Die rotationsstabile intramedulläre Osteosynthese von proximalen extraartikulären Femurfrakturen

Zusammenfassung

Ziel: Mit dem proximalen Femurnagel (PFN) und dem Gleitnagel (GLN) stehen zwei moderne Verfahren zur intramedullären Osteosynthese von proximalen extraartikulären Femurfrakturen zu Verfügung, welche eine rotationsstabile Fixierung des proximalen Fragmentes ermöglichen. Beide Verfahren sollen bezüglich des klinischen Einsatzes vergleichend evaluiert werden. Methode: In einer prospektiven Studie werden die Behandlungsverläufe von 240 Patienten aus zwei unfallchirurgischen Kliniken mit mittlerem Follow-up von 10,2 Monaten analysiert. Ergebnisse: Neben speziellen osteosynthesebezogenen Komplikationen für PFN/GLN wie Kopfperforationen (4,8 %/2,6 %), Materialdislokationen (0,8 %/0 %), intraoperativen Femurschaftfrakturen (0,8 %/2,6 %), Pseudarthrosen (0 %/0,9 %) und Materialbrüchen (0,8 %/0 %) stellen Wundheilungsstörungen (9,7 %/5,2 %) und iatrogen bedingte Komplikationen wie Fehlplatzierung des Osteosynthesematerials und Repositionsfehler (0,8 %/4,3 %) Gründe für Revisionen dar. Schlussfolgerung: Die Gleitnagelosteosynthesen weisen an speziellen osteosynthesebedingten Komplikationen (6,0 %) und Wundheilungsstörungen (5,2 %) gegenüber den PFN-Osteosynthesen (7,3 % bzw. 9,7 %) ein günstigeres Komplikationsprofil auf. Dies gilt in besonderem Maße für die Kopfperforationsrate von 4,8 % beim PFN gegenüber 2,6 % beim GLN.

Abstract

Aim: The proximal femur nail (PFN) and the gliding nail (GLN) are two modern procedures available for intramedullary osteosynthesis of proximal extra-articular femur fractures; they allow a rotationally stable fixation of the proximal fragment. In a comparative analysis of complications, both methods should be evaluated. Methods: A comparative analysis of both procedures is presented in a prospective clinical study design. The treatment of 240 consecutive patients (124 PFN/116 GLN) with an average follow-up term of 10.2 months is analysed. Results: Both PFN and GLN give rise to head perforations (4.8 % and 2.6 %), dislocations of material (0.8 % and 0 %), intraoperative femoral shaft fractures (0.8 % and 2.6 %), pseudarthrosis (0 % and 0.9 %) and fractures of material (0.8 % and 0 %) in the way of complications as well as wound-healing impairments (9.7 % and 5.2 %) and iatrogenic complications such as false placement of the osteosynthesis material and errors in reposition (0.8 % and 4.3 %). Conclusion: The gliding nail osteosynthesis yields a more favourable complication profile with regard to specific osteosynthesis-caused complications (6.0 %) and wound-healing impairments (5.2 %) in comparison with the PFN osteosynthesis (7.3 % and 9.7 %, respectively). Especially the cut-out rate of the GLN (2.6 %) is lower than that of the PFN (4.8 %).

pertrochantäre Fraktur - subtrochantäre Fraktur - PFN - Gleitnagel - cut-out

pertrochanteric fracture - subtrochanteric fracture - PFN - gliding nail - cut-out

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