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Die Sakrum-H-Fraktur zwischen traumatischer, Insuffizienz- und Ermüdungsfraktur

Gemeinsamkeiten, Unterschiede und Kontroversen

Sacral H-shaped fractures between traumatic, insufficiency and fatigue fractures

Similarities, differences and controversies

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Zusammenfassung

In der Grundgesamtheit der Stressfrakturen ist die Insuffizienzfraktur definiert als Fraktur, die durch lang anhaltende normale oder physiologische Belastung eines Knochens mit unzureichendem elastischem Widerstand entsteht. Damit ist sie klar abgegrenzt von den Ermüdungsbrüchen („fatigue fractures“), bei denen übermäßige Belastungen andauernd auf einen Knochen mit normalem elastischem Widerstand einwirken. Beide Entitäten der Stressfraktur entstehen nach Pentecost (1964) durch „die inhärente Unfähigkeit des Knochens, Belastungen standzuhalten, die ohne Gewaltanwendung in rhythmischer, wiederholter und unterschwelliger Weise ausgeübt werden“. Dies unterscheidet sie von akuten, traumatischen Frakturen. Im klinischen Alltag stellen sich diese Unterschiede nicht immer so klar dar. Am Beispiel der Sakrum-H-Fraktur wird die Relevanz einer klaren Begrifflichkeit dargelegt. Aktuelle Kontroversen in der Behandlung von Sakruminsuffizienzfrakturen werden diskutiert.

Abstract

In the basic entirety of stress fractures, insufficiency fractures are defined as fractures caused by prolonged normal or physiological loading of a bone with insufficient elastic resistance. This clearly distinguishes it from fatigue fractures, in which excessive loads are continuously applied to a bone with normal elastic resistance. According to Pentecost (1964) both entities of stress fracture result from “the inherent inability of the bone to withstand stress applied without violence in a rhythmical, repeated, subthreshold manner”. This distinguishes them from acute traumatic fractures. In the clinical routine these differences are not always so clearly presented. The example of the H‑shaped sacral fracture is used to illustrate the relevance of a clear terminology. In this context, current controversies in the treatment of sacral insufficiency fractures are discussed.

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  1. Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland

    Patrick Gahr &  Thomas Mittlmeier

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Gahr, P., Mittlmeier, T. Die Sakrum-H-Fraktur zwischen traumatischer, Insuffizienz- und Ermüdungsfraktur. Unfallchirurgie 126, 863–871 (2023). https://doi.org/10.1007/s00113-023-01346-5

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