Whiplash vertigo syndrome is often seen in victims of rear-end vehicle collisions. These patients commonly complain of headache, vertigo, tinnitus, poor concentration, irritability, and sensitivity to noise and light.

Sixteen patients (medium age, 39,5 years) that they refered in orthopaedic examination because of long-lasting subjective complaints after cervical spine injury underwent clinical, laboratorial and psychometric examinations. The mean posttraumatic interval was 43 months. Ten patients were injured in road accidents, 5 during sports and one at work, all with mechanism trial of whip. Each patient was evaluated with otorhinolaryngologic examination, audiometry tests, CT: petrus – internal auditory meatus and cerebellopontine corner. Also each patient was evaluated with neurologic examination, psychological well-being scale (sf-36), and personality profile scale.

None of the patients had neurologic symptoms, and no lesions of the cervical spine were identified. All the patients had negative clinical, radiological and standard laboratorial control, but may be is a critical point that the eleven of these patients had pathologic OGTT (Oral Glucose Tolerance Test). Also did not exist differentiations from the mean values in psychological well-being scale (SF-36), and personality profile scale of healthy population. Test results were unrelated to the length of the post-traumatic interval. However, 2 distinct syndromes were identified. Ten patients had cervicoencephalic whiplash type syndrome (CES), characterized by headache, vertigo, tinnitus poor concentration, and disturbed adaptation to light intensity. Six patients had the lower cervical spine whiplash type syndrome (LCSS), characterized by vertigo, tinnitus cervical and cervicobrachial pain.

The verification of Whiplash Vertigo syndrome require more objective clinical means. This article proposes that exists an organic base for the syndrome, but does not promote that whiplash injury certainly cause it

Aim of our study was the investigation and the cross-correlation of various neurologic scales to estimate, comparatively with the functional results of patients after damage of spinal cord injuries.

Between 1989 – 2005, 115 patients were submitted in stabilization of Lower Cervical Spine that was judged unstable.

The neurologic situation was certified with the scales: Frankel, ASIA motor score, NASCIS motor score, FIM scale, and MBI scale.

In the protocol took part the 94 patients for that existed in neurologic details and long follow-up for at least two years.

From the study of course of scores of all scales was not found statistically important difference between ASIA, NASCIS and other motor scales. However 12 patients with important improvement of mobility at ASIA motor score and NASCIS motor score they have not difference in Frankel scale, despite the make that the MRP (Motor Percentage Recovery) was improved: 21.5%

Also 8 patients with relatively big improvement in their total scores did not have corresponding functional improvement (FIM scale, and [MBI] scale)

A lot of neurologic methods – scales were used and are used today. However for the essential and modern follow-up of patients with spinal cord injuries, it needs certification with a scale of classic team of (measurement of mobility) and a scale of functional faculties of the patient

Introduction: The chevron osteotomy is an accepted method for the correction of mild and moderate hallux valgus and generally advocated for patients younger than the age of sixty years. In the current work the finite element analysis applied to calculate the stress (force per unit area) on different cuts in the metatarsal bone model of the first ray in the human foot.

Material and Methods: The cuts have the form of a simple angle with 90 degrees ‘modified chevron osteotomy’, 60 ‘typical chevron osteotomy’ 70, 50 and 30, openings correspondingly, and share a common corner C, which is at the centre of a circle that fits the head of the metatarsal. In order to calculate the maximum stresses on the cuts, the bone is assumed to be with a 150 angle to the floor, which is the angle that it takes during the push-off phase.

Results: The calculations show a considerable difference on the stress distribution on the differnt cuts. In particular in the ‘90 degrees cut’ the normal (to the cut) stress is much larger than the shear stress. The opposite is true for the 60 cut. Since shear stresses are the ones that cause material failure, it is predicted that the 90 cut will heal much faster than the 60 cut. The nodes along the cuts where the normal and the shear stress were calculated in different osteotomies.

