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Kontrastmittelverstärkter Ultraschall in der Diagnostik von Pseudarthrosen

Contrast-enhanced ultrasound in the diagnostics of non-unions

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Zusammenfassung

Pseudarthrosen stellen in der Orthopädie und Unfallchirurgie eine schwerwiegende Komplikation und eine große sozioökonomische Herausforderung dar. Eine frühzeitige und zuverlässige Diagnostik ist obligat, um die Therapie der Pseudarthrosen patientenspezifisch und effizient durchführen zu können. Der kontrastmittelverstärkte Ultraschall („contrast-enhanced ultrasound“, CEUS) stellt eine bedeutende Schnittstelle zwischen klinischen Zeichen, bildgebender Untersuchung und den Ergebnissen der paraklinischen Diagnostik (C-reaktives Protein [CRP] und Leukozytenzahl) dar. Er kann die Mikroperfusion im Pseudarthrosenspalt in Echtzeit wiedergeben und wertvolle Informationen zum Ausschluss einer Infektpseudarthrose oder zum Heilungsfortschritt nach einer Revisionsoperation liefern. Eine Etablierung dieser Diagnostikmodalität im orthopädisch-unfallchirurgischen Alltag trägt zur Optimierung der Pseudarthrosenbehandlung bei.

Abstract

Non-union represents a severe complication and a major socioeconomic challenge in orthopedics and trauma surgery. Timely and reliable diagnostics are obligatory to be able to carry out the treatment of non-unions in a patient-specific and efficient manner. Contrast-enhanced ultrasound (CEUS) is an important interface between clinical signs, imaging investigations and the results of the paraclinical diagnostics, e.g. C‑reactive protein (CRP) and leukocyte count. It can display the microperfusion inside the non-union gap in real time and provide valuable information for exclusion of an infection or on the healing progress after revision surgery. An establishment of this diagnostic modality in routine orthopedic trauma surgery contributes to optimization of the treatment of non-unions.

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Authors and Affiliations

  1. Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    Julian Doll

  2. Arcus Sportklinik, Rastatter Str. 17–19, 75179, Pforzheim, Deutschland

    Christian Fischer

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  1. Julian Doll
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  2. Christian Fischer
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Correspondence to Christian Fischer.

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J. Doll und C. Fischer geben finanzielle Forschungsunterstützung der Fa. Bracco sowie der DEGUM an.

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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Christian Tesch, Hamburg

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Doll, J., Fischer, C. Kontrastmittelverstärkter Ultraschall in der Diagnostik von Pseudarthrosen. Unfallchirurg 125, 107–112 (2022). https://doi.org/10.1007/s00113-021-01129-w

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