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Komplikationen winkelstabiler Plattenosteosynthesen am Humeruskopf

Darstellung und Management

Complications in 200 proximal humeral fractures treated with proximal humeral interlocking plates

Description and management

  • Proximale Humerusfrakturen
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Von Januar 2002–April 2005 wurden 200 dislozierte Humeruskopffrakturen bei 196 Patienten mit einem Altersdurchschnitt von 67±16 Jahren mittels winkelstabiler Platte (PHILOS, Fa. Synthes) am proximalen Humerus operativ versorgt. 162 Patienten konnten mit einem Mindestuntersuchungszeitraum von 13,8 Monaten evaluiert werden. Der mittlere Constant-Score betrugt 66±19 von maximal 100 möglichen Punkten. Bei 81 registrierten Komplikationen wurden 40 Revisionsoperationen notwendig, die meisten wegen überstehender Implantate (22-mal Schraubenspitzen, 6-mal Platten). Intraoperative Varusfehler (7) oder ungenügende Reposition der Tubercula (9) bestanden in 15 Fällen. Sekundäre Implantatdislokationen aus dem Humeruskopf oder dem Schaftanteil wurden 7-mal registriert. Humeruskopfnekrosen (5), Teilnekrosen (9) oder Sinterungen (4) traten infolge von Humerusmehrfragmentfrakturen auf und sind eher als Folge einer Durchblutungsstörung zu werten als als operationstechnischer Fehler. Trotz der nicht unerheblichen Rate an Komplikationen erlauben es die winkelstabilen Humerusplatten, dislozierte Frakturanteile sicher zu fixieren, und gestatten somit eine frühfunktionelle Beübung.

Abstract

From January 2002 to April 2005, 200 proximal humeral head fractures in 196 patients with an average age of 67 years (±16) were treated with an angular-stable proximal humeral plate (PHILOS, Synthes). A total of 162 patients were followed-up at a mean interval of 13.8 months. The mean constant score was 66±19 points. With 81 registered complications, 40 revision operations were necessary. Most of these were due to technical errors such as implant-dislocation of the screws (22) or plates (6). Intraoperative axial varus deviations (7) or insufficient reduction of the tubercula (8) were also found. Secondary implant loosening in the humeral head or in the shaft was registered in seven times. Necroses of the humeral head (5), partial necroses (9) or sintering (4) appeared to be due to the fracture type and should be rated more as a consequence of a blood circulation disturbance rather than a technical failure. Despite the considerable rate of complications, the proximal locking humeral plate offers good potential for fixing dislocated fracture parts, thus permitting early functional treatment.

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Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität, München

    M. Kettler, V. Braunstein, P. Biberthaler, M. Krammer & W. Mutschler

  2. Chirurgische Klinik und Poliklinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität, 80336 , München

    M. Kettler

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  1. M. Kettler
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  2. V. Braunstein
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  3. P. Biberthaler
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  4. M. Krammer
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  5. W. Mutschler
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Correspondence to M. Kettler.

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Kettler, M., Braunstein, V., Biberthaler, P. et al. Komplikationen winkelstabiler Plattenosteosynthesen am Humeruskopf. Trauma Berufskrankh 9 (Suppl 1), S48–S53 (2007). https://doi.org/10.1007/s10039-005-1079-6

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  • DOI: https://doi.org/10.1007/s10039-005-1079-6

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