Osteosynthese bei proximalen Femurfrakturen – Wie entscheidend sind Reposition und die Wahl des Implantats?

Zusammenfassung

Proximale Femurfrakturen sind häufige und gleichsam komplexe Verletzungen, die einer zeitnahen Versorgung bedürfen. Ziel der operativen Therapie ist stets die rasche Wiederherstellung einer schmerzfreien und belastungsstabilen Extremität. Betroffen sind meist ältere, multimorbide Patienten mit einer hohen postoperativen Komplikations- und Mortalitätsrate. Bei gleichzeitig steigender Inzidenz besteht eine hohe medizinische und volkswirtschaftliche Relevanz der Thematik. In dieser Arbeit soll anhand der aktuellen Literatur die Reposition und Implantatwahl bei der Osteosynthese von proximalen Femurfrakturen in Abhängigkeit von der Frakturmorphologie untersucht werden. Zur Standardversorgung gehören neben der Schraubenosteosynthese (SO) die Versorgung mit einer Dynamischen Hüftschraube (DHS) und die intramedulläre Nagelosteosynthese (IN). Des Weiteren wird der Einfluss der Implantatpositionierung, Frakturreposition und additiver Maßnahmen wie einer Zementaugmentation auf das Ergebnis bewertet und diskutiert. Vorrangig für die Vermeidung von Komplikationen sind eine sorgsame Frakturreposition und die regelhafte Implantatpositionierung.

Schlüsselwörter

proximale Femurfrakturen - hüftgelenksnahe Frakturen - intramedulläre Osteosynthese - dynamische Hüftschraube - pertrochantäre Fraktur

• Literatur

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