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Two techniques of closed wedge osteotomy of the proximal tibia in 132 cases using external fixation device were compared retrospectively for neurological complication rate. While in group 1 (n = 89) wedge osteotomy was performed conventionally using an oscillating saw, in group 2 (n = 43) osteotomy was done with consecutive drill holes of increasing diameter followed by osteoclasis. Neurological complications in group 1 were found postoperatively 15.7% (transient) and after 7 months follow-up time in 12.4% (persistent), in group 2 14% transient and 4.7% persistent neurological deficits were registered. The lower complication rate in group 2 is due to the reduction of postoperative tibialis anterior syndrome (type B lesions). No differences for type C lesions (extension deficit of D1) were found. No complete peroneal palsy (type A) occurred in either group. The authors conclude that reduction of neurological complications in group 2 is related to the less extensive approach of the proposed technique.

The postoperative fracture of the femur following total hip arthroplasty ranks third in occurring complications and the number of such cases is increasing. Most of the patients are elderly and multi-morbid and the fractured femur had undergone previous operations. Using the literature our own experience in 15 cases and applying a fracture classification we make suggestions for treatment of the different fracture types. Considering the patients overall health it's possible to obtain good results in the operative therapy which was necessary in most cases of these femur fractures.

UNLABELLED 65 patients with necrosis of the femoral head (not caused by a trauma) in 102 hip joints were examined at an average of 9.7 years following first operation: 1st: 30 joints underwent intertrochanteric varus angulation osteotomy (follow up 11.6 y). RESULTS 12/30 clinically not sufficient, 13/30 radiologically worse, only 2/30 improved range of movement. 2nd: 35 hip joints were treated using an artificial hip replacement (follow up 9.1 y): 77% got loose at an average of 5 years requiring 39 follow-up operations. 3rd: 5 arthrodesis were performed (follow up 11.4 y). 60% delayed nor non bony union. The results indicate a general osteopathy overlapping the size of osteonecrosis, and causing a lot of complications. Various therapeutic concepts should be considered with respect to radiological stage and age of the patient. The results of joint saving operations depend on the ability of the femoral bony structures to react sufficiently.

22 hips in 20 patients operated with Chiari's pelvic osteotomy between 1970 and 1980, were examined with clinical methods and computerized tomography. With computerized tomography one is surely able to see if the femoral head is completely covered with pelvic bone or not. It was completely covered in 36.4% only. Especially the dorsal part of the femoral head often was not. We report on the influence of former and contemporaneous intertrochanteric osteotomy on the result. The influence of the degree of covering of the femoral head upon absence of postoperative pain, motility of the hip, Trendelenburg's sign, and contentment of the patient is discussed.

Female patients planned for intertrochanteric osteotomy have to be advised in postoperative sexual impairment, besides surgical risks. Our investigation shows that the sexual experience was impaired postoperatively. Release from pain has to be contrasted to postoperative sexual problems.

25 patients suffering from femoral head necrosis in 30 hip joints were radiologically studied for an average of 11.6 years following intertrochanteric varus angulation osteotomy. Preoperatively only stages 2 and 3 according to Meyers were seen. The follow-up results could be distributed into 4 groups. At best the osteonecrosis was reconstructed within 6 to 9 years while the trabeculae started to become rearranged within 2 to 4 years. At worst, rapid destruction in absence of bony reaction was observed. The ability of the bone outside the osteonecrosis to react to changed circumstances following angulation osteotomy correlates with long-term results. This may indicate a general osteopathy even outside the necrotic area.