Skip to main content
SpringerLink
Log in

Schenkelhalsfrakturen bei jüngeren Patienten (15–50 Jahre)

Systematische Literaturrecherche zur medialen Schenkelhalsfraktur beim jungen Patienten

Fractures of the neck of the femur in younger patients (15–50 years old)

Systematic literature research on medial fractures of the neck of the femur in young patients

  • In der Diskussion
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Die nichtpathologischen Oberschenkelhalsfrakturen bei jüngeren Patienten zwischen dem 15. und 50. Lebensjahr sind seltene Verletzungen. Es sind „adäquate Schädigungen“ mit sehr hoher Energieeinleitung, verursacht durch Verkehrsunfälle, Stürze und Sportunfälle, die den gesunden Knochen frakturieren lassen – und oft genug zu Mehrfachverletzungen führen.

Die kurz- und langfristigen Komplikationen dieser Verletzung bereiten z. T. erhebliche Probleme, insbesondere die „non-union“ (NU) der Fraktur und die avaskuläre Nekrose (AVN) des Hüftkopfs. In der Fachliteratur (und von einigen Sachverständigen) wird gelegentlich der Eindruck erweckt, dass es „bewiesene“ erfolgreiche Therapieverfahren für die Methode und insbesondere den Zeitpunkt der Schenkelhalsfrakturversorgung bei jüngeren Patienten gäbe. Diese Darstellungen führten u. a. so weit, dass in gerichtlichen Auseinandersetzungen (und Urteilen) von „Behandlungsfehlern“ gesprochen wurde (Urteil IU 5146/00, OLG München; 2O 861/07 Hei, LG Ansbach; 118C 421/05, AG Köln).

Die Autoren waren als medizinische Sachverständige wiederholt aufgerufen, den aktuellen Stand der medizinischen Wissenschaft zur Frage der Biologie der Heilung von Oberschenkelhalsfrakturen und zur Frage „gesicherter“ Therapiestrategien vorzutragen. Vor diesem Hintergrund soll die vorliegende Arbeit einen Überblick über den nach den verfügbaren klinischen und experimentellen Daten derzeitig gesicherten Kenntnisstand und nicht zuletzt Anlass zur konstruktiven Diskussion geben.

Abstract

Non-pathologic fractures of the neck of the femur in younger patients aged between 15 and 50 years old are rare injuries. These are so-called effectual injuries with very high energy induction due to traffic accidents, falls and sport accidents, causing healthy bones to be fractured and often leading to multiple injuries. The short-term and long-term complications of such injuries sometimes give rise to substantial problems, in particular from non-union fractures and avascular necrosis of the head of the femur. In the literature (and from some experts) the impression is occasionally given that there might be “proven” successful therapeutic procedures for the methods and in particular the timing of treatment of fractures of the neck of the femur in younger patients. This presentation has gone so far that in some cases the term “treatment malpractice” has been used in legal disputes (and judgments) (Judgment IU 5146/00, Higher Regional Court Munich; 2O 861/07 Hei, Regional District Court Ansbach; 118C 421/05, District Court Cologne).

The authors have often been called upon as medical experts to comment on the current state of medical knowledge on the question of the biology of healing of fractures of the neck of the femur and the question of“verified” therapy strategies. With this in mind this article is designed to give a review of the current state of proven knowledge according to the available clinical and experimental data and last but not least to stimulate constructive discussion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Bachiller FG, Caballer AP, Portal LF (2002) Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop Relat Res 399:87–109

    Article  PubMed  Google Scholar 

  2. Barnes R, Brown JT, Garden RS, Nicoll EA (1976) Subcapital fractures of the femur. A prospective review. J Bone Joint Surg [Br] 58:2–24

    Google Scholar 

  3. Bartonicek J, Fric V, Skala-Rosenbaum J, Dousa P (2007) Avascular necrosis of the femoral head in pertrochanteric fractures: a report of 8 cases and a review of the literature. J Orthop Trauma 21:229–236

    Article  PubMed  Google Scholar 

  4. Bonnaire F, Schaefer DJ, Kuner EH (1998) Hemarthrosis and hip joint pressure in femoral neck fractures. Clin Orthop Relat Res 353:148–155

    Article  PubMed  Google Scholar 

  5. Chilov MN, Cameron ID, March LM (2003) Evidence-based guidelines for fixing broken hips: an update. Med J Aust 179:489–493

    PubMed  Google Scholar 

  6. Cho MR, Lee SW, Shin DK et al (2007) A predictive method for subsequent avascular necrosis of the femoral head (AVNFH) by observation of bleeding from the cannulated screw used for fixation of intracapsular femoral neck fractures. J Orthop Trauma 21:158–164

    Article  PubMed  Google Scholar 

  7. Conn KS, Parker MJ (2004) Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients. Clin Orthop Relat Res 421:249–254

    Article  PubMed  Google Scholar 

  8. Cooper A (1822) Dislocations and fractures. 1st edn. Churchill, London

  9. Damany DS, Parker MJ, Chojnowski A (2005) Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures. Injury 36:131–141

    CAS  PubMed  Google Scholar 

  10. Freeman MA (1978) Some anatomical and mechanical considerations relevant to the surface replacement of the femoral head. Clin Orthop Relat Res 134:19–24

    PubMed  Google Scholar 

  11. Frihagen F, Nordsletten L, Madsen JE (2007) Hemiarthroplasty or internal fixation for intracapsular displaced femoral neck fractures: randomised controlled trial. BMJ 335:1251–1254

