Proximale Femurfrakturen im Alter

Lohmann, R; Frerichmann, U.; Stöckle, Ulrich; Riegel, Thomas; Raschke, Michael J.

doi:10.1007/s00113-007-1257-z

Cited by 49 publications

(10 citation statements)

References 34 publications

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“…These injuries have been identified as among the most serious health care problems affecting the elderly [1]. The estimated costs of these fractures are €2 billion to €4 billion per year in Germany [2]. Worldwide, the incidence of fractures of the proximal femur is increasing because of a demographic transition resulting in higher life expectancy [1,3-5].…”

Section: Introductionmentioning

confidence: 99%

Use of the gamma3™ nail in a teaching hospital for trochanteric fractures: mechanical complications, functional outcomes, and quality of life

et al. 2012

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BackgroundTrochanteric fractures are common fractures in the elderly. Due to characteristic demographic changes, the incidence of these injuries is rapidly increasing. Treatment of these fractures is associated with high rates of complications. In addition, the long-term results remain poor, with high morbidity, declines in function, and high mortality. Therefore, in this study, complication rates and patients’ outcomes were evaluated after fixation of geriatric trochanteric fractures using the Gamma3™ nail.MethodsPatients aged 60 years old or older, with pertrochanteric and subtrochanteric femoral fractures, were included. Patients with polytrauma or pathological fractures were excluded. Age, sex, and fracture type were collected on admission. In addition, data were recorded concerning the surgeon (resident vs. consultant), time of operation, and local or systemic perioperative complications. Complications were also collected at the 6- and 12-month follow-ups after trauma. Barthel Index, IADL, and EQ-5D measurements were evaluated retrospectively on admission, as well as at discharge and during the follow-up.ResultsNinety patients were prospectively included between April 2009 and September 2010. The patients’ average age was 81 years old, and their average ASA score was 3. The incision/suture time was 53 min (95% CI 46–60 min). Hospital mortality was 4%, and overall mortality was 22% at the 12-month follow-up. Eight local complications occurred (4 haematomas, 1 deep infection, 1 cutting out, 1 irritation of the iliotibial tract, 1 periosteosynthetic fracture). The incidence of relevant systemic complications was 6%. Forty-two percent of the patients were operated on by residents in training, without significant differences in duration of surgery, complication rate, or mortality rate. The Barthel Index (82 to 71, p < .001), IADL (4.5 to 4.3, p = .0195) and EQ-5-D (0.75 to 0.66, p = .068) values did not reach pre-fracture levels during the follow-up period of 12 months.ConclusionThe results showed a relatively low complication rate using the Gamma3™ nail, even if the nailing was performed by residents in training. The high mortality, declines in function, and low quality of life could probably be attributed to pre-existing conditions, such as physical status.In summary, the Gamma3™ nail seems to be a useful implant for the nailing of trochanteric fractures, although further studies are necessary comparing different currently available devices.

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Section: Introductionmentioning

confidence: 99%

Use of the gamma3™ nail in a teaching hospital for trochanteric fractures: mechanical complications, functional outcomes, and quality of life

et al. 2012

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“…Man rechnet mit 256 000 Fällen im Jahr bei deutlich steigender Tendenz wegen der demografischen Entwicklung. In den nächsten 20 Jahren wird mit einer Zunahme der Verletzung um den Faktor 5 gerechnet [9]. Die Versorgung dieser Fraktur gehört zur "Brotund Butterchirurgie" mittlerer Krankenhäuser mit Bettengrößen zwischen 150 und 600 Betten.…”

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Pertrochantäre Femurfraktur – eine Anfängeraufgabe?

2014

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Internal fixation with nailing in pertrochanteric femur fractures is a standard operative approach. It is suitable as a "beginner's" procedure, that is quickly and easily performed. Only complex, multifragmented or markedly displaced or long-segment fractures need to be treated by staff physicians. Mortality is not affected by the surgeon's experience, but rather by comorbidity and from the preoperative duration.

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“…Auch das Auftreten von Nebendiagnosen wie Diabetes mellitus, Morbus Parkinson oder eine zunehmende Medikamenteneinnahme erklären in Zusammenhang mit Osteoporose die Zunahme von Stürzen und Frakturen im Alter [42]. Es ist somit bis zum Jahr 2050 mit einem Anstieg unter anderem auch der proximalen Femurfrakturen gerade beim alten Patienten zu rechnen [13,36]. Beim jungen Menschen wird diese Art von Fraktur in der Regel im Rahmen von Hochrasanztraumen wie Stürzen aus größerer Höhe oder Verkehrsunfällen verursacht.…”

Section: Inzidenz Der Proximalen Femurfrakturunclassified

Endoprothetik bei hüftgelenknahen Femurfrakturen

2013

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The incidence of proximal fractures of the femur will increase with the demographic change in the German population. Besides osteosynthesis, which in most cases of femoral neck, pertrochanteric and femoral head fracture is the method of choice, arthroplasty of the hip is likewise an established therapy. Indications are dislocated femoral neck fractures of the elderly. But there are good results for arthroplasty after proximal femoral fractures in younger active patients as well, when the fracture was not recognized or treated immediately. The outcome of hip arthroplasty after fracture is influenced by the elderly and unhealthy patient himself and the difficult planning and operation conditions due to fracture and its morphology. Most important for the best result are an interdisciplinary preparation of the patient and a well-planned surgery. In these cases common complications like thromboembolism, massive intraoperative blood loss and general infections like urinary tract infection can be reduced. For hip arthroplasty after fracture total hip replacement as well as hemiarthroplasty with bipolar prosthesis should be considered. The implant chosen and the implantation technique with or without bone cement has to be determined. Facts like the general state of health, biological age, level of activity and comorbidities should be taken into account appropriately.

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Proximale Femurfrakturen im Alter

Cited by 49 publications

References 34 publications

Use of the gamma3™ nail in a teaching hospital for trochanteric fractures: mechanical complications, functional outcomes, and quality of life

Use of the gamma3™ nail in a teaching hospital for trochanteric fractures: mechanical complications, functional outcomes, and quality of life

Pertrochantäre Femurfraktur – eine Anfängeraufgabe?

Endoprothetik bei hüftgelenknahen Femurfrakturen

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