Skip to main content
SpringerLink
Log in

Grenzen der Rekonstruktion – Prothesen

Limitations of reconstruction – prostheses

  • Leitthema
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Die Humeruskopffraktur ist eine häufige Verletzung, insbesondere des älteren weiblichen Patienten. Im Rahmen der Osteosynthese lassen sich in der Regel gute klinische Ergebnisse erzielen. Probleme werden jedoch weiterhin bei den die varisch dislozierten Humeruskopffrakturen, insbesondere wenn die mediale Säule zerstört ist, beobachtet. Hier sind eine anatomische Reposition des Kalottenfragments sowie ein medialer Knochenkontakt für ein gutes Operationsergebnis unentbehrlich. Ansonsten lässt sich ein sekundärer Varuskollaps und/oder ein Implantatversagen vorhersehen. Weitere Herausforderungen bilden die intraartikulären Frakturformen sowie die initial ischämen Humeruskopffrakturen. Die Indikation zur Frakturprothese ist immer dann gegeben, wenn keine stabile Osteosynthese in adäquater Reposition erzielt werden kann. Inverse Frakturprothesen stellen eine zunehmend verbreitete Therapieoption dar. Sie sollten jedoch den älteren Patienten >75 Jahren vorbehalten bleiben.

Abstract

Fractures of the proximal humerus are common, particularly seen in elderly, female patients. Using open reduction and internal fixation good clinical results can be achieved in general. But even today not every problem has been solved in the treatment of proximal humeral fractures. Varus displaced fractures are particularly challenging, especially when the medial column is destroyed. Anatomical reduction of the humeral head and medial bone contact are crucial for a good surgical outcome. Otherwise a secondary varus collapse and/or an implant failure are predictable. Further challenges are the intra-articular fracture patterns, as well as fractures with an initial ischemic humeral head. The indications for prosthetic replacement are always present if an initially stable internal fixation could not be achieved. The reverse fracture prostheses represent an increasingly common treatment option; however, the indication should be reserved for the elderly over 75 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442(1):87–92

    Article  PubMed  Google Scholar 

  2. Court-Brown C, Cattermole H, McQueen M (2002) Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment. J Bone Joint Surg Br 84(4):504–508

    Article  PubMed  CAS  Google Scholar 

  3. Court-Brown CM, Aitken S, Hamilton TW et al (2010) Nonoperative fracture treatment in the modern era. J Trauma 69(3):699–707

    Article  PubMed  Google Scholar 

  4. Vallier HA (2007) Treatment of proximal humerus fractures. J Orthop Trauma 21(7):469–476

    Article  PubMed  Google Scholar 

  5. Fjalestad T, Hole MØ, Jørgensen JJ et al (2010) Health and cost consequences of surgical versus conservative treatment for a comminuted proximal humeral fracture in elderly patients. Injury 41(6):599–605

    Article  PubMed  CAS  Google Scholar 

  6. Sanders RJ, Thissen LG, Teepen JC et al (2011) Locking plate versus nonsurgical treatment for proximal humeral fractures: better midterm outcome with nonsurgical treatment. J Shoulder Elbow Surg 20/3(372-377):1058–2746

    Google Scholar 

  7. Sudkamp N, Bayer J, Hepp P et al (2009) Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 91(6):1320–1328

    Article  PubMed  CAS  Google Scholar 

  8. Brunner F, Sommer C, Bahrs C et al (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23(3):163–172

    Article  PubMed  Google Scholar 

  9. Thanasas C, Kontakis G, Angoules A et al (2009) Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg 18(6):837–844

    Article  PubMed  Google Scholar 

  10. Hardeman F, Bollars P, Donnelly M et al (2011) Predictive factors for functional outcome and failure in angular stable osteosynthesis of the proximal humerus. Injury (Epub ahead of print)

  11. Foruria AM, Gracia MM de, Larson DR et al (2011) The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures. J Bone Joint Surg Br 93(3):378–386

    Article  PubMed  CAS  Google Scholar 

  12. Bahrs C, Schmal H, Lingenfelter E et al (2008) Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: a prospective study. BMC Musculoskelet Disord 9:21

