[Minimally invasive therapeutic concepts in fracture surgery]

Recent publications show a clear tendency towards minimally invasive procedures for fracture care in trauma patients. Intramedullary stabilization has become the first choice in reconstructing axis and length of the diaphyseal fractures of the long bones. Indications for intramedullary nailing have become wider with the development of unreamed or retrograde nailing. Essential modifications of plate osteosynthesis from limited contact implants to percutaneous plating and the development of an internal fixator have made this procedure minimally-invasive as well. Techniques of closed reduction and percutaneous osteosynthesis or arthroscopically-assisted procedures have become more important in the stabilization of metaphyseal fractures. Although long term results of some of the mentioned procedures are unknown by now, minimally-invasive techniques appear to have positive influence on functional outcome in most patients. However problems of intraoperative control of axis and rotation in long-bone fractures as well as the surgeon's high exposure to radiation remain unsolved problems in minimally-invasive traumatology.