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Sekundäre Endoprothetik des Ellenbogengelenks nach distaler Humerusfraktur

Secondary total elbow arthroplasty after distal humeral fracture

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Zusammenfassung

Die primäre prothetische Versorgung der distalen Humerusfraktur erzielt kurzfristig gute Ergebnisse. Da die Standzeit der Prothesen limitiert ist, sollte diese Therapieoption aber eher älteren Patienten mit nicht stabil zu rekonstruierenden distalen Humerusfrakturen und geringem funktionellen Anspruch vorbehalten sein. Winkelstabile Osteosynthesesysteme ermöglichen auch bei schweren intraartikulären Trümmerfrakturen des distalen Humerus eine primär übungsstabile Versorgung. Dies hat dazu geführt, dass die primäre Ellenbogengelenktotalendoprothese (EBTEP) bei der distalen Humerusfraktur selten zur Anwendung kommt.

Die sekundäre EBTEP nach Osteosyntheseversagen und bei chronisch instabilem arthrotisch verändertem Ellenbogengelenk hat dagegen auch bei jüngeren Patienten an Bedeutung gewonnen. Dies gilt insbesondere, um eine umgehende Schmerzreduktion und Funktionsverbesserung zu erreichen. Heben und Tragen von über 5 kg sowie Schlagsportarten sind nach Implantation einer EBTEP nicht erlaubt. Eine gute Patienten-Compliance ist eine wichtige Voraussetzung. Im Langzeitverlauf sind die Ergebnisse nach Implantation einer EBTEP bei Traumapatienten schlechter als bei Patienten mit rheumatoider Arthritis.

Abstract

Good short-term results have been reported for primary total elbow arthroplasty (TEA) but implant longevity is limited. Therefore, primary TEA should be reserved in particular for older patients with severe comminuted distal humeral fractures in whom successful osteosynthesis is often impossible. Angular locking compression plates afford stable fracture fixation even for a severe intra-articular fracture pattern. To date primary TEA for treatment of severe distal humeral fractures is rarely used.

Secondary TEA is used in failed osteosynthesis of distal humeral fractures and in unstable post-traumatic elbow joints with osteoarthrosis. Additionally, secondary TEA has become more popular in younger patients for immediate pain reduction and functional improvement. However, weight bearing is limited to 5 kg, racket sports are prohibited and good patient compliance is mandatory. Long-term results of TEA are poorer for trauma patients than those with rheumatoid arthritis.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. „Grant/research“ support von Medartis (Schwerpunkt Unfallchirurgie); L.P. Müller ist als „speaker/teacher“ für die Fa. Synthes tätig; L.P. Müller, K.J. Burkhart und K. Wegmann sind als Speaker/Teacher für die Fa. Medartis und die Fa. Tornier tätig. C. Ries und M. Hackl geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Unfall-, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Kerpenerstrasse 62, 50924, Köln, Deutschland

    Christian Ries, Kilian Wegmann MD, Michael Hackl MD, Klaus Josef Burkhart PhDMD & Lars Peter Müller PhDMD

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  1. Christian Ries
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  2. Kilian Wegmann MD
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  3. Michael Hackl MD
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  4. Klaus Josef Burkhart PhDMD
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  5. Lars Peter Müller PhDMD
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Correspondence to Christian Ries.

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Ries, C., Wegmann, K., Hackl, M. et al. Sekundäre Endoprothetik des Ellenbogengelenks nach distaler Humerusfraktur. Obere Extremität 9, 156–162 (2014). https://doi.org/10.1007/s11678-014-0268-y

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  • DOI: https://doi.org/10.1007/s11678-014-0268-y

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