[Treatment of Tibial Shaft Fractures with the Stable Angle Tibial Nail Targon TX]. / Versorgung von Unterschenkelfrakturen mit dem winkelstabilen Unterschenkelmarknagel Targon TX.

Tibial shaft fractures are among the most common long bone fractures in humans. The incidence is 1-2 per 100,000. The gold standard of treatment for AO type 42 A-C fractures is a locking intramedullary nail. The development of new implants has extended the indications for this minimally invasive technique, so that now AO types 41 and 43 can also be treated with special nails. Fixed-angle screw anchors increase primary stability and supplemental locking devices located proximally and distally extend the spectrum of use to metaphyseal fractures. The cannulated Targon TX titanium nail can be introduced, either with or without reaming. Using an operative video, the treatment of a tibial fracture with an intramedullary nail is demonstrated in stages and the operative steps further illustrated on artificial bone.

[No Blister-Wrapped Pills: Perforation after Ingestion a Blister-Pack]. / Keine Tabletten im Blister: Perforation nach Verschlucken von Tabletten im Blister.

BACKGROUND: Pills in sharp packaging that are accidentally swallowed (blisters) can cause perforations in the gastrointestinal tract, which are only clinically apparent after the emergence of mediastinitis or peritonitis. Mortality is high. PATIENTS: We have seen two cases in cognitively limited patients, one with oesophageal and one with ileal perforation. RESULTS: Despite surgery, the patient with oesophageal perforation died 3 weeks later of multi-organ failure. The patient with ileal perforation survived sepsis after multiple procedures. CONCLUSION: As a consequence, a hospital-wide policy was implemented prohibiting the issue of tablets in blister packaging at the bedside. No more cases have emerged since that time.

[Zwipp Percutaneous Suture of the Achilles Tendon with the Dresden Instruments]. / Die perkutane Achillessehnennaht nach Zwipp mit dem Dresdner Instrumentarium.

OBJECTIVE: Rupture of the Achilles tendon is the most common rupture of a tendon in man. Acute rupture of the Achilles tendon may be treated in a variety of manners, including conservative treatment, open suture and percutaneous suture. Surgical treatment of active patients is recommended, as the risk of re-rupture is greater after non-surgical treatment. The aim of surgery is adequate treatment of Achilles tendon rupture with a low rate of complications, high comfort for patients and fast social and occupational rehabilitation. INDICATION: The indication for surgical treatment of Achilles tendon rupture predominantly includes ruptures in active patients, with the goal of optimal functional rehabilitation. Furthermore, the percutaneous technique protects soft tissue, with a lower rate of wound healing disorders and infection than with open surgical treatment. METHOD: In our clinic we perform the percutaneous suturing technique with the Dresden instruments. The surgical technique and functional aftercare are shown in a video clip. Between 2007 and 2013, we treated 212 patients with acute Achilles tendon rupture by surgery with the Dresden instruments. There were 7 re-ruptures (3.3 %) and one case of infection within one year of surgery. SUMMARY: Percutaneous Achilles tendon suture technique with the Dresden instruments is a safe operation that protects soft tissue. Patient satisfaction is high and the rate of complications is low. This allows rapid social and occupational rehabilitation.

[Percutaneus Suture of Achilles Tendon Rupture--Operation for Beginners?]. / Perkutane Achillessehnennaht--eine sich lohnende Anfängeraufgabe?

