Introduction: Objective of our study is to present the effect of methylprednisolone sodium succinate (Solu-Medrol) on post-traumatic edema and on skin quality after a malleolar fracture. Material and Methods: 35 patients with an ankle fracture presented in our clinic from October 2001 till April 2002, 14 of whom had a surgical treatment by the day of their admission. The rest of them (a total of 21) were admitted in our clinic and were classified into 3 groups of 7 patients each. In two first groups was administered methylprednisolone in I.V. infusion during the first post-traumatic 8 hrs. Most specifically: In the first group was administered methylprednisolone I.V. in a dosage form of 500 mg every 12 hrs, for a day. In the second group was administered methylprednisolone I.V. in a dosage form of 250 mg every 8 hrs, also for a day, while in the third group there was no methylprednisolone administration. The perimeter of the ankle in lateral malleolus area was measured in both injured and healthy leg, the day of patient’s admission and the day after. The healthy leg was used as a control and skin condition was estimated clinically. Results: In group 3 there was a great increase in injured limb perimeter (of about 4–5 cm) the 2nd day and we found Chassaignac blisters of a good size (about 3–4 cm) in two patients. The first two groups presented a similar result, that means a moderate increase in injured limb perimeter without blister formation or skin necrosis. Discussion: In time intravenous administration of methylprednisolone minimized the post-traumatic edema in malleolar fractures and improved the quality of the skin which is usually an important problem in injuries of that type and prolong the hospitalization of these patients. Dosage of 250 mg x 3 for a day is equally effective compared to bigger doses and we suggest it because of the reduced danger for corticosteroids side effects.

Purpose: Purpose of that paper is the presentation of our experience and the evaluation of the results we had, using our method in the treatment of acute raptures of the Achilles tendon.

Methods-materials: A total of 27 patients (26m-1f) were treated in our clinic during the years 1996–2002. There was an age width from 21 to 67 y.o. with an average of 36, 8 years. 70.3% of the cases concerned patients in their 3rd decade of life and 92.2% of the cases involved injuries after participation in acceleration – deceleration pattern sports. All but one (he asked for treatment after a week), underwent an operation within 48 hours. The restoration of tendon’s continuity was achieved with a modified Kessler end to end suture, with plantaris use (24 cases) for repair covering as it was described by Lynn, gastrocnemius fascia use (2 cases), and tendon’s sheath use (1 case). Cordell 1,5mm and Vicryl sutures were used for tendon’s repair. In 4 cases an ABC medium suture and in 1 case a synthetic graft LARS were used. In all cases we applied immobilization with the use of a full length cast from upper thigh to metatarsal necks with the foot in gravity equinus for 3 weeks and then an additional 3 weeks immobilization in a shorter (bellow the knee) cast with the foot gradually brought to the plantigrade position. Physical therapy for 2 weeks followed the immobilization. The average follow up was 3.75 years.

Results: In the majority of the cases the postoperative period was untroubled. Two complications were noted: a case of skin necrosis which necessitate the intervention of plastic surgeons for reconstruction and a case in which the sutures came out through the incision but with preservation of an excellent functional outcome. Subjectively, 87% of the patients were very satisfied, while objectively and after a clinical examination and strength – motion tests this ratio was found higher. The return in their previous activities was clearly influenced by a phobic feeling towards the possibility of a rerapture and not at all by our intervention’s efficiency.

Conclusions: Based on very good results we had using Lynn’s technique for the surgical treatment of acute raptures of the Achilles tendon, in combination with the postoperative rehabilitation program we use, we concluded that this method ensures a curing approach of that injuries in a very efficient and effective way.

Over the last decade 18 patients with thoracic outlet syndrome (T.O.S.) were treated at our department by scalenectomy through transverse supraclavicular approach.Preoperatively all of the patients had experienced pain, paresthesias and tingling of neck and shoulder with radiation to the ipsilateral arm, whereas 8 of them had additionally vascular symptoms.

Postoperatively (6 months – 2 years) 12 patients were still suffering or they had a deterioration of symptoms. 9 were male (80%) whereas 3 were female (20%).

Resection of the first rib through transaxillary approach was performed and six months later they all had returned back to work, reporting complete relief (80%) or significant improvement (20%).After 4 years of follow up there were no recurrences.

In one case there was a long thoracic nerve palsy that spontaneously recovered after 6 months.

Whilst the cause of recurrence remains controversial, many authors suggest that this is due to adhesions of scar tissue to the nerves and vessels at the axilla. Therefore, intervention should be planned and performed by an experienced surgeon, avoiding complications and minimizing tissue trauma.

In conclusion, prevention is the best way of managing recurrences; accurate clinical evaluation, careful preoperative planning and meticulous dissection are the cornerstones of a successful outcome.