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Wandel in der Behandlung der Tibiakopffraktur

Change in the treatment of tibial plateau fractures

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Zusammenfassung

Hintergrund

Die Versorgung von Tibiakopffrakturen erfuhr in den letzten Jahren eine Reihe unterschiedlichster konzeptioneller Weiterentwicklungen, nicht nur im Hinblick auf technische Innovationen, sondern auch vor dem Hintergrund sich ändernder Frakturmuster und des wachsenden Anspruchs der Patienten.

Fragestellung

Welche Entwicklungen hatten in den letzten Jahren einen wesentlichen Einfluss auf aktuelle Versorgungsstrategien von Tibiakopffrakturen?

Material und Methode

Narratives Review PubMed-gelisteter Publikationen zum Thema der Versorgung von komplexen Tibiakopffrakturen.

Ergebnisse

Während die zweidimensionalen Klassifikationen an Bedeutung verlieren, rücken CT-basierte dreidimensionale Beurteilungen der Frakturverläufe und eine darauf basierende Zugangsstrategie in den Vordergrund. Insbesondere bei relevanter posteromedialer und/oder posterolateraler Frakturbeteiligung zeigen sich direkte dorsale Zugangswege überlegen. Die jeweils schrittweise Zugangserweiterung über spezifische Osteotomien von ligamentären Ansätzen ermöglicht darüber hinaus eine bedarfs- und frakturabhängige vollständige Gelenkflächeneinsicht und Repositionskontrolle. Bei Tibiakopffrakturen geriatrischer Patienten besitzt die primäre Endoprothesenversorgung einen wachsenden Stellenwert, um eine frühzeitige Mobilisation unter Vollbelastung mit deutlich kürzeren Rehabilitationszeiten zu ermöglichen.

Schlussfolgerung

Moderne Entwicklungen im Rahmen der Frakturversorgung um den Tibiakopf führten zu relevanter Reduktion der Infektionen und verbesserter Versorgungsrealität. Der hohe Anspruch und das verbesserte Frakturverständnis verdeutlichen jedoch nach wie vor die große Herausforderung in der Versorgung komplexer Frakturmuster.

Abstract

Background

The treatment of tibial plateau fractures has experienced a number of very different conceptual developments in recent years, not only with respect to technical innovations but also against the background of changing fracture patterns and the growing requirements of patients.

Objective

What developments in recent years have had a significant impact on current treatment strategies for tibial plateau fractures?

Methods

Narrative review of publications listed in PubMed on the topic of treatment of complex tibial plateau fractures.

Results

While the two-dimensional classifications are becoming less important, computed tomography (CT)-based three-dimensional assessment of fracture progression and an access strategy based on it are coming to the fore. Direct dorsal approaches have been shown to be superior, particularly in the case of relevant posteromedial and/or posterolateral fracture involvement. The step-by-step approach extension via specific osteotomies of ligamentous attachments also enables a needs-dependent and fracture-dependent complete joint visualization and reduction control. In the treatment of geriatric tibial plateau fractures, primary treatment with endoprostheses is becoming increasingly more important to enable early mobilization under full load bearing with significantly shorter rehabilitation times.

Conclusion

Modern developments in the context of fracture treatment around the tibial plateau have led to a relevant reduction of infections and improved surgical outcomes; however, the high demands and the improved understanding of fractures still underline the great challenge in the treatment of complex fracture patterns.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    Matthias Krause & Karl-Heinz Frosch

  2. Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland

    Karl-Heinz Frosch

Authors
  1. Matthias Krause
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  2. Karl-Heinz Frosch
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Correspondence to Matthias Krause.

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Interessenkonflikt

M. Krause und K.-H. Frosch geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Karl-Heinz Frosch, Hamburg

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Krause, M., Frosch, KH. Wandel in der Behandlung der Tibiakopffraktur. Unfallchirurgie 125, 527–534 (2022). https://doi.org/10.1007/s00113-022-01165-0

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