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Biomedical subjects

M Blauth

Publications and source records attributed to M Blauth.

At least 55 records · Page 3Linked to original sources
PubMed1999

[Effect of a crosslink or cerclage on the mechanical stability of an internal fixator].

This study was performed to evaluate the effect of a cerclage or a crosslink on internal fixator mechanical stability in an unstable spine injury model. Nine human thoracolumbar spine specimens were instrumented either with an internal fixator alone (T12-L2) or together with a cerclage or a crosslink. Four modes of loading were used: flexion, extension, lateral bending, and axial rotation. Moments itself were generated using a specially designed loading jig and loading system. The maximum moment applied was 10 Nm, three load-unload cycles were performed. The flexibility was measured by a motion tracker and range of motion (ROM), elastic zone (EZ) and neutral zone (NZ) were calculated. Statistical analysis was performed using the paired t-test (p < 0.05). For flexion, extension and lateral bending all devices were significantly more stable (p < 0.01), for axial rotation all devices were significantly less stable compared to the intact specimen (p < 0.01). But the crosslink provided significantly more stability compared to the internal fixator alone (p < 0.001). The complete device, i.e. internal fixator + crosslink, was significantly more stable compared to internal fixator + cerclage (p < 0.05). In this study the use of a cerclage had no additional effect in stabilizing the internal fixator. The operative and financial expenditure using a crosslink seems to be justified in fractures with a high rotationally instability, i.e. in type A-3-, B-, and C-injuries according to Magerl et al. [18].

Bone Plates↗
PubMed1998

[Complex injuries of the spine].

3 different types of complex spinal trauma are defined: Type I means a multilevel contiguous or non contiguous unstable injury, type II is described as a spinal injury with concomitant thoracic or abdominal lesion, type III stands for the coincidence of spinal injury and polytrauma. Overlapping of different types occurs. Type I: The incidence amounts according a german multicenter study to about 2.5%. Multilevel injuries need to be stabilized for a long distance from posterior. With a thorough analysis the segments to be fused are determined. Type II: The leading thoracic injury is a lung contusion which occurs in up to 50% of the cases. A CT scan of the thorax during the first diagnostic screening is recommended. Early reduction and stabilization from posterior should be aimed at. During the first two weeks anterior procedures are contraindicated. Abdominal injuries are to be found in 3-4% of all spinal injuries. All organs could be affected. A typical constallation is the "seat-belt syndrome" with lesions of the upper abdominal organs and a flexiondistraction injury of the upper lumbar spine. The main problem is to make the diagnosis of both components initially. Most of the patients may be treated in one operation by first taking care of the abdominal injury and than stabilizing the spine. The prognosis of this combination is favorable. Type III: In 17-18% of all polytraumatized patients lesions of the spine are to be diagnosed. From these only one third need surgical care. From 680 patients with operatively treated fractures of the thoracolumbar junction 6.2% were polytraumatized according to the multicenter study mentioned above. The risk of missing a spinal injury in polytrauma totals approximately 20%. Surgical stabilization should be performed in the primary phase (day-1-surgery). Additional injuries, potentially time consuming operations with a high blood loss sometimes necessitate a different approach. Non stabilized spinal injuries apparently do not have the same negative effect on the whole organism as long bone fractures. In the early phase of treatment on the C-spine only anterior procedures and on the thoracolumbar spine only posterior techniques should be applied.

Adolescent↗
PubMed1998

[Elbow para-articular pseudarthrosis. Etiology and treatment].