BACKGROUND: Acute rupture of the Achilles tendon is the most common tendon injury, with an incidence of 30/100,000 population. With the Dresden instruments, operative tendon suture can be standardised and is safe, quick and minimally invasive. With post-operative functional therapy in a walking boot, very good clinical results can be achieved. QUESTION: Is this operation suitable as an educational procedure and is its performance still economic? MATERIALS AND METHODS: Between 1 January 2007 and 31 December 2013, 212 patients with acute rupture of the Achilles tendon were operated using the Dresden instruments. There were 167 males and 45 females, with an average age of 46 years. 99 operations were performed by trainees, 46 by attending surgical staff, and 57 by a senior surgeon. RESULTS: With the trainees, the mean duration of the operation was 29:53 minutes, and with the attending staff 29:10 minutes (n. s., p > 0.1). The rate of complications (re-rupture, infection, and sural nerve damage) was 5/99 (5 %) for the trainees, 4/46 (8.7 %) for the attending staff, and 3/57 (5.3 %) for the senior surgeon. A total cost analysis yielded a total operative cost of 445.76 € for outpatient surgery. With a billed sum of 490.11 €, net income of 44.35 € per case is generated. In patients with reasonable indications for 2-day short inpatient treatment, total treatment cost was 3232.70 €. CONCLUSION: Percutaneous suture of the Achilles tendon with the Dresden instruments is a standardised and cost-effective surgical procedure. It is suitable as a "beginner's" procedure that can be performed quickly, safely, and cost-effectively.

[Secondary Splenic Rupture after Initially Inconspicuous CAT Scan]. / Sekundäre Milzruptur bei primär unauffälliger Computertomografie.

BACKGROUND: Splenic injuries occur in 1-5 % of blunt abdominal trauma cases. After initial haemorrhagic compression, secondary delayed spleen rupture can occur with a latency of one day to a month or longer. Mortality is then up to 15 %. The spleen injury is almost always recognisable on CT or ultrasound. CASE HISTORY: In one case from our clinic, secondary splenic rupture occurred in a patient after discharge from hospitalisation, even though the initial CT and ultrasound were unremarkable. The patient survived, and underwent emergent splenectomy 8 days after the trauma. An expert review of the case identified no errors in treatment. CONCLUSION: No case of secondary splenic rupture after initially unremarkable diagnostic studies and clinical course has previously been published. Secondary splenic rupture has a high mortality rate. Patients should be advised of potential complications after hospital discharge, and should return to the hospital immediately in case of symptoms.

[Balloonsacroplasty: C-arm or CT controlled application? : Experience with 46 patients]. / Ballonsakroplastie: C-Bogen-kontrolliert oder CT-gesteuert? : Erfahrungen bei 46 Patienten.

INTRODUCTION: Sacral insufficiency fractures are often overlooked and lead to severe therapy-resistant pain. These fractures can be most sensitively detected with magnetic resonance imaging (MRI). Similar to balloon kyphoplasty, sacroplasty provides fixation of these fractures with cement. OBJECTIVES: This study was carried out to investigate whether pain is reduced using this method and whether computed tomography (CT)-guided cement application results in less cement extravasation and fewer complications than C-arm controlled application. MATERIAL AND METHODS: In a retrospective multicenter study, 46 patients (41 female, 5 male) with an average age of 75 years were treated by sacroplasty. The procedure was performed with CT-guidance for 25 patients and with C-arm control for 21 patients. Pain was evaluated using a visual analog scale. Patients were followed up for 6 months. RESULTS: The average operation time was 35 min and postinterventional hospital stay averaged 4 days. In the CT group pain decreased from an average score of 8.8 ± 0.7 preoperatively to 2.6 ± 0.6 postoperatively (p < 0.001) and in the C-arm group pain decreased from 8.2 ±1.0 to 2.2± 1.4 (p < 0.001). There were no cases of cement extravasation in the CT group (0 out of 25 = 0 %) and 8 asymptomatic cases in the C-arm group (8 out of 21 = 38 %). In addition, there were two injuries to the superior gluteal artery with hematoma in the area of puncture, one requiring operative treatment. There were two mortalities in the CT group from lung disease and stroke during the study but this was unrelated to the operation. CONCLUSION: Balloon sacroplasty results in a reliable and significant reduction in pain for sacral insufficiency fractures. The C-arm controlled cement application resulted in more frequent extravasation and complications than CT-guided application.

