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Pilon-Frakturen

Teil 2: Repositions- und Stabilisierungstechnik, Komplikationsmanagement

Pilon fractures

Part 2: Repositioning and stabilization technique and complication management

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Zusammenfassung

Die Behandlung von Pilon-Frakturen beinhaltet die mehr oder weniger offene Reposition und innere Osteosynthese mit Platten und Schrauben, die externe Fixation mit in der Regel gelenküberbrückenden Konstruktionen oder Kombinationen aus beiden. Die meisten Behandlungsprotokolle bestehen heute aus einem mehrschrittigen Vorgehen mit zunächst externer gelenküberbrückender Fixation, einer Abschwellphase und dem späteren Wechsel auf eine interne Osteosynthese. Damit konnte die Rate der Weichteilkomplikationen und Infektionen gesenkt werden. Die Zugangsplanung orientiert sich nach dem im 3-D-Datensatz analysierten Frakturmuster und an den daraus entwickelten Strategien zur Gelenkrekonstruktion. Ziel ist die anatomische Wiederherstellung der Gelenkflächen, aber der Grad der erforderlichen anatomischen Wiederherstellung der Gelenkfläche ist unklar. Das anatomisch-radiologische Ergebnis korreliert nicht immer mit dem klinischen Ergebnis.

Abstract

The management of complex pilon fractures with soft tissue injuries has seen many trends, with changes toward staged protocols of temporary external fixation followed by delayed open reduction and internal fixation (ORIF), minimally invasive percutaneous plate osteosynthesis (MIPPO) techniques and special implants, the benefits of negative pressure wound sealing and early „fix and flap“ efforts to reconstruct soft tissue defects. Reduction and fixation must involve cautious management and careful handling of soft tissue in order to minimize the well-known complications of this difficult fracture. With these changes, the rate of soft tissue complications, infections and non-unions has decreased. The target remains the anatomical reconstruction of the articular surface as well as the geometric integrity of the distal tibia and fibula. Currently it is still unclear how much articular anatomy and perfection in reduction is needed as the radiographic results do not always correlate with the clinical results.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Krettek und S. Bachmann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    C. Krettek FRACS, FRCSEd & S. Bachmann

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Correspondence to C. Krettek FRACS, FRCSEd.

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Krettek, C., Bachmann, S. Pilon-Frakturen. Chirurg 86, 187–204 (2015). https://doi.org/10.1007/s00104-014-2917-5

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