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Unaufgebohrte Marknagelung

Unreamed intramedullary nailing

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Zusammenfassung

Die aufgebohrte bzw. unaufgebohrte Marknagelung von Frakturen langer Röhrenknochen war in den letzten Jahrzehnten ein kontroverses und sogar emotionales Thema. Dieser Beitrag gibt einen historischen Überblick über die Entwicklung und beleuchtet den Hintergrund der Notwendigkeit einer unaufgebohrten Nagelung. Weiterhin wird durch die Beschreibung und Zusammenfassung der Resultate der bisher durchgeführten zusammengesetzten randomisierten kontrollierten Studien der aktuelle Wissensstand dargestellt. Vor dem Jahr 2000 empfahlen nahezu sämtliche deutsche Leitfäden der orthopädischen und traumatologischen Chirurgie die unaufgebohrte Marknagelung als „biologischere“ Therapie, die bei geringerer Gefäßschädigung gleich gute oder sogar bessere Ergebnisse erzielt. Insbesondere bei der Behandlung offener Brüche wurde die unaufgebohrte Nagelung befürwortet.

Dies hat sich geändert, denn in der Folgezeit haben randomisierte kontrollierte Studien gezeigt, dass die unaufgebohrte Nagelung zu einer höheren Rate an verzögerter oder ausbleibender Knochenheilung führt, während für die genannten Vorteile bezüglich Blutversorgung und Infektionsrate kein Nachweis erbracht werden konnte. Gemäß der evidenzbasierten Medizin sollten isolierte Femur- und Tibiabrüche aufgebohrt genagelt werden. Bei Vorliegen eines Polytraumas ist es sicherer, Frakturen langer Röhrenknochen mittels Fixateur externe zu stabilisieren, denn sowohl für die aufgebohrte als auch für die unaufgebohrte Nagelung wurden ungünstige Verläufe beschrieben.

Abstract

Reaming and non-reaming of intramedullary nails in long bone fractures was a controversial and even emotional topic in recent decades. This article gives an historical overview of the development in this field and presents the background to the need for unreamed nailing. Furthermore, the current state of knowledge is illustrated by describing the results of a series of randomised controlled trials. Before the year 2000 nearly all German handbooks on orthopaedic and trauma surgery recommended unreamed intramedullary nailing as a more “biological” treatment that causes less harm to vascularity with equal or even better results. Unreamed nailing was in particular advocated for the treatment of open fractures.

The tide turned as randomised controlled trials conducted since 2000 gave evidence that unreamed nailing leads to a higher rate of delayed or non-union, while the advantages to blood supply and infection rate could not be proven. According to evidence based medicine isolated femur and tibia fractures should be nailed in a reamed procedure. In a severe multiple injury setting it is safer to stabilize long bone fractures with external fixators, as adverse events are described for reamed and unreamed nailing.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Die Autoren sind als Referenten für die Fa. Synthes tätig.

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  1. Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, A-6020, Innsbruck, Österreich

    R. Attal & M. Blauth

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  1. R. Attal
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  2. M. Blauth
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Correspondence to R. Attal.

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Attal, R., Blauth, M. Unaufgebohrte Marknagelung. Orthopäde 39, 182–191 (2010). https://doi.org/10.1007/s00132-009-1524-5

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