Aims: Outcome of the distal tibial fractures treated with interlocking nail. Method: We reviewed 108 patients with distal tibial fractures which were treated in our clinic between 1990 using interlocking intramedullary nailing. 94 patients (63 men and 31 women) were found in the recent follow up. AO fracture classiþcation system was used Seventy-eight patients had concomitant fractures of the lateral malleolar and 4 had medial malleolar fractures. Eight (8,5%) of the fractures were open grade I. All fractures were managed with closed reamed nailing. In fourteen cases the nail had to be shortened. The lateral malleolar fractures were þxed before tibial nailing to ensure overall alignment. Results: Union was achieved in 89 (94,6%) fractures with a mean time of union of 4,2 months (range:3–10 months). One deep infection (1,06%) lead to nonunion. Three aseptic cases had delay union which required nail dynamization. In one more nonunion case bone grafting and þbulectomy required. Postoperative transient peroneal palsy occurred in 2 (2,12%) patients which were fully recovered. One patient developed deep posterior compartment syndrome leading to FHL conctracture, needed tendon lengthening. Conclusions: Interlocking intramedullary nailing is a reliable, safe and effective method of managing distal tibial fractures with or without minimal ankle joint involvement.

Aims: To evaluate the functional recovery of the complex tibial plateau fractures Schatzker type V and VI treated with hybrid ex. fix..

Methods: Twenty-eight patients with intra-articular fractures of the proximal tibia were treated with hybrid external fixation in a three years period (1998–2001).The mean age was 35 years (17–76). According to Schatzker classification, there were 11(39.3%) fractures type V and 17(60.7) type VI, whereas 5(17.8%) fractures were open. Complex injury was recorded in 15(53.5%) patients. Closed reduction and hybrid external fixation was achieved in 21 (75%) fractures. Additional limited internal fixation was performed in 9(32%) cases. Open reduction was necessary in 7(25%) patients. Mobilization of the injured articulation was started at the 3rd postoperative day.

Results: Mean follow up period was 18 months. All fractures but one united at an average of 13.5 weeks (range from 11 to 18 weeks). The results were assessed according to the criteria of Honkonen and Jarvinen. An overall 22(78%) excellent and good results was recorded at the final follow up. Complications included one axial deformity, one septic pseudarthrosis, one peronial palsy and five pin tract infections.

Conclusions: The use of hybrid external fixation in the comminuted tibial plateau fractures (Schatzker V,VI), insure good restraining and early union, avoid major soft tissue complications and allow early mobilization and functional recovery of the knee joint.

Aim: To investigate the potential of biological fixation of cementless total hip arthroplasty (THA) in patients over 75 years old, with diagnosed osteoporosis.

Material-Methods: Between 1994–2000, 30 patients (mean age 77.3 years) underwent cementless THA.25 patients were found at the last follow-up, which ranged from 3–7 years (mean follow-up,4 years).THA was performed due to primary osteoarthritis (n=18), subcapital fracture (n=5), or dysplastic hip (n=2).7 Spotorno,9 Synergy and 9 Perfecta prostheses were implanted.Singh index was used for the evaluation of osteoporosis and Harris Hip Score (HHS) was used for the clinical evaluation of each patient.Modified Wixon score was used for the evaluation of stability probability of the tapered stem.Engh score was calculated for the evaluation of osseointegration of the porous coated implants.

Results: Pre and post-operative mean Singh index was grade 4.Mean HHS at the last follow-up was 88.6.For the Spotorno stem a stable fixation probability was calculated at 74.8%.Porous coated stems provided +13.45 mean Engh score,implying satisfactory fixation of the implant.Postoperative systematic complications are not reported.

Conclusions: In patients over 75 years old, with possible cardiopulmonary disease, cementless total hip arthroplasty offers a reliable treatment,regardless the presence of osteoporosis.Satisfactory osseointegration and absence of systematic complications is compromised by the high cost of titanium implants.

We evaluate the patients with lumbar spinal stenosis in multiple levels that were treated with posterior decompression and posterolateral fusion, using transpedicular screw fixation system. Twenty-six patients, mean age 65.7 years (range 49 to 77years), with lumbar spinal stenosis, in more than three levels, were treated surgically between 1994 and 2002. Indications for surgical treatment included low back pain and neurogenic claudication for more than 6 months. The diagnostic approach consisted of x-rays, MRI, myelography and myelo-CT. Oswestry disability score and VAS (visual analog scale), were used for the clinical evaluation of the patients. Surgical procedure consisted of wide posterior decompression, regarding laminectomy, complete or incomplete facetectomy and foraminotomy, combined with posterolateral fusion, using transpedicular screw systems and bone graft. Fusion in three levels was performed at seven patients, in four levels at ten, in five levels at seven, in six and seven levels at one patient respectively.

Mean follow-up was 26.8 months (range 12 to 38 months). Oswestry score and VAS revealed improvement 40.75% and 5.4 levels respectively. The better results were concerned to pain (2.88 levels improvement) and the less good to lifting (1.58 levels improvement). Two cases with superficial infections were observed and treated with surgical debridement. Screw breakage was observed in 1 patient and treated conservatively. Loosening of two sacral screws, which were removed, was observed in one patient.

We conclude that myelography and myelo-CT revealed with satisfactory accuracy intra and outer foraminal lumbar spinal stenosis. Posterior decompression and instrumented fusion, offer satisfactory clinical results in patients with lumbar spinal stenosis in multiple levels when performed by experienced surgical team.