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Die proximale Humerusfraktur

Konservativ vs. operativ: wann und wie?

Proximal humeral fractures

Conservative versus surgical treatment: when and which procedure?

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Zusammenfassung

Die proximale Humerusfraktur stellt nach Frakturen des proximalen Femur und des distalen Radius die dritthäufigste Fraktur des älteren Menschen dar. Eine Herausforderung stellt bei den dislozierten Frakturen einerseits die Entscheidung zwischen konservativer und operativer Therapie dar, bei Indikation zur operativen Versorgung stellt sich andererseits die Frage nach dem geeigneten Osteosyntheseverfahren oder der Indikation zur endoprothetischen Versorgung. Die osteosynthetischen Verfahren bei komplexen dislozierten Frakturen des älteren Patienten sind technisch anspruchsvoll und mit einer relativ hohen Komplikationsrate behaftet. Neuere Studien stellen die Überlegenheit der Osteosyntheseverfahren bei dislozierten 3- und 4-Fragment-Frakturen gegenüber der konservativen Therapie in Frage. Wird keine stabile Versorgung durch die Osteosynthese erreicht, ist die Indikation zur Frakturprothese gegeben. Inverse Prothesen sollten dem alten Patienten vorbehalten sein.

Abstract

Proximal humeral fractures are the third most frequent in the elderly after proximal femoral and distal radial fractures. The decision between conservative and surgical treatment is challenging and if surgical treatment is indicated one has to choose between different internal fixation methods and arthroplasty. Osteosynthesis in complex displaced fractures shows high complications rates. Recent studies have shown no advantages of osteosynthesis for complex dislocated fractures compared to conservative treatment. If a stable internal fixation cannot be reached arthroplasty should be performed. Reverse fracture arthroplasty should be reserved for the elderly over 75 years of age.

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Literatur

  1. Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72:365–371

    Article  PubMed  CAS  Google Scholar 

  2. Palvanen M, Kannus P, Niemi S, Parkkari J (2006) Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 442:87–92

    Article  PubMed  Google Scholar 

  3. Kannus P, Palvanene M, Niemi S et al (2009) Rate of proximal humeral fractures in older Finnish women between 1970 and 2007. Bone 44:656–659

    Article  PubMed  Google Scholar 

  4. Codman EA (1934) Fractures in relation to the subacromial bursa. In: Codman EA (Hrsg) The shoulder, rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. Krieger, Malabar, S 313–331

  5. Hettrich CM, Boraiah S, Dyke JP et al (2010) Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Joint Surg Am 92(4):943–948

    Article  PubMed  Google Scholar 

  6. Gerber C, Schneeberger AG, Vinh TS (1990) The arterial vascularization of the humeral head. An anatomical study. J Bone Joint Surg Am 72:1486–1494

    PubMed  CAS  Google Scholar 

  7. Neer CS 2nd (1970) Displaced proximal humeral fractures, part I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089

    Google Scholar 

  8. Habermeyer P (1997) Die Humeruskopffraktur. Unfallchirurg 100:820–837

    Article  PubMed  CAS  Google Scholar 

  9. Hertel R (2005) Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 16(Suppl 2):65–72

    Article  Google Scholar 

  10. Siebenrock KA, Gerber C (1993) The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg Am 75:1751–1755

    PubMed  CAS  Google Scholar 

  11. Hertel R, Hempfing A, Stiehler M, Leinig M (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 13(4):427–433

    Article  PubMed  CAS  Google Scholar 

  12. Hirzinger C, Tauber M, Resch H (2011) Die Fraktur des proximalen Humerus. Neue Aspekte in der Epidemiologie, Frakturmorphologie und Diagnostik. Unfallchirurg 114:1051–1058

    Article  PubMed  CAS  Google Scholar 

  13. Majed A, Macleod I, Bull AM et al (2011) Proximal humeral fracture classification systems revisited. J Shoulder Elbow Surg 20:1125–1132

    Article  PubMed  Google Scholar 

  14. Resch H, Povacz P, Fröhlich R, Wambacher M (1997) Percuteanous fixation of three- and four part fractures of the proximal humerus. J Bone Joint Surg Br 79(2):295–300

    Article  PubMed  CAS  Google Scholar 

  15. Bogner R, Hubner C, Matis N et al (2008) Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients. J Bone Joint Surg Br 90:1602–1607

