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Versorgung von Pseudarthrosen der langen Röhrenknochen

Treatment of pseudarthrosis in long bones

  • Standards in der Unfallchirurgie
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Als Pseudarthrose wird eine Frakturheilungsstörung nach konservativer oder operativer Frakturversorgung bezeichnet. In etwa 5–10 % aller Frakturen kommt es zu einer gestörten Frakturheilung. Pseudarthrosen gehören dabei zu den anspruchvollsten Komplikationen in der Versorgung von Frakturen. Die individuellen Ursachen hierfür sind vielschichtig und oftmals schwer zu diagnostizieren. Eine einheitliche Definition von Begrifflichkeiten wie Frakturheilung, verzögerte/ausbleibende Frakturheilung und Pseudarthrosen liegt jedoch bis heute nicht vor. Im deutschen Sprachgebrauch wird meist von einer Pseudarthrose gesprochen, wenn die Frakturheilung 6 Monate posttraumatisch noch nicht abgeschlossen ist.

Therapie

Unterschieden werden avitale und vitale sowie septische und aseptische Pseudarthrosen. Diverse Klassifikationen helfen dem Operateur zudem bei der Wahl der richtigen Therapie. Als therapeutisches Mittel der Wahl zur Behandlung von Pseudarthrosen gilt weiterhin die operative Revision mit Durchführung einer autologen Spongiosaplastik. Während aseptische Pseudarthrosen oft einzeitig und mittels interner Osteosynthese therapiert werden können, empfiehlt sich für die Behandlung von Infektpseudarthrosen ein zweizeitiges Vorgehen mit externer Stabilisierung. Hierbei sollte der Fokus zunächst auf einer Infektsanierung liegen, bevor, bei regelrechtem Verlauf, nach 4 bis 6 Wochen der Defektaufbau mittels Spongiosaplastik oder Segmenttransport durchgeführt werden kann. Ergänzend stehen dem Behandler weitere additive Therapieoptionen zur Verfügung.

Abstract

Background

Pseudarthrosis is an impairment of fracture healing after conservative or operative fracture treatment. Delayed unions or nonunions occur in approximately 5–10 % of all fractures. Pseudarthrosis is one of the most demanding complications in fracture treatment. The causes leading to pseudarthrosis are multifactorial and often difficult to diagnose. A common definition of various terminologies, such as fracture healing, delayed union, nonunion or pseudarthrosis is currently not available. In Germany pseudarthrosis is often used if fracture healing is not complete after 6 months.

Therapy

A differentiation is made between avascular and hypervascular and also between septic and aseptic pseudarthrosis. In addition a variety of classification systems are available to aid surgeons in selection of the correct treatment. The treatment of choice for pseudarthrosis is surgical revision with autologous cancellous bone grafting. Aseptic pseudarthrosis can often be treated by single-stage surgery using internal osteosynthesis, while a two-stage approach with external stabilization is recommended for treatment of septic pseudarthrosis. In this case the initial focus should be on treating the infection. Then, 4–6 weeks later, defect reconstruction by autologous cancellous bone grafting or segment transport can be performed. Further additive therapy options are also available for extended treatment.

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Correspondence to O. Dannenberg.

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Breer, S., Auerswald, M., Fuchs, S. et al. Versorgung von Pseudarthrosen der langen Röhrenknochen. Trauma Berufskrankh 17, 233–243 (2015). https://doi.org/10.1007/s10039-015-0100-y

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