Background: We present our further experience with the Orthofix tibial nailing system, concurrently evaluating the easy and safety of the distal targeting system for the distal locking.

Materials & Methods: Ninety-seven fresh tibial fractures in the same number of patients with a mean age of 38,5 years (17–85) were treated. Three were lost from the follow-up. Twenty of the fractures were grade I open fractures, four grade II and one grade IHA. All operations were performed in a conventional operating theater on a simple transparent operating table, with reduction of the fracture performed under manual traction and manipulation of the fracture site, hi most of the cases closed reduction was achieved and conventional reaming performed; in 14 patients the fracture was reduced through a small incision at the fracture site. Conventional reaming (power reaming) was performed in 69% of the patients; however, in 31% of the cases (30 patients), only minimal hand reaming was performed. The mean duration of the operation was 30 min. The external targeting device failed in 10 distal locking screws, in six of which the second attempt was successful. In four an image intensifier had to be used.

Results: Fracture healing, confirmed clinically and radiographically, was observed at a mean of 17 weeks (12–28 weeks). No tibial non-union necessitating reoperation occurred, however six fractures showed delayed union. Open reduction didn’t compromise the healing of the fracture. All patients eventually gained a full range of motion knee and ankle joint and only twelve of them (12%) complained of mild anterior knee pain. All patients returned to their previous activity, except for one disabled from a head injury. The later evaluation showed preservation of the tibial axis in all patients and additionally that no mechanical failure of either the nail or the screws occurred.

Conclusions: We conclude that the Orthofix nailing system is a clinically effective system. Distal locking can be performed with ease without significant exposure to radiation, provided that the operative technique is accurately followed, the nail is inserted without significant force and the distal targeting device is not subjected to any violation, such as hammering.

Unstable intertrochanteric fractures present a difficult problem with a high incidence of complications such as mechanical failure of the implants or cut-out. The use of bone cement (PMMA) has been suggested in the past but the application with hand to fill the existing voids has not given good results and also has high incidence of pseudarthrosis and infection.

A new technique is presented in which the PMMA is injected with syringe through the hole opened for the compression screws. The aim is to augment mechanical stability and also to replace the compressed spongiosa.

The study population of 105 patients with unstable intertrochanteric fractures was separated in 2 groups, hi group A (51 patients, 4 male/47 female, mean age 72.3) a conventional sliding nail was performed, while in group B (54 patients, 3 male/51 female, mean age 78.9) the new technique was applied. The two were similar regarding age and gender.

Post-operatively in group A 95% of the patients remain in bed for 1–2 weeks according to the surgeon opinion regarding the stability of osteosynthesis. 45% of them remain in a regime of bed to chair existence for 6 weeks. 72% return to its previous domicile and activity. In group B all patients were sat out the bed in the 1st day post-op and walked in the 2nd day post-op with partial weight bearing where that ability preexisted. 91% return to its previous domicile and activity.

In group A ll cases of cut-out were noted while in group B only 1 cut-out and also 2 cases, where we had screw failure, but fracture went on to union. All the difference are in favor in group B and statistical significant (p< 0,0 5). No infection was noted.

The suggested method appears to give a satisfactory solution to the problem of unstable intertrochanteric fractures, allowing fast and safe mobilization of the patient, reducing thus morbidity. Technically it is simple, easy to apply and does not require instrumentation while the extra cost is only that of a butch of PMMA.