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DOI: 10.1055/a-0900-5344
Die schlecht heilende proximale Tibiafraktur – Infektion, Malunion, Delayed Union, Nonunion – was nun?
Complication after Fracture of the Proximal Tibia – Infection, Malunion, Delayed Union Nonunion – What Now?Publication History
Publication Date:
19 November 2019 (online)
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Zusammenfassung
Die Fraktur der proximalen Tibia mit und ohne Gelenkbeteiligung ist eine schwere und komplikationsträchtige Verletzung. Sie stellt Patienten und Behandler aufgrund der operativen Anforderungen und individuellen Behandlung vor eine herausfordernde Aufgabe. Im folgenden Artikel werden Risiken und Komplikationen dargestellt sowie mögliche Behandlungspfade aufgezeigt.
Abstract
Fractures of the proximale tibia intra- and extraarticular are severe and complications are not infrequent. Due to highly demanding surgical skills and its individual treatment it represents a challenging task for patient and surgeon. In the following article we focus on complicatations and pitfalls and demonstrate problemsolving strategies.
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Literatur
- 1 Wennergren D, Bergdahl C, Ekelund J. et al. Epidemiology and incidence of tibia fractures in the Swedish Fracture Register. Injury 2018; 49: 2068-2074
- 2 Kraus TM, Martetschläger F, Müller D. et al. Return to sports activity after tibial plateau fractures: 89 cases with minimum 24-month follow-up. Am J Sports Med 2012; 40: 2845-2852 doi:10.1177/0363546512462564
- 3 Märdian S, Schwabe P, Schaser K-D. Tibiaschaftfrakturen. Z Orthop Unfall 2015; 153: 99-119
- 4 Meisinger C, Wildner M, Stieber J. et al. [Epidemiology of limb fractures]. Orthopade 2002; 31: 92-99
- 5 Rademakers MV, Kerkhoffs GM, Sierevelt IN. et al. Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma 2007; 21: 5-10
- 6 Barei DP, Nork SE, Mills WJ. et al. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 2004; 18: 649-657
- 7 Morris BJ, Unger RZ, Archer KR. et al. Risk factors of infection after ORIF of bicondylar tibial plateau fractures. J Orthop Trauma 2013; 27: e196-e200
- 8 Biggi F, Di Fabio S, DʼAntimo C. et al. Tibial plateau fractures: internal fixation with locking plates and the MIPO technique. Injury 2010; 41: 1178-1182
- 9 Castillo RC, Bosse MJ, MacKenzie EJ. et al. Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. J Orthop Trauma 2005; 19: 151-157
- 10 Henkelmann R, Frosch K-H, Glaab R. et al. Infection following fractures of the proximal tibia – a systematic review of incidence and outcome. BMC Musculoskelet Disord 2017; 18: 481
- 11 Heckman JD, Sarasohn-Kahn J. The economics of treating tibia fractures. The cost of delayed unions. Bull Hosp Jt Dis 1997; 56: 63-72
- 12 Meinberg EG, Agel J, Roberts CS. et al. Fracture and Dislocation Classification Compendium–2018. J Orthop Trauma 2018; 32 (Suppl. 01) S1-S170 doi:10.1097/BOT.0000000000001063
- 13 Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968 – 1975. Clin Orthop Relat Res 1979; (138) 94-104
- 14 Krause M, Preiss A, Müller G. et al. Intra-articular tibial plateau fracture characteristics according to the “Ten segment classification”. Injury 2016; 47: 2551-2557
- 15 Oestern H-J, Tscherne H. 148. Klassifizierung der Frakturen mit Weichteilschaden. Langenbecks Arch Chir 1982; 358: 483-483
- 16 Tscherne H, Oestern HJ. [A new classification of soft-tissue damage in open and closed fractures (authorʼs transl)]. Unfallheilkunde 1982; 85: 111-115
- 17 Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58: 453-458
