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Modernes Implantatdesign für Osteosynthesen bei vorbestehender Osteoporose

Modern implant design for the osteosynthesis of osteoporotic bone fractures

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Zusammenfassung

Der durch Osteoporose hervorgerufene Knochenverlust vermindert die Knochenstabilität und erhöht das Risiko für das primäre Auftreten von Frakturen. Ist die osteoporotische Fraktur aufgetreten, stellt die mechanische Schwächung der Knochensubstanz eine signifikante Herausforderung für die adäquate Frakturversorgung dar. Ziel der Versorgung von Frakturen bei vorbestehender Osteoporose ist die Herstellung einer sofort voll belastungsstabilen Osteosynthese. Entscheidend für die effektive Frakturbehandlung ist dabei zunächst und zuvorderst die konsequente Einhaltung der wesentlichen Prinzipien der stabilen Osteosynthese: Reposition, Kompression, langstreckige Abstützung, flächige Abstützung, daneben additive Techniken wie Winkelstabilität und Augmentation. Moderne Osteosyntheseimplantate unterstützen die Anwendung dieser Prinzipien. Designmodifikationen und technische Änderungen am Implantat bzw. der Osteosynthesetechnik versetzen den Operateur in die Lage, die wesentlichen Behandlungsprinzipien auch beim mechanisch geschwächten Knochen anzuwenden und untereinander zu kombinieren. Als wesentliche Aspekte bei den modernen Implantaten sind integrierte Kompressionstechniken, multidirektionale Winkelstabilität, Ausweitung der Abstützfläche und vielseitige Augmentationsmöglichkeiten zu nennen. Trotz moderner Implantattechnologie bleibt die osteoporotische Fraktur eine Herausforderung für den Operateur, dem eine erfolgreiche Behandlung nur bei sorgfältigster Durchführung und konsequenter Einhaltung der Grundprinzipien gelingen wird.

Abstract

Osteoporosis is characterized by a reduction of bone mass and changes in bone micro-architecture. The resulting reduction in bone strength leads to the well recognized increase in the risk of fracture, particularly at the radius, hip, and spine. The treatment of osteoporotic fractures is challenged by the reduced mechanical capacity of osteoporotic bone, reflected in reduced holding power and increased fragility. The aim of successful fracture treatment in individuals with osteoporosis is early fixation of the fracture with immediate and almost unrestricted weight-bearing capacity. The key factor for effective fracture treatment is strict adherence to the basic principles of stable fracture fixation: reposition, compression, long, wide supports, as well as additive techniques such as angular stability and bone augmentation. Modern osteosynthesis implants effectively support the application of these principles. Modifications in implant design and techniques enable the surgeon to apply and combine the essential components of the basic principles for the treatment of mechanically impaired bone. The key components employed in modern implants include integrated compression techniques, multidirectional angular stability, expandable support surfaces, as well as multiple augmentation options. However, despite modern implant technology, osteoporotic bone fractures remain a significant challenge for the orthopaedic surgeon and require meticulous planning and implementation of the basic principles.

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Interessenkonflikt

P. Augat erhält Forschungsförderung folgender Firmen: Stryker, Aesculap, Synthes, Arthrex, ITS.

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Authors and Affiliations

  1. Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg und Institut für Biomechanik, Murnau, Professor-Küntscher-Str. 8, 82418, Murnau, Deutschland

    P. Augat

  2. Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland

    V. Bühren

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Correspondence to P. Augat.

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Augat, P., Bühren, V. Modernes Implantatdesign für Osteosynthesen bei vorbestehender Osteoporose. Orthopäde 39, 397–406 (2010). https://doi.org/10.1007/s00132-009-1572-x

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