Skip to main content
SpringerLink
Log in

Endoprothetik nach Trauma

Programm- oder Notfalloperation?

Arthroplasty following trauma

Programmed or emergency surgery?

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die Indikation für die Prothesenimplantation nach Trauma ergibt sich in der Regel aus der Schwere und dem Typ der Fraktur sowie dem hohen Alter des Patienten. Somit ist die Ausgangslage für den operativen Eingriff allein aufgrund dieser Bedingungen deutlich schlechter als bei der primären endoprothetischen Versorgung degenerativer Gelenkerkrankungen. Auch die Planung der Operation erfordert eine sensitivere und meist aufwändigere Diagnostik als in der elektiven Situation, zudem geht die Prothesenimplantation nach Trauma mit einer höheren Komplikationsrate einher. Somit stellen sich folgende Fragen, die im vorliegenden Beitrag behandelt werden: Ist die notfallmäßige endoprothetische Versorgung nach Fraktur vertretbar? Wie sollte der Patient aufgeklärt werden? Stellt die endoprothetische Versorgung immer eine „Programmoperation“ dar und wann ist folglich der günstigste Operationszeitpunkt? Gilt der elektive Versorgungsansatz auch für die einfache mediale Schenkelhalsfraktur als klassische Indikation für die Endoprothesenversorgung nach Knochenbruch? Welches sind die operativen Besonderheiten der endoprothetischen Frakturversorgung und welcher Chirurg kann und sollte diesen Eingriff durchführen?

Abstract

The indication for arthroplasty following trauma is generally established on the basis of the severity and type of the fracture, as well as on patient age. Thus, the initial situation in terms of surgery, as a result of these conditions alone, is significantly worse than in the case of primary endoprosthetic treatment of degenerative joint disease. Surgical planning also requires a more sensitive and usually more intensive diagnostic workup than for elective surgery, in addition to which arthroplasty following trauma is associated with a higher complication rate. For this reason, the present article examines the following questions: Is emergency endoprosthetic treatment following fracture justifiable? How should the procedure be explained to the patient? Does endoprosthetic treatment always represent “programmed surgery” and, if so, when is the optimal time for surgery? Does elective treatment even for simple medial femoral neck fractures count as a classic indication for endoprosthetic treatment following bone fracture? What are the particular surgical features of endoprosthetic fracture treatment and which surgeon can and should perform this type of surgery?

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Abboud JA, Patel RV, Booth RE Jr, Nazarian DG (2004) Outcomes of total hip arthroplasty are similar for patients with displaced femoral neck fractures and osteoarthritis. Clin Orthop 421:151–154

    Article  PubMed  Google Scholar 

  2. Berry DJ, Knoch M von, Schleck CD, Harmsen WS (2005) Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am 87:2456–2463

    Article  PubMed  Google Scholar 

  3. Blomfeldt R, Tornkvist H, Ponzer S et al (2005) Comparison of internal fixation with total hip replacement for displaced femoral neck fractures. Randomized, controlled trial performed at four years. J Bone Joint Surg Am 87:1680–1688

    Article  PubMed  Google Scholar 

  4. Boraiah S, Ragsdale M, Achor T et al (2009) Open reduction internal fixation and primary total hip arthroplasty of selected acetabular fractures. J Orthop Trauma 23:243–248

    Article  PubMed  Google Scholar 

  5. Bystrom S, Espehaug B, Furnes O, Havelin LI (2003) Femoral head size is a risk factor for total hip luxation: a study of 42,987 primary hip arthroplasties from the Norwegian Arthroplasty Register. Acta Orthop Scand 74:514–524

    Article  PubMed  Google Scholar 

  6. Daffner SD, Cipolle MD, Phillips TG (2008) Fracture of the humeral neck with intrathoracic dislocation of the humeral head. J Emerg Med Jul 21. [Epub ahead of print]

  7. Frerichmann U, Raschke MJ, Stockle U et al (2007) Proximale Femurfrakturen im Alter – Auswertung von Krankenkassendaten von über 23 Mio. Versicherten – Teil 2. Unfallchirurg 110:610–616

    Article  CAS  PubMed  Google Scholar 

  8. Furnes O, Lie SA, Espehaug B et al (2001) Hip disease and the prognosis of total hip replacements. A review of 53,698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987–99. J Bone Joint Surg Br 83:579–586

    Article  CAS  PubMed  Google Scholar 

  9. Gjertsen JE, Lie SA, Fevang JM et al (2007) Total hip replacement after femoral neck fractures in elderly patients: results of 8,577 fractures reported to the Norwegian Arthroplasty Register. Acta Orthop 78:491–497

