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The ideal treatment of displaced intra-articular calcaneal fractures is still controversially discussed. Because of the variable fracture patterns and the vulnerable soft tissue coverage an individual treatment concept is advisable. In order to minimize wound edge necrosis associated with extended lateral approaches, selected fractures may be treated percutaneously or in a less invasive manner while controlling joint reduction via a sinus tarsi approach. Fixation in these cases is achieved with screws, intramedullary locking nails or modified plates that are slid in subcutaneously. A thorough knowledge of the three dimensional calcaneal anatomy and open reduction maneuvers is a prerequisite for good results with less invasive techniques. Early functional follow-up treatment aims at early rehabilitation independent of the kind of fixation. Peripheral fractures of the talus and calcaneus frequently result from subluxation and dislocation at the subtalar and Chopart joints. They are still regularly overlooked and result in painful arthritis if left untreated. If an exact anatomical reduction of these intra-articular fractures is impossible, resection of small fragments is indicated.

Background: The goal of the present study was to summarize current treatment for acute acromioclavicular (AC) joint dislocations., Method: In all, 796 orthopedics and/or trauma departments in Germany were identified in the national hospital directory (www.dka.de). Using the respective hospital web sites, the email addresses of the responsible shoulder/sports surgeon or, if not available, the head of department (successful in 746 cases) were identified. Emails with a link to an online survey with 36 questions and two reminders were sent; 60 were undeliverable. Thus, 686 emails probably reached the addressee. A total of 203 colleagues (30%) participated in the survey. Findings were compared to results of the survey published by Bäthis et al. in 2001., Results: More than 90% treat Rockwood I or II injuries conservatively and Rockwood IV to VI injuries surgically. However, 34% answered having never seen a Rockwood VI injury. Of those replying, 73% prefer surgical treatment for Rockwood III injuries. Favored surgical techniques were the hook plate in 44% and the arthoscopic TightRope® in 27%, while 11% prefer coracoclavicular cerclage, 6% AC joint transfixation, 3% minimally invasive AC joint reconstruction (MINAR), 1% coracoclavicular screw fixation, and 8% a completely different procedure. Concerning acute Rockwood III injuries, orthopedics and/or trauma surgeons still prefer surgical treatment but less often than 10 years ago (84%)., Conclusions: Favored techniques have completely changed since 2001 when the majority of physicians preferred AC joint transfixation or coracoclavicular cerclages, both techniques that are hardly used today. The hook plate appears to have become "standard therapy". The arthroscopic TightRope® is the second most common despite being the newest technique.

Proximal humeral fractures are always a relevant topic in routine clinical practice. Modern surgical techniques and implants do not resolve all problems. So, this fracture remains the focus of current research. As a consequence, some innovative approaches have arisen. The following recent trends can be observed and analyzed in detail: (1) Arthroscopically assisted fracture treatment and therapy of concomitant injuries/fracture sequelae, (2) locking plates: results and complication rates of recent implants, relevance of polyaxiality, impact of osteoporotic bone structure, (3) debate: what is "minimally invasive?", (4) "medial support", (5) Arthroplasty in fracture situations - the reversed shoulder arthroplasty as primary fracture prosthesis in the elderly patient.

The rising incidence of distal intra-articular humeral fracture in elderly patients associated with osteoporosis frequently leads to difficulties in acute reconstruction and may result in early failure of internal fixation. The biomechanics of the elbow joint and especially the flexor group as well as the brachioradialis muscle as part of the extensor group is analyzed. The complex motion pattern of the transarticular muscle groups increases the load on internal fixation and may affect the interface between implant and osteoporotic bone. An external fixator with motion capacity serves to protect the internal osteosynthesis and secures the fixation in osteoporotic bone.

With respect to the founding of the AOVET in 1969, the development of the systematic osteosynthesis in large and small animals is reviewed. With the introduction of the stable OS techniques corresponding to the principles and operative techniques developed by the organization of ASIF/AO (hum), the systematic operative fracture treatment in animals expanded remarkably. The application of the "absolutely" stable compression osteosynthesis was the basis for the successful fracture treatment in large animals. The systematic osteosynthesis in small animals was realized through the generation of a multitude of stabilization techniques for the different fracture types in the various anatomical areas and for special orthopaedic interventions. This was achieved through a specifically developed implant- instrument system and corresponding operation methods. This development was supported by instruction courses, published manuals and visiting fellowships. The extensive collaboration in research and development led to an increasing understanding of the diverse bone healing processes. The AOVET enjoyed a progressing integration into the AO/ASIF (hum) organization.

Osteoporosis is an age-related systemic disease leading to increased bone fragility. The vertebral bodies of the transitional area between the thoracic and lumbar spine are often involved. A large number of unreported or late-diagnosed fractures have to be assumed. If risk factors such as advanced age or comorbidities are present in the case of new-onset back pain, an osteoporotic vertebral body fracture as a possible cause has to be considered. This sets the diagnostic workup in motion, consisting of clinical and radiological examinations. In addition to conservative treatment, minimal invasive cement augmentation of the fracture via vertebroplasty or kyphoplasty is an option. Open surgical procedures, feared by older patients and their physicians, are rarely necessary. Of utmost importance after dealing with the fracture is the subsequent treatment of the underlying osteoporotic disease to prevent the occurrence of further fractures.

