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Versorgungsstrategien bei tumorbedingten pathologischen Frakturen der Extremitäten

Treatment strategies for tumor-related pathological fractures of the extremities

Zusammenfassung

Pathologische Frakturen der Extremitäten sorgen häufig für Verunsicherung hinsichtlich der Versorgungsstrategie und des Versorgungszeitpunktes. Überwiegend werden sie durch Metastasen von Brust‑, Lungen‑, Nieren- und Prostatakarzinomen sowie Myelomen verursacht. Primäre Knochentumoren spielen eine untergeordnete Rolle. Der überwiegende Teil betrifft das Femur und den Humerus sowie in seltenen Fällen die Tibia. Die operative Therapie besitzt einen großen Stellenwert, da eine Ausheilung unter konservativen Maßnahmen unwahrscheinlich ist. Vorrangige Ziele stellen die Schmerzreduktion und der Erhalt bzw. die Wiederherstellung der Funktion dar. Für die korrekte Indikationsstellung sind neben der Frakturanalyse onkologische Aspekte wie z. B. Dignität, Entität, Prognose, Verteilung und der Allgemeinzustand des Patienten zu beantworten. In der Synopse aller Faktoren kann die entsprechende Versorgungsform gewählt werden. Diese reicht von der osteosynthetischen Stabilisierung über die Verbundosteosynthese bis hin zum endoprothetischen Ersatz. Die Therapie erfolgt interdisziplinär, da neben der chirurgischen Versorgung auch ergänzende Maßnahmen in die Wege geleitet werden müssen.

Abstract

Pathological fractures of the extremities frequently lead to uncertainty with respect to the treatment strategy and timing. The origin of metastases is typically breast, bronchial, renal and prostate cancer and myelomas. Primary bone tumors play a subordinate role. The majority affect the femur, humerus and occasionally the tibia. Surgery is typically the first line treatment as healing under conservative treatment is unlikely. The most important goal is to relieve pain and the preservation or restoration of function. For correct assessment of indications, analysis of the fracture pattern and oncological aspects including dignity, entity, prognosis, metastatic status and the general condition of the patient need to be taken into consideration. Based on all these aspects the surgical approach can be chosen. Treatment options range from osteosynthetic stabilization and augmentation osteosynthesis up to endoprosthesis replacement. The treatment is carried out in an interdisciplinary procedure as additional measures need to be addressed in addition to the surgical treatment.

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Correspondence to Mohamed Omar.

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Interessenkonflikt

M. Omar, T. Graulich, C. von Falck, N. Bruns, C. Krettek und M. Ettinger geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Omar, M., Graulich, T., von Falck, C. et al. Versorgungsstrategien bei tumorbedingten pathologischen Frakturen der Extremitäten. Unfallchirurg 124, 704–719 (2021). https://doi.org/10.1007/s00113-021-01056-w

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Schlüsselwörter

  • Femur
  • Humerus
  • Tibia
  • Metastasen
  • Operative chirurgische Eingriffe

Keywords

  • Femur
  • Humerus
  • Tibia
  • Metastases
  • Operative surgical procedures