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Osteologie 2009; 18(02): 102-111
DOI: 10.1055/s-0037-1619887
Frakturen rund um das Hüftgelenk
Schattauer GmbH

Azetabulumfraktur des geriatrischen Patienten

Acetabulum fractures in the elderly
A. Hofmann
1   Zentrum für Unfallchirurgie und Orthopädie, Universitätsmedizin, Johannes Gutenberg Universität, Mainz
,
M. H. Hessmann
2   Klinik für Orthopädie und Unfallchirurgie, Endoprothesenzentrum Osthessen, Klinikum Fulda
,
L.-P. Müller
1   Zentrum für Unfallchirurgie und Orthopädie, Universitätsmedizin, Johannes Gutenberg Universität, Mainz
,
P. M. Rommens
1   Zentrum für Unfallchirurgie und Orthopädie, Universitätsmedizin, Johannes Gutenberg Universität, Mainz
› Author Affiliations
Further Information

Publication History

eingereicht: 19 March 2009

angenommen: 23 March 2009

Publication Date:
28 December 2017 (online)

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Zusammenfassung

Die Behandlung der Azetabulumfrakturen bei geriatrischen Patienten unterscheidet sich in vielerlei Hinsicht von der entsprechenden Behandlung bei jungen und mobilen Patienten. In der geriatrischen Patientengruppe sind sie zwar selten, stellen jedoch sowohl für den Patienten als auch für den behandelnden Arzt eine besondere Herausforderung dar. In der geriatrischen Patientenpopulation sind Frakturen des vorderen Azetabulumpfeilers und der Vorderwand überrepräsentiert. Sie kommen häufig durch ein niedrig energetisches Trauma bei osteoporotischen Knochenverhältnissen zustande. Für die Therapie kommen konservative und unterschiedliche operative Verfahren (offene Reposition und Osteosynthese, primäre oder sekundäre Hüftprothese) in Frage. Die Indikation wird bei jedem einzelnen Patienten differenziert gestellt. Die konservative Therapie ist aufgrund zahlreicher Komplikationen nicht weniger risikoreich als die operative Therapie und ermöglicht nur in bestimmten Fällen ein gutes Ergebnis. Die operative Behandlung erlaubt eine frühzeitige Mobilisation und funktionelle Nachbehandlung. Für die Wahl der geeigneten Behandlung sind der Gesundheitszustand des Patienten, die Frakturmorphologie und die Knochenqualität maßgeblich. Für den geriatrischen Patienten bedeutet ein Hüftpfannenbruch einen ernsten Einschnitt in seinem Leben und ist mit einer hohen Rate an möglichen Primär- und Sekundärkomplikationen verbunden.

Summary

Acetabular fractures in the elderly are a rare type of injury which requires a highly individualized management protocol. They represent a great challenge for both the surgeon and the patient in terms of difficult reconstruction and invasive forms of therapy. In the geriatric population, there are considerably more fractures that are localized in the anterior acetabulum column or wall. In these patients, acetabular fractures mostly occur in osteoporotic bone after a simple fall on the hip. For the therapy of acetabular fractures different conservative and operative treatment protocols (open reduction with internal fixation, primary or secondary total hip replacement) may be taken into account. The conservative treatment is linked with a high incidence of different complications and is often not satisfying with regard to the functional result. Although, early mobilization and physiotherapy are possible with operative reduction and fixation of the fracture, different factors like patient’s condition, fracture morphology and bone stock quality are decisive for the choice of the treatment. In the geriatric polulation, acetabular fractures represent a significant watershed moment in life which may be associated with a high rate of complications and mortality.

Schlüsselwörter

Azetabulumfraktur - geriatrische Patienten

Keywords

Acetabular fracture - geriatric patients
 

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