OP-Journal 2013; 29(1): 40-46
DOI: 10.1055/s-0032-1328428
Georg Thieme Verlag KG Stuttgart · New York

Proximale Humerusfrakturen

Martin Jaeger
,
Elia Langenmair
,
Dirk Maier
,
Kaywan Izadpanah
,
Norbert Südkamp
Further Information

Publication History

Publication Date:
08 May 2013 (online)

Zusammenfassung

Proximale Humerusfrakturen sind häufig und werden insbesondere bei älteren Frauen mit osteoporotischer Knochenstruktur beobachtet. Eine gründliche Diagnostik und exakte Frakturklassifikation erlaubt ein individuell auf den Patienten zugeschnittenes Behandlungskonzept. Das Gros der proximalen Humerusfrakturen wird weiterhin erfolgreich konservativ therapiert. Die operative Frakturversorgung ist anspruchsvoll. In Abhängigkeit von Frakturmuster, Knochenqualität, Patientenalter und Komorbidität kommen verschiedene Osteosynthesematerialien zum Einsatz. Diese umfassen K-Drähte, Marknägel und winkelstabile Plattensysteme. Fadenzuggurtungen der Rotatorenmanschette verbessern den Behandlungserfolg. Anatomische und inverse Frakturprothesen ergänzen moderne Therapieoptionen.

Proximal Humeral Fractures

Proximal humeral fractures occur frequently and are seen, in particular, in elderly women with osteoporotic bone structures. A comprehensive diagnostic work-up and exact classification of the fracture allow the treatment concept to be individually adapted to the patient. Most proximal humeral fractures are still treated with success by conservative methods. Surgical management of these fractures is a demanding challenge. Depending on the fracture pattern, bone quality, patientʼs age and comorbidities, various operative technique are available. These include K wires, medullary nails and anglar-stable plate systems. Tension band fixation of the rotator cuff improves the therapeutic success. Anatomic and reverse fracture prostheses complement the current therapeutic options.

