Aim: To evaluate time of union and functional recovery of the shoulder joint in humeral shaft fractures treated with antegrade intramedullary nailing.

Methods: During 1998–2002, 29 patients (16 male and 13 female, mean age 43.7 years) with humeral shaft fractures underwent antegrade, proximal locked, intramedullary nailing. A modified extra-articular entry point, 1 cm below the greater tuberosity, was used to avoid rotator cuff damage. The nail, after accurate measurement of its length and proximal metaphysis enlargement up to 10 mm, was impacted into the narrow, cone-shaped, distal part of the humerus, without the necessity of distal screw interlocking. Passive motion of the shoulder joint was initiated from the 2nd postoperative day and active assisted exercises after the 2nd postoperative week.

Results: Mean follow up period was 27 months. Solid callus formation was noted in all fractures, between the 14th and 18th postoperative week. No cases of intra-operative fractures, nerve irritation, rotational instability, nail migration and loss of distal impaction were noted. Mean Constant-Murley score was 93 points at the 16th postoperative week.

Conclusion: Antegrade intramedullary nailing is a reliable and beneficial procedure for the treatment of humeral shaft fractures, regarding union and functional recovery of the arm. The extra-articular entry point should be preferred to avoid rotator cuff and articular surfaces damage whereas the accurate measurement of the nail length and the firm impaction of it at the olecranon fossa makes distally interlocking unnecessary, decreasing significantly the overall operative time and the associated complications.

Purpose: The assessment of long term results and complications rate using the GN and PFN nailing systems for the treatment of peritrochanteric fractures of the femur.

Material-Methods: Between 1991–2002, 195 patients (102 male, 93 female, average age 61.2 years) with a peritrochanteric fracture of the femur (80 A2, 86 A3, 12 pathological, and 17 combined) underwent intra-medullary nailing with the GN (134 patients) or the PFN (61 patients) system. Mean follow up period was 6.5 years. Outcome analysis included time of healing, delayed union or nonunion, infection, hip function (Salvati & Wilson scale), technical complications (cut out, Z effect, malrotation) and mechanical failures (bending fatigue, loosening, breakage of the implant or screws and fracture below the tip of the nail). Intraoperative difficulties in the application of the nails or screws were registered as well.

Results: Solid union of the fracture was achieved in 171 cases (87.6 %). 25 patients died from reasons unrelated to the implant. The overall complication rate was 20.51 % (10 infections, 3 nonunions, 5 implant breakages, 11 cut-out of the neck screws, 5 Z effects and 6 distal screws failures. The Salvati and Wilson score was > 30 in 121 patients (71.1%).

Conclusions: Use of the GN and PFN systems yielded good results in our study. Technical or mechanical complications were mostly related to the operative technique and the type and preoperative reduction of the fracture, rather than these systems themselves. Z effect is a specific complication of PFN in cases with a fracture reduction in varus, especially when comminution of the medial cortex is present.

Aim:Evaluate the results of primary cemented/cementless THA for the treatment of displaced femoral neck fractures.

Material-Method:121 pts with femoral neck fractures underwent THA 2.1 days on average after their admission.The mean follow up period 4.1 y.112 pts had Garden III-IV fractures,9 pts had Garden II fractures.A cementless THA was applied in 75 pts (Group A,average age 61.4 y),46 pts were treated with cemented THA (Group B,72.4 y).Last follow up evaluation with Harris Hip Score (HHS) and radiological assessment with the Engh/Wixon scores was available in 92 pts.In 25 elderly pts a cementless THA was applied due to established impairment of their cardiopulmonary status.

Results:The mean HHS was 82,3.Radiological score for the cementless THA:+5,8 for the cup and +6,4 for the stem according to Engh scale (satisfactory integration for the prosthesis Perfecta,Synergy) and a 74,8% liability of integration according to Wixon scale (Spotorno).Complications:Early dislocation 3,loosening 5,heterotopic ossification 8,periprosthetic fracture 1,femoral nerve paresis 1,wound infection 1.No systematic complications were noted in the elderly patients with cardiopulmonary disorders,possible due to selection of a cementless THA.

Conclusions:THA (cemented/cementless) for the treatment of displaced femoral neck fractures give very good midterm results.Cementless THA is probably the choice of treatment in elderly pts with cardiopulmonary disorders.

Purpose: To present our clinical experience of intramedullary nail application during the consolidation phase after bone lengthening or bone transport.

Material and method: Thirty patients (33 cases) with secondary intramedullary nailing during consolidation phase after callus distraction with an external devise (Ilizarov frame or unilateral system) were evaluated. Docking site nonunion (17 patients), angular deformity or fracture of the lengthened area (8 patients) or intolerance of the external device (5 patients), in combination or not with a delayed distracted callus maturation, were the main reasons for this replacement.

