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Hemiprothese bei proximaler Humerusfraktur

Humeral head replacement in acute proximal humerus fractures

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Zusammenfassung

Komplexe, mehrfragmentäre Humeruskopffrakturen mit avaskulärem Kalottenfragment und nicht rekonstruierbarer Fraktur stellen Indikationen zum endoprothetischen Kopfersatz dar. Speziell entwickelte Prothesendesigns erlauben durch Variabilität die anatomische Wiederherstellung des Rotationszentrums sowie die Einpassung und stabile Fixierung der Tubercula. Diese nehmen hinsichtlich funktionellem Ergebnis die Schlüsselposition ein und unterliegen allerdings häufig einem kompletten oder zumindest partiellen Resorptionsprozess mit konsekutiver Rotatorenmanschetteninsuffizienz. Bei hohem technischen Anspruch der Operation ist auf eine korrekte Prothesenimplantation zu achten. Die zu erwartenden funktionellen Ergebnisse sind ziemlich konstant bei einem Constant-Score zwischen 50 und 60 Punkten mit einem geringen Schmerzniveau. Bei älteren Patienten mit reduzierter Knochenqualität und damit verbundener erhöhter Rate tuberculaassoziierter Komplikationen muss alternativ bereits primär ein inverses Prothesendesign angedacht werden. Die Revisionsrate liegt insgesamt bei ca. 11 %.

Abstract

Complex proximal humerus fractures with an avascular head fragment and unreconstructable fracture types represent indications for humeral head replacement. Special prosthetic designs allow modular anatomical restoration of the centre of rotation and alignment and stable fixation of the tuberosities. These play a key role with respect to the functional outcome and are often prone to complete or partial osteolysis with secondary rotator cuff deficiency. Because the operational procedure is technically demanding, attention must be paid to correct implantation. The functional results which can be expected are reliable with a moderate Constant score of 50 to 60 points and a low pain level. In elderly patients with poor bone quality and an associated increased tuberosity-related complication rate, a primary inverse prosthetic design has to be considered as a reasonable alternative. The overall revision rate is approximately 11 %.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Prof. Dr. P. Habermeyer erhält Royalties der Firma Arthrex. PD Dr. M. Tauber und Dr. P. Magosch geben an, dass kein Interessenskonflikt besteht.

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Authors and Affiliations

  1. Zentrum für Schulter- und Ellenbogenchirurgie, ATOS-Klinik München, Effnerstraße 38, 81925, München, Deutschland

    M. Tauber & P. Habermeyer

  2. Zentrum für Schulter- und Ellenbogenchirurgie, ATOS-Klinik Heidelberg, Heidelberg, Deutschland

    P. Magosch & P. Habermeyer

  3. Paracelsus Medizinische Universität Salzburg, Salzburg, Österreich

    M. Tauber

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  1. M. Tauber
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  2. P. Magosch
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  3. P. Habermeyer
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Correspondence to M. Tauber.

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Tauber, M., Magosch, P. & Habermeyer, P. Hemiprothese bei proximaler Humerusfraktur. Unfallchirurg 116, 691–697 (2013). https://doi.org/10.1007/s00113-013-2409-y

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