Proximale Femurfrakturen

Zusammenfassung

Proximale Femurfrakturen gehören zu den häufigsten Osteoporose-assoziierten Fragilitätsfrakturen des älteren Menschen und zeigen durch den demographischen Wandel steigende Inzidenzen. Die Behandlung von Patienten mit proximalen Femurfrakturen ist komplex. Das orthogeriatrische Co-Management bezeichnet dabei die inter- und multidisziplinäre Zusammenarbeit aller involvierten Fachrichtungen und Berufsgruppen. Im Fokus liegt die Wiederherstellung der bestmöglichen Mobilität und Funktionalität als primäres Behandlungsziel. Chirurgisch existieren verschiedene moderne Osteosyntheseverfahren, welche insbesondere bei Patienten mit pertrochantären Femurfrakturen eingesetzt werden können. Aufseiten der Schenkelhalsfrakturen ist in aller Regel ein endoprothetischer Gelenkersatz nötig. In beiden Fällen soll nach der Operation eine unmittelbare Mobilisation unter Vollbelastung der operierten Extremität beginnen. Essenziell ist zudem die geriatrische Mitbehandlung der Patienten. Diese soll durch Fachärzte mit geriatrischer Kompetenz gewährleistet werden. Wesentliche Vorgaben der akutstationären Versorgung von Patienten mit proximalen Femurfrakturen werden durch eine Richtlinie des Gemeinsamen Bundesausschuss (G-BA) geregelt, welche zum 01.01.2021 in Kraft getreten ist. Der vorliegende Artikel soll einen Überblick über die wichtigsten Aspekte zur Klinik, Diagnostik und Therapie der proximalen Femurfrakturen geben.

Abstract

With demographic change and aging society osteoporotic fragility fractures are showing increasing incidences. Proximal femur fractures are among the most common osteoporosis-related fragility fractures in the elderly population. The treatment of patients with proximal femur fractures is complex. To cope with the emerging challenges, orthogeriatric co-management, which refers to the interdisciplinary and multidisciplinary collaboration of all specialties involved, was introduced. The primary therapy goal is to restore the best possible mobility and functionality. There is a wide range of surgical treatment options. Modern osteosynthesis procedures are particularly applicable for trochanteric fractures. In case of femoral neck fractures, endoprosthetic joint replacement is usually necessary. Postoperative mobilization should involve full weight-bearing of the operated limb. Further, specialized geriatricians should take part in perioperative care of orthogeriatric patients. The Federal Joint Committee (G-BA) determined specific requirements for the treatment of patients with proximal femur fractures that must be met by hospitals in Germany. This article gives an overview of the most important clinical aspects, diagnostics and treatment of proximal femur fractures.

Schlüsselwörter

Orthogeriatrie - Alterstraumatologie - Hüftfraktur - Schenkelhalsfraktur - pertrochantäre Oberschenkelfraktur

Keywords

orthogeriatrics - hip fracture - femoral neck fracture - trochanteric fracture

Publication History

Received: 15 June 2024

Accepted: 01 July 2024

Article published online:
10 September 2024

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