Primary screw osteosynthesis is the treatment of choice depending on the lesions of the soft-tissue and accompanied injuries in combination with a fixateur externe. Nevertheless the primary osteosynthesis is not able to prevent necrosis of the talus completely, that occurs in a frequency of 15%. Risk factors for a posttraumatic arthritis in addition to the type of fracture and the result of reconstruction are an accompanied soft tissue defect and local capsule-band complex with necessary temporary transfixation. Early plastic reconstruction of defects can reduce the time of immobilisation and allows motion therapy. The functional results are positive compared with the radiological results that showed arthritis in 70%.
In a retrospective study the value of MR mammography in cases of radiological well-known carcinoma of the breast was evaluated preoperatively in 76 cases of histopathologically verified carcinoma one lesion was missed by MR imaging. Compared to the results of conventional X-ray mammography additional malignant lesions were detected in 5 patients ipsilaterally and in another 8 patients contralaterally by MR mammography only. In additional 4 cases MR mammography demonstrated suspicious lesions contralaterally, but histopathology revealed benign lesions. The therapeutic procedure was changed in 15 cases (18.5%) due to the findings of MR imaging: Ipsilateral mastectomy instead of tumorectomy (n = 5) or primary chemotherapy instead of operation (n = 1); contralateral additional tumorectomy (n = 3) or mastectomy (n = 2) by carcinoma and open biopsy (n = 4) by benign finding.
In this retrospective study we analyzed metacarpal (MC) fractures that were treated with minimally invasive osteosynthesis during the period 2009-2010 and 65 patients (mean age 34.8 years, female/male 13/52) with 75 metacarpal fractures were enrolled. Fractures affected MC-2 (n=9), MC-3 (n=5), MC-4 (n=15) and MC-5 (n=46). Removal of implant was performed after 6-12 weeks in 44 patients. All fractures except one showed bony healing in x-ray. At 2-months follow-up 61 patients could be evaluated and at 27-months (15-37) follow-up 34 patients could be evaluated according to the DASH score. Median DASH score results were 16 points (SD 49, n = 61) after 2 months and median DASH score results were 5 points (SD 23, n = 34) after 27 months (15-37). Range of motion was limited in 6 patients after 8 weeks (range 6-12 weeks) with a deficit in flexion of finger to distal palmar crease of 1.0 cm (range 0.5-1.5 cm), 2 patients showed a deficit in finger extension of 10° in the metacarpophalangeal joint. One patient showed restricted finger extension of 15° in the proximal phalangeal joint after tendon rupture and tendon reconstruction. Complications were observed, such as circumscribed redness in two patients at the entry point of k-wires which was managed by early removal of the implant. Perforation of the k-wire occurred in one patient with subcapital and diaphyseal fracture and was managed by plate osteosynthesis. One diaphyseal transverse refracture healed after plate osteosynthesis, three circumscribed cases of paresthesia occurred, one at the entry point of the K-wires and two at the level of fracture.
ObjectiveInternal fixation of proximal humerus fractures with an implant assuring rotational and angular stability to restore form and function of the glenohumeral joint.
IndicationsProximal humerus fractures: two-and three-part fractures, meta-and diaphyseal fractures of the proximal second fifth.
ContraindicationsComminuted fractures of the humeral head. Proximal humerus fractures in children.
Surgical TechniqueAnterior approach. Blunt dissection of the deltopectoral interval, retracting the cephalic vein medially. Judicious exposure of the fracture site and reduction of the fracture. A 90° blade plate opened up to 110-120° is inserted from anterolateral immediately proximal to or through the subcapital fracture gap. The blade of the blade plate is introduced into the proximal half of the humeral head. In the presence of an avulsion of the greater tuberosity, a wire cerclage is added.
ResultsBetween June 1998 and December 1999, we treated 20 patients (eight men, twelve women, age 65-92 years) and assessed them prospectively. All fractures were closed (AO types 11-A3 n = 8, 11-B1 n = 5, 11-B2 n = 3, 11-B3 n = 1, and 11-C2 n = 3). Loosening of plates was seen in three patients and a blade perforation in one, all requiring a revision (revision with plate blade twice, shoulder hemiarthroplasty once, early implant removal once). Five patients passed away, and two were too old to undergo a follow-up examination. The Constant score in 13 patients performed after 8 (7-10) months reached 62/100 (opposite shoulder 92/100). This corresponds to a satisfactory outcome.
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