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Unlabelled: Background The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations (PLDs) and fracture-dislocations (PLFDs) treated with external fixation and Kirschner wires (K-wires). Materials and Methods Twenty patients (18 males and 2 females) with a mean age of 38 years (range 18-59) with an acute PLD or PLFD were treated with external fixator and K-wires. There were 12 PLDs and seven transscaphoid and one transstyloid PLFDs. The median time from trauma to operation was 8 hours (range 2-12 hours). Indirect reduction via ligamentotaxis was achieved in 17 patients with a mean age of 38years (range 18-59). There were 12 PLDs and 5 trans-scaphoid PLFDs; however, in three cases (two transscaphoid and one transstyloid PLFDs), indirect reduction failed and an open reduction was required. The intercarpal ligaments were not repaired even after open reduction. Results The mean follow-up was 39 months (range 18-68 months). The flexion-extension range of motion (ROM) and grip strength of the injured wrist averaged 80% and 88%, respectively, of the corresponding values for the contralateral wrists. According to Cooney's scoring system, overall functional outcomes of the 17 patients were rated as excellent in 4 patients, good in 8, fair in 4, and poor in 1. Fifteen patients returned to their former occupations. Two patients with a trans-scaphoid perilunate injury developed nonunion of the scaphoid, and two developed posttraumatic arthritis. Conclusion External fixation plus percutaneous K-wires for the treatment of acute PLDs has satisfactory midterm functional and radiographic outcomes. When successful, this minimally invasive technique is simple and provides restoration of the carpal alignment. It may especially be useful in the polytrauma patient, thanks to its decreased operative time and diminished blood loss, when other emergent surgical procedures may be necessary. An open reduction with possible fixation may be necessary for PLDs and PLFDs, especially in the presence of polytrauma and scaphoid comminution., Level of Evidence: IV.

The purpose of this study was to review clinical and radiographic outcomes of perilunate dislocations and fracture dislocations treated with external fixation and K-wire fixation. Twenty patients (18 males and two females) with a mean age of 38 years (range 18-59) who had an acute dorsal perilunate dislocation or fracture dislocation were treated with the use of wrist external fixator and K-wires. The injuries included 12 perilunate dislocations, seven trans-scaphoid perilunate fracture dislocations, and one trans-styloid perilunate fracture dislocation. The median time from trauma to operation was 8 h (2-12 h). Indirect reduction via ligamentotaxis was achieved in all perilunate dislocation, and provisional K-wire fixation was added. In five of seven trans-scaphoid perilunate fracture dislocations, indirect reduction was achieved; whereas in the other two as well as in the case of trans-styloid perilunate fracture dislocation, open reduction was required. External fixator was supplemented with K-wires for stabilization of the fractures and the intercarpal intervals. The interosseous and capsular ligaments were not repaired, even after open reduction of fracture dislocations. The mean follow-up was 39 months (range 18-68 months). Range of motion and grip strength were measured. Cooney's scoring system was used for the assessment of clinical function. Radiographic evaluation included time to scaphoid union, measurement of radiographic parameters (scapholunate gap, scapholunate angle, lunotriquetral gap, and carpal height ratio) and any development of arthritis. The flexion-extension motion arc and grip strength of the injured wrist averaged 80 and 88%, respectively, of the corresponding values for the contralateral wrists. According to Cooney's clinical scoring system, overall functional outcomes were rated as excellent in four patients, good in eight, fair in six, and poor in two. Eighteen patients returned to their former occupations. Two patients with a trans-scaphoid perilunate injury developed nonunion of the scaphoid; one of them required scaphoid excision and midcarpal fusion. Two patients had radiographic evidence of arthritis. The use of external fixation and provisional K-wire fixation for the treatment of acute perilunate dislocations is associated with satisfactory midterm functional and radiographic outcomes. This minimally invasive treatment option is simple, reliable, and minimally invasive method that provides proper restoration and stable fixation of carpal alignment.

Purpose: To compare modular monolateral external fixators with single monolateral external fixators for the treatment of open and complex tibial shaft fractures, to determine the optimal construct for fracture union., Materials and Methods: A total of 223 tibial shaft fractures in 212 patients were treated with a monolateral external fixator from 2005 to 2011; 112 fractures were treated with a modular external fixator with ball-joints (group A), and 111 fractures were treated with a single external fixator without ball-joints (group B). The mean follow-up was 2.9 years. We retrospectively evaluated the operative time for fracture reduction with the external fixator, pain and range of motion of the knee and ankle joints, time to union, rate of malunion, reoperations and revisions of the external fixators, and complications., Results: The time for fracture reduction was statistically higher in group B; the rate of union was statistically higher in group B; the rate of nonunion was statistically higher in group A; the mean time to union was statistically higher in group A; the rate of reoperations was statistically higher in group A; and the rate of revision of the external fixator was statistically higher in group A. Pain, range of motion of the knee and ankle joints, rates of delayed union, malunion and complications were similar., Conclusion: Although modular external fixators are associated with faster intraoperative fracture reduction with the external fixator, single external fixators are associated with significantly better rates of union and reoperations; the rates of delayed union, malunion and complications are similar.

