Osteosynthesis

The osteosynthesis is the operative treatment of bone fractures and other bone injuries (eg Epiphysiolysen ) with implants usually made of metal. The goal is to fix the mating fragments restoration of axes and joint position ( reduction ) for the duration of fracture healing. In contrast to plaster the internal fixation usually allows early exercise treatment (so-called exercise stable osteosynthesis ) or even stress (so-called load-stable osteosynthesis ) of the fracture. One only shelf-stable osteosynthesis is avoided whenever possible.

The choice of whether a fracture with plaster, internal fixation or functionally treated will happen after the pattern of injury ( soft tissue, localization, stress, malposition of the fragments), after weighing between potential harmful consequences of prolonged immobilization with conservative treatment and surgical risk.

Osteosynthesis are also used in orthopedic surgery for fixation after corrective osteotomy ( osteotomy ) in bad positions or joint fusions ( arthrodesis ). Also stiffening of the spine ( spinal fusion ) in scoliosis, instability or other disease are performed by using osteosynthesis. They are also often used in resections of bone tumors for subsequent stabilization, or prophylactic for bone stabilization in brittle bone disease ( osteogenesis imperfecta ).

Osteosynthesearten

In Spickdrahtosteosynthese the fragments are joined (for example, the hand) after reduction by means of Kirschner wires. There is no compression and this method is not stable exercise. An association of fragments solely by screws ( screw fixation ) will occur at the big bone there because of the high static (body weight) and muscle tension caused by stress rarely (small bone fragments ). Through an association with metal plates ( plate fixation of various kinds ) in conjunction with the screws forces better derived ( neutralization) and fragments can be put under pressure ( compression) are. In a pathologic fracture in addition a defect filling is done by bone cement ( Doppelplattenverbundosteosynthese ). Especially in fractures of the shaft of long bones can be achieved by the introduction of long nails into the medullary cavity ( intramedullary fixation ) along the axis of the bone stability. This technique is gentle on tissue because the soft tissue does not have to be a large area opened (closed intramedullary nailing ). It leaves only small scars, as only short sections for insertion of the nail must be made in the bone, as with the ( lock nailing ), but which is introduced transversely into the nail locking screws to lock the bone against rotation. For statistical reasons applies to these methods only on the long bones, where an shaft fractures of the femur, tibia, upper arm and forearm bones.

Other techniques use wires ( cerclage ) that connect the two fragments as a wrap and secure against each other. Such cerclages be for osteosynthesis of the sternum after Längsdurchsägung ( median sternotomy ), for example in cardiac surgery may be used.

Otherwise, wire cerclage are almost exclusively used in Zuggurtungsosteosynthesen. In a tension band the pullout muscle groups lead by force deflection on the one hand and an asymmetrical force to axis fixation on the other hand to compress the fragments and better healing. These wire tension band is used, inter alia, for fractures of the olecranon ( elbow end of the ulna ) and the patella.

In comminuted fractures osteosynthesis often comes as the bone graft used. Here, a defect filling is done with the patient's own bone (eg from the iliac crest ). Whereas an additional stabilization by plates or external fixation. An external fixator is also used in open fractures or fracture of the cervical spine ( Halofixateur ).

Material types

Nails, screws, plates and wires are usually made of surgical steel or titanium. And also composite materials and, in rare cases absorbable implants made ​​of different polymers may be used. Their advantage is that they do not have to be removed by surgery. A special feature are implants made of magnesium alloys and iron -based implants. These are metal implants, but still dissolve in the body by itself.

Sklerosesäume

On X-ray images can be found after removal of a osteosynthetic supply often still compression lines ( Sklerosesäume ) that trace the former implants. At the interfaces of the cancellous bone to the introduced foreign material (eg screw) sclerosed bone as an adaptation response to the locally increased stress.

Dentistry and Oral Surgery

Special jaw implants made ​​of titanium correspond as internal osteosynthesis in mandibular hochatrophischen the principle of intramedullary splinting and also serve as an anchor for dentures by a right angle patch post, perforate the gingiva. Due to their microporous roughened surface (TPS ) and early exposure to dentures they go an intense bacteria-proof connection with the bone ( osseointegration ) a, so that they can remain in the bone permanently. They are used to fracture preventive usually in the lower jaw bone.

Pioneers of osteosynthesis

After birth year

• Ludwig Rehn (1849-1930)
• Carl Hansmann (1852-1917)
• Robert Jones ( surgeon ) ( 1857-1933 )
• Fritz König ( surgeon ) ( 1866-1952 )
• Albin Lambotte (1866-1955)
• Martin Kirschner (1879-1942)
• Robert Danis (1880-1962)
• Marius N. Smith -Petersen (1886-1953)
• Heinrich Bürkle de la Camp (1895-1974)
• Gerhard Küntscher (1900-1972)
• Alfred Nicholas Witt (1914-1999)
• Martin Allgöwer (1917-2007)
• Maurice Edmond Müller (1918-2009)
• Gavriil Abramovich Ilizarov (1921-1992)