Plating of distal tibial fractures offers some risk of soft tissue problems. Even the recently developed fixed-angle plates need great care in handling the soft tissue and may fail due to their smaller dimension. On the other hand, conventional plates still are a suitable tool for stabilization of such fractures. In case of fractures of both the tibia and fibula, stabilization of the latter is recommended as well.
{"title":"Gedeckte Plattenosteosynthese mit konventionellen Platten an der distalen Tibia1","authors":"F. Maurer1","doi":"10.1055/s-2005-865732","DOIUrl":"https://doi.org/10.1055/s-2005-865732","url":null,"abstract":"Plating of distal tibial fractures offers some risk of soft tissue problems. Even the recently developed fixed-angle plates need great care in handling the soft tissue and may fail due to their smaller dimension. On the other hand, conventional plates still are a suitable tool for stabilization of such fractures. In case of fractures of both the tibia and fibula, stabilization of the latter is recommended as well.","PeriodicalId":75462,"journal":{"name":"Aktuelle Traumatologie","volume":"35 1","pages":"146 - 150"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-865732","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58025824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vermei-Abstract Fractures of the distal radius are most common in adults. Insufficient results following conservative treatment lead to a change of paradigm: during the mid-nineties of the last century the operative procedures like percutaneous K-wiring, external fixation systems and plating with conventional 3.5 mm plate systems became extended by the invention of plate systems with head locking screws, angular stable plate systems. Meanwhile the results after palmar plating with systems in a dimension of 2.4– 3.5 mm of even extension fractures of the distal radius are so encouraging that this treatment has become a standard procedure. Only wide displaced fractures type C2 or C3 sometimes need to be addressed from dorsally. The results of 244 extension fractures of the distal radius using palmar approach in plating with three different plate systems are presented. Fracture type and patients data were comparable in all 3 groups. The functional outcome of regular vs. 3.5 mm plates with headlocking screws (LCP) showed similar results. The best outcome with statistical relevance could be created by the use of the 2.4/2.7 mm plate system (Synthes ® ). Some technical hints have to be regarded to obtain good radiological and functional results: the head locking screws in the distal fragment have to be placed subchondrally and the tips of these screws may not overtop the dorsal cortex. Thus complications like irritation of extension tendons, additional bone grafting even in osteoporotic bone or loss of reduction postoperatively become very rare. Functional treatment postoperatively reduced the rate of reflex sympathic dystrophy syndrome dramatically.
{"title":"Winkelstabile Plattensysteme am distalen Radius: Lösungsmöglichkeiten und Probleme1","authors":"K. Winker1","doi":"10.1055/s-2005-865737","DOIUrl":"https://doi.org/10.1055/s-2005-865737","url":null,"abstract":"Vermei-Abstract Fractures of the distal radius are most common in adults. Insufficient results following conservative treatment lead to a change of paradigm: during the mid-nineties of the last century the operative procedures like percutaneous K-wiring, external fixation systems and plating with conventional 3.5 mm plate systems became extended by the invention of plate systems with head locking screws, angular stable plate systems. Meanwhile the results after palmar plating with systems in a dimension of 2.4– 3.5 mm of even extension fractures of the distal radius are so encouraging that this treatment has become a standard procedure. Only wide displaced fractures type C2 or C3 sometimes need to be addressed from dorsally. The results of 244 extension fractures of the distal radius using palmar approach in plating with three different plate systems are presented. Fracture type and patients data were comparable in all 3 groups. The functional outcome of regular vs. 3.5 mm plates with headlocking screws (LCP) showed similar results. The best outcome with statistical relevance could be created by the use of the 2.4/2.7 mm plate system (Synthes ® ). Some technical hints have to be regarded to obtain good radiological and functional results: the head locking screws in the distal fragment have to be placed subchondrally and the tips of these screws may not overtop the dorsal cortex. Thus complications like irritation of extension tendons, additional bone grafting even in osteoporotic bone or loss of reduction postoperatively become very rare. Functional treatment postoperatively reduced the rate of reflex sympathic dystrophy syndrome dramatically.","PeriodicalId":75462,"journal":{"name":"Aktuelle Traumatologie","volume":"35 1","pages":"151 - 154"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-865737","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58025409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
New implants and fixation concepts – extramedullary and intra-medullary – have been recently developed for the treatment of distal femoral fractures. The Distal Femoral Nail (DFN) features a spiral blade interlocking option that provides angular stability and enlarges the contact area between bone and implant in the metaphysis. Advantages of the DFN are a minimal invasive approach that also allows fixation of ipsilateral femur and tibia fractures and its easy use in obese patients. In comparison with the Less Invasive Stabilisation System (LISS) the DFN shows equal or better results concerning non union, infection, alignement, implant failure and knee function.
