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Frakturanalyse, Indikation zur Endoprothese und Implantatwahl bei proximaler Humerusfraktur

Fracture analysis, indication for endoprosthesis and implant selection in proximal humeral fractures

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Zusammenfassung

Die proximale Humerusfraktur (PHF) ist mit stetig steigender Inzidenz die dritthäufigste Fraktur des Menschen. Grundsätzlich gibt es 3 übergeordnete Versorgungsstrategien: konservative, gelenkerhaltend-rekonstruktive oder gelenkersetzende Verfahren. Bei der Therapieentscheidung sind neben frakturmorphologischen Faktoren insbesondere patienten- und operateurspezifische Faktoren zu berücksichtigen. Im Fall der gelenkerhaltenden Therapieoptionen müssen die Risiken eines Osteosyntheseversagens sowie einer pathologischen Frakturfolge abgeschätzt werden. Wenn das konservative oder gelenkerhaltend-rekonstruktive Verfahren nicht vielversprechend erscheint, wird das gelenkersetzende Verfahren zur Therapie der Wahl. Die anatomische Frakturendoprothese ist, wenn überhaupt, nur noch bei jungen Patienten mit destruiertem Humeruskopf, bei erhaltener Rotatorenmanschette sowie großen Tubercula-Fragmenten indiziert. Im fortgeschrittenen Patientenalter bei dislozierter, mehrfragmentärer PHF wird zunehmend eine inverse Endoprothese implantiert. Bei beiden Verfahren hat die anatomische Einheilung der Tubercula einen wesentlichen Einfluss auf das funktionelle Ergebnis.

Abstract

Proximal humeral fractures (PHF) are the third most common fracture in humans and the incidence is increasing. There are basically three treatment strategies: conservative, joint-preserving reconstructive or joint-replacing procedures. In addition to fracture morphology, patient-specific and surgeon-specific factors are particularly important when deciding on treatment. The experience and training of the surgeon also play a decisive role. In the case of joint-preserving treatment, the risk of osteosynthesis failure and of sequelae of the fracture must always be assessed. If conservative or reconstructive treatment methods are not promising, the joint-replacing procedure is the treatment of choice. The anatomical fracture prosthesis is only indicated, if at all, for young patients with a destroyed humeral head with a preserved rotator cuff and large fragments of the tuberosities. In advanced age, the implantation of a reverse endoprosthesis is increasingly used for dislocated, multifragmentary PHF. In both procedures, the anatomical healing of the tuberosities has a significant impact on the functional outcome.

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Change history

  • 19 July 2022

    Im Abschnitt „Funktionelle Ergebnisse“ wurde das vorletzte Wort von „unterlegen“ zu „überlegen“ geändert.

Literatur

  1. Ambacher T, Erli H‑J, Paar O (2000) Behandlungsergebnisse nach primärer Hemialloarthroplastik bei dislozierten Humeruskopffrakturen. Zentralbl Chir 125:750–755. https://doi.org/10.1055/s-2000-10656

    Article  CAS  PubMed  Google Scholar 

  2. Boesmueller S, Wech M, Gregori M et al (2016) Risk factors for humeral head necrosis and non-union after plating in proximal humeral fractures. Injury 47:350–355. https://doi.org/10.1016/j.injury.2015.10.001

    Article  PubMed  Google Scholar 

  3. Boileau P, Alta TD, Decroocq L et al (2019) Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities? J Shoulder Elbow Surg 28:437–444. https://doi.org/10.1016/j.jse.2018.08.025

    Article  PubMed  Google Scholar 

  4. Boileau P, Krishnan SG, Tinsi L et al (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 11:401–412. https://doi.org/10.1067/mse.2002.124527

    Article  CAS  PubMed  Google Scholar 

  5. Boileau P, Trojani C, Walch G et al (2001) Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus. J Shoulder Elbow Surg 10:299–308. https://doi.org/10.1067/mse.2001.115985

    Article  CAS  PubMed  Google Scholar 

  6. Bonnevialle N, Tournier C, Clavert P et al (2016) Hemiarthroplasty versus reverse shoulder arthroplasty in 4‑part displaced fractures of the proximal humerus: multicenter retrospective study. Orthop Traumatol Surg Res 102:569–573. https://doi.org/10.1016/j.otsr.2016.02.014

    Article  CAS  PubMed  Google Scholar 

  7. Boons HW, Goosen JH, van Grinsven S et al (2012) Hemiarthroplasty for humeral four-part fractures for patients 65 years and older: a randomized controlled trial. Clin Orthop Relat Res 470:3483–3491. https://doi.org/10.1007/s11999-012-2531-0

