Introduction

Distal radius fractures are one of the most common injuries attended in hospitals. Throughout the years the treatment has change from simple cast to ORIF.

Introduction: Trochanteric bursitis rarely needs surgical treatment. A distal lengthening procedure has been described.

Purpose: To analyze the outcomes of two different surgical techniques: proximal and distal lengthening of the fascia lata.

Materials and methods: Median instead of average was used for the quantitative variables. Twenty one patients (23 hips) were treated between October 1999 and February 2006. They were divided into two groups and their previous medical and surgical history was collected. The proximal Z-plasty group included 10 hips with a median age of 54 years; median body mass index (BMI) was 28.5 and median time from onset of symptoms till surgery was 36 months. The distal Z-plasty group included 13 hips, median age was 54.6 years; median BMI was 26.3; and evolution till surgery was 18 months. Harris hip score, verbal analog scale for pain (VAS) and a Lickert satisfaction scale were used.

Results: In the “proximal group” the Harris hip score improved from 61 to 77.5. VAS improved from 82.5 to 27.5 and as regards the Lickert score 3 hips were very satisfied; three were satisfied; two hardly satisfied; one dissatisfied and one very dissatisfied. Two seromas occurred after surgery. In the “distal group” Harris score improved from 63 to 91. VAS improved from 90 to 10 and the Lickert scale gave 5 very satisfied hips; 4 satisfied; none hardly satisfied; 4 dissatisfied and none was very dissatisfied. There was a seroma after surgery.

Conclusion: Despite the low number of cases, distal Z- plasty showed better results than the proximal technique in the treatment of trochanteric bursitis.

Background: There is no consensus on the best treatment of complex intraarticular fractures and high energy diaphyseal fractures of the long bones. The Locking Compression Plate (LCP) and the Less Invasive Stabilization System (LISS) are the new implants with angular stability developed by the AO/ASIF. The new screw-plate systems seem to offer an excellent alternative for the operative fixation in these cases.

Patients and methods: In a prospective study the new system was used to treat 20 patients (8 women, 12 men; average age 39.3 yrs) with 23 high – energy injuries (multifragmentary shaft fractures or complex intraarticular) from december 2001. During a mean period of 20 (13–30) months, complications, clinical and radiographic findings were followed prospectively. One patient was lost to follow-up. 19 patients underwent a standardized follow-up examination. According to the AO classification, 6 were proximal tibial fractures 41-C; 4 distal tibial 43-C; 6 distal femoral 33-C; 3 humerus 12-C and 4 distal radius 23-C. Ten of the fractures were open, 6 grade II, and 4 grade III. Because of severe concomitant injuries, 4 fractures were first treated with an external fixator and definitively stabilized more than two weeks after the injury. 2 patients were operated on after failure of others implants and non-union.

Results: The outcome correlated with the severity of the fracture, anatomic reduction, exact positioning of the plate and concomitant injuries. Despite the large number of open and comminuted fractures no serious complications as deep infections, vascular lesions, DVT or non-unions were presented.

Conclusions: We found the new internal fixator system to be a safe and reliable procedure. The new system offers numerous fixation possibilities and has proven its worth in complex fracture situations and in revision operation. A good knowledge of biomechanics is essential as well as precise preoperative planning.

Introduction and Objectives: High-energy fractures of the pelvis carry a high mortality and pose a diagnostic and therapeutic challenge in modern orthopaedic trauma. A multidisciplinary approach has reduced mortality in the past two decades. In cooperation with the polytrauma ICU, we have developed a diagnostic-therapeutic algorithm to determine indications for laparotomy, external fixation, and angiography, in terms of clinical evolution and fracture type.

Materials and Methods: This is a retrospective study of 67 patients with pelvic fractures and persistent hae-modynamic instability who were treated in our centre between 1994 and 2002. The following parameters were analyzed: personal data, AIS, ISS, RTS, type of fracture (Young and Burgess classification), associated injuries, haematologic requirements, and degree of adherence to the algorithm in terms of diagnostic and therapeutic measures. The following results variables were examined: mortality, incidence of systemic complications associated with traumatic illness (MOF, ARDS, DIC), and length of hospital stay.

Results: The study involved a total of 67 patients, all with pelvic fractures and persistent haemodynamic instability. Average age was 37.7 years, and average time in the ICU was 13.8 days. In 53.7% of cases, patients were transported to the centre by ambulance, 41.8% by helicopter, and the remaining 4.5% by other means. Adjusted mortality was 25%. External fixation was used on 42 patients (62%) and angiography in 36 (53%). Both techniques were used in combination in 17 patients. Of the 36 patients who underwent angiography, 33 showed positive findings (91.7%). Exploratory laparotomy was required in 23 patients due to positive findings on abdominal ultrasound, which yielded positive results in 20 cases. Mortality in these patients was 45%. Average ISS was 29.

Discussion and Conclusions: Rapid evaluation and a multidisciplinary approach are necessary in handling patients with pelvic fracture and haemodynamic instability. External fixation is a rapid procedure that is safe and simple, permitting the control of haemody-namic instability, which should be considered more as an emergency stabilisation technique than a reconstructive procedure. Abdominal ultrasound is a very sensitive method when deciding whether or not to perform an exploratory laparotomy. In cases with rotational instability of the pelvis, laparatomy should be done only after pelvic fixation. A diagnostic-therapeutic algorithm has been designed for the management of pelvic instability, with particular emphasis on indicators of a poor prognosis.