[Should an osseous rupture of the ulnar styloid in radius fractures be repaired?]. / Soll ein knöcherner Ausriss des Ellengriffelfortsatzes bei Speichenbrüchen refixiert werden?

Fracture-dislocation of the ulnar styloid is an important factor of instability relating to fractures of the distal end of the radius. Refixation of the dislocated ulnar styloid can be desirable in order to improve stability of the radius fracture after reduction.

[Recurrent fracture of the pediatric forearm]. / Die Refraktur des kindlichen Unterarms.

In a retrospective multicenter study 28 relapse fractures of the forearm in children were reviewed. The male to female ratio was 23:5. Six children were younger than 6 years, 12 were between 6 and 10 years, and 10 were between 10 and 14 years old. The primary fracture was treated by cast fixation of 3-7 weeks duration. The refracture occurred on a average 14 weeks (4-32 weeks) after the primary fracture by a simple fall (n = 14) or a fall from height (n = 4), or during school (n = 6) or leisure-time (n = 3) sporting activities. In 84% of the patients partial consolidation, i.e. incomplete healing of one cortex of one or both forearm bones, preceded the refracture. In the majority of patients this was observed after a green stick fracture due to permanent angulation. Six patients were operated upon for irreducibility of the relapse fracture; the others were treated by conservative means. In two patients a second refracture occurred. Fifteen patients were available for a 2 year result. Definitive angulation of more than 10 degrees caused a clinically relevant limitation of pro-supination in five of six patients. To prevent relapse fractures of the forearm in children, complete circular consolidation of the original fracture has to be guaranteed. It remains unclear whether this is best achieved by special plaster techniques or by converting a greenstick fracture into a complete, unstable fracture.

[Osteosynthesis of ulna pseudarthrosis after Monteggia equivalents]. / Zur Osteosynthese der Ellenpseudarthrose nach Monteggia-Aquivalenten.

Stable internal fixation of the ulna is often followed by nonunion if the radial head has been resected in primary treatment of monteggia equivalents. Many patients have to undergo several operations before solid union is achieved. The reason for these disappointing results is the complex instability caused by the absence of the radial head. Our experience led us to use combined osteosynthesis with both an intramedullary compressive screw and a lateral plate. Even secondary replacement of the radial head by a spacer seems to be beneficial in the avoidance of fatigue fractures which might otherwise be caused by screw tracks. Secondary resection of the radial head practically always leads to synostosis. The results of primary treatment of monteggia fracture by the form of osteosynthesis described have proved successfully.

[Joint bridging external fixation of fractures of the distal lower leg with severe skin damage]. / Gelenkübergreifende äussere Fixation bei Frakturen am distalen Unterschenkelende mit schweren Hautschäden.

During the 36 months from April 1989 until April 1992, 34 fractures of the lower end of the leg were treated by joint bridging application of external fixation using the so-called ".. Kugelspannfixateur UNIFIX". They were: 24 intraarticular compression fractures, seven bimalleolar dislocation fractures, two shot fractures and one postoperative empyema. All demanded treatment urgently. Because of severe skin lesions or because of medical reasons, neither osteosynthesis nur conventional conservative methods could be used. With the aid of UNIFIX, good alignment was achieved in all cases and practically always maintained as long as necessary. Reduction of joint-bearing fragments was equally good as with ligamentotaxis. All skin lesions healed during the time of fixation. Only two infections of screw tracks were observed. Additional operations like primary minimal osteosynthesis or later reconstructive surgery could be carried out with the fixateur in place. They have improved the results. No severe damage to the subtalar joint was observed. Therefore this principle of treatment can be recommended providing right indication.

[Osteosynthesis of the distal tibia and simultaneous arthrodesis of the upper ankle joint with a 130 degree angled plate]. / Osteosynthese am distalen Schienbeinende und gleichzeitige Arthrodes des oberen Sprunggelenkes mit der 130 degrees-Winkelplatte.

In two patients nonunions of the distal tibia together with a destroyed ankle joint were stabilized by means of a 130 degrees angled plate. The blade was inserted through the astragulus and subtalar joint into the tuber of the calcaneus. The results were good.

[Effects of flexed position of the wrist joint after flexor tendon sutures on the median nerve]. / Auswirkung der Beugestellung des Handgelenkes nach Beugesehnennähten auf den Nervus medianus.

Twelve patients with dynamically treated ruptures of finger flexor tendons the median nerve was electroneurologically examined at an average of 16 months after operation. The parameters were abnormal in about one third to three quarters of the patients. In accordance with literature the reason for this is seen in pronounced flexion position of the wrist during treatment according to Kleinert.

[Heart arrest as a sequela of clavicular fracture]. / Herzstillstand als Folge einer Schlüsselbeinfraktur.

After a fracture of the medial part of the clavicle cardiac arrest occurred. This complication can be explained by vagus irritation because of fracture haematoma. The patient survived and was, six months later, of best health.

[Intramedullary nailing of unstable proximal humeral fractures]. / Die Markdrahtung unstabiler proximaler Humerusfrakturen.

