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Die Problematik der Tuberkularefixation in der Frakturprothetik des Humeruskopfes

Difficulties with tuberosity fixation in the replacement of the proximal humerus

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Zusammenfassung

Der endoprothetische Ersatz des Humeruskopfes bei nicht rekonstruierbaren Frakturen des proximalen Humerus wurde bereits in den 1970er Jahren von Neer mit guten Ergebnissen publiziert. Seither gelang es keiner Arbeitsgruppe, ähnlich gute Ergebnisse zu reproduzieren. Alle Studien der vergangenen 20 Jahre zeigen, dass für die Patienten ein akzeptables Schmerzniveau erreicht werden kann. Die Funktion des Schultergelenkes ist in der Regel jedoch schlecht. Auch die Entwicklung spezieller Frakturprothesen konnte diesem Trend nicht entgegenwirken. Ein wesentlicher Faktor für den Erfolg der Frakturprothetik ist die Einheilung der Tuberkula. Die vorliegende Arbeit gibt einen Überblick über verschiedene Fixationstechniken und über klinische und biomechanische Ergebnisse.

Abstract

Since Neer described the replacement of the humeral head in non-reconstructable proximal humerus fractures, this procedure has become standard. Even though Neer published good results, no other authors have been able to reproduce these results yet. All further studies described a good reduction of the pain level, while the function of the shoulder was moderate or poor. The development of special fracture prostheses did not change these findings. Several clinical studies revealed that the bony union of the tuberosities is one of the key factors to achieve good results. The different fixation techniques and clinical and biomechanical results are reviewed in the present article.

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Literatur

  1. Abu-Rajab RB, Stansfield BW, Nunn T et al (2006) Re-attachment of the tuberosities of the humerus following hemiarthroplasty for four-part fracture. J Bone Joint Surg [Br] 88-B:1539–1544

    Google Scholar 

  2. Amifeyz R, Sarangi P (2008) Shoulder hemiarthroplasty for fracture with a conservative rehabilitation regime. Arch Orthop Trauma Surg 128:985–988

    Article  Google Scholar 

  3. Baumgartner D, Lorenzetti SR, Mathys R et al (2009) Refixation stability in shoulder hemiarthroplasty in case of four-part proximal humeral fracture. Med Biol Eng Comput 47:515–522

    Article  PubMed  Google Scholar 

  4. Besch L, Daniels-Wredenhagen M, Mueller M et al (2009) Hemiarthroplasty of the shoulder after four-part fracture of the humeral head: a long-term analysis of 34 cases. J Trauma 66:211–214

    Article  PubMed  Google Scholar 

  5. Boileau P, Sinnerton RJ, Chuinard C, Walch G (2006) Arthroplasty of the shoulder. J Bone Joint Surg [Br] 88-B:562–575

    Google Scholar 

  6. Bono CM, Renard R, Levine RG, Levy AS (2001) Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder. J Bone Joint Surg [Br] 83-B:1056–1062

    Google Scholar 

  7. Demirhan M, Kilicoglu O, Altinel L et al (2003) Prognostic factors in prosthetic replacement for acute proximal humerus fractures. J Orthop Trauma 17:181–188

    Article  PubMed  Google Scholar 

  8. Dietz SO et al (2009) Tuberosity refixation in shoulder arthroplasty – a comparison of 4 methods. In: 22nd congress of the European Society of the shoulder and the elbow, congress Abstract, Madrid, Spain

  9. Frankle MA, Mighell MA (2004) Techniques and principles of tuberosity fixation for proximal humeral fractures treated with hemiarthroplasty. J Shoulder Elbow Surg 13:239–247

    Article  PubMed  Google Scholar 

  10. Frankle MA, Ondrovic LE, Markee BA et al (2002) Stability of tuberosity reattachment in proximal humeral hemiarthroplasty. J Shoulder Elbow Surg 11:413–420

    Article  PubMed  Google Scholar 

  11. Gierer P, Simon C, Gradl G et al (2006) Die Humeruskopfmehrfragmentfraktur – Versorgung mit einer Humeruskopfprothese? Klinische und radiologische Ergebnisse einer prospektiven Studie. Orthopäde 35:834–840

    Article  CAS  PubMed  Google Scholar 

  12. Greiner SH, Diederichs G, Kröning I et al (2009) Tuberosity position correlates with fatty infiltration of the rotator cuff after hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 18:431–436

    Article  PubMed  Google Scholar 

  13. Habermeyer P (2005) Univers fracture prothesis – results of the multicenter study. Congress abstract. Heidelberger Schulterkurs

  14. Hertel R (2005) Fractures of the proximal humerus in osteoporotic bone. Osteoporos Int 16:65–72

    Article  Google Scholar 

  15. Hertel R, Hempfing A, Stiehler M et al (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal Humerus. J Shoulder Elbow Surg 13:427–433

