To assess the outcome of Wilson’s osteotomy of the first metatarsal to correct Hallux Valgus.

Two hundred and forty feet in 172 patients who had surgery for pain were reviewed clinically and radiologically. Age ranged from 28 to 82 years (mean 55 years) and duration of follow-up ranged from 2 to 15 years (mean 6 years). A mini external fixation was used to stabilize the osteotomy.

The average AOFAS score improved from 51.6 to 89.5 points at the last follow-up. In 96% of the cases, the final outcome was satisfactory as far symptomatic improvement was concerned. A 4% only was dissatisfied with the outcome of the surgery due to metatar-salgia, restricted first metatarsophalangeal joint motion or lack of correction. There were no cases of avascular necrosis of the metatarsal head. We had five cases of delayed union but they didn’t need further surgery.

The average preoperative HVA and IMA were 34.80 (range: 180–540) and 15.10 (range: 100–290), while the average postoperative HVA and IMA were 16.10 (range: 70–280) and 7.20 (range: 30–90) respectively.

Wilson’s osteotomy as a method of treatment of Hallux Valgus is technically straightforward, effective and with a predictable outcome. We believe that the external fixation offered increased stability at the osteotomy site and could be the reason why patients had a very low incidence of postoperative metatarsalgia and returned to their normal activities faster, thus giving a higher satisfaction rate.

Most studies on LBP have focused on adults although many investigations have shown that the roots of LBP lie in adolescence. Several mechanical, physical and behavioral factors have associated with non-specific LBP in adolescents. To our knowledge no previous study has investigated using advanced statistics all previously reported parameters together with psychological and psychosocial factors on LBP in adolescents aged 15–19 years.

688 students aged 16± 1 years from 5 randomly selected high schools participated in this multifactorial study and completed a questionnaire containing questions on daily activity, backpacks carrying, psychological and psychosocial behavior. Anthropometric data as well biplane spinal curvatures together with questionnaire results were included in the analysis using advanced statistics.

LBP reported 41% of the participants. Generally, statistically significant correlations were found between LBP(0.002), physical activity(P< 0.001), physician consultation(P=0.024) and depression (P< 0.001) Gender-related differences were shown regarding LBP intensity(P=0.005) and frequency(P=0.013), stress(P< 0.03), depression (P=0.005) and nervous mood(P=0.036) in favor of male students. Male adolescents had continuously energy (P=0.0258) and were calm (P=0.029) in contrast to female counterparts.

LBP was gender-related and was less common in adolescents with frequent activity. Adolescent girls with stress, depressive mood and low energy have more LBP than boys that makes physician consultation for LBP more common in female adolescents.

Systematic physical activity and control of psychological profile should decrease LBP frequency and intensity

Study design: Prospective multifactorial study on low back pain (LBP) in adolescents.

Background data: Most studies on LBP have focused on adults although may investigations have shown that the roots of LBP lie in adolescence. Several mechanical, physical and behavioral factors have associated with non-specific LBP in adolescents. To our knowledge no previous study has investigated using advanced statistics all previously reported parameters together with psychological and psychosocial factors on LBP in adolescents aged 15–19 years.

Material and Methods: 688 students aged 16± 1 years from 5 randomly selected high schools participated in this study and completed a questionnaire containing questions on daily activity, backpacks carrying, psychological and psychosocial behavior. Anthropometric data as well biplane spinal curvatures together with questionnaire results were included in the analysis using advanced statistics.

Results: LBP reported 41% of the participants. Generally, statistically significant correlations were found between LBP(0.002), physical activity(P< 0.001), physician consultation(P=0.024) and depression (P< 0.001) Gender-related differences were shown regarding LBP intensity(P=0.005) and frequency(P=0.013), stress(P< 0.03), depression (P=0.005) and nervous mood(P=0.036) in favor of male students. Male adolescents had continuously energy (P=0.0258) and were calm (P=0.029) in contrast to female counterparts.

