Purpose of the study: Implants with multidirectional locking screws theoretically have many advantages for the treatment of periprosthetic fractures. In the event of osteoporotic bone, this system of plate fixation ensures stability and better bone fixation. Using screws anchored in the different angles, we proposed rigid fixation around the prosthesis. We conducted a retrospective analysis of outcomes obtained after treatment of perprosthetic femoral fractures, Vancouver B1 and C, comparing two types of implants with angular stability (straight plate and folded plate).

Material and methods: From June 1999 to December 2007, we treated 58 patients with periprothetic fractures of the femur using locking plates. Mean age was 72.4 years, 40 patients were female. Thirty-two patients (55.2%) had a total hip prosthesis, 21 a total knee prosthesis and 5 both types of prosthesis (8.6%). We noted: peri- and postoperative complications, degree of bone healing, degree of mobility (Barthel Mobility index and stand up and go test) as well as the social status of the patients.

Results: Bone healing was obtained in 56 cases (96.5%). In two patients, the implant was dislocated and in four others there were general complications. The mean time necessary to obtain total weight-bearing two-leg stance was 8.6 weeks. Forty-six patients (78%) had the same social status as before the fracture. For mobility, 52 patients (89%) achieved the same level as before fracture. Four other patients required a crutch for walking and two needed a walker. Mean Barthel index was 85 points (max 100) and improved 35 points at onset of rehabilitation. Mean stand up and go was 22 s.

Conclusion: According to the review of the literature, 35% of plates dislocate after osteosynthesis of periprosthetic fractures. In our study, the rate was 3.5%, with 7% general complications. We can thus conclude that the methods presented here enable good bone healing in the majority of cases.

Introduction: In the last ten years there is a clear favour toward internal fixation. We evaluated the technique and the clinical long term results of external fixation in a triangular frame.

Patients and Methods: From 1994 to 2001 a consecutive series of 95 patients with end stage arthritis of the ankle joint were treated. Retrospectively the case notes were evaluated. Mean age at the index procedure was 45.4 years (18–82), 67 patients were male (70.5%). In all cases the arthritic deformity was due to a posttraumatic condition. The index procedure took place on average 129 months (6–516 months) after trauma. Preoperatively 43 patients had a relevant mal-alignment. In 41 patients the range of motion (ROM) was decreased with a remaining ROM of < 20°, in further 37 cases the remaining ROM was < 10° ROM. Via a bilateral approach the malleoli and the joint surfaces were resected. An AO fixator was applied with four Steinmann-nails inserted. Follow up examination at mean 4.4 years included a standardised questionnaire and a clinical examination including the criteria of the AOFAS-Score and radiographs.

Results: In all cases the index procedure was possible although in 2 cases soft tissue contracture meant that a pes equinus position of approximately 15° was required. After mean 12.3 (8–16) weeks radiographs confirmed satisfactory union and the fixator was removed. There were no cases of DVT or PE detected in the postoperative period. In 9 cases (10.1%) we saw a reversible irritation of the dorsal cutaneous nerve. In 18 cases a pin tract infection developed (20.2%) which healed under conservative measures. In one case (1.1%) a bony infection around a pin site developed, one patient suffered a fracture of the tibia at the site of the former proximal tibial pin site due to a minor trauma. In 4 patients a non-union of the ankle arthrodesis developed (4.5%). The mean AOFAS score improved from 20.8 (Std. dev.16.2) to 69.3 at F/U (Std.dev. 21.5, p = 0,004–30, T-test). The largest improvements were found regarding to pain and walking distance. Whilst preoperatively only one patient had mild pain, at follow up 54 patients had no or only mild pain. The maximal walking distance improved from mean 675 metres to mean 3245 m (T-test, p < 0,025 –18). Analysis of the insurance status showed patients that patients insured under a workers injury compensation scheme had a mean score of 63.6 compared to 75.1 for the remaining (T-test, p=0,027).

Discussion: Non-union rates and clinical results of arthrodesis by triangular external fixation of the ankle joint do not differ to internal fixation

Methods: The complication rate and the reduced patient comfort reserve this method mainly for infected arthritis and complicated soft tissue situations.

The operative therapy of intraarticular fractures of the calcaneus is nowadays established surgical standard. Aim is an accurate reduction with reconstruction of the Boehler’s angle, the length and the subtalar joint. 3D-fluoroscopy with the Siremobil Iso-C 3D? mobile C-arm radiography system is a valuable assistance for the accurate reconstruction of the anatomical structures. Remaining incongruities can be recognized and corrected intraoperatively. The achieved reduction can be safely fixed by the advantages of a locked implant In the period of 10/2002 until 10/2004 we operated 59 patients with intraarticular fractures of the calcaneus by means of anatomical reduction and locked plate (Calcaneus TiFix, Litos, Germany) under control of 3D-fluoroscopy. After routine CT diagnostics, fractures were classified according to Sanders: 18 fractures were type II, 33 fractures type III and 9 were classified type IV.

Results: Surgical treatment of the fractures took place according on average after an interval of 8.5 days (7 to 11). A 3D-fluoroscopy was performed after reduction and temporary fixation of the fracture. There was no technical fault of the device. Median theatre time was 72 minutes (53–112 minutes) including 3-D-fluoroscopy. In 22 cases a remaining incongruity of > 1 mm could be seen on intraoperative 3-D-fluoroscopy. In these cases a reduction was performed again. The Boehler’s angle could be raised on average by 18° (11° to 22°), shortening of the hindfoot could be improved on average by 13 picture millimetres (9 to 17mm). Bone graft was not required in any case. At 6 months follow up, all patients had returned to work, or if unemployed, where judged fit to work by their GP. Three patients changed their position. 25 Patients were completely pain free at follow-up. In all cases the achieved reduction could be fixed by the implant until full weight bearing was reached.

Conclusion: The use of 3D Fluoroscopy had a real impact in the treatment of calcaneal fractures. If this short term advantage influences the long term result has to be shown in further follow up.