Essential concepts in the treatment of common joint fractures: A narrative review


      Proximal fractures of the humerus are at high risk of osteonecrosis if the medial calcar is disrupted and the metaphyseal extension of the head fragment is <8mm. Risk factors for failure of osteosynthesis include: poor bone stock, varus dislocation, head dislocation and medial comminution.
      During surgical treatment of distal humerus fractures, one should aim to restore the arc and stabilize the columns. Several technical rules have been outlined by O´Driscoll and are mentioned in this article in detail.
      In fractures of the distal radius, the length, the joint surface, and joint angles (palmar inclination ca. 11°, radial inclination ca. 22°) should be reconstructed. Several surgical factors are associated with the development of radiocarpal osteoarthritis including the sagittal depth of the articular cavity and the anterior-posterior diameter of the fossa lunata of the distal radius.
      When managing fractures of the proximal tibia, a four- or more column classification system should be used to plan the surgical steps and choose the appropriate approach(es).
      In ankle fractures, intraoperative 3-D-Scan should be considered especially in the case of syndesmotic involvement or involvement of the posterior malleolus.


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