During the last decade intramedullary nailing of the humerus became a more popular operation. Modern nails are successfully used in treatment of fractures involving proximal, distal and middle shaft humerus, as well as pseudarthrosis and pathological fractures. Minimal invasive insertion lessens the complications from neurovascular and soft tissue damage without significant delay in healing period in comparison with compression plates. Aim of our study is to present our experience and the clinical outcomes of this method.

Material and Methods: Between 1998 and 2006 50 patients (52 Fractured Hunerus) were treated in our department. The mean average age was 35 y.o. (18–55 y.o.) and the operation time was 2.5 days after the injury. All fractures were acute (Unstable, comminuted, in both limps or polytrauma patients). In 25 cases we used the unreamed Synthes nail (22 Cases Antegrade insertion and 13 Cases retrograde insertion). In 27 cases we used the T2 or Polarus reamed nail (23 cases Antegrade insertion and 4 cases retrograde insertion). The mean duration of the surgery was 1.3 h.

Results: The healing time was 12.5 weeks (8–16) and no preudarthrosis occurred. There were 4 radial nerve palsies (2 primary – 2 after operation) that were neuroapraxia and resolved in almost 6 weeks. One antegrade nail (Polarus-reamed) was malpositioned and applicated again and in 2 retrograde nails the posterior cortex of the fossa was fractured (in one case we changed fixation method-plates). No infection occurred. In some patients full abduction, elevation and external rotation achieved in 6 weeks and in some others after 3 months.

Conclusions: Intramedullary nailing of the humerus is a very good solution of fracture treatment, especially in multiple trauma patients. In good hands offers good fracture alignment and adequate stability. Postoperative rehabilitation period is short, uneventful healing is common and almost excellent results always appear.

Aims: The evaluation of the results of surgical treatment of humeral shaft fractures with intramedullary nailing (I.N.) after twelve month follow up. Methods: This study involves 18 patiens with fracture of the humeral shaft, treated operatively with I.N. of A.O. type, in a 4-year period (Jan 1998- Feb 2001). 17 were available to follow up examination. 16 men and 2 women with average 25 years of age were followed for a mean period of a year. Indication for the prosedure was the inability to maintain closed reduction. In 11 patiens the nail was inserted below the great tuberosity. The rest underwent retrograde I.N. All nails were proximally locked and x- were distally locked too. Closed reduction was achieved in 15 cases. The nail was inserted manually (with no hammer use) in all cases. Results: Clinical and radiological healing was apparent in all fractures between the 4th and 6th p.o. month. Full active motion was achieved in 8th p.o. week. There were 3 p.o. radial nerve palsies. Two of them resolved six months later. Residual pain of the shoulder was noted in one case. Conclusions: Nailing of the humeral shaft fractures using AO-type nail is a reliable method of treatment, giving very good final results. Advantages are: minimal surgical trauma, less blood loss, shorter operative time and earlier mobilization.

Aims: To present the experience of our department in the treatment of the closed shaft tibial fractures using the unreamed nail of Orthoþx. Material- Method: Between 1991–2001 we treated 180 closed fractures. There were162 men and 18 women. The preferred method of stabilization is unreamed nailing. Results: The average follow-up was 38 months. 165 of the fractures that were treated with uiin, healed in the proper time (3–6 months). The rest of them did not have callus signs and we revised the nailing using reamed nails. No screws and nail failure was observed. Three deep venous thrombosis, healed with no further complications. 65% of our patients were able to return to their usual activities within 4 months and the rest between 4–8 months. 15 non-unions and 2 malunions occurred and were treated with correction and reamed interlocking nailing. P.W.B. allowed for fractures type A and B according AO classiþcation from the beginning. F.W.B. allowed at mean 3 months. Conclusions: Immediate stabilization of the close fractures of the tibia using uiin (Orthoþx device): advances the healing of the fractures, decreases hospitalization time, helps early return to social activities, is easier for the surgeon, easier to place the distal locking screws, requires less operative time and less radiation. We did not þnd this method inferior to reamed interlocking nailing.

Aims: The purpose of this study is to evaluate the results of intrerlocking nailing (ILMN) as a þnal treatment of non septic femoral shaft pseudarthrosis. Material- Methods: The study involved 35 patiens suffering a femoral pseudarthrosis who underwent þxation with ILMN as a þnal treatment between 1999–2001. 31 male and 4 female individuals with a mean age of 25 years were followed up postoperatively for 24 months. Primary treatment had been done with plating in 29 pts, external þxation in 2 pts, AO nail in 3 and R-Tnail in one patient. The period between primary and þnal treatment ranged from 9 to 46 months. After the removal of primary þxation components all patients treated with ILMN for þxation but only 8 of them underwent autogenous bone grafting. Dynamic ILMN has been done in 32 out of 35 patiens (91%)Results: Clinical healing and radiological callus formation was apparent in all patiens after a period of 18 to 26 weeks (average time 20w). Serious complications were not observed. Light stiffness of the knee joint was noted in one and residual pain in distal metaphysis in two cases. Conclusions: The sort- term results from the use of LIN in treatment of femoral shaft pseudarthrosis have been more than encouraging. We recommend the reaming technique and the dynamization of the nail for optimal outcome. Bone grafting is not necessary.

