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Prinzipien der Kallusdistraktion

Principles of callus distraction

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Zusammenfassung

Die Kallusdistraktion basiert auf dem Prinzip, durch kontinuierliche Distraktion eines sich bildenden Kallus Knochengewebe zu regenerieren. Sie hat sich als Standardverfahren bei ausgedehnten Beinverkürzungen sowie langstreckigen Knochendefekten etabliert. Die Behandlung ist aufwändig und komplikationsträchtig und bedarf einer exakten Planung, Operationstechnik sowie sorgfältigen Nachbehandlung. Externe Fixateure sind universell einsetzbar, verursachen durch die Weichteiltransfixation allerdings Pininfekte, Schmerzen und Bewegungseinschränkungen mit entsprechender Limitierung der Aktivität. Sie werden daher vorzugsweise bei erhöhtem Infektrisiko, simultaner Verlängerung mit kontinuierlicher Achsenkorrektur und bei offenen Wachstumsfugen eingesetzt. Beim Monorail-Verfahren wird die Fixateurtragedauer verkürzt, indem die Kallusdistraktion mit einem Fixateur externe über einen Marknagel erfolgt, und der Fixateur nach Abschluss der Distraktion entfernt wird. Die intramedulläre Schienung schützt das Kallusgewebe vor Refrakturen und Achsenabweichungen. Neu entwickelte Verlängerungsnägel ermöglichen nunmehr eine vollständig interne Kallusdistraktion und eine rasche Wiederaufnahme täglicher Aktivitäten. In dieser Übersichtsarbeit werden Prinzipien der Kallusdistraktion, Komplikationsmöglichkeiten sowie deren Management dargestellt.

Abstract

Callus distraction is based on the principle of regenerating bone by continuous distraction of proliferating callus tissue. It has become the standard treatment of significant leg shortening and large bone defects. Due to many problems and complications, exact preoperative planning, operative technique and careful postoperative follow-up are essential. External fixators can be used for all indications of callus distraction. However, due to pin tract infections, pain and loss of mobility caused by soft tissue transfixation, fixators are applied in patients with open growth plates, simultaneous lengthening with continuous deformity corrections, and increased risk of infection. Distraction over an intramedullary nail allows removal of the external fixator at the end of distraction before callus consolidation (monorail method). The intramedullary nail protects newly formed callus tissue and reduces the risk of axial deviation and refractures. Recently developed, fully intramedullary lengthening devices eliminate fixator-associated complications and accelerate return to normal daily activities. This review describes principles of callus distraction, potential complications and their management.

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Danksagung.

Die Autoren danken Herrn Rene Beck für die Anfertigung der Zeichnungen.

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Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

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  1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover

    S. Hankemeier, L. Bastian, T. Gosling & C. Krettek

  2. Unfallchirurgische Klinik, Medizinische Hochschule, Carl-Neuberg-Straße 1, 30625, Hannover

    S. Hankemeier

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  1. S. Hankemeier
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  2. L. Bastian
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  3. T. Gosling
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  4. C. Krettek
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Correspondence to S. Hankemeier.

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Hankemeier, S., Bastian, L., Gosling, T. et al. Prinzipien der Kallusdistraktion. Unfallchirurg 107, 945–960 (2004). https://doi.org/10.1007/s00113-004-0842-7

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