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Komplexe proximale Humerusfraktur beim alten Menschen

Winkelstabile Plattenosteosynthese vs. Hemiarthroplastik

Complex fracture of the proximal humerus in the elderly

Locking plate osteosynthesis vs hemiarthroplasty

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Zusammenfassung

Hintergrund

Ziel der vorliegenden Untersuchung ist ein direkter Vergleich der Schulterhemiarthroplastik (SHA) mit der winkelstabilen Plattenosteosynthese (WSPOS) beim alten Patienten mit komplexer proximaler Humerusfraktur.

Patienten und Methoden

Zwischen 2003 und 2005 wurden alle Patienten (n=52, Alter ≥70 Jahre) mit 3- und 4-Segment-Frakturen des proximalen Humerus, welche mit einer WSPOS (PHILOS®) versorgt wurden, prospektiv erfasst und nach einem Jahr mittels Constant-Score (CS), Oxford Shoulder Score (OSS) und radiologisch nachkontrolliert. Verglichen wurde die WSPOS mit einem historischen Kollektiv mit identischen Einschlusskriterien, welches zwischen 1995 und 1997 an der gleichen Institution mittels SHA versorgt wurde (n=59).

Ergebnisse

Beide Patientenkollektive zeigten keine Unterschiede bezüglich Alter, Geschlechterverteilung und Frakturtypen. Der CS war signifikant besser für die WSPOS (median 71 vs. 41). Bezüglich Schmerzen zeigte sich im OSS kein Unterschied zwischen den Gruppen. In der WSPOS-Gruppe mussten signifikant mehr Revisionseingriffe durchgeführt werden (25% vs. 2%).

Schlussfolgerung

Die WSPOS liefert beim alten Patienten, bei komplexen proximalen Humerusfrakturen deutlich bessere funktionelle Resultate, ist jedoch mit mehr Rezidiveingriffen behaftet. Die Selbständigkeit der Patienten kann bei beiden Operationsmethoden bei guter Schmerzfreiheit meist erhalten werden.

Abstract

Background

The purpose of the present study was a direct comparison of fixed-angle plate fixation (FAPF) and shoulder hemiarthroplasty (SHA) for complex fractures of the proximal humerus in the elderly.

Patients and Methods

A single-institution case series of 52 consecutive geriatric patients (age ≥70 years) treated with FAPF for three- and four-part fractures of the proximal humerus between 2003 and 2005 was analysed 1 year after surgery. The analysis included Constant Score (CS), Oxford Shoulder Score (OSS), and radiological evaluation. Outcome was compared with a similar historic group of patients (n=59) who received SHA in an earlier period (1995–1997).

Results

The patient groups showed no differences in age, gender, or fracture type. Median CS was significantly better for FAPF (71 vs 41). Evaluation of pain demonstrated no differences between the two treatment modalities in the OSS. Revision surgery was performed more often in the FAPF group (25% vs 2%).

Conclusion

Compared to SHA, functional outcome was superior with FAPF. However, this was associated with a higher rate of revision surgery. Most patients were still able to live independently in their original environment, regardless of the type of surgery.

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Dietrich, M., Meier, C., Lattmann, T. et al. Komplexe proximale Humerusfraktur beim alten Menschen. Chirurg 79, 231–240 (2008). https://doi.org/10.1007/s00104-007-1436-z

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