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Die Fraktur der Gegenkortikalis bei der aufklappenden Osteotomie des Tibiakopfes

Lateral hinge fractures in open wedge high tibial osteotomy

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Zusammenfassung

Hintergrund

Die valgisierende „open wedge HTO“ („high tibial osteotomy“, hohe tibiale Umstellungsosteotomie) findet eine zunehmende Verbreitung. Ein Problem stellt die Fraktur der lateralen Kortikalis dar.

Fragestellung

Ziel der Arbeit ist es, das spezielle Problem der Fraktur der lateralen Kortikalis aufzuarbeiten und technische Hinweise zur Vermeidung und Therapie zu geben.

Material und Methode

Es werden zum einen die publizierten Ergebnisse und zum anderen Tipps aus der eigenen Erfahrung dargestellt.

Ergebnisse

Es zeigt sich, dass die instabile Typ-II-Fraktur der lateralen Kortikalis ein Problem darstellt. Unter Verwendung von kurzen Spacerplatten ohne Knochentransplantation stellen alle Frakturtypen ein Problem dar.

Schlussfolgerung

Als Klassifikation für die Fraktur der lateralen Kortikalis hat sich die Einteilung nach Takeuchi I–III bewährt. Bei Verwendung der TomoFix™-Platte kann die Situation von Typ-I- und -III-Frakturen sehr gut kontrolliert werden und ein folgenloses Ausheilungsergebnis erreicht werden. Bei Typ-II-Frakturen kann mit einer TomoFix™-Platte stabilisiert werden. Eine Knochentransplantation sollte dennoch diskutiert werden. Von kurzen Spacerplatten nach Fraktur der lateralen Kortikalis raten die Autoren ab.

Abstract

Background

Open wedge high tibial osteotomy (HTO) is an increasingly more common surgical method. A typical problem of this procedure is fracture of the lateral hinge.

Objectives

The aims of this article are to present the special issue of fractures of the lateral hinge after HTO and to discuss surgical hints on how to prevent and treat this problem.

Methods

The results of recently published clinical studies are summarized and tips from own clinical experiences are given.

Results

Type II fractures of the lateral hinge are unstable and can create a major problem. Using short spacer plates results in a problem of stability for all types of fractures.

Conclusion

The classification into Takeuchi grades I-III has been proven to be suitable for fractures of the lateral hinge. The TomoFix™ plate is a safe implant to stabilize the osteotomy in type I and III fractures with which healing can be achieved with no problems. Type II fractures can be stabilized with the TomoFix™ plate; however, an autologous bone graft has to be taken into consideration. For fractures of the lateral hinge short spacer plates are not recommended due to stability issues.

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Einhaltung ethischer Richtlinien

Interessenkonflikt

S. Schröter, A. Ateschrang, C. Ihle, U. Stöckle, L. Konstantinidis und S. Döbele geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. BG Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard Karls Universität Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland

    S. Schröter, A. Ateschrang, C. Ihle, U. Stöckle & S. Döbele

  2. Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland

    L. Konstantinidis

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  1. S. Schröter
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  2. A. Ateschrang
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  3. C. Ihle
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  4. U. Stöckle
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  5. L. Konstantinidis
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  6. S. Döbele
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Correspondence to S. Schröter.

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Schröter, S., Ateschrang, A., Ihle, C. et al. Die Fraktur der Gegenkortikalis bei der aufklappenden Osteotomie des Tibiakopfes. Orthopäde 43, 1000–1007 (2014). https://doi.org/10.1007/s00132-014-3026-3

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  • DOI: https://doi.org/10.1007/s00132-014-3026-3

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