Aims: Severe proximal tibia fractures, which include intra- and extraarticular fractures with metaphyseal-diaphyseal dissociation, pose a difþcult treatment problem for the surgeon with signiþcant complication rates. The aim of this study is to report the experience with a series of consecutive severe proximal tibial fractures treated with hybrid external þxators. Methods: Between 1997 and 2001, we treated 118 cases of proximal tibia fractures of which 52 were treated with hybrid external þxation. Inclusion criteria for hybrid treatment was severe soft-tissue injury, intra-articular displacement, and unstable fracture patterns involvment. In addition to routine demographic data, objective data collected included healing, deformity, complications, and motion. Patient were also evaluated with an SF-36 12 months after healing. Results: All proximal tibial fractures healed without additional procedures. Most patients demonstrated healing by 16 weeks. Accuracy of redution was 0–1mm in 28 patients, 2–3 mm in 19 patients, and 4–5 mm in 4 patients and greater than 5 mm in one patient. Only 5 (10%) of the 52 patients had an angular malunion greater than 6û. One case had a loss of reduction. Four patients developed a mild varus deformity. Radiographic and clinical evidence of degenerative arthritis was seen in 12/52 (23%) patients 18 months after healing. The SF-36 proþlese were health state/rate, daily activity, work activity, emotional problems, pain. Conclusion: We found that hybrid external þxation is a good alternative method for treatment of meta- and/or epiphiseal fractures. The technique and post-op management we describe respects soft-tissue and bone biology and allows early articular mobilization

Introduction: Fractures of the scapula are rare injuries. When they do occur, they are usually caused by high-energy trauma and some of the patients may have significant associated injuries. Most fractures are minimally displaced and amenable to nonsurgical treatment. Open reduction and internal fixation of intra-articular fractures are considered if there is a glenohumeral sub-luxation secondary to fracture or if there is an intra-articular displacement greater than 5 mm. Patients and Methods: This study consisted of 33 Pts from Israel and Macedonia (28 M, 5F, 18–74 year old, mean 43.5Y) followed for 2–5 years (mean 3.5Y). Fractures were classified according to Idelberg following analysis of plain radiographs and computerized radiographs. 26 patients had undisplaced or minimally displaced fractures of the glenoid and were treated conservatively by collar and cuff for three weeks, then followed by physiotherapy. The remaining seven patients had comminuted fractures with marked displacement of the glenoid and some degree of shoulder subluxation and were treated surgically. Six patients were treated by open reduction and osteosynthesis by rigid plates (3) or by screws alone (3). The 7. th. patient who was treated surgically, a 73-year-old female, had a displaced fracture of the glenoid associated with comminuted fracture of the proximal humerus. She was treated by internal fixation of the fractured glenoid by 2 screws, followed by hemi-arthroplasty of the shoulder. All patients were evaluated by the Constant’s Shoulder Score and by radiographs. Results: Overall results were excellent and good in 27/33 Pts (82%). They were almost free of pain and most of them had almost complete ROM of the affected shoulder. In the group of the patients treated conservatively for undisplaced or minimal displaced fractures of the glenoid 22/26 (85%) had satisfactory results. Five of the patients treated surgically (71%) had excellent and good results, with some better results in less comminuted fractures. The remaining 2/7 Pts treated surgically had fair results. One of them had a comminuted fracture of the glenoid and the other patient had an associated compound fracture of the proximal humerus and a shoulder hemiarthroplasty. Conclusions: Based on this study it seems that most fractures of the glenoid – undisplaced or minimally displaced – can be treated conservatively. However, for patients with displaced glenoid fractures, best results can be obtained with open reduction and internal fixation by screws or by plates. This should be followed by intensive physiotherapy