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This study reviewed 19 patients with intra-articular fractures of the distal end ofthe radius treated with augmented external fixation and injectable calcium phosphate (Norian SRS; Norian Corp, Cupertino, Calif) between November 1997 and July 2000. Average patient age was 52 years, and average follow-up was 16.3 months. Patients were evaluated clinically and radiographically using the modified Mayo Wrist Score and Knirk and Jupiter's criteria, respectively. Overall results are comparable to those from other studies of intra-articular distal radius fractures in which other grafts have been used.

Fracture fixation using rigid plates leads to direct bone union, but it also may lead to complications because of stress protection osteopenia. This study aims to compare the mechanical characteristics restored during the callus formation after an osteotomy is fixed with two types of internal plate fixation. Twenty-four adult female sheep were divided randomly into three groups of eight each, which were euthanized at 2, 4, and 6 months after operation. Half of them had their osteotomized radius fixed with a seven hole dynamic compression plate, whereas in the remainder a sliding plate was used. The sliding plate consists of two halves connected together in such a way as to permit axial sliding of the one within the other, thus allowing cyclic axial load transfer at the fracture site. Bone strips obtained from the healthy (control) and the surgically treated side were subjected to four-point bending tests. The effective modulus of elasticity, ultimate bending strength, and energy absorption to fracture (toughness) were calculated. All parameters were restored more quickly in the sliding plate group, but there was no statistically significant difference observed at 6 months when all the osteotomies were united completely. Thus, the sliding plate, by allowing axial loading at the fracture site, led to a faster callus maturation and hence bony union, which, hopefully, will permit earlier full weightbearing and functional recovery of the injured limb.

Biodegradable implants for osteosynthesis have had insufficient strength and a fast degradation rate. We produced a polymer based lactide to increase the molecular weight and strength of the implant and delay the degradation rate. This novel fiber-reinforced material in the form of plates and pins was tested in vitro for mechanical performance and in vivo in a neutral mechanical environment to assess biocompatibility. 21 rabbits with implants in the tibia and femoral condyles were killed at 1, 6, 12 months after implantation. Only a mild foreign-body reaction was observed and the implant was encapsulated by a thin 0.8-1.6 mm layer of connective tissue. Only a few lymphocytes and giant cells were detected in the early stages, dense fibroblasts in the middle stage, and giant cells clearing material particles in the late stage. In conclusion, the novel fiber-reinforced polymer based on polylactides was found mechanically superior to former degradable implants and biocompatible, showing no late inflammatory tissue response.

In the Orthopaedic Department in Patras University 427 intramedullary nailings in the lower limbs were performed between 1989 and 1994 and retrospectively reviewed to evaluate the range of complications. One hundred and seventy-two were nailings of the femur; 80 gamma nails mainly for subtrochanteric and intertrochanteric with subtrochanteric extension fractures were included, (total 252/59%); 175 (41%) were nailings of the tibia. Union was achieved in all case. Overall the complication rate in this series was 3.3% (14 cases) and included infection (4 cases), neuropraxia (2 cases), implant failure (5 cases), limb length deficiency (2 cases) and malrotation (1 case).

A 49-year-old man had posttraumatic persistent calf swelling and a tibial and fibular fracture. Despite the intramedullary nailing of the fracture, the swelling did not improve, and at the 6th postoperative week it was misdiagnosed (using venogram) as deep vein thrombosis. Therefore, it was mistreated with anticoagulants, which led to great deterioration of the local signs. An arteriogram revealed an initially missed false peroneal artery aneurysm. Surgical treatment was performed immediately. The 6-week delay had led to some atrophy of the posterior compartment muscles, fortunately without any permanent disability. The importance of proper and early diagnosis of posttraumatic persistent calf swelling is stressed.

Pigmented villonodular synovitis (PVNS) is a benign proliferative process involving the synovial membranes bursas or tendon sheaths. The rarity of the process, the absence of well-documented long follow-up examinations, as well as reports on different forms of the disease from multiple anatomic sites has lead to some confusion. This is a case report of a 44-year-old woman with recurrence of PVNS of her right knee, 17 years after the initial limited knee synovectomy. It was proven impossible to differentiate the disease from soft-tissue malignancy despite the use of all the available investigation methods, including nuclear magnetic resonance. Eventually the diagnosis was made by an open biopsy. Marginal excision of the soft-tissue mass from the popliteal fossa was performed initially, followed by a total knee synovectomy within the next two weeks. The patient remains recurrence free 32 months after the operation.