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Die Versorgung der distalen Radiusfraktur

Kirschner-Draht-Osteosynthese oder palmare winkelstabile Platte?

Treatment of distal radius fractures

Percutaneous Kirschner-wires or palmar locking plates?

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Zusammenfassung

Hintergrund

Wie wirksam ist die offene Reposition und interne Fixation mit palmarer winkelstabiler Osteosynthese im Vergleich zur geschlossenen Reposition und minimal-invasiven Retention mit Bohrdrähten zur Behandlung der distalen Radiusfraktur?

Methodik

Es wurde eine systematische Literaturrecherche unter Einschluss kontrollierter Studien im Zeitraum von 2002–2012 durchgeführt. Die Zielparameter und Ergebnisse der Literaturstellen wurden tabellarisch gegliedert und dargestellt. Neben dem Follow-up-Zeitraum wurden Komplikationen, funktionelle Scoreergebnisse, radiologische Zielgrößen und Besonderheiten der Studien erfasst.

Ergebnisse

Es konnten fünf publizierte kontrollierte Untersuchungen von ausreichender Qualität identifiziert werden. Unsere bislang noch nicht publizierten eigenen Daten einer kontrollierten prospektiv-randomisierten Studie wurden ergänzt, sodass insgesamt die Ergebnisse von sechs unabhängigen kontrollierten Studien vorlagen. In zwei Studien konnte eine bessere Funktion (DASH) nach palmarer winkelstabiler Osteosynthese, in einer nach Bohrdrähten festgestellt werden. In drei Untersuchungen wurde kein signifikanter Unterschied gefunden. Radiologisch zeigten sich Vorteile für die palmare winkelstabile Osteosynthese, da die Ulnavarianz in zwei, die Palmarinklination in zwei und die radioulnare Inklination in einer Studie besser angegeben wurde. Postoperative Komplikationen lagen nach palmarer winkelstabiler Plattenosteosynthese in 7,3% und nach Bohrdrahtosteosynthese in 20% vor, wobei die palmaren Plattenosteosynthesen die schwerwiegenderen Komplikationen zeigten.

Schlussfolgerung

Sowohl die palmare winkelstabile Plattenosteosynthese als auch die minimal-invasive Kirschner-Draht-Ostheosynthese am distalen Radius bieten eine sichere Versorgungsoption, die eine Wiederherstellung von Form und Funktion des distalen Radius erlauben. Durch die höhere Primärstabilität ermöglicht die winkelstabile Versorgung eine frühere Beübung und scheint zu besseren funktionelle Ergebnisse im frühen Verlauf zu führen. Langfristig verschwindet dieser Vorteil wieder.

Abstract

Background

How effective is open reduction and internal fixation with palmar locking plates compared to closed reduction and internal fixation with K-wires in the treatment of fractures of the distal radius?

Method and materials

A systematic review of the literature was performed for the years 2002 to 2012 to find controlled studies comparing K-wires and locking palmar plates. Follow-up, complications, functional results, radiographic results and peculiarities of the studies were analyzed.

Results

A total of five controlled studies could be found and additionally the data of one unpublished controlled prospective study were added. In two studies a better function (DASH) could be achieved following palmar locking plate osteosynthesis, in one study better results were found following K-wire osteosynthesis and three studies found no significant differences. Ulna variation was found to be better restored following palmar locking plate osteosynthesis in two, palmar inclination in two and radioulnar inclination in one study. There were 7.3% complications following palmar locking plate osteosynthesis compared to 20% following K-wire fixation; however, the complications following plate osteosynthesis were more severe.

Conclusions

Palmar locking plates as well as K-wire fixation are suitable techniques for the treatment of fractures of the distal radius. The higher stability of locking plates seems to lead to an earlier functional recovery but this possible advantage disappears in the long-term follow-up.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehung/en hin: Teile der Daten wurden mit Unterstützung der Firma Medartis, Basel, erhoben.

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Authors and Affiliations

  1. Klinik für Schulterchirurgie, Rhön-Klinikum AG , Salzburger Leite 1, 97631, Bad Neustadt a.d. Saale, Deutschland

    R. Meier

  2. Klinik für Unfallchirurgie, Medizinische Hochschule, Hannover, Deutschland

    C. Krettek

  3. Klinik für Unfallchirurgie, Orthopädie und Sporttraumatologie, Lehrstuhl der Universität Witten/Herdecke, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil, Klinikum Köln-Merheim der Kliniken der Stadt Köln gGmbH, Köln, Deutschland

    C. Probst

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  1. R. Meier
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Correspondence to R. Meier.

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Meier, R., Krettek, C. & Probst, C. Die Versorgung der distalen Radiusfraktur. Unfallchirurg 115, 598–607 (2012). https://doi.org/10.1007/s00113-012-2180-5

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