Non-unions in the proximity of the elbow are very rare and in most cases caused by mistakes in initial treatment. Reconstruction after pseudarthrosis of the elbow continues to pose a challenge for any surgeon. The aim of our study was to analyze the initial mistakes and to underline the most important aspects of reconstructive surgery. In a retrospective study over a defined period of 10 years (1/1985 to 12/1994) we were able to treat altogether 27 non-unions in the proximity of the elbow. These patients were transferred to our hospital at an average of 44 weeks after initial therapy elsewhere. The main symptoms were in 17 cases pain and in all other patients functional deficit. Reconstructive surgery was performed an average 54 weeks after the primary injury. In 24 out of 27 cases a re-osteosynthesis, in 12 an arthrolysis, in 7 a neurolysis and in 2 cases an arthroplasty was needed. The patient could return to work an average 18 weeks after the operation and 53 weeks after injury. The initial complaints were reduced in 24 of 27 cases, with a significant improvement in the ROM and functional outcome according to the Mayo Elbow Performance Index.

Adolescent↗
PubMed1998

Chest tube decompression of blunt chest injuries by physicians in the field: effectiveness and complications.

OBJECTIVE: Recent literature suggests that patients who undergo emergent tube thoracostomy in the field are at increased risks for complications. This study evaluates indications, complications, and effectiveness of field placement of chest tubes by an aeromedical service. METHODS: In a prospective study, 624 consecutive patients with chest injuries (Abbreviated Injury Scale score 1-6) were included. All patients were treated at the scene by a physician-staffed aeromedical service and transported by air to a Level I trauma center. Indications, clinical findings before and after chest tube insertion, and subsequent radiologic diagnosis by chest roentgenography were documented prospectively. RESULTS: Seventy-six chest tubes (50 unilateral, 13 bilateral) were inserted laterally in 63 patients (10%) by blunt dissection. Clinical findings included pneumothorax in 30 patients and hemothorax in 18 patients. In 15 patients receiving field chest tubes, neither pneumothorax nor hemothorax was confirmed. Six patients (<1%) arrived at the trauma center with unsuspected pneumothoraces and required chest tube insertion. No tension pneumothoraces escaped field detection and treatment. Four chest tubes placed in the field required repositioning in the hospital because of malfunction or malpositioning. Radiologic findings excluded intraparenchymal tube placements in all patients. No pleural infections were observed in these 63 patients during their hospital stay. No antibiotics were administered as a result of prehospital chest tube placement. CONCLUSION: Prehospital chest tube thoracostomy is safe, effective, and associated with low morbidity. Nontherapeutic chest tube placements occurred in 15 of 624 patients (2.4%); missed pneumothoraces occurred in 6 of 624 patients (<1%). Aggressive prehospital physician management of blunt chest trauma leads to an earlier treatment of potentially life-threatening injuries. Significant morbidity can be avoided by prompt pleural decompression using proper techniques.

Abbreviated Injury Scale↗
PubMed1998

[Reduction and positioning of cervical spine injuries].

Prerequisites for successful reduction of cervical spine injuries are an exact analysis and classification of every lesion. In locked dislocations disc protrusion should be excluded prior to reduction by MRI or CT-scan. For manual reduction and closed manipulation by the trauma surgeon we use a halo-ring which is applied in local anaesthesia and fluoroscopic control. The anatomic position is maintained by a halo-fixator until surgery. Skeletal traction is used mainly for locked dislocations and late malalignements. Traction is provided by a halo-ring and weights up to 20 kg. Repeated clinical and neurological examinations are necessary to rule out overdistraction of the spine or neurologic deterioration. The weight may be reduced after reduction to 2 kg. For intraoperative positioning and reduction of cervical spine injuries we designed a special device which is connected to the halo ring and allows to fix the head and spine in any desired position. It may be used in prone or supine position of the patient. Operative reductions are rarely necessary on the cervical spine. Typical indication are fractures of posterior elements of the spine preventing closed reduction. Reduction manoeuvers depend on the kind of injury and are mainly composed of traction and a reversal of the trauma mechanism. The most severe complication is a neurologic deterioration. Reports in literature about 13 patients having sustained such a fate are showing the following: In most cases disc material dislocated in the spinal canal during reduction could be made responsible for the catastrophic course. Especially at risk are patients with open reduction from a posterior approach.

