Aims: Severe proximal tibia fractures, which include intra- and extraarticular fractures with metaphyseal-diaphyseal dissociation, pose a difþcult treatment problem for the surgeon with signiþcant complication rates. The aim of this study is to report the experience with a series of consecutive severe proximal tibial fractures treated with hybrid external þxators. Methods: Between 1997 and 2001, we treated 118 cases of proximal tibia fractures of which 52 were treated with hybrid external þxation. Inclusion criteria for hybrid treatment was severe soft-tissue injury, intra-articular displacement, and unstable fracture patterns involvment. In addition to routine demographic data, objective data collected included healing, deformity, complications, and motion. Patient were also evaluated with an SF-36 12 months after healing. Results: All proximal tibial fractures healed without additional procedures. Most patients demonstrated healing by 16 weeks. Accuracy of redution was 0–1mm in 28 patients, 2–3 mm in 19 patients, and 4–5 mm in 4 patients and greater than 5 mm in one patient. Only 5 (10%) of the 52 patients had an angular malunion greater than 6û. One case had a loss of reduction. Four patients developed a mild varus deformity. Radiographic and clinical evidence of degenerative arthritis was seen in 12/52 (23%) patients 18 months after healing. The SF-36 proþlese were health state/rate, daily activity, work activity, emotional problems, pain. Conclusion: We found that hybrid external þxation is a good alternative method for treatment of meta- and/or epiphiseal fractures. The technique and post-op management we describe respects soft-tissue and bone biology and allows early articular mobilization.

Aims: There has been recent interest in the use of external þxation for the treatment of distal peri-articular fractures. The current study was undertaken to evaluate the role of the hybrid external þxation system in the treatment of the distal tibial fractures. Methods: We treated 137 fractures of the distal tibia, of which 46 were treated with hybrid external þxation. The indication for this method of treatment was in the presence of an unstable extra-articular fracture and/or a severe comminution of the distal tibia, as well as an associated severe soft-tissue injury. Routine demographic data, clinical and radiographic þndings as well as reduction, outcomes and complications were recorded. Patients were evaluated with outcome scale of Ovadia and Beals. Results: There were 17 closed fractures and 29 open. Twenty-one extra -and 25 intrarticular fractures were managed with a Hybrid Fixator. All fractures achieved complete healing. Reductions of C-type fractures were within 0-2 mm in 16 and 3–5mm in 56 and > 5mm in 3 patients. The Hybrid External þxator was removed at an average of 17.5 weeks. Full weight bearing was achieved at a mean of 7.8 weeks. There were no intraoperative injuries to nerves or major vessels. Using the outcome scale of Ovadia and Beals, good-excellent results were achieved in 67% (n=31) subjectively and 72% (n=33) objectively. Two poor results occurred in patients with a varus malunion. Conclusion: External þxation is a satisfactory method of treatment for fractures of the distal tibia and is associated with fewer complications than internal þxation, because it limits the amount of soft tissue.

Aims: to evaluate the process of remodelling at the bone-femoral prosthesis interface by using computerized bone mineralometry (CMB)Methods: at the Orthopaedic Clinic, University Catania we performed from January 1992 densitometric studies on uncemented, anatomically shaped, titanium stems with or without hydroxyapatite (HA) coating. Dual energy X-ray densitometry was used to quantify bone mineral concentration and bone mineral density (BMD). Measurements were performed at the calcar and the medial and lateral cortical of the femur which have been previously demonstrated to be areas of stresses transmission in the normal hip. From 1992 to 2001, 148 patients were regularly studied. 76 subjects had a HA-coating stem. Evaluation was performed at 3, 6 and 12 months after operation and then yearly. Results: in all patients a minimal remodeling process (BMD values > 1 gr/cm² ) was observed at the medial cortical and the calcar zones. We noted higher BMD values in the group with HA-coating stem within 24 months after the operation; BMD values were overlapping between the two groups after 24 months. 27 subjects had reduced densitometric values at the calcar and increased BMD at medial and lateral cortical. Conclusions: CMB appears to be a reliable tool to evaluate the interaction at the bone-femoral prosthesis interface. Densitometric values might be helpful to monitor the periprosthetic bone-remodelling process.

Aims: Various techniques for the þxation of the posterior pelvis have been used, each demonstrating drawbacks speciþc to the technique. In this study, a new protocol was described and evaluated, involving the placement of posterior pelvic screws in the computed tomography (CT) room. Methods: Between September 2001 and September 2002, sixteen patients with unstable pelvic ring injuries were stabilized with iliosacral screws under the CT guided technique, using only local anesthesia and conscious sedation. Patients with displaced fractures initially had their anterior lesion addressed with ORIF or external þxation. The posterior lesion was assessed again and if satisfactorily reduced was treated with the CT guided procedure. In addition to routine demographic data, we evaluated patient pain using an analog scale (0–10), time required per screw, radiation dosage, amount of local anesthesia and sedation required, complications, adequacy of fracture reduction and healing, and accuracy of screw placement. Results: In 16 patients we used 22 screws. The time for the procedure averaged 36 minutes per screw. There were no technical difþculties, logistical problems, or misplaced screws in any patient. There were no infections or non-unions. During ofþce follow up, all patients stated that they would choose to have the CT scan procedure again versus an operating room procedure requiring general anesthesia. Conclusion: CT guided placement of iliosacral screws is a safe, feasible, and alternative to ßuoroscopy guided placement in the operating room in selected cases.