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Komplexe Kniegelenkverletzung beim Polytrauma

Complex knee injury in polytraumatized patients

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Zusammenfassung

Die Versorgung schwerer Gelenkverletzungen beim polytraumatisierten Patienten stellt eine besondere Entität dar, da sie komplex und zeitaufwendig ist. Der behandelnde Chirurg muss entscheiden, ob ein Erhaltungsversuch der Extremität indiziert ist und welche Maßnahmen zur Stabilisierung einzuleiten sind. Die Entscheidung zur Amputation sollte vom Allgemeinzustand des Patienten sowie dem Weichteil- und neurovaskulären Status der Extremität abhängig gemacht werden. Score-Systeme können zur Entscheidungshilfe herangezogen werden, die Entscheidung hinsichtlich des Extremitätenerhaltes sollte allerdings immer individuell getroffen werden. Beim Erhaltungsversuch hat sich bei komplexen Gelenkverletzungen des Schwerverletzten ein mehrstufiges operatives Vorgehen etabliert. Im Vordergrund stehen die Sicherstellung einer suffizienten Durchblutung sowie die Sanierung der Weichteile, wobei die Indikation zur Kompartmentspaltung großzügig zu stellen ist. Um einer weiteren Kompromittierung der Weichteile sowie der Durchblutung vorzubeugen, ist eine temporäre Gelenk- und Frakturstabilisierung durchzuführen. Eine definitive operative Versorgung sollte im Zeitraum des 2-wöchigen Fensters erfolgen, d. h. nicht vor dem 5. Tag nach Trauma und günstigerweise innerhalb von 10 Tagen, soweit der Allgemeinzustand des Patienten dieses zulässt.

Abstract

In polytraumatized patients severe joint injuries represent a special entity because their management is complex and lengthy. The surgeon must decide if limb salvage is indicated and which further surgical steps have to be instituted. The decision for amputation is based on the patient’s general condition and the soft-tissue and neurovascular injury. Scoring systems are useful for decision making. Limb salvage is associated with a multistage surgical approach. Priority is given to restoration of sufficient blood supply and soft tissue repair; the indication for fasciotomy covers a wide field. To avoid further compromise to soft tissue and perfusion, temporary joint and fracture stabilization is required. Definitive surgery has to be delayed until the 2 week period, starting between the fifth and tenth day after trauma.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Medical Building, Suite 1010, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA

    P. Kobbe, B.A. Zelle & H.C. Pape

  2. Center for Surgical Research, University of Alabama at Birmingham, Birmingham, USA

    M. Frink

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  1. P. Kobbe
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  2. M. Frink
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  3. B.A. Zelle
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  4. H.C. Pape
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Correspondence to P. Kobbe.

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Kobbe, P., Frink, M., Zelle, B. et al. Komplexe Kniegelenkverletzung beim Polytrauma. Unfallchirurg 110, 235–244 (2007). https://doi.org/10.1007/s00113-007-1231-9

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