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Z Orthop Unfall 2023; 161(06): 619-627
DOI: 10.1055/a-1807-7668
Übersicht

Primär endoprothetische Versorgung von Kniegelenksfrakturen

Article in several languages: deutsch | English
Stefan Förch
1   Abteilung für Unfallchirurgie, Orthopädie, plastische und Handchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland (Ringgold ID: RIN39694)
,
Leonard Lisitano
2   Abteilung für Unfallchirurgie, Orthopädie, plastische und Handchirurgie, Universitätsklinikum Augsburg, Augsburg, Deutschland (Ringgold ID: RIN39694)
,
Edgar Mayr
3   Unfallchirurgie, Orthopädie, Hand- und Plastische Chirurgie, Universität Augsburg Medizinische Fakultät, Augsburg, Deutschland (Ringgold ID: RIN531257)
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Zusammenfassung

Während die primäre prothetische Versorgung von Schenkelhalsfrakturen ein etabliertes Verfahren und bei geriatrischen Patienten den Goldstandard darstellt, wird die primäre endoprothetische Versorgung bei kniegelenknahen Frakturen deutlich seltener angewendet. Vor allem bei älteren Patienten findet sie Anwendung bei Frakturen mit vorbestehender symptomatischer Gonarthrose oder Frakturen, die aufgrund ihrer Komplexität und vorbestehender reduzierter Knochenqualität nicht osteosynthetisch zu versorgen sind.

Die operative Umsetzung ist komplex und bedarf entsprechender Erfahrung in der Primär- und vor allem auch Revisionsendoprothetik, einer Logistik mit Vorhaltung entsprechender Implantate und einer guten präoperativen Planung.

Auch wenn hochwertige Studien weitgehend fehlen, gibt es vor allem seit Anfang der 2000er-Jahre immer wieder Berichte und Fallserien zur primären endoprothetischen Versorgung kniegelenknaher Frakturen. Kumulativ liegen Berichte von jeweils gut 200 Fällen nach distalen Femur- und proximalen Tibiafrakturen vor. Die Komplikationsraten werden zwischen 0 und 90% angegeben und betreffen vor allem Wundheilungsstörungen und Infekte. Funktionell können überwiegend sehr gute bis zufriedenstellende Ergebnisse und Bewegungsumfänge von 100° erzielt werden.

Die primäre endoprothetische Frakturversorgung kniegelenknaher Frakturen sollte in ausgewählten Fällen als Therapieoption in Betracht gezogen werden. Es lassen sich mit hoher Zuverlässigkeit gute funktionelle Ergebnisse erzielen, Hauptkomplikationen sind Wundheilungsstörungen und Infekte.

Schlüsselwörter

Frakturendoprothetik - Kniegelenk - distale Femurfraktur - proximale Tibiafraktur


Publication History

Received: 27 September 2021

Accepted after revision: 23 March 2022

Article published online:
02 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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