Die osteoporotische Humeruskopffraktur

Abstract

BackgroundTreatment of complex dislocated fractures of the proximal humerus has been contoversially discussed in recent years, particularly for elderly patients. The question of the optimal treatment of this severe injury remains unanswered.Operative therapyAlthough there was a temporary trend towards angled locking plate osteosynthesis, the euphoria was dampened by several reports of high complication and revision rates. A better understanding of fracture morphology and important prognostic factors, such as the integrity of medial support, led to further developments in implant design. In addition, augmentation of the humeral head with spongiosa or bone substitute material which can be applied directly or via cannulated screws as well as intramedullary support by fibula transplantation are gaining in importance. In the primary treatment the use of fracture prostheses plays a more subordinate role. In contrast inverse prostheses have proven to be good and reliable alternatives. The advantages are mainly in rapid reduction in pain and a much lower revision rate in comparison to osteosynthesis.Conservative therapyIn recent years conservative therapy has been increasingly and more intensively propagated. ConclusionIt must be noted that despite the frequency of proximal humeral head fractures in elderly patients, the available data are still insufficient. An established therapy algorithm does not exist, decisions concerning therapy must be individualized for each case and adapted to the requirements of patients.