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Die periprothetische Azetabulumfraktur des geriatrischen Patienten

Periprosthetic acetabular fractures in geriatric patients

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Zusammenfassung

Periprothetische Azetabulumfrakturen bei geriatrischen Patienten sind seltene Verletzungen, die aufgrund des demographischen Wandels jedoch eine steigende Inzidenz aufweisen. Zur Diagnostik wird neben konventionellen Röntgenaufnahmen regelhaft die Computertomographie (CT) eingesetzt. Zum Ausschluss einer Lockerung der Prothesenpfanne kommt die Single-Photonen-Emissions-CT(SPECT)/CT zur Anwendung. Zur Klassifikation der periprothetischen Azetabulumfraktur wurden neben der traditionellen Einteilung nach Letournel weitere Klassifikationen erarbeitet, die unter anderem die Ätiologie der Fraktur sowie die Stabilität der implantierten Prothese mit einbeziehen. Während unter bestimmten Voraussetzungen auch eine konservative Therapie periprothetischer Azetabulumfrakturen möglich ist, sind nicht selten umfangreiche operative Eingriffe notwendig, um die Stabilität des Azetabulums als Widerlager für die Prothesenpfanne wieder herzustellen. Hierzu kommen neben den klassischen Osteosyntheseverfahren der Azetabulumchirurgie spezielle Revisionspfannen, Augments und Allografts zur Anwendung. Zur Festlegung eines Therapieregimes müssen patientenspezifische Voraussetzungen, Frakturmodifikation und die Art der vorhandenen Prothese berücksichtigt werden. In der Literatur existieren mehrere Behandlungsalgorithmen, die den behandelnden Arzt bei der Entscheidungsfindung unterstützen sollen. Die Therapie periprothetischer Frakturen des Azetabulums stellt auch erfahrene Chirurgen vor große Herausforderungen und sollte in spezialisierten Zentren erfolgen.

Abstract

Periprosthetic acetabular fractures in geriatric patients are rare injuries; however, the incidence is increasing because of the current demographic developments. For diagnosis of periprosthetic acetabular fractures, conventional X‑ray images are regularly complemented by computed tomography (CT). For exclusion of loosening of the prosthesis more advanced techniques, such as single photon emission CT (SPECT/CT) are applied. In addition to classification of periprosthetic acetabular fractures by the traditional system of Letournel there are several other classification systems, which take into account the etiology of the fracture and the stability of the prosthesis. While, under certain circumstances conservative treatment of periprosthetic acetabular fractures is possible, operative treatment often requires extensive surgical procedures to restore the stability of the acetabulum as a support for the cup of the prosthesis. Besides the traditional techniques of acetabular osteosynthesis, special revision systems, augmentations and allografts are used for the reconstruction of periprosthetic acetabular fractures. To determine a therapeutic regimen patient-specific preconditions as well as fracture pattern and type of prosthesis need to be taken into account. In the literature there are several algorithms, which are aimed at supporting the attending physician in making the correct decision for the treatment of periprosthetic acetabular fractures. In cases of periprosthetic acetabular fractures even experienced surgeons are faced with great challenges. Thus, treatment should be carried out in specialized centers.

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Authors and Affiliations

  1. Klink für Unfall-, Hand und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland

    S. C. Herath, M. F. R. Rollmann, T. Histing, J. H. Holstein & T. Pohlemann

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  1. S. C. Herath
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  2. M. F. R. Rollmann
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Correspondence to S. C. Herath.

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S. C. Herath, M. F. R. Rollmann, T. Histing, J. H. Holstein und T. Pohlemann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Herath, S.C., Rollmann, M.F.R., Histing, T. et al. Die periprothetische Azetabulumfraktur des geriatrischen Patienten. Chirurg 88, 105–109 (2017). https://doi.org/10.1007/s00104-016-0340-9

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  • DOI: https://doi.org/10.1007/s00104-016-0340-9

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