The primary objective of surgical fracture management by means of osteosynthesis used to be achieving the maximum fracture stability possible; this maxim has given way over time to a more biological approach. Advances in the technical development of implants, including their material properties, have created the conditions for osteosynthetic procedures with minimal soft tissue disruption. The technical conditions of modern external fixator systems allow an unlimited number of assemblies matched to the requirements of each individual patient. Special changes in plate holes and interlocking nails have increased the angular and axial stability of the assembly and are particularly suitable for fractures with inferior bone quality, for example in the case of osteoporosis. Navigated osteosynthetic procedures permit reliable and low-risk implantation of implants in anatomically challenging regions. Out of the sometimes distressing experiences of early osteosynthetic procedures where postoperative radiographs showed delayed or absent bone healing, grew the realisation that good vascularity of the soft tissues and bones is a prerequisite for good healing and a timely and favourable outcome. This means that in each individual case an appropriate implant and stabilization method should be selected by the surgeon, who is not only familiar with anatomy but also with soft-tissue-conserving (minimally invasive) operative techniques.

With the increasing use of minimally invasive plate osteosynthesis in the last years almost every anatomical region was included in this new technique. Thus, it is not used any more for certain fractures and problematic areas, but also in fractures where it represents a challenge to established osteosynthesis techniques like intramedullary nailing or conventional plating. Therefore the challenge for the treating surgeon increased to find the right answer for the particularities of an individual fracture by choosing the optimal method. The most popular indications for the use of minimally invasive plate osteosynthesis are presented and the technical details are discussed. The possibilities for complications--in a common way and for specific fractures--are presented and discussed.

Minimally invasive techniques and developments of implants with angular stability have led to a renaissance of plate osteosynthesis for fracture stabilization in recent years. They represent a major source of success which has facilitated minimally invasive plate osteosynthesis (MIPO) or even made it feasible. For implants with LCP technology all current types of screws can be used and/or combined. However, the treating surgeon is still confronted with the decision which fixation mode, absolute or relative stability, is required for each individual fracture. Moreover, reduction techniques, intra-operative imaging and the biomechanical features of the selected implant require a more meticulous preoperative planning. Minimizing the surgical trauma has resulted in decreased complication rates of problematic fractures. However, the particular inherent risks of a closed procedure have to be evaluated for each body region to avoid severe complications.

Objective: Anatomic reduction and stable fixation by means of tissue- preserving surgical approaches. INDICATIONS Displaced acetabular fractures. Surgical hip dislocation approach with larger displacement of the posterior column in comparison to the anterior column, transtectal fractures, additional intraarticular fragments, marginal impaction. Stoppa approach with larger displacement of the anterior column in comparison to the posterior column. A combined approach might be necessary with difficult reduction. CONTRAINDICATIONS Fractures > 15 days (then ilioinguinal or extended iliofemoral approaches). Suprapubic catheters and abdominal problems (e.g., previous laparotomy due to visceral injuries) with Stoppa approach (then switch to classic ilioinguinal approach)., Surgical Technique: Surgical hip dislocation: lateral decubitus position. Straight lateral incision centered over the greater trochanter. Entering of the Gibson interval. Digastric trochanteric osteotomy with protection of the medial circumflex femoral artery. Opening of the interval between the piriformis and the gluteus minimus muscle. Z-shaped capsulotomy. Dislocation of the femoral head. Reduction and fixation of the posterior column with plate and screws. Fixation of the anterior column with a lag screw in direction of the superior pubic ramus. Stoppa approach: supine position. Incision according to Pfannenstiel. Longitudinal splitting of the anterior portion of the rectus sheet and the rectus abdominis muscle. Blunt dissection of the space of Retzius. Ligation of the corona mortis, if present. Blunt dissection of the quadrilateral plate and the anterior column. Reduction of the anterior column and fixation with a reconstruction plate. Fixation of the posterior column with lag screws. If necessary, the first window of the ilioinguinal approach can be used for reduction and fixation of the posterior column., Postoperative Management: During hospital stay, intensive mobilization of the hip joint using a continuous passive motion machine with a maximum flexion of 90 degrees . No active abduction and passive adduction over the body's midline, if a surgical dislocation was performed. Maximum weight bearing 10-15 kg for 8 weeks. Then, first clinical and radiographic follow-up. Deep venous thrombosis prophylaxis for 8 weeks postoperatively., Results: 17 patients with a mean follow-up of 3.2 years. Ten patients were operated via surgical hip dislocation, two patients with a Stoppa approach, and five using a combined or alternative approach. Anatomic reduction was achieved in ten of the twelve patients (83%) without primary total hip arthroplasty. Mean operation time 3.3 h for surgical hip dislocation and 4.2 h for the Stoppa approach. Complications comprised one delayed trochanteric union, one heterotopic ossification, and one loss of reduction. There were no cases of avascular necrosis. In two patients, a total hip arthroplasty was performed due to the development of secondary hip osteoarthritis.

A historic review distinguishes three periods in the treatment of fractures: The conservative period (approximate reduction and immobilization in traction or plaster cast), the mechanical and operative period (exact anatomical reduction and stable--even rigid--fracture fixation), and the biological and mechanical period (stability with strict attention to the biological environment of the bone circulation). Biological fracture fixation means: conservation of bone perfusion, protection of the soft tissue envelope and reduction of systemic stress by strengthening the host-defense mechanism. For preoperative planning, the following points have to be considered: choice of fixation method, reduction technique (open, closed, additional aids), surgical tactics (approach), and intra- and postoperative adjuvant therapy.