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This is a report on the stabilisation of fractures of the distal end of the radius type C2 and C3 and open fractures by external fixator. Between 1982 and 1989 38 patients with 43 fractures were treated. A follow-up was done 8 to 80 months after operation including 35 patients. 14 patients were polytraumatised. Especially in this group of patients, the advantages of this procedure can be seen. This advantages are a small stress for the patient, involving only a short time of assembling of the external fixator besides a high stability of the system. Our results show, as well as the results of the literature, that the external fixator has its place in a differentiated therapeutic concept of intraarticular fractures, open fractures and fractures with a defect of the distal radius.

Technique and results after primary valgisation osteotomy in 41 patients with femoral neck fractures are described. 2 non unions and 9 avascular femoral head necroses were observed. The primary valgisation most probably does not influence the rate of necrosis. When performed by accurate technique it lowers the incidence of non union of the femoral neck. Postoperative leg lengthening is always evident. The most current avoidable mistake is an external rotational deformity. The procedure requires proper preoperative planning.

Compound osteosyntheses are in fact mostly intended to effect temporary (i.e. for a limited time) stabilization of pathological fractures, especially of spontaneous fractures in the case of metastasizing tumours. However, in view of the fact that progression of such tumours metastasizing into the skeleton cannot be predicted with reasonable accuracy, it is better to bridge over the spontaneous fracture not only by means of a compound of bone cement and metal plate, but also to see to it--as far as ever possible--that bony healing is induced via grafting of autogenous bone material. If this is not done, prolonged stress on the metal/cement compound may result in fatigue rupture.

The complex and simple fractures seen in polytrauma patients after initial treatment sometimes show signs of poor setting and non-union with possible unfavourable functional consequences making reconstructive surgery necessary. In this report characteristic posttrauma problems and reconstructive surgery of the proximal femur, the femoral shaft and the distal femur are discussed. Possibilities other than prothesis or joint fusion, especially in the hip or knee joint, should be considered.

Evaluation of a dislocated shoulder must classify the direction of dislocation and describe additional injuries as well as the recurrence rate. This is required in all types of dislocations by recording the case history in detail, and by examining the shoulder clinically as well as radiographically in two planes. Ultrasound and arthro-computer tomography are valid methods to demonstrate injuries of bony and ligamentous structures. They may therefore influence surgical treatment. In posterior dislocation of the shoulder quite often early diagnosis is missed. If this injury is suspected, careful clinical and radiographical evaluation is most important.

In the treatment of open fractures of the lower limb and of fractures combined with severe damage of soft tissues, external fixation is favoured. Additional soft tissue damages in the compartments of the lower limb are avoided by using an external fixation in form of a clamp. In defect fractures, shattered fractures and in all fractures in the distal third the stability of clamp fixation is enhanced by plating of the fibula. Furthermore by osteosynthesis the reconstruction of the correct length of the lower limb can be performed. 36 fractures healed definitively in an average of 17.1 weeks by this procedure. Secondary procedures were: 8 cases with decompression of compartments, 11 cancellous bone grafts, 13 fixateur externes were removed because of the infection of the Schanz'screws, and healing was achieved by using a plaster cast. The therapeutical procedure was changed in 5 patients to a plate osteosynthesis and in 8 patients to an intramedullary nail.

The oblique osteotomy of metatarsale I according to Ludloff allows good and various corrections in hallux valgus deformities. Various modifications of the osteotomy are described. In case of simultaneous osteoarthritis of the metatarsophalangeal joint the additional resection according to Keller-Brandes is recommended.

25 subcutaneous tendon ruptures of the upper arm were operatively treated between 1982 and 1985. The long biceps tendon was ruptured fifteen times, the distal biceps tendon eight times and the triceps tendon twice. Operative procedures and the functional results are described. The follow-up investigation was undertaken on an average of 14 months after operation. Mechanism of injury and variations of histological findings in the different tendons are compared. The functional results are good. The operative treatment of subcutaneous tendon ruptures of the upper arm is therefore recommended.

The fracture of the distal radius loco typico is one of the most frequently occurring fractures. This article presents types of fractures, in particular Colles', Smith's, Barton's and multiple-fragment's fractures. Conservative and operative treatment is described, as well as problems related to the different procedures. Besides fracture retention by plaster splint or cast, Besides fracture retention by plaster splint or cast, transcutaneous osteosynthesis by Kirschner wire, lag screws, osteosynthesis by buttress plate and the use of the external fixator are described as examples of operative therapeutics.

In compound fractures, after debridement and stabilisation, primary open wound treatment with synthetic skin substitute is the method of choice. A follow-up examination of 171 second- and third-degree compound fractures between April 1974 and June 1981 showed an infection rate of 18,7% and an osteitis rate of 14,6%. In 23 cases conservative surgery was performed, in 17 cases primary amputation was necessary. In 85% of all cases bone healing was achieved after an average of 5,4 months.

It is shown on the basis of two observations that computed tomography represents a valuable additional means to clarify the diagnosis of congenital and traumatic changes in the pelvis, especially the sacrum and vertebral column. The article explains the differential diagnosis between congenital fissures of the pelvic arch and fractures by means of computed tomography. This is illustrated with the help of x-ray morphologic criteria.

Bone grafting of the vertebral body is an essential part in stabilisation of the spine. A modified transpeduncular approach to the vertebral body is described. Using this approach a bone graft can be placed more exactly in a shorter time.

The indications of an arthrodesis of the knee joint have changed and seem to be rare in a century of total arthroplasty. However, even nowadays the arthrodesis of the knee joint is still carried out with good results in: postinfectious gonarthrosis, irreparable posttraumatic instability, Charcots knee, Neoplastic destructions in special cases, for patients with a severe painful and deforming arthrosis of any reason, which are too young for an arthroplasty and in a century of arthroplasty for all patients after failure of arthroplasty. Within a period of 11 years from 1969-1980, 105 patients underwent an arthrodesis of the knee joint at BG Unfallklinik Tübingen. Indications and technique are given, the value of an individual postoperative care is pointed out.