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Z Orthop Unfall 2017; 155(03): 352-370
DOI: 10.1055/s-0042-116779
CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Intraartikuläre Tibiakopffrakturen

Intra-articulair tibial Plateau Fractures
Maike Reul
,
Stefaan Nijs
,
Pol Maria Rommens
,
Harm Hoekstra
Further Information

Publication History

Publication Date:
06 July 2017 (online)

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Zusammenfassung

Tibiakopffrakturen sind komplexe Gelenkfrakturen, deren adäquate Behandlung eine dezidierte klinische und radiologische Diagnostik erfordert. Bei der Behandlung hat sich das 3-Pfeiler-Konzept als ausgezeichnetes chirurgisches Planungsinstrument dieses komplexen Traumas erwiesen. Der Standard der Therapie ist die offene interne Stabilisierung (ORIF) mit anatomischer Rekonstruktion des Gelenks. Bei der Wahl der korrekten Behandlungsstrategie können gute funktionelle Resultate erreicht werden.

Tibiakopffrakturen sind Gelenkfrakturen, deren adäquate Behandlung eine dezidierte klinische und radiologische Diagnostik erfordert. Bei der Behandlung hat sich das 3-Pfeiler-Konzept als ausgezeichnetes chirurgisches Planungsinstrument dieses komplexen Traumas erwiesen. Der Standard der Therapie ist die offene interne Stabilisierung (ORIF) mit anatomischer Rekonstruktion des Gelenks. Bei Wahl der korrekten Behandlungsstrategie können gute funktionelle Resultate erreicht werden.

Abstract

Tibial plateau fractures are complex articular injuries, especially if caused by high energy. For adequate treatment a decidedly clinical and radiographic diagnostic is required. The three-column-concept has proven as excellent surgical planningstool in this complex trauma. By (1) precisely considering the specific characteristics of the fracture, (2) careful treatment of soft-tissue envelope and (3) choosing the right treatment strategy, a good functional outcome can be achieved.

Kernaussagen

  • Die Therapie der intraartikulären Tibiakopffraktur ist für den Chirurgen eine Herausforderung.

  • Ein adäquates diagnostisches Work-up mit korrekter Analyse der Frakturmorphologie und Klassifikation sowie eine kritische Betrachtung der Verletzung der Weichteile ist von entscheidender Bedeutung. Hierfür ist die Durchführung eines präoperativen CT unabdingbar.

  • Das 3-Pfeiler-Konzept hat sich als ein ausgezeichnetes chirurgisches Planungsinstrument erwiesen und sollte bei der Wahl der operativen Behandlungsstrategie genutzt werden.

  • Die offene interne Stabilisierung (ORIF) mit anatomischer Rekonstruktion des Gelenks ist der Standard in der Behandlung intraartikulärer Tibiakopffrakturen.

  • Gute Ergebnisse mit geringen Komplikationsraten können erzielt werden durch

    • gute Therapieplanung,

    • Beachtung der Weichteilsituation,

    • an die Fraktur angepasste Wahl des richtigen operativen Zugangswegs,

    • richtige Wahl der zum Einsatz kommenden Implantate.

Schlüsselwörter

Tibiakopffraktur - Frakturmorphologie - 3-Pfeiler-Konzept - Osteosynthese - funktionelles Ergebnis

Key words

tibial plateau fracture - fracture morphology - three-column-concept - osteosynthesis - functional outcome
 

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