Skip to main content
Erschienen in: Der Orthopäde 4/2014

01.04.2014 | Leitthema

Intraartikuläre Frakturen des distalen Humerus

Aspekte der operativen Behandlung bei geriatrischen Patienten

Erschienen in: Die Orthopädie | Ausgabe 4/2014

Einloggen, um Zugang zu erhalten

Zusammenfassung

Hintergrund

Ungeachtet der allgemeinen Zunahme osteoporoseassoziierter Frakturen sind Frakturen des distalen Humerus in der Gruppe geriatrischer Patienten selten; für den einzelnen Operateur bedeutet dies eine entsprechend überschaubare Fallzahl.

Ziel der Arbeit

Damit ergibt sich die Frage, inwieweit Konzepte aus der Gruppe der jüngeren Patientengruppe übertragen werden können.

Material und Methoden

Berücksichtigt man die evidenzbasierte Literatur, können die Empfehlungen auf 3 prospektive Studien reduziert werden. Dies bedeutet jedoch nur, dass die verbliebene Literatur nicht die erforderliche statistische Sicherheit bietet, um hieraus Schlussfolgerungen zuzulassen.

Ergebnisse und Diskussion

Um für die Gruppe der geriatrischen Patienten Empfehlungen auszusprechen, ist daher die Zusammenschau der aktuellen Literatur erforderlich. Die folgende Übersicht der aktuellen Literatur versucht daher, die relevanten Aspekte der Frakturversorgung einzeln zu diskutieren und eine Schlussfolgerung für die Praxis zu entwickeln.
Literatur
1.
Zurück zum Zitat Arnander MW, Reeves A, Macleod IA et al (2008) A biomechanical comparison of plate configuration in distal humerus fractures. J Orthop Trauma 22:332–336PubMedCrossRef Arnander MW, Reeves A, Macleod IA et al (2008) A biomechanical comparison of plate configuration in distal humerus fractures. J Orthop Trauma 22:332–336PubMedCrossRef
2.
Zurück zum Zitat Atalar AC, Demirhan M, Salduz A et al (2009) Functional results of the parallel-plate technique for complex distal humerus fractures. Acta Orthop Traumatol Turc 43:21–27PubMedCrossRef Atalar AC, Demirhan M, Salduz A et al (2009) Functional results of the parallel-plate technique for complex distal humerus fractures. Acta Orthop Traumatol Turc 43:21–27PubMedCrossRef
3.
Zurück zum Zitat Banerjee D, Ghosh S, Ghosh PK et al (2011) A short term experience of management of open and osteoporotic intercondylar fractures of the distal humerus using a mini-external fixator. J Indian Med Assoc 109:404, 406, 408PubMed Banerjee D, Ghosh S, Ghosh PK et al (2011) A short term experience of management of open and osteoporotic intercondylar fractures of the distal humerus using a mini-external fixator. J Indian Med Assoc 109:404, 406, 408PubMed
4.
Zurück zum Zitat Cobb TK, Morrey BF (1997) Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. J Bone Joint Surg [Am] 79:826–832 Cobb TK, Morrey BF (1997) Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. J Bone Joint Surg [Am] 79:826–832
5.
Zurück zum Zitat Coles CP, Barei DP, Nork SE et al (2006) The olecranon osteotomy: a six-year experience in the treatment of intraarticular fractures of the distal humerus. J Orthop Trauma 20:164–171PubMed Coles CP, Barei DP, Nork SE et al (2006) The olecranon osteotomy: a six-year experience in the treatment of intraarticular fractures of the distal humerus. J Orthop Trauma 20:164–171PubMed
6.
Zurück zum Zitat Douglas K, Cannada LK, Archer KR et al (2012) Incidence and risk factors of heterotopic ossification following major elbow trauma. Orthopedics 35:e815–e822PubMedCrossRef Douglas K, Cannada LK, Archer KR et al (2012) Incidence and risk factors of heterotopic ossification following major elbow trauma. Orthopedics 35:e815–e822PubMedCrossRef
7.
Zurück zum Zitat Egol KA, Tsai P, Vazques O et al (2011) Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows. Am J Orthop (Belle Mead NJ) 40:67–71 Egol KA, Tsai P, Vazques O et al (2011) Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows. Am J Orthop (Belle Mead NJ) 40:67–71