[Hemi-prosthesis in femoral neck Fracture in the Elderly--OP video and our results]. / Hemi-Prosthesis in Femoral Neck Fracture in the Elderly--OP Video and Our Results.

BACKGROUND: In geriatric patients with Pauwels II and III type femoral neck fractures, endoprosthesis is the therapy of choice. We want to demonstrate the operation technique of implantation of a hemiprosthesis (dual head prosthesis) by video in an 87-year-old female patient. In addition, we analyse the long-term results after surgery more than one year after endoprosthesis in patients with femoral neck fractures. METHOD: From 2007 to 2010, 219 public health insurance (AOK) patients with displaced femoral neck fractures were treated surgically at our hospital. This number of included patients puts us in the 97th percentile of all hospitals in Germany. Because the patients were publicly insured, all health information was available including completely retrospective post-hospital discharge as well as inpatient course and one-year mortality. RESULTS: There were 77 % female and 23 % male patients in the study with an average age of 83.5 years. In addition to the femoral neck injury, 19 % of the patients had an accompanying PCCL of 3, and 44 % had a PCCL of 4. 16 % suffered from heart failure, 23 % from diabetes, and 19 % from renal insufficiency. Time to surgery averaged one day post-injury. A dual head prosthesis (hemiprosthesis) was implanted in 81.4 % of cases, and a total joint prosthesis in 18.6 %. Average operative time skin to skin was 53 minutes. Average inpatient stay was 13 days. 71 % of patients could ambulate independently on discharge. Of the remaining patients, two-thirds were already not ambulating independently prior to the fracture. Hospital mortality averaged 6 % (national average 8.1 %), and 30-day and 90-day mortality rates were 6 % and 16.3 %. Within one year, 22.2 % of patients had died (national average 26.8 %), with a natural mortality probability of 7.1 % for an age of 83.5 years. 11 patients were re-admitted, for contralateral prosthetic implantation (n = 6) or revision after periprosthetic fracture (n = 4). 54.6 % of patients were admitted to hospital during the year for other diseases (national average 53.8 %). CONCLUSION: Endoprosthesis placement for displaced femoral neck fractures is a common, safe procedure. However, patients are old and have comorbidities. Despite recent decreases in hospital mortality, the risk of death remains more than twice as high within one year than that for uninjured patients of the same age.

[Is there Sense in Having a Certified Centre for Geriatric Trauma Surgery?]. / Lohnt sich ein zertifiziertes Zentrum für Alterstraumatologie?

INTRODUCTION: By 2030, 30 % of German residents will be over 70 years of age. In 2009, we conceptualised a TÜV (German Technical Inspection Authority) certified interdisciplinary centre for geriatric trauma care. All treatment pathways were agreed upon by all disciplines. Complex geriatric therapy was established, and patients were seen by trauma surgeons, geriatricians, therapists, and a pharmacist. Cases were discussed in team meetings. Morbidity and mortality conferences were conducted. In 2014, supplementary DGU (German Society for Trauma Surgery) certification was achieved. QUESTION: Have these measures led to improved quality of care and have the increased costs been covered? Is the formation of such a centre worthwhile for patients and hospitals? METHODS: This interdisciplinary treatment was implemented for all patients over 70 admitted with proximal femur, proximal humerus, and vertebral fractures. In 2012, there were 208 proximal femur, 171 vertebral, and 69 humeral fractures. The following parameters were defined for quality control: admission and diagnosis completed within 90 minutes, over 80 % of operations performed within 24 hours, reoperation rate under 12 %, decubitus rate under 5 %, mobilisation within 24 hours of surgery in 75 %, discharge to the previous environment in over 80 % of cases, and minimal mortality rates. RESULTS: Surgery performed within 24 hours fell just short of target in 2012 with 78 %, and 2013 with 81 %. The target time for diagnosis was reached in only 30 % of patients in 2012 and in 42 % in 2013; thus, more outpatient personnel was added. Mobilisation within 24 hours of surgery was completed in 79 % of patients in 2012. Implementation of decubitus standards reduced the rate of decubitus formation from 8 to 3.2 %. Reoperation rate was 5.2 % in 2012 and 3.1 % in 2013. In 2012, 6.4 % and in 2013, 9.3 % of discharged patients required short- and long-term care facilities for the first time, and the rest were discharged to rehabilitation or directly back home. Mortality rates for proximal femur fractures were 5.7 % in 2010, 5.1 % in 2011, 2.9 % in 2012, and 3.0 % in 2013. The implementation of complex geriatric therapy generated 103 treatments in 2012 with revenue of 912,000 €, and 160 treatments in 2013 with revenue of 1.35 million €. CONCLUSION: Interdisciplinary geriatric-trauma therapy for older patients resulted in improved measurable outcomes. Interdisciplinary geriatric trauma care with implementation of complex therapy benefits both patients and hospitals.

