Skip to main content
Erschienen in: Der Unfallchirurg 2/2015

01.02.2015 | Originalien

Operative Therapie der Acetabulumfraktur beim älteren Patienten

Osteosynthese oder Endoprothese

verfasst von: Dr. C. Fölsch, M.M. Alwani, V. Jurow, R. Stiletto

Erschienen in: Die Unfallchirurgie | Ausgabe 2/2015

Einloggen, um Zugang zu erhalten

Zusammenfassung

Hintergrund

Die exakte anatomische Rekonstruktion und stabile Osteosynthese einer Acetabulumfraktur ist Voraussetzung für ein gutes postoperatives Ergebnis. Ab der 7. Lebensdekade beeinträchtigt eine veränderte Knochenqualität zunehmend die Fixierung des Osteosynthesematerials.

Patienten und Methode

Diese retrospektive Studie vergleicht mit objektiven und subjektiven Scores die Ergebnisse der Osteosynthese des Acetabulums und der Implantation einer Hüftendoprothese bei 24 Patienten jeweils älter als 65 Jahre mit Acetabulumfrakturen Typ A, B und C der AO-Klassifikation. Verschiedene Scores für die körperliche Funktion, Schmerzen sowie allgemeine Gesundheit und psychosoziale Aspekte wurden untersucht. Die Untersuchung erstreckte sich über ein Zeitintervall von mindestens 1,5 bis zu 10,0 Jahren.

Ergebnisse

Nur bei 40 % der Patienten konnte eine gute Reposition des Acetabulums erzielt werden und die langfristigen radiologischen Resultate waren entsprechend. Schmerzreduktion sowie Mobilisierung waren nach Implantation einer Endoprothese geringfügig besser und periartikuläre Ossifikationen fanden sich häufiger nach der Osteosynthese. Operative Revisionen wurden nach der Osteosynthese häufiger beobachtet. Bei geringer Fallzahl ergab sich keine signifikante Differenz zwischen den beiden Gruppen. Patienten mit endoprothetischer Versorgung wiesen im Vergleich zur Osteosynthese vergleichbare funktionelle Ergebnisse auf.

