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Frakturendoprothetik an der Schulter

Wann und wie?

Fracture endoprostheses of the shoulder

When and how?

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Aufgrund ihrer Häufigkeit und Komplexität ist die proximale Humerusfraktur eine Herausforderung des chirurgischen Alltages. Wenn eine primäre Rekonstruktion nicht möglich ist, besteht die Indikation zum endoprothetischen Ersatz. Entscheidend für eine gute Funktion der anatomischen Frakturprothese ist die Einheilung der Tuberkula. Modulare Prothesen bieten die Kombination verschiedener Komponenten und können im Revisionsfall eine Konversion zur inversen Prothese ohne Schaftwechsel ermöglichen und sollten heutzutage verwendet werden. Bei vorbestehender Insuffizienz der Rotatorenmanschette mit Atrophie und fettiger Degeneration der Muskulatur ist die primär inverse Frakturprothese das Implantat der Wahl. Zur Rotationsverbesserung finden sich neue Ansätze in Überlegungen und Techniken zur Tuberkularefixation auch bei der inversen Frakturprothese. Die Tuberkularefixation sollte zur Weichteildeckung und Stabilisierung der Prothese sowie zur Funktionsverbesserung genutzt werden.

Abstract

Proximal humeral fractures are common in the daily clinical routine and remain a surgical challenge due to their complexity. If it is not possible to achieve a primary reconstruction by osteosynthesis, primary fracture arthroplasty is indicated. A decisive factor for the clinical outcome of anatomical fracture arthroplasty is correct ingrowth of the tuberosities. Modular prostheses provide a combination of various components and in the case of revision allow conversion to a reverse prosthesis without removal of the shaft. In the case of rotator cuff insufficiency with atrophy and fatty degeneration of the musculature, reverse shoulder arthroplasty is the method of choice. New approaches in considerations and techniques of tuberosity fixation are applied to help improve external rotation. To achieve a soft tissue covering of the prosthesis and for stabilization and improvement of function, the tuberosity refixation should be used routinely.

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Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH Hannover, Humboldtstraße 5, 30169, Hannover, Deutschland

    J. Imrecke, J.C. Katthagen &  H. Lill

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  1. J. Imrecke
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  2. J.C. Katthagen
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  3. H. Lill
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Correspondence to H. Lill.

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J. Imrecke, J.C. Katthagen und H. Lill geben an, dass kein Interessenkonflikt besteht.

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Imrecke, J., Katthagen, J. & Lill, H. Frakturendoprothetik an der Schulter. Trauma Berufskrankh 17, 160–165 (2015). https://doi.org/10.1007/s10039-015-0079-4

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