Advertisement

Schulterendoprothetik bei posttraumatischen Deformitäten durch Frakturfolgen

Shoulder arthroplasty for treatment of the sequelae of proximal humerus fractures

  • 28 Citations

Zusammenfassung

Frakturfolgen nach proximalen Humerusfrakturen können erhebliche klinische Bedeutung besitzen. Eine Differenzierung der Frakturfolgen erlaubt auch eine differenzierte Indikation zur Korrekturosteotomie, Rekonstruktion oder zu verschiedenen Prothesenvarianten. Die Integrität des Tuberculum majus sowie dessen Verbindung zur Metaphyse bestätigt sich als wichtigstes prognostisches Kriterium für den Erfolg nach sekundärer Implantation von anatomischen Schulterprothesen. Bei Gelenkinkongruenz aber intakten Tuberkula kann durch Implantation anatomischer Prothesen ein besseres Outcome erzielt werden als nach primärer Frakturprothetik. Bei subkapitalen Pseudarthrosen sind die Ergebnisse nach Rekonstruktion denjenigen nach anatomischer Prothese überlegen. Mit inversen Prothesen werden bei erheblichen Fehlstellungen der Tuberkula mit Knochenverlust bessere Ergebnisse als mit anatomischen erzielt. Die Ergebnisse sind in Abhängigkeit vom Weichteil-, Muskel- und Knochendefekt schlechter als bei Cuffarthropathie. Die sekundären Eingriffe bei Frakturfolgen sind komplex und mit hohen Komplikationsraten verbunden.

Abstract

The sequelae of fractures of the proximal humerus can be of considerable clinical significance. Careful classification of the sequelae allows precise determination of whether correction osteotomy, reconstruction, or implantation of one of the various prostheses available is indicated. The integrity of the greater tuberosity, its position and continuous osseous integration to the metaphysis of the proximal humerus is the most important predictive factor for a good outcome following implantation of an anatomical shoulder prosthesis. When there is some incongruence of the glenohumeral joint while the greater tuberosity remains intact, shoulder arthroplasty can give a better clinical outcome than is seen after arthroplasty for a primary fracture. In the case of nonunion of subcapital fractures the results achieved by reconstruction, i.e. bone grafting and internal fixation using plates with fixed-angle blades, are superior to those possible with an anatomical prosthesis. Reverse shoulder arthroplasty gives better results than anatomical prostheses in the treatment of severe tuberosity malunion. The results of reverse shoulder arthroplasty for the sequelae of fractures are also influenced by the integrity of or damage to the soft tissues, the muscles of the rotator cuff (teres minor muscle), and bone. Secondary interventions for the sequelae of fractures of the proximal humerus are complex and involve high rates of complications and revisions.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. 1.

    Antuna SA, Sperling JW, Sanchez-Sotelo J, Cofield RH (2002) Shoulder arthroplasty for proximal humeral malunions: long-term results. J Shoulder Elbow Surg 11: 122–129

  2. 2.

    Armengol-Barallat J, Trojani CH, LeHuec JC (2000) Results of shoulder arthroplasty in locked dislocation and fracture dislocation (Type 2sequelae). In: Walch G, Boileau P, Mole D (eds) 2000 Protheses d’Epaule recul de 2 a 10 ans. Sauramps Medical, Montpellier, pp 307–315

  3. 3.

    Beredjiklian MD, Pedro K, Iannotti JP et al. (1998) Operative treatment of malunion of a fracture of the proximal aspect of the humerus. J Bone Joint Surg Am 80: 1484–1495

  4. 4.

    Boileau P, Walch G, Trojani C et al. (1999) Sequelae of fractures of the proximal humerus: surgical classification and limits of shoulder arthroplasty. In: Walch G, Boileau P (eds) 1999 Shoulder Arthroplasty. Springer, Berlin Heidelberg New York, pp 349–358

  5. 5.

    Boileau P, Watkinson D, Hatzidakis AM et al. (2006) The Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 15: 527–540

  6. 6.

    Boileau P, Chuinard C, LeHuec JC et al. (2006) Proximal humerus fracture sequelae: Impact of a new classification on arthroplasty. Clin Orthop 442: 121–130

  7. 7.

    Bosch U, Skutek M, Fremerey RW, Tscherne H (1998) Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus. J Shoulder Elbow Surg 7: 479–484

  8. 8.

    Brunner U (2000) Results in shoulder arthroplasty in severe tuberositiy malunion (type IV fracture sequelae). In: Walch G, Boileau P, Mole D (eds) 2000 Protheses d’Epaule recul de 2 a 10 ans. Sauramps Medical, Montpellier, pp 307–315

  9. 9.

