Distale Radiusfraktur – 20 Jahre winkelstabile Osteosynthese

Zusammenfassung

Zur operativen Therapie distaler Radiusfrakturen wird die Technik der winkelstabilen Plattenosteosynthese seit 20 Jahren genutzt und hat sich weitestgehend gegenüber der Kompressionsplatte durchgesetzt. Während die Kompressionsplatte durch die Zugkräfte ihrer im Knochen verankerten Schrauben gegen den Knochen gepresst wird und diesen dadurch schient, gleicht das Prinzip der winkelstabilen Platte einem Fixateur externe, welcher die Fraktur überbrückt, anstatt sie zu schienen. Die mechanische Grundlage hierfür bildet ein Gewinde im Schraubenkopf und im entsprechenden Schraubenloch der Osteosyntheseplatte. Ein Abkippen oder axiales Abrutschen der Schrauben wird dadurch vermieden, die Schrauben bleiben in einem stabilen Winkel zur Platte: somit besteht Winkelstabilität. Frakturen des distalen Radius im Erwachsenenalter stellen eine häufige Verletzung dar. Die konservative Therapie durch Immobilisation führt bei stabilen Frakturen ohne Gelenkbeteiligung in der Regel zu guten Ergebnissen. Bei instabilen oder die Gelenkfläche einbeziehenden Frakturen ist das Ziel einer dauerhaft stabilen und schmerzfreien Gelenkfunktion oft nur mittels offener Reposition und übungsstabiler Plattenosteosynthese zu erreichen. Die operative Therapie wird durch multifragmentäre Frakturformen und die oftmals schlechte Knochenqualität der bevorzugt im höheren Lebensalter vorkommenden Fraktur erschwert. Eine strenge Indikationsstellung auf Grundlage detaillierter Kenntnisse von Anatomie und Biomechanik, Zugangswegen und geeigneten Implantaten führt in den meisten Fällen zu guten Ergebnissen.

Distal Radius Fractures – 20 Years of Locking Compression Plates

The technique of locking compression plates (LCP) has been used for the operative treatment of distal radius fractures for 20 years and is gaining in importance compared to the dynamic compression plates (DCP). In contrast to the DCP, which is pressed against the bone by the tractive forces of the screws, the principle of the newer LCP imitates an external fixator, which bridges the fracture rather than splinting it. A thread in the screw head and in the plateʼs corresponding screw hole enables this technique. A tilting or axial sliding of the screw is prevented and the screws remain in a fixed angle to the plate. Fractures of the distal radius in adults are the most common injury. In stable fractures without articular involvement the conservative treatment by immobilisation leads to good results in general. In unstable or intraarticular fractures the goal of a permanently stable and painless joint function often can only be achieved by means of open reduction and internal plate fixation. Surgical therapy is complicated by the multifragmentary injury patterns and the frequently poor quality of bone in a large proportion of elderly patients. Thorough indications based on detailed knowledge of the anatomy and biomechanics, approaches and appropriate implants lead to good results in most cases.

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