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Wertigkeit einer kombinierten Ossifikationsprophylaxe mit Indometacin und Bestrahlung bei Azetabulumfrakturen

Value of a combined ossification prophylaxis with indomethacin and radiotherapy for acetabular fractures

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Zusammenfassung

Hintergrund

In der Azetabulumchirurgie gelten heterotope Ossifikationen (HO) als eine wesentliche zugangsabhängige Komplikation. Es stellte sich die Frage, ob eine Kombinationsprophylaxe mit Indometacin und Bestrahlung der Monoprophylaxe beim dorsalen, erweiterten iliofemoralen oder kombiniertem Zugang überlegen ist.

Material und Methoden

24 Patienten mit Kombinationsprophylaxe wurden nach 24 Monaten retrospektiv untersucht. Anhand einer systematischen Literaturrecherche erfolgte die vergleichende Auswertung unterschiedlicher Prophylaxeregime. Eigene Ergebnisse wurden in den Vergleich integriert.

Ergebnisse

Im eigenen Krankengut entwickelte ein Patient eine HO. Die Literaturanalyse zeigte die niedrigsten Ossifikationsraten nach Kombinationsprophylaxe. In den untersuchten Gruppen waren die Unterschiede in den Häufigkeiten statistisch signifikant (p<0,01, χ2-Test).

Schlussfolgerung

Aufgrund unserer und anderer publizierter Daten gibt es Hinweise dafür, dass eine Kombinationsprophylaxe anderen Regimen überlegen ist.

Abstract

Background

Heterotopic ossification is a complication in patients with surgically treated acetabular fractures. The incidence is related to the surgical approach (extended iliofemoral, posterior or a combined approach). The objective of this study was to evaluate the incidence of heterotopic ossification in patients with acetabular fractures who received a combined prophylaxis with both a single dose of radiation and indomethacin compared to those who received only a prophylaxis with radiation or indomethacin.

Patients and Methods

A total of 24 patients with a combined prophylaxis after surgery were examined retrospectively 24 months after trauma. A systematic literature review was performed and our own results were compared with different methods for prophylaxis of heterotopic ossification from the literature.

Results

Only one patient developed a heterotopic ossification. In accordance with the literature, combined prophylaxis showed the least incidence of ossification compared to the other methods. Differences in incidence frequencies were significant between the different prophylaxis methods.

Conclusion

A combined prophylaxis for heterotopic ossification in surgically treated acetabular fractures seems to be a better alternative than a prophylaxis with radiation or indomethacin alone.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie, Otto-von-Guericke-Universität, Leipziger Straße 44, 39120 , Magdeburg

    S. Piatek, D. Arbter & S. Winckler

  2. Klinikum Südstadt, Rostock

    T. Westphal

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  1. S. Piatek
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  2. T. Westphal
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Correspondence to S. Piatek.

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Piatek, S., Westphal, T., Arbter, D. et al. Wertigkeit einer kombinierten Ossifikationsprophylaxe mit Indometacin und Bestrahlung bei Azetabulumfrakturen. Unfallchirurg 109, 556–562 (2006). https://doi.org/10.1007/s00113-006-1083-8

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