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Die Unfallchirurgie

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01.10.2011 | Leitthema

Probleme und Kontroversen in der Behandlung von Sprunggelenkfrakturen

verfasst von: PD Dr. S. Rammelt, D. Heim, L.C. Hofbauer, R. Grass, H. Zwipp

Erschienen in: Die Unfallchirurgie | Ausgabe 10/2011

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Zusammenfassung

Sprunggelenkfrakturen sind die häufigsten Verletzungen eines lasttragenden Gelenks, ihre Versorgung gehört zur täglichen Routine im unfallchirurgischen Alltag. Trotz eines gestiegenen Verständnisses der Pathomechanismen und der vergleichweise einfachen Osteosynthesetechniken sind die mittel- und langfristigen Ergebnisse nicht immer zufriedenstellend. Der folgende Artikel widmet sich daher im Spiegel der aktuellen Literatur explizit den ungelösten Problemen und kontrovers diskutierten Fragen in der Sprunggelenkchirurgie. Dazu gehören die therapeutische und prognostische Relevanz der angewandten Klassifikationen, die Kriterien für die Indikationsstellung, häufige Probleme bei der operativen Versorgung, die Frage nach der Notwendigkeit und Technik der Versorgung der Tibiahinterkantenfrakturen sowie das Erkennen und Behandeln der Syndesmoseninstabilität. Ein im klinischen Alltag stetig zunehmendes Problem sind Sprunggelenkfrakturen bei älteren Patienten insbesondere mit vorliegender Osteoporose, Diabetes mellitus sowie einer neurogenen Osteoarthropathie.

Ali MS, McLaren CA, Rouholamin E, O’Connor BT (1987) Ankle fractures in the elderly: nonoperative or operative treatment. J Orthop Trauma 1:275–280PubMed

Anand N, Klenerman L (1993) Ankle fractures in the elderly: MUA versus ORIF. Injury 24:116–120PubMed

Assal M, Sangeorzan BJ, Hansen ST (2007) Post-traumatic osteonecrosis of the lateral tibial plafond. J Foot Ankle Surg 13:24–29

Baird RA, Jackson ST (1987) Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament. J Bone Joint Surg Am 69:1346–1352PubMed

Bauer M, Bengner U, Johnell O, Redlund-Johnell I (1987) Supination-eversion fractures of the ankle joint: changes in incidence over 30 years. Foot Ankle Int 8:26–28

Bauer M, Jonsson K, Nilsson B (1985) Thirty-year follow-up of ankle fractures. Acta Orthop 56:103–106

Baumhauer JF, O’Keefe RJ, Schon LC, Pinzur MS (2006) Cytokine-induced osteoclastic bone resorption in charcot arthropathy: an immunohistochemical study. Foot Ankle Int 27:797–800PubMed

Beumer A, Campo MM, Niesing R et al (2005) Screw fixation of the syndesmosis: a cadaver model comparing stainless steel and titanium screws and three and four cortical fixation. Injury 36:60–64PubMed

Bibbo C, Lin SS, Beam HA, Behrens FF (2001) Complications of ankle fractures in diabetic patients. Orthop Clin North Am 32:113–133PubMed

10.

Boden SD, Labropoulos PA, McCowin P et al (1989) Mechanical considerations for the syndesmosis screw. A cadaver study. J Bone Joint Surg Am 71:1548–1555PubMed

11.

Broos PLO, Bisschop APG (1991) Operative treatment of ankle fractures in adults: correlation between types of fracture and final results. Injury 22:403–406PubMed

12.

Buckingham R, Hepple S, Winson I (2000) Outcome of ankle fractures in the elderly. J Foot Ankle Surg 6:175–178

13.

Chantelau E, Onvlee GJ (2006) Charcot foot in diabetes: farewell to the neurotrophic theory. Horm Metab Res 38:361–367PubMed

14.

Chantelau E, Richter A, Ghassem-Zadeh N, Poll LW (2007) „Silent“ bone stress injuries in the feet of diabetic patients with polyneuropathy: a report on 12 cases. Arch Orthop Trauma Surg 127:171–177PubMed

15.

Chissell HR, Jones J (1995) The influence of a diastasis screw on the outcome of Weber type-C ankle fractures. J Bone Joint Surg Br 77:435–438PubMed

16.

