Rittstieg P, Wurm M, Müller M, Biberthaler P
Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
Unfallchirurg. 2020 Jun;123(6):479-490. doi: 10.1007/s00113-020-00805-7.
Shaft fractures of the tibia and fibula mainly affect younger patients and are therefore of great socioeconomic importance. Due to the high proportion of high-energy direct trauma mechanisms and the thin soft tissue covering layer of the ventromedian tibia, open factures occur in up to 39%. A structured diagnostic and therapeutic approach is essential for successful treatment. Reamed intramedullary nailing is currently the gold standard surgical procedure. The suprapatellar approach, representing an interesting alternative to the popular infrapatellar approach, postoperative complications, such as anterior knee pain as well as the management of non-unions are discussed in this article. Furthermore, the indications and the application of minimally invasive plate osteosynthesis (MIPO) and external fixators are described. Every trauma surgeon should be familiar with the etiology and the surgical treatment of compartment syndrome. A firm knowledge of the classifications of open and closed soft tissue injury is mandatory.
胫腓骨干骨折主要影响年轻患者，因此具有重大的社会经济意义。由于高能直接创伤机制占比高，且胫骨前内侧软组织覆盖层薄，开放性骨折发生率高达39%。结构化的诊断和治疗方法对于成功治疗至关重要。扩髓髓内钉固定术是目前的金标准手术方法。本文讨论了髌上入路，它是常用的髌下入路的一种有趣替代方法，还讨论了术后并发症，如膝前疼痛以及骨不连的处理。此外，还描述了微创钢板接骨术（MIPO）和外固定器的适应证及应用。每位创伤外科医生都应熟悉骨筋膜室综合征的病因及手术治疗。必须牢固掌握开放性和闭合性软组织损伤的分类。
