Aim: Lumbar spinal stenosis is a common disease in spine surgery, especially for older patients. Internal laminoplasty technique is minimal invasive and can offer relieve from symptoms and early recovery to the patient. This method is our choice for surgical treatment in lateral spinal stenosis.

Material and Method: From 1996–2002, 48 patients (28 male-28 female) operated for lumbar spinal stenosis (central or lateral).Eighteen(18) of them in level L3-L4, twenty two(22) in level L4-L5 and eight(8) in level L5-S1 with mane age of 62 years. Their clinical condition was neurogenic claudication, radiculopathies and/or bladder dysfunction. Preoperative examination included X-rays, 3-D X-rays, CT-scan (in combination with myelography in many cases) and MRI.

Results: We used internal laminoplasty without fusion for all cases.

We had no infection or neurological complication. 44patients (91%) mentioned sufficient clinical improvement and pain relief.

Conclusions: Internal laminoplasty technique is a progress in microsurgery, which reduces iatrogenic damage and rehabilitation time, giving excellent results when it is indicated.

Aim: To describe the technique and the mid term results of anterior shoulder instability arthroscopic reconstruction.

Patients-methods: Between March and December 2000 29 patients-28 males with ages ranging between 19–29 years (mean age 23 y.) and 1 female 24 years old-underwent arthroroscopic stabilization of anterior shoulder instability. During the procedure the anterior-inferior part of the labrum was reattached to the glenoid using bioabsorbable and metallic suture anchors. In selected patients in which capsule plication after anchors’ insertion was insufficient additional capsular shrikange or/and rotators’ interval closure was also performed.

Results: Postoperatively patient evaluation took place using Rowe-Zarins scale. According to this score 22 patients (75,9%) had excellent or very good outcome. Three (3) patients (10,35%) were lost during follow up while 1 (3,45%) died. From the remaining 25 patients 2 had recurrence of the instability (6.9%) and in 1 patient (3,45%) a stiff shoulder was noticed and arthroscopically resolved. Finally a disengaged metallic suture anchor was noticed incidentally during routine radiographic examination in one patient (3,45%).The anchor was successfully removed under arthroscopic visualization without compromising the final outcome.

Conclusions: Arthroscopic reconstruction of anterior shoulder instability when precisely performed after correct patient selection is an effective technique achieving results comparable to those of traditional open procedures.

Aim: The description of technique and early results of arthroscopic rotator cuff tears (RCT) reconstruction.

Patients-Methods: Âetween 01/2001 and 02/2003 26 patients, ranging in age from 33–82 (mean age 61,5 y.) – 17 males, 9 females – with RCT underwent arthroscopic reconstruction including debridement, sub-acromial decompression and mobilization of the rotator cuff. The RCT was then repaired with the arm in neutral position using “side to side” suturing technique and rotator cuff anchors when needed. Postoperatively, rehabilitation program included initially passive, active kinisiotherapy while exercises under resistance were finally performed..

Results: All patients were evaluated using ASES and UCLA scores pre-and postoperatively. Pain relief postoperatively was noticed in almost all reconstructed patients. In order to indentify functional improvement range of motion and strength were seperately evaluated. Range of motion just as pain remission was notably improved in almost all patients while strength ameliorate most in patients with complete restoration of rotator cuff tear. The interval between reconstruction and full patients’ recovery ranged between 3 months – pat. < 60 years – to 6–8 months – pat. > 60 years.

Conclusions: Arthroscopic RCT reconstruction although a demanding technique achieves satisfactory early results—mainly regarding pain relief and range of motion improvement- comparable to those of open repair reducing also postoperative morbidity.

Aim: Traumatic shoulder dislocation in patients older than 50 years is an unusual injury with specific anatomic lesions and different treatment considerations than these encountered in younger patients. We present our experience in treating such kind of injuries.

