Stronger flexor tendon repair techniques achieving excellent zero time biomechanics are considered the cornerstone of the early active motion rehabilitation protocols in digital flexor tendon surgery. Stronger suture materials are being introduced constantly without being tested biomechanically. The purpose of this study was to identify the role of the suture material on the flexor tendon repair techniques.

Seventy two tendon segments from thirty six cadaveric flexor tendons were lacerated and repaired with 2 different repair techniques and 3 different suture materials. The repair techniques involved an easier form of the popular Strickland technique and the stronger Modified Becker technique. Ethilon, Ethibond and the newer Fiberwire sutures were used, creating a wide range of materials with diverse biomechanical properties. The repair constructs were tested in an in vitro linear load to failure model where the ultimate strength, the 2 mm gap load and the mode of failure were recorded. Furthermore, a similar test was performed using only suture materials tied in a loop in order to compare the materials without any tendon or repair technique interaction.

The Modified Becker repairs demonstrated higher loads to failure than the Modified Strickland repairs irrespective of the suture material. Stronger suture materials increased significantly the strength of the modified Becker repair. The biomechanical characteristics of the modified Strickland technique were not influenced by the different suture materials. The 2 mm gap loads were not influenced by the suture material with either technique. The mode of failure was by suture breakage in the case of the Modified Becker repair and mostly by suture pullout in the case of the modified Strickland technique. The superior strength characteristics of the Fiberwire over the rest of the suture materials were also observed in the suture material study.

Suture materials do not have a significant effect on the biomechanical characteristics of every flexor tendon repair technique. Techniques most likely to benefit are those that grasp the tendon substance tightly and are limited only by the breaking strength of the suture material itself.

Objective: The purpose of this study was to evaluate the type and the dosage regimer the antibiotics administered prophylactically or curatively in six orthopaedic departments of «KAT» hospital.

Material-Method: Our study group consisted of 1231 patients who were hospitalized between September and November 2003. 1002 patients were treated surgically whilst 229 patients were managed conservatively. Among the patients who were operated 270 underwent THR or TKR, 306 patients were operated for NOF fracture, 195 patients were admitted because of long-bone fractures, 30 patients were operated for fracture or chronic deformity of the hand or the foot, 26 patients for open fractures, 52 patients underwent spine surgery and finally 53 patients were admitted for metal work removal.

Results: All patients were given antibiotics as prophylaxis for a period of 1–7 days 8 patients received antibiotics based on the cultures whilst 113 patients received empiric chemotherapy for some kind of infection. The microbiology lab recorded the microflora in every department and the percentage of resistance of the most important pathogens. Those were: 47% Gram(+) (45% staphylococcus) and 53% Gram(−). Of the identified staphylococci 44% were MR. MRSA-CNS was detected to be completely resistant to b-lactams and at a percentage up to 80% to amynoglycosides. The percentage of resistance of Pseudomonas was 55% to quinolones, 48% to aminoglycosides and 90% to b-lactams. We did notice that the use of the antibiotics was not based on a specific antibiotic policy and in a high percentage; the empirical use of chemotherapy was not documented on the laboratory data.

Conclusion: Taking into consideration the modern scientific data regarding the antibiotic treatment; the rational use of antibiotics in clinical practice requires the implementation of policies, the continuous education of the doctors as well as the intervention for proper prescriptions.

Aims: Demonstration of our results from treating displaced femoral neck fractures with a new method of closed reduction and internal þxation. Methods: Between 1995 and 1999 we treated 37 patients (21 female and 16 male) with displaced subcapital femoral fractures in the age group between 65 and 70 years. The selection of the appropriate treatment was according to our treatment algorithm based on the age, the displacement of the fracture, the general physical condition, the bone density and the functional demands of the patient. We performed closed reduction using an alternative method. The patient is placed on the traction table without traction of the injured limb. We apply traction on the abducted (> 45¡) healthy limb until the pelvis is mobilized. Finally, a radiological check is performed to decide whether we should modify the traction. This method is also used in other age groups. In 1 case closed reduction was not successful and an open reduction was performed. As a method of internal þxation we used 3 cannulated hip screws. Follow-up of the patients exceeded the period of 2 years. Results: The average Harris Hip Score at 2 years was 76. There were 3 cases of avascular necrosis and 2 cases of non-union of the fracture. In all these 5 patients we performed a conversion to total hip arthroplasty. Conclusions: Although displaced subcapital femoral fractures still remain the unsolved fractures, especially in ages between 65 and 70 years, proper selection of patients and satisfactory reduction of the fracture are the most important factors for a successful internal þxation of the fracture. The proposed alternative method of closed reduction leads to favorable results, comparable to the classical methods of closed reduction.

The use of hybrid þxation (cementless acetabular component and cemented femoral component) in primary total hip arthroplasty has been based on several observations: 1. The long-term problems associated with cemented acetabular þxation 2. The durable long-term results reported with cemented femoral þxation and 3. The encouraging reports of different centers on using the above technique. Methods: Between 1992 and 1997, 194 primary hybrid total hip arthroplasties were performed in our department in 171 patients. Follow up was performed at 5 to 10 years after the procedure. The average age at the time of the procedure was 69 years (range, 44 Ð 82 years). There were 102 women (123 hips) and 69 men (71 hips). 2 different groups of arthroplasties were used; one consisting of a microporous coated cup and one consisting of a hydroxyapatite-layered cup. The patients were prospectively observed clinically using the Harris Hip Score and radiographically. Results: The Harris Hip Score was preoperatively 43 in average (range, 15–55) and postoperatively increased to 88 points (range, 61–100). Five arthroplasties were revised; 1 due to acetabular loosening, 3 due to femoral loosening and 1 due to aseptic loosening. No cup migration of more than 1 mm could be observed. There were no radiolucencies around any of the screws used for the þxation of the cup. Conclusions: The clinical results of the hybrid total hip arthroplasties show excellent intermediate period results in respect of clinical performance and þxation durability.

From 1970, when Buchholz started incorporating antibiotics in bone cements, until now, many studies have been published supporting the beneficial effects of Palacos R with gentamicin in prevention and therapy of infections in orthopaedic surgery.

Despite the continuously increasing rates of genta-micin-resistant strains, the empirical use of gentamicin was reduced only as far as its systemic administration is concerned, while its local use in addition to bone cements has increased. The latter is justified by the gradual release of the antibiotic and its low toxicity.

We studied during the period of August 2000 to August 2001, 668 operations which were performed with P-G in 6 orthopaedic clinics of KAT hospital (129 total hip arthroplasties, 258 total knee arthroplasties, 29 hip revisions, 11 knee revisions and 241 hip hemiarthroplasties) and 137 operations with simple cement, out of total 1346 operations. All the above surgeries were performed either in 5 classical operational fields or in 2 controlled ventilation ones. The rate of infection was 1,02% in total, and does not differ from the infection rate of the 3rd orthopaedic department of the same hospital that performs the same operations in the same operating rooms without the usage of P-G, with the exception of revisions that P-G was used.

We believe that the high gentamicin-resistant rates of nosocomial microorganisms in combination with the non-complete inhibition of biofilm formation, the negative effect that gentamicin has on bone regeneration and the entailed risk of emergence of resistant organisms to gentamicin because of the continuous and long lasting release of the antibiotic in subtherapeutic concentrations, does not justify the use of Palacos R with gentamicin as prevention of infections. Perhaps the development of other bone-loaded antibiotics, that do not affect the strength of the cement, would be better accepted than gentamicin in the future.