    Brunner U, Boileau P, Köhler S (2006) Ergebnisse und Konsequenzen in der Prothetik aus einer großen Multicenterstudie. In: Lill H (Hrsg) Die proximale Humerusfraktur. Thieme, Stuttgart, S 167–177

  10. 10.

    Brunner U (2007) Anatomische Prothese oder sekundäre Rekonstruktion. In: Brunner U (Hrsg) Spezialgebiete aus der Schulter- und Ellenbogenchirurgie. Steinkopff, Darmstadt, S 63–70

  11. 11.

    Brunner U, Nadjar R (2007) Bedeutung und Behandlung knöcherner Begleitverletzungen nach Schulterluxation. Arthroskopie (in Druck)

  12. 12.

    Cheng SL, Mackay MB, Richards RR (1997) Treatment of locked posterior fracture dislocations of the shoulder by total shoulder arthroplasty. J Shoulder Elbow Surg 6: 11–17

  13. 13.

    Clinton J, Franta AK, Lenters TR et al. (2007) Nonprosthetic Glenoid arthroplasty and total shoulder arthroplasty yield similar self-assessed outcomes in the management of comparable patients with glenohumeral arthritis. J Shoulder Elbow Surg 15, Epub ahead of print

  14. 14.

    Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orhtop Scand 72: 365–371

  15. 15.

    Dines DM, Warren RF, Altchek DW, Moeckel B (1993) Posttraumatic changes of the proximal humerus: Malunion, nonunion, and osteonecrosis. Treatment with modular hemiarthroplasty or total shoulder arthroplasty. J Shoulder Elbow Surg 2: 11–21

  16. 16.

    Duparc F, Trojani C, Boileau P (2000) Results of shoulder arthroplasty in cephalic collapse or necrosis following proximal humerus fractures. In: Walch G, Boileau P, Mole D (eds) Protheses d’Epaule recul de 2 a 10 ans. Sauramps Medical, Montpellier, pp 279–289; 2001

  17. 17.

    Duralde XA, Flatow EL, Pollack RG et al. (1996) Operative treatment of nonunions of the surgical neck of the humerus. J Shoulder Elbow Surg 5: 169–180

  18. 18.

    Gerber C (1990) Reconstructive surgery following malunion of fractures of the proximal humerus in adults. Orthopade19: 316–323

  19. 19.

    Gerber C, Warner JJP (1997) Alternatives to Hemiarthroplasty for complex proximal humeral fractures. In: Warner JP, Ianotti JP, Gerber C (eds) 1997 Complex and revision problems in shoulder surgery. Lippincott Raven, Philadelphia, pp 215–243

  20. 20.

    Gerber C, Hersche O, Berberat C (1998) The clinical relevance of posttraumatic avascular necrosis of the humeral head. J Shoulder Elbow Surg 7: 586–590

  21. 21.

    Habermeyer P, Schweiberer L (1992) Korrektureingriffe infolge von Humeruskopffrakturen. Orthopade 21: 148–157

  22. 22.

    Hawkins RJ, Neer CS, Pianta RD (1987) Locked posterior dislocations of the shoulder. J Bone Joint Surg Am 69: 9–18

  23. 23.

    Ianotti JP, Sidor ML (1997) Malunions of the proximal Humerus. In: Warner JP, Ianotti JP, Gerber C (eds) 1997 Complex and revision problems in shoulder surgery. Lippincott Raven, Philadelphia, pp 491–500

  24. 24.

    Kannus P, Palvanen M, Niemi S et al. (2000) Osteoporoticfractures of the proximal humerus in elderly finnish persons: sharp increase in 1970–1998 and alarming projections for the new millennium. Acta Orthop Scand 71: 465–470

  25. 25.

    Kettler M, Biberthaler P, Braunstein V et al. (2006) Treatment of proximal humeral fractures with the Philos angular stable plate: Presentation of 225 cases of dislocated fractures. Unfallchirurg 109: 1032–1040

  26. 26.

    Leger O, Trojani C, LeHuec JC (2000) Results of shoulder arthroplasty in non-union of the surgical neck (Type 3 fracture sequelae). In: Walch G, Boileau P, Mole D (eds) 2000 Protheses d’Epaule recul de 2 a 10 ans. Sauramps Medical, Montpellier, pp 301–306

  27. 27.

    LeHuec JC, Trojani C, Boileau P (2000) Sequelae of proximal humeral fractures: Validation of the surgical classification In: Walch G, Boileau P, Mole D (eds) 2000 Protheses d’Epaule recul de 2 a 10 ans. Sauramps Medical, Montpellier, pp 317–324

  28. 28.

    Lin JS, Klepps S, Miller S et al. (2006) Effectiveness of replacement arthroplasty with calcar grafting and avoidance of greater tuberosity osteotomy for the treatment of humeral surgical neck nonunions. J Shoulder Elbow Surg 15: 12–18

  29. 29.

