Perkutane Fixation des distalen Radius - Sind perkutane Spickdrahttechniken noch indiziert?

Zusammenfassung

Bei der häufigsten Fraktur des menschlichen Körpers, der distalen Radiusfraktur, konkurrieren derzeit viele verschiedene operative Therapiekonzepte. Neben den invasiven Methoden wie z. B. die Plattenosteosynthese wird die spezielle Indikationsstellung zur geschlossenen Reposition und minimalinvasiven Osteosynthese mit K-Drähten anhand eigener Daten und der Literaturübersicht erörtert. Die K-Draht-Osteosynthese (KDO) ist eine Alternative zur Plattenosteosynthese bei A2- und A3-Frakturen. Bei C3-Frakturen spielt sie eine wichtige Rolle in der Kombination mit anderen Osteosyntheseverfahren wie Plattenosteosynthese oder Fixateur externe. Die KDO ist indiziert bei kindlichen Frakturen, die mehr als Schaftbreite disloziert sind. Alte Patienten mit C-Frakturen haben ein signifikant besseres funktionelles Outcome mit KDO vs. konservativ. Die KDO ist 60 % billiger als eine moderne (LCP) Plattenosteosynthese. Sie ist extrem kostengünstig und bringt bei korrekter Indikationsstellung ein zufriedenstellendes funktionelles Ergebnis.

Abstract

Fractures of the distal end of the radius are common injuries and are the commonest bony injury around the wrist. Management of these fractures has remained controversial as far as modality of treatment is concerned. There are aggressive concepts with open reduction and internal fixation with plates and minimally invasive pinning after closed reduction. The latter treatment concept is evaluated using own data and results from the literature. Percutaneous pinning is used as treatment alternativ in ASIF A2 and A3 fractures. In C3 type fracture they can play an important part as supplementary adjunct in combination with external fixation or plates. Furthermore percutaneous pinning techniques can be used in distal radius fractures in children with dislocation. Elderly patients with type C fractures do gain superior results in functional outcome using this technique than with reduction and casting alone. Percutaneous pinning is very cost-effective in comparison to plating. When using correct indications this technique can provide excellent functional results.

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