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Offene Stabilisierung und Endoprothetik bei geriatrischen Patienten mit acetabulären Frakturen

Kombination minimal-invasiver Operationstechniken

Open stabilization and primary hip arthroplasty in geriatric patients with acetabular fractures

Combination of minimally invasive techniques

  • Medizin aktuell/Technische Innovationen
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Zusammenfassung

Acetabulumfrakturen des geriatrischen osteoporosekranken Patienten nach einem niederenergetischen Trauma gewinnen aufgrund demographischer Veränderungen zunehmend an Bedeutung. Die Ergebnisse der aktuellen therapeutischen Ansätze sind in dieser Patientenpopulation jedoch eher ungünstig, während Risiken und therapieinduzierte Morbidität sowohl der chirurgischen, als auch konservativen Therapieoptionen erheblich sind.

Die Therapie geriatrischer Patienten ist nicht nur durch ihre häufig komplexe medizinische Vorgeschichte eine Herausforderung. Zusätzlich ist die schnelle funktionelle Rehabilitation und Rückkehr in ihre vorherige Lebenssituation essentiell, um einen körperlichen und geistigen Abbau zu verhindern. Hierin unterscheiden sie sich maßgeblich von jüngeren Patientenkollektiven, für die schlussendlich die langfristige Prognose entscheidend ist.

Der vorliegende Artikel setzt sich kritisch mit der aktuellen Literatur auseinander und berichtet über erste Ergebnisse eines neuen chirurgischen Konzepts bei 6 geriatrischen Patienten im Alter zwischen 82 und 91 Jahren. Aufgezeigt wird die Kombination eines minimal-invasiven vorderen Zugangs zur offenen Reposition und Stabilisation des Acetabulums, sowie eines minimal-invasiven vorderen Zugangs (AMIS®) für einen primären prothetischen Gelenkersatz.

Abstract

Fractures of the acetabulum after low-energy trauma in geriatric patients suffering from osteoporosis are increasing in number and significance due to demographic changes. The results of current therapeutic principles though tend to be poor in this population, while risk and treatment-related morbidity of surgical or conservative approaches are substantial.

The treatment of geriatric patients can be challenging, not only because of their often complex medical history. They essentially need rapid functional restoration and return to their familiar environment to avoid general decline unlike younger patients for whom rather the long-term perspective is crucial.

This article critically discusses the current literature and reports on first experiences with a new surgical concept in six geriatric patients aged 82–91 years: the combination of an anterior minimally invasive approach for open reduction and internal fixation of the acetabulum combined with an anterior minimally invasive (AMIS®) approach to the hip for total hip arthroplasty with promising short-term results.

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  1. Klinik für Traumatologie, Universitätsspital Basel, Spitalstraße 21, CH-4031, Basel, Schweiz

    F. Saxer, P. Studer & M. Jakob MD

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  1. F. Saxer
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  2. P. Studer
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  3. M. Jakob MD
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Correspondence to M. Jakob MD.

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Saxer, F., Studer, P. & Jakob, M. Offene Stabilisierung und Endoprothetik bei geriatrischen Patienten mit acetabulären Frakturen. Unfallchirurg 114, 1122–1127 (2011). https://doi.org/10.1007/s00113-011-2064-0

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