Schlussfolgerung

Der primäre Gelenkersatz mit Pfannenaufbau erscheint als gute Alternative wenn eine anatomische oder gute Rekonstruktion des Acetabulums aufgrund des Verletzungsmusters und schlechter Knochenqualität beim älteren Patienten nicht möglich ist.
Literatur
1.
Zurück zum Zitat Baumgaertel F (1992) Diagnosis, classification and surgical indications in acetabulum fractures. Orthopade 21:427–441PubMed Baumgaertel F (1992) Diagnosis, classification and surgical indications in acetabulum fractures. Orthopade 21:427–441PubMed
2.
Zurück zum Zitat Bellabarba C, Berger RA, Bentley CD et al (2001) Cementless acetabular reconstruction after acetabular fracture. J Bone Joint Surg Am 83:868–876CrossRefPubMed Bellabarba C, Berger RA, Bentley CD et al (2001) Cementless acetabular reconstruction after acetabular fracture. J Bone Joint Surg Am 83:868–876CrossRefPubMed
3.
Zurück zum Zitat 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 23:243–248CrossRefPubMed 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 23:243–248CrossRefPubMed
4.
Zurück zum Zitat Burk DL Jr, Mears DC, Kennedy WH et al (1985) Three-dimensional computed tomography of acetabular fractures. Radiology 155:183–186CrossRefPubMed Burk DL Jr, Mears DC, Kennedy WH et al (1985) Three-dimensional computed tomography of acetabular fractures. Radiology 155:183–186CrossRefPubMed
5.
Zurück zum Zitat Carroll EA, Huber FG, Goldman AT et al (2010) Treatment of acetabular fractures in an older population. J Orthop Trauma 24(10):637–644CrossRefPubMed Carroll EA, Huber FG, Goldman AT et al (2010) Treatment of acetabular fractures in an older population. J Orthop Trauma 24(10):637–644CrossRefPubMed
6.
Zurück zum Zitat Coventry MB (1974) The treatment of fracture-dislocation of the hip by total hip arthroplasty. J Bone Joint Surg Am 56:1128–1134PubMed Coventry MB (1974) The treatment of fracture-dislocation of the hip by total hip arthroplasty. J Bone Joint Surg Am 56:1128–1134PubMed
7.
Zurück zum Zitat D’aubigne RM, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36:451–475 D’aubigne RM, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36:451–475
8.
Zurück zum Zitat DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replecement. Clin Orthop 121:20–32PubMed DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replecement. Clin Orthop 121:20–32PubMed
9.
Zurück zum Zitat Ferguson TA, Patel R, Bhandari M, Matta JM (2010) Fractures of the acetabulum in patients aged 60 years and older. J Bone Joint Surg Br 92:250–257CrossRefPubMed Ferguson TA, Patel R, Bhandari M, Matta JM (2010) Fractures of the acetabulum in patients aged 60 years and older. J Bone Joint Surg Br 92:250–257CrossRefPubMed
10.
Zurück zum Zitat Frank C, Siozos P, Wentzensen A et al (2010) Total hip replacement for coxarthrosis following acetabular fracture. Significance of age and injury severity. Unfallchirurg 113:1013–1022CrossRefPubMed Frank C, Siozos P, Wentzensen A et al (2010) Total hip replacement for coxarthrosis following acetabular fracture. Significance of age and injury severity. Unfallchirurg 113:1013–1022CrossRefPubMed
11.
Zurück zum Zitat Gänsslen A (2010) Biomechanical principles for treatment of osteoporotic fractures of the pelvis. Unfallchirurg 113:272–280CrossRefPubMed Gänsslen A (2010) Biomechanical principles for treatment of osteoporotic fractures of the pelvis. Unfallchirurg 113:272–280CrossRefPubMed
12.
Zurück zum Zitat Hamer AJ, Stockley I (1994) Acetabular fracture treated by primary hip arthroplasty. Injury 25:399–400CrossRefPubMed Hamer AJ, Stockley I (1994) Acetabular fracture treated by primary hip arthroplasty. Injury 25:399–400CrossRefPubMed
13.
Zurück zum Zitat Helfet DL (1998) Surgery of pelvis and acetabulum: 4th international consensus, Birmingham Alabama (personnel communication) Helfet DL (1998) Surgery of pelvis and acetabulum: 4th international consensus, Birmingham Alabama (personnel communication)
