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Versorgung pertrochantärer Femurfrakturen

Biomechanische Überlegungen

Treatment of peritrochanteric fractures

Biomechanical considerations

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Zusammenfassung

Bei der pertrochantären Femurfraktur sind biomechanische Überlegungen von großer Bedeutung. Häufig bestehen begleitend geriatrische Erkrankungen und Osteoporose, die hohe Anforderungen an die Primärstabilität der operativen Versorgung stellen. Bei der instabilen Fraktur (AO/ASIF 31-A2 und -A3) können schon Alltagsbelastungen die kritischen Grenzen überschreiten und das Versagen der Frakturversorgung einleiten. Sowohl intra- als auch extramedulläre Implantate kommen mit Erfolg auch bei instabiler Fraktur zum Einsatz. Verschiedene Variationen in der Verankerung der Schenkelhalsträger und im Design der Implantate sind verfügbar und weisen unterschiedliche Charakteristika in der Primärstabilität auf. Biomechanische Untersuchungen zeigen, wie eine Erhöhung der Stabilität durch Implantate neuerer Generation erreicht wird. Entscheidend für die Stabilität ist jedoch nach wie vor die korrekte Reposition und Operationstechnik. Ergänzende Maßnahmen (z. B. die Augmentation) weisen vielversprechende Ansätze auf, jedoch sind weiterführende Untersuchungen und Weiterentwicklungen erforderlich, um die Primärstabilität der instabilen Fraktur bei osteoporotischer Knochenqualität zu optimieren.

Abstract

Biomechanical considerations are relevant in the treatment of peritrochanteric fractures. Concomitant diseases and osteoporosis place high demands on the primary stability of the operative treatment. In the situation of unstable fractures (AO/ASIF 31-A2 and A3), even normal activities of life can easily exceed the critical limits of stability, which can result in implant failure. Both intramedullary and extramedullary implants are used successfully in the treatment of even unstable fractures. Different variations in the implant design and anchorage of the load carrier of the femoral neck are available and may have different biomechanical characteristics. Biomechanical tests show that new developments of implants can increase stability. Nevertheless, accurate reduction and operative technique is essential to ensure uneventful fracture healing. Although some supportive measures are very promising, such as augmentation, further research is required to increase stability in the unstable and osteoporotic fracture situation.

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Authors and Affiliations

  1. Forschungsinstitut für Rehabilitationsmedizin, Zentrum für Muskuloskelettale Forschung, Universität Ulm, Karl-Wilhelm-Heck-Straße 12, 88410, Bad Wurzach, Deutschland

    G. Krischak

  2. Institut für Unfallchirurgische Forschung und Biomechanik, Zentrum für Muskuloskelettale Forschung, Universität Ulm, Ulm, Deutschland

    L. Dürselen

  3. Klinik für Unfallchirurgie, Hand-, Plastische und Wiederherstellungschirurgie, Zentrum für Chirurgie, Zentrum für Muskuloskelettale Forschung, Universitätsklinikum Ulm, Ulm, Deutschland

    G. Röderer

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  1. G. Krischak
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  2. L. Dürselen
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  3. G. Röderer
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Correspondence to G. Krischak.

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Krischak, G., Dürselen, L. & Röderer, G. Versorgung pertrochantärer Femurfrakturen. Unfallchirurg 114, 485–490 (2011). https://doi.org/10.1007/s00113-011-1976-z

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  • DOI: https://doi.org/10.1007/s00113-011-1976-z

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