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Osteosynthese bei Acetabulumfrakturen im Alter

Ist eine Rekonstruktion sinnvoll?

Acetabular fractures in the elderly

Outcome of open reduction and internal fixation

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Zusammenfassung

Acetabulumfrakturen im Alter sind selten. Bei osteoporotisch veränderter Knochenstruktur und einer erhöhten Komorbidität bei diesen Patienten ist bisher keine einheitliche Strategie in der Versorgung gegeben. Konservative Therapieansätze, offene Reposition und Osteosynthese allein, augmentierende Osteosynthese zur sekundären Frühimplantation einer Totalendoprothese (TEP) oder primäre Hüft- (H-)TEP stehen sich häufig alternativ und konkurrierend gegenüber. Ziel dieser Untersuchung war es, die klinischen und radiologischen Ergebnisse nach operativer Versorgung von Acetabulumfrakturen zu evaluieren und eine entsprechende Strategie zur Versorgung dieser Gelenkfrakturen des älteren Patienten darzustellen.

In einem Zeitraum von 6 Jahren (2001–2006) wurden 48 Patienten nach Acetabulumfrakturen behandelt, die >60 Jahre waren. Durch eine offene Reposition und Platten-/Schraubenosteosynthese (ORIF) wurden 39 dieser Patienten operativ versorgt. Bei 9 Patienten wurde eine konservative Therapie eingeleitet. Sieben der 39 operativ versorgten Patienten erhielten sekundär einen endoprothetischen Hüftgelenkersatz (H-TEP). In der konservativ behandelten Gruppe mussten 2 Patienten sekundär mit einer H-TEP versorgt werden. Insgesamt konnten 29 Patienten nachuntersucht werden. Eine klinische Untersuchung und Nachkontrolle mit Fragebögen [Merle d’Aubigné, EuroQol- (EQ-)5D und SF-12] wurde bei 19 operierten Patienten (ORIF-Gruppe) durchgeführt. Eine ausschließliche Nachkontrolle mit Fragebögen erfolgte bei weiteren 10 Patienten. Von den Patienten welche zur klinischen Nachuntersuchung herangezogen wurden, erhielten insgesamt 5 eine sekundäre H-TEP.

Für die Patienten, die offen reponiert und mit einer Plattenosteosynthese stabilisiert worden waren und sekundär keine H-TEP implantiert bekamen konnten sehr gute funktionelle und klinische Ergebnisse nach Auswertung des Merle d’Aubigné-, EQ-5D- und SF-12-Fragebogens gezeigt werden. Die radiologische Auswertung zeigte keine wesentliche Verschlechterung der Gelenkstellung im Sinne einer posttraumatischen Arthrose im Vergleich zur unverletzten Seite. Die Ergebnisse zeigen, dass auch im höheren Lebensalter eine operative Stabilisierung zu guten funktionellen Ergebnissen führt.

Abstract

The aim of this study was to analyze the clinical outcome and incidence of hip arthritis in elderly patients with acetabular fractures. Because of poor bone quality in the elderly, even a low-energy trauma may lead to an acetabular fracture. An anatomical reconstruction of the acetabulum is necessary to achieve sufficient stability also for a potential hip arthroplasty. So far, there is very limited information on the outcome of acetabular fractures in the elderly.

During a period of 6 years (2001–2006), 48 patients older than 60 years were admitted to our department with an acetabular fracture. Thirty-nine patients were treated operatively and nine patients non-operatively. Twenty-nine operatively treated patients were followed up. Nineteen of them were assessed using EQ-5D, SF-12 and Merle d’Aubigné questionnaires in addition to their clinical examination. Ten other surgical patients were only examined using the questionnaires. Of the 29 patients that were followed up, 5 underwent total hip arthroplasty due to secondary post-traumatic hip arthritis after open reduction and internal fixation (ORIF). The range of motion of the operated hip was comparable to that of the non-operated contralateral side. However, the internal rotation was found to be slightly decreased at the operated side when compared to the non-operated contralateral side. Merle d’Aubigné score and physical and mental SF-12 score components as well as quality of life were better in patients treated with ORIF compared to those patients that were treated by secondary hip arthroplasty.

Regarding the different treatment strategies (ORIF vs primary hip arthroplasty vs non-operative treatment) of acetabular fractures in the elderly, data from the literature are conflicting. Our results indicate that ORIF represents a good treatment option for acetabular fractures in the elderly. In patients that did not develop secondary hip arthritis, a good clinical outcome and quality of life was documented.

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Danksagung

Die vorliegende Studie wurde teilweise durch Mittel der Deutschen Arthrosehilfe e.V. Frankfurt/M. unterstützt. Die verwendeten Daten wurden im Rahmen der Multicenterstudie Becken der Arbeitsgruppe Becken der Deutschen Gesellschaft für Unfallchirurgie e.V. und der Deutschen AO erhoben.

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Kirrbergerstraße 1, 66421, Homburg/Saar, Deutschland

    G. Tosounidis, U. Culemann, M. Bauer, J.H. Holstein, P. Garcia, R. Kurowski, A. Pizanis & T. Pohlemann

  2. Institute for Evaluative Research in Medicine, University of Bern, Bern, Schweiz

    E. Aghayev

Authors
  1. G. Tosounidis
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  2. U. Culemann
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  3. M. Bauer
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  4. J.H. Holstein
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  5. P. Garcia
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  6. R. Kurowski
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  7. A. Pizanis
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  8. E. Aghayev
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  9. T. Pohlemann
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Correspondence to G. Tosounidis.

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Tosounidis, G., Culemann, U., Bauer, M. et al. Osteosynthese bei Acetabulumfrakturen im Alter. Unfallchirurg 114, 655–662 (2011). https://doi.org/10.1007/s00113-011-2021-y

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  • DOI: https://doi.org/10.1007/s00113-011-2021-y

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