Davidovitch RI, Walsh M, Spitzer A, Egol KA (2009) Functional outcome after operatively treated ankle fractures in the elderly. Foot Ankle Int 30:728–733PubMed

17.

Day GA, Swanson CE, Hulcombe BG (2001) Operative treatment of ankle fractures: a minimum ten-year follow-up. Foot Ankle Int 22:102–106PubMed

18.

DeGroot H, Al-Omari AA, El Ghazaly SA (2011) Outcomes of suture button repair of the distal tibiofibular syndesmosis. Foot Ankle Int 32:250–256PubMed

19.

Ebraheim NA, Elgafy H, Padanilam T (2003) Syndesmotic disruption in low fibular fractures associated with deltoid ligament injury. Clin Orthop Relat Res 409:260–267PubMed

20.

Ebraheim NA, Lu J, Yang H, Rollins J (1998) The fibular incisure of the tibia on CT scan: a cadaver study. Foot Ankle Int 19:318–321PubMed

21.

Ebraheim NA, Mekhail AO, Haman SP (1999) External rotation-lateral view of the ankle in the assessment of the posterior malleolus. Foot Ankle Int 20:379–383PubMed

22.

Egol KA, Amirtharajah M, Tejwani NC et al (2004) Ankle stress test for predicting the need for surgical fixation of isolated fibular fractures. J Bone Joint Surg Am 86:2393–2398PubMed

23.

Espinosa N, Smerek JP, Myerson MS (2006) Acute and chronic syndesmosis injuries: pathomechanisms, diagnosis and management. Foot Ankle Clin 11:639–657PubMed

24.

Femino JE, Gruber BF, Karunakar MA (2007) Safe zone for the placement of medial malleolar screws. J Bone Joint Surg Am 89:133–138PubMed

25.

Ferries JS, DeCoster TA, Firoozbakhsh KK et al (1994) Plain radiographic interpretation in trimalleolar ankle fractures poorly assesses posterior fragment size. J Orthop Trauma 8:328–331PubMed

26.

Fitzpatrick DC, Otto JK, McKinley TO et al (2004) Kinematic and contact stress analysis of posterior malleolus fractures of the ankle. J Orthop Trauma 18:271–278PubMed

27.

Fogel GR, Morrey BF (1987) Delayed open reduction and fixation of ankle fractures. Clin Orthop Relat Res 215:187–195PubMed

28.

Follak N, Kloting I, Merk H (2005) Influence of diabetic metabolic state on fracture healing in spontaneously diabetic rats. Diabetes Metab Res Rev 21:288–296PubMed

29.

Gardner MJ, Brodsky A, Briggs SM et al (2006) Fixation of posterior malleolar fractures provides greater syndesmotic stability. Clin Orthop Relat Res 447:165–171PubMed

30.

Gardner MJ, Demetrakopoulos D, Briggs SM et al (2006) The ability of the Lauge-Hansen classification to predict ligament injury and mechanism in ankle fractures: an MRI study. J Orthop Trauma 20:267–272PubMed

31.

Geerling J, Zech S, Citak M et al (2007) Evaluation der Stellung der distalen Fibula nach geschlossener Reposition und Stellschraubenplatzierung mit intraoperativer dreidimensionaler Bildgebung (ISO-C-3D). Fuß Sprungg 5:254–261

32.

Gill JB, Risko T, Raducan V et al (2007) Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures. J Bone Joint Surg Am 89:994–999PubMed

33.

Grass R, Rammelt S, Heineck J, Zwipp H (2005) Die Rückfußarthrodese durch retrograde Marknagelung. Orthopade 34:1238–1244PubMed

34.

Hamid N, Loeffler BJ, Braddy W et al (2009) Outcome after fixation of ankle fractures with an injury to the syndesmosis: the effect of the syndesmosis screw. J Bone Joint Surg Br 91:1069–1073PubMed

35.

Hansen M, Le L, Wertheimer S et al (2006) Syndesmosis fixation: analysis of shear stress via axial load on 3.5-mm and 4.5-mm quadricortical syndesmotic screws. J Foot Ankle Surg 45:65–69PubMed

36.

Haraguchi N, Armiger RS (2009) A new interpretation of the mechanism of ankle fracture. J Bone Joint Surg Am 91:821–829PubMed

37.

