Zusammenfassung
Operationsziel
Minimal-invasive Plattenosteosynthese distaler meta- und/oder diaphysärer Tibiafrakturen.
Indikationen
Tibiafrakturen extraartikulär oder mit einfacher, nicht oder wenig dislozierter Gelenksbeteiligung (AO 42-A–C + AO 43-A, -C1, -C2) am distalen Tibiaschaft. Geschlossene oder offene Weichteile, besonders geeignet bei geschlossenem Weichteilschaden nach Oestern-Tscherne Grad I–II.
Kontraindikationen
Hochgradig offene Frakturen, bei denen das Implantat nicht gedeckt wäre und komplexe Pilonfrakturen.
Operationstechnik
Geschlossene Reposition manuell, über die Platte oder mittels Fixateur externe/Distraktor. Kurzer Zugang über dem medialen Malleolus. Epiperiostales Einschieben der Platte anteromedial nach kranial. Schrittweises Optimieren der Reposition und Setzen von Schrauben im distalen und proximalen Hauptfragment. Überbrückendes Fixationsprinzip mit Erreichen relativer Stabilität. Stabilisation der Fibula in speziellen Situationen.
Weiterbehandlung
Mobilisation nach 1–3 Tagen mit Abrollbelastung für 6 Wochen. Vollbelastung nach 8–10 Wochen. Optionale Metallentfernung nach 1–2 Jahren bei Weichteilirritationen.
Ergebnisse
Bei 85% der Patienten wurde innerhalb von 4 Monaten eine Heilung mit guter Funktion beobachtet. In 5–10% der Fälle kam es zu einer verzögerten Heilung, bei 5% der Patienten zu einer „non-union“ oder einem Malalignement. Im Langzeit-Follow-up von 2 Jahren zeigten sich alle Patienten mit der Funktion zufrieden.
Abstract
Objective
Minimally invasive plate osteosynthesis of distal metaphyseal and/or diaphyseal tibial fractures.
Indications
Extraarticular tibial fractures or distal tibial fractures with simple intraarticular components (AO 42 A–C + AO 43 A, C1, C2) of the distal tibia shaft. Closed or open soft tissue conditions, most suitable for closed soft tissue damage Oestern–Tscherne grade I–II.
Contraindications
High degree open fractures, where the plate would not be covered by soft tissue. Comminuted Pilon fractures.
Surgical technique
Closed reduction manually, over the plate or the external fixator/large distractor. Short incision on the medial malleolus. Epiperosteal insertion of the plate anteromedial. Improve reduction stepwise and insertion of screws on each main fragment. Relative stability is achieved by using bridging techniques. Fibula fixation in special cases.
Postoperative management
Mobilization after 1–3 days with toe-touch weight bearing. Full weight bearing after 8–10 weeks. Implant removal optional after 1–2 years in cases of soft tissue irritation.
Results
Uneventful healing with good function was observed in 85% of patients within 4 months. Delayed unions were observed in 5–10% of cases and nonunions or malalignment were observed in 5% of patients. All patients were satisfied with function at the 2-year follow-up.
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Literatur
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Müller, T., Sommer, C. Minimal-invasive Plattenosteosynthese am distalen Tibiaschaft. Oper Orthop Traumatol 24, 354–367 (2012). https://doi.org/10.1007/s00064-012-0169-4
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DOI: https://doi.org/10.1007/s00064-012-0169-4
Schlüsselwörter
- Metaphysäre Tibiafrakturen
- Distale Tibiafrakturen
- Extraartikuläre Frakturen
- Minimal-invasive Plattenosteosynthese (MIPO)
- Externe Fixatoren