Frakturen des Sakrums

Zusammenfassung

Für Frakturen entlang der Wirbelsäule besteht ein Konsens über den Diagnosealgorithmus und die Behandlung. Das Kreuzbein stellt eine knöcherne Verbindung zwischen der Wirbelsäule und dem Becken her und überträgt und gleicht Kräfte von den unteren Extremitäten auf den Rumpf und umgekehrt aus. Diese anatomische Position macht es anfällig für Frakturen als Teil des Beckenrings und Frakturen aufgrund axialer Kräfte durch die Wirbelsäule. Für eine gute klinische Praxis ist es wichtig, den Traumamechanismus und das Alter des Patienten zu berücksichtigen. Für das geriatrische Patientenkollektiv haben sich die Klassifikationen Fragilitätsfraktur des Beckens (FFP) und Osteoporosefraktur des Beckens (OF) etabliert und stellen eine einfache Entscheidungshilfe im Praxisalltag dar. Jüngere Patienten erleiden häufiger Hochenergietraumata und Verletzungen, die sich nicht auf den knöchernen Anteil des Beckenringes beschränken. Bei diesen oft komplexeren Verletzungen kann die AO-Klassifikation bei der Therapientscheidungsfindung hilfreich sein. Die Notwendigkeit von Interventionen zur Stabilisierung des Patienten im Rahmen eines „damage control“-Ansatzes bestimmen die therapeutische Strategie bei der Behandlung dieser Patienten. Die folgenden Erläuterungen zur Klassifizierung und der daraus resultierenden Therapie können dabei helfen, Sakrumfrakturen als eigenständige Entität sowohl im Sinne der verlängerten Wirbelsäule als auch des Beckenrings zu differenzieren.

Abstract

For fractures along the spine, there exists a consensus on the diagnostic algorithm and treatment. The sacrum establishes a bony connection between the spine and the pelvis, transmitting and redistributing forces between the lower extremities and the trunk. This anatomical position renders it susceptible to fractures as part of the pelvic ring and fractures due to axial forces through the spine. In the context of good clinical practice, it is imperative to consider the trauma mechanism and the patient's age. For the geriatric patient population, classifications such as Fragility Fracture of the Pelvis (FFP) and Osteoporotic Fracture of the Pelvis (OF) have been established, serving as straightforward decision-making aids in routine clinical practice.

Younger patients more commonly experience high-energy trauma and injuries that extend beyond the bony portion of the pelvic ring. In such cases of often more complex injuries, the AO classification can be valuable in guiding therapeutic decisions. The necessity of interventions for patient stabilization within a "damage control" approach determines the therapeutic strategy for managing these patients. The following explanations of classification and resultant therapies can assist in distinguishing sacral fractures as a distinct entity, both in the context of the extended spine and the pelvic ring.

Schlüsselwörter

Sakrumfrakturen - Beckenringverletzungen - Insuffizienzfrakturen - Alterstraumatologie - Hochenergietrauma

Keywords

sacral fractures - pelvic ring injuries - fragility fractures - geriatric traumatology - high energy trauma

Publication History

Article published online:
13 February 2024

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