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Background Arthroscopic ankle arthrodesis (AAA) has risks of complications, such as delayed union and non-union. The number and direction of the inserted screws have been reported as important factors affecting the time to union of AAA. However, the ratio of inter-screw distance (ISD) to tibial width (TW) in different planes has not been investigated. Therefore, we aimed to explore the effect of this ratio on bone union following AAA. Methods We retrospectively enrolled 63 patients (64 ankles) undergoing AAA from 2013 to 2019. Then, their age, body mass index (BMI), sex, diabetes mellitus (DM) status, Takakura–Tanaka classification, number of screws and radiographic parameters were analysed. Results The patients had a mean age of 70.3 (range, 45–91) years. Bone fusion was achieved in 57 ankles (89%) in a mean period of 3.3 (range, 2–6) postoperative months. There were four cases of delayed union and three of non-union. No significant differences in age, BMI, sex, DM, Takakura–Tanaka classification, and number of screws could be detected between the groups. However, the sagittal ISD/TW ratio was significantly larger in the union group than in the delayed/non-union group with a cut-off value of 57.0%. Conclusion Larger sagittal ISD/TW ratios result in reduced post-AAA delayed union or non-union. The surgeon should be aware that the anterior and posterior screw widths should be approximately 60% or more of the anteroposterior width of the tibia.

The objective of this study is to evaluate the efficacy of percutaneous platelet concentrate (PC) injection in increasing the chances of attaining union in delayed union of long bones and to know whether the time taken for union decreases with use of PC. Forty delayed unions (15–30 weeks old) were randomized into a study group in which autologous PC prepared by blood bank centrifuge was percutaneously injected at the fracture site under image intensifier after activation with 10% calcium gluconate and a control group where patients were observed over time. Follow-up was every 6 weeks till fracture union. At each follow-up visit clinical and radiological parameters of union were assessed. Percentage union was 78% (18/23) in PC group and 59% (10/17) in control group, respectively (p = 0.296). The mean time to fracture union treated with PC (15.33 ± 9.91 weeks) was not different from the control group (13.10 ± 7.21 weeks; p = 0.540). In the PC group union is seen in 12 weeks after PC injection in 60 per cent of the cases. Isolated percutaneous PC injection increases union rates in delayed union of long bones. The results were, however, not statistically significant but show high positive association. Further studies are required to recommend routine use of PC injection.

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. 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. 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. 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 purpose of this study is to compare the results of middle third humeral shaft fractures treated with minimally invasive plate osteosynthesis (MIPO) with those treated with an expandable nail technique. Thirty-four patients with middle third humeral shaft fractures were retrospectively analyzed and divided into two groups: group A included 15 patients treated by MIPO and group B included 19 patients treated with an expandable intramedullary nail. The operation time, postoperative complications, time to fracture union, the UCLA End-Result score of the shoulder, and Mayo elbow performance index (MEPI) were recorded and compared. The mean operation time in group A was 108.3 ± 28.7 min and 85.0 ± 35.7 min in group B, a difference of 23.3 (27.4%) minutes (P 0.05). One case of delayed union was identified in group A. The mean UCLA End-Result score in group A was 34.2 ± 1.1 points (31–35 points)and 31.8 ± 2.6 points (26–35) in group B (t = 3.318 P = 0.002, P < 0.05). All the patients had excellent elbow functions. In surgical treatment of middle third humeral shaft fractures, MIPO appeared to offer advantages in terms of better shoulder and no iatrogenic radial nerve injuries, although technically more difficult and time consuming.

Fractures of the upper cervical spine account for about 20% of all cervical spinal injuries. Only in a minority of cases a neurological damage occurs. With exception of the type-2-dens fracture the treatment of choice is non-operatively in the halo-thoracic brace. We report about our experience with Bremer® Halo System, an open ring carbon fibre design which especially facilitates the treatment of head injured patients in bed. We treated 13 patients (m/w 9/4), mean ages 40 years (range 18–73) with 10 dens fractures Anderson and d’Alonzo-type III and 3 hangman’s fractures Effendi-type I. Five patients had additional head injury. Two of them were unconscious at the time of application of the halo-device. Our routine follow-up included roentgenograms after halo-application and 6 weeks later. After 3 months CT-scans were performed to evaluate fracture union. After 12–20 weeks the halo-device could be removed. We observed one halo ring loosening in a patient with oversize skull resulting in earlier removal in presence of an already established union. In one case we had a delayed union which eventually united in stiff collar after 6 month. No pin tract infection was observed. All patients returned to their pre-injury activities. A slightly limited rotation of the head was observed in most of the patients. The Bremer® Halo System proved to be a reliable unsophisticated halo system in the treatment of upper cervical spinal injuries. The feature of the open ring design especially facilitates the treatment of an accompanying head injury. We experienced a problem with a limited size of the halo ring.

The treatment of open segmental tibia fracture associated with bone loss is very demanding. Despite the fact that the principles of the distraction osteogenesis are being followed commonly in these fractures, there is not a single technique that fits all situations. In this article, we report a case where the initial fractures were stabilized with a monolateral bridging external fixator with no evidence of callus formation 6 weeks later. The proximal fracture was used as “an osteotomy” for bone transport after a latent period of 6 weeks of compression. The successful outcome in this patient, confirms that distraction of a delayed union even when it is mobile, can lead to bone formation and healing of the delayed union.

Clinical application of electric stimulation and electromagnetic field stimulation include the treatment of delayed union and nonunion. In the literature success rates up to 90% are reported for the treatment of delayed union and nonunion with pulsed electromagnetic stimulation. We report our experience with pulsed electromagnetic stimulation in the treatment of nonunion. All patients treated with pulsed electromagnetic stimulation for a nonunion between January 1996 and January 2000 were included. A total of 93 patients were included. One group was treated for long bone fractures (LBF) (64 patients). The other group consisted of patients treated for non long bone fractures (NLBF). We evaluated our findings according to clinical and radiographic criteria. The success rate of our treatment of a nonunion with pulsed electromagnetic field was 76% for the LBF group and 79% for the NLBF group. Pulsed electromagnetic field stimulation of a nonunion showed to be an effective treatment in our study.