Die streckseitigen Verletzungen der Finger sind aufgrund des mannigfaltigen Verletzungsrisikos im beruflichen und privaten Alltag durch scharfe oder stumpfe Gewalteinwirkungen regelmäßig in der chirurgischen Notfallversorgung zu behandeln. Es muss hierbei mit unterschiedlichsten Verletzungsbildern, von Stauchungen mit minimalem Weichteilschaden, über Schnitt- und Quetschverletzungen, Säge-, Hobel- und Bisswunden bis zum großflächigen Weichteilverlust, z. B. im Rahmen einer Aushülsung, umgegangen werden.

An die erfolgreiche Etablierung der letzten Jahre anknüpfend fand der AO Trauma Workshop intensiv auch dieses Jahr während des VSOU-Kongresses in Baden-Baden großes Interesse. Der Kurs war mit 24 Teilnehmern ausgebucht, und es bestand noch eine große Warteliste an Interessierten, die aus Kapazitätsgründen leider nicht berücksichtigt werden konnten.

Verbleibende Fehlstellungen nach Frakturen am distalen Radius korrelieren im Outcome mit einer schlechten Funktion durch Bewegungseinschränkung, Schmerzen und Kraftminderung. In Abhängigkeit von der Fehlstellung treten zudem degenerative Veränderungen wie Arthrose des Hand- und des distalen Radioulnargelenkes sowie fehlstellungsbedingte Impaktionssyndrome auf. Oberstes Ziel der operativen Versorgung ist somit die Wiederherstellung der Anatomie.

Das süddeutsche AO-Trauma-Seminar hat eine lange Tradition und wurde von sehr bekannten AO-Mitgliedern wie Caius Burri, Eugen Kuner und Siegfried Weller erstmals veranstaltet.

ZusammenfassungDie Bedeutung der operativen im Gegensatz zur konservativen Behandlung der Klavikulafraktur hat in den letzten Jahren deutlich zugenommen. Minimalinvasive Verfahren, wie die Osteosynthese mittels TEN und neue Plattenformen in Kombination mit der Winkelstabilität, gewährleisten sichere Stabilisierungen mit dem Vorteil der Frühmobilisation. Dennoch hat die konservative Therapie ihren Stellenwert bei wenig dislozierten Frakturen und älteren, multimorbiden Patienten. Der Patient ist somit individuell in die Entscheidung mit einzubeziehen. Absolute Indikationen für die operative Therapie sind selten. Nur bei offenen Frakturen oder drohender Perforation sowie neurovaskulären Begleitverletzungen besteht eine absolute OP-Indikation. Einfache Frakturformen können gut minimalinvasiv mittels TEN versorgt werden. Bei mehrfragmentären Frakturformen ist die Plattenosteosynthese Mittel der Wahl, um eine sichere Stabilisierung ohne Implantatwanderung zu gewährleisten.

Am 15.10.2021 fand zum zweiten Mal ein ORP-Tag in Karlsruhe statt. Mit 40 Anmeldungen war der Kurs ausgebucht, und sowohl Teilnehmer als auch Referenten haben sich gefreut, wieder einmal einen Traumatag mit entsprechendem Hygienekonzept in Präsenz und nicht nur online durchzuführen.

ZusammenfassungRevisionseingriffe sind anspruchsvoll und eine genaue Problemanalyse ist Voraussetzung für eine erfolgreiche Behandlung. Dabei sind alle Aspekte, wie die Biomechanik, Vaskularität sowie die individuellen Ansprüche des Patienten zu berücksichtigen. Nur bei Kenntnis verschiedener Osteosynthesetechniken, Techniken der Endoprothetik und Revisionsendoprothetik können komplexe Situationen bestmöglich gelöst werden.

Bei der Versorgung von Unterarmfrakturen müssen die Prinzipien der anatomischen Reposition Anwendung finden. Der Unterarm ist in seiner Funktion als Gelenkverbindung zu sehen, und es werden nur gute klinische Ergebnisse erzielt, wenn die Prinzipien der Behandlung der Unterarmschaftfrakturen denjenigen von Gelenkfrakturen entsprechen. Bei Unterarmverletzungen ist immer auch auf Begleitverletzungen zu achten, die teilweise schwierig festzustellen sind. Insbesondere ist bei den Sonderformen wie Monteggia- und Galeazzi-Fraktur an typische Begleitverletzungen wie Coronoid- und Radiusköpfchenfrakturen sowie die Essex-Lopresti-Verletzung zu denken. Wenn möglich, sollte eine frühfunktionelle Behandlung angestrebt werden. Eine Ruhigstellung über mehr als 14 Tage kann zu Bewegungseinschränkungen führen. Bei den häufig vorliegenden Kombinationsverletzungen von Fraktur und Bandverletzung muss in der Nachbehandlung ein Kompromiss von zu langer und zu geringer Ruhigstellungszeit gefunden werden.

