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Periprothetische Femurfrakturen

Langzeitergebnisse nach plattenosteosynthetischer Stabilisierung

Periprosthetic fractures

Long-term results after plate osteosynthesis stabilization

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Zusammenfassung

Hintergrund

Die Inzidenz periprothetischer Frakturen (PPF) ist in den letzten Jahren deutlich gestiegen. Die Therapie ist von der Frakturlokalisation und der Prothesenstabilität abhängig. Ziel dieser Studie war es, unser Therapiekonzept zur Versorgung der PPF anhand klinischer Langzeitergebnisse zu evaluieren.

Patienten und Methoden

Von 1988 bis 2006 wurden 99 Patienten mit einer PPF in unserer Klinik behandelt, wobei in 86 Fällen ein plattenosteosynthetisches Verfahren zur Anwendung kam. Von diesen konnten 56 Patienten 7,3±2,8 Jahre postoperativ nachuntersucht werden.

Ergebnisse

Am häufigsten wurden Frakturen vom Typ Johansson III beobachtet (44%). Insgesamt wurden 71 konventionelle und 15 winkelstabile Plattenosteosynthesen durchgeführt, wobei Komplikationen in 15 Fällen (17,5%) auftraten (3 Plattenbrüche, 3 Plattenausrisse, 6 Pseudarthrosen, 2 tiefe Wundinfekte, 1 Nachblutung).

Schlussfolgerung

Unsere Daten zeigen, dass plattenosteosynthetische Verfahren eine alternative Therapieoption zur Versorgung periprothetischer Frakturen auch bei teilweise gelockertem Prothesenlager darstellen. Eine günstige Indikation sehen wir insbesondere bei geriatrischen Patienten und Fehlen lockerungsspezifischer Beschwerden.

Abstract

Background

Due to the increasing age of patients and the rising number of joint replacements, the incidence of periprosthetic fractures (PPF) is also increasing. The treatment should be selected with knowledge of the prefracture interface status and the type of fracture involved. The aim of this study was to evaluate our treatment of PPF with long-term follow-up.

Patients and methods

From 1988 to 2006, 99 patients with PPF were treated in our department. In 86 cases a plate osteosynthesis was used. After a mean time of 7.3±2.8 years, we studied 56 patients and monitored their complications.

Results

The most diagnosed fracture was Johansson type III (44%). Seventy-one patients were treated with a conventional and 15 with locking-plate osteosynthesis. In 15 cases (17.5%) we found severe complications (3 breaks and 3 dislocations of the plates, 6 cases of pseudarthrosis, 2 deep wound infections, and 1 case of postoperative bleeding).

Conclusion

Due to the minor frequency of severe complications, plate osteosynthesis of a periprosthetic fracture with a loosened interface is a good therapeutic option for individual patients, particularly for geriatric patients and those without disorders specific to a loosened interface.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinik Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    M. Rupprecht, L. Großterlinden, F. Barvencik, M. Gebauer, D. Briem, J.M. Rueger & W. Lehmann

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  1. M. Rupprecht
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  2. L. Großterlinden
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  3. F. Barvencik
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  4. M. Gebauer
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  5. D. Briem
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  6. J.M. Rueger
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  7. W. Lehmann
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Correspondence to M. Rupprecht.

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Rupprecht, M., Großterlinden, L., Barvencik, F. et al. Periprothetische Femurfrakturen. Unfallchirurg 111, 812–820 (2008). https://doi.org/10.1007/s00113-008-1470-4

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