Computed Tomography and Pathobiomechanical-Based Treatment of Volar Distal Radius Fractures.

Today, there are various classifications for distal radius fractures (DRF). However, they are primarily based on plain radiographs and do not provide sufficient information on the best treatment option. There are newer classifications that simultaneously consider the pathobiomechanical basis of the fracture mechanism and analysis of computed tomography images. Main determinants of which type of DRFs occurs are the strength/direction of the applied forces on the carpus and radius, and the position of the wrist relative to the radius during the fall. Reconstruction of the mechanism of injury provides information about which anatomic structures are involved, such as torn ligaments, bone fragments, and the dislocated osteoligamentous units. This article attempts to combine and modify current pathobiomechanically oriented classifications with an improved understanding of the "key fragments" to subsequently offer a treatment approach to stabilize these critical fragments through specific types of internal fixation.

[Midterm results after sole percutaneous treatment for central impression fractures of the base of the middle phalanx]. / Mittelfristige Ergebnisse nach alleiniger perkutaner Versorgung zentraler Impressionsfrakturen der Mittelphalanxbasis.

PURPOSE: This study investigated the midterm results after sole percutaneous treatment for central depression fractures of the base of the middle phalanx. PATIENTS AND METHODS: 19 men and 2 women with an average age of 31.9 (18 - 57) years with a central depression fracture of the middle phalanx treated solely by intramedullary reposition with a bended K-wire and percutaneous K-wire fixation were followed on average of 13.2 (3 - 40) months. RESULTS: At the time of the last follow-up, all patients were able to pursue their previous occupational activity as well as their usual leisure activities and were painfree (VAS 0). The postoperative active flexion of the affected PIP joint was 86° with an average extension deficit of 1° or 93 % of the range of motion of the uninjured PIPJ of the opposite side. Radiologically there was a nice remodeling of the articular surface with no osteoarthrosis. There were no pin-associated complications or wound healing disorders. CONCLUSION: The sole intramedullary reduction with K-wire osteosynthesis is a suitable and reliable method for the treatment of the central impression fracture. Good functional results can be achieved with low surgical effort.