Prothetische Versorgung der proximalen Femurfrakturen

Abstract

The endoprosthetic replacement of the hip joint or its components in fractures of the proximal femur is a standard method. Indications for replacement are strongly dislocated intracapsular femoral neck fractures in elderly patients, fractures with an existing arthritis of the hip joint, and profound osteoporosis. Improved perioperative management and more gentle anesthetic techniques have helped to reduce perioperative mortality from nearly 50% to 11.5% over the last 40 years. As routine treatment options, the bipolar endoprosthesis without replacement of the acetabular joint surface and total hip replacement in case of degenerative arthritis of the acetabular joint surface are commonly used. The mere replacement of the femoral head with a simple femoral head prosthesis should be reserved for exceptional cases. For the implantation of a hip joint prosthesis and its uncomplicated post-treatment and long-term durability, careful preoperative planning is essential together with the selection of a suitable implant, its optimal bony fixation, avoidance of intra-operative complications and restoration of the anatomical landmarks such as the centre of rotation of the hip joint, the offset of the prosthetic shaft as well as leg length. Despite the high standard of endoprosthetics in Germany, the results are still improvable in comparison to other countries. Measures which preserve the joint as well as the bone will be increasingly important in prophylaxis of further complications. In addition, more attention should be paid to the prophylaxis of falls and a sufficiently guide-lined therapy of osteoporosis for the prophylaxis of fractures of the elderly.

Optimaler Zeitpunkt zur prothetischen Versorgung von Schenkelhalsfrakturen

“…6% [4], die Einjahresmortalität bei ca. 27% [2]. Hieraus ist ersichtlich, welche enormen Auswirkungen eine Schenkelhalsfraktur für den älteren Menschen mit sich bringt.…”

“…Dennoch ist eine optimale Versorgung der Schenkelhalsfraktur eher im Tagesprogramm als zu später Nacht gewährleistet, da weiterhin der wichtigste Prognosefaktor eine gute Reposition (bei Osteosynthesen) und eine fehlerfreie Implantation bei Prothesen ist [2]. Nötige Revisionen aufgrund von Luxationen, Lockerung oder Infektionen sind eine extreme Belastung für die äl-teren Patienten und gehen regelhaft mit einem schlechten Outcome einher.…”

Primary total hip arthroplasty for displaced intracapsular fracture of the femoral neck: Medium-term functional and radiographic outcomes

“…Absence of sclerotic subchondral bone in the acetabular region, evident in degenerated hip and poorer quality of the bone (osteoporosis) in older patients, worsen the conditions for long-term fixation of components in contrast to the situation in patients undergoing THA due to degenerative changes of the hip [3,10,[25][26][27]33,46,47].…”

“…Primary total hip arthroplasty (THA) for displaced intracapsular fractures of the femoral neck, according to most authors, is indicated in patients who are older than 70 years, physically active and cooperative, and in a good general condition [1][2][3][4][5][6][7][8][9]. However, some authors point out that the rate of complications in the early postoperative period and failures of the arthroplasty later due to loosening of individual components is higher when compared to the rate of complications following THA for osteoarthritis [10][11][12][13].…”

Perioperative Application of a Serum Protein Solution (Biseko®) After Proximal Femur Fracture of Elder Patients

“…The proximal femur fracture is one of the most common injuries of the elderly people and still involves a high rate of complications [1], though perioperative mortality has been reduced from 50 to 11.5% within the last 40 years [2]. Due to osteoporosis as seen in most patients of this age the stability of the bone is reduced and small accidents might lead to fractures of the bone [3].…”