Operative Therapie medialer Oberschenkelhalsbrüche

Zusammenfassung

Die mediale Schenkelhalsfraktur hat eine mit dem Lebensalter steigende Inzidenz. Da das Kopffragment bei dieser intrakapsulären Fraktur von der Durchblutung abgeschnitten werden kann, ist die Femurkopfnekrose- und Pseudarthroserate hoch. Sie steigt mit zunehmendem Lebensalter, dem Dislokationsgrad der Fraktur und dem Intervall bis zur operativen Stabilisierung. Bei jungen Patienten bis 60 Jahren sollte bei varisch eingestauchten und undislozierten Frakturen eine Osteosynthese in situ erfolgen und mit Teilbelastung behandelt werden. Bei älteren Patienten sollte bei dislozierten Frakturen primär eine endoprothetische Versorgung erfolgen, da die Komplikationsrate geringer ist und die Mobilisation unter Vollbelastung erfolgen kann. Bei sehr alten Patienten mit sehr schlechter Knochenqualität, die nicht in der Lage sind, eine Teilbelastung durchzuführen, ist selbst bei undislozierten Frakturen eine Prothese zu erwägen.

Summary

The incidence of femural neck fractures rises proportional to the age of the patient. Because of the intracapsular localization of these fractures, femoral head necrosis and non-union are common complications. The complication rate increases with the age of the patient, the grade of fracture dislocation and the time to surgery. In younger patients below 60 years of age in situ-fixation by screws or DHS is indicated in valgus impacted and undisplaced fractures. Partial weight bearing is necessary for the time of bone healing. Older patients with weak bone on the other hand should be treated by hemior total hip arthroplasty even in undisplaced fractures if bone quality is weak to ensure early mobilization. In elderly the complication rate after endoprothesis is below that after osteosynthesis.

Schlüsselwörter

Operationsindikation - mediale Schenkelhalsfrakur - Hüftendoprothese

Keywords

Indication for surgery - femoral neck fracture - hip arthroplasty

• Literatur

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