Zusammenfassung
Hintergrund
Frakturen des distalen Humerus sind für den Unfallchirurgen nach wie vor eine Herausforderung. Trotz zahlreicher Innovationen im Hinblick auf Implantatdesign und Operationstechniken sind die Ergebnisse insbesondere bei komplexeren Frakturen mit höhergradigen Weichteilschäden nicht immer zufriedenstellend. Zahlreiche Komorbiditäten in einem immer älter werdenden Patientenkollektiv erschweren das perioperative Management und tragen zur hohen Komplikationsrate bei.
Methoden
Während bei einfachen, nur partiell intraartikulären Frakturen die Schraubenosteosynthese ihren Stellenwert hat, ist die winkelstabile Doppelplattenosteosynthese mittlerweile der Goldstandard in der Versorgung intraartikulärer distaler Humerusfrakturen. Als Standardzugang hat sich hier die Exposition des Gelenks über eine Olekranonosteotomie bewährt. Neben der Plattenosteosynthese hat aber auch der externe Fixateur eine Bedeutung, insbesondere im Rahmen der Primärversorgung bei offenen Frakturen.
Schlussfolgerung
Ein anerkannter Therapiealgorithmus existiert nicht und die Wahl des geeigneten Therapieverfahrens muss immer individuell und an den Patienten angepasst getroffen werden.
Abstract
Background
The surgical treatment of comminuted fractures of the distal humerus remains a challenging problem for orthopedic surgeons. Despite improved implant designs and new developments in surgical techniques these fracture are associated with high complication rates and poor clinical outcomes. Comorbidities, such as diabetes and osteopenia in combination with severe soft tissue damage worsen the healing capacity and make the rehabilitation more difficult.
Methods
Internal fixation with locking plates has become the current gold standard in the operative treatment of intra-articular fractures of the distal humerus, although locking screw osteosynthesis still has a place for simple, only partial intra-articular fractures. The standard approach has been established as exposure of the joint by olecranon osteotomy; however, complex fractures with severe soft tissue damage may require primary external fixation prior to definitive treatment.
Conclusion
To date, there is still no generally accepted treatment algorithm and the decision on how to treat these fractures has to made on an individual basis, taking fracture patterns, soft tissue damage, general condition of the patient and comorbidities into account.
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C. Kösters, M.J. Raschke und B. Schliemann geben an, dass kein Interessenkonflikt besteht.
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Kösters, C., Raschke, M. & Schliemann, B. Die distale Humerusfraktur – wann und welche Osteosynthese?. Trauma Berufskrankh 17, 2–6 (2015). https://doi.org/10.1007/s10039-015-0013-9
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DOI: https://doi.org/10.1007/s10039-015-0013-9