Aim: Evaluation of health-related quality of life in scoliotic patients as compared to age matched general population individuals. Correlation with the curve degree and the method of treatment.

Material – method: Ninety patients with idiopathic scoliosis were interviewed. The assessment included: a) the SF-36 questionnaire, evaluating general health status, b) Specific Quality of Life Instrument, designed and validated for adolescents with spinal deformities, c) Postoperative Patients Satisfaction Score, for patients operated on for scoliosis. Patients were subdivided to three groups according to the curve degree and method of treatment: Group A, patients with curves < 20o, treated with observation and regular follow up. Group B, curves between 20o and 40o, treated with a Boston brace. Group C, curve > 40o, operative treatment.

Results: SF – 36 physical health summaries were not significantly different among the three groups, nor between the scoliotic patients and normal individuals. Mental health summaries and quality of life scores were lower in Group B and C patients.

Conclusion: Patients treated for idiopathic scoliosis were found to have approximately the same quality of life as the general population. Quality of life deterioration in scoliotic patients is mainly related to psychological rather than physical factors.

Purpose: To evaluate the functional outcome following internal fixation of bicondylar distal humerus fractures (AO type C) using the ACUMED modified titanium plates.

Material-Methods: Fourteen patients (9 male, 5 female) aging 18 to 78 years (av. 54 y.) with bicondylar distal humerus fractures, between September 2002 and May 2004, were included in our study. All of them underwent open reduction and internal fixation. The articular surface was reduced through a transolecranic approach using one or two compression screws and the fractures was then fixated using the modified titanium ACUMED plates.

Results: Postoperative follow-up ranged from 6 to 24 months (av. 12 m.). The results were evaluated using the Mayo Clinic Score. The mean range of elbow flexion-extension was 115o. Nine patients had an excellent/good result, 3 had affair and 2 a poor result. One patient underwent a second procedure for symptomatic metalwork. In one case there was soft tissue infection that resolved successfully with antibiotic administration.

Conclusion: The internal fixation of bicondylar AO (type C) distal humerus fractures with the ACUMED plates through a transolecranic approach is an extensive but atraumatic operation that offers excellent reduction and a stable osteosynthesis leading to a good functional outcome.

Aim: We show the short term results of cementless THA in patients younger than fifty years old who were suffering from avascular necrosis of the femoral head.

Materials Methods: From 09/1997 to 04/2002 we have treated 21 young patients (7 males and 14 females), aged from 24 to 50 years (mean: 37 y) and 27 hip (6 bilateral and 15 unilateral) suffering from AN, with cementless THA. Preoperatively all patients were assessed clinically for their function with D Aubigne Postel scoring system and we also assessed joint destruction and femoral head subsideness with radiographs and MRI respectively. All hips were III or IV Ficat stage and probably there was severe pain and limitation of joint functionality. We used a porous coated component for the acetabulum (Duraloc) and a partially coated cementless femoral stem with distal fixation (AML).

Results: We had no early or late infections, no dislocations and no nerve palsies. 2 patients had persistent thigh pain who has subsided a year after operation. At last follow up (88 30 months, mean: 48 m) we evaluate clinically and radiologically all patients using DAubigne Postel score and radiographs. We had 25 hips (93%) with excellent or good results and 2 hips in two different cases of bilateral replacements with fair or poor result. No evidence of radiological looseness of the components was found. All patients were very satisfied with their function in regard to previous condition and most of them returned to their normal life.

Conclusion: Cementless total hip replacements show excellent short term results in young patients with final stage avascular necrosis thought we need longer follow-up to come in to definite conclusions.

Purpose: The results of surgical treatment of intertrochanteric hip fractures using a sliding hip screw-plate and Norian-SRS, as an adjuvant means of stabilization, are presented.

