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Erschienen in: Der Orthopäde 1/2011

01.01.2011 | Leitthema

Knöcherne Rotatorenmanschettenausrisse

Arthroskopische Konzepte

verfasst von: PD Dr. S. Greiner, M. Scheibel

Erschienen in: Die Orthopädie | Ausgabe 1/2011

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Zusammenfassung

Knöcherne Ausrisse der Rotatorenmanschette im Sinne von Frakturen der Tubercula majus und minus sind seltene Verletzungen, bei denen sowohl hinsichtlich ihrer Klassifikation als auch Therapie noch keine einheitlichen Empfehlungen bestehen. Da bei beiden Verletzungen die konservative Therapie insbesondere bei dislozierten Fragmenten an ihre Grenzen stößt, ist eine operative Vorgehensweise in solchen Fällen häufig indiziert. Im Zuge der Weiterentwicklung arthroskopischer Techniken finden sich auch bzgl. Versorgung dieser Verletzungen in der jüngeren Vergangenheit einige Berichte über arthroskopisch assistierte oder rein arthroskopische Verfahren. Im Folgenden werden anhand der aktuellen Literatur arthroskopische Konzepte und deren Vor- und Nachteile zur Versorgung knöcherner Rotatorenmanschettenausrisse vorgestellt.
Literatur
1.
Zurück zum Zitat Bahrs C, Lingenfelter E, Fischer F et al (2006) Mechanism of injury and morphology of the greater tuberosity fracture. J Shoulder Elbow Surg 15:140–147CrossRefPubMed Bahrs C, Lingenfelter E, Fischer F et al (2006) Mechanism of injury and morphology of the greater tuberosity fracture. J Shoulder Elbow Surg 15:140–147CrossRefPubMed
2.
Zurück zum Zitat Berbig R, Keller H, Metzger U (1994) Isolated fracture of the lesser tuberosity of the humerus: case reports and review of the literature. Z Unfallchir Versicherungsmed 87:159–168PubMed Berbig R, Keller H, Metzger U (1994) Isolated fracture of the lesser tuberosity of the humerus: case reports and review of the literature. Z Unfallchir Versicherungsmed 87:159–168PubMed
3.
Zurück zum Zitat Bhatia DN, Rooyen KS van, Toit DF du, De Beer JF (2006) Surgical treatment of comminuted, displaced fractures of the greater tuberosity of the proximal humerus: a new technique of double-row suture-anchor fixation and long-term results. Injury 37:946–952CrossRefPubMed Bhatia DN, Rooyen KS van, Toit DF du, De Beer JF (2006) Surgical treatment of comminuted, displaced fractures of the greater tuberosity of the proximal humerus: a new technique of double-row suture-anchor fixation and long-term results. Injury 37:946–952CrossRefPubMed
4.
Zurück zum Zitat Bono CM, Renard R, Levine RG, Levy AS (2001) Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder. J Bone Joint Surg [Br] 83:1056–1062 Bono CM, Renard R, Levine RG, Levy AS (2001) Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder. J Bone Joint Surg [Br] 83:1056–1062
5.
Zurück zum Zitat Bonsell S, Buford DA Jr (2003) Arthroscopic reduction and internal fixation of a greater tuberosity fracture of the shoulder: a case report. J Shoulder Elbow Surg 12:397–400CrossRefPubMed Bonsell S, Buford DA Jr (2003) Arthroscopic reduction and internal fixation of a greater tuberosity fracture of the shoulder: a case report. J Shoulder Elbow Surg 12:397–400CrossRefPubMed
6.
Zurück zum Zitat Caniggia M, Maniscalco P, Picinotti A (1996) Isolated avulsion fracture of the lesser tuberosity of the humerus. Report of two cases. Panminerva Med 38:56–60PubMed Caniggia M, Maniscalco P, Picinotti A (1996) Isolated avulsion fracture of the lesser tuberosity of the humerus. Report of two cases. Panminerva Med 38:56–60PubMed
7.
