Siekmann H, Bowen T S, Huschak M, Radetzki F, Bauer C, Walther J
Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Martin-Luther Universität, Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
Abteilung für Unfall- und Wiederherstellungschirurgie, Martin-Luther-Universität, Halle Wittenberg, Halle (Saale), Deutschland.
Unfallchirurg. 2020 Jan;123(1):29-35. doi: 10.1007/s00113-019-0638-4.
The exact incidence of postoperative periprosthetic humeral fractures (PPHF) months or years after fracture-related implantation of a hemiprosthesis is unknown. The currently available literature is predominantly concerned with operative treatment approaches. As a rule, these involved older patients and severe fracture conditions so that severe complications and unsatisfactory healing results were described. This article presents an alternative conservative treatment approach which is discussed based on the results of treatment.
Between 2011 and 2016 a conservative treatment of 5 female patients with PPHF could be carried out. Of the patients 4 were clinically and radiologically controlled at a mean follow-up time of 23 months. The fifth patient died 2 months after the trauma and only partial information of the treatment was available.
There were no intrahospital complications and just one posthospital complication. In the case of the patient who later died, repeated and unauthorized removal of the upper arm brace occurred in the nursing institution resulting in a lesion of the radial nerve. Of the four patients who completed treatment, three were very satisfied with the outcome of treatment. The mean DASH (Disabilities of Arm, Shoulder and Hand) and Oxford shoulder scores were on average 74 and 25 points, respectively. At the time of the follow-up examination all patients were free of pain, without the use of analgesics; however, there were still some limitations in the activities of daily life, which in three of the four patients was similar to the results following implantation of the fracture prosthesis.
The conservative treatment of PPHF can be a safe treatment option in multimorbid and chronically ill patients. A close outpatient control and good patient compliance are important. In incompliant and dementia patients, the risk of failure of conservative treatment is increased.
半关节置换术后数月或数年发生的假体周围肱骨骨折（PPHF）的确切发生率尚不清楚。目前可得的文献主要关注手术治疗方法。通常，这些研究涉及老年患者和严重骨折情况，因此描述了严重并发症和不尽人意的愈合结果。本文提出了一种替代性的保守治疗方法，并根据治疗结果进行讨论。
2011年至2016年间，对5例PPHF女性患者进行了保守治疗。其中4例患者在平均23个月的随访期内接受了临床和放射学检查。第五例患者在创伤后2个月死亡，仅获得部分治疗信息。
住院期间无并发症，出院后仅发生1例并发症。在后来死亡的患者中，护理机构中发生了上臂支具的反复且未经授权的拆除，导致桡神经损伤。在完成治疗的4例患者中，3例对治疗结果非常满意。平均上肢、肩部和手部功能障碍（DASH）评分和牛津肩部评分分别平均为74分和25分。在随访检查时，所有患者均无疼痛，无需使用镇痛药；然而，日常生活活动仍存在一些限制，4例患者中有3例的情况与骨折假体植入后的结果相似。
PPHF的保守治疗对于多病和慢性病患者可能是一种安全的治疗选择。密切的门诊随访和良好的患者依从性很重要。对于依从性差和患有痴呆症的患者，保守治疗失败的风险会增加。
