DMP und die Frakturversorgung – Proximale Humerusfrakturen

Zusammenfassung

Proximale Humerusfrakturen zählen zu den häufigsten Indikatorfrakturen einer Osteoporose und treten beim älteren Patienten vor allem nach einem niedrigenergetischen Trauma auf. Neben einer sorgfältigen klinischen Untersuchung ist die Bildgebung (Röntgen/Computertomographie) unerlässlich für die weitere Therapieplanung. Diese kann bei einem älteren Patienten jedoch nicht ausschließlich anhand der klinischen und bildgebenden Befunde erfolgen, es müssen zahlreiche Kontextfaktoren (funktioneller Anspruch, Begleiterkrankungen) beachtet werden. Der Großteil der proximalen Humerusfrakturen, gerade im geriatrischen Patientenkollektiv, wird konservativ behandelt. Bei operativer Versorgung ist im Rahmen der Etablierung alterstraumatologischer Versorgungskonzepte ein Trend zum vermehrten Gelenksersatz zu beobachten. Oberstes Ziel hat die schnellstmögliche Wiederherstellung der Selbstständigkeit und Alltagsfähigkeit des Patienten. Eine operative Versorgung wird daher auch bei bestehenden Komorbiditäten häufiger erwogen und erfolgt bei zunehmender Evidenz mittels inverser Schultergelenksendoprothese. Unabhängig vom gewählten Versorgungspfad ist die sekundäre Frakturprophylaxe im Sinne einer osteologischen Diagnostik und spezifischen Therapie essenziell.

Abstract

Proximal humerus fractures are among the most common indicator fractures of osteoporosis and occur in older patients primarily after low-energy trauma. In addition to a careful clinical examination, diagnostic imaging (radiography/computed tomography) is essential for further treatment planning. However, in an older patient, this cannot be done solely on the basis of clinical and imaging findings; numerous contextual factors (functional demands, concomitant diseases) must be taken into account. The major part of proximal humerus fractures, especially in geriatric patients, is treated conservatively. In surgical treatment increased rates of joint replacement can be observed as part of the establishment of geriatric trauma care concepts. The primary goal is to restore the patient's independence and abilities for daily living as soon as possible. Surgical treatment is therefore considered more frequently even in the case of existing comorbidities and, as evidence increases, is carried out using reverse shoulder arthroplasty. Regardless of the chosen treatment path, secondary fracture preventions with osteological diagnostics and specific therapy is crucial.

Schlüsselwörter

Proximale Humerusfraktur - Indikatorfraktur - inverse Prothese

Keywords

Proximal humerus fracture - indicator fracture - reverse shoulder - arthroplasty

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