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Therapie der Humerusschaftfraktur

Therapy of humeral shaft fractures

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Zusammenfassung

Die Humerusschaftfraktur ist seltener als die proximale Humerusfraktur und wird gerne als Domäne der konservativen Therapie dargestellt. Dieses ist sicherlich auch durchaus noch eine zeitgemäße Möglichkeit der Behandlung. Die operative Versorgung der Humerusfrakturen wird jedoch durch neu entwickelte Implantate deutlich erleichtert und erfüllt eher die Ansprüche des modernen Patienten und Behandlers an eine schnelle und schmerzarme Wiederherstellung der Funktion. Insbesondere bei Längs- und Mehretagenfrakturen stehen mit den Nägeln der neueren Generation Implantate zur Verfügung, welche in der Regel eine übungsstabile Versorgung ermöglichen. Retrograde und antegrade Nägel haben Vor- und Nachteile, häufig richtet sich die Entscheidung nach der proximalen oder distalen Lage der Fraktur. Platten stellen eine mögliche Alternative dar und haben ihren Vorteil vor allem bei kombinierten Frakturen des Humeruskopfes und -schaftes und im distalen Schaftbereich. Beim Vorliegen einer primären Läsion des N. radialis wird von einer Exploration eher abgeraten, sollte es zu keiner Remission kommen, kann die Exploration auch nach Monaten noch mit gleichem Erfolg durchgeführt werden.

Abstract

Fractures of the humeral shaft are less frequent than those of the proximal humerus. The formerly recommended treatment of humeral shaft fractures was conservative according to Böhler. This still remains an adequate concept of treatment but according to a change in the technical possibilities and the demands of patients and physicians on fast restoration of function and low pain, there is a trend towards surgical stabilization of humeral shaft fractures. The implant of choice is discussed controversially and consists of various types of nails versus plating. The technique of nailing is antegrade or retrograde and depends on the localization of the fracture. In our opinion good indications for plating are combined fractures of the proximal humerus and the shaft as well as very distal humeral shaft fractures. A primary lesion of the radial nerve is no imperative indication for exploration and different studies have shown the same results for exploration after 2 or 3 months if there is no spontaneous remission.

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Literatur

  1. Ajmal M, O’sullivan M, Mccabe J et al (2001) Antegrade locked intramedullary nailing in humeral shaft fractures. Injury 32:692–694

    Article  PubMed  CAS  Google Scholar 

  2. Apivatthakakul T, Phornphutkul C, Laohapoonrungsee A et al (2009) Less invasive plate osteosynthesis in humeral shaft fractures. Oper Orthop Traumatol 21:602–613

    Article  PubMed  Google Scholar 

  3. Apivatthakakul T, Patiyasikan S, Luevitoonvechkit S (2010) Danger zone for locking screw placement in minimally invasive plate osteosynthesis (MIPO) of humeral shaft fractures: a cadaveric study. Injury 41:169–172

    Article  PubMed  CAS  Google Scholar 

  4. Bhandari M, Devereaux PJ, Mckee MD et al (2006) Compression plating versus intramedullary nailing of humeral shaft fractures – a meta-analysis. Acta Orthop 77:279–284

    Article  PubMed  Google Scholar 

  5. Blum J, Rommens PM, Janzing H et al (1998) Retrograde nailing of humerus shaft fractures with the unreamed humerus nail. An international multicenter study. Unfallchirurg 101:342–352

    Article  PubMed  CAS  Google Scholar 

  6. Boehler L (1964) Against the operative treatment of fresh humeral shaft fractures. Langenbecks Arch Klin Chir Ver Dtsch Z Chir 308:465–475

    Article  PubMed  CAS  Google Scholar 

  7. Borens O, Mouhsine E, Chevalley F (2001) Preliminary results of retrograde nailing of the humerus. Swiss Surg 7:76–81

    Article  PubMed  CAS  Google Scholar 

  8. Brug E, Joist A, Meffert R (2002) Postoperative radial paralysis. Fate or negligence, conservative wait or revision? Unfallchirurg 105:82–85

