Zusammenfassung
Die Dynamisierung von Osteosynthesen ist ein häufig eingesetztes Verfahren, um die Frakturheilung zu beschleunigen. Der Begriff der Dynamisierung wird jedoch für verschiedene Methoden der Osteosyntheseveränderung während des Knochenheilungsvorganges benutzt. Die Dynamisierung durch Entfernung von Verriegelungsschrauben bei der intramedullären Marknagelung wird am häufigsten durchgeführt. Dadurch kann es zu einer Teleskopbewegung zwischen Marknagel und Röhrenknochen kommen, die zum Schließen möglicher Frakturspalten und zur Kompression der Frakturflächen führt. Experimentelle und klinische Studien haben gezeigt, dass dies in einer Beschleunigung der Frakturheilung resultieren kann. Speziell bei größeren Frakturspalten und -formen, die eine Abstützung der Fragmente erlauben, kann dieses Vorgehen sinnvoll sein. Ein weiteres Dynamisierungsverfahren ist die Flexibilisierung der Osteosynthese während des Frakturheilungsverlaufes. Dieses Vorgehen erfolgt überwiegend bei der Fixateur-externe-Osteosynthese; hier wird durch eine teilweise Entfernung von Stabilisationselementen am Fixateur externe die Flexibilität der Osteosynthese erhöht. Für dieses Verfahren werden gute Studienergebnisse berichtet, wenn die Dynamisierung in der späten Heilungsphase vorgenommen wird. Bei einer ausreichenden Kallusbildung können Kallusüberbrückung und -umbau dadurch beschleunigt werden. Für das umgekehrte Vorgehen einer Osteosynthese, die bewusst flexibel gewählt und dann nach einer gewissen Zeit versteift wird, wurden keine positiven Effekte auf die Knochenheilung beobachtet. Eine stabile Osteosynthese von Anfang an sollte das Ziel sein. Bei Vorliegen einer zu flexiblen Frakturfixation sollte die Osteosynthese so bald wie möglich stabilisiert werden.
Abstract
The dynamization of fracture fixation is a frequently used method to improve the fracture healing process; however, the term dynamization is used for different methods of altering the fixation of fractures during the bone healing process. The dynamization of intramedullary nail fixation by removing the interlocking screws is the most frequently applied method. This method can cause a telescopic movement between the nail and tubular bone that closes gaps in bony continuity and potentially compresses the fracture fragments. Experimental and clinical studies showed that this dynamization can accelerate the bone healing process. In particular dynamization may improve the outcome for fractures with residual fracture gaps following reduction but which allows support of the fragments. An alternative dynamization method involves decreasing the stiffness of the fracture fixation during the healing process. This method is used mainly with external fixation. In this procedure, stabilizing elements of the fixator are removed at some time during the treatment leading to greater flexibility of the fixation. Good results are reported for this method when the dynamization is performed in the late phase of the fracture healing process. If sufficient callus formation has taken place, callus bridging and maturation can be achieved. For reverse dynamization, which starts with a flexible fixation and is later stabilized, no significant advantages could be shown. The aim of fracture treatment should be stable fixation from the beginning. If the fracture fixation is unstable, it should be stabilized as soon as possible.
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Claes, L. Dynamisierung der Osteosynthese. Unfallchirurg 121, 3–9 (2018). https://doi.org/10.1007/s00113-017-0455-6
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DOI: https://doi.org/10.1007/s00113-017-0455-6