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Osteologie 2017; 26(04): 229-235
DOI: 10.1055/s-0038-1628302
Osteomyelitis
Schattauer GmbH

Die septische Pseudarthrose

Septic non-union
C. Zeckey
1   Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München
,
W. Böcker
1   Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München
,
V. Herterich
1   Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, Klinikum der Universität München, LMU München
› Author Affiliations
Further Information

Publication History

eingegangen: 11 October 2017

angenommen: 16 October 2017

Publication Date:
24 January 2018 (online)

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Zusammenfassung

Die septische Pseudarthrose stellt weiterhin ein hochgradiges Problem in der muskulo -skelettalen Chirurgie dar. Das Zusammenspiel zwischen komplexen Behandlungsstrategien und dem entsprechend hohen Interventions-portfolio einerseits, andererseits aber ebenso durch die wechselnde und unterschiedliche Virulenz der Erreger sowie der variablen Immunkompetenz der betroffenen Patienten verkomplizieren die Situation erheblich. Neben den erheblichen medizinischen Problemen resultieren ebenso sozioökonomische Einschränkungen für die Betroffenen, was die Situation weiter verschärft. Unzureichende chirurgische Strategien resultieren in insuffizienten Ergebnissen mit Rezidiven oder Amputationen, die leider trotz ausführlichster Planung und chirurgischer Radikalität nie ganz ausgeschlossen werden können. Das prinzipielle Vorgehen bei septischen Pseudarthrosen besteht nach Diagnosestellung in der Resektion des in fizierten Knochenareals, der Isolation der entsprechenden Keime, der entsprechenden Antibiotikatherapie sowie aus anschließend folgenden rekonstruktiven Eingriffen nach Infektberuhigung. Kritisch ist hierbei das ,,dead-space“-Management nach ossärer Rekonstruktion durch Defektauffüllung unter Nutzung von Knochenzementen. Hier stehen verschiedene Optionen wie z. B. das Masquelet-Verfahren oder der Segmenttransport zur Verfügung. Der vorliegende Artikel soll Informationen über die Inzidenz der septischen Pseudarthrose, das typischerweise vorliegende Keimspektrum, die verfügbaren chirurgischen Behandlungsstrategien und einen Überblick über die aktuelle Literatur geben.

Summary

Septic non-union still portrays a high-grade problem in musculosceletal surgery. The interaction between complex therapeutic concepts and therefore high interventional portfolio on the one hand as well as changing and varying virulence of pathogens on the other furthermore complicate the situation substantially. To make things worse for patients, results are – besides the significant medical issue – also a series of socio-economic restrictions. Unsatisfying results with relapses and amputations, which can not be excluded in spite of extensive planning and extensive surgery arise from insufficiently performed surgical strategies. The general approach on septic non-unions after diagnosis consists of resection of infected bone area, isolation of the according pathogen, corresponding antiobiotics treatment as well as reconstructive surgical interventions afterwards. Especially dead-space management after osseous resection using bone cements turn out to be one of the critical phases. In case of bony defects, options can be Masquelet-Procedures or segmental bone transports inducing distraction osteogenesis. The present article aims to provide information on incidence of septic non-union, relevant pathogen ranges, surgical approaches as well as an overview on current literature.

Schlüsselwörter

Pseudarthrose - Osteomyelitis - ossärer Defekt

Keywords

Non-union - osteomyelitis - bone-defect
 

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