Lösungsmöglichkeiten bei fehlgeschlagenen Osteosynthesen am Azetabulum

Zusammenfassung

Osteosynthesen am Azetabulum sind komplex und erfordern eine sehr sorgfältige Planung und präoperative Vorbereitung. Das Ziel ist eine möglichst anatomische Rekonstruktion ohne Stufen oder Defekt in der Gelenkfläche. Wenn es intraoperativ nicht gelungen ist, eine optimale Rekonstruktion zu erreichen, muss man abwägen, ob es sinnvoll ist, eine Reosteosynthese vorzunehmen. Das Risiko für Infekte, heterotope Ossifikationen, Hüftkopfnekrosen und Knorpelschäden ist ungleich höher als beim primären Eingriff. Häufig kan es gerade bei älteren Patienten dann sinnvoll sein, die Fraktur heilen zu lassen und im Verlauf eine Prothese einzubauen. Bei jüngeren Patienten, sollte versucht werden, ein ideales Ergebnis zu erreichen und nach genauer Planung eine Reosteosynthese durchzuführen. Ein postoperatives CT ist daher nach einer primären Rekonstruktion als Qualitätskontrolle unabdingbar.

Abstract

Osteosynthesis on the acetabulum is complex and requires very careful planning and preoperative preparation. The goals are an anatomical reconstruction as possible without steps or defects in the articular surface. If intraoperatively it has not been possible to achieve an optimal reconstruction, one has to consider whether it makes sense to carry out reosteosynthesis. The risk of infections, heterotopic ossifications, femoral necrosis and cartilage damage is much higher than with the primary procedure. Often, especially in older patients, it can make sense to have the fracture healed and to implant a prosthesis in the course. In younger patients, an attempt should be made to achieve an ideal result and to carry out reosteosynthesis after careful planning. A postoperative CT is therefore essential as a quality control after a primary reconstruction.

Schlüsselwörter

Reosteosynthese - Azetabulum - Arthrose - Hüftprothese - Gelenkstufe - Plattenosteosynthese

Key words

Reosteosynthesis - acetabulum - arthrosis - hip prosthesis - incongruency - plate osteosynthesis

Publikationsverlauf

Artikel online veröffentlicht:
28. Mai 2020

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