[Pertrochanteric femur fracture - our technique and results]. / Pertrochantäre Femurfraktur - Technik und eigene Ergebnisse.

BACKGROUND: In patients over 65 years, pertrochanteric proximal femur fractures are very common, with an incidence of 966/100,000. Treatment of choice is nailing or dynamic hip screws. The operative approaches are standardised and easy to learn. PURPOSE: We want to demonstrate the operation technique by video and our own results of the last two years. PATIENTS: From 1 January 2012 until 31 December 2013, 210 patients with an average age of 80.7 years and pertrochanteric fractures underwent treatment. RESULTS: Preoperative delay averaged one day. Skin to skin operative time averaged 48 minutes. There were 6 misplaced implants and cutouts (2.8 %), one infection (0.5 %), and 6 operative revisions because of hematoma or seroma (2.8 %). Four patients (1.9 %) died of cardiovascular failure with ASA 3 and 4 during the inpatient stay. CONCLUSION: Internal fixation with nailing in pertrochanteric femur fractures is a standard operative approach. It is quickly learnt and easily performed.

[New minimally invasive approach for palmar plating in distal radius fractures]. / Ein neuer Zugang zur minimalinvasiven palmaren Plattenosteosynthese bei distaler Radiusfraktur.

Distal radius fractures are among the most common fractures. Types A3 and C2 make up almost half of these. Volar fixed-angle plate fixation is the gold standard of treatment today. We wanted to minimise the approach to the distal radius through a transverse 2-3 cm incision in the wrist flexor fold, tunnelling beneath the pronator muscle. The operative technique is demonstrated here. 11 patients, averaging 70 years of age, underwent surgery for 7 A3 and 4 C2 type fractures. Average operating time was 50 minutes. Length of admission averaged 2.9 days. Using a visual analogue scale, pain decreased from 6/10 preoperatively to 3/10 on post-op day one and 2/10 on post-op day three. After 6 weeks, flexion and extension averaged 45-0-45°, and radial and ulnar deviation 20-0-20°. Pronation and supination averaged 85-0-85°. Grip strength with manometer averaged 90 % compared to the contralateral side at 6 weeks and 96 % at 3 months. As comparison, from 1 January 2008 until 31 May 2013, we treated 908 patients with distal radius fractures with volar fixed-angle plates through a conventional longitudinal incision of 5-8 cm. The average skin to skin time was 46 minutes, with an average length of admission of 5.6 days. A minimally invasive approach to treat distal radius fractures with volar plate fixation and sparing of the pronator muscle is possible. The initial patients treated with this approach experienced minimal post-operative pain, shorter hospital admissions, and rapid grip strength recovery with almost undisturbed rotational motion.

[Geriatric complex treatment of proximal femoral fractures? Who profits the most?]. / Geriatrische Komplexbehandlung bei proximalen Femurfrakturen. Wer profitiert am meisten?

