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Anatomische Frakturendoprothese – wer und wie?

Anatomical fracture endoprosthesis—who and how?

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Zusammenfassung

Ziel dieses Übersichtsbeitrags ist es, die Indikationen für eine anatomische Frakturendoprothese, meist als Schulterhemiendoprothese (SHEP), sowie ihren Stellenwert im Vergleich zu anderen Verfahren, aufzuzeigen. Für die erfolgreiche Implantation einer SHEP nach proximaler Humerusfraktur (PHF) sind v. a. die Heilung der Tubercula in anatomischer Position und eine intakte Rotatorenmanschette wichtig. Bei älteren Patienten (> 70 Jahre) erzielt die Implantation der inversen Schulterendoprothese (iSTEP) zuverlässigere Ergebnisse und geht mit einer geringeren Revisionsrate einher. Die Indikation zur Implantation einer SHEP bei nichtrekonstruierbaren PHF, meist mit einem „head split“, sollte abgewogen sowie in Fällen mit gut erhaltenen, großen Tubercula und bei jüngeren Patienten in Betracht gezogen werden. Komplikationen der SHEP, wie sekundäre Rotatorenmanschetteninsuffizienz, Tubercula-Dislokation/-Resorption und sekundärer Glenoidverbrauch, können mithilfe einer Konversion oder eines Wechsels auf eine iSTEP behoben werden.

Abstract

The aim of this review article is to present the indications for an anatomical fracture prosthesis, mostly as a shoulder hemiprosthesis (SHEP) and its value in comparison to other procedures. The healing of the tuberosities in the anatomical position and an intact rotator cuff are particularly important for the successful implantation of a SHEP after proximal humeral fractures. For older patients (> 70 years), the use of reverse shoulder arthroplasty achieves more reliable results and is associated with a lower revision rate. The indications for implantation of a SHEP in non-reconstructible proximal humeral fractures, usually with a head split, should be carefully considered and can be used in cases with well-preserved large tuberosities and in younger patients. Complications of SHEP, such as secondary rotator cuff insufficiency, tuberosity dislocation or resorption and secondary glenoid wear, can be treated using a conversion or a change to reverse shoulder arthroplasty.

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Danksagung

Wir danken Herrn Dr. med. Falk Reuther für die Zurverfügungstellung der Bilder in Abb. 5.

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Authors and Affiliations

  1. Schulter- und Ellbogenchirurgie, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz

    Florian Freislederer,  Raphael Trefzer, Stephan Radzanowski,  Fabrizio Moro &  Markus Scheibel

  2. Centrum für Muskuloskeletale Chirurgie (CMSC), Charité-Universitätsmedizin Berlin, Berlin, Deutschland

    Markus Scheibel

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  1. Florian Freislederer
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  2. Raphael Trefzer
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  3. Stephan Radzanowski
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  4. Fabrizio Moro
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  5. Markus Scheibel
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Correspondence to Florian Freislederer.

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Interessenkonflikt

F. Freislederer, R. Trefzer, S. Radzanowski, F. Moro und M. Scheibel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Helmut Lill, Hannover

Markus Scheibel, Zürich

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Freislederer, F., Trefzer, R., Radzanowski, S. et al. Anatomische Frakturendoprothese – wer und wie?. Unfallchirurgie 125, 681–689 (2022). https://doi.org/10.1007/s00113-022-01212-w

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