Streicher G, Reilmann H
Unfallchirurgische Klinik, Städtisches Klinikum Braunschweig gGmbH, Holwedestrasse 16, 38118 Braunschweig, Deutschland.
Unfallchirurg. 2008 Nov;111(11):905-18. doi: 10.1007/s00113-008-1511-z.
Distal tibial fractures can be divided by mechanism into injuries caused by torsion trauma or by compression trauma. The latter ones are often associated with a complete destruction of the tibial joint surface, so-called tibial plafond fractures. Another group of fractures are the distal metaphyseal fractures of the tibia with only minimal involvement of the ankle as a result of low energy torsion trauma. Multiple factors can be held responsible for posttraumatic complications and poor outcome: malalignment, nonanatomic reduction of the joint surface or bone defects, and severe soft tissue injury. Therefore a sophisticated therapeutic regime of distal tibial fractures is necessary, which we present in detail in this article. In cases with only minor soft tissue injury a primary definitive open reduction internal fixation (ORIF) of the tibial fracture is possible. Fractures with severe soft tissue injury should be initially fixed with an external fixator. Definitive fixation and reconstruction should here be performed in subsequent operations. Early functional therapy can be attempted if fractures are reliably stabilized.
胫骨远端骨折可根据机制分为由扭转创伤或压缩创伤引起的损伤。后者通常与胫骨关节面的完全破坏有关，即所谓的胫骨平台骨折。另一组骨折是由于低能量扭转创伤导致的胫骨远端干骺端骨折，踝关节仅轻度受累。创伤后并发症和不良预后可能由多种因素导致：对线不良、关节面非解剖复位或骨缺损以及严重的软组织损伤。因此，需要一种复杂的胫骨远端骨折治疗方案，我们将在本文中详细介绍。对于软组织损伤较轻的病例，可行胫骨骨折一期确定性切开复位内固定术（ORIF）。软组织损伤严重的骨折应首先用外固定架固定。在此情况下，确定性固定和重建应在后续手术中进行。如果骨折得到可靠固定，可以尝试早期功能治疗。