BACKGROUND: Geriatric complex treatment (GCT) is a new type of early rehabilitative care. The main goal is to maintain personal autonomy. GCT includes 21 treatments by physio-, occupational and speech therapists, accompanied by specialized nurses. The aim of this study was to investigate how elderly patients benefit from the GCT after hip fractures (HF). PATIENTS AND METHODS: In all, 124 patients [≥70 years; 50 patients underwent GCT, 74 underwent standard traumatologic care (STC)] after operative treatment for HF were included. Cognitive impairment was diagnosed in 46% of GCT patients and 70% were classified as ASA III. In the STC group, 23% were cognitively impaired and 50% were classified ASA III. RESULTS: Significantly more patients of the GCT group were both cognitively impaired and classified as ASA III. Among the cognitively impaired, the STC group reached a median of 20 points on the Barthel index, while the GCT group reached 60 points. CONCLUSION: The GCT patients in our study were more likely to be dependent on care and have cognitive deficits. Only cognitively impaired patients were shown to benefit from GCT. In the remaining patients no difference was found, thus, only cognitively impaired patients currently undergo GCT at our clinic.

[Pertrochanteric fracture - operation for beginners?]. / Pertrochantäre Femurfraktur - eine Anfängeraufgabe?

BACKGROUND: In patients over 65 years, pertrochanteric proximal femur fractures are very common, with an incidence of 966/100,000. Treatment of choice is nailing or dynamic hip screws. The operative approaches are standardised and easy to learn. QUESTION: Is nail fixation a good procedure for surgical training? PATIENTS: From 1 January 2012 until 31 December 2013, 210 patients with an average age of 80.7 years and pertrochanteric fractures underwent treatment. 139 patients (66%) were treated by surgical trainees, 55 (26%) by staff surgeons, and 16 by the head of the department (8%). RESULTS: Preoperative delay averaged one day. Skin to skin operative time averaged 48 minutes for all patients. For trainees, the procedure averaged 45 minutes, while the more complex cases treated by staff surgeons (multi-fragment, markedly displaced) averaged 67 minutes and thus took significantly longer (p < 0.1). There was no difference in complications. There were 6 misplaced implants and cutouts (2.8%), one infection (0.5%), and 6 operative revisions because of hematoma or seroma (2.8%). Four patients (1.9%) died of cardiovascular failure with ASA 3 and 4 during the inpatient stay (2 in each group). CONCLUSION: Internal fixation with nailing in pertrochanteric femur fractures is a standard operative approach. It is suitable as a "beginner's" procedure, that is quickly and easily performed. Only complex, multifragmented or markedly displaced or long-segment fractures need to be treated by staff physicians. Mortality is not affected by the surgeon's experience, but rather by comorbidity and from the preoperative duration.

[Kyphoplasty in the treatment of osteoporotic spine fractures - experience with 1069 cases]. / Kyphoplastie bei osteoporotischer Wirbelfraktur - Erfahrungen mit 1069 Fällen.

BACKGROUND: Kyphoplasty has been established as treatment for painful osteoporotic vertebral compression fractures for over ten years. Its effectiveness has been substantiated in multiple clinical studies. Not only is prompt pain reduction achieved, but according to a new, large, long-term study, long-term survival is also increased. PATIENTS: Balloon kyphoplasty was performed for 1069 patients between 01.01.2008 and 31.12.2013. In all cases, pain was rated more than 6/10 points, and a recent fracture was evident on cross-sectional imaging (CT or MRT STIR T2) performed to supplement spine X-rays. Average patient age was 77 ± 5.2 years. 73 % of patients were female. Treated fracture levels ranged from T 3 to L 5. METHODS: A single level was treated in 627 cases, two levels were treated simultaneously in 246 cases, three levels in 73 cases, and four levels in 29 cases. Average operative time for all patients was 35 minutes. Pain was reduced from 8.0 ± 1.0 preoperative to 2.2 ± 1.3 points postoperative in visual analogue scale (p < 0.1). Average intrahospital time was 9 days. Asymptomatic cement leckages were seen in 20 % of the cases. 855 were released home from the hospital and 210 patients went on to rehabilitation. Seven major complications (0.9 %) occurred during the hospital time (four mortalities during hospital admission, three neurological deficits, one lateral implant protrusion and a subdural bleeding). CONCLUSION: Kyphoplasty is a good procedure for treating painful osteoporotic fractures from the lumbar to the thoracic spine. Major complications occur rarely after kyphoplasty; however, they must be considered and clarified.

