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Frakturen des proximalen Humerus im hohen Lebensalter

Osteosynthese versus Gelenkersatz

Fractures of the proximal humerus in the elderly

Osteosynthesis versus joint replacement

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Zusammenfassung

Hintergrund

Aufgrund des demographischen Wandels der Gesellschaft kommt der Fraktur des proximalen Humerus des älteren Menschen eine zunehmende klinische und ökonomische Bedeutung zu.

Fragestellung

Inzidenz und Klinik der proximalen Humerusfraktur im hohen Lebensalter, Beschreibung von Behandlungsoptionen sowie Entwicklung von Therapieempfehlungen.

Material und Methoden

Übersicht und Diskussion aktuell verfügbarer Literatur und Behandlungskonzepte sowie Darstellung eigener Therapiealgorithmen für die Behandlung der proximalen Humerusfraktur.

Ergebnisse

Bei der überwiegenden Anzahl der Fälle operativ zu versorgender Frakturen kann kopferhaltend vorgegangen werden. Der primäre Gelenkersatz wird bei älteren Trümmerfrakturen, Headsplit-Frakturen oder ausgedehnter Weichteilkompromittierung mit Avaskularität der Kalotte erforderlich. Der sekundäre prothetische Ersatz kann bei Versagen der Osteosynthese oder bei der symptomatischen Kopfnekrose notwendig werden.

Schlussfolgerung

Die Wahl des optimalen Behandlungskonzepts richtet sich nach dem Gesamtzustand des Patienten, der Frakturmorphologie und den Begleitverletzungen.

Abstract

Background

Expected changes in population demographics will have significant implications for society and health care provision for the treatment of proximal humeral fractures in the elderly.

Objectives

This article presents the incidence and clinical characteristics of geriatric fractures of the proximal humerus, a description of therapeutic options and treatment recommendations.

Methods

The published scientific data were reviewed and current opinion available to guide patient care are presented.

Results

The majority of fractures of the proximal humerus that require operative treatment are amenable to reconstruction. Primary arthroplasty is usually reserved for comminuted fractures with delayed presentation, head-splitting fractures or those in which the humeral head is devoid of soft tissue attachments. Secondary replacement may be required in cases of fixation failure and symptomatic avascular necrosis.

Conclusion

Decision-making is dependent on the fracture pattern as well as on patient and surgeon-related factors.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Gradl, H.-C. Pape, M. Tingart, D. Arbab geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie, Klinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    G. Gradl & H.-C. Pape

  2. Klinik für Orthopädie, Klinikum der RWTH Aachen, Aachen, Deutschland

    M. Tingart & D. Arbab

Authors
  1. G. Gradl
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  2. H.-C. Pape
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  3. M. Tingart
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  4. D. Arbab
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Correspondence to G. Gradl.

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Gradl, G., Pape, HC., Tingart, M. et al. Frakturen des proximalen Humerus im hohen Lebensalter. Orthopäde 43, 339–346 (2014). https://doi.org/10.1007/s00132-013-2161-6

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  • DOI: https://doi.org/10.1007/s00132-013-2161-6

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