Zusammenfassung
Die Prävalenz periprothetischer Humerusfrakturen (PHF) ist derzeit mit 0,6–2,4 % gering. Aufgrund der zunehmenden Primärimplantationsrate ist jedoch eine quantitative Zunahme in naher Zukunft zu erwarten. Die überwiegende Anzahl der PHF ereignet sich im Rahmen der Implantation. Hier ist das Risiko bei zementfreien Schäften sowie Totalendoprothesen erhöht. Weitere Risikofaktoren sind insbesondere das weibliche Geschlecht sowie die Schwere der Komorbiditäten. Postoperative PFH sind mit einer Prävalenz zwischen 0,6 und 0,9 % wesentlich seltener, ursächlich sind hier in der Regel niedrig energetische Stürze. Die Prognose bzw. das funktionelle Outcome nach Revisionsosteosynthese von PHF sind elementar abhängig von der sorgsamen Indikationsstellung, der operativen Versorgung und dem prätraumatischen Funktionszustand der Schulter.
Im Armentarium der periprothetischen Osteosynthese am Humerus spielen Cerclagesysteme und winkelstabile Implantate sowie deren Kombination die zentrale Rolle. Bei Trümmerfrakturen mit ausgedehnten Defektzonen, stark ausgedünnter Kortikalis oder ausgeprägten Lysezonen ist die biologische Augmentation der Osteosynthese zu evaluieren. Bei korrekter Indikationsstellung, insbesondere stabil verankerter Prothese, berichten verschiedene Arbeitsgruppen eine hohe knöcherne Ausheilungsrate. Da die Behandlung der PHF komplex ist, sollte sie an dezidierten Zentren durchgeführt werden, um gerade den beim älteren Menschen potenziell vorliegenden Begleiterkrankungen gerecht zu werden.
Abstract
The prevalence of periprosthetic humeral fractures (PHF) is currently low and accounts for 0.6–2.4 %. Due to an increase in the rate of primary implantations a quantitative increase of PHF is to be expected in the near future. The majority of PHF occur intraoperatively during implantation with an increased risk for cementless stems and when performing total arthroplasty. Additional risk factors are in particular female gender and the severity of comorbidities. In contrast, postoperative PHF mostly due to low-energy falls, have a prevalence between 0.6 % and 0.9 % and are significantly less common. The prognosis and functional outcome following revision by open reduction internal fixation (ORIF) essentially depend on a thorough assessment of the indications for revision surgery, the operative treatment and the pretraumatic functional condition of the affected shoulder. In the armamentarium of periprosthetic ORIF of the humerus cerclage systems and locking implants as well as a combination of both play a central role. In comminuted fractures with extensive defect zones, severely thinned cortex or extensive osteolysis a biological augmentation of the ORIF should be considered. In this context when the indications are correctly interpreted, especially in the case of a stable anchored stem, various groups have reported that a high bony union rate can be achieved. As the treatment of PHF is complex it should be performed in dedicated centers in order to adequately address potential comorbidities, especially in the elderly population.
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Kirchhoff, C., Brunner, U. & Biberthaler, P. Periprothetische Humerusfraktur. Unfallchirurg 119, 273–280 (2016). https://doi.org/10.1007/s00113-016-0161-9
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DOI: https://doi.org/10.1007/s00113-016-0161-9