Skip to main content
SpringerLink
Log in

Proximaler Humerusnagel bei körpernahen Oberarmbrüchen

Nailing of the proximal humerus following proximal fractures of the upper arm

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Frakturen des proximalen Humerus stellen beim älteren Patienten, bedingt durch Osteopenie und Verletzungsschwere, eine Herausforderung für die operative Versorgung dar. Seit wenigen Jahren stehen intramedulläre Implantate zur Verfügung, mit denen auch Mehrfragmentfrakturen mit hoher Primärstabilität versorgt werden können. Bei limitierten Weichteilschäden kann durch frühe Physiotherapie ein gutes funktionelles Ergebnis erreicht werden. Seit 2003 verwenden wir den T2-PHN (Fa. Stryker) und konnten bisher 15 Patienten nach 1-jähriger Beobachtung auswerten. Bei einem Durchschnittsalter von 64,6 Jahren lag der durchschnittliche Constant-Score nach 1 Jahr bei 68,3 (±17,3) auf der betroffenen Seite, seitenadaptiert wurden 79% erreicht. Der Anteil der 4-Segment-Frakturen lag bei 60%. Bei 4 Patienten beobachteten wir eine partielle Humeruskopfnekrose ohne Therapiekonsequenz. Implantatentfernungen waren in 5 Fällen wegen überstehender Schrauben oder vorstehendem proximalem Nagelende nötig. Mit den modernen Verriegelungsmarknägeln ist eine Gewebe schonende und sehr stabile Versorgung der proximalen Humerusfrakturen möglich.

Abstract

Proximal humerus fractures are a challenge in surgical treatment, particularly in elderly patients, because of the osteopenia involved and the severity of the injuries. For the past few years intramedullary implants making it possible to achieve a high degree of stability in the primary treatment of even comminuted fractures have been available. Since the soft tissues are protected by the minimally invasive implantation technique used, early physiotherapy is possible and functional results are good. Since 2003 we have been using the T2 PHN (Stryker Co.), and so far 1-year follow-up examinations have been possible in 15 patients. The average age of these patients was 64.6 years, and the mean Constant score for the affected side after 1 year was 68.3. The side-adapted score was 79%. There was a high percentage of four-fragment fractures: 60%. Four patients developed partial avascular necrosis, which did not, however, require further treatment. Implants were removed in 5 cases because of an overlying locking screw or a protruding proximal end of the nail. These modern medullary nails allow minimally invasive treatment of even complex proximal humeral fractures with a high level of primary stability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Literatur

  1. Adedapo AO, Ikpeme JO (2001) The results of internal fixation of three- and four-part proximal humeral fractures with the Polarus nail. Injury 32: 115–121

    Article  PubMed  Google Scholar 

  2. Blum J, Hessmann MH, Sternstein W et al. (2004) Angle stable interlocking in proximal humeral nails — a biomechanical comparison between spiral blade and screw fixation. J Orthop Trauma [Suppl 9] 18: S51

  3. Boehm D, Wollmerstedt N, Doesch M et al. (2004) Development of a questionnaire based on the Constant-Murley-Score for patient self-evaluation of shoulder function. Unfallchirurg 107: 397–402

    Google Scholar 

  4. Hepp P, Lill H, Bail H et al. (2003) Where should implants be anchored in the humeral head? Clin Orthop 415: 139–147

    PubMed  Google Scholar 

  5. Hessmann MH, Rommens PM (2003) Das biomechanische Verhalten winkelstabiler Implantatsysteme am proximalen Humerus. Huber, Bern

  6. Hessmann MH, Blum J, Hofmann A et al. (2003) Internal fixation of proximal humeral fractures: current concepts. Eur J Trauma 29: 253–261

    Google Scholar 

  7. Kuner EH, Siebler G (1987) Dislocation fractures of the proximal humerus — results following surgical treatment. A follow-up study of 167 cases. Unfallchirurgie 13: 64–71

    CAS  PubMed  Google Scholar 

  8. Lill H, Josten C (2000) Proximal and distal humerus fractures in advanced age. Orthopaede 29: 327–341

    Google Scholar 

  9. Lill H, Lange K, Prasse-Badde J et al. (1997) T-plate osteosynthesis in dislocated proximal humerus fractures. Unfallchirurgie 23: 183–190

    CAS  PubMed  Google Scholar 

  10. Lill H, Bewer A, Korner J et al. (2001) Conservative treatment of dislocated proximal humeral fractures. Zentralbl Chir 126: 205–210

    Article  CAS  PubMed  Google Scholar 

  11. Lill H, Hepp P, Rose T et al. (2004) The angle stable locking-proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-splitting-approach — technique and first results. Zentralbl Chir 129: 43–48

    Article  CAS  PubMed  Google Scholar 

  12. Lungershausen W, Bach O, Lorenz CO (2003) Locking plate osteosynthesis for fractures of the proximal humerus. Zentralbl Chir 128: 28–33

    Article  CAS  PubMed  Google Scholar 

  13. Mathews J, Lobenhoffer P (2004) Results of intramedullary nailing of unstable proximal humeral fractures in geriatric patients with a new antegrade nail system. Unfallchirurg 107: 372–380

    Article  CAS  PubMed  Google Scholar 

  14. Mittlmeier TW, Stedtfeld HW, Ewert A et al. (2003) Stabilization of proximal humeral fractures with an angular and sliding stable antegrade locking nail (Targon PH). J Bone Joint Surg Am 85-A [Suppl 4] : 136–146

  15. Resch H (2003) Fractures of the humeral head. Unfallchirurg 106: 602–617

    Article  CAS  PubMed  Google Scholar 

  16. Stedtfeld HW, Attmanspacher W, Thaler K et al. (2003) Fixation of humeral head fractures with antegrade intramedullary nailing. Zentralbl Chir 128: 6–11

    Article  PubMed  Google Scholar 

  17. Tingart M, Bathis H, Bouillon B et al. (2001) The displaced proximal humeral fracture: is there evidence for therapeutic concepts? Chirurg 72: 1284–1291

    Article  CAS  PubMed  Google Scholar 

  18. Widen A (1949) Fractures of the upper end of the humerus with great displacement treated by marrow nailing. Acta Chir Scand 97: 439–441

    Google Scholar 

  19. Wijgman AJ, Roolker W, Patt TW et al. (2002) Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am 84-A: 1919–1925

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. BG-Unfallklinik, Murnau

    O. M. Trapp, R. Beickert & V. Bühren

  2. BG-Unfallklinik, Prof.-Küntscher-Straße 8, 82418, Murnau

    O. M. Trapp

Authors
  1. O. M. Trapp
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Beickert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. Bühren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. M. Trapp.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Trapp, O.M., Beickert, R. & Bühren, V. Proximaler Humerusnagel bei körpernahen Oberarmbrüchen. Trauma Berufskrankh 7, 89–96 (2005). https://doi.org/10.1007/s10039-005-1001-2

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-005-1001-2

Schlüsselwörter

Key words

Search

Navigation