Our purpose was to evaluate the use of indirect and closed reduction with Ilizarov external fixator in intraarticular calcaneal fractures.

In a period of 3 years, 16 patients with 18 intraarticular fractures of calcaneus (eleven type III and seven type IV according to Sanders classification) were treated with the Ilizarov fixator. Twelve patients were male and four female. The average age was 42 years (range 25 – 63 years). Three fractures were open. Fractures were evaluated by preoperative radiographs and CT scans. Restoration of the calcaneal bone anatomy was obtained by closed means using minimally invasive reduction technique by Ilizarov fixator. Arthrodiatasis and ligamento-taxis, and closed reduction of the subtalar joint were performed in 14 cases. In 4 cases the depressed posterior calcaneal facet was elevated by small lateral incision and stabilized in frame by wires. Postoperatively, partial, early weight bearing was encouraged in all patients.

The mean follow-up period was 1,5 years (range 1 – 3 years). The AOFAS Ankle – Hindfoot Score, and physical examination were used in functional evaluation. The average score was 79,8 (range 72 – 90). Six patients had limited degenerative radiological findings of osteoarthrosis about the subtalar joint and three of them had painful subtalar movement. One of the patients complained of heel pad pain. Nine (6.25%) grade II pin tract infections were detected from a total of 144 wires. No secondary reconstructive procedures, including osteotomies, subtalar fusions, or amputations, have been done.

Indirect closed reduction of calcaneal bone anatomy and arthrodiatasis of subtalar joint with Ilizarov external fixator is a viable surgical alternative for intraarticular calcaneal fractures

Whiplash vertigo syndrome is often seen in victims of rear-end vehicle collisions. These patients commonly complain of headache, vertigo, tinnitus, poor concentration, irritability, and sensitivity to noise and light.

Sixteen patients (medium age, 39,5 years) that they refered in orthopaedic examination because of long-lasting subjective complaints after cervical spine injury underwent clinical, laboratorial and psychometric examinations. The mean posttraumatic interval was 43 months. Ten patients were injured in road accidents, 5 during sports and one at work, all with mechanism trial of whip. Each patient was evaluated with otorhinolaryngologic examination, audiometry tests, CT: petrus – internal auditory meatus and cerebellopontine corner. Also each patient was evaluated with neurologic examination, psychological well-being scale (sf-36), and personality profile scale.

None of the patients had neurologic symptoms, and no lesions of the cervical spine were identified. All the patients had negative clinical, radiological and standard laboratorial control, but may be is a critical point that the eleven of these patients had pathologic OGTT (Oral Glucose Tolerance Test). Also did not exist differentiations from the mean values in psychological well-being scale (SF-36), and personality profile scale of healthy population. Test results were unrelated to the length of the post-traumatic interval. However, 2 distinct syndromes were identified. Ten patients had cervicoencephalic whiplash type syndrome (CES), characterized by headache, vertigo, tinnitus poor concentration, and disturbed adaptation to light intensity. Six patients had the lower cervical spine whiplash type syndrome (LCSS), characterized by vertigo, tinnitus cervical and cervicobrachial pain.

The verification of Whiplash Vertigo syndrome require more objective clinical means. This article proposes that exists an organic base for the syndrome, but does not promote that whiplash injury certainly cause it

To study the preliminary clinical results of patients submitted to kyphoplasty with an expandable titanium cage (OsseoFix).

Between 09-2008 and 02-2009 16 patients (6 men, 10 women, total 36 vertebrae) with a mean age of 67 (23 to 81) were submitted to kyphoplasty using a system involving the implantation of an expandable titanium cage (OsseoFix) for the treatment of fractures in the lower thoracic and lumbar spine. Five patients were submitted to kyphoplasty at one level, 4 at two levels, 5 at three levels, and 2 at four levels. Two patients additionally needed a posterior spinal fusion. The underlying causes for the spinal fractures were: secondary osteoporosis (7), recent acute trauma (5), and malignancy (4: 1 Hodgkin lymphoma, 1 Non-Hodgkin lymhoma, 1 metastatic breast cancer, 1 metastatic prostate cancer). In 8 patients biopsy specimens were harvested at the same procedure.

Mean follow-up time was 4 months (2 to 6). No intra-operative complication occurred. No bone cement leakage or pulmonary embolism was observed. The mean pain improvement, as measured with the VAS scale, was 5,12 (7,81 preop – 2,69 postop). The mean vertebral body height restoration was 19,5%, and the kyphotic angle was corrected by a mean of 2,24°.