Results: Average follow-up time was 4 (2–12 years). Average external fixation index was 40 days/cm of distraction. Intramedullary infection afterwards the placement of the nail was presented in one case (3,03%), and slight callus length loss in 5 cases (15,2%). Failure of union at the docking site with nail breakage was happened in 1 case (3,03%). In the other patients, ossification was achieved in the lengthened callus area as well as at the docking site, in an average time of 5,9 months from the moment of the nail insertion. All the patients were satisfied after the abstraction of the external devise, while their joint mobility and functionalism were improved rapidly.

Conclusions: The use of intramedullary nailing during consolidation phase after callus distraction, is a treatment option for delayed callus maturation or docking site nonunion, reducing the prolonged use of the external fixator.

Purpose: We present the midterm results of conservative treatment of upper (atlas and axis) cervical spine injuries and we propose a CT-based radiological follow-up study.

Material and Methods: In a 12 year period (1990–2001), 45 patients (33 male and 12 female) with a mean age 37.2 years (range 15–75) were presented with an acute injury of the upper cervical spine. There were 19 fractures of the atlas (8 Jefferson’s fractures, 6 isolated lateral mass fractures and 5 posterior arch fractures) and 26 axial fractures (12 odontoid fractures, types I–III according to Anderson’s classification and 14 traumatic spondylolisthesis, types I–II according to Effendi classification). Twenty (20) patients were immobilized using halo-vest and 25 Minerva orthosis. Two (2) patients presented with Brown-Sequard syndrome. All patients were retrospectively reviewed and had clinical and radiological follow-up study (plain films and CT spiral reconstruction films).

Mean follow-up was 6.2 years. Mean immobilization time was 3.8 months range.

Results: Patients with incomplete neurological lesion did not recover. One patient with an isolated atlas lateral mass fracture, developed a hemiparesis during his hospitalization, which was partially resolved. In the final follow-up study, all patients presented a stable upper cervical spine, on the dynamic flexion/extension plain films. In the final CT spiral reconstruction films, fracture line was evident in 12 patients (27%), while atlantoaxial joint incongruity was obvious in 5 patients. Seven (7) patients (16%) complained for residual neck pain and stiffness and presented reduced range of motion.

Conclusion: Conservative treatment of atlantoaxial injuries is effective and offers a stable upper cervical spine. Solid fracture union is not always present. CT spiral reconstruction is very helpful in detecting transverse ligament efficacy and atlantoaxial joint incongruity.

Aim: To evaluate the midterm results of primary cemented or cementless total hip arthroplasty for the treatment of displaced femoral neck fractures.

Material and Methods: Between 1990–2000, 121 patients with displaced fractures of the femoral neck underwent primary prosthetic replacement 2.1 days on average after their admission. The mean age of the patients was 65,7 years (ranged 33–88) and the mean follow up period 4,1 years (mean 2–10 years), 112 patients had type III–IV femoral neck fractures according to Garden classification while the rest 9 patients had Garden II fractures but with associated osteoarthritis of the hip joint, A cement-less total hip arthroplasty was applied in 75 patients (Group A, average age 61,4 years) while the rest 46 patients were treated with cemented T.H.A (Group B, average age 72.4 years). Last follow up evaluation with the modified Harris Hip Score (HHS) and radiological assessment with the Engh and Wixon et al scores was available in 92 patients. 10,8% of the patients died from reasons unrelated to the implant, In 30 elderly patients (< 75 years old, 22 available in the last follow up) a cementless T.H.A. was applied due to established impairment of their cardiopulmonary status (coronary disease, chronic heart failure, COPD, positive history of myocardial infarction) or systematic diabetes mellitus.

Results: The mean HHS was 82, 3 degrees (52–97). Radiological score for the cementless T.H.A. was +5, 8 for the cup and +6,4 for the stem according to Engh scale (satisfactory integration for the proximal porous prosthesis-Perlecta, Synergy), and a 74,8% liability of integration according to Wixon scale (Sportono type of prosthesis). Complications were recorded in 19 patients: Early T.H.A, dislocation 3, 26% (3 Pi), loosening 5,4% (5 Pt), heterotopic ossification 8,6% (8 Ft), periprosthetic fracture 1,08 % (1 Pt) and femoral nerve paresis 1,08 % (1 Pt). One patient (1, 08%) had superficial wound infection treated with i.v. antibiotics, continuous irrigation and debridement. No systematic postoperative complications (acute renal failure, heart failure, coma) were noted in the elderly patients with cardiopulmonary disorders, possible due to selection of a cementless prosthesis and therefore to the lesser intraoperative time and the avoidance of toxic reactions from the cement.

Conclusion: Total cemented or cementless prosthetic replacement for the treatment of femoral neck fractures in selected cases give very good midterm results. Cementless T.H.A, is probably the choice of treatment in elderly patients with cardiopulrconary disorders, as the integration of the prosthesis is not affected from the degree of osteoporosis and the toxicity of cement is avoided.