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Introduction The purpose of this study was to determine the effectiveness of circular external fixation (CEF) as a definitive treatment option for patients with complex tibial plateau fractures (Schatzker VI) compared with the outcomes of a fixed angle locking plates’ group. Methods Level III evidence. Retrospective, comparative study in a Level I Trauma Center. Fourteen patients treated with CEF (Group A) were compared to fourteen patients treated with minimal invasive angle locking plates (Group B). The mean time from fractures to surgery was 19 days for Group A with a mean ISS of 24 and 7 days for Group B with a mean ISS of 14. The main outcome measures were clinical and radiographic. Results Complete union was obtained in Group A at an average of 22 weeks and at 17 weeks in Group B. Two patients developed non-union, one in each group. Normal alignment was observed in both groups, no statistical differences were observed in Paley’s anatomical posterior proximal tibial angle (aPPTA) and mechanical medial proximal tibial angle (mMPTA) between two groups. Results based on the Association for the Study and Application of the Method of Ilizarov criteria for Group A: 71% excellent and 29% good as far as bone outcomes are concerned and as 57% excellent, 37% good, and 7% fair for functional outcomes. Conclusions Definitive fixation with circular external fixator is effective in complex Schatzker VI tibial plateau fractures. Advantages include maintaining the frame till union, reduced risk of infection, early mobilization, restoration of the normal lower extremity alignment, versatility, and improved union rate in patients with multiple traumatic injuries, infection, and soft tissue injuries.

The timing of definitive fixation for simultaneous fractures of the humerus in polytrauma patient is controversial. We report on the management of a patient that sustained bilateral "floating arm" fractures of the humeri. When dealing with such injury patterns, it is important to always carry out stabilization of the humeral diaphysis first and afterwards to treat the sub-injury or over-injury fractures. Our patient healed after twelve weeks in both humeri. After seven years MEPS showed excellent and good results in the right and left arms, while UCLA scores proved excellent in both sides. We encountered no intraoperative and postoperative complications.

Different internal fixation techniques (ORIF) have been proposed for the reduction and stabilization of traumatic diastase of the pubic symphysis: two-hole plates, multi-hole plates and double plates. Classically the synthesis of the symphysis is executed with 2 plates of 3.5 or 4.5 mm (anterior and sovrapubic), where screws are inserted from anterior to posterior. Since 2005 to January 2008, the first author has treated 16 patients modifying the anterior screws positioning for the stabilization of the pubic symphysis. In the 16 considered cases we have positioned just 2 anterior screws, one for each pubic branch, in the conviction of a better respect of the physiological forces lines. All the screws have a length from 55 to 65 mm. Functional results were excellent in 90%, good in 10%; reductions resulted excellent in 90% and good in 10%. The modified screws fixation method could be proposed in the management of treatment of anterior unstable pelvic ring.

Objective The surgical technique developed provides a lateral approach based on the identification of three major cutaneous windows in complex fractures.

We examined patients affected by a posterior wall fracture of the acetabulum treated with a minimally invasive posterior approach (from 12 to 18 cm). During 2004-2006 19 patients were treated by this approach. 4 patients had a combined surgery by the ileo-inguinal approach. Fracture fixation was performed using reconstruction plates and screws. All the patients were studied with typical X-rays projection for pelvis and iliac oblique view and obturator oblique view (Judet view) and CT scan with 3D reconstruction. After 3 months a CT scan was performed on about 30% of our patients, which demonstrated the perfect healing of the fractures. The most important advantages we observed using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early post-operative rehabilitation we examined the trophism of the gluteus maximus, which was found to be better than in patients treated with the typical Kocher-Langenbeck approach. The only absolute contraindication for this technique is in obese patients. The post-operative complications include one case of heterotypic ossification of the gluteus minimus and one case of peroneal-nerve palsy with the spontaneous and complete recovery within 6 months. According to our experience this kind of approach could be used for posterior wall fracture of the pelvis and it can be extended to transverse fractures. In the post-operative period the greatest advantage is the lesser muscle damage and therefore a most effective rehabilitation.