Conclusion: The FEM analysis confirm our clinical results of this modified chevron osteotomy of 90 degrees. The osteotomy site is firmly secured, avoiding early displacement of the lateral fragment and give earlier fusion.

INTRODUCTION: Cases of aseptic non-unions in patients with a femoral shaft fracture, who have initially been subjected to internal fixation by plating, are not rare. The aim of this retrospective, polycentric study was to evaluate intramedullary nailing as method of treatment of these patients.

MATERIALS AND METHODS: Thirty patients with aseptic femoral shaft non-union, after plating, were treated by reamed intramedullary nailing (IMN). The type of nailing was chosen according to the type of non-union. The mean follow-up time was 30 months and for statistical analysis, the student’s t-test was used.

RESULTS: All non-unions were healed in a mean time of 7.8 months (5–18) after nailing. The mean healing time after fracture was about 18.6 months (9–54). The healing times were irrelevant to whether the fracture was open or closed, the type non-union (atrophic or hypertrophic) and the type of fracture, according the AO classification. On the contrary, the delay from the initial plating to definitive treatment (IMN) affected the healing time and the final outcome, in a statistically significant way. Healing time was increased by 34.45% when the definitive operation was performed after between 8 and 16 months compared to the ones before the 8th month and by 72.28% if the IMN was delayed to between 16 and 24 months.

DISCUSSION: In conclusion IMN can be an ideal and cost effective method in treating patients with aseptic femoral non-union, after plating failure. This definitive operation should be performed as soon as the non-union is diagnosed in order to avoid unnecessary delay in fracture healing.

Purpose: The purpose of this prospective investigation is to determine if soft tissue and intra-articular local anaesthetic injection with bupivacaine and adrenaline have beneficial post-operative effects in patients who had total knee replacement (TKR) for osteoarthritis.

Material and Methods: 97 patients were divided randomly into 2 groups. The mean age was 74.7 years. In control group I there were 17 men and 33 women with a mean age of 73.5 years, in group II 16 men and 31 women of mean age of 74.9 years. The patients who were allocated to control group I (n =50) had no intraarticular treatment. We used general anaesthesia in all these patients. The study group II of 47 patients had received intraoperative injection of 0.25% bupivacaine(8ml) with epinephrine (1ml – 1mg) with 2/3 injected into the soft tissues and 1/3 injected into the joint. Clinical parameters evaluated included pain, blood use and bleeding index (calculated by preoperative haemoglobin minus postoperative hemoglobin plus the number of units of packed red blood cells transfused) and range of motion (ROM) at discharge.

Results: Flexion at discharge was improved from 70 (60–90)° in the control group to 90 (80–120)° in study group II (p = 0.005), the difference between the two groups receiving different amounts of analgesics were statistically significant. Number of days until 90 degrees of flexion and until discharge was reduced in group II compared with the control group I (p = 0.003 and 0.002). Also and the blood loss decreased.

Conclusion: This simple method is effective in improving all the postoperative course of primary TKR and should be considered as a part of a perioperative patient treatment program.

Purpose: The evaluation of midterm results of a proposed surgical technique for the correction of hallux valgus deformity.

Material-Methods: Fifty-one female patients with sixty-two hallux valgus deformities were operatively treated between 1997–2002. The average age was 54.9 years and the mean follow up period was 32.7 months. A modified – 90 degrees angled – chevron osteotomy fixed with a Hebert screw was performed in all patients. Concomitant lesser toes abnormalities were managed at the same time. Preoperative, postoperative and last follow up radiographic intermetatarsal (IMA) and hallux valgus (HVA) angles, were measured and compared. Subjective analysis consisting of the AOFAS hallux scale was performed.

Results: The averaged preoperative HVA was 34.1 (range 22–56) and the averaged IMA 15.5 (range 10–29). The corresponding postoperative angles were 14.2 (range 0–28) and 8.1 (range 6–22). The mean AOFAS score was 94.3 (65–100). All the osteotomies were fused and there was not any case of non-union or loosening. Two patients showed late recurrence of the deformity but refused any further treatment.

