Due to its considerable systemic impact, several local and general methods to control surgical ( intra/perioperative) bleeding have been developed, with particular characteristics adapted to each type of surgery. In orthopaedic procedures, elective or urgent, bleeding is to be seriously considered , since usually both bones and soft tissues are injured or cut, so adapted haemostatic means have to be used. This issue is of particular importance especially when very small vessels are involved, and especially on large surfaces, since ligation or cauterization are useless in these situations. An effective tool in these circumstances is the group of fibrin sealants, which can stop diffuse bleeding on surfaces when produced by very small vessels. The authors present their clinical experience with fibrin sealants, underlining the indications and the limits of the method.

Treating chronic bone infection is challenging, requiring complete excision of the affected areas and antimicrobial therapy. Acquiring active concentrations of antibiotics is difficult, as well as filling up bone defects resulting from sequestrectomy, and very few methods of treatment address both issues simultaneously. The authors describe the clinical results after using Collatamp G, a collagen-based, antibiotic filled sponge with two actions: local delivery of high antibiotic doses without systemic side effects and enhancement of healing due to collagen, thus covering the bone defect without any further osteoplastic surgery. This paper thus identifies Collatamp G as a biomaterial able to solve the above mentioned problems in treating bone infections.Keywords: bone infections, collagen matrix, gentamicine, antibiotic delivery

Polytrauma represents one of the most challenging aspects of modern medicine, due to its high mortality and morbidity, affecting especially young, active patients. Therefore, research is nowadays directed towards optimising the treatment for these patients, which is extremely difficult, as polytrauma is characterized by a complicated pathophysiology with intricate pathways, potentially generating local and general complications and requiring a multidisciplinary approach. An essential issue for these patients is a careful monitoring algorithm, able to determine an appropriate therapeutic response in due time, so objective, measurable and reproducible elements able to do this have been sought. Since biochemical markers have these properties, and the most important pathogenic element in polytrauma is the Systemic Inflammatory Response Syndrome (SIRS), the authors of this paper evaluate the predictive value of inflammatory markers in order to improve the monitoring algorithm of these patients. The results of this prospective study demonstrate some statistically significant correlations, such as those between lactate (at admission and 24 hours later) and mortality, as well as between IL-6 and early systemic complications, which are of great value because they can concentrate the efforts of the multidisciplinary team and save the life of the poytrauma patient.

Complex limb trauma are extremely severe and pose a threat both to the patient’s life, because of their systemic impact, as well as to the vitality of the traumatized limb, because of potentially severe septic complications. Post-traumatic (post fracture) osteitis is most often a consequence of an open fracture (always contaminated) or a closed operated fracture which was contaminated by pathogenic germs, the most common of which is Staphylococcus aureus (but Gram-negative bacteria, such as Klebsiella, Pseudomonas and Proteus are also worth mentioning). The consequence of an acute osteitis which was incompletely or inadequately treated is chronic osteitis, which requires long-term treatment, with inconsistent outcome results. To describe this topic, we present the case of a 15 year old pacient, which presents at the hospital as a surgical emergency, following a complex high energy trauma cause by a smash-up, whose survival and then healing, in spite of complete and correct approach, were extremely problematic/challenging, and called for a massive amount of human, financial and temporal resources.

Modern traumatology is characterized by high energy trauma, simultaneously affecting parts of the body especially in young patients. One of the most severe aspects resulting of high energy trauma is that of multiple skeletal injuries, with bone loss, which require complex treatment; this refers both to methods of filling the bone defects and to interdisciplinary approach whenever soft tissues are injured, as well. This case demonstrate the impact of modern approach in high energy trauma, with multiple aspects: bone substitutes as effective technique of bone filling and prevention of septic complications, as well as team work for concomitant treatment of associated injuries. The outcome of the patient, compared to the initial status, demonstrate the benefit of bone substitutes for a rapid recovery of trauma patients, with major impact on social and professional recovery.