Zurück zum Zitat Carrera EF, Matsumoto MH, Netto NA, Faloppa F (2004) Fixation of greater tuberosity fractures. Arthroscopy 20:e109–e111PubMed Carrera EF, Matsumoto MH, Netto NA, Faloppa F (2004) Fixation of greater tuberosity fractures. Arthroscopy 20:e109–e111PubMed
8.
Zurück zum Zitat Demirhan M, Kilicoglu O, Altinel L et al (2003) Prognostic factors in prosthetic replacement for acute proximal humerus fractures. J Orthop Trauma 17:181–188CrossRefPubMed Demirhan M, Kilicoglu O, Altinel L et al (2003) Prognostic factors in prosthetic replacement for acute proximal humerus fractures. J Orthop Trauma 17:181–188CrossRefPubMed
9.
Zurück zum Zitat Earwaker J (1990) Isolated avulsion fracture of the lesser tuberosity of the humerus. Skeletal Radiol 19:121–125CrossRefPubMed Earwaker J (1990) Isolated avulsion fracture of the lesser tuberosity of the humerus. Skeletal Radiol 19:121–125CrossRefPubMed
10.
Zurück zum Zitat Flatow EL, Cuomo F, Maday MG et al (1991) Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus. J Bone Joint Surg [Am] 73:1213–1218 Flatow EL, Cuomo F, Maday MG et al (1991) Open reduction and internal fixation of two-part displaced fractures of the greater tuberosity of the proximal part of the humerus. J Bone Joint Surg [Am] 73:1213–1218
11.
Zurück zum Zitat Gartsman GM, Taverna E (1996) Arthroscopic treatment of rotator cuff tear and greater tuberosity fracture nonunion. Arthroscopy 12:242–244CrossRefPubMed Gartsman GM, Taverna E (1996) Arthroscopic treatment of rotator cuff tear and greater tuberosity fracture nonunion. Arthroscopy 12:242–244CrossRefPubMed
12.
Zurück zum Zitat Gartsman GM, Taverna E, Hammerman SM (1999) Arthroscopic treatment of acute traumatic anterior glenohumeral dislocation and greater tuberosity fracture. Arthroscopy 15:648–650CrossRefPubMed Gartsman GM, Taverna E, Hammerman SM (1999) Arthroscopic treatment of acute traumatic anterior glenohumeral dislocation and greater tuberosity fracture. Arthroscopy 15:648–650CrossRefPubMed
13.
Zurück zum Zitat Green A, Izzi J Jr (2003) Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg 12:641–649CrossRefPubMed Green A, Izzi J Jr (2003) Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elbow Surg 12:641–649CrossRefPubMed
14.
Zurück zum Zitat Greiner SH, Diederichs G, Kroning I et al (2009) Tuberosity position correlates with fatty infiltration of the rotator cuff after hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 18:431–436CrossRefPubMed Greiner SH, Diederichs G, Kroning I et al (2009) Tuberosity position correlates with fatty infiltration of the rotator cuff after hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 18:431–436CrossRefPubMed
15.
Zurück zum Zitat Gruson KI, Ruchelsman DE, Tejwani NC (2008) Isolated tuberosity fractures of the proximal humeral: current concepts. Injury 39:284–298CrossRefPubMed Gruson KI, Ruchelsman DE, Tejwani NC (2008) Isolated tuberosity fractures of the proximal humeral: current concepts. Injury 39:284–298CrossRefPubMed
16.
Zurück zum Zitat Hepp P, Theopold J, Engel T et al (2008) Lesser tuberosity avulsion in combination with multifragment fracture of the greater tuberosity. A rare entity at the proximal humerus. Unfallchirurg 111:628–631CrossRefPubMed Hepp P, Theopold J, Engel T et al (2008) Lesser tuberosity avulsion in combination with multifragment fracture of the greater tuberosity. A rare entity at the proximal humerus. Unfallchirurg 111:628–631CrossRefPubMed
17.
