The purpose of this study was to investigate the outcome of acetabular fractures treated in our institution with marginal impaction.

Over a 5 year period consecutive acetabular cases treated in our institution with marginal impaction were eligible for inclusion in this study. Exclusion criteria were patients lost to follow up and pathological fractures. A retrospective analysis of prospectively documented data was performed. Demographics, fracture types according to the Judet-Letournel classification, radiological criteria of intra-operative reduction (Matta) and secondary collapse, complication rates, and the EuroQol-5D questionnaire were documented over a median period of follow-up of 40 months (12–206).

Out of 400 cases, eighty-eight acetabular fractures met the inclusion criteria. The majority (93.2%) involved males with a median age of 40.5 years (16–80). Half of them were posterior-wall fractures, 21.6% bicolumn, 14.7 %posterior-wall and column, 6.8% transverse, 5.7% anterior-column, 1.1% anterior-column posterior hemi-transverse. In 75% of the cases anatomical intra-operative reduction was achieved. Structural-bone-graft was used in 73.9%, and two-level reconstruction in 61%. At the last follow-up, the originally achieved anatomical reduction was lost in 17/66 (25.8%), (10 PW, 4 PC+PW, 1 PC, 1 Transverse, 1 Bicolumn fracture). Avascular necrosis developed in 9.1% and heterotopic ossification in 19.3%. Full return to previous activities was documented in 48.9% of cases, the EuroQol general heath state score had a median of 80% (30–95%), full recovery was recorded as to the patients’ mobility in 51.1%, as to pain in 47.7%, as to self-care in 70.5%, as to work-related activities in 55.7%, and as to emotional parameters in 65.9%. Reoperation (heterotopic-ossification excision, total-hip-arthroplasty, removal of metalwork) was necessary in 19.2% of cases.

Utilising different techniques of elevation of the articular joint impaction leads to joint preservation with satisfactory overall functional results. Secondary collapse was noted in 25.8% of the patients predisposing to a poorer outcome

Anterior wall and/or column acetabular fractures (AW/ C) have a low incidence rate. Paucity of information exists regarding the clinical results of these fractures. We present our experience in treating AW/C at a tertiary referral centre.

Between Jan-2002 and Dec-2007, 200 consecutive patients were treated in our institution with displaced acetabular fractures. All AW/C fractures according to the Letournel classification were included in the study. All patients underwent plain radiography and CT investigations. Retrospective analysis of the medical notes and radiographs was performed for type of associated injuries, operative technique, peri-operative complications. Radiological assessment of fracture healing was determined by Matta’s criteria and functional hip scores were assessed using Merle-d’-Aubigne scoring. The mean follow up was 44.5 months (28–64).

15 patients (10 males) met the inclusion criteria (mean age 55.5 years). Four had associated anterior dislocation. Associated injuries included pneumothorax, splenic rupture, tibial and distal radius fractures. Five were treated by percutaneous methods, 8 with plate-screw fixation, and 2 with circlage wire, (10 ilioinguinal approaches). Mean time-to-surgery was 14 days(10–21 days). The average operative time for the percutaneous group was 75min vs. 190min in the orif group. Mean postoperative-in-patient-stay was 4 days(3–7 days), and 21 days(14–37 days). One patient developed chest infection post-operatively, two loss of sensation over the distribution of lateral cutaneous nerve. None of them developed incisional hernia, deep venous thrombosis and pulmonary embolism. At the last follow-up radiological outcome was excellent in 11 and good in 4 patients; clinical outcome was excellent in 12 and good in 3 patients, and none of the patients has developed heterotopic calcification or early osteoarthritis.

Our results on management of these fractures are comparable to the early results reported by Letournel. Operative treatment for the rare anterior wall and anterior column fractures yields a favourable outcome resulting in early mobilization with limited patient morbidity

To estimate the prevalence of clavicular fractures, number of cases required operative treatment, and whether removal of the implant is a frequent necessity.

Between November 2005 and Nov 2007 all patients presenting in our institution with clavicular fractures were eligible for participation. Patients below 18 years of age, and pathological fractures were excluded. Retrospective review of clinical notes and radiographs. Demographic details, mode of injury, treatment protocol, operative procedures performed, time to union, complications post-surgery stabilization, and the number of cases that required implant removal were documented and analysed in a computerized database. The mean time of follow up was 24 weeks (12–48).