Cervical Vertebrae↗
PubMed1998

[Ventral interbody spondylodesis in injuries of the cervical spine. Indications, surgical technique and results].

Lower cervical spine injuries with instability of the anterior and/or posterior column can be treated by anterior interbody fusion and plate fixation. Plates available for anterior instrumentation of the lower cervical spine can be divided into locking or non-locking systems with uni- or bicortical screw purchase. Our biomechanical comparative testing of different screw fixation systems demonstrates improved stability with the use of bicortical purchase. Clinical studies, however, have proven high fusion rates without loss of correction and a low implant related morbidity with the use of unicortical as well of bicortical plate systems. Correct reduction and intraoperative positioning of the unstable cervical spine is crucial to avoid implant related complications. Also, limitations of anterior instrumentation for the treatment of specific lesions of the lower cervical spine have to be considered, e.g. in complex lesions with axial instability or in fracture dislocations with ankylosing spondylitis. Changes or alterations of adjacent segments can be reduced by the use of plates with correct lengths, contact of uninjured adjacent discs with implants should be avoided. A comparative analysis of two patient collectives--89 patients (1972-1983) and 102 patients (1987-1994), all of them treated with bicortical plate fixation--revealed different results in terms of implant failure, operative reduction and loss of correction. All but one surgical fusions had healed radiologically. Implant related complications during the first 3 months after the initial operation were lower in the latter group, only 3 out of 102 patients (3%) with implant loosening versus 7 our of 89 patients (8%) with implant breakage or loosening required surgical revision. In all cases technical errors could be detected. Clinical follow-ups with personal examination was performed in 144 patients: 57 of 72 survivors of series I (79%) after an average time of 11 years 9 months and 87 out of 94 survivors of series II (85%). The radiologic examination revealed 2 patients with screw breakage in series I, one patient with an asymptomatic implant loosening in series II. Only one case was observed with a loss of correction after loosened and early removed hardware. In all other patients there was no difference of radiologic angles between postoperative X-ray and follow-up. 16 patients, 12 of series I, 4 of series II, were fused in a kyphotic position after insufficient preoperative reduction. Radiologic alterations of adjacent segments, i.e. spondylophyts or "spontaneous" fusions, were observed in more than 50% of all patients of both series. However, complaints or persistent pain did not correlate with radiologic findings. Also in both series there was a high percentage of patients with mild, residual neck pain in spite of a very good radiologic result. Only in a very few cases the complaints had to be treated by drugs.

Adolescent↗
PubMed1998

[Injuries of the cervical spine in children].

Injuries of the spine in children rarely occur. They amount to about 0.2% of all fractures and dislocation and to 1.5 to 3% of all lesions of the spine. The younger an injured child is, the more likely it has sustained a lesion of the upper cervical spine. This spinal segment in comparison to adults is concerned more often and accounts for 50% of all C-spine injuries. Important differences between the adult spine and the spine in the child disappear with the age of 10 years. Later diagnostics, classification and treatment correspond widely with the principles valid in adults. The knowledge of the normal shape and development of the spine are crucial in avoiding misinterpretations of X-ray films. Typical examples include the confusion of synchondrosis with fractures or of subluxations of the atlas and the C2/C3 segment with "true" instabilities. Relevant lesions always are accompanied by clear clinical symptoms. Specific injuries of the growing axial skeleton are lesions of the cartilaginous endplates and "fractures" of the synchondrosis. Atlantooccipital dislocations (AOD) occur typically in children. According to our experiences with 16 AOD we propose--dependent on the direction of dislocation of the occipital condyles--a simplified classification in anterior, posterior and completely unstable AOD. In one boy in our series we treated the lesion successfully by temporary internal fixation. He presented a massive improvement of initially subtotal neurologic symptoms. Injuries to the synchondrosis of the dens represent another typical lesion in childhood. Four out of 5 children treated in our clinic were involved as back seat passengers in head-on motor vehicle accidents. Three of them were restrained by 4 point children's seat harnesses. For conservative treatment we prefer a halo and plaster-vest for 12 weeks after closed reduction. We recommend operative treatment in cases of major dislocation with greater instability where it may be impossible to maintain alignment with halo fixation. Surgical equipment and techniques correspond in detail to those used in adults. Three of the five children mentioned have been stabilized successfully by anterior screw fixation. Atlantoaxial dislocations (AAD) are divided into translatory and rotatory instabilities. Sagittal dislocations of the atlas in children also need to be fixed by a fusion between C1 and C2. Rotatory instabilities in the acute phase are easy to reduce and are treated with a halo-fixator. According to our experiences in two delayed cases anatomical reduction is also possible after months partly by open, partly by closed means. For the lower C-spine lesion with encroachment of the spinal canal and above all ligamentous injuries represent a clear indication for operative treatment because, similar to the adult spine, they do not become stable after close management.

