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Luxationssicherheit und Funktion nach inverser Frakturprothese bei 3- und 4-Fragmentfrakturen des proximalen Humerus

Stability and functional aspects after reversed modular fracture arthroplasty in case of 3- and 4-part fractures of the humeral head

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Zusammenfassung

Hintergrund

Dislozierte proximale Humeruskopfmehrfragmentfrakturen stellen insbesondere im Alter eine therapeutische Herausforderung dar. Die vorliegende Studie untersucht die klinischen Ergebnisse und das Komplikationsmuster nach inverser endoprothetischer Versorgung.

Material und Methoden

Wir analysierten im Rahmen einer retrospektiven Kohortenanalyse ein Kollektiv mit 23 Patienten über ein Follow-up von 21,3 Monaten. Das mittlere Alter betrug 78,8 ± 6,2 Jahre. Alle Patienten erhielten eine modulare inverse Frakturprothese mit der Option einer Tubercularefixation. Die Patienten wurden mittels der Erhebung des Bewegungsausmaßes, des Constant-Murley-Scores, des altersadaptierten Constant-Murley-Scores und der konventionell-radiologischen Ergebnisse analysiert.

Ergebnisse

Die klinische Untersuchung mit Erhebung des Constant-Murley-Scores zeigte ein gutes Ergebnis nach Versorgung mit modularer inverser Frakturprothese (Constant-Score: 50,1 Punkte). Im Vergleich des Bewegungsausmaßes zeigt sich bei Patienten, welche eine Glenosphere der Größe 42 mm erhielten, eine verbesserte Innenrotationsfähigkeit. Bei allen Patienten konnte eine sehr gute Schmerzreduktion erreicht werden. Die Analyse der Komplikationen zeigte 1 Luxation (4,35 %) bei sehr großem Tuberculum-majus-Fragment, welches als Hypomochlion fungierte.

Schlussfolgerungen

Das funktionelle Ergebnis ist mit der vorhandenen Literatur vergleichbar. Zufrieden stellende objektive und subjektive klinische Ergebnisse können nach Versorgung mit einer inversen Frakturprothese erwartet werden.

Abstract

Background

Dislocated proximal humeral fractures remain as a therapeutic challenge, especially in the elderly. The aim of this study was to examine the functional results and the pattern of complications after reversed endoprosthetic treatment.

Methods

We retrospectively analyzed a cohort of 23 patients with a mean follow-up of 21,3 months (mean age 78,8 ± 6,2 years). All patients received a modular reversed fracture endoprosthesis with the option for tuberosity-refixation. The results were obtained including shoulder range of motion, Constant-Murley-Score, age-adjusted Constant-Murley-Score and radiographic results.

Results

Clinical examination confirmed good results after modular reversed fracture prosthesis (Constant-Score: 50,1 points). The comparison of internal rotation showed better results with glenosphere sizes of 42 mm. In all patients, a very good pain relief was achieved. The analysis of complications showed one dislocation (4,35 %).

Conclusions

Functional results are comparable to values in literature. Satisfying objective and subjective clinical results can be achieved after treatment with reversed Endoprothesis.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Merschin und R. Stangl geben an, dass kein Interessenkonflikt besteht.

Die Untersuchung fand entsprechend den Richtlinien der Deklaration von Helsinki (Oktober 2013) im Einklang mit nationalem Recht statt. Jeder der Patienten willigte schriftlich in die Studienteilnahme ein.

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  1. Klinik für Unfall-, Schulter- und Wiederherstellungschirurgie, Sportmedizin und Sporttraumatologie, Krankenhaus Rummelsberg gGmbH, ein Haus der Sana Kliniken AG, Rummelsberg 71, 90592, Schwarzenbruck, Deutschland

    David Merschin &  Richard Stangl

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  1. David Merschin
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Correspondence to David Merschin.

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Merschin, D., Stangl, R. Luxationssicherheit und Funktion nach inverser Frakturprothese bei 3- und 4-Fragmentfrakturen des proximalen Humerus. Obere Extremität 9, 280–288 (2014). https://doi.org/10.1007/s11678-014-0270-4

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  • DOI: https://doi.org/10.1007/s11678-014-0270-4

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