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Behandlung von Handwurzelfrakturen

Empfehlungen der Sektion Handchirurgie der Deutschen Gesellschaft für Unfallchirurgie

Treatment of carpal fractures

Recommendations of the Hand Surgery Group of the German Trauma Society

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Zusammenfassung

Vorrangiges Ziel der Behandlung von Handwurzelfrakturen ist der Erhalt einer schmerzfreien Funktion des Handgelenks. Bei klinischem Verdacht auf deren häufigste Form, die Skaphoidfraktur, ist die Indikation zur Schnittbilddiagnostik großzügig zu stellen. Nur stabile und undislozierte Skaphoidfrakturen können konservativ behandelt werden, ansonsten ist die Verschraubung unter anatomischer Wiederherstellung der Form anzustreben. Zweithäufigste Brüche sind die des Os triquetrum, die in Form von Chipfrakturen konservativ therapiert werden können. Korpusfrakturen des Triquetrums sowie der übrigen Karpalia werden abhängig von Dislokation und Instabilität konservativ oder operativ versorgt. Bei perilunären Luxationsfrakturen, bei denen die Frakturlinie durch jeden Handwurzelknochen verlaufen kann, bevorzugt aber das Skaphoid betroffen ist, sind wie bei den karpometakarpalen Luxationsfrakturen eine exakte, vorzugsweise offene Reposition, eine stabile Osteosynthese der frakturierten Karpalia und eine Bohrdrahttransfixierung angezeigt.

Abstract

The primary goal in the treatment of carpal fractures is the preservation of a painless wrist function. Scaphoid fractures are the most common carpal fractures and when such a fracture is clinically suspected CT or MRI scans are usually advisable. Only stable and non-displaced scaphoid fractures can be treated conservatively, all other fractures require internal fixation with restoration of normal anatomy. Second most common are fractures of the triquetrum which can occur as chip avulsions of the dorsal rim and are usually treated symptomatically. Fractures of the body of the triquetrum should be treated according to the degree of instability and displacement. This is virtually true for all carpal bones. Perilunate fracture dislocations of the carpus deserve special attention. In these severe injuries a fracture line can run through all carpal bones but the scaphoid is mostly affected. Accurate reduction and internal fixation by screws and K-wires are indicated not only in these cases, but also in carpometacarpal fracture dislocations.

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Authors and Affiliations

  1. Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    M. Schädel-Höpfner & J. Windolf

  2. Klinik für Handchirurgie, Rhön-Klinikum Bad Neustadt, Bad Neustadt, Deutschland

    K.J. Prommersberger

  3. Abteilung für Hand-, Replantations- und Mikrochirurgie, Unfallkrankenhaus Berlin, Berlin, Deutschland

    A. Eisenschenk

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  1. M. Schädel-Höpfner
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  2. K.J. Prommersberger
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  3. A. Eisenschenk
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  4. J. Windolf
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Correspondence to M. Schädel-Höpfner.

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Unter besonderer Mitarbeit von

R. Böttcher (Berlin), E. Brück (Gießen), T. Ebinger (Stuttgart), J. Frank (Frankfurt), R. Friedel (Jena), H. Grunwald (Emmerich), P. Haensel (Chemnitz), H.J. Helling (Hamm), M. Langer (Münster), M. Sauerbier (Bad Soden am Taunus), U. Schächinger (Regensburg), W. Schäfer (Gummersbach), C. Voigt (Solingen), K.D. Werber (München)

Mit Zustimmung von

G. Böhringer (Gießen), C. Braun (Kleve), C. Burger (Bonn), P. Catala (Hamburg), C. Dumont (Göttingen), A. Junge (Trier), H. Krimmer (Ravensburg), C. Kühne (Marburg), P. Laier (Karlsruhe), W. Linhart (Heilbronn), M. Lopatecki (Baden-Baden), R. Meier (Würzburg), M. Mentzel (Ulm), P. Muhl (Elmshorn), R. Oberbeck (Essen), T. Pillukat (Bad Neustadt), J.M. Rueger (Hamburg), D.J. Schaefer (Basel), H. Siebert (Berlin), R. Stiletto (Biberach), D. Stosch (Düsseldorf), H. Towfigh (Hamm), K. Tsironis (Frechen), R. Zettl (Marburg)

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Schädel-Höpfner, M., Prommersberger, K., Eisenschenk, A. et al. Behandlung von Handwurzelfrakturen. Unfallchirurg 113, 741–756 (2010). https://doi.org/10.1007/s00113-010-1822-8

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