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Distale Humerusfraktur beim älteren Menschen

Pro und Contra endoprothetischer Ersatz

Fractures of the distal humerus in the elderly

Pros and cons of endoprosthetic replacement

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Zusammenfassung

Die distale intraartikuläre Humerusfraktur des älteren Menschen stellt den behandelnden Chirurgen vor Probleme. Im Gegensatz zu den Frakturen des proximalen Femurs gibt es für diese Region keine eindeutigen Empfehlungen, ab wann ein endoprothetischer Ersatz des Ellenbogengelenks indiziert ist. Hinzu kommt, dass die klinischen Ergebnisse von Ellenbogenprothesen nicht denen von Hüftprothesen gleich kommen und eine deutliche Gebrauchseinschränkung der Extremität resultiert. Ein weiterer erschwerender Faktor ist, dass die Patientengruppe der über 65-Jährigen sehr heterogen ist, sodass das Patientenalter alleine keine Entscheidungsgrundlage für oder gegen eine Osteosynthese bzw. Prothese sein kann. In der vorliegenden Arbeit soll anhand der aktuellen Literatur die Diagnostik und Therapie der distalen Humerusfraktur unter besonderer Berücksichtigung der Frage, wann eine Prothese und wann eine Osteosynthese beim älteren Patienten indiziert ist, dargestellt werden.

Abstract

The intraarticular fracture of the distal humerus in an elderly patient remains a challenge for trauma surgeons. In case of severe co-morbidities and/or osteoporosis stable fixation with screws and plates is difficult and in some cases can be impossible. Even if osteosynthesis is feasible the clinical outcome is still incalculable due to delayed or non-union of the fracture fragments. Endoprosthetic replacement of the elbow joint for comminuted distal humerus fractures has been used for almost 20 years. The clinical results are predominantly excellent or good and better predictable than those of osteosynthesis. There still is no guideline when a prosthesis for the elbow joint should be used. We reviewed the literature and outline the current recommendations for diagnostics and surgical therapy for distal humerus fractures in the elderly.

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Literatur

  1. Ali A, Shahane S, Stanley D (2010) Total elbow arthroplasty for distal humeral fractures: indications, surgical approach, technical tips, and outcome. J Shoulder Elbow Surg 19:53–58

    Article  PubMed  Google Scholar 

  2. Baksi DP, Pal AK, Baksi D (2010) Prosthetic replacement of elbow for intercondylar fractures (recent or ununited) of humerus in the elderly. Int Orthop 35:1171–1177

    Article  PubMed  Google Scholar 

  3. Becker L, Schmidt-Horlohe K, Bonk A et al (2011) Total elbow arthroplasty as a treatment option in complex injuries of the elbow in elderly patients. Z Orthop Unfall [Epub ahead of print]

  4. Burg A, Berenstein M, Engel J et al (2011) Fractures of the distal humerus in elderly patients treated with a ring fixator. Int Orthop 35:101–106

    Article  PubMed  Google Scholar 

  5. Burkhart KJ, Muller LP, Schwarz C et al (2010) Treatment of the complex intraarticular fracture of the distal humerus with the latitude elbow prosthesis. Oper Orthop Traumatol 22:279–298

    Article  PubMed  Google Scholar 

  6. Burkhart KJ, Nijs S, Mattyasovszky SG et al (2011) Distal humerus hemiarthroplasty of the elbow for comminuted distal humeral fractures in the elderly patient. J Trauma [Epub ahead of print]

  7. Chalidis B, Dimitriou C, Papadopoulos P et al (2009) Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury 40:582–590

    Article  PubMed  CAS  Google Scholar 

  8. Cobb TK, Morrey BF (1997) Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. J Bone Joint Surg Am 79:826–832

    PubMed  CAS  Google Scholar 

  9. Dietz SO, Muller LP, Korner J et al (2005) Surgical treatment of type I capitellar-humeral fractures using the Henry ventral approach approach. Short- and medium-term results. Unfallchirurg 108:200–202, 204–205