Adolescent↗
PubMed1997

[Perforation of the cervical esophagus after ventral fusion of the cervical spine. Defect coverage by muscle-plasty with the sternocleidomastoid muscle: case report and review of the literature].

The therapy for spontaneous or artificial perforation of the esophagus remains a controversial matter. The following case report deals with the medical history of an artificial esophageal perforation after operative treatment of cervical disc disease. A 68-year-old male patient underwent a C4/C5 and C5/C6 discectomy with interbody fusion of C7-T1 vertebral body, according to Smith-Robinson. During this operation, a 3-cm-long lesion was made in the posterior wall of the esophagus, which was treated 24 h later with a primary suture. The clinical follow-up was complicated by mediastinitis with subsequent multiorgan failure. After recovery from this critical condition the patient dysphagia, which was related to a persistent lesion in the posterior esophageal wall with endoscopically demonstrated dislocation of a screw. After removal of the screw, the lesion was covered by means of sternocleidomastoid myoplasty. Moderate postoperative dysphagia was successfully treated by bougienage.

Aged↗
PubMed1997

[Long-term results of therapy of open and closed fractures of the elbow joint].

Fractures of the elbow joint are quite rare compared with the total incidence of injuries to the extremities. However, elbow fractures often result in significant disability. Therefore in a retrospective study, we have evaluated criteria that are of prognostic value for late functional outcome. Sixty-four (10.3%) of 622 patients with closed elbow fractures and 107 (89%) of 119 patients with open elbow fractures underwent a physical examination. The mean follow-up time was 8.2 years. The functional outcome was recorded by a modified score (0-max. 15) according to Morrey. Epidemiological data from both groups revealed a greater severity and higher degree of injury in open fractures than in closed fractures. In contrast, both groups presented a comparably good functional result. The most significant factor for poor outcome (score < 5) was identified as nerve lesions. Among all nerve lesions in open fractures, 45% resulted in a functional score of < 5; in 42% of closed fractures combined with a nerve lesion a similarly poor result was also noted. A second major factor appeared to be the method of primary therapy. An external joint transfixation resulted in a score of < 5 in 32% of patients that were treated primarily by transfixation. In cases initially treated with open reduction and internal fixation, only 18.5% of open fractures and 3.1% of closed fractures presented a similar low score. According to our results the late functional outcome of elbow fractures depends less on the type of fracture than on the presence of a nerve lesion and the method of primary treatment, which should facilitate early mobilization.

Elbow Joint↗
PubMed1997

[Fractures of the thoracolumbar spine. Late results of dorsal instrumentation and its consequences].