Zurück zum Zitat Iannotti JP, Gabriel JP, Schneck SL et al (1992) The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg [Am] 74:491–500 Iannotti JP, Gabriel JP, Schneck SL et al (1992) The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg [Am] 74:491–500
18.
Zurück zum Zitat Ji JH, Kim WY, Ra KH (2007) Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. Arthroscopy 23:1133–1134CrossRefPubMed Ji JH, Kim WY, Ra KH (2007) Arthroscopic double-row suture anchor fixation of minimally displaced greater tuberosity fractures. Arthroscopy 23:1133–1134CrossRefPubMed
19.
Zurück zum Zitat Ji JH, Shafi M, Song IS et al (2010) Arthroscopic fixation technique for comminuted, displaced greater tuberosity fracture. Arthroscopy 26:600–609CrossRefPubMed Ji JH, Shafi M, Song IS et al (2010) Arthroscopic fixation technique for comminuted, displaced greater tuberosity fracture. Arthroscopy 26:600–609CrossRefPubMed
20.
Zurück zum Zitat Kim E, Shin HK, Kim CH (2005) Characteristics of an isolated greater tuberosity fracture of the humerus. J Orthop Sci 10:441–444CrossRefPubMed Kim E, Shin HK, Kim CH (2005) Characteristics of an isolated greater tuberosity fracture of the humerus. J Orthop Sci 10:441–444CrossRefPubMed
21.
Zurück zum Zitat Kim KC, Rhee KJ, Shin HD, Kim YM (2008) Arthroscopic fixation for displaced greater tuberosity fracture using the suture-bridge technique. Arthroscopy 24:120–123PubMed Kim KC, Rhee KJ, Shin HD, Kim YM (2008) Arthroscopic fixation for displaced greater tuberosity fracture using the suture-bridge technique. Arthroscopy 24:120–123PubMed
22.
Zurück zum Zitat Kim SH, Ha KI (2000) Arthroscopic treatment of symptomatic shoulders with minimally displaced greater tuberosity fracture. Arthroscopy 16:695–700CrossRefPubMed Kim SH, Ha KI (2000) Arthroscopic treatment of symptomatic shoulders with minimally displaced greater tuberosity fracture. Arthroscopy 16:695–700CrossRefPubMed
23.
Zurück zum Zitat Kowalsky MS, Bell JE, Ahmad CS (2007) Arthroscopic treatment of subcoracoid impingement caused by lesser tuberosity malunion: a case report and review of the literature. J Shoulder Elbow Surg 16:e10–e14CrossRefPubMed Kowalsky MS, Bell JE, Ahmad CS (2007) Arthroscopic treatment of subcoracoid impingement caused by lesser tuberosity malunion: a case report and review of the literature. J Shoulder Elbow Surg 16:e10–e14CrossRefPubMed
24.
Zurück zum Zitat Kristiansen B, Barfod G, Bredesen J et al (1987) Epidemiology of proximal humeral fractures. Acta Orthop Scand 58:75–77CrossRefPubMed Kristiansen B, Barfod G, Bredesen J et al (1987) Epidemiology of proximal humeral fractures. Acta Orthop Scand 58:75–77CrossRefPubMed
25.
Zurück zum Zitat LaBriola JH, Mohaghegh HA (1975) Isolated avulsion fracture of the lesser tuberosity of the humerus. A case report and review of the literature. J Bone Joint Surg [Am] 57:1011 LaBriola JH, Mohaghegh HA (1975) Isolated avulsion fracture of the lesser tuberosity of the humerus. A case report and review of the literature. J Bone Joint Surg [Am] 57:1011
26.
Zurück zum Zitat Le Huec JC, Schaeverbeke T, Moinard M et al (1994) Isolated avulsion fracture of the lesser tubercle of the humerus in children. Acta Orthop Belg 60:427–429 Le Huec JC, Schaeverbeke T, Moinard M et al (1994) Isolated avulsion fracture of the lesser tubercle of the humerus in children. Acta Orthop Belg 60:427–429
27.
