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Periprothetische intertrochantäre Femurfraktur nach Oberflächenersatz des Hüftgelenks

Versorgung mit Zugschraubenosteosynthese

Periprosthetic intertrochanteric fracture of the femur following articular resurfacing of the hip joint

Treatment with lag screw osteosynthesis

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Zusammenfassung

Durch Verbesserung von Implantatdesign, Materialkombination und Instrumentarium erlebt der Oberflächenersatz des Hüftgelenks eine Renaissance. Damit steigt aber allgemein das Risiko, auch bei diesem Prothesentyp eine periprothetische Fraktur zu erleiden. Dabei unterscheiden sich die mehrheitlich iatrogen verursachten Kopf-Hals-Frakturen von den traumatisch bedingten trochantären Frakturen. Besonders bei letzteren stellt sich die Frage eines Prothesenerhalts da es sich um ein junges, aktives Patientenklientel handelt.

Wir berichten über einen damals 31-jährigen Patienten, der bei einliegendem Oberflächenersatz nach McMinn eine intertrochantäre Fraktur 31 A2.1 nach der AO-Klassifikation (AO Arbeitsgemeinschaft für Osteosynthesefragen) erlitt und in unserer Einrichtung mit 3 AO-Zugschrauben in perkutaner Technik versorgt wurde. Zweiundzwanzig Monate nach der operativen Stabilisierung zeigte sich ein gutes Bewegungsausmaß bei in guter Stellung vollständig konsolidierter Fraktur. Der Harris Hip Score betrug bei der Nachuntersuchung 97 Punkte.

Abstract

Improvements in implant design, material combination and operating instruments have led to an increased number of resurfacing arthroplasties of the hip joint especially in younger patients. Therefore, there is generally a higher risk of periprosthetic fractures even with this type of prosthesis. These fractures are divided into mainly iatrogenic fractures of the head/neck part of the femur and trochanteric fractures of the femur caused by trauma. Especially in the second group preservation of the prosthesis is much desired since the patient cohort is often very young and active.

We report on a 31-year-old male patient who suffered an intertrochanteric fracture (classification AO 31 A2.1) after resurfacing arthroplasty of the hip joint (McMinn BHR prosthesis). The patient was treated with 3 AO lag screws by the percutaneous technique following closed reduction. During follow-up 22 months after the operation the reduction was preserved and the fracture fully consolidated with a good range of motion of the hip joint. The Harris hip score gave a result of 97 points.

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Authors and Affiliations

  1. Klinik für Unfall-, Wiederherstellungs- und Handchirurgie, Städtisches Klinikum, Krankenhaus Dresden-Friedrichstadt, Friedrichstr. 41, 01067, Dresden, Deutschland

    T. Lein, M. Kothe & F. Moritz

  2. Klinik für Orthopädie und Spezielle orthopädische Chirurgie, Städtisches Klinikum, Krankenhaus Dresden-Friedrichstadt, Dresden, Deutschland

    J. Schlee & D.T. Wubtaye

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  1. T. Lein
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  2. J. Schlee
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  3. M. Kothe
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  4. F. Moritz
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  5. D.T. Wubtaye
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Correspondence to T. Lein.

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Lein, T., Schlee, J., Kothe, M. et al. Periprothetische intertrochantäre Femurfraktur nach Oberflächenersatz des Hüftgelenks. Unfallchirurg 113, 944–950 (2010). https://doi.org/10.1007/s00113-009-1714-y

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