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Behandlungsergebnisse nach zementierter Hemiprothese zur Versorgung instabiler pertrochantärer Femurfrakturen alter Patienten

Treatment results after cemented hemiprosthesis for care of unstable pertrochanteric femoral fractures in the elderly

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Zusammenfassung

Hintergrund

Die optimale Versorgungsstrategie instabiler pertrochantärer Femurfrakturen im Kollektiv der alten Patienten ist Bestandteil der aktuellen Diskussion.

Patienten und Methoden

Erfasst wurden von 2003 bis 2009 im eigenen Patientenkollektiv demographische Daten, der Zeitpunkt der ersten Vollbelastung, Komplikationen und die postoperative Mobilität.

Ergebnisse

Die Einschlusskriterien erfüllten 91 Patienten (Alter 87,7±6,8 Jahre). Es lagen in 89% der Fälle 31A2.X-Frakturen vor. Drei Revisionseingriffe, darunter eine septische Prothesenlockerung und 2 Hämatomausräumungen, wurden durchgeführt. Die 30-Tages-Mortalität betrug 5,5%. Eine Vollbelastung war im Durchschnitt nach 3,5 Tagen möglich. Die Elektrolytentgleisung, das postoperative Durchgangssyndrom und die Harnwegsinfektion stellten die 3 häufigsten allgemeinen Komplikation mit über 30% dar.

Schlussfolgerung

Die zementierte hemiprothetische Versorgung instabiler pertrochantärer Femurfrakturen alter Patienten kann ohne Nachteile hinsichtlich der Mortalität und mit sehr rascher Mobilisierung durchgeführt werden. Die Behandlungsergebnisse der primär prothetischen Versorgung, insbesondere die schnelle Vollbelastung sowie die geringe Anzahl von Revisionsoperationen lassen die zementierte Hemiprothese als Alternative zur Osteosynthese zu.

Abstract

Background

The optimal treatment strategy for unstable trochanteric fractures in the elderly is still controversial because of the frequent failure of osteosynthesis.

Methods

A cohort of patients with unstable trochanteric fractures who were treated with cemented hemiarthroplasty and presented in our department during the period 2003–2009 was analyzed. Complications, reoperations, walking ability and full weight bearing were documented.

Results

A total of 91 patients were included (mean age 87.7±6.8 years) and predominantly 31A2 fractures (89%) were treated. There were 3.3% reoperations in the cohort and the 30 day mortality was 5.5%. At least 1 general complication occurred in over 50% of the patients. However, 30% of the patients had lower urinary tract infections, disturbances of electrolyte balance or transitory psychotic symptoms. On average full weight bearing could be performed at 3.5 (±3) days after the operation.

Conclusion

Cemented hemiarthroplasty is a safe treatment strategy for unstable trochanteric fractures in the elderly, which allows early full weight bearing. Because of frequent general complications, more interdisciplinary units and centres of excellence are needed to handle this challenging cohort.

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  1. Chirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Campus Innenstadt, Nußbaumstr. 20, 80336, München, Deutschland

    S. Grote, F. Stegmeyer, V. Bogner, P. Biberthaler & W. Mutschler

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  1. S. Grote
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  2. F. Stegmeyer
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  3. V. Bogner
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  4. P. Biberthaler
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  5. W. Mutschler
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Correspondence to S. Grote.

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Grote, S., Stegmeyer, F., Bogner, V. et al. Behandlungsergebnisse nach zementierter Hemiprothese zur Versorgung instabiler pertrochantärer Femurfrakturen alter Patienten. Unfallchirurg 115, 234–242 (2012). https://doi.org/10.1007/s00113-010-1884-7

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  • DOI: https://doi.org/10.1007/s00113-010-1884-7

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