Conclusions: Hebert screw is a reliable fixation method of the chevron osteotomy for the treatment of hallux valgus. The osteotomy site is firmly secured, avoiding early displacement of the lateral fragment.

Purpose: The purpose of this study was to evaluate the results of 23 patients with septic nonunion of the distal tibial metaphysis type Pilon fractures treated with Ilizarov technique.

Material and Methods: Between 1990 and 2002 the Ilizarov technique was used in 23 patients with posttraumatic infected nonunion of the distal tibia. Seventeen were males and 6 females. Average age was 40.1 years (range16–68 years). Mean duration of nonunion was 13,8 months and the average number of failed previous surgical procedures 2.2.

According to AO classification there were 3 non-unions with quiescent infection and no drainage, 4 with active infection and no drainage, and 16 with infection and drainage. The ankle joint was ankylosed in 6 patients preoperatively and it was painful in all patients. Thirteen patients had an angular deformity of more than 7 degrees (range 7–30 degrees, mean 16 degrees). Sixteen patients had a mean bone defect of 2.5 cm (range 1 to 6 cm). Monofocal or bifocal compression-distraction osteogenesis technique with or without bridging the ankle joint was performed in all cases. Ankle arthrodesis was necessary in 4 cases. Mean external fixation time was 139.6 days and mean follow-up period was 4 years.

Results: The results were evaluated using the functional and radiological scoring system described by Paley. The results were excellent in 7 patients (30.4%) good in 9 (39.1%) fair in 5 (21.7%) and 2 (8.69%) poor while the functional results were excellent in 4 patients (17.39%) good in 8 (34,8%), fair in 7 (30,4%) and poor in 4 (17,39%). Bone union and eradication of infection were achieved in all cases. Four bone defects required bone grafting and freshening at the docking site. Ankle motion was difficult to record preoperatively but good to very good ankle function was obtained at final follow up evaluation in 12 patients.

Conclusions: The Ilizarov technique is a reliable method in the treatment of metaphyseal septic nonunion of the distal tibia particularly in cases with angular deformity, ankle joint contracture and bone defects. Compliance of the patient is absolutely necessary.

We reviewed 13 patients with infected nonunion of the distal femur and bone loss, who had been treated by radical surgical debridement and the application of an Ilizarov external fixator. All had severely restricted movement of the knee and a mean of 3.1 previous operations. The mean length of the bony defect was 8.3 cm and no patient was able to bear weight.

The mean external fixation time was 309.8 days. According to Paley’s grading system, eight patients had an excellent clinical and radiological result and seven excellent and good functional results. Bony union, the ability to bear weight fully, and resolution of the infection were achieved in all the patients. The external fixation time was increased when the definitive treatment started six months or more after the initial trauma, the patient had been subjected to more than four previous operations and the initial operation had been open reduction and internal fixation.

Aims: Consideration of gravity of talar neck fractures and evaluation of their treatment results. Methods: From 1992 to 2001 were admitted to our department 26 patients, suffering from talar neck fractures. We were able to reexam 22 patients (17 males and 5 females), with mean age 34,14y. (16 to 64y.). Fourteen pt. (63,6%) were car accident victims. In the rest of them fracture occurred after fall from height more than 3m. There were 8 (36.3%) multi-injured patients. Preoperative diagnostic approach included simple x-rays and CT scan and Hawkins classiþcation was used. All patients underwent surgical treatment. Operative technique included open reduction and internal þxation using screws and/or K-Ws. Postoperatively patients were evaluated with radiological and clinical criteria according to Iowa Ankle Evaluation score. Results: Mean follow up was 58 months (from 12 months to 9 years). Results were excellent in 10 (45,4%), good in 6 (27.2%), fair in 4 (18.1%) and poor in 2 (11%) patients. Two cases developed avascular necrosis (1 type D and 1 type C) followed by body collapse and treated with ankle arthrodesis. Furthermore 1 patient underwent ankle and 6 patients subtalar arthrodesis because of arthritis caused from concomitant fractures. Conclusions: Treatment of talar neck fractures is a challenge because of high rate of complications, because of talusñ shape and vascular anatomy. Anatomic reduction and rigid internal þxation, in combination with immobilization and no weight bearing until restoration of talusñ architecture is achieved, are essential requirements for good result.

