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Behandlung der Schenkelhalsfrakturen

Treatment of femoral neck fractures

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Zusammenfassung

Aufgrund der hohen Inzidenz (600–900/Jahr >65 Jahre), der zu erwartenden Zunahme bis zum 5fachen im Jahr 2050 und der zunehmenden kapazitativen Beschränkungen in den Bereitschaftsdiensten sind Schenkelhalsfrakturen gesundheitspolitisch und ökonomisch relevant. Eine frühzeitige operative Versorgung innerhalb von 6 h verbessert die Ergebnisse der Osteosynthese, innerhalb von 24 h reduziert sie die allgemeinen Komplikationen und innerhalb 48 h die Mortalität. Es besteht Übereinkunft, dass das Hüftgelenk bei jungen, aktiven Patienten erhalten werden sollte, unabhängig vom Bruchtyp und der Dislokation; bei stärkerer Dislokation beim alten Patienten ist eine endoprothetische Versorgung wünschenswert. Unterschiedliche Versorgungstaktiken bestehen bez. der Behandlung der eingestauchten Fraktur, der Festlegung des Dislokationsgrades sowie des Alters und Zustandes derjenigen Patienten, die von einer Endoprothese profitieren. Totalendoprothesen haben beim aktiveren Patienten bessere Ergebnisse als Hemiarthroplastiken. Beim älteren Patienten sind zementierte Endoprothesen vorzuziehen. Die DGU empfiehlt die prophylaktische Osteosynthese der impaktierten Fraktur, die Osteosynthese der nicht dislozierten Fraktur und der gering dislozierten Frakturen zeitnah.

Abstract

Due to the high incidence (600–900 patients/year >65 years old), the expected increase in frequency by a factor of five by 2050, and the proportionately shrinking capacity in trauma centers, femoral neck fractures are relevant to health care both economically and politically. Surgical treatment within 6 h improves results of osteosynthesis, within 24 h reduces general complications, and within 48 h reduces mortality. The literature displays great regional differences in methods and results. There is however general agreement that the hip joint should be preserved in young, active patients, regardless of fracture type and dislocation and that endoprosthesis is desirable for elderly patients with severe dislocation. The controversies begin with compressed fracture, determination of the degree of dislocation, and age and physical condition of patients who would profit from endoprosthesis. Total endoprostheses show better results in more active patients than do hemiarthroconstructions. Cemented endoprostheses are preferable in older patients due to their better function and lower postoperative pain. The DGU recommends prophylactic osteosynthesis for impacted fracture and osteosynthesis for nondislocated fracture or when closely following slightly dislocated fracture.

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  1. Klinik für Unfall-, Wiederherstellungs- und Handchirurgie, Städtisches Klinikum Dresden-Friedrichstadt, Friedrichstraße 41, 0167, Dresden, Deutschland

    F. Bonnaire, T. Lein & K.-J. Engler

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  1. F. Bonnaire
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  2. T. Lein
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  3. K.-J. Engler
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Correspondence to F. Bonnaire.

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Bonnaire, F., Lein, T. & Engler, KJ. Behandlung der Schenkelhalsfrakturen. Chirurg 79, 595–616 (2008). https://doi.org/10.1007/s00104-008-1551-5

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