To show the role and effectiveness of semi-constrained total elbow arthroplasty in restoring elbow function in severe, irreversible post-traumatic osseous and chondral injuries.

Eighteen patients, aged 19–80, 11 male and 7 female, suffering from serious, irreversible anatomical and functional lesions of the elbow joint due to previous severe untreated or inadequately treated fractures (T-type transcondylar, trochlear-condylar, open fxs with large bony defects, severe osteochondral, heterotopic ossification in ICU fracture patients). Postop follow up was 9–57 months.

All patients were treated with modular, cemented, semi-constrained linked total elbow arthroplasty. A functional brace was used post-operatively, and motion was permitted on the 3rd post-op day. The patients were allowed a full range of motion at 1 week post-op and they were subjected to vigorous physiotherapy.

Post-op results were evaluated by using Mayo, DASH, quick-DASH scores and measuring grip strength and range of motion. Our results ranged from satisfactory to excellent in 16 patiens, with good strength and wide motion arc (with up to 15o extension-flexion deficit). One old female patient suffered a severe cerebral stroke with a bad outcome. In another young male patient the motion arc reached only 40% of the normal (spasticity, ICU patient with brain injury).

Semi-constrained linked total elbow arthroplasty proves to be an effective method of treatment in severe, irreversible, intraarticular post-traumatic elbow injuries with chondral destruction and grave functional deficit, provided the proper technique is employed and a vigorous rehabilitation program is followed.

We prove the importance of the complete osteoligamentary elbow reconstruction and the usefulness of the liga-mentoplasty by palmaris longus combined with other procedures in complex elbow unstable injuries.

17 patients aged between 17 and 72 suffered elbow luxation or subluxation with rupture of the medial collateral ligament, associated with:

Fracture of the radius head,

In 3 compaound injuries we had open fractures with Brahial artery lesion, Ulnar nerve pulsy, radial nerve laceration, Brahial plexus injury.

The lesions happened between 2 hours and 2 yrs pre-operatively, caused to work accidents or to traffic accidents with a follow up between 8–62 months. 10 of the injuries were operated almost in emergency by ligamen-toplasty with palmaris longus, coronoidal process fixation with screw or ancor, radial head osteosynthesis or prosthesis. The vascular injuries urgently operated while the nerve lesions left for secondary repair. A functional splint was applied postoperatively, initially fixated between 110–85 degrees. The splint removed 2 months postoperatively, while full rang of motion obtained.

We performed both Mayo clinic, DAS scores and grasp strength force and Range of Motion measurement evaluation procedures

Satisfactory to excellent results have been obtained in 11 cases with stable joints and range of motion with 20 degrees extension-flexion deficit while in I case the instability persited, in another one arrived 50% of the normal range of motion.

The complex elbow injuries with ligamentary instability are effectively treated if except fractures we always repair The medial-anterior ligaments lesion with liga-mentoplasty and ancors.

Aim: We prove the importance of the medial ligamentary system of the elbow for its stability and the usefulness of the ligamentoplasty by palmaris longus tendon as reconstructive technique.

Methods and patients: 9 patients aged between 17 and 58 (17,18,28,32,35,38,40,56,58,), 6 male, 3 female suffered the following injuries:1)elbow luxation or sub-luxation with rupture of the medial collateral elbow ligament, associated with: 1)Forearm bone fractures, 2)Ulnar nerve pulsy, 3)fracture of the coronoidal process, 4)Fracture of the radius head, 5)fracture of the humerus with radial and musculocutaneous nerve pulsy. The lesions happened since 2 week, 2 month and 2 yrs respectively. The 17 yrs old young man was injured during a weightlifting championship game and the next 4 suffered traffic and work accidents, while the 18 yrs old last one suffered an iatrogenic ligamentary lesion, the rest of the lesions have been caused to work accidents or to motor vehicle accidents

All patients were operated by ligamentoplasty with palmaris longus by medial incision, fenestration of the medial epicondyl and olecranon and transoseus pivoting of the palmaris longus which was enforced by 2 anchor sutures.

An elbow flexion-extension functional splint was applied postoperatively, initially fixated between 110–85 degrees. The splint was removed 2 months postoperatively, while full rang of motion has been obtained.

Results: Follow up was between 6 and 18 month. The 16 yrs old boy return in full sport activity and obtained at the elbow joint full range of motion. the second –young man-patient presents an extension defect of 15 degrees and the 56 yrs old women has a 25degreed deficit of both extension and flexion but she continues the therapy program.

Conclusion: The medial ligamentary system lesion with elbow instability must be repaired by medial ligamentoplasty and the well done technique followed by correct therapy program improved results.

Background: We presents the axial and via perforator vascularised flaps for covering lower limb posttraumatic, septic and diabetic necrosis.

