During the last few years, the arthroscopically assisted technique for reduction and internal fixation of tibial plateau fractures is of increasing popularity. The accumulated surgical experience allowed the possibility of treating type I, II, III according to Schatzker classification.

During the last two years 17 patients who had suffered a tibial plateau fracture were treated this way. The mean age was 44 years, while the mean FU was 16 months. According to Schatzker classification 8 fractures were type I, 6 fractures type II and 3 fractures type III. The bone reduction was achieved under arthroscopic view and flouroscopy. In all cases the fracture was fixed by the with cannulated Herbert type screws. Meniscal lesions were fixed in 9 patients, while in 5 patients ruptures of the ACL were detected, which were reconstructed at a later stage.

Full range of motion of the knee was restored in 11 patients, while lack of full knee flexion (mean 100) was found in 6 patients. All patients were assessed with a modified Lyslom Knee Scale. The Knee score was 85 points to 96 points (mean 92 points), while the anterior knee pain was the common problem especially following increased activities.

The proposed arthroscopically assisted technique for reduction and fixation of certain types of tibial plateau fractures consists a alternative minimal invasive approach. Visualization of the whole joint is possible and concomitant lesions can be detected and possibly fixed at the same time

Introduction: The treatment of injuries involving the acetabulum is challenging. Letournel classification system is the most popular and the most widely accepted, but difficult to be applied. The pattern of the fracture depends on the number of the fracture lines identified on the AP and Judet radiographic views.

Materials and Methods: 147 patients were randomly selected from our acetabular fracture database, which includes 615 patients who have been treated in our institution during the last 25 years and were divided into eight subgroups.

Each group represented all types of acetabular fractures and each patient had a radiographic evaluation of an AP view of the pelvis and two 458 oblique views (Judet views). All X-rays were assessed by eight orthopaedic surgeons in two sessions.

In the first session were asked by the orthopedic surgeons to classify the fractures according to the Letournel classification and a diagram showing the six important radiological Lines. During the second session, that followed six weeks after the first session, the same X-ray pack was given to the same surgeons with different ranking and numbering. In addition a table-algorithm was given to the surgeons with the 10 types of fractures according to the Letournel classification divided in three groups in accordance with the integrity of ilioischial and iliopectineal lines that we accept as basic lines and instructions on the integrity/interruption of one or both of the basic lines and the obturator ring.

Results: Comparison of the two sessions or of the two phase’s observation was accomplished by the use of two parameters; Initially, the proportion of agreement of all observers in the first and second observation phase was assessed taking our diagnosis as the ‘gold’ standard. The unweighted kappa coefficient was utilised to estimate the observers’ agreement arising from the examination of the given X-rays. Finally, the agreement of the observers, related to the intraoperative diagnosis was estimated. The main finding of the herein study lies on the improvement of the agreement rate experienced within both groups, in session B over session A. It is reasonable to assume that the main reason behind this result is the provision of the guideline algorithm protocol in the second session. The total agreement rate was increased from 59.9% in session A to 72.1% in session B, (pvalue = 0.0267).

Conclusion: The application of the proposed algorithm to the Letournel classification system in conjunction to surgical experience, improves the ability to classify even the most complex acetabular fractures.

Aim: To evaluate the feasibility of Norian S.R.S in the treatment of comminuted distal radius fractures.

Material and methods: 24 patients with comminuted distal radius fractures were open reduced and preserved with external fixation. The bone gaps were filled with Norian S.R.S. The wrist was mobilized at the 3rd postoperative week and the external fixation was removed the 4th–6th postoperative week, when the fracture healing was radiologically confirmed. All the patients had regular clinical and radiological control the first postoperative date and the 1rd, 3rd, 4th postoperative week and monthly until the 9th postoperative month.

Results: In the postoperative follow-up we didn’t note any loss of reduction and the joint range of motion compared with the contralateral exceeded 50% in 3 months and came close to 85% in 6 months. There were no clinically significant adverse effects or complications.

Conclusions: We believe that the use of Norian S.R.S. offers the potential for filling bony voids, does not exhibit tissue reactions and is progressively absorbed. The results of this study are comparable with other therapeutic approaches. Additionally, the use of the Norian S.R.S offers the potential of earlier mobilization and as an implant is bioabsobable through osteoclastic activity. In conclusion we believe that use of Norian S.R.S in the filling of bony defects in the comminuted distal radius fractures is a reliable and safe method of treatment.

