Goals: Advantage of the dorsal fixation of C1/2

Materials and Methods: From 01/2006 to 12/2006 22 patients with a traumatic fracture of C1/2 were operativly stabilized. The avarage age was 79 year (66–92). No neurological deficit. Diagnostic was always a CT-scan for classification of fracture typ. 7 patients were temporarily immobilized with HALO fixateur. Within th next 8 days final operation hab been carried out. 7 patients with Anderson fractures typ II were stabilized with open fixation from ventral (group 1). 4 Jefferson fractures and 2 combined C1/2 fractures were were stabilized with open fixation from dorsal (Magerl) (group 2). Percutanous fixation from dorsal was done in 5 patients with fractures of the atlas, 4 with Anderson fractures typ II (group3). Clinical and radiological follow up was done in 18 patients

Results: Duration for operation was in 64min in group1, 134min in group 2 and in 42min in group3. No neurological deficit or damage of A.vertebralis occurred. Blood loss was in group 1 and 3 under 50ml in group 2 750ml. In group3 one slightly dislocation of screw happened without need of revision. Movement of cervical spine was reduced in group 2 and 3. During follow up 3 of seven ventral stabilized Anderson fractures typ II (group1) were dislocated. Dorsal percutanous fixation for operatively revision was done.

Discussion: Percutanous dorsal transarticular screw fixation C1/2 is a challanging procedure for stabilization of atlantoaxial fractures. Main advantages compared to other operation techniques are less blood loss, short operation time, high rate of success.

Due to the fact that the treatment of distal femoral fractures is a therapeutic challenge, new specific implants were continuously developed. The techniques should guarantee a reliable bone healing for two different groups. For young patients with high energy trauma and more or less severe collateral injury and for old patients with osteopenic bone, weal soft tissue and a high rate of co-morbidity. Present widespread techniques are reduction and fixation with LISS plate or retrograde nails. In this clinical study from 2003 to 2006 we compared our supracondylar nail (SCN, Stryker) with the LISS plate. We were looking at a series of 77 patients (55 SCN and 23 LISS) with A (36) and C (41) fractures of the distal femur. 43 (78%) of the SCN group healed without complications, 1 malrotation, 1 case of infection, 2 pseudarthrosis and 5 problems with the distal locking screws were observed. In the LISS group only 23 (56%) healed primarily, whereas the complications occured more frequent. Beside radiographic control and clinical examination the success of operation was assessed with a standardised questionare (KOOS). The SCN group showed again a higher rate of satisfaction compared to LISS.

Conclusion: The SCN is working in A and also in complex C fractures. Furthermore we saw less rate of complications and more satisfied patients with the SCN.

Object: We performed retrograde nailing of type C fractures and periprothetic percondylar fractures of the distal femur using a new dedicated femoral implant (T2 Supra-Condylar Nail). Herewith a powerful tool for the treatment of complex very distal femoral fractures was created. This nail has four distal locking holes placed from 6 to 32 mm at the end of the nail for a 3 plane fixation.

We present the new implant and the preliminary clinical outcome in 25 cases.

Methods: A consecutive series of 24 patients with 25 fractures of the distal femur (6 fractures AO type A, 1 type B, 12 type C fractures and 6 periprothetic fractures) was operated between January 2003 and September 2004. The epidemiology was typical for trauma patients with 18 male and 6 female patients. The mean age was 50.8 years (range 21–92 ys). The bone stock was osteopenic in 9 cases and regular in 16 cases. There were 6 patients who sustained polytrauma, 5 paraplegic patients fell out of their wheelchair. The remaining 13 patients suffered isolated injuries.

The patients were followed up clinically and radiographically.

Results: Seven patients were stabilized intramedullary at the day of the accident, 11 patients in the next 5 days. The remaining 6 fractures were initially stabilized with an external fixator in case of multiple injury. 7 percondylar fractures were stabilized with a short nail of 200 mm in cases of implants in the proximal femur (hip prosthesis: 3, DHS: 2, gamma nail: 2).

Mean duration of operation was 106 minutes.

The retrograde nailing using the T2 implant is a good suitable method performing a correct reposition of the fragments with high primary stability. There were no problems in woundhealing at all. Postoperatively a wheightbearing mobilisation with 20kg was possible and range of motion was unlimited.

Radiographs showed better ossification compared with plate osteosynthesis. Only one nail is broken out and needed a corrective operation with a plate. We saw no greater X- or O-deformity or rotation divergence. Only in 3 cases of delayed union, a spongioaplasty was indicated.

Conclusions: The retrograd nailing of distal femoral fractures type A is well accepted. After changing a C fracture in A fracture, it is also possible to stabilize complex intraarticular fractures intramedullarly. If a stabile metaphyseal block of minimal 3,5 centimeter is present after anatomical reconstruction of the joint, even in cases of osteoporotic bone stock, a intramedullary nailing is possible. Also in cases of periprothetic fractures with a short metaphyseal block of the distal femur, the T 2 supracondylar nail with its 4 locking screws at the end of the nail can stabilize this block in a 3 plane fixation.