Stellenwert der Endoprothetik nach Acetabulumfraktur.

Acetabular fractures are articular fractures and should be treated by open, anatomic reduction and internal fixation. In cases of high-quality surgery, the necessity for hip replacement can be avoided in 80% of patients. In elderly patients in a good general condition and with good bone quality, open reduction and internal fixation is also recommended. The necessity for hip replacement can be avoided in up to 70%. Conservative treatment of acetabular fractures in elderly patients is associated with many complications and with poor long-term functional results. In the case of osteoporotic fractures, fracture comminution and subchondral impaction, primary endoprosthetic replacement is a good alternative. The main challenge is to achieve a strong anchorage of the artificial cup in the broken acetabulum; therefore, an additional osteosynthesis of the acetabulum may sometimes be necessary. Because the anterior column is mostly involved, the ilioinguinal and modified Stoppa approaches are suitable for osteosynthesis. The osteosynthesis and endoprosthetic replacement can be performed in one surgical intervention or two consecutively scheduled surgeries. Depending on the bone quality, the precision of reduction and stability of osteosynthesis, a non-cemented cup or a cemented cup can be inserted within a reinforcement ring. In periprosthetic acetabular fractures, reduction and fixation of the acetabular fracture has to be done prior to replacement of the loosened cup. A separate access for the osteosynthesis is generally needed. As the loosened cup may hinder reduction of the acetabular fracture, both operative steps have to be done in one surgical intervention. [ABSTRACT FROM AUTHOR]