Sommer Christoph, Lodde Moritz, Hofmann-Fliri Ladina, Raschke Michael J
Kantonsspital Graubünden, Chur, Schweiz.
Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland.
Unfallchirurgie (Heidelb). 2025 Sep 9. doi: 10.1007/s00113-025-01629-z.
The bony consolidation of fractures depends on various factors. Under optimal conditions fracture healing takes place within a few weeks. An essential requirement for fracture healing is the restoration of adequate biomechanical stability with an interfragmentary movement which is as ideal as possible. Distal femoral fractures can be particularly challenging especially in the presence of extensive soft tissue damage, multiple fragmented fractures and involvement of the joint. The currently applied surgical techniques of single lateral plate, double plate and intramedullary nail osteosynthesis as well as combination procedures have a relatively high complication rate. The principle of the biphasic plate is based on the transverse and longitudinal slots placed in the plate, which enables a "controlled instability". This results in a relatively high interfragmentary movement even at low loads (flexible phase) and a low movement at high loads (stiff phase). Therefore, the implant becomes more rigid at higher mechanical demands. In biomechanical tests the stress distribution of the implant, the number of cycles up to failure and the maximum load are superior compared to the locking compression plate distal femur (LCP-DF). Future studies will need to compare and evaluate the potential clinical and economic benefits in direct comparison to the currently established surgical techniques. Preclinical studies have so far demonstrated the safety and applicability of the biphasic plate and the innovative principle of controlled instability in fracture healing.
骨折的骨愈合取决于多种因素。在最佳条件下，骨折愈合在几周内即可发生。骨折愈合的一个基本要求是通过尽可能理想的骨折块间移动来恢复足够的生物力学稳定性。股骨远端骨折可能特别具有挑战性，尤其是在存在广泛软组织损伤、多块骨折以及关节受累的情况下。目前应用的单侧钢板、双侧钢板和髓内钉内固定术以及联合手术技术的并发症发生率相对较高。双相钢板的原理基于钢板上的横向和纵向狭槽，这能够实现“可控不稳定”。这导致即使在低负荷下（柔性阶段）骨折块间移动也相对较高，而在高负荷下移动较低（刚性阶段）。因此，在更高的力学需求下，植入物会变得更坚固。在生物力学测试中，与股骨远端锁定加压钢板（LCP-DF）相比，该植入物的应力分布、直至失效的循环次数和最大负荷更优。未来的研究需要与目前已确立的手术技术进行直接比较，以比较和评估其潜在的临床和经济效益。迄今为止，临床前研究已经证明了双相钢板的安全性和适用性以及骨折愈合中可控不稳定这一创新原理。