{"title":"Stellenwert intramedullärer Osteosynthesen gegenüber winkelstabilen Implantaten bei metaphysären Frakturen - distaler Femurnagel (DFN)1","authors":"E. Schwab1","doi":"10.1055/s-2005-865731","DOIUrl":"https://doi.org/10.1055/s-2005-865731","url":null,"abstract":"New implants and fixation concepts – extramedullary and intra-medullary – have been recently developed for the treatment of distal femoral fractures. The Distal Femoral Nail (DFN) features a spiral blade interlocking option that provides angular stability and enlarges the contact area between bone and implant in the metaphysis. Advantages of the DFN are a minimal invasive approach that also allows fixation of ipsilateral femur and tibia fractures and its easy use in obese patients. In comparison with the Less Invasive Stabilisation System (LISS) the DFN shows equal or better results concerning non union, infection, alignement, implant failure and knee function.","PeriodicalId":75462,"journal":{"name":"Aktuelle Traumatologie","volume":"35 1","pages":"126 - 129"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-865731","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58025806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Winkelstabile Implantate sind insofern keine Innovation, da sie nicht erst in den vergangenen Jahren entwickelt wurden, sondern bereits Mitte des vergangenen Jahrhunderts zum Einsatz kamen. Durch ihre hohe Praktikabilität konnten bereits damals die Behandlungsergebnisse entscheidend verbessert werden. Das Prinzip der Winkelstabilität in der Osteosynthese, insbesondere am proximalen Femur, hat eine besondere Wertigkeit, einerseits aufgrund der akuten lebensbedrohlichen Instabilität und die Anwendung an einer belasteten Extremität, andererseits durch die Problematik ausgedehnter spongiöser Bruchflächen, die mit hohen Scherkräften belastet sind und dem individuellen Osteoporosestatus. Die Vorteile winkelstabiler schräg axialer dynamischer Stabilisierungssysteme am proximalen Femur bestehen vor allem in der Sicherung der Frakturstabilität, die immer Übungsstabilität beinhalten muss und die in einem sehr hohen Prozentsatz primäre volle Belastungsstabilität garantiert. Der Unterschied zu winkelstabilen Implantaten für andere Regionen und insbesondere winkelstabilen Osteosynthesen im Bereich der oberen Extremität liegt darin, dass zwei sich ergänzende Verfahren für dieselbe Region entwickelt wurden, einerseits Implantate mit und ohne Gleitlascheneffekt und andererseits Implantate mit extramedullärer oder intramedullärer Stabilisierungsmöglichkeit. Grundsätzlich müssen die Winkelstabilität beeinflussende Effekte bzw. gefährdende Faktoren besondere Berücksichtigung unter spezieller Berücksichtigung der Frakturklassifikation und der daraus resultierenden Formvariabilität finden. Davon abhängig ist die Implantatauswahl (ob extraoder Abstract
{"title":"Winkelstabile Implantate am proximalen Femur1","authors":"K.-K. Dittel1, M. Rapp1","doi":"10.1055/s-2005-865733","DOIUrl":"https://doi.org/10.1055/s-2005-865733","url":null,"abstract":"Winkelstabile Implantate sind insofern keine Innovation, da sie nicht erst in den vergangenen Jahren entwickelt wurden, sondern bereits Mitte des vergangenen Jahrhunderts zum Einsatz kamen. Durch ihre hohe Praktikabilität konnten bereits damals die Behandlungsergebnisse entscheidend verbessert werden. Das Prinzip der Winkelstabilität in der Osteosynthese, insbesondere am proximalen Femur, hat eine besondere Wertigkeit, einerseits aufgrund der akuten lebensbedrohlichen Instabilität und die Anwendung an einer belasteten Extremität, andererseits durch die Problematik ausgedehnter spongiöser Bruchflächen, die mit hohen Scherkräften belastet sind und dem individuellen Osteoporosestatus. Die Vorteile winkelstabiler schräg axialer dynamischer Stabilisierungssysteme am proximalen Femur bestehen vor allem in der Sicherung der Frakturstabilität, die immer Übungsstabilität beinhalten muss und die in einem sehr hohen Prozentsatz primäre volle Belastungsstabilität garantiert. Der Unterschied zu winkelstabilen Implantaten für andere Regionen und insbesondere winkelstabilen Osteosynthesen im Bereich der oberen Extremität liegt darin, dass zwei sich ergänzende Verfahren für dieselbe Region entwickelt wurden, einerseits Implantate mit und ohne Gleitlascheneffekt und andererseits Implantate mit extramedullärer oder intramedullärer Stabilisierungsmöglichkeit. Grundsätzlich müssen die Winkelstabilität beeinflussende Effekte bzw. gefährdende Faktoren besondere Berücksichtigung unter spezieller Berücksichtigung der Frakturklassifikation und der daraus resultierenden Formvariabilität finden. Davon abhängig ist die Implantatauswahl (ob extraoder Abstract","PeriodicalId":75462,"journal":{"name":"Aktuelle Traumatologie","volume":"35 1","pages":"155 - 162"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-865733","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58025837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Appelt1, F.-X. Huber1, K. DaFonseca1, P. Meeder1
In the age of outstanding internal implants and techniques for operative treatment of extra-articular proximal tibial fractures the usefulness of the external fixator (e.f.) has to be called into question. Substantial advantages of e.f. especially in this location are excellent protection of soft tissues, easy enlargement to adjacent joints and supplementary stabilization of metaphyseal comminuted fractures.
