{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T03:25:30Z","timestamp":1788837930295,"version":"build-2803163510"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Orthop Unfall"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n          Einleitung Die Mehrzahl an \u2013 tumorbedingten \u2013 pathologischen Frakturen tritt bei Patienten mit Knochenmetastasen auf. Bei zumeist j\u00fcngeren Patienten kann eine pathologische Fraktur allerdings auch sowohl durch einen benignen als auch malignen Knochentumor bedingt sein. Die korrekte Diagnosestellung ist bei den zuvor genannten Differenzialdiagnosen von enormer Bedeutung. Eine Frakturversorgung bei einem malignen Knochentumor f\u00fchrt unweigerlich zu einer Tumorzellverschleppung und kann die onkologische Situation deutlich verschlechtern.<\/jats:p><jats:p>Das Ziel dieser \u00dcbersichtsarbeit ist es daher, dem Leser zum einen eine diagnostische Hilfestellung bei einer vermuteten pathologischen Fraktur an die Hand zu geben und zum anderen auf die Therapie einer pathologischen Fraktur bei benignen Knochentumoren zu fokussieren.<\/jats:p><jats:p>\n          Methoden Es handelt sich um ein nicht systematisches Review zur Diagnostik und Therapie pathologischer Frakturen bei benignen Knochentumoren oder Tumor-like Lesions anhand einer elektronischen PubMed-Datenbankrecherche. Eigene Vorgehensweisen, insbesondere zum Ausschluss eines malignen Knochentumors, werden ebenfalls vorgestellt.<\/jats:p><jats:p>\n          Ergebnisse und Diskussion Bei Vorliegen einer Fraktur ohne Einwirkung eines ad\u00e4quaten Traumas ist immer an die M\u00f6glichkeit einer pathologischen Fraktur zu denken. Neben einer allgemeinen Tumoranamnese muss insbesondere erfragt werden, ob schon vor dem Eintreten der Fraktur Schmerzen bestanden haben. Bei klinischem Verdacht auf eine pathologische Fraktur oder dem Verdacht in der konventionell radiologischen Bildgebung sollte vor einer etwaigen Frakturversorgung eine MRT-Untersuchung des betroffenen Skelettabschnitts mit Kontrastmittel erfolgen. Eine CT-Untersuchung ist ebenfalls hilfreich, um die kn\u00f6cherne Destruktion genau zu beurteilen. Sollte ein maligner oder lokal aggressiver benigner Knochentumor, wie z.\u00a0B. der Riesenzelltumor (RZT) oder die aneurysmatische Knochenzyste (AKZ) in der Bildgebung nicht definitiv ausgeschlossen werden k\u00f6nnen, ist eine bioptische Abkl\u00e4rung obligat. Die Biopsie des Knochens muss immer unter der Annahme erfolgen, dass die histologische\n          Aufarbeitung einen malignen Knochentumor ergibt und muss daher nach strengen onkologischen Kriterien durchgef\u00fchrt werden. Bei eindeutiger radiologischer Diagnose, z.\u00a0B. einer juvenilen Knochenzyste (JKZ) oder eines nicht ossifizierenden Fibroms (NOF), kann, je nach Lokalisation, eine konservative Frakturversorgung erwogen werden. Bei Vorliegen eines lokal aggressiven benignen Knochentumors, wie dem RZT oder der AKZ, muss neben der Frakturversorgung auch eine K\u00fcrettage des Tumors erfolgen. Insbesondere beim RZT ist hierbei, je nach Tumorausdehnung, individuell eine neoadjuvante Therapie mit Denosumab vor der K\u00fcrettage und Osteosynthese zu erw\u00e4gen bzw. auch die En-bloc-Resektion des Tumors.<\/jats:p><jats:p>\n          Schlussfolgerung Pathologische Frakturen, insbesondere bei j\u00fcngeren Patienten, d\u00fcrfen nicht \u00fcbersehen werden. Erst nach definitivem Ausschluss eines malignen oder benignen lokal aggressiven Knochentumors sollte eine Frakturversorgung erfolgen. Bei Vorliegen eines lokal aggressiven Knochentumors muss neben der Frakturversorgung i.d.R. eine K\u00fcrettage des Tumors erfolgen \u2013 ggf. auch eine En-bloc-Resektion beim RZT. Benigne \u2013 nicht aggressive \u2013 Tumoren k\u00f6nnen, je nach Lokalisation, ggf. konservativ behandelt werden.<\/jats:p>","DOI":"10.1055\/a-1850-2540","type":"journal-article","created":{"date-parts":[[2022,7,26]],"date-time":"2022-07-26T23:07:13Z","timestamp":1658876833000},"page":"69-78","source":"Crossref","is-referenced-by-count":4,"title":["Die pathologische Fraktur bei benignen Knochenl\u00e4sionen - Diagnostik und Therapie"],"prefix":"10.1055","volume":"162","author":[{"given":"Daniel","family":"Spodeck","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Unfall-, Hand- und Wiederherstellungschirurgie, Universit\u00e4tsklinikum Essen, Essen, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiebke","family":"Guder","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Tumororthop\u00e4die, Universit\u00e4tsklinikum Essen, Essen, 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