Patients-methods: Between January December 2002 9 patients-4 males, 5 females – with ages ranging between 50–72 years (mean age 64 y.), have been treated in our department suffering from first traumatic shoulder dislocation. Rehabilitation program and overall recovery progress was observed in an outpatient basis while postoperative outcome was evaluated using ASES and UCLA rating scores.

Results: In 4 patients rotator cuff tear was found and reconstructed by suturing the lesion. One (1) of these patients, who had a coexisted bony Bankart lesion, presented 1 ½ month postoperative with recurrence of dislocation. Bony Bankart lesion prevented reduction in 2 patients and was reconstructed using open stabilization in one and arthroscopic to the other. HAGL lesion was detected in another patient and treated with open reduction and shoulder stabilization. Finally 2 patients with shoulder dislocation and coexisted greater tuberosity fracture were treated with closed reduction.

Conclusions: Ttraumatic shoulder dislocation in patients older than 50 years consists a distinct entity which if inadequately treated leaves the shoulder with severe functional impairment. Recurrent shoulder dislocation is an unusual complication in such patients but on the other hand rotator cuff tears and glenoid bony lesions are frequently encountered necessitating treatment. Postoperative patients should be examined in small intervals with a high degree of suspicion for the above mentioned coexisted lesions.

Introduction: The combined fractures of the clavicle (or A-C dislocation) and the scapular neck are complex injuries related to high energy trauma. Their management varies depending on the degree of instability and the presence of neurovascular complications. We evaluated the results of the treatment given to this rare injury.

Material and Method: During a five year period (1997–2001) we treated 12 patients with floating shoulder. The injury was in all cases the result of severe road traffic accident. Nine patients were males and three females with age ranging from 20 to 51 years. Seven patients had injured the right shoulder, the remaining five having injured the left one. Eight patients had additional injuries (chest in four, head in two, fracture of the T4 with complete paraplegia in one, chest and abdominal in one).

Three patients had neurovascular complications and were operated upon. Two of them with vascular injury were operated ungently and had arterial graft and stabilization of the clavicle or the A-C joint with tension band. The third patient with only neurological injury (axillary and suprascapular nerves) had similar stabilization of his clavicle. The remaining nine patients with minor displacement of the fractures and stable shoulder girdle were managed conservatively.

Results: We reexamined eleven patients. The mean follow-up period was 19 months (8–56 months). In nine patients-including the three operated-the fractures had healed in satisfactory position. In the remaining two the fracture of the scapular neck was malunited, resulting in loss of shoulder normal configuration and restriction of shoulder elevation. In two of the operated patients the coexistence of neurological injury resulted in poor functional outcome. The third one-with the axillary and suprascapular nerve injury-improved in relation to the axillary nerve within six months from the injury and had a fairly useful upper extremity. In the Constant-Murley scale the score ranged from 28–89 points (average 67 points).

Conclusion: In conclusion, fractures of the clavicle (or A-C dislocations) and the scapular neck are injuries of high energy and are usually encountered in multiplez injured patients. Severe displacement is usually related to instability of the shoulder girdle and neurovascular injuries; urgent operation is then necessary and the final result is often poor. In cases of severe displacement the stabilization of only the clavicle is not sufficient and open reduction and internal fixation of the scapular neck is recommended.

During the decade 1986–1996 were admitted in our hospital 2267 patients with hip fractures. From them 179 (7.98%) had already operated on for fracture to their other hip and the majority of them had a good way of life after the first operation. In 125 cases (69.83%) the second fracture was similar to the first.

The mean age was 78.5 years. From the 179 patients, 145 were women and 34 men (rate 4.3/1). The 94 (52.5 %) were intertrochanteric and the other 85 (47.5%) subcabital fractures. The mean time between fractures was 6.5 years in patients under 70 years and decreased in those over 80 years in 3.5 years.

On the bases of our follow up, mean time 18 months (12m–24m), from the 179 patients, 55 (30.7%) died during the first six months, (3 during hospitalization) and 13 (tot 37.98%) later but before our re-examination.

