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The treatment of comminuted fractures of the radial head with concomitant injuries of the ulnar complex by resection of the radial head usually does not provide satisfactory long-term results. Other than joint instability in the elbow and a limited range of motion, radius proximalisation in the sense of ulnocarpal impingement, osteoarthritis and pain in the elbow have been described. Between 1995 and 1997, 11 radial head prostheses were implanted in ten patients who had sustained a comminuted fracture of the radial head with concomitant injury to the ulnar complex. A follow-up survey was conducted with the patients on average 5 years after the injury. Eight patients with nine implants participated in the follow-up, one patient had died and another refused to participate but declared that he did not suffer from any impairment. According to the Morrey score, two of the results were found to be very good, five to be good, one to be fair and one to be poor. Despite the severe injuries sustained by the elbow, neither joint instability in the elbow nor proximalisation of the radius, cubitus valgus, ulnar nerve syndrome, nor loosening of the prosthesis were found in any of the patients. In the event of comminuted fractures of the radial head which are impossible to reconstruct by osteosynthesis and which occur with concomitant ulnar ligamentous or osseous injury, the implantation of a prosthesis is preferred over the resection of the head of the radius.

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A stable and optimal reduction and a rigid internal osteosynthesis are requisites for healing of the radius fracture. Open reduction of the DRUJ is only indicated when soft tissue interposition prevents exact reposition. Surgical revision of the distal radioulnar joint was not necessary in our patients. Patients after Kirschner-wire fixation showed a diminished pro- or supination. To prevent Kirschner-wire failure, postoperative cast immobilization is indicated. Due to the retrospective nature of the study it is not definitely clear if Kirschner wire fixation is superior to immobilization.

ObjectiveInternal fixation of proximal humerus fractures with an implant assuring rotational and angular stability to restore form and function of the glenohumeral joint. IndicationsProximal humerus fractures: two-and three-part fractures, meta-and diaphyseal fractures of the proximal second fifth. ContraindicationsComminuted fractures of the humeral head. Proximal humerus fractures in children. Surgical TechniqueAnterior approach. Blunt dissection of the deltopectoral interval, retracting the cephalic vein medially. Judicious exposure of the fracture site and reduction of the fracture. A 90° blade plate opened up to 110-120° is inserted from anterolateral immediately proximal to or through the subcapital fracture gap. The blade of the blade plate is introduced into the proximal half of the humeral head. In the presence of an avulsion of the greater tuberosity, a wire cerclage is added. ResultsBetween June 1998 and December 1999, we treated 20 patients (eight men, twelve women, age 65-92 years) and assessed them prospectively. All fractures were closed (AO types 11-A3 n = 8, 11-B1 n = 5, 11-B2 n = 3, 11-B3 n = 1, and 11-C2 n = 3). Loosening of plates was seen in three patients and a blade perforation in one, all requiring a revision (revision with plate blade twice, shoulder hemiarthroplasty once, early implant removal once). Five patients passed away, and two were too old to undergo a follow-up examination. The Constant score in 13 patients performed after 8 (7-10) months reached 62/100 (opposite shoulder 92/100). This corresponds to a satisfactory outcome.