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Biomechanik der Frakturbehandlung

Biomechanics of fracture treatment

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Die Heilung von Frakturen wird wesentlich durch die mechanischen Bedingungen in der unmittelbaren Frakturumgebung beeinflusst, welche wiederum von der Art der Frakturstabilisation abhängt.

Biomechanik der Osteosynthese

Die Art und Ausführung einer Osteosynthese bestimmen die Steifigkeit und die Festigkeit des Verbunds aus Osteosynthese und frakturiertem Knochen. Während Erstere den zeitlichen Ablauf der Heilung beeinflussen kann, ist Letztere für die Belastungsfähigkeit der behandelten Extremität entscheidend und lässt Aussagen über den Versagensmechanismus des Osteosyntheseimplantats zu.

Entwicklung optimierter Implantate

Die Anforderungen an eine funktionierende Osteosynthese hängen entscheidend von der Anatomie und der physiologischen Belastung des heilenden Knochens ab und unterscheiden sich zwischen Frakturen im diaphysären und epi-/metaphysären Knochen. Bei diaphysären Frakturen kann die Wahl einer ausreichend dynamischen Osteosynthese über die Bildung eines periostalen Frakturkallus zu einer raschen Heilung führen. Bei Frakturen im Gelenkbereich stellen eine gute Wiederherstellung der Gelenkgeometrie und deren Retention die wesentlichen Aspekte für den Heilungserfolg dar. Basierend auf diesen Vorgaben lassen sich unter mechanischen Gesichtspunkten optimierte Implantate entwickeln und auf ihre sichere und Erfolg versprechende Anwendung untersuchen.

Abstract

Background

The local mechanical environment is one of the key elements for the successful healing of bone fractures.

Biomechanics of osteosynthesis

The choice and implementation of the fracture fixation technique (e.g., the type and performance of the osteosynthesis) determine this mechanical environment. It can be characterized by the stiffness and strength of the bone–implant construct. Bone–implant stiffness primarily determines the temporal course of the healing process by providing the mechanical window for bone formation and bone remodeling. Bone–implant strength on the other hand determines the load-bearing capacity and also influences the failure characteristics of the specific fracture healing construct.

Requirements for osteosynthesis/development of optimized implants

The requirements for successful fracture treatment depend on the anatomy and physiological loading situation of the individual bone. Thus, different requirements have to be respected for treatment of diaphyseal compared to epi-/metaphyseal fractures. Diaphyseal fractures require a certain amount of dynamic interfragmentary movement in order to stimulate secondary healing by periosteal callus formation. Fractures around a joint on the other hand rely on accurate restoration of joint congruity and its retention. Based on these different requirements, osteosynthesis implants can be optimized according to their mechanical performance and safe application for patient treatment.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. P. Augat, M. Bottlang und S. Hungerer geben an, dass kein Interessenkonflikt besteht. Alle nationalen Richtlinien zur Haltung und zum Umgang mit Labortieren wurden eingehalten und die notwendigen Zustimmungen der zuständigen Behörden liegen vor.

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Authors and Affiliations

  1. Institut für Biomechanik, BG-Unfallklinik Murnau, Prof.-Küntscher-Straße 8, 82418, Murnau, Deutschland

    P. Augat (Ph.D.)

  2. Institut für Biomechanik, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich

    P. Augat (Ph.D.)

  3. Legacy Research Institute, Portland, OR, USA

    M. Bottlang Ph.D.

  4. Abteilung Unfallchirurgie, BG-Unfallklinik Murnau, Murnau, Deutschland

    S. Hungerer M.D.

Authors
  1. P. Augat (Ph.D.)
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  2. M. Bottlang Ph.D.
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  3. S. Hungerer M.D.
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Correspondence to P. Augat (Ph.D.).

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Augat, P., Bottlang, M. & Hungerer, S. Biomechanik der Frakturbehandlung. Trauma Berufskrankh 15, 232–239 (2013). https://doi.org/10.1007/s10039-013-2038-2

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