Azetabulumfrakturen: Komplikationen und Endoprothetik

S. C. Herath; J. H. Holstein; A. Pizanis; T. Pohlemann

doi:10.1055/s-0034-1382862

Zeitschrift für Orthopädie und Unfallchirurgie, Inhaltsverzeichnis

Z Orthop Unfall 2014; 152(4): 399-413
DOI: 10.1055/s-0034-1382862

Refresher Orthopädie und Unfallchirurgie

Georg Thieme Verlag KG Stuttgart · New York

Azetabulumfrakturen: Komplikationen und Endoprothetik

Fractures of the Acetabulum: Complications and Joint Replacement

Autor*innen

S. C. Herath

Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes – UKS, Homburg/Saar
J. H. Holstein

Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes – UKS, Homburg/Saar
A. Pizanis

Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes – UKS, Homburg/Saar
T. Pohlemann

Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes – UKS, Homburg/Saar

Abstract

Zusammenfassung

Azetabulumfrakturen nehmen als Gelenkbrüche eine Sonderstellung unter den Beckenfrakturen ein. Schon durch die Tatsache, dass sie meist durch Einwirkung großer Kraft auf den Körper entstehen, und aufgrund ihrer Lokalisation in einer anatomisch komplizierten Region ist mit einer erhöhten Rate an Komplikationen zu rechnen. Neben den allgemeinen und perioperativen Komplikationen spielen auch Spätfolgen, insbesondere die posttraumatische Arthrose, eine große Rolle. Sowohl die primäre operative Rekonstruktion des Azetabulums als auch ein eventuell notwendiger endoprothetischer Gelenkersatz stellen hohe Anforderungen an die diagnostischen und operativen Fähigkeiten des behandelnden Arztes. Die Kenntnis der für die verschiedenen Frakturtypen und Operationstechniken spezifischen Risiken ist essenziell für eine erfolgreiche Therapie. Aufgrund der im Vergleich zur primären Hüftendoprothetik deutlich schlechteren Langzeitergebnisse ist bei Azetabulumfrakturen, unabhängig vom Patientenalter, wann immer möglich eine operative Rekonstruktion anzustreben.

Abstract

Acetabular fractures assume a special role amongst the fractures of the pelvis, because they involve a major weight-bearing joint. As those fractures mostly result from exposure to great force, and because of their location in an anatomically complex region, a high rate of complications has to be anticipated. Besides general and perioperative complications long-term consequences, especially post-traumatic arthrosis, are relevant problems when it comes to treating fractures of the acetabulum. The primary reconstruction of the acetabulum, as well as a possibly necessary prosthetic replacement of the hip joint, makes high demands on the diagnostic and operative capabilities of the attending physician. Exact knowledge of the specific risks and pitfalls for each type of fracture and for the specific surgical techniques is crucial for a successful treatment. Due to the much worse long-term outcome when compared to primary total hip replacement in patients with osteoarthritis, acetabular fractures should, regardless of the patient’s age, whenever possible be treated by operative reconstruction.

Key words

Azetabulumfraktur - Beckenfraktur - Komplikationen - Endoprothetik - Osteosynthese - Rekonstruktion

Key words

acetabular fracture - pelvic fracture - complications - endoprosthetic replacement - osteosynthesis - reconstruction

