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Fracturas do colo do fémur em adultos jovens
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As fracturas do colo do fémur são frequentes em idosos, sendo a osteoporose o seu principal factor de risco. Este género de fracturas é raro em adultos jovens - com idades inferiores a 50-60 anos, dependendo da literatura - representando apenas entre 2 a 10% do total das mesmas, sendo na sua maioria causadas por traumatismos de alta energia.
A abordagem a estas fracturas em idosos encontra-se bem suportada pela evidência científica existente, sendo a artroplastia da anca a cirurgia de eleição para a maioria dos doentes nesta faixa etária. Este suporte científico adequado não existe em relação à abordagem das mesmas fracturas em doentes fisiológica e cronologicamente mais jovens, permanecendo assim um desafio e uma fonte de debate entre os especialistas.
Pela idade mais reduzida e pelas necessidades funcionais elevadas que os adultos jovens apresentam, o recurso à artroplastia deve ser evitado, revelando-se necessário uma abordagem diferente entre as diferentes populações etárias.
A suspeita clínica de fractura do colo do fémur é confirmada por métodos imagiológicos, existindo duas classificações classicamente utilizadas para as descrever, a de Pauwels e a de Garden.
Estas fracturas devem ser abordadas cirurgicamente tão cedo quanto possível, principalmente se descoptadas, uma vez que é fundamental providenciar uma redução anatómica e uma fixação estável para se atingir uma correcta consolidação. Não existe consenso acerca do método ideal de osteossíntese destas fracturas, existindo vários materiais e implantes disponíveis.
O maior desafio da abordagem a estas fracturas continua a ser a prevenção das suas principais complicações e consequente morbilidade, que apresentam incidências elevadas, nomeadamente a necrose asséptica da cabeça do fémur (NACF) e a pseudartrose, bem como da sua abordagem depois de as mesmas se desenvolverem.
Femoral neck fractures are common in the elderly, with osteoporosis being the main risk factor in this population. This type of fractures is uncommon in young adults - younger than 50-60 years – accounting for only about 2-10% of all femoral neck fractures and are often due to high-energy trauma. The management of these fractures in the elderly patients is well supported by the current scientific evidence. The surgical approach to these patients often requires a hip replacement. However, the evidence regarding the management of these fractures in the physiological and chronological younger patients is frequently insufficient and is often a source of debate among experts. The younger patients age and their high functional demands mandate a different approach for these patients, since hip arthroplasty should be avoided in this age group whenever possible. Femoral neck fractures require confirmation by imaging methods. There are two well-known and widely used classification systems for these fractures: Pauwels classification and Garden classification. This type of fractures should be treated as soon as possible, especially if displaced. Obtaining anatomic reduction and stable internal fixation is crucial to achieve union. There are several biomechanical methods available for the fixation of these fractures but the debate on the optimal method of fixation remains. The biggest challenge regarding the treatment of femoral neck fractures in young adults is to effectively prevent and to deal with their most frequent complications: osteonecrosis of the femoral head and non-union. These complications have high incidence in these patients and are associated to high rates of morbidity.
Femoral neck fractures are common in the elderly, with osteoporosis being the main risk factor in this population. This type of fractures is uncommon in young adults - younger than 50-60 years – accounting for only about 2-10% of all femoral neck fractures and are often due to high-energy trauma. The management of these fractures in the elderly patients is well supported by the current scientific evidence. The surgical approach to these patients often requires a hip replacement. However, the evidence regarding the management of these fractures in the physiological and chronological younger patients is frequently insufficient and is often a source of debate among experts. The younger patients age and their high functional demands mandate a different approach for these patients, since hip arthroplasty should be avoided in this age group whenever possible. Femoral neck fractures require confirmation by imaging methods. There are two well-known and widely used classification systems for these fractures: Pauwels classification and Garden classification. This type of fractures should be treated as soon as possible, especially if displaced. Obtaining anatomic reduction and stable internal fixation is crucial to achieve union. There are several biomechanical methods available for the fixation of these fractures but the debate on the optimal method of fixation remains. The biggest challenge regarding the treatment of femoral neck fractures in young adults is to effectively prevent and to deal with their most frequent complications: osteonecrosis of the femoral head and non-union. These complications have high incidence in these patients and are associated to high rates of morbidity.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Fracturas do colo do fémur Necrose asséptica da cabeça do fémur Pseudartrose Adultos jovens Ortopedia