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서 론: 족관절 외과 골절에 대해서 최소 침습적 방법으로 금속판 고정술을 실시하고 합병증 및 유용성에 대해서 후향적으로 평가하였다. 대상 및 방법: 2001년 1월부터 2003년 12월까지 총 13례를 대상으로 1년 이상 추시 관찰하였으며 비골 골절은 AO-OTA분류상 A형이 4례, B형이 9례였다. 수술 방법은 도수견인하여 골절을 정복한 후 최소한의 피부 절개를 한 다음 골정복 겸자나 K-강선으로 임시고정 후 경피적 으로 반관상 금속판을 삽입하고 영상증폭기 투시하에서 나사못을 고정하였다. 결 과: 전례에서 완전한 골유합을 얻었으며 완전체중부하까지의 기간은 평균 10주였다. 금속판의 부적절한 굽힘으로 인한 부정유합은 없었다. 2례에서 금속판이 외과 원위부 보다 더 하방에 위치하여서 불편함을 호소하였으나 기능장애는 야기하지는 않았다. 결 론: 족관절 외과 골절에서 금속판을 이용한 최소 침습적 수술은 피부괴사와 같은 연부조직 문제나 골이식술의 빈도를 줄일 수 있는 유용한 방법이라고 사료되었다.

목 적: 경골 원위 골간단부 골절에서 최소 침습적 금속판 고정술을 시행한 환자를 대상으로 결과를 분석하여 이의 유용성에 대해 알아보고자 한다. 대상 및 방법: 경골 원위 골간단부 골절에 대해 최소 침습적 금속판 고정술을 시행하였던 19례를 대상으로 임상적 및 방사선학적인 평가를 하 였다. 평균 연령은 46세 (20세~69세)이었고, 평균 추시 기간은 15개월 (6개월~37개월)이었다. 경골 원위부 골절은 AO/OTA 골절 분류에 따 라 관절면을 침범하지 않은 골절이 16례 (A1 4례, A2 8례, A3 4례), 관절면을 침범한 골절이 3례 (C1 2례, C2 1례)이었으며, 개방성 골절이 2 례이었다 (Gustilo-Anderson I형 1례, III-A형 1례). 결 과: 전 예에서 골유합을 이루었고, 방사선학적 골유합 시기는 평균 18주 (12주~24주)이었으며, Baird의 방법에 의한 족관절의 평균 기능 적 점수는 94.2점이었다. 1 cm 이상의 단축이나 5도 이상의 부정유합, 심부감염, 내고정물의 실패가 발생한 경우는 없었다. 결 론: 경골 원위 골간단부 골절의 치료에 있어서 최소 침습적 금속판 고정술은 족관절을 기능적으로 회복하면서 높은 골유합률을 얻을 수 있어 좋은 치료 방법으로 사료된다.

목 적: 불안정한 원위 경골 골절의 치료에 있어서 최소 침습적 금속판 고정술의 유용성에 대해 알아보고자 하였다. 대상 및 방법: 2001년 3월부터 2003년 12월까지 원위 경골 골절을 최소 침습적 금속판 고정술로 치료하고 1년 이상 추시가 가능하였던 21예 를 대상으로 하였다. 관절외 골절이 18예였고 관절내 골절이 3예였으며, AO 분류에 따르면 42-A형이 6예, 42-B형이 4예, 42-C형이 1예, 43-A형이 7예, 43-C형이 3예였다. Gustilo-Anderson 분류 제II형의 개방성 골절이 1예 있었다. 결과로는 골유합 시기, 축성 및 회전 변형, 족근 관절의 운동 범위 및 합병증을 조사하였다. 결 과: 전 예에서 평균 16.1주 (11~24주)에 골유합을 얻었으며, 지연 유합이나 불유합은 없었다. 7도의 후방 각 변형이 1예 있었으나, 회전 변 형은 없었다. 족근 관절의 운동은 전 예에서 5도 이내의 운동 범위의 소실로 만족스럽게 회복되었다. 합병증으로 1예에서 골절이 유합된 후 피 하 농양이 발생하여 배농과 함께 내고정물 제거술로 치유되었다. 결 론: 불안정한 원위 경골 골절에 대한 최소 침습적 금속판 고정술은 전통적인 관혈적 정복에 비해 기술적으로는 훨씬 어렵지만 연부조직의 손상과 감염의 빈도를 최소화하고 만족스러운 골유합을 얻을 수 있는 유용한 치료 방법으로 사료된다.

