Die proximale extraartikuläre Tibiafraktur

Abstract

Operative stabilization of proximal tibial fractures by use of conventional osteosynthesis is still problematic. The choice of the osteosynthetic treatment is strongly influenced by the situation of the surrounding soft tissue. Additional problems in this particular location may occur with malalignment in the fracture site after operation. Primary intraoperative malalignment may occur due to dislocating muscle forces or to the operative approach itself. Secondary dislocation is mainly due to the unstable fixation of the proximal fragment by the implant. Today many different implants with specific biomechanical properties are available. Each system requires a particular operative technique and can lead to individual implant-related problems. The new angle stable implant systems (e. g. LISS = "less invasive stabilization system"), offer significant advantages over conventional plate osteosyntheses and external fixation systems. Improvement of the geometry of standard intramedullary osteosyntheses and introduction of angle stability in the proximal interlocking screws (PTN = "proximal tibial nail") seemingly make this system the optimal solution, concerning biomechanics. On the background of our own clinical experiences and biomechanical investigations, the article discusses solutions for this particular problem.

Bone transport for limb reconstruction following severe tibial fractures

“…The most frequent mechanism of injury is high energy and over 50% may be classified as type III Gustilo-Anderson fractures. 1 , 2 Complications regularly occur, influenced by severity of soft tissue damage and degree of fracture site contamination. Infection (5-16%), non-union (5-30%), loss of fixation, and abnormal biomechanics usually result in significant patient morbidity.…”

Die Winkelstabilität bei modernen Marknagelsystemen

“…Das neue, noch in der Erprobung befindliche Tibianagelsystem (TNS) der AO (Abb.17), welches aus einem "Proximalen Tibianagel (PTN)" weiterentwickelt wurde (Abb.18 und 19), integriert die Winkelstabilitä t durch Kompression des proximalsten Bolzens mittels einer Endkappe. Biomechanische Studien bescheinigen dieser neuen proximalen Bolzenanordnung sehr hohe Stabilitä t [7,8].…”

Winkelstabile Platten-Schrauben-Verbindungen: distales Femur/proximale Tibia

“…Zu dem in analoger Weise verfügbaren LISS-System zur Versorgung proximaler Tibiafrakturen gibt es bisher nur wenige Literaturmitteilungen. Hansen et al [4] berichteten anhand biomechanischer Untersuchungen über "entscheidende Vorteile gegenüber den instabileren konventionellen Plattensystemen und externen Fixationssystemen". Sie beschrieben dabei auch ein Implantatversagen mit Ausriss der monokortikalen distalen Schraube im Schaftbereich, sodass für die Anwendung an der proximalen Tibia ebenso wie für den Femur die Verwendung von bikortikalen Schrauben empfohlen werden sollte.…”