Der Unfallchirurg
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Radial head fractures are the most frequent fractures of the elbow joint in adults. For Mason type II fractures without concomitant injuries favorable results have been shown with operative and conservative management. There is insufficient evidence concerning elbow joint stability after conservative treatment compared to open reduction and internal fixation (ORIF). ⋯ Both conservative management and operative treatment had a good functional outcome. Operative treatment showed a positive tendency concerning radiological and functional outcome without statistical significance.
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Approximately 7-10% of all emergency department patients are diagnosed with distortion of the upper ankle joint. A dislocation of the upper ankle joint without fracture is described in the literature as being very rare. ⋯ We report the course, treatment and results 12 months after trauma of a posteromedial first-degree open dislocation of the upper ankle joint without fracture. To our knowledge, there is no record of this pathology mentioned in the German language literature.
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Special and specialized instruments help perform reduction more effectively and in a tissue-preserving manner. In addition to other articles, the application and advantages of the following instruments are presented: colinear reduction forceps, cerclage, cerclage passer, distal radius reduction clamp, modular external fixator, extension table, distraction frame, joystick, manipulators, distractor and assistance of reduction with elastic nails.
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The technique of fracture treatment by minimally invasive plate osteosynthesis (MIPO) is today part of the treatment repertoire of any experienced trauma surgeon. The minimization of any additional iatrogenic damage to the tissues and the preservation of the osteogenic fracture hematoma are the decisive differences to open reduction and internal fixation (ORIF). The MIPO technique is particularly applied in metaphyseal and diaphyseal fractures, which cannot be treated with intramedullary nails as well as in fractures with critical soft tissue covering and complex fractures with metaphyseal extension fractures. ⋯ The minimally invasive approach by the trauma surgeon in MIPO fracture treatment is mainly defined by the selected gentle reduction technique. Because the fracture zone cannot be directly viewed, good knowledge of the anatomy and careful surgical planning including reduction on an adequate image basis are of decisive importance. This article introduces the principles of the reduction techniques in minimally invasive plate osteosynthesis and their practical application is described in detail.