Out of 16,280 adult fractures that presented to our institution, 200 (1.23%), (137 males) patients met the inclusion criteria with a mean age of 43 years (19–95) and a mean ISS of 9 (4–38). There were 4 of the medial, 153 of the middle and 43 of the lateral clavicle fractures (3 were open). 178 (89%) patients were treated non-operatively and 22 (11%) operatively. Indications for surgery included open fracture, bony spike/skin threatened, grossly displaced/comminuted fracture, polytrauma and non-union. Mean time to radiological union was 14 weeks (5–38 weeks). Out of the 200 patients 12 (6%) developed non-union. Out of the 22 operated patients, 7 (32%) required plate removal and 1 had screw removal. Indications for removal of implant included, periprosthetic fracture (1), prominent metal work through skin (3), pain in shoulder (2), pressure symptoms (1). Post removal of implant, 6 (75%) patients claimed improvement in symptoms. Functional outcome was excellent/good in 90% of cases.

The incidence of clavicular fractures was 1.23%. A small number of patients (11%) required operative treatment out of which one third had metal work removal. The majority of clavicular fractures can be treated non-operative with good functional results.

Introduction. Posterior superior glenoid impingement as a cause of partial rotator cuff lesions and posterior superior labral tears in overhead athletes was first described in the early 90’s by Walch and Jobe.

Material and methods. From January 1994 to January 2002, 71 patients were treated (48 men and 23 women). The majority were overhead athletes: handball (39), ketcher sports (12), volleyball (8), others (12). Indications for surgery were shoulder pain with athletic activity and a failed trial of conservative treatment. Mean age was 26 (range, 17–41) years. Mean duration of symptoms was 31 (range, 7–120) months. Following diagnostic arthroscopy–excluding anterior inferior ligament lesions and other significant intaarticular pathology–the partial rotator cuff lesions and posterior superior labral tears were debrided arthroscopically. During postoperative rehabilitation emphasis was placed on strengthening rotator cuff muscles, restoring normal scapulohumeral rhythm and avoiding stretching of the anterior static glenohumeral stabilizers.

Results. In 97% of cases a partial rotator cuff were found, and 90% had significant posterior–superior labral lesions. There were also 6 SLAP type II lesions that were repaired. Sixty four out of 71 patients were available for a follow up of minimum 2 years: 61% were able to return to preinjury activity level without any shoulder symptoms and 22% were not able to return to their desired sport. Overall satisfaction rate was 84%. The average time for return to sports participation was 9 (range, 4–12) months. Thirty six out of 46 patients had a telephone interview in a second minimum 5 years follow up. Fifty two percent (52%) were still active overhead athletes and 48% had stopped athletic activity (half of them because of shoulder problems). Six patients had secondary operations: 4 a capsular shift procedure and 2 a subacromial decompression.

Conclusion. In patients with symptomatic posterior superior impingement arthroscopic debridement followed by careful rehabilitation is an acceptable treatment. There is some tendency for the symptoms to recur over time.

Aims: The purpose of our study is to present the results of the use of external þxation, as a þnal method of treatment for tibial shaft fractures. Methods: In 5 years period, we treated 143 tibial shaft fractures in 135 patients. 112 were male and 23 were female, aged 15 to 80 years old (mean 35 y.o.). Our indications were: 16 closed fractures with severe soft tissue injury, 19 closed fractures with threatened compartment syndrome, 90 open fractures, Gustilo type II or III, 18 closed fractures in polytrauma patients. Results: Union, without the need of changing method was achieved in 121 fractures. The mean time of union was 22 weeks for closed fractures, 25 weeks for type II open fractures and 28 weeks for type III open fractures.

The main complications were 13 nonunions, 40 super-þcial pin infection, 2 malunions, 2 osteomyelitis, 2 patients with fat embolism syndrome and 3 deaths due to pulmonary embolism. Conclusions: External þxation is a proper deþnite treatment for tibial shaft fractures according to the indications mentioned above. Technically it is easy to apply and there is no need of surgery to remove it. The procedure of normal union is not disturbed. Most of the complications can be managed without removing the device. The advantages of the method make it comparable or superior to intramedulary nailing although there is a delay in full weight bearing.

Purpose: The purpose of this study is the analysis of the results of the surgical treatment of complex and displaced acetabular fractures.

Material: We have the results of thirty four comminuted acetabular fractures that were treated with open reduction and internal fixation. Most of them concerned fractures of both columns.