[Clinical cost analysis of balloon kyphoplasty--is there a possibility of cost-covering treatment?]. / Klinische Kostenanalyse der Ballonkyphoplastie--ist eine kostendeckende Durchführung möglich?

Financial pressure on hospitals has been a major issue in the health care system of the past years and the financial situation is often what decides about the future of the hospitals. Therefore today the economic feasibility of patient treatment in hospitals is more important than ever before. After the degradation of the case-based lump sum of I09D to I09F on a one and two level kyphoplasty we took that as motivation to do a cost analysis on 10 randomised cases. The average age of the patients was 75 years (m : f = 2 : 8), the average stay in hospital was 8 days (3-12 d). The analysis was done by a searching of documents in cooperation with the firm GFG-Beratungsgesellschaft mbH (Mönchengladbach, Germany). We found that the average overall cost which includes the cost of hospital stay and the expenditure on material was 7512.53 € and the average earnings of the cases was 7610,97 €, the difference and in that way the proceeds was 98.44 €. On that result performance of a one-level kyphoplasty especially after the degradation of the case-based lump sum in 2013 is possible in a cost-covering way, an increase in profit may be possible by a decrement of hospital stay. In 2014 one- and two-stage kyphoplasty once underwent a reduction of G-DRG from I09F to I09E. At the same time the cost weight of lump compensation I09E was increased by 0.071 with the result that in 2014, with an increased federal base value of 3156.82 € (in 2013 the federal base rate value was 3068.37 €), additional proceeds of 404,92 € can be realised in the field of one- and two-stage kyphoplasty compared to in 2013. On that result a one-level kyphoplasty especially after the degradation of the case-based lump sum in 2013 and in 2014 is possible in a cost-covering manner, an increase in profit may be possible by a decrement of hospital stay.

[Dislocated femoral neck fractures in geriatric patients. One-year follow-up]. / Die dislozierte Schenkelhalsfraktur des geriatrischen Patienten. Einjahresergebnisse.

BACKGROUND: In geriatric patients with Pauwels II and III type femoral neck fractures, endoprosthesis is the treatment of choice. PURPOSE: What are the long-term results after surgery? MATERIALS AND METHODS: In 2007 and 2008, 104 public health insurance (AOK) patients with displaced femoral neck fractures were treated surgically at our hospital. This number of included patients places us in the 97th percentile of all hospitals in Germany. Because the patients were publicly insured, all health information was available, including completely retrospective posthospital discharge, inpatient course, and 1-year mortality. RESULTS: A total of 77 women and 27 men (average age of 83.5 years) were included in the study. In addition to the femoral neck injury, 19% of the patients had an accompanying PCCL of 3, and 44% had a PCCL of 4. In addition, 16% suffered from heart failure, 23% from diabetes, and 19% from renal insufficiency. Time to surgery averaged 1-day postinjury. A dual head prosthesis (hemiprosthesis) was implanted in 81.4 % of cases, and a total joint prosthesis in 18.6%. Average operative time skin to skin was 53 min. Average inpatient stay was 14 days in 2007 and 12 days in 2008. On discharge, 71% of patients could ambulate independently. Of the remaining patients, two-thirds were already not ambulating independently prior to the fracture. Hospital mortality averaged 6% (national average 8.1%), and 30-day and 90-day mortality rates were 6% (n = 7) and 16.3% (n = 17). Within 1 year, 22.2% of patients (n = 23) died (national average 26.8%), with a natural mortality probability of 7.1% for an age of 83.5 years. Five patients were re-admitted, for contralateral prosthetic implantation (n = 4) or revision after periprosthetic fracture (n = 1), and 54.6% of patients were admitted to hospital during the year for other diseases (national average 53.8%). CONCLUSION: Endoprosthesis placement for displaced femoral neck fractures is a common, safe procedure. However, the patients are old and have comorbidities. Despite recent decreases in hospital mortality, the risk of death remains more than twice as high within 1 year than that for uninjured patients of the same age.

