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Klinisches Outcome (Median 5 Jahre) nach winkelstabiler Plattenosteosynthese von 228 Patienten mit dislozierter proximaler Humerusfraktur

Longer-term functional outcomes (median 5 years) after locked plating for displaced fractures of the proximal humerus

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Zusammenfassung

Hintergrund

Ziel dieser Studie war es, das klinische Outcome bei Patienten mit dislozierter proximaler Humerusfraktur und winkelstabiler Plattenosteosynthese 5 Jahre postoperativ zu erheben und Risikofaktoren für ein schlechtes Ergebnis zu identifizieren.

Methodik

467 Patienten wurden zwischen 02/2002 und 02/2012 aufgrund einer dislozierten proximalen Humerusfraktur mit einer winkelstabilen Plattenosteosynthese versorgt. Von 228 Patienten (Follow-up Rate 48,8 %) wurde die Schulterfunktion im Verlauf durch regelmäßige klinische Kontrollen bis 2 Jahre postoperativ und nach Median 5,7 Jahre (95 % CI: 5,4–6,1) postoperativ anhand des Constant Score und DASH Score erfasst.

Ergebnisse

Bei 228 Patienten (68,9 % Frauen, mittleres Alter: 65,7 Jahre, 95 % Konfidenzintervall (CI): 63,6–67,7; 31,1 % Männer, mittleres Alter: 55,5 Jahre 95 % CI: 52,3–58,6) betrug der mittlere Constant-Score 5,7 Jahre nach Versorgung einer dislozierten proximalen Humerusfraktur mittels winkelstabiler Plattenosteosynthese 75,5 Punkte (95 % CI: 72,6–78,4). Der mittlere alters- und geschlechtsnormalisierte Constant-Score lag bei 85,5 Punkten (95 % CI: 81,6–89,3) und der Constant-Score im Vergleich zum unverletzten Arm betrug 84,5 % (95 % CI: 81,1–87,9). Die Bewertung der Schulterfunktion war in 41,7 % der Patienten „sehr gut“ (100–86 Punkte), 24,1 % „gut“ (85–71), 19,3 % „befriedigend“ (70–56) und in 14,9 % „schlecht“ (kleiner 56). Der beobachtete Constant-Score nach 5 Jahren korrelierte negativ mit dem Patientenalter (Pearson: r = − 0,2, p < 0,01) und einer ungeplanten Revisionsoperation (Pearson r = − 0,3, p < 0,01).

Diskussion

5 Jahre nach winkelstabiler Plattenosteosynthese einer dislozierten proximalen Humerusfraktur lässt sich bei 2/3 der Patienten (65,8 %) ein sehr gutes bis gutes klinisches Ergebnis nachweisen. In ca. 15 % der Fälle liegt eine „schlechte“ Schulterfunktion vor, die gehäuft bei Patienten mit hohem Lebensalter beobachtet wird oder bei Patienten die einer ungeplanten Revisionsoperation unterzogen werden mussten.

Abstract

Background

Aim of the study was to evaluate clinical outcomes 5 years following locked plating for proximal humeral fractures and to identify risk factors for a poor outcome.

Methods

467 patients with displaced proximal humeral fractures were treated by open reduction and locking plate fixation between 02/2002 and 02/2012. 228 patients (follow-up rate 48.8 %) were followed by use of the Constant and DASH score. Final follow-up was performed after a median of 5.7 years (95 % CI: 5.4; 6.1).

Results

Of 228 patients, 68.9 % female (mean age 65.7 years, 95 % CI: 63.6; 67.7) and 31.1 % male (mean age 55.5 years, 95 % CI: 52.3; 58.6) the absolute Constant Score (CS) five years after surgery was 75.5 (95 % CI: 72.6; 78.4). The normalized CS (nCS) was 85.5 (95 % CI: 81.6; 89.3) and the CS in percentage to the contralateral side (% CS) was 84.5 % (95 % CI: 81.1; 87.9). The shoulder function was rated “excellent” (100–86 points) in 41.7 %, “good” (85–71) 24.1 %, “moderate” (70–56) 19.3 % and “poor” (< 56) 14.9 %. The CS at five years correlated negatively with patient age (r = − 0.2, p < 0.01) and with the occurrence of revision surgery (r = − 0.3, p < 0.01).

Conclusions

Five years after locked plating of displaced proximal humeral fractures patients show good to excellent outcomes in 2/3 of cases. However, worse long-term outcomes are observed in 15 % of cases, particularly in patients of higher age that underwent revision surgery.

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Einhaltung ethischer Richtlinien

Interessenkonflikt

G. Siebenbürger, N. Biermann, F. Haasters, W. Mutschler und B. Ockert geben an, dass kein Interessenkonflikt besteht.

Alle 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 Patienten liegt eine Einverständniserklärung vor.

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Authors and Affiliations

  1. Schulter- und Ellenbogenchirurgie + Portrait, Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie – Campus Großhadern, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland

    Georg Siebenbürger, Niklas Biermann,  Florian Haasters,  Wolf Mutschler &  Ben Ockert

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  1. Georg Siebenbürger
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  2. Niklas Biermann
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  3. Florian Haasters
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  4. Wolf Mutschler
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  5. Ben Ockert
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Correspondence to Ben Ockert.

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Level of Evidence:Level II für prognostische Studien entsprechend Centre for Evidence-Based Medicine, Oxford, UK

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Siebenbürger, G., Biermann, N., Haasters, F. et al. Klinisches Outcome (Median 5 Jahre) nach winkelstabiler Plattenosteosynthese von 228 Patienten mit dislozierter proximaler Humerusfraktur. Obere Extremität 9, 215–221 (2014). https://doi.org/10.1007/s11678-014-0272-2

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