Due to results of biomechanical examinations, the dorsal-ventral stabilization of thoracic spine and lumbar spine fractures is an acknowledged method. Different possible complications - among them life-threatening ones- of this method have been published already. We will discuss a complex case wherein an erosion of the aorta led to an acute hemorrhagic shock symptomatology 98 days after primary dorsal-ventral care. Retrospectively, an already close contact of the aorta to the pressed-in chip could be identified as the reason in a postoperative CT control after ventral care. However, due to a postoperative course of infection the chip position has been accepted as such and not been changed. But this difficult and complex etiopatology has shown that chip and respectively material positions with contact to adjacent soft tissue structure are not acceptable.

ZusammenfassungFingerstrecksehnenverletzungen nach palmarer Plattenosteosynthese einer distalen Radiusfraktur bei eigenen und nachbehandelten Patienten führten zur Untersuchung der Ursachen dieser Schädigung. Nach einer Mindestbeobachtungszeit von 3 Monaten konnten bei 119 distalen instabilen Radiusfrakturen nach palmarer Plattenosteosynthese 5 Strecksehnenrupturen beobachtet werden. Vier der fünf Strecksehnenrupturen sind sehr wahrscheinlich auf Sehnenverletzungen durch die Plattenosteosynthese zurückzuführen. Eine der fünf Strecksehnenrupturen ist Folge einer mechanischen Irritation bei sehr engem Strecksehnenfach und zeigte keinen Kontakt zum Implantat. Alle Frakturen heilten ohne weitere Komplikationen zeitgerecht aus. In allen Fällen erfolgte eine operative Revision des betroffenen Strecksehnenapparates. Strecksehnenverletzungen sind nach palmarer winkelstabiler Plattenosteosynthese im eigenen Patientenkollektiv eine relativ häufige Komplikation (4,2 %). In der Literatur sind nur wenige Fälle von Strecksehnenverletzungen nach palmarer Plattenosteosynthese beschrieben worden. Häu-figste Ursache von Strecksehnenläsionen war die Sehnenverletzung durch dorsal herausragende Gewinde der Osteosyntheseschrauben. Zur Vermeidung sekundärer Strecksehnenrupturen ist neben einer vorsichtigen Bohrung der knöchernen Fragmente und einer korrekten Schraubenlänge eine zeitgerechte Materialentfernung nach Frakturkonsolidierung zu erwägen. AbstractThe internal fixation of fractures of the distal radius can lead to complications related to the implants although there have been few reports in the literature. Extensor tendon ruptures secondary to the volar plate ostheosynthesis of distal radius fractures were detected in 5 of 119 treated cases in our clinic. The rupture of the extensor digitorum comm.dig. II tendon were most frequent followed by the rupture of the extensor pollices longus tendon. Partial ruptures of the extensor indicis tendon also have seen. All distal radius fractures cured regularly in time without any other complications. The ruptures occurred 3 to 60 weeks after initial treatment with a volar plate. The tendon repair surgery with the volar plate explantation in all cases has shown the mechanical irritation by prominent screws or bone fragments. Only one case of a extensor tendon rupture was caused by a mechanic irritation from a fracture fragment three weeks after osteosynthesis. Radiographs don't expose prominent implantats or fracture fragments for a liability to tendon ruptures surely. To avoid extensor tendon ruptures a correct srew length implantation and a carefully drilling is recommended. In spite of quite safely implants a scheduled explantation after regular healing of the fracture is to consider.

This result encourages us to prefer the minimally invasive head-conserving therapy of medial hip head fractures, especially for treatment of Pauwell's I and II injuries.

Better and comparable picture series can be created by standardisation of the imaging technique using this X-ray device.

This tool may help to improve the prognosis of osseous integration of the implanted material and lower the rate of pseudarthrosis. Furthermore, the handling of the thoracoscopic ventral stabilisation may be somewhat easier and, even for the inexperienced surgeon, there is now an instrument available to fit in the graft with a satisfactory result.