Intraarticular fractures of the distal humerus comprise 1% of all fractures in adults. Triceps reflecting and olecranon osteotomy approach provide adequate exposure in intraarticular fracture with its own advantage and disadvantages. Forty consecutive patients with fractures of the distal humerus were treated over a 36-month period. The patients were randomly allotted into two groups; group A consists of twenty patients with olecranon osteotomy and group B consists of twenty patients with triceps reflecting approach. In both the groups fracture was fixed using orthogonal or parallel plating techniques. Clinical outcome was assessed using the DASH SCORE, radiological union and complications was noted in both the group and compared. In group A the mean DASH score was 15.9 points. Three patients underwent a second procedure for hardware removal, 2 patients had non-union at osteotomy site, one patient had transient ulna nerve neuropraxia and one patient had superficial infection. In group B the mean DASH score was 14 points. There was no statistical significance between both groups regarding final outcome except complications were more in osteotomy approach. We conclude both approach is an effective procedure with an excellent or good functional outcome but osteotomy approach has more complications

Background. The distal part of the radius is the most common localisation of fractures of the human body. Dislocated intraarticular fractures of the distal radius (FDR) are frequently treated by open reduction and internal fixation with a volar locking plate (VLP) under fluoroscopic guidance. Typically the locking screws are placed subchondral near the joint line to achieve maximum stability of the osteosynthesis. To avoid intraarticular screw placement an intraoperative virtual implant planning system (VIPS) as an application for mobile C-arms was established. The aim of the study was the validation of the implemented VIPS comparing the intraoperative planning with the actual placement of the screws. The study was conducted as a single-centre randomised controlled trial in a primary care institution. The hypothesis of the study was that there is conformity between the virtual implant position and the real implant placement. Patients/Material and Methods. 30 patients with FDR type A3, C1 and C2 according to the AO-classification were randomised in two treatment groups and allocated either in the conventional or in the VIPS group in which the patients underwent an intraoperative planning before screw placement. The randomisation was performed on the basis of a computer-generated code. After fracture reduction an initial diaphyseal fixation of the plate was done. Then the matching of the three-dimensional virtual plate with the image of the real plate in the fluoroscopy shots in two planes was performed automatically. The implant placement was planned intraoperatively in terms of orientation, angulation and length of the screws. After the placement of four or five locking screws the implant position was verified with an intraoperative three-dimensional mobile C-arm scan. The locking screws near the joint line were examined and compared in relation to the actual and the planned inclination angle, the azimuth angle which is determined analogue to a compass rose and the screw-tip distance. The planned and actual parameters of the locking screws were then statistically analysed applying the Shapiro-Wilk - and the Students t-test. Results. 15 patients with FDR were treated in the VIPS arm. In the VIPS group six fractures type A3 one type C1 and eight type C2 were included. The control group showed a similar fracture distribution with six type A3 and nine type C2 fractures. The discrepancy between the actual and the planned screw-tip distance was 2,24 ± 0,97 mm and did not differ significantly (p>0,05). The angle of the planned and actual screw placement also did not vary significantly (p>0,05). The difference of the actual to the planned azimut angle accounted for 18,69°± 29,84. The planned and real inclination of the screws differed by 1,66° ± 4,46. Conclusion. The analysis shows that the screws were almost placed as planned. Differences between actual and planned placement of the screws were observed but were not statistically significant. Therefore the hypothesis of the study can be accepted. We assume, that the precise planning of the screw placement in FDR with VIPS can be transported into the surgical treatment

Purpose. To elucidate whether there is an advantage in external fixation supplementation of K-wires in comparison to K-wires and plaster, in the treatment of distal radius fractures without metaphyseal comminution. Indications. Distal intraarticular radius fractures, Frykman VIII or VIII without metaphyseal comminution. Contraindications. Metaphyseal comminution, general medical contraindications for surgical intervention. Study design. Fifty-one patients were prospectively randomised in two groups: 24 patients were treated with K-wire and spanning external fixation supplementation, and 27 were treated with K-wires and plaster. Results. Patients were monitored following the operation with a minimum follow up of 1 year, and checked independently of surgeon for pain, satisfaction and range of motion. There was a statistically significant difference in favour of the external fixation patient group for pain (Visual Analogue Score, Ex-Fix group: mean 14.9, plaster group: mean 28.1, p<0.001) and satisfaction (Ex-Fix group: mean 89.7, plaster group: mean 76.3, p<0.001,). Although one would expect that range of motion would be reduced in the external fixation group, there were no statistically significant differences found in favour of plaster; on the contrary supination results were surprisingly in favour of the external fixation group (Ex-Fix group: mean 54.4, plaster group: mean 45.2, p<0.05). Conclusion. In this study, external fixation supplementation of K-wiring had statistically significant superior results in patient satisfaction score, pain score, and wrist supination in comparison to plaster augmentation of K-wiring