The need for urgent reduction of a traumatically dislocated hip is not in doubt (Epstein, 1973) but how this is best achieved with an ipsilateral fracture of the femoral shaft is a point for debate; reported management options are anecdotal. We felt any hip surgery could only compromise further viability of the femoral head and any local haematoma would decompress through capsular tears; hence we sought closed reduction. We achieved this by restoring the lever-arm properties of the femur by plate osteosynthesis; intramedullary nailing could not be considered because of skeletal immaturity.

Besides the microsurgical ventral decompression for treatment of cervical disc prolapses, combined with an intercorporal fusion using an autologous bone graft from the iliac crest and a plate osteosynthesis, the microsurgical, transoral approach to the craniocervical junction has proven to be an effective procedure for adequate indications. Even for surgical treatment of diseases and injuries of the craniocervical junction ventral, anterolateral, lateral and dorsal approaches are applicable alone or in combination. The special anatomic and functional conditions of this region, however, obviously require that the indicational criteria for the various approaches differ from those selected for the other cervical segments. The postoperative complication risk requires that particulary critical consideration be given to the question of isolated transoral interventions. The same holds true for the question as the necessity for additional ventral stabilisation in combined dorsoventral interventions. This report is about 20 patients who underwent transoral decompression, about the indications and the procedure typical problems.

Nine patients with displaced calcaneal fractures were approached through bilateral incisions and stabilized with minimal internal fixation. All patients were men, with an average age of 35 years (range, 19-65). All fracture patterns had three-part split depression fractures of the posterior facet, a single intact sustentacular tali fragment, middle facet, and anterior body fractures. The reduction of tubercle impaction and varus angulation was accomplished by stabilization of the sustentacular tali-posterior tubercle fracture line through a modified medial vertical incision. Minimal fixation using either a three-prong staple or 4-mm lag screws was sufficient to stabilize this fracture pattern. Posterolateral facet articular elevation, and final reconstruction of Bohler's and Gissane's angles were performed through an extended lateral incision. Five of nine calcanei were stabilized with lag screws only and four required minimal lateral plate osteosynthesis. Preoperative Bohler's and Gissane's angles averaged 6 degrees and 138 degrees; postoperative angles averaged 34 degrees and 123 degrees, respectively. The average difference between postoperative Bohler's and Gissane's angles compared with the normal contralateral side was 1 degree each. There was no loss of reduction, and healing was uneventful. There was anatomic reconstruction of both medial and lateral cortexes in all cases. In this specific fracture pattern, medial stabilization of the sustentacular talitubercle fracture line can reduce both the amount and extent of lateral fixation, facilitate anatomic reduction of the posterior facet, and reduce postoperative implant sequelae after internal fixation.

In our article we were more concerned with a situation in which a mandibulotomy, used to provide surgical access to the tumour, is reconstructed with small plate osteosyntheses. In these cases postoperative therapy may be considered necessary soon after the ablative surgery either as an adjuvant or as therapy. We felt it important to ascertain both the potential tumour shielding effects of such plates as well as the dose enhancement phenomenon occurring due to secondary ionisation

Indications given, the adequately dimensioned plate osteosynthesis must be preferred to any other treatment for stabilizing an infected femur pseudarthrosis, regardless of the osseous support. Otherwise the fixateur externe is indicated. Its assembly on the upper leg requires a special knowledge which reflects the individual bone- and soft-tissue-assessments. We distinguish between fixateur type I to IV on the upper leg, all of which are exemplified. Complications are at first mainly loss of blood and infective activity, later chronic soft-tissue fistulae, abscesses, osteomyelitic residual cavities, and spontaneous fractures. A study analyses the treatment and the late results of 96 infected femur pseudarthroses.

Small plate osteosynthesis is becoming increasingly popular in reconstruction following ablative surgery for oral malignancies. In those cases where postoperative radiotherapy is to be included in the treatment it has been suggested that these plates may cause problems such as dose enhancement and tumour shielding and should therefore be removed prior to the radiotherapy. A physical method is described to assess the anticipated radiation dose changes at the tissue/plate interface both behind and in front of the plate. As a result of this assessment certain recommendations are made.