Material – Methods: 103 patients (27 male, 76 female) with intertrochanteric hip fractures, were treated with a sliding hip screw. Their age ranged from 56 to93 years (av. 68,9y) . In group A (50 patients) we only used a sliding hip screw -plate, while in group B ( 53 patients) we also used Norian-SRS above the upper surface of the sliding hip screw.

Results: Postoperative follow-up ranged from 5 to17 μnνϵς. Mobilization was initiated on the 2nd day with partial weight bearing. A group progressed to full weight bearing in 3 , while B group in 2 months. 8 patients in group A and 2 in group B developed varous deformity. Screw cut out developed in 5 patient of group A and none of group B. Backsliding of the screw ranged from 0 to 16 mm. (av. 4,95 mm.) in group A and from 0 to16mm. (av. 3,25mm.) in group B.

Conclusion: Norian-SRS augmentation of intertrochanteric hip fractures treated with a sliding hip screw-plate, increases the stability of the osteosynthesis, permitting earlier rehabilitation and mobilization of the patient and leading to better functional results.

Aim: Nanoindentation is a technique, developed over the last 15 years which is now widely used in the materials science for probing the mechanical properties of thin films. The properties most commonly measured are Young’s modulus (E), and Hardness (H). One of the great advantages of the technique is its ability to probe a surface and map its properties on a spatially – resolved basis, often with a resolution of better than 1μm.

Materials and methods: specimens from 5 lumbar vertebrae (L-4) were obtained from fresh, unembalmed human cadavers (2 males and 3 females), aged from 16 to 90 years. After carefully removing posterior elements and soft tissues, the vertebral bodies were cut to a thickness of 5mm and embedded in epoxy resin to provide support for the porous network. Then the samples were metallograpically polished to produce smooth testing surfaces and nanoindentation tests were conducted to measure Young’s modulus and hardness of individual trabeculae. Measurements were made in both longitudinal and transverse direction in relation to the longitudinal axes of the trabeculae. The indentation load – displacement data obtained in these tests were analyzed, using the method of Oliver and Pharr.

Results: a total of 719 nanoindentations were produced in this research. A mean of 7–8 indentations were made in 103 separate trabeculae both in longitudinal and transverse direction. The mean Young’s modulus was found to be 13.7(2.5) Gpa, which is higher than the one obtained by classic micromechanical tests. There were no significant differences of elastic moduli among the longitudinal and the transverse directions of the trabeculae (13.8. Gpa and 13.5 Gpa, respectively).

Conclusion: nanoindentation is a very promising technique for evaluating intrinsic mechanical properties of bone at sub-micro level of organization. It may have many applications and may contribute to the improvement of our knowledge concerning bone biomechanics, the effects of metabolic bone diseases on bone mechanical properties and the capabilities of surgical treatment

Aim: In this study we present the results of the management of muskoloskeletal injuries accompanied by rupture of a main arterial vessel, focusing on the priorities in salvaging the affected limp.

Material – methods: In a period of 5 years (Sep.1999– Sep 2004), 24 patients having sustained multiple injuries were admitted with signs of poor vascularization distally to the lesion. 19 were male and 5 female, their ages ranging from 16 to 49 years (av. 28 years). The musculoskeletal injuries were: open III C humeral fracture in 2 patients, open III C femoral fractures 4, open III C tibial shaft fractures 10, knee joint dislocations 8 patients. All patients had a preoperative angiography in order to assess the severity of the vascular lesion. Immediate stabilization of the fracture with an external fixation system was performed, followed by restoration of the vascular injury by means of a by-pass, end-to-end suture or interposition of a “stent”.

Results: Postoperative follow-up ranged from 6 to 54 months (mean 34 mon.). Amputation was performed in 4 patients due to failure of the revascularization procedure 2 weeks postoperatively. External fixation was maintained as a final method of treatment in 7 cases, while in 13 cases we exchanged it to intramedullary nailing. In the 8 cases of knee dislocation, ligament reconstruction was imperative. Eventually 20 limps were salvage with a satisfactory functional outcome.

