[Reconstruction of soft tissue defects of the lower extremities]. / Rekonstruktion von Weichteildefekten an der unteren Extremität.

A reliable reconstruction of soft tissue defects of the lower extremities especially in the distal third of the leg is still a special challenge for reconstructive surgeons. The possibility of salvaging the leg has to be evaluated in the setting of an interdisciplinary team and the timing of the operation(s) with respect to the safety of the patient and a systematic approach with the selection of a suitable flap have to be defined. Traditionally local muscle flaps or free flaps have been established for coverage of defects of the lower extremities. Recently perforator-based flaps have gained popularity for reconstruction of lower extremity defects. Furthermore, new surgical techniques and developments in association with the demographic change have led to a paradigm shift.

[Pilonidal sinus: Secondary wound closure vs. Limberg flap : Cost and satisfaction analysis]. / Sinus pilonidalis: Sekundäre Wundheilung vs. Limberg-Lappenplastik : Eine Zufriedenheits- und Kostenanalyse.

BACKGROUND: After excision of a pilonidal sinus, several treatment options are possible, but no gold standard has been established. A literature review revealed no study comparing the costs and time off work after either secondary wound closure or treatment with a Limberg transposition flap. The aim of this study was to focus on these aspects by analysing the patients treated at the KlinikumStadtSoest. METHOD: Sixty patients with pilonidal sinus after excision were treated either by secondary wound closure or Limberg transposition flap at the KlinikumStadtSoest between 2011 and 2012. The authors analysed retrospectively the patients' demographics, cost, and satisfaction with both techniques and compared them. RESULTS: For secondary wound closure (group 1) 19 out of 31 patients and for Limberg transposition flap (group 2) 21 out of 29 met the inclusion criteria. Time off work following the final surgery (group 1: 69 day vs. group 2: 30 days, p = 0.046) and the number of dressing changes (group 1: 107 times vs. group 2: 16 times, p = 0.000) were significantly lower in the group of Limberg transposition flap (group 2) as well as the associated costs. The surgery-related costs were lower when treated by secondary wound closure. DISCUSSION: Plastic reconstruction with Limberg transposition flap (group 2) provides a chance to reduce the period of incapacity for work due to a shorter treatment period. With that said, patients should nonetheless be offered both techniques as the current literature does not reveal a clear benefit for either procedure.

[Sacral Skin Elasticity - Establishing a Non-Invasive Mechanical Method for Measurement]. / Sakrale Hautelastizität - Etablierung einer noninvasiven mechanischen Messmethode.

OBJECTIVE: Some patients with sacral scars, e. g. those developing after pilonidal sinus surgery, report discomfort when sitting or putting strain on the scars. In order to establish objective criteria for the assessment of this kind of discomfort and for the evaluation of scar quality after various types of surgical interventions, it is of interest to provide a method which enables physicians to assess skin quality in the sacral region. For this purpose, we developed a mechanical, non-invasive, fast and cost-neutral method for the measurement of skin distensibility and mobility. We examined a healthy sample of 100 study participants to establish benchmark values for scar-free skin in the sacral region and to identify the factors which impact skin quality, e. g. age, weight and sex. METHOD: With the participant in a standing position, 4 vertically arranged measurement points, which are exactly spaced in cranial to caudal direction by 10 mm-100 mm-10 mm, are marked in the lumbar and sacral region, respectively. The participant is then asked to bend forward and - with arms and legs fully stretched on both sides - to touch both their patellae with the balls of their hands so that the distance between the measurement points can be measured in this position as well. Then, with the participant standing upright again, another measurement is taken to establish the distance by which the lowest point can be manually moved in cranial direction. RESULTS: The sacral-lumbar skin distension quotient (lumbar skin distension / sacral skin distension×100), which can easily be calculated from the measurements, is independent of age and BMI and has a standard range of about 80-93%. Sacral skin mobility ranges from 11 to 18 mm, but is slightly negatively influenced by a high BMI. CONCLUSION: By comparing lumbar and sacral skin distension in the same study participant, we are able to obtain intraindividually valid findings about possible changes in skin and scar quality. Owing to the lack of known published data about sacral skin elasticity, the proposed measurement method, while restricted to a number of special cases, seems to be practicable and independent of the patient's general condition. Compared with devices that have been used for the measurement of elasticity in other skin areas, our procedure is generally available and cost-neutral.

