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

      Abstract

      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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      References

        • Okike K
        • Lee OC
        • Makanji H
        • Harris MB
        Vrahas MS. factors associated with the decision for operative versus non-operative treatment of displaced proximal humerus fractures in the elderly.
        Injury. 2013; 44: 448-455
        • Hertel R
        • Hempfing A
        • Stiehler M
        • Leunig M.
        Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus.
        J Shoulder Elbow Surg. 2004; 13: 427-433
        • Bastian JD
        • Hertel R.
        Initial post-fracture humeral head ischemia does not predict development of necrosis.
        J Shoulder Elbow Surg. 2008; 17: 2-8
        • Jung SW
        • Shim SB
        • Kim HM
        • Lee JH
        • Lim HS.
        Factors that influence reduction loss in proximal humerus fracture surgery.
        J Orthop Trauma. 2015; 29: 276-282
        • Krappinger D
        • Bizzotto N
        • Riedmann S
        • Kammerlander C
        • Hengg C
        • Kralinger FS.
        Predicting failure after surgical fixation of proximal humerus fractures.
        Injury. 2011; 42: 1283-1288
        • Savvidou OD
        • Zampeli F
        • Koutsouradis P
        • Chloros GD
        • Kaspiris A
        • Sourmelis S
        • et al.
        Complications of open reduction and internal fixation of distal humerus fractures.
        EFORT Open Rev. 2018; 3: 558-567
        • O'Driscoll SW
        • Sanchez-Sotelo J
        • Torchia ME.
        Management of the smashed distal humerus.
        Orthop Clin North Am. 2002; 33: 19-33
        • Korner J
        • Lill H
        • Müller LP
        • Hessmann M
        • Kopf K
        • Goldhahn J
        • et al.
        Distal humerus fractures in elderly patients: results after open reduction and internal fixation.
        Osteoporos Int. 2005; 16: 73-79
        • O'Driscoll SW.
        Optimizing stability in distal humeral fracture fixation.
        J Shoulder Elbow Surg. 2005; 14: 186-194
        • Sanchez-Sotelo J
        • Torchia ME
        • O'Driscoll SW
        Complex distal humeral fractures: internal fixation with a principle-based parallel-plate technique.
        J bone Joint Surg. 2007; 89: 961-969
        • Lutz M
        • Arora R
        • Krappinger D
        • Wambacher M
        • Rieger M
        • Pechlaner S.
        Arthritis predicting factors in distal intraarticular radius fractures.
        Arch Ortho Trauma Surg. 2011; 131: 1121-1126
        • Esenwein P
        • Sonderegger J
        • Gruenert J
        • Ellenrieder B
        • Tawfik J
        • Jakubietz M.
        Complications following palmar plate fixation of distal radius fractures: a review of 665 cases.
        Arch Ortho Trauma Surg. 2013; 133: 1155-1162
        • Szita J
        • Cserhati P
        • Bosch U
        • Manninger J
        • Bodzay T
        • Fekete K.
        Intracapsular femoral neck fractures: the importance of early reduction and stable osteosynthesis.
        Injury. 2002; 33: 41-46
        • Nyholm AM
        • Palm H
        • Sandholdt H
        • Troelsen A
        • Gromov K
        collaborators. osteosynthesis with parallel implants in the treatment of femoral neck fractures: minimal effect of implant position on risk of reoperation.
        J Bone Joint Surg. 2018; 100: 1682-1690
        • Nilsson LT
        • Johansson A
        • Strömqvist B.
        Factors predicting healing complications in femoral neck fractures. 138 patients followed for 2 years.
        Acta Orthop Scand. 1993; 64: 175-177
        • Haidukewych GJ
        • Israel TA
        • Berry DJ.
        Reverse obliquity fractures of the intertrochanteric region of the femur.
        J Bone Joint Surg Am. 2001; 83: 643-650
        • Im G-I
        • Shin Y-W
        • Song Y-J.
        Potentially unstable intertrochanteric fractures.
        J Orthop Trauma. 2005; 19: 5-9
        • Sadowski C
        • Lübbeke A
        • Saudan M
        • Riand N
        • Stern R
        • Hoffmeyer P.
        Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or a 95° screw-plate: a prospective, randomized study.
        J Bone Joint Surg Am. 2002; 84: 372-381
        • Geller JA
        • Saifi C
        • Morrison TA
        • Macaulay W.
        Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures.
        Int Orthop. 2010; 34: 719-722
        • Eggli S
        • Hartel MJ
        • Kohl S
        • Haupt U
        • Exadaktylos AK
        • Röder C.
        Unstable bicondylar tibial plateau fractures: a clinical investigation.
        J Orthop Trauma. 2008; 22: 673-679
        • Papagelopoulos PJ
        • Partsinevelos AA
        • Themistocleous GS
        • Mavrogenis AF
        • Korres DS
        • Soucacos PN.
        Complications after tibia plateau fracture surgery.
        Injury. 2006; 37: 475-484
        • Schatzker J.
        Compression in the surgical treatment of fractures of the tibia.
        Clin Orthop. 1974; 105: 220-239
        • Kfuri M
        • Schatzker J.
        Revisiting the schatzker classification of tibial plateau fractures.
        Injury. 2018; 49: 2252-2263
        • Höiness P
        • Engebretsen L
        • Strömsöe K.
        The influence of perioperative soft tissue complications on the clinical outcome in surgically treated ankle fractures.
        Foot & Ankle int. 2001; 22: 642-648
        • Höiness P
        • Engebretsen L
        • Strömsöe K.
        Soft tissue problems in ankle fractures treated surgically: a prospective study of 154 consecutive closed ankle fractures.
        Injury. 2003; 34: 928-931
        • Sung KH
        • Kwon SS
        • Yun YH
        • Park MS
        • Lee KM
        • Nam M
        • et al.
        Short-Term outcomes and influencing factors after ankle fracture surgery.
        J Foot Ankle Surg. Nov-Dec 2018; 57: 1096-1100
        • Chissell HR
        • Jones J.
        The influence of a diastasis screw on the outcome of weber type-C ankle fractures.
        J Bone Joint Surg Br. 1995; 77: 435-438
        • Lauge-Hansen N.
        Fractures of the ankle: II. combined experimental-surgical and experimental-roentgenologic investigations.
        Arch Surg. 1950; 60: 957-985
        • Summers HD
        • Sinclair MK
        • Stover MD.
        A reliable method for intraoperative evaluation of syndesmotic reduction.
        J Orthop Trauma. 2013; 27: 196-200
        • Bartonicek J
        • Rammelt S
        • et al.
        Anatomy and classification of the posterior tibial fragment in ankle fractures.
        Arch Orthop Trauma Surg. 2015; 135: 505-516