Aims: The objective of our study is to elucidate the chondrogenic potential of free autologous periosteal grafts in treating articular cartilage defects, especially in complicated cases where apart from the cartilage defect there are coexisting lesions. Methods: 60 young rabbits were randomly divided in 5 groups. A cartilage defect 0.5 ⋄ 0.5 was created in both knees of each rabbit and covered with free autologous periosteal graft. In the right knee an additional ligamentous lesion was created. Results: All the knees were amputated at one, two and three months postoperatively. Apart from the histological examination, the cartilage specimens were tested biomechanically. An indentation test was used using a Shore A sclerometer and the data were evaluated and compared. In the test group the produced fibrocartilage or hyaline-like cartilage, was mechanically inferior (hardness 50–70 GPa) comparing to the control knees group (98 GPa). The results were statistically evaluated (using O’Driscoll’s histological grading scale and Wilcoxon rank sum test). Conclusions: Autologous periosteal transplantation can be used in daily practise, as it is a method relatively easy to perform with low cost and without any contra-indications. Nevertheless, in cases of unstable knees the method has poor results and ligamentous repair is recommended first.

Purpose of this study is to compare the indications and the clinical results of the surgical treatment of CTS in relation to the EMS studies.

Material & Method: From September 1998 until the end of 2002, at Lefkadas hospital, 153 patients [189 hands] were treated with surgical decompression for C.T.S. Ninety operations were executed on the right wrist, fifty-five on the left & twenty-two bilateral. 121 patients were females & 32 males.

The classic microsurgical technique was executed at 149 patients. (A three-centimeter longitudinal incision, which was never extended beyond the distal crease of wrist. At twenty-one patients, the double-incision technique was performed [a small transverse incision at the wrist’s distal crease, & a short longitudinal incision five centimeters away from the distal crease of wrist). While in 20 patients we decompressed the C.T. from just one small transverse incision at the wrist’s distal crease.

It was possible to follow up, with clinical findings and repeated EMS, only sixty of them.

All operations were executed under local anesthesia and loupes were always used.

The cases that we operated on are of medium and of advanced severity of chronic carpal tunnel syndrome, while, according to the neurologist, at least five cases were acute.

The first follow-up was done on the 2nd or 3rd postoperative day. The patients’ positive assertions that numbness – tingling and nocturnal pain that used to jolt them awake at night were cured were of a great importance.

After the sixth postoperative month, a new EMG study was performed, at the patient’s convenience. A questionnaire was given to the patient to answer.

Results: Except for four patients, two of them didn’t improve their symptoms after the operation, while the rest two after the fourth postoperative week relapsed (relapse confirmed via electromyography), all other patients had either full recovery or significant improvement. The above-mentioned results are confirmed by clinical history, physical examination, study of the answers of the questionnaire that have been given to them, and at the end of the EMG study that always have been performed (showing normal or improved status in comparison to the pre-operative state).

Conclusion: Clinical postoperative findings match electromyography studies (at least in the first postoperative year).

Aim of this study: The aim of this prospective study was the evaluation of the results of intramedullary nailing with mild reaming for the treatment of closed tibial fractures.

Patients and Method: During the period 2001–2003 a total of 22 closed tibial fractures were managed. Fractures were classified according to the AO system. The method of treatment was determined by the degree of comminution at the fracture site as well as of the presence or not of intact fibula. Dynamic nailing was performed for the treatment of 9 fractures type A, static nailing following dynamization in 4–6 weeks with the presence of radiological callus formation was performed for the treatment of 5 fractures type B with > 50% comminution and dynamic nailing was performed for the treatment of 8 fractures type B with < 50% comminution. In 2 cases with intact fibula (A31, B21) osteotomy of the fibula performed at the same time. The mean size of the reaming was 11mm for the total of cases.

Results: The mean union time was 16 weeks, no infection or mechanical failure was recorded. Two cases of non-union were recorded (patient under anti-depression therapy and fracture type B23 in a patient with bilateral tibial fracture). Revision nailing were performed for these two cases (union in 14 and 16 weeks respectively).

Conclusion: Intramedullary nailing with limited reaming is a valuable method for the management of closed tibial fractures, especially in high energy fractures. Osteotomy of the tibia improves the mechanical environment at the fracture site.

Purpose of this study is to compare the two techniques, [sliding nail plate, or locking intramedullary nail type ã], and to estimate their results of the surgical treatment of the subtrochanteric fractures of the femur.

Material and methods. From the January 1999 till December 2002, 38 subtrochanteric fractures patients have been operated in our clinic. According to the classification of AO/ASIF 12 of them were type A, 18 were type B and 8 type C. 28 patients were female & 10 male, aged from 41 to 90 years (mean 85 years old). 22 of cases were followed up for at least 6 months up to 20 months. 5 of the patients died for reasons other than the fracture itself and its treatment. The remaining 11 cases failed to appear for a follow-up.

They were all surgically treated. In 8 cases we performed the 135 DHS nailing and in the 21 cases the 95 DCP nailing. In the remaining 9 fracture cases we performed intramedullary nail type ã nail. In some cases, (plaiting – surgery) we used allograft. There were no intrasurgical complications.

Two material breakages, [failure], occurred as post-surgical complication [95 DCP), the one was treated with locking intramedullary nail type ã, and the other with prosthetic replacement [ Thomson].

The patients started moving immediately, although they used partial wait bearing in a period of 3 days to 6 weeks, depending on the type of fracture and internal fixation. The operation lasted from 3/4h up to 2h and we transfused from 1 to 3 blood units (mean 2,5)..

Results were better with locking intramedullary nail, than with any type of plating, [biological advantages – less failure].

Conclusion. All subtrocanteric fractures should be treated by stable internal fixation. Our recent experience with the new undreamed AO nail, and its versatile proximal locking has been very favorable.

Purpose of this study is to examine the long-term follow-up in prosthesis reconstruction after proximal humerus resections.

Material and methods From February 1975 to December 1990, 144 patients have been operated for a musculoskeletal tumor of the shoulder girdle with resection and reconstruction using a modular cemented prosthesis. The MRS prosthesis is assembled in three parts with a ball shaped rotating head stitched to the glenoid and acromium. Seventy patients died and 3 patients were lost to follow-up: 71 achieved a follow-up more than 10 years (123–259, av 175 mo). Age ranged from 9 to 73 years (mean 29.7). The resection was intrarticular in 44 cases, in 12 more the glenoid was resected along with the proximal humerus (extrarticular resection) and in 15 cases we performed a Tikhoff –Lindberg procedure.

Infection occurred in 7 patients (10%) from 1 to 144 months (median 12 mo): in 6 patients prosthesis removal was needed to achieve healing.

Mechanical complications were present in 19 patients (27%): 15 (21%) had prosthetic head instability (5 surgically treated), 2 breakage of the prosthetic stem and 2 prosthetic disassembly.

Results: A detailed roentgen graphic analysis has been developed to better define the long-term course of the cement bone interface. Only 3 aseptic stem loosening were detected at 1, 3 and 11 years (after a supercondylar fracture occurred 8 months before). Eighteen patients were reoperated (25%); in 4 cases with minor surgery. Failure of the system occurred in 11 cases (15%).

Conclusion: The long durability of this cemented prosthesis has been demonstrated with very few cases of stem loosening in the early follow-up time. The problem of a good prosthetic head suture is still under concerning particularly in Tikhoff-Lindberg procedure.