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Zehn Jahre palmare winkelstabile Plattenosteosynthese zur Behandlung der distalen Radiusfraktur: wer profitiert?

Ten years of volar locking plate fixation in the treatment of distal radius fractures: who benefits?

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Zusammenfassung

Die Einführung der palmaren winkelstabilen Plattenosteosynthese hat zu einem Paradigmenwechsel in der Versorgung von distalen Radiusfrakturen geführt. Sie stellt heute ein etabliertes Verfahren zu deren Behandlung dar und führt bei sachgerechter Indikation zu guten klinischen und radiologischen Ergebnissen. Anhand randomisierter Studien und deren Metaanalysen konnte aber noch keine signifikante Überlegenheit der palmaren Platte gegenüber den Alternativverfahren nachgewiesen werden. In dieser Übersichtsarbeit wird auf der Basis der aktuellen Literatur dargestellt, welche Patientengruppen und Frakturformen von der Implantation der palmaren Plattenosteosynthese einen besonderen Nutzen haben.

Während für junge Patienten die mit der palmaren Platte erzielten guten Repositionsergebnisse im Vordergrund stehen, profitieren ältere Patienten insbesondere von der frühfunktionellen Behandlung des verletzten Handgelenks. Unter Kenntnis der Anatomie und der Frakturmorphologie am distalen Radius sowie Berücksichtigung der Implantatlage kann das Risiko von Beuge- und Strecksehnenrupturen deutlich gesenkt werden. Anhand klinischer und radiologischer Indikatoren können zudem Patienten identifiziert werden, die nach knöcherner Konsolidierung der Fraktur von einer Implantatentfernung profitieren.

Die Anwendung der palmaren Platte führt im Vergleich zu den Alternativimplantaten zu deutlich höheren Personal- und Materialkosten. Innerhalb des DRG-Vergütungssystems ist mit den palmaren Platten weiterhin eine kostendeckende Versorgung möglich. Der Nachweis, dass die mit der palmaren Plattenosteosynthese erzielte Frühfunktionalität auch aus volkswirtschaftlicher Sicht einen Vorteil darstellt, steht jedoch noch aus.

Abstract

The introduction of volar locking plate fixation has led to a paradigm shift and it now represents an established procedure for the treatment of distal radius fracturesresulting in good clinical and radiological outcomes. However, no randomized trials and meta-analyses could show any significant superiority for volar locking plates compared to the alternative methods. This review article based on the current literature presents which patient groups and types of fractures have a special advantage from locking plates. While for younger patients the good reduction results by locking plates are of high relevance, elderly patients in particular benefit from early functional treatment of injured wrists after surgery. Knowing the anatomy and morphology of fractures of the distal radius as well astaking plate position into consideration significantly decreases the risk of flexor and extensor tendon injuries. There are clinical and radiological indicators that can identify patients who will benefit from implant removal after fracture consolidation. The application of volar locking plates results in significantly higher labor and material costs compared to alternative implants. In the German diagnosis-related groups (DRG) payment system, cost-effective treatment with palmar plates remains possible. Evidence that the early functionality after surgery attained with volar plate fixation is an advantage from an economic perspective is still pending.

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  1. Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Deutschland

    Tim Lögters, Michael Schädel-Höpfner & Joachim Windolf

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  1. Tim Lögters
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Lögters, T., Schädel-Höpfner, M. & Windolf, J. Zehn Jahre palmare winkelstabile Plattenosteosynthese zur Behandlung der distalen Radiusfraktur: wer profitiert?. Obere Extremität 7, 200–208 (2012). https://doi.org/10.1007/s11678-012-0193-x

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