Die Tuberculum majus Fraktur – eine Problemfraktur?

Zusammenfassung

Die isolierte Fraktur des Tuberculum majus ist eine häufige Fraktur des proximalen Humerus. In der Literatur herrscht Uneinigkeit bez. der korrekten therapeutischen Herangehensweise, sodass diese Fraktur häufig als Problemfraktur gewertet wird. Um einen praktikablen Ansatz für die Therapieentscheidung zu erstellen, wurden anhand einer Literaturrecherche sowie der Erfahrungen der Autoren aus dem klinischen Alltag 4 Aspekte dieser Frakturversorgung untersucht: die richtige Diagnostik, Kriterien zur Indikationsstellung einer operativen oder konservativen Therapie, Aspekte der richtigen konservativen Therapie sowie Aspekte der richtigen operativen Therapie. Bei einem standardisierten Behandlungsschema und Achtsamkeit auf mögliche Fallstricke sollte die isolierte Fraktur des Tuberculum majus i. d. R. keine Problemfraktur darstellen. Dabei sind Frakturmorphologie und funktioneller Anspruch des Patienten die entscheidenden Kriterien für ein operatives oder konservatives Prozedere. Komplikationen konservativ geführter Frakturen, wie die sekundäre Dislokation, werden nur selten beobachtet. Bei einer operativen Versorgung ist die Erfahrung des Operateurs entscheidend und führt in der Mehrzahl der Fälle zu funktionell guten postoperativen Ergebnissen. Aufgrund der Möglichkeit für eine begleitende Verletzung der Rotatorenmanschette sollte nach Luxationsmechanismus, nach Einleitung der entsprechenden Diagnostik, eine Operationsindikation großzügig gestellt werden.

Abstract

The isolated fracture of the greater tuberosity is a common fracture among fractures of the proximal humerus. There is no consensus in the current literature on how to best approach the treatment of these fractures so that they are often considered to be problematic. In order to provide a feasible approach to the fracture treatment the authors analyzed the current literature and regarded their own clinical experience regarding these four factors: the correct diagnostic measures, criteria to choose between operative or conservative treatment, aspect regarding the correct conservative treatment and aspects regarding the correct operative treatment. With standardized treatment protocols and awareness for possible pitfalls, the isolated fracture of the greater tuberosity, generally speaking, is not a problematic fracture. Fracture morphology and the patient’s functional demands are the deciding criteria for operative or conservative treatment. Complications of conservative treatment, such as secondary dislocation, are rare. In surgically treated fractures the experience of the surgeon is significant and usually yields good functional results. Due to the possibility of a co-lesion of the rotator cuff after shoulder dislocation, the indication for surgery should be given more liberally in these cases.

Schlüsselwörter

Tuberculum-majus-Fraktur - Arbeitsunfall - Schulterluxation

Keywords

greater tuberosity fracture - work-related injury - shoulder dislocation

Publication History

Article published online:
09 November 2022

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