    Article  PubMed  PubMed Central  Google Scholar 

  8. Brunner F, Sommer C, Bahrs C et al (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23:163–172. https://doi.org/10.1097/BOT.0b013e3181920e5b

    Article  PubMed  Google Scholar 

  9. Carbone S, Papalia M (2016) The amount of impaction and loss of reduction in osteoporotic proximal humeral fractures after surgical fixation. Osteoporos Int 27:627–633. https://doi.org/10.1007/s00198-015-3304-x

    Article  CAS  PubMed  Google Scholar 

  10. Codman EA (1934) The shoulder — rupture of the supraspinatus ten-don and other lesions in or about the subacromial bursa. Thomas Todd, Boston

    Google Scholar 

  11. Grammont PM, Trouilloud P, Laffay JP, Deries X (1987) Etude et realisation d’une novelle prothese d’epaule. Rhumatologie 39:17–22

    Google Scholar 

  12. Grubhofer F, Wieser K, Meyer DC et al (2016) Reverse total shoulder arthroplasty for acute head-splitting, 3‑ and 4‑part fractures of the proximal humerus in the elderly. J Shoulder Elbow Surg 25:1690–1698. https://doi.org/10.1016/j.jse.2016.02.024

    Article  PubMed  Google Scholar 

  13. Gupta AK, Harris JD, Erickson BJ et al (2015) Surgical management of complex proximal humerus fractures—a systematic review of 92 studies including 4500 patients. J Orthop Trauma 29:54–59. https://doi.org/10.1097/BOT.0000000000000229

    Article  PubMed  Google Scholar 

  14. Hertel R, Hempfing A, Stiehler M, Leunig M (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 13:427–433. https://doi.org/10.1016/j.jse.2004.01.034

    Article  CAS  PubMed  Google Scholar 

  15. Jain NP, Mannan SS, Dharmarajan R, Rangan A (2019) Tuberosity healing after reverse shoulder arthroplasty for complex proximal humeral fractures in elderly patients—does it improve outcomes? A systematic review and meta-analysis. J Shoulder Elbow Surg 28:e78–e91. https://doi.org/10.1016/j.jse.2018.09.006

    Article  PubMed  Google Scholar 

  16. Katthagen JC, Huber M, Grabowski S et al (2017) Failure and revision rates of proximal humeral fracture treatment with the use of a standardized treatment algorithm at a level‑1 trauma center. J Orthop Traumatol 18:265–274. https://doi.org/10.1007/s10195-017-0457-8

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kelly BJ, Myeroff CM (2020) Reverse shoulder arthroplasty for proximal humerus fracture. Curr Rev Musculoskelet Med 13:186–199. https://doi.org/10.1007/s12178-020-09597-0

    Article  PubMed  PubMed Central  Google Scholar 

  18. Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52:1077–89

    Article  Google Scholar 

  19. Noyes MP, Kleinhenz B, Markert RJ, Crosby LA (2011) Functional and radiographic long-term outcomes of hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 20:372–377. https://doi.org/10.1016/j.jse.2010.06.009

    Article  PubMed  Google Scholar 

  20. Passaretti D, Candela V, Sessa P, Gumina S (2017) Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropolitan area. J Shoulder Elbow Surg 26:2117–2124. https://doi.org/10.1016/j.jse.2017.05.029

    Article  PubMed  Google Scholar 

  21. Peters P‑M, Plachel F, Danzinger V et al (2020) Clinical and radiographic outcomes after surgical treatment of proximal humeral fractures with head-split component. J Bone Joint Surg 102:68–75. https://doi.org/10.2106/JBJS.19.00320

    Article  PubMed  Google Scholar 

  22. Rupp M, Walter N, Pfeifer C et al (2021) The incidence of fractures among the adult population of Germany. Dtsch Arztebl Int. https://doi.org/10.3238/arztebl.m2021.0238

    Article  PubMed  PubMed Central  Google Scholar 

  23. Savin DD, Zamfirova I, Iannotti J et al (2016) Survey study suggests that reverse total shoulder arthroplasty is becoming the treatment of choice for four-part fractures of the humeral head in the elderly. International Orthopaedics (SICOT) 40:1919–1925. https://doi.org/10.1007/s00264-016-3227-y

    Article  Google Scholar 

  24. Samilson RL, Prieto V (1983) Dislocation arthropathy of the shoulder. J Bone Joint Surg Am 65(4):456–460. https://doi.org/10.2106/00004623-198365040-00005