The main advantage of using an expandable metal cage in kyphoplasty is the improved reduction of the vertebral body compression and the minimal risk of bone cement leakage. Especially in young patients, the maintenance of the reduction could potentially be achieved even without cementation, by the mere support provided by the cage. A longer follow-up time is needed for the safe validation of these preliminary encouraging results

Aim of our study was the investigation and the cross-correlation of various neurologic scales to estimate, comparatively with the functional results of patients after damage of spinal cord injuries.

Between 1989 – 2005, 115 patients were submitted in stabilization of Lower Cervical Spine that was judged unstable.

The neurologic situation was certified with the scales: Frankel, ASIA motor score, NASCIS motor score, FIM scale, and MBI scale.

In the protocol took part the 94 patients for that existed in neurologic details and long follow-up for at least two years.

From the study of course of scores of all scales was not found statistically important difference between ASIA, NASCIS and other motor scales. However 12 patients with important improvement of mobility at ASIA motor score and NASCIS motor score they have not difference in Frankel scale, despite the make that the MRP (Motor Percentage Recovery) was improved: 21.5%

Also 8 patients with relatively big improvement in their total scores did not have corresponding functional improvement (FIM scale, and [MBI] scale)

A lot of neurologic methods – scales were used and are used today. However for the essential and modern follow-up of patients with spinal cord injuries, it needs certification with a scale of classic team of (measurement of mobility) and a scale of functional faculties of the patient

Aim: Our purpose was to evaluate the use of indirect and closed reduction with Ilizarov external fixator in intra-articular calcaneal fractures.

Materials and Methods: In a period of 5 years (2004–2008), 26 patients with 29 intra-articular fractures of calcaneus (eighteen type III and eleven type IV according to Sanders classification) were treated with the Ilizarov fixator. Twenty-one patients were male and five female. The average age was 45 years (range 22 – 67 years). Five fractures were open. Fractures were evaluated by preoperative radiographs and CT scans. Restoration of the calcaneal bone anatomy was obtained by closed means using minimally invasive reduction technique by Ilizarov fixator. Arthrodiatasis and ligamentotaxis, and closed reduction of the subtalar joint were performed in 24 cases. In 5 cases the depressed posterior calcaneal facet was elevated by small lateral incision and stabilized in frame by wires. Postoperatively, partial, early weight bearing was encouraged in all patients.

Results: The mean follow-up period was 2,1 years (range 1 – 4 years). The AOFAS Ankle – Hindfoot Score, and physical examination were used in functional evaluation. The average score was 77,4 (range 70–90). Seven patients had limited degenerative radiological findings of osteoarthrosis about the subtalar joint and three of them had painful subtalar movement. Two of the patients complained of heel pad pain. Nine patients had grade II pin tract infections and were detected from a total of 258 wires. No secondary reconstructive procedures, including osteotomies, subtalar fusions, or amputations, have been done.

Conclusion: Indirect closed reduction of calcaneal bone anatomy and arthrodiatasis of subtalar joint with Ilizarov external fixator is a viable surgical alternative for intra-articular calcaneal fractures.

Purpose: The relationship between pain, quality of life (QOL) anxiety and depression in patients with chronic pain is complex. The aim of this study was focused in osteoid osteomas which treated with Radiofrequency thermal ablation (RFTA).

Patients and Methods: We determine the pain characteristics severity, duration, meaning of pain, (MINESOTA score), psychological distress (HADS), physical functioning, social functioning and quality of life (SF −36) and determine which of these variables improved after Radiofrequency thermal ablation in osteoid osteomas. A total of 26 patients with osteoid osteoma which proceed in RFTA and completed the questionnaires, evaluated pain, quality of life, anxiety, depression, physical functioning, and social functioning before and after the procedure in a mean follow up of 17 months. Pearson correlation coefficients were calculated to examine the relationships among the study variables. A multiple regression analysis was performed to determine which variables were the most important predictors.

Results: Pain was significantly correlated with all the other variables, in particular depression and anxiety. Pain QuoL and Depression improved dramatically after kyphoplasties in a follow up of 17 months period.

Conclusion: The clinical results indicate a 100% success rate with complete remission of symptoms and no relapses having been reported at the time of those patients who have arrived at the one year follow up. CT-guided RF ablation is a safe, simple and effective method of treatment for osteoid osteoma. and improve quality of life, anxiety and depression in these patients.

Introduction: The chevron osteotomy is an accepted method for the correction of mild and moderate hallux valgus and generally advocated for patients younger than the age of sixty years. In the current work the finite element analysis applied to calculate the stress (force per unit area) on different cuts in the metatarsal bone model of the first ray in the human foot.