Discussion: LBP was gender-related and was less common in adolescents with frequent activity. Adolescent girls with stress, depressive mood and low energy have more LBP than boys that makes physician consultation for LBP more common in female adolescents.

Conclusion: Systematic physical activity and control of psychological profile should decrease LBP frequency and intensity.

Purpose: This study was performed to evaluate the results of intramedullary nailing of distal tibial fractures located within 5 cm of the ankle joint.

Materials and Method: From 1990 to 2007, 142 tibial fractures that involved the distal 5 cm of the tibia were treated with reamed intramedullary nailing with use of either two or three distal interlocking screws. Twenty-one tibial fractures were open and were treated primarily with external fixation and then with intramedullary nailing.

Seventy patients (49%) were under 20 years old, 85 (59%) were men and traffic accident was the main cause of fracture in 58 (41%) patients.

108 patients were treated with GK nail, 14 patients with modified GK nail and 20 patients with S2 nail.

All patients were allowed postoperatively full weight bearing with crutches till the fracture healing. Patients were evaluated clinically and radiographs were reviewed every three weeks till fracture healing. Last follow-up was at two years postoperatively.

The functional results were evaluated with the Iowa Ankle-Evaluating System.

Results: Acceptable radiographic alignment, defined as < 5° of angulation in any plane, was obtained in 135 patients (95%). No patient had any change in alignment between the immediate postoperative and the final radiographic evaluation. We had no non-unions or failures of the implant.

Complications included one superficial infection at the entry point of the nail and one iatrogenic fracture at the time of the intramedullary nailing. The fractures united at an average of 12.5 weeks.

The functional outcome was determined at one and two years postoperatively.

There was improvement in the Iowa Ankle-Evaluating System scores with time.

Conclusion: Intramedullary nailing is an effective alternative for the treatment of distal metaphyseal tibial fractures. Simple articular extension of the fracture is not a contraindication to intramedullary fixation. Functional outcomes improve with time.

Aims: To study the efþcacy of Texas Scottish Rite Hospital transpedicular screws versus laminar hooks in lumbar spine. Methods: 40 patients with unstable thoracolumbar fractures and spinal canal encroachment were randomly sampled into two groups: 20 patients received hooks in Òclaw conþgurationÒ in thoracic and lumbar spine (Group A), and 20 patients hooks in thoracic and transpedicular screws in the lumbar spine (Group B). Gardner kyphotic deformity; anterior vertebral body height (AVBH); Posterior vertebral body height (PVBH); and Spinal canal encroachment (SCE) were measured in roentgenograms and CT-scan. Results: All patients were followed for 52 months, (range, 42–71 months) postoperatively. Gardner angle was corrected at 45% and 48% with a loss of correction of 1.5û and 1û for Group A and B respectively. AVBH was corrected at 16% and 33% in Group A and B with loss of correction of 11% only in group A. PVBH was restored only in Group B at 3%, while the loss of correction was 4% and 1% for group A and B respectively. SCE was postoperatively decreased at 19% and 32% in group A and B respectively. On the latest evaluation there was an increase of SCE at 9% in group A, while it was furthermore decreased at 10.5% in-group B. All patients with incomplete neurologic lesions in-group A and B were postoperatively improved at 1.1 degrees and 1.7 degrees respectively. There was no screw failure, while there was two hook dislodgements in the thoracic spine (one in each group). There was neither pseudarthrosis nor neurologic deterioration in this series. Conclusions: The use of pedicle screws in the lumbar spine for stabilization of thoracolumbar injuries offers better correction of posttraumatic kyphotic deformity, restores and maintains better than hooks anterior and posterior vertebral body height of the fractured vertebra without loss of correction, and safeguard continuous remodeling of spinal canal resulting in increasing spinal canal clearance with time lapsed from operation.