[Comparison of Treatments for an Infected Pilonidal Sinus: Differences in Scar Quality and Outcome Between Secondary Wound Healing and Limberg Flap in a Prospective Study]. / Therapievergleich bei infiziertem Sinus pilonidalis - Unterschiede von Narbenqualität und Outcome nach Sekundärheilung oder Limberglappenplastik im Rahmen einer prospektiven Studie.

OBJECTIVE: There are various options for wound treatment after the excision of a pilonidal sinus. The aim of our study was to compare secondary healing to Limberg flap wound closure, with a focus on scar quality and patient complaints, rate of recurrence, period of absence from work as well as functional and aesthetic results one year after surgery. METHOD: 33 out of 55 patients who underwent pilonidal sinus excision in our department (KlinikumStadtSoest, Soest, Germany) between 2011 and 2012 were enrolled in the study. 16 of these 33 patients had chosen secondary wound healing and 17 were treated with a Limberg flap for defect coverage. First and foremost, we aimed to objectify scar quality and elasticity by measuring the parameters of skin distensibility and mobility. To this end, we used a self-developed method to ascertain the sacral lumbar skin distension quotient (SL quotient) as well as sacral skin mobility. 100 healthy volunteers served as a control group. Also we collected information about pain, time of absence from work and frequency of recurrence and asked patients about their satisfaction with the functional and aesthetic results. RESULTS: The results for the sacral lumbar skin distension quotient were significantly better after Limberg flap wound closure compared with secondary wound healing. As regards distensibility, there was a marked trend to more favourable values in the Limberg group. No differences in distensibility and mobility were observed between the Limberg group and the control group, whereas skin distensibility was significantly reduced (p=0.001) in secondary healing compared with the control group. Time off work was significantly longer in secondary healing (mean 63 days) than after Limberg flap (mean 29 days). No differences were identified regarding patient satisfaction, pain scores and frequency of recurrence. CONCLUSION: Wound closure via Limberg flap after the excision of an infected pilonidal sinus not only helps to reduce absence from work, but also produces a scar which is more distensible and movable compared with secondary healing. Patient satisfaction and pain scores were very good in both groups, with no differences observed by us. We are planning to collect more data with a bigger sample of patients and a longer follow-up period in future studies. For the time being, we will continue to provide both treatment methods to our patients.

[Pelvic reconstruction after tubular rectumresection (extended abdominoperineal resection combined with extended transpelvic myocutaneous M. rectus abdominis flap (extended VRAM) in low rectum cancer - case series)]. / Perineale Rekonstruktion nach zylindrischer Rektumexstirpation (Defektdeckung durch erweiterte, myokutane vertikale M. rectus abdominis Lappenplastik (extended VRAM) nach zylindrischer Rektumexstirpation beim tiefsitzenden Rektumkarzinom - Fallserie).

In advanced lower rectal cancer tubular abdomino-perineal resection (APR) in combination with simultaneous extended distally pedicled vertical rectus abdominis muscle flap (VRAM) facilitates a more radical tumor resection. Additionally a prolapse of small intestine into the pelvis can be blocked and a perineal defect coverage can be achieved. 4 patients have been treated with an interdisciplinary one stage combined tubular APR and extended VRAM. In all cases a R0 resection and a complete defect closure could be achieved.The extended VRAM is an appropriate technique to close the pelvic defect because it originates from a non irradiated area, has a monitor island, and the donor site does not handicap the patient as much as local flaps. This interdisciplinary approach facilitates a more radical tumor resection and thus reduces the risk of recurrence.

[Carpal tunnel syndrome in children with mucopolysaccharidosis type 1H: diagnosis and therapy in an interdisciplinary centre]. / Karpaltunnelsyndrom bei Kindern mit Mukopolysaccharidose Typ 1H. Diagnostik und Therapie im Rahmen eines interdisziplinären Zentrums.

