Osteosynthese bei proximaler Oberarmkopffraktur: Unterfütterung mittels Knochenblock (Bovist) bei der Plattenosteosynthese

Zusammenfassung

Fehlende mediale Rekonstruierbarkeit aufgrund von Trümmerzonen bzw. Substanzdefekten nach Varusfrakturen durch das „Aushöhlen des Kopffragmentes“ können kopferhaltend mithilfe eines Allografts mechanisch stabil versorgt werden. In diesem Artikel wird die Technik mittels „Bovist“ beschrieben. Sie ist unserer Ansicht nach technisch einfacher als die Rekonstruktion mittels eines Fibula-Allografts und bietet den Vorteil, dass der Schaft für spätere Revisionen nicht langstreckig durch die eingeheilte Fibula verschlossen ist. Der Name leitet sich von der Pilzform des Knochenblocks ab, der sich im proximalen Schaft selbst verankert und das Kopffragment ruht mechanisch stabil auf seinem „Schirm“. Der Artikel fokussiert sich auf die operative Technik und liefert die relevante Literatur.

Abstract

Complex proximal humerus fractures in the elderly are treated, if surgically, in most cases with a reversed arthroplasty. The results tend to be satisfying, even when tuberosity healing is compromised. In the young and active patients open reduction and locking plate fixation is widely used. Medial comminution is a challenging situation for the treating surgeon. We present a method to obtain the intrinsic stability needed for uneventful healing. A femoral head allograft is shaped in a mushroom-like formation. The stalk is positioned in the shaft and the cap under the head fragment. Biomechanical studies have proven the capacities of allograft augmentation, more frequently for fibula struts but although for femoral head allograft. Fibula grafts placed like an intramedullary rod supporting the head fragment on top are easily available on the market. The drawback is the revision of a solidly, healed long intramedullary fibula, that must be removed for a stemmed prosthesis. In summary the proposed method seems capable from a biomechanical standpoint and is easy to revise at a later stage due to the cancellous material locked high up in the proximal humerus shaft.

Schlüsselwörter

Humeruskopffraktur - Allograft Rekonstruktion - Bovist

Keywords

proximal humerus fracture - allograft reconstruction - puffball

Publication History

Article published online:
04 August 2022

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