Sprunggelenksfraktur im Alter – was ist anders?

Zusammenfassung

Aufgrund der demografischen Entwicklung ist mit einer deutlichen Zunahme von Sprunggelenksfrakturen beim älteren Patienten zu rechnen. Im Vergleich zum jungen Patienten finden sich Unterschiede hinsichtlich des Traumamechanismus, des Frakturmusters, der Knochenqualität und der Nebenerkrankungen. Auch beim älteren Patienten steht die Wiederherstellung der Funktion an oberster Stelle des therapeutischen Regimes. Die konservative Therapie wird bei stabilen Frakturformen sowie instabilen Frakturen mit Kontraindikationen zur operativen Therapie empfohlen. Die operative Therapie sollte weichteiladaptiert und durch spezielle operative Techniken und Implantate individuell erfolgen. Hierbei hat die initiale Transfixation mittels Fixateur externe einen hohen Stellenwert. Die operativen Techniken reichen von dorsaler Plattenpositionierung über K-Draht-Techniken, Hakenplatten, Fibulanägel bis hin zu winkelstabilen Plattensystemen, die gute postoperative Ergebnisse zeigen. Eine primäre Versteifung mittels retrograder Nagelarthrodese ist nur als Salvage-Verfahren Ausnahmefällen vorbehalten.

Abstract

Because of the demographic changes there will be an increase of osteoporotic ankle fractures in the elderly. Differences to ankle fractues in younger patients are observed regarding the trauma mechanism, bone quality and comoribidities. The goal of operative treatment is reconstruction of the function and exact anatomy of the ankle joint with respect to the soft tissue trauma. Preoperatively CT scan is recommended for diagnosis and preoperative planning. Recommended operative techniques are the use of locking plates, dorsal plate positioning and second stage reconstruction with initial use of external fixation. Primary arthrodesis using a retrograde intramedullary nail should be considered as salvage procedure in exceptional cases.

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