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.

Aims: To investigate the potential of biological þxation of cementless total hip prosthesis in patients over 75 years old, with diagnosed osteoporosis. Methods: Between 1994Ð2000, 30 patients (mean age 77.3 years) underwent total hip arthroplasty (THA). Twenty-two (22) patients, 10 male and 12 female, were found at the last follow-up, which ranged from 1.5–7 years (mean follow-up, 3 years). THA was performed due to primary osteoarthritis (n=16), subcapital fracture (n=4), or dysplastic hip (n=2). Eight (8) smooth, tapered design (CLS) and 14 proximally porous coated prostheses were implanted. Singh index was used for the evaluation of osteoporosis and modiþed Harris Hip Score was used for the clinical evaluation of each patient. Modiþed Wixon score was used for the evaluation of stability probability of the tapered stem. Engh score was calculated for the evaluation of osseointe-gration of the porous coated implants. Results: Pre and post-operative mean Singh index was grade 4. Mean modiþed Harris Hip Score at the last follow-up was 88.6. For the CLS-Spotorno stem a stable þxation probability was calculated at 74.8%, while possible instability was calculated at 48.17%. Porous coated stems provided +13.45 mean Engh score, implying satisfactory þxation of the implant. Post-operative systematic complications are not reported, in contrast to 3 dislocations in the þrst post-operative period, which were treated by closed reduction. Conclusions: In patients over 75 years old, with possible cardiopulmonary disease, cementless total hip arthroplasty offers a reliable treatment, regardless the presence of osteoporosis. Satisfactory osseointegration and absence of systematic complications is compromised by the high cost of titanium implants.

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.

Aim: The evaluation and guantification of radiologic parameters observed in the late stages of hip arthritis.

Materials and Methods : The present study concerns the retrospective evaluation of the preoperative X-rays of 80 patients affected from primary hip arthritis only on one side in an advanced stage, that were treated in our department with total hip arthroplasty. From the present study we excluded patients with hip arthritis secondary to trauma, rheumatoid arthritis or congenital hip dislocation. The onset of the symptoms ranged between six months and twenty years (mean time5, 6 years).

We evaluated the following parameters:

Neck-shaft angle

These parameters were measured from two idependent observers. Every single measurement was done twice from both observersjn order to estimate the interobserver and the intraobserver error. The measurements were done in both hips of the patients-the affected and the healthy one-on an A-P pelvis radiogramm.

Results: From the above measurements, it results that in hip arthritis the neck-shaft angle changes (it becomes varous).The calcar was found thickened in the affected hip in a mean value of 1,45mm. The thickness of the cortex at the level of the lesser trochanter was found greater in the non-affected side in a mean value of 0,7mm. The bone loss of the femur head was approximately 2,5mm. The distance between the rotation center of the hip and the point at which the neck axis crosses the transtrochanteric line was found greater in the non-affected side, in a mean value of 3,12mm.

Conclusions: The modifications observed in hip arthritis that concern the load transmission across the neck of the femur result in changes that can be radiologically identified and measured. In the first place the thickness of the calcar is influenced, as it does the distance between the rotation center of the hip and the trochanteric line. In the advanced stages of hip arthritis the sedimentation (bone loss) of the femur head can also be measured.