14.
Zurück zum Zitat Helfet DL, Borrelli J, DiPasquale T, Sanders R (1992) Stabilization of acetabular fractures in elderly patients. J Bone Joint Surg Am 74(5):753–765PubMed Helfet DL, Borrelli J, DiPasquale T, Sanders R (1992) Stabilization of acetabular fractures in elderly patients. J Bone Joint Surg Am 74(5):753–765PubMed
15.
Zurück zum Zitat Hessmann MH, Nijs S, Rommens PM (2002) Acetabular fractures in the elderly. Results of a sophisticated treatment concept. Unfallchirurg 105:893–900CrossRefPubMed Hessmann MH, Nijs S, Rommens PM (2002) Acetabular fractures in the elderly. Results of a sophisticated treatment concept. Unfallchirurg 105:893–900CrossRefPubMed
16.
Zurück zum Zitat Hoellen IP, Mentzel M, Bischoff M et al (1997) Acetabular fractures in elderly persons. Primary endoprosthetic treatment. Orthopade 26:348–353PubMed Hoellen IP, Mentzel M, Bischoff M et al (1997) Acetabular fractures in elderly persons. Primary endoprosthetic treatment. Orthopade 26:348–353PubMed
17.
Zurück zum Zitat Hoffmann R, Stöckle U, Nittinger M et al (2000) Operative treatment of complex acetabular fractures through the modified extensile iliofemoral approach (Maryland). Unfallchirurg 103:12–21CrossRefPubMed Hoffmann R, Stöckle U, Nittinger M et al (2000) Operative treatment of complex acetabular fractures through the modified extensile iliofemoral approach (Maryland). Unfallchirurg 103:12–21CrossRefPubMed
18.
Zurück zum Zitat Jacobs C, Grützner PA (2012) Revision surgery following acetabular fractures. What makes sense?. Trauma Berufskrankh 14(Suppl 2):135–139CrossRef Jacobs C, Grützner PA (2012) Revision surgery following acetabular fractures. What makes sense?. Trauma Berufskrankh 14(Suppl 2):135–139CrossRef
19.
Zurück zum Zitat Jeffcoat DM, Carroll EA, Huber FG et al (2012) Operative treatment of acetabular fractures in an older population through a limited ilioinguinal approach. J Orthop Trauma 26:284–289CrossRefPubMed Jeffcoat DM, Carroll EA, Huber FG et al (2012) Operative treatment of acetabular fractures in an older population through a limited ilioinguinal approach. J Orthop Trauma 26:284–289CrossRefPubMed
20.
Zurück zum Zitat Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary Report. J Bone Joint Surg Am 46:1615–1646PubMed Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary Report. J Bone Joint Surg Am 46:1615–1646PubMed
21.
Zurück zum Zitat Kobayashi S, Saito N, Horiuchi H et al (2000) Poor bone quality or hip structure as risk factors affecting survival of total-hip arthroplasty. Lancet 355:1499–1504CrossRefPubMed Kobayashi S, Saito N, Horiuchi H et al (2000) Poor bone quality or hip structure as risk factors affecting survival of total-hip arthroplasty. Lancet 355:1499–1504CrossRefPubMed
22.
Zurück zum Zitat Kuner EH (1997) Indication, technique and complications in the surgical treatment of acetabular fractures. Orthopade 26:327–335PubMed Kuner EH (1997) Indication, technique and complications in the surgical treatment of acetabular fractures. Orthopade 26:327–335PubMed
23.
Zurück zum Zitat Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop Relat Res 151:81–106PubMed Letournel E (1980) Acetabulum fractures: classification and management. Clin Orthop Relat Res 151:81–106PubMed
24.
Zurück zum Zitat Letournel E (1993) The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res 292:62–76PubMed Letournel E (1993) The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res 292:62–76PubMed
25.
Zurück zum Zitat Lichte P, Sellei RM, Kobbe P et al (2013) Predictors of poor outcome after both column acetabular fractures: a 30-year retrospective cohort study. Patient Saf Surg 7(1):9CrossRefPubMedCentralPubMed Lichte P, Sellei RM, Kobbe P et al (2013) Predictors of poor outcome after both column acetabular fractures: a 30-year retrospective cohort study. Patient Saf Surg 7(1):9CrossRefPubMedCentralPubMed
26.