    Article  CAS  PubMed  Google Scholar 

  25. Scheibel M, Peters P, Moro F, Moroder P (2019) Head-split fractures of the proximal humerus. Obere Extrem 14:93–102. https://doi.org/10.1007/s11678-019-0520-6

    Article  Google Scholar 

  26. Schliemann B, Wähnert D, Theisen C et al (2015) How to enhance the stability of locking plate fixation of proximal humerus fractures? An overview of current biomechanical and clinical data. Injury 46:1207–1214. https://doi.org/10.1016/j.injury.2015.04.020

    Article  PubMed  Google Scholar 

  27. Schmalzl J, Jessen M, Gilbert F et al (2020) Proximal humeral fracture morphology in patients with advanced osteoarthritis: An observational study in a surgically treated cohort. J Orthop Surg (hong kong). https://doi.org/10.1177/2309499020944114

    Article  Google Scholar 

  28. Schmalzl J, Jessen M, Gilbert F et al (2021) Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort. Eur J Orthop Surg Traumatol 31:517–524. https://doi.org/10.1007/s00590-020-02801-4

    Article  PubMed  Google Scholar 

  29. Schmalzl J, Jessen M, Sadler N et al (2020) High tuberosity healing rate associated with better functional outcome following primary reverse shoulder arthroplasty for proximal humeral fractures with a 135° prosthesis. BMC Musculoskelet Disord 21:35. https://doi.org/10.1186/s12891-020-3060-8

    Article  PubMed  PubMed Central  Google Scholar 

  30. Schmalzl J, Piepenbrink M, Buchner J et al (2021) Higher primary stability of tuberosity fixation in reverse fracture arthroplasty with 135° than with 155° humeral inclination. J Shoulder Elbow Surg 30:1257–1265. https://doi.org/10.1016/j.jse.2020.09.009

    Article  PubMed  Google Scholar 

  31. Sebastiá-Forcada E, Cebrián-Gómez R, Lizaur-Utrilla A, Gil-Guillén V (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg 23:1419–1426. https://doi.org/10.1016/j.jse.2014.06.035

    Article  PubMed  Google Scholar 

  32. Stolberg-Stolberg J, Köppe J, Rischen R et al (2021) The surgical treatment of proximal humeral fractures in elderly patients—an analysis of the long-term course of locked plate fixation and reverse total shoulder arthroplasty based on health insurance data. Dtsch Arztebl Int. https://doi.org/10.3238/arztebl.m2021.0326

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tauber M, Hirzinger C, Hoffelner T et al (2015) Midterm outcome and complications after minimally invasive treatment of displaced proximal humeral fractures in patients younger than 70 years using the Humerusblock. Injury 46:1914–1920. https://doi.org/10.1016/j.injury.2015.05.017

    Article  PubMed  Google Scholar 

  34. Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F (1996) Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67(3):264–268. https://doi.org/10.3109/17453679608994685

    Article  CAS  PubMed  Google Scholar 

  35. Werner BS, Chaoui J, Walch G (2018) Glenosphere design affects range of movement and risk of friction-type scapular impingement in reverse shoulder arthroplasty. Bone Joint J 100-B:1182–1186. https://doi.org/10.1302/0301-620X.100B9.BJJ-2018-0264.R1

    Article  CAS  PubMed  Google Scholar 

  36. Wiesel BB, Nagda S, Williams GR (2013) Technical pitfalls of shoulder Hemiarthroplasty for fracture management. Orthop Clin North Am 44:317–329. https://doi.org/10.1016/j.ocl.2013.03.006

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Unfall‑, Handchirurgie und Sportmedizin, ViDia Kliniken Karlsruhe, Steinhäuserstraße 18, 76135, Karlsruhe, Deutschland

    M. Kimmeyer,  V. Rentschler,  C. Gerhardt &  L. J. Lehmann

  2. Klinik und Poliklinik für Unfall‑, Hand‑, Plastische und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland

    J. Schmalzl

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M. Kimmeyer, V. Rentschler, J. Schmalzl, C. Gerhardt und L. J. Lehmann geben an, dass kein Interessenkonflikt besteht.

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Kimmeyer, M., Rentschler, V., Schmalzl, J. et al. Frakturanalyse, Indikation zur Endoprothese und Implantatwahl bei proximaler Humerusfraktur. Unfallchirurgie 125, 671–680 (2022). https://doi.org/10.1007/s00113-022-01213-9

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