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DOI: 10.1055/a-1999-7680
Intraoperative Azetabulumfraktur
Article in several languages: deutsch | English
Zusammenfassung
Die intraoperative Azetabulumfraktur ist eine seltene Komplikation in der Hüfttotalendoprothetik. Sie tritt hauptsächlich als Folge der Impaktion einer zementfreien Press-fit-Pfanne auf. Risikofaktoren sind eine verminderte Knochenqualität, ein stark sklerotischer Knochen und ein zu groß gewähltes Press-fit. Der Zeitpunkt der Diagnose bestimmt das therapeutische Vorgehen. Intraoperativ erfasste Frakturen sollten immer mit einer entsprechenden Stabilisierung behandelt werden. Postoperativ entscheidet die Stabilität der Implantate sowie der Fraktur darüber, ob zunächst ein konservatives Behandlungsprozedere möglich ist. Die meisten intraoperativ diagnostizierten Azetabulumfrakturen sind mit einer Multi-Hole-Pfanne mit zusätzlichen in den unterschiedlichen Azetabulumregionen verankernden Schrauben zu versorgen. Bei großen Hinterwandfragmenten oder einer Beckendiskontinuität ist primär eine Plattenosteosynthese des hinteren Pfeilers indiziert. Alternativ kann eine Cup-Cage-Rekonstruktion zur Anwendung kommen. Insbesondere beim älteren Patienten muss das Therapieziel die schnelle Mobilisierung durch eine adäquate Primärstabilität sein, um das Komplikations-, Revisions- und Mortalitätsrisiko auf ein Minimum zu reduzieren.
Schlüsselwörter
Hüfttotalendoprothese - Komplikationen - intraoperative Azetabulumfraktur - periprothetische Fraktur - PfannenrevisionPublication History
Received: 14 November 2022
Accepted: 14 December 2022
Article published online:
02 March 2023
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