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Rupturen der tibiofibularen Syndesmose

Konservative Behandlung – Stellschraube – „tight rope“

Rupture of the tibiofibular syndesmosis

Conservative treatment – bone screws – Tight Rope

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die anatomische Reposition und Stellschraubenfixierung ist gegenwärtig der Standard zur Versorgung der instabilen Symdesmosenläsion. Der Anteil der isolierten tibiofibularen Syndesmosenruptur ist gering. Jede 10. Sprunggelenkfraktur weist jedoch bei genauer Betrachtung eine zusätzliche relevante Syndesmosenverletzung auf. Die Klassifikation von Lauge-Hansen beruht auf der Analyse des Pathomechanismus und führt zu einer zielgerichteten Behandlung. Die Sprunggelenkverletzungen mit Läsion der Syndesmosen zeigen trotz operativer Versorgung ein signifikant schlechteres Outcome. Dies ist multifaktoriell begründet, v. a. in der Schwere der Verletzung, aber auch der Qualität der Reposition und Fixierung. Alternativ zur Stellschraube wird eine Versorgung mittels Fadenzugsystem (Ankle TightRope®) vorgestellt.

Abstract

The standard treatment of distal ruptures of the tibiofibular syndesmosis is an anatomical reduction of the fibula and fixation with one or two tibiofibular syndesmosis screws. The incidence of isolated distal rupture of the tibiofibular syndesmosis is rare. On the other hand 1 in 10 fractures of the ankle is associated with a relevant syndesmotic instability. The classification of Lauge Hansen is based on the analysis of the pathomechanism. A correct reduction and positioning of the screws is mandatory for a good clinical result. Injuries of the ankle combined with syndesmotic instability lead to worse outcome than those without, even after surgical treatment. This can be explained by many reasons, especially by the severity of the injuries but also by the quality of reduction and fixation. The syndesmosis screw fixation method is presented as a standard fixation and additionally the Ankle TightRope® is described as a valid treatment alternative.

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  1. Abteilung für Unfallchirurgie und Sportorthopädie, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Deutschland

    P. Gutsfeld

  2. BG-Unfallklinik Murnau, Murnau, Deutschland

    V. Bühren

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Gutsfeld, P., Bühren, V. Rupturen der tibiofibularen Syndesmose. Trauma Berufskrankh 13, 166–174 (2011). https://doi.org/10.1007/s10039-011-1733-0

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