Somberg Ole, Rosteius Thomas, Bernstorff Maria, Schildhauer Thomas A, Königshausen Matthias
Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
Unfallchirurgie (Heidelb). 2025 May 6. doi: 10.1007/s00113-025-01584-9.
The treatment of fracture sequelae following proximal humeral fractures presents a significant challenge, as they range from necrosis and pseudarthrosis to malunions. Classifications such as Boileau's facilitate diagnosis and treatment planning. Type 1 sequelae, characterized by necrosis, can be treated with either anatomical or reverse prostheses depending on the condition of the rotator cuff. Type 2 sequelae involve locked dislocations and may require bony reconstructions. Type 3 pseudarthrosis is managed either with joint-preserving techniques or prosthetic replacement, depending on the degree of degenerative changes. Type 4 malunions often benefit from corrective osteotomies and/or prosthesis implantation. Studies have demonstrated significant functional improvements following surgical intervention, with individual factors such as deformities or rotator cuff condition influencing treatment strategies.
肱骨近端骨折后骨折后遗症的治疗是一项重大挑战,因为其范围从坏死、假关节到畸形愈合。像布瓦洛(Boileau)分类法等有助于诊断和治疗规划。1型后遗症以坏死为特征,可根据肩袖状况使用解剖型或反置假体进行治疗。2型后遗症涉及锁定脱位,可能需要进行骨重建。3型假关节根据退变程度采用保留关节技术或假体置换进行处理。4型畸形愈合通常通过截骨矫正和/或假体植入获益。研究表明,手术干预后功能有显著改善,诸如畸形或肩袖状况等个体因素会影响治疗策略。