    Article  PubMed  CAS  Google Scholar 

  9. Catanzarite J, Alan R, Baig R et al (2009) Biomechanical testing of unstable humeral shaft fracture plating. J Surg Orthop Adv 18:175–181

    PubMed  Google Scholar 

  10. Cheng HR, Lin J (2008) Prospective randomized comparative study of antegrade and retrograde locked nailing for middle humeral shaft fracture. J Trauma 65:94–102

    Article  PubMed  Google Scholar 

  11. Cole PA, Wijdicks CA (2007) The operative treatment of diaphyseal humeral shaft fractures. Hand Clin 23:437–448

    Article  PubMed  Google Scholar 

  12. Connolly S, Mckee MD, Zdero R et al (2010) Immediate plate osteosynthesis of open fractures of the humeral shaft. J Trauma 69:685–690

    Article  PubMed  Google Scholar 

  13. Court-Brown CM, Rimmer S, Prakash U et al (1998) The epidemiology of open long bone fractures. Injury 29:529–534

    Article  PubMed  CAS  Google Scholar 

  14. Frigg R (2001) Locking Compression Plate (LCP). An osteosynthesis plate based on the Dynamic Compression Plate and the Point Contact Fixator (PC-Fix). Injury 32(Suppl 2):63–66

    Article  PubMed  Google Scholar 

  15. Grassmann JP, Jungbluth P, Bullermann L et al (2010) Radial nerve palsy associated with humeral shaft fractures – early exploration or expectant procedure? An analysis concerning current strategies of treatment. Z Orthop Unfall 148(6): 691–696

    Article  PubMed  CAS  Google Scholar 

  16. Hak DJ, Althausen P, Hazelwood SJ (2010) Locked plate fixation of osteoporotic humeral shaft fractures: are two locking screws per segment enough? J Orthop Trauma 24:207–211

    Article  PubMed  Google Scholar 

  17. Konrad GG, Mehlhorn A, Kuhle J et al (2008) Proximal humerus fractures – current treatment options. Acta Chir Orthop Traumatol Cech 75:413–421

    PubMed  CAS  Google Scholar 

  18. Kostler W, Strohm PC, Sudkamp NP (2002) New techniques for bone synthesis on the humerus. Chirurg 73:969–977

    Article  PubMed  CAS  Google Scholar 

  19. Lee YH, Chung MS, Gong HS et al (2008) Sural nerve autografts for high radial nerve injury with nine centimeter or greater defects. J Hand Surg Am 33:83–86

    Article  PubMed  Google Scholar 

  20. Lin J, Inoue N, Valdevit A et al (1998) Biomechanical comparison of antegrade and retrograde nailing of humeral shaft fracture. Clin Orthop Relat Res:203–213

    Google Scholar 

  21. Lin J, Hou SM, Hang YS (2000) Treatment of humeral shaft delayed unions and nonunions with humeral locked nails. J Trauma 48:695–703

    Article  PubMed  CAS  Google Scholar 

  22. Marty B, Kach K, Friedl HP et al (1994) Intramedullary nailing of the humerus shaft fracture. Unfallchirurg 97:424–429

    PubMed  CAS  Google Scholar 

  23. Muller ME, Nazarian S, Koch P et al (1990) The comprehensive classification of fractures of the long bones. Springer, Berlin Heidelberg New York

  24. Muller CA, Henle P, Konrad G et al (2007) The AO/ASIF Flexnail: a flexible intramedullary nail for the treatment of humeral shaft fractures. Unfallchirurg 110:219–225

    Article  PubMed  CAS  Google Scholar 

  25. Niemeyer P, Hauschild O, Strohm PC et al (2004) Fracture treatment in the elderly. Acta Chir Orthop Traumatol Cech 71:329–338

