Introduction: Increasing number of osteoporotic fractures of the femur, especially upper part of the femur creates everyday problem of health services. Treatment of these fractures has been improving markedly during the past 25 years. DHS, gamma nail and some other implants are very useful in everyday surgery. However some of complications still can not be resolved like cut out. Osteoporotic fractures in subtrochanteric area represent even bigger challenging. Diaphyseal fractures are also difficult to be treated. The main problem is quality of osteoporotic bone. Plate with parallel screws doesn’t provide reliable fixation. Intramedulary nails, because of wide channel in distal femur area also don’t provide desirable fixation stability.

Material and Method: We analysed results of using of one new device: selfdynamisable internal fixator (SIF) in the series of 389 patients treated because of upper femur fractures. That device has possibilities of spontaneous dynamisation in two axes: along the femoral neck axis and along the diaphyseal axis. Spontaneous dynamisation in the diaphyseal axis is very important if diaphyseal or subrtochanteric fracture or comminuted fracture of the upper femur with subtrochanteric extension treated. For activation of axial dynamisation it not necessary to do any action from outside the body. This feature is activated spontaneously if there is no progress in fracture union within 6–8 weeks. This device provides three-dimensional fixation using clams and rod onto the lateral surface of the femur. The age of patients was from 59 to 87 years. This internal fixator is applied using minimally invasive method – by one or two small incisions.

Results: During the treatment it has been confirmed working of self-dynamisation concept. Spontaneous dynamisation in the long axis of the femur has been proven in 21% of patients with subtrochanteric and diaphyseal fractures and it has been proven radiologically that sliding happened between 1–4 mm (average 2.5 mm). Such dynamisation together with 3D configuration of screws resulted in relatively quick fracture healing. Follow up was 19 months (6–60). Altogether 97.6% fractures healed within normal healing time. There were 1 infection, 2 cut out, 1 mechanical complication, 4 delay unions and one non-union.

Conclusion: According to results obtained, it can bee concluded that new biological internal fixator is suitable for minimally invasive technique, without opening of fracture site.

The paper present our results in application of new method for nonunion treatment of the femoral diaphysis.

The internal fixator has been applied with 36 patients. Bone graft substitution is used with 11 (30,5%) patients. The method of placement and results of the work according to the modified system of the Karlstrom-Olerud method have been presented. Excellent condition was found with 25 (69,4%) patients, satisfactory with 8 (22,2%) and poor with 3 (8,3%) patients. Average healing time is 57 weeks.

The method in which the internal fixator is applied provides complete stability of the nonunion and makes possible spontaneous-biological dinamization of the nonunion. It doesn’t damage the periosteal and medullary bone vascularization which favors healing process.

Aims: The purpose of this abstract is to present one new minimally invasive method and one 3D device for internal þxation. Methods: The device is constructed to be self-dynamisable. It has been investigated biomechanicaly. In clinical use it has been applied to 34 patient. Twenty-nine applications have been performed to the femoral comminuted fractures, four in established femoral non-union and one in pathological metastatic fracture. The age of patients was from 17 to 73 years. Twenty-three were mail and eleven females. This internal þxator is applied by small incisions using indirect or direct fracture reduction. Results: Received clinical results are promising, as it has been shown early callus formation and radiological union within the 3–4 months. It has been allowed to patients early full weight bearing. During the treatment it has been conþrmed working of self-dynamisation concept, which probably all together with 3D conþguration resulted in unexpectedly quick fracture healing. Follow up was 11 months (3–27). This concept is compatible with reduction device developed by the author and mechanical monitoring device recently developed by the author and Professor Perren in Davos. Conclusions: According to the þrst 34 patients, it can bee concluded that new internal þxator can be successfully used routinely in every day practice.

Cluster bombs are an inhuman weaponary, intended, among other things, for mass kiling of humans. The use of modern weaponary can cause very serious damage of all structures in injured extremity. During the war on teritory of Yugoslavia in 1999. at our clinic for orthopaedic and tramatology Ð Clinical Center Nis, we have treated 120 injured patients. The youngest injured patient was 17 the oldest 77. In evaluated group the patients of third and forth decade of life have been dominated.

Multiple injuries were the most often (caused by cluste bombs). All victims got hard wounds of lesia type due to injuring by a great number of sharpnelñs. The hospital treatment complexity of these wounds is pointed out. Such treatment is caused by a number of simultaneous wounds of many sistems in organisam. We have treated war wounds with fractures of extremity with the Ç Mitkovic È external þxator (using convergent method of pin applications), living the wounds open and performing necessary debridments.AT and antibiotic therapy was administrated. Surgical treatment of war wounds, external þxation, living the wounds open and performing necessary debridments, adequate drug therapy, are essential in achieving good results in this patients.

To take care of casualties is a complex task requesting the teamwork of orthopaedists, common surgeries and plastic surgery specialists.