The use of external fixation in open tibia fractures with severe soft tissue injury is the most preferred and safe treatment. The primary allograft application is doubtful due to high infection risk.

The evaluation of the results of open tibia fractures type II and III according Gustillo-Anderson that were treated with simultaneous external fixation and allograft application.

From 2005–2007, twenty nine open tibia shaft fractures in 27 patients (2 bilateral) with mean age of 35 years-old were treated.

According Gustillo-Anderson classification, there were 20 GII, 6GIIIa and 3GIIIb open tibia shaft fractures without severe bone loss. All patients were treated with thorough and extensive surgical debridment, external fixation and simultaneous application of allograft and double antibiotic scheme. The patients were followed up initially weekly till stitches removal and every second week till the external fixation removal without developing any signs of infection.

Overall, there were uncomplicated union in 23 cases (18 GII, 3GIIIa and 2GIIIb) whereas in 5 cases we had to change method of treatment (3 GII and 2GIIIa) due to union delay or non acceptable fracture angulations. There were also a case that developed deep infection and septic pseudarthrosis.

The simultaneous external fixation and allograft application seems to provide a small advantage in open fracture consolidation despite the established wisdom for allograft use on a later stage. The proper initial open fracture estimation, the right surgical treatment, the surgeon’s experience and a strict patient’s follow up schedule are fundamental for a good final outcome

To analyze the treatment results of late instability and dislocation of the hip following total hip arthroplasty.

The study refers to 16 patients from 42 to 71 years old when had primary THA. The mean time of late dislocation was 9,5 years and the revision mean time was 11 years following THA. In most patients extensive polyethylene wear was documented, in 12 patients the cup or the polyethylene insert on a stable metal implant was revised and in 4 patients new polytethylene cemented insert was placed in a stable metal implant. In all cases exchange of the femoral component metal head took place.

During follow up and re-evaluation 2–7 years after the revision there were 13 patients (81.25 %) with a stable THA and good function. Instability remained in three patients, which in 2 was resolved with re-revision of the cup whereas in the third (over aged) a special abduction brace was applied.

Late hip dislocation 5 or more years after THA occurs mainly due to extensive polyethylene wear and in contrast with early dislocation requires more often surgical intervention. The main cause of late hip dislocation was the extensive polyethylene wear, which in three cases was associated with prosthesis mal-orientation at primary implantation and in lots of cases with age-related neuromuscular deficit.

The treatment of late instability with repetitive dislocations requires surgical intervention. The revision might need exchange of cup or polyethylene insert on a stable metal implant or new polytethylene cemented insert on a stable metal implant.

Introduction: The aim of this study is to correlate the long-term functional outcome of the wrist joint to the establishment of radiological osteoarthritic disfigurements that develop after treating comminuted intrarticular fractures of the distal radial epiphysis with external fixation.

Materials and Methods: Forty patients (22 male and 18 female) aging between 19 and 72 y.o who suffered a comminuted intrarticular fracture of the distal radial epiphysis from 1996 to 2002 and were treated with external fixation. The follow up started in 1996 and ended in 2007 (m.t 8 years). The fracture pattern was classified according to the Melone classification, the osteoarthritis stage according to the radiological findings and the functional outcome according to PRWE and UEFS forms.

Results: From 40 overall patients, twenty seven (67,5%) were classified as Melone II fracture pattern, nine (22,5%) as Melone III and four (10%) as Melone IV. In addition, 15% (6 pts) developed stage I osteoarthritic disfigurements, 45% (18 pts) stage II, 25% (10 pts) stage III and 15% (6 pts) stage IV. It’s quite remarkable the fact that among the patients with Melone II fracture pattern, 22,2% developed stage I osteoarthritis, 55,5% stage II and 11,1% stage III and IV respectively. The patients with Melone III fracture pattern developed stage II, III and IV osteoarthritis in a percentage of 33,33%. All the patients with Melone IV fracture pattern developed stage III osteoarthritis. The PRWE wrist evaluation form showed that 77,5% of the patients scored equal or less than 10/150 and 22,5% between 11/150 and 30/150. The UEFS wrist evaluation form showed similar results with 62,5% score of 8/80 and 27,5% score between 9/80 and 14/80. As final result, it seems that the development of osteoarthritis does not affect the functional outcome of the wrist in 95% of the patients whereas the rest 5% experienced minor or moderate wrist joint impairment.

Discussion and Conclusions: Fractures that are either unstable and/or involve the articular surfaces can jeopardize the integrity of the articular congruence and/or the kinematics of these articulations. However, the limitation of external fixation to achieve articular congruity in the comminuted intra-articular fractures of the distal radius has been documented in the literature. The fracture pattern, the degree of displacement, the stability of the fracture and the age and physical demands of the patient determine the best treatment option.

In addition, it seems that the radiological findings do not walk along with the clinical features and the wrist functionality in a major percentage. Our results indicate the importance of anatomical reduction and especially the restoration of radial length in order to obtain good functional future outcome.

INTRODUCTION: Cases of aseptic non-unions in patients with a femoral shaft fracture, who have initially been subjected to internal fixation by plating, are not rare. The aim of this retrospective, polycentric study was to evaluate intramedullary nailing as method of treatment of these patients.

MATERIALS AND METHODS: Thirty patients with aseptic femoral shaft non-union, after plating, were treated by reamed intramedullary nailing (IMN). The type of nailing was chosen according to the type of non-union. The mean follow-up time was 30 months and for statistical analysis, the student’s t-test was used.

RESULTS: All non-unions were healed in a mean time of 7.8 months (5–18) after nailing. The mean healing time after fracture was about 18.6 months (9–54). The healing times were irrelevant to whether the fracture was open or closed, the type non-union (atrophic or hypertrophic) and the type of fracture, according the AO classification. On the contrary, the delay from the initial plating to definitive treatment (IMN) affected the healing time and the final outcome, in a statistically significant way. Healing time was increased by 34.45% when the definitive operation was performed after between 8 and 16 months compared to the ones before the 8th month and by 72.28% if the IMN was delayed to between 16 and 24 months.

DISCUSSION: In conclusion IMN can be an ideal and cost effective method in treating patients with aseptic femoral non-union, after plating failure. This definitive operation should be performed as soon as the non-union is diagnosed in order to avoid unnecessary delay in fracture healing.

Aim: This paper presents the treatment of malunited fractures of tibia with intramedullary interlocking nail with correction of malunion, in order to prevent gait abnormalities and pathological loading of the adjacent joints. Method: We treated sixteen fractures of tibia that were treated initially with P.O.P. or external þxation and led to malunion or considered leading to malunion. In most patients there was combination of deformities with severe gait abnormality. In case of solid malunion the deformity was corrected after open osteotomy at the fracture site. In case of non solid malunion the deformity was corrected closed or semi-closed. Stabilization was achieved with interlocking intramedullary nailing. Fibular osteotomy was performed when needed. All patients were mobilized early. Results: All fractures healed without deformity and patients returned to their previous activities. Conclusion: Although intramedullary interlocking nailing is the treatment of choice for fractures of long bones its indication can be extended to malunited fractures. This method maintains stable correction of the deformity until union and allows early mobilization of the patient. It is easier to correct rotational or angular deformities than shortening.