Die gekreuzte Schraubenosteosynthese proximaler Humerusfrakturen

Abstract

Between March 1997 and October 1999 thirty-one patients with displaced proximal humeral fractures were treated with crossed screw osteosynthesis. Insertion of the screws was realized by using a deltoideo-pectoral approach placing the screws anteriorly and posteriorly in a crossed manner from the distal fragment into the humeral head. Additionally, in all two-part-fractures a tension band was applied. In all three-part-fractures, the greater tuberosity was reattached by additional screws. In 21 patients (14 female, 7 male, median age 62 years, 18-86) a clinical and radiological follow-up (median 18 months, 10-29) was obtained. Fractures were classified as two-part-fractures in 10 patients and as three-part-fractures in 11 patients. According to the Constant-Score, "excellent" and "good" results were achieved in 15 patients, "moderate" results were found in 3 patients. However, in 3 patients results were only "poor" (1 two-part-, 2 three-part-fractures). The complication rate was 29% (premature hardware removal due to head perforation in 3 cases; humeral head necrosis necessitating prosthetic replacement in 2 patients; secondary displacement in 1 case). Crossed screw osteosynthesis represents an justified alternative in the surgical treatment of displaced proximal humeral fractures permitting early functional therapy.

Internal Fixation of Unstable Proximal Humerus Fractures With an Anatomically Preshaped Interlocking Plate: A Clinical and Radiologic Evaluation

“…8,9 A variety of procedures with different approaches, reduction techniques, implants, and subsequent degree of postoperative stability have been reported. For example, pins, 10,11 staples, 7,12,13 screws, 10,11,13,14 suture fixation and tension band fixation, 7,13,15,16 plates, [17][18][19][20][21] intramedullary nails, [22][23][24] and hemiarthroplasty [25][26][27][28][29][30] have been used with varying success with regard to biomechanical stability and functional outcome. In addition, differences in methods, evaluation technique, rating scales, and interpretation of findings have given rise to widely differing recommendations.…”

Complication rates and outcomes stratified by treatment modalities in proximal humeral fractures: a systematic literature review from 1970–2009

“…Complications documented after surgical head-preserving therapy were: rotator cuff lesion (<100%) [55], malunion (<77%) [56], malreduction (<61%) [57], fracture-displacement (<54%) [58], humeral head necrosis (<50%) [59], impingement (<47%) [60], secondary screw perforation (<42%) [61], posttraumatic osteoarthritis (<33%) [60], screw loosening (<27%) [62], implant loosening (<27%) [63], nonunion (<27%) [63], reflex dystrophy (<25%) [59], heterotopic ossification (<24%) [64], infection (<23%) [65], implant failure (<14%) [66] and primary screw perforation (<14%) [67]. …”

Lessons Learned From a Case of Proximal Humeral Locked Plating Gone Awry

“…These implants allow the introduction of multidirectional, fixed-angle locking screws and appear biomechanically advantageous, especially in the cancellous bone of the proximal humerus of elderly patients with osteoporosis. [2][3][4][5][6][7] The introduction of these new devices has provided surgeons an opportunity to reevaluate their methods of managing proximal humerus fractures. As a result, surgical indications have broadened.…”