Study design Sheep anterior spinal fusion model with autogenous and xenogenous bone grafts. Objective To investigate whether the relationship between cross-sectional area of the bone graft and area of the adjacent vertebral endplates has an effect on graft fracture rate. Summary of background data Anterior spondylodesis with autogenous iliac crest transplant is a frequently performed operation to stabilize spinal motion segments but to date no precise recommendations with respect to minimum graft size are available in the literature. Methods Anterior spondylodesis using autogenous and xenogenous grafts of constant size in combination with an angular stable plate (Macs TL®). Autogenous iliac crest graft was inserted in eight sheep and xenogenic, commercially available bovine graft (Tutobone®) in the additional eight animals. The surface areas of the endplates of the fused intervertebral space were calculated using CT scans and contact radiographs of the specimens obtained after 24 weeks. The graft itself was evaluated for fractures and osteolysis. Results A fracture occurred in tricortical, autogenous grafts if the graft cross-sectional area was less than 21% of the area of the adjacent endplates. All xenogenic grafts fractured and therefore a comparable value could not be determined. Conclusion The results clearly indicate that the relation between graft cross-sectional area and endplate area defines the survival or fracture of the graft in anterior spinal fusion. Although it is difficult to directly apply the results to the clinical situation it is suggested to choose a sufficiently large graft, in order to reduce the risk of autogenous graft fracture in anterior spondylodesis.

The purpose of the present study was to evaluate the Reamer/Irrigator/Aspirator (RIA), a reaming system designed to incorporate the advantages of irrigation and suction for every day clinical use. The evaluation process was focused on the displacement of the medullary content and its impact on cortical perfusion. The results of the RIA reamed nailing were compared to conventional non-reamed nailing (NRN). The tibia of the sheep was used as an acute fracture model. The fracture and nailing procedure was followed by intravital staining with Procion red. The effects on cortical perfusion (Procion red staining) were addressed in polymer embedded sections and cryosections. Sudan III stained cryosections were evaluated with respect to the cortical fat distribution. After irrigation and suction minute amounts of fat were observed in the cortex, whereas after non-reamed nailing the endosteal third of the cortical bone was penetrated with fat. Non-reamed nailing acutely showed better perfusion in the endosteal tenth and periosteal third of the cortical bone, after irrigation and suction reaming perfusion was preserved to a lesser degree. Irrigation and suction significantly reduces fat intravasation, and thus the danger of system-wide damage. Therefore, the Reamer/Irrigator/Aspirator is as efficient as its experimental predecessors.

The aim of the study was to evaluate the application of a locked internal fixator in complex fractures of the proximal femur, in which the internal fixation with standard implants was not possible due to poor quality of bone or already failed internal fixation in the past.Ten patients suffering from a pertrochanteric (n = 5), periprosthetic (n = 1) or subtrochanteric (n = 4) femural fracture between 2003 and 2008 were prospectively registered, underwent open reduction and internal fixation with an "upside-down" femur LISS (less invasive stabilisation system) and were followed up. In all these patients a primary internal fixation had failed or the local bone situation and circulation were poor. The mean follow-up was 14 +/- 25 months. X-ray images and a clinical examination were performed at each appointment.All fractures reached a primarily stable fixation with the locked internal plate fixator. Seven patients showed a complete bone healing after 3 months of follow-up and could bear full body weight afterwards. Three patients with preoperatively existing vascular disease or chronic osteomyelitis showed a deep wound infection postoperatively, which led to the explantation of the implant.The "reversed" locked internal fixator could be a successful alternative implant for stabilisation of proximal femur fractures which could not be fixated by standard implants due to poor bone quality and circulation. It can also be used as a salvage procedure after internal failed fixation in proximal femur fractures.

