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Schulterendoprothetik bei posttraumatischen Deformitäten durch Frakturfolgen

Shoulder arthroplasty for treatment of the sequelae of proximal humerus fractures

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Zusammenfassung

Frakturfolgen nach proximalen Humerusfrakturen können erhebliche klinische Bedeutung besitzen. Eine Differenzierung der Frakturfolgen erlaubt auch eine differenzierte Indikation zur Korrekturosteotomie, Rekonstruktion oder zu verschiedenen Prothesenvarianten. Die Integrität des Tuberculum majus sowie dessen Verbindung zur Metaphyse bestätigt sich als wichtigstes prognostisches Kriterium für den Erfolg nach sekundärer Implantation von anatomischen Schulterprothesen. Bei Gelenkinkongruenz aber intakten Tuberkula kann durch Implantation anatomischer Prothesen ein besseres Outcome erzielt werden als nach primärer Frakturprothetik. Bei subkapitalen Pseudarthrosen sind die Ergebnisse nach Rekonstruktion denjenigen nach anatomischer Prothese überlegen. Mit inversen Prothesen werden bei erheblichen Fehlstellungen der Tuberkula mit Knochenverlust bessere Ergebnisse als mit anatomischen erzielt. Die Ergebnisse sind in Abhängigkeit vom Weichteil-, Muskel- und Knochendefekt schlechter als bei Cuffarthropathie. Die sekundären Eingriffe bei Frakturfolgen sind komplex und mit hohen Komplikationsraten verbunden.

Abstract

The sequelae of fractures of the proximal humerus can be of considerable clinical significance. Careful classification of the sequelae allows precise determination of whether correction osteotomy, reconstruction, or implantation of one of the various prostheses available is indicated. The integrity of the greater tuberosity, its position and continuous osseous integration to the metaphysis of the proximal humerus is the most important predictive factor for a good outcome following implantation of an anatomical shoulder prosthesis. When there is some incongruence of the glenohumeral joint while the greater tuberosity remains intact, shoulder arthroplasty can give a better clinical outcome than is seen after arthroplasty for a primary fracture. In the case of nonunion of subcapital fractures the results achieved by reconstruction, i.e. bone grafting and internal fixation using plates with fixed-angle blades, are superior to those possible with an anatomical prosthesis. Reverse shoulder arthroplasty gives better results than anatomical prostheses in the treatment of severe tuberosity malunion. The results of reverse shoulder arthroplasty for the sequelae of fractures are also influenced by the integrity of or damage to the soft tissues, the muscles of the rotator cuff (teres minor muscle), and bone. Secondary interventions for the sequelae of fractures of the proximal humerus are complex and involve high rates of complications and revisions.

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Brunner, U., Köhler, S. Schulterendoprothetik bei posttraumatischen Deformitäten durch Frakturfolgen. Orthopäde 36, 1037–1049 (2007). https://doi.org/10.1007/s00132-007-1157-5

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