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Proximale Humerusfraktur im fortgeschrittenen Lebensalter

Lebensqualität, klinische Ergebnisse und Institutionalisierung nach primärer inverser Frakturprothesenimplantation

Proximal humeral fractures in the elderly

Quality of life, clinical results and institutionalization following primary reverse fracture arthroplasty

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An Erratum to this article was published on 08 March 2017

Zusammenfassung

Hintergrund

Die Behandlung der proximalen Humerusfraktur alter Patienten bleibt eine Herausforderung. Im Rahmen des demographischen Wandels werden sowohl die Inzidenz wie auch die mittelbaren und unmittelbaren Verletzungsfolgen in den kommenden Jahren zunehmen. Die Erfassung der optimalen Therapieoption sollte neben funktionellen Parametern auch globale Gesundheitsparameter wie die Lebensqualität inkludieren.

Ziel der Arbeit

Ziel dieser retrospektiven Studie ist die Erfassung der Schultergelenkfunktion, der Lebensqualität, des Ausmaßes einer anschließenden Institutionalisierung (die Notwendigkeit einer Versorgung in einer Pflegeeinrichtung, ggf. temporär) und des Einflusses eines kognitiven Defizits auf das Outcome und das Komplikationsmuster nach primärer inverser Schultergelenkprothesenimplantation.

Studiendesign und Untersuchungsmethoden

In dieser Studie wurden 34 Patienten (mittleres Alter 79,8 ± 6,7 Jahre; 29 weiblich) nach Implantation einer inversen modularen Frakturendoprothese nachuntersucht. Das Follow-up lag im Mittel bei 23 Monaten (SD ± 10,6 Monate). Erfasst wurden neben dem funktionellen Ergebnis (Constant-Score, CS) auch das Ausmaß bzw. die Änderung der Institutionalisierung und der Lebensqualität (vor und nach Traumaereignis) mithilfe des EQ-5D™-Fragebogens.

Ergebnisse

Die klinische Untersuchung zeigte im CS ein gutes bis befriedigendes Ergebnis (54 Punkte, SD ± 9). Bezug nehmend auf die altersadaptierten Normwerte entspricht dies 78,9 %. Der Vergleich von Patienten mit/ohne fortgeschrittenem kognitivem Defizit zeigte keinen relevanten Unterschied (53 vs. 54 Punkte im CS; p = 0,6525). Die Rate an dauerhaften Institutionalisierungen (z. B. Notwendigkeit einer Pflegeeinrichtung) nach Versorgung einer proximaler Humerusfraktur mit inverser Frakturprothese beträgt 2,94 %. Die Lebensqualitätsmessung entsprechend EQ-5D™ zeigte einen Wert von 0,801 im Fragebogen „health-related quality of life“ (HRQoL). Auch die Komplikationsrate beträgt 2,94 % mit einer in Regression befindlichen inkompletten N.-radialis-Läsion.

Diskussion

Die Ergebnisse dieser Studie zeigen gute funktionelle Ergebnisse, eine sehr geringe Komplikations- und Institutionalisierungsrate und gute Ergebnisse der Lebensqualität. Zusätzlich sind die Ergebnisse – im Vergleich mit anderen Studienhinsichtlich der Lebensqualität im EQ-5D™ besser als jene nach winkelstabiler Plattenosteosynthese oder konservativer Therapie.

Abstract

Background

Treatment of humeral head fractures in the elderly remains a challenge. Within the framework of demographic change the incidence as well as the direct and indirect consequences of injuries will rise. The analysis of an optimal treatment should include functional parameters as well as global health parameters, e.g. quality of life.

Objective

The aim of this study was the evaluation of functional outcome, institutionalization (necessity of placement in a residential care home for the elderly, even if temporary), the influence of cognitive deficits, quality of life and the pattern of complications after primary reverse shoulder arthroplasty.

Material and methods

The study included a total of 34 patients (mean age 79.8 ± 6.7 years, 29 female) after implantation of a reversed modular fracture arthroplasty. The mean follow-up was 23 ± 10.6 months). The functional Constant-Murley score (CS), radiology results as well as the extent of institutionalization and quality of life as measured by the EQ-5D questionnaire were collated.

Results

The clinical examination showed good results in the CS (54 points, SD ± 9). In comparison to the age and gender-related CS according to Gerber the patient scores amounted to 78.9 %. The comparison of patients with and without cognitive deficits did not show any differences (53 vs. 54 points, p = 0.6525). The rate of institutionalization after treatment of humeral head fractures by reversed fracture arthroplasty was 2.94 %. The quality of life measured with EQ-5D showed a health-related quality of life (HRQoL) of 0.801. The rate of complications was 2.94 % involving an incomplete lesion of the radial nerve which was in regression.

Conclusion

The results of this study showed good to moderate functional results, very low rates of complications and institutionalization and very good results according to the HRQoL. In comparison to conservative treatment or plate osteosynthesis, better results were achieved in this study with respect to HRQoL.

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Authors and Affiliations

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

    D. Merschin & R. Stangl

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Correspondence to D. Merschin.

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Interessenkonflikt

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

Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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W. Mutschler, München

V. Braunstein, München

H. Polzer, München

Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/s00113-017-0321-6 zu finden.

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Merschin, D., Stangl, R. Proximale Humerusfraktur im fortgeschrittenen Lebensalter. Unfallchirurg 119, 1015–1022 (2016). https://doi.org/10.1007/s00113-015-0009-8

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