Unstable subcapital fractures and dislocation fractures of the humerus can usually be set by closed reduction. Stabilization of these fractures by intramedullary pins is a method which avoids damage to the soft tissues around the shoulder. Since 1985, elastic steel pins with special features have been in use. The last 20 mm of the tip of the pins is angulated at 15 degrees, and the distal end is curved in a special way for the last 20 mm. According to our experience, the results after using this method in the treatment of unstable fractures of the surgical neck (ASIF type A II/2) and dislocation fractures (ASIF type A III/2) are fair to very good. For unstable fractures (ASIF type C I/2) and other dislocation fractures (ASIF type C III/2), the method is only suitable if good reduction is possible. Between the end of February 1985 and the end of December 1990, 101 fractures of the proximal end of the humerus were treated by closed reduction and fixation with intramedullary pins. Following fractures in the anatomical neck, aseptic necrosis of the fragment of the head leads to unfavorable results. In two patients, pseudarthrosis with poor function developed. Disturbance of wound healing, postoperative hematoma, infection, myositis ossificans, or Sudeck's desease have not been observed.

[Complications in surgical management of pelvic fractures]. / Komplikationen der operativen Versorgung von Beckenfrakturen.

In the care of pelvic injuries complications arise because of organizational and technical factors, some of which are described here. The following measures are important: autotransfusion, emptying the bladder and catheterization, checking and protection of the colon, correct management of the operation table, and prophylactic measures to avoid thrombosis. From an operational/technical point of view, it is most important that a larger with good exposure route be chosen that takes the anatomical structures into account. Of 123 cases, 20% were not ideally reduced. Twice massive bleeding occurred from the A. glutea superior, once the sacral dura was opened without any adverse effects, infection occurred 8 times and 10 times peroneal paralysis was observed.

Plating of fresh clavicular fractures: results of 122 operations.

A total of 131 fractures of the clavicle were operated on in 129 patients. There was no bony infection or infected pseudarthrosis. Four clavicles refractured after removal of the plate and five operations led to pseudarthroses which were successfully treated by reoperation. Radiological and clinical results in the majority of the re-examined patients were excellent. Indications, operative technique and causes of poor results are described.

[Simultaneous dislocation-fracture of both ends of the clavicle]. / Simultane Luxationsfraktur beider Schlüsselbeinenden.

A case of simultaneous dislocation-fracture of both ends of the right clavicle in a 17-year old patient is being described. Treatment consisted in operative reduction of both injuries. The sterno-clavicular joint was stabilized by a transarticular K-wire, the acromioclavicular injury was treated by extraarticular tension-band-wiring. Healing was without complications and the result 37 months after injury was excellent.

[Intramedullary nailing of unstable forearm shaft fractures in children]. / Markdrahtung instabiler Unterarmschaftbrüche bei Kindern.

Forearm diaphyseal fractures in children are commonly treated by conservative management. In about 5% of cases, however, unstable fractures occur and require surgical intervention. We prefer the intramedullary pinning procedure, which has already been published in a similar version in 1913 by Schöne and in 1947 by Bsteh. 41 patients were followed up between 1979 and 1988. One instance with a severe infection of a second-degree open fracture required two reoperations and was completely restored with a very good result. An overall assessment of our collective yielded 31 patients with findings rated as very good, four patients rated as good, five as satisfactory and one as moderate.

[Unstable fractures of the lateral end of the clavicle and principles of their treatment]. / Unstabile Bruchformen am äusseren Schlüsselbeinende und Grundsätze der Behandlung.

25 fractures of the lateral end of the clavicle were treated during the last six years. 22 of them were unstable because of additional rupture of the coracoclavicular ligaments. Only in two patients conservative treatment was successful, in six cases conservative treatment was unsuccessful. Altogether 20 fractures had to be operated. Coracoclavicular screw fixation (Bosworth) is recommended for simple fractures and plating for multifragmental injuries. Operative methods using K-wires are frequently impaired by wire-migration and therefore require a longer period of external immobilization. Independent of the type of surgery objective and subjective results were equally good.

Flexible intramedullary pins in the treatment of unstable proximal humeral fractures.

A series of 35 proximal humeral fractures treated with flexible intramedullary pins between 1986 and 1988 are presented. Special design features of the pins include a proximal 15 degrees angulated 20 mm tip and a 20 mm curve distally. The method is suitable for fractures in the surgical neck with displacement of bone width (AO-type A2/2). In cases of fracture-dislocation or three- or four-part fractures it is only suitable when the fragments can be reduced satisfactorily. Complications are minimal with 95 per cent bone union.

[Experiences with the treatment of Monteggia-type fractures in adults]. / Erfahrungen mit der Behandlung von Monteggia-Aquivalenten bei Erwachsenen.

Early results obtained in 23 Monteggia-type fractures were analysed. Osteosynthesis of the fracture of the ulnar shaft has to be carried out according to the art. Application of a plate on the radial or the ulnar side always leads to secondary angulation. If primary resection of the radial head is carried out poor results must be expected. The fractured radial head should be reconstructed, replaced by an implant, or at least left in place until the fracture of the ulna is consolidated. In Monteggia type-I/6 fractures the coronoid process must be reliably stabilized. Conservative treatment is inadequate for Monteggia-type fractures.