{"title":"Ist die Fixateur-externe-Osteosynthese an der proximalen Tibia noch zeitgemäß?1","authors":"A. Appelt1, F.-X. Huber1, K. DaFonseca1, P. Meeder1","doi":"10.1055/s-2005-865739","DOIUrl":"https://doi.org/10.1055/s-2005-865739","url":null,"abstract":"In the age of outstanding internal implants and techniques for operative treatment of extra-articular proximal tibial fractures the usefulness of the external fixator (e.f.) has to be called into question. Substantial advantages of e.f. especially in this location are excellent protection of soft tissues, easy enlargement to adjacent joints and supplementary stabilization of metaphyseal comminuted fractures.","PeriodicalId":75462,"journal":{"name":"Aktuelle Traumatologie","volume":"35 1","pages":"140 - 145"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-865739","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58026085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Schwarz1, S. Glasmacher1, M. Seiwerts3, A. Verheyden2, C. Josten1
. Abstract In addition to the conventional stabilisation procedures, new trends with reduced operation trauma achieve acceptance concerning the treatment of supra-and interkondylar (C)fractures of the distal femur. Retrograde intramedullary nailing techniques provide advantages in regard to centre line of weight bearing, bone loss of the distal metaphysis and the periosseous blood supply. By the development of a new retrograde nail with diagonal intersecting distal interlocking bolts the indication spectra is extended. Anatomical examinations, implantations in cadaver femora and three-dimensional CT computer simulations were used to optimise the nail features and to reduce implantation failures.
{"title":"Distale Femurfraktur - optimierte Verriegelungsmöglichkeiten eines retrograden Marknagels durch 3D-Simulation1","authors":"C. Schwarz1, S. Glasmacher1, M. Seiwerts3, A. Verheyden2, C. Josten1","doi":"10.1055/s-2005-865745","DOIUrl":"https://doi.org/10.1055/s-2005-865745","url":null,"abstract":". Abstract In addition to the conventional stabilisation procedures, new trends with reduced operation trauma achieve acceptance concerning the treatment of supra-and interkondylar (C)fractures of the distal femur. Retrograde intramedullary nailing techniques provide advantages in regard to centre line of weight bearing, bone loss of the distal metaphysis and the periosseous blood supply. By the development of a new retrograde nail with diagonal intersecting distal interlocking bolts the indication spectra is extended. Anatomical examinations, implantations in cadaver femora and three-dimensional CT computer simulations were used to optimise the nail features and to reduce implantation failures.","PeriodicalId":75462,"journal":{"name":"Aktuelle Traumatologie","volume":"22 1","pages":"130 - 133"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-865745","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58026128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The treatment of proximal humerus fractures with intramedullary nails with angle stable bolts is contradictory to the classic intramedullary nailing with elastic nails. However in osteoporotic bone stock these nails allow a multi dimensional bracing of the fragments with the locking bolts leading to sufficient primary stability even in complex cases. The minimal invasive implantation technique reduces the soft tissue damage to a minimum and permits early rehabilitation especially in elderly patients.
{"title":"Nagelsystem am proximalen Humerus1","authors":"L. Kinzl, R. Eisele, U. Liener","doi":"10.1055/s-2005-865738","DOIUrl":"https://doi.org/10.1055/s-2005-865738","url":null,"abstract":"The treatment of proximal humerus fractures with intramedullary nails with angle stable bolts is contradictory to the classic intramedullary nailing with elastic nails. However in osteoporotic bone stock these nails allow a multi dimensional bracing of the fragments with the locking bolts leading to sufficient primary stability even in complex cases. The minimal invasive implantation technique reduces the soft tissue damage to a minimum and permits early rehabilitation especially in elderly patients.","PeriodicalId":75462,"journal":{"name":"Aktuelle Traumatologie","volume":"35 1","pages":"108 - 112"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-865738","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58025470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Möglichkeiten und Grenzen mit dem LISS (distaler Femur)1","authors":"D. Höntzsch1","doi":"10.1055/s-2005-865728","DOIUrl":"https://doi.org/10.1055/s-2005-865728","url":null,"abstract":"","PeriodicalId":75462,"journal":{"name":"Aktuelle Traumatologie","volume":"35 1","pages":"121 - 125"},"PeriodicalIF":0.0,"publicationDate":"2005-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-2005-865728","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58025738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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