Erfahrungen mit der OrTra®-Prothese bei der Versorgung proximaler Humerusfrakturen - Indikation, Technik und Ergebnisse

Schittko, A.; Braun, W.; Rüter, Axel

doi:10.1055/s-2003-37365

Cited by 6 publications

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“…Während der primäre knieendoprothetische Ersatz bei ausgeprägten Trümmerfrakturen des distalen Femur und/oder der Tibia bislang aufgrund der operationstechnischen Verankerungsmög-lichkeiten Einzelfällen vorbehalten bleibt [23], hat sich der Ersatz des Humeruskopfes bei bestimmten komplexen Frakturmustern des proximalen Oberarmes als eine effektive Alternative zur osteosynthetischen Versorgung dieser Frakturen durchgesetzt [47]. Der akute Ersatz des Ellenbogen-, Hand-und des oberen Sprunggelenkes durch endoprothetische Implantate wird derzeit bei traumatischer Gelenkzerstö-rung nicht empfohlen [54].…”

Section: > Navigationssysteme Ermögli-chen Einen Kleineren Zugangunclassified

Unfallchirurgie im Alter

Siebert

Beck

2005

Chirurg

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The indications for the surgical treatment of fractures in elderly patients should consider the individual's general health status, the specific pattern of injury, and the ability of the patient to actively participate in the rehabilitation process. Intramedullary systems are the gold standard for shaft and metaphyseal fractures due to the decreased operative trauma and the possibility of early weight bearing and functional treatment. Minimally invasive locking plate systems can frequently be applied, offer decreased risk of secondary fracture displacement, and have great advantages in the treatment of periprosthetic fractures with firm implants. The possible reasons for falls should be diagnosed in order to allow their prevention. An exact assessment of the severity of osteoporosis in important in allowing adequate treatment for associated pain and for decreasing the risk of future osteoporosis related fractures.

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Section: > Navigationssysteme Ermögli-chen Einen Kleineren Zugangunclassified

Unfallchirurgie im Alter

Siebert

Beck

2005

Chirurg

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“…Schittko et al propose a middle part with multiple holes for an unconstrained placement of the tuberosities using the Ortra prosthesis [45]. A further method of tuberosity reconstruction is presented by Sosna et al [46], where humeral plating and hemiarthroplasty is combined.…”

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confidence: 99%

Review of fixation techniques for the four-part fractured proximal humerus in hemiarthroplasty

et al. 2011

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IntroductionThe clinical outcome of hemiarthroplasty for proximal humeral fractures is not satisfactory. Secondary fragment dislocation may prevent bone integration; the primary stability by a fixation technique is therefore needed to accomplish tuberosity healing. Present technical comparison of surgical fixation techniques reveals the state-of-the-art approach and highlights promising techniques for enhanced stability.MethodA classification of available fixation techniques for three- and four part fractures was done. The placement of sutures and cables was described on the basis of anatomical landmarks such as the rotator cuff tendon insertions, the bicipital groove and the surgical neck. Groups with similar properties were categorized.ResultsMaterials used for fragment fixation include heavy braided sutures and/or metallic cables, which are passed through drilling holes in the bone fragments. The classification resulted in four distinct groups: A: both tuberosities and shaft are fixed together by one suture, B: single tuberosities are independently connected to the shaft and among each other, C: metallic cables are used in addition to the sutures and D: the fragments are connected by short stitches, close to the fragment borderlines.ConclusionsA plurality of techniques for the reconstruction of a fractured proximal humerus is found. The categorisation into similar strategies provides a broad overview of present techniques and supports a further development of optimized techniques. Prospective studies are necessary to correlate the technique with the clinical outcome.

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Primary Hemiarthroplasty for Proximal Humeral Fractures in the Elderly: Long-Term Functional Outcome and Social Implications

Dietrich

Meier

Zeller

et al. 2007

Eur J Trauma Emerg Surg

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Background: Primary shoulder hemiarthroplasty is an established treatment modality for complex fractures of the proximal humerus. Long-term functional outcome is often disappointing. However, little is known about social implications particularly in the elderly. Methods: A single-institution case series of consecutive geriatric patients (age > 70 years) treated with shoulder hemiarthroplasty for complex fractures of the proximal humerus between 1994 and 1997 was analysed. Postoperative morbidity, long-term function, radiological outcome and social implications were evaluated. Results: Seventy-seven patients fulfilled the study criteria. Median age at the time of operation was 80 years (range 70-93 years). Systemic and local postoperative complications were observed in 8% including 2 patients (3%) with revision surgery. Postoperative mortality was 1%. Forty-eight patients (62%) were available for follow-up (median 49 months, range 25-80 months), 22 (29%) died from causes unrelated to hemiarthroplasty before follow-up and 7 patients (9%) did not attend follow-up examination. Median Constant-Murley score was 41 points (range 17-77 points). Long-term results concerning pain were satisfying. The Oxford shoulder score ranged from 14 to 40 (median 30). Forty-one patients (85%) still lived in their original environment and managed their daily life independently despite poor shoulder function. Four patients (8%) lived in a retirement home and 3 (6%) in a nursery home. Eighty percent of our patients were still able to use public transportation, do the daily shopping and wash their whole body by themselves. Conclusion: Most patients managed their daily life independently despite poor shoulder function.

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Erfahrungen mit der OrTra®-Prothese bei der Versorgung proximaler Humerusfrakturen - Indikation, Technik und Ergebnisse

Cited by 6 publications

References 0 publications

Unfallchirurgie im Alter

Unfallchirurgie im Alter

Review of fixation techniques for the four-part fractured proximal humerus in hemiarthroplasty

Primary Hemiarthroplasty for Proximal Humeral Fractures in the Elderly: Long-Term Functional Outcome and Social Implications

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