Between January 1989 and July 1992, 76 patients with thoracolumbar fractures were operatively treated at the Department of Trauma Surgery, Hannover Medical School. After a mean of more than 3 years, 56 of 62 patients (90%) still alive who had their implants removed were examined. According to the ASIF classification 33 patients sustained type A fractures, 13 type B and 10 type C. Three patients with incomplete paraplegia returned to normal; in one case of complete paraplegia no change occurred. In 40 cases the dorsal instrumentation was combined with transpedicular cancellous bone grafting. The mean operative time totaled 3 h. In this series, two complications (3.6%) were observed: one iatrogenic vertebral arch fracture without consequences and one deep infection. Compared to the preoperative status, our follow-up examinations demonstrated permanent physical and social sequelae; the percentage of individuals able to do physical labor was reduced by half (22 to 11 patients) whereas the share of unemployed or retired patients doubled (4 to 8 patients). At the time of follow-up examination only 21 of 42 patients continued in sports. The assessment of complaints and functional outcome with the "Hannover Spinal Trauma Score" reflected a significant difference (P < 0.001) between the status before injury (96.6/100 points) and at the time of follow-up (71.4/100 points). The radiographic assessment in the lateral plane (Cobb technique) demonstrated a significant (P < 0.001) mean restoration from an initial angle of -15.6 degrees (kyphosis) to +0.4 degree (lordosis). Serial postoperative radiographic follow-up showed progressive loss of correction; at follow-up examination we found a mean of 10.1 degrees (P < 0.001). Compared to the preoperative deformity a mean improvement of 6.1 degrees to an average of -9.7 degrees at follow-up examination was noted. The addition of transpedicular cancellous bone grafting did not decrease the loss of correction. CT scans after implant removal were performed in 9 cases: only 3 of 9 patients showed evidence of intervertebral fusion. No correlation could be found between ASIF classification and radiographic outcome. However, the preoperative wedge angle of the vertebral body correlated significantly with the postoperative loss of reduction. Due to disappointing results after dorsal stabilization with transpedicular cancellous bone grafting we recommend a combined procedure with dorsal stabilization and ventral fusion in cases of complete or incomplete burst injury of the vertebral body.

Adolescent↗
PubMed1997

[New developments in joint surgery].

The treatment of joint injuries has seen a marked development in the last years. The surgical trauma of articular reconstruction was reduced and our deeper understanding of the mechanism of connective tissue healing influenced the rehabilitation program after joint injuries significantly. Indirect soft-tissue sparing reduction techniques can be applied to most joint fractures and improved fixation techniques using intraoperative fluoroscopy or arthroscopy allow to avoid vast exposures of the joint. The process of ligament healing requires joint movement and a certain stress to the healing tissue in order to achieve optimum scar strength, stiffness and remodeling. Immobilisation thus should be avoided completely after ligament injuries and certain lesions can be treated non-operatively with a high success rate (MCL rupture, ankle sprain, elbow dislocation). In other injuries, surgery should stabilize the joint thus allowing functional rehabilitation (cruciate ligament tears, shoulder dislocation).

External Fixators↗
PubMed1997

[New developments in surgery of the injured spine].

There are many new options, and those procedures that are interesting from the aspect of traumatology have been selected: (1) A special positioning aid for the treatment of injuries to the cervical spine. The appliance has proved extremely useful for reduction and immobilization of fractures and dislocations and also allows reliable positioning of the head in all desired surgical positions when ventral and/or dorsal approaches are used. (2) A new titanium H-plate, which can be fixed either with the usual 3.5-mm-thick screws or with unconventional 4.5-mm-thick screws in the case of lesions to the lower cervical spine. (3) A new technique for less invasive atlanto-axial screw fixation, with a cannula system extending to the axis from small incisions at the level of the upper thoracic spine, by way of which the C-1 joint block can be drilled, milled and screwed. (4) Jeanneret's CerviFix rod system. This system has progressed beyond the drawbacks of plating as performed so far for internal fixation of the dorsal cervical spine, in which screws could be inserted only at predetermined intervals and angles. Movable grips, lateral stabilizers and extension pieces mean that the system is very well able to fulfil the demands of a variable and stable implant. (5) Transthoracic endoscopic spinal surgery, which is excellently suited to fusion of a traumatized segment to supplement reduction and instrumentation from a dorsal approach. (6) A reduced-invasion method at the thoracolumbar transition, with no insertion of implants from a ventral approach and blocking through a small left lateral thoracotomy with autogeneic shavings from the iliac crest.

