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Konservative Therapie proximaler Humerusfrakturen

Conservative treatment of proximal humeral fractures

Zusammenfassung

Hintergrund

Abhängig vom Frakturtyp, dem Lebensalter und den funktionellen Patientenansprüchen stehen operative und konservative Therapieoptionen für die proximale Humerusfraktur zur Verfügung. Die konservative Therapie stellt insbesondere im geriatrischen Patientengut eine kostengünstige und wenig belastende Behandlungsoption dar. Anhand dieser Arbeit sollen die klinischen und radiologischen Ergebnisse der konservativen Therapie proximaler Humerusfrakturen analysiert werden.

Material und Methoden

Für diese Studie wurden 84 Patienten (weiblich = 65; männlich = 19) mit einem Durchschnittsalter von 67 (21–97) Jahren mit konservativ behandelter proximaler Humerusfraktur eingeschlossen. Initial wurden die Frakturen mittels Nativröntgen und Computertomographie beurteilt. Alle Patienten wurden für insgesamt 4 Wochen nach dem Trauma mit einer Immobilisationsorthese versorgt. Bereits nach der ersten Woche erfolgten aktive Pendelübungen. Nach 6 und 97 (84–120) Monaten wurden die Patienten mittels Constant Score, Oxford Shoulder Score und nativradiologisch beurteilt.

Ergebnisse

Gemäß der Neer-Klassifikation lagen 19 2-Part- (23 %), 40 3-Part- (47 %) und 25 4-Part-Frakturen (30 %) vor. Nach 6 Monaten war der Constant Score der betroffenen Schulter im Vergleich zur unverletzten Gegenseite noch immer geringer (75 vs. 91; p < 0,001). Der alters- und geschlechtsadaptierte Constant Score lag nach sechs Monaten bei 84 %. Der mittlere Oxford Shoulder Score betrug 40 Punkte. Im Vergleich zur Kontrolle nach sechs Monaten hatte sich der adaptierte Constant Score nach 97 Monaten verbessert (84 % vs. 88 %; p < 0,001).

Schlussfolgerung

Die konservative Therapie proximaler Humerusfrakturen kann bereits nach 6 Monaten zu einer hohen Patientenzufriedenheit und einer akzeptablen Schulterfunktion führen. Neben dem Risiko einer sekundären Dislokation mit schwerer Fehlstellung birgt die konservative Therapie Risiken für eine Humeruskopfnekrose und eine posttraumatischen Omarthrose (Evidenzlevel: Level IV, retrospektive Analyse).

Abstract

Background

Depending on the fracture type, patient age and functional demands, surgical or conservative treatment options are available for patients suffering from a fracture of the proximal humerus. Conservative treatment of proximal humeral fractures is a cost-efficient and less invasive treatment option, particularly for geriatric patients. This retrospective comparative study evaluated the clinical and radiological results of conservative treatment for patients with proximal humeral fractures.

Material and methods

This study included 84 patients (female = 65; male = 19) with a mean age of 67 years (range 21–97 years) treated conservatively for proximal humeral fractures. Initially, the fractures were assessed using plain radiographs and computed tomography. All patients received an arm sling for 4 weeks after the trauma. After 1 week, assisted mobilization was started with pendulum exercises. After 6 and 97 months (84–120) patients were assessed clinically with the Constant score and Oxford shoulder score and analyzed using plain radiographs.

Results

According to the Neer classification 19 were 2‑part fractures (23%), 40 were 3‑part fractures (47%) and 25 were 4‑part fractures (30%) were included in this study. After 6 months the Constant score of the affected shoulder had improved when compared to the first measurement after the initial trauma (15 vs. 75; p < 0.001). In comparison to the healthy contralateral shoulder, the Constant score of the affected shoulder was lower (75 vs. 91.0; p < 0.001). After 6 months the age and sex-adjusted Constant score was 84%, and the mean Oxford shoulder score was 40 points. After 97 months (84–120) the adjusted Constant Score showed further improvement (84% vs. 88%; p < 0.001).

Conclusion

Conservative treatment of proximal humeral fractures can lead to acceptable shoulder function and high patient satisfaction after 6 months. In addition to the risk of secondary dislocation with severe malalignment, conservative treatment runs the risk of avascular necrosis of the humeral head and posttraumatic glenohumeral osteoarthritis (Level of evidence: Level IV, retrospective study).

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Correspondence to Malte Holschen.

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Interessenkonflikt

M. Holschen, J. Clasing, T. Bartscht, Y. Ameziane, G. Möllenhoff und J. Steinbeck geben an, dass kein Interessenkonflikt besteht.

Alle Patienten haben nach vorheriger Aufklärung schriftlich in die Untersuchung eingewilligt. Die Studie wurde von der Ethikkommission der Westfälischen Wilhelms Universität und der Ärztekammer Westfalen/Lippe genehmigt.

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Holschen, M., Clasing, J., Bartscht, T. et al. Konservative Therapie proximaler Humerusfrakturen. Obere Extremität (2022). https://doi.org/10.1007/s11678-022-00693-w

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  • DOI: https://doi.org/10.1007/s11678-022-00693-w

Schlüsselwörter

  • Konservative Therapie
  • Pseudarthrose
  • Fehlstellung
  • Osteoporose
  • Komplikationen

Keywords

  • Conservative treatment
  • Pseudarthrosis
  • Malalignment
  • Osteoporosis
  • Complications