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Minimalinvasive Versorgung geriatrischer und osteoporotischer Femurfrakturen mit polyaxial-winkelstabilem Implantat (NCB-DF®)

Minimally invasive treatment of geriatric and osteoporotic femur fractures with polyaxial locking implants (NCB-DF®)

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Zusammenfassung

Hintergrund

Die periprothetische Femurfraktur eines multimorbiden Patientenkollektivs stellt eine unfallchirurgische Herausforderung dar. Ziel dieser Studie ist die prospektive Evaluierung der minimalinvasiv implantierten Non-Contact-Bridging-Distal-Femur- (NCB-DF®-)Platte.

Patienten und Methoden

Insgesamt wurden 30 Osteosynthesen bei 29 Patienten (Alter ~76 Jahre, ASA ~ 2,9) erfasst. Neunzehn Frakturen waren periprothetisch, 17-mal war ein pathologisch veränderter Knochen vorbekannt. Bei 25 Patienten konnte minimalinvasiv in standardisierter Technik vorgegangen werden. Nach 6, 12 und 24 Wochen erfolgten radiologische und klinische Verlaufskontrollen.

Ergebnisse

Hinsichtlich der revisionspflichtigen Komplikationen (insgesamt 14%) wurden ein Plattenbruch nach 16 Wochen sowie 3 Schraubenkorrekturen („minor revisions“) festgestellt. In den radiologischen Kontrollen nach 24 Wochen zeigte sich bei 2 Patienten ein sekundärer Korrekturverlust mit 10 bzw. 15° Extensionsdefizit im Kniegelenk.

Schlussfolgerung

Die polyaxial-winkelstabile NCB-DF®-Plattenosteosynthese stellt bei der Versorgung periprothetischer Femurfrakturen in standardisierter minimalinvasiver Technik eine sichere Alternative dar. Die Revisionsrate innerhalb der ersten 24 Wochen ist im Vergleich zu den Ergebnissen anderer Verfahren niedriger.

Abstract

Background

Periprosthetic femur fractures in elderly patients are a challenging surgical procedure. The aim of this study was a prospective evaluation of minimally invasive implantation of non-contact bridging (NCB-DF®) plates.

Patients and methods

A total of 30 osteosynthesis procedures in 29 patients (average age 76 years and mean ASA 2.9) with complex femur fractures were registered, 19 fractures were periprosthetic and osteoporosis was present in 17 bones. In 25 patients a minimally invasive percutaneous procedure was performed using a standardized technique. An x-ray examination and clinical follow-up were performed after 6, 12 and 24 weeks.

Results

The early complications (14% in total) included 1 plate breakage after 16 weeks as well as 3 minor revisions for screw length correction. The x-ray follow-up after 24 weeks showed a secondary extension deficit of 10° and 15° in the knee joint in 2 patients, respectively.

Conclusion

The NCB-DF® implantation using a standardized minimally invasive technique in periprosthetic femur fractures is a safe alternative in elderly patients. In this very sensitive population the early revision rate within the first 24 weeks is noticeable lower compared to similar procedures.

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Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht. Die Koautoren R. Zettl und S. Ruchholtz sind als Ausbilder in Kursen des Zimmer-Instituts tätig.

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Authors and Affiliations

  1. Klinik für Orthopädie und Rheumatologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland

    B.F. El-Zayat MD & T. Efe

  2. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland

    R. Zettl, A. Krüger, F. Eisenberg & S. Ruchholtz

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  1. B.F. El-Zayat MD
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  2. R. Zettl
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  3. T. Efe
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  4. A. Krüger
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  5. F. Eisenberg
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  6. S. Ruchholtz
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Correspondence to B.F. El-Zayat MD.

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El-Zayat, B., Zettl, R., Efe, T. et al. Minimalinvasive Versorgung geriatrischer und osteoporotischer Femurfrakturen mit polyaxial-winkelstabilem Implantat (NCB-DF®). Unfallchirurg 115, 134–144 (2012). https://doi.org/10.1007/s00113-010-1871-z

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