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OP-Journal 2018; 34(03): 315-327
DOI: 10.1055/a-0624-4213
Fachwissen
Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie von Verletzungen am proximalen Femur und Beckenavulsionsverletzungen bei Kindern sowie der Epiphysiolysis capitis femoris

Kai Ziebarth
,
Nadine Kaiser
,
Thoralf Liebs
Further Information

Publication History

Publication Date:
09 November 2018 (online)

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Zusammenfassung

Obwohl es sich bei Avulsionsverletzungen des Beckens, Frakturen des proximalen Femurs und der Epiphyseolysis capitis femoris um relativ seltene Krankheitsbilder handelt, ist eine korrekte Diagnostik und Therapie essentiell um langfristige Beschwerden und Einschränkungen zu verhindern. Eine Kenntnis der kindlichen Anatomie ist Voraussetzung für eine erfolgreiche Behandlung. Frakturen am proximalen Femur müssen größtenteils operiert und anatomisch reponiert werden, da wenig Remodellierungspotenzial besteht. Schenkelhalsfrakturen müssen kontrolliert reponiert werden, um die Gefäßversorgung des Femurkopfes nicht zu gefährden. Es empfiehlt sich somit eine offene Reposition. Avulsionsverletzungen müssen bei Sportverletzungen beim Kind aktiv gesucht werden und können klinisch angesichts der starken Schmerzangaben häufig dramatisch erscheinen. Die Domäne der Avulsionsverletzung ist die konservative Therapie. Ein Kind zwischen 10 und 16 Jahren mit Knieschmerzen und eingeschränkter Hüftrotation oder hinkendem Gangbild muss zum Ausschluss einer ECF radiologisch abgeklärt werden. Das positive Drehmann-Zeichen ist klinisch pathognomonisch für eine ECF. Klinische Klassifikationen können die Stabilität der Wachstumsfuge nicht genau vorhersagen, daher ist nach Diagnosestellung eine Stockentlastung bis zur operativen Versorgung empfehlenswert. Die Behandlung der ECF besteht immer in der operativen Stabilisation des Femurkopfes mit Schrauben oder Drähten und, je nachdem, in der anatomischen Wiederherstellung der proximalen femoralen Anatomie.

Abstract

Injuries of the proximal aspect of the femur in children are much less frequent than injuries of the upper extremities. Knowledge and respect of the anatomy is the key to sufficient therapy and good patient outcomes. Most fractures of the proximal aspect of the femur need open reduction and internal fixation, since there is insufficient potential for remodelling. Fractures of the femoral neck need an open reduction so that the perfusion of the femoral head is not put at risk. In sports injuries, avulsion fractures have to be searched for. Children suffering from these fractures can present with surprisingly high levels of pain. Most avulsion fractures are treated conservatively. In a child aged 10 – 16 years presenting with knee pain, who is limping or who has a decreased range of motion of the hip, a slipped capital femoral epiphysis (SCFE) must be ruled out radiographically. The Drehmann sign is pathognomonic for a SCFE. Current clinical classifications are not able to predict the stability of the physis. Therefore, non-weight-bearing is mandatory in the interval between diagnosis and operative treatment. Treatment of SCFE always includes an operative stabilization of the femoral head using transphyseal screws or wires. Contemporary treatment includes a reconstruction of the proximal femoral anatomy in displaced cases.

Schlüsselwörter

Hüftschmerz - Epiphysiolysis capitis femoris - proximale Femurfraktur - Avulsion - Hüfte

Key words

hip pain - slipped capital femoral epiphysis - proximal femoral fracture - avulsion - hip
 

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