Aim: Periprosthetic fractures are usually difþcult to be stabilized using plates and screws because of the presence of the underlying intramedullary stem, PMMA cement and thin periprosthetic femoral cortex. Modern techniques using cerclages and bands may be useful. Material & Methods: This study compares Ç in vitro È the mechanical performance of þve different osteosynthesis techniques applied on a oak femoral model obliquely oscillated to mimic a short oblique fracture: (a) double stainless steel wiring, (b) two 4.5 mm lag screws, © combination of one 4.5 mm cortical screw and one stainless steel wire, (d) one titanium cerclage CCG (Compression Cerclage Gudolf) combined with one 4.5 mm screw, and (e) double CCG Cerclage. The þve þxation constructs were subjected to a non-cyclic destructive axial compression and torsional loading. Results: The highest torque stiffness showed the double CCG and the double screw constructs, followed by and combination of CCG-screw and double wire constructs. The mode of failure in torque was a longitudinal crack close to screw tip and loosening of CCG and wire. The double screw, double CCG and screw- CCG constructs provided the highest stiffness in axial compressive forces. The mode of failure under compression was either loosening of CCG and wire or bending of the screw. Conclusions: This comparative study showed that double CCG can used in the treatment of oblique periprosthetic femoral fractures with the advantages of the simple technique, biocompatibility of titanium, no interference in modern imaging techniques and avoidance of stripping of muscles and degloving of bone surfaces as in platting often happens.

Aim of the study : The purpose of this work was to study the short term results of the surgical treatment of subtrochanteric femoral fractures with the use of long gamma nail.

Material – method : Fifteen consecutive patients suffering from subtrochanteric fracture of their femur, were treated by means of long gamma nail in our clinic during the last two years. The type of fracture concluded comminuted subtrochanteric fractures, unstable spiral fractures and fractures on previous operated on peritrochanteric fractures.

Results : The patient’s age averaged the 76 years. There were 4 men and 11 women. The follow-up period was from 5 months to 2 years. The blood transfusion averaged the 2 units. All patients ambulated the second postoperative day and the fracture healing observed two months later. We have no infection, pseudarthrosis or hardware failure at this series.

Conclusion : Long gamma nail is a method of choice in the treatment of subtrochanteric femoral fractures. We can achieve stable osteosynthesis, without soft tissue damage and immediate ambulating of the patient.

Introduction-Aim: The fractures which occurred at the midshaft of the femur, in which there is a prosthesis, are difficult to stabilize using free screws or plates, because of the presence of the underlying intramedullary stem, PMMA cement and thin periprosthetic femoral cortex. Although the periprosthetic fractures are usually oblique with a big contact surface between the pieces of the fracture and with the datum of the intramedullary presence of the femoral stem of the prosthesis, which increases the stability, this study compares five different types of internal fixation a rather unstable «worst case scenario» oblique midshaft fracture of the femur.

Material & Methods: We compared «in vitro» the mechanical performance of five different ïsteosynthesis techniques applied on a oak femoral model obliquely oscillated to mimic a short oblique 60o fracture. We compared the following kind of osteosynthesis: (a) double stainless steel wiring, (b) two 4.5 mm lag screws, (c) combination of one 4,5 mm cortical screw and one stainless steel wire, (d) double CCG cerclage, and (e) one titanium cerclage CCG (Compression Cerclage Gudolf) combined with one 4.5 mm screw. The five fixation constructs were subjected to a noncyclic destructive axial compression and torsional loading.

Results: The highest torque stiffness showed the double CCG and the double screw constructs, followed by the combination of CCG-screw and double wire constructs. The mode of failure in torque was a longitudinal crack close to the screw tip and loosening of CCG and wire. The double screw, double CCG and screw-CCG constructs provided the highest stiffness in axial compressive forces. The mode of failure in compression was loosening of CCG and wire and bending of screw.

Conclusions: The advantages of using the CCG is the simple technique, biocomptability of titanium, no interference in modern imaging techniques and avoidance of stripping of muscles. The method with the CCG titanium band proved biomechanically so stable as the system with the double 4,5 mm screw and recommend an alternative solution for the osteosynthesis of the distal periprosthetic fractures of the femur, especially for the cases with periprosthetic osteoporosis.