[New surgical treatment procedures in fractures of the distal tibia (LCP, MIPO)].
All along the operative treatment of distal tibial fractures is a difficult procedure. In most cases the clinical situation is characterized by small distal fragments in combination with crucial soft-tissue conditions. That's why complications as primary or secondary displacements, mal unions, delayed or non unions and as well as a high rate of deep wound infection are often seen. Thus internal fixations with traditional implants (standard screws and plates) could consider inevitable this crucial biology and biomechanics only insufficiently. The nowadays available internal fixators with optional angular-stable screws expand the possibilities of internal fixation in these severe situations. Their minimal invasive application (MIPO, Minimally Invasive Plate Osteosynthesis) takes care of the soft tissue and reduces the surgical trauma furthermore. With the variety of their possible applications (combination of angular stability with standard application) also the demands increase, however, both onto the surgeons, but also onto the general practitioners in the aftercare. The combination of most different tactics in one implant results in the consequence, that at the same bone simultaneously direct and indirect bone healing will be expected. The radiological differentiation between desired and unwanted healing processes becomes thus difficult. Pre- and perioperative procedures require from the trauma surgeon a huge infrastructure and a high measure of biomechanical and biological experience. In the postoperative management of these injuries an unlimited cooperation between traumatologists and general practitioners is indispensable for a further successful course.
Ryf
C
C
Spital Davos, Klinik für Chirurgie-Orthopädie, Davos Platz. cryf@spitaldavos.ch
Götsch
U
U
Perren
T
T
Rillmann
P
P
D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D002146:Bony Callus / Q000000981:diagnostic imaging; D016267:External Fixators; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D017102:Fracture Healing; D006801:Humans; D008279:Magnetic Resonance Imaging; D019060:Minimally Invasive Surgical Procedures; D011182:Postoperative Care; D011183:Postoperative Complications; D011542:Pseudarthrosis / Q000175:diagnosis / Q000209:etiology; D017695:Soft Tissue Injuries / Q000150:complications; D013978:Tibial Fractures / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome