The advantages of arthroscopic refixation and augmentation of the cruciate ligament in comparison to open methods are conserving innervation of the most important structures of the knee joint, a clear-cut reduction in morbidity, and more rapid rehabilitation of the knee joint. In principle, however, as far as ligament replacement and fixation of the augmented ligament parts are concerned, the technique corresponds to the open method. As the early results refer to a period of 2 years at most, however, it is too soon to report them. Nevertheless, the results of follow-up in our present study are identical to those previously reported by other authors.

Consideration of technical developments, a review of the literature and of our own experience with 535 patients compared with nearly 20,000 patients of an ASIF population treated during the same period show that the indications for treatment of extra- and intracapsular fractures of the proximal femur have become much simpler. (1) Extracapsular fractures of the proximal femur fall into two groups: pertrochanteric fractures are fixed by means of the dynamic hip screw and intratrochanteric unstable fractures by means of either the dynamic hip screw (valgus type) or a 95 degrees condylar plate. (2) Intracapsular fractures are treated according to the patient's age group. In patients younger than 70 years femoral head preservation is achieved by compressing screw osteosyntheses, while in patients over 70 years head resection is performed an a total endoprothesis inserted. In patients with life expectation shorter than 3-5 years a femoral head prothesis is inserted.

The last 20 years have seen a great deal of controversy about the indications for and the timing of operative fracture treatment in multiply injured patients. In central Europe a standardized concept of treatment has been widely adopted since the late 1970s. In this concept a few types of fractures are given a high priority and are operated on early. Most fracture types, however, are not stabilized by internal fixation until several days after the injury. The treatment of closed femoral shaft fractures is still hotly debated. So far, not a single prospective study proving the advantages or disadvantages of early fixation has been published.

The diagnosis and treatment of pelvic fractures and dislocations demand that the pelvic girdle and the acetabulum be examined separately. Fractures of the pelvic girdle are present in more than 60% of cases but have to be stabilized only in 9%, in contrast to acetabular fractures, which need to be reduced and internally fixated in 55%. Combined fractures need surgical management in 66% of cases. Fractures of the pelvic girdle are best diagnosed by means of plain radiograms and computed tomograms to distinguish posterior instability. These techniques are the basis of the treatment plan for external or internal fixation. External fixation is an effective method from the aspect of hemorrhage control but not sufficient to avoid postoperative pain. Early open reduction and internal anterior and posterior fixation is the treatment of choice if good rehabilitation is to be achieved. Acetabular fractures occur mostly in young patients. Only accurate articular reduction of displaced fractures can bring about a good functional result, as this minimizes posttraumatic arthritis. Radiological evaluation is done with three standard views: 1. A. P. X-ray of the pelvis; 2. oblique view of the obturator; 3. oblique view of the ilium. When those are considered in combination with a CT scan, acetabular fractures can be classified. The Letournel classification is extremely important for reduction and fixation, as no one surgical approach has been found that is satisfactory for all acetabular fractures. Internal stabilization is provided with single screws and plates.

Kniegelenksluxationen finden sich in 7% aller Kniebandrekonstruktionen. Die häufigste Unfallursache sind Motorrad- und Fußgängerunfälle in 66%. Im Gegensatz zur Literatur fanden wir nur 1 Gefäßschaden, jedoch neurologische Komplikationen (Peronaeus) in über 30%. Die Bandrekonstruktion erfolgt mit resorbierbarem Nahtmaterial und Metallklammern, die temporäre Stabilisierung erfolgt mit PDS-Kordeln und zusätzlichem Gips für 6 Wochen. Die Nachuntersuchung nach durchschnittlich 2,5 Jahren zeigte gute bis exzellente Ergebnisse in 70,8%. 50% waren überhaupt nicht behindert. 50% der Patienten betreiben wieder Sport.

Motorische Ersatzoperationen werden durchgeführt, um den Funktionsverlust ausgefallener Muskelgruppen zu kompensieren. Dazu wird die Sehne eines (oder mehrerer) funktionsfähigen Muskels an ihrem Ansatz durchtrennt und mit der Sehne des (der) zu ersetzenden Muskels verbunden. Klinische Studien (1) zeigen, daß die transferierten Muskeln die Aufgabe der ersetzten Muskeln übernehmen können. Allerdings eignet sich nicht jeder Muskel für einen Transfer, und am Arm kommt es eher zu einer Funktionsanpassung als am Bein (2). Während bisher vor allem mechanische Aspekte des Transfers diskutiert werden, ist die Anpassung der motorischen Leistungen, die einer Funktionsumkehr zugrunde liegen, kaum untersucht (3).