[Knee angular deformity correction using unicorticotomy and callus distraction by external fixation method and presentation of new external fixation device for varus correction of proximal tibia].

The main goal of this paper is to present clinical results of surgical correction of angular (varus and valgus) deformities of knee area. Goal is also to present new external fixation device for surgical treatment of varus deformity of proximal tibia. As material it has been used series of 70 patients treated during the period of 6.5 years in University Orthopaedic and traumatology clinic. Biomechanical investigation of 80% cut bone model fixed by new external fixation device was performed in the measurement laboratory of Mechanical Faculty University of Nis. Clinical results of treatment of 58 high tibial surgeries (49 varus and 9 valgus) and 12 distal femur surgeries (2 varus and 10 valgus) showed that unicorticotomy and callus distraction by the use of Mitkovic external fixation device leaded to correction and bone union. Superficial pin tract infection happened in 9 patients and has been successfully treated without pins removal. Biomechanical investigation of new device showed that during axial loading of bone model by 690 N (70 kg) movement of medial distal end of bone model was 0.30 mm while posterior distal end of bone model was 0.26 mm. From results obtained in can be concluded that unicorticotomy and gradual callus distraction by the use of external fixation is one reliable method. Biomechanical testing of new external fixation device showed that it is more stable in control of varus and posterior position of proximal tibial fragment.

Surgical treatment of displaced acetabular fractures.

INTRODUCTION: Acetabular fractures are severe injuries, generally caused by high-energy trauma, most frequently from traffic accidents or falls from heights. Fractures of the extremities, head injuries, chest, abdomen and pelvic ring injuries are most commonly associated injuries. OBJECTIVE: The purpose of this study was to evaluate the results of open reduction and internal fixation of acetabular fractures. The open anatomical reduction of the articular surface combined with a rigid internal fixation and early mobilisation have become the standard treatment of these injuries. METHODS: We conducted a retrospective analysis of 22 patients of average age 43.13 years. The patients were treated by open reduction and internal fixation at the Orthopaedic Clinic of Nis from 2005-2009. The follow-up was 12 to 60 months, with the average of 21.18 months after surgery. RESULTS: All injured patients were operated on between 4 and 11 days (5.7 days on the average). According to the classification by Judet and Letournel, 15 (68.18%) patients had an elementary acetabular fracture, whereas 7 (31.82%) patients had associated fracture. A satisfactory postoperative reduction implying less than 2 mm of displacement was achieved in 19 (86.36%) patients. The radiological status of the hip joint, determined according to Matta score, was excellent in 15 (68.18%) patients, good in 4 (18.18%) patients and moderate in 3 (13.63%) patients. According to Merle d'Aubigné Scale, the final functional results of the treatment of all operated patients were excellent in 12 (54.54%) patients, good in 7 (31.81%) patients and moderate in 3 (13.63%) patients. CONCLUSION: Surgical treatment of dislocated acetabular fractures requires an open reduction and a stable internal fixation. Excellent and good results can be expected only if anatomical reduction and stable internal fixation are achieved.

Treatment of open tibial shaft fracture with soft tissue and bone defect caused by aircraft bomb--case report.

INTRODUCTION: Aircraft bombs can cause severe orthopaedic injuries. Tibia shaft fractures caused by aircraft bombs are mostly comminuted and followed by bone defects, which makes the healing process extremely difficult and prone to numerous complications. The goal of this paper is to present the method of treatment and the end results of treatment of a serious open tibial fracture with soft and bone tissue defects resulting from aircraft bomb shrapnel wounds. CASE OUTLINE: A 26-year-old patient presented with a tibial fracture as the result of a cluster bomb shrapnel wound. He was treated applying the method of external bone fixation done two days after wounding, as well as of early coverage of the lower leg soft tissue defects done on the tenth day after the external fixation of the fracture. The external fixator was removed after five months, whereas the treatment was continued by means of functional plaster cast for another two months. The final functional result was good. CONCLUSION: Radical wound debridement, external bone fixation of the fracture, and early reconstruction of any soft tissue and bone defects are the main elements of the treatment of serious fractures.

[External fixation in the treatment of open tibial shaft fractures].

BACKGROUND/AIM: Besides the conquasant fractures, open tibia shaft fractures belong to the group of the most severe fractures of tibia. Open tibia shaft fracture is one of the most common open fractures of long bones. They most frequently occur as a result of traffic accidents caused by the influence of a strong direct force. METHODS: Within the period from January, 2000 to December 31, 2005 at the Clinic for Orthopaedics and Traumatology, Clinical Center Nis, 107 patients with open tibial fractures were treated. We analyzed 96 patients with open tibial fracture. In the series analyzed, the male sex was prevalent--there were 74 men (77.08%). The mean age was 47.3 years. The youngest patient was 17 years old, while the oldest patient was 79. According to the classification of the Gustilo et al. in the analysed group there were 30 (31.25%) open tibial fractures of the I degree, 31 (32.29%) of the II degree, 25 (26.05%) of the III A degree, 8 (8.33%) of the III B degree and 2 (2.08%) of the III C degree. In 95 of the patients the treatment of open tibia shaft fractures consisted of the surgical treatment of wound and the external fixation of the fractured bone using "Mitkovic" type external fixator with a convergent method of pin applications. One primary amputations had been done in patients with grade IIIC open tibial fracture with large soft tissue defect. RESULTS: Of the 96 open tibial fractures available for follow-up, 73 (76.04%) healed without severe complications (osteitis, pseudoarthrosis, valgus malunion and amputation). There were nine (9.38%) soft tissue pin track infections and six (6.25%) superficial wound infections. The mean time of union was 21 (14-36) week. Among severe local complications associated with open tibial fractures, in eight patients (8.33%) was registered osteitis, and in nine patients (9.38%) fracture nonunion and the development of pseudoarthrosis. Three of the patients (3.13%) had more than 10 degree valgus malunion. In one patients (1.04%) deep pin track infection developed. Two patients (2.08%) had below the knee amputation (one primary in patient with type III C open fracture and one secondary after the development of deep infections). CONCLUSION: Surgical treatment of wounds, external fixation, leaving the wounds open and performing necessary debridements, adequate drug therapy administration are essential for obtaining good results in patients with open tibial shaft fractures.