Therapie von Humerusschaftfrakturen

Frakturen des Humerusschaftes sind seltene Verletzungen der oberen Extremität. Die Wahl der individuell besten Versorgungsstrategie stellt im klinischen Alltag mitunter weiterhin eine Herausforderung dar. Patientenspezifische Faktoren sollten neben der Frakturmorphologie, dem Entstehungsmechanismus und möglichen Begleitverletzungen (u. a. vorliegende neurologische oder Weichteilschädigung) die Grundlage dieser Entscheidungsfindung bilden.

Abstract

Humeral shaft fractures are a rare but challenging entity of injuries of the upper extremity. Despite all advances in the past decades – including improved imaging, adjusted surgical techniques and new implant designs – the treatment of humeral shaft fractures and especially the treatment choice remains challenging. Treatment options need to be evaluated individually under consideration of fracture morphology, soft tissue and potential neurological damage as well as patient-specific factors (i.e., age, comorbidities). Moreover, the risk of common complications such as radial nerve palsy, infection, non-union and malrotation needs to be evaluated in order to facilitate the best possible therapy for each patient. The regular available treatment options include conservative (cast, brace, etc.) and surgical measures (ante- and retrograde nailing, angle-stable plate osteosynthesis). Furthermore, (temporary) external fixation remains an option in emergency and complicative cases. However, none of the aforementioned options have proven a superior gold standard. This review evaluates the currently available treatment options and their individual advantages as well as the probability of possible complications and is aiming to supply a guide for individual treatment choice.

Kernaussagen

• Humerusschaftfrakturen sind vergleichsweise seltene Verletzungen, die jedoch nach einem klaren diagnostischen und therapeutischen Therapiealgorithmus versorgt werden.

• Für die Therapie von Humerusschaftfrakturen stehen konservative sowie operative (intramedullär/Marknägel vs. extramedullär/Plattenosteosynthesen) Verfahren zur Verfügung, wobei für kein Verfahren eine deutliche Überlegenheit nachgewiesen werden konnte.

• Die Wahl der Therapie sollte unter Berücksichtigung patientenindividueller (Alter, Komorbiditäten, Compliance etc.) und frakturmorphologischer (Hochrasanztrauma, Weichteilschaden, Kettenverletzung, einfache oder mehrfragmentäre Fraktur, Radialisläsion etc.) Faktoren getroffen werden.

• Die häufigsten Komplikationen nach Humerusschaftfrakturen sind Achs-/Rotationsfehlstellungen, Pseudarthrosen, Infekte und sekundäre (iatrogene) Radialisparesen.

• Im Fall einer primären Radialisparese muss nicht zwingend die offene Darstellung des Nervs erfolgen, da auch ohne operative Therapie hohe spontane Remissionsraten berichtet werden. Bei Anzeichen einer Nervendurchtrennung oder -einklemmung sollte jedoch entweder simultan zur Osteosynthese (vor allem Marknagelversorgung) die minimalinvasive Liberation und Freilegung erwogen bzw. zeitnah die chirurgische Intervention/Rekonstruktion angestrebt werden.

• Im Falle komplikativer Verläufe bietet der Fixateur externe oder auch der funktionelle Brace eine mögliche Rückzugsoption. In Einzelfällen kann eine Ausheilung auch mit einem dieser Verfahren erwogen werden.

Schlüsselwörter

Frakturbehandlung - Plattenosteosythese - Nagelosteosynthese - obere Extremität - Radialisnervläsion

Keywords

fracture treatment - plate osteosynthesis - nailing - upper extremity - radial nerve palsy

Publication History

Article published online:
28 July 2023

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