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The retrospective study concerns use of the AO method for the treatment of 75 ankle fractures between 1990 and 1995. After a mean follow-up of 5 years and 7 months the Cedell criteria were used for a subjective evaluation of results. Good results were obtained in 53 out of 75 patients submitted to surgery (70%), with a significant difference between uni-malleolar fractures and bi- and tri-malleolar fractures. Dorsal flexion measured an average of 24 degrees (80% of the healthy contralateral side), plantar flexion 36 degrees (90% of the healthy side). The presence of a fracture-dislocation considerably worsens prognosis because of the cartilaginous damage produced. The risk of poor results increases considerably when reduction of fracture is insufficient or absent. Post-traumatic arthrosis constitutes a common complication (25%) and it particularly affects females aged between 45 and 65 years, as a result of the presence of post-menopausal osteoporosis. Accurate reduction, fracture stabilization, sex and age constitute essential elements for satisfactory final results.

A total of 15 patients affected with Perthes' disease that occurred during adolescent were followed-up in order to study progression of the disease, and to identify the "risk factors" capable of influencing the future of the lesion. Age of onset was on the average 11 years (10-13 years), age at follow-up was 38 years (20-56 years). On diagnosis, 2 hips were classified as Catterall group II, 8 as group III, 6 as group IV. Treatment was conservative in 11 patients and surgical in 4 (valgus osteostomy). A total of 88% of the hips healed with deformity to a greater or lesser degree of the femoral epiphysis (Stulberg III-IV and V). The most significant prognostic factors that emerged from the present study were the early closing of growth plate (femoral and triradiate), disorders in growth of the proximal femur, acetabular roof insufficiency, and changes in the acetabulum.

Long-term follow-up (5 years and 7 months) was obtained for the results of core decompression in 18 patients (20 hips) affected with ischemic necrosis of the femoral head at Ficat stages I and IIA. Two methods were used to diagnose osteonecrosis: bone scan, and MRI. Progression of the disease was monitored by annual MRI. The persistence of pain, progression of the disease in the Ficat scale, the use of total arthroplasty, were considered to be signs of failure. Core decompression was favorable in 16 hips, there was progression of the disease in 4. Good results were observed in 90% of the stage I necroses and in 70 of the stage IIA necroses. The results of the present study suggest bone reaming as the treatment of choice in initial stages of necrosis. Thus, the need for arthroplasty in young patients is delayed.

It is the purpose of this study to compare the prognostic value of the Herring classification (lateral pillar) with that of the Catterall classification. The material is constituted by 45 patients affected with Perthes' disease and reviewed an average of 24 years after onset. At follow-up the hips were divided into three classes based on joint congruency as suggested by Stulberg. The Catterall classification demonstrated overall a better predictive value for the Herring system. Instead, the most satisfactory reproducibility seems to be that of Herring: 80% as compared to 42% for the Catterall classification.

Meyer's femoral cephalic dysplasia (FCD) is a rare affection that is often confused with Perthes' disease from which it differs in terms of both treatment and prognosis. A constant feature is the absence of the nucleus of ossification that does not occur until 15-18 months of age; at times there are multiple nuclei of ossification, so that the epiphysis has a "morulated" aspect. Fusion of the various centers of ossification occurs at about 5 years of age. The epiphysis does not collapse and it preserves its density and its structure. Differential diagnosis involves Perthes' disease and other pathologies such as multiple dysplasia epiphysealis, hypothyroidism, dyschondroplasia.