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Erschienen in: Der Orthopäde 2/2010

01.02.2010 | Leitthema

Unaufgebohrte Marknagelung

verfasst von: Dr. R. Attal, M. Blauth

Erschienen in: Die Orthopädie | Ausgabe 2/2010

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Zusammenfassung

Die aufgebohrte bzw. unaufgebohrte Marknagelung von Frakturen langer Röhrenknochen war in den letzten Jahrzehnten ein kontroverses und sogar emotionales Thema. Dieser Beitrag gibt einen historischen Überblick über die Entwicklung und beleuchtet den Hintergrund der Notwendigkeit einer unaufgebohrten Nagelung. Weiterhin wird durch die Beschreibung und Zusammenfassung der Resultate der bisher durchgeführten zusammengesetzten randomisierten kontrollierten Studien der aktuelle Wissensstand dargestellt. Vor dem Jahr 2000 empfahlen nahezu sämtliche deutsche Leitfäden der orthopädischen und traumatologischen Chirurgie die unaufgebohrte Marknagelung als „biologischere“ Therapie, die bei geringerer Gefäßschädigung gleich gute oder sogar bessere Ergebnisse erzielt. Insbesondere bei der Behandlung offener Brüche wurde die unaufgebohrte Nagelung befürwortet.
Dies hat sich geändert, denn in der Folgezeit haben randomisierte kontrollierte Studien gezeigt, dass die unaufgebohrte Nagelung zu einer höheren Rate an verzögerter oder ausbleibender Knochenheilung führt, während für die genannten Vorteile bezüglich Blutversorgung und Infektionsrate kein Nachweis erbracht werden konnte. Gemäß der evidenzbasierten Medizin sollten isolierte Femur- und Tibiabrüche aufgebohrt genagelt werden. Bei Vorliegen eines Polytraumas ist es sicherer, Frakturen langer Röhrenknochen mittels Fixateur externe zu stabilisieren, denn sowohl für die aufgebohrte als auch für die unaufgebohrte Nagelung wurden ungünstige Verläufe beschrieben.
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Metadaten
Titel
Unaufgebohrte Marknagelung
verfasst von
Dr. R. Attal
M. Blauth
Publikationsdatum
01.02.2010
Verlag
Springer-Verlag
Erschienen in
Die Orthopädie / Ausgabe 2/2010
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-009-1524-5

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