Collum femorisfrakturer.ao-danmark.dk/wp-content/uploads/2020/02/PMH-Col... · 2020. 2. 3. ·...
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Collum femorisfrakturer.
Epidemiologi, frakturtyper, behandling. Osteosyntese vs. alloplastik
AO Basic Danmark 2019
Peter Max Halschou-Jensen Afdelingslæge, Traumesektionen Ortopædkirurgisk afdeling Herlev Universitetshospital
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INDHOLD (15 min.)
- Epidemiologi
- Klassifikation
- Behandling, valg af metode/implantat
- Komplikationer
- Fremtiden
- Take-home messages
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Epidemiologi
- Ca. 10.000 hoftenære frakturer DK/år
- Ca. 55% defineres som collumfrakturer
- Gennemsnitsalder 80 år.
- ¾ er kvinder
- Høj dødelighed
- Hvad ellers?
- Lavenergi traume
- Osteoporose, KOL, hjertesvigt, demens
- ”Tung” medicinsk patient
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Klassifikation
Garden, Pauwel, AO m.fl.
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Klassifikation
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Klassifikation
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Behandling – Valg af implantat
Caput bevarende Caput exciderende
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Behandling – Valg af implantat ?
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Behandling – Valg af implantat ?
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Behandling – Valg af implantat ?
A new algorithm for hip fracture surgery. Reoperation rate reduced from 18 % to 12 % in 2,000 consecutive patients followed for 1 year. Palm H, Krasheninnikoff M, Holck K, Lemser T, Foss NB, Jacobsen S, Kehlet H, Gebuhr P. Acta Orthop. 2012
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Behandling – Valg af implantat ?
3 punkts fiksation: - Head - Medial cortex (calcar) - Lateral cortex
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Behandling – i det store billede
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Komplikationer
Osteosyntese Hemialloplastik
AVN, cut-out, non-union, forkortning, smerte, inf. Luxation, inf., periprostetisk fraktur, bruskslid
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Komplikationer
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Fremtiden ?
- Alloplastik: THA/HA, adgang, +/-cement, dual-mobility?
- IF: Pin-DynaLoc / Gannet / Targon?
- Komorbiditet
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Take-Home messages…
- Tilstræb hurtig mobilisering
- Obs blodforsyning til caput!
- 3-punkts støtte ved osteosyntese
?