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Tibial pilon fractures are one of the most severe types of fractures, not only due to the complexity of their treatment, but also due to the important sequelae they may cause. Moreover, an important percentage of them are open fractures or importantly involve the soft tissues, thus making treatment even more difficult. Thirty-seven patients with tibial pilon fractures treated surgically were included in this study. The results of the FREMAP functional assessment scale were analyzed together with Burwell-Charnley's radiographic criteria. Although there is no consensus on which is the best treatment, it is evident that combined treatment including external and internal fixation with a plate provides the best results.

Background and Purpose: Autogenous bone grafts from the iliac crest are frequently harvested for autologous bone transplantation, because this is still the gold standard in the treatment of many bone defects. However, significant donor site morbidity must be considered. We have developed a simple method to treat the bone defect in the donor site in order to reduce some of the morbidity. In this method, the bone defect size and shape determines its application., Method: After the conventional method of tricortical bone harvesting from the iliac crest, bone defect is repaired by means of a transversal fence of appropriate thin tricortical chips obtained from the posterior lateral wall of the bone defect itself. The mechanical stability of this fence results from impactation of the ends of the tricortical chips into both lateral cancellous bone walls of the repaired bone defect. Thus, no hardware is required, and both the bone defect and ilium contour are restored., Results: This simple method allows ilium bone defect healing and bone contour recovery after graft harvest, by using the same gold standard graft. Although not much time is necessary to reconstruct the donor site, the bone defect size and shape determine its application., Interpretation: This method may be a recommendable option for bone defect reconstruction after iliac crest tricortical bone graft harvest as the primary procedure. The advantages of this technique are bone defect healing and bone contour restoration with prevention of a visible deformity over the groin, with no foreign material insertion, thus avoiding additional cost., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

The technique of choice for excision of osteochondromas located in the lateral aspect of the tibia is a transfibular approach to expose the lesion for resection. A drawback of this approach is that removal of the lesion leaves a void that may cause a visible deformity and adversely affect long-term function. Fibular rotational osteotomy followed by fibular graft may minimize the resultant deformity, producing a more satisfactory functional and cosmetic result. The authors report a retrospective case series consisting of 5 cases in which a fibular graft rotation was performed after rotational osteotomy via a transfibular approach. Retrograde intramedullary fixation by means of a Kirschner wire, in combination with the design of the fibular osteotomy, provided rotational graft and fibular stability until healing occurred.

The in vivo evaluation, in New Zealand rabbits, of a SiO(2)-P(2)O(5)-CaO sol-gel glass and a SiO(2)-P(2)O(5)-CaO-MgO glass-ceramic, both bioactive in Kokubo's simulated body fluid (SBF), is presented. Bone defects, performed in the lateral aspect of distal right femoral epiphysis, 5mm in diameter and 4mm in depth, were filled with (i) sol-gel glass disks, (ii) glass-ceramic disks, or (iii) no material (control group). Each group included 8 mature and 8 immature rabbits. A 4-month radiographic study showed good implant stability without axial deviation of extremities in immature animals and periosteal growth and remodelling around and over the bone defect. After sacrifice, the macroscopic study showed healing of bone defects, with bone coating over the implants. The morphometric study showed a more generous bone formation in animals receiving sol-gel glass or glass-ceramic disks than in control group. Histomorphometric study showed an intimate union of the new-formed bone to the implants. This study allows considering both materials as eligible for bone substitution or repair. Their indications could include cavities filling and the coating of implant surfaces. The minimum degradation of glass-ceramic disks suggests its application in locations of load or transmission forces. As specific indication in growth plate surgery, both materials could be used as material of interposition after bony bridges resection.

We studied the effect of implantation of self-reinforced polyglycolic acid (SR-PGA) screws through the greater trochanter in rabbits. 15 rabbits aged 10 weeks had an SR-PGA screw inserted through the left trochanter physis. A similar drilling was made through the right greater trochanter without screw implantation. The animals were assigned to 3 groups of 5, and were killed after 1, 2 or 3 months. Radiographs of both femurs were obtained monthly and the articulo-trochanteric distance and the neck-shaft angle were measured. After killing the animals, a histological study was performed. The drilling on the right trochanter generated a bony bridge in all the animals. The SR-PGA screws did not give rise to an epiphysiodesis. The progressive peripheral degradation of the implants gave rise to the formation of only modest bridges, which were smaller in size than those observed in the control trochanter. Our findings suggest that absorbable PGA screws implanted through a growth plate cause only minor bone formation and no epiphyseodesis.