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Operationstechnik und deren Ergebnisse der Pilon-tibiale-Fraktur

Operative techniques and results of tibial pilon fractures

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Zusammenfassung

Hintergrund

Die anatomische Wiederherstellung von Pilon-tibiale-Frakturen ist eine große Herausforderung hinsichtlich der präoperativen Planung, des Zeitmanagements und der operativen Durchführung.

Fragestellung

Darstellung der verschiedenen zur Verfügung stehenden operativen Verfahren und deren klinischem Outcome.

Material und Methode

Grundlage bilden die etablierten Osteosyntheseverfahren neben neueren minimal-invasiven Behandlungskonzepten und die Darstellung aktueller Studienergebnisse.

Ergebnisse

Das Behandlungsergebnis ist abhängig von der initialen Frakturschwere und dem begleitenden Weichteilschaden. Essenziell ist eine anatomische Reposition mit weniger als 2 mm Gelenkstufe. Insgesamt erreicht nur knapp die Hälfte aller Patienten innerhalb eines Jahres Arbeitsfähigkeit. Dabei ist das gewählte Osteosyntheseverfahren nicht relevant. Sowohl die offene Plattenosteosynthese als auch die Kombination aus Fixateur externe und minimal-invasiver Gelenkrekonstruktion mit und ohne Arthroskopie erreichen gleichwertige Ergebnisse.

Schlussfolgerungen

Gute klinische Ergebnisse können durch eine exakte präoperative Planung des Operationsverfahrens, -zeitpunkts und der notwendigen Operationsschritte erreicht werden. Bei Missachtung dieser Punkte oder nicht ausreichender chirurgischer Expertise drohen Funktionsverlust und Einschränkung der Lebensqualität.

Abstract

Background

The anatomical reconstruction of tibial pilon fractures is a major challenge with respect to preoperative planning, time management and the intraoperative procedure.

Objective

Presentation of the various surgical procedures available and the clinical outcome.

Material and methods

The established open reduction and internal plate fixation procedures form the basis for new minimally invasive treatment concepts. The current results of comparative studies and basic literature are discussed.

Results

The treatment result depends on the severity of the initial fracture and accompanying soft tissue damage. Essential is an anatomical reduction with an articular displacement of less than 2 mm. Overall, only approximately half of all patients return to work within 1 year. The fixation procedure used is not relevant for this purpose. Both plate fixation and the combination of external fixator plus minimally invasive articular reconstruction with and without arthroscopy achieve equivalent results.

Conclusion

Good clinical results can be achieved by an accurate preoperative planning with respect to the surgical procedure, time of surgery and the surgical steps. In cases of disregarding these points and inadequate surgical expertise, loss of function and reduced quality of life are impending.

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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 Trauma 15:153–160

    Article  CAS  PubMed  Google Scholar 

  2. Bonato LJ, Edwards ER, Gosling CM et al (2017) Patient reported health related quality of life early outcomes at 12 months after surgically managed tibial plafond fracture. Injury 48:946–953

    Article  PubMed  Google Scholar 

  3. Bone L, Stegemann P, Mcnamara K et al (1993) External fixation of severely comminuted and open tibial pilon fractures. Clin Orthop Relat Res 1993 Jul(292):101–107

    Google Scholar 

  4. Busel GA, Watson JT (2017) Plating of pilon fractures based on the orientation of the fibular shaft component: a biomechanical study evaluating plate stiffness in a cadaveric fracture model. J Orthop 14:308–312

    Article  PubMed  Google Scholar 

  5. De-Las-Heras-Romero J, Lledo-Alvarez AM, Lizaur-Utrilla A et al (2017) Quality of life and prognostic factors after intra-articular tibial pilon fracture. Injury 48(6):1258–1263. doi:10.1016/j.injury.2017.03.023

    Article  PubMed  Google Scholar 

  6. Dickson KF, Montgomery S, Field J (2001) High energy plafond fractures treated by a spanning external fixator initially and followed by a second stage open reduction internal fixation of the articular surface – preliminary report. Injury 32(Suppl 4):SD92–SD98

