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Frakturen durch Materialentfernungen

Fractures due to removal of support devices

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Komplikationen durch Materialentfernungen

Frakturen durch Materialentfernungen stellen mit insgesamt 0–1,5 % eine seltene, aber schwerwiegende Komplikation operativer Therapien dar, insbesondere da diese Verfahren einerseits als Abschluss der Behandlung angesehen, andererseits in 50–60 % der Fälle als hochelektive Eingriffe bei beschwerdefreien Patienten durchgeführt werden. Durch erweiterte Indikationsstellungen zur operativen Frakturversorgung in den letzten Jahrzehnten ist auch mit einem Anstieg der Inzidenz von Materialentfernungen zu rechen. Im folgenden Beitrag erfolgt einführend eine Begriffsbestimmung und Unterteilung der unterschiedlichen Frakturentitäten in intraoperative iatrogene Frakturen und Refrakturen. Anschließend werden die jeweiligen Ursachen diskutiert und die vorhandene Datenlage für die großen Röhrenknochen aufgeführt.

Resümee

Fehlermöglichkeiten, die zu einer Fraktur durch Materialentfernung führen, können bereits im Rahmen der Indexoperation auftreten und ziehen sich durch sämtliche Phasen der Materialentfernung, wie Indikationsstellung, Planung, Durchführung und operative Nachbehandlung. Anhand der vorliegenden Datenlage sind gegenwärtig keine evidenzbasierten Empfehlungen zur Implantatentfernung abzuleiten, und die Indikation muss daher kritisch und individuell gestellt werden.

Abstract

Complications of implant removal

Fractures during removal of implants are rare (0–1.5 %) but serious complication, particularly because these procedures are thought to be the end of primary treatment, but if this occurs, then the patient will be back at the beginning of therapy. Furthermore 50–60 % of implant removals are highly elective surgeries on healthy patients. Due to the increasing number of operative fracture fixation procedures, the number of patients requesting implant removal will also increase in the upcoming decades. In this paper, an overview of the different causes for fractures based on implant removal procedures (intraoperative vs. postoperative) is given. Finally, the data in the literature are reviewed for long bones and recommendation are made to prevent such complications.

Conclusion

Errors leading to fractures during implant removal may happen during initial fracture fixation, as well as during all stages of the implant removal procedure, e.g., assessment of indication, planning and performing the operative procedure, as well as operative after care. Based on the published literature, no evidence-based recommendations for implant removal can be given and each decision has to be made on an individual basis after critical evaluation.

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Friedrich-Schiller-Universität Jena, Erlanger Allee 101, 07740, Jena, Deutschland

    F. Gras, I. Marintschev, M. Lenz, K. Klos, V. König & G.O. Hofmann

  2. Klinik für Unfall- und Wiederherstellungschirurgie, BG-Kliniken Bergmannstrost , Halle (Saale), Deutschland

    G.O. Hofmann

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  1. F. Gras
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  2. I. Marintschev
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Correspondence to F. Gras.

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Gras, F., Marintschev, I., Lenz, M. et al. Frakturen durch Materialentfernungen. Trauma Berufskrankh 15, 25–32 (2013). https://doi.org/10.1007/s10039-013-1926-9

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