Aim: To study the postoperative results of an alternative method of pin placement for acute pelvic ring stabilization with an external fixation.

Introduction: External fixation for stabilization of pelvic ring fractures is the only and a safe method for emergency treatment. According to literature pins of the fixator should be placed urgently on the superior iliac rim and as soon as general condition of the patient permits, revision is required in order to manage in a finitive way the injury.

Material-Method: Inclusion criteria were high energy trauma, severe pelvic instability, heamodynamic instability, acute management of a pelvic fracture and minimum follow up of 2 years. Patients with a simultaneus major head, chest or abdominal injury were excluded from the study. Between 2000–01, 19 patients (15 male and 4 female with a mean age of 28 years old) underwent acute pelvic stabilization with an external fixation. In 12 patients, mechanism of injury was road accident and in 7 patients a fall from a height. Fracture type according to Tyle classification was 2 type A, 12 type B and 5 type C. In 6 patients the pins were placed in an oblique plane to the superior iliac rim (Group I) and in 13 patients there were placed in the sagital plane, just below the superior anterior iliac spine (Group II). The mean time for external fixation application was 15 min for group I and 22 min for group II.

Results: 14 patients were heamodynamically stabilized in the early postoperative period and 5 patients were transmitted to Intensive Care Unit. In 17 patients a rigid fixation of the pelvis was achieved and remained as a definite method of treatment and in 2 patients of Group I, replacement of the external fixator and an adjacent stabilization of posterior elements was required. No patient required adjacent posterior element stabilization as the primary reduction and stabilization was satisfactory. Mean time of stabilization was 7 weeks for type A, 10 weeks for type B and 11 weeks for type C fractures. 13 patients were totally recovered and returned to their previous occupation and 6 patients have minor problems that are attributed to the pelvic ring fracture.

Conclusions: External fixator’s placement for pelvic ring stabilization should be performed in a way that it will be a finitive method for osteosynthesis of the pelvis. We suggest pin placement in the sagital plane, below the superior anterior iliac spine instead of placement at the superior iliac rim.

The attempt to achieve and institude the potential less minimal invasive hip hemiarthroplasty by using common instruments is the aim of our study.

We report on a randomly selected group of 80 patients, 40 of which were operated by a small incision 5–10 cm (group A) and 40 by a standard incision 15–20 cm (group B). The approach was through the gluteus medius muscle (lateral-Hartinge) in all of the cases. In group A an additional small transverse incision of the fascia was needed without any other inside extension. There were no statistical differences in gender, age (mean age 80 and 79 years old respectively), weight of the patients (average BMI 27,5 kg/m2 and 27 kg/m2 respectively) and implant type.

The operations were supervised by the same surgeon. PMMA was used in 18 of the cases in each group.

Blood loss was less in group A (mean 200cc less) and 21 patients were not transfused at all intraoperatively. A second assistant was necessary in educational operations. Four of the patients had postoperatively bruises and skin scratches. Early postoperative pain was less in the first group, but was the same two months postoperatively. Thirteen patients slept on the operated leg on the 2nd and 3rd postoperative day. Discharge from the hospital was available two days earlier in the first group. We had one hip dislocation in the first group in a psychiatric patient who had also DVT.

In conclusion , minimal invasive surgery in hip hemi-arthroplasty is possible to be performed with the use of common instruments and it is worth once while. Experience of the surgical team is necessary for reducing operative time and further research is needed for establishing possible contraindications.

Aims: The purpose of our study is to present the results of the use of external þxation, as a þnal method of treatment for tibial shaft fractures. Methods: In 5 years period, we treated 143 tibial shaft fractures in 135 patients. 112 were male and 23 were female, aged 15 to 80 years old (mean 35 y.o.). Our indications were: 16 closed fractures with severe soft tissue injury, 19 closed fractures with threatened compartment syndrome, 90 open fractures, Gustilo type II or III, 18 closed fractures in polytrauma patients. Results: Union, without the need of changing method was achieved in 121 fractures. The mean time of union was 22 weeks for closed fractures, 25 weeks for type II open fractures and 28 weeks for type III open fractures.

The main complications were 13 nonunions, 40 super-þcial pin infection, 2 malunions, 2 osteomyelitis, 2 patients with fat embolism syndrome and 3 deaths due to pulmonary embolism. Conclusions: External þxation is a proper deþnite treatment for tibial shaft fractures according to the indications mentioned above. Technically it is easy to apply and there is no need of surgery to remove it. The procedure of normal union is not disturbed. Most of the complications can be managed without removing the device. The advantages of the method make it comparable or superior to intramedulary nailing although there is a delay in full weight bearing.

