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Background: Periprosthetic fractures are increasing in frequency. Classification: A treatment-oriented classification is the Vancouver classification. Therapy: Type A fractures will usually be treated conservatively, type C fractures are treated in the same way as shaft fractures, type B1 fractures are the domain of plate fixation and type B2 and B3 fractures require an exchange of the prosthesis possibly with bone augmentation. [ABSTRACT FROM AUTHOR]

Hintergrund: Instabilitäten am Schultereckgelenk und Frakturen der lateralen Klavikula gehören zu den häufigsten Traumafolgen am Schultergürtel. Eine Vielzahl an Operationsverfahren ist für diese beiden Pathologien beschrieben, und viele Innovationen wurden kürzlich eingeführt. Dieser Beitrag soll einen Überblick über den aktuellen Kenntnisstand sowie Hilfestellungen für den chirurgischen Alltag geben.Methoden: Bei beiden Pathologien finden die minimalinvasiven arthroskopisch assistierten Verfahren zunehmend Anwendung. Gegenüber den konventionell-offenen Verfahren bestehen diverse Vorteile: geringe Zugangsmorbidität, Möglichkeit zur Detektion und Therapie von häufigen Begleitpathologien sowie ein einzeitiges Vorgehen ohne notwendige Implantatentfernung.Ergebnisse: Bei der Schultereckgelenkinstabilität liegen sehr gute mittelfristige Ergebnisse für die arthroskopischen Doppelbuttontechniken vor. Bei der Frakturversorgung muss je nach Frakturtyp individuell das richtige Verfahren ausgewählt werden. Das Hybridverfahren aus Plattenosteosynthese und korakoklavikulärer Augmentation ist die stabilste Technik. [ABSTRACT FROM AUTHOR]

Background: Fractures of the humeral shaft occur with an incidence of 2-4% among all fractures in humans. With both non-operative treatment and surgical treatment, such as open reduction, internal fixation or intramedullary osteosynthesis, good results can be achieved; however, a gold standard has not yet been identified in the literature or in practice. Objective: The purpose of this article is to summarize the available evidence and to propose an algorithm for the treatment of humeral shaft fractures. Material and methods: Included were a selective literature search in the Medline database and the clinical experience of the authors. Conclusion: Surgical treatment options for humeral shaft fractures with proven high success rates are open reduction with subsequent plate osteosynthesis and intramedullary nail osteosynthesis. Despite a great deal of research on minimally invasive surgical options and optimized design of implants, non-operative treatment is still an option for treatment of fractures of the upper arm. [ABSTRACT FROM AUTHOR]

Forearm fractures are common bony injuries in adults. Simple diaphyseal fractures of both radius and ulna must be distinguished from complex Galeazzi, Monteggia and Essex-Lopresti injuries. After radiological diagnosis, operative treatment is usually required. The forearm forms a functional joint; therefore, anatomical reconstruction must be carefully carried paying particular attention to the rotational and longitudinal axes. Reduction is conducted with a 3.5 mm limited-contact dynamic compression plate (LCDCP) using 2 separate approaches for both bones with at least 3 bicortical screws at each fracture site. Interfragmentary traction screws are used if necessary and early postoperative functional mobilization is desirable. Plate removal is indicated if the implant causes discomfort. [ABSTRACT FROM AUTHOR]

In the routine clinical practice surgeons are rarely confronted with the operative correction of pediatric distal forearm fractures that have healed in malalignment. The reason for this is certainly the capability for spontaneous correction of the growth plate at the distal radius. In this way even gross misalignment can be tolerated depending on the age and can be left to spontaneous correction. In individual cases, however, the spontaneous correction also reaches its limits. In most cases, this affects children beyond the age of 10 years who no longer have sufficient corrective capabilities. A second group of children are children with posttraumatic distal radial growth arrest. If there are indications for operative correction, there are basically three methods to choose from. In the case of axis misalignment alone, osteotomy and palmar plate osteosynthesis are performed. In the case of axis misalignment with a loss in length, the interposition of a bone graft should be performed in addition to osteotomy and plate osteosynthesis. If displacement has occurred due to posttraumatic distal radial growth arrest, osteotomy should be combined with callus distraction. [ABSTRACT FROM AUTHOR]

Anterior fusion is the gold standard procedure for unstable traumatic spinal injuries because most injuries can be managed with this atraumatic approach, which also allows good correction of kyphosis. To prevent functional deficits and degeneration of the adjacent segments, the length of fusion should be as short as possible. In recent years, a trend towards anterior fusion with cages in combination with bone substitutes can be recognized. In contrast, fusion performed with a tricortical iliac bone graft is performed less frequently because relevant donor site morbidity has to be taken into account. Additional anterior plate fixation is mandatory in cases of anterior stabilization for traumatic instability of the cervical spine. Besides anterior fusion, restoration of the sagittal profile seems to be important for the outcome following traumatic cervical spine injuries. This is due to the fact that persisting cervical kyphosis has a negative impact on the long-term results after cervical spine stabilization. [ABSTRACT FROM AUTHOR]

