Der Einfluss von Immunsuppression auf den peri- und postoperativen Verlauf in der operativen Versorgung der distalen Radiusfraktur

Die distale Radiusfraktur stellt die häufigste Fraktur des Menschen dar. Aus epidemiologischer Sicht bestehen zwei Häufigkeitsgipfel. Diese liegen im Kindesalter und im vorangeschrittenen Alter bei über 65 Jahren. Ebenso wie die distale Radiusfraktur durch die demographisch bedingte Veränderung der...

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Bibliographic Details
Main Author: Dannenberg, Svea
Contributors: Frink, Michael (Prof. Dr. med.) (Thesis advisor)
Format: Dissertation
Language:German
Published: Philipps-Universität Marburg 2018
Unfall,- Wiederherstellungs-, und Handchirurgie
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Table of Contents: The fracture of the distal radius is the most common bone fracture of the human body. Considered epidemiologically, there are two peaks of frequency; the first during childhood, the second around the age of 65 years. Since the population is changing due to demographic aging, the operative treatment for the fracture of the distal radius is becoming even more relevant. Just like the distal radius fracture, diseases that are mostly treated by the use of immunosuppressive drugs or that are defined by the state of immunosuppression, will also become more relevant in the daily clinical routine as the result of the aging population. Many side effects of immunosuppressive drugs are well known and proven. There are recommendations based on several studies concerning the peri- and postoperative use of these drugs. This study approaches the topic of peri and postoperative management by specifically focusing on the fracture of the distal radius in a retrospective study design. The medical history of 38 pairs of patients was analyzed. These pairs were created utilizing a matching process. They differed from each other concerning the condition of immunosuppression. The matching process considered the sex, the age, the date of surgery and the Charlson comorbidity score. The following information was collected for every index patient and match patient: sex, age, body mass index, abuse of alcohol, being a smoker or non smoker, drugs, laboratory values of leukocytes and C-reactive protein (CRP), classification of the fracture, preclinical time, number of days until surgery, method of anesthesia, surgical procedure, total length of surgery, postoperative need for analgesic medication, duration of inpatient treatment, and occurred complications. The exact documentation of the reason for the immunosuppression, immunosuppressive drugs, length of therapy, and drug dosage was performed for the index patients. The collected information was statistically compared and evaluated. There was no significant difference between the index group and the match group regarding the rate of postoperative complications (p: ,824), duration of inpatient stay (p: ,768), preclinical time (p: ,625), duration until the date of surgery (p: ,641) and the length of surgery (p: ,346). The outcome of this study is compatible with the current recommendations that exist for the peri and postoperative use of immunosuppressive drugs. These recommendations state that it is not necessary to stop the therapy for a surgical treatment. However, to be able to provide a more specific recommendation, to achieve the best case outcome, prospective studies with a larger number of cases, will be required.