    Article  PubMed  Google Scholar 

  13. Hertel R (2005) Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 16(Suppl 2):65–72

    Article  Google Scholar 

  14. Majed A, Macleod I, Bull AMJ et al (2011) Proximal humeral fracture classification systems revisited. J Shoulder Elbow Surg 20(5):827–832

    Article  Google Scholar 

  15. Plecko M, Kraus A (2005) Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Oper Orthop Traumatol 17(1):25–50

    Article  PubMed  Google Scholar 

  16. Agudelo J, Schürmann M, Stahel P et al (2007) Analysis of efficacy and failure in proximal humerus fractures treated with locking plates. J Orthop Trauma 21(10):676–681

    Article  PubMed  Google Scholar 

  17. Gardner MJ, Weil Y, Barker JU et al (2007) The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma 21(3):185–191

    Article  PubMed  Google Scholar 

  18. Owsley K, Gorczyca J (2008) Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures. J Bone Joint Surg Am 90(2):233–240

    Article  PubMed  Google Scholar 

  19. Lee C-W, Shin S-J (2009) Prognostic factors for unstable proximal humeral fractures treated with locking-plate fixation. J Shoulder Elbow Surg 18(1):83–88

    Article  PubMed  Google Scholar 

  20. Solberg BD, Moon CN, Franco DP, Paiement GD (2009) Locked plating of 3- and 4-part proximal humerus fractures in older patients: the effect of initial fracture pattern on outcome. J Orthop Trauma 23(2):113–119

    Article  PubMed  Google Scholar 

  21. Krappinger D, Bizzotto N, Riedmann S et al (2011) Predicting failure after surgical fixation of proximal humerus fractures. Injury (Epub ahead of print)

  22. Voigt C, Hurschler C, Althainz J et al (2008) Effect of additive fiber cerclage of the rotator cuff in angle-stable plate-stabilized proximal humeral fractures: a biomechanical study of human shoulder specimens. Unfallchirurg 111(7):514–522

    Article  PubMed  CAS  Google Scholar 

  23. Badman B, Frankle M, Keating C et al (2011) Results of proximal humeral locked plating with supplemental suture fixation of rotator cuff. J Shoulder Elbow Surg 20(4):616–624

    Article  PubMed  Google Scholar 

  24. Kim KC, Rhee KJ, Shin HD (2008) Tension band sutures using a washer for a proximal humerus fracture. J Trauma 64(4):1136–1138

    Article  PubMed  Google Scholar 

  25. Yang H, Li Z, Zhou F et al (2011) A prospective clinical study of proximal humerus fractures treated with a locking proximal humerus plate. J Orthop Trauma 25(1):11–17

    Article  PubMed  Google Scholar 

  26. Lescheid J, Zdero R, Shah S et al (2010) The biomechanics of locked plating for repairing proximal humerus fractures with or without medial cortical support. J Trauma 69(5):1235–1242

    Article  PubMed  Google Scholar 

  27. Gardner MJ, Boraiah S, Helfet DL, Lorich DG (2008) Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma 22(3):195–200

    Article  PubMed  Google Scholar 

  28. Osterhoff G, Baumgartner D, Favre P et al (2011) Medial support by fibula bone graft in angular stable plate fixation of proximal humeral fractures: an in vitro study with synthetic bone. J Shoulder Elbow Surg 20(5):740–746

    Article  PubMed  Google Scholar 

  29. Goldhahn J, Suhm N, Goldhahn S et al (2007) Influence of osteoporosis on fracture fixation – a systematic literature review. Osteoporos Int 19(6):761–772

    Article  Google Scholar 

  30. Barvencik F, Gebauer M, Beil FT et al (2010) Age- and sex-related changes of humeral head microarchitecture: histomorphometric analysis of 60 human specimens. J Orthop Res 28(1):18–26

    PubMed  Google Scholar 

  31. Resch H (2011) Proximal humeral fractures: current controversies. J Shoulder Elbow Surg 20(5):827–832

    Article  PubMed  Google Scholar 

  32. Lill H, Hepp P, Korner J et al (2003) Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens. Arch Orthop Trauma Surg 123(2–3):74–81

