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Gelenkübergreifender Fixateur externe zur temporären Stabilisierung komplexer Frakturen des Kniegelenks

External fixator for temporary stabilization of complex periarticular knee fractures

  • Operative Techniken
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Temporäre Stabilisierung des Kniegelenks, zur Beruhigung der Weichteile und Abschwellung bis zur definitiven Versorgung.

Indikationen

Bikondyläre distale Femur- und Tibiakopffrakturen, zusätzliche Gefäßverletzung, offene Frakturen (zweit- oder drittgradig), schwerer Weichteilschaden, ggf. unikondyläre Fraktur und kontralaterale Seitenbandverletzung (relativ), (offene) Kniegelenkluxationen (relativ), Polytrauma.

Kontraindikationen

Unsichere Pinfixierung, schwere Osteoporose (relativ).

Operationstechnik

Je 2 femorale und tibiale Pins, die über 2 Längsträger verbunden sind, werden mit 2 zusätzlichen Verbindungsstangen über Kombinationsbacken kniegelenkübergreifend verbunden. Alternativ ist dieses durch eine direkte Verbindung der proximalen Längsträger mit den distalen bei femoral ventraler Lage der Pins möglich. Hierbei sollte auf ausreichenden Abstand zu offenen Wunden, zur Fraktur als auch zu späteren Zugängen geachtet werden. Das Kniegelenk wird in einer Flexionsstellung von 5–15° achsengerecht fixiert.

Weiterbehandlung

Planung der definitiven Versorgung sowohl in Abhängigkeit des Allgemeinzustandes des Patienten als auch des Lokalbefundes.

Abstract

Objective

Temporary stabilization of the knee joint in order to minimize soft tissue strain until definitive surgery is possible.

Indications

Bicondylar distal femoral and tibial plateau fractures, additional vascular injury, open fractures (second or third degree), severe soft tissue damage, unicondylar fracture with contralateral ligament tear, (open) knee dislocation, polytrauma.

Contraindications

Unsafe pin placement, severe osteoporosis.

Surgical technique

Two femoral and tibial pins are connected by two rods and are spanned over the knee with two additional longitudinal rods via a tube-to-tube clamp. Alternatively, this can be facilitated by a direct connection of two rods in case of anteriorly placed femoral pins. A reasonable distance should be kept to open wounds, the fracture, and later operative approaches. The knee is fixed in 5–15° of flexion.

Postoperative management

Definitive treatment depending on patient well-being and amenable soft tissue.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20251, Hamburg, Deutschland

    C. Cramer & K.-H. Frosch

Authors
  1. C. Cramer
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  2. K.-H. Frosch
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Correspondence to C. Cramer.

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Interessenkonflikt

C. Cramer und K.-H. Frosch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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K. Dresing, Göttingen

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R. Himmelhan, Mannheim

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Cramer, C., Frosch, KH. Gelenkübergreifender Fixateur externe zur temporären Stabilisierung komplexer Frakturen des Kniegelenks. Oper Orthop Traumatol 32, 410–420 (2020). https://doi.org/10.1007/s00064-020-00674-8

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