The normal sagittal alignment of the cervical spine is lordotic and is affected by the posture of the head and neck. The question of whether loss of cervical lordosis is the result of muscle spasm after injury or a normal variation, and the clinical significance of such changes in sagittal profile of the cervical spine has been an issue of several studies. The purpose of this paper is to study the incidence of normal cervical lordosis and its changes after neck injury compared to the healthy population. We studied the lateral radiographs of the cervical spine of 60 patients with neck injury compared to 100 patients without a neck injury. Lateral radiographs were obtained in the standing or sitting position, and the curvature of the cervical spine was measured using the angle formed between the inferior end plates of the C2 and C7 vertebrae. In the patients without neck injury, lordotic and straight cervical spine sagittal alignment was observed in 36.5% each, double curvature in 17%, and kyphotic in 10%. In the patients with neck injury, lordotic sagittal alignment was observed in 36%, straight in 34%, double curvature in 26% and kyphotic in 4%. No significant difference between the two groups regarding all types of sagittal alignment of the cervical spine was found (p > 0.100). The alterations in normal cervical lordosis in patients with neck injury must be considered coincidental. These alterations should not be associated with muscle spasm caused by neck pain.

The management of scaphoid nonunion in heavy manual workers is challenging. Symptoms appear earlier and manual labor-related stress at the operated nonunion site may worsen the postoperative outcome. This study involved 16 heavy manual workers with scaphoid nonunion (11 cases involving the dominant hand) treated by internal fixation and autologous bone grafting. The nonunion was in 12 patients in the waist, in 3 patients in the proximal, and in 1 patient in the distal pole of the scaphoid. Clinical and radiographic evaluation of union was done according to the criteria of Bynum et al. and Fernandez and Eggli. Pain, wrist motion, and grip strength were evaluated and compared to the contralateral side. At a mean follow-up of 24 months (range, 10 months to 6 years), the mean range of motion and the grip strength compared to the contralateral hand were 95% and 91%, respectively. Overall hand function was excellent in 13 patients, good in 2 patients, and fair in 1 patient. All except one patient were pain free and returned to their work without or with minimal complaints at an average of 3.4 months (range, 2-6 months), postoperatively. In 15 patients, scaphoid nonunions healed at a mean time of 64 days. One patient had a reoperation, and union was observed at 90 days after the second operation. In all patients, the radiolunate angle was restored to normal. One patient developed complex regional pain syndrome that resolved completely after 2 months with adequate intensive physical therapy. Clinical symptoms of scaphoid nonunions are more severe and appear earlier in heavy manual workers; in this group of patients, surgical treatment is necessary. The double-threaded screw provides adequate stabilization for union. Autologous cancellous bone graft, because of its plasticity and malleability to exactly fill the scaphoid defect, is recommended.

The aim of this study was to evaluate the effectiveness of unilateral external fixator as primary and definitive treatment for open tibial fractures, fractures with severe soft tissues injuries, threatened compartment syndrome, and in multiply injured patients. Two hundred and twenty-three tibial shaft fractures (212 patients) were treated. In open fractures, union was achieved in 25 weeks, while in closed in 21. There were 18 nonunions, 21 delayed unions, 4 malunions, 58 pin infections and 3 osteomyelitis. A reoperation was performed in 42 patients. Fat embolism was diagnosed in three patients, pulmonary embolism in five and deep venous thrombosis in 14. The external fixator was definitive treatment in 87.27%. Unilateral external fixators can be used as primary and definitive treatment for complicated tibia shaft fractures. Re-operation or change of the method must be performed only when there is a delay in callus formation.

In Greece, spinal cord injury patients have serious problems concerning their treatment, social management and vocational integration. Unfortunately the treatment of such patients is usually limited to that offered in institutions for the chronically sick, after they have received their acute initial care in general hospitals. The large number of institutional beds (1287 in 1986) in relation to the small number of active rehabilitation beds (116 beds in 1989) is noteworthy. Generally speaking, the specialisation of health personnel is limited. In practice there is no programme of social rehabilitation, except for special concessions. Disabled individuals can refer to the Professional Integration Service for their vocational reintegration. We must note that vocational counsellors do not take part in the rehabilitation team. The idea of intervention for the adaptation of architectural barriers is now beginning to be considered in theory. Physicians are making efforts to establish 'basic' spinal cord units.