AimTo compare systemic fat extravasation in unreamed and experimentally reamed nailing.MethodsAn osteotomy was created in the proximal third of the femoral shaft in 16 sheep, and intramedullary pressure increase and fat extravasation were monitored for the two nailing techniques.ResultsThe highest intramedullary pressures, median 2700mmHg, and highest percentages of fat extravasation, peaking at almost 90% of fat, were found for the unreamed nailing technique. The values for the reamed group were significantly lower.ConclusionsThe extravasation of intramedullary fat can be attributed to the great increase in intramedullary pressure that occurs during unreamed nailing. Correctly performed intramedullary reaming with the new reaming system produces lower pressures and much less systemic fat extravasation, reducing the risk for fat embolism.

Background. The use of conventional implants for intramedullary nailing of humeral shaft fractures is associated with specific difficulties. During antegrade implantation structures of the rotator cuff can be affected leading to a reduced functional result of the shoulder. If the nail is implanted in a retrograde manner problems arise due to a relatively large hole close to or within the olecranon fossa, which is necessary for insertion of the nail. Supracondylar fractures as well as persistent elbow pain and loss of function are reported in the literature. To overcome these disadvantages a flexible nail has been developed that can be stiffened and locked after implantation.Method. Between October 2000 and February 2002, 34 patients were treated with the flexible nail at our institution; 29 were available for follow-up. Fracture healing was documented on radiographs and clinical outcome was evaluated with use of the Constant as well as the Kwasny score.Results. Median duration until fracture consolidation was 10 weeks. In two patients fracture union was not achieved within the follow-up period. The median outcome measured with the Constant score was 93 points and 2.5 with the Kwasny score. Both values correspond to a very good functional outcome.Conclusion. We conclude that the flexible humeral nail is an excellent treatment option for humeral shaft fractures. Damage to the rotator cuff and the distal humerus can be avoided due to its unique flexible construction, improving the functional outcome of intramedullary nailing for the treatment of humeral shaft fractures.

Intramedullary pressure during reaming is influenced by various factors, including those of the patient, such as bone morphology and location and type of fracture, and those related to reaming technique and instruments. Through intensive research, technical developments and the use of modern materials, intramedullary pressure caused by modern reaming systems can be reduced to a minimum and, perhaps, completely avoided through use of the reaming-irrigation-aspiration system.

Human epidermal growth factor (hEGF) and basic fibroblast growth factor (bFGF) influence critical characteristics of chondrocytes. The effects on metabolism and differentiation were evaluated following transfection using specific plasmids coding for both cytokines. Chondrocytes were isolated from femoral head cartilage of patients undergoing a hip arthroplasty for femoral neck fracture. Following collagenase-digestion, cells were cultured in monolayers, and cell proliferation, glucosaminoglycan-production and collagen type II expression were monitored 10 days after isolation. Addition of recombinant hEGF and bFGF resulted in a significant increase in cell proliferation and glucosaminoglycan production. Chondrocytes were transfected with vectors coding for either hEGF or bFGF and the production of these proteins was measured in supernatants by ELISA. Expression kinetics showed different patterns: hEGF was detectable 2.5 days following transfection and peaked at day 5.5, whereas bFGF-production reached its maximum 1.5 days after transfection, declining thereafter. Chondrocytes endogenously produced significant amounts of bFGF within 5 days following isolation. Proliferation of hEGF-transfected cells increased up to 81%; bFGF-transfection caused an increase up to 76%. Similarly, glucosaminoglycan-production was enhanced up to 120% by hEGF-transfection and 37% by bFGF transfection, respectively. Collagen type II production decreased following transfection with both plasmids. Temporary in vitro gene transfer of the growth factors hEGF and bFGF provides a method to stimulate chondrocyte proliferation and induces signs of dedifferentiation, which would limit a reasonable clinical application.

Anhand einer Kasuistik wird das Ossiculum terminale (Bergmann) beschrieben, welches dem seltenen, ins Erwachsenenalter persistierenden Knochenkern des Apex dentis axis entspricht. In der unfallchirurgischen Praxis spielt dieses Ossikel als Differentialdiagnose zu einer frischen Fraktur der Densspitze (nach der Klassifikation von Anderson/D’Alonzo Typ I) eine Rolle. Zur Diagnose ist das konventionelle Röntgen meist nicht ausreichend, die ergänzende Durchführung einer Computertomographie und/oder Kernspintomographie wird angeraten. Eine Instabilität aufgrund eines Ossiculum terminale liegt nicht vor, beim Ausschluss einer frischen Fraktur oder einer verletzungsbedingten ligamentären Instabilität ist keine weitere Therapie erforderlich.