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Unfallchirurgie

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Qualitätssicherung durch Zusammenarbeit in der Chirurgie

Part of the book series: Langenbecks Archiv für Chirurgie ((KONGRESSBAND,volume 1995))

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Summary

As the acetabulum is the most loaded joint, exact reduction of the weight-bearing part of the articular surface is essential to prevent post-traumatic coxarthrosis after acetabular fracture. A prerequisite for successful treatment is the precise classification of the frequently complex fracture types according to the principles of Letournel. This is based on a complete radiological investigation, including anteroposterior views, iliac-oblique, obturator-oblique radiographs, and computed tomography (CT) scans of the fractured joint. Concerning the choice of surgical approach, the entire operative management (reduction and fixation) as well as intraoperative complications have to be considered. Anterior column fractures are mostly stabilized using an ilioinguinal approach. For fractures of the posterior column regions, the Kocher-Langenbeck approach is preferable. The combined anterior and posterior approach as well as extended exposures should be restricted to special complex fractures or stabilization of delayed fractures and nonunions.

Zusammenfassung

Die Acetabulumfraktur betrifft das am stärksten belastete Gelenk des Körpers. Eine exakte Wiederherstellung der Gelenkfläche im belasteten Anteil zur Vermeidung einer posttraumatischen Coxarthrose ist daher zwingend. Voraussetzung einer erfolgreichen Behandlung ist die exakte Klassifikation der häufig komplexen Frakturform nach den Kriterien von Letournel auf der Grundlage einer vollständigen radiologischen Diagnostik (Röntgen-Beckenübersicht, Ala-, Obturator-Aufnahme, 2D-CT). Bei der Wahl des Zugangs muß der gesamte Operationsablauf mit den erforderlichen Repositionsmanövern und der erforderlichen Stabilisierung einschließlich möglicher intraoperativer Schwierigkeiten berücksichtigt werden. Frakturen des vorderen Pfeilers werden am günstigsten über den ilioinguinalen Zugang stabilisiert, während bei Frakturen der hinteren Pfeilerregion der Kocher-Langenbeck-Zugang angewendet wird. Kombinierte oder erweiterte Zugänge sollten auf seltene, anders nicht stabilisierbare komplexe Frakturen oder veraltete Frakturen beschränkt bleiben.

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Authors and Affiliations

  1. Abteilung für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    A. Meißner & M. Fell

  2. Klinik und Poliklinik für Unfallchirurgie, Plastische und Wiederherstellungschirurgie, Klinikum, Universität Göttingen, Robert-Koch-Straße 40, 37076, Göttingen, Deutschland

    K. M. Stürmer

  3. Abteilung für Unfallchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland

    I. Coen & K. P. Schmit-Neuerburg

  4. Krankenhaus Am Urban, Dieffenbachstraße 1, 10967, Berlin, Deutschland

    R. Letsch, H. J. Kock & J. Hanke

  5. Berufsgenossenschaftliche Kliniken Bergmannsheil Bochum, Universitätsklinik, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    A. Ekkernkamp, P. A. W. Ostermann & G. Muhr

  6. Unfallchirurgische Klinik, Medizinische Hochschule Hannover, D-30623, Hannover, Deutschland

    P. Lobenhoffer

  7. Unfall- und Wiederherstellungschirurgie, Virchow-Klinikum, Humboldt-Universität Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    R. Hoffmann & N. P. Haas

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  1. A. Meißner
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  2. M. Fell
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  3. K. M. Stürmer
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  4. I. Coen
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  5. K. P. Schmit-Neuerburg
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  6. R. Letsch
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  7. H. J. Kock
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  9. A. Ekkernkamp
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  10. P. A. W. Ostermann
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  12. P. Lobenhoffer
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Editors and Affiliations

  1. Steinhölzle 16, D-89197, Westerstetten-Vorderdenkental, Deutschland

    W. Hartel

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© 1995 Springer-Verlag Berlin Heidelberg

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Meißner, A. et al. (1995). Unfallchirurgie. In: Hartel, W. (eds) Qualitätssicherung durch Zusammenarbeit in der Chirurgie. Langenbecks Archiv für Chirurgie, vol 1995. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-85235-0_41

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  • DOI: https://doi.org/10.1007/978-3-642-85235-0_41

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-60425-9

  • Online ISBN: 978-3-642-85235-0

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