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Therapie von Femurschaftfrakturen

Treatment of femoral fractures

  • Standards in der Unfallchirurgie
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Femurschaftfrakturen werden meist durch Hochrasanztraumen verursacht. Deshalb sind sie häufig mit weiteren, oft lebensbedrohenden Verletzungen assoziiert, die abgeklärt und einer adäquaten Therapie zugeführt werden müssen. Dabei ist neben den offensichtlichen schweren Begleitverletzungen v. a. auch auf Gefäß- und Nervenläsionen zu achten. Oft ist zunächst eine primäre Stabilisierung im Fixateur externe im Rahmen des Konzepts der „damage control surgery“ indiziert. Zur definitiven Versorgung kommen überwiegend die ante- und die retrograde Marknagel-, seltener die konventionelle oder die winkelstabile Plattenosteosynthese oder Verfahrenskombinationen zur Anwendung. Bei der Therapie mit Marknagelosteosynthese werden die frakturnahen Weichteile durch den frakturfernen operativen Zugang geschont. In der Regel kann die Femurschaftfraktur geschlossen reponiert werden. Bei Femurschaftfrakturen können ipsilaterale Frakturen sowohl des proximalen Femurs als auch Verletzungen der Kniegelenk- und Unterschenkelregion auftreten. Im Bereich des Femurs entwickelt sich nur selten ein Kompartmentsyndrom, dennoch müssen die Weichteile vor und nach der Frakturstabilisierung sorgfältig klinisch evaluiert werden.

Abstract

Femoral shaft fractures usually occur following high- impact trauma. Therefore, patients may suffer additional life- threatening injuries, which require adequate diagnostic work up and appropriate therapy. In addition to polytrauma injuries, diagnostic attention must be directed to detect vascular and nerval lesions. Often primary stabilization is performed using an external fixator as part of the concept of damage control surgery. For definitive stabilization, ante- or retrograde intramedullary nailing is predominately used and less frequently conventional or angular stable plate osteosynthesis or combination of these stabilization techniques. The concept of i.m. nailing preserves the soft tissue envelope by utilizing insertion points distant to the fracture site. Regularly, closed techniques can be employed for fracture reduction. Femur shaft fractures may be accompanied by ipsilateral fractures of the femur, and by injuries of the knee joint and lower leg. Although compartment syndrome is a rare complication of femoral shaft fractures, soft tissue condition require careful clinical evaluation prior to and after fracture stabilization.

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Hierholzer, C., Woltmann, A. & Bühren, V. Therapie von Femurschaftfrakturen. Trauma Berufskrankh 13, 109–124 (2011). https://doi.org/10.1007/s10039-011-1726-z

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  • DOI: https://doi.org/10.1007/s10039-011-1726-z

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