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Primäre Endoprothetik bei proximalen Humerusfrakturen

Primary hemiarthroplasty in proximal humerus fractures

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Zusammenfassung

Komplexe proximale Humerusfrakturen stellen noch immer eine große Herausforderung dar. Nicht alle können rekonstruiert werden. Indikationen für den primären Gelenkersatz ergeben sich beim älteren Patienten (>60 Jahre) aus „kritischen Frakturtypen“ und dem Vorliegen von definierten Ischämieprädiktoren.

Voraussetzungen für ein gutes funktionelles Ergebnis sind neben einer weichteilschonenden Operationstechnik, eine sichere Tubercularefixation, eine gute Weichteilbalancierung der Rotatorenmanschette und eine korrekte Wiederherstellung von humeraler Länge, Retroversion und Offset sowie eine adäquate Physiotherapie. Multicenterstudien nach primärer Hemiarthroplastik ergaben durchschnittliche Ergebnisse im Constant-Murlay-Score von 56,0–73,5 Punkten. 79% der Patienten äußerten im Follow-up keine oder nur geringe Schmerzen, das Bewegungsausmaß war akzeptabel (41,9% Anteversion >90°, 34,7% Abduktion >90°). Generell lag die subjektive Bewertung über den objektiven Ergebnissen.

Die beschriebenen Komplikationsraten der primären Frakturprothetik am proximalen Humerus sind noch relativ hoch, eine aktuelle Studie beschrieb eine 10-Jahres-Überlebensrate von 100%.

Abstract

The surgical treatment of complex proximal humerus fractures is still a great challenge. Not all fracture types can be successfully reconstructed. Indications for a primary joint replacement arise from critical fracture patterns and defined predictors of ischemia in the elderly (age >60 years).

If good functional results are to be achieved a soft-tissue-preserving surgical technique, secure tuberosity attachment and accurate soft tissue balancing of the rotator cuff, correct restoration of height, retrotorsion and offset, and appropriate physiotherapy afterwards are essential. In multicentre studies in patients who had undergone primary hemoarthroplasty average Constant-Murlay Scores of 56.0–73.5 point were recorded. At follow-up, 79% of the patients reported only mild pain or none at all, and the ROM was acceptable (41.9% anteversion >90°, 34.7% abduction >90°). Generally, subjective evaluations were much better than the objective results.

The incidence of complications after humeral head replacement is still relatively high, whereas the 10-year survival rate of shoulder hemiarthroplasties has been found in a recent study to be 100%.

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Danksagung

Wir danken der radiologischen Abteilung unserer Klinik für die Abb. 7a–d.

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  1. Klinik für Unfall- und Wiederherstellungschirurgie, Diakoniekrankenhaus Friederikenstift gGmbH, Humboldtstraße 5, 30169, Hannover, Deutschland

    C. Voigt &  H. Lill

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  2. H. Lill
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Correspondence to H. Lill.

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Voigt, C., Lill, H. Primäre Endoprothetik bei proximalen Humerusfrakturen. Orthopäde 36, 1002–1012 (2007). https://doi.org/10.1007/s00132-007-1155-7

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