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The XS nail which is introduced here fulfils the requirements made of an implant as regards maximum protection of soft tissue, secure fracture fixation and early exercise tolerance, including ankle fractures. No implant dislocation, no deep infection and no re-osteosynthesis were observed. Its advantages over conventional techniques lie precisely in the treatment of complex fractures and for patients with poor bone, vascular and soft-tissue situations.

Introduction: Due to the increase in the incidence of osteoporosis with age and the high biochemical load on the proximal femur, the pertrochanteric femur fracture is the typical fracture of the elderly. The number of different fracture types and the characteristic features of this patient population places high demands on any universally applicable implant. The rotational instability of the head-neck fragment in the case of a trochanter minor defect, in particular, is a significant factor in the care of pertrochanteric femur factures. The object of this study was to show that the gliding nail constitutes a universal implant for the care of proximal femur fractures with constantly maintained stability under load. Material and Methods: Between March 1996 and April 2001, 501 patients with per-and subtrochanteric fractures and an average age of 76 were included in the study. All osteosyntheses were carried out using the gliding nail which has an I-beam cross-section profile blade. 73.2% were treated operatively for closed isolated per-or subtrochanteric femur fractures. Results: All patients were restored to full weight-bearing postoperatively. The combined overall early and late complication rate following gliding nail synthesis was only 5.4%. Neither blade cut-out nor head-neck rotation was observed following gliding nail osteosynthesis. Three-month mortality rose from 2.4% in patients with no complications to 90% in patients with four complications. 92.1% of patients were independently mobile at the time of the follow-up examination. Conclusion: With its low complication rate and the ever-present possibility of full weight bearing, the gliding nail fulfills all the requirements of a modern implant for the treatment of proximal femur fractures. In our opinion, its most advantageous features are the high moment of resistance of the I-beam cross-section profile blade which ensures the possibility of gliding, the minimalized risk of proximal cut-out due to the large surface area with two planes of support in the bone, and its secure rotational stability in terms of both nail and bone. The impaction of the blade, which requires no reaming with its resulting loss of bone substance, is responsible for the excellent bone-implant interface.

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IntroductionOlecranon fractures are common fractures, most of them associated with damage to the soft-tissue as a result of direct trauma. Associated injuries, such as coronoid process or radial-head fractures, are present in approximately 20 % of the patients [26]. The reconstruction of the joint surfaces involves an open anatomic reduction. Subsequent treatment requires an osteosynthesis that is stable enough for early active motion [3,8,9,20]. Various forms of osteosynthesis, such as tension-band wire, intramedullary screw fixation, and plate osteosynthesis, are available for this type of reconstruction, the choice depending on the position and type of fracture. In the case of a small proximal fragment, even exstirpation of the fragment, with trans-osseous refixation of the triceps tendon, has been described [9, 10, 21]. The usual forms of osteosynthesis frequently show problems related to secure fixation. Particularly in the case of classical tensionband wiring in simple fractures, there often is proximal wire migration, resulting in pain across the tip of the olecranon and the occasional formation of fistulae, which necessitates prema- AbstractIntroduction: The open reduction and internal fixation of olecranon fractures places high demands on the fixation device regarding the osseous anchorage and soft-tissue damage. In tension-band wiring, implant loosening and failure of osteosynthesis are frequent complications following mobilization. One of the biomechanical reasons given for this is the eccentric position of the tension band. Plate osteosynthesis -reserved for the more complex types of fracture -does not always provide sufficient stability, particularly in the case of fractures associated with osteoporosis and additional medial, lateral, frontal and extremely small proximal fragments. Another problem is the subcutaneous position of the implant, which can increase soft-tissue complications. Materials and Methods: The IP-X(X)S(L) nail described here is a locking nail with the option of interfragmentary compression. It is locked by threaded K-wires and has been used for all olecranon fractures treated in our clinic since May 1999. From May 1999 until December 2002, 80 olecranon fractures were treated with the XS nail. After an average period of 15 months, 73 of these 80 (follow-up 91.3 %) patients were investigated. Included in this group were 49 (67.1 %) patients with comminuted fractures and 24 (32.9 %) patients with two-fragment fractures. Olecranon osteotomies were excluded. Results: There were six (8.2 %) cases of dislocation of the transverse locking wires, two requiring re-osteosynthesis which were without complications. Two (2.7 %) cases had to be revised because of irritation of nerve structures. No cases of acute or chronic osteitis, implant failure or non-union after primary XS-nail osteosynthesis were found. Using the Murphy score, 47 (64.4 %) excellent, 21 (28.8 %) good, 3 (4.1 %) satisfactory and 2 (2.7 %) poor re-