Elbow arthrodesis (EA) is a rare procedure to be performed and it is still considered a salvage approach to be chosen in selective cases only5,9,10 . As reported by Koller it is one of the most difficult arthrodesis to perform for the surgeon with a high impact on the patients’ quality of life7 . This procedure is even more challenging when a massive bony defect occurs as it is the case after removal of a failed total elbow arthroplasty4 . Traditional EA is performed between the humerus and the ulna, due to the larger surface areas available, as reported by Staples, who described the employment of an olecranon wedge against the humerus15, or by Muller and Song, who suggested a plate compression between those two bones7,14 . The hypothesis whether an radiohumeral arthrodesis may be performed when the proximal ulna is completely absent due to reabsorption is based on anectodal evidence and few alternatives, as vascularized bone grafting, or renewed arthroplasty are available to the surgeon6,9 . We present a case report of a 75 year old woman who had a history of multiple total elbow replacement failures with a massive ulnar bone loss in which a radiohumeral arthrodesis with external fixation was performed. Complete fusion was obtained with more than satisfactory results on the patient’s quality of life.

The fractures of the distal tibia represent 7-10% of all tibial fractures and they usually are the result of high energy injuries as such as traffic accidents or fall from a height; in these cases the axial compression causes complex articular fractures characterized by metaphysis break and bone loss. Better prognosis are given in case of low energy traumas.The study evaluates the results of the surgical treatment of distal tibia fractures, using minimally invasive plateosteosynthesis (MIPPO) technique. We treated in our unit 30 patients with distal tibia fractures with the MIPPO technique.The fractures, intra-articular or extra-articular, were classified according to the AO classification. The cases studied did not involve open fractures or cutaneous lesions and we excluded the C3 and B2,B3 fractures, for which traditional osteosynthesis is preferable. We had one case of superficial wound infection in a diabetic patient with the dehiscence of the surgical wound than solved with the correct consolidation of the fractures; a malunion with more than 5 degrees of varus, one case of asymptomatic breaking of the distal screws. On the whole the outcomes were positive, thanks to a correct clinical indication. In conclusion we think that two are the elements that direct the choice regarding the type of approach and the type of device for the synthesis. The first is the condition of the skin, as far as its integrity is concerned, and the second is the articular condition, as far as the comminution and the number of fragments are concerned. Therefore we need to choose a synthesis that can guarantee a good outcome and can avoid dreadful complications and MIPPO is a valid technique when used correctly and by experts.

Complex proximal tibial plateau fractures need surgical treatment to achieve good clinical results. The treatment of this kind of fractures is often complicated either by the patient’s compromised general conditions, or by soft tissue damage. The locking plate combines the technical advantages of an angular stable plate with those of the modern biological plating technique. From December 2002 to December 2008 we treated 18 patients with complex fractures of the tibial plateau (Schatzker VI). All patients were treated with a fixed angle locking plate, 15 with the LISS (Less Invasive Stabilisation System) and 3 with ZPLT (Zimmer Periarticular Locking Plate system). Average time for full weight bearing was 16.2 weeks. In 3 cases we removed the fixation devices after healing because the patients didn’t tolerate the fixation devices. Two patients developed superficial infections that we treated with antibiotic therapy. In 2 cases the LISS plate broke because of pseudarthrosis at the diaphyseal level. To conclude, analysing the results we obtained, we consider that the LISS system is an extremely effective fixation device for the treatment of such difficult and complicated fractures as high energy tibial plateau fractures certainly are. Indirect reduction of the fracture, obtained either with an external fixator, or with traction, must precede the use of the fixation device. The failures, such as post-op malalignment or loss of reduction, are due to a wrong evaluation of the fracture morphology. In fact, comminuted fractures, dislocation and rotation of the medial tibial plateau cannot be stabilised just with lateral angular stable plates, but fixation of the medial tibial plateau must be performed first.

Control on a priority basis of significant sites of hemorrhage in patients with abdominal trauma and pelvic disruption may be critical for survival. Purpose of this study was to evaluate retrospectively a work-up based on initial pelvic radiograph, abdominal ultrasound (US) and contrast CT (CESCT).