1st order
- Osteosynthesis – surgical procedure to treat fractures (broken bones) and other bone injuries (e.g., epiphysiolysis) to quickly restore full function. This is done by implants (by means of insertion of force carriers such as screws or plates).
Osteosynthesis is indicated in the following conditions:
Established indications
- Unstable fracture
- Dislocated intra-articular radius fracture – bone fracture whose fracture line passes through a joint and whose fracture ends are mismatched
- Open fracture 2nd and 3rd degree.
- Smith fracture, dislocated
- Fracture with pronounced but closed soft tissue damage.
- Acutely occurred circulatory disturbances after successful reduction.
- Vascular injury
- Complex concomitant injuries of the wrist/palm.
- Traumatic compression of the median nerve
- Nerve injury
- Non-successful conservative reduction/retention attempts.
Relative indications
- Bilateral fractures
- Multiple injuries
- Additional local injuries requiring surgery
- Serial injuries of the upper extremity
- Special requirements, occupational or functional in nature, on the part of the affected person.
- Express wish of the person concerned
2nd order
- External fixator (external tensioner)
Other notes
- Patients with an extraarticular (“outside the joint”) dislocated (“displaced”) radial fracture: patients benefit more from open reduction (realignment of fractured bone) and volar internal fixation than from immobilization by plaster cast; one year after surgery, functional outcome was significantly better after surgery.
- When intramedullary nailing was used, complication rates ranged from 17.6% to 50% and were significantly more common than when plate osteosynthesis was used. The most common complications were neurapraxia (traumatic lesions of peripheral nerves) of the facial nerve.
- In elderly patients (> 70 years) after surgically treated distal radius fracture (DRF), early functional follow-up treatment at 6 weeks showed statistically significantly better functional results compared with follow-up treatment with additive wrist orthosis (medical device for effective immobilization of the wrist) in functional position (standard treatment). Early functional post-treatment was performed in self-training frequency with free movement and pain-adapted load increase. The study also comes show that a protective effect orthosis in terms of radiological outcome is not present.
- In a controlled randomized trial, it was shown that omitting closed reduction (reinstatement of fractured bones) before plaster application does not bring any disadvantages in case of planned surgery. From the point of view of the authors, therefore, a fundamental implementation of the reduction is not recommended.
Operative procedures in children
- Fractures of the child’s distal forearm (fractures in the epiphyseal and diaphyseal regions): percutaneous wire osteosynthesis (esp. Kirschner wire or cribbing wire, also cerclages); material removal: after 3-4 weeks.
- Fractures in the metaphyseal area: intramedullary fixation.
- Fractures in the transition from diaphysis to metaphysis: plate osteosynthesis.
Sports abstinence about 3-4 weeks after wire removal or plaster removal.If there is a fracture in the shaft of one of the bones of the forearm or a combined fracture of the radius (radius) and ulna (ulna), the break from sports should be about 6 weeks. Legend
- Epiphysis: joint end of the bone (near the joint), which is initially cartilaginous and in which bone nuclei develop in the course of bone maturation.
- Metaphysis: transition from the epiphysis to the diaphysis; in growth, the metaphysis contains the epiphyseal joint responsible for bone growth.
- Diaphysis: long tubular bone located between the two metaphyses; contains the medullary cavity of the bone
Structure of a long bone: epiphysis – metaphysis – diaphysis – metaphysis – epiphysis.
Note: Many fractures of the radius in under 10-year-olds can be treated with splint or plaster without repositioning (setting broken bones back in place).