Haraguchi N, Haruyama H, Toga H, Kato F (2006) Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg Am 88:1085–1092PubMed

38.

Harper MC (1995) The short oblique fracture of the distal fibula without medial injury: an assessment of displacement. Foot Ankle Int 16:181–186PubMed

39.

Harper MC, Hardin G (1988) Posterior malleolar fractures of the ankle associated with external rotation-abduction injuries. Results with and without internal fixation. J Bone Joint Surg Am 70:1348–1356PubMed

40.

Harris J, Fallat L (2004) Effects of isolated Weber B fibular fractures on the tibiotalar contact area. J Foot Ankle Surg 43:3–9PubMed

41.

Hartford JM, Gorczyca JT, McNamara JL, Mayor MB (1995) Tibiotalar contact area. Contribution of posterior malleolus and deltoid ligament. Clin Orthop Relat Res 320:182–187PubMed

42.

Heim D, Heim U, Regazzoni P (1993) Malleolarfrakturen mit Gabelsprengung – Erfahrungen mit der Stellschraube. Unfallchirurgie 19:307–312PubMed

43.

Heim D, Niederhauser K (2007) Die Drittelrohrhakenplatte. Operat Orthop Traumatol 3:305–309

44.

Heim D, Niederhauser K, Simbray N (2010) The Volkmann dogma: a retrospective, long-term, single-center study. Eur J Trauma Emerg Surg 36:515–519

45.

Heim D, Schmidlin V, Ziviello O (2002) Do type B malleolar fractures need a positioning screw? Injury 33:729–734PubMed

46.

Heim U (1983) Malleolarfrakturen. Unfallheilkunde 86:248–258PubMed

47.

Heim U, Pfeiffer KM (1988) Periphere Osteosynthesen. Springer, Berlin Heidelberg New York

48.

Heineck J, Serra A, Haupt C, Rammelt S (2009) Accuracy of corrective osteotomies in fibular malunion: a cadaver model. Foot Ankle Int 30:773–777PubMed

49.

Herscovici D Jr, Scaduto JM, Infante A (2007) Conservative treatment of isolated fractures of the medial malleolus. J Bone Joint Surg Br 89:89–93PubMed

50.

Hintermann B, Regazzoni P, Lampert C et al (2000) Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br 82:345–351PubMed

51.

Höcker K, Pachucki A (1989) Die Incisura fibularis tibiae. Die Stellung der Fibula in der distalen Syndesmose am Querschnitt. Unfallchirurg 92:401–406PubMed

52.

Hofbauer LC, Brueck CC, Singh SK, Dobnig H (2007) Osteoporosis in patients with diabetes mellitus. J Bone Miner Res 22:1317–1328PubMed

53.

Hoiness P, Stromsoe K (2004) Tricortical versus quadricortical syndesmosis fixation in ankle fractures: a prospective, randomized study comparing two methods of syndesmosis fixation. J Orthop Trauma 18:331–337PubMed

54.

Hopfner S, Krolak C, Kessler S, Tiling R (2006) Präoperative Bildgebung bei diabetisch-neuropathischer Osteoarthropathie: Ist der zusätzliche Einsatz von (18)F-FDGPET sinnvoll? Nuklearmedizin 45:15–20PubMed

55.

Hovis WD, Kaiser BW, Watson JT, Bucholz RW (2002) Treatment of syndesmotic disruptions of the ankle with bioabsorbable screw fixation. J Bone Joint Surg Am 84:26–31PubMed

56.

Illgner U, Podella M, Rummler M et al (2009) Rekonstruktive Chirurgie beim Charcot-Fuss: 5-Jahres-Langzeitoutcome. Orthopade 38:1180–1186PubMed

57.

Jarde O, Vives P, Havet E et al (2000) Fractures malleolaires. Criteres predictifs de l’arthrose a long terme. Etude retrospective de 32 cas. Acta Orthop Belg 66:382–388PubMed

58.

Jaskulka RA, Ittner G, Schedl R (1989) Fractures of the posterior tibial margin: their role in the prognosis of malleolar fractures. J Trauma 29:1565–1570PubMed

59.

Jenkinson RJ, Sanders DW, Macleod MD et al (2005) Intraoperative diagnosis of syndesmosis injuries in external rotation ankle fractures. J Orthop Trauma 19:604–609PubMed

60.

