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.
Key words
fracture sequelae - Boileau classification - correction - osteotomy
