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Arthritis und Rheuma 2016; 36(05): 330-334
DOI: 10.1055/s-0037-1617746
Schulterschmerz
Schattauer GmbH

Endoprothetik bei akuten Frakturen des proximalen Humerus

Shoulder arthroplasty for acute fractures of the proximal humerus
F. Reuther
1   DRK Kliniken Berlin Köpenick, Klinik für Unfallchirurgie und Orthopädie, Berlin
,
T. Ganschow
1   DRK Kliniken Berlin Köpenick, Klinik für Unfallchirurgie und Orthopädie, Berlin
,
K. Schmitz
1   DRK Kliniken Berlin Köpenick, Klinik für Unfallchirurgie und Orthopädie, Berlin
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
20. Dezember 2017 (online)

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Zusammenfassung

Die Behandlung der komplexen proximalen Humerusfraktur beim älteren Patienten wird weiterhin kontrovers diskutiert. Die Optionen reichen von konservativer Therapie über minimal osteosynthetische Techniken, winkelstabile Platten oder intramedulläre Fixationen bis zur prothetischen Versorgung. Bei Patienten mit nicht rekonstruierbarer Humeruskopffraktur, intakter Rotatorenmanschette und weitgehend erhaltenen Tuberkula kann die Fraktur- Hemiprothese zum Einsatz kommen. Inzwischen wird bei Patienten über 70 Jahren eher die Indikation zur primären inversen Frakturprothese gestellt, da die funktionellen Ergebnisse nach Fraktur-Hemiprothesen oft nicht vorhersagbar sind. Die im Design zur Frakturversorgung adaptierten inversen Frakturprothesen könnten Probleme wie Notching am Skapulahals und eingeschränkte Rotationsfähigkeit reduzieren. Welcher Prothesentyp eingesetzt wird, hängt von den vorliegenden allgemeinen und lokalen Voraussetzungen des Patienten und der Erfahrung des Operateurs ab.

Summary

The treatment of complex proximal humeral fractures in elderly patients is a subject of controversial debate. Therapeutic options include conservative treatment, minimally invasive osteosynthesis, intramedullary nailing and open reduction internal fixation with locking plates. Anatomic fracture prostheses should be deployed in cases of non-reconstructable proximal humeral fractures in patients under 70 years old with an intact rotator cuff and sufficient tuberosities. The use of reverse fracture prostheses has recently become popular in patients older than 70 years due to the rather poor and unepredictable results after anatomic fracture-hemiprostheses. The modification of the design of reverse fracture prostheses is believed to solve current problems and complications such as scapular notching and limited external rotation. Longer followup periods will clarify whether these expectations can be fulfilled. The final decision which type of prosthesis is the best option depends on individual patient related factors and the surgeon’s expertise.

Schlüsselwörter

Modulare Humeruskopfprothese - proximale Humerusfraktur - inverse Schulterprothese

Keywords

Modular humeral head arthroplasty - proximal humerus fracture - reverse shoulder prosthesis
 

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