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.

There are a few reports in the literature that compare the results of medial and lateral meniscectomy, especially in older patients.

Eighty three patients that underwent partial menis-cectomy were studied (45 men, 38 women), all older than 45 years. Forty eight cases considered medial and 35 cases lateral meniscectomy, mainly of the posterior horn. According to Outbridge and French Arthroscopic system criteria, there was not significant difference for the osteoarthritic changes that were found arthroscopically. 48% of the patients had no arthritic damage. Radiological evaluation of the results was done with Fairbank classification and International Knee Documentation Committee criteria, pre and postoperatively. Preoperatively, 50% of the patients had no pathologic radiological findings and postoperatively, both groups had similar radiological results. Tapper – Hoover criteria and Lysholm II Score were used for the evaluation of clinical results. 83% of medial and 78% of lateral meniscus tear’s repair had satisfactory clinical results and no statistical significance was documented in our series, despite reports from the literature of poorer clinical results for lateral meniscectomy. In both groups, clinical results were not influenced by the severity of cartilage lesions or by the age of patients, but by the amount of meniscus removal and the delay of arthroscopy, greater than 2 months.

This study evaluates the results of our technique of proximal tibial osteotomy for treatment of osteoarthritis of the medial compartment of the knee.

One hundred and thirty eight knees were operated upon from 1981 to 1990. The degree of appropriate correction was measured in standing radiographs of the whole limb. Our technique consists of the creation of an osteotomy running obliquely just above the tibial tuberosity to the posterior tibial surface. No wedge is removed. Realignment is obtained by sliding the two osteotomy surfaces until the desirable correction is obtained. The osteotomy is fixed by a 90° blade-plate. By this technique precise correction can be achieved.

One hundred and seventeen knees were evaluated after a mean FU of 5, 5 years with 91% excellent or good result. In a second evaluation of 93 knees in a mean FU of 7.8 years, the good results dropped to 72%. In a third evaluation of 81 knees, after a mean FU of 11.8 years (range 9 to 16), only 54% of the knees maintained acceptable results.

The best results in the last evaluation were seen in 43 knees in which the postoperative alignment of femorotibial angle was 178° to 182°. Undercorrected or excessively overcorrected knees showed deterioration of the results in 4 to 9 years depending on the degree of mal-correction.

The results deteriorate with passage of time especially if precise correction is not achieved. Accurate preoperative radiographic measurements and precise operative technique is required to obtain exact correction of the axis in order to maintain the good results for a long period of time.

Introduction. We present the results of the management of irreducible dislocation or fracture / dislocation of the elbow using the “Orthofix” external fixator in cases where the condition of the soft tissues was contraindicated for extensile surgical approaches or the internal fixation would not be stable enough to permit safe joint mobilization postoperatively.

Materials and methods. Twelve (12) patients were treated using elbow external fixation,5 with supracondylar fracture and severe osteoporosis and 7 with fracture / dislocation of the elbow and excessive soft tissue impairment (two of them with open fracture). For the patients with fracture, we performed minimal internal fixation using small incisions and minor soft tissue detachments and then we applied the elbow external fixator for the neutralization of the fixation. This permitted the immediate active assisted joint mobilization postoperatively without interfering with the stability of the joint and of the fixation. The same happened for the patients that their elbow remained unstable after reduction of traumatic dislocation, where the external fixation maintained the reduction of the joint. Prerequisite for the safe mobilization of the joint was the application of the external fixation at the center of rotation of the elbow which is the transepicondylar axis, in order to comply with the biomechanics of the joint.

Results. The fixator was applied for a mean of 10 weeks (6 – 16 weeks). All the fractures united and no instability of the joint was noted. The range of motion was between useful limits with lack of extension less than 30 degrees and flexion more than 130 degrees, pronation 60 degrees and supination 55 degrees (mean values). Pin track infection was presented in 3 patients and the treatment was local care and antibiotics. One patient had radial nerve palsy immediately after the operation, who recovered totally after four months without any treatment.

Conclusions. The external fixation of the elbow provides sufficient stability permitting the immediate mobilization of the joint postoperatively and in combination with the minimal soft tissue damage during the operation prevents the postoperative stiffness. It is a safe alternative solution when the condition of soft tissues around the elbow do not permit a thorough open procedure.