Conclusion: In polytrauma patients with both musculoskeletal and vascular injuries the immediate application of an external fixator represents a precausative for a successful vascular operation. Exchanging the external fixation system to interlocking intramedullary nailing accelerates the healing process.

Purpose: We evaluate the results of treatment of A.O. type C distal femoral fractures with 3 methods of internal fixation (condylar plate, 95° condylar blade plate, D.C.S.).

Material-Methods: From 1988–2003, 108 patients (59 male, 49 female), aging 19 to 84 years (aver. 46 years), with 116 fractures A.O. /C were treated. 108 were closed and 8 open, Gustillo type II. We used condylar plate in 38 patients (group A), 95° condylar blade plate in 24 (group B) and D.C.S. in 54 (group C).

Results: Postoperative follow-up ranged from 1 to 15 years. An early mobilization programme was initiated. The results were evaluated using the Schatzker-Lambert criteria. Pseudarthrosis was found in 4 cases in group A, 6 in B and 3 in C. Varous deformity was present in 10 cases in group A, 6 in B and 2 in C. Severe knee stiffness was present in 2 patients of group A, 2 of B and none of group C.

Conclusion: The Dynamic Condylar Screw – D.C.S. seems to have an advantage compared to the other 2 methods of internal fixation regarding the treatment of A.O. /C distal femoral fractures offering stability, anatomical reduction, and early mobilization with a good functional outcome.

Aim: The results of operative treatment of acetabular fractures, as well as its role in the prevention of post-traumatic osteoarthritis are presented. Methods: From 1990 to 2000, þfty patients had an open reduction and internal þxation of an acetabular fracture. Thirty-two patients were male and eighteen were female, with an average age of 37,8 years (range: 18 to 71 years). The mechanism of injury was a motor vehicle accident in most cases (84%). 22 fractures were A-type, 24 B-type and 4 C-type according to the AO classiþcation, while according to the Letournel-Judet classiþcation 21 fractures were simple and 21 complex. Osteosynthesis was achieved with either lag screws alone or with a combination of lag screws and a buttress plate. Results: Follow-up ranged from 2–10 years (average: 5,8 years). Clinical evaluation according to the Dñ Aubigne-Postel scoring system gave 20 excellent (40%), 18 good (36%), 5 fair (10%) and 7 poor (14%) results. Early postoperative complications included 5 cases of common peroneal nerve palsy and 3 cases of wound infection. Late complications included 1 case of avascular necrosis of the femoral head, 12 cases of post-traumatic osteoarthritis (24%) and 5 cases of Brooker III heterotopic ossiþcation (10%). Conclusions: Operative treatment of ace-tabular fractures although demanding bears very good results. Post-traumatic arthritis remains a common complication, even if care is taken for the anatomic reduction of the fracture.

Aims: The purpose of our study is to evaluate the results of the treatment of unstable upper humerus fractures with the implantation of the Plant-Tan Plate which is a combination of an internal fixator with a neutralization plate. Methods: In a period of 17 months (January2001–May2002), 10 fractures in 10 patients (7female – 3 male) were treated. Their ages ranged from 45 to 75 years (mean 67.8 years). Patients with unstable fractures (two to four according to Neer’s classification are include in the study. The Plant-Tan Plate was used. Two head screws were placed in all fractures. The follow-up ranged from 4 to 21 months (mean 14.5months). The ASES scoring system was used to evaluate the results. Results: All our patients achieved clinical and radiological union of the fractures in a period of 4 months. The average cumulative score of activities of daily living of ASES Scoring System was 23 out of 30 (76.66%). One superficial wound infection occurred which was resolved with the administration of antibiotics. Conclusions: The Plant-Tan Plate rapresents a new, promising method of internal fixation for fractures of the proximal humerus, which offers anatomical reduction and a stable osteosynthesis (provding angular and rotational stability), so that an early rehabilitation program can be instituted.