Kannus P, Palvanen M, Niemi S et al (2002) Increasing number and incidence of low-trauma ankle fractures in elderly people: Finnish statistics during 1970–2000 and projections for the future. Bone 31:430–433PubMed

61.

Kennedy JG, Soffe KE, Dalla Vedova P et al (2000) Evaluation of the syndesmotic screw in low Weber C ankle fractures. J Orthop Trauma 14:359–366PubMed

62.

Koller A, Hafkemeyer U, Fiedler R, Wetz HH (2004) Rekonstruktive Fußchirurgie bei diabetisch-neuropathischer Osteoarthropathie. Orthopade 33:983–991PubMed

63.

Koval KJ, Petraco DM, Kummer FJ, Bharam S (1997) A new technique for complex fibula fracture fixation in the elderly: a clinical and biomechanical evaluation. J Orthop Trauma 11:28–33PubMed

64.

Kristensen KD, Hansen T (1985) Closed treatment of ankle fractures. Stage II supination-eversion fractures followed for 20 years. Acta Orthop Scand 56:107–109PubMed

65.

Lauge-Hansen N (1950) Fractures of the ankle II: Combined experimental/surgical and experimental roentgenologic investigation. Arch Surg 60:957–985PubMed

66.

Lauge-Hansen N (1963) Knöchelbrüche und Bandverletzungen des Fußgelenkes und des Fußes. Zbl Chir 88:545–561

67.

Lemon M, Somayaji HS, Khaleel A, Elliott DS (2005) Fragility fractures of the ankle: stabilisation with an expandable calcaneotalotibial nail. J Bone Joint Surg Br 87:809–813PubMed

68.

Leontaritis N, Hinojosa L, Panchbhavi VK (2009) Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am 91:333–339PubMed

69.

Lillmars SA, Meister BR (2001) Acute trauma to the diabetic foot and ankle. Curr Opin Orthop 12:100–105

70.

Lindsjö U (1981) Operative treatment of ankle fractures. Acta Orthop Scand 52(Suppl):1–131

71.

Lindsjö U (1985) Classification of ankle fractures: the Lauge-Hansen or AO system? Clin Orthop Relat Res 199:12–16PubMed

72.

Litchfield JC (1987) The treatment of unstable fractures of the ankle in the elderly. Injury 18:128–132PubMed

73.

Lloyd J, Elsayed S, Hariharan K, Tanaka H (2006) Revisiting the concept of talar shift in ankle fractures. Foot Ankle Int 27:793–796PubMed

74.

Lu H, Kraut D, Gerstenfeld LC, Graves DT (2003) Diabetes interferes with the bone formation by affecting the expression of transcription factors that regulate osteoblast differentiation. Endocrinology 144:346–352PubMed

75.

Macko VW, Matthews LS, Zwirkoski P, Goldstein SA (1991) The joint-contact area of the ankle. The contribution of the posterior malleolus. J Bone Joint Surg Am 73:347–351PubMed

76.

Makwana NK, Bhowal B, Harper WM, Hui AW (2001) Conservative versus operative treatment for displaced ankle fractures in patients over 55 years of age. A prospective, randomised study. J Bone Joint Surg Br 83:525–529PubMed

77.

Manjoo A, Sanders DW, Tieszer C, MacLeod MD (2010) Functional and radiographic results of patients with syndesmotic screw fixation: implications for screw removal. J Orthop Trauma 24:2–6PubMed

78.

Manyi W, Guowei R, Shengsong Y, Chunyan J (2000) A sample of Chinese literature MRI diagnosis of interosseous membrane injury in Maisonneuve fractures of the fibula. Injury 31(Suppl 3):107–110

79.

Markolf KL, Schmalzried TP, Ferkel RD (1989) Torsional strength of the ankle in vitro. The supination-external-rotation injury. Clin Orthop Relat Res 246:266–272PubMed

80.

Mast JW, Teipner WA (1980) A reproducible approach to the internal fixation of adult ankle fractures: rationale, technique, and early results. Orthop Clin North Am 11:661–679PubMed

81.

McConnell T, Creevy W, Tornetta P 3^rd (2004) Stress examination of supination external rotation-type fibular fractures. J Bone Joint Surg Am 86:2171–2178PubMed

82.