Zurück zum Zitat Matta JM, Anderson LM, Epstein HE, Hendricks P (1986) Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res 205:230–240PubMed Matta JM, Anderson LM, Epstein HE, Hendricks P (1986) Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res 205:230–240PubMed
27.
Zurück zum Zitat Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am A-78:1632–1645 Matta JM (1996) Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am A-78:1632–1645
28.
Zurück zum Zitat Matta JM, Ferguson TA (2005) Total hip replacement after acetabular fracture. Orthopedics 28:959–960PubMed Matta JM, Ferguson TA (2005) Total hip replacement after acetabular fracture. Orthopedics 28:959–960PubMed
29.
Zurück zum Zitat Mayo KA, Letournel E, Matta JM et al (1994) Surgical revision of malreduced acetabular fractures. Clin Orthop Relat Res 305:47–52PubMed Mayo KA, Letournel E, Matta JM et al (1994) Surgical revision of malreduced acetabular fractures. Clin Orthop Relat Res 305:47–52PubMed
30.
Zurück zum Zitat Mears DC (1999) Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. J Am Acad Orthop Surg 7:128–141PubMed Mears DC (1999) Surgical treatment of acetabular fractures in elderly patients with osteoporotic bone. J Am Acad Orthop Surg 7:128–141PubMed
31.
Zurück zum Zitat Miller AN, Prasarn ML, Lorich DG, Helfet DL (2009) The radiological evaluation of acetabular fractures in the elderly. J Bone Joint Surg Br 92(4):560–564 Miller AN, Prasarn ML, Lorich DG, Helfet DL (2009) The radiological evaluation of acetabular fractures in the elderly. J Bone Joint Surg Br 92(4):560–564
32.
Zurück zum Zitat Ochs BG, Marintschev I, Hoyer H et al (2010) Changes in the treatment of acetabular fractures over 15 years: analysis of 1266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU). Injury 41:839–851CrossRefPubMed Ochs BG, Marintschev I, Hoyer H et al (2010) Changes in the treatment of acetabular fractures over 15 years: analysis of 1266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU). Injury 41:839–851CrossRefPubMed
33.
Zurück zum Zitat Parreira JG, Coimbra R, Rasslan S et al (2000) The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures. Injury 31:677–682CrossRef Parreira JG, Coimbra R, Rasslan S et al (2000) The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures. Injury 31:677–682CrossRef
34.
Zurück zum Zitat Pennal GF, Davidson J, Garside H, Plewes J (1980) Results of treatment of acetabular fractures. Clin Orthop Relat Res 151:115–123PubMed Pennal GF, Davidson J, Garside H, Plewes J (1980) Results of treatment of acetabular fractures. Clin Orthop Relat Res 151:115–123PubMed
35.
Zurück zum Zitat Pritchett JW, Bortel DT (1991) Total hip replacement after central fracture dislocation of the acetabulum. Orthop Rev 20:607–610PubMed Pritchett JW, Bortel DT (1991) Total hip replacement after central fracture dislocation of the acetabulum. Orthop Rev 20:607–610PubMed
36.
Zurück zum Zitat Ragnarsson B, Mjoberg B (1992) Arthrosis after surgically treated acetabular fractures. A retrospective study of 60 cases. Acta Orthop Scand 63:511–514CrossRefPubMed Ragnarsson B, Mjoberg B (1992) Arthrosis after surgically treated acetabular fractures. A retrospective study of 60 cases. Acta Orthop Scand 63:511–514CrossRefPubMed
37.
Zurück zum Zitat Ranawat A, Zelken J, Helfet D, Buly R (2009) Total hip arthroplasty of posttraumatic arthritis after acetabular fracture. J Arthroplasty 24(5):759–767CrossRefPubMed Ranawat A, Zelken J, Helfet D, Buly R (2009) Total hip arthroplasty of posttraumatic arthritis after acetabular fracture. J Arthroplasty 24(5):759–767CrossRefPubMed
39.
Zurück zum Zitat Rommens PM, Ingelfinger P, Nowak TE et al (2011) Traumatic damage to the cartilage influences outcome of anatomically reduced acetabular fractures: a medium-term retrospective analysis. Injury 42(10):1043–1048CrossRefPubMed Rommens PM, Ingelfinger P, Nowak TE et al (2011) Traumatic damage to the cartilage influences outcome of anatomically reduced acetabular fractures: a medium-term retrospective analysis. Injury 42(10):1043–1048CrossRefPubMed