Aims: The evaluation of outcome of 4-part valgus impacted fractures of the proximal humerus after reconstruction with stable transosseous suturing þxation and early postoperative passive motion. Methods: 51 patients, 33 women and 18 men (average age 49,5 years) with displaced 4-part Òvalgus impactedÒ fractures of the proximal humerus, were treated operatively in the last 10 years (1991–2001). Stable þxation of the tuberosities to each other, to the metaphysis and to the articular part of the humeral head, was achieved with non-absorbable (Ethibon No 5) sutures, avoiding any use of hard material. Early passive motion with pendulum exercises was applied to all patients at the 2nd postoperative day, followed by active assisted exercises after the 4th to 6th postoperative week, and þnal strengthening exercises after the 2nd to 3rd postoperative month. Results: Long term results (mean follow up period 5.6 years), were evaluated according to Constant-Murley Scoring System. 42 patients (82.3%) had very good result (Constant score > 80) without pain and satisfactory motion (160û forward elevation, 50û to 80û external rotation and internal rotation up to T12). The incidence of avascular necrosis was 3,9%. Complications developed in 6 patients: 1 malunion of the great tuberosity, 3 heterotopic ossiþcations and 2 nonunions revised to hemi-arthroplasty and plate osteo-synthesis plus bone grafting. Conclusions: Advantages of this minimally invasive technique are: shorter operative time, no use of hardware, less soft tissue damage, low incidence of avascular necrosis, stable osteosynthesis with tension band effect, and adequate rotator cuff repair, allowing for early joint motion.

The aim of the present study was to compare the mechanical properties of the torn menisci between stable and ACL unstable knees. Material and method: Ten medial menisci from isolated bucket handle tears and ten from ACL deþcient knees (injury < 3 months) during ACL reconstruction were obtained after an arthroscopic partial meniscectomy. They were þxed and tested mechanically in tension. The modulus of elasticity (E), maximum stress σmax, maximum load, and stress-strain curves were evaluated. Results: In the isolated tears E was 56.35 Mpa (median values) and in the ACL deþcient knees was 163.0 MPa and it was signiþcant (P=0,023). The maximum failure stress σmax was 9,22 Mpa for the þrst group and 17,26 Mpa for the latter and this was also signiþcant (P=0.04) Conclusions: The bucket handle torn menisci from the stable knees had inferior mechanical characteristics compared to the ACL deþcient knees. In other words isolated meniscal tears seem to be an inferior material compared to those of the ACL deþcient knees. The authors believe that it is worth considering a low cost and morbidity partial meniscectomy in isolated bucket handle tears, instead of a more demanding and long lasting meniscal repair operation followed by an also longer rehabilitation time.

Aims: To evaluate the effectiveness of the Ilizarov method in treating septic nonunions of lower extremities. Method: Between 1990–2001, 74 patients (59 males and 15 females), with infected nonunion of the tibia and femur were treated using the Ilizarov device (the monofocal or bifocal com-pressiondistraction technique). The average age was 36 years (range 17–68 years) and the patients were evaluated using a modiþed Paley classiþcation for septic nonunions. The mean preoperative bone defect was 9 cm (range 3–18 cm) and it was present in 39 of 74 patients. The mean lengthening index was 36 days/cm (range 27–42 days/cm), the mean external þxation time was 6,3 months (range 3–24 months) and the mean follow up period after frame removal was 4 years (range 1–11 years). Results: Bone union was achieved in all 74 patients (100%) with no infection recurrence. The bone results were excellent in 52 patients (70%), good in 11 (15%), fair in 6 (8%) and poor in 5 (7%), whereas the functional results were excellent in 27 patients (36,5%), good in 35 (47%), fair in 7 (9,5%) and poor in 5 (7%). In four patients bone grafting at the docking site was needed. Late complications included: 9 axial deformities (12,2%), 2 re-fractures (2,7%) and 28 patients (37,8%) with joint stiffness. Conclusions: The Ilizarov technique in the treatment of septic nonunion has a high rate of success considering bone union, bone loss restoration and eradication of infection Sports Ð varia

