Download PDF
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
› Author Affiliations
Further Information

Publication History

Publication Date:
20 December 2017 (online)

Also available at
    Permissions and Reprints

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
 

  • Literatur

  • 1 Hirzinger C, Tauber M, Resch H. [Proximal humerus fracture – New aspects in epidemiology, fracture morphology, and diagnostics]. Der Unfallchirurg 2011; 114 (12) 1051-1058.
    CrossrefSearch in Google Scholar
  • 2 Torrens C, Corrales M, Vila G. et al. Functional and quality-of-life results of displaced and nondisplaced proximal humeral fractures treated conservatively. Journal of orthopaedic trauma 2011; 25 (10) 581-587.
    CrossrefSearch in Google Scholar
  • 3 Strohm PC, Kostler W, Sudkamp NP. [Proximal humerus fracture - what to do?]. Zeitschrift für Orthopädie und Unfallchirurgie 2008; 146 (03) 312-317.
    Thieme ConnectSearch in Google Scholar
  • 4 Owsley KC, Gorczyca JT. Fracture displacement and screw cutout after open reduction and locked plate fixation of proximal humeral fractures [corrected]. The Journal of bone and joint surgery American volume 2008; 90 (02) 233-240.
    CrossrefSearch in Google Scholar
  • 5 Krappinger D, Bizzotto N, Riedmann S. et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury 2011; 42 (11) 1283-1288.
    CrossrefSearch in Google Scholar
  • 6 Jost B, Spross C, Grehn H, Gerber C. Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg 2013; 22 (04) 542-549.
    CrossrefPubMedSearch in Google Scholar
  • 7 Karataglis D, Stavridis SI, Petsatodis G. et al New trends in fixation of proximal humeral fractures: a review. Injury 2011; 42 (04) 330-338.
    CrossrefSearch in Google Scholar
  • 8 Resch H, Tauber M, Neviaser RJ. et al. Classification of proximal humeral fractures based on a pathomorphologic analysis. J Shoulder Elbow Surg 2016; 25 (03) 455-462.
    CrossrefPubMedSearch in Google Scholar
  • 9 Robinson CM, Amin AK, Godley KC. et al. Modern perspectives of open reduction and plate fixation of proximal humerus fractures. J Orthop Trauma 2011; 25 (10) 618-629.
    CrossrefSearch in Google Scholar
  • 10 Sudkamp NP, Audige L, Lambert S. et al. Path analysis of factors for functional outcome at one year in 463 proximal humeral fractures. J Shoulder Elbow Surg 2011; 20 (08) 1207-1216.
    CrossrefSearch in Google Scholar
  • 11 Nho SJ, Brophy RH, Barker JU. et al. Management of proximal humeral fractures based on current literature. The Journal of bone and joint surgery American volume 2007; 89 (Suppl. 03) 44-58.
    CrossrefSearch in Google Scholar
  • 12 Hertel R, Hempfing A, Stiehler M, Leunig M. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. Journal Shoulder Elbow Surg 2004; 13 (04) 427-433.
    Search in Google Scholar
  • 13 Nijs S, Reuther F, Broos P. Primary fracture arthroplasty of the proximal humerus using a new and freely adjustable modular prosthesis combined with compression osteosynthesis of the tuberosities. Operative Orthopädie und Traumatologie 2011; 23 (01) 21-28.
    CrossrefSearch in Google Scholar
  • 14 Bastian JD, Hertel R. Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series. J Shoulder Elbow Surg 2009; 18 (02) 216-219.
    CrossrefSearch in Google Scholar
  • 15 Reuther F, Muhlhausler B, Wahl D, Nijs S. Functional outcome of shoulder hemiarthroplasty for fractures: A multicentre analysis. Injury 2010; 41 (06) 606-612.
    CrossrefSearch in Google Scholar
  • 16 Schmal H, Klemt C, Sudkamp NP. [Evaluation of shoulder arthroplasty in treatment of four-fragment fractures of the proximal humerus]. Unfallchirurg 2004; 107 (07) 575-582.
    Search in Google Scholar
  • 17 Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg Br 2008; 90 (11) 1407-1413.
    Search in Google Scholar
  • 18 Kralinger F, Schwaiger R, Wambacher M. et al. Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br 2004; 86 (02) 217-219.
    CrossrefSearch in Google Scholar
  • 19 Esen E, Dogramaci Y, Gultekin S. et al. Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: a retrospective study in 42 patients. Injury 2009; 40 (12) 1336-1341.
    CrossrefSearch in Google Scholar
  • 20 Habermeyer P. Schulterchirurgie. 4th ed. München: Elsevier, Urban & Fischer; 2010. xii 868.
    Search in Google Scholar
