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Frakturen des Kniegelenks im hohen Lebensalter

Osteosynthese vs. Gelenkersatz

Fractures of the knee joint in the elderly

Osteosynthesis versus joint replacement

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Zusammenfassung

Hintergrund

Das Ziel der offenen Reposition und internen Fixation („open reduction and internal fixation“, ORIF) nach kniegelenknaher Fraktur ist die exakte anatomische Rekonstruktion der Gelenkflächen, um ein frühes und belastungsstabiles Knochenlager zu schaffen. Die primäre Endoprothetik als Erstbehandlung der kniegelenknahen Fraktur kann bei einer geringen Anzahl geriatrischer Patienten eine alternative Behandlungsoption darstellen.

Ziel der Arbeit

Gegenüberstellung von Chancen und Risiken der primären Endoprothetik im Vergleich zur ORIF als Goldstandard der Erstbehandlung kniegelenknaher Frakturen im höheren Lebensalter.

Material und Methode

Es erfolgte eine selektive Literaturrecherche unter Berücksichtigung nationaler Empfehlungen und eigener Erfahrungen als Verantwortliche eines Zentrums für Alterstraumatologie.

Ergebnisse

Ist der Weichteilmantel durch die Verletzung nicht geschädigt, kann die primäre Endoprothetik einen Vorteil gegenüber der ORIF bieten, wenn bei einer vorbestehenden Arthrose und hohem Lebensalter ein belastungsstabiles Gelenk wegen schlechter Compliance unabdingbar ist.

Diskussion

Zwar wird durch die Prothese das Risiko für einen postoperativen Korrekturverlust minimiert, allerdings sind die Revisionsmöglichkeiten durch voluminöse Prothesen mit hohem Kopplungsgrad sehr beschränkt. Die Indikation zur primären Prothesenimplantation zur Akutbehandlung kniegelenknaher Frakturen sollte daher eng gestellt werden, da sie der erste und letzte Eingriff zur Frakturbehandlung des geriatrischen Patienten sein sollte.

Abstract

Background

The aim of open reduction and internal fixation (ORIF) of fractures around the knee joint is the exact anatomic reconstruction of joint surfaces in order to achieve an early and load stable bone situation. Primary endoprosthetics as the initial treatment can represent an alternative treatment option for a closely selected number of geriatric patients.

Objectives

The chances and risks of primary endoprosthetics in comparison to ORIF as the gold standard for initial treatment of fractures close to the knee joint in the elderly are presented

Material and methods

A selective search of the literature was carried out in consideration of national recommendations and own experience gained as head of a center for geriatric traumatology.

Results

If the soft tissue coverage is not damaged by the injury, primary endoprosthetics can offer advantages compared to ORIF when a load stable joint is indispensable due to poor compliance, pre-existing arthritis and advanced age.

Discussion

The risk of postoperative loss of correction is minimized by the prosthesis but the revision possibilities are very limited due to voluminous prostheses with a high degree of coupling. The indications for primary prosthesis implantation for acute treatment of fractures close to the knee should therefore be closely controlled because this should be the first and last intervention for fracture treatment in geriatric patients.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Pape, A. Hoffmann, T. Gerich, M. Van der Kerkhofe, M. Weber, H.-C. Pape geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Orthopädische Klinik, Centre Hospitalier de Luxembourg, 78 rue d’Eich, 1460, Luxembourg, Luxembourg

    D. Pape & A. Hoffmann

  2. Sports Medicine Research Laboratory, Public Research Centre for Health, Luxembourg, Centre Médical de la Fondation Norbert Metz, Luxembourg, Luxembourg

    D. Pape & A. Hoffmann

  3. Unfallchirurgische Klinik, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg

    T. Gerich

  4. Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland

    M. Van der Kerkhofe, M. Weber & H.-C. Pape

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  1. D. Pape
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  2. A. Hoffmann
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  3. T. Gerich
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  4. M. Van der Kerkhofe
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  5. M. Weber
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  6. H.-C. Pape
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Correspondence to D. Pape.

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Pape, D., Hoffmann, A., Gerich, T. et al. Frakturen des Kniegelenks im hohen Lebensalter. Orthopäde 43, 365–373 (2014). https://doi.org/10.1007/s00132-014-2267-5

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  • DOI: https://doi.org/10.1007/s00132-014-2267-5

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