Zurück zum Zitat Levine B, Pereira D, Rosen J (2005) Avulsion fractures of the lesser tuberosity of the humerus in adolescents: review of the literature and case report. J Orthop Trauma 19:349–352PubMed Levine B, Pereira D, Rosen J (2005) Avulsion fractures of the lesser tuberosity of the humerus in adolescents: review of the literature and case report. J Orthop Trauma 19:349–352PubMed
28.
Zurück zum Zitat Mclaughlin HL (1963) Dislocation of the shoulder with tuberosity fracture. Surg Clin North Am 43:1615–1620PubMed Mclaughlin HL (1963) Dislocation of the shoulder with tuberosity fracture. Surg Clin North Am 43:1615–1620PubMed
29.
Zurück zum Zitat Neer CS (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg [Am] 52:1077–1089 Neer CS (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg [Am] 52:1077–1089
30.
Zurück zum Zitat Norris TR, Turner JA, Bovill D (1990) Nonunion of the upper humerus: an analysis of the etiology and treatment in 28 cases. In: Anonymous (ed) Surgery of the shoulder. Mosby, St. Louis, pp 63–67 Norris TR, Turner JA, Bovill D (1990) Nonunion of the upper humerus: an analysis of the etiology and treatment in 28 cases. In: Anonymous (ed) Surgery of the shoulder. Mosby, St. Louis, pp 63–67
31.
Zurück zum Zitat Nove-Josserand L, Walch G, Levine CH, Noel E (1995) Fracture of the lesser tuberosity of the humerus in adults. About 17 cases. J Shoulder Elbow Surg 4:30CrossRef Nove-Josserand L, Walch G, Levine CH, Noel E (1995) Fracture of the lesser tuberosity of the humerus in adults. About 17 cases. J Shoulder Elbow Surg 4:30CrossRef
32.
Zurück zum Zitat Ogawa K, Takahashi M (1997) Long-term outcome of isolated lesser tuberosity fractures of the humerus. J Trauma 42:955–959CrossRefPubMed Ogawa K, Takahashi M (1997) Long-term outcome of isolated lesser tuberosity fractures of the humerus. J Trauma 42:955–959CrossRefPubMed
33.
Zurück zum Zitat Park TS, Choi IY, Kim YH et al (1997) A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis 56:171–176PubMed Park TS, Choi IY, Kim YH et al (1997) A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis 56:171–176PubMed
34.
Zurück zum Zitat Parsons BO, Klepps SJ, Miller S et al (2005) Reliability and reproducibility of radiographs of greater tuberosity displacement. A cadaveric study. J Bone Joint Surg [Am] 87:58–65 Parsons BO, Klepps SJ, Miller S et al (2005) Reliability and reproducibility of radiographs of greater tuberosity displacement. A cadaveric study. J Bone Joint Surg [Am] 87:58–65
35.
Zurück zum Zitat Paschal SO, Hutton KS, Weatherall PT (1995) Isolated avulsion fracture of the lesser tuberosity of the humerus in adolescents. A report of two cases. J Bone Joint Surg [Am] 77:1427–1430 Paschal SO, Hutton KS, Weatherall PT (1995) Isolated avulsion fracture of the lesser tuberosity of the humerus in adolescents. A report of two cases. J Bone Joint Surg [Am] 77:1427–1430
36.
Zurück zum Zitat Patten RM, Mack LA, Wang KY, Lingel J (1992) Nondisplaced fractures of the greater tuberosity of the humerus: sonographic detection. Radiology 182:201–204PubMed Patten RM, Mack LA, Wang KY, Lingel J (1992) Nondisplaced fractures of the greater tuberosity of the humerus: sonographic detection. Radiology 182:201–204PubMed
37.
Zurück zum Zitat Reinus WR, Hatem SF (1998) Fractures of the greater tuberosity presenting as rotator cuff abnormality: magnetic resonance demonstration. J Trauma 44:670–675CrossRefPubMed Reinus WR, Hatem SF (1998) Fractures of the greater tuberosity presenting as rotator cuff abnormality: magnetic resonance demonstration. J Trauma 44:670–675CrossRefPubMed
38.
