[Results of conservative treatment of bony palmar plate avulsion of the middle joint (type I and type II according to Hintringer and Leixnering)]. / Ergebnisse der konservativen Behandlung von knöchernen palmaren Plattenausrissen am Mittelgelenk (Typ I und II nach Hintringer und Leixnering).

At the Unfallkrankenhaus Lorenz Böhler, avulsion fractures of the palmar plate of the proximal interphalangeal (PIP) joint type I the and II are treated by immobilisation in a PIP-Stack splint. We use 147 the classification of Hintringer and Leixnering (1991). The were immobilised for three weeks. For follow-up, 102 patients with 106 injured fingers from an overall of 147 patients treated by this method were investigated personally. 27 patients who could not attend, were evaluated by telephone. 22(17 to 25) months after the accident results were subjectively and objectively very good in 80% of the patients. In none of the patients extension was limited. In 18 patients, flexion was limited 5 to 10 degrees, in two patients 15 to 20 degrees. No patient had a limitation of flexion of more than 20 degrees.

[Intramedullary nailing of unstable proximal humeral fractures]. / Die Markdrahtung unstabiler proximaler Humerusfrakturen.

Unstable subcapital fractures and dislocation fractures of the humerus can usually be set by closed reduction. Stabilization of these fractures by intramedullary pins is a method which avoids damage to the soft tissues around the shoulder. Since 1985, elastic steel pins with special features have been in use. The last 20 mm of the tip of the pins is angulated at 15 degrees, and the distal end is curved in a special way for the last 20 mm. According to our experience, the results after using this method in the treatment of unstable fractures of the surgical neck (ASIF type A II/2) and dislocation fractures (ASIF type A III/2) are fair to very good. For unstable fractures (ASIF type C I/2) and other dislocation fractures (ASIF type C III/2), the method is only suitable if good reduction is possible. Between the end of February 1985 and the end of December 1990, 101 fractures of the proximal end of the humerus were treated by closed reduction and fixation with intramedullary pins. Following fractures in the anatomical neck, aseptic necrosis of the fragment of the head leads to unfavorable results. In two patients, pseudarthrosis with poor function developed. Disturbance of wound healing, postoperative hematoma, infection, myositis ossificans, or Sudeck's desease have not been observed.

Flexible intramedullary pins in the treatment of unstable proximal humeral fractures.

A series of 35 proximal humeral fractures treated with flexible intramedullary pins between 1986 and 1988 are presented. Special design features of the pins include a proximal 15 degrees angulated 20 mm tip and a 20 mm curve distally. The method is suitable for fractures in the surgical neck with displacement of bone width (AO-type A2/2). In cases of fracture-dislocation or three- or four-part fractures it is only suitable when the fragments can be reduced satisfactorily. Complications are minimal with 95 per cent bone union.

[Treatment of unstable fractures of the proximal end of the humerus using elastic curved intramedullary wires]. / Die Behandlung unstabiler Frakturen am proximalen Humerusende durch elastische vorgebogene Markdrähte.

At the Accident Hospital Lorenz Böhler and the Accident Hospital Meidling in Vienna, 48 patients with proximal humeral fractures were treated by closed reduction, intramedullary fixation with elastic pins and immobilization for two weeks in a Velpeau type stockinette (Gilchrist) between February 1985 and February 1986. The pins have a diameter of 2 mm. At there lower end there is a 20 mm long elastic curve which is ment to anker the pin in the entry hole to the intramedullary cavity, preventing sliding out of the implant. At the upper end the last 20 mm of the wire are angulated for 15 degrees. AO-classification was used. 39 patients had surgical neck-fractures. There were 34 displaced fractures (AO-type A 2/2), six dislocation- and more segment fractures and three epiphyseal separations of the adductiontype. The functional results of 36 patients were evaluated according to Neer's table. 29 patients had more than 80 points, four patients had more than 70 points and three had poor results. Reason for poor results was in one case a fracture with dislocation of the greater tuberosity which should have been treated by open reduction and the age in a 82 year old patient, who had a poor functional result after twelve weeks of treatment despite good fracture healing. There were no problems with wound healing, infections, myositis ossificans or Sudeck disease. Closed reductions of unstable surgical neck fractures and intramedullary fixation causes least damage to the soft tissues of the shoulder, leading to early good functional results.

[Therapy of severe hand infections with local penicillin-streptomycin administration]. / Die Therapie schwerer Handinfektionen mit lokaler Penicillin-Streptomycingabe.

The primary goal of treatment of severe hand infections (finger joint infection, tenosynovitis, infections of the palm and the dorsum of the hand) is nowadays not only a matter of bringing the infection under control, but also trying to get a good functional result. To reach good results the author regards two steps in treating severe hand infections as indispensable: a) the principle of early operation (the average interval between the first examination in the hospital and surgery was only 0,5 days) and b) the local instillation of antibiotics in high concentration (penicillin and streptomycin). Over a period of three years 187 patients with severe hand infections were treated. 11 (5.8%) patients required a second operation and 5 (2.6%) patients a finger amputation. The functional result was in 85% of cases very good or good and in 15% poor.