Osteoporose als Risikofaktor für das Versagen der winkelstabilen Plattenosteosynthese am proximalen Humerus

 

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Zusammenfassung

Ziel

Die winkelstabile Plattenosteosynthese ist ein Standardverfahren zur Behandlung der proximalen Humerusfraktur des älteren Menschen. Ziel dieser Studie war es, den Einfluss der Osteoporose auf das Versagen dieses Osteosyntheseverfahrens zu evaluieren.

Methode

Über acht Jahre wurden Frauen > 50 Jahre und Männer > 60 Jahre, die aufgrund einer proximalen Humerusfraktur mittels winkelstabiler Plattenosteosynthese versorgt wurden, prospektiv erfasst. Alle Patienten erhielten eine Knochendichtemessung (DXA) während des stationären Aufenthaltes.

Ergebnisse

Von 167 Patienten waren 65,9 % von einer Osteoporose betroffen. Bei Patienten mit Osteoporose traten signifikant häufiger revisionspflichtige Komplikationen auf (19,1 % vs. 7,0 %). Des Weiteren zeigten sich in dieser Gruppe signifikant häufiger varisch dislozierte B2- und stark dislozierte C2-Frakturen.

Diskussion

Zusammenfassend ließ sich nachweisen, dass für Patienten mit Osteo porose ein signifikant erhöhtes Risiko besteht, nach winkelstabiler Plattenosteosynthese des proximalen Humerus eine revisionspflichtige Komplikation zu erleiden. Eine mögliche Ursache könnte neben der verminderten Knochendichte auch das vermehrte Auftreten von varisch und stark dislozierten Frakturformen sein.

Summary

Objectives

Locking plate fixation for the treatment of unstable proximal humeral fractures in the elderly is widely accepted. Within this patient group osteoporosis is a common comorbidity. Therefore, the present study aimed to evaluate the influence of osteoporosis on failure of locking plate fixation and on fracture pattern.

Methods

Women > 50 and men > 60 years with proximal humeral fracture and locking plate fixation were prospectively included over eight years with a follow up of two years. Bone mineral density measurement (DXA) was performed for all patients during in-patient hospital treatment.

Results

Out of 167 patients 65,9 % were diagnosed with osteoporosis according to the WHO guidelines. Patients with osteoporosis showed a significantly higher rate of revision surgery (19,1 % vs. 7,0 %). Furthermore, osteoporosis was associated with a significantly higher incidence of AO 11-B2 and C2 fractures. These fracture entities showed a significantly higher rate of loss of fixation in osteoporotic patients.

Discussion

In conclusion, patients with osteoporosis feature a significantly increased risk for complications and revision surgery after locking plate fixation of proximal humeral fractures. In addition to biomechanical limitations due to low bone mineral density, a different fracture pattern with focus on varus dislocation might contribute to a higher failure rate.

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