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Introduction Soft tissue conditioning due to posttraumatic oedema after complicated joint fractures is a central therapeutic aspect both pre- and postoperatively. Six to ten days are passing on average until the patient is suitable for surgery. The aim was to compare the decongestant effect of vascular impulse technology (VIT) with that of conventional elevation. Materials and Methods In this monocentric RCT, 68 patients with joint fractures of the upper (n = 36) and lower (n = 32) extremity were included and randomised after consent in a 1:1 ratio. The variables were evaluated for all fractures together and additionally subdivided into upper or lower extremity for better clinical comparability. The primary endpoint was the time in days from hospital admission to operability. Secondary endpoints were total length of stay, oedema reduction, pain intensity, complications and revisions. Results The time from admission until operability was reduced by 1.4 (95% CI: -0.4; 3.1) days in the mITT analysis (p = 0.120), being statistically significant with 1.7 (95% CI: 0.1; 3.3) days in the as-treated sensitivity analysis (pAT = 0.038). Significant less pain was found in the intervention group and a significantly faster oedema reduction. Due to rare occurrences, nothing can be derived in regard to complications and revisions. Conclusion Administration of VIT therapy did not lead to a significant reduction in the time until operability but was superior to elevation in regard of soft tissue conditioning and pain reduction. Thus, it seems like a helpful tool in the treatment of posttraumatic oedema after complex joint fractures of the lower and upper extremity, especially in tibial head and lower leg fractures.

Vom Sonntag, 6. Dezember, bis Donnerstag, 10. Dezember 2015, fand in Davos der einzige deutsch-sprachige AO Master Kurs weltweit statt, gemeinsam organisiert von der AOTrauma Deutschland, Osterreich und Schweiz. Der ausgebuchte AO Master Kurs wurde von Paul Grutzner (Ludwigshafen), Franz Kralinger (Wien) und Marius Keel (Bern) geleitet. 12 weitere Referenten aus drei Landern (Deutschland, Osterreich und Schweiz) unterrichteten 47 Teilnehmer aus Deutschland (30), Osterreich (9), Schweiz (6), Ungarn (1) und Italien (1), was einem Betreuungsverhaltnis von unter 1:3 entspricht. Alle Teilnehmer waren erfahrene Facharzte, davon die meisten in ihrer Klinik als Oberarzt oder Chefarzt tatig. 60 % der Teilnehmer arbeiten in Einrichtungen der traumatologischen Maximalversorgung.

The complication rate of conventional plate osteosynthesis (CPO) of periprosthetic femoral fractures above total knee arthroplasties (TKA) is high. Indirect reduction techniques were introduced to reduce surgical dissection at the fracture site. Twenty-one patients (4 men and 17 women) with femoral fractures above well-fixed total knee arthroplasties were consecutively treated with the indirect reduction technique. AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of the Problems of Internal Fixation) Type 33A fractures were included. The mean age was 78 years (range, 67-94 years). Four fractures were stabilised with bone grafts, three in combination with bone cement. Nineteen of the patients were seen at a 1-year follow-up, 15 were seen after a long-term follow-up of 9 years (range, 7-12 years). There was only one implant failure in a comminuted fracture with severe osteoporosis, no infection, and no non-union. At the 1-year follow-up malalignment of 5 degrees varus occurred in one patient. The mean range of motion of the eighteen patients was 98 degrees (range, 65-110 degrees). The mean knee society score was 74 (range, 62-84), the mean function score was 52 (range, 39-72). At the long-term follow-up, the mean range of motion of the patients was 101 degrees (range, 65-115 degrees). The mean knee society score was 77 (range, 65-88), the mean function score was 55 (range, 40-75). Our results suggest the 95 degrees condylar blade plate in the indirect reduction technique is still a good implant with good long-term results. It works best in proximal fractures when there is minimal comminution of the distal fragment in the hands of an experienced trauma surgeon. Knee function and range of motion increased less over time.

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