At the University ENT Clinic Frankfurt 105 patients with zygomatic fractures were treated from 1980 until 1986: 45 were treated with a maxillary sinus stent, part of them in combination with wire osteosynthesis, miniplate osteosynthesis was performed in 30 patients, some fractures seemed stable after reposition without fixation. The zygomatic fractures are classified into 3 types requiring different surgical treatments. Comparing the long term results of these methods with the pre- and postoperative radiological and functional data, patients with type 2 and 3 fractures do better with miniplate osteosynthesis than with the other treatments. In combination with an orbital floor fracture, the degree of enophthalmus is more severe in those patients where fractures were only repositioned without fixation.

The success of precisely indicated surgical treatment of posttraumatic deformities of the femur shaft depends on painstaking preoperative planning with exact assessment of the locus of correction, careful determination of the correction angle, and choice of an adequate operation method. In correction operations plate osteosynthesis is necessary, in contrast to the various possibilities for care of primary fractures of the femur. Therefore we concentrate in this paper mainly on the use of plate osteosynthesis, without forgetting that there are also indications for intramedullary nailing, especially of not yet consolidated fractures or aseptic wound healing impairments. Long X-rays of the leg are an essential part of the preoperative preparation. The success of all operative treatments does not depend only on the degree of disablement, the age of the patient, and realistic target. Particularly in view of the difficulty of plate osteosynthesis and the variety of methods of primary osteosynthesis, the surgeon has to consider the rules of biomechanics as they apply to the incorrectly set femur and to simulate the surgical treatment with preoperative planning in order to attain physiological axial conditions with the best operative method. This applies particularly to the knee joint. Axial deformities are very often combined with shortening, and surgical correction is therefore sometimes difficult.

Summary Personal experience gained with functionally stable osteosynthesis after a Le Fort-I osteotomy and segmental osteotomies of the upper jaw are dealt with. Surgical interventions were performed on 40 patients: 7 cases of Le Fort-I osteotomy, 21 cases of Le Fort-I osteotomy with an additional segmental osteotomy, and 17 cases of segmental osteotomies. The osteotomized upper jaw was fixed bilaterally to the zygomatic-alveolar crest and to the pyriform aperture, by osteosythesis plates. Bone grafts were routinely inserted between the maxillary tuberosity and the pterygoid process, and in the region of the lateral wall of the maxillary sinus. Duration of the clinical treatment: 2 weeks. 3 weeks after the surgical intervention, a prosthetic replacement in the form of a removable bridge was fitted so that the patient could resume his activities 4 weeks after the operation. In the follow-up period of up to one year, no relapses have occurred. However, the follow-up period is less than 6 months in most patients. In the overwhelming majority of the cases, the osteosynthesis plates are still in situ.

Es wurden 36 Handgelenksarthrodesen kontrolliert. Die angewandten Operationsverfahren wurden in 2 Gruppen unterteilt. Die eine Gruppe wurde mit kortiko-spongiosem Span und stabiler Osteosynthese, die zweite Gruppe mit einer nicht stabilen Fixation behandelt. 13 Patienten der ersten und 14 der zweiten Gruppe konnten nachuntersucht und beurteilt werden. Mit allen Verfahren war eine Versteifung des Handgelenks erreicht worden. Die stabile Form der Arthrodese bietet die sichere Erhaltung der erreichten Handstellung, deutliche Verkurzung der Gesamtbehandlungszeit und Beseitigung der Gefahrenmomente der Pseudarthrosenentstehung.

Zugversuche an Osteosyntheseplatten-Knochenverbindungen zeigten in Abhangigkeit vom Plattentyp und der Anzahl der verwendeten Stellschrauben deutliche Unterschiede. Normale Rundlochplatten verrutschten bei hoheren Zugkraften eher als DC-Platten unter gleichen Bedingungen. Eine DC-Platte mit rauher Oberflache erzielte grosere Haltekrafte als eine polierte des gleichen Typs. Mit der Anzahl der eingesetzten Schrauben wuchs der Widerstand gegen des Verrutschen der Platte, jedoch war die Zunahme nicht proportional zu der Schraubenzahl.