The aim of the present study was to compare the amount of blood loss between Gamma nail and DHS operative procedures in treating fractures N.O.F.

Material and Method: thirty patients 81 years of age (average), suffering from N.O.F. fracture were divided in two groups, depending on sex, age, weight and type of fracture, in such way that for every patient operated using one procedure there was a similar one treated with the other one (pairing). The admission and discharge Ht, the blood unites needed for the whole patients hospitalization time were compared.

Statistically T-test, Pearson chi square – Fisher exact test were used.

Results: The average age for the Gamma nail group and DHS group were 82 yrs (sd=11,5) and 81,3 (sd=10,6), the admission Ht 36,9% (sd=4,0) and 36,72% (3,27) and the discharge Ht. was 33,2% (sd=2) and 34,9% (sd=2.9) respectively. For the first group (Gamma nail) 2.3 (sd=1.1) units of blood were used, compared to 2.4 (sd=0.7) for the second one (DHS). There was no statistical difference concerning the age and the population sample, the admission and discharge Ht, and the blood units needed between these two groups.

Conclusion: There is no difference concerning blood loss between Gamma nail and DHS in treating fractures N.O.F.

Purpose: The evaluation of blood supply of the humeral head in displaced 4-part “valgus impacted” fractures with digital angiographic image processing.

Material-Methods: 14 patients with acute 4-part valgus impacted fractures of the proximal humerus (9 women and 5 men, average age 43,6 years) were included in the study. The average impaction angle was 42.4o and the lateral displacement of the humeral head between 1–7 mm. Preoperative angiography of the proximal humerus was performed 6 to 12 hours after admission. Fixation of the fracture was achieved with in situ transosseous suturing fixation of the tuberosities to each other, to the metaphysis and to the articular part of the humeral head avoiding any reduction maneuvers and use of hard material. Postoperative angiography was performed 8 to 10 weeks after the operation.

Results: Digital angiographic image processing, using the segmentation technique, showed no statistical difference in the supply of the humeral head before and after the operation. The average blank number of small vessels and the overall area of blood supply (vessels/mm2) were about the same in 13 patients and no signs of avascular necrosis were seen 18–20 months after the operation. Partial avascular necrosis was seen in one case with 7 mm lateral displacement.

Conclusions: Although the small number of cases, in situ transosseous suturing fixation of the 4-part valgus impacted fractures seems to preserve the remaining blood supply of the humeral head. The incidence of avascular necrosis is higher in cases with severe lateral displacement.

Aim: A comparison of two different techniques of acro-mioclavicular joint reduction in complete AC disruption.

Methods: During 1992–2001, 59 patients (50 male; 9 female; average 32.3y), underwent surgical reconstruction for complete (Allman-Tossy III) AC dislocation. Fixation of the joint was achieved in all patients by double-banded coracoclavicular stabilization, using heavy nonabsorbable sutures in a double-banded ligamentous substitution manner. In 35 patients (group I) a temporary acromioclavicular fixation was done (with K-W, removable at 6th postoperative week), whereas in the rest 24 patients (group II) an additional fixation of the acromioclavicular disruption, with nonabsorbable sutures, without using K-W was performed.

Results: Mean follow-up period was 6.4 years. Our results according to Constant-Murley score were excellent or very good in 25 patients (71.4%) of group I and 21 (87.5%) patients of group II. Loss of reduction (3), calcification (5) and superficial pin infection (2) were noted with greater frequency in patients of group I. Three of them reoperated because of K-W migration or breakage. Complications of group II included 1 superficial infection, 1 calcification with restriction of joint motion and 1 case with slight loss of reduction.