Volltext

Referenzen

Literaturverzeichnis
1 Alonso JE, Davila R, Bradley E. Extended iliofemoral versus triradiate approaches in management of associated acetabular fractures. Clin Orthop Related Res 1994; 305: 81-87
2 Anglen JO, Moore KD. Prevention of heterotopic bone formation after acetabular fracture fixation by single-dose radiation therapy: a preliminary report. J Orthop Trauma 1996; 10: 258-263
3 Ballmer PM, Isler B, Ganz R. Ergebnisse operativ behandelter Acetabulumfrakturen. Unfallchirurg 1988; 91: 149-153
4 Bosse MJ, Poka A, Reinert CM et al. Preoperative angiographic assessment of the superior gluteal artery in acetabular fractures requiring extensile surgical exposures. J Orthop Trauma 1988; 2: 303-307
5 Brumback RJ, Ellison TS, Molligan H et al. Pudendal nerve palsy complicating intramedullary nailing of the femur. J Bone Joint Surg Am 1992; 74: 1450-1455
6 Buchanan JR. Bowel entrapment by pelvic fracture fragments: a case report and review of the literature. Clin Orthop Related Res 1980; 147: 164-166
7 Buerger PM, Peoples JB, Lemmon GW et al. Risk of pulmonary emboli in patients with pelvic fractures. Am Surg 1993; 59: 505-508
8 Burd TA, Lowry KJ, Anglen JO. Indomethacin compared with localized irradiation for the prevention of heterotopic ossification following surgical treatment of acetabular fractures. J Bone Joint Surg Am 2001; 83: 1783-1788
9 Cheng SL, Rosati C, Waddell JP. Fatal hemorrhage caused by vascular injury associated with an acetabular fracture. J Trauma 1995; 38: 208-209
10 Chiu FY, Lo WH, Chen TH et al. Fractures of posterior wall of acetabulum. Arch Orthop Trauma Surg 1996; 115: 273-275
11 Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach. Description of operative technique and preliminary treatment results. Clin Orthop Related Res 1994; 305: 112-123
12 Coon WW. Epidemiology of venous thromboembolism. Ann Surg 1977; 186: 149-164
13 Coon WW. Risk factors in pulmonary embolism. Surg Gynecol Obstet 1976; 143: 385-390
14 Cryer HM, Miller FB, Evers BM et al. Pelvic fracture classification: correlation with hemorrhage. J Trauma 1988; 28: 973-980
15 Cutler BS, Greenfield LJ, Salm TJ. Transatrial interruption of the inferior vena cava. Arch Surg 1990; 125: 1222-1223
16 Daum WJ, Scarborough MT, Gordon jr. W et al. Heterotopic ossification and other perioperative complications of acetabular fractures. J Orthop Trauma 1992; 6: 427-432
17 Dennis JW, Menawat S, Von Thron J et al. Efficacy of deep venous thrombosis prophylaxis in trauma patients and identification of high-risk groups. J Trauma 1993; 35: 132-138 discussion 138–139
18 Ecke H, Patzak HJ, Hofmann D. Überbrückungszuggurtungen zur Wiederherstellung rupturierte Amphiarthrosen am Beckenring. Unfallchirurgie 1991; 17: 335-342
19 Fassler PR, Swiontkowski MF, Kilroy AW et al. Injury of the sciatic nerve associated with acetabular fracture. J Bone Joint Surg Am 1993; 75: 1157-1166
20 Fishmann AJ, Greeno RA, Brooks LR et al. Prevention of deep vein thrombosis and pulmonary embolism in acetabular and pelvic fracture surgery. Clin Orthop Related Res 1994; 305: 133-137
21 Fox MA, Mangiante EC, Fabian TC et al. Pelvic fractures: an analysis of factors affecting prehospital triage and patient outcome. South Med J 1990; 83: 785-788
22 Frank JL, Reimer BL, Raves JJ. Traumatic iliofemoral arterial injury: an association with high anterior acetabular fractures. J Vasc Surg 1989; 10: 198-201
