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Introduction. Pregnancy is a well-known risk factor for asymptomatic hemangiomas discovered incidentally, becoming aggressive or symptomatic, most often in the third trimester of pregnancy, related to hemodynamic and endocrine changes that occur during pregnancy. Many patients experience incomplete spontaneous remission after birth. Material and method. We report the case of a 24-year-old woman, who presented for incomplete paraplegia, pain in the spine, instability of walking of the left lower limb, bilateral plantar paresthesia, possible walking with metal support. Results and discussions. The MRI performed identifies T9 vertebral fracture-compression on pathological bone, T10-T12 vertebral hemangiomas. Conclusions. In order to obtain favorable results, the patient benefited from the support and treatment of a multidisciplinary team: neurosurgeons, imagers, physical and rehabilitation medicine doctors and physiotherapists, and represented a real challenge regarding the complexity of the factors involved. Keywords: hemangioma, rehabilitation, multidisciplinary team

The aim of the study was to determine prospectively the importance of synovial fluid white cell count and intraoperative frozen and permanent sections analysis (number of polymorphonuclear leukocytes per high-power field) in the diagnosis of septic total knee arthroplasty. There were studied prospectively 72 patients who needed a revision total knee arthroplasty between 2013-2015. 30 patients were diagnosed with prosthetic joint infection due to high rates of ESR (93%) and CRP (90%) and preoperative positive culture from aspirated synovial fluid and 42 patients were considered to have aseptic failure according to negative preoperative culture from joint aspirate. For all the patients was analysed synovial fluid white cell count and histopathological aspect of intraoperative frozen and permanent sections of periprosthetic tissue. The results showed a median value of 13800 of sinovial white cells count for infected knee and 92 for noninfected knee. 90% of the patients with joint infection had more than 5 polymorphonuclear leukocytes per high power field on intraoperative frozen sections and 83% on permanent sections. None of the patients from aseptic group had more than 5 polymorphonuclear leukocytes per field on permanent sections. The erythrocyte sedimentation rate and C-reactive protein level can be supplemented with cultures of aspirated joint fluid and fluid white cell count to confirm the diagnosis of periprosthetic infection. When the preoperative diagnosis remain unclear, the histological examination of frozen or permanent sections of periprosthetic tissue with at least 5 polymorphonuclear leukocytes per high power field, is predictive for the presence of infection.

The prospective study targets the tibial pylon fractures admitted in our clinic, to which a new treatment protocol was applied, consisting of two surgical steps, assessing in the end the results achieved at the discharge of the patient and later follows up. The study group consist of 196 patients (198 fractures), in the period 2012-2015. The average evaluation time was of 16 months. The average age of the patients was 46.5 years (19-83 years), this type of fracture especially affecting active people. The etiology was dominated by high falls (109 cases), most of them being work related accidents. The most frequently applied osteosynthesis principle was staged osteosynthesis which consisted of first stage fibula semitubular plate osteosynthesis and external fixator tibia pylon, followed by minimally invasive or limited approach locked plate tibia pylon fixation. (64.14%) Olerud and Molander clinical score at more than one year after the last surgical intervention highlights good results: excellent results in the amount of 37% to 15% in the first lot, good results 52% to 29%, moderate success 7% to 39% and poor 4% to 17%. Two stage surgery protocol with external fixation in emergency and minimally invasive internal fixation with locked plate performed after the dissappearance of the local edema, as the second surgical step, allows anatomically correct articular reconstruction without skin complications, with decrease of arthitic late complications.

The paper propose a complex annalysis regarding etiopathogenic approach of the tibial pilon. The study was made upon the articular fractures of distal tibia, hospitalised and treated in Orthopaedic-Traumatology Clinic of Constanta Emergency Clinical Hospital, between 2007-2011, and consist of 245 patients. The lesional graduality will be found in the anathomoclinical forms of the fractures. The grade of soft tissue devitalisation will influence the local evolution and will promote the appearance and extension of skin necrosis in case of ireversible ischemia. In case of direct trauma, but with low energy or in case of indirect trauma, perifracture lesions are restrained and evolution can be favourable to cicatrization. The correct dyagnosis of these fractures are a mandatory stage of the presurgical planning and was made by annalysing the x-rays made in 2 incidencies, in emergency, and which were repeated when it was needed. The lesional graduality of bone and soft tissue structures is direct proportional with the type of traumatic mechanism and with the level of energy which produced the fracture. The traumatic mechanism can produce lesional characteristics, by direct mechanism (work accidents, falling from high or same level) or by indirect mechanism with forces transmitted through talus (forced inversion/eversion). The fracture type must be evaluated upon the clinical and prognostical criteria of AO and Ruedi-Allgower classification, which suggest the therapeutical manners too. The evaluation of soft tissues is made by the Gustilo-Anderson classification, the only one which can establish correctly the graduality and the severity of lesions.

The aim of the study is to evaluate the surgical treatment comparing the results obtained with different techniques. We revised 68 cases with acute Achilles tendon rupture who underwent surgical correction between 2004 and 2011, with a 40 month average follow-up. 34 of these were submitted to a classical open repair using the Kessler or Krakow technique, 25 to a mini-invasive technique (Achilon) and 9 to a percutaneous technique (Tenolig). We report a 29% rate of complications when using the classical technique: the major complications were one re-rupture, two surgical wound dehiscences, one infection and one sural nerve injury. In the mini-invasive/percutaneous techniques, two re-ruptures occurred (5.9% total, one in each technique) and one fistula at the needle insertion location. In regards to the percutaneous and mini-invasive techniques, the functional results and degree of satisfaction were higher, with fewer complications, reflecting a trend that has been expressed in the international literature.

The ankle stability and its biomechanics can be compromised after ligamentous and malleolus lesions. The complete early diagnosis, and also the early and late postsurgery results, must be formulated and explained using the tibio-astragalus radiologic indices. The paper evaluates the importance of these presurgery and postsurgery indices, analyzing also the late results under causal report. Our subordinating to the exigency of radiologic indices to obtain a reparation as anatomic as possible, shows that the surgical treatment must be applied to osteo-ligamentous lesions properly, so that to get the remake of tibio-astragalus biomechanics.