[Unreamed antegrade humeral interlocking nailing]

In a prospective clinical study 111 fractures of the humerus in 109 consecutive patients were stabilized with unreamed antegrade interlocking nailing. 97 patients were evaluated with individual follow-up, in the mean at 24.2 months postoperatively. Mean fracture consolidation time was 12.3 weeks (9-16 weeks). Five patients presented a non union. At follow-up 19 patients had a limitation in motion of the shoulder, in the mean with 20% compared to the opposite side. Eight patients had permanent shoulder pain, in nine patients shoulder pain occurred during manual strain of the upper limb. Neither limitation of motion nor pain at the elbow region was present in all cases at follow-up. Ultrasound examination revealed in six cases a lesion of the rotator cuff, which was linked in these cases with permanent pain at the shoulder joint. In five patients a prominent nail tip at the entrance point caused a lesion of the rotator cuff with impingement syndrome. Eight out of nine preoperative palsies of the radial nerve recovered within a mean period of 4.3 months without operative measurements. Unreamed antegrade interlocking nailing of humeral fractures is a safe technique regarding consolidation rate with advantages regarding early mobilization of the upper limb. Careful suturing of the rotator cuff and countersinking of the proximal nail tip at the entrance point is a prerequisite in avoiding permanent lesions of the rotator cuff and shoulder pain.

[Snowboarding accidents 1991 to 1994--an analysis]

437 snowboard injuries were taken under surveilance in the years 1991 till 1994. The average age was 21.5 years. 422 (97%) injuries were caused by a crash, only 15 (3%) by a collision. 178 patients (41%) needed only one single office visit, 259 patients (59%) had to undergo longer outpatient treatment (mean 27d). Only 34 patients (8%) needed inpatient treatment with an average stay of 4.44 days. 127 patients (29%) were on sick leave for several days (mean 20.57d). The most common diagnosis was a distortion 183 (38%), followed by fractures 148 (31%) and contusions 98 (21%). The upper extremities were the predominant injury site in 51% (245) with no prevalence of left or right. The lower extremities were injured in 34% (163) with a prevalence of the left leg 2/3. Head, spine, chest and abdomen were injured in 15% (69). The typical snowboarders injury however is an injury of the wrist (182/27%). Here of 71 (39%) were fractures of the distal radius. The knee joint being the second most common injury sight in 109 (16%) cases, mainly with sprains (63p/60%), seldomly with meniscal tears and/or ligament ruptures (10p/10%) and rarely fractures (3p / 3%). The fixation of both legs during snowboarding seems to be protective against complex knee joint injuries. Other regions were injured in less than 10%.

[Epiphyseal growth after replantation in childhood]

Long-term results in 17 patients with 19 replanted parts of the upper extremity after replantation during childhood are presented. Regarding longitudinal epiphyseal growth, three patients had normal growth. In 15 cases, average length of the replanted digits attained 88.6% of normal and one patient gained overgrowth of 118% of normal. In every case, consolidation of the fracture was seen. Four patients developed a deviation of the replanted finger in the frontal plane. The cause of deviation in every case was incorrect primary reposition and not a disturbance of growth of the replanted epiphysis.