- 18 Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984; 24: 742-746
- 19 Trampuz A, Zimmerli W. Diagnosis and treatment of implant-associated septic arthritis and osteomyelitis. Curr Infect Dis Rep 2008; 10: 394-403
- 20 Sun Y, Wang H, Tang Y. et al. Incidence and risk factors for surgical site infection after open reduction and internal fixation of ankle fracture: a retrospective multicenter study. Medicine (Baltimore) 2018; 97: e9901
- 21 Barwick TW, Montgomery RJ. Knee arthrodesis with lengthening: experience of using Ilizarov techniques to salvage large asymmetric defects following infected peri-articular fractures. Injury 2013; 44: 1043-1048
- 22 Phisitkul P, McKinley TO, Nepola JV. et al. Complications of locking plate fixation in complex proximal tibia injuries. J Orthop Trauma 2007; 21: 83-91
- 23 Marsh JL, Buckwalter J, Gelberman R. et al. Articular fractures: does an anatomic reduction really change the result?. J Bone Joint Surg Am 2002; 84: 1259-1271
- 24 Xu S-G, Mao Z-G, Liu B-S. et al. Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection. Injury 2015; 46: 184-188
- 25 Suzuki T, Morgan SJ, Smith WR. et al. Postoperative surgical site infection following acetabular fracture fixation. Injury 2010; 41: 396-399
- 26 Ovaska MT, Mäkinen TJ, Madanat R. et al. Risk factors for deep surgical site infection following operative treatment of ankle fractures. J Bone Joint Surg Am 2013; 95: 348-353
- 27 Heppert V, Rheinwalt K, Winkler H. et al. Infection of the proximal tibia after fractures – an avoidable complication. Eur J Orthop Surg Traumatol 1997; 7: 195-198
- 28 Cattaneo R, Catagni M, Johnson EE. The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clin Orthop Relat Res 1992; (280) 143-152
- 29 Fang C, Wong T-M, Lau T-W. et al. Infection after fracture osteosynthesis – Part I. J Orthop Surg (Hong Kong) 2017; 25: 2309499017692712
- 30 Kheir MM, Tan TL, Ackerman CT. et al. Culturing periprosthetic joint infection: number of samples, growth duration, and organisms. J Arthroplasty 2018; 33: 3531-3536.e1
- 31 Fadel M, Hosny G. The Taylor spatial frame for deformity correction in the lower limbs. Int Orthop 2005; 29: 125-129
- 32 Ali AM, El-Shafie M, Willett KM. Failure of fixation of tibial plateau fractures. J Orthop Trauma 2002; 16: 323-329
- 33 Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 2002; 84: 1541-1551
- 34 Kerkhoffs GM, Rademakers MV, Altena M. et al. Combined intra-articular and varus opening wedge osteotomy for lateral depression and valgus malunion of the proximal part of the tibia. Surgical technique. J Bone Joint Surg Am 2009; 91 (Suppl. 21) S101-S115
- 35 Frosch K-H, Krause M, Frings J. et al. [Posttraumatic deformities of the knee joint: intra-articular osteotomy after malreduction of tibial head fractures]. Unfallchirurg 2016; 119: 859-876
- 36 Lee O-S, Ahn S, Lee YS. Comparison of the leg-length change between opening- and closing-wedge high tibial osteotomy: a systematic review and meta-analysis. J Knee Surg 2019; 32: 372-379
- 37 Marti RK, Verhagen RA, Kerkhoffs GM. et al. Proximal tibial varus osteotomy. Indications, technique, and five to twenty-one-year results. J Bone Joint Surg Am 2001; 83: 164-170
- 38 Weber BG, Čech O. Pseudarthrosis: Pathophysiology, Biomechanics, Therapy, Results. Bern: H. Huber; 1976
- 39 DiPasquale D, Ochsner MG, Kelly AM. et al. The Ilizarov method for complex fracture nonunions. J Trauma 1994; 37: 629-634
- 40 Moghaddam A, Zietzschmann S, Bruckner T. et al. Treatment of atrophic tibia non-unions according to “diamond concept”: Results of one- and two-step treatment. Injury 2015; 46 (Suppl. 04) S39-S50