    Lind T, Kroner TK, Jensen J (1989) The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg 108: 285–287

  30. 30.

    Loew M, Heitkemper S, Parsch D et al. (2006) Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus. J Bone Joint Surg Br 88: 345–350

  31. 31.

    Mansat P, Guity MR, Bellumore Y, Mansat M (2004) Shoulder arthroplasty for late sequelae of proximal humeral fractures. J Shoulder Elbow Surg 13: 305–312

  32. 32.

    Matsen FA (1994) Smothness. In: Matsen FA, Lippitt SB, Sidles JA, Harryman DT (eds) Practical Evaluation and Management of the Shoulder. Saunders, Philadelphia, p 190

  33. 33.

    Neer CS (1990) Old Trauma in glenohumeral shoulder arhtroplasty. In: Shoulder Reconstruction, Vol. 3 Saunders, Philadelphia, pp 222–234

  34. 34.

    Neyton L, Garaud P, Boileau P (2006) Results of reverse shoulder arthroplasty in proximal humerus fracture sequelae. In: Walch G, Boileau P, Mole D et al. (eds) Reverse shoulder arthroplasty. Sauramps Medical, Montpellier, pp 81–101

  35. 35.

    Nicholson GP, Flatow EL, Bigliani LU (1994) Shoulder arthroplasty for proximal humeral fractures. In: Friedman RJ (ed) Arthroplasty of the shoulder. Thieme, New York, pp 183–193

  36. 36.

    Norris TR, Green A, McGuigan FX (1995) Late prosthetic shoulder arthroplasty for displaced proximal humerus fractures. J Shoulder Elbow Surg 4: 271–280

  37. 37.

    Orfaly RM, Rockwood CA Jr, Esenyel CZ, Wirth MA (2007) Shoulder arthroplasty in cases with avascular necrosis of the humeral head. J Shoulder Elbow Surg 16: 27–32

  38. 38.

    Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop 442: 87–92

  39. 39.

    Pritchett JW, Clark JM (1987) Prosthetic replacement for chronic unreduced dislocation of the shoulder. Clin Orhtop 216: 89–93

  40. 40.

    Russo R, Vernaglia Lombardi L, Giudice G et al. (2005) Surgical treatment of sequelae of fractures of the proximal third of the humerus. The role of osteotomies. Chir Organi Mov 90: 159–169

  41. 41.

    Sajadi KR, Zuckerman JD (2007) Shoulder arthroplasty for posttraumatic arthritis. Semin Arthroplasty 18: 89–95

  42. 42.

    Seebauer L, Walter W, Keyl W (2005) Reverse total shoulder arthroplasty for the treatment of defect arthropathy. Operat Orthop Traumatol 17: 1–24

  43. 43.

    Siegel JA, Dines DM (2003) Techniques in managing proximal humeral malunions. J Shoulder Elbow Surg 12: 69–78

  44. 44.

    Tanner MW, Cofield RH (1983) Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus. Clin Orthop 179: 116–128

  45. 45.

    Trojani C, Boileau P, Le Huec JC et al. (2001) Sequelae of fractures of the proximal humerus: Surgical Classification. In: Walch G, Boileau P, Mole D (eds) 2000 Protheses d’Epaule recul de 2 a 10 ans. Sauramps Medical, Montpellier, pp 271–277

  46. 46.

    Walch G, Badet R, Nove-Josserand L, Levigne C (1996) Nonunion of the surgical neck of the humerus: Surgical treatment with an intramedullary bone peg, internal fixation and cancellous bone grafting. J Shoulder Elbow Surg 5: 161–168

  47. 47.

    Voigt C, Woltmann A, Partenheimer A, Lill H (2007) Management of complications after angularly stable locking proximal humerus plate fixation. Chirurg 78: 40–46

  48. 48.

    Wiedemann E, Brunner U, Hauptmann S, Mutschler W (2004) Die Implantation einer Endoprothese bei Humeruskopffraktur. Operat Orthop Traumatol 16: 1–27

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Correspondence to Prof. Dr. U. Brunner.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Brunner, U., Köhler, S. Schulterendoprothetik bei posttraumatischen Deformitäten durch Frakturfolgen. Orthopäde 36, 1037–1049 (2007) doi:10.1007/s00132-007-1157-5

Download citation

Schlüsselwörter

  • Proximale Humerusfraktur
  • Frakturfolgen
  • Schulterprothese
  • Korrekturosteotomie
  • Osteosynthese

Keywords

  • Proximal humerus fracture
  • Fracture sequelae
  • Shoulder prosthesis
  • Correction osteotomy
  • Internal fixation