Material and Methods: The cuts have the form of a simple angle with 90 degrees ‘modified chevron osteotomy’, 60 ‘typical chevron osteotomy’ 70, 50 and 30, openings correspondingly, and share a common corner C, which is at the centre of a circle that fits the head of the metatarsal. In order to calculate the maximum stresses on the cuts, the bone is assumed to be with a 150 angle to the floor, which is the angle that it takes during the push-off phase.

Results: The calculations show a considerable difference on the stress distribution on the differnt cuts. In particular in the ‘90 degrees cut’ the normal (to the cut) stress is much larger than the shear stress. The opposite is true for the 60 cut. Since shear stresses are the ones that cause material failure, it is predicted that the 90 cut will heal much faster than the 60 cut. The nodes along the cuts where the normal and the shear stress were calculated in different osteotomies.

Conclusion: The FEM analysis confirm our clinical results of this modified chevron osteotomy of 90 degrees. The osteotomy site is firmly secured, avoiding early displacement of the lateral fragment and give earlier fusion.

Purpose: Our aim was to evaluate the use of Ilizarov external fixator for ankle arthrodesis in severe post-traumatic or other ankle arthritis.

Patients and Methods: In the period of 8 years, 19 patients underwent ankle arthrodesis with the Ilizarov external fixator for severe ankle arthritis. In four patients the indication for arthrodesis was infection following failed surgical management of tibia plafond fractures, four patients had failed prior ankle arthrodesis and the rest suffered severe ankle arthritis. Eleven patients were male, eight female, with a mean age of 52 years (range 30–71 years). Seven patients had deformities greater then 10°. All had painful stiff ankle joints and 12 patients had disorder of ankle joint anatomy with significant limp. Anterior approach to the ankle joint was preferred, associated with distal fibular osteotomy. Secondary gradual corrections of postoperative deformity and additional compression at the arthrodesis site were performed with the Ilizarov system by closed manipulation. Following frame removal the arthrodesis was immobilised in a cast for a mean of 4 weeks.

Results: The mean follow-up period was 3,9 years. A solid ankle arthrodesis was achieved in 18 of the 19 cases. Failure of solid arthrodesis was detected in one patient with insufficient arthroscopic removal of articular cartilage and internal fixation was performed. In one case with major pin tract infection at the distal talus ring distal expansion of the frame was required. According to the Mazur rating system in 12 patients the results were good, in 5 patients fair and in 2 patients poor.

Conclusion: The use of Ilizarov external fixator for ankle arthrodesis provides significant interfragmentary compression forces, allows early weight bearing and post-operative adjustment of alignment of arthrodesis. This method should be considered as the treatment of choice in ankle arthrodesis, especially in revision cases and in the cases with infection around of the ankle joint.

Aim of the study: The evaluation of denervation efficiency in the treatment of the arthritis of the base of the thumb.

Material and method. Between 2001– 2004, 15 patients were surgically treated for arthritis of the basis of the thumb. There were all females of an average age of 53 years. In all patients the procedure was done ambulatory under local anesthesia. After completing a protocol form, regarding pain motion and power of the thumb, an incision was made at the level of the wrist crease extended from the level of FCR to the level of the 2nd extensor compartment. Through this incision the articular branches which conform the studies of Wilhem and Fusche supply the 1st CMC joint were divided.

A supplementary incision for the first intermetacarpal space was made. The patients were free to return to their activities the third postoperative day and they were reviewed after 3, 6, 12, 24 months by an independent doctor. Their data were also recorded conform the protocol

Results: Twelve patients out of 15 had excellent improvement of their strength. Pinch and grip power was doubled. Mobility of the thumb according to Kapanji scale was improved in all cases. Pain was reduced in 65% average. The patients were satisfied from the operation. There was one patient with poor improvement and two patients who never shown up at the follow-up. As the last were at the beginning of our learning curve we think that could have a less satisfactory result.

Discussion: The method is simple with minimal impact to the patient activity or life. It gives good results in 65% –75% and leaves further operative procedures possible. Although there not enough data yet for this procedure and our number of cases is small with short follow-up we believe that it is a nice procedure, it satisfies both the patient and the surgeon regarding the overall improvement of mobility and pain.

Purpose: The purpose of this prospective investigation is to determine if soft tissue and intra-articular local anaesthetic injection with bupivacaine and adrenaline have beneficial post-operative effects in patients who had total knee replacement (TKR) for osteoarthritis.

Material and Methods: 97 patients were divided randomly into 2 groups. The mean age was 74.7 years. In control group I there were 17 men and 33 women with a mean age of 73.5 years, in group II 16 men and 31 women of mean age of 74.9 years. The patients who were allocated to control group I (n =50) had no intraarticular treatment. We used general anaesthesia in all these patients. The study group II of 47 patients had received intraoperative injection of 0.25% bupivacaine(8ml) with epinephrine (1ml – 1mg) with 2/3 injected into the soft tissues and 1/3 injected into the joint. Clinical parameters evaluated included pain, blood use and bleeding index (calculated by preoperative haemoglobin minus postoperative hemoglobin plus the number of units of packed red blood cells transfused) and range of motion (ROM) at discharge.

