Der Unfallchirurg
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Materials with different characteristics are used for cement augmentation and as bone graft substitutes. ⋯ Cement augmentation has large potential especially in osteoporotic bone. In load-bearing regions acrylic-based cements remain the standard of choice. Ceramic cements are preferred in non-load-bearing areas. Their combination with resorbable metals offers still largely unexplored potential. Virtual biomechanics can help improve the targeted application of cement augmentation.
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Proximal humeral and trochanteric femoral fractures in older patients are typically caused by low-energy trauma and are therefore often associated with osteoporosis. The treatment of such fragility fractures can be difficult as implant purchase is reduced in osteoporotic bone. By augmenting the fixation with cement the contact surface between implant and bone can be increased, which improves the stability of the osteosynthesis. ⋯ Augmentation seems to be a safe and valuable addition to available treatment options especially for patients with fragility fractures.
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Fractures of the patella can lead to substantial functional impairments due to its crucial function in the extensor mechanism of the knee joint. Patellar fractures are associated with a comparatively high complication rate depending on the osteosynthesis procedure used. Despite established diagnostics and various osteosynthesis procedures they are still a therapeutic challenge. ⋯ For a good functional result after a patellar fracture, the fracture morphology must be completely understood and the optimal choice of the osteosynthesis method is crucial. Distal (or proximal) pole fractures and the increasing number of osteoporotic fractures of old patients due to the demographic change, remain a therapeutic challenge and require special consideration in the selection of the osteosynthesis procedure.
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Fracture dislocations of the proximal tibia are associated with a markedly high incidence of ligament ruptures. Despite knowledge on the frequency of accompanying ligament injuries, even now neither adequate diagnostics nor targeted treatment of associated ligament injuries are the gold standard in the treatment algorithm for tibial plateau fractures. To be able to assess the risk and the type of accompanying ligament injuries in tibial plateau fractures, it is recommended to decidedly analyze the fracture morphology. ⋯ Bony avulsions should either be addressed directly during osteosynthesis or indirectly retained via interfragmentary compression. In cases of direct visualization or relevant instability, intraligamentous tears should at least be intraoperatively reduced. If patients suffer from persistent instability a secondary ligament reconstruction with autologous tendons can be carried out following bony consolidation of the tibial plateau fracture.
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The treatment of tibial plateau fractures has experienced a number of very different conceptual developments in recent years, not only with respect to technical innovations but also against the background of changing fracture patterns and the growing requirements of patients. ⋯ Modern developments in the context of fracture treatment around the tibial plateau have led to a relevant reduction of infections and improved surgical outcomes; however, the high demands and the improved understanding of fractures still underline the great challenge in the treatment of complex fracture patterns.