Carpal tunnel syndrome is common in children with mucopolysaccharidosis type 1H (MPS type 1H). Clinical signs of carpal tunnel syndrome are frequently absent in these children and it is often very difficult to perform and interpret neurophysiological investigations. In this article we wish to present our experience and results regarding the diagnosis and postoperative results after decompression of the median nerve.In an interdisciplinary set-up we are currently treating 11 MPS type 1H children following blood stem cell transplantation. 7 patients were operated 12 times (5 bilateral operations) because of a carpal tunnel syndrome (age at the time of operation 83,3 months, (43-143 months), 2 male, 5 female). 6 patients had a follow up after 23,7 months (9-59 months). 6 patients had a histological analysis of the flexor retinaculum. Three patients had a postoperative neurophysiological investigation.Each of the operated patients had at least 1 preoperative clinical sign of a carpal tunnel syndrome. We found at least 1 pathological finding in motor and sensory nerve conduction studies in each patient. 6 of the 7 children operated on were symptom-free at postoperative follow-up. 1 of the 3 patients with a postoperative neurophysiological follow up showed a deterioration of the nerve conduction studies. This patient was free of symptoms postoperatively. Biopsy of the flexor retinaculum confirmed abundant proteoglycan deposition. We had neither postoperative complications nor were revisional operations necessary.The Diagnosis of a carpal tunnel syndrome in children with MPS Typ 1H needs a thorough medical history, the correct interpretation of the clinical symptoms and sophisticated nerve conduction studies. Wether the improvement of the postoperative clinical situation lasts has to be evaluated in a long term investigation especially because in one patient in our group we saw a deterioration of the nerve conduction studies postoperatively.

Postoperative insole-paedobarographic gait analysis for patients with flap coverages of weight-bearing and non-weight-bearing areas of the foot.

Functional results regarding shoe modifications, gait analysis and long-term durability of the reconstructed foot have not been reported using insole paedobarography. This article presents insole-paedobarographic gait analysis and discusses the various pressure distribution patterns following the reconstruction of the foot. This retrospective study reports on the clinical and functional results in 23 out of 39 patients who received flap coverage of their feet in our department in the period from 2001 to 2010. Mean follow-up time amounted to 46.6 months. Patients were separated into two groups, those with flap coverage to the sole of the foot (group 1) and those with flap coverage to non-weight-bearing areas of the foot (group 2). Gait analysis was accomplished by using insole paedobarography. The results of the gait analysis have shown that in both patient groups, when comparing affected feet with sound feet, the affected feet were exposed to significantly less support time (group 1; affected vs. sound feet: 0.44 ± 0.07 s vs. 0.55 ± 0.11 s, p = 0.047), (group 2; affected vs. sound feet: 0.47 ± 0.07 s vs. 0.54 ± 0.07 s, p = 0.029). In addition, in both patient groups, the analysis of peak-pressure distributions revealed greater pressures on the affected feet compared to the sound feet (group 1; affected vs. sound feet: 47.9 ± 10.13 N cm(-2) vs. 36.3 ± 7.5 N cm(-2), p = 0.008), (group 2; affected vs. sound feet: 38.08 ± 13.98 N cm(-2) vs. 32.92 ± 14.77 N cm(-2), p = 0.061). The insole paedobarography can contribute to a more precise gait analysis following a soft-tissue reconstruction not only of the sole but also of other foot regions as well. It can help to identify and correct movement sequences and peak-pressure distributions which are damaging to the flaps. The resulting potential minimisation of the ulceration rate can lead to a further optimisation in the rate of completely rehabilitated patients and a reduction in the revision rate.

[Certified breast centers in Germany : How much is plastic surgery involved?]. / Zertifizierte Brustzentren in Deutschland : Beteiligung der Plastischen Chirurgie.

INTRODUCTION: This study was designed to assess the degree of cooperation between plastic surgeons and gynecologists in certified breast centers in Germany. The rate of breast reconstruction after mastectomy remains low at 8-13%. In certified breast centers plastic surgeons are often not members of the team. METHODS: A total of 220 hospitals affiliated to the West German Breast Center (WBC) were contacted in 2007 and 80 breast centers and hospitals returned the questionnaire. This study is based on the data of approximately 24,000 patients. RESULTS: At the time of the investigation 60 out of the 80 hospitals (75%) were certified breast centers. Many different criteria have been applied for certified breast centers: the state of Nordrhein-Westfalen, the DKG/DGS (German Cancer Society/German Society of Senology), EUSOMA and others. In 8 hospitals (10%) a plastic surgeon was part of the team in the breast center. Most breast centers (44 out of 80) function with 3-4 attending specialists for breast surgery. DISCUSSION: The cooperation between gynecologists and plastic surgeons within a breast center can be strengthened. A microsurgical breast augmentation is not the ideal solution for every patient with a mastectomy but every patient has the right to obtain complete information about the whole spectrum of breast reconstruction including microsurgical free flap reconstruction.

Standardized combined cryotherapy and compression using Cryo/Cuff after wrist arthroscopy.

PURPOSE: cryotherapy and compression as integral part of the RICE regimen are thought to improve treatment outcome after sport injuries. Using standardized cryotherapy and compression perioperatively has been reported with conflicting clinical results. The impact of combined cryotherapy and compression is compared to standard care among patients undergoing wrist arthroscopy. METHODS: fifty-six patients undergoing wrist arthroscopy were assessed, 54 patients were randomized to either Cryo/Cuff (3 × 10 min twice daily) or standard care over 3 weeks. Follow-up clinical visits were at postoperative days 1, 8, and 21. One patient in each group was lost during follow-up. Fifty-two patients were analyzed. Statistics were performed as Intention-to-treat analysis. Outcome parameters were pain, three-dimensional volume of the wrist, range of motion, and DASH score. RESULTS: the Cryo/Cuffgroup had a 49% reduction in pain level (VAS 3.5 ± 0.4 vs. VAS 1.8 ± 0.2 on the 21st postoperative day) when compared to a reduction of 41% in the control group (VAS 5.1 ± 0.6 preoperatively vs. VAS 3.0 ± 0.5 on the 21st postoperative day). Swelling and range of motion were not as significantly different between the two groups as were DASH scores (DASH-score Cryo/Cuff group preoperatively 37.3 ± 3.5 and postoperatively 36.9 ± 3.5; DASH-score control group preoperatively 42.8 ± 4.3 and postoperatively 41.9 ± 4.9). The CONSORT score reached 17 out of 22. CONCLUSION: there was no significant effect of additional home-based combined cryotherapy and compression using the Cryo/Cuff wrist bandage, following wrist arthroscopy regarding pain, swelling, range of motion, and subjective impairment assessed using the DASH score over 3 weeks in comparison with the control group.

In vivo reflectance-mode confocal microscopy provides insights in human skin microcirculation and histomorphology.

PURPOSE: Various approaches are used to study microcirculation, however, no modality evaluates microcirculation and histomorphology on cellular levels. We hypothesized that reflectance-mode confocal microscopy (RCM) enables simultaneous evaluation in vivo of both microcirculation and histomorphology. PRINCIPALS: The forearm of 20 volunteers was exposed to either local heat stress (HS-group), or to local cold stress (CS-group). RCM was performed prior and after temperature stress to evaluate quantitative blood-cell flow, capillary loop diameter, granular cell size, and basal layer thickness. RESULTS: In the HS-group, we observed significant increase in capillary loop diameter and increased blood-cell flow after heat stress. In the CS-group, significant decreases of capillary loop diameter and in blood-cell flow were determined following cold stress. Granular cell size and basal layer thickness differed insignificantly prior and after local temperature stress. CONCLUSIONS: RCM provides real-time and in vivo high resolution imaging of temperature-dependent changes in the human skin microcirculation and histomorphology on cellular levels.

[Organ transplantation, composite tissue allotransplantation, and plastic surgery]. / Organtransplantation, Gewebetransplantation und plastische Chirurgie.

Transplantations play an increasing role for plastic reconstructive surgeons. The increasing number of solid organ transplantations and the improved long-term survival rates lead to increased numbers of these patients also undergoing plastic and reconstructive procedures. Free flap transfer in solid organ transplant patients is feasible with no higher risk to both transplant function and postoperative complications than for nontransplant patients, even during immune suppression. Composite tissue allotransplantation (CTA) is an evolving field in plastic reconstructive surgery with hands, arms, partial faces, abdominal walls, and knee joints being transferred in clinical settings. However only an interdisciplinary approach using all available resources in highly selected patients after exhausting all other plastic reconstructive procedures is able to achieve reasonable results. The potential complications of long-term immune suppression and patient compliance have to be balanced with the expected and achieved functional result of CTA, whose procedures must be discussed as a potential tissue or organ transplantation, given the legal and logistic implications. The interdisciplinary cooperation of transplant surgeons, microsurgeons, psychologists, and ergo- and physiotherapists is mandatory to achieve successful CTA results.

[Bases and methods of suturing]. / Grundlagen und Techniken der chirurgischen Naht.

