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Stellenwert der Endoprothetik bei der Primärversorgung distaler Humerusfrakturen

The role of total elbow arthroplasty as a primary treatment for distal humeral fractures

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Frakturen des distalen Humerus sind selten und stellen nur einen kleinen Anteil an der Gesamtheit adulter Frakturen dar. Durch den demografischen Wandel wird es zu einer Zunahme der in der Regel mehrfragmentären geriatrischen Frakturen mit begleitender schlechter Knochenqualität kommen. Da die konservative Therapie nicht zu zufriedenstellenden Ergebnissen führt, stellen die offene Gelenkrekonstruktion und übungsstabile Osteosynthese heute den Goldstandard dar. Allerdings ist in dem zuvor genannten Patientenkollektiv eine Osteosynthese nicht immer zu realisieren und die Komplikationsfrequenz hoch. In diesen Fällen ist in den vergangenen Jahren die Frakturversorgung mit einer Ellenbogenprothese zunehmend im Fokus. Nach Publikation erster Ergebnisse durch Cobb und Morrey wurde diese Behandlungstechnik zunehmend für spezielle Indikationen anerkannt. Unerlässlich für eine erfolgreiche Therapie und somit zufriedene Patienten ist neben der richtigen Indikationsstellung auch ein detailliertes Verständnis der zugrunde liegenden Pathologie und der operativen Technik. Dieser Artikel beleuchtet die historische Entwicklung der Ellenbogenprothese bei Frakturen, schildert die operative Technik und stellt aktuelle Ergebnisse, aber auch die Komplikationen dar.

Abstract

Fractures of the distal humerus are rare and account for only a small proportion of fractures in adult patients. Due to demographic changes surgeons will be faced with an increasing number of complex multifragment fractures with diminished bone quality in geriatric patients. As conservative treatment frequently leads to limited and painful elbow function, open reduction and stable internal fixation with early range of motion exercises are considered the gold standard. However, in combination of comminution and an osteoporotic bone stock, complication rates remain considerably high and stable fixation might be impossible. In these patients primary total elbow arthroplasty has become increasingly popular in recent years. Since Cobb and Morrey published their landmark paper on the use of total elbow arthroplasty for distal humeral fractures it has become accepted that this technique is a valuable treatment option. Detailed knowledge and understanding of the technical aspects of total elbow arthroplasty are the key factors for a successful procedure and patient satisfaction. This articles highlights the history of total elbow arthroplasty for trauma fractures, provides detailed information on the correct indications, the operative procedure, results and complications.

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Correspondence to Kay H. Schmidt-Horlohé.

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K.H. Schmidt-Horlohé und R. Hoffmann geben an, dass kein Interessenkonflikt besteht.

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Schmidt-Horlohé, K., Hoffmann, R. Stellenwert der Endoprothetik bei der Primärversorgung distaler Humerusfrakturen. Trauma Berufskrankh 17, 7–14 (2015). https://doi.org/10.1007/s10039-015-0015-7

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