Osteoporotische Frakturen des Beckenrings

 

 Buy Article Permissions and Reprints

Zusammenfassung

Durch die Alterung der Bevölkerung sind wir mit einer Zunahme an osteoporotischen und Ermüdungsfrakturen des Beckenrings konfrontiert. Sie werden durch niedrigenergetische Traumen verursacht. Die konventionelle Diagnostik ist weniger aufschlussreich als bei Jugendlichen und Erwachsenen, eine CT- oder MRT-Diagnostik ist erforderlich. Die Erscheinungsformen sind multipel und bieten ein ganzes Spektrum von Instabilitäten. Die konventionelle Klassifikation trifft nicht auf alle Erscheinungsformen dieser Frakturen zu. Die Behandlung umfasst sowohl konservative als auch operative Verfahren. Entscheidend dabei sind der Grad und die Lokalisation der Instabilität. Die Osteosyntheseformen unterscheiden sich von denen der Beckenringfrakturen bei Erwachsenen. Der transsakrale Positionsstab, die iliolumbale Fixation und die winkelstabile Plattenosteosynthese kommen zunehmend zum Einsatz.

Abstract

Due to the aging population, we are confronted with a growing number of osteoporotic and insufficiency fractures of the pelvic ring. They are the result of a low-energy trauma. With conventional X-rays, it is not always possible to identify the lesions. In all cases, additional CT or MRI examinations are necessary. The morphology of the lesions is very variable and represents a spectrum of instability. Conventional classification is not applicable for all fracture types. Therapy includes a wide range between conservative and operative concepts. The choice of treatment is determined by the degree and the localization of the instability. Osteosynthesis techniques differ from the techniques we use in adults. The trans-sacral positioning bar, iliolumbar fixation and angle stable plate osteosynthesis are used increasingly often.

• Literatur

• 1 Tile M, Hear T, Vrahas M. Biomechanics of the pelvic Ring. In: Tile M, Helfet D, Kellam J, eds. Fractures of the Pelvis and Acetabulum. Philadelphia: Lippincott Williams & Wilkins; 2003: 32-45
  Google Scholar
• 2 Rommens PM, Hessmann MH. 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 2002; 16: 92-98
  CrossrefPubMedGoogle Scholar
• 3 Tile M. Pelvic ring fractures: should they be fixed?. J Bone Joint Surg [Br] 1998; 70: 1-12
  PubMedGoogle Scholar
• 4 Burkhardt M, Culemann U, Seekamp A, Pohlemann T. Strategies for surgical treatment of multiple trauma including pelvic fracture. Review of the literature. Unfallchirurg 2005; 108: 812-820
  CrossrefPubMedGoogle Scholar
• 5 Gotis-Graham I, McGuigan L, Diamond T et al. Sacral insufficiency fractures in the elderly. J Bone Joint Surg [Br] 1994; 76: 882-886
  PubMedGoogle Scholar
• 6 Grasland A, Pouchot J, Mathieu A, Paycha F, Vinceneux P. Sacral insufficiency fractures: an easily overlooked cause of back pain in elderly women. Arch Intern Med 1996; 156: 668-674
  CrossrefPubMedGoogle Scholar
• 7 Taillandier J, Langue F, Alemanni M, Taillandier-Heriche E. Mortality and functional outcomes of pelvic insufficiency fractures in older patients. Joint Bone Spine 2003; 70: 287-289
  CrossrefPubMedGoogle Scholar
• 8 Weber M, Hasler P, Gerber H. Sacral insufficiency fractures as an unsuspected cause of low back pain. Rheumatology (Oxford) 1999; 38: 90-91
  PubMedGoogle Scholar
• 9 Linstrom NJ, Heiserman JE, Kortman KE et al. Anatomical and biomechanical analyses of the unique and consistent locations of sacral insufficiency fractures. Spine (Phila Pa 1976) 2009; 34: 309-301
  CrossrefPubMedGoogle Scholar
• 10 Dalal SA, Burgess AR, Siegel JH et al. Pelvic fracture in multiple trauma: classification by mechanism is key pattern of organ injury, resuscitative requirements, and outcome. J Trauma 1989; 29: 981-1000
  CrossrefPubMedGoogle Scholar
• 11 Mehling I, Hessmann MH, Rommens PM. Stabilization of fatigue fractures of the dorsal pelvis with a trans-sacral bar: operative technique and outcome. Injury 2012; 43: 446-451
  CrossrefPubMedGoogle Scholar
• 12 Fuchtmeier B, Maghsudi M, Neumann C, Hente R, Roll C, Nerlich M. Die minimal-invasive Stabilisierung des dorsalen Beckenrings mit dem transiliakalen Fixateur interne (TIFI): operative Technik und erste klinische Ergebnisse. Unfallchirurg 2004; 107: 1142-1151
  CrossrefPubMedGoogle Scholar
• 13 http://www.awmf.org/uploads/tx_szleitlinien/034-003_S3_Prophylaxe__Diagnostik_und_Therapie_der_Osteoporose_bei_Erwachsenen_lang_10-2009_12-2012.pdf Stand: 10/2009
  PubMed
• 14 Peichl P, Holzer LA, Maier R, Holzer G. Parathyroid hormone 1–84 accelerates fracture-healing in pubic bones of elderly osteoporotic women. J Bone Joint Surg [Am] 2011; 93: 1583-1587
  CrossrefPubMedGoogle Scholar
• 15 Aspenberg P, Genant HK, Johansson T et al. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res 2010; 25: 404-414
  CrossrefPubMedGoogle Scholar
• 16 Goldhahn J, Féron JM, Kanis J et al. Implications for fracture healing of current and new osteoporosis treatments: An ESCEO consensus paper. Calcif Tissue Int 2012; 90: 343-353
  CrossrefPubMedGoogle Scholar

• Supplementary Material