Proximale periprothetische Femurfrakturen: Klassifikation und Therapie

Zusammenfassung

Bei periprothetischen Frakturen am Femur muss unterschieden werden zwischen proximalen Frakturen, die rund um die Hüft-TEP liegen, und distalen Frakturen, die das Kniegelenk betreffen. In dieser Arbeit werden die proximalen Femurfrakturen behandelt. Es ist wichtig, bereits präoperativ eine Klassifikation der Fraktur durchzuführen, um die entsprechende präoperative Planung möglichst genau umsetzen zu können. Bereits im Vorfeld sollte abgeklärt werden, ob ein Prothesenwechsel erforderlich ist, d. h. ob die Prothese locker ist oder nicht, oder ob eine offene Reposition und innere Fixierung möglich ist. Abhängig vom geplanten Vorgehen müssen die entsprechenden Implantate bereitstehen, um nicht intraoperativ an eine Versorgungsgrenze zu kommen. Insgesamt ist von einer Inzidenzsteigerung periprothetischer Frakturen auszugehen, da es einerseits aufgrund des steigenden Lebensalters und der damit verbundenen Risikofaktoren zu einer Zunahme kommen wird, andererseits auch durch die steigende Anzahl der Primärendoprothetik. Die Versorgung von periprothetischen Frakturen stellt eine große Herausforderung aus wirtschaftlicher, aber auch operativer Sicht dar. Sie benötigt große Erfahrung und sollte daher spezialisierten Abteilungen mit interdisziplinärer Zusammenarbeit vorbehalten sein.

Abstract

Periprosthetic femoral fractures can be categorized into proximal fractures around a hip stem or distally around a knee arthroplasty. This paper focuses on the proximal periprosthetic fractures. It is important to classify the fracture at diagnosis and to perform accurate planning of the surgery. Basically it is necessary to decide if the implant is fixed or loose, in the latter case a revision surgery including the change of the endoprosthesis is neccessary. If the implant is fixed an open reduction and internal fixation can be done. All implants have to be available on site because in the course of the intervention the plan could change. Due to rising numbers of primary arthroplasties and more elderly patients an increase of periprosthetic fractures can be expected. The treatment of periprosthetic fractures is an economic and surgical challenge. It is important to provide competence for these cases concerning both operative techniques and interdisciplinary treatment.

Fazit

Kernaussagen

Die operative Behandlung von periprothetischen Frakturen stellt oft eine komplexe Herausforderung dar.

Wichtig sind die präoperative Planung und Klassifizierung und dann die rasche Versorgung des Patienten. Dabei ist ein Algorithmus zur Wahl der Operationstechnik und der zu verwendenden Implantate je nach Frakturtyp hilfreich, um eine stabile Reposition zu erreichen.

Key words

Femur - periprothetisch - Fraktur - Klassifikation - winkelstabile Platte - Revisionsendoprothese

Key words

femur - periprosthetic - fracture - classification - locking plate - revision arthroplasty

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