 
  • Literatur

  • 1 Court-Brown C, Caesar B. Epidemiology of adult fractures: A review. Injury 2006; 37: 691-697
  • 2 Péntek M, Horváth C, Boncz I et al. Epidemiology of osteoporosis related fractures in Hungary from the nationwide health insurance database, 1999–2003. Osteoporos Int 2008; 19: 243-249
  • 3 Palvanen M, Kannus P, Niemi S et al. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res 2006; 442: 87-92
  • 4 Bahrs C, Schmal H, Lingenfelter E et al. Inter- and intraobserver reliability of the MTM-classification for proximal humeral fractures: a prospective study. BMC Musculoskelet Disord 2008; 9: 21
  • 5 Hertel R, Hempfing A, Stiehler M et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 2004; 13: 427-433
  • 6 Majed A, Macleod I, Bull AMJ et al. Proximal humeral fracture classification systems revisited. J Shoulder Elbow Surg 2011; 20: 1125-1132
  • 7 Hertel R. Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 2005; 16 (Suppl. 02) S65-S72
  • 8 Bastian J, Hertel R. Initial post-fracture humeral head ischemia does not predict development of necrosis. J Shoulder Elbow Surg 2008; 17: 2-8
  • 9 Boileau P, Trojani C, Walch G et al. Shoulder arthroplasty for the treatment of the sequelae of fractures of the proximal humerus. J Shoulder Elbow Surg 2001; 10: 299-308
  • 10 Boileau P, Chuinard C, Le Huec JC et al. Proximal humerus fracture sequelae: impact of a new radiographic classification on arthroplasty. Clin Orthop Relat Res 2006; 442: 121-130
  • 11 Court-Brown CM, McQueen MM. Nonunions of the proximal humerus: their prevalence and functional outcome. J Trauma 2008; 64: 1517-1521
  • 12 Court-Brown CM, McQueen M. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. J Bone Joint Surg Am 2009; 91: 2771 author reply 2771 – 2772
  • 13 Iyengar JJ, Devcic Z, Sproul RC et al. Nonoperative treatment of proximal humerus fractures: a systematic review. J Orthop Trauma 2011; 25: 612-617
  • 14 Fjalestad T, Hole MØ, Jørgensen JJ et al. Health and cost consequences of surgical versus conservative treatment for a comminuted proximal humeral fracture in elderly patients. Injury 2010; 41: 599-605
  • 15 Olerud P, Ahrengart L, Ponzer S et al. Internal fixation versus nonoperative treatment of displaced 3-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg 2011; 20: 747-755
  • 16 Sanders RJ, Thissen LG, Teepen JC et al. Locking plate versus nonsurgical treatment for proximal humeral fractures: better midterm outcome with nonsurgical treatment. J Shoulder Elbow Surg 2011; 20: 1118-1124
  • 17 Jakob R, Miniaci A, Anson P et al. Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br 1991; 73: 295-298
  • 18 Resch H. Proximal humeral fractures: current controversies. J Shoulder Elbow Surg 2011; 20: 827-832
  • 19 Ogawa K, Kobayashi S, Ikegami H. Retrograde intramedullary multiple pinning through the deltoid “V” for valgus-impacted four-part fractures of the proximal humerus. J Trauma 2011; 71: 238-244
  • 20 Resch H, Povacz P, Frohlich R et al. Percutaneous fixation of three- and four-part fractures of the proximal humerus. J Bone Joint Surg Br 1997; 79: 295-300
  • 21 Brunner F, Sommer C, Bahrs C et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 2009; 23: 163-172
  • 22 Blum J, Hansen M, Rommens PM. [Angle-stable intramedullary nailing of proximal humerus fractures with the PHN (proximal humeral nail)]. Oper Orthop Traumatol 2009; 21: 296-311
  • 23 Lanting B, Macdermid J, Drosdowech D et al. Proximal humeral fractures: a systematic review of treatment modalities. J Shoulder Elbow Surg 2008; 17: 42-54
  • 24 Sudkamp N, Bayer J, Hepp P et al. Open reduction and internal fixation of proximal humeral fractures with use of the locking proximal humerus plate. Results of a prospective, multicenter, observational study. J Bone Joint Surg Am 2009; 91: 1320-1328
  • 25 Thanasas C, Kontakis G, Angoules A et al. Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg 2009; 18: 837-844
  • 26 Fjalestad T, Stromsoe K, Blucher J et al. Fractures in the proximal humerus: functional outcome and evaluation of 70 patients treated in hospital. Arch Orthop Trauma Surg 2005; 125: 310-316
  • 27 Krappinger D, Bizzotto N, Riedmann S et al. Predicting failure after surgical fixation of proximal humerus fractures. Injury 2011; 42: 1283-1288
  • 28 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: 1207-1210
  • 29 Krappinger D, Roth T, Gschwentner M et al. Preoperative assessment of the cancellous bone mineral density of the proximal humerus using CT data. Skeletal Radiol 2011; 41: 299-304
  • 30 Tingart M, Apreleva M, von Stechow D et al. The cortical thickness of the proximal humeral diaphysis predicts bone mineral density of the proximal humerus. J Bone Joint Surg Br 2003; 85: 611-617
  • 31 Bastian J, Hertel R. Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series. J Shoulder Elbow Surg 2009; 18: 216-219
  • 32 Dietrich M, Meier C, Lattmann T et al. [Complex fracture of the proximal humerus in the elderly. Locking plate osteosynthesis vs. hemiarthroplasty]. Chirurg 2008; 79: 231-240
  • 33 Fialka C, Stampfl P, Arbes S et al. Primary hemiarthroplasty in four-part fractures of the proximal humerus: randomized trial of two different implant systems. J Shoulder Elbow Surg 2008; 17: 210-215
  • 34 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: 217-219
  • 35 Amirfeyz R, Sarangi P. Shoulder hemiarthroplasty for fracture with a conservative rehabilitation regime. Arch Orthop Trauma Surg 2008; 128: 985-988
  • 36 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: 535-539
  • 37 Klein M, Juschka M, Hinkenjann B et al. Treatment of comminuted fractures of the proximal humerus in elderly patients with the Delta III reverse shoulder prosthesis. J Orthop Trauma 2008; 22: 698-704
  • 38 Gallinet D, Clappaz P, Garbuio P et al. Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res 2009; 95: 48-55
  • 39 Werner C, Steinmann P, Gilbart M et al. Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 2005; 87: 1476-1486
  • 40 Rockwood C. The reverse total shoulder prosthesis. The new kid on the block. J Bone Joint Surg Am 2007; 89: 233-235
  • 41 Boileau P, Watkinson D, Hatzidakis A et al. Neer Award 2005: The Grammont reverse shoulder prosthesis: Results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 2006; 15: 527-540
  • 42 Favard L, Levigne C, Nerot C et al. Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time?. Clin Orthop Relat Res 2011; 469: 2469-2475