23 Furrer M, Gautier E, Triller J et al. Beckenfraktur mit schockierender arterieller retroperitonealer Blutung und gleichzeitigem Extremitäten-Ischämiesyndrom: Diskussion des Managements anhand eines Fallbeispiels. Swiss Surg/Schweizer Chir/Chir Suisse/Chir Svizz 1996; 2: 238-243
24 Gänsslen A, Pohlemann T, Paul C et al. Welche prognostischen Faktoren beeinflussen das Langzeitergebnis nach Acetabulum-T-Frakturen?. Hefte Z Unfallchir 1996; 262: 72
25 Geerts WH, Code KI, Jay RM et al. A prospective study of venous thromboembolism after major trauma. NEJM 1994; 331: 1601-1606
26 Ghalambor N, Matta JM, Bernstein L. Heterotopic ossification following operative treatment of acetabular fracture. An analysis of risk factors. Clin Orthop Related Res 1994; 305: 96-105
27 Gilliland MD, Ward RE, Barton RM et al. Factors affecting mortality in pelvic fractures. J Trauma 1982; 22: 691-693
28 Goulet JA, Bray TJ. Complex acetabular fractures. Clin Orthop Related Res 1989; 240: 9-20
29 Greenfield LJ. The PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prévention du risque d’embolie pulmonaire par interruption cave) Randomized study. Perspect Vasc Surg Endovasc Ther 2006; 18: 187-188
30 Gruen GS, Mcclain EJ, Gruen RJ. The diagnosis of deep vein thrombosis in the multiply injured patient with pelvic ring or acetabular fractures. Orthopedics 1995; 18: 253-257
31 Gruen GS, Mears DC, Tauxe WN. Distinguishing avascular necrosis from segmental impaction of the femoral head following an acetabular fracture: preliminary report. J Orthop Trauma 1988; 2: 5-9
32 Hak DJ, Hamel AJ, Bay BK et al. Consequences of transverse acetabular fracture malreduction on load transmission across the hip joint. J Orthop Trauma 1998; 12: 90-100
33 Hardy SL. Femoral nerve palsy associated with an associated posterior wall transverse acetabular fracture. J Orthop Trauma 1997; 11: 40-42
34 Helfet DL, Borrelli jr. J, Dipasquale T et al. Stabilization of acetabular fractures in elderly patients. J Bone Joint Surg Am 1992; 74: 753-765
35 Helfet DL, Schmeling GJ. Management of complex acetabular fractures through single nonextensile exposures. Clin Orthop Related Res 1994; 305: 58-68
36 Helfet DL, Schmeling GJ. Somatosensory evoked potential monitoring in the surgical treatment of acute, displaced acetabular fractures. Results of a prospective study. Clin Orthop Related Res 1994; 301: 213-220
37 Heppert V, Holz F, Winkler H et al. Musculus-rectus-abdominis-Nekrose. Komplikation nach ilioinguinalem Zugang. Unfallchirurg 1995; 98: 98-101
38 Hessmann MH, Nijs S, Rommens PM. Acetabulumfrakturen im Alter. Ergebnisse eines differenzierten Behandlungskonzeptes. Unfallchirurg 2002; 105: 893-900
39 Hoellen IP, Mentzel M, Bischoff M et al. Acetabulumfraktur beim alten Menschen. Primäre endoprothetische Versorgung. Orthopäde 1997; 26: 348-353
40 Johnson EE, Eckardt JJ, Letournel E. Extrinsic femoral artery occlusion following internal fixation of an acetabular fracture. A case report. Clin Orthop Related Res 1987; 217: 209-213
41 Johnson EE, Kay RM, Dorey FJ. Heterotopic ossification prophylaxis following operative treatment of acetabular fracture. Clin Orthop Related Res 1994; 305: 88-95
42 Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am 1964; 46: 1615-1646
43 Khansarinia S, Dennis JW, Veldenz HC et al. Prophylactic Greenfield filter placement in selected high-risk trauma patients. J Vasc Surg 1995; 22: 231-235 discussion 235–236
44 Knudson MM, Collins JA, Goodman SB et al. Thromboembolism following multiple trauma. J Trauma 1992; 32: 2-11
