Most complications after gamma nail fixation can be prevented by following certain rules. The other inevitable problems can be dealt with either through a conversion to a total hip replacement, a re-osteosynthesis with a long gamma nail or an additional condylar plate. Conversion to total hip replacement may be a demanding operation with a higher than normal complication rate. Removal of the gamma nail should be performed cautiously as re-fractures can occur.

The osteosynthesis of trochanteric fractures requires a minimal invasive technique to guarantee fully weight bearing and early rehabilitation in elderly patients. In this retrospective study we want to prove if the gamma nail meets all requirements and if the results improved after initiation of the new instrumentarium and standardization of the operative technique. From January 1992 until April 2000 we treated 387 patients with a gamma nail. The average age was 79.4 years. We used the new instrumentarium suitable for radiography since June 1996, the operative technique was standardized since the same time. The evaluation occurred on the basis of clinical and radiological findings included analysis of complications. We've seen intraoperative problems in 29% before June 1996, this rate could be reduced to 9%. General postoperative complications presented in equal frequency. After improvement of the technique dislocations of the neck screw and relevant sinking of the fractures were more rarely. The rate of reoperations after complications of the implant was 8% in both groups. In consideration of technical standards the postoperative full weight bearing and early mobilisation is possible even in old patients.

The anatomical structures of the elbow joint were dissected in layers in human cadavers. The surgical dissection was divided into to deep and superficial areas. Each step was documented by digital video and photographs. The functional and anatomical preparation allowed us to establish the limits and scope of diagnostic and therapeutic procedures by arthroscopy. Résumé IntroductionArthroscopy of the elbow joint requires detailed understanding of the surgical anatomy due to the proximity of neurovascular structures to all approaches. This involves not only the main peripheral nerves and vessels but numerous small cutaneous branches. The video-documented anatomical dissection of the elbow joint allows the description of local topography from the dynamic and functional points of view and identifies the risks associated with the different approaches. The demonstration also allowed an understanding of the arthroscopic findings that are available from the different approaches. Materials and methodsPreparation was made from fresh human cadavers. Each layer of the elbow joint was video documented in its static and functional anatomy. Thus, the different arthroscopic approaches could be demonstrated in their surroundings. Some unusual cuts were made to facilitate the view of the functional anatomy of the joint. Anterolateral approachThe anterolateral approach is the most important and most frequently used arthroscopic approach. We mark the osseus structures, which allows orientation (Fig. 1). We identify the gap between the lateral epicondyle of the humerus and the radial head. The lateral antebrachial cutaneous nerve, which is the terminal branch of the musculocutaneous nerve, is visible in the preparation of the subcutaneous layer. Risk of damaging this nerve is minimized by flexing the elbow and pronating the forearm (Fig. 2). We introduced the arthroscope into the joint anteriorly to the lateral epicondyle over the radial head in the direction of the cubital fossa. The radial nerve lies between the brachialis and the brachioradialis muscles (Fig. 3). The nerve is protected from the Presented at the SICOT/SIROT conference,

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