{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T05:26:48Z","timestamp":1741325208050,"version":"3.38.0"},"reference-count":41,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Orthop Unfall"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n          Hintergrund und Planung Intraoperative periprothetische Femurfrakturen z\u00e4hlen zu den schwerwiegenden Komplikationen sowohl in der Prim\u00e4r- als auch in der Revisionsendoprothetik. H\u00e4ufig werden diese trotz intraoperativer radiologischer Kontrollen nicht erkannt. Da bei einer unbemerkten intraoperativ entstandenen Fraktur h\u00e4ufig ein Revisionseingriff notwendig wird, welcher in der Literatur mit erh\u00f6hten Mortalit\u00e4tsraten einhergeht, ist die intraoperative Diagnose und entsprechend direkte und suffiziente Versorgung entscheidend. Es existieren patienten-, operations- sowie implantatspezifische Risikofaktoren, welche die Wahrscheinlichkeit f\u00fcr intraoperative Frakturen erh\u00f6hen. Zu den wichtigsten Risikofaktoren auf Patientenseite z\u00e4hlen Alter, Geschlecht sowie verschiedene Vorerkrankungen wie bspw. Osteoporose oder Erkrankungen aus dem rheumatischen Formenkreis. Die wichtigsten operations- und implantatspezifischen Risikofaktoren sind ein minimalinvasiver Zugang sowie eine\n          zementfreie Press-fit-Verankerung. Die Klassifikation der intraoperativen periprothetischen Femurfrakturen kann mit der Vancouver-Klassifikation oder der modifizierten Mallory-Klassifikation erfolgen. Anhand dieser k\u00f6nnen Therapieempfehlung abgeleitet werden. Zur Frakturversorgung stehen unterschiedliche Strategien zur Verf\u00fcgung.<\/jats:p><jats:p>\n          Therapie Generell gilt, dass bei einem stabilen Schaft eine Osteosynthese mit Erhalt des Implantates erfolgen kann. Diese kann in der Mehrzahl der F\u00e4lle bei nicht dislozierten Frakturen mittels Cerclagen erfolgen. Bei einer instabilen Situation kann aber auch ein Wechsel des Schaftes notwendig werden. Bei h\u00f6hergradigen Frakturen kann eine Stabilisierung mittels Plattenosteosynthese erforderlich werden. Ziel ist es, eine m\u00f6glichst anatomische Reposition zur bestm\u00f6glichen kn\u00f6chernen Konsolidierung mit einer suffizienten Implantatstabilit\u00e4t und Wiederherstellung der Biomechanik zu erreichen.<\/jats:p>","DOI":"10.1055\/a-2051-8613","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T23:26:17Z","timestamp":1693351577000},"page":"349-359","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative periprothetische Femurfrakturen \u2013 wann reicht die Cerclage?"],"prefix":"10.1055","volume":"162","author":[{"given":"Sebastian","family":"Hardt","sequence":"additional","affiliation":[{"name":"Centrum f\u00fcr Muskuloskeletale Chirurgie, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Campus Charit\u00e9 Mitte, Berlin, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregor","family":"Giebel","sequence":"additional","affiliation":[{"name":"Centrum f\u00fcr Muskuloskeletale Chirurgie, Charit\u00e9 Universit\u00e4tsmedizin Berlin, Campus Charit\u00e9 Mitte, Berlin, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Hube","sequence":"additional","affiliation":[{"name":"Orthop\u00e4dische Chirurgie, OCM-Klinik M\u00fcnchen, M\u00fcnchen, Deutschland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,8,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1670","DOI":"10.1302\/0301-620X.102B12.BJJ-2020-0367.R1","article-title":"High mortality following revision hip arthroplasty for periprosthetic femoral fracture","volume":"102-B","author":"T Khan","year":"2020","journal-title":"Bone Joint J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1302\/0301-620X.101B10.BJJ-2018-1596.R1","article-title":"Patient and implant survival following intraoperative periprosthetic femoral fractures during primary total hip arthroplasty: An analysis from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man","volume":"101-B","author":"JN Lamb","year":"2019","journal-title":"Bone Joint J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"9","DOI":"10.2106\/00004623-200401000-00003","article-title":"The cumulative long-term risk of dislocation after primary Charnley total hip arthroplasty","volume":"86","author":"DJ Berry","year":"2004","journal-title":"J Bone Joint Surg Am"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/BF00934256","article-title":"Fracture of the lower extremity after total hip replacement","volume":"108","author":"LI L\u00f6wenhielmHansson","year":"1989","journal-title":"Arch Orthop Trauma Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1016\/j.injury.2007.02.048","article-title":"Epidemiology of periprosthetic femur fracture around a total hip arthroplasty","volume":"38","author":"H Lindahl","year":"2007","journal-title":"Injury"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1016\/S0883-5403(96)80031-3","article-title":"Femoral component revision using an uncemented, proximally coated, long-stem prosthesis","volume":"11","author":"AL Malkani","year":"1996","journal-title":"J Arthroplasty"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/S0020-1383(02)00161-4","article-title":"Dall-Miles plates for periprosthetic femoral fractures: A critical review of 16 cases","volume":"34","author":"E Tsiridis","year":"2003","journal-title":"Injury"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1016\/j.arth.2015.02.026","article-title":"Intraoperative Periprosthetic Femur Fracture: A Biomechanical Analysis of Cerclage Fixation","volume":"30","author":"NB Frisch","year":"2015","journal-title":"J Arthroplasty"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1055\/b-0038-159986","volume-title":"Expertise Orthop\u00e4die und Unfallchirurgie H\u00fcfte. 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