Aims: The topographical measurement and representation of the ACL insertion on the tibial plateau, based on a greek population sample. Methods: Fourty eight tibial plateaus were explanted during TKA surgery in 33 female and 15 male patients (average age of 71.2 yrs) suffering from osteoarthritis and rheumatoid arthritis. By means of a calliper, measurements were conducted in order to determine the dimensions shown. Data were used for a topographical representation.

Conclusions: To the authors’ best knowledge, this is the first such anthropometric study on a greek population and its results provide a confirmation on the relatively wide base of ACL insertion on the tibial plateau. The biomechanical performance of this natural configuration for a full range of motion, is possibly not sufficiently reproduced by conventional ACL reconstruction techniques using just one bundle.

Aims: The effectiveness of the local treatment of experimental osteomyelitis caused by MRSA (Methicillin Resistant Staph. aureus) performed with the implantation of acrylic bone cement (PMMA) mixture plus 4% grepaßoxacin into the femur of rabbits. Methods: 36 rabbits with chronic MRSA osteomyelitis of the right femur (Norden Model) were treated with a new local grepaßoxacin delivery system prepared by a mixture of PMMA plus 4% grepaßoxacin. Osteomyelitis was introduced by inoculating of the MRSA and the placement of a needle serving as a foreign body. The follow-up of the infection was performed by clinical, microbiological and x-rays þndings. On the 3rd week all animals were reoperated and the needle was removed followed by implantation of the mixture. One control and þve treated animals were sacriþced each week thereafter until the 6th week. Results: Osteomyelitis was induced in all rabbits. The in vitro grepaßoxacin levels were high for 6 weeks at least. Concerning the histological þndings serious tissue reactions were not observed. The lesions and the bone structure are progressively rehabilated after the implantation. The biomechanical study didnñt inßuence the mechanical properties of bone cement due to grepaßoxacin. Conclusions: The above mixture could be an approved supplementary method for the treatment of bone infections. In the chronic osteomyelitis itñs possible to replace the gentamycin PMMA beads. Furthermore could be use as a spacer in loosen arthroplasties due infection in combination with antibiotic administration.

Aims: The effectiveness of the local treatment of experimental osteomyelitis by MRSA with a mixture of calcium phosphate bone cement and 3% teicoplanin into the femur of rabbits. Methods: Thirty-six male rabbits with chronic (3 weeks) MRSA (Methicillin Resistant Staph. aureus) osteomyelitis of the right femur (Model of Norden CW) were treated with a new local Teico-planin delivery system prepared by a mixture of calcium phosphate cement plus 3% teicoplanin. Osteomyelitis was introduced by inoculating 107 cfu/ml of the MRSA strain in a 2mm hole of the bone medula, placement of a needle serving as a foreign body and subsequent closure with a sterile bone wax. The follow-up of the infection was performed by clinical, microbiological, x-rays and histological þndings. On the third week all animals were reoperated and the needle was removed followed by implantation of the above mixture. One control and þve treated animals were sacriþced each week thereafter until the sixth week. Results: Cultures of the treated animals were positive during the þrst week but turned negative after the second week, while throughout the same period cultures from the controls remain positive. Clinical and histologic studies were in accordance. Conclusions: The above mixture could be approved as a supplementary method in the treatment of bone infections. It can be used by replacing the gentamycin polymethyl-methacrylate beads whose use demands reoperation to be removed. Finally it offers the possibility to contribute to the þlling of the bone gaps as it can be replaced by host bone.

Aims: To evaluate the results of our preliminary experience with the retrograde nailing for distal femoral fractures. Methods: During the period 1997 Ð 2000, 39 patients with 43 fractures of the distal femur, treated with retrograde intramedullary nail. There were 10 periprosthetic, 2 nonunions after previous failed þxation and 1 pathological fracture. 12 fractures were extra-articular, 18 had intra-articular extension and 2 fractures were open Type II according to Gustillo classiþcation. The mechanism of injury was road trafþc accident in 15 cases, with 9 of those being polytrauma patients, simple fall in and 1 spontaneous fracture. Results: Union was achieved in 11,3 weeks average time. There were 2 mal-unions and 1 nonunion needed reoperation. From the rest of the patients there were 4 with an excellent functional score, 19 good and 2 fair results. There were one superþcial infection, treated conservatively. In one patient the metalwork removal was necessary because he complained of pain from the distal interlocking screws. Conclusions: Retrograde intramedullary nailing, appears to be a reliable technique to treat fractures of the distal femur. It is accompanied by a high union rate and a low infection rate. It offers the advantage of little soft tissue impairment and adequate stability necessary for the fracture healing. Blood loss is usually small and therefore the method is suitable for fracture treatment in elderly and polytrauma patients. The accuracy of the reduction remains a question, because there is no precise method to test it intraoperatively.

