Introduction

Grade IIIa/b open tibial fractures (OTF) result mostly following high energy trauma and may be accompanied by significant associated injuries. Aim of this study was to compare the characteristics and the outcome of OTF between patients of different injury severities.

Purpose: The evaluation of the results of the interlocking intramedullary nailing in the treatment of open and closed femoral and tibial fractures.

Material-Methods: During the decade 1996–2005, 408 patients with 429 femoral and tibial shaft fractures were treated with interlocking intramedullary nailing. All the nails inserted after reaming. From the 182 femoral fractures, there were 155 closed,

10 open, 9 pathological fractures and 8 non-unions. Accordingly, from a total of 247 tibial fractures, 190 were closed, 27 were open and there were also 30 non-unions. The average age was 37 years. The patients were assessed clinically and radiologically according to a specific protocol. Follow-up 1–9 years (average of 4, 4 years).

Results: There were 291 men (71%) and 117 women (29%). The mechanism of injury was a car or motor-vehicle accident in 210 cases, fall from a height in 134, direct force injury in 73 and labor accident in 12 cases. The average period of hospitalization was 5, 2 days. The average time to union was 3, 3 months and it was longer in open than the closed fractures. The percentage of union in all the cases was 96%.

Conclusion: Reamed interlocking intramedullary nails have been associated with higher union rates and lower union time without increasing complications in either closed or open fractures These advantages support their application in the treatment of all the closed and most of the open femoral and tibial shaft fractures.

A rare case of radiocarpal dislocation is presented. The lunate and proximal pole of the scaphoid were displaced in a volar and proximal direction. The injury was missed initially and the patient was subsequently operated on six weeks later. Open reduction and internal fixation of the scaphoid was performed and this was followed by an uneventful postoperative period, with a satisfactory functional outcome at the eight-year follow-up, despite carpal instability non-dissociative-dorsal intercalated segmental instability configuration of the carpus.

We believe that although open reduction in neglected cases carries the potential risks of avascular necrosis and nonunion of the affected carpal bones, an attempt should be made to restore the anatomy of the carpus.