It is a privilege for me to introduce this Instructional Lecture book for the 11th EFORT Congress. The format of the Congress combines a National society, SECOT, and the European Federation, EFORT. For this lecture book,the topics selected are original and attractive and will predicate further lectures. The main goal of EFORT is to convey the latest knowledge of diseases and trauma of the Musculoskeletal system to all European Surgeons. We also wish to welcome colleagues from all over the world,especially from Latin-America and Asia, who are joining us. The Scientifc programme combines multiple aspects of Orthopaedics and Traumatology, paying attention particularly to the latest treaments for infections, m- astatic disease, Trauma care and arthroplasty registers, from a European perspective. Our Instructional Lecturers are from all over Europe, and present topics from diverse areas of interest. These lectures give the opportunity to learn about various deseases but also our speakers' special experience based on their National philosophy - again a chance to widen our European horizons. As the chairman of the Local Organising Committee. I thank all of our Lecturers for their for excellent contributions for publication in this collection. My special thanks go the Professor George Bentley for organising this edition. EFORT should be congratulated for all its efforts in providing training material for all Orthopaedic surgeons,and particularly for this selection of Instructional Lectures for the Congress in Madrid.

Professor George Bentley is Professor of Orthopaedic Surgery and Director of the Institute of Orthopaedics, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA 4LP, UK. He is Director of Clinical Studies, Clinical Training and Research Advisor. Furthermore, he is Honorary Consultant Orthopaedic Surgeon, Royal National Orthopaedic Hospital Trust, Stanmore. He is Past President of EFORT, Chairman Awards and Prizes Com., and Chairman Scientific Publ. Com.

1;European InstructionalLectures;1 1.1;Part IGeneral Orthopaedics;12 1.1.1;Necrotising Fasciitis;13 1.1.1.1;Definition;13 1.1.1.2;Aetiology;13 1.1.1.3;Epidemiology;13 1.1.1.4;Risk Factors;14 1.1.1.5;Pathophysiology;14 1.1.1.6;Diagnosis;14 1.1.1.6.1;Clinical Presentation;15 1.1.1.6.2;Laboratory Evaluation;15 1.1.1.6.3;Radiologic Evaluation;16 1.1.1.6.4;Histologic Evaluation;16 1.1.1.7;Diferential Diagnosis;16 1.1.1.8;Management;17 1.1.1.8.1;Surgical Debridement;17 1.1.1.9;Antibiotic Therapy;17 1.1.1.9.1;Supportive Therapy;18 1.1.1.9.2;Adjunctive Therapies;18 1.1.1.10;Outcome;18 1.1.1.10.1;Our Experience;19 1.1.1.11;Conclusions;19 1.1.1.12;References;23 1.1.2;Trauma: Non-Union: New Trends;25 1.1.2.1;Introduction;25 1.1.2.2;Low Instensity Pulsatile Ultrasound (LIPUS);25 1.1.2.3;Magnetic Field Induction;26 1.1.2.4;Growth Factor Treatment;26 1.1.2.5;Stem-Cell Therapy;28 1.1.2.6;References;28 1.2;Part IIBone and Joint Tumours;30 1.2.1;Bone Tumours: Work Up 2009;31 1.2.1.1;Introduction;31 