Proximale Humerusfraktur

Zusammenfassung

Die osteoporotische proximale Humerusfraktur des alten Menschen ist nach wie vor eine Herausforderung. Rekonstruktive Behandlungsverfahren zeigen weiterhin eine hohe Komplikationsrate, sodass häufig zwischen einem konservativen oder gelenkersetzenden Verfahren gewählt wird. Dabei galt die anatomische Frakturprothese lange als Standard für den Gelenkersatz. Heute geht der Trend eindeutig zur inversen Prothese. Im Gegensatz zur anatomischen Prothese hängt das klinische Ergebnis weniger ausgeprägt von der Einheilung der Tuberkelfragmente ab. Dies spiegelt sich in den bisherigen kurz- und mittelfristigen Nachuntersuchungen wider, bei denen die inverse Prothese vergleichsweise bessere klinische Ergebnisse verbunden mit einer geringeren Revisionsrate aufweist.

Abstract

Osteoporotic fracture of the humerus in geriatric patients is still challenging. Reconstructive therapy is still associated with a high rate of complications. In consequence, patients are frequently treated non-surgically, or receive a shoulder replacement. Anatomical hemi-arthroplasty used to be the most frequent procedure. However, there is now a trend to reverse shoulder arthroplasty, as the clinical outcome is then less dependent on the growth of tuberosities. This is reflected in several studies that demonstrate better short and medium term outcomes than with hemiarthroplasty. Moreover, the rate of revision surgery is markedly lower.

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