    Article  PubMed  CAS  Google Scholar 

  10. Doornberg J, Lindenhovius A, Kloen P et al (2006) Two and three-dimensional computed tomography for the classification and management of distal humeral fractures. Evaluation of reliability and diagnostic accuracy. J Bone Joint Surg Am 88:1795–1801

    Article  PubMed  Google Scholar 

  11. Dubberley JH, Faber KJ, Macdermid JC et al (2006) Outcome after open reduction and internal fixation of capitellar and trochlear fractures. J Bone Joint Surg Am 88:46–54

    Article  PubMed  Google Scholar 

  12. Fevang BT, Lie SA, Havelin LI et al (2009) Results after 562 total elbow replacements: a report from the Norwegian Arthroplasty Register. J Shoulder Elbow Surg 18:449–456

    Article  PubMed  Google Scholar 

  13. Frankle MA, Herscovici D, Dipasquale TG et al (2003) A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma 17:473–480

    Article  PubMed  Google Scholar 

  14. Gausepohl T (2011) Osteosynthesis in distal intra-articular humeral fractures. External fixation with motion capacity. Unfallchirurg 114:130–135

    Article  PubMed  CAS  Google Scholar 

  15. Haussler B, Gothe H, Gol D et al (2007) Epidemiology, treatment and costs of osteoporosis in Germany – the BoneEVA Study. Osteoporos Int 18:77–84

    Article  PubMed  CAS  Google Scholar 

  16. Hessmann MH, Ring DC (2007) Humerus: Humerus, distal. In: Rüedi TP, Buckley RE, Moran CG (eds) AO principles of fracture management. Thieme, Stuttgart, p 609–625

  17. Huang JI, Paczas M, Hoyen HA et al (2011) Functional outcome after open reduction internal fixation of intra-articular fractures of the distal humerus in the elderly. J Orthop Trauma 25:259–265

    Article  PubMed  Google Scholar 

  18. Kaiser T, Brunner A, Hohendorff B et al (2011) Treatment of supra- and intra-articular fractures of the distal humerus with the LCP Distal Humerus Plate: a 2-year follow-up. J Shoulder Elbow Surg 20:206–212

    Article  PubMed  Google Scholar 

  19. Kamineni S, Morrey BF (2004) Distal humeral fractures treated with noncustom total elbow replacement. J Bone Joint Surg Am 86:940–947

    PubMed  Google Scholar 

  20. Korner J, Lill H, Muller LP et al (2003) The LCP-concept in the operative treatment of distal humerus fractures–biological, biomechanical and surgical aspects. Injury 34 (Suppl 2):B20–30

    Article  PubMed  Google Scholar 

  21. Korner J, Lill H, Muller LP et al (2005) Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos Int 16 (Suppl 2):73–79

    Article  Google Scholar 

  22. Kraus E, Harstall R, Borisch N et al (2009) Primary total elbow replacement for complex intra-articular distal humerus fractures. Unfallchirurg 112:692–698

    Article  PubMed  CAS  Google Scholar 

  23. Lee KT, Lai CH, Singh S (2006) Results of total elbow arthroplasty in the treatment of distal humerus fractures in elderly Asian patients. J Trauma 61:889–892

    Article  PubMed  Google Scholar 

  24. Liu JJ, Ruan HJ, Wang JG et al (2009) Double-column fixation for type C fractures of the distal humerus in the elderly. J Shoulder Elbow Surg 18:646–651

    Article  PubMed  Google Scholar 

  25. Lucke M, Siebenlist S, Stöckle U (2009) Ellenbogenverletzungen im Alter. In: Stöckle U (Hrsg) Ellenbogenchirurgie. Elsevier, München, S 203–212

  26. McKee MD, Wilson TL, Winston L et al (2000) Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am 82:1701–1707

    Article  PubMed  Google Scholar 

  27. McKee MD, Veillette CJ, Hall JA et al (2009) A multicenter, prospective, randomized, controlled trial of open reduction – internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J Shoulder Elbow Surg 18:3–12

    Article  PubMed  Google Scholar 

  28. Müller LP, Kamineni S, Rommens PM et al (2005) Primary total elbow replacement for fractures of the distal humerus. Oper Orthop Traumatol 17:119–142

