Pseudarthrosen und schlecht heilende Frakturen am Humerusschaft und am distalen Humerus

Zusammenfassung

Frakturen am Humerusschaft werden häufig konservativ im Brace behandelt und werden allgemein als benigne Frakturen mit hoher Heilungspotenz eingestuft. Dennoch kommt es, je nach Abschnitt, in 12 – 24% zur Ausbildung einer Pseudarthrose. Meist ist die Funktionalität des Armes so gestört, dass eine operative Behandlung notwendig wird. Eine exakte Analyse ist für den Erfolg der Therapie unumgänglich. Die Plattenosteosynthese, bevorzugt mit interfragmentärer Kompression und Anlagerung autologer Knochenspäne, führt in der überwiegenden Mehrzahl der Fälle zu einer raschen und soliden Heilung und ermöglich gleichzeitig die Korrektur relevanter Fehlstellungen. Bei atrophen Pseudarthrosen sind zusätzlich Maßnahmen zur Verbesserung der lokalen Biologie notwendig. Am distalen Humerus ist häufiger die suprakondyläre Region betroffen. Hier steht die Einstauchung und Kompression der Knochenenden gegeneinander sowie die Defektauffüllung mit autologen Knochenspänen im Vordergrund. Eine Doppelplattenosteosynthese sorgt für ausreichende Stabilität. Ein ausgedehntes Kapselrelease verhindert eine erhöhte Belastung der Frakturzone und verhindert eine zu starke postoperative Bewegungseinschränkung. Bei Fällen, die nicht stabil rekonstruierbar sind, stellt die Ellbogentotalendoprothese eine sehr gute Rettungsoperation dar.

Abstract

Fractures of the humeral shaft are treated with reduction and functional bracing in the majority of cases. Although the humerus shaft has a high potential to heal, depending on the different shaft areas there is a nonunion rate between 12 and 24%. A precise analysis of each case is mandatory for successful treatment. Compression plating and additional autologous bone graft has proven to be successful in the majority of cases, leading to solid bony healing and correction of malalignment. In atrophic situations methods like decortication are necessary to improve biologic environment. At the distal humerus more often the supracondylar region is affected. Impaction and interfragmentary compression after debridement as well as autologous bone graft and stable double plating technique is leading to improved stability. As there is nearly always severe joint stiffness, an extended capsular release is necessary to minimize the load at the fracture side. If a stable and adequate reconstruction is impossible, a semiconstrained total elbow prosthesis may be a perfect salvage procedure.

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