Primäre Ellenbogenprothese bei distalen Humerustrümmerfrakturen

Zusammenfassung

Die primäre Implantation von Hüft- und Schulterprothesen bei osteoporotischen Trümmerfrakturen älterer Patienten ist allgemein akzeptiert. Die primäre prothetische Versorgung des Ellenbogengelenkes in der Fraktursituation, wenn absehbar ist, dass eine übungsstabile Osteosynthese nicht erreicht werden kann, wird zunehmend diskutiert. Erste Berichte aus der Literatur [[1], [2], [3], [4], [5], [6]] deuten zumindest in der frühen postoperativen Phase daraufhin, dass in dieser Situation die prothetische Versorgung bessere klinische Ergebnisse bei kürzeren Operationszeiten als die Osteosynthese hat. 49 distale Humerusfrakturen bei 48 Patienten (Durchschnittsalter 67 Jahre) wurden primär mittels Coonrad-Morrey-Totalendoprothese versorgt. 43 Patienten wurden nach durchschnittlich 7 Jahren nachuntersucht. Nach der AO-Klassifikation fanden sich 5 A-Frakturen, 5 B-Frakturen und 33 C-Frakturen. Der mittlere Bewegungsumfang lag bei Flexion/Extension 131 - 24 - 0°, der mittlere Mayo-Score bei 93. 32 der 49 Ellenbogen hatten keine Komplikationen beim Follow-up. 10 zusätzliche operative Eingriffe und 5 Revisionsarthroplastien mussten im Verlauf durchgeführt werden. Die retrospektive Analyse zeigte, dass die primäre totalendoprothetische Versorgung in der Fraktursituation bei strikter Indikationsstellung erfolgversprechend ist.

Abstract

The use of hip- and shoulder arthroplasty in elderly patients for grossly displaced intraarticular fractures is being more and more accepted. Total elbow replacement (TER) has not been considered as an option for the treatment of extensively comminuted fractures of the distal humerus because surgeons feel the outcome is not predictable after TER generally. On the basis of a Medline literature research of this issue and the documented results based on the improvement of the designs of the implants, operative technique and the selection of patients, TER has a definite role in the treatment of some fractures of the distal humerus. We retrospectively reviewed forty-nine acute distal humeral fractures in forty-eight patients who were treated with total elbow arthroplasty as the primary option. The average age of the patients was sixty-seven years. Forty-three fractures were followed for at least two years (average duration of follow-up seven years). According to the AO classification, five fractures were type A, five were type B, and thirty-three were type C. The average flexion arc was 24 degrees to 131 degrees and the Mayo elbow performance score averaged 93 points. Thirty-two of the forty-nine elbows had neither a complication nor any further surgery from the time of the index arthroplasty to the most recent follow-up evaluation. Ten additional procedures, including five revision arthroplasties, were required in nine elbows. When osteosynthesis is not considered to be feasible, especially in patients who are physiologically older and place lower demands on the joint, total elbow arthroplasty can be considered, when strict inclusion criteria are observed.

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