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Intraartikuläre Frakturen der distalen Tibia

Funktionelles Outcome und gesundheitsbezogene Lebensqualität nach operativer Versorgung

Intraarticular fractures of the tibial plafond

Functional outcome and health-related quality of life after surgery

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Pilon-tibiale-Frakturen sind seltene, schwere Verletzungen, die durch komplexe Bruchlinienverläufe, eine Zerstörung des Gelenkknorpels und erhebliche Weichteilschäden charakterisiert sind. Ziel der zweizeitigen internen Osteosynthese ist die anatomische Rekonstruktion, um das Ausmaß einer posttraumatischen Arthrose zu minimieren. In einer retrospektiven Studie wurden bei 21 Patienten nach einer medianen Nachbeobachtungszeit von 36 Monaten Bewegungsumfänge, spezifische Funktionsdaten und die gesundheitsbezogene Lebensqualität erhoben. Bei 9 Patienten traten lokale Komplikationen auf. Der Bewegungsumfang im betroffenen oberen Sprunggelenk (OSG) sowie die Funktion der betroffenen Extremität waren zum Zeitpunkt der Nachuntersuchung deutlich reduziert. Der körperliche Summenscore lag deutlich, der mentale nur geringfügig unterhalb der populationsbasierten Norm. Analog wurde die gesundheitsbezogene Lebensqualität eingestuft. Somit ist die funktionelle Prognose von Frakturen des Pilon tibiale trotz eindeutiger Verbesserungen im chirurgischen Management weiterhin unbefriedigend. Innovative Therapieansätze müssen die durch die Zerstörung der Gelenkflächen im OSG hervorgerufenen biologischen Schäden kausal minimieren.

Abstract

Fractures of the tibial plafond are rare but severe injuries which are characterized by complex fracture lines, destruction of the chondral layer and significant soft tissue damage. The key goal of staged internal fixation is anatomical reconstruction in order to minimize the risk and degree of post-traumatic osteoarthritis. There is a paucity of data on functional outcome and health-related quality of life after surgical treatment of these fractures. A retrospective study of 21 patients was conducted with follow-up for a median interval of 36 months. The range of motion (ROM) of the ankle joint, specific function, and health-related quality of life were assessed. A total of nine patients encountered local complications. At the time of follow-up the mean difference in ROM between the injured and the contra-lateral ankle joint and extremity function was clearly reduced. The mean physical component score indicated significant impairment, whereas the mental component score was only slightly below the population norm. Health-related quality of life factors were analogously assessed. Despite substantial improvement in surgical treatment the functional prognosis of fractures of the tibial plafond remains unsatisfactory. Innovative treatment approaches must target and overcome the biological damages to the joint cartilage.

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Stengel, D., Knof, I., Ekkernkamp, A. et al. Intraartikuläre Frakturen der distalen Tibia. Trauma Berufskrankh 13, 5–11 (2011). https://doi.org/10.1007/s10039-010-1698-4

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