Periprothetische Frakturen an der oberen Extremität (Humerus, Ellenbogen)

Periprothetische Frakturen an der oberen Extremität nehmen mit steigenden Implantationszahlen von Schulter- und Ellenbogenendoprothesen zu und sind aufgrund häufiger Begleitprobleme (Osteoporose, Osteolysen, Weichteillimitierungen) therapeutisch anspruchsvoll. Ziel des Artikels ist die Darstellung von Klassifikation, Diagnostik und zeitgemäßen Therapieprinzipien periprothetischer Frakturen an Humerus und Ellenbogen, praxisorientiert und stabilitätsbasiert.

Abstract

Background

Periprosthetic fractures of the upper extremity are increasingly observed in parallel with the rising numbers of shoulder and elbow arthroplasties. Their management is particularly demanding due to common comorbidities such as osteoporosis, osteolysis, and limited soft-tissue conditions.

Objective

To summarize classification systems, diagnostic strategies, and current treatment principles for periprosthetic fractures of the humerus and elbow, with a focus on stability-based, practical approaches.

Methods

Narrative review of the available literature on epidemiology, risk factors, classification systems (Wright and Cofield, Kirchhoff, Mayo/O’Driscoll, Unified Classification System [UCS]), imaging modalities, and treatment strategies including osteosynthesis and revision arthroplasty.

Results

After shoulder arthroplasty, the incidence of periprosthetic fractures is typically reported at 2–3%, with some studies exceeding 5%. Intraoperative fractures occur more frequently with reverse prostheses (≈2.5%) compared to anatomic implants (< 0.2%). Implant stability is the key determinant of treatment: stable components can often be managed with bridging locking plate osteosynthesis, supplemented by cerclage and cortical strut allografts when required. Loose stems necessitate revision arthroplasty with a long stem; allografts may aid reconstruction in the presence of bone defects. In elbow arthroplasty, prosthesis design strongly influences the need for condylar reconstruction and dictates the surgical approach. Functional outcomes are heterogeneous, complication rates remain substantial, and most evidence is derived from small, heterogeneous case series.

Conclusion

A structured diagnostic work-up combined with a classification- and stability-oriented surgical strategy is essential. With careful indication, satisfactory clinical and radiological outcomes can be achieved; however, higher-level evidence — particularly for elbow arthroplasty — is still required.

Schlüsselwörter

periprothetische Frakturen - Humerus - Ellenbogen

Keywords

periprosthetic fractures - humerus - elbow

Publication History

Article published online:
10 November 2025

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