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Quantifizierung des Behandlungserfolgs bei geriatrischen Sakrumfrakturen

Quantification of treatment success for geriatric sacral fractures

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Zusammenfassung

Hintergrund

Geriatrische Sakrumfrakturen stellen eine eigenständige Frakturentität mit wachsender Inzidenz und von steigender gesundheitsökonomischer Relevanz dar. Die Ziele der Behandlung sind sehr unterschiedlich zu denen bei jüngeren Patienten mit Hochenergiebeckenverletzungen. Um den Erfolg der Behandlung geriatrischer Sakrumfrakturen beurteilen zu können, müssen daher andere, vielleicht auch neue Messinstrumente zur Anwendung kommen.

Fragestellung

Literaturübersicht zu den vorhandenen Konzepten und Messinstrumenten der Outcome-Messung nach geriatrischen Sakrumfrakturen.

Methodik

Narrativer Übersichtsartikel basierend auf einer Recherche der relevanten deutsch- und englischsprachigen Literatur der letzten 10 Jahre.

Ergebnisse

Geriatrische Sakrumfrakturen führen zu einer verminderten Mobilität, einer erhöhten körperlichen und sozialen Abhängigkeit und einer hohen Morbiditäts- und Mortalitätsrate. Standardisierte spezifische Beurteilungsverfahren zur Beurteilung des funktionellen Ergebnisses nach geriatrischen Sakrumfrakturen fehlen. Bis diese entwickelt werden, scheint die parallele Erfassung von Mortalität, Timed „Up and Go“ Test, Oswestry Disability Index und einem generischen Gesundheitsfragebogen (Short Form-36, EurQul-5D) am sinnvollsten.

Schlussfolgerung

Unser Wissen über den natürlichen Verlauf nach geriatrischen Sakrumfrakturen ist derzeit limitiert, durch das Fehlen gut validierter Instrumente zur Messung des radiologischen und funktionellen Outcome. Dies gilt es zu beachten, wenn der Erfolg neuer Therapien für diese Patienten beurteilen werden muss. Zukünftige Studien sollten existierende Scores für diese Patientengruppe validieren und neue spezifische Messinstrumente entwickeln.

Abstract

Background

Geriatric sacral fractures represent an independent fracture entity of increasing incidence and growing socioeconomic relevance. The goals of treatment are very different to those in younger patients with high-energy pelvic fractures. Hence, new outcome measurement instruments are required in order to assess the success of treatment.

Objective

Literature review summarizing existing concepts and providing an overview of outcome measurement instruments for geriatric sacral fractures.

Methods

Narrative review article based on an analysis of the German and English-speaking literature from the last 10 years.

Results

Geriatric sacral fractures result in impaired mobility, increased physical and social loss of dependency and increased morbidity and mortality rates. There is a lack of standardized specific assessment procedures for functional outcome measurement after geriatric sacral fractures. Until these are developed and validated, a parallel acquisition of mortality, the timed up and go test, the Oswestry disability index (ODI) and a generic healthcare questionnaire score (SF-36, EQ-5D) seem to be most suitable.

Conclusion

At present our knowledge about the natural course of geriatric sacral fractures is limited by the lack of well-validated instruments to measure functional and radiographic outcomes. This has to be considered when evaluating the success of new treatment options for these patients. Future studies should validate existing scores for this population and develop new specific outcome instruments.

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Authors and Affiliations

  1. Klinik für Traumatologie, UniversitätsSpital Zürich, Raemistrasse 100, 8091, Zürich, Schweiz

    Georg Osterhoff

  2. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    Max J. Scheyerer

  3. Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    Ulrich J. Spiegl

  4. Zentrum für Wirbelsäulen- und Skoliosetherapie, Schön Klinik Nürnberg Fürth, Europa-Allee 1, 90763, Fürth, Deutschland

    Klaus J. Schnake

  5. Abteilung für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Deutschland

    Holger Siekmann

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  1. Georg Osterhoff
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  3. Ulrich J. Spiegl
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  5. Holger Siekmann
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Consortia

Arbeitsgruppe Osteoporotische Frakturen der Sektion Wirbelsäule der Deutschen Gesellschaft für Orthopädie und Unfallchirurgie

Corresponding author

Correspondence to Georg Osterhoff.

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Interessenkonflikt

G. Osterhoff, M.J. Scheyerer, U.J. Spiegl, K.J. Schnake und H. Siekmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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W. Mutschler, München

H. Polzer, München

B. Ockert, München

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Osterhoff, G., Scheyerer, M.J., Spiegl, U.J. et al. Quantifizierung des Behandlungserfolgs bei geriatrischen Sakrumfrakturen. Unfallchirurg 122, 293–298 (2019). https://doi.org/10.1007/s00113-018-0511-x

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  • DOI: https://doi.org/10.1007/s00113-018-0511-x

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