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Arthroskopisch gestütztes Frakturmanagement

Oberes Sprunggelenk und Kalkaneus

Arthroscopy-guided fracture management

Ankle joint and calcaneus

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Zusammenfassung

Das arthroskopische Frakturmanagement am oberen Sprunggelenk und am Kalkaneus bedarf einer differenzierten Betrachtung. Ziel ist eine Minimierung des operationsbedingten Weichteiltraumas und die visuelle arthroskopische Bestätigung des Repositionserfolgs. Darüber hinaus werden unfallbedingte Knorpelschäden sicher erkannt und mit behandelt. Eine schwere Impression der Gelenkfläche mit der Notwendigkeit der Spongiosaunterfütterung, der mehrfragmentäre Gelenkbruch und insbesondere der höhergradige Weichteilschaden sind die limitierenden Faktoren für ein rein arthroskopisches Vorgehen. Eine Alternative zum minimal-invasiven arthroskopischen Vorgehen ist die offene Arthroskopie im Rahmen der konventionellen Osteosynthese. Insbesondere bei komplexen Kalkaneusfrakturen erleichtert dieses Vorgehen dem Operateur die korrekte Einschätzung des eigenen Osteosyntheseerfolgs, da anderenfalls verbliebene Gelenkstufen u. U. in der intraoperativen Bildgebung nicht erkannt werden.

Abstract

Arthroscopic fracture management of the ankle and calcaneus requires a differentiated approach. The aim is to minimize surgical soft tissue damage and to visualize anatomical fracture reduction arthroscopically. Moreover, additional cartilage damage can be detected and treated. The arthroscopic approach is limited by deep impressions of the joint surface needing cancellous bone grafting, by multiple fracture lines on the articular side and by high-grade soft tissue damage. An alternative to the minimally invasive arthroscopic approach is open arthroscopic reduction in conventional osteosynthesis. This facilitates correct assessment of surgical reduction of complex calcaneal fractures, otherwise remaining non-anatomical reduction might not be fluoroscopically detected during surgery.

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Literatur

  1. Blauth M, Bastian L, Krettek C et al (2001) Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma15(3):153–160

    Google Scholar 

  2. Dodd A, Simon D, Wilkinson R (2009) Arthroscopically assisted transfibular talar dome fixation with a headless screw. Arthroscopy 25(7):806–809

    Article  PubMed  Google Scholar 

  3. Gavlik JM, Rammelt S, Zwipp H (2002) Percutaneous, arthhroscopically-assisted osteosynthesis of calcaneus fractures. Arch Orthop Trauma Surg 122:424–428

    PubMed  Google Scholar 

  4. Geary NP (2004) Arthroscopically assisted internal fixation of a talus body fracture. Injury Int J Care Injured 35:86–89

    Google Scholar 

  5. Gohm A, Osti M, Benedetto KP (2010) Arthroskopisch assistierte Osteosynthese von Frakturen der distalen Tibia. Arthroskopie 23:119–123

    Article  Google Scholar 

  6. Hintermann B, Regazzoni P, Lampert C et al (2000) Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br 82:345–351

    Article  PubMed  CAS  Google Scholar 

  7. Kopp L, Obruba P, Mišičko R et al (2012) Arthroscopically-assisted osteosynthesis of calcaneal fractures: clinical and radiographic results of a prospective study. Acta Chir Orthop Traum Cech 79:228–232

    PubMed  CAS  Google Scholar 

  8. Kralinger F, Lutz M, Wambacher M et al (2003) Arthroscopically assisted reconstruction and percutaneous screw fixation of a pilon tibial fracture. Arthroscopy 19(5):1–4

    Google Scholar 

  9. Leetun DT, Ireland ML (2002) Arthroscopically assisted reduction and fixation of a juvenile tillaux fracture. Arthroscopy 18(4):427–429

    Article  PubMed  Google Scholar 

  10. Leontaritis N, Hinojosa L, Panchbhavi VK (2009) Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am 91:333–339

    Article  PubMed  Google Scholar 

  11. Manca M, Marchetti S, Restuccia G et al (2002) Combined percutaneous internal and external fixation of type-C tibial plafond fractures. J Bone Joint Surg Am 84:109–115

    PubMed  Google Scholar 

  12. Ono A, Nishikawa S, Nagao A et al (2004) Arthroscopically assisted treatment of ankle fractures: arthroscopic findings and surgical outcomes. Arthroscopy 20(6):627–631

    Article  PubMed  Google Scholar 

  13. Parisien JS, Vangsness T (1985) Arthroscopy of the subtalar joint: an experimental approach. Arthroscopy 1:53–57

    Article  PubMed  CAS  Google Scholar 

  14. Rammelt S, Gavlik JM, Barthel S, Zwipp H (2002) The value of subtalar arthroscopy in the management of intra-articular calcaneus fractures. Foot Ankle Int 23:906–916

    PubMed  Google Scholar 

  15. Rammelt S, Amlang M, Barthel S et al (2010) Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res 468:983–990

    Article  PubMed  Google Scholar 

  16. Salvi AE, Metelli GP, Bettinsoli R, Hacking SA (2009) Arthroscopic-assisted fibular synthesis and syndesmotic stabilization of a complex unstable ankle injury. Arch Orthop Trauma Surg 129:393–396

    Article  PubMed  Google Scholar 

  17. Sanders R (1992) Intra-articular fractures of the calcaneus: present state of the art. J Orthop Trauma 6(2):252–265

    Article  PubMed  CAS  Google Scholar 

  18. Schofer M, Schoepp C, Rülander C, Kortmann HR (2005) Operative und konservative Behandlung der Kalkaneusfrakturen. Trauma Berufskrankh 7(Suppl 1):156–161

    Article  Google Scholar 

  19. Schuberth JM, Cobb MD, Talarico RH (2009) Minimally invasive arthroscopic-assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases. J Foot Ankle Surg 48(3):315–322

    Article  PubMed  Google Scholar 

  20. Thordarson DB, Bains R, Shepherd LE (2001) The role of ankle arthroscopy on the surgical management of ankle fractures. Foot Ankle Int 22:123–125

    PubMed  CAS  Google Scholar 

  21. Wyrsch B, McFerran MA, McAndrew M et al (1996) Operative treatment of fractures of the tibial plafond. J Bone Joint Surg Am 78:1646–1656

    PubMed  CAS  Google Scholar 

  22. Zwipp H, Tscherne H, Wülker N, Grote R (1989) Der intraartikuläre Fersenbeinbruch – Klassifikation, Bewertung und Operationstechnik. Unfallchirurg 92:117–129

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Berufsgenossenschaftliche Unfallklinik Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland

    C. Schoepp & D. Rixen

  2. Komitee TRAUMA der AGA, Gesellschaft für Arthroskopie und Gelenkchirurgie, Wien, Österreich

    C. Schoepp

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  1. C. Schoepp
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  2. D. Rixen
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Correspondence to C. Schoepp.

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Schoepp, C., Rixen, D. Arthroskopisch gestütztes Frakturmanagement. Unfallchirurg 116, 318–325 (2013). https://doi.org/10.1007/s00113-012-2347-0

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  • DOI: https://doi.org/10.1007/s00113-012-2347-0

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