Zusammenfassung
Obwohl Beckenringfrakturen im Vergleich zum Gesamtkollektiv aller Frakturen mit 0,3–8,0% eher selten sind, steigt die Zahl von Beckenfrakturen bei älteren Patienten. Entsprechend des höheren Alters unterscheiden sich Unfallmechanismus, Frakturmorphologie, Therapie und Nachbehandlung. Frakturen im Alter werden vorwiegend durch Niedrigenergietraumen verursacht. Dieses erschwert die Diagnosefindung und führt insbesondere bei Insuffizienzfrakturen des Sakrums zu einem langen Leidensweg bis die richtigen therapeutischen Schritte eingeleitet werden. Bei der Therapie von Beckenringfrakturen im Alter muss ursächlich zwischen Hochenergietraumen, die im zunehmenden Alter abnehmen und Niedrigenergietraumen, die entsprechend zunehmen, unterschieden werden. Der schwerverletzte ältere Patient mit Beckenfraktur unterliegt einem höheren Risiko, einen hämorrhagischen Schock zu erleiden, gleichzeitig ist bei komplexen Frakturmustern und Osteoporose die Indikation zur Beckenzwinge kritisch zu stellen. Frakturen, die durch Niedrigenergietraumen entstehen führen, erscheinen häufig als isolierte Verletzungen des vorderen Beckenrings. Inwieweit eine Fraktur des hinteren Beckenrings übersehen wird ist fraglich. Die Frakturen können z. T. konservativ behandelt werden. Entscheidend für eine konservative Behandlung ist der Ausschluss einer Verletzung des hinteren Beckenrings, die meist durch eine Computertomographie erfolgt. Wenn eine osteoporotische Fraktur des Sakrums vorliegt, kann diese entweder durch konservative Maßnahmen oder Verschraubung aber auch mittels zusätzlichen Augmentationsverfahren wie Sakroplastie oder Sakroplastie mit zusätzlicher iliosakraler Verschraubung versorgt werden. Gerade bei Älteren empfiehlt sich eine perkutane, dreidimensional navigierte, iliosakrale Verschraubung, um eine suffiziente Schmerzreduktion und frühe Mobilisation zu gewährleisten.
Abstract
The incidence of pelvic fractures at 0.3–8% is low compared to all fractures. Nevertheless, the number of pelvic fractures in the elderly is increasing. Due to the increased age of the patient differences in trauma mechanism, fracture pattern and therapy occur. Most pelvic fractures in the elderly are caused by low-energy trauma. This makes it difficult to find the right diagnosis especially in insufficiency fracture of the pelvis. The time until the right treatment is started is prolonged significantly. Elderly patients who suffer from a high-energy fracture have a significantly higher risk of haemorrhage. At the same time emergency stabilisation of the pelvis using a C-clamp is dangerous due to the special fracture morphology with transiliac instabilities and the combination with osteoporosis. Low-energy trauma leads to simple fractures of the pubis, which often can be treated without operation. In these cases fractures of the dorsal pelvic ring need to be excluded using CT scan. Fracture of the dorsal part of the pelvic ring such as insufficiency fractures of the sacrum should be stabilized by 3D-guided percutaneous iliosacral screw fixation to reduce pain and allow early mobilisation.
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Fuchs, T., Rottbeck, U., Hofbauer, V. et al. Beckenringfrakturen im Alter. Unfallchirurg 114, 663–670 (2011). https://doi.org/10.1007/s00113-011-2020-z
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DOI: https://doi.org/10.1007/s00113-011-2020-z