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Arthrodesen mit intramedullären Kraftträgern

Arthrodesis with intramedullary implants

  • Leitthema
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Trauma und Berufskrankheit

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Zusammenfassung

Arthrodesen am Sprung- und Kniegelenk haben weiterhin ihre Berechtigung und erleben durch die steigenden Fallzahlen der Endoprothetik und damit auch der Komplikationen eine Renaissance. Bei regelhafter Ausführung ist mit keiner weiteren Operation zu rechnen. Externe Osteosyntheseverfahren weisen gegenüber internen gewisse Nachteile auf, wie die höhere Pseudarthroserate, die häufigen Pininfektionen und der geringere Patientenkomfort. Intramedulläre Osteosynthesen werden seit vielen Jahrzehnten für Versteifungsoperationen eingesetzt. Als zentraler Kraftträger sind sie den meisten anderen Osteosyntheseformen biomechanisch überlegen. Zudem können sie fernab der Fusionsstelle ohne großen Weichteilschaden eingebracht werden. Wesentliche Prinzipien einer Arthrodese sind die Aneinanderlagerung gut durchbluteter Knochenflächen, die stabile Fixation und die Kompression. Verzichtet man bei Marknagelarthrodesen auf Kompression, muss mit einem deutlichen Abfall der Steifigkeit gerechnet werden, verglichen mit komprimierten Marknagelarthrodesen.

Arthrodesis of the ankle and knee continues to have a place, and with the increasing numbers of joint replacement operations with their attendant complications this technique is enjoying a revival. When it is correctly carried out no further surgery should be needed. In osteosynthesis, external procedures have some disadvantages relative to internal ones, such as a higher incidence of pseudarthrosis, frequent pin infections and a lower level of comfort and convenience for the patient. Intramedullary operations have been used for many decades for arthrodesis. Intramedullary implants are biomechanically superior to other forms of fixation. In addition they can be inserted at a point distant from the site of fusion without causing a relevant damage to the soft tissues. The basic principles of an arthrodesis are the apposition of bone surfaces with good blood supply, stable fixation, and compression. If compression is omitted when an arthrodesis is carried out by means of nailing a significant lower degree of stiffness must be expected than is achieved with compressed medullary nail arthrodesis.

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Mückley, T., Hofmann, G.O. Arthrodesen mit intramedullären Kraftträgern. Trauma Berufskrankh 7, 107–111 (2005). https://doi.org/10.1007/s10039-005-1006-x

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  • DOI: https://doi.org/10.1007/s10039-005-1006-x

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