Several observational and experimental studies have investigated the potential anabolic effects of statins on undisturbed bone but only a few recent studies have examined the effect of statins on skeletal repair. The goal of the study is to investigate any potential early anabolic effect of the systemic administration of simvastatin in low doses (based on earlier safety and efficacy studies on undisturbed bone) on fracture healing.

Fifty-four skeletally mature male New Zealand White rabbits were used for the study. The rabbits were assigned to one of three experimental groups: a control group, and two groups that were orally administrated a diet with 10 and 30 mg/kg/day of simvastatin, respectively. A complete biochemical blood count was performed to exclude drug-induced complications. Half of the animals of each group were sacrificed at 15 days and the other half at 30 days after surgery at which time intervals healing quality was assessed. The bones were subjected to biomechanical testing, histomorphometric analysis and peripheral Quantitative Computed Tomography.

In animals received simvastatin of 30 mg/kg/day a significant reduction of BMD, stiffness, and energy absorbed to failure were observed. At 15 days, the amount of cartilaginous callus formation was reduced, and the void space was significantly increased, in the animals of both groups that received simvastatin when compared to the control group (p< .05).

Our results suggest that simvastatin doses of 30mg/ kg/day may have a negative anabolic effect on callus formation in rabbits, whereas doses of 10 mg/kg/day seem not to produce a significant positive or a negative effect, especially at the early stages of fracture remodeling.

Aim: To review the operative results and to determine factors that may significantly influence the outcome.

Method: We retrospectively reviewed 38 patients treated with femoral interlocking nailing and tibial external fixation in a 5-year period (1996–2000). Two patients were excluded because of early death. Minimum follow-up was 2 years. There were 29 men and 7 women with a mean age of 27 years. Eight femoral (22%) and 29 tibial fractures (81%) were open. Associated injuries to th head, chest, and abdomen were seen in 17 patients (47%). Concomitant musculoskeletal trauma was present in 30 patients (83%). Final functional results were evaluated according to Karlstrom’s and Olerud’s criteria. Various factors were assessed including age, severity of open fractures, neurovascular injuries, fracture comminution, ligamentous knee injuries, concomittant injuries in the same limb or in the contralateral limb, existence of multiple trauma. Multivariate models were derived to detetermine predictors of outcome.

Results: All femoral fractures and 31 tibial fractures (86%) united without additional intervention. Radiographic femoral union averaged 14 weeks and tibial union 20 weeks. A total of 18 secondary procedures were required. Functional results were excellent or good in 26 patients (72%). Increasing age, fracture comminution and associated injury in the contralateral limb were not influenced the final result. Open grade III tibial fractures (p< 0.03), severity of knee ligamentous injury (p< 0.02) and concomitant trauma to the same extremity (particularly to the ankle and foot – p< 0.02), contributing significantly to an unsatisfactory outcome.

Aims: The purpose of this retrospective review was to analyze our results with the use of the Marchetti-Vicenzi elastic locked nail in femoral shaft fractures. Methods: Between Jan.1994 and Dec.1997, 75 femoral fractures in 73 patients were treated in our department. There were 51 men and 22 women with a mean age of 29 years. All patients were followed to fracture union. In 67 cases (89%) the cause of injury was a R.T.A. According to Winquist and Hansen, there were 8 fractures of type 0 (no comminution), 5 of type I, 22 of type II, 29 of type III and 11 of type IV. Six fractures were open grade II and two were grade IIIa. Multiple injuries were seen in 22 patients (30%). Results: Certain intraoperative complications were encountered in 25 cases (33%). Open nailing was required in 21 fractures (28%) mainly because of the loss of reduction (absence of guide wire) or because the distal pins jammed at the fracture site. Distal locking mechanism problems (bending of protruding locking wire or breakage of safety loops) occurred in 11cases (15%). In 3 patients the distal pins protruded from the anterior cortex and in another 4 breakage of one or more pins occurred during the postoperative period. Delayed union was seen in 7 patients (9%). Five fractures (7%) progressed to non-union. All the non-united fractures were type III or IV. The remaining fractures united after a mean period of 15 weeks. Four fractures (5%) which were located in the distal third, united with signiþcant varus deformity (≥10¡). Shortening (≥2 cm) were seen in 4 patients (5%). There was one deep infection that led to nonunion. Conclusions: Because of the high complication rate in this series, we do not recommend this type of elastic nail for the treatment of femoral shaft fractures.

Aim of the study: In the present retrospective report, the clinical and radiographic results of implantation of the Perfecta cementless T.H.R. were analyzed, in patients who were followed for a mean period of 6.9 years.

Material and methods: Between January 1993 – March 1998, 227 Perfecta T.H.R were performed in 214 patients. Five patients died and 14 patients were lost to follow-up, leaving 195 patients (208 T.H.R) available for the study. There were 50 men and 145 women with a mean age at operation of 65 years (27–83). The most common diagnosis was primary osteoarthritis (69%). The patients were assessed clinically using the HHS and radiographically for signs of loosening, polyethylene wear and osteolytic lesions.

Results: There were 14 intraoperative femoral fissures (6%) in the metaphyseal area. The mean HHS at the most recent follow-up was 90. Four patients (2%) had moderate thigh pain. Radiolucent lines around the porous coated part of the components were not observed, and progressive loss of proximal density was not seen. In the cup, a measured migration (> 3mm) in the plain films was not seen, while stem migration was noticed in 5 hips but the patients were asymptomatic. Fifteen cups (7%) had polyethylene wear and in 12 hips (6%) small osteolytic lesions were seen. Seven hips (3%) were revised: 2 hips for deep infection, 2 for acetabular loosening and 3 for instability.

Conclusions: Our clinical and radiographic medium – term results of Perfecta cementless T.H.R are very encouraging.