Frakturprothetik an der Schulter - nur noch invers?

Zusammenfassung

Frakturen am proximalen Humerus sind häufige Verletzungen und ihre Behandlung stellt insbesondere bei alten Patient*innen mit erheblicher Osteoporose weiterhin eine große Herausforderung dar. In den letzten 10 Jahren hat neben der konservativen Therapie und der Osteosynthese der Gelenkersatz mittels inverser Schultertotalendoprothese in der Frakturbehandlung stark an Bedeutung gewonnen. Eine im Vergleich zur Hemiprothese einfachere Operationstechnik und der Umstand, dass ein Einheilen der Tubercula zwar erstrebenswert, im Gegensatz zur Hemiprothese für eine brauchbare Funktion jedoch nicht zwingend notwendig ist, haben in manchen Abteilungen dazu geführt, dass die inverse Schultertotalendoprothese die Hemiprothese in der Frakturbehandlung völlig verdrängt hat. Dennoch verbleiben spezielle Fälle, die auch heute noch einer Frakturhemiprothese bedürfen, sodass diese anspruchsvolle Operationstechnik und die wesentlichen Details, die für ein gutes funktionelles Ergebnis unumgänglich sind, auch weiterhin gepflegt und gelehrt werden müssen. Sowohl für die inverse Schultertotalendoprothese als auch für die Frakturhemiprothese sind spezielle Frakturdesigns in zementierter Form zu bevorzugen. Weiterhin ist eine möglichst anatomische Einheilung der Tubercula durch eine ausgereifte Refixationstechnik anzustreben. Beide Prothesentypen haben weiterhin ihren festen Platz im Versorgungsspektrum proximaler Humerusfrakturen, wenngleich sich die Wertigkeiten deutlich zugunsten der inversen Schultertotalendoprothese verschoben haben.

Abstract

Fractures of the proximal humerus are frequent and still challenging to treat, especially in elderly patients with severe osteoporosis. During the last decade, beside conservative treatment and osteosynthesis, reverse shoulder arthroplasty has become the preferred method of choice. Because of a somewhat easier operative technique, and because the anatomic healing of the tuberosities is not as important as in hemiarthroplasties in order to achieve a satisfying functional result, reverse shoulder arthroplasty has replaced hemiarthropasty in the treatment of fractures of the proximal humerus in some departments. In our experience even today there are a few specific fracture cases, where hemiarthroplasty is still advantageous and recommended. Therefore, this demanding technique and all its important details that are necessary to achieve a good functional outcome must be kept in mind and also taught to our residents. Specific cemented fracture stems are advantageous for fracture arthroplasty with both designs and an anatomic and stable fixation with a meticulous fixation technique should lead to tuberosity healing and good clinical results. Although reversed shoulder prosthesis has gained ground in fracture treatment compared to hemiarthroplasty, there is still a need for both techniques in our daily practice.

Schlüsselwörter

proximale Humerusfraktur - Schulterprothese - Schulterfunktion

Keywords

proximal humerus fracture - Shoulder prosthesis - shoulder function

Publication History

Article published online:
04 August 2022

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