[Technic for surgical reconstruction in comminuted fractures of the head of the radius]. / Tehnica de reconstituire chirurgicala in fracturile cominutive ale capului radial.

Osteosynthesis n comminuted fracture of the head of the radius is extremely difficult because of the small size of the bone fragments. The particularly rich innervation of the elbow explains the violent vasomotor reaction that accompanied injuries of the elbow, reaction responsible in the last instance of the onset of biological alterations the articulation. For this reason, the therapeutical solutions must have in view rapid restoring of the passive and active movements of the elbow. Reactions of the radius head is often followed by ossification around the radius stump, subluxation of the inferior articulation and valgus of the ulna. Osteosynthesis is only possible if there is a single detached bone fragment in posterioexternal position with respect to the radius head circumference. The authors describe an original technique, i.e. reducing the fractured bone fragments which are then fixed with a Kirschner rod, brought out percutaneously. A description is given of the operative procedure and postoperative care in the first eight patients operated. Very good results were obtained in 4 case, good results in 3 and poor results in one case.

[The Paltrinieri operation in treatment of pseudarthroses of the leg]. / Operatia Paltrinieri în tratamentul pseudartrozelor de gamba.

The authors present 8 cases of pseudarthroses of the tibia secondary to surgical and orthopaedic treatments of fractures of the leg, in whom para-focal osteotomia was performed. The Paltrinieri method is a simple and efficient intervention based on the biochemical principle of re-establishing a normal tibial axis, and on exclusion of the pseudarthrosis focus from under the influence of negative mechanical factors, an intervention which leads to a revival of the capacities of consolidation of the pseudarthrosis. The very good results obtained justify the recommendation ofthis therapeutical method in the treatment of pseudarthroses, especially of the suppurated pseudarthroses of the leg.

Osteosynthesis of fractures of the femur with flexible metallic intramedullary nails.

The authors discuss their use of Ender's method in the treatment of fractures of the femur. The diameter and length of the nails depends on the type of fracture. 1) Three nails of 4 mm diameter are introduced in parallel from the medial condyle in fractures of the femoral neck; 2) 5 mm nails are used, in similar fashion, for the fixation of intertrochanteric and subtrochanteric fractures; 3) 5 mm nails are used for diaphyseal, supracondylar and intercondylar fractures, introduced in crossed fashion ("Eiffel Tower" technique) from both medial and lateral condyles. This method of fixation has proved to be extremely stable. The operation itself is quick, with no blood loss or shock. The patient can resume partial weight bearing after a week in stabilised intertrochanteric and shaft fractures, after a month in less stable types, and after three to four months in fractures of the neck of the femur. This report is based on the first 250 cases treated by this method.

[Flexible metallic intramedullary nail, an ideal osteosynthesis material for femoral fractions]. / Cuiul metalic suplu intramedular, material de osteosintezu ideal pentru fracturile femurului.

The authors have used modified Ender nails for the treatment of femural fractures. Nails of different sizes are used in different arrangements, depending on the site of the lesion. Thus, for fractures of the femural neck 3 metallic nails, with a diameter of 4 mm are used, introduced through the internal supra-condylian aspect in paralel arcs; two nails, 5 mm in diameter, are introduced in the same way for the correction of the fractures involving the trochanterian massif; for fractures sited under the trochanterian massif (diaphysis, supracondylian, and supra- and inter-condylian), 5 mm diameter nails are used, placed on the internal and external aspects of the condyl in metalic arcs. This type of intervention was demonstrated to be stable, rapid, non-haemorrhagic and with low risk of shock. Supported walking is started in the first week after surgery--in cases with fractures of the trochanterian massif and of the diaphysis--provided these are stable fractures, in the first month when unstable fractures occur at the same level, and after 3--4 months in cases of fractures of the cervical neck. The authors' experience in the treatment of 250 cases is presented.

Hydroelectrolytic changes caused by prolonged clinical recumbency.

Investigations effected in 16 subjects of 20-69 years at bed rest after bone fractures demonstrated, in an interval of 10-27 days after surgery, normal plasma sodium concentration and a decreased urinary elimination, an increased plasma potassium concentration but a decreased urinary output. The osmotic changes were not significant. The plasma vasopressin activity was increased. Three urinary aldosterone determinations showed an increased output. The serum calcium level was within normal limits but its urinary output was initially slightly decreased, contrary to its augmented elimination after simple voluntary bed rest, as results from literature. The hydroxyproline elimination was increased, demonstrating an active collagen metabolism.

[Our new methods in the treatment of pertrochanteric and basocervical fractures]. / Noile noastre orientari în tratamentul fracturilor pertrochanteriene si bazicervicale

The authors have employed the Ender intervention in the pertrochanteral and basi-cervical fractures, an osteo-synthesis technique which is less traumatizing and of shorter duration, providing only a very limited access of pathogenic germs and allowing for an early mobilization. In 25 patients that have been operated on the results have been very satisfactory.