The definite treatment of closed or compound fractures of the long bones in polytrauma patients, who had been treated by bridging external fixation during the damage control phase is challenging, especially if it is performed delayed when the risk of infection is increased. In such cases the use of ring type external fixators seems to be a good choice.

During the last two years (mean FU 16 months), 22 Polytrauma patients with fractures of the long bones were treated with the use of ring type external fixators as the definite method. Multiplanar reduction at the fracture site could be achieved with this method. 14 patients had a high ISS score in the emergency department. 14 had sustained fracture of the femur while the remaining 8 patients had suffered a tibial fracture.

In all but one patient the bone union was achieved in a mean time of 19 months. In a patient with a tibial fracture where a bone defect the bone union was accomplished with bone grafting and the use of growth factors. No complications or loss of reduction were seen, while local signs of infection at the site of half pins insertion in three patients were subsided with administration of local antibiotics.

The definite treatment with ring type external fixators of long bone fractures in polytrauma patients seems to be a very good choice. Bone consolidation with no evidence of bone infection was achieved in all patients. while low rate of complications were seen

During the last few years, the arthroscopically assisted technique for reduction and internal fixation of tibial plateau fractures is of increasing popularity. The accumulated surgical experience allowed the possibility of treating type I, II, III according to Schatzker classification.

During the last two years 17 patients who had suffered a tibial plateau fracture were treated this way. The mean age was 44 years, while the mean FU was 16 months. According to Schatzker classification 8 fractures were type I, 6 fractures type II and 3 fractures type III. The bone reduction was achieved under arthroscopic view and flouroscopy. In all cases the fracture was fixed by the with cannulated Herbert type screws. Meniscal lesions were fixed in 9 patients, while in 5 patients ruptures of the ACL were detected, which were reconstructed at a later stage.

Full range of motion of the knee was restored in 11 patients, while lack of full knee flexion (mean 100) was found in 6 patients. All patients were assessed with a modified Lyslom Knee Scale. The Knee score was 85 points to 96 points (mean 92 points), while the anterior knee pain was the common problem especially following increased activities.

The proposed arthroscopically assisted technique for reduction and fixation of certain types of tibial plateau fractures consists a alternative minimal invasive approach. Visualization of the whole joint is possible and concomitant lesions can be detected and possibly fixed at the same time

Introduction: The treatment of injuries involving the acetabulum is challenging. Letournel classification system is the most popular and the most widely accepted, but difficult to be applied. The pattern of the fracture depends on the number of the fracture lines identified on the AP and Judet radiographic views.

Materials and Methods: 147 patients were randomly selected from our acetabular fracture database, which includes 615 patients who have been treated in our institution during the last 25 years and were divided into eight subgroups.

Each group represented all types of acetabular fractures and each patient had a radiographic evaluation of an AP view of the pelvis and two 458 oblique views (Judet views). All X-rays were assessed by eight orthopaedic surgeons in two sessions.

In the first session were asked by the orthopedic surgeons to classify the fractures according to the Letournel classification and a diagram showing the six important radiological Lines. During the second session, that followed six weeks after the first session, the same X-ray pack was given to the same surgeons with different ranking and numbering. In addition a table-algorithm was given to the surgeons with the 10 types of fractures according to the Letournel classification divided in three groups in accordance with the integrity of ilioischial and iliopectineal lines that we accept as basic lines and instructions on the integrity/interruption of one or both of the basic lines and the obturator ring.

Results: Comparison of the two sessions or of the two phase’s observation was accomplished by the use of two parameters; Initially, the proportion of agreement of all observers in the first and second observation phase was assessed taking our diagnosis as the ‘gold’ standard. The unweighted kappa coefficient was utilised to estimate the observers’ agreement arising from the examination of the given X-rays. Finally, the agreement of the observers, related to the intraoperative diagnosis was estimated. The main finding of the herein study lies on the improvement of the agreement rate experienced within both groups, in session B over session A. It is reasonable to assume that the main reason behind this result is the provision of the guideline algorithm protocol in the second session. The total agreement rate was increased from 59.9% in session A to 72.1% in session B, (pvalue = 0.0267).

Conclusion: The application of the proposed algorithm to the Letournel classification system in conjunction to surgical experience, improves the ability to classify even the most complex acetabular fractures.