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Management der fehlgeschlagenen vorderen Schulterstabilisierung

Management of failed anterior shoulder stabilization

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Obere Extremität Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Schulterluxationen sind häufige Verletzungen und entsprechend müssen Revisionsstabilisierungen durchgeführt werden, sofern die primären Therapieansätze fehlschlagen. Jeder Schulterchirurg sollte deshalb mit deren Management vertraut sein.

Fragestellung

In der vorliegenden Arbeit wird der aktuelle Wissensstand zum Management von fehlgeschlagenen vorderen Schulterstabilisierungen und glenoidalen/humeralen Knochensubstanzdefekten wiedergegeben.

Material und Methoden

Grundlage sind aktuelle Studienergebnisse nach arthroskopischer und offener Re-Stabilisierung.

Ergebnisse

Bei Ausschluss knöcherner Versagensursachen liegt die Reluxationsrate nach arthroskopischer Restabilisierung zwischen 4,5 und 25%. Liegen begleitende knöcherne Glenoiddefekte über 25% der Glenoidbreite vor, steigt die Reluxationsrate sprunghaft an, sodass diese zusätzlich versorgt werden sollten. Ossäre humerale Defekte sind ggf. zu adressieren, wobei Ergebnisse vergleichender Langzeitstudien rar sind.

Schlussfolgerungen

Eine genaue Ursachenanalyse der Reluxation bildet die Grundlage für die richtige Operationsindikation. Zur Reduktion der Reluxationsrate ist eine zielgerichtete Behandlung aller Pathologien erforderlich.

Abstract

Background

Shoulder dislocations are common injuries and recurrent dislocations after primary stabilization are also relatively common. Therefore, every shoulder surgeon should know how to handle this condition properly.

Objective

The aim of this article is to present the current knowledge about the management of failed anterior shoulder stabilization including the treatment of humeral and glenoid bone defects.

Methods

The results are based on the current study results in the literature concerning arthroscopic and open shoulder revision stabilization.

Results

The redislocation rate after arthroscopic revision stabilization is between 4.5 and 25% after exclusion of osseous defects. When bony Bankart lesions with a defect size of more than 25% of the glenoid width are prevalent, the redislocation rate increases significantly. Therefore, these defects have to be addressed separately with bony reconstruction procedures. Bony defects of the humerus occasionally have to be addressed, but comparative and prospective long-term studies are rare.

Conclusion

For the management of failed anterior stabilization a detailed investigation of the cause of the failure should be carried out. Specific therapy of the pathology can then be carried out to optimize patient treatment and reduce the risk for redislocation.

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  1. Sektion Sportorthopädie, Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberanerstr. 142, 18057, Rostock, Deutschland

    Thomas Tischer & Peter C. Kreuz

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Correspondence to Thomas Tischer.

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Tischer, T., Kreuz, P. Management der fehlgeschlagenen vorderen Schulterstabilisierung. Obere Extremität 9, 90–95 (2014). https://doi.org/10.1007/s11678-014-0255-3

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  • DOI: https://doi.org/10.1007/s11678-014-0255-3

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