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Distale Femurfrakturen

Distal femoral fractures

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Zusammenfassung

Distale Femurfrakturen sind problematisch, da sie v. a. junge Patienten nach Hochrasanztraumen mit ausgedehnten Weichteilverletzungen und ossären Trümmerzonen sowie ältere Patienten mit schlechter Vaskularität und oft beträchtlicher Osteoporose betreffen. Gerade diese Frakturen profitierten von den neuen, biologischen Behandlungsprinzipien, die das chirurgische Trauma erheblich reduzierten. Dabei handelt es sich v. a. um intramedulläre Nägel und eingeschobene Platten/Plattenfixateure, wobei Marknägel v. a. bei extraartikulären und einfachen artikulären Frakturen zur Anwendung kommen. Platten(-Fixateure) sind seit der Entwicklung winkelstabiler Platten-Schrauben-Verbindungen für minimalinvasive Eingriffe gut geeignet und können auch bei komplexen Gelenkfrakturen eingesetzt werden. Bei Gelenkfrakturen müssen die artikulären Fragmente anatomisch reponiert und mit absoluter Stabilität fixiert werden. Technische sowie demographische Entwicklungen werden künftig eine noch differenziertere Herangehensweise an diese Verletzungen erfordern.

Abstract

Fractures of the distal femur still represent injuries that are difficult to treat as they either affect younger patients after a high-energy trauma with soft tissue damage and osseous comminution or elderly people with impaired local vascularity and a poor bone stock. However, exactly these fractures profit from new, biological principles of treatment, which help to diminish additional surgical trauma by indirect fracture reduction and insertion of stabilizing implants via mini-incisions. Basically, these techniques are represented by retrograde intramedullary nails and submuscularilly inserted plates/internal fixateurs. While intramedullary nails are well suited to fix extramedullary and simple articular fractures (C1), plates can also be used to treat complex articular fractures. Nevertheless, any displaced articular fracture component must still be anatomically reduced by an open approach and fixed with absolute stability. Technical advances as well as demographic changes will continue to represent challenges in the treatment of these fractures.

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  1. Unfallchirurgische Abteilung, Landesklinikum Waldviertel Horn, Spitalgasse 10, A-3580, Horn, Österreich

    T. Neubauer

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Neubauer, T. Distale Femurfrakturen. Unfallchirurg 115, 433–450 (2012). https://doi.org/10.1007/s00113-012-2218-8

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  • DOI: https://doi.org/10.1007/s00113-012-2218-8

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