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Primär endoprothetische Versorgung von Acetabulumfrakturen

Primary joint replacement for the treatment of acetabular fractures

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Zusammenfassung

Die Reposition und Osteosynthese stellen den Goldstandard der Behandlung von dislozierten Acetabulumfrakturen dar. Nur in Einzelfällen ist ein primärer endoprothetischer Gelenkersatz gerechtfertigt. Indikationen sind lediglich nichtrekonstruierbare Acetabulumfrakturen, begleitende dislozierte Schenkelhalsfrakturen und nichtrekonstruierbare Frakturen des Femurkopfes.

Aufgrund der schwierigen Pfannenverankerung müssen beim endoprothetischen Gelenkersatz zur Behandlung einer Acetabulumfraktur regelmäßig Revisionspfannen eingesetzt werden. Die meisten Möglichkeiten bietet der Kocher-Langenbeck-Zugang, da er eine gleichzeitige Osteosynthese der für die Pfannenstabilität wichtigen dorsalen Anteile des Acetabulums erlaubt.

Die Ergebnisse hinsichtlich der Lebensdauer der Prothesenpfanne nach einer Acetabulumfraktur sind deutlich schlechter als bei der elektiven Primärendoprothetik, sodass im weiteren Verlauf mit Wechseloperationen zu rechnen ist. Insbesondere bei jüngeren, aber auch bei betagten Patient*innen sollte jede Anstrengung unternommen werden, um eine Press-Fit-Verankerung der Pfanne zu ermöglichen. Konkret bedeutet dies, dass in den meisten Fällen eine Osteosynthese zur Stabilisierung des Acetabulums vor der Implantation einer Endoprothese sinnvoll ist. Ein zweizeitiges Vorgehen mit früh-sekundärem endoprothetischem Eingriff bietet gegenüber der einzeitigen Operation Vorteile für das Gesamtergebnis.

Abstract

Open reduction and internal fixation are the gold standard for the treatment of dislocated acetabular fractures. A primary joint replacement is only justified in isolated cases. The indications are merely non-reconstructable acetabular fractures, accompanying displaced fractures of the femoral neck and non-reconstructable fractures of the femoral head.

Because of the difficulties in achieving sufficient cup stability, joint replacement for the treatment of acetabular fractures regularly requires implants designed for revision arthroplasty. The Kocher-Langenbeck approach provides the most versatile options, as it enables simultaneous stabilization of the dorsal acetabular structures, which are essential for the stability of the cup.

For primary joint replacement as a treatment of acetabular fractures, survival of the prosthetic cup is markedly worse when compared to elective primary joint replacement. Particularly in younger patients but also in aged patients, every effort should be made to achieve a press fit of the cup. In most cases, this will include reduction and fixation of the fracture for stabilization of the acetabulum prior to joint replacement. A staged approach with an early secondary replacement intervention seems to provide better overall results than simultaneous fracture fixation and joint replacement.

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Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Eberhard-Karls-Universität Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland

    Steven C. Herath, Markus Alexander Küper, Mika Rollmann, Tina Histing & Benedikt Braun

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  1. Steven C. Herath
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  2. Markus Alexander Küper
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  3. Mika Rollmann
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  4. Tina Histing
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Correspondence to Steven C. Herath.

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Interessenkonflikt

S.C. Herath, M.A. Küper, M. Rollmann, T. Histing und B. Braun geben an, dass kein Interessenkonflikt besteht.

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

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Wolfgang Lehmann, Göttingen

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Herath, S.C., Küper, M.A., Rollmann, M. et al. Primär endoprothetische Versorgung von Acetabulumfrakturen. Unfallchirurgie 126, 119–124 (2023). https://doi.org/10.1007/s00113-022-01266-w

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