Die Schenkelhalsfraktur bei jüngeren Patienten (15–50 Jahre). Klinisch-radiografisches Outcome 4 Jahre nach operativer Therapie

Zusammenfassung

Einleitung: Die traumatische Schenkelhalsfraktur ist eine seltene Verletzung bei jüngeren Patienten, die zwischen dem 15. und 50. Lebensjahr sind. Die kurz- und langfristigen Komplikationen dieser Verletzung bereiten erhebliche Probleme, insbesondere die Pseudarthrose und die Hüftkopfnekrose. In der Literatur ist die Datenlage hinsichtlich der Versorgungsstrategien und deren Outcome für jüngere Patienten eher schwach.
Material und Methode: Vor diesem Hintergrund wurde aus einer Gesamtheit von 376 Patienten mit Schenkelhalsfrakturen 6 % (n = 23) identifiziert, die jünger als 50 Jahre alt waren. 17/23 Frakturen wurden osteosynthetisch versorgt. Perioperative Daten, Verläufe und das klinisch-radiografische Outcome 4,2 Jahre postoperativ konnten von 11 der 17 Patienten retrospektiv ausgewertet werden.
Ergebnisse: Die durchschnittliche Zeitspanne zwischen Unfallereignis und Operationszeitpunkt betrug 22 h. Im Follow-up-Intervall trat bei einem der osteosynthetisch versorgten Patienten eine Hüftkopfnekrose auf, weswegen ein Gelenkersatz durchgeführt wurde, eine Pseudarthrose trat nicht auf. Das klinische Outcome war sehr gut, der durchschnittliche Harris-Hip-Score betrug 95 Punkte (von max. 100 Punkten).
Schlussfolgerung: Die osteosynthestische Versorgung der traumatischen Schenkelhalsfraktur bei jüngeren Patienten zeigte gute Ergebnisse und hat in der Versorgung medialer Schenkelhalsfrakturen ihren Stellenwert.

Abstract

Introduction: Traumatic fractures of the neck of the femur are rare injuries in younger patients between 15 and 50 years old. The short-term and long-term complications may cause substantial problems, in particular non-union and avascular necrosis (AVN) of the head of the femur. In the literature (and from some experts) the impression is occasionally given that there might be “proven” successful therapeutic procedures.
Methods: For this purpose we retrospectively analysed follow-up-data from our own patients in the years 2003–2007 and compared them with the literature. We identified 23 of a total of 376 patients with a femoral neck fracture as a cohort being younger than 50 years. 17 of those 23 patients were treated with an internal fixation. We were able to collect and analyse complete clinical and radiological data of 11 of these 17 patients 4.2 years after surgery.
Results: The mean interval between accident and surgery was 22 hours. Only one of the patients developed an AVN after internal fixation of the fracture and was implanted a total hip replacement 18 months postoperatively. There was no non-union of the femoral neck The clinical outcome after 4.2 years was very good. The mean Harris Hip Score was 95 points (of a max. of 100 pts.).
Conclusions: The osteosynthesis of femoral neck fractures in younger patients showed good results and a low risk of AVN and non-union. Therefore the internal fixation of the femoral neck fracture should be preferred for the younger patients instead of a primary total hip replacement.

Schlüsselwörter

Oberschenkelhalsfraktur - jüngere Patienten - Outcome - Therapieverfahren - Frakturversorgungszeitpunkt

Key words

fractures of the neck of the femur - young patients - outcome - therapeutic procedures - interval to surgery

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