Zusammenfassung
Bei der Versorgung proximaler extraartikulärer Tibiafrakturen können neben dem oftmals ausgeprägten Weichteilschaden insbesondere die speziellen biomechanischen Bedingungen der proximalen Tibiaregion eine Herausforderung darstellen. Für die operative Versorgung stehen verschiedene Osteosyntheseverfahren zur Verfügung. Der Fixateur externe empfiehlt sich insbesondere als Notfall- und Kurzzeitimplantat zur temporären Stabilisierung von Frakturen mit höhergradigem Weichteilschaden. Die Marknagelosteosynthese stellt bei korrekter Durchführung ein minimal invasives, aber technisch anspruchsvolles Verfahren zur Versorgung der proximalen Tibiafraktur dar. Winkelstabile Implantate zur Plattenosteosynthese wie z. B. das „less invasive stabilization system“ (LISS) erfüllen die Forderungen einer schnellen Montage, eines weichteilschonenden Operationsverfahrens und einer hohen biomechanischen Stabilität. Die Inzidenz von Achsfehlstellungen und Instabilitäten mit verzögerter Heilung kann durch die Verwendung dieser neuartigen Implantate verringert werden.
Abstract
The treatment of proximal extra-articular tibial fractures can be challenging due to extensive soft tissue damage and the special biomechanical conditions in the proximal tibial region. Different osteosynthetic procedures are available for operative stabilization. Treatment with an external fixator is recommended in particular as an emergency and short-term implant for temporary stabilization of fractures with extensive soft tissue damage. Intramedullary nailing represents a minimally invasive but technically demanding procedure to stabilize proximal tibial fractures. Angularly stable implant systems such as the so-called less invasive stabilization system fulfill the demands of fast implantation, soft tissue protection, and high biomechanical stability. The rate of malalignments and instabilities with delayed healing can be reduced using these new implants.
Literatur
Boldin C, Fankhauser F, Hofer HP, Szyszkowitz R (2006) Three-year results of proximal tibia fractures treated with the LISS. Clin Orthop Relat Res 445: 222–229
Cole PA, Zlowodzki M, Kregor PJ (2004) Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma 18: 528–535
Court-Brown CM, McBirnie J (1995) The epidemiology of tibial fractures. J Bone Joint Surg Br 77: 417–421
Freedman EL, Johnson EE (1995) Radiographic analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res: 25–33
Gerber A, Ganz R (1998) Combined internal and external osteosynthesis a biological approach to the treatment of complex fractures of the proximal tibia. Injury 29 [Suppl 3]: C22–C28
Gruner A, Hockertz T, Reilmann H (2000) [Proximal tibial fractures]. Unfallchirurg 103: 668–684
Koval KJ, Hoehl JJ, Kummer FJ, Simon JA (1997) Distal femoral fixation: a biomechani cal comparison of the standard condylar buttress plate, a locked buttress plate, and the 95-degree blade plate. J Orthop Trauma 11: 521–524
Krettek C, Stephan C, Schandelmaier P et al. (1999) The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails. J Bone Joint Surg Br 81: 963–968
Lang GJ, Cohen BE, Bosse MJ, Kellam JF (1995) Proximal third tibial shaft fractures. Should they be nailed? Clin Orthop Relat Res64–74
Mueller CA, Eingartner C, Schreitmueller E et al. (2005) Primary stability of various forms of osteosynthesis in the treatment of fractures of the proximal tibia. J Bone Joint Surg Br 87: 426–432
Müller ME, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of the long bones. Springer, Berlin Heidelberg New York
Nork SE, Barei DP, Schildhauer TA et al. (2006) Intramedullary Nailing of Proximal Quarter Tibial Fractures. J Orthop Trauma 20: 523–528
Oestern HJ, Tscherne H (1983) [Physiopathology and classification of soft tissue lesion]. Hefte Unfallheilkd 162: 1–10
Peindl RD, Zura RD, Vincent A et al. (2004) Unstable proximal extraarticular tibia fractures: a biomechanical evaluation of four methods of fixation. J Orthop Trauma 18: 540–545
Raschke MJ, Hoffmann R, Khodadadyan C et al. (1996) [Supportive composite-hybrid fixation of percutaneous screw fixation of tibial head fractures]. Unfallchirurg 99: 855–860
Schlenzka R, Gotzen L, Schmidt R (1986) [Stabilization of the short proximal and distal main fragments of the tibia with monofixation. An experimental study. I. Axial stress]. Unfallchirurg 89: 214–219
Young MJ, Barrack RL (1994) Complications of internal fixation of tibial plateau fractures. Orthop Rev 23: 149–154
Interessenkonflikt
Keine Angaben.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Konrad, G., Südkamp, N. Proximale extraartikuläre Tibiafraktur. Chirurg 78, 163–173 (2007). https://doi.org/10.1007/s00104-006-1292-2
Issue Date:
DOI: https://doi.org/10.1007/s00104-006-1292-2