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Diaphysäre Unterschenkelfrakturen beim Kind

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Orthopädie und Unfallchirurgie

Part of the book series: Springer Reference Medizin ((SRM))

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Zusammenfassung

Im Wachstumsalter treten Frakturen im Unterschenkelschaftbereich vor allem als isolierte Tibiaschaftbrüche auf. Betroffen sind vor allem sportlich aktive Kinder um das 8. Lebensjahr. Durch das starke Periost und die geringe Knochenstabilität von Kleinkindern kommt es zu Toddler-Frakturen, diese sind mitunter nur durch ein hinkendes Gangbild erkennbar und bleiben am initialen Röntgenbild mitunter unsichtbar. Isolierte Tibiaschaftfrakturen im Wachstumsalter lassen sich mehrheitlich mit sehr gutem Ergebnis konservativ im Oberschenkelgipsverband behandeln. Dabei ist auf eine Verhinderung einer Varus- oder Rekurvationsfehlstellung zu achten. Instabile kombinierte Schien- und Wadenbeinschaftbrüche benötigen häufig eine elastisch stabile Markraumschienung (ESMS) der Tibia zur Stabilisation, und nur selten ist ein anderes Osteosyntheseverfahren erforderlich. Die Symptomkombination von starken Schmerzen, zunehmendem Schmerzmittelbedarf, Sensibilitätsstörungen am Fußrückenbereich, starke Unterschenkelschwellung, Anschwellung und bläuliche Verfärbung der Zehen bei engem Gipsverband, deutet auf ein Kompartmentsyndrom hin, das eine dringliche Faszienspaltung erfordert. Hemmende oder stimulative Wachstumsstörungen spielen im Unterschenkelschaftbereich eine untergeordnete Rolle. Durch den teilweise dünnen Weichteilmantel und die weniger gut durchbluteten Weichteile kommt es im Unterschenkelbereich auch im Wachstumsalter mitunter zu Weichteildefekten und Frakturheilungsverzögerungen, die eine frühzeitige und ggf. aufwendige Behandlung erfordern.

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  1. Kinderchirurgie, Universitäts-Kinderspital beider Basel, Basel, Schweiz

    Johannes Mayr & Benjamin Frei

  2. Universtätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich

    Annelie M. Weinberg

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  2. Benjamin Frei
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  3. Annelie M. Weinberg
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Editors and Affiliations

  1. Klinik für Orthopädie, Klinikum Osnabrück GmbH Klinik für Orthopädie, Osnabrück, Niedersachsen, Deutschland

    Martin Engelhardt

  2. Unfallchirurgie, Universitätsklinikum Münster Unfallchirurgie, Münster, Nordrhein-Westfalen, Deutschland

    Michael Raschke

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  1. Department of Orthopaedic Surgery, Medical University of Graz, Graz, Österreich

    Annelie M. Weinberg

  2. Kinderchirurgie, UKBB, Basel, Schweiz

    Johannes Mayr

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Mayr, J., Frei, B., Weinberg, A.M. (2022). Diaphysäre Unterschenkelfrakturen beim Kind. In: Engelhardt, M., Raschke, M. (eds) Orthopädie und Unfallchirurgie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-54673-0_253-1

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