  • 21 Loew M, Heitkemper S, Parsch D. et al. Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus. J Bone Joint Surg Br 2006; 88 (03) 345-350.
    Search in Google Scholar
  • 22 Boileau P, Winter M, Cikes A. et al. Can surgeons predict what makes a good hemiarthroplasty for fracture?. J Shoulder Elbow Surg 2013; 22 (11) 1495-506.
    Search in Google Scholar
  • 23 Frankle M. Stability of tuberosity reattachment in proximal humeral hemiarthroplasty. Journal of Shoulder and Elbow Surgery 2002; 11 (05) 413-420.
    CrossrefSearch in Google Scholar
  • 24 Krause FG, Huebschle L, Hertel R. Reattachment of the tuberosities with cable wires and bone graft in hemiarthroplasties done for proximal humeral fractures with cable wire and bone graft: 58 patients with a 22-month minimum follow-up. J Orthop Trauma 2007; 21 (10) 682-686.
    CrossrefSearch in Google Scholar
  • 25 Dietz SO, Broos P, Nijs S. Suture fixation versus cable cerclage of the tuberosities in shoulder arthroplasty-clinical and radiologic results. Arch Orthop Trauma Surg 2012; 132 (06) 793-800.
    CrossrefSearch in Google Scholar
  • 26 Nijs S, Broos P. Outcome of shoulder hemiarthroplasty in acute proximal humeral fractures: a frustrating meta-analysis experience. Acta orthopaedica Belgica 2009; 75 (04) 445-451.
    Search in Google Scholar
  • 27 Rosas S, Law TY, Kurowicki J. et al. Trends in surgical management of proximal humeral fractures in the Medicare population: a nationwide study of records from 2009 to 2012. J Shoulder Elbow Surg 2016; 25 (04) 608-613.
    CrossrefSearch in Google Scholar
  • 28 Chalmers PN, Slikker 3rd W, Mall NA. et al. Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty. Journal Shoulder Elbow Surg 2014; 23 (02) 197-204.
    Search in Google Scholar
  • 29 Shukla DR, McAnany S, Kim J. et al. Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: a metaanalysis. J Shoulder Elbow Surg 2016; 25 (02) 330-340.
    CrossrefSearch in Google Scholar
  • 30 Sirveaux F, Wein-Remy F, Block D. et al. Early functional results of the reverse shoulder prosthesis for acute fracture in elderly are improved by tuberosity healing. SECEC. 2011. Lyon: France.;
    Search in Google Scholar
  • 31 Cazeneuve JF, Cristofari DJ. The reverse shoulder prosthesis in the treatment of fractures of the proximal humerus in the elderly. J Bone Joint Surg Br 2010; 92 (04) 535-539.
    CrossrefPubMedSearch in Google Scholar
  • 32 Kohut G, Dallmann F, Irlenbusch U. Wear-induced loss of mass in reversed total shoulder arthroplasty with conventional and inverted bearing materials. Journal of biomechanics 2012; 45 (03) 469-473.
    CrossrefSearch in Google Scholar
  • 33 Reuther PJF, Kohut G, Nijs S. Specially designed inverse shoulder prosthesis for the treatment of complex proximal humeral fractures. SECEC. 2011. Lyon: France.;
    Search in Google Scholar
  • 34 Cazeneuve JF, Cristofari DJ. Long term functional outcome following reverse shoulder arthroplasty in the elderly. Orthopaedics & traumatology, surgery & research 2011; 97 (06) 583-589.
    CrossrefSearch in Google Scholar
  • 35 Simovitch RW, Zumstein MA, Lohri E. et al. Predictors of Scapular Notching in Patients Managed with the Delta III Reverse Total Shoulder Replacement. The Journal of Bone and Joint Surgery 2007; 89 (03) 588-600.
    CrossrefSearch in Google Scholar
  • 36 Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. Journal Shoulder Elbow Surg 2011; 20 (01) 146-157.
    Search in Google Scholar
  • 37 Reuther F, Kohut G, Nijs S. [Newly developed modular reverse fracture endoprosthesis in nonreconstructable humeral head fracture in old people]. Oper Orthop Traumatol 2014; 26 (04) 369-382 quiz 82-84..
    CrossrefSearch in Google Scholar
  • 38 Formaini NT, Everding NG, Levy JC, Rosas S. Tuberosity healing after reverse shoulder arthroplasty for acute proximal humerus fractures: the “black and tan” technique. J Shoulder Elbow Surg 2015; 24 (11) e299-e306.
    Search in Google Scholar
  • 39 Kohut RFG, Kääb M, Nijs S, Irlenbusch U. Conversion from hemiarthroplasty for fracture to inverse arthroplasty of the shoulder. Can the humeral stem be left in place?. SGO. 2011. Lausanne: Switzerland.;
    Search in Google Scholar
  • 40 Reuther F. Primäre Endoprothetik. Obere Extremität 2012; 07 (03) 117-121.
    CrossrefSearch in Google Scholar