Die polyaxial-winkelstabile Platte in der Versorgung von 3- und 4-Fragment-Frakturen des Humeruskopfs: objektive Ergebnisse und Patientenzufriedenheit

Zusammenfassung

Einleitung: In den zurückliegenden Jahren wurden neue winkelstabile Plattenimplantate mit polyaxialer Schraubenausrichtung zur Versorgung dislozierter Frakturen des proximalen Humerus entwickelt. Da über diese polyaxialen Plattenimplantate bei der 3- und 4-Fragment-Fraktur des proximalen Humerus in der Literatur nur wenige Daten vorliegen, war es das Ziel dieser Studie Ergebnisse und Komplikationen bei dislozierten 3- und 4-Fragment-Frakturen nach Verwendung eines polyaxialen Implantats darzustellen. Patienten und Methoden: Innerhalb eines Zeitraums von 51 Monaten wurden 105 Patienten mit einer dislozierten 3- oder 4-Fragment-Fraktur des proximalen Humerus mittels einer polyaxial-winkelstabilen Platte versorgt. Die Komplikationen wurden erfasst, der Constant-Murley-Score erhoben und mit der Patientenzufriedenheit („sehr zufrieden“ bis „unzufrieden“) korreliert. Zusätzlich wurden die Ergebnisse mit denen monoaxialer Plattenimplantate innerhalb der Literatur verglichen. Es wurde ferner untersucht, ob die operative Erfahrung der jeweiligen Operateure zum Versorgungszeitpunkt einen Einfluss auf das klinische Endergebnis der Patienten hatte. Ergebnisse: Es konnten 65 Patienten (Durchschnittsalter 71,3 ± 11,4; durchschnittlicher Nachuntersuchungszeitraum: 19,6 ± 9,8 Monate [10–44 Monate]) mit einer dislozierten 3- bzw. 4-Fragment-Fraktur retrospektiv nachuntersucht werden (Frauen: n = 54; Männer: n = 11). Insgesamt fanden sich 27 3-Fragment-Frakturen und 38 4-Fragment-Frakturen. Der durchschnittliche Constant-Murley-Score lag bei 62,1 ± 16,5 Punkten bei einer Komplikationsrate von 26 %. Dabei zeigten sich vorwiegend Schraubenperforationen nach intraartikulär. Die Zufriedenheit mit dem klinischen Endergebnis innerhalb des Gesamtkollektivs war hoch. 40 % der Patienten äußerten, mit dem Endergebnis „sehr zufrieden“ zu sein, 29 % äußerten sich „zufrieden“ („neutral“: 12 %, „unzufrieden“: 19 %). Zusätzlich beeinflusste die operative Erfahrung des Operateurs das klinische Endergebnis der Patienten. Schlussfolgerung: Im Vergleich zur Literatur lassen sich bei 3- und 4-Fragment-Frakturen des proximalen Humerus mit polyaxialen Plattenimplantaten keine besseren Ergebnisse oder niedrigere Komplikationsraten als mit monoaxialen Implantaten feststellen. Trotz allem zeigt sich die Mehrheit der Patienten mit dem klinischen Endergebnis bei altersentsprechender Funktion zufrieden. Dabei findet sich eine enge Korrelation zwischen dem Grad der Zufriedenheit und der objektiven Funktion der Schulter. Ein hohes Maß an operativer Erfahrung und das Wissen zur Vermeidung typischer Komplikationen sind entscheidend, um ein gutes Ergebnis zu erzielen.

Abstract

Introduction: In recent years, new angle-stable plate implants with polyaxial screw direction were developed with the aim of an improved treatment of displaced 3- and 4-part fractures of the proximal humerus. There are only a few studies available about polyaxial implants in the treatment of 3- and 4-part proximal humerus fractures. Therefore, the aim of this study was to evaluate clinical results and complications of open reduction and internal fixation of displaced 3- and 4-part fractures using a polyaxial plate. Patients and Methods: Within 51 months, 105 patients with a displaced 3- or 4-part fracture of the proximal humerus were treated with a polyaxial locking plate. The complications were evaluated and the Constant & Murley score was assessed and correlated with patient satisfaction (“very satisfied” to “not satisfied”). Additionally, the results were compared with those of monoaxial plates from the literature. Furthermore, the operative experience of the surgeons at the time of surgery was correlated with the objective results of the patients. Results: 65 patients (average age: 71.3 ± 11.4 years; average follow-up: 19,6 ± 9,8 month [10–44 month]) with a displaced 3- or 4-part fracture were re-examined retrospectively (female: n = 54; male: n = 11). Overall, there were 27 3-part fractures and 38 4-part fractures. The Constant and Murley Score was on average 62.1 ± 16.5 points and the complication rate was 26 %. The most frequent complication was screw perforation through the humeral head. Patient satisfaction with clinical outcome was high within the whole study group. 40 % of the patients were “very satisfied” with their shoulder function, 29 % were “satisfied” (“fair”: 12 %, “not satisfied”: 19 %). Additionally, the operative experience of the surgeons influenced the final clinical result. Conclusion: In comparison to the literature we could not delineate better clinical outcomes or lower complication rates with polyaxial implants compared to monoaxial plates in 3- and 4-part fractures. Nevertheless, the majority of patients were satisfied with the clinical result in the context of age-related shoulder function. In addition, a close correlation could be detected between the degree of satisfaction and the objectively measured shoulder function. A high level of operative experience is required to avoid typical complications and to achieve a good clinical result.

Schlüsselwörter

polyaxial - winkelstabile Platte - proximale Humerusfraktur - Patientenzufriedenheit

Key words

polyaxial - locking plate - proximal humerus fracture - patient satisfaction

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