McCullough CJ, Burge PD (1980) Rotatory stability of the load-bearing ankle. An experimental study. J Bone Joint Surg Br 62:460–464PubMed

83.

Michelson J, Solocoff D, Waldman B et al (1997) Ankle fractures. The Lauge-Hansen classification revisited. Clin Orthop Relat Res 345:198–205PubMed

84.

Michelson JD, Magid D, McHale K (2007) Clinical utility of a stability-based ankle fracture classification system. J Orthop Trauma 21:307–315PubMed

85.

Michelson JD, Magid D, Ney DR, Fishman EK (1992) Examination of the pathologic anatomy of ankle fractures. J Trauma 32:65–70PubMed

86.

Michelson JD, Varner KE, Checcone M (2001) Diagnosing deltoid injury in ankle fractures: the gravity stress view. Clin Orthop Relat Res 387:178–182PubMed

87.

Miller AN, Carroll EA, Parker RJ et al (2010) Posterior malleolar stabilization of syndesmotic injuries is equivalent to screw fixation. Clin Orthop Relat Res 468:1129–1135PubMed

88.

Mittlmeier T, Klaue K, Haar P, Beck M (2008) Charcot-Fuß. Eine Standortbestimmung und Perspektiven. Unfallchirurg 111:218–231PubMed

89.

Mittlmeier T, Klaue K, Haar P, Beck M (2010) Should one consider primary surgical reconstruction in charcot arthropathy of the feet? Clin Orthop Relat Res 468:1002–1011PubMed

90.

Mont MA, Sedlin ED, Weiner LS, Miller AR (1992) Postoperative radiographs as predictors of clinical outcome in unstable ankle fractures. J Orthop Trauma 6:352–357PubMed

91.

Moore JA Jr, Shank JR, Morgan SJ, Smith WR (2006) Syndesmosis fixation: a comparison of three and four cortices of screw fixation without hardware removal. Foot Ankle Int 27:567–572PubMed

92.

Needleman RL, Skrade DA, Stiehl JB (1989) Effect of the syndesmotic screw on ankle motion. Foot Ankle Int 10:17–24

93.

Nelson MC, Jensen NK (1940) Treatment of trimalleolar fractures of the ankle. Surg Gynec Obst 71:509

94.

Nielsen JO, Dons-Jensen H, Sorensen HT (1990) Lauge-Hansen classification of malleolar fractures. An assessment of the reproducibility in 118 cases. Acta Orthop Scand 61:385–387PubMed

95.

Nielson JH, Gardner MJ, Peterson MG et al (2005) Radiographic measurements do not predict syndesmotic injury in ankle fractures: an MRI study. Clin Orthop Relat Res 436:216–221PubMed

96.

Nielson JH, Sallis JG, Potter HG et al (2004) Correlation of interosseous membrane tears to the level of the fibular fracture. J Orthop Trauma 18:68–74PubMed

97.

Olerud C, Molander H (1986) Bi- and trimalleolar ankle fractures operated with nonrigid internal fixation. Clin Orthop Relat Res 206:253–260PubMed

98.

Panchbhavi VK, Mody MG, Mason WT (2005) Combination of hook plate and tibial pro-fibular screw fixation of osteoporotic fractures: a clinical evaluation of operative strategy. Foot Ankle Int 26:510–515PubMed

99.

Park SS, Kubiak EN, Egol KA et al (2006) Stress radiographs after ankle fracture: the effect of ankle position and deltoid ligament status on medial clear space measurements. J Orthop Trauma 20:11–18PubMed

100.

Pelton K, Thordarson DB, Barnwell J (2010) Open versus closed treatment of the fibula in Maissoneuve injuries. Foot Ankle Int 31:604–608PubMed

101.

Peter RE, Harrington RM, Henley MB, Tencer AF (1994) Biomechanical effects of internal fixation of the distal tibiofibular syndesmotic joint: comparison of two fixation techniques. J Orthop Trauma 8:215–219PubMed

102.

Pettrone FA, Gail M, Pee D et al (1983) Quantitative criteria for prediction of the results after displaced fracture of the ankle. J Bone Joint Surg Am 65:667–677PubMed

103.

