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DOI: 10.1055/a-1218-9128
Behandlungsmöglichkeiten nach fehlgeschlagenen Osteosynthesen am Femurschaft mit Pseudarthrosen und Torsionsdifferenzen
Treatment Options for Pseudarthrosis and Torsion Differences after Failed Ostheosynthesis of Femoral Shaft Fractures
Zusammenfassung
Femurschaftfrakturen sind komplikationsträchtige Verletzungen. Die exakte Reposition der Fragmente, weichteilschonendes Operieren und stabile Osteosyntheseverfahren stellen hohe Anforderungen dar. Kommt es zur Pseudarthrosenbildung, ist in jedem Fall ein individueller Behandlungsplan zu erstellen. Frakturen mit erhaltender Biologie und geringem Knochenverlust lassen sich durch vergleichsweise einfache Techniken zur Durchbauung bringen. Die infizierte Defektpseudarthrose stellt die aufwendigste Komplikation dar. Hierbei muss einerseits die Osteitis saniert werden, andererseits müssen Knochen und Weichteile rekonstruiert werden. Vielfach ist hier ein interdisziplinäres Vorgehen zwischen Unfallchirurg, Gefäßchirurg und plastischem Chirurgen erforderlich. Besonderes Augenmerk muss auf die Führung des Patienten gelegt werden. Behandlungsverläufe von vielen Monaten sind keine Seltenheit. Durch eine korrekte Erstbehandlung lassen sich viele Komplikationen vermeiden, daher sind an die erste Operation genauso hohe Anforderungen zu stellen wie an die weitere Behandlung der Pseudarthrose. Die postoperative Torsionsfehlstellung nach antegrader Marknagelosteosynthese ist eine häufig unterschätze Komplikation mit erheblichen Folgen. Eine intra- und postoperative Kontrolle der Torsion sollte obligat durchgeführt und dokumentiert werden.
Abstract
Femoral shaft fractures are complex and demanding injuries. Exact repositioning of fragments, protection of soft tissue and a stable osteosynthesis are mandatory. Pseudarthrosis of the femur needs an individual patient-related treatment. With intact biology and little bone loss, simple therapeutic technics can result in healing of the fracture. Infected pseudarthrosis is the most challenging complication. Osteitis needs to be adressed and the soft tissue needs to be reconstructed. Interdisciplinary cooperation between trauma, vascular and plastic surgeons is recommended to achieve good results. Patient guidance is esential because of the prolonged treatment period. Initial surgery planning is crucial as complications can be avoided by adequat first treatment. Postoperative maltorsion and malialignement following antegrade intramedullary nailing is an underestimated complication that can lead to failure in remobilization. An intra- and postoperative control for correct torsion of the lower extremity is recommend and should be recored properly.
Publication History
Article published online:
17 November 2020
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