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Komplikationen nach osteosynthetischer Versorgung von Azetabulumfrakturen

Complications after osteosynthetic treatment of acetabular fractures

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Zusammenfassung

Die frühen Arbeiten von Judet und Letournel in den 70er und 80er Jahren führten zu einem Paradigmenwechsel in der Behandlung von Azetabulumfrakturen – weg von der rein konservativen hin zur operativen Therapie. Die komplexe dreidimensionale knöcherne Anatomie und der periazetabuläre Weichteilmantel mit engem topographischem Bezug zu intra- und extrapelvinen neurovaskulären/viszeralen Strukturen implizieren eine erhöhte Rate sowie ein vergleichsweise erhöhtes Risiko intra- und postoperativer Komplikationen bei gleichzeitig bestehender Anforderung an eine sorgfältige anatomische Rekonstruktion mit einer Gelenkstufen-/spalttoleranz von weniger als 1–2 mm. Gleichzeitig sind Frakturen des Azetabulums vergleichsweise selten, sodass eigentlich nur entsprechende Zentren über die entsprechende Erfahrung sowie die Infrastruktur zur Versorgung von Azetabulumfrakturen verfügen. Ziel dieser Arbeit war es daher, die potenziellen intra- und postoperativen Komplikationen im Rahmen der operativen Versorgung von Azetabulumfrakturen darzustellen sowie praktische Ansätze zur Therapie und Prophylaxe aufzuzeigen.

Abstract

The early work of Judet and Letournel in the 1970s and 1980s led to a paradigm shift in the treatment of acetabular fractures. The previously purely conservative treatment was replaced more and more by open surgical approaches. The complex, three-dimensional bony anatomy and the periacetabular soft tissue with a close topographic relationship to intrapelvic and extrapelvic neurovascular and visceral structures implicate an increased rate as well as a high risk for intraoperative and postoperative complications. Simultaneously, anatomical reconstruction with a gap step-off less than 1–2 mm is required. Fractures of the acetabulum are comparatively rare and only few trauma centers have the capability and the infrastructure to treat acetabular fractures. Therefore, the aim of this review was to illustrate the possible intraoperative and postoperative complications of osteosynthetic treatment of acetabular fractures as well as to identify possible strategies for treatment and prevention.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. P. Schwabe, F. Wichlas, C. Druschel, C. Jacobs, N.P. Haas, K.-D. Schaser, S. Märdian geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    P. Schwabe, F. Wichlas, C. Druschel, C. Jacobs, N.P. Haas, K.-D. Schaser & S. Märdian

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  1. P. Schwabe
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  2. F. Wichlas
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  3. C. Druschel
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  4. C. Jacobs
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Correspondence to P. Schwabe.

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Schwabe, P., Wichlas, F., Druschel, C. et al. Komplikationen nach osteosynthetischer Versorgung von Azetabulumfrakturen. Orthopäde 43, 24–34 (2014). https://doi.org/10.1007/s00132-013-2121-1

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