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Z Orthop Unfall 2015; 153(1): 99-119
DOI: 10.1055/s-0033-1358089
Refresher Orthopädie und Unfallchirurgie
Georg Thieme Verlag KG Stuttgart · New York

Tibiaschaftfrakturen

Fractures of the Tibial Shaft
S. Märdian
,
P. Schwabe
,
K.-D. Schaser
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Publication History

Publication Date:
04 March 2015 (online)

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Zusammenfassung

Tibiaschaftfrakturen sind die am häufigsten auftretenden diaphysären Frakturen langer Röhrenknochen des Menschen. Die häufigsten Unfallmechanismen sind Verkehrsunfälle (37,5 %), Stolperstürze (17,8 %), Sportunfälle (30,9 %) gefolgt von Gewalttaten (4,5 %).

Die klinische Untersuchung mit korrekter Klassifikation des Frakturmusters und insbesondere des Grades des Weichteilschadens ist von immenser Bedeutung für die therapeutische Kaskade. Diese folgt vor allem – bedingt durch den vorliegenden Weichteilschaden – einem festgelegten Algorithmus. An bildgebender Diagnostik ist die konventionelle Radiografie obligat, Schnittbilddiagnostik ist komplexen Frakturmustern und zusätzlichen intraartikulären Pathologien vorbehalten.

Die Therapie der Tibiaschaftfraktur ist eine Domäne der operativen Stabilisierung, welche – in Abhängigkeit vom Weichteilschaden – primär erfolgen sollte. Hierbei sind intramedulläre Verfahren (allen voran die intramedulläre Marknagelosteosynthese) die Verfahren der Wahl.

Die schwerwiegendste Frühkomplikation dieser Verletzung ist das Kompartmentsyndrom. Dies bedarf der schnellen Diagnosestellung und eines adäquaten chirurgischen Managements, um ausgedehnte Myonekrosen mit ischämischen Kontrakturen und irreversiblen neurovaskulären Defiziten zu vermeiden. Abgesehen von postoperativen Infektionen, die vor allem bei offenen Verletzungen die vorherrschende Komplikation darstellen, treten Pseudarthrosen als typische und teilweise schwer behandelbare Spätkomplikationen auf, die je nach Typ einem dezidierten Therapiealgorithmus folgen.

Abstract

The tibia shaft is the most often fractured long bone of human beings. Among others traffic accidents (37.5 %), falls (17.8 %), sport accidents (30.9 %) and assaults (4.5 %) are typical mechanisms. A brief clinical examination including the correct classification of the fracture pattern and even more important the degree of the soft tissue damage are the most crucial factors for the following therapeutic cascade. This follows a defined algorithm based on the degree of soft tissue damage. As biplanar X-ray diagnostics are obligatory, CT scans are subject to complex fracture patterns and accompanying intraarticular pathologies.

The treatment of tibial shaft fractures is the preserve of operative stabilization, which should be done primarily depending on the degree of the soft tissue injury. Here intramedullary methods – especially intramedullary nailing – are the golden standard.

The most serious complication of these fractures is the development of a compartment syndrome. This requires rapid diagnosis and an adequate surgical management in order to avoid extensive muscle necrosis with ischaemic contractures and irreversible neurovascular deficits. Apart from postoperative infections, which are the predominant complication especially in open injuries, non union provide typical and late complications which are partly difficult to treat. These should, depending on their type, follow a dedicated treatment algorithm.

Key words

Tibiaschaftfraktur - Marknagel - intramedulläre Stabilisierung - Weichteilschaden

Key words

tibial fracture - intramedullary nailing - intramedullary stabilization - soft tissue damage

Literaturverzeichnis als PDF

 

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