40.
Zurück zum Zitat Romness DW, Lewallen DG (1990) Total hip arthroplasty after fracture of the acetabulum. Long-term results. J Bone Joint Surg Br 72:761–764PubMed Romness DW, Lewallen DG (1990) Total hip arthroplasty after fracture of the acetabulum. Long-term results. J Bone Joint Surg Br 72:761–764PubMed
41.
Zurück zum Zitat Schlickewei W, Kuner EH, Elsasser B (1997) Long-term results and late complications following acetabular fractures. Orthopade 26:375–383PubMed Schlickewei W, Kuner EH, Elsasser B (1997) Long-term results and late complications following acetabular fractures. Orthopade 26:375–383PubMed
42.
Zurück zum Zitat Schmidt-Rohlfing B, Reilmann H, Pape HC (2010) Fractures of the acetabulum. Diagnostic and therapeutic strategies. Unfallchirurg 113:217–229CrossRefPubMed Schmidt-Rohlfing B, Reilmann H, Pape HC (2010) Fractures of the acetabulum. Diagnostic and therapeutic strategies. Unfallchirurg 113:217–229CrossRefPubMed
43.
Zurück zum Zitat Siegmeth A, Mullner T, Kukla C, Véscei V (2000) Acompanying injuries in severe pelvic trauma. Unfallchirurg 103:572–581CrossRefPubMed Siegmeth A, Mullner T, Kukla C, Véscei V (2000) Acompanying injuries in severe pelvic trauma. Unfallchirurg 103:572–581CrossRefPubMed
44.
Zurück zum Zitat Spencer RF (1989) Acetabular fractures in older patients. J Bone Joint Surg Br 71:774–776PubMed Spencer RF (1989) Acetabular fractures in older patients. J Bone Joint Surg Br 71:774–776PubMed
45.
Zurück zum Zitat Stalp M, Koch C, Regel G et al (2001) Development of scoring system for the standardized evaluation of the quality of rehabilitation in polytraumatized patients (HASPOC). Chirurg 72:312–318CrossRefPubMed Stalp M, Koch C, Regel G et al (2001) Development of scoring system for the standardized evaluation of the quality of rehabilitation in polytraumatized patients (HASPOC). Chirurg 72:312–318CrossRefPubMed
46.
Zurück zum Zitat Tosounidis G, Culemann U, Bauer M et al (2011) Acetabular fractures in the elderly. Outcome of open reduction and internal fixation. Unfallchirurg 114:655–662CrossRefPubMed Tosounidis G, Culemann U, Bauer M et al (2011) Acetabular fractures in the elderly. Outcome of open reduction and internal fixation. Unfallchirurg 114:655–662CrossRefPubMed
47.
Zurück zum Zitat Volkmann R, Maurer F, Eingartner C, Weller S (1995) Primary total endoprosthetic hip joint replacement in acetabulum fractures. Unfallchirurgie 21:292–297CrossRefPubMed Volkmann R, Maurer F, Eingartner C, Weller S (1995) Primary total endoprosthetic hip joint replacement in acetabulum fractures. Unfallchirurgie 21:292–297CrossRefPubMed
48.
Zurück zum Zitat Weber M, Berry DJ, Harmsen WS (1998) Total hip arthroplasty after operative treatment of an acetabular fracture. J Bone Joint Surg Am 80:1295–1305PubMed Weber M, Berry DJ, Harmsen WS (1998) Total hip arthroplasty after operative treatment of an acetabular fracture. J Bone Joint Surg Am 80:1295–1305PubMed
49.
Zurück zum Zitat Wright R, Barrett K, Christie MJ et al (1994) Acetabular fractures: long-term follow-up of open reduction and internal fixation. J Orthop Trauma 8:397–403CrossRefPubMed Wright R, Barrett K, Christie MJ et al (1994) Acetabular fractures: long-term follow-up of open reduction and internal fixation. J Orthop Trauma 8:397–403CrossRefPubMed
Metadaten
Titel
Operative Therapie der Acetabulumfraktur beim älteren Patienten
Osteosynthese oder Endoprothese
verfasst von
Dr. C. Fölsch
M.M. Alwani
V. Jurow
R. Stiletto
Publikationsdatum
01.02.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Die Unfallchirurgie / Ausgabe 2/2015
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI
https://doi.org/10.1007/s00113-014-2606-3

Weitere Artikel der Ausgabe 2/2015

Der Unfallchirurg 2/2015 Zur Ausgabe

Einführung zum Thema

Rehabilitation

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.