Die tiefe Infektion nach osteosynthetischer Versorgung hüftgelenknaher Femurfrakturen – Behandlungsergebnisse und Lebensqualität

Abstract

Proximal femur fractures are the second most prevalent fractures in patients older than 65 years. Despite large improvements in implant design and surgical technique, complications in fracture healing are very common. Deep infection after osteosynthetic treatment is considered to be one of the major complications with a high rate of mortality. Little is known about the adequate treatment and results in patients with infection of proximal femur fractures. The aim of this study was to evaluate the different treatment options for eradication of infection as well as to analyse the clinical outcome and quality of life. 40 patients treated for infected proximal femur fractures between 2001 and 2010 were retrospectively analysed. Quality of life was assessed in 21 patients after an average of 40 months using the WOMAC and the SF-12 score. Surgical treatment included complete removal of infected implants and radical debridement. In 20 patients resection arthroplasty had to be performed. Ten patients were treated with a modular prosthesis, 4 patients were treated with a proximal femur replacement. Due to severe infection and risk-increasing comorbidities, resection arthroplasty had to be performed in the remaining 12 patients. Re-osteosynthesis could be performed in 13 patients. Average time of treatment was 67 days. At the time of follow-up the rate of mortality proved to be 15%. The rate of reinfection was 14.6%. At the time of follow-up infection was still prevalent in 2 patients. Dislocation after the hip prosthesis occurred in 3 of 14 patients. Of the 13 patients who received re-osteosynthesis one patient suffered a reinfection. Delayed fracture healing was treated with spongiosa grafts in 2 cases. 33% of the patients with resection arthroplasty died during follow-up. Statistical analysis showed better results in WOMAC and SF-12 scores in patients with hip prosthesis. Patients with re-osteosynthesis showed a larger variation in results. Deep infection after osteosynthetic treatment of proximal femur fractures is a severe complication. Radical surgical treatment and adequate local and systemic antibiotic application can help clear an infection. Quality of life is significantly reduced. Treatment should therefore be adapted to the individual patient's condition.