1.2.1.2;Primary Evaluation;31 1.2.1.2.1;X-Ray, CT;31 1.2.1.2.2;MRI;33 1.2.1.2.3;Ultrasound;36 1.2.1.2.4;Scintigraphy;38 1.2.1.2.5;PET, PET/CT;39 1.2.1.2.5.1;PET;39 1.2.1.2.5.2;PET/CT;39 1.2.1.2.6;Comparison of the Different Methods and Summary;39 1.2.1.3;Monitoring Response to Therapy;41 1.2.1.4;Follow-Up Monitoring;42 1.2.1.4.1;Soft Tissue Sarcoma;42 1.2.1.4.2;Adult Osteosarcoma;42 1.2.1.4.3;Adult Ewing-Sarcoma (incl. PNET);42 1.2.1.5;References;43 1.2.2;Diagnosis and Treatment of Soft Tissue Sarcomas;45 1.2.2.1;Introduction;45 1.2.2.2;Clinical Features;45 1.2.2.3;Diagnostic Algorithm and Imaging of the STS;46 1.2.2.4;Biopsy and Histological Examination;47 1.2.2.5;Staging and Prognostic Factors;49 1.2.2.6;Local Control Rate and Survival;50 1.2.2.7;Other Factors Influencing Survival;51 1.2.2.8;Surgery of STS;51 1.2.2.9;Surgical Margins;51 1.2.2.10;Reconstructive Surgery in Deep STS;52 1.2.2.11;Treatment of Local Recurrent Tumour;54 1.2.2.12;Surgery of Lymph Node and Other Distant Metastases;54 1.2.2.13;Radiotherapy;54 1.2.2.14;Chemotherapy;55 1.2.2.15;The Effectivity of Different Drugs in the Treatment of STS;56 1.2.2.16;Conclusions;56 1.2.2.17;References;56 1.3;Part IIIPaediatrics;59 1.3.1;Management of Lower Limb Deformities;60 1.3.1.1;Introduction;60 1.3.1.2;Advances in Deformity Correction;60 1.3.1.3;Guidelines for the Treatment of Congenital Deformities of the Lower Extremity;63 1.3.1.3.1;Congenital Femoral Deficiency (CFD);63 1.3.1.3.2;Fibula Deficiency;65 1.3.1.3.3;Tibial Hemimelia;66 1.3.1.3.4;Lengthening of Short Stature Patients;66 1.3.1.4;Prevention of Complications;66 1.3.1.5;In Conclusion;66 1.3.1.6;References;67 1.3.2;Total Hip Replacement in the Congenitally Dislocated Hip Using the Paavilainen Technique..1;68 1.3.2.1;Patients and Methods;68 1.3.2.2;Results (Table .1.);70 1.3.2.3;Discussion;71 1.3.2.4;References;71 1.4;Part IVTrauma;73 1.4.1;Operative Strategy for Fracture-Dislocation of the Elbow;74 1.4.1.1;Introduction;74 1.4.1.2;Diagnostic Tools;74 1.4.1.2.1;Conventional Imaging;74 1.4.1.2.2;Computed Tomography;75 1.4.1.2.3;Evidence-Based Medicine?;77 1.4.1.2.4;Injury Mechanism;77 1.4.1.2.5;Fracture Fixation;77 1.4.1.2.6;Surgical Approaches;77 1.4.1.2.7;Coronoid Process;77 1.4.1.2.8;Radial Head;79 1.4.1.2.9;The "Terrible Triad";80 1.4.1.2.10;Trans-Olecranon Dislocation;80 1.4.1.2.11;The Role of Hinged External Fixation;81 1.4.1.3;References;81 1.4.2;Fractures of the Scaphoid: Diagnosis and Management;84 1.4.2.1;Foreword;84 1.4.2.2;Diagnosis;84 1.4.2.2.1;Differential Diagnosis;85 1.4.2.2.2;Classification;85 1.4.2.3;Treatment;85 1.4.2.3.1;Transcaphoid-Perilunar Dislocations;87 1.4.2.3.2;Scaphoid Fractures in Children;87 1.4.2.3.3;"Old" Fractures;88 1.4.2.3.4;Bone Union;88 1.4.2.3.5;Rehabilitation;88 1.4.2.4;Aknowledgements;88 1.4.2.5;References;88 1.5;Part VSpine;90 1.5.1;Treatment of Thoraco-Lumbar Fractures;91 1.5.1.1;Introduction;91 1.5.1.2;Epidemiology of Spinal Injuries;91 1.5.1.3;Initial Management of Polytrauma Patients with a