    Article  PubMed  CAS  Google Scholar 

  16. Platzer P, Thalhammer G, Oberleitner G et al (2008) Displaced fractures of the greater tuberosity: a comparison of operative and nonoperative treatment. J Trauma 65(4):843–845

    Article  PubMed  Google Scholar 

  17. Ji JH, Shafi M, Song IS et al (2010) Arthroscopic fixation technique for comminuted, displaced greater tuberosity fracture. Arthroscopy 26:600–609

    Article  PubMed  Google Scholar 

  18. Voigt C, Lill H (2011) Innovationen und Prognosen. Unfallchirurg 114:1083–1090

    Article  PubMed  CAS  Google Scholar 

  19. Scheibel M, Martinek V, Imhoff AB (2005) Arthroscopic reconstruction of an isolated avulsion fracture. Arthroscopy 21(4):487–494

    Article  PubMed  Google Scholar 

  20. Sosef N, Leerdam R von, Ott P et al (2010) Minimal invasive fixation of proximal humeral fractures with an intramedullary nail: good results in elderly patients. Arch Orthop Trauma Surg 130(5):605–611

    Article  PubMed  Google Scholar 

  21. Broek CM Van Den, Besselaar M Van Den, Coenen JMF, Vegt PA (2007) Displaced proximal humeral fractures: intramedullary nailing versus conservative treatment. Arch Orthop Trauma Surg 127:459–463

    Article  PubMed  Google Scholar 

  22. Thanasas C, Kontakis G, Angoules A et al (2009) treatment of proximal humerus fracture with locking plates: a systematic review. J Shoulder Elbow Surg 18(6):837–844

    Article  PubMed  Google Scholar 

  23. Jaeger M, Maier D, Izadpanah K, Strohm P, Südkamp NP (2011) Grenzen der Rekonstruktion-Prothesen. Unfallchirurg 114:1068–1074

    Article  PubMed  CAS  Google Scholar 

  24. Gardner MJ, Boraiah S, Helfet DL, Lorich DG (2008) Indirect medial reduction and strut support of proximal humerus fractures using an endosteal implant. J Orthop Trauma 22(3):195–200

    Article  PubMed  Google Scholar 

  25. Frangen Th, Müller EJ, Dudda M et al (2007) Proximal humeral fractures in geriatric patients. Is the angle stable plate osteosynthesis really a breakthrough? Acta Orthop Belg 73:571–579

    PubMed  Google Scholar 

  26. Krettek C (2011) If it looks normal, it works normal is challenged in proximal humerus fractures. Angular stable plate fixation in elderly patients is not superior to conservative treatment. J Bone Joint Surg [Nicht in der Medline???]

  27. Fjalestad T, Stromsoe K, Blicher J, Tennoe B (2005) Fractures in the proximal humerus: functional outcome and evaluation of 70 patients treated in hospital. Arch Orthop Trauma Surg 125:310–316

    Article  PubMed  Google Scholar 

  28. Fjalestad T, Hole MØ, Hovden IA, Blücher J, Strømsøe K (2012) Surgical treatment with an angular stable plate for complex displaced proximal humeral fractures in elderly patients: a randomised controlled trial. J Orthop trauma 26(2):98–106

    Article  PubMed  Google Scholar 

  29. Reuther F, Garbers E, Rudolph T (2011) Operative Therapie proximaler Humerusfrakturen. Obere Extremität 6:282–288

    Article  Google Scholar 

  30. Nijs S, Broos P (2009) Outcome of shoulder hemiarthroplasty in acute proximal humeral fractures—a frustrating meta-analysis experience. Acta Orthop Belg 75(4):445–451

    PubMed  Google Scholar 

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  1. Schulter- und Ellenbogenchirurgie, Arcus Sportklinik, Rastatter Str. 17–19, 75179, Pforzheim, Deutschland

    S. Franke & T. Ambacher

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  1. S. Franke
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  2. T. Ambacher
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Correspondence to S. Franke.

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Franke, S., Ambacher, T. Die proximale Humerusfraktur. Obere Extremität 7, 137–143 (2012). https://doi.org/10.1007/s11678-012-0171-3

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  • DOI: https://doi.org/10.1007/s11678-012-0171-3

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