Distale Humerusfraktur beim älteren Menschen

So, Dietz; Nowak, T.; Burkhart, Klaus J.; Müller, Lars Peter; Rommens, P

doi:10.1007/s00113-011-2080-0

Cited by 13 publications

(3 citation statements)

References 40 publications

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“…Historically used in cases of severe rheumatoid arthritis, recent advances in implant materials have made total elbow arthroplasty a viable option in nonreconstructable distal humeral fractures ([ 18 ]; Fig. 7 ).…”

Section: Arthroplasty For Distal Humeral Fracturesmentioning

confidence: 99%

“…Postoperative immobilization can be an option in exceptional cases to protect the osteosynthesis. If reconstruction is not possible because of fracture complexity or bone quality, recent studies have shown excellent functional outcome, low failure rates, and entirely pain-free outcomes for total elbow joint replacement [ 18 , 23 ]. The disadvantages are the life-long limitation in weight-bearing of up to 5 kg, the limited longevity of the implant, and the potential for complicated revision surgery [ 24 ].…”

Section: Fracture Management In the Elderlymentioning

confidence: 99%

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Fracture-pattern-related therapy concepts in distal humeral fractures

et al. 2018

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Around one third of humeral fractures and 2–6% of all fractures occur to the distal part of the humerus. There is a bimodal distribution differentiating between young male patients with high-energy and elderly female patients with low-energy trauma related to osteoporosis. The AO classification and Dubberley subclassification are used in daily routine. Most fractures are diagnosed on radiographs. For further evaluation, three-dimensional computed tomography is recommended, especially for comminuted or complex fractures. Owing to the long immobilization and resultant poor functional outcome, conservative treatment is followed for inoperable patients. The operative approach and osteosynthesis depend on the fracture pattern. In A1 avulsion fractures, open reduction and screw fixation are recommended. In A2/A3 fractures, a triceps-sparing approach following a 90° double-plate construction (radial dorsal/ulnar lateral) with locking plates is favored. Partial articular B1/B2 fractures are exposed via a medial or lateral approach using unilateral locking plates to stabilize the medial/lateral column. Coronal shear fractures (B3) are classified after Dubberley and are treated via an extended Kocher approach and headless compression screws in anteroposterior direction. If there is a further posterior comminution or a lateral column fragment, stabilization is needed for the lateral/medial column with a precontoured locking plate. In solely articular fracture patterns, a dorsal approach with either a 90° or 180° double-plate construction is advised. If a reconstruction is not possible owing to fracture complexity or bone quality, total elbow arthroplasty is a viable option. However, lifelong limitation in weight-bearing up to 5 kg, limited longevity, and the potential for complicated revision surgery should be considered.

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Section: Arthroplasty For Distal Humeral Fracturesmentioning

confidence: 99%

Section: Fracture Management In the Elderlymentioning

confidence: 99%

Fracture-pattern-related therapy concepts in distal humeral fractures

et al. 2018

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“…Während die Doppelplattenosteosynthese bei Gelenkfrakturen des distalen Humerus allgemein anerkannt und wissenschaftlich belegt ist, bleibt die Frage nach der optimalen Plattenpositionierung Gegenstand der akademischen Diskussion [4,18]. Einige Autoren bevorzugen die parallele Positionierung (radial und ulnar, 180°-Stellung), während andere Autoren sich durch eine Platzierung der Implantate im rechten Winkel zueinander (ulnar und dorsoradial, 90°-Stellung) eine bessere Verzahnung der Schrauben und hierdurch eine erhöhte Stabilität der Osteosynthese versprechen.…”

Section: Gelenkerhaltunclassified

Ellenbogenfraktur im Alter – Erhalt oder Ersatz?

Plath¹,

Förch²,

Haufe³

et al. 2018

Z Orthop Unfall

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Distal humerus fractures show increasing incidence with age. Due to preexisting osteoporosis, the surgeon is regularly confronted with complex comminuted intraarticular fractures. The maintenance of autonomy in daily life and avoidance of permanent care dependency is a dogma in the care of geriatric patients. Accordingly, a stable post-operative situation that allows early functional post-operative treatment is mandatory, especially in the elderly patient. Open reduction and stable internal fixation using double plate osteosynthesis are the current osteosynthetic standard of treatment. Modern precontoured systems with angular stability facilitate stable fixation and reduce surgery time. However, complication rates are high, despite the good functional outcomes in the few available studies which use modern plate systems in a geriatric patient population. Due to the high rate of primary stability, elbow arthroplasty has become an established treatment option for complex distal humerus fractures in elderly patients. Consequently arthroplasty registry data report a growing number of elbow replacements for fracture in recent decades. The standard implant design in the fractures in geriatric patients is the cemented "semi-constrained" total elbow arthroplasty. The disadvantages of total elbow replacement are the lifelong stringent weight restriction patients must adhere to, as well as potential long-term complications associated with arthroplasty, such as aseptic loosening and periprosthetic fractures. Comparative studies with short- and medium-term follow-up show overall comparable functional results for elbow arthroplasty and double plate osteosynthesis, with fewer complications and revisions as well as a shorter duration of surgery within the arthroplasty group. However, long-term outcome studies are necessary to identify potential long-term complications associated with arthroplasty and are pending. Therefore, in reconstruction of fractures of the distal humerus which allow stable fixation and early functional post-operative treatment, open reduction and double plate internal fixation with modern locking plate systems remains the gold standard even for geriatric patients.

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