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Der Unfallchirurg

, Volume 118, Issue 3, pp 259–270 | Cite as

Schenkelhalsfraktur

  • P. GiererEmail author
  • T. Mittlmeier
CME Zertifizierte Fortbildung

Zusammenfassung

Frakturen des Schenkelhalses zeigen mit steigendem Lebensalter einen exponentiellen Anstieg der Inzidenz. Junge Menschen sind selten und wenn, im Rahmen von Hochrasanztraumen, betroffen. Bei älteren und alten Patienten ist häufig, bedingt durch eine begleitende Osteoporose, ein Bagatelltrauma ausreichend. Die Behandlungsoptionen haben sich in jüngster Zeit nur wenig geändert. Die konservative Behandlung kommt allenfalls für undislozierte und valgusimpaktierte Typ-I-Garden-Frakturen infrage und zeigt dennoch eine hohe sekundäre Dislokationsrate. Daher werden undislozierte Frakturen und Frakturen beim jungen Menschen üblicherweise osteosynthetisch versorgt. Neben der kanülierten Schraubenosteosynthese werden winkelstabile Gleitschrauben zur Stabilisierung der Fraktur eingebracht. Bei älteren Patienten steht die rasche Mobilisation im Vordergrund. Die Hüftendoprothetik als Totalendoprothese oder Hemiendoprothese stellt hier das risikoärmste Verfahren dar und erlaubt die unmittelbare Vollbelastung. Neben der suffizienten operativen Therapie ist zur Prophylaxe weiterer Frakturen eine leitliniengerechte Osteoporosetherapie einzuleiten, und die Patienten sind einer angepassten Rehabilitation zuzuführen.

Schlüsselwörter

Klassifikation Osteosynthese Hüftendoprothese Dislokationen Osteoporose 

Femoral neck fracture

Abstract

The incidence of femoral neck fractures increases exponentially with rising age. Young patients are rarely affected but when they are it is mostly due to high energy accidents, whereas older patients suffer from femoral neck fractures by low energy trauma due to osteoporotic changes of the bone mineral density. Treatment options have not essentially changed over the last few years. Non-operative treatment may be a choice in non-dislocated and impacted fractures. Due to the high risk of secondary fracture displacement prophylactic screw osteosynthesis is recommended even in Garden type I fractures. Osteosynthetic fracture stabilization with cannulated screws or angle stable sliding screws, is usually applied in non-displaced fractures and fractures in younger patients. Older patients need rapid mobilization after surgery; therefore, total hip arthroplasty and hemiarthroplasty are commonly used with a low incidence of secondary complications. In addition to sufficient operative treatment a guideline conform osteoprosis therapy should be initiated for the prophylaxis of further fractures and patients should undertake a suitable rehabilitation.

Keywords

Classification Osteosynthesis Dislocations Hip prosthesis Osteoporosis 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. P. Gierer und T. Mittlmeier geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Chirurgie, Abteilung für Unfall-, Hand- und WiederherstellungschirurgieUniversitätsmedizin RostockRostockDeutschland

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