Suprapatellarer Zugang zur Tibiamarknagelung mit magnetfeldgeführter, distaler Verriegelung

TY - JOUR

T1 - Suprapatellarer Zugang zur Tibiamarknagelung mit magnetfeldgeführter, distaler Verriegelung

AU - Rueger, J M

AU - Rücker, A H

AU - Hoffmann, Michael

PY - 2015/4

Y1 - 2015/4

N2 - Closed tibial shaft fractures are the domain of intramedullary nailing. With the introduction of new nail designs and technologies, even small, dislocated distal fragments can be anatomically aligned and safely fixed. Unsolved or to a lesser degree controlled are the problems of distal locking in the freehand technique, which can still be difficult and can lead to a significant radiation exposure, and how to control very short proximal tibial fragments in metaphyseal tibial fractures or tibial segmental fractures, where the proximal fracture line also runs through the metaphysis.By using a suprapatellar approach, i.e. a skin incision proximal to the patella with an entry point into the tibial bone from within the knee at the same site as for a standard infrapatellar approach, and then nailing the tibia in a semi-extended position, i.e. the knee is only flexed 10-20°, the intraoperative dislocation of a short proximal fragment can be avoided. The main indications for semi-extended tibial nailing are a short diaphyseal fragment in an isolated tibial shaft fracture, a segmental fracture where the proximal fracture line is metaphyseal and in patients where infrapatellar soft tissues are compromised.The use of the electromagnetic guidance system SureShot® generates reliable and reproducible results, reduces the operating time and is independent from radiation for distal locking.

AB - Closed tibial shaft fractures are the domain of intramedullary nailing. With the introduction of new nail designs and technologies, even small, dislocated distal fragments can be anatomically aligned and safely fixed. Unsolved or to a lesser degree controlled are the problems of distal locking in the freehand technique, which can still be difficult and can lead to a significant radiation exposure, and how to control very short proximal tibial fragments in metaphyseal tibial fractures or tibial segmental fractures, where the proximal fracture line also runs through the metaphysis.By using a suprapatellar approach, i.e. a skin incision proximal to the patella with an entry point into the tibial bone from within the knee at the same site as for a standard infrapatellar approach, and then nailing the tibia in a semi-extended position, i.e. the knee is only flexed 10-20°, the intraoperative dislocation of a short proximal fragment can be avoided. The main indications for semi-extended tibial nailing are a short diaphyseal fragment in an isolated tibial shaft fracture, a segmental fracture where the proximal fracture line is metaphyseal and in patients where infrapatellar soft tissues are compromised.The use of the electromagnetic guidance system SureShot® generates reliable and reproducible results, reduces the operating time and is independent from radiation for distal locking.

KW - Bone Nails

KW - Bone Plates

KW - Bone Screws

KW - Electromagnetic Fields

KW - Equipment Design

KW - Fracture Fixation, Intramedullary

KW - Humans

KW - Prosthesis Design

KW - Surgery, Computer-Assisted

KW - Tibial Fractures

KW - Treatment Outcome

U2 - 10.1007/s00113-014-2669-1

DO - 10.1007/s00113-014-2669-1

M3 - SCORING: Zeitschriftenaufsatz

C2 - 25835205

VL - 118

SP - 302

EP - 310

JO - UNFALLCHIRURGIE

JF - UNFALLCHIRURGIE

SN - 0177-5537

IS - 4

ER -