The new method of antegrade intramedullary fixation of humeral head fractures is based on a straight proximal humeral nail with special head fixation screws and conventional interlocking screws at the proximal end of the shaft fragment leaving an axillary nerve shelter space in between. The nail acts as a central load carrier. The head fixation screws run through threaded holes in the proximal end of the nail thus being held in a stiff angle and without gliding. The entry points of these screws correspond to the anatomical main portions of the lesser and greater tubercle. They allow a three-dimensional screw grip to the subchondral bony layer of the head fragment. The purpose of this intramedullary construct is to keep the fracture stable at a grade which allows instant postoperative active exercise and which corresponds to the needs of mechanical tranquility in a predominantly endosteal healing area. In a prospective clinical study 45 patients could be followed up after 3, 6 and 12 months. We found an ongoing improvement of the postoperative results up to an average Constant Score of 85.7 pts after one year. The complication rate was 16 %. The main complication was the screw protrusion into the joint.
Arthroscopy of the ankle joint meanwhile enjoys widespread use in those departments that perform arthroscopy so that the application of arthroscopic techniques can be considered a standard procedure also for the talocrural articulation. Various indications have become generally accepted and further areas of application will emerge. As is the case for the knee joint, arthroscopy of the ankle joint solely for diagnostic purposes has become obsolete and due to improved preoperative methods for diagnosis is no longer necessary as the sole procedure. The diagnostic work-up is normally followed by arthroscopic or open treatment. The multitude of clinical examinations and imaging techniques currently available enables noninvasive clarification of pathological conditions in the ankle joint to the greatest possible extent, making detailed preoperative planning possible in most cases. The present article describes the technique, indications, complications, and perspectives for arthroscopy of the talocrural articulation.
Since the mid 1980 s the arthroscopically and radiologically controlled management of tibial plateau fractures is an established part of arthroscopic surgery of the knee. The aim of this study is to analyse the results of this method in our patient population. Between January 1, 1994 and December 31, 1998 59 patients were operated under arthroscopic and radiologic control. Of the 59 tibial plateau fractures there were concomitant ligamentous injuries in 21 cases. In 34 cases an additional arthroscopic procedure was performed (partial meniscectomy 19 times, a meniscal repair 7 times. An arthroscopic procedure was necessary because of chondral lesions 14 times, and in 10 cases a rupture of the ACL was found, which was treated by resection). None of the 8 patients with lateral wedge fracture had a concomitant intraarticular lesion. The intraoperative use of Endobon provided good mechanical stability, but it is not always necessary. The negative aspect of Endobon, however, is the high cost. The number of complications in our series was low (3 intra- and 6 postoperative complications). The average follow-up interval was 48 months. According to the Lysholm-Score, 41 patients investigated obtained an average of 84 points. Because of its good results this procedure can be recommended when conducted by an experienced arthroscopic surgeon. However, the range of indications is limited to special tibial plateau fractures. In case of intraoperative problems or complications we recommend an early change to conventional methods of internal fixation of tibial plateau fractures.
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