„Plate-assisted segmental bone transport“ mit Verlängerungsnagel und Platte: Neue Technik zur Behandlung von Knochendefekten in Tibia und Femur
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„Plate-assisted segmental bone transport“ mit Verlängerungsnagel und Platte : Neue Technik zur Behandlung von Knochendefekten in Tibia und Femur. / Kähler Olesen, Ulrik.
I: Der Unfallchirurg, Bind 121, Nr. 11, 2018, s. 874-883.Publikation: Bidrag til tidsskrift › Review › Forskning › fagfællebedømt
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TY - JOUR
T1 - „Plate-assisted segmental bone transport“ mit Verlängerungsnagel und Platte
T2 - Neue Technik zur Behandlung von Knochendefekten in Tibia und Femur
AU - Kähler Olesen, Ulrik
PY - 2018
Y1 - 2018
N2 - BACKGROUND: Distraction osteogenesis represents an effective procedure for treatment of bone defects from various causes (e.g. trauma, malignancy, congenital and infection). In the past the available procedures were practically exclusively external.PRINCIPLES: In the plate-assisted segmental bone transport (PABST) procedure a commercially available motorized intramedullary lengthening nail is used for segment transport. The transport segment is transported along a bone plate, which is responsible for maintaining the position of the proximal and distal main fragments.SURGICAL TECHNIQUE: In staged sequences, a plate spanning the defect is placed. A lengthening nail is inserted in an antegrade or retrograde direction and a vascularized transport segment is created with an osteotomy. Bone transport is initiated at 1.0 mm a day. The transport segment is pulled or pushed into place, depending on the location of the bone void. In due time, a docking procedure is performed and full weight bearing is allowed. Supplementary lengthening can be initiated at docking or in a separate procedure. In smaller defects the gap is closed immediately over the plate and the bone is lengthened by the nail in the opposite end of the defect.CONCLUSION: The presented method is a valuable addition to the armamentarium for treatment of bone defects. The main advantages are the avoidance of external fixation (fixation wires, Schanz screws) and the creation of physiological bone substitute. Vital soft tissues are essential for a good outcome. With appropriate management (systematic debridement, local and systemic administration of antibiotics and free soft tissue flaps), this method can be a solution to even complex reconstructive problems.
AB - BACKGROUND: Distraction osteogenesis represents an effective procedure for treatment of bone defects from various causes (e.g. trauma, malignancy, congenital and infection). In the past the available procedures were practically exclusively external.PRINCIPLES: In the plate-assisted segmental bone transport (PABST) procedure a commercially available motorized intramedullary lengthening nail is used for segment transport. The transport segment is transported along a bone plate, which is responsible for maintaining the position of the proximal and distal main fragments.SURGICAL TECHNIQUE: In staged sequences, a plate spanning the defect is placed. A lengthening nail is inserted in an antegrade or retrograde direction and a vascularized transport segment is created with an osteotomy. Bone transport is initiated at 1.0 mm a day. The transport segment is pulled or pushed into place, depending on the location of the bone void. In due time, a docking procedure is performed and full weight bearing is allowed. Supplementary lengthening can be initiated at docking or in a separate procedure. In smaller defects the gap is closed immediately over the plate and the bone is lengthened by the nail in the opposite end of the defect.CONCLUSION: The presented method is a valuable addition to the armamentarium for treatment of bone defects. The main advantages are the avoidance of external fixation (fixation wires, Schanz screws) and the creation of physiological bone substitute. Vital soft tissues are essential for a good outcome. With appropriate management (systematic debridement, local and systemic administration of antibiotics and free soft tissue flaps), this method can be a solution to even complex reconstructive problems.
U2 - 10.1007/s00113-018-0546-z
DO - 10.1007/s00113-018-0546-z
M3 - Review
C2 - 30242443
VL - 121
SP - 874
EP - 883
JO - Der Unfallchirurg
JF - Der Unfallchirurg
SN - 0177-5537
IS - 11
ER -
ID: 217606490