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Grundlagen der Versorgung offener Frakturen

Principles of treatment for open fractures

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Offene Frakturen entstehen häufig im Rahmen von Hochenergietraumata wie Verkehrsunfällen oder Stürzen aus großer Höhe und führen nicht selten zu persistierenden Funktionseinschränkungen und Invalidität. Aufgrund der Komplexität der Verletzung sind oft mehrere Operationen bis zur definitiven Versorgung notwendig. Dies führt zu deutlich prolongierten Behandlungsverläufen und langem Krankenhausaufenthalt. Im Vergleich zu geschlossenen Verletzungen kommt es bei offenen Frakturen im Verlauf der Behandlung wesentlich häufiger zu Komplikationen wie Wundheilungsstörungen, Infektionen oder der Entwicklung von Pseudarthrosen. Ziele der Behandlung umfassen Infektionsprävention, Frakturheilung sowie die möglichst vollständige Wiederherstellung der Funktion der betroffenen Extremität. Neben einer adäquaten Erstbehandlung und dem zügigen Transport in das nächstgelegene geeignete Krankenhaus kommt der frühzeitigen Einleitung einer Antibiotikatherapie große Bedeutung zu. Das initiale Management beinhaltet die möglichst vollständige Erfassung der Verletzung, das ausgiebige Débridement sowie die Frakturstabilisierung.

Abstract

Open fractures are frequently caused by high-energy trauma, e.g. road traffic accidents or falls from a height and often lead to persisting functional impairment and disability. Due to the complex nature of the injuries several operations are often neccessary before full recovery can be achieved. This results in significantly prolonged courses of treatment and long stays in hospital. Compared with closed injuries complications, such as impaired wound healing, infections or nonunion occur much more frequently in open fractures during the course of treatment. The goals of treatment include infection prevention, fracture healing and complete restoration of function of the affected limb. Besides adequate initial treatment and prompt transport to the nearest suitable hospital, early initiation of antibiotic therapy is of pivotal importance. The initial management includes an accurate diagnosis of the injury, which must be as complete as possible, thorough debridement and fracture stabilization.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie und Orthopädie, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Warener Str. 7, 12683, Berlin, Deutschland

    Denis Gümbel, Julia Seifert & Axel Ekkernkamp

  2. Klinik und Poliklinik für Unfall-, Wiederherstellungschirurgie und Rehabilitative Medizin, Zentrum für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland

    Denis Gümbel, Matthias Napp, Julia Seifert & Axel Ekkernkamp

Authors
  1. Denis Gümbel
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  2. Matthias Napp
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  3. Julia Seifert
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  4. Axel Ekkernkamp
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Correspondence to Denis Gümbel.

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Interessenkonflikt

D. Gümbel, M. Napp, J. Seifert und A. Ekkernkamp geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Gümbel, D., Napp, M., Seifert, J. et al. Grundlagen der Versorgung offener Frakturen. Trauma Berufskrankh 18, 2–6 (2016). https://doi.org/10.1007/s10039-016-0138-5

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  • DOI: https://doi.org/10.1007/s10039-016-0138-5

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