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Versorgungswirklichkeit bei osteoporosebedingten Frakturen in der deutschen Unfallchirurgie

Ein Beitrag zur Versorgungsforschung

Reality of treatment of osteoporotic fractures in German trauma departments

A contribution for outcome research

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Zusammenfassung

Ziel dieser Untersuchung war es, die Versorgungssituation von Patienten mit osteoporotischer Fraktur in Deutschland zu ermitteln. Mittels eines Fragebogens wurden 409 unfallchirurgische Kliniken im gesamten Bundesgebiet zu Diagnostik und Therapie dieser Frakturen befragt. Über 80% der Fragebögen wurden zurückgesandt. Die Daten wurden mit den Leitlinien des Dachverbands der deutschsprachigen osteologischen Fachgesellschaften verglichen. 35% der Abteilungen verfügen über ein standardisiertes Vorgehen. Von diesen Kliniken führen 30% die Diagnostik und 51% die Therapie in Übereinstimmung mit den Leitlinien durch. Eine leitliniengerechte Diagnostik und Therapie, also eine leitliniengerechte Versorgung, wird von 12% angeboten. Die Mehrheit der unfallchirurgischen Kliniken verfügt demnach über kein definiertes Vorgehen bei Patienten mit osteoporotischen Frakturen. Unsere Ergebnisse zeigen die momentan unzureichende Versorgungswirklichkeit, aber auch das enorme Verbesserungspotenzial, das unseres Erachtens durch eine verstärkte Aufklärung und interdisziplinäre Zusammenarbeit ausgeschöpft werden kann.

Abstract

The implementation of clinical pathways has a proven positive effect on the diagnostic workup and initiation of therapy in osteoporotic fracture patients. Unlike in most countries, fracture care in Germany is provided by so-called trauma surgeons. Therefore, it is essential to focus on the trauma surgeon for correct diagnostic workup and therapy initiation after a fragility fracture. A questionnaire was mailed to 409 departments of traumatology inquiring about the existence of a standardized clinical pathway for diagnosis and treatment of patients with fragility fractures. One of the central issues of the survey was whether those pathways comply with national guidelines. Only institutions that stated that they followed a clinical pathway were analyzed. 80% of institutions took part in our survey, 35% of which reported following a defined clinical pathway. Diagnostic workup is in concordance with the national guidelines in 30%, and therapy is guideline-based in 51%, with 12% basing both diagnostic workup and therapy on the guidelines. Thus, the vast majority of German traumatology departments do not follow national guidelines regarding osteoporosis diagnostics and therapy in patients with fragility fractures, leading to a great opportunity to improve fragility fracture care by means of both education and interdisciplinary cooperation.

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland

    T. Vogel

  2. Chirurgische Klinik und Poliklinik Innenstadt, Klinikum der Universität München, München, Deutschland

    P. Kampmann, D. Bürklein, B. Ockert, K.G. Kanz & W. Mutschler

  3. Institut für Klinische Radiologie, Klinikum der Universität München, München, Deutschland

    H. Böhm & K.J. Pfeifer

  4. Abteilung und Poliklinik für Sportorthopädie am Klinikum rechts der Isar, Klinikum der Technischen Universität München, München, Deutschland

    C. Kirchhoff

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  1. T. Vogel
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  2. P. Kampmann
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  3. D. Bürklein
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  4. H. Böhm
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  7. K.G. Kanz
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  8. K.J. Pfeifer
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  9. W. Mutschler
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Correspondence to T. Vogel.

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Vogel, T., Kampmann, P., Bürklein, D. et al. Versorgungswirklichkeit bei osteoporosebedingten Frakturen in der deutschen Unfallchirurgie. Unfallchirurg 111, 869–877 (2008). https://doi.org/10.1007/s00113-008-1504-y

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  • DOI: https://doi.org/10.1007/s00113-008-1504-y

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