Endoscopes↗
PubMed1997

In vitro and in vivo radiomorphometric analyses of distal screw hole position of the solid tibial nail following insertion.

OBJECTIVE: The objective of this study was to analyse the position of the distal interlocking holes of an unreamed solid tibial nail relative to the adjacent cortices of the tibial bone. DESIGN. IN VITRO: and in vivo radiographic-morphometric analysis. BACKGROUND: To date, 'radiation-independent' intramedullary distal interlocking aiming systems have not been successful, primarily because proximally mounted aiming devices cannot account for the deformation of the nail during insertion; therefore the distal interlocking holes relative to the adjacent cortices must be understood. METHODS: A two-dimensional radiographic-morphometric analysis was performed in 40 tibiae after in vitro (n = 20) and in vivo (n = 20) implantation of unslotted stainless steel unreamed 8- and 9-mm diameter intramedullary nails. RESULTS: The combined in vitro and in vivo results showed average distances between the upper distal transverse hole and the anterior aspect of the tibia of 12.3 mm (SD 1.7 mm; variance 2.9 mm(2); range 7.6 mm). CONCLUSIONS: The distances between the upper distal transverse hole and the anterior aspect of the tibia are the most reliable parameters of distal nail hole position. RELEVANCE: For a 'radiation-independent' distal interlocking aiming system for unreamed intramedullary tibial nails to be successful, it could take advantage of the relatively constant distance between the anterior cortex and the most proximal distal screw hole.

Journal Article↗
PubMed1997

Dosage, anticoagulant, and antithrombotic effects of heparin and low-molecular-weight heparin in the treatment of deep vein thrombosis.

We have performed a prospective, randomized, controlled trial comparing continuous intravenous unfractionated heparin with twice-daily subcutaneous (s.c.) high-dose low-molecular-weight (LMW) heparin in the initial treatment of 50 patients with acute proximal deep vein thrombosis. In this article we analyze the relationship between the dosage of the heparins, the anticoagulant effects on aPTT, and thrombin and factor Xa inhibition to the improvement of the Marder score after a 10-day treatment period. Improvement of the Marder score was observed in about 70% of patients without regard to administration of unfractionated or LMW heparin. Patients in both treatment categories were divided into two groups, namely, those who showed an improvement of the Marder score and those who did not. In the group of patients with unfractionated heparin and regression of thrombus size the mean dosage was 33,000 U/day, whereas the mean dosage was 37,000 U/day in the patients with status idem of the Marder score after the 10-day treatment period. Thrombin clotting time values were in contrast to the dosage. Patients with regression of thrombosis showed higher thrombin clotting time values compared with those with status idem. These results were also seen with aPTT and the Heptest coagulation assay, but the differences between the two groups were less pronounced. No differences between these two groups of patients were seen or detected with the S2222 chromogenic anti-factor Xa method. Patients receiving 2 x 12,000 IU s.c./day LMW heparin did not show these differences, the dosage being adjusted by the anti-Xa levels, ranging from 0.6 to 1.0 U/mL 4 hours after the s.c. injection. The groups of patients categorized as to improvement or not of the Marder score did not show differences in the daily dose. The anti-Xa activity was higher in patients with regression of thrombosis compared with patients without regression. The other coagulation parameters did not show any relation to the clinical outcome of thrombus regression. The relationship between the change of the Marder score at day 10 and the anticoagulant effect on the different coagulation systems correlated weakly for patients receiving unfractionated heparin. The highest correlation was found for the improvement of Marder score and thrombin inhibition in the heparin group with r = 0.42. For LMW heparin no correlation could be detected. Heptest coagulation values were in the same range for patients receiving unfractionated and LMW heparin. In contrast to the chromogenic anti-Xa assay, aPTT, thrombin clotting time, and prothrombin time values differed substantially in the two treatment regimens. Treatment of recent deep vein thrombosis with unfractionated heparin profits from laboratory monitoring, whereas monitoring of the anticoagulant effect during the treatment with s.c. LMW heparin does not influence the outcome on thrombus regression.

