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Background: Traumatic hip dislocation combined with fracture of the femoral head is a rare condition for which little known in terms of long-term prognosis. The aim of the retrospective study presented here was to evaluate the clinical and radiological outcome of this specific injury., Patients and Methods: In a 23 year period, 18 patients (17 male) with an average age of 25.6 (range 15-55 years) were treated. There were four type-I, three type-II, no type-III, and 11 type-IV fractures according to the Pipkin classification (1957)., Results: The average time to sufficient reduction was 136 min (60-420 min), two by open means. A total of 16 patients were operated for open reduction and internal fragment fixation, 13 through a dorsal approach. All patients filled out a standardized questionnaire, and clinical and radiological examinations were also carried out on average 12.6 years (range 59-247 months) after injury. Four scoring systems were used to classify the outcome: Thompson and Epstein (1951): very good = 1, good = 10, fair = 4, poor = 3; Merle D'Aubigne (1954): very good = 9, good = 5, fair = 0, poor = 4; Harris (1969): Pipkin I = 81 points, Pipkin II = 97 points, Pipkin IV = 73 points (mean); Brooker (1973): grade I = 5, grade II = 1, grade IV = 2., Conclusion: Quality of life was not reduced in most patients in the long term, however three of four patients suffering Pipkin type-IV fractures developed functional restrictions with poor results. We conclude that acute reduction of the dislocated joint and anatomical reconstruction of the femoral head instead of primary hip replacement may end in good to excellent results in type-I and type-II fractures. Due to the young age of these patients, joint reconstruction should always be the first choice even in type-IV fractures with a higher probability of poor prognosis.

Aim: Intramedullary nailing is the treatment of choice for the stabilization of fractures of long tubular bones. An important disadvantage of this method is the increase in intramedullary pressure and the resulting release of fat into the venous blood system during reaming of the medullary canal. We have developed a new type of rinsing-suction-reamer (SSB) in order to minimize these disadvantages. Trials were initiated to investigate whether it is possible to ream the medullary canal with the SSB without pressure increase in comparison with the standard AO-reamer (AOB)., Methods: Reamed intramedullary nailing was performed in 20 isolated pig femora. The intramedullary pressure was recorded continuously., Results: While stepwise reaming was performed, the pressure only rose above the physiological level in AOB. During insertion of the guide wire and the nail, comparable values were measured for AOB and SSB., Conclusion: Our experiments show that reaming of the medullary canal is possible without a pressure increase using the SSB in comparison with AOB.

From 1990 to 1997, callus distraction of the first metacarpal bone was performed on 34 patients with a traumatic amputation of the thumb, if replantation was not possible. After a period of 7 +/- 11 months (range, 1-48), a corticotomy and continuous distraction with an external fixator was carried out. Of the patients, 31 (91%) were reviewed after treatment. The follow-up period range was 41 +/- 32 months. With this method, the average lengthening of the thumb was 78% in comparison to the uninjured side. Complications were rupture of the callus in one case, four patients suffered a superficial wound infection, and seven patients showed pin tract infection without osteitis. At follow-up examination, 20 patients (64.5%) showed excellent, 9 (29%) good and 2 patients (6.5%) unsatisfying results.

The Essex-Lopresti lesion, a combination of radial head fracture and distal radioulnar dislocation, rarely occurs but nevertheless represents a frequently unknown result after forearm fracture. The responsible physician soon has to initiate surgical treatment to prevent his patient from permanent pain of the wrist. Previously unrecognised distal radioulnar dislocation remains to be an unsolved problem. A generally accepted management concept does not exist. Since rupture of the membrana interossea nearly ever occurs, resection of the radial head is followed by radial shifting and seems to be obsolete under these circumstances. An exemplary case is presented and surgical management in this situation is discussed.