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Frakturen des Humeruskopfes

Fractures of the humerus head

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Zusammenfassung

Humeruskopffrakturen sind eine häufige Verletzung, insbesondere des älteren Menschen. Es lassen sich hochenergetische Traumata des jüngeren Menschen von niederenergetischen Stürzen aus dem Stand des älteren, durch Osteoporose gekennzeichneten Patienten abgrenzen. Auch heute ist die konservative Therapie eine weit verbreitete und anerkannte Therapieform, die nicht nur einfachen Frakturformen vorbehalten ist. Im Rahmen der Osteosynthese haben sich winkelstabile Implantate als Standard durchgesetzt. Mit ihnen ist jedoch häufig eine hohe Komplikationsrate assoziiert. Probleme bereiten weiterhin die varusdislozierten Humeruskopffrakturen, insbesondere, wenn die mediale Säule im Bereich des Kalkars zerstört ist. Ist keine stabile Osteosynthese mehr zu erzielen, erscheint ein endoprothetischer Ersatz indiziert. Dabei hängt das klinische Ergebnis anatomischer Frakturprothesen maßgeblich von der korrekten Einheilung der Tuberkel ab. Inverse Frakturprothesen stellen eine Alternative dar. Ihr Einsatz ist jedoch sorgfältig abzuwägen und sollte Patienten über 75 Jahren vorbehalten bleiben.

Abstract

Fractures of the proximal humerus are commonly seen especially in the elderly population. High-energy trauma in young people can be distinguished from low-energy trauma in the elderly resulting from falls of a low height which are typically characterized by osteoporosis. A precise analysis of fractures is essential for a good understanding of the fracture and an individual therapy for which the LEGO-Codman classification provided by Hertel is recommended. Nonsurgical therapy is commonly performed and widely accepted not only for simple fractures. For osteosynthesis angular stable implants became the gold standard but are frequently associated with a high rate of complications some of which can be lowered by an improved surgical technique. Even today varus dislocated fractures are challenging, especially in combination with destruction of the medial column. In those cases where stable osteosynthesis can no longer be achieved arthroplasty is indicated. The clinical results of anatomic fracture arthroplasty are strongly related with correct ingrowth of the tuberosities. Reverse fracture arthroplasty may be considered but indications should be interpreted with caution and preferably used in patients older than 75 years.

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  1. Department Orthopädie und Traumatologie, Albert-Ludwigs-Universität Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland

    M. Jaeger, K. Izadpanah, D. Maier, K. Reising, P.C. Strohm & N.P. Südkamp

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  1. M. Jaeger
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  2. K. Izadpanah
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  3. D. Maier
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  4. K. Reising
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  5. P.C. Strohm
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  6. N.P. Südkamp
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Correspondence to M. Jaeger.

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Jaeger, M., Izadpanah, K., Maier, D. et al. Frakturen des Humeruskopfes. Chirurg 83, 285–296 (2012). https://doi.org/10.1007/s00104-011-2262-x

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  • DOI: https://doi.org/10.1007/s00104-011-2262-x

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