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Femoral fractures, after hip arthroplasty (Periprosthetic fractures), may impose an immense problem in the treatment and recovery of such patients. The treatment is very difficult because there is not any universal treatment method. In the present study, the patients with femoral fractures after total hip arthroplasty are presented, treated at the Clinic of Orthopedics of the Clinical Center Nis. Vancouver Classification System was used. The fractures have been fixed by cerclage wire, Muller's plates and Mitkovic's selfdynamizing Internal Fixator. The authors present 37 patients with femoral fractures after total hip arthroplasty. The average age is 67.3 years (26 women, 11 men). Type A fracture was found in 8 patients, type B in 23 patients and type C in 6 patients. The femoral fracture occurred during the period from 2 months up to 4 years after the primary arthroplasty. Patients were followed 1-5 years after the surgery. All patients were mobile early and able to walk with crutches. The signs of fracture consolidation and healing appeared 3- 5 months after the operation. In 5 cases there was no fracture consolidation up to 4 years. There were no mechanical complications. Periprosthetic femoral fractures are considered severe complications, particularly among the elderly. Mitkovic's dynamisable Internal Fixator represents an implant which enables fixation of all types of periprosthetic fractures, without impairing periosteal vascularisation, the fixation being at the same time less invasive compared to other implants. In addition, the implant enables dynamic fixation of a fracture, which reduces the risk of mechanical complications related to fixation. [ABSTRACT FROM AUTHOR]

Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint. [ABSTRACT FROM AUTHOR]

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Introduction. Femoroacetabular impingement is the result of the pathological conditions in the osseous acetabulum and/or the proximal femur. One of its causes is a non-anatomically healed femoral neck fracture. Case report. A male, aged 51, with a subcapital left femoral neck fracture was treated conservatively. The fracture healed 9 months later and although the patient was walking on crutches he suffered from pain in the left groin. The X-ray images showed the valgus and the retroposition of the left femoral head. The patient was operated on and intraoperatively the thickness and a bone prominence in the anterosuperior femoral neck area in the line of the previous fracture were found, which was pressing and spreading beneath the acetabular labrum, thus squeezing the acetabular cartilage. The labrum lesion which was found was the result of the mechanical pressure of the existing femoral neck deformity during the hip movements. Irretrievably damaged part of the labrum was resected and the anterosuperior femoral headneck osteochondroplasty was done. One year after the surgery, the patient had no pain, he walked without limping, the impingement test was negative, the radiological parameters were adjusted and there were no signs of the avascular necrosis of the femoral head. Conclusion. The femoral neck fracture should be treated adequately with the full anatomical position and the proper internal fixation. If the deformity occurs as the result of a treatment, it should be removed as soon as possible to prevent the osteoarthritis of the hip. [ABSTRACT FROM AUTHOR]