Fractures of the distal radius are the most common fracture types. Preclinically, immobilization is essential. Typical collateral injuries are injuries of the processus styloides ulnae, the triangular fibrocartilage complex, scapholunate lesions or carpal fractures. At the emergency department, the primary goal is diagnosis, reduction and immobilization with a dorsoradial splint. In addition to normal x-ray, computed tomography, nuclear magnetic resonance imaging, and arthroscopy are important for the diagnosis of complex fractures and collateral wrist injuries. If the fracture is stable without displacement, conservative therapy with x-ray control at specific intervals is possible. In case of primary instability or secondary displacement, surgery is indicated and, depending on the morphology, may include osteosynthesis using k-wires, plates, screws or external fixator. Although surgery results in anatomical repositioning, there is no evidence for a better clinical outcome. However, rehabilitation is able to optimize the outcome if there is good communication between the physician and physical therapist. Rehabilitation includes early physiotherapy, massages and lymph drainage. In case of complex problems, inpatient rehabilitation treatment may be indicated. [ABSTRACT FROM AUTHOR]

Shaft fractures of the humerus are considered to be benign fractures and are still treated conservatively even today. Indications for operative procedures are open fractures, closed fracture types with severe soft tissue damage or complicated fractures which compromise muscles, blood vessels or nerves. Further indications for operative treatment are patients with multiple injuries including humeral shaft fractures. The standard techniques for stabilization of shaft fractures of the humerus are closed reduction with antegrade or retrograde nailing and open reduction and stabilization with locking or non-locking plates. The reasons for revision after operative treatment are radial nerve palsy and the development of pseudarthrosis. In 90 % of cases primary palsy of the radial nerve undergoes spontaneous remission without further operative treatment but secondary palsy of the radial nerve following surgery should be promptly treated. After conservative treatment pseudarthrosis occurs in 2-8 % and after operative treatment in 6-15 % of the cases. After open surgical resection of the pseudarthrosis and changing the type of osteosynthesis, stabilization should be completed with cancellous bone transplantation. Distal humeral fractures, often comminuted or complex fracture types, must be fixed by anatomical reconstruction and stabilization with 90° or 180° locking compression plates to stabilize the ulnar and radial axis of the elbow. The necessity of postoperative physiotherapy for the patient requires high stability of the osteosynthesis used. Even with the best radiological and anatomical results movement restrictions often remain after surgical treatment of the distal humerus; therefore, it should be borne in mind that a total elbow replacement is a primary option particularly for geriatric patients. [ABSTRACT FROM AUTHOR]

Background: Periprosthetic fractures are increasing in frequency. Classification: A treatment-oriented classification is the Vancouver classification. Therapy: Type A fractures will usually be treated conservatively, type C fractures are treated in the same way as shaft fractures, type B1 fractures are the domain of plate fixation and type B2 and B3 fractures require an exchange of the prosthesis possibly with bone augmentation. [ABSTRACT FROM AUTHOR]

Reasons for failure of plate osteosynthesis: Not uncommonly, the management of plate fixation failure can pose a challenge for the surgeon. Therefore it is first necessary to recognize the underlying reason and to address it in the context of a correct therapy strategy. Peri-implant fractures at the end of the plate, screw breakage or loosening as well as plate breakage at the site of the initial fracture line can lead to failure of the plate fixation construct. Commonly, a secondary fracture at the end of the plate is caused by an adequate force impact in mostly younger male patients in an employable age. On the other hand, in geriatric patients brittle fractures due to a low impact in inadequate accidents are seen at an increasing rate resulting from a generalized fragility of osteoporotic bone. However, in most cases the mechanical failure of plate osteosynthesis is the result of plate breakage or screw loosening based on a delayed bone fracture union. Therapy: Numerous options for internal fixation are available to readdress the instability, ranging from additional plating through intramedullary nailing to conversion to endoprosthetic arthroplasty at an appropriate fracture location near a joint. The choice of treatment should depend on the type of plate failure as well as the individual bone quality. In cases of delayed fracture union, the surgical treatment should imperatively focus on measures to support fracture healing. [ABSTRACT FROM AUTHOR]

Nonoperative treatment, e.g. with a sling or a figure-of-eight bandage, has so far been considered to be the gold standard for midshaft clavicle fractures even when substantial displacement has been present. However, more recent studies have shown poorer results following nonoperative treatment of dislocated clavicle fractures compared with operative treatment. The main reasons are a higher nonunion and shortening rate of displaced midshaft fractures, which often result in poor functional outcome and low patient satisfaction. Operative methods, e.g. locking plates or intramedullary fixation technique have proven to have much better outcome in the treatment of midshaft clavicle fractures with displacement and comminution than conservative methods. Adults with a displaced midshaft fracture have for example a nonunion rate of up to 15% after conservative therapy whereas it is 2-3% after operative treatment. The traditional view that clavicular midshaft fractures no matter what grade of dislocation and what type of fracture should be treated conservatively is no longer valid today. Instead possible complications and risks of the conservative and operative treatment always have to be taken into account and weighed individually for therapy decision-making in the clinical routine. The analysis of current studies shows that patients with dislocated comminuted fractures benefit from surgery. [ABSTRACT FROM AUTHOR]

Copyright of Trauma und Berufskrankheit is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Trauma und Berufskrankheit is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Trauma und Berufskrankheit is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)