Zurück zum Zitat Robinson CM, Teoh KH, Baker A, Bell L (2009) Fractures of the lesser tuberosity of the humerus. J Bone Joint Surg [Am] 91:512–520 Robinson CM, Teoh KH, Baker A, Bell L (2009) Fractures of the lesser tuberosity of the humerus. J Bone Joint Surg [Am] 91:512–520
39.
Zurück zum Zitat Ross GJ, Love MB (1989) Isolated avulsion fracture of the lesser tuberosity of the humerus: report of two cases. Radiology 172:833–834PubMed Ross GJ, Love MB (1989) Isolated avulsion fracture of the lesser tuberosity of the humerus: report of two cases. Radiology 172:833–834PubMed
40.
Zurück zum Zitat Scheibel M, Martinek V, Imhoff AB (2005) Arthroscopic reconstruction of an isolated avulsion fracture of the lesser tuberosity. Arthroscopy 21:487–494CrossRefPubMed Scheibel M, Martinek V, Imhoff AB (2005) Arthroscopic reconstruction of an isolated avulsion fracture of the lesser tuberosity. Arthroscopy 21:487–494CrossRefPubMed
41.
Zurück zum Zitat Shibuya S, Ogawa K (1986) Isolated avulsion fracture of the lesser tuberosity of the humerus. A case report. Clin Orthop Relat Res 211:215–218PubMed Shibuya S, Ogawa K (1986) Isolated avulsion fracture of the lesser tuberosity of the humerus. A case report. Clin Orthop Relat Res 211:215–218PubMed
42.
Zurück zum Zitat Song HS, Williams GR Jr (2008) Arthroscopic reduction and fixation with suture-bridge technique for displaced or comminuted greater tuberosity fractures. Arthroscopy 24:956–960CrossRefPubMed Song HS, Williams GR Jr (2008) Arthroscopic reduction and fixation with suture-bridge technique for displaced or comminuted greater tuberosity fractures. Arthroscopy 24:956–960CrossRefPubMed
43.
Zurück zum Zitat Taverna E, Sansone V, Battistella F (2004) Arthroscopic treatment for greater tuberosity fractures: rationale and surgical technique. Arthroscopy 20:e53–e57CrossRefPubMed Taverna E, Sansone V, Battistella F (2004) Arthroscopic treatment for greater tuberosity fractures: rationale and surgical technique. Arthroscopy 20:e53–e57CrossRefPubMed
44.
Zurück zum Zitat Laarhoven HA van, Slaa RL te, Laarhoven EW van (1995) Isolated avulsion fracture of the lesser tuberosity of the humerus. J Trauma 39:997–999CrossRefPubMed Laarhoven HA van, Slaa RL te, Laarhoven EW van (1995) Isolated avulsion fracture of the lesser tuberosity of the humerus. J Trauma 39:997–999CrossRefPubMed
45.
Zurück zum Zitat White GM, Riley LH Jr (1985) Isolated avulsion of the subscapularis insertion in a child. A case report. J Bone Joint Surg [Am] 67:635–636 White GM, Riley LH Jr (1985) Isolated avulsion of the subscapularis insertion in a child. A case report. J Bone Joint Surg [Am] 67:635–636
46.
Zurück zum Zitat Williams GR Jr, Wong KL (2000) Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am 31:1–21CrossRefPubMed Williams GR Jr, Wong KL (2000) Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am 31:1–21CrossRefPubMed
Metadaten
Titel
Knöcherne Rotatorenmanschettenausrisse
Arthroskopische Konzepte
verfasst von
PD Dr. S. Greiner
M. Scheibel
Publikationsdatum
01.01.2011
Verlag
Springer-Verlag
Erschienen in
Die Orthopädie / Ausgabe 1/2011
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-010-1676-3

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