8.
Zurück zum Zitat Frankle MA, Herscovici D Jr, Dipasquale TG et al (2003) A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma 17:473–480PubMedCrossRef Frankle MA, Herscovici D Jr, Dipasquale TG et al (2003) A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma 17:473–480PubMedCrossRef
9.
Zurück zum Zitat Garland DE, O’hollaren RM (1982) Fractures and dislocations about the elbow in the head-injured adult. Clin Orthop Relat Res (168):38–41 Garland DE, O’hollaren RM (1982) Fractures and dislocations about the elbow in the head-injured adult. Clin Orthop Relat Res (168):38–41
10.
Zurück zum Zitat Gofton WT, Macdermid JC, Patterson SD et al (2003) Functional outcome of AO type C distal humeral fractures. J Hand Surg [Am] 28:294–308 Gofton WT, Macdermid JC, Patterson SD et al (2003) Functional outcome of AO type C distal humeral fractures. J Hand Surg [Am] 28:294–308
11.
Zurück zum Zitat Greiner S, Haas NP, Bail HJ (2008) Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system. Arch Orthop Trauma Surg 128:723–729PubMedCrossRef Greiner S, Haas NP, Bail HJ (2008) Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system. Arch Orthop Trauma Surg 128:723–729PubMedCrossRef
12.
Zurück zum Zitat Helfet DL, Schmeling GJ (1993) Bicondylar intraarticular fractures of the distal humerus in adults. Clin Orthop Relat Res (292):26–36 Helfet DL, Schmeling GJ (1993) Bicondylar intraarticular fractures of the distal humerus in adults. Clin Orthop Relat Res (292):26–36
13.
Zurück zum Zitat Houben PF, Bongers KJ, Vd Wildenberg FA (1994) Double tension band osteosynthesis in supra- and transcondylar humeral fractures. Injury 25:305–309PubMedCrossRef Houben PF, Bongers KJ, Vd Wildenberg FA (1994) Double tension band osteosynthesis in supra- and transcondylar humeral fractures. Injury 25:305–309PubMedCrossRef
14.
Zurück zum Zitat Jost B, Adams RA, Morrey BF (2008) Management of acute distal humeral fractures in patients with rheumatoid arthritis. A case series. J Bone Joint Surg [Am] 90:2197–2205 Jost B, Adams RA, Morrey BF (2008) Management of acute distal humeral fractures in patients with rheumatoid arthritis. A case series. J Bone Joint Surg [Am] 90:2197–2205
15.
Zurück zum Zitat Jupiter JB, Neff U, Holzach P et al (1985) Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg [Am] 67:226–239 Jupiter JB, Neff U, Holzach P et al (1985) Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg [Am] 67:226–239
16.
Zurück zum Zitat Kamineni S, Morrey BF (2004) Distal humeral fractures treated with noncustom total elbow replacement. J Bone Joint Surg [Am] 86-A:940–947 Kamineni S, Morrey BF (2004) Distal humeral fractures treated with noncustom total elbow replacement. J Bone Joint Surg [Am] 86-A:940–947
17.
Zurück zum Zitat Kamrani RS, Mehrpour SR, Aghamirsalim MR et al (2012) Pin and plate fixation in complex distal humerus fractures: surgical technique and results. Int Orthop 36:839–844PubMedCentralPubMedCrossRef Kamrani RS, Mehrpour SR, Aghamirsalim MR et al (2012) Pin and plate fixation in complex distal humerus fractures: surgical technique and results. Int Orthop 36:839–844PubMedCentralPubMedCrossRef
18.
Zurück zum Zitat Koch FW (2002) Heterotope postoperative Ossifikationen. Steinkopff, Darmstadt Koch FW (2002) Heterotope postoperative Ossifikationen. Steinkopff, Darmstadt
19.
Zurück zum Zitat Korner J, Lill H, Muller LP et al (2005) Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos Int 16(Suppl 2):S73–S79PubMedCrossRef Korner J, Lill H, Muller LP et al (2005) Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos Int 16(Suppl 2):S73–S79PubMedCrossRef
20.
