Der Unfallchirurg
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Comment Letter
[Gunshot and stabbing injuries : Look beyond the horizon].
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Osteochondral fractures are traumatic shearing injuries to the cartilage and the subchondral bone which lead to defects in the articular surface and potentially lead to further degeneration and arthritis. Early diagnosis and therapy are therefore very important. As the resolving power of conventional X-rays is limited for this situation, magnetic resonance imaging (MRI) is regarded as the gold standard for diagnostics. ⋯ Concerning treatment options for osteochondral fractures, there are two potential strategies that can be applied: the first is removal of small osteochondral fragments with subsequent formation of regeneration tissue and the second is refixation of the dislocated fragment and therefore a 1-stage reconstruction of the joint surface. It is important to also address concomitant injuries. Even though there is no consensus for a standardized or evidence-based therapy in literature, this article gives an overview of the diagnostics and available therapeutic options.
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According to the future demographic trends the incidence of proximal humeral fractures and subsequent posttraumatic malunions and nonunions of the proximal humerus are expected to substantially increase. ⋯ A variety of corrective surgical strategies are available, which are indicated depending on the location and extent of the malunion. The depicted single-cut osteotomy technique represents an elegant therapeutic option for multidimensional deformities of the proximal humerus. Nonunions of the proximal humerus can usually be successfully managed with autologous cancellous bone grafting and locking plate osteosynthesis.
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Arthroplasty of symptomatic sequelae after fractures of the proximal humerus is a demanding procedure for surgeons. Exact preoperative planning is crucial in order to achieve acceptable functional results. ⋯ Each case needs a thorough and individualized preoperative assessment along with exact planning and should therefore be reserved for experienced shoulder surgeons only.