Aims: to evaluated the radiological evolution of autologous bone graft in acetabular structural and cavitary defects in primary total hip artrhoplasty using an expansion cup (CLS, Sulzer Orthopaedics). Methods: we reviewed, retrospectively, 19 patients (9 males, 10 females, average age 64,7 years) treated in our Unit from January 1994 through July 2000 with acetabular bone grafting. According to the AAOS classiþcation, 11 patients showed a segmental acetabular deþciency requiring a structural graft, 8 had a cavitary defect treated with avoid-þlling bone. X-rays were standardized and investigated for evidence of graft remodelling (obliteration of the interface bone-graft, change in density, bridging trabeculation, reorientation of trabecular pattern) and cupñs loosening (radiolucency, cup migration, ratio graft/cup, breakage of screws). Results: all, but one, patients were evaluated at aminimal follow-up of 2 years (average time 53 month). Osteo-integration was appreciated radiographically at 6 months while union at 12 months in all cases. No cupñs loosening was experienced. Reasorption was evident as a round off and smoothing of the edge of the structural graft in 8 patients while the percentage of bone graft surrounding the cup did not change over time. Conclusions: we believe that the use of an expansion cup, with its elastic properties, allows micro-movements at the interface bone-implant creating a dynamic system that could improve osteo-induction and osteo-integration of the graft.

Aims: Treatment of fractures of the distal femur have changed in recent years toward minimally invasive techniques in order to avoid extensive bone exposition that could interfere with union processes, complicate articular reconstruction and increase infection rate. We have used the LISS plate in order to investigate clinical and surgical advantages and complications in simple articular and complex extraarticular fractures of segment 33. Methods: From March 2000 trough February 2002 we have treated 6 patients with 33 A fracture, and 4 patients with 33 C fractures. A bilateral synthesis was undertaken. 1 patient had a Gustillo 3 while 1 a Gustillo 2 lesion associated to the fracture. 2 patients sustained a periprosthetic fracture in THA, while a patient a fracture in proximal femoral nailing. The patient with Gustillo 3 lesion sustained plastic surgery. The minimal follow up was 7 months. Results: The mean time of plating was 52 minutes, 2 patients required blood transfusion. No infections were encountered. All fractures united; the mean time of union was 86 days. At 6 months, segmental range of motion varied from 0 to 6 degrees in extension and from 82 to 123 degrees in ßexion. Conclusion: The LISS plate represents an excellent mean of synthesis combining the philosophy of internal þxation with angular stability to minimal invasiveness. Furthermore it allows to manage the problems of periprosthetic fractures avoiding prosthetic replacement.