[Percutaneous treatment of unstable spine fractures - OP video and results from over 300 cases]. / Perkutane Versorgung von instabilen Wirbelfrakturen - OP-Video und Ergebnisse von über 300 Fällen.

Minimally invasive surgery for vertebral fractures results in less approach-related morbidity, decreased postoperative pain, and rapid mobilisation of patients. Such procedures can be performed even in elderly patients. However, along with the many advantages, minimally invasive procedures are technically demanding, require sophisticated tools, and there is a learning curve for surgeons. Intraoperative visualisation is often possible only radiologically, and implants are generally much more expensive. Using the data from over 300 unstable vertebral fracture cases treated over the past 3.5 years, we have developed a differentiated treatment concept, depending on the age of the patient and the fracture characteristics. Unstable fractures with involvement of the posterior edge are stabilised from posterior, percutaneously with a fixator. In patients under 60 years, monoaxial screws with inserted rods (top loading) are used, with which distraction and restoration of lordosis are also possible. Patients over 60 years are treated percutaneously with a polyaxial sextant system with rods inserted to avoid avulsion of the pedicle screws from the vertebral body. To avoid cutting through the vertebra, the fenestrated screws can be augmented with cement. The operation technique is demonstrated by a video.

[Management of dislocated radial head fractures with biodegradable implants]. / Versorgung von dislozierten Radiuskopffrakturen mit bioresorbierbaren Implantaten.

BACKGROUND: The Mason classification is used for radial head fractures. Mason type I fractures are managed by a functional conservative treatment of no loading for six weeks. Mason II fractures with a displacement greater than 10° or a depression of greater than 2 millimeters are treated with open reduction and use of biodegradable implants constructed of polylactide. These implants have the advantage of maintaining the joint surface by placement beneath the surface of the articular cartilage. Furthermore, the implants can be placed from various positions through the articular surface and are therefore more versatile than other modes of open reduction. METHOD: The OP technique in Mason II radial head fracture is demonstrated in a video for the example of a 31-year-old male patient. RESULTS: 35 patients were treated using the new polylactide pins (Polypin®). Average follow-up for 34 patients was 38 months. 31 patients with Mason type II fractures presented with a score of 96 out of 100 using the Broberg Morrey score. CT scans were performed after 18 and 24 months in all patients. One first degree asymptomatic osteolysis was observed at 18 months which was reduced at 24 months. Two years later the pins were not visible on conventional X-rays. CT scans at 5 years revealed the implants to be in various levels of resorption and bony regrowth. CONCLUSION: Dislocated radial head fractures can be treated with good results with biodegradable implants.

[Intramedullary stabilisation of clavicula fractures]. / Intramedulläre Stabilisierung von Klavikulafrakturen.

With an incidence of 64/100,000, clavicular shaft fractures are one of the most common fractures. Intramedullary fixation with Prevot nails was initially reported in the late 1990s. This procedure offers minimally invasive stabilization of the fracture, thus enabling immediate mobilization and rapid loading capacity. Using a case study, the positioning and procedure are demonstrated on video. The intramedullary implant accommodates the varying tension loading of the clavicle. This treatment is ideal for clavicular fractures with 2-3 fragments. Compared to patients treated conservatively, operated patients achieve more rapid and improved mobility. Employment disability is shorter, and malunion occurs less frequently.