Purpose: To present/evaluate the results of ‘intramedullary hip screw’ (IMHS) for treatment of subtrochanteric fractures of the hip.

Materials and Methods: Between 2003–2005 fifty four (54) patients aged 62–92 years old (average: 77,3 yrs) with subtrochanteric fractures of the hip were treated in our department with intramedullary hip screw (IMHS). Thirty one (31) patients were women and twenty three (23) were men. Thirty (30) fractures were located in the right hip and the remaining twenty four (24) in the left one. All patients were operated by the same surgical team –within 3 days from injury in the 86% of the cases. The duration of the procedure was between 55–75 minutes. Post-op, the patients were mobilized early with -at least–partial weight bearing and they were followed-up -clinically and radiologicallly for 7–30 months.

Results: 85% of the fractures were united within 14 weeks uneventfully. In seven cases, bone grafts were used. Three (3) cases of superficial wound inflammation and two case of haematoma were noticed. All above cases were treated successfully. Neither femur’s fractures (near or distal to the tip of IMHS) nor failure of implants were noticed. The 75% of patients achieved the pre-op status of rehabilitation.

Conclusions: The results of this study show that ‘intramedullary hip screw’ (IMHS) seems to be a reliable treatment for the subtrochanteric fractures of the hip; and it could be considered as one of treatment of choice for them.

Purpose: Description of the types of injuries occurring in ‘’semi-professional’’ soccer players, analysis some factors influencing the occurrence and registration of treatment’s options.

Material & Method: Between 1999–2003, 112 males semi-professional soccer players of different levels of skill, aged 16–38 (average: 28,4yrs) sustained 128 injuries during games or practice. Previous injuries, frequency of playing soccer weekly and options of treatment were also registered.

Results: 89% of injuries caused by trauma and 11% by overuse. 68% of injuries involved the lower extremity, 21% the upper extremity, 7% both upper & lower extremity and 4% the spine. Joints sprains predominated (36%), followed by fractures (25%), menisci tears (12%), ligaments injuries (10%), e.t.c. More than 15 different injuries were treated. Injuries to the ankle were most prevalent (42%), followed by the knee (26%) and the wrist (17%). The 2/3 of the injured players were playing soccer ‘’occasionally’’ (no more than 1–2 times per week, usually without any previous training), while the 1/3 had suffered previous injury in the same area of their body. 45% of injured players were > 30yrs old. Most injuries occurred during games. The treatment was surgically or conservatively (in ratio 1:1), depending on the type of injury.

Conclusions: Soccer players sustained a variety of injuries. Poor physical condition (occasionally playing & practicing), and ‘’personal’’ factors (previous injuries, level of skill) seemed to be related with the frequency and the severity of the occurred injuries. The treatment is based on the type of injury.

Purpose: The evaluation of the results of intramedullary nailing of open fractures of tibial shaft, which have been initially treated with external fixation.

Material & Method: Between 1997–2003, in 58 open fractures of tibial shaft (Gustillo type II & IIIa), the initially applied external fixation was replaced by an intramedullary nail type Russell-Taylor or Grosse-Kempf, either due to delay in union progress or due to frame‘s loosening. The conversion of external fixation to intramedullary nail was performed between 12th–15th week (average: 14th week), in two stages (1st stage: removal of EX.FIX, 2nd stage: insertion of I..N); with 13–22 days interval between the stages. In all cases, no elements of infection were noticed. In 45% of the patients bone grafting was performed at the time of nail‘s insertion. 37 patients were men and 21 were women, aged 19–52 years old (average: 31,7yrs). All patients were treated by the same surgical team and followed-up routinely.

Results: Union was achieved in 85% of the fractures, usually between 16–23 weeks (average: 18,7 weeks) from nail‘s insertion. In 7 cases, another operation was needed. Bone grafting in five, exchange of nail in two. Neither infection nor DVT was noticed. 82% of patients started sociallizing within 4 weeks, while 79% returned to pre-injury activities.

Conclusions: In cases that the union progress of the externally fixed open fractures of tibial shaft is not satisfactory; the conversion of external fixation to intramedullary nail seems to be a reliable option. The key points for the success of the method are timing and conditions of that conversion.

From 1985 to 1998 we used the Souter implant for elbow replacement in the rheumatoid population. We have followed this cohort prospectively, and present simple outcome measures including initial pain relief, early complication rates, radiological changes with time, and survivorship.

We performed 71 Souter elbow replacements in 62 rheumatoid patients (51 female, 11 male). The average age at surgery was 61 (range 38–79). All patients had end stage arthropathy. Early results and complications were assessed in all patients. Subsequently, ten cases were revised for loosening, and eight patients (10 elbows) died before recent follow up, leaving 51 cases for long term study. Clinical and radiological data were obtained.

On early follow up, 94% had no or minimal pain. Thirty-one percent suffered a complication. Overall, 18% cases had ulnar nerve problems and 7% dislocated in the first year. Seven percent had wound problems, including two deep infections. At mean long term follow up of 6 years (range: 2–15 years) there were high rates of satisfaction in patients with retained prostheses. Progressive radiolucency around the humeral component was common and treated expectantly. Late instability was not seen. Pain relief was maintained.

There have been few long-term reports on the Souter elbow replacement. This group of patients from a single centre has been followed prospectively. Infection and ulnar nerve complications are comparable with other series, and are less related to prosthesis. The rate of humeral component loosening in this series is high. The rate of dislocation, however, is low. This prosthesis sacrifices stability to transmit forces through the soft tissues. Although stability is acceptable there is no beneficial reduction in loosening.

The purpose of this study was to evaluate the outcomes of treatment of rheumatoid elbows with Kudo Total Elbow Replacements.

Between 1993–1997 we performed 39 Kudo Total Elbow Replacements in 35 patients with Rheumatoid Arthritis, aged 39–81 years old (mean age: 60,7 yrs). Eleven patients (13 elbows) were male and 24 (26 elbows) were female. Twenty-eight (28) replacements were performed on the right side and eleven (11) on the left. All the patients were evaluated clinically (pre-op and post-op, using Mayo score system) and radiographically. In seven elbows another procedure (radial head excision (three), radial head excision & synovectomy (three), arthroscopy & interposition arthroplasty(one)) had been performed previously for the rheumatoid arthritis. Eight elbows seemed to have ulnar nerve problems pre-op. We followed-up 31 patients (35 elbows). Mean follow-up was 5years (range: 4–8 years).

The pre-operative pain had been reduced significantly in almost all patients. In the majority, the movement had also been improved post-operatively. Two elbows were unstable (one subluxated, one dislocated). Both presented early postoperatively. Only one patient developed a postoperative ulnar nerve problem and that resolved. One elbow had a delay in wound healing. Radiolucency appeared around both the humeral and ulnar components in five elbows, around humeral component in two and around ulnar component also in two. Five elbow replacements were revised. Four of them due to aseptic loosening and one due to instability problem (dislocation). No deep infection was noticed in any elbow.

In our hands, Kudo Elbow Replacements seemed to have aseptic loosening rates comparable to other series and low dislocation rates.