Konservative Therapie dislozierter proximaler Humerusfrakturen

Abstract

Between 11/1989 and 6/1998 52 patients (10 m., 42 f., age median 72 years, 31-88) with proximal humeral fractures have been treated by conservative means (angulation of humeral head > 45 degrees and/or shaft displacement > 1 cm and displacement of greater tuberosity > 0.5 cm). In 37 patients (71%, 31 f., 6 m., age median 75 years, 36-88) a clinical and radiological follow-up could be obtained after median 20 months (3-93). According to the Neer-classification, subcapital 2-part fractures were found in 19 cases and 3-part fractures in 12 cases. 4-part fractures were diagnosed in 6 cases. By using the Constant-Score, the final result was scored "excellent" in 10 patients and "good" in 13 patients. In 7 patients each the results achieved were "moderate" or "poor". The underlying cause for the poor results was primarily due to persisting painful impairment in range of motion and loss of strength. Radiologically, persisting axial deviation was present in 23 cases, arthrosis in 14 patients and humeral head necrosis in 8 patients. Most commonly, poor functional and radiological results occurred in 4-part fractures. However, conservative therapy of displaced 2-part and 3-part fractures is a considerable therapeutical option since the final results are predominantly good. In contrast, due to the poor results after conservative therapy 4-part fractures should be treated surgically.

Primary Shoulder Arthroplasty Versus Conservative Treatment for Comminuted Proximal Humeral Fractures: A Systematic Literature Review

“…Seven observational studies included conservative treatment (n=100) and 27 studies described operative treatment with arthroplasty (n=996). From the seven conservative studies, three studies included only conservatively treated patients [26,30,37], one paper included conservative and arthroplasty patients [34] and three studies compared conservative treatment with osteosynthesis [23,35,36]. The other papers only studied arthroplasty patients [12-20, 22, 24, 25, 27-29, 31, 32, 39-43].…”

Arthroscopical Findings after Antegrade Nailing of a Proximal Humeral Fracture

“…Conservative treatment of unstable fracture types showed unsatisfactory results [21]. Developing different implants and applying different operative techniques alleviated us from some of our treatment problems, albeit none of the new developments could solve all problems [22,23].…”

Versorgung von 3- und 4-Segment-Frakturen des proximalen Humerus mit dem proximalen Humerusnagel T2 PHN

“…[12,13]. Während weitgehende Einigkeit zur konservativen Therapie bei undislozierten, stabilen Frakturen besteht [14], verdeutlicht die Vielfalt der heute verfügbaren Implantate und Operationsmethoden das Fehlen eines allgemein anerkannten Versorgungskonzeptes bei dislozierten, instabilen Frakturen. Neue winkelstabile Platten bedeuten zwar einen deutlichen Fortschritt in den Versorgungsmöglichkeiten, jedoch besteht die Problematik der exzentrischen Implantatlage mit in der Praxis erkennbaren Plattenbrüchen und durchschneidenden Schrauben [7].…”

“…Ermutigt durch unsere und publizierte Ergebnisse in der Marknagelung proximaler Humerusfrakturen, haben wir das Verfahren bei 3-und 4-Segment-Frakturen angewandt. Selbst bei den Patienten mit einer partiellen Humeruskopfnekrose sind die Funktionswerte ermutigend, so dass wir übereinstimmend mit anderen Autoren [2,10,11,14,17] die primäre Hemiarthroplastik nur noch in Ausnahmefällen, wie Head-Split-Frakturen oder bei Pa-…”