[Change in procedure and re-osteosynthesis of the femur. Definition and retrospective analysis]. / Verfahrenswechsel und Reosteosynthese am Oberschenkel. Begriffsbestimmung und retrospektive Analyse.

The change of treatment modality in osteosynthesis is based on two principles. On one hand, one can exchange the implant as part of a two step procedure to reduce side effects of stabilizing fractures. On the other hand, a reosteosynthesis may be required for treatment of complications. A retrospective analysis was undertaken to differentiate the situation of indication, technique and results of patients with fractures of the femur. Indications for two step procedure of therapy at the femur are limited to fractures of polytraumatized patients and fractures with severe soft tissue damage. External fixator devices have been used for stabilization of long bone fractures with severe soft tissue damage using the two step procedure in the past decades; nowadays unreamed nailing is commonly preferred. Reosteosynthesis may be appropriate for the treatment of failing of osteosynthesis; they can also be used due to delayed union or nonunion of fractures, osseous deficiency or infection. In the case of failing osteosynthesis, the reasons for failing have to be studied thoroughly and a variety of subsequent procedures has to be taken into consideration for successful treatment.

[Initial results of treatment of a two-stage surgical technique of chronic flexor tendon injuries with Kleinert modified early mobilization]. / Erste Behandlungsergebnisse einer zweizeitigen Versorgungstechnik veralteter Beugesehnenverletzungen mit modifizierter Frühmobilisierung nach Kleinert.

The authors present first results after secondary two-stage flexor-tendon reconstruction and a modified postoperative management according to Kleinert. Between 1990 and 1993 we treated eight men and two women with an average age of 35 (19 to 58) years. All injuries were in zone 2. We used the silastic rod (5 mm) as an active gliding prosthesis in stage I. All patients received a palmaris tendon graft in stage II. The patients were treated with a modified Kleinert splinting technique inactivating the palmar traction, employing extension by a rubber band during the night after the second week. We had no complications during the whole treatment phase, no rupture of the tendon grafts and no infection. In our functional results, we saw in one case a lack of PIP-joint flexion of 10 degrees and in another an extension deficit of 15 degrees in the DIP-joint. With this modified technique we achieved satisfying results especially in otherwise non cooperative patients.