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Posttraumatische Arthrose des Glenohumeralgelenks

Von der Teil- bis zur inversen Prothese

Posttraumatic arthrosis of the glenohumeral joint

From partial resurfacing to reverse shoulder arthroplasty

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Zusammenfassung

Hintergrund

Die prothetische Versorgung symptomatischer Frakturfolgezustände nach proximaler Humerusfraktur stellt hohe Ansprüche an den Chirurgen. Nur mit exakter präoperativer Planung sind akzeptable Ergebnisse zu erreichen.

Fragestellung

Darstellung der Überlegungen zu Operationsplanung und Implantatwahl unter Berücksichtigung der knöchernen Situation und der umgebenden Weichteile.

Methode

Selektive Literaturrecherche sowie Auswertung des eigenen Patientenkollektivs.

Ergebnisse

Geometrie, Heilungssituation der knöchernen Strukturen und der Zustand der umgebenden Weichteile sind zu berücksichtigen und beeinflussen die Wahl des Implantats. Mangelhafte Planung kann nicht nur intraoperativ zu technischen Schwierigkeiten führen, sondern auch maßgeblich das subjektive postoperative Ergebnis für den Patienten beeinträchtigen. Durch resultierende Fehlbelastung können Komponenten rasch auslockern und es kommt damit zum Implantatversagen. Entscheidend zur Abschätzung des erreichbaren postoperativen Ergebnisses sind die Position und die Heilung der Tuberkula gegenüber dem Humerusschaft. Diese Tatsache spiegelt sich in der gebräuchlichen Einteilung nach Boileau wider, welche als Entscheidungshilfe über die Implantatwahl und chirurgische Strategie herangezogen werden kann. Da diese schwierig zu behandelnden Fälle glücklicherweise nicht sehr häufig vorkommen, ist auch die Datenlage in der Literatur zu entsprechenden Ergebnissen relativ gering und uneinheitlich. Diese Resultate werden einander gegenübergestellt und diskutiert.

Schlussfolgerung

Die Behandlung dieses heterogenen Patientengutes muss individuell geplant werden und sollte erfahrenen Schulterchirurgen vorbehalten sein.

Abstract

Background

Arthroplasty of symptomatic sequelae after fractures of the proximal humerus is a demanding procedure for surgeons. Exact preoperative planning is crucial in order to achieve acceptable functional results.

Objective

Discussion of preoperative considerations in planning the procedure and choosing the appropriate implant taking the osseous anatomy and surrounding soft tissue situation into consideration.

Methods

Selective literature review and description of personal experience.

Results

The geometry and consolidation status of bone fragments as well as the conditions of the surrounding soft tissue have to be taken into account and influence the choice of implant used. Insufficient planning will not only cause intraoperative technical problems but can also greatly influence the subjective patient assessment of the postoperative outcome. Unequal strain distribution can cause early loosening of components resulting in malfunctioning of the implant. In this respect, knowledge of the position and consolidation status of fractured tuberosities with respect to the humeral shaft is essential and allows an approximate estimation of the achievable outcome. This is taken into account by the classification of Boileau which can also help to decide on which type of implant to use. Because such cases are scarce, reported results in the literature are heterogeneous, which is discussed in this article.

Conclusion

Each case needs a thorough and individualized preoperative assessment along with exact planning and should therefore be reserved for experienced shoulder surgeons only.

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Authors and Affiliations

  1. Univ. Klink für Unfallchirurgie und Sporttraumatologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich

    N. Matis, R. Ortmaier, P. Moroder, H. Resch & A. Auffarth

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  2. R. Ortmaier
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Correspondence to N. Matis.

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N. Matis, R. Ortmaier, P. Moroder, H. Resch und A. Auffarth geben an, dass kein Interessenkonflikt besteht.

Für das vorliegende Manuskript wurden keine Studien an Menschen oder Tieren durchgeführt.

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C. Krettek, Hannover

R. Meller, Hannover

N. Matis und R. Ortmaier haben zu gleichen Teilen zur Erstellung des Manuskripts beigetragen.

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Matis, N., Ortmaier, R., Moroder, P. et al. Posttraumatische Arthrose des Glenohumeralgelenks. Unfallchirurg 118, 592–600 (2015). https://doi.org/10.1007/s00113-015-0021-z

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