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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.

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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

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