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Frakturendoprothetik der distalen Humerusfraktur

Fracture endoprosthesis of distal humerus fractures

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Zusammenfassung

Der Goldstandard der Versorgung der distalen Humerusfrakturen ist die winkelstabile Plattenosteosynthese. Aufgrund neuer, Low-profile-Implantate mit der Möglichkeit der winkelstabilen Verankerung konnten die Primärstabilität und das Weichteilmanagement verbessert werden. Gerade bei den osteoporotischen Trümmerfrakturen gerät die Osteosynthese jedoch an ihre Grenzen und die endoprothetische Versorgung wurde zunehmend als Therapiealternative etabliert. Obwohl die Komplikationsrate über die Jahre deutlich gesenkt werden konnte, liegt sie noch immer deutlich über der Komplikationsrate der Hüftprothetik. Außerdem wird dem Patienten ein Belastungslimit von 5 kg auferlegt. Die Indikation zur Frakturprothese wird daher streng gestellt und sollte bei der nicht stabil rekonstruierbaren Trümmerfraktur des älteren Patienten mit schlechter Knochenqualität Anwendung finden oder bei einfachen Frakturen bei vorbestehender deutlich symptomatischer Arthrose oder Arthritis. In dem vorliegenden Artikel werden moderne Konzepte der Ellenbogenendoprothetik wie modulare konvertible Prothesensysteme, die Hemiprothese des distalen Humerus und der Radiuskopfersatz im Rahmen der TEP vorgestellt und diskutiert.

Abstract

The treatment of choice for fractures of the distal humerus is double plate osteosynthesis. Due to anatomical preshaped angle stable plates the primary stability and management of soft tissues has been improved. However, osteoporotic comminuted fractures in the elderly are often not amenable to stable osteosynthesis and total elbow arthroplasty has been established as an alternative therapy. Although complication rates have been reduced, complications of total elbow arthroplasty are still much more frequent than in total hip replacement. Furthermore, patients are advised not to exceed a weight bearing of 5 kg. Therefore, the indications for elbow arthroplasty must be evaluated very strictly and should be reserved for comminuted distal humeral fractures in the elderly with poor bone quality that are not amenable to stable osteosynthesis or for simple fractures in cases of preexisting symptomatic osteoarthritis. This article introduces and discusses modern concepts of elbow arthroplasty, such as modular convertible prosthesis systems, hemiarthroplasty and radial head replacement in total elbow arthroplasty.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. L.P. Müller, K. Wegmann, K.J. Burkhart geben eine Referententätigkeit für Tornier an. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Unfall-, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland

    L.P. Müller, K. Wegmann & K.J. Burkhart

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  1. L.P. Müller
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  2. K. Wegmann
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  3. K.J. Burkhart
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Correspondence to L.P. Müller.

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Müller, L., Wegmann, K. & Burkhart, K. Frakturendoprothetik der distalen Humerusfraktur. Unfallchirurg 116, 708–715 (2013). https://doi.org/10.1007/s00113-013-2411-4

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