Obere Extremität

, Volume 4, Issue 4, pp 229–239 | Cite as

Die Versorgung proximaler Humerusfrakturen mit winkelstabiler Plattenosteosynthese (PHILOS®) beim älteren Menschen

Fünfjahresergebnisse
Originalarbeit

Zusammenfassung

Im Rahmen einer prospektiv-konsekutiven Studie sollte der klinische Langzeitverlauf älterer Patienten nach winkelstabiler Plattenosteosynthese (PHILOS®, Synthes GmbH, Oberdorf, Schweiz) dislozierter und/oder instabiler proximaler Humerusfrakturen erfasst werden.

Zum Unfallzeitpunkt waren 61 Verletzte >65 Jahre alt, 30 davon verstarben im Nachkontrollzeitraum von durchschnittlich 5 Jahren (Spannweite 4–6). Insgesamt konnten 28 Überlebende mit 3 Zwei-, 13 Drei- und 12 Vierfragment-Frakturen klinisch objektiv und subjektiv nachuntersucht werden. Eine vergleichende Humeruskopf-Schaft-Achsenbestimmung erfolgte zwischen dem Durchleuchtungsbild am Ende des operativen Eingriffes und der Einjahreskontrolle. Der absolute und relative Constant Murley Score (CMS), der Disabilities of the Arm, Shoulder and Hand (DASH) Score, der Mini-Mental-Status-Test (MMST) sowie Schmerz, Schwäche und Zufriedenheit (visuelle Analogskala, VAS 0–10) wurden im Verlauf nach 6, 12 und mindestens 48 Monaten erhoben.

Radiologisch fand sich im Vergleich der Humeruskopf-Schaft-Achsen zwischen initial postoperativer und Einjahreskontrolle kein signifikanter Repositionsverlust. Im Mittel 5 Jahre nach der Operation verrichteten 9 von 10 untersuchten Patienten ihre Alltagstätigkeiten ohne Einschränkungen. Relativer CMS, DASH-Score sowie Schmerz und Zufriedenheit zeigten über den Nachuntersuchungszeitraum eine signifikante Verbesserung in der Gesamtgruppe.

Insgesamt bewährte sich die winkelstabile Versorgung proximaler Humerusfrakturen mit PHILOS® auch im Langzeitverlauf beim älteren Verletzten. Neben dem Alter spielte vor allem die Reoperationsnotwendigkeit für das klinische Outcome eine Rolle. Große Vergleichsstudien sind notwendig, um das zukünftige, möglichst optimale Indikationsspektrum derartiger Osteosynthesen zu ermitteln.

Schlüsselwörter

Fraktur Proximaler Humerus Winkelstabile Plattenosteosynthese Winkelstabilität Älterer Mensch 

Locking plate osteosynthesis (PHILOS®) for fractures of the proximal humerus in elderly patients

Five-year follow-up results

Abstract

Within the framework of a prospective study, the clinical long-term outcome of a consecutive series of patients treated with a locking compression plate (PHILOS®, Synthes GmbH, Oberdorf, Switzerland) for dislocated and/or unstable proximal humerus fractures was assessed.

A total of 61 patients were older than 65 years at the time of accident and fulfilled the prospective study criteria. Thirty patients died within the follow-up period (range 4–6 years). Thus, a total of 28 patients (3 two-part, 13 three-part, and 12 four-part fractures) who attended standardized follow-up (Constant-Murley Score [CMS], DASH, mini-mental test, patient’s self assessment of pain, weakness and satisfaction with the visual analogue scale, VAS 0–10) were clinically and subjectively examined at 6, 12 and not less than 48 months (p<0.05).

The radiological evaluation at the 1 year follow-up assessed the humeral head shaft axis and could not demonstrate any significant loss of reduction over time. Five years (mean) following the operation, 9 of 10 patients reported being able to undertake their daily activities without any limitation. The relative CMS, the DASH as well as the average VAS of pain and satisfaction showed a significant improvement over the observation period.

Thus, angle stable fixation of proximal humerus fractures with the PHILOS® has also stood the long-term test in the elderly. Besides age, the need for any secondary intervention has the largest impact on the outcome of patients. In the future, apart from detailed case analysis, large studies should further evaluate the optimal indications for this kind of internal fixation in comparison to conservative treatment or any arthroplastic solution.

Keywords

Fracture Proximal humerus Locking compression plate osteosynthesis Angle stability Elderly 

Notes

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Fa. Synthes, Oberdorf, Schweiz.

Danksagung

Wir bedanken uns sehr herzlich bei allen involvierten Patienten und Klinikmitarbeitenden, sowie bei Prof. Dr. P. Regazzoni vom Universitätsspital Basel und der Fa. Synthes, Oberdorf, Schweiz, für die Unterstützung der Studie.

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Copyright information

© Springer 2009

Authors and Affiliations

  1. 1.Klinik für Orthopädische Chirurgie und Traumatologie des BewegungsapparatesKantonsspital BruderholzBruderholzSchweiz
  2. 2.Amsler ConsultingBiel-BenkenSchweiz
  3. 3.Computer Aided Radiology and Surgery (CARCAS)UniversitätsspitalBaselSchweiz

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