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Proximale Humerusfraktur

Ist die winkelstabile Plattenosteosynthese der konservativen Behandlung überlegen?

Proximal humerus fracture

Is fixed-angle plate osteosynthesis superior to conservative treatment?

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Zusammenfassung

Obwohl die proximale Humerusfraktur eine der häufigsten Frakturen überhaupt ist, ist die Evidenzlage schlecht, hat sich aber in den letzten Jahren etwas verbessert. Einigkeit herrscht in der Literatur darüber, dass undislozierte Frakturen mit gutem Ergebnis konservativ behandelt werden können. Zwei neuere prospektiv-randomisierte Studien zeigen, dass dies auch für dislozierte 3- und 4-Teile-Frakturen gilt.

Auch bei komplexen dislozierten Frakturen des älteren Menschen sind die Ergebnisse der winkelstabilen Plattenosteosynthese der konservativen Therapie nicht überlegen, unter zahlreichen Aspekten sogar schlechter. Die winkelstabile Plattenosteosynthese hat die Erwartungen nicht erfüllt. Hohe Komplikations- und Revisionsraten sowie moderate funktionelle Ergebnisse sind in zahlreichen Studien abgebildet.

Konventionelle oder inverse Prothese sind komplexen nicht rekonstruierbaren und/oder retinierbaren Frakturformen vorbehalten. Auch für die dislozierte 4-Teile-Fraktur des >60-jährigen Patienten ist der statistisch haltbare Nachweis der Überlegenheit der Frakturprothese in der prospektiv randomisierten Analyse nicht gelungen.

Keywords

Despite the fact that proximal humerus fractures represent one of the most frequent types of all fractures, the quality of evidence is poor although it has improved in recent years. It is widely agreed in the literature that nondisplaced fractures can be treated conservatively with good outcome. Two recent prospective randomized studies have shown that this also applies to displaced three- and four-part fractures.

The results of fixed-angle plate osteosynthesis are also not superior to conservative management in complex displaced fractures in the elderly and in many aspects are even worse. Fixed-angle plate osteosynthesis has not fulfilled expectations. High rates of complications and revision surgeries as well as moderate functional results have been demonstrated in numerous studies.

Conventional fracture prostheses or inverse prostheses are solutions fo complex not reducible and/or retainable. Also for the dislocated 4-part fracture of the patient above 60ears no general advantages of the joint replacement compared to conservative treatment could be shown in a recent scandinavian prospective randomized clinical trial.

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  1. Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30173, Hannover, Deutschland

    C. Krettek & U. Wiebking

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  1. C. Krettek
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  2. U. Wiebking
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Correspondence to C. Krettek.

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Krettek, C., Wiebking, U. Proximale Humerusfraktur. Unfallchirurg 114, 1059–1067 (2011). https://doi.org/10.1007/s00113-011-2053-3

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