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Proximale Humerusfrakturen – Primäre Endoprothetik

Proximal humeral fractures—Primary endoprosthetics

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Frakturen des proximalen Humerus sind in der täglichen unfallchirurgischen Routine häufig zu finden und zeigen eine steigende Inzidenz in der älteren Bevölkerung. Gerade bei komplexen Frakturmustern ist die Entscheidung zwischen gelenkerhaltenden Verfahren oder einem prothetischen Ersatz schwierig. Bei jüngeren Patienten sollte generell eine Gelenkrekonstruktion angestrebt werden. Sollte es zu einem sekundären Osteosyntheseversagen kommen, ist meist eine Konversion auf eine inverse Prothese indiziert. Hier ist mit einem geringeren Bewegungsumfang sowie einer höheren Komplikationsrate verglichen mit einer Primärimplantation zu rechnen. Sollte keine Osteosynthese möglich sein, besteht bereits primär die Indikation zum endoprothetischen Ersatz. Entscheidend für das funktionelle Outcome einer anatomischen Prothese ist das Einheilen der Tuberkula. Bei älteren Patienten geht daher der Trend zur primären inversen Prothesenimplantation mit einem deutlich homogeneren klinischen Ergebnis unabhängig von der Rotatorenmanschettenfunktion. Der folgende Beitrag stellt die aktuelle Literatur vor und soll bei der Entscheidung im Alltag helfen.

Abstract

Fractures of the proximal humerus are common in daily surgical practice and show an increasing incidence especially in the older population. In complex fracture patterns the choice between joint-preserving procedures and joint replacement is difficult. In younger patients it is generally recommended to attempt a primary joint reconstruction. In cases of secondary failure of osteosynthesis a conversion to a reverse fracture prothesis is often indicated. A lower range of motion and a higher complication rate compared to a primary implantation of a prothesis has to be expected. In the presence of irreparable fractures a primary fracture arthroplasty is indicated. A decisive factor for the functional outcome of an anatomical arthroplasty is the correct healing of the tuberosities. Especially in older patients the trend is towards the implantation of a primary reverse fracture prothesis resulting in more homogeneous clinical results, irrespective of rotator cuff function. This article reviews the current literature and is intended to provide a decision support in everyday clinical practice.

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Literatur

  1. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697

    Article  Google Scholar 

  2. Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72:365–371

    Article  CAS  Google Scholar 

  3. Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92

    Article  Google Scholar 

  4. Iyengar JJ, Devcic Z, Sproul RC, Feeley BT (2011) Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma 25:612–617

    Article  Google Scholar 

  5. Handoll HH, Keding A, Corbacho B, Brealey SD, Hewitt C, Rangan A (2017) Five-year follow-up results of the PROFHER trial comparing operative and non-operative treatment of adults with a displaced fracture of the proximal humerus. Bone Joint J 99-B:383–392

    Article  CAS  Google Scholar 

  6. Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J (2011) Hemiarthroplasty versus nonoperative treatment of displaced 4‑part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 20:1025–1033

    Article  Google Scholar 

  7. Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J (2011) Internal fixation versus nonoperative treatment of displaced 3‑part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 20:747–755

    Article  Google Scholar 

  8. Siebenbürger G, Van Delden D, Helfen T, Haasters F, Böcker W, Ockert B (2015) Timing of surgery for open reduction and internal fixation of displaced proximal humeral fractures. Injury 46(Suppl 4):S58–S62

    Article  Google Scholar 

  9. Hertel R, Hempfing A, Stiehler M, Leunig M (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 13:427–433

    Article  CAS  Google Scholar 

  10. Foruria AM, de Gracia MM, Larson DR, Munuera L, Sanchez-Sotelo J (2011) The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures. J Bone Joint Surg Br 93:378–386

    Article  CAS  Google Scholar 

  11. Krappinger D, Bizzotto N, Riedmann S, Kammerlander C, Hengg C, Kralinger FS (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury 42:1283–1288

    Article  Google Scholar 

  12. Codemann E (1934) Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. In: Todd T (Hrsg) The shoulder, S 262–293

    Google Scholar 

  13. Neer CS (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089

    Article  Google Scholar 

  14. Majed A, Macleod I, Bull AM et al (2011) Proximal humeral fracture classification systems revisited. J Shoulder Elbow Surg 20:1125–1132

