Open wounds treatment is very often a challenge for both the physician and patient. They require long term complex treatment with surgical debridement, dressing changing, additional therapies including expensive medication, with a high risk of failure. The most difficult to treat are the diabetic wounds and those that are associated with advanced arterial disease. In these special cases, the peripheral vascularization is severely impaired and the complications are imminent. Sixteen patients were selected from those appearing to our hospital departments of orthopedic and plastic surgery. Inclusion criteria included patients with a recurrent mixed fibrotic and granular wound base following trauma or diabetes, in which NPWT was indicated, without exclusion criteria. Patients enrolled were treated with regularly scheduled NPWT dressing change and using of a collagen scaffold. Patients were followed until healing, with visual representations of wound progression and time to full healing recorded. Both applications of these therapies appeared to accelerate the wound healing by clearing degenerative fibrous tissue and expediting wound granulation without additional complication. Some of the patients were healed partially and plastic surgery techniques were applied. Use of collagen scaffolds in conjunction with negative pressure wound therapy in the care of complex wounds is a reliable and effective method combining both the new granular tissue formation capacity of the scaffold to hold osteoblasts. In our experience, we have noticed that the patients benefit greatly when collagen scaffolds is combined with NPWT. It is our belief that this combination therapy combines the molecular clearing of non-viable collagen with the wound granulation necessary to advance complex wounds in healing.

Centromedullary nailing is the most preferred surgical technique for the treatment of lower limb fractures and sometimes also on the upper extremity. It is a minimal invasive surgical intervention used mainly for long bones fractures that permits treatment without opening the fracture site thus preserving the local vascularization. With the improved knowledge and understanding of the fracture pattern and of the implantation technique good stability and rapid bone healing is obtained.We present a study on 8 patients with long bones fractures (femur, tibia, humerus) that were surgically treated with intramedullary nailing which failed due to non-union. Implant failure usually occured at 6 to 10 months after surgery. In our group of patients the primary causes of non-union was improper fracture reduction, infection and faulty surgical technique. The implant usually failed several months after loading when the nail was not sharing but bearing all the weight. In this cases the metallic implant usually fails due to fatigue in its weakest point. Loss of reduction, inadequate fixation, a need to change implant and breakage of nails were considered as implant failure.Inappropriate usage of intramedullary nailing technique will lead to nonunion or delayed union and after loading the affected limb the metallic implant will bear all the mechanical forces. This will lead to implant failure and a new difficult surgery for the patients.Revision surgery should address both the biological part and the mechanical part of bone union .

In the case of patients suffering from medial compartment osteoarthritis of the knee, a high tibial osteotomy is the preferred treatment for preserving the knee articulation and correcting the knee biomechanical axis. Nowadays, the open wedge high tibial osteotomy is the preferred surgical technique for treating patient with varus knee angulation. The procedure consists in creating a medial gap in the proximal tibial metaphysis that is filled with autologus bone graft or bone substitutes. Synthetic bone substitutes made by bioceramics like hydroxyapatite or tricalcium phosphate are becoming more popular. Tricalcium phosphate (TCP) used as a bone substitute has shown to have osteoconductive properties and it is resorbable. We describe our experience in Orthopaedics III Department of the Clinical Emergency Hospital Bucharest, where we treated a total of 26 patients suffering from medial compartment osteoarthritis of the knee with high tibial open wedge osteotomy, between 2011 and 2015. TCP wedge implants were successfully used as bone substitutes for the tibial medial osteotomy in conjunction with a proximal tibia plate and screws. Open wedge high tibia osteotomy used for correcting the biomechanical axis of the lower limb is a safe surgical procedure that preserves the anatomical knee joint.