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DOI: 10.1055/a-1040-1355
Der geriatrische Traumapatient
Geriatric Trauma PatientsZusammenfassung
Die prähospitale, stationäre und poststationäre Versorgung von immer mehr hochbetagten Patienten mit typischen alterstraumatologischen Frakturen stellt eine Herausforderung für Rettungsdienst, Krankenhäuser und Krankenkassen dar. Diese Herausforderungen in der Behandlung der alterstraumatologischen „Big Five“ soll im Fokus dieses Artikels stehen.
Abstract
A continuous increase in geriatric trauma patients can be expected over the next years. Injuries in geriatric patients are often underestimated and are therefore sometimes assigned to hospitals that do not have sufficient supply capacities, for example neurosurgery. Falling is the main cause of trauma in geriatric patients. Slowed reflexes, muscle wasting and osteoporosis can also lead to severe fractures due to falls from standing or sitting. Trauma centers specialized for old age can significantly improve the outcome of geriatric trauma patients. Proximal femoral fractures almost always require surgical treatment. The aim of the surgical treatment is treatment within 24 hours and rapid postoperative mobilization under full load. In case of a proximal humerus fracture, the patientʼs individual requirements, the functional extent before the trauma and the fracture type must be evaluated in order to determine the appropriate conservative or surgical treatment. Pelvic ring fractures cause symptoms similar to those of proximal femoral fractures, but often cannot be detected in conventional x-rays. If left untreated, they are associated with persistent pain, immobility, and loss of autonomy. Cervical spine fractures are often asymptomatic. For this reason, the cervical spine should be immobilized prophylactically with every head impact. Due to the decrease in brain volume, cerebral hemorrhages show weakened symptoms with high mortality in geriatric patients.
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In den nächsten Jahren ist mit einer kontinuierlichen Zunahme der Zahl geriatrischer Traumapatienten zu rechnen.
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Verletzungen von geriatrischen Patienten werden häufig unterschätzt; dadurch werden diese Patienten teilweise Krankenhäusern zugewiesen, die dann keine ausreichenden Versorgungskapazitäten, z. B. neurochirurgisch, vorhalten.
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Der Sturz stellt die Hauptursache für Traumata beim geriatrischen Patienten dar. Durch verlangsamte Reflexe, Muskelschwund und Osteoporose kommt es auch durch Stürze aus dem Stand oder Sitz bereits zu schweren Frakturen.
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Alterstraumazentren können durch die interdisziplinäre Versorgung das Outcome von geriatrischen Traumapatienten deutlich verbessern.
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Proximale Femurfrakturen müssen fast immer operativ versorgt werden. Ziele der operativen Behandlung sind eine Versorgung innerhalb von 24 Stunden und die zügige postoperative Mobilisation unter Vollbelastung.
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Bei der Therapie der proximalen Humerusfraktur müssen individueller Anspruch des Patienten, das Funktionsausmaß vor der Fraktur und der Frakturtyp streng evaluiert werden, um die adäquate konservative oder operative Therapie festzulegen.
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Beckenringfrakturen verursachen ähnliche Symptome wie proximale Femurfrakturen, können aber häufig im konventionellen Röntgenbild nicht nachgewiesen werden. Unbehandelt gehen sie mit persistierenden Schmerzen, Immobilität und Autonomieverlust einher.
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Frakturen der Halswirbelsäule sind häufig asymptomatisch. Daher sollte bei jedem Kopfanprall prophylaktisch eine Ruhigstellung der Halswirbelsäule erfolgen.
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Durch die Abnahme des Hirnvolumens bei geriatrischen Patienten zeigen Hirnblutungen eine abgeschwächte Symptomatik bei hoher Mortalität.
Schlüsselwörter
Geriatrie - Unfallchirurgie - proximale Femurfrakturen - proximale Humerusfrakturen - AlterstraumatologieKey words
geriatrics - trauma surgery - proximal femoral fractures - proximal humerus fractures - geriatric traumatologyPublication History
Article published online:
12 February 2021
© 2021. Thieme. All rights reserved.
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