    Article  Google Scholar 

  15. Nijs S, Broos P (2009) Outcome of shoulder hemiarthroplasty in acute proximal humeral fractures: a frustrating meta-analysis experience. Acta Orthop Belg 75:445–451

    PubMed  Google Scholar 

  16. Reuther F, Kohut G, Nijs S (2014) Newly developed modular reverse fracture endoprosthesis in non-reconstructable humeral head fracture in old people. Oper Orthop Traumatol 26:369–382 (quiz 382)

    Article  CAS  Google Scholar 

  17. Nho SJ, Brophy RH, Barker JU, Cornell CN, MacGillivray JD (2007) Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am 89(Suppl 3):44–58

    PubMed  Google Scholar 

  18. Scheibel M (2011) Humeral head fracture and cuff. Unfallchirurg 114:1075–1078, 1081-2

    Article  CAS  Google Scholar 

  19. Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M (1995) Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br 77:296–298

    Article  CAS  Google Scholar 

  20. Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA (2006) The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am 88:1699–1704

    Article  Google Scholar 

  21. Sebastiá-Forcada E, Cebrián-Gómez R, Lizaur-Utrilla A, Gil-Guillén V (2014) Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg 23:1419–1426

    Article  Google Scholar 

  22. Nijs S, Reuther F, Broos P (2011) Primary fracture arthroplasty of the proximal humerus using a new and freely adjustable modular prosthesis combined with compression osteosynthesis of the tuberosities. Oper Orthop Traumatol 23:21–28

    Article  CAS  Google Scholar 

  23. Favard L (2013) Revision of total shoulder arthroplasty. Orthop Traumatol Surg Res 99:S12–S21

    Article  CAS  Google Scholar 

  24. Krishnan SG, Reineck JR, Bennion PD, Feher L, Burkhead WZ (2011) Shoulder arthroplasty for fracture: does a fracture-specific stem make a difference. Clin Orthop Relat Res 469:3317–3323

    Article  Google Scholar 

  25. Boileau P, Winter M, Cikes A et al (2013) Can surgeons predict what makes a good hemiarthroplasty for fracture. J Shoulder Elbow Surg 22:1495–1506

    Article  Google Scholar 

  26. Antuña SA, Sperling JW, Cofield RH (2008) Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg 17:202–209

    Article  Google Scholar 

  27. Lévigne C, Boileau P, Favard L et al (2008) Scapular notching in reverse shoulder arthroplasty. J Shoulder Elbow Surg 17:925–935

    Article  Google Scholar 

  28. Favard L, Levigne C, Nerot C, Gerber C, De Wilde L, Mole D (2011) Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time. Clin Orthop Relat Res 469:2469–2475

    Article  Google Scholar 

  29. Sebastia-Forcada E, Lizaur-Utrilla A, Cebrian-Gomez R, Miralles-Muñoz FA, Lopez-Prats FA (2017) Outcomes of reverse total shoulder arthroplasty for proximal humeral fractures: primary arthroplasty versus secondary arthroplasty after failed proximal humeral locking plate fixation. J Orthop Trauma 31:e236–e240

    Article  Google Scholar 

  30. Walch G, Bacle G, Lädermann A, Nové-Josserand L, Smithers CJ (2012) Do the indications, results, and complications of reverse shoulder arthroplasty change with surgeon’s experience. J Shoulder Elbow Surg 21:1470–1477

    Article  Google Scholar 

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Authors and Affiliations

  1. Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Deutschland

    D. Wincheringer,  U. Schweigkofler,  M. Kremer &  R. Hoffmann

  2. Orthopaedicum Wiesbaden, Friedrichstr. 29, 65185, Wiesbaden, Deutschland

    D. Wincheringer

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  2. U. Schweigkofler
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  3. M. Kremer
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  4. R. Hoffmann
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Correspondence to D. Wincheringer.

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Interessenkonflikt

D. Wincheringer, U. Schweigkofler, M. Kremer und R. Hoffmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Wincheringer, D., Schweigkofler, U., Kremer, M. et al. Proximale Humerusfrakturen – Primäre Endoprothetik. Trauma Berufskrankh 21, 2–8 (2019). https://doi.org/10.1007/s10039-019-0419-x

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  • DOI: https://doi.org/10.1007/s10039-019-0419-x

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