Lösungsmöglichkeiten bei fehlgeschlagenen Osteosynthesen an Schulter und Schultergürtel

Zusammenfassung

Die Behandlung von fehlgeschlagenen Osteosynthesen an Schulter und Schultergürtel stellt oft eine große Herausforderung an das Behandlungsteam dar. Am häufigsten gibt es Fehlschläge am proximalen Humerus und am Schlüsselbein, die eine auf den Einzelfall abgestimmte individuelle Behandlung erfordern. Neben der konservativen symptomorientierten Therapie sind in manchen Fällen die Reosteosynthese mit oder ohne Knochenaugmentation bzw. Spongiosaplastik oder der endoprothetische Ersatz zu bevorzugen. Wichtig für die Erzielung eines guten Ergebnisses ist neben einer exakten Ursachenanalyse ein frühzeitiges Einschreiten, um Vernarbungen, Kontrakturen bzw. fortgeschrittene Muskelatrophien zu vermeiden. Bei adäquater rechtzeitiger Therapie kann i. d. R. ein zufriedenstellendes Ergebnis erzielt werden.

Abstract

Treatment of failed osteosynthesis at the shoulder or shoulder girdle is often challenging. Failures are most commonly encountered after osteosyntheses of the proximal humerus and the clavicle. A case by case decision, focusing at patientsʼ demands is mandatory. Conservative management, as well as, in some cases, revision surgery, respectively reosteosynthesis with or without augmentation using cancellous bone grafts or endoprosthetic replacement, is recommended. It is very important to perform a careful analysis of each case and if needed an early intervention to avoid severe scar formation or muscle atrophy. If the applied treatment concept is adequate and conducted early enough, satisfying results may be expected.