    Article  CAS  PubMed  Google Scholar 

  16. Ianotti JP, Gabriel JP, Schneck SL et al (1992) The normal glenohumeral relationships: an anatomical staudy of one hundred and forty shoulders. J Bone Joint Surg Am 74:491–500

    Google Scholar 

  17. Kontakis GM, Tosounidi TI, Christoforakis Z et al (2009) Early management of complex proximal humerus fractures using the Aequalis fracture prosthesis – a two to five-year follow-up report. J Bone Joint Surg [Br] 91-B:335–340

  18. Krailinger F, Schwaiger R, Wambacher M et al (2004) Outcome after primary hemiarthroplasty for fracture oft he head of the humerus – a retrospective multicenter study of 167 patient. J Bone Joint Surg [Br] 86-B:217–219

  19. Krause FG, Huebschle L, Hertel R (2007) Reattachment of the tuberosities with cable wires and bone graft in hemiarthroplasties for proximal humeral fractures with cable wire and bone graft: 58 patients with a 22-months minimum follow up. J Orthop Trauma 21:682–686

    Article  PubMed  Google Scholar 

  20. Lanting B, MacDermid J, Drosdowech D et al (2008) Proximal humeral fractures: A systematic review of treatment modalities. J Shoulder Elbow Surg 17:42–54

    Article  PubMed  Google Scholar 

  21. Liem D, Marquardt B, Witt KA, Steinbeck J (2007) Schulterprothetik-Biomechanik und Design. Orthopäde 36:1027–1036

    Article  CAS  PubMed  Google Scholar 

  22. Loebenberg MI, Jone DA, Zuckerman JD (2005) The effect of greater tuberosity placement on active range of motion after hemiarthroplasty for acute fractures of the proximal humerus. Bull Hosp Jt Dis 62:90–93

    PubMed  Google Scholar 

  23. Loew M, Heitkemper S, Parsch D et al (2006) Influence oft he design oft he prosthesis on the outcome after hemiarthroplasty oft h shoulder in displaced fractures oft he head oft he humerus. J Bone Joint Surg [Br] 88-B:345–350

  24. Murachovsky J, Ikemoto RY, Nascimento LG et al (2006) Pectoralis Major Tendon reference (PMT): A new method for accurate restoration of humeral length with hemiarthroplasty for fracture. J Shoulder Elbow Surg 15:675–678

    Article  PubMed  Google Scholar 

  25. Neer CS (1970) Displaces proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52:1077–1089

    PubMed  Google Scholar 

  26. Nho SJ, Brophy RH, Barker JU et al (2007) Management of proximal humeral fractures based on current literature. J Bone Joint Surg Am 89:44–58

    Article  PubMed  Google Scholar 

  27. Reuther F, Mueller S, Wahr D (2007) Management of humeral head fractures with a trauma shoulder prosthesis: Correlation between joint function and healing of the tuberosities. Acta Orthop Belg 73:179–187

    PubMed  Google Scholar 

  28. Robinson CM, Page RS, Hill RMF et al (2003) Primary Hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am 85:1215–1223

    Article  PubMed  Google Scholar 

  29. Rueter A (2001) Indikation und Technik der Schulterendoprothese bei der Frakturversorgung. Chirurg 72:1246–1252

    Article  Google Scholar 

  30. Sanchez-Stello J (2006) Proximal humerus fractures. Clin Anat 16:588–598

    Article  Google Scholar 

  31. Sosna A, Pokorny D Hromadka R et al (2008) A new technique for reconstruction of the proximal humerus after three- and four-part fractures. J Bone Joint Surg [Br] 90-B:194–199

    Google Scholar 

  32. Voigt C, Lill H (2007) Primäre Endoprothetik bei proximalen Humerusfrakturen. Orthopäde 36:1002–1012

    Article  CAS  PubMed  Google Scholar 

  33. Küchle R, Hofmann A, Hessmann M et al (2006) Die Kleeblattplatte zur Versorgung der Humeruskopffraktur: eine Standortbestimmung. Unfallchirurg 109:1017–1024

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Zentrum für Muskuloskeletale Chirurgie, Klinik und Poliklinik für Unfallchirurgie, Universitätsmedizin - Johannes Gutenberg Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland

    S.-O. Dietz, S. Kuhn, E. Gercek, F. Hartmann, L.P. Müller, B. Andress, H. Bertrams & P.M. Rommens

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  1. S.-O. Dietz
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  2. S. Kuhn
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  3. E. Gercek
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  4. F. Hartmann
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  5. L.P. Müller
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  6. B. Andress
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  7. H. Bertrams
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  8. P.M. Rommens
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Correspondence to S.-O. Dietz.

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Dietz, SO., Kuhn, S., Gercek, E. et al. Die Problematik der Tuberkularefixation in der Frakturprothetik des Humeruskopfes. Obere Extremität 5, 106–114 (2010). https://doi.org/10.1007/s11678-010-0074-0

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  • DOI: https://doi.org/10.1007/s11678-010-0074-0

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