of intramedullary nailing of open fractures of tibial shaft, which have been initially treated with external fixation.

Material & Method: Between 1997–2003, in 58 open fractures of tibial shaft (Gustillo type II & IIIa), the initially applied external fixation was replaced by an intramedullary nail type Russell-Taylor or Grosse-Kempf, either due to delay in union progress or due to frame‘s loosening. The conversion of external fixation to intramedullary nail was performed between 12th–15th week (average: 14th week), in two stages (1st stage: removal of EX.FIX, 2nd stage: insertion of I..N); with 13–22 days interval between the stages. In all cases, no elements of infection were noticed. In 45% of the patients bone grafting was performed at the time of nail‘s insertion. 37 patients were men and 21 were women, aged 19–52 years old (average: 31,7yrs). All patients were treated by the same surgical team and followed-up routinely.

Results: Union was achieved in 85% of the fractures, usually between 16–23 weeks (average: 18,7 weeks) from nail‘s insertion. In 7 cases, another operation was needed. Bone grafting in five, exchange of nail in two. Neither infection nor DVT was noticed. 82% of patients started sociallizing within 4 weeks, while 79% returned to pre-injury activities.

Conclusions: In cases that the union progress of the externally fixed open fractures of tibial shaft is not satisfactory; the conversion of external fixation to intramedullary nail seems to be a reliable option. The key points for the success of the method are timing and conditions of that conversion.