The evaluation of the remaining 111 patients, according pain and activities of the patients was: 16 (14.3%) very good, 52 (47%) good and 43 (38.7%) fair.

The patients with the better results were those under 75 years, who had similar hip fractures and had been operated on the first 3 days. In the other hand the majority of the 43 patients with the fair results were over 85 years.

We found out that the bilateral non simultaneous hip fractures had a high mortality incidence. We believe that, except the age, there were other risk factors for this high mortality, such as, cardiovascular diseases, chest and urinary infections, bed sores etc.

We noticed also that in all patients there was a decrease of the bone mass as a result of the extended immobilization and poor nutrition.

Purpose: To present the technique and the results of simultaneous arthroscopic reconstruction of Bankart and SLAP lesions in patients with anterior shoulder instability.

Method: We performed shoulder arthroscopy in 95 patients aged 16–38 years (mean age:24,8) suffering anterior shoulder instability. Preoperative evaluation included clinical assessment, x-rays, MRI-arthrogram and examination under anaesthesia in comparison to the healthy shoulder. SLAP lesion was fixed using metallic suture anchors (FASTAK 2,4mm x 11,7 mm-Arthrex).The anchor was inserted in a 45° direction relative to the glenoid level. Bankart lesion was reconstructed using 2–3 bioabsorbable suture anchors (Panalok-Mitek J& J).The arthroscope was inserted through standard posterior, anterosuperior and anteroinferior portals while a posterolateral portal (portal of Whilrnington) was created for SLAP lesion repair. Patients’ average follow-up was 22 months (range, 18–30 months) and the results were evaluated using the ASES score.

Results: SLAP lesion was found in 13 patients: 6 pat.-type II (46%), 3 pat.-type I (23%), 2 pat.-type IV (15%), 1pat.-type III (7,6%) and 1 pat with a complex lesion. Of these patients 10 had also co-existed Bankart lesion. In 2 patients Hill-Sachs lesion was found while degenerative rotator cuff changes existed in 3 patients. While performing clinical evaluation anterior instability signs and symptoms were apparent with the patients complaining also for discomfort and crepitus during overhead activities. MRI preoperative sensitivity for SLAP lesion diagnosis was 59% while specificity and Positive predictive value were 90% and 76% respectively. Shoulder function and the overall ASES score improved from 44 pre-op. to 96 post-op.

Conclusion: Combined Bankart and SLAP lesions are uncommon in non-throwing patients with anterior instability. Arthroscopic suture anchors fixation ensures early and reliable rehabilitation. MRI arthrography study by a skeletal radiologist predicts to a high rate diagnosis.

Introduction: Isolated compressive fractures of the scaphoid and lunate fossa of the distal radius are rare injuries and their closed reduction is almost impossible. Frequently the displacement becomes accepted and conservative treatment was applied which in the long-term could have catastrophic consequences concerning the fate of articular cartilage.

Material and Methods: Seven patients (6 males and 1 female) of mean age 30 years old (range 18–42) were studied with compressive fracture of scaphoid (4 patients) or lunate (3 patients) fossa. All patients (except one with compressive fracture of the lunate fossa who was treated early), were initially treated conservatively. Mean delay of surgical treatment was 36 days (3 patients) while two patients were operated 2 and 2, 5 years postinjury. One patient with fractured lunate fossa had concomitant fracture of the lunate. The vast majority of the patients underwent supplementary imaging techniques (CT scan, MRI, 3D-CT scan). The majority of patients were approached both intraarticularly and extraarticularly.

Results: Results were estimated after an average follow-up of 12 months (range, 6 months – 3 years) according to clinical and radiological criteria. Six patients revealed excellent or good result while one had a fair result.

Conclusion: In conclusion, operative treatment of these intraarticular fractures should be attempted independently of the time elapsed from injury on the premise that there are no arthritic changes and an adequate pre-operative planning has done.