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Proximale Humerusfrakturen

Entscheidende Faktoren zur Therapiefindung, Behandlung und Komplikationen

Proximal humerus fractures

Decisive factors for therapy choice, treatment and complications

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Zusammenfassung

Die Mehrzahl der proximalen Humerusfrakturen kann mit zufriedenstellenden Ergebnissen konservativ behandelt werden. Frakturformen, bei welchen eine operative Maßnahme notwendig wird, stellen wegen der hohen Komplikationsrate eine große Herausforderung für den Therapeuten, die Nachbehandlung und nicht zuletzt auch für den Patienten selbst dar. Anhand der Bildgebung und der daraus resultierenden Klassifikation ein Behandlungskonzept zu erstellen ist nicht ausreichend. Faktoren, welche den Patienten, die Verletzung und schließlich auch den Therapeuten berücksichtigen, müssen beachtet werden. Nach operativer Rekonstruktion des proximalen Humerus werden regelhaft Komplikationsraten von > 30 % berichtet. Daher behandeln einige Therapeuten mittlerweile auch komplexe Frakturformen älterer Patienten konservativ. Bei der operativen Rekonstruktion proximaler Humerusfrakturen finden winkelstabile Implantate eine hohe Akzeptanz und weite Verbreitung. Spezifische Komplikationen wie die primäre oder sekundäre Schraubenperforation sind nach Anwendung dieser Implantate häufig und bedingen eine hohe Rate an Revisionsoperationen.

Abstract

The majority of proximal humerus fractures are treated conservatively resulting in satisfying results. Fractures which need to be treated operatively are challenging for the therapist, postoperative treatment and the patient. It is inadequate to establish a therapy concept only by using radiological images and the resulting classification. Factors which take the patient, the injury and the surgeon into consideration have to be included in the decision-making process. Operative reconstruction results in a high rate of complications. This could be the reason why even complex fractures are treated conservatively by some therapists, especially in older patients. Locking plates are used increasingly. Specific complications, such as primary or secondary screw perforation result in a high rate of revision surgery.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. V. Braunstein gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Orthopädie und Unfallchirurgie, Sports Clinic München, Ottobrunnerstraße 55, 81737, München, Deutschland

    V. Braunstein

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Correspondence to V. Braunstein.

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Braunstein, V. Proximale Humerusfrakturen. Unfallchirurg 116, 680–683 (2013). https://doi.org/10.1007/s00113-013-2408-z

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