Adult↗
PubMed1997

A new technique for the distal locking of solid AO unreamed tibial nails.

Proximally mounted distal aiming systems have failed primarily because of nail deformation during insertion. A mechanical aiming device for the insertion of distal locking screws for solid unreamed AO tibial nails was developed and was tested in twenty unreamed solid tibial nailing procedures in a video-documented prospective clinical study. The rate of accurate screw placement, time expended, complications, and outcome for each patient were recorded. Distal locking was performed successfully in all cases without image intensification. Although a high percentage (55%) of fractures were open, the total mean operative time was 108 minutes (range, 60 to 180 minutes) and the mean time for distal locking (three screws) was 15.5 minutes (range, 8.0 to 39.0 minutes). Notable drill-nail contact occurred in 15 percent of the distal screws placed, demonstrating accurate aiming and drilling. There were no major intra- or postoperative complications related to the distal aiming system.

Adolescent↗
PubMed1997

Recurrent rotational deformity of the femur after static locking of intramedullary nails: case reports.

Rotational deformity following intramedullary nailing may cause symptoms and require surgical correction by osteotomy. Reamed, locked intramedullary nailing may be performed, but concern about cortical blood supply and potential pulmonary dysfunction from reaming have led many surgeons to limit this and use smaller diameter nails. Slotted nails are commonly used but are less stiff in torsion than the newer unslotted nails, particularly at the lower diameters. We report two cases of recurrent femoral rotational deformity after using statically interlocked slotted intramedullary nails to correct existing femoral rotational deformities. These patients show that small diameter statically interlocked femoral nails with diminished bone-nail contact must be stiff enough in rotation to avoid potential recurrence.

Adult↗
PubMed1997

[Complex trauma of the elbow].

The complex injury is characterized by a fracture and/or dislocation of the elbow in association with a serial injury of the upper extremity, or a severe soft tissue trauma, or a prolonged ischemia caused by vascular injury or compartment syndrome. They are defined as complex injuries because their treatment differs from that of a simple fracture implying that standardized concepts usually cannot be employed. The results of primary treatment show a high rate of complications. They are accompanied by functional deficits including pseudarthrosis and ankylosis. As a consequence, ulnar neuropathy may occur. Inadequate treatment leads to delayed rehabilitation and several secondary operations. The main goal points at the reconstruction of the elbow joint to restore function. Therefore, the logistical pathway of individual therapy is the key for success. The operation has to include fracture stabilisation of all injuries of the upper extremity. Only stable osteosynthesis makes early mobilisation possible. Transfixation of the elbow joint should be reserved for exceptional cases. The principals of AO have proven to be practical both for the distal humerus and the proximal forearm. Successful reconstruction of the elbow joint often demands extended approaches. ORIF of the proximal ulna can be achieved by indirect reposition techniques. Dynamic stabilisation should be established by conservation of the radial head and coronoid process. For treatment of soft tissue injury it is necessary to undertake local reconstructive measures. Operative treatment is widely indicated for forearm compartment syndrome. Diagnosis and therapy of possible accompanying vascular injury should be made early to avoid prolonged ischemia. Operative treatment of nerve injury is only indicated in case of sharp dissection of the nerve. Otherwise the reconstruction should be performed, but not earlier than three months. Rehabilitation outcome depends on primary therapy. Sufficient functional results are only achieved after early mobilisation and intensive physiotherapy. If necessary, arthrolysis is planned early and combined with removal of implants at 6 months post injury.

Compartment Syndromes↗