45 Konrath GA, Hamel AJ, Sharkey NA et al. Biomechanical consequences of anterior column fracture of the acetabulum. J Orthop Trauma 1998; 12: 547-552
46 Kudsk KA, Mcqueen MA, Voeller GR et al. Management of complex perineal soft-tissue injuries. J Trauma 1990; 30: 1155-1159 discussion 1159–1160
47 Lautel J, Sejourne P, Schvingt E et al. [A rare complication of the acetabulum: incarceration of a small intestine loop in the fracture area]. J Chir 1976; 111: 185-192
48 Letournel E, Judet R. Fractures of the Acetabulum. Berlin, Heidelberg, New York, Tokio: Springer; 1993
49 Lewallen D. Total Hip Arthroplasty after prior acetabular Fracture. In: Morrey B, ed. Reconstructive Surgery of the Joints. Edinburgh: Churchill Livingstone; 1996: 1077ff
50 Lin PS, Cavarocchi NC, Comerota AJ et al. Acute bowel entrapment and perforation following operative reduction of pelvic fracture. J Trauma 1987; 27: 684-686
51 Lo TC, Healy WL, Covall DJ et al. Heterotopic bone formation after hip surgery: prevention with single-dose postoperative hip irradiation. Radiology 1988; 168: 851-854
52 Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am 1996; 78: 1632-1645
53 Matta JM, Anderson LM, Epstein HC et al. Fractures of the acetabulum. A retrospective analysis. Clin Orthop Related Res 1986; 205: 230-240
54 Matta JM, Merritt PO. Displaced acetabular fractures. Clin Orthop Related Res 1988; 230: 83-97
55 Mckee MD, Waddell JP. Entrapment of the bladder in an acetabular fracture. A case report. J Bone Joint Surg Am 1997; 79: 113-117
56 Mears D. Extensile exposure of the pelvis. Contemp Orhop 1983; 6: 21-31
57 Montgomery KD, Geerts WH, Potter HG et al. Thromboembolic complications in patients with pelvic trauma. Clin Orthop Related Res 1996; 329: 68-87
58 Montgomery KD, Potter HG, Helfet DL. Magnetic resonance venography to evaluate the deep venous system of the pelvis in patients who have an acetabular fracture. J Bone Joint Surg Am 1995; 77: 1639-1649
59 Nahas S, Yeoh C, Velayudham S. Excessive venous bleeding in a patient with acetabular pelvic fracture secondary to inferior vena cava filter occlusion. BMJ Case Rep 2012;
60 Neuerburg J, Gunther RW, Rassmussen E et al. New retrievable percutaneous vena cava filter: experimental in vitro and in vivo evaluation. Cardiovasc Intervent Radiol 1993; 16: 224-229
61 Nigst H. Spezielle Frakturen- und Luxationslehre: ein kurzes Handbuch in fünf Bänden. Stuttgart: Thieme; 1964
62 O’Malley KF, Ross SE. Pulmonary embolism in major trauma patients. J Trauma 1990; 30: 748-750
63 Olson SA, Bay BK, Chapman MW et al. Biomechanical consequences of fracture and repair of the posterior wall of the acetabulum. J Bone Joint Surg Am 1995; 77: 1184-1192
64 Patch D, Lewallen D. Reconstruction of deficit acetabulum using bone graft and fixed porous ingrowth cup: a 5 year roentgenographic survey. Orthop Trans 1993; 17: 151
65 Trojan E, Perschl A. Die Behandlungsergebnisse von 79 frischen, traumatischen Hüftgelenksverrenkungen und und Hüftgelenksverrenkungsbrüchen. Ergebn Chir Orthop 1956; 40: 90-164
66 Pohlemann T, Culemann U, Gänsslen A et al. Die schwere Beckenverletzung mit pelviner Massenblutung: Ermittlung der Blutungsschwere und klinische Erfahrung mit der Notfallstabilisierung. Unfallchirurg 1996; 99: 734-743
67 Pohlemann T, Gänsslen A, Hartung S et al. Beckenverletzungen Ergebnisse einer prospektiven, multizentrischen Studie; mit 224 Tabellen. Berlin, Heidelberg, New York: Springer; 1997
