Zementaugmentation am proximalen Humerus

Zusammenfassung

Osteoporotische Frakturen am proximalen Humerus stellen auch heute noch, trotz der stark verbesserten Implantate und der verfeinerten Operationstechnik, eine große Herausforderung dar. Neben der Komplexität der Frakturen und den häufigen Komorbiditäten dieser Patienten ist es vor allem der schlechte Halt der Implantate im osteoporotischen Oberarmkopf, der zu einer hohen Rate an Komplikationen führt. Hier stehen der sekundäre Repositionsverlust und das Durchschneiden bzw. Ausreißen der Schrauben an führender Stelle. Durch Verbesserung des Knochen-Implantat-Interfaces kann die In-situ-Schraubenaugmentation mit Knochenzement deren Halt deutlich verbessern und damit ein Nachsinken der Fragmente verhindern und trotz der schlechten Knochenqualität eine frühfunktionelle Nachbehandlung ermöglichen.

Abstract

Osteoporotic fractures of the proximal humerus still present a great challenge despite the greatly improved implants and the refined surgical technique.Beside the complexity of these fractures and a high number of comorbidities, the insufficient screw purchase in the osteoporotic bone of the humeral head is the main reason for high complication rates. Secondary loss of reduction as well as cutting through or pulling out the screws are the most frequent failures. By improving the mechanical properties of the bone-implant-interface, in situ screw augmentation with bone cement leads to better screw purchase within the humeral head. This leads to higher stability and avoids sinking of the fracture fragments, enabling even in patients with poor bone quality, early functional follow-up treatment program.

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