Zusammenfassung
Operationsziel
Anatomische Reposition und stabile Fixation proximaler Femurfrakturen. Verhinderung von Komplikationen durch sorgfältige Technik und dringliche Operation.
Indikationen
M/1- und M/2-Frakturen jenseits des 4. Lebensjahrs.
Kontraindikationen
E/1-Frakturen, Fixation mit Kirschner-Drähten.
M/3-Frakturen, Fixation mit elastisch-stabiler intramedullärer Marknagelung.
Frakturen bis zum 4. Lebenjahr, Fixation mit Kirschner- Drähten.
Operationstechnik
Darstellung der Fraktur über einen lateralen Zugang. Reposition und Stabilisierung mit zwei bis drei kanülierten Schrauben.
Weiterbehandlung
Entlastung für 4–6 Wochen, dann Vollbelastung. Physiotherapie optional. Im Verlauf kernspintomographische Kontrolle des Femurkopfs wegen der Gefahr einer avaskulären Nekrose bei Auftreten von Beschwerden oder 1 Jahr nach der Fraktur.
Ergebnisse
Ergebnisse Aufgrund der Seltenheit der Fraktur sind nur wenig Ergebnisse publiziert. Nach M/1-Frakturen entstehen häufiger avaskuläre Nekrosen des Femurkopfs als nach M/2-Frakturen. Die Gefahr muss mit bis zu 40% beziffert werden.
Abstract
Objective
Optimal reposition and stable fixation of M/1 and M/2 fractures are necessary. Careful operation and urgent surgery prevent complications.
Indications
M/1 and M/2 fractures of the proximal femur in children > 4 years.
Contraindications
E/1 fractures are fixed with Kirschner wires.
M/3 fractures are fixed with elastic stable intramedullary nailing.
Fractures up to the age of 4 are fixed with Kirschner wires.
Surgical Technique
Surgical approach via a lateral incision. Anatomic fixation of the fracture with two to three cannulated screws.
Postoperative Management
No weight bearing during the first 4–6 weeks. Physiotherapy is optional. Magnetic resonance imaging at least 1 year after the fracture or immediately in case of problems to control the vascular situation of the femoral head.
Results
Due to the rarity of these fractures, only few results from large series have been published. M/1 fractures show a higher complication rate than M/2 fractures. The risk of avascular necrosis has to be estimated at up to 40%.
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Dietz, HG. Schraubenosteosynthese proximaler Femurfrakturen im Kindesalter. Orthop Traumatol 21, 349–357 (2009). https://doi.org/10.1007/s00064-009-1810-8
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DOI: https://doi.org/10.1007/s00064-009-1810-8