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Primäre Frakturprothese und inverse Schulterprothese bei komplexer Humeruskopffraktur

Eine Alternative zur gelenkerhaltenden Osteosynthese?

Primary fracture protheses and reverse shoulder arthroplasty in complex humeral head fractures

An alternative to joint-preserving osteosynthesis?

Zusammenfassung

Hintergrund

In den letzten Jahren hat sich bei der operativen Versorgung komplexer Humeruskopffrakturen ein dynamischer Wandel vollzogen. So hat der primäre Einsatz von inversen Schulterfrakturprothesen bei älteren Patienten erheblich an Bedeutung gewonnen. Die kurz- bis mittelfristigen Ergebnisse der inversen Frakturprothetik präsentieren sich vielversprechend, Langzeitergebnisse stehen jedoch noch aus. Hingegen hat die anatomische Frakturprothetik zugunsten der Osteosynthese und inversen Frakturprothese stark an Stellenwert verloren.

Indikationen

Dieser Übersichtsartikel beschäftigt sich mit der Frage, ob und wann eine primäre Frakturprothese zur Behandlung der komplexen Humeruskopffraktur eine Alternative zur gelenkerhaltenden Osteosynthese darstellt bzw. dieser sogar vorzuziehen ist. Des Weiteren soll auf das jeweilige Indikationsspektrum der anatomischen und inversen Frakturprothetik eingegangen werden.

Abstract

Background

The surgical management of complex humeral head fractures has adapted dynamically over the course of the last decade. The primary use of reverse shoulder arthroplasty in elderly patients has gained in relevance due to promising short and middle-term results. Long-term results, however, are still pending. The appliance of anatomical hemiarthroplasty, on the other hand, has lost in significance in favour of osteosynthesis and reverse shoulder arthroplasty.

Indications

This review article follows the question as to under which circumstances primary fracture arthroplasty reflects an alternative or even a preference to joint-preserving osteosynthesis in the treatment of complex proximal humeral fractures. It also specifies spectrums of indications for anatomical hemiarthroplasty and reverse shoulder arthroplasty.

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Abbreviations

AO:

Arbeitsgemeinschaft für Osteosynthesefragen

ASES:

American Shoulder and Elbow Surgeons Score

CRPS:

Chronisches regionales Schmerzsyndrom

DASH:

Disabilities of the Arm, Shoulder, Hand Score

HA:

Anatomische Frakturhemiprothese

LOE:

„Level of evidence“

MRA:

Multivariater Regressionsanalyse

OSS:

Oxford Shoulder Score

OTA:

Orthopedic Trauma Association

PE:

Polyethylen

RSA:

Inverse Frakturprothese

UCLA:

University of California Los Angeles Score

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Correspondence to B. Erdle.

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Interessenkonflikt

B. Erdle, K. Izadpanah, H. Eberbach, J. Zwingmann, M. Jaeger, N. Südkamp und D. Maier geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Erdle, B., Izadpanah, K., Eberbach, H. et al. Primäre Frakturprothese und inverse Schulterprothese bei komplexer Humeruskopffraktur. Orthopäde 47, 410–419 (2018). https://doi.org/10.1007/s00132-018-3570-3

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Schlüsselwörter

  • Ältere
  • Frakturfixierung, interne
  • Hemiprothese
  • Proximale Humerusfraktur
  • Schulterprothese

Keywords

  • Elderly
  • Fracture fixation, internal
  • Hemiarthroplasty
  • Humeral fractures, proximal
  • Prosthetic Shoulder