Z Orthop Unfall 2020; 158(05): 524-531
DOI: 10.1055/a-0974-3887
Review/Übersicht

Corrective Osteosynthesis in Failed Proximal Humeral Fractures

Article in several languages: English | deutsch
Rony-Orijit Dey Hazra
1  Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover
,
Helmut Lill
1  Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover
,
Alexander Ellwein
2  Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), DIAKOVERE Annastift, Hannover
,
Mara Warnhoff
1  Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover
,
Gunnar Jensen
1  Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover
› Author Affiliations

Abstract

Despite implant improvement and increasing standardisation of operation techniques, the rate of therapy failure of proximal humeral fracture care with primary osteosyntheses is estimated to be 10 to 20%. Most commonly failure is precipitated by: material failure, technical error, non-anatomical repositioning, avascular necrosis, lacking medial support. An additive medial stabilisation of the so-called “calcar region” can decrease failure rates significantly. An early correction osteosynthesis with the purpose of restoring the anatomy is indicated in bony, non-consolidated “fresh” fractures. Bony consolidated fractures should be classified according to Boileau and Walch. The authors of this article advice a structured and classification-adapted approach to treatment with a correction osteosynthesis. Post-traumatic deficits can be augmented utilising the following methods: correction osteosynthesis with allogeneic/autologous bone grafts, correction osteosynthesis with hydroxyapatite grafts. For the additive stabilisation of repositioned and fixated fractures, the following are described: correction osteosynthesis with an additive ventral one-third tubular plate, correction osteosynthesis with cement-augmented screws. Based on results of endoprosthetics following fractures of the proximal humerus, the correction osteosynthesis indeed represents a real therapeutic alternative in patients that are below the age of 60, a good bone mass and with relative functional requirements.



Publication History

Publication Date:
21 October 2019 (online)

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