Fragility fractures of the pelvic ring (FFP) are increasing in frequency and require challenging treatment. A new comprehensive classification considers both fracture morphology and degree of instability. The classification system also provides recommendations for type and invasiveness of treatment. In this article, a literature review of treatment alternatives is presented and compared with our own experiences. Whereas FFP Type I lesions can be treated conservatively, FFP Types III and IV require surgical treatment. For FFP Type II lessions, percutaneous fixation techniques should be considered after a trial of conservative treatment. FFP Type III lesions need open reduction and internal fixation, whereas FFP Type IV lesions require bilateral fixation. The respective advantages and limitations of dorsal (sacroiliac screw fixation, sacroplasty, bridging plate fixation, transsacral positioning bar placement, angular stable plate) and anterior (external fixation, angular stable plate fixation, retrograde transpubic screw fixation) pelvic fixations are described.

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Current evidence supports the individualized treatment of proximal humeral fractures. Treatment decisions must always be made jointly with the patient in consideration of his or her individual needs and characteristics. Particularly for elderly patients, the possibility of conservative treatment should be carefully considered. If conservative treatment is not possible, then the type of operation performed should also be a function of the surgeon's individual skills and experience with particular types of implant.

VBS provides clinical outcomes comparable with BKP. The stent allows a reconstruction of the anterior column with reduced subsequent loss of correction.

Background and purpose The diagnosis and treatment of isolated greater tuberosity fractures of the proximal humerus is not clear-cut. We retrospectively assessed the clinical and radiographic outcome of isolated greater tuberosity fractures.Patients and methods 30 patients (mean age 58 (26–85) years, 19 women) with 30 closed isolated greater tuberosity fractures were reassessed after an average follow-up time of 3 years with DASH score and Constant score. Radiographic outcome was assessed on standard plain radiographs.Results 14 of 17 patients with undisplaced or slightly displaced fractures (≤ 5 mm) were treated nonoperatively and had good clinical outcome (mean DASH score of 13, mean Constant score of 71). 8 patients with moderately displaced fractures (6–10 mm) were either treated nonoperatively (n = 4) or operatively (n = 4), with good functional results (mean DASH score of 10, mean Constant score of 72). 5 patients with major displaced fractures (> 10 mm) were all operated with good clinical results (mean DASH score of 14, mean Constant score of 69). The most common discomfort at the follow-up was an impingement syndrome of the shoulder, which occurred in both nonoperatively treated patients (n = 3) and operatively treated patients (n = 4). Only 1 nonoperatively treated patient developed a non-union. By radiography, all other fractures healed.Interpretation We found that minor to moderately displaced greater tuberosity fractures may be treated successfully without surgery.

The actual evaluated interspinous devices led to a significant reduction in ROM during flexion-extension, but to a significant increase in ROM for the whole specimen (L2-L5) during lateral bending and rotation, which could increase the risk of adjacent segment degeneration.

Background: The use of hip and shoulder arthroplasty in elderly patients for grossly displaced intraarticular fractures is becoming more and more accepted. Total elbow replacement (TER) has not been considered an option for the treatment of extensively comminuted fractures of the distal humerus because surgeons feel the outcome is generally not predictable after TER. Evaluation of TER: On the basis of a MEDLINE literature search of this issue and the documented results based on the improvement of implant designs, operative technique and patient selection, TER has a definite role in the treatment of some fractures of the distal humerus. IntroductionWhenever possible, we perform open reduction and internal fixation of distal humeral fractures. Surgical treatment of comminuted intraarticular fractures is difficult, though; achieving stable and anatomic reduction of the width and angle of the trochlea and the capitellum and the loss of range of motion as a consequence of surgery itself are common problems. Even if stable anatomic fixation is achieved by open reduction and internal fixation, joint stiffness or instability, nerve lesions, and heterotopic bone formation might spoil the result.

The management of open fractures remains one of the greatest challenges to orthopedic trauma surgeons. Damage to the soft tissue envelope together with periosteal stripping are the most important factors making open fractures prone to complications such as nonunion and infection. Urgent and thorough soft tissue debridement, proper surgical fracture stabilization as well as the administration of intravenous and local antibiotics as adjunctive therapy are mandatory to reduce the risk of infection. Intramedullary nail osteosynthesis has become an accepted treatment method of open long bone fractures. Especially at sites of sparse soft tissue coverage like the proximal and distal tibia, early intramedullary stabilization proved advantageous for its superior biomechanical stability, the chance of early soft tissue reconstruction, shorter healing times, and quicker rehabilitation. However, due to a potential risk of deep infection, especially when a reamed technique is applied, nailing of open fractures remains contentious. In this review, we focus on the current evidence of nail osteosynthesis in open fractures and delineate its value with respect to other possible treatment options.