Conclusions: Reduction of the acromioclavicular joint in association with adequate retention of the coracoclavicular joint are the cornerstones for a good surgical result. Double banded coracoclavicular fixation and acromio-clavicular repair with heavy nonabsorbable sutures and no use of K-W, seems to be the best surgical technique provided adequate stabilization of acromioclavicular joint, preservation of clavicular rotation, no risk of implant migration and no need of material removal.

The purpose of this study is to determine the indications and effectiveness of hybrid external fixation in the treatment of tibial plateau fractures and to evaluate the patient’s functional recovery.

Twenty-seven patients with 28 intra-articular fractures of the proximal tibia were surgically treated with hybrid external fixation in a two years period (1999–2001). There were 25 patients (19 men and 6 women) available for the last follow up evaluation. The mean age was 35 years (17–76). According to Schatzker classification, there were 6 fractures type V and 22 type VI. Three of them were open fractures. The method included, indirect reduction based on ligamentotaxis and compression of the fractured segments with olive pins, in most patients. Additional limited internal fixation with free screws was also performed in 5 cases. Open reduction was necessary in 6 patients. Mobilization of the injured articulation was started at the third postoperative day, while full weight bearing was allowed after three months. The fixator was removed in average 12th week. Final evaluation was done according subjective, functional, clinical and radiological criteria. Mean follow up period was 14 months.

All fractures except one united at an average time of 13, 5 weeks. Twenty-two patients (77.6%) graded as excellent and good, hi detail, subjective results were acceptable in 72%, functional in 84%, clinical in 70% and radiological in 80%. Complications included one axial deformity, one septic pseudarthrosis, one peronial palsy and superficial pin path infections.

The use of hybrid external fixation in the comminuted tibial plateau fractures (Schatzker V, VI), insure good restraining and early union, avoid major soft tissue complications and allow quick mobilization and functional recovery of the knee joint. Moreover it is an application rather atraumatic because, only occasionally requires open reduction.

Aim: To examine the in vitro effects of several non-steroidal anti-inflammatory drugs (NSAIDs) on pro-inflammatory cytokines and PGE₂ production by interface membrane from loose endoprosthesis of hip or knee arthroplasty. Since these factors are strongly implicated in the bone resorption process and aseptic prosthesis failure we hypothesize that the probable inhibition of their production by prophylactic administration of NSAIDs, will retard these processes.

Materials and Methods: Interface membranes were harvested from ten patients who were subjected to revision surgery for aseptic total hip or knee replacement loosening and cultured for 72h in the absence or presence of therapeutic dosages of each, of aceclofenac, piroxicam, tenoxicam and indomethacin. Paracetamol was used as neutral control. In conditioned media the levels of IL-6, IL-1 (3, TNF-a and PGE2 were determined by ELISA and the data were analyzed by the Student’s t-test (significance level p< 0.05).

Results: All the tested NSAIDs caused a statistically significant decrease on IL-6 and TNF-a levels, with aceclofenac and tenoxicam to be more effective (caused decrease in 7 out of 10 samples), while they had low or controversial effect on IL-1β production, except aceclofenac that seemed to augment the IL-1β levels (statistically significant increase in 5 out of 9 samples). Finally all the tested drugs, except paracetamol, caused a marked reduction (80–99%) of PGE2 levels.

Conclusions: The stimulatory effect of IL-6 and TNF-α in the osteoclastic bone resorption process is well established. Considering the above results, the tested IMSAIDs (especially aceclofenac and tenoxicam) reduce the in vitro production of these mediators by interface membranes. Hence, it is reasonable to propose that the prophylactic treatment with these drugs could delay the process of the aseptic loosening. However, in order to support this hypothesis, more experiments are required by which the effects of them on other factors implicated in the loosening process, such as metalloproteinases, will be examined.