Alters- und geschlechtsabhängige Knochenmineraldichteverteilung und mechanische Eigenschaften des proximalen Humerus

Abstract

These findings provide an insight into the fracture mechanism of the proximal humerus and should be the basis for designing structure-oriented implants with improved implant-bone stability in osteoporotic patients.

Biology and Biomechanics in Osteosynthesis of Proximal Humerus Fractures

“…In all age groups, the highest BMD was found in the most cranial aspects of the medial and dorsal regions of the proximal humerus (Figures 1, 2). Along with increasing age, the osseous density was found to constantly decrease at different levels and regions [9]. In further analysis, structural and connectivity parameters, bone strength, and trabecular orientation, showed region-and level-related characteristics [21].…”

“…This is primarily due to the fact that sufficient implant-fixation in humeral head fractures is often not achieved due to substantial bone tissue loss with increasing age [9].…”

“…Although the importance of bone quality has been emphasized for successful outcome of these surgeries, only a few studies have investigated a real bone mineral density of the humeral head. Knowledge about bone strength is important for the understanding of the origin of fractures as well as for optimising fracture fixations in weak bone [9][10][11][12][13][14]. As early as 1947, Berndt [15] demonstrated definitive age-and sex-related differences in bone structure and density of the proximal humerus by means of X-ray analyses.…”

“…In the last few years intensive work was performed to analyse the regional differences in bone quality and their effect on the screw placement and led to in-depth information about bone mass distribution and bone strength of the proximal humerus [9][10][11][21][22][23]. In an analysis of age-and gender-related characteristics of bone quality and bone strengths in a cadaver study we could demonstrate a statistically significant correlation between increasing age and decreasing BMD in female specimens.…”

Management of complications after angularly stable locking proximal humerus plate fixation

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Hannover mit Unfallklinik, Hannover

Komplikationsmanagement nach winkelstabiler Plattenosteosynthese am proximalen Humerus OriginalienBei der Versorgung instabiler proximaler Humerusfrakturen sind aufgrund der hohen Dislokationsneigung der Fragmente durch die Zugwirkung der ansetzenden Rotatorenmanschette sowie der häufig osteoporotischen Knochenstruktur des vorwiegend betroffenen älteren Patientenklientels [20] "sehr gute" und "gute" Ergebnisse nicht immer möglich [7,13,18,20,22,26,32]. Das Therapieziel der anatomischen Reposition und stabilen Fixation der Frakturfragmente kann auch mit winkelstabilen Implantaten nicht immer erreicht werden.

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