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Aktuelle Behandlung der Beckenringfraktur

Current treatment of pelvic ring fractures

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Zusammenfassung

Der Verletzung des Beckenringes kommt eine hohe Bedeutung im Rahmen eines Polytraumas zu. Der Einsatz differenzierter diagnostischer Verfahren in der Frühphase des Beckentraumas sowie die frühzeitige Stabilisierung dieser Frakturen im Sinne des „damage control“ haben zu nachhaltigen Verbesserungen in der Behandlung geführt. Dies gilt insbesondere für die Gruppe älterer Patienten, die zahlenmäßig zunehmen und aktuell im Fokus der Weiterentwicklungen von Behandlungsregimen stehen.

Nach wie vor besteht eine erhöhte Mortalität bei Patienten mit Beckenringfrakturen, insbesondere bei polytraumatisierten Patienten. Sowohl die Standardisierung des Notfallmanagements im Schockraum als auch die sinnvolle Erweiterung und Anwendung neuer „tools“ in der Präklinik tragen dazu bei, die Behandlungsoptionen ständig weiterzuentwickeln. Da aber auch die längerfristigen Probleme nach der Versorgung instabiler Beckenringfrakturen weiterhin problematisch bleiben, müssen die notwendigen Behandlungsverfahren weiterhin regelmäßig den Anforderungen angepasst werden.

Abstract

Pelvic injuries are often associated with multiple injuries of other body regions, neurovascular and visceral lesions, as well as hemodynamic instability. The use of a standardized classification characterizing the severity and stability of pelvic fractures and the early stabilization of pelvic ring injuries in appreciation of damage control principles has helped to improve the number of survivors. This is particularly necessary due to the higher number of older patients.

Complex pelvic trauma still represents a life-threatening situation for the patient, particularly in multiple traumatized patients. Standardized clinical investigations and modern concepts even in the preclinical therapy of complex pelvic fractures make a contribution to enhancement of treatment options. Because of the still problematic long-term results after surgery of instable pelvic fractures, the need for modern treatment concepts has to be adapted to the requirements.

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Literatur

  1. Burkhardt M et al (2012) Acute management and outcome of multiple trauma patients with pelvic disruptions. Crit Care 16(4):R163

    Article  PubMed  Google Scholar 

  2. Culemann U et al (2010) Concept for treatment of pelvic ring injuries in elderly patients. A challenge. Unfallchirurg 113(4):258–271

    Article  PubMed  CAS  Google Scholar 

  3. Hauschild O et al (2008) Mortality in patients with pelvic fractures: results from the German pelvic injury register. J Trauma 64(2):449–455

    Article  PubMed  Google Scholar 

  4. Pohlemann T et al (2011) Survival trends and predictors of mortality in severe pelvic trauma: estimates from the German Pelvic Trauma Registry Initiative. Injury 42(10):997–1002

    Article  PubMed  Google Scholar 

  5. Gilliland MD et al (1982) Factors affecting mortality in pelvic fractures. J Trauma 22(8):691–693

    Article  PubMed  CAS  Google Scholar 

  6. Grotz MR et al (2005) Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury 36(1):1–13

    Article  PubMed  CAS  Google Scholar 

  7. Holstein JH et al (2012) What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res 470(8):2090–2097

    Article  PubMed  Google Scholar 

  8. Hopp SJ, Culemann U, Pohlemann T (2009) Surgical management of pelvic penetrating trauma – case report and review of literature. Injury 40(10):1115–1117

    Article  PubMed  CAS  Google Scholar 

  9. Bosch U et al (1992) Classification and management of complex pelvic trauma. Unfallchirurg 95(4):189–196

    PubMed  CAS  Google Scholar 

  10. Tosounidis G et al (2010) Changes in epidemiology and treatment of pelvic ring fractures in Germany: an analysis on data of German Pelvic Multicenter Study Groups I and III (DGU/AO). Acta Chir Orthop Traumatol Cech 77(6):450–456

    PubMed  CAS  Google Scholar 

  11. Chia JP et al (2004) Pelvic fractures and associated injuries in children. J Trauma 56(1):83–88

    Article  PubMed  Google Scholar 

  12. Momiy JP et al (2006) Pelvic fractures in children. Am Surg 72(10):962–965

    PubMed  Google Scholar 

  13. Oransky M et al (2010) Surgical treatment of unstable pelvic fracture in children: long term results. Injury 41(11):1140–1144

    Article  PubMed  CAS  Google Scholar 

  14. American College of Surgeons (2004) Comittee on trauma: advanced trauma life support course for physicians. In: Student Manual 2004. Am Coll Surg, Chicago

  15. Gonzalez RP, Fried PQ, Bukhalo M (2002) The utility of clinical examination in screening for pelvic fractures in blunt trauma. J Am Coll Surg 194(2):121–125

    Article  PubMed  Google Scholar 

  16. Sauerland S et al (2004) The reliability of clinical examination in detecting pelvic fractures in blunt trauma patients: a meta-analysis. Arch Orthop Trauma Surg 124(2):123–128

    Article  PubMed  Google Scholar 

  17. Pehle B et al (2003) Significance of physical examination and radiography of the pelvis during treatment in the shock emergency room. Unfallchirurg 106(8):642–648

    Article  PubMed  CAS  Google Scholar 

  18. Edeiken-Monroe BS, Browner BD, Jackson H (1989) The role of standard roentgenograms in the evaluation of instability of pelvic ring disruption. Clin Orthop Relat Res 240:63–76

