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Inverse Frakturprothese – eine Trendwende

Current trends in reverse fracture arthroplasty

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Zusammenfassung

Ihre zuverlässigen Ergebnisse haben die inverse Prothese zur präferierten Versorgungsmethode für nichtrekonstruierbare proximale Humerusfrakturen gemacht. Essenziell bleibt die individuelle Betrachtung des Patienten und der Frakturmorphologie. Prognose- und therapierelevante Aussagen zur Durchblutung des Humeruskopfes können gut anhand von CT-Aufnahmen getroffen werden; hierbei muss zwischen harten und weichen Kriterien gegen eine Rekonstruktion unterschieden werden. Inverse Frakturprothesen mit eingeheilten Tubercula weisen ein besseres Bewegungsausmaß und mehr Kraft für Außenrotation und Anteversion, weniger Komplikationen und eine längere Überlebensrate auf, weshalb diese, wann immer möglich, refixiert werden sollten. Der Trend der letzten Jahre geht zu einem anatomischen Prothesendesign mit einer humeralen Inklination von 135°. Die Revisionsrate bei primären Frakturprothesen ist insgesamt gering, mit der Instabilität als häufigstem Revisionsgrund, gefolgt von periprothetischen Frakturen und Infektionen. Verglichen mit einer konservativen Behandlung, einer Osteosynthese bei höherem Patientenalter, einer Hemiprothese und einer elektiv implantierten Prothese sind die klinische Ergebnisse nach der Versorgung mit einer inverser Frakturprothese besser oder gleichwertig. Auch inverse Prothesen, die wegen Frakturfolgezuständen implantiert wurden, erzielten kein signifikant schlechteres mittelfristiges klinisches Outcome. Selbst sekundär implantierte inverse Prothesen können die Funktion der Schulter signifikant verbessern.

Abstract

The reliable results of reverse arthroplasty have made this the preferred treatment method for non-reconstructable proximal humeral fractures. The individual consideration of the patient and the morphological features of the fractures are essential. Computed tomography (CT) images provide crucial information on the perfusion of the humeral head relevant for the prognosis and treatment. In this context a differentiation must be made between hard and soft criteria against a reconstruction. Tuberosities should be reduced whenever possible, because reverse arthroplasty with healed tuberosities provides a better range of motion and more strength for external rotation and anteversion, less complications and longer survival rates. In recent years the trend has been towards anatomical designs of prostheses with a humeral inclination of 135°. Revision rates for primary fracture prostheses are overall low with instability as the main reason for revision surgery, followed by periprosthetic fractures and infections. Reverse fracture arthroplasty has comparable or better clinical results compared to conservative treatment, osteosynthesis for geriatric patients, hemiarthroplasty and prosthesis implantation by elective surgery. Reverse arthroplasties, which were implanted in conditions of fracture sequelae, did not achieve significantly poorer clinical outcome at mid-term follow-up and can significantly improve shoulder function.

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  1. Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Humboldtstr. 5, 30169, Hannover, Deutschland

    M. Warnhoff, G. Jensen, H. Lill & A. Ellwein

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Warnhoff, M., Jensen, G., Lill, H. et al. Inverse Frakturprothese – eine Trendwende. Unfallchirurgie 125, 690–698 (2022). https://doi.org/10.1007/s00113-022-01211-x

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