Purpose: To investigate the accuracy of the MRI of the knee for the detection of injuries of the meniscus, cruciate ligaments and articular cartilage, in comparison with the preoperative clinical examination and intraoperative findings.

Material and methods: During 2002 88 patients underwent surgical arthroscopy in our institution, with the diagnosis of meniscal and or cruciate tear. 56 from these patients had preoperative MRI of the affected knee. The accuracy, sensitivity and specificity of the MRI findings were correlated with the lesions identified during arthroscopy. Furthermore, the predictive value of the preoperative MRI was compared with the preoperative clinical evaluation, as well as definitive intraoperative findings.

Results : The accuracy for tears of the medial, lateral meniscus, anterior and posterior cruciate ligaments and articular cartilage was 81%, 77%, 86%, 98% and 60% respectively. The specificity was 69%, 88%, 89%, 75% and 73% respectively. The positive predictive value was 83%, 81%, 90%, 100% and 53% respectively. Finally, the clinical examination had less reliability in the detection of these injuries.

Conclusions: As seen in this retrospective study the accuracy of the MRI in detecting injuries to the knee is superior to the clinical examination. The arthroscopy still remains the gold standard for definitive diagnosis.

Aims: The evaluation of the results becoming from the use of demineralized bone matrix (DBM) in the bone defects.

Methods: In the present study the above substance was implanted during the period 2000–2002 (28 months) to 24 patients, 11 males and 13 females average age 39.1 for the males and 60 for the females. As a cause was referred in 12 patients the fall, in 3 patients the car crash, in 5 patients following the removal of osteosynthesis materials, in 2 patients the bone cysts, in 1 patient fracture of ankle joint following fusion and in 1 patient a pseudarthrosis. The implantation of DBM concerned 8 hips, 4 femurs, 6 knees, 1 humerus, 1 forearm, 1 ankle, 2 metacarpal and 1 phalanx. All the fractures as well the fusion were treated through internal fixation. There was a regular post op follow-up and concerned the clinical and x-ray examination per month until the total incorporation of the graft (12 weeks).

Results: In all patients the total incorporation of the DBM was accomplished in a brief period of time, depended on the place of implantation without having local or systemic side effects. We have to remark the early signs of bone shadow around the 3rd week, as well the incorporation of the matrix around the 12th week in the x-ray findings.

Conclusions: The use of DBM in bone defects could play an important role to the filling of bone defects due to fractures or benign cysts as a result of its incorporation and without inducing local or systematic side effects.

Aims: The experimental application and biomechanical evaluation of a double – bundle ACL reconstructive technique(Ä plasty)

Methods: The reported technique suggests use of a pair of grafts, with common origin and different insertions. Experimental surgery was conducted on 25 porcine knee joints, divided as follows: Group A of 15 joints for the reported technique and group B of 10 joints for a single – bundle technique. Group A was divided in subgroups A1, A2 and A3, depending on different distances between insertion points. For surgery and testing a device was designed, with adaptors serving specimen alignment adjustments. A dial gauge was used for monitoring displacements caused by simulated drawer tests. Tests were carried out at knee flexion angles of 30, 60 and 90 degrees and with the natural ACL intact, ruptured and reconstructed. Measurements of Knee laxity were recorded

Results: In the intact condition, no statistical difference was found between specimens used to compare the two techniques (p-value equals 0,905). Overall, the double – bundle technique provided significantly lower laxity values, than the one – bundle technique (2.0 plus/minus 0.6 mm and 3.4 plus/minus 0.9 mm, respectively, with p – value less than 0.001). Laxity values obtained with the double – bundle technique were significantly lower, when adopting a large distance between insertions (p – value equals 0.016).

Conclusions: As the two techniques were compared on a uniform specimen population, results of in vitro biomechanical testing advocate that the reported double- bundle technique offered ACL reconstructions of superior stability. This is a promising technique which is deserved biggest study in vivo.

Aims: The topographical measurement and representation of the ACL insertion on the tibial plateau, based on a greek population sample.

Methods: Fourty eight tibial plateaus were explanted during TKA surgery in 33 female and 15 male patients (average age of 71.2 yrs) suffering from osteoarthritis and rheumatoid arthritis. By means of a calliper, measurements were conducted in order to determine the dimensions shown. Data were used for a topographical representation.

Conclusions: To the authors’ best knowledge, this is the first such anthropometric study on a greek population and its results provide a confirmation on the relatively wide base of ACL insertion on the tibial plateau. The biomechanical performance of this natural configuration for a full range of motion, is possibly not sufficiently reproduced by conventional ACL reconstruction techniques using just one bundle.