    PubMed  Google Scholar 

  19. Hopp SJ et al (2013) Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment. Arch Orthop Trauma Surg 133(7):1003–1009

    Article  PubMed  Google Scholar 

  20. Buse S et al (2005) Urinary tract injuries in polytraumatized patients. Unfallchirurg 108(10):821–828

    Article  PubMed  CAS  Google Scholar 

  21. Trunkey DD (1983) Hemorrhage in pelvic injuries. Sci Am 249(2):20–27

    Article  Google Scholar 

  22. Bone L (1992) Skeletal trauma. In: J.J. Browner B, Levine A, Trafton P (Hrsg) Saunders, Philadelphia

  23. Westhoff J et al (2008) Interventional emergency embolization for severe pelvic ring fractures with arterial bleeding. Integration into the early clinical treatment algorithm. Unfallchirurg 111(10):821–828

    Article  PubMed  CAS  Google Scholar 

  24. Miller PR et al (2003) External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial hemorrhage. J Trauma 54(3):437–443

    Article  PubMed  Google Scholar 

  25. Pohlemann T et al (1996) Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group. Unfallchirurg 99(3):160–167

    Article  PubMed  CAS  Google Scholar 

  26. Regel G et al (1997) Fracture management in polytrauma. Timing and tactics. Unfallchirurg 100(3):234–248

    Article  PubMed  CAS  Google Scholar 

  27. Tscherne H, Pohlemann T (1998) Becken und Acetabulum. Springer, Berlin Heidelberg New York Tokyo

  28. Tile M, HD, Kellam JF et al (1995) In: Müller ME (Hrsg) Comprehensive classification of fractures in the pelvis and acetabulum. Maurice E. Müller Foundation, Berne

  29. Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67–81

    PubMed  CAS  Google Scholar 

  30. Kido A et al (2008) Statistical analysis of fatal bleeding pelvic fracture patients with severe associated injuries. J Orthop Sci 13(1):21–24

    Article  PubMed  Google Scholar 

  31. Verbeek D et al (2008) Acute management of hemodynamically unstable pelvic trauma patients: time for a change? Multicenter review of recent practice. World J Surg 32(8):1874–1882

    Article  PubMed  Google Scholar 

  32. Hauschild O et al (2012) Angioembolization for pelvic hemorrhage control: results from the German pelvic injury register. J Trauma Acute Care Surg 73(3):679–684

    Article  PubMed  Google Scholar 

  33. Noda M et al (2008) Visualization of efficacy of recombinant factor FVIIa in a pelvic fracture patient. J Trauma 64(6):E86–E88

    Article  PubMed  Google Scholar 

  34. Meighan A et al (1998) Pelvic fractures: the golden hour. Injury 29(3):211–213

    Article  PubMed  CAS  Google Scholar 

  35. Osborn PM et al (2009) Direct retroperitoneal pelvic packing versus pelvic angiography: a comparison of two management protocols for haemodynamically unstable pelvic fractures. Injury 40(1):54–60

    Article  PubMed  Google Scholar 

  36. Rommens PM, Hessmann MH (2002) Staged reconstruction of pelvic ring disruption: differences in morbidity, mortality, radiologic results, and functional outcomes between B1, B2/B3, and C-type lesions. J Orthop Trauma 16(2):92–98

    Article  PubMed  CAS  Google Scholar 

  37. Matta JM, Saucedo T (1989) Internal fixation of pelvic ring fractures. Clin Orthop Relat Res 242:83–97

    PubMed  Google Scholar 

  38. Tosounidis G et al (2007) Percutaneous sacroiliac lag screw fixation of the posterior pelvic ring. Increasing safety by standardization of visualization and insertion technique. Unfallchirurg 110(8):669–674

    Article  PubMed  CAS  Google Scholar 

  39. Schweitzer D et al (2008) Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures. Injury 39(8):869–874

    Article  PubMed  Google Scholar 

  40. Frey ME et al (2008) Percutaneous sacroplasty for osteoporotic sacral insufficiency fractures: a prospective, multicenter, observational pilot study. Spine J 8(2):367–373

    Article  PubMed  Google Scholar 

  41. Dong JL, Zhou DS (2011) Management and outcome of open pelvic fractures: a retrospective study of 41 cases. Injury 42(10):1003–1007

    Article  PubMed  Google Scholar 

  42. Pohlemann T et al (1996) Outcome after pelvic ring injuries. Injury 27(Suppl 2):B31–B38

    Article  PubMed  Google Scholar 

  43. Taller S et al (2009) Nonunions or malunions of pelvic fractures. Acta Chir Orthop Traumatol Cech 76(2):121–127

    PubMed  CAS  Google Scholar 

  44. Galanski M (2006) Verletzungen des Beckenrings und der Beckenorgane. Diagnostik und radiologisch-interventionelle Therapie. Chirurg 77:800–814

    Article  PubMed  CAS  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. U. Culemann, H.J. Oestern und T. Pohlemann geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigen oder des gesetzlich bestellten Betreuers vor.

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Authors and Affiliations

  1. Klinik für Unfallchirurgie, Orthopädie und Neurotraumatologie, Allgemeines Krankenhaus Celle, 29223, Celle, Deutschland

    U. Culemann & H.J. Oestern

  2. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland

    T. Pohlemann

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  1. U. Culemann
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  2. H.J. Oestern
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  3. T. Pohlemann
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Correspondence to U. Culemann.

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Culemann, U., Oestern, H. & Pohlemann, T. Aktuelle Behandlung der Beckenringfraktur. Chirurg 84, 809–826 (2013). https://doi.org/10.1007/s00104-012-2391-x

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