Zurück zum Zitat Kundel K, Braun W, Wieberneit J et al (1996) Intraarticular distal humerus fractures. Factors affecting functional outcome. Clin Orthop Relat Res 332:200–208PubMedCrossRef Kundel K, Braun W, Wieberneit J et al (1996) Intraarticular distal humerus fractures. Factors affecting functional outcome. Clin Orthop Relat Res 332:200–208PubMedCrossRef
21.
Zurück zum Zitat Lan X, Zhang LH, Tao S et al (2013) Comparative study of perpendicular versus parallel double plating methods for type C distal humeral fractures. Chin Med J (Engl) 126:2337–2342 Lan X, Zhang LH, Tao S et al (2013) Comparative study of perpendicular versus parallel double plating methods for type C distal humeral fractures. Chin Med J (Engl) 126:2337–2342
22.
Zurück zum Zitat Li SH, Li ZH, Cai ZD et al (2011) Bilateral plate fixation for type C distal humerus fractures: experience at a single institution. Int Orthop 35:433–438PubMedCentralPubMedCrossRef Li SH, Li ZH, Cai ZD et al (2011) Bilateral plate fixation for type C distal humerus fractures: experience at a single institution. Int Orthop 35:433–438PubMedCentralPubMedCrossRef
23.
Zurück zum Zitat Liu JJ, Ruan HJ, Wang JG et al (2009) Double-column fixation for type C fractures of the distal humerus in the elderly. J Shoulder Elbow Surg 18:646–651PubMedCrossRef Liu JJ, Ruan HJ, Wang JG et al (2009) Double-column fixation for type C fractures of the distal humerus in the elderly. J Shoulder Elbow Surg 18:646–651PubMedCrossRef
24.
Zurück zum Zitat Mckee MD, Veillette CJ, Hall JA et al (2009) A multicenter, prospective, randomized, controlled trial of open reduction – internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J Shoulder Elbow Surg 18:3–12PubMedCrossRef Mckee MD, Veillette CJ, Hall JA et al (2009) A multicenter, prospective, randomized, controlled trial of open reduction – internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J Shoulder Elbow Surg 18:3–12PubMedCrossRef
25.
Zurück zum Zitat Nauth A, Schemitsch EH (2011) Distal humerus fractures, in evidence-based orthopedics. Wiley-Blackwell, Oxford. doi:10.1002/9781444345100.ch43 Nauth A, Schemitsch EH (2011) Distal humerus fractures, in evidence-based orthopedics. Wiley-Blackwell, Oxford. doi:10.1002/9781444345100.ch43
26.
Zurück zum Zitat O’Driscoll SW (2005) Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 14:186S–194SCrossRef O’Driscoll SW (2005) Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 14:186S–194SCrossRef
27.
Zurück zum Zitat Prasad N, Dent C (2008) Outcome of total elbow replacement for distal humeral fractures in the elderly: a comparison of primary surgery and surgery after failed internal fixation or conservative treatment. J Bone Joint Surg [Br] 90:343–348 Prasad N, Dent C (2008) Outcome of total elbow replacement for distal humeral fractures in the elderly: a comparison of primary surgery and surgery after failed internal fixation or conservative treatment. J Bone Joint Surg [Br] 90:343–348
28.
Zurück zum Zitat Reising K, Hauschild O, Strohm PC et al (2009) Stabilisation of articular fractures of the distal humerus: early experience with a novel perpendicular plate system. Injury 40:611–617PubMedCrossRef Reising K, Hauschild O, Strohm PC et al (2009) Stabilisation of articular fractures of the distal humerus: early experience with a novel perpendicular plate system. Injury 40:611–617PubMedCrossRef
29.
Zurück zum Zitat Ring D, Gulotta L, Jupiter JB (2003) Unstable nonunions of the distal part of the humerus. J Bone Joint Surg [Am] 85-A:1040–1046 Ring D, Gulotta L, Jupiter JB (2003) Unstable nonunions of the distal part of the humerus. J Bone Joint Surg [Am] 85-A:1040–1046
30.
Zurück zum Zitat Ruan HJ, Liu JJ, Fan CY et al (2009) Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus. J Trauma 67:1397–1401PubMedCrossRef Ruan HJ, Liu JJ, Fan CY et al (2009) Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus. J Trauma 67:1397–1401PubMedCrossRef
