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 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.

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.

Abstract: The effect of a modified Boston Brace with antirotatory blades upon the fate of idiopathic scoliotic (IS) curves, mainly right thoracic with a compensatory left lumbar, is studied. This report refers to curves within the generally accepted range of Cobb angle (20° – 40°) appropriate for conservative treatment.

Method and Material: Out of 166 children suffering IS with Cobb angle > 10°, 67 (61 girls, and 6 boys), having a mean follow up 2,3 years (4 months to 7 years), were studied. A brace of Boston type with antirotatory blades was applied in 36 scoliotic children. The curve type was: 18 thoracic (T) right (rt) + Lumbar (L) left (lt) in children with a mean age 13,1 years, 3 T lt + L rt in children with a mean age 16,3 years, 7 T rt in children with a mean age 13 years and 8 thoracolumbar (TL) rt curves in children with a mean age 12,1 years. Full documentation during the FU had 23 out of the 36 children with 14 T rt + L lt, 1 T lt + L rt (15 in total – double curve group), 4 T rt (thoracic group) and 4 TL curves (thora-columbar group). Traditionally deterioration (increase) or improvement (decrease) of a curve is considered a change of 5ï Cobb compared with the initial reading.

Results: In the 15 double curve group children the mean FU was 28 months. In this group 5 curves were improved, 6 remained stable and 4 were increased. For the 4 thora-columbar curves with a mean FU 8 months, 3 remained stable and 1 improved. For the 4 thoracic curves with a mean FU 9 months, 2 were stable and 2 improved. During the final FU of the above 23 scoliotic children, when the assessment of Cobb angle was made with children out of the brace, 8 curves were improvement, 11 remained stable and 4 deteriorated (one patient out of 4 (4,3%) was operated upon). All the deteriorated curves were double (T rt + L lt). When the assessment of Cobb angle was made with children in the brace, 10 curves were improved, 12 remained stable and 1 deteriorated

Discussion: The brace treatment affected more the double curves while single curves remained unaffected. Rotation remained unchanged in all curve types except in the lumbar component of double (right thoracic-left lumbar) curves. A composite spiral trunk rotator muscle has been proposed, (consisted of the ipsilateral scapular elevator and rhomboid, the anterior serrated, external oblique and contralateral internal oblique abdominal muscle, (Benninghoff 1985, Wemyss-Holden 1990), which is considered that have an effect on the trunk rotation during gait. Asymmetry of one or more constituent muscles creates scoliosis. These findings are consistent with the view that neuromuscular factors are responsible for the initiation of idiopathic scoliosis. The antirotatory blades of the brace are acting upon the above described composite spiral trunk rotator muscle blocking the deterioration of the scoliotic curve or improving the double curves thus supporting the above aetiologic view. In conclusion the conservative treatment using this brace is beneficially affecting the natural history of the IS in children 12–15 years of age.