Zusammenfassung
Hintergrund
Die Versorgung oberer Sprunggelenkfrakturen gehört zu den Standardverfahren einer jeden unfallchirurgischen Klinik.
Therapie
Voraussetzung einer erfolgreichen Therapie sind ein profundes Frakturverständnis und die kompromisslose anatomische Rekonstruktion der Sprunggelenkgabel zur Vermeidung einer posttraumatischen Arthrose. Operative Strategien und Erfordernisse werden anhand der Frakturpathomechanik erläutert und implantatbedingte Besonderheiten erklärt.
Abstract
Background
Ankle fracture surgery is a common task in trauma centers.
Therapy
The key of successful treatment is a thorough understanding of fracture pathomechanics and a meticulous anatomical reduction of the upper ankle joint to prevent secondary arthritis. Surgical strategies and requisites are explained according to the fracture’s pathomechanics. Implant-related properties are highlighted.
Literatur
Albers GH, De Kort AF, Middendorf PR et al (1996) Distal tibiofibular synostosis after ankle fracture. A 14-year follow-up study. J Bone Joint Surg Br 78:250–252
Alonso A, Khoury L, Adams R (1998) Clinical tests for ankle syndesmosis injury: reliability and prediction of return to function. J Orthop Sports Phys Ther 27:276–284
Bankston AB, Anderson LD, Nimityongskul P (1994) Intramedullary screw fixation of lateral malleolus fractures. Foot Ankle Int 15:599–607
Beumer A, Campo MM, Niesing R et al (2005) Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation. Injury 36:60–64
Carr JB (2003) Malleolar fractures and soft tissue injuries of the ankle. In: Browner BD, Jupiter JB, Levine AM, Trafton PG (Hrsg) Skeletal trauma: Basic science, management and reconstruction. Saunders, Philadelphia, S 2307–2374
Femino JE, Gruber BF, Karunakar MA (2007) Safe zone for the placement of medial malleolar screws. J Bone Joint Surg Am 89:133–138
Ferries JS, Decoster TA, Firoozbakhsh KK et al (1994) Plain radiographic interpretation in trimalleolar ankle fractures poorly assesses posterior fragment size. J Orthop Trauma 8:328–331
Franke J, Von Recum J, Suda AJ et al (2012) Intraoperative three-dimensional imaging in the treatment of acute unstable syndesmotic injuries. J Bone Joint Surg Am 94:1386–1390
Grass R, Biewener A, Rammelt S et al (2003) Aktuelle Überlegungen zur Behandlung von OSG-Frakturen. Trauma Berufskrankh 5:141–148
Greenfield DM, Eastell R (2001) Risk factors for ankle fracture. Osteoporos Int 12:97–103
Gutsfeld P, Bühren V (2011) Rupturen der tibiofibularen Syndesmose. Trauma Berufskrankh 13:166–174
Haraguchi N, Armiger RS (2009) A new interpretation of the mechanism of ankle fracture. J Bone Joint Surg Am 91:821–829
Heim U (1983) Malleolarfrakturen. Unfallheilkunde 86:248–258
Holz R, Füchtmeier B, Mayr E (2011) Ursachen der fehlgeschlagenen Osteosynthese am Sprunggelenk. Unfallchirurg 114:913–921
Klitzman R, Zhao H, Zhang LQ et al (2010) Suture-button versus screw fixation of the syndesmosis: a biomechanical analysis. Foot Ankle Int 31:69–75
Kukkonen J, Heikkila JT, Kyyronen T et al (2006) Posterior malleolar fracture is often associated with spiral tibial diaphyseal fracture: a retrospective study. J Trauma 60:1058–1060
Laer L von, Kraus R, Linhart WE (2007) Frakturen und Luxationen im Kindesalter. Thieme, Stuttgart New York
Lauge-Hansen N (1950) Fractures of the ankle. II. Combined experimental-surgical and experimental-roentgenologic investigations. Arch Surg 60:957–985
Mcbryde A, Chiasson B, Wilhelm A et al (1997) Syndesmotic screw placement: a biomechanical analysis. Foot Ankle Int 18:262–266
Mcgarvey WC, Clanton TO, Lunz D (2004) Malleolar fracture after total ankle arthroplasty: a comparison of two designs. Clin Orthop Relat Res 424:104–110
Michelson JD (2003) Ankle fractures resulting from rotational injuries. J Am Acad Orthop Surg 11:403–412
Michelson JD, Varner KE, Checcone M (2001) Diagnosing deltoid injury in ankle fractures: the gravity stress view. Clin Orthop Relat Res 387:178–182
Müller M, Nazarian S, Koch P et al (1990) The AO classification of long bones. Springer, Berlin Heidelberg New York
Nielsen JO, Dons-Jensen H, Sorensen HT (1990) Lauge-Hansen classification of malleolar fractures. An assessment of the reproducibility in 118 cases. Acta Orthop Scand 61:385–387
Pichl J, Hoffmann R (2011) Geriatrische Sprunggelenkfrakturen. Unfallchirurg 114:681–687
Pichl J, Schmidt-Horlohé K, Hoffmann R (2011) Osteosynthese von Frakturen des oberen Sprunggelenks. Trauma Berufskrankh 13:146–153
Rajagopalan S, Lloyd J, Upadhyay V et al (2011) Osteonecrosis of the distal tibia after a pronation external rotation ankle fracture: literature review and management. J Foot Ankle Surg 50:445–448
Rammelt S, Grass R, Zwipp H (2008) Sprunggelenkfrakturen. Unfallchirurg 111:421–437
Rammelt S, Zwipp H, Grass R (2008) Sprunggelenkfrakturen: operative Technik. Unfallchirurg 111:439–447
Rammelt S, Heim D, Hofbauer LC et al (2011) Probleme und Kontroversen in der Behandlung von Sprunggelenkfrakturen. Unfallchirurg 114:847–860
Ramsey PL, Hamilton W (1976) Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 58:356–357
Ruffing T, Muhm M, Winkler H (2011) Die reife Two- und Triplane-Fraktur. Unfallchirurg 114:730–735
Schepers T (2011) To retain or remove the syndesmotic screw: a review of literature. Arch Orthop Trauma Surg 131:879–883
Thordarson DB, Motamed S, Hedman T et al (1997) The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am 79:1809–1815
Weber BG (1966) Die Verletzungen des oberen Sprunggelenkes. Huber, Bern
Weber M, Burmeister H, Flueckiger G et al (2010) The use of weightbearing radiographs to assess the stability of supination-external rotation fractures of the ankle. Arch Orthop Trauma Surg 130:693–698
Xenos JS, Hopkinson WJ, Mulligan ME et al (1995) The tibiofibular syndesmosis. Evaluation of the ligamentous structures, methods of fixation, and radiographic assessment. J Bone Joint Surg Am 77:847–856
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Lenz, M., Gras, F., Klos, K. et al. Standards in der Versorgung oberer Sprunggelenkfrakturen. Trauma Berufskrankh 15, 58–67 (2013). https://doi.org/10.1007/s10039-013-1930-0
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DOI: https://doi.org/10.1007/s10039-013-1930-0
Schlüsselwörter
- Sprunggelenk
- Knochenfraktur
- Prothesen und Implantate
- Intraoperative Komplikationen
- Postoperative Komplikationen