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Die Behandlung von Acetabulumfrakturen bei geriatrischen Patienten mittels modifizierter Kabelcerclage und primärer Hüfttotalprothese

Erste Ergebnisse

Treatment of acetabular fractures in the elderly with primary total hip arthroplasty and modified cerclage

Early results

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Zusammenfassung

Die optimale Behandlung einer Acetabulumfraktur beim betagten Patienten ist und bleibt ein Diskussionsthema. Der behandelnde Arzt muss zwischen konservativer Behandlung, geschlossener Reduktion mit perkutaner Fixation, offener Reduktion mit Osteosynthese oder primäre/sekundärer Hüfttotalprothese (HTP) eine Entscheidung treffen, wobei jede dieser Behandlungsformen ihre Vor- und Nachteile mit sich bringt.

Zwischen Februar 1998 und Dezember 2000 wurden prospektiv an unserer Klinik 15 Patienten (2-mal Querfrakturen, 8-mal T-Frakturen, 2-mal Querfrakturen mit dorsaler Pfannenrandfraktur, 2-mal Frakturen des dorsalen Pfeilers und des dorsalen Pfannenrandes und eine 2-Pfeiler-Fraktur) mit einem durchschnittlichen Alter von 81 Jahren, mittels Kabelcerclage und primärer HTP behandelt.

Alle Patienten wurden nach durchschnittlich 36 Monaten nachuntersucht. Trotz eines Patienten mit 3 Hüftluxationen innerhalb der ersten 10 Monaten, wurde bei allen Patienten ein sehr gutes oder gutes Ergebnis erreicht. Während diesem relativ kurzen Zeitraum kam es radiologisch zu einem Verlust der Reposition der Fraktur von maximal 1 mm, einer Pfannenmigration von maximal 3,2 mm und es wurde keine Pseudarthrose oder Implantatlockerung festgestellt.

Die hier vorgestellte Behandlungsform ist unserer Meinung nach eine gute Behandlungsmöglichkeit von Hüftpfannenfrakturen beim geriatrischen Patienten. Sie bedarf jedoch noch eines größeren Patientenkollektivs und einer längeren Verlaufskontrolle um eine definitive Aussage treffen zu können.

Abstract

This prospective study addresses early results of the treatment of acute acetabular fractures in elderly patients by total hip arthroplasty and cerclage wiring.

Fifteen patients with an average age of 81 years were treated at our institution between February 1998 and December 2000. There were two transverse fractures, eight T-shaped fractures, two transverse fractures with associated posterior wall fracture, two posterior column fractures with associated posterior wall fracture, and one fracture of both columns. Treatment consisted of cerclage wiring of the fracture and primary non-cemented total hip replacement.

All of the patients were followed for a mean of 36 months. Although there was one patient with three hip dislocations during the first 10 months after the operation, we found an excellent or good result for the entire group. During this relatively short follow-up period, we have not found a radiological loss of fracture reduction of more than 1 mm or a cup migration of more than 3.2 mm. All of the fractures healed and no loosening of the implant was evident.

Primary total hip arthroplasty combined with internal fixation is a valid treatment option for acetabular fractures in the elderly. Preliminary results are convincing, but a bigger patient population and a longer follow-up time are necessary before we are able to draw final conclusions.

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Authors and Affiliations

  1. Service d’orthopédie et de traumatologie de l’appareil moteur, Centre Hospitalier Universitaire Vaudois CHUV, Lausanne, Schweiz

    O. Borens, M. Wettstein, R. Garofalo, C. H. Blanc, C. Kombot, P.-F. Leyvraz & E. Mouhsine

  2. Service d’orthopédie et de traumatologie de l’appareil moteur, Centre Hospitalier Universitaire Vaudois CHUV, Rue du Bugnon 46, 1011, Lausanne, Schweiz

    O. Borens

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  1. O. Borens
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  2. M. Wettstein
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  3. R. Garofalo
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  4. C. H. Blanc
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  5. C. Kombot
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  6. P.-F. Leyvraz
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  7. E. Mouhsine
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Correspondence to O. Borens.

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Borens, O., Wettstein, M., Garofalo, R. et al. Die Behandlung von Acetabulumfrakturen bei geriatrischen Patienten mittels modifizierter Kabelcerclage und primärer Hüfttotalprothese. Unfallchirurg 107, 1050–1056 (2004). https://doi.org/10.1007/s00113-004-0827-6

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  • DOI: https://doi.org/10.1007/s00113-004-0827-6

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