Zusammenfassung
Die Nagelosteosynthese und Plattenosteosynthese sind anerkannte, teils konkurrierende Operationsverfahren bei dislozierten proximalen Humerusfrakturen. Zunehmende Erkenntnisse über einzelne Implantattypen und postoperative Ergebnisse ermöglichen mittlerweile eine differenzierte Anwendung der Osteosyntheseverfahren.
Ideale Indikationen für die Nagelosteosynthese stellen dislozierte subkapitale 2-Segment- (und 3-Segment-) Frakturen sowie in den Schaft reichende Spiralfrakturen dar. Proximale Humerusfrakturen jüngerer Patienten < 60 Jahre eignen sich dagegen aufgrund der Rotatorenmanschettenproblematik ebenso wie 4-Segment-Frakturen besser für die Plattenosteosynthese. Hohe initiale Komplikationsraten können durch die Vermeidung von Anwenderfehlern wie primäre Schraubenperforationen und Beachtung implantatspezifischer Besonderheiten wie den korrekten Eintrittspunkt reduziert werden. Unter korrekter Indikationsstellung werden gute funktionelle klinische Ergebnisse nach Nagelosteosynthese erreicht. Neue arthroskopische Techniken, die Beachtung und Therapie von Begleitpathologien sowie Weiterentwicklungen etablierter Implantate verbessern die Anwendung der Nagelosteosynthese zunehmend und reduzieren bislang kritische Aspekte wie Rotatorenmanschettenaffektionen.
Abstract
Nail- and plate-osteosynthesis are established forms of treatment of dislocated proximal humeral fractures. Findings about different implants and postoperative results allow for differentiated use of osteosynthesis- techniques. Ideal indications for nail-osteosynthesis are dislocated subcapital two-part (and three-part) fractures as well as spiral fractures with involvement of the shaft. Fractures of younger patients < 60 years and four-part fractures seem better suited for plate-osteosynthesis. High initial complication-rates can be reduced by consideration of implant associated peculiarities as the correct entry-point and avoiding faults during implantation like primary intraarticular screw-perforation. Within approved indications good functional clinical results can be achieved. New arthroscopic techniques, treatment of concomitant pathologies and further development of established implants will improve the use of nail-osteosynthesis and reduce critical aspects as affection of the rotator cuff.
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Katthagen, J., Voigt, C., Jensen, G. et al. Nagelosteosynthese proximaler Humerusfrakturen. Obere Extremität 7, 128–136 (2012). https://doi.org/10.1007/s11678-012-0176-y
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DOI: https://doi.org/10.1007/s11678-012-0176-y