    Article  PubMed  Google Scholar 

  10. Josten C, Korner J (1998) Verletzungen des Hüftgelenks und des proximalen Femurs. In: Mutschler W, Haas N (Hrsg) Praxis der Unfallchirurgie, 1. Aufl. Thieme, Stuttgart New York, S 395–406

  11. Keats AS (1978) The ASA classification of physical status – a recapitulation. Anesthesiology 49:233–236

    Article  CAS  PubMed  Google Scholar 

  12. Kraus E, Harstall R, Borisch N, Weber D (2009) Primary total elbow replacement for complex intra-articular distal humerus fractures. Unfallchirurg 112:692–698

    Article  CAS  PubMed  Google Scholar 

  13. Maroney SS, Devinney DS (2009) Intrathoracic fracture-dislocation of the proximal humerus treated with reverse total shoulder arthroplasty. Orthopedics 32:924–927

    Article  PubMed  Google Scholar 

  14. Mishra V, Thomas G, Sibly TF (2004) Results of displaced subcapital fractures treated by primary total hip replacement. Injury 35:157–160

    Article  CAS  PubMed  Google Scholar 

  15. Muller-Mai C, Schulze-Raestrup U, Ekkernkamp A, Smektala R (2006) Influence of operation time point on the frequency of early complications after surgical femoral neck fracture treatment. Chirurg 77:61–69

    Article  CAS  PubMed  Google Scholar 

  16. Muller CA, Bayer J, Szarzynski E, Sudkamp NP (2008) Implantation of bipolar prosthesis for treatment of medial femoral neck fractures in the elderly – clinical and radiographic outcome. Zentralbl Chir 133:590–596

    Article  CAS  PubMed  Google Scholar 

  17. Petersen AB (2006) Studies based on the Danish Hip Arthroplasty Register. Dan Med Bull 53:103

    Google Scholar 

  18. Raunest J, Engelmann R, Jonas M, Derra E (2001) Morbidity and mortality in para-articular femoral fractures in advanced age. Results of a prospective study. Unfallchirurg 104:325–332

    Article  CAS  PubMed  Google Scholar 

  19. Schleicher I, Kordelle J, Jurgensen I et al (2003) Femoral neck fractures in the elderly – bipolar hemiarthroplasty in total hip replacement. Unfallchirurg 106:467–471

    Article  CAS  PubMed  Google Scholar 

  20. Schliemann B, Seybold D, Gessmann J et al (2009) Bipolar hemiarthroplasty in femoral neck fractures – impact of duration of surgery, time of day and the surgeon’s experience on the complication rate. Z Orthop Unfall 147:689–693

    Article  CAS  PubMed  Google Scholar 

  21. Schoffl H, Froschauer SM, Huemer GM (2009) Intrathoracal displacement of the humeral head after fracture. Wien Klin Wochenschr 121:246

    Article  PubMed  Google Scholar 

  22. Skeide BI, Lie SA, Havelin LI, Engesaeter LB (1996) Total hip arthroplasty after femoral neck fractures. Results from the national registry on joint prostheses. Tidsskr Nor Laegeforen 116:1449–1451

    CAS  PubMed  Google Scholar 

  23. Tidermark J, Zethraeus N, Svensson O et al (2002) Femoral neck fractures in the elderly: functional outcome and quality of life according to EuroQol. Qual Life Res 11:473–481

    Article  PubMed  Google Scholar 

  24. Tidermark J, Ponzer S, Svensson O et al (2003) Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. A randomised, controlled trial. J Bone Joint Surg Br 85:380–388

    Article  CAS  PubMed  Google Scholar 

  25. Voigt C, Lill H (2007) Primary hemiarthroplasty in proximal humerus fractures. Orthopade 36:1002–1012

    Article  CAS  PubMed  Google Scholar 

  26. Voigt C, Ewig M, Vosshenrich R, Lill H (2009) Value of MRI in preoperative diagnostics of proximal humeral fractures compared to CT and conventional radiography. Unfallchirurg Jul 19. [Epub ahead of print]

  27. Woolson ST, Kang MN (2007) A comparison of the results of total hip and knee arthroplasty performed on a teaching service or a private practice service. J Bone Joint Surg Am 89:601–607

    Article  PubMed  Google Scholar 

  28. Zofka P (2007) Bipolar hip hemiarthroplasty. Acta Chir Orthop Traumatol Cech 74:99–104

    CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Keine Angaben

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstraße 1, 48149, Münster, Deutschland

    C. Kösters, B. Schliemann &  M.J. Raschke

Authors
  1. C. Kösters
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Schliemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M.J. Raschke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M.J. Raschke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kösters, C., Schliemann, B. & Raschke, M. Endoprothetik nach Trauma . Trauma Berufskrankh 12, 47–52 (2010). https://doi.org/10.1007/s10039-010-1599-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-010-1599-6

Schlüsselwörter

Keywords

Search

Navigation