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Probleme und Kontroversen in der Behandlung von Sprunggelenkfrakturen

Problems and controversies in the treatment of ankle fractures

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Zusammenfassung

Sprunggelenkfrakturen sind die häufigsten Verletzungen eines lasttragenden Gelenks, ihre Versorgung gehört zur täglichen Routine im unfallchirurgischen Alltag. Trotz eines gestiegenen Verständnisses der Pathomechanismen und der vergleichweise einfachen Osteosynthesetechniken sind die mittel- und langfristigen Ergebnisse nicht immer zufriedenstellend. Der folgende Artikel widmet sich daher im Spiegel der aktuellen Literatur explizit den ungelösten Problemen und kontrovers diskutierten Fragen in der Sprunggelenkchirurgie. Dazu gehören die therapeutische und prognostische Relevanz der angewandten Klassifikationen, die Kriterien für die Indikationsstellung, häufige Probleme bei der operativen Versorgung, die Frage nach der Notwendigkeit und Technik der Versorgung der Tibiahinterkantenfrakturen sowie das Erkennen und Behandeln der Syndesmoseninstabilität. Ein im klinischen Alltag stetig zunehmendes Problem sind Sprunggelenkfrakturen bei älteren Patienten insbesondere mit vorliegender Osteoporose, Diabetes mellitus sowie einer neurogenen Osteoarthropathie.

Abstract

Ankle fractures are the most frequent injuries of a load-bearing joint. Their treatment belongs to the daily routine in trauma surgery. However, despite an increased understanding of the mechanism of injury and relatively straightforward fixation techniques, the medium- to long-term results are often less than satisfactory. The following article therefore explicitly focusses on unsolved problems and controversies in the treatment of ankle fractures in the light of the current literature. These include the therapeutic and prognostic relevance of frequently used classification systems, criteria for the indication for surgery, frequent hazards in internal fixation, the question of whether and how to fix the posterior malleolus, and the detection and treatment of syndesmotic instability. Furthermore, trauma surgeons face the increasing incidence of ankle fractures in the elderly. The presence of osteoporosis, diabetes mellitus and neuropathic osteoarthropathy represents a special challenge.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland

    S. Rammelt, R. Grass & H. Zwipp

  2. Department für Chirurgie, Spital Frutigen, Frutigen, Schweiz

    D. Heim

  3. Schwerpunkt Endokrinologie, Medizinische Klinik III, Universitätsklinium Carl Gustav Carus, Dresden, Deutschland

    L.C. Hofbauer

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  1. S. Rammelt
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  2. D. Heim
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  3. L.C. Hofbauer
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  4. R. Grass
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  5. H. Zwipp
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Correspondence to S. Rammelt.

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Rammelt, S., Heim, D., Hofbauer, L. et al. Probleme und Kontroversen in der Behandlung von Sprunggelenkfrakturen. Unfallchirurg 114, 847–860 (2011). https://doi.org/10.1007/s00113-011-1978-x

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