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Behandlung der proximalen Humerusfraktur

Von konservativ bis zur inversen Prothese

Treatment of proximal humeral fractures

From conservative to the inverse prosthesis

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Die proximale Humerusfraktur ist eine häufige Fraktur des älteren Patienten und stellt hohe Anforderungen an den behandelnden Chirurgen. Das Therapiespektrum reicht von der konservativen Behandlung über die operative, kopferhaltende Therapie bis zum endoprothetischen Ersatz. Ziel dieses Beitrags ist es – auf Basis einer systematischen und selektiven Analyse der Literatur – den aktuellen Stand der Behandlung darzustellen.

Ergebnisse

Nicht und wenig dislozierte proximale Humerusfrakturen (PHF) werden konservativ behandelt. Für dislozierte, komplexe 3- und 4-Teile-Frakturen erbringt die prothetische Versorgung schlechtere Ergebnisse als die kopferhaltende Therapie. Die konservative und die kopferhaltende Osteosynthese zeigen vergleichbare funktionelle Therapieresultate. Die niedrigste Komplikationsrate ist bei konservativer Therapie zu verzeichnen. Die Daten stützen sich meist auf Fallserien und sehr wenige randomisierte, kontrollierte Studien.

Diskussion

Aktuell kann noch keine generelle Empfehlung abgegeben werden, wie die dislozierten und insbesondere die komplexen PHF behandelt werden sollten. Der Trend geht jedoch eher zur kopferhaltenden Therapie. Aufgrund noch wenig abgesicherter Evidenz in der Literatur sollte über das Vorgehen individualisiert entsprechend des Alters, des Anspruchs des Patienten und der Erfahrung des Operateurs entschieden werden. Gerade beim Älteren sollte die Möglichkeit einer konservativen Therapie abgewogen werden. Implantatunabhängig gilt für die operative, kopferhaltende Therapie, dass die Wiederherstellung der Anatomie einen signifikanten Einfluss auf das zu erwartende Endergebnis hat.

Abstract

Background

Proximal humeral fractures are common fractures of the elderly patient. This fracture places high demands on the treating trauma surgeon. The available treatment choices range from conservative approaches to surgical procedures such as head-preserving therapy or prosthetic replacements. The aim of this review is to summarize and present the current management of proximal humeral fractures based on a systematic and selective analysis of the literature.

Results

Minimal or nondisplaced proximal humeral fractures are treated conservatively. For displaced three- and four-part fractures, the results of the prosthetic replacement are inferior to head preserving therapy. For conservative and other head-preserving osteosynthesis procedures, comparable score results of the therapy were demonstrated. The lowest complication rate was found in conservative therapy. Overall, the data were derived from case series and only a few randomized, controlled studies.

Discussion

Currently, no general recommendations can be given for the treatment of displaced and complex proximal humeral fractures. However, we noted a trend towards head-preserving therapy. Based on the little evidence available, management should be personalized according to age demands of the patients. Especially in the elderly patient, conservative treatment and the experience of the surgeon should be considered. For all head-preserving procedures, reconstruction of the anatomy has a significant effect on the clinical outcome.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Bahrs, T. Klopfer, S. Scheiderer und U. Stöckle geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik für Unfall- und Wiederherstellungschirurgie, BG-Unfallklinik Tübingen, Schnarrenbergstraße 95, 72074, Tübingen, Deutschland

    C. Bahrs, T. Klopfer, S. Scheiderer & U. Stöckle

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  1. C. Bahrs
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  2. T. Klopfer
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  3. S. Scheiderer
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  4. U. Stöckle
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Correspondence to C. Bahrs.

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Bahrs, C., Klopfer, T., Scheiderer, S. et al. Behandlung der proximalen Humerusfraktur . Trauma Berufskrankh 16, 46–52 (2014). https://doi.org/10.1007/s10039-014-2067-5

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