Zusammenfassung
Hintergrund
Aufgrund über mehrere Wochen oder Monate verspätet diagnostizierter Luxationen der Schulter nach anterior oder posterior stellt sich, abhängig von der Schwere der Verletzung, die Frage nach der adäquaten Therapie dieser eher seltenen Verletzung.
Therapiewahl
Bei der chronisch verhakten anterioren Luxation, die mit weiteren Verletzungen des Glenoids oder des Humeruskopfs einhergehen kann, finden sich beim älteren Patienten häufig Vernarbungen oder Rupturen der Rotatorenmanschette. Daher ist nicht selten die Versorgung mittels Hemi- oder Totalendoprothese das Mittel der Wahl. Bei der posterioren chronisch verhakten Luxation, die eher das Patientengut im mittleren Alter betrifft, bestehen in fast allen Fällen vorwiegend anteriore Impressionsverletzungen des Humeruskopfs im Sinne eines umgekehrten Hill-Sachs-Defekts. Diese Humeruskopfdefekte lassen sich normalerweise bis zu einer bestimmten Defektgröße mittels Knochenspänen rekonstruieren. Bei großen nichtrekonstruierbaren Defekten bleibt auch hier häufig nur die prothetische Versorgung als therapeutische Alternative.
Schlussfolgerung
Entscheidend ist, Schulterluxationen nach anterior oder posterior frühzeitig zu diagnostizieren, um eine chronisch verhakte Luxation im Verlauf zu verhindern. Tritt sie dennoch auf, bieten sich abhängig von der Defektgröße sowohl die knöcherne Rekonstruktion als auch der prothetische Gelenkersatz mit guten bis zufriedenstellenden Ergebnissen an.
Abstract
Background
Because of a delayed diagnosis over several weeks or months of either anterior or posterior dislocation of the shoulder, the question of an adequate therapy of this relatively rare injury arises, depending on the severity of the injury.
Therapy selection
In cases of chronic locked anterior dislocation, which can be accompanied by further glenoid or humeral head injuries, it is not uncommon to find scar tissue or ruptures of the rotator cuff in elderly patients. Therefore, treatment with a hemiprosthesis or total prosthesis is often the method of choice. In most cases of posterior chronic locked dislocations, which more often affect middle-aged patients, there are predominantly anterior impression injuries of the humeral head in the sense of Hill-Sachs defects. These humeral head defects can normally be reconstructed up to a certain defect size by bone slivers. In larger defects which cannot be reconstructed, the only therapeutic alternative is prosthetic treatment.
Conclusion
It is decisive to make an early diagnosis of either anterior or posterior shoulder dislocation in order to avoid the occurrence of a chronic locked dislocation. If this still occurs, depending on the size of the defect, bony reconstruction and prosthetic joint replacement can provide good to satisfactory results.
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Interessenkonflikt. M. Königshausen, J. Gessmann, T.A. Schildhauer und D. Seybold geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Königshausen, M., Gessmann, J., Schildhauer, T. et al. Behandlungsmöglichkeiten der chronisch verhakten Schulterluxation. Trauma Berufskrankh 16, 258–263 (2014). https://doi.org/10.1007/s10039-014-2148-5
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DOI: https://doi.org/10.1007/s10039-014-2148-5