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Knochenersatz durch Kallusdistraktion an der unteren Extremität

Bone replacement by means of callus distraction on the lower extremity

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die erfolgreiche Behandlung einer posttraumatischen chronischen Osteitis an der unteren Extremität gelingt oftmals nur um den Preis eines mehr oder weniger ausgedehnten Knochenverlusts. Zur Wiederherstellung langstreckiger knöcherner Substanzdefekte haben sich in den vergangenen Jahren verschiedene Verfahren des Segmenttransports, basierend auf der Ilizarov-Kallusdistraktion, etabliert. Für die technische Umsetzung eines solchen Segmenttransports stehen gleichermaßen extra- und intramedulläre Verfahren zur Verfügung. Die Indikationsstellung für einen Segmenttransport über Ringfixateur, monolateralen Fixateur externe oder intramedullären Kraftträger in Kombination mit Fixateur externe oder Seilzug als Transportsystem muss individuell unter Berücksichtigung verschiedener Faktoren entschieden werden. Dabei spielen Dauer und Ausdehnung der vorbestehenden Osteitis, zeitlicher Aufwand zur erfolgreichen Behandlung der Infektion, Weichgewebesituation, resultierende Länge der Defektstrecke nach Resektion sowie Alter, Risikofaktoren und Komorbidität des Patienten eine Rolle. Im folgenden Beitrag soll aus einer langjährigen klinischen Erfahrung in der Behandlung von postinfektiösen Defektzuständen an der unteren Extremität ein Algorithmus zum differenzierten Einsatz der verschiedenen Segmenttransporttechniken diskutiert werden.

Abstract

Successful treatment of posttraumatic chronic osteitis is often only achieved at the cost of some degree of bone loss. Various procedures for segmental transfer based on Ilizarov’s callus distraction technique have become established for reconstruction of extensive bony substance defects in recent years. Technically, both extramedullary and intramedullary procedures are available for the achievement of such a segmental transfer. Various factors must be taken into account when it is necessary to decide whether segmental transfer by means of a ring fixator, a unilateral fixateur externe or an intramedullary force carrier in combination with a fixateur externe or tension wires as the transfer system is indicated. These include how long the history of osteitis already is, how extensive it is, time taken for successful treatment of infection, soft tissue situation, resulting length of the defect following resection, and the patient’s age, together whether there are any patient-specific risk factors or comorbidities. In this paper an algorithm for deciding on the specific situations in which the different techniques of segmental transfer are indicated is discussed on the basis of many years of clinical experience in postinfectious defects on the lower extremities.

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Hofmann, G.O., Mückley, T. & Diefenbeck, M. Knochenersatz durch Kallusdistraktion an der unteren Extremität. Trauma Berufskrankh 7, 282–289 (2005). https://doi.org/10.1007/s10039-005-1040-8

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