[Proximal tibial fractures sustained during alpine skiing - incidence and risk factors]. / Proximale Tibiafrakturen im Skisport - Inzidenz und Risikofaktoren.

BACKGROUND: Prior to introduction of carving skis, complex fractures of the proximal tibia were rarely seen. Recently these fractures are being seen more frequently in connection with alpine skiing. The aim of this study was to find out the incidence of proximal tibia fractures in alpine skiing and to identify possible risk factors. METHODS: All patients with proximal tibia fractures related to alpine skiing in a large German ski resort were included. Fracture type, patient and skiing related factors were recorded. Incidence of fractures was determined by using the number of all registered skiers. Multinomial logistic regression analysis was used to calculate the odds ratios for risk factors. RESULTS: Between 2007 and 2010 a total of 188 patients was treated for proximal tibia fractures caused by alpine skiing. Forty-three patients had a type-A injury, 96 patients a type-B injury, and 49 patients a type-C injury. The incidence of injury increased continuously, starting from 2.7 and climbing to 7.0 per 105 skiing days. The risk factors compared to patients with type-A fractures, type-C fracture occurred in older (OR 0.93; 0.89 - 0.97) and heavier (OR 0.86; 0.74 - 0.99) individuals and were more likely on icy snow conditions (OR 0.22; 0.05 - 0.96), higher speed (OR 0.29; 0.09 - 0.97) and skiing skill (OR 0.35; 0.13 - 0.95). These was also seen in artificial and icy snow conditions (OR 0.25; 0.07 - 0.87) when compared to type-B fractures. CONCLUSION: The incidence of proximal tibia fractures related to skiing has increased over the past four years. Risk factors such as age, BMI, snow conditions, speed, and the skill of the skiers, were identified as causes contributing to complex fractures.

[Distal humerus fractures in children]. / Distale Humerusfrakturen beim Kind.

Fractures of the distal humerus belong to the most common injuries of the upper arm in childhood. Most frequently occurring is the supracondylar fracture of the distal humerus. In these cases and in the second most common epicondylar fractures, the metaphysis is affected and these fractures are therefore extra-articular. They have to be distinguished from articular fractures regarding therapy and prognosis. The growth potential of the distal epiphysis is very limited as is the possibility of spontaneous correction so that major dislocations should not be left uncorrected. Unstable and especially dislocated articular fractures must be anatomically reconstructed employing various osteosynthetic techniques, mostly combined with immobilization. Insufficient reconstruction, growth disturbance and non-union can result in axial deformities, such as cubitus valgus and varus, restriction of motion, pain and nerve palsy.

[Current therapy options for fractures of the femoral head]. / Aktuelle Therapieoptionen bei Hüftkopfluxationsfrakturen.

Fractures of the femoral head (Pipkin fractures) are relatively uncommon. In cases of immediate, gentle reposition and considerate soft tissue treatment during operative treatment, Pipkin 1 and 2fractures can heal with good long-term results. However, some long-term problems regularly occur. Conservative therapy is possible in cases of anatomic articulation or the presence of only very small fragments that do not compromise articulation after closed reduction. Differentiated indications for conservative treatment in Pipkin 1 and Pipkin 2 fractures can result in a better outcome than operative treatment. All other fractures should be treated operatively. The approach has to be adapted to fragment size and location. Small fragments in Pipkin 1 fractures can simply be removed, but larger fragments in Pipkin 1 and Pipkin 2 fractures should be fixed, preferably via an anterior approach. Pipkin 3 fractures generally require total hip arthroplasty. Pipkin 4 fractures have a relatively poor outcome. The strategy of treatment depends on the necessity of operative fixation of the acetabular fracture and the size of the femoral fragment. The anterior approach is preferred in cases of stable joint situations with only a small acetabular rim fragment, and in cases of instability the dorsal approach is preferred. Surgical luxation can be advantageous for the treatment of Pipkin 4 fractures.

[External fixator or bone pin osteosyntheses in unstable distal intra-articular radius fractures in elderly patients]. / Fixateur extern oder Spickdrahtosteosynthesen bei instabilen distalen intraartikulären Radiusfrakturen älterer Patienten.

Hyperdistraction with external fixation in the treatment of distal intraarticular fractures (Frykman types VII/VIII) in elderly patients results in a higher risk of secondary shortening and loss of the radius length with functional impairment. Using the modified K-wire technique of Kapandjii, a more sufficient restoration of articular congruency can be achieved. The overall score showed 87.5% excellent and good results in the Kapandjii group, compared to 76.5% in the external-fixation group.