[Intra-articular proximal tibia fractures].
Intraartikuläre proximale Tibiafraktur.
Computed tomography
Endoprosthesis
Osteosynthesis, fracture
Tibial plateau
Total knee replacement
Journal
Unfallchirurgie (Heidelberg, Germany)
ISSN: 2731-703X
Titre abrégé: Unfallchirurgie (Heidelb)
Pays: Germany
ID NLM: 9918384886306676
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
accepted:
21
06
2023
medline:
25
8
2023
pubmed:
8
8
2023
entrez:
8
8
2023
Statut:
ppublish
Résumé
The incidence of proximal intra-articular tibial fractures is continuously increasing. In addition to high-energy trauma in young patients, osteoporotic fractures occur more frequently in geriatric patients. After a thorough clinical examination including X‑ray and computed tomography (CT) imaging, consolidation of the soft tissue is followed by surgical treatment to achieve the best possible anatomic reconstruction of the articular surface. Nonanatomic reduction with articular gaps >2.5 mm leads to a significantly increased risk of osteoarthritis. Selection of the surgical approach and planning of the osteosynthesis are based on the fracture morphology and the existing soft tissue damage. In addition to arthroscopically assisted percutaneous procedures, sophisticated osteosynthesis is often necessary, which requires several surgical approaches. In this context, posterior surgical approaches are becoming increasingly more important. Primary knee arthroplasty can also play a role, particularly in older patients. Die Inzidenz proximaler intraartikulärer Tibiafrakturen nimmt stetig zu. Neben Hochrasanztraumata beim jungen Patienten treten gehäuft osteoporotische Frakturen geriatrischer PatientInnen auf. Einer dezidierten klinischen Diagnostik, einschließlich bildgebender Röntgen- und Computertomographie(CT)-Untersuchung, folgt nach der Weichteilkonsolidierung meist die operative Therapie zur möglichst anatomischen Rekonstruktion der Gelenkfläche. Eine nichtanatomische Rekonstruktion mit Gelenkstufen von mehr als 2,5 mm birgt ein relevant erhöhtes Arthroserisiko. Zugangswahl und Planung der Osteosynthese richten sich nach morphologischen Frakturmerkmalen und vorliegendem Weichteilschaden. Neben arthroskopisch-gestützten, perkutanen Verfahren sind häufig aufwendige Osteosynthesen notwendig, die mehrere Zugänge erfordern. Hier gewinnen v. a. die posterioren Zugänge zunehmend an Bedeutung. Insbesondere beim älteren Patienten kann auch ein primärer endoprothetischer Ersatz eine Rolle spielen.
Autres résumés
Type: Publisher
(ger)
Die Inzidenz proximaler intraartikulärer Tibiafrakturen nimmt stetig zu. Neben Hochrasanztraumata beim jungen Patienten treten gehäuft osteoporotische Frakturen geriatrischer PatientInnen auf. Einer dezidierten klinischen Diagnostik, einschließlich bildgebender Röntgen- und Computertomographie(CT)-Untersuchung, folgt nach der Weichteilkonsolidierung meist die operative Therapie zur möglichst anatomischen Rekonstruktion der Gelenkfläche. Eine nichtanatomische Rekonstruktion mit Gelenkstufen von mehr als 2,5 mm birgt ein relevant erhöhtes Arthroserisiko. Zugangswahl und Planung der Osteosynthese richten sich nach morphologischen Frakturmerkmalen und vorliegendem Weichteilschaden. Neben arthroskopisch-gestützten, perkutanen Verfahren sind häufig aufwendige Osteosynthesen notwendig, die mehrere Zugänge erfordern. Hier gewinnen v. a. die posterioren Zugänge zunehmend an Bedeutung. Insbesondere beim älteren Patienten kann auch ein primärer endoprothetischer Ersatz eine Rolle spielen.
Identifiants
pubmed: 37552247
doi: 10.1007/s00113-023-01352-7
pii: 10.1007/s00113-023-01352-7
doi:
Types de publication
English Abstract
Journal Article
Langues
ger
Sous-ensembles de citation
IM
Pagination
715-726Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
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