31.
Zurück zum Zitat Sabalic S, Kodvanj J, Pavic A (2013) Comparative study of three models of extra-articular distal humerus fracture osteosynthesis using the finite element method on an osteoporotic computational model. Injury 44(Suppl 3):S56–S61PubMedCrossRef Sabalic S, Kodvanj J, Pavic A (2013) Comparative study of three models of extra-articular distal humerus fracture osteosynthesis using the finite element method on an osteoporotic computational model. Injury 44(Suppl 3):S56–S61PubMedCrossRef
32.
Zurück zum Zitat Sanders RA, Sackett JR (1990) Open reduction and internal fixation of delayed union and nonunion of the distal humerus. J Orthop Trauma 4:254–259PubMedCrossRef Sanders RA, Sackett JR (1990) Open reduction and internal fixation of delayed union and nonunion of the distal humerus. J Orthop Trauma 4:254–259PubMedCrossRef
33.
Zurück zum Zitat Sane AD, Dakoure PW, Dieme CB et al (2009) Olecranon osteotomy in the treatment of distal humeral fractures in adults: anatomical and functional evaluation of the elbow in 14 cases. Chir Main 28:93–98PubMedCrossRef Sane AD, Dakoure PW, Dieme CB et al (2009) Olecranon osteotomy in the treatment of distal humeral fractures in adults: anatomical and functional evaluation of the elbow in 14 cases. Chir Main 28:93–98PubMedCrossRef
34.
Zurück zum Zitat Shin SJ, Sohn HS, Do NH (2010) A clinical comparison of two different double plating methods for intraarticular distal humerus fractures. J Shoulder Elbow Surg 19:2–9PubMedCrossRef Shin SJ, Sohn HS, Do NH (2010) A clinical comparison of two different double plating methods for intraarticular distal humerus fractures. J Shoulder Elbow Surg 19:2–9PubMedCrossRef
35.
Zurück zum Zitat Stoffel K, Cunneen S, Morgan R et al (2008) Comparative stability of perpendicular versus parallel double-locking plating systems in osteoporotic comminuted distal humerus fractures. J Orthop Res 26:778–784PubMedCrossRef Stoffel K, Cunneen S, Morgan R et al (2008) Comparative stability of perpendicular versus parallel double-locking plating systems in osteoporotic comminuted distal humerus fractures. J Orthop Res 26:778–784PubMedCrossRef
36.
Zurück zum Zitat Vazquez O, Rutgers M, Ring DC et al (2010) Fate of the ulnar nerve after operative fixation of distal humerus fractures. J Orthop Trauma 24:395–399PubMedCrossRef Vazquez O, Rutgers M, Ring DC et al (2010) Fate of the ulnar nerve after operative fixation of distal humerus fractures. J Orthop Trauma 24:395–399PubMedCrossRef
37.
Zurück zum Zitat Walz M, Auerbach F (2006) Distal intraarticular humerus fractures in elderly patients. Treatment with combined percutaneous screw fixation and an external fixator. Unfallchirurg 109:940–947PubMedCrossRef Walz M, Auerbach F (2006) Distal intraarticular humerus fractures in elderly patients. Treatment with combined percutaneous screw fixation and an external fixator. Unfallchirurg 109:940–947PubMedCrossRef
38.
Zurück zum Zitat Wilkinson JM, Stanley D (2001) Posterior surgical approaches to the elbow: a comparative anatomic study. J Shoulder Elbow Surg10:380–382CrossRef Wilkinson JM, Stanley D (2001) Posterior surgical approaches to the elbow: a comparative anatomic study. J Shoulder Elbow Surg10:380–382CrossRef
Metadaten
Titel
Intraartikuläre Frakturen des distalen Humerus
Aspekte der operativen Behandlung bei geriatrischen Patienten
Publikationsdatum
01.04.2014
Erschienen in
Die Orthopädie / Ausgabe 4/2014
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI
https://doi.org/10.1007/s00132-013-2162-5

Weitere Artikel der Ausgabe 4/2014

Der Orthopäde 4/2014 Zur Ausgabe

CME Zertifizierte Fortbildung

Kindliche Kniebinnenverletzungen

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.