Königshausen Matthias, Rausch Valentin, Mempel Eileen, von Glinski Alexander, Ull Christopher, Bernstorff Maria, Schildhauer Thomas, Seybold Dominik, Gessmann Jan
Chirurgische Universitäts- und Poliklinik, BG Klinik Bergmannsheil Bochum, Ruhr-Universität Bochum.
Z Orthop Unfall. 2018 Dec;156(6):646-652. doi: 10.1055/a-0619-6400. Epub 2018 Jul 4.
Bilateral acute proximal humerus fractures are rare. There are no data available about these bilateral injuries. The aim of the study was to analyse bilateral proximal humerus fractures retrospectively in terms of incidence, complications and revisions.
All bilateral proximal humerus fractures were evaluated retrospectively using the institution's database, with the focus on cause of the injury, fracture severity and the clinical course compared to published information on monolateral proximal humerus fractures. Bilateral posterior dislocation fractures were excluded, because these fractures are a separate entity.
Between 2005 and 2016, n = 17 patients were primarily treated within our hospital for an acute proximal humerus fracture on both sides (n = 12 female, n = 5 male, average age: 68 years; overall 34 proximal humerus fractures). The general trauma mechanism was a fall on both arms (82% [18% polytrauma]). There were 65% displaced 3-/4-part proximal humerus fractures. Angle-stable plate osteosynthesis was performed predominantly (64%), followed by fracture prosthesis (18%; tension wiring: 3%; non-operatively: 15%). Overall, n = 10 patients (59%) or n = 18 (53%) proximal humerus fractures developed a complication, primarily with loss of reduction or implant loosening (44%). In n = 14 (78%) of the complications further operations were necessary. Alcohol abuse was increasingly found in 29% of the cases within the bilateral patient cohort compared to patients with monolateral fractures.
Bilateral proximal humerus fractures are mainly associated with comminuted displaced fractures and a higher complication rate in comparison to monolateral fractures after surgical treatment.
双侧急性肱骨近端骨折较为罕见。目前尚无关于这些双侧损伤的数据。本研究的目的是对双侧肱骨近端骨折的发病率、并发症及翻修情况进行回顾性分析。
利用机构数据库对所有双侧肱骨近端骨折进行回顾性评估，重点关注损伤原因、骨折严重程度以及与已发表的单侧肱骨近端骨折信息相比的临床病程。双侧肱骨后脱位骨折被排除，因为这些骨折是一个单独的类型。
2005年至2016年期间，我院共收治17例双侧急性肱骨近端骨折患者（女性12例，男性5例，平均年龄68岁；共34处肱骨近端骨折）。常见的创伤机制是双臂着地（82%[18%为多发伤]）。65%为移位的三部分或四部分肱骨近端骨折。主要采用角稳定钢板内固定（64%），其次是骨折假体置换（18%；张力带钢丝固定：3%；非手术治疗：15%）。总体而言，10例患者（59%）或18处（53%）肱骨近端骨折出现并发症，主要是复位丢失或植入物松动（44%）。14例（78%）并发症患者需要进一步手术。与单侧骨折患者相比，双侧患者队列中29%的病例酗酒情况增多。
与单侧骨折相比，双侧肱骨近端骨折主要与粉碎性移位骨折相关，手术治疗后并发症发生率更高。
