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Erschienen in: Die Unfallchirurgie 9/2020

13.08.2020 | Ultraschall | Leitthema

Konservative Therapieoptionen der Pseudarthrosen

verfasst von: Dr. T. Großner, G. Schmidmaier

Erschienen in: Die Unfallchirurgie | Ausgabe 9/2020

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Zusammenfassung

Hintergrund

Pseudarthrosen entstehen in 5–10 % aller Frakturen, wobei sich diese Rate in Bezug auf die anatomische Lokalisation stark unterscheidet. Alle Pseudarthrosen haben gemeinsam, dass unabhängig von der Zeit, ohne eine weitere medizinische Therapie, keine Heilung zu erwarten ist. Es existieren unterschiedlichste operative Ansätze, um dieses äußerst komplexe Krankheitsbild zu therapieren, was mit einer Rate von 75–85 % der Fälle auch erfolgreich gelingt. Dem stehen die konservativen Therapiemöglichkeiten gegenüber, die bei jeder Behandlungsplanung in Betracht gezogen werden sollten. Insbesondere die vitalen Pseudarthrosen sprechen in der frühen Phase z. T. sehr gut auf nichtinvasive Verfahren an.

Methoden und Ergebnisse

Durch Basismaßnahmen, wie Optimierung der Komorbiditäten und Risikofaktoren sowie Belastungsaufbau einer Extremität, kann bereits eine Heilung erzielt werden. Elaboriertere Verfahren wie „low-intensity pulsed ultrasound“ (LIPUS) oder extrakorporale Stoßwellentherapie (ESWT) können in 63–94 % der Fälle eine operative Therapie überflüssig machen und weisen dabei keine oder lediglich sehr geringe Nebenwirkungen auf, bei deutlich geringeren Kosten. Allerdings muss eine hohe Compliance des Patienten sichergestellt werden. Als optimale Voraussetzungen für einen konservativen Therapieversuch sollte die Pseudarthrose durch eine adäquate Osteosynthese stabil und infektionsfrei sein, keine Fehlstellung aufweisen und der Defekt kleiner als 5 mm sein.

Schlussfolgerung

Es ist in jedem Einzelfall durch einen erfahrenen Arzt kritisch zu überprüfen, ob eine konservative Behandlungsoption für dieses komplexe Krankheitsbild besteht.
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Metadaten
Titel
Konservative Therapieoptionen der Pseudarthrosen
verfasst von
Dr. T. Großner
G. Schmidmaier
Publikationsdatum
13.08.2020
Verlag
Springer Medizin
Erschienen in
Die Unfallchirurgie / Ausgabe 9/2020
Print ISSN: 2731-7021
Elektronische ISSN: 2731-703X
DOI
https://doi.org/10.1007/s00113-020-00851-1

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