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Winkelstabile Plattenosteosynthese des Radiuskopfes

Klinische und radiologische Ergebnisse

Locking plate osteosynthesis of the radial head fractures

Clinical and radiological results

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Zusammenfassung

Fragestellung

Die Versorgung von Radiuskopffrakturen wird weiterhin kontrovers diskutiert. Insbesondere Mehrfragmentfrakturen sind mit einer hohen Komplikationsrate wie Pseudarthrosen, Implantatversagen und Radiuskopfnekrosen nach Osteosynthese vergesellschaftet. Daher empfehlen einige Autoren pauschal, Mehrfragmentfrakturen mittels Radiuskopfprothese zu versorgen. In jüngerer Zeit wurden jedoch spezielle winkelstabile Radiuskopfplatten entwickelt, die eine stabilere Versorgung auch von Mehrfragmentfrakturen ermöglichen und somit eine Erweiterung des Indikationsspektrums der Osteosynthese erlauben könnten.

Patienten und Methode

Mittels eines winkelstabilen Radiuskopfplattensystems wurden 21 Patienten versorgt. Es handelte sich um 13 Männer und 8 Frauen mit einem mittleren Alter von 50 (29–67) Jahren. Nach der Mason-Klassifikation wurden 15 als Mason III und 6 als Mason IV klassifiziert. Die durchschnittliche Zeitspanne zwischen Trauma und Operation betrug 5,6 (0–13) Tage. Diese Patienten wurden mittels „Mayo Elbow Performance Score“ (MEPS) klinisch sowie radiologisch nachuntersucht.

Ergebnisse

Nach durchschnittlich 12,1 (5–23) Monaten konnten alle 21 Patienten nachuntersucht werden. Nach dem MEPS erreichten 12 Patienten ein sehr gutes, 6 ein gutes und 3 ein befriedigendes Ergebnis. Der mittlere MEPS betrug 87,1. Die Flexion betrug im Mittel 135,2º (100–150°), das Extensionsdefizit 12,1º (0–30°), die Pronation 70,9º (40–80°) und die Supination 63,6º (20–80°). Alle Frakturen heilten problemlos. Es gab keine Implantatversager oder Pseudarthrosen. Eine partielle Nekrose und 4 Fälle von heterotopen Ossifikationen wurden beobachtet: 2-mal Typ I, einmal Typ IIb, einmal Typ IIIb nach Hastings.

Schlussfolgerung

Die Ergebnisse zeigen, dass mit den neuen winkelstabilen Radiuskopfimplantaten auch bei Mehrfragmentfrakturen gute Ergebnisse ohne die altbekannten Komplikationen erreicht werden können. Die radiuskopfspezifischen winkelstabilen Implantate erlauben eine Erweiterung des Indikationsspektrums für die Osteosynthese der Radiuskopffraktur.

Abstract

Background

Therapy of radial head fractures is still controversially discussed. Especially comminuted fractures are at risk of complications such as radial head necrosis, nonunion and secondary loss of reduction after open reduction and internal fixation. The aim of this study was to evaluate clinical and radiographic results of ORIF (open reduction internal fixation) of radial head fractures using a new radial head-specific locking plate system.

Patients and methods

A total of 21 patients (13 men and 8 women) were treated with locking plate osteosynthesis of radial head fractures. Mean age was 50 years (range 29–67 years). According to the Mason classification, 15 were type III and 6 type IV. Mean time between trauma and surgery was 5.6 days (range 0–23 days). These patients were reexamined using the Mayo Elbow Performance Score and x-rays in two planes.

Results

In all, 21 patients were reexamined with a mean follow-up of 12.1 months (range 5–23 months). The mean Mayo Elbow Performance Score was 87.1. Excellent results were obtained in 12 patients, good results in 6 patients, and fair results in 3 patients. Mean extension deficit was 12.1°, mean flexion 135.2°, mean pronation 70.9°, and mean supination 63.6°. All fractures healed uneventfully. There was no complete radial head necrosis but one partial. Four cases of heterotopic ossification were detected: Hastings classification I (n = 2), IIb (n = 1), IIIb (n = 1).

Conclusion

ORIF of radial head fractures using locking plates can lead to good and excellent results. Modern implants may allow for reconstruction of comminuted fractures avoiding arthroplasty in these young patients.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: K.J. Burkhart und L.P. Müller waren Teil des Entwicklungsteams der Medartis-Radiuskopfplatten. K.J. Burkhart, L.P. Müller, K. Wegmann: Beratertätigkeit für Medartis. Medartis unterstützt die biomechanischen Labore der Universitätskliniken Köln und Mainz mit einem jährlichen Grant. D. Gruszka, S. Frohn, P.M. Rommens und C.M. Eicker geben an, dass kein Interessenkonflikt besteht.

Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Köln, Deutschland

    K.J. Burkhart, K. Wegmann & L.P. Müller

  2. Zentrum für Orthopädie und Unfallchirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland

    D. Gruszka & P.M. Rommens

  3. Klinik für Orthopädie und Unfallchirurgie, Hand- und Fußchirurgie , Katholisches Klinikum Essen, Essen, Deutschland

    S. Frohn & C.M. Eicker

  4. Klinik für Schulterchirurgie, Rhön-Klinikum Bad Neustadt/Saale, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Deutschland

    K.J. Burkhart

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  1. K.J. Burkhart
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  2. D. Gruszka
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  3. S. Frohn
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  7. L.P. Müller
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Correspondence to K.J. Burkhart.

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K.J. Burkhart und D. Gruszka haben zu gleichen Teilen zur Erstellung des Manuskripts beigetragen.

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Burkhart, K., Gruszka, D., Frohn, S. et al. Winkelstabile Plattenosteosynthese des Radiuskopfes. Unfallchirurg 118, 949–956 (2015). https://doi.org/10.1007/s00113-014-2562-y

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