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Interprothetische Frakturen am Femur

Interprosthetic fractures of the femur

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die Versorgung interprothetischer Frakturen stellt ein zunehmendes Problem in der Unfallchirurgie dar. Grundsätzlich können interimplantäre Frakturen, z. B. zwischen einer Hüftprothese und einem distalen Verriegelungsnagel, ebenfalls dieser Problematik zugeordnet werden. Am häufigsten treten interprothetische Frakturen als suprakondyläre Frakturen oberhalb der Knieimplantate auf. Bei interprothetischen Frakturen muss wie bei periprothetischen Frakturen unterschieden werden, ob die Prothesen fest sitzen oder gelockert sind. Sitzen sie fest, ist die winkelstabile Platte die geeignete Versorgung zur Stabilisierung dieser Verletzungen. Bei ihrer Verwendung sollte aufgrund der ohnehin bereits besonders kompromittierten Durchblutung am Femur die Operation außerordentlich schonend unter Erhalt der Biologie erfolgen. Cerclagen sollten zurückhaltend eingesetzt werden, da sie zusätzlich die Durchblutung stören und biomechanisch winkelstabilen Schrauben unterlegen sind. Sind die Prothesen gelockert, muss ein Prothesenwechsel erfolgen. In Einzelfällen, wenn es nicht möglich ist, einen längeren Schaft aufgrund des gegenüberliegenden Kraftträgers einzubringen, kann es notwendig werden, einen vollständigen Femurersatz durchzuführen oder eine Durchsteckprothese zu verwenden, wie sie in ausgewählten Fällen in der Revisionsendoprothetik zum Einsatz kommt.

Abstract

The treatment of interprosthetic fractures is challenging and the incidence is increasing as a result of increasing patient longevity and rising arthroplasty rates. Interprosthetic fractures occur between arthroplasty stems or any intramedullary implant that has been implanted for fracture fixation. Management of these fractures is a complex undertaking. The majority of fractures are localized at the femoral supracondylar level after knee resurfacing arthroplasty. The fixation status of the arthroplasty component determines the management strategies. As a result of clinical and biomechanical studies, loosening of the implant usually requires revision arthroplasty, whereas minimally invasive reduction and locked internal fixation is the treatment of choice for stable implants. Minimally invasive surgery is necessary to not further compromise local perfusion. As locked plating provides superior biomechanical stability, the use of cerclage cables should be carefully evaluated. Complex fracture configurations, inferior bone stock or an intramedullary canal that is already occupied by support structures might obviate the implantation of long revision stems and might require a more extensive approach (e.g., total femoral arthroplasty).

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Lehmann, W., Rupprecht, M., Rücker, A. et al. Interprothetische Frakturen am Femur. Trauma Berufskrankh 14, 190–195 (2012). https://doi.org/10.1007/s10039-012-1900-y

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  • DOI: https://doi.org/10.1007/s10039-012-1900-y

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