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Essex-Lopresti-Verletzungen

Instabilitätseinschätzung und Therapie des distalen Radioulnargelenks

Essex-Lopresti injury

Assessment of instability and treatment of the distal radioulnar joint

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Die Unterarmknochen sind durch mehrere Bandsysteme gelenkig miteinander verbunden. Neben dem proximalen und distalen Radioulnargelenk mit seinem Bandapparat übernimmt die Membrana interossea wesentliche Aufgaben bei der Kraftübertragung von der Speiche auf die Elle. Bei Resektion des Speichenkopfs im Zusammenhang mit nichtrekonstruierbaren Frakturen ist die Intaktheit der Membran prognostisch bedeutsam. Ihre Mitverletzung bedingt eine Proximalisierung der Speiche und wirkt sich auf die Mechanik des Handgelenks aus. Klinisch und radiologisch zeigt sich die Ruptur der Membrana interossea fast ausschließlich im Handgelenk.

Therapie

Die gestörte Funktion des Handgelenks kann auf unterschiedliche Weise wiederhergestellt werden: in der Akutsituation durch Rekonstruktion oder Ersatz des Speichenkopfs, in der chronischen Situation am ehesten durch eine Ulnaverkürzungsosteotomie. Chirurgische Techniken zur Reparatur der Membran selbst sind derzeit noch nicht verfügbar.

Abstract

Background

Both forearm bones are firmly connected to each other through three distinct ligament systems. Besides the proximal and distal radioulnar joint with its ligament apparatus, the interosseous membrane plays an important role in transferring forces from the radius to the ulna. After resection of the radial head due to a comminuted fracture the integrity of the membrane is of great prognostic value. A disruption of the membrane inevitably leads to a proximal migration of the radius thus compromising the mechanics of the wrist joint. Clinically and radiologically a ruptured membrane becomes apparent exclusively at the level of the wrist joint.

Therapy

The deranged function may be restored in various ways. In the acute situation repair of the radial head or its replacement is recommended. In the chronic situation the easiest solution would be a shortening of the ulna. Surgical techniques for a direct repair of the membrane are presently not available.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Gausepohl gibt an, dass kein Interessenkonflikt besteht. Diese Studie beinhaltet keine Studien an Menschen oder Tieren.

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    T. Gausepohl

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Gausepohl, T. Essex-Lopresti-Verletzungen. Trauma Berufskrankh 16, 231–236 (2014). https://doi.org/10.1007/s10039-014-2144-9

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  • DOI: https://doi.org/10.1007/s10039-014-2144-9

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