If pharmaceutic modulation of scar formation does not improve the quality of the healing process over conventional healing, the surgeon must rely on personal skill and experience. Therefore a profound knowledge of wound healing based on experimental and clinical studies supplemented by postsurgical means of scar management and basic techniques of planning incisions, careful tissue handling, and thorough knowledge of suturing remain the most important ways to avoid abnormal scarring. This review summarizes the current experimental and clinical bases of surgical scar management.

[Diagnostic value of unspecific requested and implemented MRI for detecting intracarpal lesions, compared to arthroscopic findings at 217 patients]. / Wertigkeit unspezifisch angeforderter und durchgeführter MRT-Diagnostik bei intrakarpalen Verletzungen im Vergleich zum Arthroskopiebefund an 217 Patienten.

AIM: The purpose of this study was to evaluate the diagnostic value of MRI for detecting intracarpal lesions in clinical routine. PATIENTS AND MATERIALS: In a retrospective study, we reviewed the charts of 506 patients who had undergone wrist arthroscopy in our department between May 1998 and November 2002. Out of 506 patients 217 had an MRI. The MRI was performed at 31 different radiology facilities using a number of techniques. The MRI results were compared with the arthroscopic findings, taking the arthroscopic results as a "gold standard" (sensitivity = SEN, specificity = SPE, positive predictive value = PPV, negative predictive value = NPV, accuracy = ACC). RESULTS: The following results were found: For tears of the scapholunate ligament the avalues are SEN 18.5 %, SPE 95 %, PPV 71 %, NPV 66 %, ACC66 %. Not one of 16 tears of the lunotriquetral ligament was found by MRI. CONCLUSION: In our data we found a low sensitivity for unspecific requested and implemented MRI for detecting intracarpal lesions. Therefore the indication for MRI should only be made after experienced hand surgeons have examined the wrist. In our opinion, only direct MR-arthrography is equal to arthroscopy, so that only an experienced radiologist who is familiar with this technique should perform the MRI diagnostics of the hand.

[A flap simulator for training in local defect coverage]. / Lappensimulator für lokale Defektdeckungen: Flap Lab I der MHH.

The Hannover Medical School (Germany) developed the"Flap Lab I" flap simulator, a practical improvement to surgeon training. It provides realistic conditions for understanding and following the principles for planning and performing local flaps for coverage of skin defects. The Flap Lab I has proved to be a very good training model in several training courses. This article introduces among others the Z-flap, reverse Z-flap (so-called hanging man), and Limberg flap.

[Breast reconstruction for patients with breast carcinoma : an analysis based on the data of 4,335 patients from 16 hospitals]. / Brustrekonstruktionen bei Patientinnen mit Mammakarzinom : Eine Analyse anhand der Daten von 4335 Patientinnen aus 16 Kliniken.

BACKGROUND: [corrected] The rate of breast reconstructions after mastectomy because of breast carcinoma has not been thoroughly studied, based on a representatively large data pool. METHODS: We analyzed the data of 4,335 patients with breast carcinoma from 16 hospitals together with the German Breast Center (Westdeutsches Brustcentrum). RESULTS: Of the studied patients, 34% (1,488 of 4,335) had mastectomies. Breast reconstruction was performed in 13% (197) of those with mastectomy. None of the 197 with breast reconstruction was operated on by a plastic surgeon or had a microsurgical reconstructive procedure (free flap). CONCLUSION: The aim of this study is to increase the number of breast reconstructions after mastectomy, including microsurgical procedures, and to improve cooperation between gynecologists and plastic surgeons.

[Neurovascular flaps for the reconstruction of fingertip injuries]. / Neurovaskuläre Lappen zur Rekonstruktion von Fingerendglieddefekten.

The fingertip is an extremely specialized end organ with a highly developed sense of touch. In this article, we present the different ways of reconstructing a traumatized fingertip. Additionally, we systematically explain the differential indications for the different techniques available. The whole spectrum of fingertip reconstruction is discussed, starting from local neurovascular flaps (palmar VY-Atasoy flap, Kutler flap, palmar Moberg flap, lateral Venkataswami and Subramanian flap, palmar Hueston flap), distant flaps (Littler flap, Foucher flap, dorsal metacarpal artery flap, cross-finger flap, reversed cross-finger flap) and finally free flap transfer (free toe-pulp transfer, spare-part transplantation). The advantages and disadvantages of each flap are highlighted. We develop an algorithm to facilitate finding the correct type of reconstruction.