    PubMed  CAS  Google Scholar 

  26. O’toole RV, Andersen RC, Vesnovsky O et al (2008) Are locking screws advantageous with plate fixation of humeral shaft fractures? A biomechanical analysis of synthetic and cadaveric bone. J Orthop Trauma 22:709–715

    Article  Google Scholar 

  27. Perren SM (2008) Fracture healing. The evolution of our understanding. Acta Chir Orthop Traumatol Cech 75:241–246

    PubMed  Google Scholar 

  28. Putti AB, Uppin RB, Putti BB (2009) Locked intramedullary nailing versus dynamic compression plating for humeral shaft fractures. J Orthop Surg (Hong Kong) 17:139–141

    Google Scholar 

  29. Rommens PM, Kuechle R, Bord T et al (2008) Humeral nailing revisited. Injury 39:1319–1328

    Article  PubMed  CAS  Google Scholar 

  30. Sarmiento A, Latta LL (2007) Humeral diaphyseal fractures: functional bracing. Unfallchirurg 110:824–832

    Article  PubMed  CAS  Google Scholar 

  31. Sarmiento A, Waddell JP, Latta LL (2002) Diaphyseal humeral fractures: treatment options. Instr Course Lect 51:257–269

    PubMed  Google Scholar 

  32. Scheerlinck T, Handelberg F (2002) Functional outcome after intramedullary nailing of humeral shaft fractures: comparison between retrograde Marchetti-Vicenzi and unreamed AO antegrade nailing. J Trauma 52:60–71

    Article  PubMed  Google Scholar 

  33. Sarmiento A, Zagorski JB, Zych GA et al (2000) Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am 82:478–486

    Article  PubMed  CAS  Google Scholar 

  34. Schittko A (2003) Humerus shaft fractures. Unfallchirurg 106:145–158; quiz 159–160

    Article  PubMed  CAS  Google Scholar 

  35. Schittko A (2004) Humeral shaft fractures. Chirurg 75:833–846; quiz 847

    Article  PubMed  CAS  Google Scholar 

  36. Shao YC, Harwood P, Grotz MR et al (2005) Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br 87:1647–1652

    Article  PubMed  CAS  Google Scholar 

  37. Strohm PC, Kostler W, Sudkamp NP (2008) Proximal humerus fracture – what to do? Z Orthop Unfall 146:312–317

    Article  PubMed  CAS  Google Scholar 

  38. Stuby FM, Hontzsch D (2009) Humerus shaft fractures. Z Orthop Unfall 147:375–390

    Article  PubMed  CAS  Google Scholar 

  39. Wang JP, Shen WJ, Chen WM et al (2009) Iatrogenic radial nerve palsy after operative management of humeral shaft fractures. J Trauma 66:800–803

    Article  PubMed  Google Scholar 

  40. Zobrist R, Messmer P, Levin LS et al (2002) Endoscopically controlled stabilization of humerus shaft fractures. The endoscope as an aid in minimally invasive osteosynthesis. Unfallchirurg 105:246–253

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department Orthopädie und Traumatologie, Klinikum der Albert-Ludwigs-Universität Freiburg, Hugstetterstr. 55, 79106, Freiburg i. Breisgau, Deutschland

    P.C. Strohm, D.C. Kubosch, E.J. Hübner, N.P. Südkamp, M. Jaeger & K. Reising

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  1. P.C. Strohm
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  2. D.C. Kubosch
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  3. E.J. Hübner
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  4. N.P. Südkamp
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  5. M. Jaeger
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  6. K. Reising
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Correspondence to P.C. Strohm.

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Strohm, P., Kubosch, D., Hübner, E. et al. Therapie der Humerusschaftfraktur. Chirurg 82, 947–956 (2011). https://doi.org/10.1007/s00104-010-2055-7

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  • DOI: https://doi.org/10.1007/s00104-010-2055-7

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