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Operative Versorgung proximaler Humerusfrakturen mittels Kombinationsosteosynthesen

Ein narratives Review

Operative management of proximal humeral fractures using combined osteosynthesis

A narrative review

  • Übersicht
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Zusammenfassung

Die Osteosynthese komplexer proximaler Humerusfrakturen stellt nach wie vor eine Herausforderung dar. Neben der anatomischen Reposition ist die Stabilität der Osteosynthese von besonderer Bedeutung. Die winkelstabile Plattenosteosynthese hat sich als Standardimplantat durchgesetzt, dennoch zeigen sich insbesondere bei komplexen Fraktursituationen und bei Patienten mit reduzierter Knochenqualität relevante Komplikationsraten. In den letzten Jahren haben additive Verfahren wie Augmentation, Kalkarschraube, Fibulagraft und Doppelplattenosteosynthesen Einzug in das Versorgungsportfolio erhalten. Biomechanische und erste klinische Studien weisen auf höhere Stabilität und Verringerung der Komplikationen hin. Allerdings ist es noch zu früh, ein spezielles Verfahren hervorzuheben und so werden mehr hochwertige und vergleichende klinische Studien benötigt, um evidenzbasierte Behandlungsempfehlungen abzugeben.

Abstract

The osteosynthesis of complex proximal humeral fractures is still challenging. In addition to achieving anatomical reduction, the stability of the osteosynthesis is of paramount importance. Locking plate osteosynthesis has become established as the standard; however, particularly in complex fracture scenarios and in patients with reduced bone quality, significant complication rates are observed. In recent years, additive techniques such as augmentation, calcar screw, fibular graft, and double-plate osteosynthesis have been incorporated into the treatment portfolio. Biomechanical and preliminary clinical studies suggest an increase in stability and a reduction in complications. Nevertheless, it is still too early to single out a specific procedure and, thus, more high-quality and comparative clinical studies are required to provide evidence-based treatment recommendations.

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  1. Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich für arthroskopische und spezielle Gelenkchirurgie/Sportverletzungen, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    Pierre Hepp, Ralf Henkelmann, Tobias Schöbel & Jan Theopold

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Hepp, P., Henkelmann, R., Schöbel, T. et al. Operative Versorgung proximaler Humerusfrakturen mittels Kombinationsosteosynthesen. Obere Extremität (2024). https://doi.org/10.1007/s11678-024-00793-9

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