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. 2022 Jun;125(6):479-491.
doi: 10.1007/s00113-022-01184-x. Epub 2022 May 6.

[Shaft fractures of the lower limb in adolescents]

[Article in German]
Jan-Sebastian Beume  1 , Peter P Schmittenbecher  2
Affiliations

[Shaft fractures of the lower limb in adolescents]

[Article in German]
Jan-Sebastian Beume et al. Unfallchirurgie (Heidelb). 2022 Jun.

Abstract
in English, German

Shaft fractures of the lower extremities are rare during adolescence. Conservative treatment is no longer used for the upper leg and the significance is declining for the lower leg, as only minor axis deviations and malrotations of the shaft are acceptable and conservative therapy is associated with severe impairments in the daily routine; however, conservative treatment is still an option for femoral fractures in children < 3 years of age and for stable fractures of the lower leg. Various osteosynthesis procedures can be used depending on the body weight and epiphyseal maturation. Elastic stable intramedullary nailing is the first choice, followed by solid adolescent femoral or tibial nailing for higher body weights and external fixation for open or multifragmentary fractures. Plate osteosynthesis is an established alternative. Following correct surgical treatment, all fractures have movement and at least partial load-bearing stability and the results are satisfactory. Regular controls are recommended up to the end of the growth period.

Schaftfrakturen an der unteren Extremität sind in der Adoleszenz selten. Die konservative Therapie hat am Oberschenkel keinen, am Unterschenkel einen rückläufigen Stellenwert, da nur geringe Achsabweichungen oder Rotationsfehler akzeptabel und große Einschränkungen im Alltag mit dem konservativen Vorgehen verbunden sind. Am Oberschenkel ist die konservative Therapie jedoch bei Kindern im Alter < 3 Jahre, am Unterschenkel bei stabilen Frakturen eine relevante Option. Je nach Körpergewicht und Fugenreife bieten sich verschiedene Osteosyntheseverfahren an. Die elastisch-stabile intramedulläre Nagelung stellt die erste Wahl dar; es folgen der solide Adoleszentenfemur- oder -tibianagel bei höherem Körpergewicht sowie der Fixateur externe bei offenen oder mehrfragmentären Frakturen. Die Plattenosteosynthese ist eine etablierte Alternative. Nach korrekter operativer Versorgung sind alle Frakturen bewegungs- und viele zumindest teilbelastungsstabil sowie die Ergebnisse gut. Kontrollen sind bis zum Wachstumsabschluss zu empfehlen.

Keywords: Aftercare; Conservative treatment; Elastic stable intramedullary nailing; External fixators; Nailing.

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References

Literatur

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