The stability of external distance osteosynthesis for complete tibia and femur defects rests solely on the rigidity of the external support. The rigidity of the external support is an function of the mechanical data of its individual elements, of the hold between the bone and the other system, as well as of the individually optimized construction form. The response of an osseous contact area which is not resistant to compression when external osteosynthesis is applied is mechanically similar to the response to distance osteosynthesis in the presence of a defect. The basic application rules for distance osteosynthesis of the lower limbs are given. The symmetric frame fixator applied in a three-dimensional arrangement is indicated for tibia defects. External distance osteosynthesis of femur defects can only be recommended when plate osteosynthesis alone or plate osteosynthesis in conjunction with a bracket fixator are out of the question. The various application forms for external osteosynthesis of femur defects are described and their indication with respect to knee function given. Although none of the construction forms for defects in the tibia and especially in the femur can eliminate mechanical interfragmental movement of the main fragments, their clinical use has been successfully established; however, surgical and osteoplastic measures must ensure more and more biological stability with time. The necessary surgical techniques and procedures are described. Whereas even extensive defects of the femur can be bridged exclusively with autologous cancellous bone, varied measures are required for the lower leg, depending on the various individual conditions. Should the direct bridging of the main tibia fragments not be appropriate, fibular-tibial synostosis is necessary. The various options for such fibular-tibial osteoplasty which may be required, depending on the individual case, are described.

114 children with femoral shaft fractures were treated between 1975 and 1981 at the Department of Paediatric Surgery of the University of Munich. Follow-up examination of 80 children with 81 femoral fractures was possible. 57% were treated conservatively by traction, 43% got an operative treatment by plate osteosynthesis or nailing. With regard to leg length discrepancies there was a significant difference between a control group of children without preceding trauma and one with femoral fractures. After conservative treatment we found an average discrepancy of 0.24 cm. Overgrowth could not be reduced by greater overlapping of fragments at the time of union. After osteosynthesis we found an average discrepancy of 1.2 cm. The data obtained showed no connection between the period osteosynthesis material was implanted and the measurements of leg length discrepancy. Equalization of the discrepancies during further growth cannot be expected.

Experience in the management of 916 fractures of the mandible stimulated us to develop new methods and surgical techniques for functionally-stable intraoral internal plate osteosynthesis. The development of a fixation bar which is adapted to the alveolar process of the fractured mandible enables a compression of this area prior to the plate osteosynthesis. This procedure facilitates the plate application from the intraoral approach so that in 358 cases all types of fractures of the body, angle and ascending ramus can be reduced using this access, and not only the selected favourable cases. A new plate and screws of our own design have been successfully used in cases with comminuted multifragmentary and defect fractures. The rigid fixation of the head of the screws to the plate produces an optimal functional stability compared with conventional systems. The combination of the advantages of an external fixation device and those of stable internal osteosynthesis produces a long term functional stability even in cases with extensive defects where delayed consolidation is to be expected; tilting and loosening of the screws or resorption of the compact bone underneath the plate do not occur. Thus the extraoral approach and visible skin incisions can be avoided. This procedure is time sparing and less traumatic to the soft tissues compared with the extraoral approach. The extremely low complication rate in 358 fractures managed by plate osteosynthesis using the intraoral approach confirms the efficiency of this method.

Im Zeitraum vom 1.1. 1975 bis 31. 12. 1986 wurden in der Unfallchirurgischen Klinik der Johann-Wolfgang-GoetheUniversitat Frankfurt a. M. 726 Unterschenkelbruche behandelt, von denen nach 1977 50 mit einer dorsal plazierten schmalen AO-DC-Platte stabilisiert wurden. Die Grunde fur die dorsale Plazierung der Platte werden diskutiert und die Ergebnisse aufgezeigt.

Background : Among various fixation methods for metacarpal fractures, plate osteosynthesis is the most rigid and allows early rehabilitation leading to early return to work. Many authors have reported high complication rates and most of them were because of thick plate. The aim of this study was to report early results of plate osteosynthesis of metacarpal fractures with low profile miniplate. Methods : This was a hospital based prospective study. Unstable and irreducible fractures were managed by open reduction and internal fixation with low profile miniplate and were followed up for 6 months. The functional outcome after fracture treatment was assessed by ability to perform acts of daily life and calculating American Society for Surgery of the Hand Total Active Flexion (ASSH TAF) score. Results : There were 16 patients with 17 metacarpal fractures, 87.5% were male with mean age of 31.50±9.02 years. Fourteen (87.5%) patients could perform their activities of daily living at four weeks. The mean Total Active Flexion was 261.76±24.87 at final follow up. Fourteen (87.5%) patients had excellent, one (6.25%) good and one (6.25%) poor out come at the end of 6 months. Conclusion: Low severity metacarpal fractures can be treated successfully by open reduction internal fixation with low-profile miniplate, allowing early and safe mobilization. Key words: low-profile plate, metacarpal fractures, plate osteosynthesis DOI: 10.3126/jnhrc.v7i1.2274 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 19-24