Results: Flexion at discharge was improved from 70 (60–90)° in the control group to 90 (80–120)° in study group II (p = 0.005), the difference between the two groups receiving different amounts of analgesics were statistically significant. Number of days until 90 degrees of flexion and until discharge was reduced in group II compared with the control group I (p = 0.003 and 0.002). Also and the blood loss decreased.

Conclusion: This simple method is effective in improving all the postoperative course of primary TKR and should be considered as a part of a perioperative patient treatment program.

Purpose: The evaluation of midterm results of a proposed surgical technique for the correction of hallux valgus deformity.

Material-Methods: Fifty-one female patients with sixty-two hallux valgus deformities were operatively treated between 1997–2002. The average age was 54.9 years and the mean follow up period was 32.7 months. A modified – 90 degrees angled – chevron osteotomy fixed with a Hebert screw was performed in all patients. Concomitant lesser toes abnormalities were managed at the same time. Preoperative, postoperative and last follow up radiographic intermetatarsal (IMA) and hallux valgus (HVA) angles, were measured and compared. Subjective analysis consisting of the AOFAS hallux scale was performed.

Results: The averaged preoperative HVA was 34.1 (range 22–56) and the averaged IMA 15.5 (range 10–29). The corresponding postoperative angles were 14.2 (range 0–28) and 8.1 (range 6–22). The mean AOFAS score was 94.3 (65–100). All the osteotomies were fused and there was not any case of non-union or loosening. Two patients showed late recurrence of the deformity but refused any further treatment.

Conclusions: Hebert screw is a reliable fixation method of the chevron osteotomy for the treatment of hallux valgus. The osteotomy site is firmly secured, avoiding early displacement of the lateral fragment.

Purpose: The purpose of this study was to evaluate the results of 23 patients with septic nonunion of the distal tibial metaphysis type Pilon fractures treated with Ilizarov technique.

Material and Methods: Between 1990 and 2002 the Ilizarov technique was used in 23 patients with posttraumatic infected nonunion of the distal tibia. Seventeen were males and 6 females. Average age was 40.1 years (range16–68 years). Mean duration of nonunion was 13,8 months and the average number of failed previous surgical procedures 2.2.

According to AO classification there were 3 non-unions with quiescent infection and no drainage, 4 with active infection and no drainage, and 16 with infection and drainage. The ankle joint was ankylosed in 6 patients preoperatively and it was painful in all patients. Thirteen patients had an angular deformity of more than 7 degrees (range 7–30 degrees, mean 16 degrees). Sixteen patients had a mean bone defect of 2.5 cm (range 1 to 6 cm). Monofocal or bifocal compression-distraction osteogenesis technique with or without bridging the ankle joint was performed in all cases. Ankle arthrodesis was necessary in 4 cases. Mean external fixation time was 139.6 days and mean follow-up period was 4 years.

Results: The results were evaluated using the functional and radiological scoring system described by Paley. The results were excellent in 7 patients (30.4%) good in 9 (39.1%) fair in 5 (21.7%) and 2 (8.69%) poor while the functional results were excellent in 4 patients (17.39%) good in 8 (34,8%), fair in 7 (30,4%) and poor in 4 (17,39%). Bone union and eradication of infection were achieved in all cases. Four bone defects required bone grafting and freshening at the docking site. Ankle motion was difficult to record preoperatively but good to very good ankle function was obtained at final follow up evaluation in 12 patients.

Conclusions: The Ilizarov technique is a reliable method in the treatment of metaphyseal septic nonunion of the distal tibia particularly in cases with angular deformity, ankle joint contracture and bone defects. Compliance of the patient is absolutely necessary.

We reviewed 13 patients with infected nonunion of the distal femur and bone loss, who had been treated by radical surgical debridement and the application of an Ilizarov external fixator. All had severely restricted movement of the knee and a mean of 3.1 previous operations. The mean length of the bony defect was 8.3 cm and no patient was able to bear weight.

The mean external fixation time was 309.8 days. According to Paley’s grading system, eight patients had an excellent clinical and radiological result and seven excellent and good functional results. Bony union, the ability to bear weight fully, and resolution of the infection were achieved in all the patients. The external fixation time was increased when the definitive treatment started six months or more after the initial trauma, the patient had been subjected to more than four previous operations and the initial operation had been open reduction and internal fixation.