Problematik osteoporotischer Frakturen am Ellenbogen

According to demographic data, treatment of osteoporotic fractures will increase in importance. In geriatric patients, injuries to the elbow mainly involve fractures of the olecranon and the distal humerus. Luxations of the elbow with isolated ligamentous tears are rather rare as the weakened bone fractures before the joint displaces. Osteoporotic fractures of the elbow frequently feature destruction of the articular surface combined with severe comminution of the metaphyseal bone. Due to the complex anatomy of the elbow joint and fracture patterns of the osteopenic bone, treatment of these fractures remains a challenge. As conservative fracture treatment leads to poor functional outcome, these fractures are mainly treated by open reduction and internal fixation. In osteoporotic olecranon fractures, reconstruction of the joint surface and osteosynthesis by plate fixation is the treatment of choice. New anatomically preshaped implants with several options for angular stable screw fixation have proved reliable for stable osteosynthesis. In massive comminution and non-reconstructable situations of the olecranon in elderly patients, the resection of the defect with adquate refixation of the triceps muscle can be considered. With respect to the distal humerus, supra-diacondylar fractures are observed in the majority of osteoporotic cases. In recent years, the therapy of choice has become double plating osteosynthesis in combination with olecranon osteotomy. The anatomically preshaped implants with different possibilities of angular stable fixation have also shown promising results. As in younger patients, the aim of the operative procedure is the reconstruction of a congruent articular surface as well as preservation of the extensor system for early functional movement. For complex and non-reconstructable fractures, total elbow arthroplasty is the preferred option.