[Lymphadenectomy of the inguinal region and pelvis]. / Lymphadenektomie der Leisten- und Beckenregion.

The draining lymph nodes of extra-abdominal tumors and malignant lesions of the lower extremity are located in the groin and iliac region. Malignancies with lymphatic drainage into this region include tumors of the anorectum, penis and vulva, skin (melanoma, squamous cell carcinoma), and soft tissue sarcomas. Current clinical research in biology, routes of lymphatic spread, and the possibility of marking the sentinel lymph node has directed lymphadenectomy strategy toward differential procedures, depending on the type of underlying malignancy. The spectrum of lymphadenectomy includes diagnostic lymph node removal of clinically enlarged nodes, removal of the sentinel node, and radical lymphadenectomy. Lymphadenectomy can also be indicated as a palliative procedure. The indications also depend on the type of tumor, previous treatment, and disease prognosis. This review presents the current state of indications and surgical techniques of inguinal and iliacal lymphadenectomy.

[Dorsal capsulodesis versus triscaphe arthrodesis in patients with scapholunate dissociation. Do the results depend on the diagnosis or the operation?]. / Differenzialindikation der dorsalen Kapsulodese und der STT-Arthrodese bei Patienten mit einer skapholunären Dissoziation. Ist das Ergebnis abhängig von der Diagnose oder dem Operationsverfahren?

BACKGROUND: Dorsal capsulodesis and triscaphe arthrodesis are possible treatment modalities for patients with scapholunate dissociation. In light of overlapping indications for either operation for patients with carpal instability, it is important to compare the postoperative results. METHODS: From 1998 until 2002, we operated on 87 patients suffering from scapholunate dissociation. 52 patients were treated by dorsal capsulodesis after R. Berger and 35 patients were treated by triscaphe arthrodesis as published by Watson. Of these 87 patients, we managed to follow-up 77 patients (47 dorsal capsulodesis und 30 triscaphe arthrodesis) with a physical examination, X-ray of the wrists and Krimmer Score. RESULTS: In terms of grip-strength, range of motion, functional outcome (Krimmer Score), duration of the operation and hospitalisation, the dorsal capsulodesis group performed better (p < 0.05) than the triscaphe arthrodesis group at the time of follow-up. At follow-up, pain reduction was significant in both groups (p < 0.05). Krimmer Score (functional outcome) and the rate of complication was clearly better for the dorsal capsulodesis group as compared to the triscaphe arthrodesis group. CONCLUSION: In case of non-static scapholunate dissociation, dorsal capsulodesis should be the first choice treatment. In case of a young manually working man with static scapholunate dissociation, it should be a case-to-case decision whether performing a triscaphe arthrodesis or a dorsal capsulodesis. With this investigation we wanted to discuss and demonstrate the difficulties with the differential-indication for the two operations. Generally speaking the postoperative results did not depend on the type of scapholunate dissociation (dynamic versus static) but rather on the chosen surgical procedure.

[Differential therapy of radial head fracture: a critical analysis based on outcome of 53 patients]. / Die Differenzialtherapie der Radiusköpfchenfraktur: Eine kritische Analyse anhand der Ergebnisse von 53 Patienten.

We investigated 53 patients with 57 radial head fractures (4 patients with bilateral fractures) treated between 1993 and 1998. We focused on patients with radial head fractures asking about (1) the relation between fracture type and therapy and (2) the correlation between chosen treatment and result. We saw the following fractures: Mason I: 3 cases, Mason II: 26 cases, Mason III: 11 cases, and Mason IV: 15 cases. Good results were achieved by 30 patients with 31 fractures, fair results by 8 patients with 9 fractures, and poor results by 13 patients with 14 fractures. Patients with a Mason I fracture achieved good results with functional therapy. Of the 26 Mason II fractures, 14 were treated with screws, 14% of whom had poor results subjectively. Six patients were treated with a K wire, titanium nail, or prevot nail, none of whom had poor results. Of 11 patients with a Mason III fracture, 10 were treated by resection of the radial head, and in 1 patient we implanted a prosthesis due to an intraoperatively detected elbow instability after resection and achieved good postoperative results. Only one patient (9%) had poor long-term results subjectively. Of 15 patients with a Mason IV fracture, 11 were treated by resection of the radial head: 5 patients (33%) had poor long-term results, only 3 of whom (20%) subjectively considered the results poor.