[Diagnostics and classification of distal radius fractures]. / Diagnostik und Klassifikation der distalen Radiusfraktur.

Fractures of the distal radius show a wide spectrum of different fracture patterns. Although standard X­ray images are sufficient for extra-articular fractures, the exact analysis of intra-articular fractures requires the use of computed tomography (CT) with coronal, sagittal and axial sectional images. The classification is based on the Working Group for Osteosynthesis Questions (AO) criteria. The treatment strategy can be more precisely defined by a CT-based classification. Special attention must be paid to the presence of the key corners, as they have a high risk for primary or secondary dislocation if they not adequately stabilized.

[Experiences with arthroplasty of the basal joint of the thumb : The"mini-hip" gains ground]. / Erfahrungen mit Endoprothetik am Daumensattelgelenk : Die "Mini-Hüfte" auf dem Vormarsch.

The complex kinematics of the saddle joint has been a challenge in the development of trapeziometacarpal prostheses. The introduction of the dual-mobility design increases the range of motion and limits strains on the cup fixation. Therefore, rates of loosening and dislocation have been markedly reduced. Furthermore, several studies showed a similar relief of pain, range of movement and grip strength compared to the results of resection arthroplasty. The preservation of the length of the first ray as well as the more stable and functional joint can be favourable in younger and active patients. Further investigation is needed to determine whether or not those higher demands affect long-term survivorship. The high grade of patient satisfaction, the shorter recovery time and the safe surgical technique motivates considering the implantation of a total endoprosthesis with a dual-mobility cup as an attractive alternative to resection arthroplasty in the operative treatment for trapeziometacarpal osteoarthritis.

Corrective osteotomy after malunited distal radius fractures.

Posttraumatic malunion or secondary dislocation can cause wrist joint incongruency. Uncorrected malalignment increases the risk of secondary degenerative changes and chronic pain. Therefore, early correction using the available fixed-angle devices, cancellous bone grafting only becomes necessary in larger bony defects. Premounting the plate through a palmar approach with regard to the desired correction angles leads to predictable results by precise correction. In case of posttraumatic growth arrest with larger discrepancy of the radius and the ulna, a two-staged procedure is advisable.