    Article  PubMed  Google Scholar 

  7. Heim U (1991) Die Pilon-tibial-Fraktur : Klassifikation, Operationstechnik, Ergebnisse. Springer, Berlin New York

    Book  Google Scholar 

  8. Iundusi R, Gasbarra E, D’arienzo M et al (2015) Augmentation of tibial plateau fractures with an injectable bone substitute: CERAMENT. Three year follow-up from a prospective study. BMC Musculoskelet Disord 16:115

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ketz J, Sanders R (2012) Staged posterior tibial plating for the treatment of orthopaedic trauma association 43C2 and 43C3 tibial pilon fractures. J Orthop Trauma 26:341–347

    Article  PubMed  Google Scholar 

  10. Lee YS, Chen SW, Chen SH et al (2009) Stabilisation of the fractured fibula plays an important role in the treatment of pilon fractures: a retrospective comparison of fibular fixation methods. Int Orthop 33:695–699

    Article  PubMed  Google Scholar 

  11. Luo H, Chen L, Liu K et al (2016) Minimally invasive treatment of tibial pilon fractures through arthroscopy and external fixator-assisted reduction. Springerplus 5:1923

    Article  PubMed  PubMed Central  Google Scholar 

  12. Meng YC, Zhou XH (2016) External fixation versus open reduction and internal fixation for tibial pilon fractures: a meta-analysis based on observational studies. Chin J Traumatol 19:278–282

    Article  PubMed  PubMed Central  Google Scholar 

  13. Papadokostakis G, Kontakis G, Giannoudis P et al (2008) External fixation devices in the treatment of fractures of the tibial plafond: a systematic review of the literature. J Bone Joint Surg Br 90:1–6

    Article  CAS  PubMed  Google Scholar 

  14. Richards JE, Magill M, Tressler MA et al (2012) External fixation versus ORIF for distal intra-articular tibia fractures. Orthopedics 35:e862–e867

    Article  PubMed  Google Scholar 

  15. Ruedi T, Allgower M (1978) Late results after operative treatment of fractures of the distal tibia (pilon tibial fractures) (author’s transl). Unfallheilkunde 81:319–323

    CAS  PubMed  Google Scholar 

  16. Sirkin M, Sanders R, Dipasquale T et al (2004) A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 18:S32–S38

    Article  PubMed  Google Scholar 

  17. Teeny SM, Wiss DA (1993) Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res 1993 Jul(292):108–117

    Google Scholar 

  18. Teitz CC, Carter DR, Frankel VH (1980) Problems associated with tibial fractures with intact fibulae. J Bone Joint Surg Am 62:770–776

    Article  CAS  PubMed  Google Scholar 

  19. Torino D, Mehta S (2016) Fibular fixation in distal tibia fractures: reduction aid or nonunion generator? J Orthop Trauma 30(Suppl 4):S22–S25

    Article  PubMed  Google Scholar 

  20. Wang C, Li Y, Huang L et al (2010) Comparison of two-staged ORIF and limited internal fixation with external fixator for closed tibial plafond fractures. Arch Orthop Trauma Surg 130:1289–1297

    Article  PubMed  Google Scholar 

  21. Wang D, Xiang JP, Chen XH et al (2015) A Meta-analysis for postoperative complications in tibial plafond fracture: open reduction and internal fixation versus limited internal fixation combined with external fixator. J Foot Ankle Surg 54:646–651

    Article  PubMed  Google Scholar 

  22. Watson JT, Moed BR, Karges DE et al (2000) Pilon fractures. Treatment protocol based on severity of soft tissue injury. Clin Orthop Relat Res 375:78–90

    Article  Google Scholar 

  23. Xiao R, Tang Q, Cai C (2005) Treatments of tibial Pilon fractures with a combination of limited internal fixation and external fixation. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 19:603–606

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Unfall‑, Hand- und Wiederherstellungschirurgie, Chirurgische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland

    R. Rotter & P. Gierer

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  1. R. Rotter
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  2. P. Gierer
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Correspondence to R. Rotter.

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R. Rotter und P. Gierer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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R. Gaulke, Hannover

T. Mittlmeier, Rostock

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Rotter, R., Gierer, P. Operationstechnik und deren Ergebnisse der Pilon-tibiale-Fraktur. Unfallchirurg 120, 652–657 (2017). https://doi.org/10.1007/s00113-017-0371-9

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  • DOI: https://doi.org/10.1007/s00113-017-0371-9

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