    Article  PubMed  Google Scholar 

  29. Müller M, Allgöwer M, Schnider R (1992) Manual der Osteosynthese. Springer, Berlin Heidelberg New York

  30. Nauth A, Mckee MD, Ristevski B et al (2011) Distal humeral fractures in adults. J Bone Joint Surg Am 93:686–700

    Article  PubMed  Google Scholar 

  31. Obremskey WT, Bhandari M, Dirschl DR et al (2003) Internal fixation versus arthroplasty of comminuted fractures of the distal humerus. J Orthop Trauma 17:463–465

    Article  PubMed  Google Scholar 

  32. Palvanen M, Kannus P, Niemi S et al (1998) Secular trends in the osteoporotic fractures of the distal humerus in elderly women. Eur J Epidemiol 14:159–164

    Article  PubMed  CAS  Google Scholar 

  33. Prasad N, Dent C (2008) Outcome of total elbow replacement for distal humeral fractures in the elderly: a comparison of primary surgery and surgery after failed internal fixation or conservative treatment. J Bone Joint Surg Br 90:343–348

    Article  PubMed  CAS  Google Scholar 

  34. Robinson CM, Hill RM, Jacobs N et al (2003) Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 17:38–47

    Article  PubMed  Google Scholar 

  35. Rubberdt A, Surke C, Fuchs T et al (2008) Preformed plate-fixation system for type AO 13C3 distal humerus fractures: clinical experiences and treatment results taking access into account. Unfallchirurg 111:308–322

    Article  PubMed  CAS  Google Scholar 

  36. Rueger JM, Rucker A, Briem D (2007) Distal fracture of the humerus. Chirurg 78:959–971 (quiz 972)

    Article  PubMed  CAS  Google Scholar 

  37. Schildhauer TA, Nork SE, Mills WJ et al (2003) Extensor mechanism-sparing paratricipital posterior approach to the distal humerus. J Orthop Trauma 17:374–378

    Article  PubMed  Google Scholar 

  38. Stein G, Weber O, Burkhart KJ et al (2010) Total elbow joint arthroplasty. Surgical approaches. Unfallchirurg 113:1006–1012

    Article  PubMed  CAS  Google Scholar 

  39. Theivendran K, Duggan PJ, Deshmukh SC (2010) Surgical treatment of complex distal humeral fractures: functional outcome after internal fixation using precontoured anatomic plates. J Shoulder Elbow Surg 19:524–532

    Article  PubMed  Google Scholar 

  40. Walz M, Auerbach F (2006) Distal intraarticular humerus fractures in elderly patients. Treatment with combined percutaneous screw fixation and an external fixator. Unfallchirurg 109:940–947

    Article  PubMed  CAS  Google Scholar 

  41. Weber O, Burger C, Kabir K et al (2009) Primary endoprosthetic replacement of fractured elbow in elderly patients. Unfallchirurg 112:778–784

    Article  PubMed  CAS  Google Scholar 

  42. Weber O, Burger C, Stein G et al (2010) Endoprosthesis for the fractured elbow: uni- and bicompartmental alloarthroplasty of the humero-ulnar joint. Unfallchirurg 113:977–983

    Article  PubMed  CAS  Google Scholar 

  43. Wright JG, Einhorn TA, Heckman JD (2005) Grades of recommendation. J Bone Joint Surg Am 87:1909–1910

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Zentrum für Muskuloskeletale Chirurgie, Klinik und Poliklinik für Unfallchirurgie, Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55101, Mainz, Deutschland

    S.-O. Dietz, T.E. Nowak & P.M. Rommens

  2. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland

    K.J. Burkhart & L.P. Müller

Authors
  1. S.-O. Dietz
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  2. T.E. Nowak
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  3. K.J. Burkhart
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  4. L.P. Müller
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  5. P.M. Rommens
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Correspondence to S.-O. Dietz.

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Dietz, SO., Nowak, T., Burkhart, K. et al. Distale Humerusfraktur beim älteren Menschen. Unfallchirurg 114, 801–815 (2011). https://doi.org/10.1007/s00113-011-2080-0

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  • DOI: https://doi.org/10.1007/s00113-011-2080-0

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