Defect bridging is still problematic in the secondary treatment of Achilles tendon ruptures. Smaller defects can be treated without problems by the well-known standardized methods, whereas other methods have to be applied for treating larger defects. Free transplants with autogenous or exogenous material should be mentioned in this context. Complications are more likely to occur with exogenous material, free transplants from the fascia lata require an additional intervention to remove the transplant from another localization. These methods cannot be applied to achieve reliable restoration of continuity for defects with a length of 10 cm. Therefore, in these special cases, we carry out the tendon transplantation with a free tendon-muscle graft from the triceps surae muscle. We achieved reliable restoration of continuity with complication-free healing of the free transplant in, up to now, three cases, in association with the formation of a strong, functionally high grade scar plate in the area of the tendon.

From 1988From to 1996 femoral shaft fractures in children were treated by external fixation. The average age was 8.4 years (range: 2 to 16 years). Thirty-three children sustained multiple injuries (27%), and 13 children had 2nd-or 3rd-degree open fractures (10.7%). This study not only analyzes the expenditure of the operation and the corresponding follow-up period, but also the complications and the final results. The average operation time was 1 h (range: 0.2 to 2.8 h). The infection rate was 6.6%. Removal of the external fixator was carried out in 35.5% of the cases on an outpatient basis. Refractures were noted in 7 cases (5.8%). The time of consolidation was 55.3 days on average (range: 36 to 94 days) and depended on the fracture type as well as on the fixator type. By using the dynamic fixation models the consolidation time could be reduced to 46 days in comparison to the stiff AO fixation models with a mean consolidation time of 68 days. Oblique and transverse fractures showed an average healing time of 54 days. Complications such as refractures, infections, delayed unions and changes in therapy mainly occurred after oblique fractures. The average follow-up time was 32 ± 18.7 months (range: 24 to 64 months). The extent of leg length differences, on average 1.3 cm, depended on the delay of surgical intervention. There was no clinical evidence of malangulation (by definition > 20°). The results do not differ from other operative procedures. The external fixator proved to be a valuable method for the treatment of pediatric femoral shaft fractures: hospital stay is reduced and full weight bearing can be achieved early. However, transverse fractures, which showed the highest complication rate, should be treated by intramedullary nailing.

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