Schlüsselwörter

Implantatversagen - Pseudarthrose - Reosteosynthese - Revisionsprothese

Key words

implant failure - nonunion - revision osteosynthesis - revision endoprosthesis

Publikationsverlauf

Artikel online veröffentlicht:
06. Februar 2020

• Literatur

• 1 Robinson CM. Fractures of the clavicle in the adult: Epidemiology and classification. J Bone Joint Surg Br 1998; 80: 476-484
• 2 Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle-third fractures of the clavicle gives poor results. J Bone Joint Surg Br 1997; 79: 537-539
• 3 Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am 2007; 80: 1-10
• 4 Knudsen FW, Andersen M, Krag C. The arterial supply of the clavicle. Surg Radiol Anat 1989; 11: 211-214
• 5 Havet E, Duparc F, Tobenas-Dujardin AC. et al. Vascular anatomical basis of clavicular non-union. Surg Radiol Anat 2008; 30: 23-28
• 6 McKee RC, Whelan DB, Schemitsch EH. et al. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am 2012; 94: 675-684
• 7 Liu HH, Chang CH, Chia WT. et al. Comparison of plates versus intramedullary nails of displaced midshaft clavicular fractures. J Trauma 2010; 69: E82-E87
• 8 Schemitsch LA, Schemitsch EH, Kuzyk P. et al. Prognostic factors for reoperation after plate fixation of the midshaft clavicle. J Orthop Trauma 2015; 29: 533-537
• 9 Gausden EB, Villa J, Warner SJ. et al. Nonunion after clavicle osteosynthesis: high incidence of Propionibacterium acnes. J Orthop Trauma 2017; 31: 229-235
• 10 Banerjee R, Waterman B, Padalecki J. et al. Management of distal clavicle fractures. J Am Acad Orthop Surg 2011; 19: 392-401
• 11 Zhang C, Huang J, Luo Y. et al. Comparison of the efficacy of a distal clavicular locking plate versus a clavicular hook plate in the treatment of unstable distal clavicle fractures and a systematic literature review. Int Orthop 2014; 38: 1461-1468
• 12 Klein SM, Badman BL, Keating CJ. et al. Results of surgical treatment for unstable distal clavicular fractures. J Shoulder Elbow Surg 2010; 19: 1049-1055
• 13 Villa JC, van der List JP, Gausden EB. et al. Plate fixation and bone grafting of distal clavicle nonunions: radiologic and functional outcomes. Arch Orthop Trauma Surg 2016; 136: 1521-1529
• 14 Gupta R, Sood M, Malhotra GD. et al. Functional outcome of modified Weaver Dunn technique for acromioclavicular joint dislocation. Indian J Orthop 2018; 52: 418-422
• 15 Seiler JG, Jupiter J. Intercalary tri-cortical iliac crest bone grafts for the treatment of chronic clavicular nonunion with bony defect. J Orthop Tech 1993; 1: 19-22
• 16 Simpson NS, Jupiter JB. Clavicular nonunion and malunion: evaluation and surgical management. J Am Acad Orthop Surg 1996; 4: 1-8
• 17 Momberger NG, Smith J, Coleman DA. Vascularized fibular grafts for salvage reconstruction of clavicle nonunion. J Shoulder Elbow Surg 2000; 9: 389-394
• 18 Chieh-Ting Huang T, Sabbagh MD, Lu CK. et al. The vascularized medial femoral condyle free flap for reconstruction of segmental recalcitrant nonunion of the clavicle. J Shoulder Elbow Surg 2019; 28: 2364-2370
• 19 Rollo G, Pichierri P, Marsilio A. et al. The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem?. Clin Cases Miner Bone Metab 2017; 14: 372-378
• 20 McKnight B, Heckmann N, Hill JR. et al. Surgical management of midshaft clavicle nonunions is associated with a higher rate of short-term complications compared with acute fractures. J Shoulder Elbow Surg 2016; 25: 1412-1417
• 21 McGahan JP, Rab GT, Dublin A. Fractures of the scapula. J Trauma 1980; 20: 880-883
• 22 Lantry JM, Roberts CS, Giannoudis PV. Operative treatment of scapular fractures: a systematic review. Injury 2008; 39: 271-283
• 23 Tatro JM, Gilbertson JA, Schroder LK. et al. Five to ten-year outcomes of operatively treated scapular fractures. J Bone Joint Surg Am 2018; 100: 871-878
• 24 Wang WZ, Zhang HM, Han L. [Internal fixation for unstable scapular fracture]. Zhongguo Gu Shang 2012; 25: 687-689
• 25 Lewis S, Argintar E, Jahn R. et al. Intra-articular scapular fractures: outcomes after internal fixation. J Orthop 2013; 10: 188-192
• 26 Zahid M, Rashid EH, Inam H. et al. Outcomes of open reduction and internal fixation in displaced intra-articular scapular fractures: a case series. Acta Orthop Belg 2017; 83: 16-21
• 27 Nork SE, Barei DP, Gardner MJ. et al. Surgical exposure and fixation of displaced type IV, V and VI glenoid fractures. J Orthop Trauma 2008; 22: 487-493
• 28 Court-Brown CM, Clement ND, Duckworth AD. et al. The spectrum of fractures in the elderly. J Bone Joint Surg Br 2014; 96: 366-372
• 29 Krettek C, Wiebking U. Proximale Humerusfraktur. Ist die winkelstabile Plattenosteosynthese der konservativen Behandlung überlegen?. Unfallchirurg 2011; 114: 1059-1067
• 30 Bogner R, Ortmaier R, Moroder P. et al. Minimally invasive treatment of displaced proximal humeral fractures in patients older than 70 years using the humerusblock. Biomech Res Int 2016; 2016: 6541849
• 31 Plecko M, Kraus A. Internal fixation of proximal humerus fractures using the locking proximal humerus plate. Oper Orthop Traumatol 2005; 17: 25-50
• 32 Brunner F, Sommer C, Bahrs C. et al. Open reduction and internal fixation of proximal humerus fractures using a proximal humeral locked plate: a prospective multicenter analysis. J Orthop Trauma 2009; 23: 163-172
• 33 Acklin YP, Stoffel K, Sommer C. A prospective analysis of the functional and radiological outcomes of minimal invasive plating in proximal humerus fractures. Injury 2013; 44: 456-460
• 34 Rothstock S, Plecko M, Kloub M. et al. Biomechanical evaluation of two intramedullary nailing techniques with different locking options in a three-part fracture proximal humerus model. Clin Biomech 2012; 27: 686-691
• 35 Kloub M, Holub K, Urban J. et al. Intramedullary nailing of displaced four-part fractures of the proximal humerus. Injury 2019; 50: 1978-1985
• 36 Erdle B, Izadpanah K, Eberbach H. et al. [Primary fracture prostheses and reverse shoulder arthroplasty in complex humeral head fractures: an alternative to joint-preserving osteosynthesis?]. Orthopade 2018; 47: 410-419
• 37 Shannon SE, Wagner ER, Houdek MT. et al. Reverse shoulder arthroplasty for proximal humeral fractures: outcomes comparing primary reverse for fracture versus arthroplasty after failed osteosynthesis. J Shoulder Elbow Surg 2016; 25: 1655-1660
• 38 Cicak N, Klobucar H, Medancic N. Reverse shoulder arthroplasty in acute fractures provides better results than in revision procedures for fracture sequelae. Int Orthop 2015; 39: 343-348
• 39 Santana F, Alentorn-Geli E, Girro P. et al. Reverse shoulder arthroplasty for fracture sequelae: how the initial fracture treatment influences the outcomes of joint replacement. Acta Orthop Traumatol Turc 2019; 53: 278-281
• 40 Jost B, Spross C, Grehn H. et al. Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg 2013; 22: 542-549
• 41 Hinds RM, Garner MR, Tran WH. Geriatric proximal humeral fracture patients show similar clinical outcomes to non-geriatric patients after osteosynthesis with endosteal fibular strut allograft augmentation. J Shoulder Elbow Surg 2015; 24: 889-896
• 42 Bosch U, Skutek M, Fremerey RW. Outcome after primary and secondary hemiarthroplasty in elderly patients with fracture of the proximal humerus. J Shoulder Elbow Surg 1998; 7: 479-484
• 43 Hussey MM, Hussey SE, Mighell MA. Reverse shoulder arthroplasty as a salvage procedure after failed internal fixation of fractures of the proximal humerus: outcomes and complications. Bone Joint J 2015; 97-B: 967-972
• 44 Shannon SF, Wagner ER, Houdek MT. et al. Reverse shoulder arthroplasty for proximal humeral fractures: outcomes comparing primary reverse arthroplasty for fracture versus reverse arthroplasty after failed osteosynthesis. J Shoulder Elbow Surg 2016; 25: 1655-1660