    Article  PubMed  Google Scholar 

  12. Garden RS (1971) Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg [Br] 53:183–197

    Google Scholar 

  13. Gautier E, Ganz K, Krugel N et al (2000) Anatomy of the medial femoral circumflex artery and its surgical implications. J Bone Joint Surg [Br] 82:679–683

    Google Scholar 

  14. Gillespie WJ (2001) Extracts from „clinical evidence“: hip fracture. BMJ 322:968–975

    Article  CAS  PubMed  Google Scholar 

  15. Haidukewych GJ, Rothwell WS, Jacofsky DJ et al (2004) Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg [Am] 86-A:1711–1716

    Google Scholar 

  16. Haleem S, Heinert G, Parker MJ (2008) Pressure sores and hip fractures. Injury 39:219–223

    Article  CAS  PubMed  Google Scholar 

  17. Harper WM, Barnes MR, Gregg PJ (1991) Femoral head blood flow in femoral neck fractures. An analysis using intra-osseous pressure measurement. J Bone Joint Surg [Br] 73:73–75

    Google Scholar 

  18. Hirschwald A (1878) Verhandlungen der Deutschen Gesellschaft für Chirurgie, Siebenter Congress 1878, S 89–93

  19. Holmberg S, Kalen R, Thorngren KG (1987) Treatment and outcome of femoral neck fractures. An analysis of 2418 patients admitted from their own homes. Clin Orthop Relat Res 218:42–52

    PubMed  Google Scholar 

  20. Jain R, Koo M, Kreder HJ et al (2002) Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg [Am] 84-A:1605–1612

    Google Scholar 

  21. Kregor PJ (1996) The effect of femoral neck fractures on femoral head blood flow. Orthopedics 19:1031–1036; quiz 1037–1038

    CAS  PubMed  Google Scholar 

  22. Kuner EH, Lorz W, Bonnaire F (1995) Femoral neck fractures in adults: joint sparing operations. I. Results of an AO collective study with 328 patients. Unfallchirurg 98:251–258

    CAS  PubMed  Google Scholar 

  23. Manninger J, Kazar G, Fekete G et al (1985) Avoidance of avascular necrosis of the femoral head, following fractures of the femoral neck, by early reduction and internal fixation. Injury 16:437–448

    Article  CAS  PubMed  Google Scholar 

  24. Moon ES, Mehlman CT (2006) Risk factors for avascular necrosis after femoral neck fractures in children: 25 Cincinnati cases and meta-analysis of 360 cases. J Orthop Trauma 20:323–329

    Article  PubMed  Google Scholar 

  25. München GO (2001) Urteil I U 5146/00, OLG München

  26. Nishino M, Matsumoto T, Nakamura T, Tomita K (1997) Pathological and hemodynamic study in a new model of femoral head necrosis following traumatic dislocation. Arch Orthop Trauma Surg 116:259–262

    Article  CAS  PubMed  Google Scholar 

  27. Parker MJ, Banajee A (2005) Surgical approaches and ancillary techniques for internal fixation of intracapsular proximal femoral fractures. Cochrane Database Syst Rev: CD001705

    Google Scholar 

  28. Parker MJ, Raghavan R, Gurusamy K (2007) Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res 458:175–179

    PubMed  Google Scholar 

  29. Robinson CM, Court-Brown CM, McQueen MM, Christie J (1995) Hip fractures in adults younger than 50 years of age. Epidemiology and results. Clin Orthop Relat Res 312:238–246

    PubMed  Google Scholar 

  30. Roshan A, Ram S (2008) The neglected femoral neck fracture in young adults: review of a challenging problem. Clin Med Res 6:33–39

    Article  PubMed  Google Scholar 

  31. Sevitt S, Thompson RG (1965) The distribution and anastomoses of arteries supplying the head and neck of the femur. J Bone Joint Surg [Br] 47:560–573

    Google Scholar 

  32. Stürmer KMH (2001) Leitlinien der Unfallchirurgie. 3. Aufl. Thieme, Stuttgart

  33. Upadhyay A, Jain P, Mishra P et al (2004) Delayed internal fixation of fractures of the neck of the femur in young adults. A prospective, randomised study comparing closed and open reduction. J Bone Joint Surg [Br] 86:1035–1040

    Google Scholar 

  34. Whiteside LA, Lange DR, Capello WR, Fraser B (1983) The effects of surgical procedures on the blood supply to the femoral head. J Bone Joint Surg [Am] 65:1127–1133

    Google Scholar 

  35. Zuckerman JD, Skovron ML, Koval KJ et al (1995) Postoperative complications and mortality associated with operative delay in older patients who have a fracture of the hip. J Bone Joint Surg [Am] 77:1551–1556

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Orthopädisch-Unfallchirurgisches Zentrum , Universitätsmedizin Mannheim, Medizinische Fakultät der Universität Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    D. Sachse, F. Bludau & U. Obertacke

Authors
  1. D. Sachse
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Bludau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Obertacke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. Sachse.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sachse, D., Bludau, F. & Obertacke, U. Schenkelhalsfrakturen bei jüngeren Patienten (15–50 Jahre). Unfallchirurg 113, 69–74 (2010). https://doi.org/10.1007/s00113-009-1699-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-009-1699-6

Schlüsselwörter

Keywords

Search

Navigation