Skip to main content
Log in

Mediale Schenkelhalsfraktur des biologisch jungen 60-Jährigen

Osteosynthese vs. Prothese

Fractures of the medial femur in the physically active 60-year-olds

Internal fixation or joint replacement

  • Proximale Femurfrakturen
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Es gibt nur wenige Veröffentlichungen speziell zum Schenkelhalsbruch des aktiven 60-Jährigen. In den großen Prothesenregistern Skandinaviens werden die Frakturen in diesem Alter nur am Rande miterfasst. Die vorhandenen klinischen Arbeiten sind aufgrund regionaler Unterschiede in der Versorgungsstruktur und in Überzeugungen im Ergebnis nicht einheitlich. Eine Osteosynthese ist dann Erfolg versprechend, wenn ein aktiver Patient mit gesundem Gelenk und guter Knochensubstanz bei nur mäßiger Dislokation bis Garden III schnell (ideal innerhalb 6 h) und schonend mit einem stabilen Implantat versorgt werden kann. Die umgekehrte Konstellation mit inaktivem, vorgealtertem Patienten, Gelenkdegeneration, Osteoporose, schwerer Dislokation Grad Garden IV und verspäteter Zuweisung stellt die Idealvoraussetzung zur Implantation einer Prothese dar. Diese kann zementiert oder unzementiert, als Hemiarthroplastik (HAP) oder Totalendoprothese implantiert werden; hierüber ist eine Einzelfallentscheidung erforderlich. Wir empfehlen für den Regelfall in Deutschland aufgrund der guten infrastrukturellen Vorraussetzungen und technischen Möglichkeiten die Behandlung des aktiven 60-Jährigen bei einer intrakapsulären Schenkelhalsfraktur mit einer gelenkerhaltenden Operation. Eine altersabhängige Komplikationsrate ist nicht nachgewiesen, sodass sich dieses Konzept auch auf die jungen Alten übertragen lässt.

Abstract

There are few publications on the optimal treatment for fractures of the femoral neck in active 60-year-old patients. Fractures in this age group are hardly mentioned in the large Scandinavian prosthesis registers, and the data collected in earlier clinical studies are not comparable because of regional differences in treatment options and attitudes. Internal fixation is often successful in an active patient with a healthy joint and compact bone mass when the malalignment following fracture is not too pronounced (Garden grade no higher than III) and the bone can be stabilized within 6 hours by a means of a stable implant without causing too much soft tissue damage. In the reverse situation of an inactive patient with severe joint degeneration, osteoporosis or Garden grade IV dislocation after the fracture and delay in admission to the trauma centre, conditions are exactly right for implantation of a prosthesis, which might be cemented or cement-free, a hemiarthroplasty (HAP) or a total endoprosthesis. This must be decided individually for each patient. As a rule, because of the satisfactory infrastructures and excellent technical options available here, in Germany we recommend joint-conserving treatment for an active 60-year-old with an intracapsular fracture of the femoral neck. No age-dependent complication rate has been documented, so that this regimen can be extended to the so-called young old population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Bezwada HP, Shah AR, Harding SH et al. (2004) Cementless bipolar hemiarthroplasty for displaced femoral neck fractures in the elderly. J Arthroplasty 19: 73–77

    Article  Google Scholar 

  2. Chapman MW, Stehr JH, Eberle CF et al. (1975) Treatment of intracapsular hip fractures by the Deyerle method. A comparative review of one hundred and nineteen cases. J Bone Joint Surg Am 57: 735–744

    PubMed  Google Scholar 

  3. Dixon S, Bannister G (2004) Cemented bipolar hemiarthroplasty for displaced intracapsular fracture in the mobile active elderly patient. Injury 35: 152–156

    Article  PubMed  Google Scholar 

  4. Gray AJ, Parker MJ (1994) Intracapsular fractures of the femoral neck in young patients. Injury 25: 667–669

    Article  PubMed  Google Scholar 

  5. Khan RJ, MacDowell A, Crossman P et al. (2002) Cemented or uncemented hemiarthroplasty for displaced intracapsular femoral neck fractures. Int Orthop 26: 229–232

    Article  PubMed  Google Scholar 

  6. Kuner EH, Lorz W, Bonnaire F (1995) Femoral neck fractures in adults: joint sparing operations. I. Results of an AO collective study with 328 patients. Unfallchirurg 98: 251–258

    PubMed  Google Scholar 

  7. Malchau H, Herberts P, Eisler T et al. (2002) The Swedish total hip replacement register. J Bone Joint Surg Am [Suppl 2] 84-A:2–20

  8. Manninger J, Kazar G, Fekete G et al. (1985) Avoidance of avascular necrosis of the femoral head, following fractures of the femoral neck, by early reduction and internal fixation. Injury 16: 437–448

    Article  PubMed  Google Scholar 

  9. McKinley JC, Robinson CM (2002) Treatment of displaced intracapsular hip fractures with total hip arthroplasty: comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation. J Bone Joint Surg Am 84-A: 2010–2015

  10. Parker MJ (2002) Evidence-based results depending on the implant used for stabilizing femoral neck fractures. Injury [Suppl 3] 33:C15–18

    Google Scholar 

  11. Ravikumar KJ, Marsh G (2000) Internal fixation vs. hemiarthroplasty vs. total hip arthroplasty for displaced subcapital fractures of femur — 13 year results of a prospective randomised study. Injury 31: 793–797

    Article  PubMed  Google Scholar 

  12. Spotorno L, Schenk RK, Dietschi C et al. (1987) Personal experiences with uncemented prostheses. Orthopade 16: 225–238

    PubMed  Google Scholar 

  13. Squires B, Bannister G (1999) Displaced intracapsular neck of femur fractures in mobile independent patients: total hip replacement or hemiarthroplasty? Injury 30: 345–348

    Article  PubMed  Google Scholar 

  14. Zetterberg CH, Irstam L, Andersson GB (1982) Femoral neck fractures in young adults. Acta Orthop Scand 53: 427–435

    PubMed  Google Scholar 

Download references

Interessenkonflikt:

Keine Angaben

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. Bonnaire.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bonnaire, F., Jaminet, P., Lein, T. et al. Mediale Schenkelhalsfraktur des biologisch jungen 60-Jährigen. Trauma Berufskrankh 9 (Suppl 1), S5–S12 (2007). https://doi.org/10.1007/s10039-005-1054-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-005-1054-2

Schlüsselwörter

Keywords

Navigation