Frakturfolge Typ 2 des proximalen Humerus – klinische Ergebnisse nach endoprothetischer Therapie

Abstract

Fracture sequelae type 2 of the proximal humerus-clinical results after arthroplastyLocked dislocations of the glenohumeral joint are rare but often painful and are associated with limited range of motion in the shoulder. In patients of advanced age, arthroplasty is increasingly indicated as a surgical treatment option. Preoperatively, the direction of dislocation, the presence and extent of a glenoid defect, and the soft tissue situation (rotator cuff status, joint capsule) should be analyzed in a differentiated manner. Based on the above factors, we recommend the subclassification of type 2 according to Boileau: posterior locked dislocation (2a), anterior locked dislocation without glenoid defect (2b), and anterior locked dislocation with glenoid defect (2c). In the case of dorsally locked dislocation, a good clinical result can be achieved by using an anatomical endoprosthesis. For ventrally locked dislocations, we recommend using an inverse total endoprosthesis with, if necessary, bony glenoid reconstruction and transfer of the pectoralis major muscle. Level of evidence: IV

Surgical treatment of fracture sequelae of the proximal humerus according to a pathology-based modification of the Boileau classification results in improved clinical outcome after shoulder arthroplasty

“…In type 2a lesions, posterior locked shoulder dislocation is present. Studies by our group showed that glenoid defects are very rarely observed in dorsal dislocation, and treatment with an ASA can achieve better functional results as long as the rotator cuff is intact [ 11 , 22 ].…”