Zusammenfassung
Hintergrund
Zehn bis 30 % der Klavikulafrakturen betreffen das laterale Drittel. Die laterale Klavikulafraktur ist als Verletzung der akromiokorakoklavikulären Region in vielen Fällen eine Kombination aus Fraktur und ligamentärer Verletzung. Für die Wahl des optimalen Therapieverfahrens ist daher die Bewertung der Stabilität von entscheidender Bedeutung.
Ziel
Ziel dieser Arbeit ist es, eine Übersicht über die bestehenden Klassifikationssysteme zu geben und die einzelnen Frakturtypen unter Berücksichtigung anatomisch-funktioneller Aspekte bzgl. Stabilität und Instabilität zu ordnen. Weiterhin werden die etablierten Operationsverfahren mit ihren typischen Vor- und Nachteilen dargestellt, um frakturtypspezifisch geeignete Operationsverfahren zu ermitteln.
Ergebnisse und Diskussion
Stabile Frakturen heilen unter konservativer Behandlung meist problemlos aus, instabile Frakturen haben ein höheres Risiko, in einer symptomatischen Pseudarthrose zu enden. Instabile Frakturen sollten daher bei hohem funktionellem Anspruch des Patienten operativ therapiert werden. Die operative Behandlung instabiler Frakturen führt mit winkelstabiler Plattenosteosynthese und zusätzlicher korakoklavikulärer(CC)-Fixierung zu guten klinischen Ergebnissen. Die arthroskopisch unterstützte CC-Fixierung bietet neben der Behandlung von Begleitpathologien den Vorteil der Minimal-Invasivität.
Abstract
Background
Fractures of the distal third of the clavicle represent 10–30 % of all clavicle fractures . Frequently, these fractures result in instability due to a combination of bony and ligamentous injury. Thus, assessment of the stability is essential for adequate treatment of these fractures.
Aim
This article presents a review of the different classification systems for distal clavicle fractures with respect to anatomical and functional factors to allow for comprehensive assessment of stability. Furthermore, the different treatment options for each fracture type are analyzed.
Results and discussion
Fractures to the distal third of the clavicle without instability can be treated conservatively with satisfactory outcome. In contrast, instability may result in symptomatic non-union under conservative treatment; therefore, distal clavicle fractures with instability should be treated operatively with respect to the functional demands of the patient. Operative treatment with locked plating in combination with coracoclavicular fixation results in excellent functional results. Arthroscopically assisted fracture fixation may be beneficial in terms of a minimally invasive approach as well as assessment and treatment of associated glenohumeral lesions.
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Danksagung
Die Autoren danken Herrn Igor Zovic für die Darstellung der Frakturtypen.
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B. Ockert, E. Wiedemann und F. Haasters geben an, dass kein Interessenkonflikt besteht.
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F. Haasters, München
B. Ockert, München
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Ockert, B., Wiedemann, E. & Haasters, F. Laterale Klavikulafraktur. Unfallchirurg 118, 397–406 (2015). https://doi.org/10.1007/s00113-015-0003-1
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DOI: https://doi.org/10.1007/s00113-015-0003-1
Schlüsselwörter
- Klassifikation
- Akromioklavikular(AC)-Gelenk
- Korakoklavikuläre(CC)-Bänder
- Arthroskopie
- Operative Therapie