Proximale Humerusfraktur – was sagt die aktuelle Literatur? View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-03

AUTHORS

M. Warnhoff, H. Lill, G. Jensen, A. Ellwein, R.-O. Dey Hazra

ABSTRACT

Die proximale Humerusfraktur bleibt als dritthäufigste Fraktur des alternden Menschen dynamisch abgebildet in aktueller Literatur und neuen Innovationen. Besonders kontrovers wurde die 2015 vorgestellte PROFHER-Studie („Proximal Fracture of the Humerus Evaluation by Randomization Trial“) diskutiert, welche ein vergleichbares Outcome von konservativem und operativem Vorgehen bei proximalen Humerusfrakturen beschrieb. Bezogen auf die operative Versorgung mittels winkelstabiler Plattenosteosynthese ist in der aktuellen Literatur ein Rückgang der Komplikationsrate auf 12,8 % zu beobachten. Innovationen der letzten Jahre sind v. a. polyaxiale Schraubensysteme, zementaugmentierte Schrauben, carbonfaserverstärkte Platten aus dem Kunststoff Polyetheretherketon (PEEK), Doppelplattenosteosynthese bei komplexen 4‑Segment-Frakturen, arthroskopisch assistierte Versorgung von Tuberculum-majus-Frakturen und arthroskopisch assistierte Arthrolyse und Metallentfernung. Bei den dislozierten „fragility fractures of the elderly“ geht der Trend zu einer primär endoprothetischen Versorgung, wenn ein konservatives Vorgehen nicht möglich ist. Dies deckt sich mit der aktuellen Studienlage, welche ein besseres klinisches Outcome nach primärer Implantation einer Endoprothese aufzeigt. Hier hat sich die inverse Schulterprothese gegenüber anatomischen Frakturprothesen durchgesetzt. Innovationen sind hier die zunehmende Bedeutung der Refixation der frakturierten Tubercula mit Cerclagesystemen sowie neue Prothesenmodelle mit integrierten Refixationsmöglichkeiten. Zusammenfassend verbleibt die Versorgungstrategie eine Individualentscheidung, bei der Frakturmorphologie, Patient und Expertise des Operateurs bedacht werden müssen. More... »

PAGES

9-17

References to SciGraph publications

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  • Journal

    TITLE

    Obere Extremität

    ISSUE

    1

    VOLUME

    14

    Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s11678-018-0496-7

    DOI

    http://dx.doi.org/10.1007/s11678-018-0496-7

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1110507141


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