Methods and patients: During the past 4 years we operated 23 patients, 20 males and 3 females with posttraumatic or septic lower limb necrosis: two of the external maleolar area, 6 of the dorsal foot, three of the Achilles tendon area, 2 anterior lower tibia, 4 of the calcaneal area. Osteomyelitis was present in 6 cases (tibia, metatarsals, calcaneus)

All traumatic cases happened almost 2 weeks before operation except three which caused between 2 and 6 months earlier. In the 2 diabetic cases the lesion appeared between 3 and 5 month ago.

We have performed: 9 sural flaps, 5 perforator-posterior tibial artery flap, 1 medial plantar, 4 based on distal perforators of the peroneal artery, 1 Saphenous, 2 muscular flaps.

All patients were between 17 and 81 years all and the follow up between 8 month and 2 years. Everywhere before the flap we performed surgical debridement.

As supplementary combined reconstructive technique we performed: 1. Mega papineau technique, 2. Bone filling, 3. Distraction osteogennesis, with spatial Taylor frame.

Results: We covered successfully the defects, with satisfactory aesthetical results, while the functional ability was not compromised.

Results: The above flaps have been proved effective for covering the lower limb defects.

These flaps are better tolerated by the patient than the traditional techniques and safer, less demanding and faster to perform than the free tissue transfers.

The axillary nerve injuries most commonly are observed after trauma such as contusion-stretch, gunshot wound, laceration and iatrogenic injuries. Two of the most commons causes seem to be the glenohumeral dislocation and the proximal humerus fractures. The axillary nerve may sustain a simple contusion, or its terminal elements may be avulsed from the deltoid muscle. Compressive neuropathy in the quadrilateral space also has been reported (quadrilateral space syndrome, Calhill and Palmer, 1983). The axillary nerve injuries incidence represents less than 1% of all nerve injuries.

Aim: The purpose of this study was to analyze outcome in patients, who presented with injuries to the axillary nerve

Material and methods: We report a series of 15 cases of axillary nerve lesions, which were operated between 1995 and 2002. These injuries resulted from shoulder injury either with or without fracture and or dislocation.

Patients were operated between 3 to 6 months after trauma and an anterior deltopectoral approach was usually followed during surgery. The follow up period ranged from 1 to 8 years.

Results: The results were considered as satisfactory in 11 out of 15 axillary nerve lesions. According to clinical examination, of the function of the shoulder and the muscle strength the results were classified as excellent in 5 cases, good in 6 cases and poor in 4 cases.

Conclusions: If indicated, nerve repair can lead to useful function in carefully selected patients

Aim: To assess outcome in adolescent periarticular fractures treated with cannulated Herbert screws. Patients and methods: During the period November 99–March 02, twenty nine adolescent patients were admitted to our department with the diagnosis of a periarticular fracture. All patients were male, 12–17 years old (average 15 years). All fractures were treated with cannulated Herbert screws. Twelve of these were fractures of the elbow, 6 of the knee and 11 of the ankle. All the fractures were treated with internal fixation. All patients underwent preoperative CT scan with 2-D reconstruction.

In all the cases the anatomical reduction was achieved and cannulated Herbert screws were applied with respect to the epiphyseal plate through minimal surgical incision..

The follow up period varied from one to six months, while all patients followed a rehabilitation program.

Results: All fractures healed well, without any reduction of the joint mobility or other postoperative complications.

Conclusions: Internal fixation of adolescent periarticular fractures with cannulated Herbert screws, can be considered as a useful method of treatment, since the anatomical reduction obtained, can be held with a very small operative incision, while the epiphyseal plate is respected.

Introduction: The growth plate almost always is involved in periarticular fractures in children. Treatment and prognosis of these fractures depends on the extend of the injury. Reduction has to itle and anatomical while fixation has to be secure and minimal secondary to the small size of epiphysis. The K-wires do not cause so much tissue damage but there is the possibility of sliding suiting in loss of fixation. On the other hand they offer no fracture compression. The use of screws may result in bone collapse. It is also inappropriate for small fragments.

Patients and Methods: From November 1999 untill December of 2001 17 patients with a diagnosis of a periarticular fracture were admitted to the pediatric orthopaedic department of KAT Hospital. There were 9 fractures of the elbow and 8 ankle fractures. Mean age was 12 years (6–14) (11 boys and 6 girls). Plain radiographs and CT were obtained before surgery to evaluate the kind and extend of the fracture. After limited arthrotomy percutaneous fixation was obtained with the use of at least wires 2 FFS wires and then a splint or cast was applied.

Results: FFS screws were removed in 3–6 weeks without anesthesia. In all of the patients the fracture was healed and there was not any infection or loss of reduction. Screws breakage was seen in Datient with no any functional consequences.

Conclusion: The use of FFS allows compressive fixation in periarticular fractures in children. It can be used percutaneously and it can be removed without need for another surgery.