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Pseudarthrosen

Von der Diagnose bis zur Ausheilung

Non-unions

From diagnosis to healing

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Zusammenfassung

Pseudarthrosen stellen ein relevantes medizinisches und sozioökonomisches Problem dar. Unterschieden werden hyper-, oligo- und atrophe sowie septische und aseptische Pseudarthrosen. Die korrekte Klassifikation ist für die Therapie essenziell. Das „diamond concept“ beschreibt 5 Säulen, auf denen die Knochenheilung beruht und die bei der Pseudarthrosentherapie gleichwertig beachtet werden müssen: Osteogenese (Stammzellen) – Osteoinduktion (Wachstumsfaktoren) – Osteokonduktion (Gerüst) – mechanische Stabilität – Vaskularität. Einfluss haben zudem prädisponierende Faktoren des Patienten. Der Goldstandard in der Therapie sind Pseudarthrosenresektion, Dekortikation und autologe Spongiosaplastik. Für kein anderes der zahlreich zur Verfügung stehenden Verfahren wurde bisher in der Monotherapie eine Überlegenheit nachgewiesen. Die Kombination verschiedener Verfahren – die Polytherapie – erscheint jedoch Erfolg versprechend. Ziel ist es, die Konzepte zu optimieren.

Abstract

Non-unions are a relevant medical and socio-economic problem. Hyper-, oligo- and atrophic non-unions as well as septic and aseptic non-unions are differentiated. Correct classification is essential for the selected therapy. The “diamond concept” describes five pillars, on which bone healing is based and that have to be considered in the treatment of non-unions: osteogenic cells (mesenchymal stem cells), osteoinduction (growth factors), osteoconduction (scaffolds), mechanical stability, and vascularization. Factors that predispose to non-union also influence fracture healing. The gold standard of therapy are still resection of the non-union, decortication and autologous bone grafting. No advantage could be proven for any of the numerous procedures in monotherapy. But the combination of various procedures – polytherapy – seems to be promising. The aim is to optimize these concepts.

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  1. Klinik für Orthopädie und Unfallchirurgie, Zentrum für Pseudarthrosen, BG-Unfallklinik Duisburg, Großenbaumer Allee 250, 47249, Duisburg, Deutschland

    E. Steinhausen, M. Glombitza, H.-J. Böhm, P.-M. Hax & D. Rixen

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  1. E. Steinhausen
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  2. M. Glombitza
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  3. H.-J. Böhm
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  4. P.-M. Hax
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Correspondence to E. Steinhausen.

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Steinhausen, E., Glombitza, M., Böhm, HJ. et al. Pseudarthrosen . Unfallchirurg 116, 633–649 (2013). https://doi.org/10.1007/s00113-013-2413-2

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