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Snapping hip (Coxa saltans) is the abrupt sliding of the iliotibial tract over the greater trochanter. In the case of pain, which cannot be alleviated by a conservative treatment, an operation is advised. The methods of operation applied up to this day showed--especially because of their high recidive-quotas--great disadvantages. In a detailed post-operational check-up over the past 20 years the new method of "diagonal notching" (27 cases) developed at the Orthopedic Hospital München-Harlaching was compared to the old method of fixing the tract according to M. Lange (24 cases). After "diagonal notching" the snapping occurred again seven times less than after fixing the tract. After "diagonal notching" only 4% of the patients had to be re-operated, however, after fixing the tract a re-operation was necessary on 38% of the patients. 91% of the patients were relieved from their pain almost completely after "diagonal notching", compared to only 50% after fixing the tract. Considering that the "diagonal notching" offers simple technics of operation and better results than other methods, the "diagonal notching" should be used as method of choice to eliminate a snapping hip.

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.

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.