Phillips WA, Schwartz HS, Keller CS et al (1985) A prospective, randomized study of the management of severe ankle fractures. J Bone Joint Surg Am 67:67–78PubMed

104.

Pinzur M (2004) Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. Foot Ankle Int 25:545–549PubMed

105.

Rammelt S, Endres T, Grass R, Zwipp H (2004) The role of external fixation in acute ankle trauma. Foot Ankle Clin 9:455–474PubMed

106.

Rammelt S, Grass R, Zwipp H (2008) Sprunggelenkfrakturen. Unfallchirurg 111:421–437PubMed

107.

Rammelt S, Zwipp H, Grass R (2008) Sprunggelenkfrakturen: operative Technik. Unfallchirurg 111:439–447PubMed

108.

Ramsey PL, Hamilton W (1976) Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg Am 58:356–357PubMed

109.

Richter J, Schulze W, Muhr G (1999) Stabile Knöchelbrüche. Indikation zur Operation oder konservativen Therapie? Orthopade 28:493–499PubMed

110.

Saltzman CL, Hagy ML, Zimmerman B et al (2005) How effective is intensive nonoperative initial treatment of patients with diabetes and Charcot arthropathy of the feet? Clin Orthop Relat Res 435:185–190PubMed

111.

Saltzman CL, Salamon ML, Blanchard GM et al (2005) Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthop J 25:44–46PubMed

112.

Sasse M, Nigg BM, Stefanyshyn DJ (1999) Tibiotalar motion-effect of fibular displacement and deltoid ligament transection: in vitro study. Foot Ankle Int 20:733–737PubMed

113.

Schaffer JJ, Manoli A 2nd (1987) The antiglide plate for distal fibular fixation. A biomechanical comparison with fixation with a lateral plate. J Bone Joint Surg Am 69:596–604PubMed

114.

Schepers T (2010) To retain or remove the syndesmotic screw: a review of literature. Arch Orthop Trauma Surg (epub ahead of print)

115.

Schock HJ, Pinzur M, Manion L, Stover M (2007) The use of gravity or manual-stress radiographs in the assessment of supination-external rotation fractures of the ankle. J Bone Joint Surg Br 89:1055–1059PubMed

116.

Seitz WH Jr, Bachner EJ, Abram LJ et al (1991) Repair of the tibiofibular syndesmosis with a flexible implant. J Orthop Trauma 5:78–82PubMed

117.

SooHoo NF, Krenek L, Eagan MJ et al (2009) Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg Am 91:1042–1049PubMed

118.

Stark E, Tornetta P 3rd, Creevy WR (2007) Syndesmotic instability in Weber B ankle fractures: a clinical evaluation. J Orthop Trauma 21:643–646PubMed

119.

Stiehl JB, Skrade DA, Johnson RP (1992) Experimentally produced ankle fractures in autopsy specimens. Clin Orthop Relat Res 285:244–249PubMed

120.

Stoffel K, Wysocki D, Baddour E et al (2009) Comparison of two intraoperative assessment methods for injuries to the ankle syndesmosis. A cadaveric study. J Bone Joint Surg Am 91:2646–2652PubMed

121.

Stormont DM, Morrey BF, An KN, Cass JR (1985) Stability of the loaded ankle. Relation between articular restraint and primary and secondary static restraints. Am J Sports Med 13:295–300PubMed

122.

Streubel PN, McCormick JJ, Gardner MJ (2011) The posterior malleolus: should it be fixed and why? Curr Orthop Pract 22:17–24

123.

Stromsoe K, Hoqevold HE, Skjeldal S, Alho A (1995) The repair of a ruptured deltoid ligament is not necessary in ankle fractures. J Bone Joint Surg Br 77:920–921PubMed

124.

Stufkens SA, Bekerom MP van den, Kerkhoffs GM et al (2010) Long-term outcome after 1822 operatively treated ankle fractures: A systematic review of the literature. Injury 42(2):119–127

125.

Sutter PM, Peltzer J (2010) Principles of operative treatment of malleolar fractures today. Eur J Trauma Emerg Surg 36:505–514

126.

Thompson MC, Gesink DS (2000) Biomechanical comparison of syndesmosis fixation with 3.5- and 4.5-millimeter stainless steel screws. Foot Ankle Int 21:736–741PubMed

127.