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.

The surgical treatment of scaphoid nonunion is controversial.

The purpose of this study is to present our experience from the surgical treatment of 16 scaphoid nonunions in heavy manual workers.

Sixteen patients with sixteen nonunions of the scaphoid were treated during the last 6 years (13 male and 3 female). Established nonunion was present in 7 months to 7 years. Five nonunions were Alnot stage I, 5 were IIa, 5 were IIb and 1 nonunion was stage IIIa. One case considered the distal pole and 15 the proximal pole of the scaphoid. In 5 patients there was avascular necrosis of the scaphoid and in 6 patients DISI was present. All sixteen patients complained about pain, resulting to disability to work.

All patients were treated with an autocompression screw and small autologus cancellus bone grafts. In one case with a proximal third non-union, screw fixation was not achieved. The mean time of union was 70 days. Mean follow up was 3 years. All patients returned early to their occupation without pain. Grip strength reached 90% (70% preoperatively) and range of motion reached 95% (80% preoperatively), compared to the contralateral side. Excellent functional results were in eleven patients, good in four and average in one patient. In four cases there was a previous carpal dislocation.

Symptoms of non-union of the scaphoid appear earlier in heavy manual workers and their surgical treatment should not be delayed. We believe that the use of autocompression screws and cancellous bone grafts is the first choice of treatment for nonunions (Alnot stage I and II) of middle and distal third of the scaphoid.

The aim of this study was to evaluate and compare the results of acromioplasty in two groups of patients operated upon for impingement syndrome using two different techniques, In one group the insertion of the devoid was partially divided (deltoid off strategy) while in the other the insertion of the deltoid was preserved (deltoid on strategy).

Twenty-one patients, suffering from impingement syndrome of the shoulder, were operated during the period 1996–2001. Preoperatively all patients presented with positive impingement test and they were complaining of night pain as well as pain during activity. Two different techniques were used. In 2 group of 10 patients. the “deltoid off’”strategy was applied and the acromioplasty was performed with the use of an osteotome. In a second group of 11 patients the “deltoid on” strategy was applied and the acrormioplasty was performed by using a high speed burr.

Eight out of 10 patients of the first group were satisfied with the results of the operation, whereas all the 11 patients of the second group were satisfied. The return to full activity in patients with the “deltoid off” strategy was 10 weeks in average, while in the “deltoid on” group it was 8 weeks. Night pain subsided in ail patients in both groups. Two patients of the first group complained of mild pain with daily living activities, while 10 out of the 11 patients of the second group had no pain at all. Finally 2 patients of the first group and none of the second group presented residual painful arc.

We conclude that the “deltoid on” technique for treatment of the impingement syndrome of the shoulder appears more simple and reliable, has less morbidity and gives better clinical results, compared to the “deltoid off” technique.

In this paper the results of correction of bone deformities using the llizarov methods, are presented.

Fifty-nine patients, 42 with malunion and 17 with mal-nonunion of tibia or femur were operated upon using the llizarov circular fixator. Another 28 cases were corrected using a unilateral device. There were: a) 30 angular deformities, 18 of which were combined with shortening, b) 21 angular deformities associated with translation and c) 36 complex, deformities including angulation, translation, shortening and malrotation.

Two rings above and two below the apex of the deformity were always required. Different types of hinges were used between them, depending on the type of the deformity. The corticotomy was performed at the apex of the deformity for the majority of the cases. In 18 patients with hypovascular and eburnated bone, or bone covered with soft tissue of poor quality, the corticotomy was done more proximal or more distal to the apex of the deformity. In complex deformities the correction sequence was: 1) correction of angulation and shortening simultaneously, 2) correction of rotation, 3) and finally correction of translation. The true plane of the deformity and the plane of placement of the hinges were determined by a computerized formula that we developed.

The deformities were corrected in all cases in which the hinges were placed at the correct position but in 5 cases we had to re-orient the hinges in order to achieve the correction. The corticotomy or pseudarthrosis consolidated in all cases. Residual leg length discrepancy remained in three patients, not exceeding 135 cm. Great care was taken to prevent complications during operation as well as during the post operative period. However, there were numerous obstacles, problems and true complications. All these were managed aggressively as soon as they appeared. The final results were very satisfactory.

We conclude that the revolutionary llizarov methods can solve bone deformity problems that cannot be faced by the traditional methods. It is critically important to place the hinges at the correct position in order to achieve the desired correction. Our computer program definitely helps to this purpose. The surgeon must always be vigilant in order to prevent complications and to deal with them immediately.