Aims: The purpose of our study is to present pitfalls and complications of intramedullary nailing in the treatment of femoral fractures and to examine their effect in bone healing. Methods: 180 patiens, suffering a femoral fracture, underwent primary intramedullary nailing and were followed up from 1996 to 2000 in our clinic (mean 16 months). 163 were men and 17 were women with a mean age 28 years. Four types of implants were used including AO, R-T, GK reamed nails and AO-PFN in 15 patiens who suffered also a unilateral intertrochanteric fracture. Results: Almost all fractures (98%) healed successfully. Insigniþcant complications and pitfalls happened in 20% of patients but did not inhibit bone healing. They concerned predominantly the size of the nail, the entry point, the valgus of varus insertion of the wire guide and the position of nail and screws. Serious complications were: one case with ARDS, one with fat embolism, 3 non-unions, 7 malunions, 2 with positive Trendelenburg sign and 15 cases with knee joint stiffness. Conclusions: Pitfalls and complications during intramedullary nailing procedure for the surgical treatment of femoral fractures do happen. Usually they are of less technical importance and have no effect in bone healling.

Aims: The purpose of this study is to examine the rate of pseudarthrosis and possible factors involving the healing of the fracture after interlocking nailing (ILMN) as treatment of femoral shaft fractures. We examined the type of the fractures, surgical pitfalls, complications, if the patients smoked cigarettes or tooled other medications and drugs. Methods: Between 1996–2001 we treated 165 patients who had 180 fractures of the femur shaft. In 4 out of our patients primary have treated using interlocking intramedullary nailing we occurred pseud-arthrosis. We have use AO nail in 3 patients and R-T nail in one patient. After the removal of primary nailing þxation components all patients treated with ILMN wider nail and autogenous bone grafting. The preferred method of stabilization is reamed interlocking intra-medullary nailing using AO Nail. Results: Radiological callus formation was apparent in all patients after a period of 18 to 26 weeks (average time 20w). Serious complications were not observed Stiffness of the knee joint was noted in one and pain in distal metaphysis in two cases. Conclusions: The sort-term results have been more than encouraging. We recommend the reaming technique and the dynamization of the nail for optimal outcome. Bone grafting is necessary according to our opinion. Several factors involved the healing of the femoral shaft fracture, after interlocking intramedullary nailing as primary treatment.

Aims: The aim of this paper is to present our experience in the treatment of comminuted fractures of the distal humerus. Our surgical target was to reconstruct all three edges of the triangle to achieve the best functional result. Methods: In a period of 5 years, 28 patients who suffered a comminuted fracture of the distal humerus were operated with open reduction and internal fixation. Those were 21 males and 7 females with a mean age of 25 years. According to AO/ASIF classification there were 5 patients with A1 fracture, 3 pts A2, 6 B2, 8 B3, 3 C1, 1 C2 and 2 pt C3. In 25 patients was applied posterior approach after transolecranon osteotomy and lateral approach in the rest 3 patients. All patients were evaluated clinically and radiologically. Results: The mean time of follow up was 12 months. In 7 patients full range of motion was achieved, in 8 functional range of motion and in 4 limited but in functional range. The mean range of elbow flexion – extension arc was 115°. Complications included postoperative paresis of ulnar or radial nerve, ectopic bone formation and material failure. Conclusions: The comminuted intraarticular fractures of the distal humerus demand careful preoperative planning, extensive but atraumatic exposures and the use of the appropriate fixation materials for each case. Low complication rate and excellent functional results are ensured.

Purpose: We present our experience in recurrence of anterior knee instability after reconstruction of anterior cruciate ligament.

Material-methods: In our department, from 1996 to 2002, 359 patients with average age 24.2 years were treated for anterior knee instability. 159 patients underwent acl reconstruction with the use of bone-patellar tendon-bone graft, 188 pts with hamstrings tendons and 19 pts with quadriceps tendon-bone graft. During the follow-up period, 12 cases with recurrence of anterior knee instability came up. In nine patients BPTB graft was used and in three hamstrings. Five patients suffered a sports accident while seven presented a progressive graft laxity. At the revision, hamstrings were used in nine patients and quadriceps tendon-bone graft in three pts.

Results: All patients had a follow-up period free of complications, were subjected to the same rehabilitation program and returned to their usual activities into the expected for the particular operation period.

Conclusion: The revision of ACL reconstruction demands careful preoperative planning, organized surgery with capability to apply alternative solutions and understanding of the patient’s demands.

Our aim is to study the epidemiology of delayed union and pseudarthrosis of femoral fractures which were treated in our clinic with intramedullary nailing technique and simultaneously to speculate for the application of the method and for the reasons which might guide to these complications.

During a 36 month-period, from 1999 to 2001, 46 patients suffering femoral shaft fractures were treated in our clinic. They were 43 men and 3 women and their average age was 22.8 years. Twenty-eight fractures were in the right leg and 18 in the left. All patients underwent primary closed intramedullary locked nailing with AO type of nail, except 4 patients who also suffered a unilateral intertrochanteric fracture and were treated with AO-PFN nail. Reaming was done in 33 cases. No condition or disease able to inhibit fracture healing was observed. All patients were operated in the first three days after submission by the same team of surgeons. Thirty patients underwent static intranaedullary locked nailing and the rest dynamic from the beginning.

The average time of post-operative follow up, clinical and radiological, was seven months. Thirty-three fractures were healed successfully in six months (mean: 4.2 months). In 10 cases delayed union was observed (mean: 7.2 months) and in the rest three pseudarthrosis. The last group underwent revision of the intramedullary nailing with an AO nail of greater diameter. Reasons for delayed union (21, 74%) and pseudarthrosis (6, 52%) are considered: a)soft tissues enclosed between the bony segments, b)lated nail dynamization, c)factors concerning the technique.

Undoubtfully, closed intramedullary locked nailing is the method of choice for the surgical treatment of femoral fractures. However, fracture healing sometimes exceeds the usual period of 4–6 months. Unfortunately, whereas infrequently, the surgeon also faces pseudarthrosis which is a difficult to solve problem.