Method: Thirty two of the fractures were operated through one technique (Kocher-Langenbeck, ilioinguinal, expansive iliofemoral, or lateral by lifting the greater trochanter).The other two were operated with a double procedure (Kocher-Langenbeck and ilioinguinal). For the internal fixation reconstruction plates were used together with free screws and sometimes hook like wires.

Results: Anatomic reduction was performed in 24 cases. The result was graded as excellent in 42%, good in 34%, fair in 16%, and poor in 8% of the cases. Posttraumatic arthritis was seen in cases were anatomic reduction was not possible and the level of the arthritis was in absolute relationship with the quality of the reduction. In cases were the reduction was anatomic, posttraumatic arthritis was rare. The clinical results were in absolute relationship with the quality of the reduction and they were satisfactory as soon as the relationship of the weight bearing surface of the acetebulum and the femoral head is regular. Avascular necrosis of the femoral head was seen in two cases.

Conclusion: The anatomic reduction of displaced complex acetebular fractures prevents posttraumatic arthritis and ensures satisfactory clinical results. The aim of the operation must always be the anatomic reduction of the acetabular cup and the bone structures around it. When this is not technically possible we have to try for the restoration of the relationship between the femoral head and the acetabular roof.

The surgical treatment of scaphoid nonunion is controversial.

The purpose of this study is to present our experience from the surgical treatment of 16 scaphoid nonunions in heavy manual workers.

Sixteen patients with sixteen nonunions of the scaphoid were treated during the last 6 years (13 male and 3 female). Established nonunion was present in 7 months to 7 years. Five nonunions were Alnot stage I, 5 were IIa, 5 were IIb and 1 nonunion was stage IIIa. One case considered the distal pole and 15 the proximal pole of the scaphoid. In 5 patients there was avascular necrosis of the scaphoid and in 6 patients DISI was present. All sixteen patients complained about pain, resulting to disability to work.

All patients were treated with an autocompression screw and small autologus cancellus bone grafts. In one case with a proximal third non-union, screw fixation was not achieved. The mean time of union was 70 days. Mean follow up was 3 years. All patients returned early to their occupation without pain. Grip strength reached 90% (70% preoperatively) and range of motion reached 95% (80% preoperatively), compared to the contralateral side. Excellent functional results were in eleven patients, good in four and average in one patient. In four cases there was a previous carpal dislocation.

Symptoms of non-union of the scaphoid appear earlier in heavy manual workers and their surgical treatment should not be delayed. We believe that the use of autocompression screws and cancellous bone grafts is the first choice of treatment for nonunions (Alnot stage I and II) of middle and distal third of the scaphoid.

Introduction. We present the results of the management of irreducible dislocation or fracture / dislocation of the elbow using the “Orthofix” external fixator in cases where the condition of the soft tissues was contraindicated for extensile surgical approaches or the internal fixation would not be stable enough to permit safe joint mobilization postoperatively.

Materials and methods. Twelve (12) patients were treated using elbow external fixation,5 with supracondylar fracture and severe osteoporosis and 7 with fracture / dislocation of the elbow and excessive soft tissue impairment (two of them with open fracture). For the patients with fracture, we performed minimal internal fixation using small incisions and minor soft tissue detachments and then we applied the elbow external fixator for the neutralization of the fixation. This permitted the immediate active assisted joint mobilization postoperatively without interfering with the stability of the joint and of the fixation. The same happened for the patients that their elbow remained unstable after reduction of traumatic dislocation, where the external fixation maintained the reduction of the joint. Prerequisite for the safe mobilization of the joint was the application of the external fixation at the center of rotation of the elbow which is the transepicondylar axis, in order to comply with the biomechanics of the joint.

Results. The fixator was applied for a mean of 10 weeks (6 – 16 weeks). All the fractures united and no instability of the joint was noted. The range of motion was between useful limits with lack of extension less than 30 degrees and flexion more than 130 degrees, pronation 60 degrees and supination 55 degrees (mean values). Pin track infection was presented in 3 patients and the treatment was local care and antibiotics. One patient had radial nerve palsy immediately after the operation, who recovered totally after four months without any treatment.

Conclusions. The external fixation of the elbow provides sufficient stability permitting the immediate mobilization of the joint postoperatively and in combination with the minimal soft tissue damage during the operation prevents the postoperative stiffness. It is a safe alternative solution when the condition of soft tissues around the elbow do not permit a thorough open procedure.