Search

This paper gives recommendations for treatment of thoracolumbar and lumbar spine injuries. The recommendations are based on the experience of the involved spine surgeons, who are part of a study group of the "Deutsche Gesellschaft für Unfallchirurgie" and a review of the current literature. Basics of diagnostic, conservative, and operative therapy are demonstrated. Fractures are evaluated by using morphologic criteria like destruction of the vertebral body, fragment dislocation, narrowing of the spinal canal, and deviation from the individual physiologic profile. Deviations from the individual sagittal profile are described by using the monosegmental or bisegmental end plate angle. The recommendations are developed for acute traumatic fractures in patients without severe osteoporotic disease.

Fractures of the olecranon account for 7% of fractures in adult patients. Of all elbow fractures, 38% are isolated fractures of the olecranon. Falling on the 90 degrees flexed elbow is the most common cause of isolated olecranon fractures. Reconstitution of the joint surface is the main treatment goal, as well as stability of the joint and full range of motion and muscular strength. This can only be achieved in most cases by open reduction and precision osteosynthesis. Tension band wiring and plate osteosynthesis are the most commonly used techniques. Operative therapy is the therapy of choice, since it permits early physical therapy. Some non-dislocated fractures and fractures in elderly and multimorbid patients are indications for conservative therapy.

Irrespective of an anterior open or endoscopic approach, the combined postero-anterior instrumentation of thoracolumbar fractures requires time consuming intraoperative maneuvers changing the patients position from prone to lateral.A standardised anterior endoscopically assisted approach for the segments Th4 to L4 is described, allowing the patient to remain in prone position, using a 4-5cm incision combined with a retractor system. The approach to the anterior spine in prone position is feasible by using a self holding retractor system for the region from Th4 to L4. Time of anaesthesia for the one stage combined procedure can be reduced by about 40 min, when changing the position of the patient is no longer necessary. The minimal incision in combination with the retractor system allows mainly the use of conventional instruments and implants, which provides reasonable lower costs. The advantages of the open and the endoscopical technique are combined. The main advantage of the prone position is the opportunity to access the anterior and posterior spine simultaneously, which is extremely helpful in reduction maneuvers.