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Frakturversorgung beim Polytrauma im Kindesalter

Fracture stabilization in polytraumatized children

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Zusammenfassung

Polytraumata sind im Kindesalter selten. Schwere Einzelverletzungen, v. a. isolierte Schädel-Hirn-Traumata, sind am häufigsten. Der Unfalltod ist jedoch nach wie vor die häufigste Todesursache bei Kindern >1 Jahr in industrialisierten Ländern. Die Letalität der Polytraumata im Kindesalter liegt bei ca. 19%. Für das Überleben sind die Extremitätenverletzungen beim polytraumatisierten Kind von eher untergeordneter Bedeutung, spielen jedoch eine wichtige Rolle für das Langzeitergebnis und die Lebensqualität. Die Versorgungsstrategie der Extremitätenverletzungen im Kindesalter im Rahmen der Polytraumaversorgung unterscheidet sich in der Indikationsstellung deutlich zu den Indikationen bei Monoverletzungen. Hierbei wird v. a. Gesichtspunkten wie Intensivpflege, Lagerung und schnellere Mobilisierung Rechung getragen und die Indikation zum operativen Vorgehen viel großzügiger gestellt.

Abstract

Polytrauma is a rare diagnosis in childhood. Even after high-energy accidents isolated injuries of the skull and brain or extremities are more common. Injury is still the most frequent cause of death in childhood in industrialized countries. The lethality of polytraumatized children is about 19%. Injuries of the extremities do not play such an important role for the survival of polytraumatized children but for the definitive outcome. The diagnostic algorithm for polytraumatized children is related to adults and includes spiral computed tomography in the emergency room. Plain radiographs are still the gold standard for the diagnostic workup of fractures. Generally therapeutic approaches in the treatment of fractures in children are often conservative. Because of the special situation in polytrauma with ICU care and the need for venous catheters, fast mobilization and positioning in bed, indications for operative treatment and definitive stabilization of fractures are required for polytraumatized children.

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Authors and Affiliations

  1. Department Orthopädie und Traumatologie, Kindertraumatologie, Klinikum der Albert-Ludwigs-Universität Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland

    P.C. Strohm

  2. Klinik für Kinderchirurgie, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland

    P.P. Schmittenbecher

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Correspondence to P.C. Strohm.

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Strohm, P., Schmittenbecher, P. Frakturversorgung beim Polytrauma im Kindesalter. Unfallchirurg 114, 323–332 (2011). https://doi.org/10.1007/s00113-011-1967-0

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