Die proximale Tibiafraktur

Grüner, A.; Hockertz, Thomas; Reilmann, H.

doi:10.1007/s001130050601

Cited by 21 publications

(8 citation statements)

References 7 publications

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“…Some studies have even popularized intramedullary nailing in open fractures [5, 7, 8]. With the introduction of the MIPO technique (minimally invasive plate osteosynthesis) and new plate designs that function as internal fixators [9], plate fixation of tibia fractures gained renewed attention [10, 11]. Some authors actually recommend using plate and screw fixation to repair distal tibiofibular fractures [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Complications after surgical management of distal lower leg fractures

Neumann

Strohm

Reising

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundOsseous healing of distal lower leg fractures can be prolonged and is often associated with wound healing problems because of the marginal soft - tissue and vascular supply in this area. Postoperative complications are frequent, and according to the literature, open reduction and plate fixation is thought to be associated with higher complication rates. The objective of this study was to evaluate the most common postoperative complications following intramedullary nailing or plate osteosynthesis of distal lower leg injuries with a focus on combined tibio-fibular fractures. The outcomes of patients with and without complications associated the two surgical techniques were compared.MethodsDuring a 5-year period, all surgically treated distal tibiofibular fractures were retrospectively collected from the clinical database and were evaluated for the presence of postoperative complications which included compartment syndrome, wound infection, delayed union and non-union, synostosis and rotational malalignment. Postoperative complications were reviewed and correlated with patient risk factors.ResultsA total of 199 patients were included in the study, and 75 complications were reported. The majority of complications were associated with closed fracture types treated with intramedullary nailing, delayed union being the most frequent. For open fractures, surgical treatment with plate fixation had a complication rate of 12% compared with 25% after intramedullary nailing.DiscussionIn general, distal lower leg fractures are associated with a high risk of postoperative complications. Distal diaphyseal tibial fractures that have been treated with intramedullary nailing devices have a higher risk of delayed union or non - union.ConclusionPlate fixation in distal metaphyseal fractures has a higher risk of problems related to wound healing and postoperative wound infections.

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Section: Introductionmentioning

confidence: 99%

Complications after surgical management of distal lower leg fractures

Neumann

Strohm

Reising

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…Hier ist insgesamt eine relativ geringe axiale Steifigkeit für beide extramedullären Verfahren zu erkennen, wobei das LISS gegenüber der konventionellen Plattenosteosynthese den entscheidenden Vorteil einer hohen Elastizität besitzt [7]. Während es den axial einwirkenden Kräften in aller Regel nur bis maximal 600 N widerstehen kann, richtet es sich nach dem Nachlassen der äußeren Kraft wieder vollständig auf.…”

Section: Diskussionunclassified

Proximaler Tibianagel (PTN) - biomechanische Untersuchungen

2005

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Die Stabilisierung proximaler metaphysärer und Schaftfrakturen der Tibia stellt unter Verwendung bisher gebräuchlicher Osteosyntheseverfahren unverändert ein Problem dar. Die Wahl des Operationsverfahrens hängt hierbei nicht nur von der Situation der oftmals erheblich kompromittierten frakturumgebenden Weichteile ab, sondern bestimmt sich anhand der schwierigen biomechanischen Grundbedingungen dieser anatomischen Region. Neben einer häufigen intraoperativen Dislokation der Fraktur, durch Muskelzug und den operativen Zugang bedingt, kommt es gehäuft zu sekundären Fehlstellungen durch relative Implantatinstabilität. Bis zum jetzigen Zeitpunkt haben sich verschiedene Verfahren zur Versorgung dieser Frakturen entwickelt, welche differierende biomechanische Eigenschaften besitzen, unterschiedliche Operationstechniken erfordern und immer auch spezifische Probleme aufwerfen. Die Verbesserung der bisher üblichen Geometrie intramedullärer Kraftträger sowie die Einführung von Winkelstabilität im Bereich der proximalen Verriegelungsschrauben (PTN = "proximaler Tibianagel") lassen dieses Verfahren theoretisch als biomechanisch optimale Lösung erscheinen. Vor dem Hintergrund eigener biomechanischer Untersuchungen sollen Lösungsmöglichkeiten für diese spezielle Problematik aufgezeigt werden. AbstractOperative stabilization of proximal tibial fractures still is problematic when conventional osteosyntheses are used. The choice of type of osteosynthesis to treat specific fractures is strongly influenced by the situation of surrounding soft tissues and the difficult biomechanical conditions of this area. Primary intraoperative malalignment may occur due to dislocating muscle forces or to the operative approach itself. Secondary dislocation mainly is due to the unstable fixation of the proximal fragment by the implant. Until now, many different implants with specific biomechanical properties are available. Each system requires a particular operative technique and can lead to individual implant-related problems. Improvement of the geometry of standard intramedullary osteosyntheses and introduction of angle stability in the proximal interlocking screws (PTN = proximal tibial nail) let this system theoretically appear to be a biomechanically optimal solution. Against the background of own clinical experiences and biomechanical investigations, solutions for this particular problem are to be described and their significance judged. Schwerpunktthema 134

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“…Die intramedulläre Nagelung von Frakturen langer Röhrenknochen stellt in der modernen Traumatologie ein Stan- dardverfahren dar, führt jedoch bei proximalen Frakturen der Tibia oftmals zu Achsabweichungen in verschiedenen Ebenen [5,15]. Hierbei muss zwischen primär intraoperativ entstandenen und sekundär postoperativ aufgetretenen Fehlstellungen unterschieden werden,da diesen beiden Gruppen vollkommen andere Mechanismen zu Grunde liegen.…”

Section: Nagelungunclassified

Die proximale extraartikuläre Tibiafraktur

Hansen¹,

Mehler²,

Voltmer³

et al. 2002

Der Unfallchirurg

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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.

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Die proximale Tibiafraktur

Cited by 21 publications

References 7 publications

Complications after surgical management of distal lower leg fractures

Complications after surgical management of distal lower leg fractures

Proximaler Tibianagel (PTN) - biomechanische Untersuchungen

Die proximale extraartikuläre Tibiafraktur

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