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Konservative Frakturbehandlung

Oberes Sprunggelenk und Pilon tibiale

Conservative fracture management

The upper ankle and tibial pilon

  • Leitthema
  • Published:
Trauma und Berufskrankheit

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Zusammenfassung

Spunggelenkfrakturen sind häufige Verletzungen in der Traumatologie und Sportmedizin. Die Therapiestratifizierung, ob konservativ oder operativ, ist weiterhin Gegenstand intensiver Diskussionen. Lauge-Hansen-, AO/OTA- (Arbeitsgemeinschaft für Osteosynthesefragen/“Orthopaedic Trauma Association“) sowie die Weber-Klassifikation gelten als für die Beschreibung und Charakterisierung des Frakturtyps geeignet und sind im klinischen Alltag bewährt. Für die Therapiestratifizierung sind Frakturcharakteristika, aber auch Kovariablen wie Komorbiditäten, Compliance, Mobilität u. a. bedeutend. Die Frakturstabilität ist eine Determinante für eine konservative Behandlung. Sie kann dynamisch oder statisch radiologisch bestimmt werden. Bei Erfüllung der Stabilitätskriterien kann eine konservative, funktionelle Therapie eingeleitet werden. Diese subsumiert eine Immobilisierung in Gips, Cast, Unterschenkelorthese oder Luftkammerschiene mit adaptierten Belastungsformen von Entlastung bis hin zur schmerzorientierten Vollbelastung an Unterarmgehstützen. Das funktionelle Outcome ist bei Integrität der Gelenkkongruenz meist als gut einzuschätzen. Komplikationen sind selten.

Abstract

Ankle fractures are common injuries in orthopaedic trauma and sports medicine. Treatment stratification indicating non-operative or operative treatment remains controversial. The Lauge-Hansen, AO/OTA, as well as the Weber classifications are commonly used in clinical routine to describe the fracture pattern and characteristics. Fracture characteristics, as well as co-variables such as comorbidity, patient compliance, level of mobility among others, are relevant to further decision making. Fracture stability, which can be tested by dynamic or static radiographic analysis, is a determinant of conservative treatment. In cases where stability criteria are fulfilled, functional, non-surgical treatment can be initiated. Non-operative treatment includes plaster, cast, splint, brace, or air-cast immobilization combined with a variable degree of weight-bearing supported by crutches. Functional outcome following non-operative treatment has been demonstrated to be generally good if joint congruity is preserved. Complications are uncommon.

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Abbreviations

AO:

Arbeitsgemeinschaft für Osteosynthesefragen

AOFAS:

„American Orthopaedic Foot and Ankle Society Score“

CT:

Computertomographie

MRT:

Magnetresonanztomographie

OR:

„odds ratio“

OTA:

„Orthopaedic Trauma Association“

pAVK:

Periphere arterielle Verschlusskrankheit

PNP:

Polyneuropathie

SF-36:

„Short form-36“

TCW:

Talokruraler Winkel

TFA:

Tibiofibularer Abstand

TTA:

Tibiotalarer Abstand

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Authors and Affiliations

  1. Chirurgische Universitäts- und Poliklinik, BG-Universitätsklinik Bergmannsheil GmbH, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    M.O. Coulibaly, T. Fehmer, M. Königshausen, M. Dudda, T.A. Schildhauer & S. Jung

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  1. M.O. Coulibaly
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  2. T. Fehmer
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  3. M. Königshausen
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  4. M. Dudda
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  5. T.A. Schildhauer
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  6. S. Jung
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Correspondence to M.O. Coulibaly.

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Coulibaly, M., Fehmer, T., Königshausen, M. et al. Konservative Frakturbehandlung. Trauma Berufskrankh 13, 154–159 (2011). https://doi.org/10.1007/s10039-011-1749-5

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