    Google Scholar 

  33. Jakob R, Miniaci A, Anson P et al (1991) Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br 73(2):295–298

    PubMed  CAS  Google Scholar 

  34. Kralinger F, Unger S, Wambacher M et al (2009) The medial periosteal hinge, a key structure in fractures of the proximal humerus: a biomechanical cadaver study of its mechanical properties. J Bone Joint Surg Br 91(7):973–976

    Article  PubMed  CAS  Google Scholar 

  35. Chesser TJ, Langdon IJ, Ogilvie C et al (2001) Fractures involving splitting of the humeral head. J Bone Joint Surg Br 83(3):423–426

    Article  PubMed  CAS  Google Scholar 

  36. Brunner F, Sommer C, Bahrs C et al (2009) Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 23(3):163–172

    Article  PubMed  Google Scholar 

  37. Konrad G, Sudkamp N (2009) Open reduction and internal fixation of proximal humeral fractures. J Bone Joint Surg (Epub ahead of print)

  38. Greiner S, Kaab M, Haas N, Bail H (2008) Humeral head necrosis rate at mid-term follow-up after open reduction and angular stable plate fixation for proximal humeral fractures. Injury 40(2):186–191

    Article  PubMed  Google Scholar 

  39. Bastian J, Hertel R (2008) Initial post-fracture humeral head ischemia does not predict development of necrosis. J Shoulder Elbow Surg 17(1):2–8

    Article  PubMed  Google Scholar 

  40. Gardner MJ, Voos JE, Wanich T et al (2006) Vascular implications of minimally invasive plating of proximal humerus fractures. J Orthop Trauma 20(9):602–607

    Article  PubMed  Google Scholar 

  41. Sanchez-Sotelo J (2006) Proximal humerus fractures. Clin Anat 19(7):588–598

    Article  PubMed  Google Scholar 

  42. Hoffmeyer P (2002) The operative management of displaced fractures of the proximal humerus. J Bone Joint Surg Br 84(4):469–480

    Article  PubMed  CAS  Google Scholar 

  43. Hertel R, Hempfing A, Stiehler M, Leunig M (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 13(4):427–433

    Article  PubMed  CAS  Google Scholar 

  44. Cazeneuve JF, Cristofari DJ (2010) The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg Br 92(4):535–539

    Article  PubMed  CAS  Google Scholar 

  45. Gallinet D, Clappaz P, Garbuio P et al (2009) Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res 95(1):48–55

    Article  PubMed  CAS  Google Scholar 

  46. Klein M, Juschka M, Hinkenjann B et al (2008) Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma 22(10):698–704

    Article  PubMed  Google Scholar 

  47. Cazeneuve JF, Cristofari DJ (2009) Delta III reverse shoulder arthroplasty: radiological outcome for acute complex fractures of the proximal humerus in elderly patients. Orthop Traumatol Surg Res 95(5):325–329

    Article  PubMed  Google Scholar 

  48. Zumstein M, Pinedo M, Old J, Boileau P (2011) Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: A systematic review. J Shoulder Elbow Surg 20(1):146–157

    Article  PubMed  Google Scholar 

  49. Gallinet D, Clappaz P, Garbuio P et al (2009) Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res 95(1):48–55

    Article  PubMed  CAS  Google Scholar 

  50. Bufquin T, Hersan A, Hubert L, Massin P (2007) Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br 89(4):516–520

    Article  PubMed  CAS  Google Scholar 

  51. Favard L, Levigne C, Nerot C et al (2011) Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time? Clin Orthop Relat Res 469(9):2469–2475

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Department Orthopädie und Traumatologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106, Freiburg i.Br., Deutschland

    M. Jaeger, D. Maier, K. Izadpanah, P. Strohm & N.P. Südkamp

Authors
  1. M. Jaeger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Maier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Izadpanah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Strohm
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N.P. Südkamp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Jaeger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jaeger, M., Maier, D., Izadpanah, K. et al. Grenzen der Rekonstruktion – Prothesen. Unfallchirurg 114, 1068–1074 (2011). https://doi.org/10.1007/s00113-011-2054-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-011-2054-2

Schlüsselwörter

Keywords

Search

Navigation