Objective: The aim of this study was to compare midterm functional and radiographic results of minimal invasive plate osteosynthesis (MIPO) with intramedullary nailing (IMN) of simple intra-articular distal tibial fractures (AO-OTA type 43 C1-C2). Methods: Seventy-three simple intra-articular distal tibial fracture patients were evaluated retrospectively. All were treated between 2009 and 2014. The average age of the patients was 40.3 years. Thirty-seven patients were treated with IMN and 36 patients were treated with MIPO. Fibular plate osteosynthesis was applied in 5 cases (13.5%) in the IMN group and in 23 patients (63.9%) in the MIPO group. Results: Functional results and complications of IMN and MIPO methods were assessed in 73 patients. The average union time was 16.4 ± 2.7 weeks in the IMN group and 15.2 ± 1.8 weeks in the MIPO group (p = 0.079). The average Olerud-Molander Ankle Score was 87.8 ± 8.1 in the IMN group and 81.5 ± 11.8 in the MIPO group (p = 0.013). Four patients in the IMN group experienced valgus malunion, while it was not observed in any patients in the MIPO group (p = 0.042). Recurvatum malunion was detected in 10 patients in the MIPO group and not seen in the IMN group (p = 0.001). Ankle dorsiflexion angle was 25.8 ± 4.5° in the IMN group and 33.3 ± 8.9° in the MIPO group (p = 0.000). Conclusion: Simple intra-articular distal tibial fractures are successfully treated with IMN and MIPO. Prevalence of valgus malunion was higher in the IMN group and recurvatum was more prevalent in the MIPO group. MIPO is the first preference according to the literature; however, successful results have been obtained with IMN in this fracture pattern. Level of Evidence: Level III, Therapeutic Study. Keywords: Distal tibial fractures, Intra-articular fractures, Intramedullary nailing, Minimally invasive plate osteosynthesis, Minimally invasive surgery

The genesis and clinical characteristics of Scheuthauer-Marie-Sainton's syndrome (dysostosis cleido-cranialis), of congenital pseudoarthrosis of the clavicula of post-traumatic clavicular pseudoarthrosis in childhood determine the differential diagnostic considerations of pseudoarthrosis in children in cases which are initially not clear. The therapy is, however, independent of the cause of the disease: Resection of the pseudoarthrotic bone, filling of the defect via a cortico-spongious block and stabilisation via plate osteosynthesis.

A false aneurysm of the popliteal artery caused acute ischemic symptoms 23 years after plate osteosynthesis of a distal femoral fracture. The protruding tip of a screw was found in the center of the aneurysmal sac.

Cases have been presented that demonstrate the advantages of small plate ostesynthesis in the reconstruction of the mandible following resection of neoplastic disease. Mandibulotomies provide improved access to tumors and thus allow the tumor to be better excised. Prelocalization of the plates allows the precise reconstruction of the mandible following mandibulotomy with minimal morbidity and disturbance of function.

The static and functional relationships of the mandible cause special problems for a stable plate osteosynthesis. For anatomic reasons, the traction strapping necessary in the alveolar crest region is very frequently impossible to carry out. Thus, a special plate was developed for compression osteosynthesis of the mandible. The plate has two functional parts. The center part permits a compression osteosynthesis in the body of the mandible by use of an axial compression thread. The fragments are additionally fixed by inserting a notched inlay section in the bone. The ends of the plate have a DCP hole projecting upward at an angle. This prevents cleavage secondarily in the fracture fissure away from the plate.

Trapezial plate osteosynthesis is an advanced technology for anterior internal stabilization in cervical spine injuries and for the treatment of neck instability due to nontraumatic causes.

The absolute number of patients with post-traumatic osteomyelitis has risen due to an increasing incidence of open fractures and to the extended indication for surgery of the bone (Bohm and Horster, 1979; Muller, 1981; Muller and Rehn, 1978). The consequences of osteomyelitis are not limited to the affected bone or surrounding tissue. Lengthy illness, uncertain healing results, and the disruption of family and social ties lead to psychologic behavioral disorders and social conflicts. In addition, the direct costs and financial consequences of osteomyelitis represent problems. Posttraumatic osteomyelitis, however, is preventable. Aside from prophylactic measures, this catastrophy can almost certainly be avoided with expert clinical assessment and optimal, preferably early therapy (Fig. 3, 5, 7, 8) (Muller and Rehn, 1978).