Purpose: The floating knee injuries are rare injuries and have severe complications. There is controversy in the literature regarding the gold standard of treatment. We present our experience treating 25 patients with this type of injury.

Materials and Methods: There were 23 males and 2 females, aged 18 to 65 years, with a mean ISS (injury severity score) 25 (ranged, 18 to 45). All patients were operated the day of admission. Based on Letts’ classification there were 8 fractures type A, 6 type B, 7 type C, and 4 type D. The management in type A and B in non polytrauma patients was external fixation of the tibia followed by intramedullary nail of the femur, while in type C and D external fixation of the femur followed by external or internal fixation of the tibia.

Results: The mean follow-up was 4 years (ranged 1–7 years). One patient died before the completion of the therapy. Fracture union was accomplished to all the patients. Three patients were reoperated for nonunion or malunion of the femur and one for nonunion of the tibia. There was no infection. The main complication was the knee stiffness but it was resolved without a second operation. Two patients had pulmonary embolism and one fat embolism. The final results based on Karlstrom and Olerud criteria were excellent in 5 patients, good in 14 and fair in 5.

Conclusion: The treatment of the floating knee injuries is based on ISS and the Letts classification. In type A and B in non polytrauma patients, we believe that the best way of treatment is external fixation of the tibia followed by intramedullary nail of the femur.

Aims: This is a retrospective study, comparing prosthesis survivorship, complications and functional results in geriatric patients treated with different types of prosthetic replacement for subcapital fractures of the hip. Methods: In the years 1985–1999, 292 elderly (aged 65–80 years) patients with displaced, nonpathologic sub-capital hip fractures were operated on. Of those, 143 were lost to follow-up; therefore, prospectively collected data of 149 patients were retrospectively reviewed. 54 patients received a unipolar, 48 a bipolar prosthesis and 47 underwent a primary total hip arthroplasty (THA). Mean follow-up was 5.3 years. The patients did not differ in pre-injury characteristics. Analysis of variance was used to compare the three patient groups in terms of early and late complications, need for revision surgery, and functional outcome. Results: A statistically signiþ-cant difference was noted, regarding need for revision surgery, since 5 (9.25%) of the unipolar and 5 (10.4%) of the bipolar prostheses had to be re-operated, compared to 2 (4.25%) from the THA group. Of note, 4 of the revised bipolar prostheses had loose stems. The THA group also proved superior, when recovery of instrumental activities was investigated. Conclusions: Elderly patients, whose biologic age poses high functional demands on them, with a displaced subcapital hip fracture, should receive a total hip arthroplasty. Stem loosening seems more likely, as a mode of failure, in bipolar prostheses, than acetabular erosion.

We reviewed 40 patients who underwent V-Y skin flap reconstruction following distal fingertip skin loss.Of the patients 35 were males and 5 females with an average age of 35 years at operation.Surgery was performed as an emergency in all patients.In all cases a single digit was involved.The majority of the injuries were transverse amputations.Mean advancement of the flap was 12 mm.At the follow-up evaluation (mean 2 years),8 patients complained of pain (2 with functional impairment),15 complained of cold intolerance,and 5 had nail deformities.Sensibility of advanced skin was normal in 28 cases,while two-point discrimination averaged 7 mm.This discrimination was virtually identical to contralatertal digits in 25 of the cases.Overall 28 patients were satisfied with their results,while the rest of them were mildly displeased,either with the functional impairment or with the appearance of the involved digits.

The reported results for primary lumbar disc surgery in open standard technique are succesful in 80–95% of patients, while after repeated surgery range from 28 to 81%.

The best clinical results occur when there is an indication of neurological impairment, nerve root compression and radiological confirmation. We report the results of a retrospective study on 54 patients, aged 30 – 65 years, who were presented with recurrence of symptoms and operated on for a 2nd or 3rd time after a previous discectomy, between the period 1990 to 2001.

Objective: The aim of the study is to determine the factors that influence the results after repeated surgery and to analyse those that lead to failure.

Material and Methods: The 54 patients were submitted in a detailed clinical and radiological examination (CT-scan, MRI, EMG) in an attempt to determine the exact indication for re-operation.

The preoperative findings for the revision surgery were: Radiculopathy secondary to a new herniation, 14 patients.

Due to recurrent disc prolapse at the same level, 9 patients.

Due to lateral recess stenosis, 12 patients.

Instability secondary to a previous wide laminectomy, 4 patients.

No obvious cause, probably due to fibrosis, 5 patients. Multiple root syndrome due to a tumor, 1 patient. Cauda equina syndrome due to an hematoma 1 patient.

The follow-up of the patients ranges between 1–12 years and the results of the revision surgery are classified according to Finnegan’s classification.

Results: From the 54 patients, 30 had a good result (56.6%), 16 fair (29.4%) and 8 poor (15%)

Forty-six patients rated the revision surgery worthwhile (85%).

Conclusions: The factors with good prediction of the results were:

Relief of pain more than 6 months after the previous surgery.

Sciatica > Low back pain.

Nerve root compression from a new herniation in another level or recurrence at the same.

Lateral recess stenosis.

Good correlation of the clinical and radiological findings.

The factors with bad prediction were

The intra-operative fibrosis.

Pain relief less than 6 months

The bad psychological condition of the patients.

Instability of the thumb trapeziometacarpal joint is a major factor in the cause of degenerative disease. Surgically stabilized joint should be subject to less shear forces and hence, will be less likely to develop degenerative changes. The results of volar ligament reconstruction were assessed in 12 patients (8 men- 4 women). The average age at surgery was 35 years. All thumbs were radiographic stage I. All had failed conservative treatment with splinting and anti-inflammatory medication. Operativelly a strip of Flexor Carpi Radialis tendon was used for ligament reconstruction according to the technique described by Eaton, Glickel and Littler. The follow-up period averaged 7 years. At final follow-up 8 thumbs were stage I, 3 were stage II, and one was stage III. Ten patients were at least 90 % satisfied with the results of the surgery and only two had symptomatic thumb basal joint.

We reviewed the functional outcome of cominnuted intraarticular fractures of the distal humerus managed with internal fixation with plates and screws. 15 patients (10 men-5 women) were reviewed over a mean of 29 months postoperatively. The age of the patients at operation ranged from 18 to 72 years. Patients were treated within 7 days of injury, using a posterior approach,with or without olecranon osteotomy and with anterior transposition of the ulnar nerve. Bone grafting was used in 7 cases in addition to internal fixation. Postoperative mobilisation was prompt in all patients,who were meticously reviewed for : 1)Function of the upper extremity,with the aid of the scale of DASH (Disabilities of the arm,shoulder and hand), 2)Ulnar nerve (pain, sensitive and movement dissability, functionality), 3)Range of elbow motion, 4) strength of the muscles controlling the elbow, wrist and hand. 5)Post-operative radiographic appearance, 6)Subjective evaluation, 7)Complications. All the patients were satisfied with the outcome of the operation,as well as with the activities which could postoperatively be undertaken. The mean range of motion for elbow (flexion-extension) was 118° in average,while muscle strength for elbow motion was moderately reduced. No case of ulnar neuropathy was observed. On the other hand postoperative complications were considerably frequent, yet they were mild and subsided eventually without further operation.