Der Wunsch nach einer gewebeschonenden und im metaphysären und osteoporotischen Knochen besser belastbaren Osteosynthese hat in den letzten Jahren zur Entwicklung von winkelstabilen Osteosyntheseplatten geführt, die in minimalinvasiver Technik eingesetzt werden können. Die winkelstabile Osteosynthese verzichtet bei diaphysären und metaphysären Frakturen auf eine genaue Reposition der Fragmente und eine Stabilisierung über Kompression und strebt eine flexible Fixation mit interfragmentären Bewegungen an, die eine Kallusheilung stimulieren soll. Die neuen winkelstabilen Plattensysteme erfordern eine veränderte Operationstechnik, aber auch Verständnis für die anderen biomechanischen Bedingungen und veränderten Knochenheilungsvorgänge. Für den Chirurgen gibt es im Vergleich zur Kompressionsosteosynthese mehr Möglichkeiten, die biomechanischen Eigenschaften der Osteosynthese zu beeinflussen und mögliche Überlastungen von Implantaten zu vermeiden. Die Komplikationsraten mit der neuen Technik zeigen jedoch, dass noch nicht alle Probleme mit kritischen Fraktursituationen gelöst sind und dass das Wissen um die biomechanischen Bedingungen der winkelstabilen Plattenosteosynthese wichtige Voraussetzungen für das Gelingen der neuen Osteosynthesetechnik sind.
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Prof. Dr. Lutz Claes
Institut für Unfallchirurgische Forschung und Biomechanik
Universitätsklinikum Ulm
Helmholzstr.14
89081Ulm
Phone: 0731/50055301
Fax: 0731/50055302
Email: lutz.claes@uni-ulm.de
