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Ablauforganisation – unfallchirurgisches und anästhesiologisches Management bei Hüftfrakturen

Procedural organisation: surgical and anaesthesiological management in hip fractures

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Zusammenfassung

Die allgemeinen und speziellen Komplikationen bei Patienten mit hüftnahen Frakturen, wie auch die in der Folge resultierende Beeinträchtigung der Mobilität und der kognitiven Funktion, lassen sich durch einen strukturierten Ablauf von Diagnostik, Therapie und Rehabilitation, basierend auf einem multidisziplinären Behandlungspfad, reduzieren.

In der initialen Phase liegt der Fokus nach der Sicherung der Diagnose und dem Einleiten einer adäquaten Schmerztherapie auf der Erfassung der allgemeinen Risikofaktoren, der kognitiven Funktion und einem geriatrischen Screening. Die Indikation zur Operation und die Festlegung der Operationsmethode (totale oder teilweise Hüftprothese, Osteosynthese) werden von unfallchirurgischer Seite vorgegeben. Die unfallchirurgische Therapieentscheidung orientiert sich, abgesehen vom Frakturtyp, am Alter des Patienten, seiner kognitiven Funktion, der vorbestehenden Mobilität bzw. dem funktionellen Anspruch und der Operationstauglichkeit. Im Mittelpunkt der anästhesiologischen Evaluierung steht die Risikostratifzierung für den Patienten hinsichtlich der Operationstauglichkeit und die Frage, ob wesentliche Grunderkrankungen in einem definierten Zeitraum (24 bis maximal 48 h) verbessert werden können. Die präoperative Diagnostik und eventuell erforderliche Interventionen sind interdisziplinär zu koordinieren. Postoperativ erfolgt eine weitere Evaluierung hinsichtlich der Lebensumstände des Patienten vor dem Sturzereignis, des Ernährungszustandes, des weiteren Versorgungsbedarfs sowie hinsichtlich sturzspezifischer Medikamente, die Osteoporosetherapie und ein Delir-Screening.

Summary

In patients with hip fractures, in order to reduce the high number of general complications and those associated with the specific treatment, the functional loss and cognitive impairment, implementation of co-ordinated, multidisciplinary treatment pathways, and rehabilitation, is mandatory. The imminent treatment of proximal femoral fracture consists of major orthopaedic surgery in most cases (total or partial hip arthroplasty, osteosynthesis). After the diagnosis of a hip fracture, an adequate pain medication should be initiated. The decison making for the fracture treatment includes fracture type, patient’s age, cognitive function, mobility before the fall and functional demands of the patient in the context of patients life expectancy and goals of care. The anaesthesiological evaluation focuses on risk assessment. Medical abnormalities should be optimized within 24 to 48 h, or an increased perioperative risk due to comorbidities has to be accepted. The timing and the course of further preoperative diagnostic examinations and therapeutic interventions should be co-ordinated between the involved medical disciplines. After the operation a structured screening for delirium should be initiated and further evaluation of patient’s nutrition, fall-associated medication, living conditions and osteoporosis treatment has to be performed.

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Authors and Affiliations

  1. Abteilung für Unfallchirurgie, LKH Klagenfurt, Klagenfurt, Austria

    Ernst J. Müller

  2. Unfallkrankenhaus Meidling, Köglergasse 2A, 1120, Vienna, Austria

    Ingeborg Gerstorfer

  3. A.ö. Krankenhaus der Elisabethinen Klagenfurt GmbH, Klagenfurt, Austria

    Walter Müller MSc, MD

  4. Department of Acute Geriatrics, Hospital of Gmunden, Miller von Aichholzstraße 49, 4810, Gmunden, Austria

    Peter Dovjak MD

  5. Christian-Doppler-Klinik, Ignaz Harrer-Straße 79, 5020, Salzburg, Austria

    Bernhard Iglseder MD

  6. Abteilung für Akutgeriatrie und Remobilisation und Abteilung für chronisch Kranke, Klinkum Klagenfurt am Wörthersee, Klagenfurt, Austria

    Georg Pinter

  7. Vorstand Institut für physikalische Medizin und Rehabilitation, SMZ-Sophienspital, Apollogasse 19, 1070, Vienna, Austria

    Katharina Pils

  8. Medizinische Abteilung, Hanusch Krankenhaus, Vienna, Austria

    Peter Mikosch

  9. AUVA Trauma Center Meidling, Kundratstraße 37, 1120, Vienna, Austria

    Michaela Zmaritz & Heinrich W. Thaler MD

  10. Weißgerber Lände 40, 1030, Vienna, Austria

    Monique Weissenberger-Leduc MD

  11. Landeskrankenhaus Hochzirl, 6170, Zirl, Tyrol, Austria

    Markus Gosch MD

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  1. Ernst J. Müller
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Müller, E., Gerstorfer, I., Dovjak, P. et al. Ablauforganisation – unfallchirurgisches und anästhesiologisches Management bei Hüftfrakturen. Wien Med Wochenschr 163, 435–441 (2013). https://doi.org/10.1007/s10354-013-0249-6

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