Versorgungsmöglichkeiten am distalen Femur und Femurschaft: der Vorteil der Winkelstabilität

Zusammenfassung

Die Therapie von Femurschaft- und distalen Femurfrakturen stellt auch heute noch oftmals eine chirurgische Herausforderung dar, und war lange Zeit mit einer beträchtlichen Komplikationsrate verbunden. Trotz verbesserter Implantate und Techniken waren die Plattenosteosynthese und auch die Marknagelosteosynthese mit z. T. erheblichen Raten an Infektionen, Pseudarthrosen und Fehlstellungen behaftet. Die Beachtung der Weichteilsituation durch „biologische“ Osteosynthesen und minimalinvasive Zugänge verringerten die Komplikationsraten deutlich. Aus diesen Überlegungen heraus entstanden die winkelstabilen Plattensysteme wie z. B. das LISS (Less Invasive Stabilization System), deren Vorteile in der winkelstabilen Verankerung der Schrauben, der anatomisch gut angepassten Plattenform und technischen Hilfen zur minimalinvasiven, schonenden Plattenfixation liegen. Dieser Artikel gibt einen kurzen Überblick über die momentan verfügbaren Versorgungsmöglichkeiten distaler Femurfrakturen und Femurschaftfrakturen, mit einem besonderen Schwerpunkt auf den winkelstabilen Systemen. Hierzu ausgewählte Fallbeispiele demonstrieren die Überlegenheit dieser Art der operativen Versorgung besonders bei der Anwendung komplexer distaler Femurfrakturen.

Treatment Options for the Femur Shaft and Distal Femur – Advantages of Angular Stability

Even today the treatment of fractures of the femoral shaft and distal femur often presents a surgical challenge and was associated with a considerable incidence of complications for a long time. In spite of improved implants and techniques not only plate fixation but also intramedullary nailing were accompanied with significant rates of infection, non-union, and malpositioning. Taking into account the soft-tissue situation by means of “biological fixation” and minimally invasive approaches has markedly reduced the incidence of complications. Based on these considerations, as just one example, the LISS (less invasive stabilisation system) was introduced in the 1990s; advantages of the LISS are the angle-stable fixation of the screws, the anatomically well-adapted plate form and the technical aids for minimally invasive, conserving plate fixation. The present article provides a brief overview of the currently available treatment options for distal femur and femoral shaft fractures with particular emphasis on angle-stable systems. Selected case reports demonstrate the superiority of this method for surgical treatment, especially when used for complex distal femur fractures.

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