Infekt bei intramedullärem Implantat

Zusammenfassung

Infektionen an langen Röhrenknochen und intramedullärem Implantat stellen eine besondere Herausforderung in der chirurgischen Behandlung dar. Der Vorteil der intramedullären Platzierung des Osteosynthesematerials schlägt im Falle einer Infektion in das Gegenteil um, da die Infektion in aller Regel den gesamten Markraum betrifft, in dem das Implantat platziert ist. Bei der operativen Therapie steht die konsequente Sequestrektomie mit Implantatentfernung im Vordergrund. Gerade bei Trümmerzonen im Frakturbereich kann die Sequestrektomie oft nur über einen offenen Zugang erreicht werden, die u. U. auch eine Segmentresektion beinhaltet. Für die Knochen- und Weichteilrekonstruktion ist nach der Infekteradikation die Optimierung der Perfusion zu prüfen. Die Stabilisierung im Sanierungsintervall mit einem Fixateur beeinträchtigt den Markraumzugang und sollte der definitiven Rekonstruktion vorbehalten bleiben. Temporär kann die Immobilisierung im Cast vorgenommen werden, am Femur hat sich die Behandlung mit einem Wechselnagel in unserem Therapiekonzept bewährt. Begleitend zu den chirurgischen Maßnahmen sind die interdisziplinäre Betreuung und die Antibiotikabehandlung entsprechend dem ABS-Prinzip umzusetzen. Infektionen an langen Röhrenknochen und intramedullärem Implantat stellen eine besondere Herausforderung in der chirurgischen Behandlung dar.

Abstract

The most important surgical treatment is thorough sequestrectomy with implant removal. Particularly with fragmentation zones in the fracture area, sequestrectomy can often only be achieved through an open access, possibly including segment resection. For bone and soft tissue reconstruction, it must be checked that perfusion is optimised after infection has been eradicated. Stabilisation of the site of restoration with a fixateur impairs access to the medullary space and should only be performed during the final reconstruction. Temporary immobilisation in the cast is also possible. We have obtained good results with an interlocking nail on the femur. In parallel to the surgery, interdisciplinary care must be provided, with antibiotic therapy in accordance with the ABS principle.

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