68 Pohlemann T, Gänsslen A, Weber U et al. Neurologische Langzeitergebnisse nach instabilen Beckenring- und Acetabulumfrakturen: eine prospektive 2-Jahres-Untersuchung. Hefte Z Unfallchir 1996; 262: 70
69 Poole GV, Ward EF, Griswold JA et al. Complications of pelvic fractures from blunt trauma. Am Surg 1992; 58: 225-231
70 Probe R, Reeve R, Lindsey RW. Femoral artery thrombosis after open reduction of an acetabular fracture. Clin Orthop Related Res 1992; 283: 258-260
71 Ragnarsson B, Mjoberg B. Arthrosis after surgically treated acetabular fractures. A retrospective study of 60 cases. Acta Orthop Scand 1992; 63: 511-514
72 Reinert CM, Bosse MJ, Poka A et al. A modified extensile exposure for the treatment of complex or malunited acetabular fractures. J Bone Joint Surg Am 1988; 70: 329-337
73 Rommens PM, Broos PL, Vanderschot P. Vorbereitung und Technik der operativen Behandlung von 225 Acetabulumfrakturen. Zweijahresergebnisse in 175 Fällen. Unfallchirurg 1997; 100: 338-348
74 Romness DW, Lewallen DG. Total hip arthroplasty after fracture of the acetabulum. Long-term results. J Bone Joint Surg Br 1990; 72: 761-764
75 Rothenberger DA, Fischer RP, Perry jr. JF. Major vascular injuries secondary to pelvic fractures: an unsolved clinical problem. Am J Surg 1978; 136: 660-662
76 Routt jr. ML, Swiontkowski MF. Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure. J Bone Joint Surg Am 1990; 72: 897-904
77 Sevitt S, Gallagher N. Venous thrombosis and pulmonary embolism. A clinico-pathological study in injured and burned patients. Br J Surg 1961; 48: 475-489
78 Shackford SR, Davis JW, Hollingsworth-Fridlund P et al. Venous thromboembolism in patients with major trauma. Am J Surg 1990; 159: 365-369
79 Slawson RG, Poka A, Bathon H et al. The role of post-operative radiation in the prevention of heterotopic ossification in patients with post-traumatic acetabular fracture. Int J Radiat Oncol Biol Phys 1989; 17: 669-672
80 Tile M. Fractures of the acetabulum. Orthop Clin North Am 1980; 11: 481-506
81 Tile M. Fractures of the Pelvis and Acetabulum. Baltimore: Williams & Wilkins; 1995
82 Tosounidis G, Culemann U, Bauer M et al. Osteosynthese bei Acetabulumfrakturen im Alter. Ist eine Rekonstruktion sinnvoll?. Unfallchirurg 2011; 114: 655-662
83 Trunkey DD, Chapman MW, Lim jr. RC et al. Management of pelvic fractures in blunt trauma injury. J Trauma 1974; 14: 912-923
84 Tscherne H, Pohlemann T. Becken und Acetabulum. Berlin, Heidelberg, New York: Springer; 1998
85 Weber M, Berry DJ, Harmsen WS. Total hip arthroplasty after operative treatment of an acetabular fracture. J Bone Joint Surg Am 1998; 80: 1295-1305
86 White RH, Goulet JA, Bray TJ et al. Deep-vein thrombosis after fracture of the pelvis: assessment with serial duplex-ultrasound screening. J Bone Joint Surg Am 1990; 72: 495-500
87 Wolinsky P, Davison B, Shyr Y et al. Predictors of total hip arthroplasty in patients following open reduction and internal fixation of acetabular fractures. Boston: 12th Annual Meeting OTA; 1996
88 Wolinsky PR, Johnson KD. Delayed catastrophic rupture of the external iliac artery after an acetabular fracture. A case report. J Bone Joint Surg Am 1995; 77: 1241-1244
89 Zeichen J, Pohlemann T, Gänsslen A et al. Nachuntersuchungsergebnisse nach operativer Versorgung von komplizierten Acetabulumfrakturen über erweiterte Zugänge. Unfallchirurg 1995; 98: 361-368

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