Purpose: We present the results of the management of muskoloskeletal lesions accompanied by rupture of a main arterial vessel, foccusing on the priorities in salvaging the affected limp.

Materials – methods: In a period of 3 years and 6 months (Sep.1999–Mar 2003), 21 patients having sustained multiple injuries were admitted with signs of poor vascularization distally to the lesion. 16 were male and 5 female, their ages ranging from 16 to 49 years (average 27 years). The musculoskeletal injuries were: open III C humeral fracture in 2 patients, open III C femoral fractures 5, open III C tibial shaft fractures 10, knee joint dislocations 4 patients. All patients had a preoperative angiography in order to assess the severity of the vascular lesion. Immediate stabilization of the fracture with an external fixation system was performed, followed by restoration of the vascular injury by means of a by-pass, end-to-end suture or interposition of a “stent”.

Results: Follow-up ranged from 6 to 48 months (mean 27 mon.). Amputation was performed in 3 patients due to failure of the revascularization procedure 2 weeks postoperatively. External fixation was maintained as a final method of treatment in 5 cases, while in 9 cases we exchanged it to intramedullary nailing. In the 4 cases of knee dislocation, ligament reconstruction was imperative. Eventually 18 limps were salvage with a satisfactory functional outcome.

Conclusion: In polytrauma patients with both musculoskeletal and vascular injuries the immediate application of an external fixator represents a precausative for a successful vascular operation. Exchanging the external fixation system to interlocking intramedullary nailing accelerates the healing process.

Aim: The purpose of our study is to evaluate the results of interlocking intramedullary nailing for femoral shaft fractures giving special attention in the number of the distal bolts.

Materials – methods: In a period of 3.5 years (6/1999 – 12/2002), 74 patients with femoral shaft fractures were treated with the Russell – Taylor interlocking intramedullary nailing. 46 were male and 28 female; their ages ranging from 16 to 79 years (mean 37.5years). According to the A.O. Classification 21 were type A, 25 type B and 29 type C. The Russell-Taylor Nail was used. Reaming was performed in all cases. The distal bolts were inserted using the “FREE-HAND” technique. One screw was inserted in 44 cases and two in 30 in a random manner.

Results: No postoperative complications occurred. Follow-up ranged from 6 to 36 months (mean 18 months). In the cases where two distal bolts were inserted the fractures united in a period of 4 to 6 months (average 4.8 m.), while these where one screw was placed healed in a period of 4 to 10 months (average 6.5 m.).

Conclusion: The Russell-Taylor interlocking itramedullary nail is an efficient method of treatment for femoral shaft fractures. The insertion of two distal screws offers additional stability, which accelerates the healing process and is advocated for all femoral shaft fractures.

Humeral diaphysis fractures consist a rather frequent injury. The aim of our study is to evaluate the results of the treatment of humeral diaphysis fractures with the use of an interlocking intramedullary nail.

During the period March 1999 – December 2001, 25 intramedullary nailings were performed in 24 patients with a humeral fracture (16 women and 8 men), aged 26–81 years (Average: 57.1 years) using a Russell-Taylor humeral nail. There were 16 cases of acute humeral fractures, 3 cases of pathologic fractures, and 6 cases of delayed union or non-union. Follow-up ranged from 6 to 36 months (Average: 20 months). Fracture union was recorded, and the results were evaluated according to the scoring system of Neer.

No immediate postoperative complications were recorded. The final result was excellent in 9 cases (36%), good in 12 (48%), unsatisfactory in 3 (12%), while there was one failure (4%), where a reoperation was required. Fracture union was achieved within 4 months in 21 cases (84%), while 2 cases of delayed union and 2 non-unions were recorded.

Interlocking intramedullary nailing offers a dependable solution in the treatment of humeral diaphysis fractures, providing a very satisfactory functional outcome and a high union rate. It offers an excellent option in the treatment of pathologic fractures of the humerus, as well as in severely comminuted fractures and humeral fractures in polytrauma patients.