Thomsen NO, Overgaard S, Olsen LH et al (1991) Observer variation in the radiographic classification of ankle fractures. J Bone Joint Surg Br 73:676–678PubMed

128.

Thordarson DB, Motamed S, Hedman T et al (1997) The effect of fibular malreduction on contact pressures in an ankle fracture malunion model. J Bone Joint Surg Am 79:1809–1815PubMed

129.

Thordarson DB, Samuelson M, Shepherd LE et al (2001) Bioabsorbable versus stainless steel screw fixation of the syndesmosis in pronation-lateral rotation ankle fractures: a prospective randomized trial. Foot Ankle Int 22:335–338PubMed

130.

Thornes B, Shannon F, Guiney AM et al (2005) Suture-button syndesmosis fixation: accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res 431:207–212PubMed

131.

Tochigi Y, Rudert MJ, Saltzman CL et al (2006) Contribution of articular surface geometry to ankle stabilization. J Bone Joint Surg Am 88:2704–2713PubMed

132.

Bekerom MP van den, Haverkamp D, Kerkhoffs GM, Dijk CN van (2010) Syndesmotic stabilization in pronation external rotation ankle fractures. Clin Orthop Relat Res 468:991–995PubMed

133.

Bekerom MP van den, Haverkamp D, Kloen P (2009) Biomechanical and clinical evaluation of posterior malleolar fractures. A systematic review of the literature. J Trauma 66:279–284PubMed

134.

Bekerom MP van den, Dijk CN van (2010) Is fibular fracture displacement consistent with tibiotalar displacement? Clin Orthop Relat Res 468:969–974PubMed

135.

Vasarhelyi A, Lubitz J, Gierer P et al (2006) Detection of fibular torsional deformities after surgery for ankle fractures with a novel CT method. Foot Ankle Int 27:1115–1121PubMed

136.

Vioreanu M, Brophy S, Dudeney S et al (2007) Displaced ankle fractures in the geriatric population: Operative or non-operative treatment. Foot Ankle Surg 13:10–14

137.

Weber BG (1966) Verletzungen des oberen Sprunggelenkes Aktuelle Probleme in der Chirurgie, Bd. 3. Huber, Bern Stuttgart

138.

Weber M (2004) Trimalleolar fractures with impaction of the posteromedial tibial plafond: implications for talar stability. Foot Ankle Int 25:716–727PubMed

139.

Weber M, Burmeister H, Flueckiger G, Krause FG (2010) The use of weightbearing radiographs to assess the stability of supination-external rotation fractures of the ankle. Arch Orthop Trauma Surg 130:693–698PubMed

140.

Weber M, Krause F (2005) Peroneal tendon lesions caused by antiglide plates used for fixation of lateral malleolar fractures: the effect of plate and screw position. Foot Ankle Int 26:281–285PubMed

141.

Weening B, Bhandari M (2005) Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. J Orthop Trauma 19:102–108PubMed

142.

Wukich DK, Kline AJ (2008) The management of ankle fractures in patients with diabetes. J Bone Joint Surg Am 90:1570–1578PubMed

143.

Yde J, Kristensen KD (1980) Ankle Fractures, supination-eversion fracture stage II, primary and late results of operative and non-operative treatment. Acta Orthop Scand 51:695–702PubMed

144.

Zenker H, Nerlich M (1982) Prognostic aspects in operated ankle fractures. Arch Orthop Trauma Surg 100:237–241PubMed

145.

Zwipp H, Rammelt S (2002) Frakturen und Luxationen. In: Wirth CJ (Hrsg) Orthopädie und Orthopädische Chirurgie. Fuß, 1. Aufl. Thieme, Stuttgart, S 531–618

146.

Zwipp H, Rammelt S, Dahlen C, Reichmann H (1999) Das Charcot-Gelenk. Orthopade 28:550–558PubMed

Titel: Probleme und Kontroversen in der Behandlung von Sprunggelenkfrakturen
verfasst von: PD Dr. S. Rammelt
D. Heim
L.C. Hofbauer
R. Grass
H. Zwipp
Publikationsdatum: 01.10.2011
Verlag: Springer-Verlag
Erschienen in: Die Unfallchirurgie / Ausgabe 10/2011
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI: https://doi.org/10.1007/s00113-011-1978-x

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Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
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