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DOI: 10.1055/s-0034-1383279
Periprothetische Frakturen an der oberen Extremität
Periprosthetic Fractures of the Upper LimbPublication History
Publication Date:
05 August 2015 (online)
![](https://www.thieme-connect.de/media/op-journal/201501/lookinside/thumbnails/10-1055-s-0034-1383279_op291-1.jpg)
Zusammenfassung
Mit der zunehmenden Anzahl implantierter Endoprothesen an der oberen Extremität hat in naher Vergangenheit auch die Anzahl von Komplikationen, insbesondere der periprothetischen Frakturen, zugenommen. Deren Behandlung richtet sich nach dem implantierten Prothesentyp, der Lokalisation der Fraktur, der Frakturform, der aktuellen Stabilität der Prothese im Knochen und der Knochenqualität. Natürlich muss auch auf patientenspezifische Besonderheiten wie den Allgemeinzustand des Patienten und das Patientenalter Bedacht genommen werden. Wenige periprothetische Frakturformen können an der oberen Extremität konservativ behandelt werden. Meist ist ein operatives Vorgehen erforderlich, welches, je nach Situation, einen Wechsel auf eine Langschaftprothese, eine Stabilisierung der Fraktur mit Zerklagen und/oder eine winkelstabile Plattenosteosynthese oder bei schlechter Knochenqualität die Augmentation der Frakturzone mit überbrückenden kortikalen Knochenspänen (Strut Grafts) notwendig macht. Bei gelockerten Prothesen ist ein Prothesenwechsel unbedingt erforderlich. Bei ausgedehnten Knochendefekten kommt die Auffüllung des Markraums mit Spongiosa (Impaction Grafting) oder der Knochenaufbau mit Allografts in Verbindung mit Revisionsprothesen in Betracht. Durch ein individuelles Behandlungskonzept aufbauend auf bestimmten Grundregeln kann auch bei schwierigen, komplexen Situationen ein brauchbares funktionelles Ergebnis für den Patienten erreicht werden.
Abstract
According to an increasing number of joint replacements at the upper limb during the last decades, there is also a remarkable number of complications. Periprosthetic fractures are one of the main reasons for revision surgery. The current treatment of periprosthetic fractures at the humerus or forearm is strongly influenced by the type of prosthesis in place, the localization of the fracture, the fracture type, the stability of the implant-bone-interface and the local bone quality. Patient related factors like general health status, comorbidities as well as age have to be considered when establishing a specific treatment plan. In the upper limb only a few periprosthetic fractures may be treated conservatively, such as humeral shaft fractures or non displaced apophyseal fractures. In most of the cases an operative treatment seems to be appropriate. According to the specific situation a long stem prosthesis splinting the fracture zone with additional cerclage wires may lead to good stabilization and rapid fracture healing. In good bone quality a locking plate in a bridging technique may lead to good bone healing. These plates are preferably fixed with locking screws and cerclage wires or locking attachment plates. In poor bone quality, severe osteoporosis or osteolysis cortical strut allografts have been shown to successfully augment the bone at the fracture site. If there is severe ballooning of the shaft due to aseptic loosening, impaction grafting may improve bone quality and fixation of the prosthesis after revision. In severe defect situations a structural allograft-prosthesis-composite may be used to salvage these very difficult situations. By employing an individually adapted treatment protocol based on some guidelines and general recommendations a satisfying outcome may become realistic also in these very complicated complex cases with periprosthetic fractures.
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