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Osteologie 2011; 20(01): 05-10
DOI: 10.1055/s-0037-1619976
Frakturheilung
Schattauer GmbH

Versorgung osteoporotischer Frakturen aus traumatologischer Sicht

Treatment of osteoporotic fractures: a trauma perspective
M. Schieker
1   Chirurgische Klinik – Innenstadt, Klinikum der LMU München
,
F. Jakob
2   Orthopädisches Zentrum für Muskuloskelettale Forschung, Universität Würzburg
,
M. Amling
3   Institut für Osteologie und Biomechanik, Universitätsklinikum Hamburg-Eppendorf
,
W. Mutschler
1   Chirurgische Klinik – Innenstadt, Klinikum der LMU München
,
W. Böcker
1   Chirurgische Klinik – Innenstadt, Klinikum der LMU München
› Author Affiliations
Further Information

Publication History

eingereicht: 14 February 2011

angenommen: 16 February 2011

Publication Date:
30 December 2017 (online)

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Zusammenfassung

Frakturen bei Osteoporose werden aufgrund der demografischen Entwicklung ein zunehmendes Problem darstellen. Klinische Empirie spricht häufig dafür, dass bei Osteoporose die Frakturheilung verzögert oder gestört ist. Präklinische Daten aus reproduzierbaren Tiermodellen für die Osteoporose stützen diese Hypothese. Evidenzbasierte Daten aus kontrollierten klinischen Studien gibt es jedoch kaum. Zu einer erhöhten Komplikationsrate nach der chirurgischen Stabilisierung kommt es aufgrund der für die Verankerung der Implantate wichtigen, unzureichenden Knochenfestigkeit, der bestehenden Begleit-erkrankungen und eingeschränkter Compliance. Hierfür gibt die Datenlage aus klinischen Studien eine ausreichende Grundlage. Deshalb sollte der behandelnde Orthopäde/Unfallchirurg bereits in der Operationsplanung diese speziellen Bedingungen beim alten Patienten einbeziehen und die Operation und das gewählte Implantat entsprechend differenziert planen und durchführen. Da noch immer zumeist die Fraktur ohne relevantes Trauma die Erstmanifestation einer Osteoporose darstellt, sollte die leitliniengerechte Nachbehandlung zur Vermeidung von Folgefrakturen unbedingt bereits vom Chirurgen eingeleitet werden. Letztlich sollten aus traumatologischer Sicht alle Patientinnen älter als 50 Jahre und Patienten älter als 60 Jahre mit Frakturen bezüglich ihres Knochenstatus abgeklärt und entsprechend behandelt werden.

Summary

Fractures in osteoporotic patients are an increasing problem due to the aging society. Clinical experience gives rise to the theory that fracture healing is delayed and impaired in osteoporotic bone. This hypothesis is also supported by preclinical animal models. However, there is no evidence-based data from clinical studies. Due to insufficient bone stability, co-morbidities and limited patient compliance there is an increased rate of complications after surgical stabilization of osteoporotic fractures in the elderly patient. Therefore, the orthopedic surgeon has to take these conditions into consideration for preoperative planning of the operation and the choice of implants. Fragility fractures are often the first symptom of osteoporosis. Therefore, tertiary prevention according to the DVO-guidelines should already be initiated by the surgeon. All female patients older than 50 years and all male patients older than 60 years with fragility fractures should be assessed for bone quality and treated as recommended.

Schlüsselwörter

Osteoporotische Fraktur - Frakturversorgung - Alterstraumatologie - Frakturheilung

Keywords

Osteoporotic fracture - fracture fixation - orthogeriatrics - fracture healing
 

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