Z Orthop Unfall 2020; 158(05): 524-531
DOI: 10.1055/a-0974-3887
Review/Übersicht

Corrective Osteosynthesis in Failed Proximal Humeral Fractures

Article in several languages: English | deutsch
Rony-Orijit Dey Hazra
1   Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover
,
Helmut Lill
1   Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover
,
Alexander Ellwein
2   Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), DIAKOVERE Annastift, Hannover
,
Mara Warnhoff
1   Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover
,
Gunnar Jensen
1   Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover
› Author Affiliations
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Abstract

Despite implant improvement and increasing standardisation of operation techniques, the rate of therapy failure of proximal humeral fracture care with primary osteosyntheses is estimated to be 10 to 20%. Most commonly failure is precipitated by: material failure, technical error, non-anatomical repositioning, avascular necrosis, lacking medial support. An additive medial stabilisation of the so-called “calcar region” can decrease failure rates significantly. An early correction osteosynthesis with the purpose of restoring the anatomy is indicated in bony, non-consolidated “fresh” fractures. Bony consolidated fractures should be classified according to Boileau and Walch. The authors of this article advice a structured and classification-adapted approach to treatment with a correction osteosynthesis. Post-traumatic deficits can be augmented utilising the following methods: correction osteosynthesis with allogeneic/autologous bone grafts, correction osteosynthesis with hydroxyapatite grafts. For the additive stabilisation of repositioned and fixated fractures, the following are described: correction osteosynthesis with an additive ventral one-third tubular plate, correction osteosynthesis with cement-augmented screws. Based on results of endoprosthetics following fractures of the proximal humerus, the correction osteosynthesis indeed represents a real therapeutic alternative in patients that are below the age of 60, a good bone mass and with relative functional requirements.



Publication History

Article published online:
21 October 2019

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