[The problem of osteosynthesis in peripheral replantation]

In this report, 16 cases of peripheral replantation are described, in which osteosynthesis was carried out by means of AO-mini or small-fragment plates with the obvious advantage of allowing early mobilisation. A disadvantage of this method is that it is necessary to dissect the soft tissue to a greater extent and to elevate the periosteum more than in using Kirschner wires, this dissection to permit sufficient fixation of the plate and screws. As a result, primary technical difficulties in the venous anastomosis may occur and there is a risk of adhesions developing between the extensor apparatus and the bone (two cases). Difficulties occur when using plates and screws for comminuted and juxtaarticular fractures. In these cases Kirschner wire osteosynthesis is preferred. For injuries in zones 1 and 2 in the majority of the cases an osteosynthesis with wire is indicated. Only in cases of replantation in zone 2, where the DIP joint is destroyed, can an arthrodesis be performed by means of a screw. When using the above mentioned osteosynthesis for peripheral replantations, we have achieved good to very good end results in the majority of the cases.